精神分裂症患者认知功能损害与阴阳性症状的关系

目的：探讨精神分裂症认知功能损害与阴性、阳性症状的关系。方法:至73例入组的患者随机给予利培酮、氯氮平治疗12周,并于治疗前、后盲法评定Wisconsin卡片分类测验（WCST）,Wechsler记忆测验（WMS）,阴状症状评定量表（SANS）与阳性症状评定量表（SAPS）。结果：治疗前精神分裂症患者的阴性症状、阳性症状均与认知功能有显著相关。主要与执行功能相关;注意障碍与记忆相关。治疗后,仅SAPS中怪异行为得分与WCST的持续反应数、持续错误数显著相关。结论：精神分裂症的认知功能损害是原发性的,并不是在阳性、阴性症状基础上产生的。     

氯氮平治疗对首发精神分裂症患者认知功能的影响

目的观察氯氮平治疗对首发精神分裂症认知功能的影响。方法将31例首发精神分裂症患者经氯氮平治疗前及治疗12周后,用韦氏成人智力量表、韦氏记忆量表、阳性症状量表、阴性症状量表、简明精神症状评定量表、维斯康星卡片分类测验进行评估,观察氯氮平对认知功能的影响及与精神症状变化的关系。结果治疗后,阳性症状量表、阴性症状量表、简明精神症状评定量表、维斯康星卡片分类测验中错误应答数的评估分值显著降低(P＜0．01)。维斯康星卡片分类测验中的非持续性错误、韦氏记忆量表中的再生、理解评估分值明显降低(P＜0．05)。结论氯氮平治疗精神分裂症可改善部分患者的认知功能。     

分裂样精神病和首发精神分裂症长期随访对照研究

目的 探讨分裂样精神病与首发精神分裂症的症状结构及远期预后有无差异。方法 对164例分裂样精神病或首发精神分裂症患随机给予氯丙嗪或氯氮平治疗；按DSM-IV标准划分诊断；于治疗前分别作韦氏成人智力量表、韦氏记忆量表、铁槽铁钉测验、利手测验、动作功能测验、手功能协调测验、连线测验A和B、威斯康星卡片分类测验及言语流利性测验10项神经心理测查各1次，并作BRPS、SANS、CGI、功能总体评定量表、Simpson/Minidotes副反应量表、迟发性运动障碍评定量表（TD）各1项，于治疗12周末及治疗52周末再分别评定1次上述各项测查。结果 在治疗前及治疗12周末、治疗52周末分裂样精神病与首发精神分裂症状患在阳性症状、阴性症状、认知功能水平及迟发性运动障碍方面的差异均有显性，前阳性症状较重，阴性症状少，认知功能及社会功能恢复较好。TD发生少。结论 分裂样精神病具有独特临床特征。应在疾病分类学中保留其独立的位置。     

首发精神分裂症患者临床特点的性别差异

目的:探讨首发精神分裂症患者临床症状及社会功能的性别差异.方法:164例首发精神分裂症患者在治疗前和治疗后12周及1年时分别主定简明精神病评定量表(BPRS),阴性症状评定量表(SANS),功能大体评定量表(GAF),Simpson锥体外系副反应量表(SAEPS)及社会功能缺陷筛选量表(SDSS),结果:男女精神分裂症患者起病年龄,病程,受教育年限及阳性家族史的比例差异无显著性,但女性的已婚率(57.1%),显著高于男性(20.7%),治疗前后阴阳性症状及治疗后SAEPS总分,药物剂量男女差异皆无显著性,治疗前后女性的社会功能(尤其在躯体活动和家庭职能方面)显著优于男性,结论:首先精神分裂症患者的临床特征在治疗前和治疗后一年中无性别差异.但女性的社会功能优于男性.     

精神分裂症症状与认知功能损害的关系

目的：探讨精神分裂症症状与认知功能损害的关系。方法：对１８例阴性精神分裂症和１５例阳性精神分裂症采用氯氮平治疗;对１１例阴性精神分裂症和１３例阳性精神分裂症采用利培酮治疗。并分别评估其治疗前和治疗８周后的阳性症状,阳性症状记忆,注意及执行功能。结果：精神分裂症的记忆损害与阴性症状和阳性症状都呈显著性相关,注意及执行功能损害与阴性症状显著相关,与阳性症状无明显相关;记忆随思维贫乏的改善而改善,注意和执行功能损害的改善与症状的改善无明显相关。结论：精神分裂症认知功能损害主要与阴性症状相关,但精神分裂症的大部分认知功能并不随阴性症状改善而改善。     

首发及慢性精神分裂症患者与健康人认知功能的差异

目的比较首发及慢性精神分裂症与健康人认知功能的差异,并探讨影响认知功能的相关因素。方法符合美国精神障碍诊断与统计手册第四版（DSM—Ⅳ）诊断标准的首发精神分裂症住院患者90例,慢性精神分裂症患者89例,健康人94例;使用重复性神经心理测查系统（RBANS）检测认知功能,阳性和阴性症状量表（PAN-SS）、临床总体印象量表（CGI）评估患者精神症状及严重程度,Simpson锥体外系不良反应量表（SEPS）、异常不自主运动评定量表（AIMS）评定锥体外系不良反应及迟发性运动障碍。结果三组教育年限之间差异有统计学意义（F=41,P〈0．001）,即刻记忆和延时记忆因子在慢性患者和首发患者之间差异不显著,无统计学意义（P=0．42,P=0.13）,RBANS总分及其它因子分在三组之间均有显著性差异（P〈0.05—0．001）;慢性患者的受教育年限、既往住院次数、病程、精神症状、AIMS、SEPS与认知功能存在着显著相关性（P〈0．05～0．000）;首发患者的年龄、受教育年限、首次精神症状发生年龄、精神症状、CGI与认知功能存在着显著相关性（P〈0．05—0．000）。结论认知功能障碍是精神分裂症的核心症状之一;影响首发精神分裂症和慢性分裂症患者认知功能的因素有一定的差异。     

首发精神分裂症病人的抑郁症状

目的探讨首发精神分裂症病人抑郁症状的发生率、特征及相关因素。方法于入院、治疗3、6、9、12月时用汉密尔顿抑郁量表(HAMD)、简明精神病评定量表(BPRS)、阴性症状量表中文版(SANS-CV)、临床总体印象量表(CGI)及功能总体评定量表(GAF)对164例首发精神分裂症患者进行评定。结果急性期首发精神分裂症病人轻度或以上程度抑郁症状的发生率为71%,但在缓解期降至12%。急性期突出的抑郁表现为认知障碍与迟缓(因子分各占HAMD总分的35%和29%)。抑郁症状随着精神病性症状的缓解而减轻,与性别、发病年龄、受教育时间、病程及前驱期长短无关。HAMD总分在急性期仅与BPRS的焦虑抑郁因子分有关,但在缓解期与阴阳性症状、临床总体印象以及总体功能均有密切的相关性;急性期以及治疗3个月时的抑郁症状与随后的阴阳性症状、总体功能的变化无关。结论首发精神分裂症急性期的抑郁症状可能是一个独立的症状群,抑郁程度不能作为预测首发精神分裂症病人预后的指标。     

首发精神分裂症患者认知功能相关因素的5年随访

目的探讨首发精神分裂症患者在急性期和维持治疗期认知功能与精神症状和社会功能的关系。方法对164例首发精神分裂症患者进行随访观察,于治疗前、治疗12周末、治疗1年末、2年末、3年末、4年末、5年末各做1次韦氏成人智力量表、韦氏记忆量表、铁槽铁钉测验、手指敲击试验、动作功能测验、手功能协调测验、连线测验A和B、威斯康星卡片分类测验(WCST)及言语流利性测验等10项神经心理测查及简明精神症状评定量表(BPRS)、阴性症状评定量表(SANS)、功能总体评定量表(GAF)评定。结果治疗前各项认知功能测查结果与BPRS、SANS、GAF均无显著相关(P>0.05);治疗12周末、治疗1年末、2年末手指敲击测验、动作功能测验、总记忆商(MQ)等与BPRS总分显著相关(P<0.003);治疗12周末、治疗1年末、2年末、3年末、5年末铁槽铁钉测验、手指敲击测验、手功能协调性测验、智商(IQ)、MQ等与SANS、GAF总分显著相关(P<0.003)。结论治疗前首发精神分裂症患者认知功能与阳性症状、阴性症状、社会功能相互独立;维持治疗期随着疾病的演变,它们之间的相关性也在发生着变化。     

奥氮平对首发精神分裂症患者的疗效及认知功能影响

目的观察奥氮平对首发精神分裂症患者的疗效及认知功能的影响。方法对31例首发精神分裂症患者在奥氮平治疗前及治疗12周后，用阳性症状量表（SAPS）、阴性症状量表（SANS）、韦氏成人智力量表（WAIS—R）、韦氏记忆量表（WMS）、简明精神病评定量表（BPRS）、韦斯康星卡片分类测验（WCST）进行评估，并观察奥氮平对精神分裂症症状的疗效及对认知功能的影响。结果治疗后SAPS、SANS、BPRS〈WCST中错误应答数的评估分值显著降低（P〈0．01），且非持续性错误、WMS的再生、理解评估分值也明显降低（P〈0．05）。结论奥氮平治疗精神分裂症疗效可靠并可显著改善部分患者的认知功能。     

盐酸文拉法辛对以阴性症状为主的精神分裂症患者听觉P300的影响

目的 研究盐酸文拉法辛对以阴性症状为主的精神分裂症患者听觉P300的影响,为临床治疗阴性精神分裂症提供理论基础。方法 60例以阴性症状为主的精神分裂症患者为对照组,服用抗精神病类药物进行治疗,60例以阴性症状为主的患者为研究组,使用抗精神病药物合并文拉法辛缓释片治疗。分别于治疗前及治疗后第5周末,对两组患者进行听觉P300检测以及阳性和阴性综合征量表（PANSS）评定。结果 研究组治疗后潜伏期P2、N2、P3均显著低于治疗前（P〈0.05）,其中N2、P3亦低于对照组（P〈0.01）,研究组治疗后波幅P3均高于对照组和同组治疗前（P〈0.01）;对照组治疗后潜伏期P2低于治疗前,波幅P2高于治疗前（P〈0.05）。研究组治疗后PANSS总分及阴性因子、阳性因子评分均低于对照组和同组治疗前（P〈0.01）。结论 盐酸文拉法辛可提高以阴性症状为主精神分裂症患者的认知功能,改善其听觉P300各项指标。     

Risperidone,negative symptoms and cognitive deficit in schizophrenia: an open study

The aim of this study was to evaluate the effects of a new antipsychotic compound on negative symptoms and cognitive deficit in schizophrenia. Psychiatric symptoms and cognition were assessed in 25 patients with schizophrenia, at baseline and after they had taken risperidone for 4 weeks. The Positive and Negative Symptoms Scale (PANSS), the Wisconsin Card Sorting Test (WCST) and two WAIS sub-tests were used to assess the patients. After the study period, both negative and positive symptoms and also measures of cognitive performance improved significantly. The WCST results correlated with negative symptom scores before and after treatment. This suggests that negative symptoms and cognitive deficit have a common underlying substrate which is the target of the risperidone treatment. Our data show that risperidone may have a substantial effect on complex cognitive functions in schizophrenia, and they suggest that certain cognitive deficits are relatively dependent on the negative symptoms of this disorder.     

Elevated plasma superoxide dismutase in first-episode and drug naive patients with schizophrenia: inverse association with positive symptoms

Excessive free radical production or oxidative stress may be involved in the pathophysiology of schizophrenia as evidenced by increased superoxide dismutase (SOD) activities, a critical enzyme in the detoxification of superoxide radicals. This study compared plasma SOD activities in 78 never-medicated first-episode and 100 medicated chronic schizophrenia patients to 100 healthy control subjects and correlated these SOD activities with the Positive and Negative Syndrome Scale (PANSS) among the schizophrenic patients. We found that both first-episode and chronic patients had significantly increased plasma SOD activities compared to controls, and that chronic schizophrenic patients on antipsychotic medication had significantly higher SOD activities than first episode schizophrenic patients. Plasma SOD activities were also negatively correlated with positive symptoms of schizophrenia, but only in first-episode patients. Thus, oxidative stress appears to be greater in first episode schizophrenic patients with fewer positive symptoms and may become greater as schizophrenia becomes more chronic, although we cannot exclude the possibility that chronic antipsychotic treatment may increase SOD activities and presumed oxidative stress in schizophrenia.     

精神分裂症患者共情能力及相关因素分析

目的 通过比较住院精神分裂症患者治疗前后共情缺陷、社会功能和精神症状的差异,探讨共情能力的相关因素及药物治疗对共情能力的影响。方法 对60例（男30例,女30例）住院精神分裂症患者予新型抗精神病药物治疗3个月,采用人际反应指针量表（IRI—C）、阳性和阴性症状评定量表（PANSS）及个体和社会功能量表（PSP）,分别对患者治疗前后的共情水平、精神症状、社会功能进行评定,比较各项测量指标前后的变化,并通过各测量指标治疗后减分率的相关分析,探讨精神分裂症患者共情能力、临床症状以及社会功能的关系,以及药物治疗对共情能力的影响。结果 精神分裂症患者予新型抗精神病药治疗3个月后,共情能力、精神症状、社会功能均有所改善。治疗前后各项评分减分率进行Pearson相关分析显示,精神分裂症患者的共情能力与阴性症状呈负相关,与社会功能呈正相关。结论 非经典抗精神病药物治疗可改善共情能力、精神症状和社会功能,精神分裂症患者的阴性症状随着共情能力的改善而改善。     

Non-verbal behaviour deficits in schizophrenia: an ethological study of drug-free patients

The aims of this study were (i) to define the dimensions of non-verbal behaviour which distinguish between schizophrenic patients and control subjects and (ii) to examine the relationship between patients' non-verbal behaviour and clinical symptoms. The non-verbal behaviour of 28 drug-free patients with schizophrenia according to Research Diagnostic Criteria (RDC) and 25 control subjects was videotaped during interviews and scored according to an ethological scoring system. Patients' symptoms were rated on the Scale for the Assessment of Negative Symptoms, the Scale for the Assessment of Positive Symptoms and the Brief Psychiatric Rating Scale. As a group, schizophrenic patients showed a global restriction of non-verbal expressiveness, as indicated by their lower scores on prosocial behaviour, gesture and conflict. However, some patients had normal ethological profiles. Non-verbal behaviour was largely independent of negative and positive symptoms. Deficits in non-verbal behaviour may play a role in determining or aggravating dysfunctional patterns of relating in schizophrenia. Ethological analysis provides further support for the model that conceptualizes positive symptoms, negative symptoms and disorders of social relationships as three separate dimensions of the schizophrenic syndrome.     

以阳性、阴性症状为主的首发精神分裂症患者血清蛋白因子水平与PANSS评分的相关性

目的探讨以阳性、阴性症状为主的首发精神分裂症患者血清白细胞介素-6(IL-6)、钙结合蛋白S100β(S100β)、神经营养因子-3(NT-3)三种蛋白因子的浓度水平差异以及与其阳性与阴性症状量表(PANSS)评分中阳性症状、阴性症状、认知、兴奋及抑郁情绪评分之间的相关性。方法以2014年1月-2015年11月于昆明医科大学第一附属医院精神科门诊及住院的首发精神分裂症患者为患者组,选取同期来自本院体检中心的健康体检者为对照组。采用酶联免疫吸附技术(ELISA)测定44例以阳性症状为主的首发精神分裂症患者(阳性组)、38例以阴性症状为主的首发精神分裂患者(阴性组)和78名健康对照者(对照组)血清中蛋白因子IL-6、S100β、NT-3的浓度,通过PANSS对患者组和对照组的阳性症状、阴性症状、认知功能、兴奋症状及抑郁情绪进行定量评估。结果 1三组血清IL-6浓度比较,差异有统计学意义(F=31.34,P0.01),两两比较,对照组IL-6浓度低于阳性组和阴性组,阳性组低于阴性组,差异均有统计学意义(P均0.05);2三组S100β浓度比较,差异有统计学意义(F=9.19,P0.05),两两比较,阳性组、阴性组的S100β浓度均高于对照组(P均0.05),两患者组间比较差异无统计学意义(P0.05);3三组NT-3浓度比较,差异有统计学意义(F=10.45,P0.05),两两比较,阳性组、阴性组NT-3浓度均低于对照组(P均0.05),两患者组间比较差异无统计学意义(P0.05)。阳性组血清NT-3浓度与兴奋评分呈正相关(r=0.38,P0.05)。结论以阴性症状为主的首发精神分裂症患者的神经炎症反应较以阳性症状为主的患者更强烈,以阳性症状为主的首发精神分裂症患者的异常兴奋可能与其细胞营养不足有关,以阳性症状为主的首发精神分裂症的病理机制可能与以阴性症状为主的首发精神分裂症不尽相同。     

Social cognition and symptom dimensions

This study used the Picture Arrangement subtest of the Wechsler Adult Intelligence Scale to assess social cognitive functioning of psychotic patients diagnosed with bipolar, schizophrenia, or schizoaffective disorder. All participants were rated on positive and negative symptom rating scales, from which three symptom dimensions were obtained. Symptom dimensions were not significantly related to ratings of symptom severity or mental status examination scores. Disorganized symptoms were correlated with a wide range of impairments on nearly all subscale measures of social cognition. Negative symptoms were correlated with lower ratings of capacity for emotional investment, complexity of representations, and integration of episodes. Psychoticism was associated with negative affect tone. Diagnostic categories were not related to social cognitive impairments independent of estimates of premorbid level of cognitive function. Evidence of syndromal differences suggests that heterogeneity of variance in studies of functioning of schizophrenic patients can be reduced by inclusion of symptom dimensions.     

Ego-pathology and common symptom factors in schizophrenia

The phenomenological construct of ego-pathology in schizophrenia has been widely referred to in psychopathological textbooks but was systematically assessed in very few empirical studies. This study investigated the association between ego-pathology (Ego-Pathology Inventory) and common symptom factors (Positive and Negative Symptom Scale) in paranoid schizophrenia patients within 3 days after admission and after 2 weeks of treatment. The predictive value of ego-pathology for short-term treatment outcome was also assessed. A factor analysis of all subscale scores revealed a four-factor solution: positive symptoms, negative symptoms, and two distinct ego-pathology factors, i.e., general and identity. Although the ego-pathology subscale "activity" loaded on the positive symptom factor, the other four subscales formed the two ego-pathology factors with no high loadings on other factors. High scores on ego-demarcation at admission predicted poor treatment outcome after 2 weeks. The findings suggest that ego-pathology might be used to capture additional and clinically meaningful symptom dimensions in schizophrenia.     

Exploration of irony appreciation in schizophrenia

Irony is a form of speech used to convey feelings in an indirect way. Patients with schizophrenia demonstrated an impaired irony processing, associated with poor theory-of-mind. We investigated irony appreciation in a sample of 20 subjects with schizophrenic disorder by using cartoon images. The primary aim was to examine the association between Positive and Negative Symptoms Scale (PANSS) scores (i.e. positive, negative and cognitive) and irony visual joke appreciation. The group performed significantly worse in the Theory of Mind (ToM) condition than in the physical one. We report a significant relationship between ToM performances with PANSS positive and cognitive symptoms but not with negative symptom scores. Average humour score significantly correlated with positive symptoms, i.e. more severe symptoms, less funny the cartoon, while the difficulty in understanding the jokes was related to PANSS cognitive cluster score, i.e. more cognitive symptoms, less difficult the ToM jokes. Our results offer evidence for a compromised ToM capability in appreciating visual jokes linked to specific symptomatology.