自知力评估量表在神经分裂症中的应用

将自知力评估量表应用于精神分裂症病人。对１１１例住院的精神分裂症病人进行治疗前后自知力评估。１．ＳＡＵＭＤ评分在治疗前后有显著差异，主要表现为症状分的差异，尤其以目前症状分的变化比较显著，而归因分治疗前后的变化无统计学意义。     

自知力评估量表(SAUMD)在精神分裂症中的应用

目的 将自知力评估量表(SAUMD)应用于精神分裂症病人。方法对111例住院的精神分裂症病人进行治疗前后自知力评估。结果 1.SAUMD评分在治疗前后有显著差异,主要表现为症状分的差异,尤其以目前症状分的变化比较显著,而归因分治疗前后的变化无统计学意义。2.SAUMD与临床医师对自知力的判断与阳性症状分评定相关性较高,而与阴性症状分评定相关性较差。3.在不同亚型精神分裂症病人之间,自知力评分对治疗的反应有显著差异。结论 精神病人的认知归因可能与预后有关。临床医师在治疗过程中,除了重视病人阳性症状的改善外,还需注意阴性症状及认知归因方面的改善。     

精神分裂症患者自知力的临床评价：（附45例分析）

对符合ＣＣＭＤ－２诊断标准的４５例精神分裂症患者自知力进行分析。结果显示：自知力完整的病人占１１．１％。自知力存在与否主要与患者所处的发病时期有关；自知力障碍程度愈重，ＧＡＳ评分愈低，ＢＰＲＳ总分则愈高，与ＢＰＲＳ之缺乏活力、激活性和敌对猜疑项因子分有关。并就自知力对发裂症的诊断、疗效判断、治疗顺从性及预后评估等方面的作用进行评价。     

精神病病人的自知力研究

为了解精神分裂症和躁狂抑郁症病人自知力表现的异同，应用自知力评估量表比较精神分裂症和躁狂抑郁症住院病人６周治疗前后自知力的变化。结果：（１）精神分裂症病人自知力评分显著高于躁狂抑郁症组，主要表现在对症状缺乏认识，抑郁发作病人的自知力缺失主要表现在对症状的归因解释方面；（２）经过６周治疗，两组病人的自知力均有恢复，尤其是躁狂发作病人；（３）临床医师对自知力的判断与自知力评估量表结果的相符率为７５％～８９％。提示不同精神疾病的病人其自知力缺损的内容不完全一样，对治疗的反应也不完全一样。     

抑郁症自知力与抑郁症状关系的研究

目的　探讨抑郁症自知力的临床价值及其相关因素。方法　对４７ 例抑郁症患者进行自知力与自知力和治疗态度问卷（ Ｉ Ｔ Ａ Ｑ） 、汉密尔顿抑郁量表（ Ｈ Ａ Ｍ Ｄ） 的评定及其相关分析。结果　按 Ｈ Ａ Ｍ Ｄ 自知力评定为无自知力１６ 例， Ｉ Ｔ Ａ Ｑ 评定无自知力６ 例。自知力与 Ｈ Ａ Ｍ Ｄ 总分及认识障碍、迟缓二因子显著相关，与抑郁情绪、偏执症状、自罪感、迟滞症状呈显著相关。结论　提示影响抑郁症自知力的最主要因素为严重抑郁情绪和偏执症状，临床上要准确判断抑郁症的自知力，既要重视病人对症状的认识，也要重视其对待治疗的态度。     

精神分裂症自知力及其与临床变量关系的研究

对１５３例符合ＣＣＭＤ－２诊断指标的精神分裂症患者进行了自知力及其与临床变量关系的研究，结果表明，自知力与患者的年龄，文化，职业，婚姻，经济状况，病程，诊断分型，用药剂量，住院次数，住院时间无明显关系，而与患者的治疗依从性ＢＰＲＳ总分，ＳＡＮＳ总分，ＳＡＰＳ总分，ＣＧＩ－ＳＩ分有明显关系，本文就自知力及其与临床有关变量的关系进行了讨论。     

利培酮与氟哌啶醇对精神分裂症自知力的影响

目的　比较利培酮和氟哌啶醇治疗精神分裂症病人的自知力改善情况。　　方法　对精神分裂症患者随机使用上述两种药物 ,应用Markova自知力量表 ,比较治疗前后自知力总评分和因子评分的改变。　　结果　治疗前后两组病人自知力总评分无显著性差异 ,因子 1 ,3有显著性差异。　　结论　利培酮有利于精神分裂症病人自知力的恢复。     

抑郁发作患者的自知力特点及其影响因素分析

目的探讨抑郁发作患者的自知力特点及其影响因素。方法对符合中国精神疾病分类方案与诊断标准第二版修订本（ＣＣＭＤ－Ⅱ－Ｒ）诊断标准的４３例抑郁发作患者的自知力及其影响因素进行半定量评估。结果４３例抑郁发作患者存在自知力障碍者达２６例（６０５％）；抑郁发作不同类型之间自知力障碍的分布及程度均无明显差异；影响抑郁患者自知力的因素主要有本次发作的病期、文化程度、是否伴有妄想等。结论自知力障碍在抑郁患者中出现的比率相对较低，程度也较轻；影响抑郁患者自知力的因素较多而且广泛。     

精神分裂症的自知力及其相关因素研究

为探讨精神分裂症的自知力的临床价值及其相关因素，对１１８例精神分裂症患者进行了自知力与简明精神病量表（ＢＰＲＳ）、阴性症状量表（ＳＡＮＳ）、阳性症状量表（ＳＡＰＳ）、临床疗效总评量表中的疗效总评项目（ＣＧＩ－ＧＩ）、治疗依从性的评定及其相关分析。结果显示，自知力完整者占１１．０％；自知力评分越高，ＢＰＲＳ、ＳＡＮＳ、ＳＡＰＳ、ＣＧＩ－ＧＩ和治疗依从性评分越高；自知力与ＢＰＲＳ、ＳＡＮＳ、ＳＡＰＳ中的某些症状因子评分，以及受教育年限也有显著相关性，而与年龄、病程、住院次数及住院总时间无显著相关性。提示自知力与其它精神症状的严重程度及其变化、疗效、治疗依从性均有密切的关系，自知力的评定对精神分裂症具有重要的临床价值。     

自知力教育配合治疗精神分裂症对照研究

目的：探讨自知力教育在精神分裂症治疗中的作用。方法：对８２例精神分裂症患者随机分组,应用自知力教育配合氟哌啶醇（４０例）及单用氟哌啶醇（４２例）进行对照治疗,疗程１２周。采用简明精神病评定量表（ＢＰＲＳ）、阴性症状评定量表（ＳＡＮＳ）、阳性症状评定量表（ＳＡＰＳ）、及自知力与治疗态度问卷表（ＩＴＡＱ）进行测定。结果：自知力教育配合氟哌啶醇组疗效显著较好。结论：自知力教育配合治疗是治疗精神分裂症的有效方法,能较早、较好地出现治疗效果。     

Psychopathological characteristics and treatment response of first episode compared with multiple episode schizophrenic disorders

Objective The aim was to investigate the hypothesis that patients with first episode schizophrenic disorders have a more favorable treatment response than those with multiple episodes. Method A total of 400 inpatients from an ongoing multi-centre, follow-up program who fulfilled ICD-10 criteria for schizophrenic disorders (F2) were assessed at admission to and discharge from hospital using the Positive and Negative Syndrome Scale (PANSS). Results At admission, first episode patients (n = 121) showed higher levels of positive symptoms (PANSS positive subscore) and lower ones of negative symptoms (PANSS negative subscore) than multiple episode patients (n = 279), whereas the global disease severity (PANSS total score) was comparable. Analyses of covariance revealed that treatment response (adjusted symptom levels at discharge) was more favorable in first-episode patients, with respect to both positive and negative symptoms. Conclusion The results are compatible with the hypothesis that treatment response becomes less favorable during the course of schizophrenic illness. This finding might be associated with progressive neurobiological alterations. The study was performed within the framework of the German Research Network on Schizophrenia, which is funded by the German Federal Ministry for Education and Research BMBF (grant 01 GI 0233).     

Clinical efficacy of carbamazepine in affective, schizoaffective, and schizophrenic disorders

The therapeutic effects of carbamazepine (CBZ) were evaluated in 103 patients with affective disorders, 54 with schizophrenic disorders, and 26 with schizoaffective disorders by a multi-institutional open study. The rate of marked and moderate improvement was 72.8% in affective disorders, 54.6% in schizophrenic disorders, and 61.5% in schizoaffective disorders. Symptom items of the Clinical Psychopharmacology Research Group rating scale for mania showed significant improvement in the patients with affective disorders as well as in those of the other two groups. In the Brief Psychiatric Rating Scale as applied to patients with schizophrenic or schizoaffective disorders, symptom items related to affect and emotion showed significant improvement. The antimanic efficacy of CBZ was also noted in many poor responders to lithium. Side-effects were observed in 82 patients (44.8%), and abnormal laboratory findings in 37 patients (44.8%), and abnormal laboratory findings in 37 patients. The present study seems to confirm the usefulness of CBZ for the treatment of affective disorders and in some cases, of schizophrenic and schizoaffective disorders.     

氯氮平治疗难治性精神分裂症的效能及相关因素

为探讨氯氮平（ＣＬＺ）治疗难治性精神分裂症的效能及相关因素，将符合研究标准的患者共４９例进行为期６周ＣＬＺ治疗。结果显示，ＣＬＺ起效快，不仅对阳性症状有效，对阴性症状也有效。对可能影响ＣＬＺ疗效的因素进行多元回归分析发现，如下因素依次对疗效产生积极的影响：（１）治疗前简明精神病评定量表的焦虑抑郁因子分高；（２）治疗前阴性症状量表的注意障碍因子分高而思维贫乏因子分低；（３）治疗前阳性症状量表的阳性思维障碍因子分低；（４）本次治疗前的住院次数少；（５）家族史阴性；（６）首次住院年龄大。提示氯氮平对难治性精神分裂症不失为有效和相对安全的药物。     

Premenstrual exacerbation of depression: one process or two?

BACKGROUND: Premenstrual symptoms occur in the setting of other psychiatric disorders, particularly affective disorders. The nosologic issue of whether premenstrual syndrome is an entity distinct from other psychiatric disorders is controversial. METHOD: We review the association between depression and premenstrual syndrome and describe symptoms in a small series of patients (N = 5) with premenstrual syndrome both during and after resolution of major depression. RESULTS: The overall symptom severity decreased after antidepressant treatment, but this decrease was only significant for dysphoria. In two subjects, other cyclical symptoms consistent with premenstrual syndrome became more apparent after treatment of major depression, possibly because background symptoms of depression improved. CONCLUSION: Premenstrual symptoms, including dysphoric changes and irritability, can continue despite effective treatment of major depression.     

Psychopathological and social status of patients with affective, schizophrenic and schizoaffective disorders after long-term course

A total of 106 affective, 101 schizoaffective and 148 schizophrenic disorders were investigated after a long-term course of illness (mean follow-up period 25.1 years), employing narrow definitions and using reliable international instruments of evaluation. In addition, the social consequences of the illness were evaluated (upward and downward social and occupational drift, premature retirement and achievement of the expected social development). Considering all aspects of outcome, schizophrenic patients (narrow defined, slightly modified DSM-III criteria) had persistent alterations in several aspects of social life, communication and cognitive functions, in some cases to a very high degree. Although the outcome of affective disorders is not always favourable, it is significantly more favourable than that of schizophrenia. Schizoaffective disorders occupy a position between affective and schizophrenic disorders regarding outcome, but with more similarities to that of affective than to that of schizophrenic disorders.     

Lateralized neuropsychological dysfunction in affective disorder and schizophrenia.

The authors compared the cognitive functioning of 22 schizophrenic patients, 105 patients with affective disorder, and 99 age-matched normal control subjects. Results of an aphasia screening test indicated that the schizophrenic patients made more total errors and more dominant temporal/temporoparietal errors than patients with affective disorders and that patients in both groups made more errors than controls. Patient sex, age, drug treatment received at test time, previous neuroleptic drug treatment, and severity of illness did not account for the differences. These findings support the validity of the authors' diagnostic research criteria and confirm prior reports of differences in dominant hemisphere dysfunction between schizophrenic patients and patients with affective disease.     

Dissociation of cognitive from affective components of theory of mind in schizophrenia

Patients suffering from schizophrenia show impaired emotional and social behavior, such as misinterpretation of social situations and lack of theory of mind. However, there is conflicting evidence regarding their ability to perform on theory of mind tasks. Based on previous findings with patients suffering from prefrontal damage, the present study suggests that the behavioral deficit of schizophrenic patients may be due to impaired 'affective theory of mind' abilities, rather than to a general impairment in theory of mind. To test this hypothesis we assessed the ability of 22 schizophrenic patients and 55 age-matched healthy controls, to judge first and second order affective vs. cognitive mental state attribution, based on eye gaze. The relationships between negative and positive symptoms of schizophrenia, and affective and cognitive theory of mind were also assessed. Results indicated that while healthy controls made fewer errors on affective as compared to cognitive theory of mind conditions, schizophrenic patients showed a less prominent trend. Although the pattern of reaction time did not differ significantly between groups, the patients made significantly more errors in the affective conditions, as compared to controls. Furthermore, correlation analysis indicated that impaired affective theory of mind in these patients correlated with their level of negative symptoms. These results indicate that individuals with high level of negative symptoms of schizophrenia may demonstrate selective impairment in their ability to attribute affective mental states. These findings offer new insight into the affective facets of social behavior that may underlie the profound behavioral disturbances observed in schizophrenia.     

首发精神分裂症患者症状群因子分析研究

目的　探讨首发精神分裂症患者治疗前存在的独立症状群及其治疗后的变化。方法　对首发精神分裂症患者 ,在治疗前后分别评定简明精神病评定量表、阴性症状评定量表、汉密尔顿抑郁量表和测查 7种认知功能 ,然后进行因子分析。结果　首发精神分裂症患者的认知症状、阴性症状、情感症状在治疗前、后完全独立 ,无明显变化 ;而阳性症状的独立性在治疗前、后则不稳定 ,因子负荷分别在执行功能、情感症状因子上。结论　在首发精神分裂症患者中情感症状、认知症状是独立存在的 ,与治疗干预、阴性症状及阳性症状关系不肯定 ,应重视对两者的评估和治疗。     

Outcome of schizoaffective disorder at two long-term follow-ups: comparisons with outcome of schizophrenia and affective disorders

OBJECTIVE: This research assessed whether the outcome of schizoaffective disorder is more similar to that of schizophrenia or that of affective disorders. METHOD: The authors conducted a prospective follow-up study of 101 schizoaffective, schizophrenic, bipolar manic, and depressed patients assessed at three times: during hospitalization and 2 and 4-5 years later. The follow-up test battery involved detailed assessment of social functioning, work performance, symptoms, posthospital treatment, and rehospitalization. RESULTS: Outcome for schizoaffective patients 4-5 years after hospitalization differed significantly from that for patients with unipolar depression. However, the differences between schizoaffective and bipolar manic patients were more equivocal. Unlike the patients with bipolar disorder, only a limited number of patients with schizoaffective disorder showed complete recovery in all areas throughout the year preceding the 2-year follow-up and the year preceding the 4- to 5-year follow-up. The differences in outcome between schizoaffective and schizophrenic patients were also mixed. These two groups showed some similarities in outcome, but there were fewer schizoaffective than schizophrenic patients with uniformly poor outcome in all areas. CONCLUSIONS: Overall, schizoaffective patients showed some similarities to both schizophrenic and bipolar manic patients. Schizoaffective patients had somewhat better overall posthospital functioning than patients with schizophrenia, somewhat poorer functioning than bipolar manic patients, and significantly poorer functioning than patients with unipolar depression. The data suggest that when mood-incongruent, schizophrenic-like psychotic symptoms are present in the acute phase, they predict considerable difficulty in outcome, even when affective syndromes are also present, as in schizoaffective disorder. It is likely that schizoaffective disorder is not just a simple variety of affective disorder.