男性精神分裂症患者基于事件的前瞻记忆研究

目的：研究男性精神分裂症患者基于事件的前瞻记忆受损程度以及与临床症状的关系。方法：运用神经心理学方法,测定19例精神分裂症患者和20名健康志愿者为对照组的前瞻记忆成绩、持续注意力及执行功能。结果：精神分裂症患者前瞻记忆中的错误显著高于对照组。该损害与注意力、执行功能障碍呈正相关,与年龄和阴性症状无关。结论：精神分裂症患者能够形成完整的意图,但其监视、识别线索、提取或执行意图的功能受损。该损害可能起因于患者的注意和执行功能障碍,而与其特定症状无关。     

Habitual prospective memory in schizophrenia

Background  

Prospective memory (PM), the act of remembering that something has to be done in the future without any explicit prompting to recall, provides a useful framework with which to examine problems in internal-source monitoring. This is because it requires distinguishing between two internally-generated processes, namely the intention to perform an action versus actual performance of the action. In habitual tasks, such as taking medicine every few hours, the same PM task is performed regularly and thus it is essential that the individual is able to distinguish thoughts (i.e., thinking about taking the medicine) from actions (i.e., actually taking the medicine).     

Premorbid personality in schizophrenia spectrum: A prospective study

Schizophrenia has been linked with premorbid character anomalies since it was first described. However, few prospective studies of premorbid personality characteristics in schizophrenia and related disorders have been conducted. This study evaluates premorbid personality in children who developed schizophrenia spectrum disorder in adult life. In 1972, 265 children at an average age of 12 (90 with at least one schizophrenic parent) from the Copenhagen Perinatal Cohort participated in a 1-day follow-up during which they were in contact with seven examiners who rated their personality by means of an Adjective Check List (ACL). In 1991–93, adult psychiatric status was assessed for 242 of these individuals, who were classified into three categories: schizophrenia spectrum (n=24), other psychiatric diagnoses (n=72) and healthy controls (n=145). Personality characteristics derived from the ACL were linked to these three diagnostic categories. Twelve-year-old children destined to develop a disorder in the schizophrenia spectrum deviated significantly from healthy controls on a number of personality characteristics: they were rated significantly lower than controls on intelligence, concentration, maturity, friendliness, cooperation, self-control and significantly higher on aggression. Non-significant trends indicated that this group displayed more deviant personality scores than psychiatric controls. Children who later develop schizophrenia spectrum disorder differed from normal controls with respect to a number of personality traits. The ACL may be too insensitive to discriminate between premorbid personality in the schizophrenia spectrum and other psychopathology.     

Event-based prospective memory in schizophrenia

Although memory deficits have been well documented in schizophrenia, so far, there is dearth of literature about prospective memory (PM), that is memory for future events, in this disorder. The present study investigated event-based PM in schizophrenia. Additionally, the relationship of event-based PM with clinical variables of schizophrenia was also assessed. Task incorporating event-based prospective memory was administered on 42 schizophrenia patients and 42 nonpsychiatric comparison subjects. Patients with schizophrenia were additionally rated on The Scale for the Assessment of Positive Symptoms, The Scale for the Assessment of Negative Symptoms and The Brief Psychiatric Rating Scale. Results showed schizophrenia patients to have poor event-based prospective memory. However, no significant correlation was observed between the clinical variables and PM.     

Activity-based prospective memory in schizophrenia

The study reports activity-based prospective memory as well as its clinical and neuropsychological correlates in schizophrenia. A total of 42 persons diagnosed with schizophrenia and 42 healthy controls were administered prospective memory, set-shifting, and verbal working memory tasks. The schizophrenia group was additionally administered various psychopathology rating scales. Group differences, with poorer performances of the schizophrenia group, were observed on the measures of prospective memory, working memory, and set shifting. The performance on prospective memory tasks correlated with the performance levels on verbal working memory and set-shifting tasks but not with the clinical measures. This study demonstrated impaired activity-based prospective memory in schizophrenia. The impairment can be due to deficits in various neuropsychological domains.     

A prospective,open-label trial of olanzapine in adolescents with schizophrenia

BACKGROUND: Olanzapine is an atypical antipsychotic that has efficacy in adults with psychotic disorders. This preliminary study examined the effectiveness of olanzapine in adolescents with schizophrenia or its related conditions. METHOD: Adolescents aged 12-17 years (inclusive) with a diagnosis of schizophrenia, schizoaffective, or schizophreniform disorder were enrolled in this 8-week, open-label, outpatient study. The Positive and Negative Syndrome Scale (PANSS), the Clinical Global Impressions Scale (CGI), and the Children's Global Assessment Scale (CGAS) were administered as outcome measures. Extrapyramidal side effects were assessed at each visit. Olanzapine was initiated at a dose of 2.5 mg/day and could be increased to a maximum total daily dose of 20 mg. RESULTS: Sixteen participants with a mean age of 13.8 (SD = 1.5) years were treated. Significant improvements were found in the PANSS, CGI severity, and CGAS scores. Reductions in both positive and negative symptoms were found. Increased appetite and sedation were the most frequently reported side effects. Two subjects required treatment for extrapyramidal side effects. CONCLUSIONS: Psychotic symptoms significantly improved during study. Overall, olanzapine was well tolerated. Future studies are needed to confirm these findings, to assess long-term treatment outcomes, and to compare the effectiveness of olanzapine with that of other antipsychotics.     

精神分裂症患者基于事件前瞻记忆缺陷的功能磁共振成像特点

目的应用功能磁共振成像(fMRI)技术探讨精神分裂症基于事件前瞻记忆缺陷的生物学基础及神经机制。方法采取横断面病例对照研究方法,共招募20名健康志愿者(对照组)和20例精神分裂症患者(观察组)入组,以双重任务前瞻记忆实验范式作为刺激任务,同时应用阳性与阴性症状量表和阴性症状评定量表评定精神症状严重程度,采用锥体外系不良反应量表评定锥体外系不良反应严重程度。应用Matlab2011b,SPM8软件对影像学数据进行预处理及统计分析。采用独立样本t检验分析比较两组的脑区激活情况,设定激活差异显著水平为P<0.005(未校正)。选取前瞻记忆主要激活脑区,应用REST1.8软件提取激活脑区的血氧水平依赖性信号强度,采用Pearson相关分析探究脑区激活强度的相关因素。结果预处理中发现,观察组2例被试者有明显的头部运动(移动>2.5 mm,转动>2.5°),剔除图像分析,最后观察组18例,对照组20例被试者的图像数据进入统计分析。相对于健康志愿者,精神分裂症患者在执行前瞻记忆任务时的正确率较低且反应时更长[(83.40±15.33)%比(94.30±10.94)%,(870.54±156.70)ms比(757.33±187.44)ms;均P<0.05]。进行中任务的反应时与阴性症状量表评分呈正相关(r=0.494,P=0.037),前瞻记忆任务的正确率与智商呈正相关(r=0.558,P=0.016),前瞻记忆任务的反应时与氯丙嗪等效剂量呈正相关(r=0.492,P=0.038)。fMRI扫描显示精神分裂症患者右额中回、双侧顶下小叶(角回、缘上回)、右前扣带回以及右楔前叶脑区激活明显低于健康志愿者(均P<0.005)。右缘上回(r=-0.589,P=0.010)、左角回(r=-0.593,P=0.010)、右楔前叶(r=-0.590,P=0.010)的激活程度与氯丙嗪等效剂量呈负相关。右前扣带回(r=-0.537,P=0.021)、右额中回(r=-0.501,P=0.034)的激活程度与进行中任务的反应时呈负相关。结论前瞻记忆需要消耗认知资源。精神分裂症患者存在显著的基于事件前瞻记忆缺陷,其缺陷机制可能与额中回、顶下小叶(缘上回、角回)、前扣带回以及楔前叶功能紊乱有关。     

Insight and work performance in schizophrenia

Research has linked impaired insight in schizophrenia to poorer medication compliance and poorer treatment outcome. The current study attempts to replicate previous findings that impaired insight is related to deficits in work function. To examine this question, 121 participants with schizophrenia or schizoaffective disorder enrolled in vocational rehabilitation were classified as having unimpaired (N = 65), or impaired (N = 56) insight. Next, participants were assigned a work placement and their work performance assessed on the third, fifth, and seventh weeks of work by using the Work Behavior Inventory. Among the 85 participants who completed these weeks of work, a multivariate analysis of variance and subsequent analysis of variance showed participants with impaired insight had significantly poorer ratings of work quality, work habits, cooperativeness, and personal presentation. When measures of global intelligence and executive function were entered as covariates in individual analysis of covariance, groups differed on measures of cooperativeness and personal presentation. Implications for rehabilitation are discussed.     

Alcohol use and abuse in schizophrenia. A prospective community study

The authors examined patterns of alcohol use among 115 DSM-III schizophrenics discharged from the state hospital and participating in an urban aftercare program. According to ratings by mobile outreach clinicians, 45% of the patients used alcohol, and 22% were clearly abusing alcohol. Alcohol use was associated with younger age, male sex, street drug use, medication noncompliance, lack of psychosocial supports, increased symptomatology, chronic medical problems, and a higher rate of rehospitalization. Even minimal drinking, not considered alcohol abuse by clinicians, predicted rehospitalization during 1-year prospective follow-up.     

A prospective evaluation of adherence to medication in first episode schizophrenia.

The aim of this study was to identify the features of first episode schizophrenia that predict adherence antipsychotic medication at six-month follow-up. We used validated instruments to assess clinical and socio-demographic variables in all patients with first episode schizophrenia from a defined geographical area admitted to a Dublin psychiatric hospital over a four-year period (N=100). At six-month follow-up (N=60) we assessed adherence to medication using the Compliance Interview. One third of patients with schizophrenia were non-adherent with medication within six months of their first episode of illness. High levels of positive symptoms at baseline, lack of insight at baseline, alcohol misuse at baseline and previous drug misuse predict non-adherence. These results indicate that an identifiable subgroup of patients with first episode schizophrenia is at high risk of early non-adherence to medication. While high positive symptom scores pre-date and predict non-adherence in most patients, reduced insight is the best predictor of non-adherence in patients who do not misuse alcohol or other drugs.     

A prospective study of Quality of life in schizophrenia in three European countries

Only a small number of studies have tried to identify factors influencing the subjective QoL of patients suffering from schizophrenia in a longitudinal design. These studies suffer from small clinical samples or compare baseline data only with a single follow-up. The European Schizophrenia Cohort Study overcomes these shortcomings by providing data from five time points on 1208 patients in psychiatric treatment in three European countries over a period of 2 years. QoL was measured with the brief version of Lehman's Quality of Life Interview. Random effects, between-effects and within-effects regression models were computed in order to measure the influence on subjective QoL of patients' socio-demographic and clinical characteristics and objective QoL. Objective QoL scores were generally found to be related to the equivalent subjective QoL scores. People's financial situation, and depressive and positive symptoms had a general effect on almost all subjective domains. The significant effects of objective finances on subjective domains like health and social relations raise interesting possibilities for intervention. Sufficient financial resources appear to be a necessary condition for achieving satisfactory QoL in schizophrenia patients. However, changes in individual's characteristics and circumstances did not relate as strongly as expected to changes in QoL, suggesting effective intervention may be difficult.     

A 3-year prospective study of neurological soft signs in first-episode schizophrenia

Neurological soft signs are biological traits that underlie schizophrenia and are found to occur at higher levels in at-risk individuals. The expression of neurological soft signs may be modifiable during the onset of the first psychotic episode and the subsequent evolution of the illness and its treatment. This study investigates neurological soft signs in 138 patients with first-episode schizophrenia and tracks the expression of motor soft signs in the following 3 years. For the 93 patients who have completed the 3-year follow-up, we find that neurological soft signs are stable in the 3 years that follow the first psychotic episode, and that neurological soft signs are already elevated at the presentation of first-episode psychosis in medication-naive subjects. The level of neurological soft signs at clinical stabilization is lower for patients with a shorter duration of untreated psychosis. Although the quantity of neurological soft signs does not significantly change in the 3 years that follow the first episode, the relationship between neurological soft signs and negative symptoms does not become apparent until 1 year after the initial episode. A higher level of neurological soft signs is related to a lower educational level and an older age at onset, but the level of neurological soft signs does not predict the outcome in terms of relapse or occupational functioning.     

Language reactivity and work functioning in schizophrenia

Some studies have found that the speech of certain schizophrenia patients becomes more disordered in stressful laboratory situations. It is unknown, however, whether affective reactivity of speech is associated with stress responsiveness of symptoms in the real world. This study examines whether language-reactive patients report more stress-related impairments in work functioning than language-nonreactive patients. Forty-six patients provided speech samples and completed a work history interview. It was found that the language-reactive patients were more likely than the language-nonreactive patients to endorse items pertaining to social anxiety and difficulty relating to others as reasons for their work difficulties. This suggests that language-reactive patients are more sensitive to social stressors than language-nonreactive patients.     

Neurocognitive predictors of work outcome in recent-onset schizophrenia

While the role of neurocognitive impairment in predicting functional outcome in chronic schizophrenia is now widely accepted, the results that have examined this relationship in the early phase of psychosis are surprisingly rather mixed. The predictive role of cognitive impairment early in the illness is of particular interest because interventions during this initial period may help to prevent the development of chronic disability. In a University of California, Los Angeles (UCLA) longitudinal study, we assessed schizophrenia patients with a recent first episode of psychosis using a neurocognitive battery at an initial clinically stabilized outpatient point and then followed them during continuous treatment over the next 9 months. Three orthogonal cognitive factors were derived through principal components analysis: working memory, attention and early perceptual processing, and verbal memory and processing speed. All patients were provided a combination of maintenance antipsychotic medication, case management, group skills training, and family education in a UCLA research clinic. A modified version of the Social Adjustment Scale was used to assess work outcome. Multiple regression analyses indicate that the combination of the 3 neurocognitive factors predicts 52% of the variance in return to work or school by 9 months after outpatient clinical stabilization. These data strongly support the critical role of neurocognitive factors in recovery of work functioning after an onset of schizophrenia. Cognitive remediation and other interventions targeting these early cognitive deficits are of major importance to attempts to prevent chronic disability.     

A prospective 12-week study of quetiapine in adolescents with schizophrenia spectrum disorders

OBJECTIVE: The aim of this study was to investigate the effectiveness, tolerability, and safety of quetiapine in adolescents with schizophrenia, schizophreniform, and schizoaffective disorders in a prospective open-label study. METHOD: A total of 56 subjects (all-subjects-treated, AST), ages 12-17, received 200-800 mg of quetiapine per day (forced titration to 400 mg within week 1; median study dose 600 mg/day at week 6) in Germany, 2002 through 2004. Primary outcome measure was the change of Positive and Negative Syndrome Scale (PANSS) total score (based on the intent-to-treat (ITT) population, n = 52), secondary outcome measures were changes of PANSS subscales, severity of illness, subjective wellbeing, and safety/tolerability (the latter based on the AST population). Correlates of PANSS response (=50% reduction in PANSS total score) and discontinuation due to lack of effectiveness were analyzed by Cox regression analyses. RESULTS: Twenty-seven subjects (48%) completed the study; 17 subjects (30%) were discontinued due to lack of effectiveness. A significant reduction of PANSS total score (last observation carried forward, LOCF; p < 0.0001; effect size = 0.92) and of secondary effectiveness outcomes were detected. In all, 34.6% fulfilled the PANSS response criterion, correlated with the degree of PANSS total change within week 1. Somnolence (21.4%) and fatigue (17.9%) were the most frequent adverse events. A significant mean weight gain (6.2 kg) and mean decrease in total serum thyroxine (2.5 ng/dl) were detected. CONCLUSIONS: In this sample of mostly drug-na?ve patients with early-onset schizophrenia spectrum disorders, significant reductions in PANSS total and positive scores were detected. Controlled studies are needed to confirm these findings. The significant weight gain with its potentially severe medical consequences must be weighed against quetiapine's effectiveness.     

Predicting violence in schizophrenia: a prospective study

BACKGROUND: People with schizophrenia are more violent than the general population, but this increased risk is attributable to the actions of a small subgroup. Identifying those at risk has become an essential part of clinical practice. AIMS: To estimate the risk factors for assault in patients with schizophrenia. METHODS: Two hundred seventy-one patients with schizophrenia were interviewed using an extensive battery of instruments. Assault was measured from multiple data sources over the next 2 years and criminal records were obtained. Multiple sociodemographic and clinical variables measured at baseline were examined as possible predictors of assault during follow-up. RESULTS: Sixty-nine (25%) patients committed assault during the 2-year follow-up. The model that best predicted assault included a history of recent assault (OR 2.33, 95% CI 1.17-4.61), a previous violent conviction (OR 2.02, 95% CI 1.04-3.87), having received special education (OR 2.76, 95% CI 1.22-6.26) and alcohol abuse (OR 3.55, 95% CI 1.24-10.2). CONCLUSIONS: Previously established risk factors including a history of violence and alcohol abuse are replicated in this study. Although low premorbid IQ did not predict violence, a need for special education did.     

Progress in the prospective study of the schizophrenia prodrome

Further understanding of the schizophrenia spectrum has helped to define the prodrome of the illness, leading to hopes of earlier identification and intervention in susceptible, at-risk individuals. Given the heterogeneity and comorbidity observed in the clinically and demographically identified prodromal sample, it is essential that neurobiological markers that are more closely linked to brain function, and perhaps the ability to predict evolution of psychosis, be identified. Ultimately, it may be possible to identify an algorithm of risk factors that will combine clinical and demographic risk factors with vulnerability markers associated with later development of schizophrenia to better target at-risk individuals for preventative treatment.     

A prospective cohort study of genetic and perinatal influences in the etiology of schizophrenia

In this study, we examined whether fetal hypoxia and other obstetric complications (OCs) are related to risk for adult schizophrenia; whether such effects are specific to cases with an early age at onset; and whether the obstetric influences depend on, covary with, or are independent of familial risk. Subjects were 72 patients with schizophrenia or schizoaffective disorder; 63 of their siblings not diagnosed with schizophrenia; and 7,941 nonpsychiatric controls, whose gestations and births were monitored prospectively with standard research protocols as part of the National Collaborative Perinatal Project. Adult psychiatric morbidity was ascertained via a longitudinal treatment data base indexing regional public health service utilization, and diagnoses were made by review of all pertinent medical records according to DSM-IV criteria. We found that the odds of schizophrenia increased linearly with increasing number of hypoxia-associated OCs and that this effect was specific to cases with an early age at onset/first treatment contact. There were no relationships between schizophrenia and birth weight or other (prenatal/nonhypoxic) OCs. Siblings of patients with schizophrenia were no more likely to have suffered hypoxia-associated OCs than were nonpsychiatric cohort controls. Because the majority of individuals exposed to fetal hypoxia did not develop schizophrenia, such factors likely are incapable of causing schizophrenia on their own. Together, these findings suggest that hypoxia acts additively or interactively with genetic factors in influencing liability to schizophrenia. We propose a model in which the neurotoxic effects of fetal hypoxia may lead to an earlier onset of psychosis because of premature pruning of cortical synapses.