精神分裂症患者情绪记忆损害的研究

目的 探讨精神分裂症患者的情绪记忆及其与精神症状的相关性.方法 采用情绪图片的同忆和再认测试评定40例精神分裂症患者与40名止常对照的情绪记忆,同时采用阳性与阴性症状量表(PANSS)评定患者临床症状.结果 两组间图片评分测试结束10 min后和72 h后对负性和中性图片的回忆率以及负性和止性图片的再认正确率差异均有统计学意义(P＜0.05).PANSS量衷阴性症状评分与负性和正性图片再认正确率呈负相关(r=-0.91,P＜0.01;r=-0.38,P＜0.05).患者组病程与10 min后负性图片回忆率(r=-0.33,P＜0.05)、72h后负性和正性图片回忆率(r=-0.36,P＜0.05;r=-0.36,P＜0.05)、负性图片再认正确率(r=-0.34,P＜0.05)呈负相关.结论 精神分裂症患者存在情绪记忆损害,且与精神症状相关.     

有遗传史的精神分裂症患者某些特征研究

目的:探讨首发精神分裂症患者的微小躯体异常(MPAs)与阴性症状及语词记忆缺陷的关系。方法:对36例有家族史和50例无家族史的首发精神分裂症患者进行躯体异常量表(W S)、阳性和阴性症状量表(PANSS)评定,并在恢复期进行选择性提醒测验。结果:有家族史组MPAs评分异常的比例显著高于无家族史组(P<0.05);有家族史组PANSS总分、阴性因子分显著高于无家族史组,其中阴性症状子项目中情感迟钝、抽象思维困难、交流缺乏自发性和流畅性3项评分显著高于无家族史组;有家族史组语词记忆10次通过率低;回忆总数、保持数、长时再现数及恒定长时再现数均低于无家族史组。结论:有家族史的精神分裂症患者MPAs异常比例高,阴性症状较多,语词记忆能力也明显较差,反映遗传可产生多方面影响。     

无抽搐电休克维持治疗对难治性精神分裂症患者的疗效和认知功能的影响

目的:探讨无抽搐电休克维持治疗(M-ECT)对难治性精神分裂症患者的疗效和认知功能的影响。方法:将60例难治性精神分裂症患者随机分为两组,给予研究组药物联合为期26周的MECT,对照组仅使用药物治疗;治疗前、治疗2周、4周、13周和26周分别进行阳性与阴性症状量表(PANSS)、威斯康星卡片分类测验(WCST)、韦氏记忆测验(WMS)评定。结果:治疗后各时间点两组PANSS总分、治疗2周后的阳性症状分、治疗4周后的阴性症状分和一般病理分均较基线时明显下降(P均0.05);研究组PANSS总分在治疗13周、26周明显低于对照组(P均0.05);阳性症状分治疗后各时间点明显低于对照组(P均0.05);阴性症状分和一般病理分在治疗26周明显低于对照组(P均0.05)。治疗13周时,WCST完成分类数、WMS联想得分明显高于对照组(P均0.05);治疗26周时,WCST错误应答数明显低于对照组;WMS再认、联想得分明显高于对照组(P均0.05)。结论:药物联合M-ECT能快速缓解难治性精神分裂症患者的阳性症状,疗效优于单纯药物治疗,并对患者部分记忆和执行功能有改善。     

重复经颅磁刺激和无抽搐电休克对慢性精神分裂症阴性症状的疗效比较

目的:比较重复经颅磁刺激(rT MS)和无抽搐电休克治疗(MECT)对慢性精神分裂症患者阴性症状的疗效及安全性。方法:80例慢性精神分裂症住院患者分为rT MS组和MECT组,各40例。rT MS组接受rT MS治疗,MECT组接受MECT,观察4周。采用阳性和阴性症状量表(PANSS)、治疗中出现的症状量表(TESS)及韦氏记忆量表(WMS)在治疗前和治疗结束时评估症状及不良反应,比较两组疗效及安全性。结果:治疗4周,rT MS组PANSS总分、阳性症状、阴性症状及一般精神病理评分差值显著高于MECT组(F=11.890,F=14.406,F=17.850,F=37.682;P均0.05);WMS评分再认、图片、联想及背数记忆评分差值rT MS组显著低于MECT组(F=28.500,F=43.530,F=29.125,F=25.232;P均0.05);MECT组TESS评分显著高于rT MS组(F=46.805,P0.05)。结论:rT MS治疗较MECT更能在短期内改善精神分裂症患者阴性症状,且安全性更高。     

精神分裂症患者项目记忆和源记忆的研究

目的探讨精神分裂症患者和正常人的项目记忆与源记忆的差异,检验项目记忆与源记忆有不同神经基础的假说,检验项目记忆与源记忆成绩和精神症状是否有关联性。方法采用对高频中文实义词的学习和再认的项目记忆任务与对同类物体的实义词、图片、想象三种表现方式的学习和再认的源记忆任务,对一般状况匹配的54例精神分裂症患者(研究组)和54名正常人(对照组)进行测试,比较两组项目记忆和源记忆成绩的差异,并对精神分裂症患者组进行双分离分析和阳性及阴性症状量表(PANSS)评分。结果研究组的项目记忆成绩Pr值和源记忆成绩I值分别为0.60±0.16和0.62±0.16,与对照组(分别为0.82±0.08和0.88±0.09)比较,差异均有显著性(P<0.001)。项目记忆成绩Pr值与精神症状不相关;而源记忆的成绩I值与PANSS总分、阳性症状评分之间存有相关性,分别为r=-0.283,P=0.038;r=-0.288,P=0.035。结论精神分裂症患者的项目记忆和源记忆均明显受损。有限的神经心理学研究分析显示,作为情景记忆的不同组成成分,项目记忆和源记忆的神经基础可能不同。     

精神分裂症记忆与阳性、阴性症状的研究

目的探讨精神分裂症患者记忆特点及与阳性、阴性症状的关系。方法采用修正的加工分离记忆实验程序测试精神分裂症患者记忆变化情况,用PANSS评定精神分裂症患者阳性、阴性症状分。结果精神分裂症外显记忆与对照组比较明显受损(P0.05),其文字概念和图像概念实验类型驱动的内隐记忆成绩与对照组比较也受损(P0.05);阳性症状为主的患者外显记忆成绩均高于阴性症状为主的患者组(P0.05);阳性症状为主的患者内隐记忆成绩与以阴性症状为主的患者组之间的差异无统计学意义(P0.05);阳性症状与外显记忆无显著相关关系(P0.05),阴性症状与外显记忆呈显著负相关关系(P0.01);阳性症状、阴性症状与内隐记忆均无显著相关关系(P0.05)。结论精神分裂症外显记忆严重受损,而内隐记忆不同程度的受损;外显记忆与阳性症状无相关性,与阴性症状有显著相关;内隐记忆与阳性、阴性症状均无明显相关性。     

职业技能训练对康复期精神分裂症患者阴性症状及认知功能的影响

目的探讨职业技能训练对康复期精神分裂症患者阴性症状及认知功能的影响。方法将86例康复期精神分裂症患者采用随机数字表法分为观察组和对照组,各43例,对照组给予常规药物治疗及护理,观察组在对照组基础上联合职业技能训练,随访12周,比较两组阳性阴性症状量表(PANSS)、韦氏成人智量表(WAIS-RC)、威斯康星分类检测卡片(WCST)等指标。结果两组实际完成随访各40例。干预后观察组阴性量表、一般病理症状、PANSS总分均明显低于对照组(P0.05);WAIS-RC数字符号、数字广度、视觉深度、以及WCST完成分类数、正确应答数、概念化水平百分数、持续应答数均明显高于对照组,持续性错误数明显低于对照组(P0.05)。结论职业技能训练有助于缓解康复期精神分裂症患者阴性症状,改善认知功能。     

女性精神分裂症患者认知障碍与阴、阳性症状关系的探讨

目的 研究女性精神分裂症患者认知障碍与阴、阳性症状群的关系.方法 将新入院且未经治疗的女性精神分裂症患者按要求分为阳性症状群组(P组)和阴性症状群组(N组),并分别做韦氏记忆量表(WMS)和威斯康星卡片分类测验(WCST)检查.结果 WMS检查显示,阳性症状群组明显优于阴性症状群组,有显著性差异,健康对照组理解因子显著优于阳性症状组,但其他各因子与阳性对照组无显著性差异.WCST检查阳性症状群组Rc、Re、Rpe三因子明显优于阴性症状群组,阳性症状群组和健康对照组无显著性差异.结论 女性分裂症患者认知障碍与阴性症状群的关系明显较阳性症状群密切.     

利培酮及氯氮平对首发精神分裂症患者认知功能及P300的影响

目的比较利培酮和氯氮平对首发精神分裂症患者认知功能的影响。方法对64例首发精神分裂症采用随机对照研究法观察12周,利培酮组33例,平均有效治疗剂量(4.5±1.2)mg/d,氯氮平组31例,平均有效治疗剂量(269.4±133.3)mg/d。于治疗前后行阴性和阳性症状量表(PANSS)、韦氏记忆量表(WMS)和事件相关电位P300检测。结果首发精神分裂症患者在长时记忆、短时记忆、瞬时记忆及记忆商数(MQ)受损较为明显,与对照组比较有显著性差异(P<0.05)。P300电位成分中P2、N2及P3潜伏期明显延长,P2及P3波幅明显降低,与对照组比较均有显著性差异(P<0.05)。经过12周治疗利培酮和氯氮平组PANSS总分、阳性症状分、阴性症状分及一般精神病理症状分均降低,2组无显著性差异(P>0.05)。利培酮组的WMS的再认、联想及记忆商(MQ)明显高于氯氮平组;2组治疗前后P300各指标均无显著性差异。结论首发精神分裂症患者存在着认知功能障碍,利培酮对首发精神分裂症认知功能的改善明显优于氯氮平。两药均不能改善患者的P300。     

元认知训练对慢性精神分裂症患者辅助治疗的临床研究

目的:评价元认知训练(MCT)对慢性精神分裂症的疗效。方法:将80例慢性精神分裂症患者采用随机数字表法分为研究组(n=40)和对照组(n=40),研究组进行MCT、对照组进行文摘讨论,治疗4周。采用阳性与阴性症状量表(PANSS)和精神分裂症认知功能评定量表(SCoRS)分别于治疗前后对入组者进行评定。结果:治疗4周后,两组间PANSS总分及阳性症状比较有显著性差异(P 0. 05);两组间SCoRS各项评分比较差异有统计学意义(P 0. 05)。结论:MCT对慢性精神分裂症患者的阳性症状及认知功能有明显改善作用。     

精神分裂症症状与胆囊收缩素A受体基因之间的关系

目的 探讨精神分裂症症状与胆囊收缩素Ａ（ＣＣＫ－Ａ）受体基因之间的关系。方法 自行设计ＣＣＫ－Ａ受体引物,采用聚合酶链反应（ＰＣＲ）扩增技术,分析８４例男性慢性精神分裂症患者（患者组）和７０名男性健康者（对照组）ＣＣＫ－Ａ受体基因的多态性;同时评定患者发病时的临床症状。结果（１）患者组与对照组间的ＣＣＫ－Ａ受体等位基因,基因型差异均无显著性;（２）有幻觉妄想综合征的２７例患者ＣＣＫ－Ａ受体等位基因     

利培酮与氯氮平对精神分裂症患者认知功能影响的对照研究

目的：观察利培酮与氯氮平对精神分裂症患者认知功能的影响。方法：将80例精神分裂症住院患者随机分为两组,并分别予以利培酮与氯氮平治疗12周,于入组前及治疗结束时测查威斯康星卡片分类测验,韦氏记忆测验,阳性和阴性症状量表,并与正常人比较,借以分析两药对认知功能的影响。结果：两组间在威斯康星卡片分类测验,韦氏记忆测验,阳性和阴性症状量表中的认知因子分上并无显著性差异,治疗前后比较利培酮组（40例）在记忆,阳性和阴性症状量表中的认知因子分及威斯康星卡片分类测验中的完成分类数和概念的水平,其百分数有显著差异,而氯氮平组（33例）仅在阳性和阴性症状量表中的认知因子及威斯康星卡片分类测验中的概念水平,其百分数有显著差异,在威斯康星卡片分类测验中完成第一个分类的次数有增加趋势。结论：利培酮对认知功能障碍的治疗作用优于氯氮平。     

Prose memory deficits associated with schizophrenia

Memory of contextual information is essential to one's quality of living. This study investigated if the different components of prose memory, across three recall conditions: first learning trial immediate recall, fifth learning trial immediate recall, and 30-min delayed recall, are differentially impaired in people with schizophrenia, relative to healthy controls. A total of 39 patients with schizophrenia and 39 matched healthy controls were recruited. Their prose memory, in terms of recall accuracy, temporal sequence, recognition accuracy and false positives, commission of distortions, and rates of learning, forgetting, and retention were tested and compared. After controlling for the level of intelligence and depression, the patients with schizophrenia were found to commit more distortions. Furthermore, they performed poorer on recall accuracy and temporal sequence accuracy only during the first initial immediate recall. On the other hand, the rates of forgetting/retention and recognition accuracy were comparable between the two groups. These findings suggest that people with schizophrenia could be benefited by repeated exposure to the materials to be remembered. These results may have important implications for rehabilitation of verbal declarative memory deficits in schizophrenia.     

Opposite links of positive and negative symptomatology with memory errors in schizophrenia

We wished to confirm and extend a previous correlational study of our group, suggesting that positive symptoms in schizophrenia were linked to an increase in certain types of memory errors, and negative symptoms to a decrease in other types of errors. A post-hoc analysis was conducted in 33 schizophrenic patients and 40 normal control subjects on memory errors collected in a free recall task and two types of recognition tasks. The memory errors were intrusions and list errors in free recall, and decision bias towards false alarms in recognition, all assumed to reflect a source-monitoring failure. In a first analysis, the patient sample was split along the median for positive symptoms as rated by the Scale for the Assessment of Positive Symptoms (SAPS). In a second analysis, it was split along the median for negative symptoms as rated by the Scale for the Assessment of Negative Symptoms (SANS). Patients with high ratings of positive symptoms made more memory errors (intrusions, list errors, false alarms) than those with low ratings, supporting the hypothesis of a link between positive symptomatology and source-monitoring failure. On the other hand, patients with high ratings of negative symptoms made fewer of these errors than the other patients. Fewer errors were specifically associated with more affective flattening, alogia and anhedonia, whereas avolition was entirely unrelated to them.     

Positive symptomatology and source-monitoring failure in schizophrenia--an analysis of symptom-specific effects

Recent research has suggested that certain positive symptoms in patients with schizophrenia are linked to self monitoring/reality-monitoring deficits. We wished to investigate the association between such deficits and three specific symptoms: hallucinations, delusions and thought disorganisation. Forty patients with schizophrenia and 40 normal controls were administered a source-monitoring task. Twenty-four items were produced, either verbally by the experimenter, or verbally by the subject, or presented as pictures. Then, subjects were read a recognition list including the produced target items mixed with distractors. They were required to recognise the target items and to remember their source of production. The pattern of memory deficits has previously been reported (Brébion, G., Smith, M., Gorman, J., Amador, X., 1997. Discrimination accuracy and decision biases in different types of reality monitoring in schizophrenia. Journal of Nervous and Mental Disease 185, 247-253). The current analyses focussed on the false recognition of distractors, and on the errors in the source attribution of the recognised target items. Results showed that higher hallucination scores were associated with an increased tendency towards false recognition of non-produced items. In addition, hallucinators were more prone than control subjects to misattribute to another source the items they had produced themselves. Furthermore, hallucinators and delusional patients were more prone than the other patients to report that spoken items had been presented as pictures. This latter finding suggests that both hallucinations and delusions are associated with confusion between imagined and perceived pictures. Our previous report stated that only one of the three investigated types of response bias was associated with global positive symptomatology. However, this finer-grained analysis revealed that the three of them were in fact associated with hallucinations and/or delusions. On the other hand, thought disorganisation appeared to be independent from these mechanisms.     

Intact suppression of increased false recognition in schizophrenia

OBJECTIVE: Recognition memory is impaired in patients with schizophrenia, as they rely largely on item familiarity, rather than conscious recollection, to make mnemonic decisions. False recognition of novel items (foils) is increased in schizophrenia and may relate to this deficit in conscious recollection. By studying pictures of the target word during encoding, healthy adults can suppress false recognition. This study examined the effect of pictorial encoding on subsequent recognition of repeated foils in patients with schizophrenia. METHOD: The study included 40 patients with schizophrenia and 32 healthy comparison subjects. After incidental encoding of 60 words or pictures, subjects were tested for recognition of target items intermixed with 60 new foils. These new foils were subsequently repeated following either a two- or 24-word delay. Subjects were instructed to label these repeated foils as new and not to mistake them for old target words. RESULTS: Schizophrenic patients showed greater overall false recognition of repeated foils. The rate of false recognition of repeated foils was lower after picture encoding than after word encoding. Despite higher levels of false recognition of repeated new items, patients and comparison subjects demonstrated a similar degree of false recognition suppression after picture, as compared to word, encoding. CONCLUSIONS: Patients with schizophrenia displayed greater false recognition of repeated foils than comparison subjects, suggesting both a decrement of item- (or source-) specific recollection and a consequent reliance on familiarity in schizophrenia. Despite these deficits, presenting pictorial information at encoding allowed schizophrenic subjects to suppress false recognition to a similar degree as the comparison group, implying the intact use of a high-level cognitive strategy in this population.     

Recollection and familiarity in negative schizophrenia

Using the "remember-know" procedure to assess recognition memory, previous studies yielded evidence of impaired recollection but intact familiarity in schizophrenia patients. However, so far, the recognition memory performance of schizophrenia patients has not yet been analysed using the dual-process signal detection model (DPSD) by Yonelinas [Yonelinas, A. P. (2001). Components of episodic memory: The contribution of recollection and familiarity. Philosophical Transactions of Royal Society of London. Series B: Biological Sciences, 356(1413), 1363-1374], which accurately accounts for response and memory bias. Also, clinical symptoms have not yet been taken into account. Based on findings from neuropsychological and neurobiological research we hypothesized that high negative symptoms might be associated with a profile of impaired recollection and spared familiarity. The recognition memory performance of 22 schizophrenia patients scoring higher or lower on the negative symptoms subscale of the Positive and Negative Syndrome Scale (PANSS) was assessed by means of a word list discrimination task. Following the rationale of the dual-process signal detection model, estimates of recollection and familiarity were derived. The recollection estimate, derived by the DPSD model, was lower in patients with more severe negative symptomatology compared with both the patients with lower negative symptoms scores and healthy individuals. Familiarity was not affected if IQ was partialled out. Furthermore, the results yielded increased false alarm rates in patients with negative schizophrenia. The findings confirm an association of negative symptoms and recollection impairment in schizophrenia.     

Schizophrenia patients demonstrate a dissociation on declarative and non-declarative memory tests

Declarative memory refers to the recall and recognition of factual information. In contrast, non-declarative memory entails a facilitation of memory based on prior exposure and is typically assessed with priming and perceptual-motor sequencing tasks. In this study, schizophrenia patients were compared to normal comparison subjects on two computerized memory tasks: the Word-stem Priming Test (n=30) and the Pattern Sequence Learning Test (n=20). Word-stem Priming includes recall, recognition (declarative) and priming (non-declarative) components of memory. The schizophrenia patients demonstrated an impaired performance on recall of words with relative improvement during the recognition portion of the test. Furthermore, they performed normally on the priming portion of the test. Thus, on tests of declarative memory, the patients had retrieval deficits with intact performance on the non-declarative memory component. The Pattern Sequence Learning Test utilizes a serial reaction time paradigm to assess non-declarative memory. The schizophrenia patients' serial reaction time was significantly slower than that of comparison subjects. However, the patients' rate of acquisition was not different from the normal comparison group. The data suggest that patients with schizophrenia process more slowly than normal, but have an intact non-declarative memory. The schizophrenia patients' dissociation on declarative vs. non-declarative memory tests is discussed in terms of possible underlying structural impairment.     

精神分裂症患者胰岛素抵抗及分泌水平对认知功能 的影响

目的 探讨胰岛素抵抗及分泌功能对于精神分裂症患者认知功能的影响,并进一步探讨胰岛素抵抗及分泌水平与临床症状之间的相关性.方法 共纳入193例精神分裂症患者(男113例,女80例),其中非胰岛素抵抗组68例,胰岛素抵抗组125例,胰岛细胞功能正常组78例,胰岛细胞功能降低组115例.采用重复性成套神经心理状态测验(RBANS)和Stroop色词测验(SCWT)评估患者的认知功能,采用阳性与阴性症状量表(PANSS)评估患者的精神病性症状.分别采用化学发光免疫分析法及全自动生化分析仪检测胰岛素及血糖水平.结果 胰岛素抵抗组较非胰岛素抵抗组的SCWT单字和单色卡片错误数减少,RBANS的数字广度及词汇再识分数增加,差异有统计学意义(P<0.05).胰岛细胞功能降低组较胰岛细胞功能正常组SCWT的单字和单色卡片中的错误数增多,时间增长,差异有统计学意义(P<0.05).胰岛细胞功能降低组较胰岛细胞功能正常组RBANS的图形临摹、线条定位、数字广度、编码测验、注意量表分、故事回忆分均减少,差异有统计学意义(P<0.05).胰岛素抵抗指数(HOMA-IR)与PANSS总分之间呈负相关(r=-0.139,P<0.05),未发现胰岛细胞功能与临床症状之间存在相关性.结论 胰岛素抵抗组较非胰岛素抵抗组可能有较好的认知功能;胰岛细胞功能降低组较胰岛细胞功能正常组认知功能更差;胰岛素抵抗与精神病性症状严重程度之间存在负相关性.     

单纯药物与药物联合重复经颅磁刺激治疗首发精神分裂症幻听症状的随机对照研究

目的：探讨单纯药物与药物联合重复经颅磁刺激（rTMS）治疗首发精神分裂症患者幻听症状的疗效及安全性。方法将80例具有幻听症状的首发精神分裂症患者随机分为研究组和对照组,每组各40例。研究组在药物（利培酮）基础上联合rTMS治疗,对照组采用单纯药物（利培酮）治疗。分别于治疗前及治疗1,2,4周末应用阳性和阴性症状量表（PANSS）评定临床疗效,通过不良反应评价其安全性。结果治疗4周末,两组患者PANSS总分及各因子分均较治疗前显著下降（P＜0．01）;治疗4周末,研究组PANSS阳性症状因子显效率（30％）高于对照组（10％）,差异有统计学意义（P＜0．05）;研究组PANSS总分和阳性症状因子分在第2周和4周末均低于对照组（P ＜0．05）。两组患者各不良反应发生率的差异无统计学意义（P ＞0．05）。结论 rTMS可以缩短药物治疗精神分裂症幻听症状的起效时间,并可提高药物的疗效,且安全性好。