精神分裂症患者工作记忆的功能磁共振成像

目的:探讨精神分裂症患者工作记忆受损的中枢机制。方法:采用组块设计,让10名正常对照和20名精神分裂症患者进行数字再认(识记2或5个数字并判断是否出现过)和箭头方向判断(左或右),并同时进行血氧水平依赖对比功能磁共振(BOLD-fMRI)成像。结果:与对照组相比在高、低认知负荷下,精神分裂症患者基底节区(尾状核)激活均增高(P<0.001),左背外侧前额皮层(DLPFC)激活区域有增大趋势。结论:基底节和背外侧前额皮层(DLPFC)功能异常可能是精神分裂症患者工作记忆受损的中枢基础。     

DRD3基因Ser9Gly多态性与不同性别精神分裂症患者工作记忆的关联研究

目的:探讨DRD3基因Ser9Gly多态性与汉族人群不同性别精神分裂症患者工作记忆的关联.方法:选取符合美国精神障碍诊断与统计手册第4版(DSM-Ⅳ)中精神分裂症的诊断标准的汉族患者526例和415例汉族健康对照,检测DRD3基因Ser9Gly多态性,用中国修订韦氏成人智力量表(WAIS-RC)进行智商(IQ)评定,N-back任务测量工作记忆能力.采用协方差分析等方法分析DRD3基因Ser9Gly多态性与精神分裂症工作记忆的关联.结果:在全体被试中,男性的1-back[(0.50±0.27) vs.(0.56±0.25)]和2-back[(0.25±0.22) vs.(0.28±0.22)]任务错误率小于女性(均P＜0.05).男性患者中,Ser/Ser基因型的1-back任务错误率[(0.39±0.23) vs.(0.33±0.23)]高于Gly/Ser基因型,IQ[(97.4±15.1) vs.(101.9±13.4)]低于Gly/Ser基因型(均P＜0.05);男性对照组中,不同基因型之间工作记忆及IQ得分差异无统计学意义(均P＞0.05).女性被试中,Ser9Gly多态性不同基因型的工作记忆与IQ得分差异无统计学意义(均P＞0.05).结论:精神分裂症患者的工作记忆可能存在性别差异,Ser9Gly多态性在汉族人群中与精神分裂症的工作记忆障碍有一定相关性.     

工作记忆相对完好精神分裂症和双相障碍患者的脑功能活动特征

目的:探讨工作记忆(WM)相对完好的精神分裂症(SZ)和双相障碍(BD)患者的脑功能活动特征。方法:纳入符合美国精神障碍诊断与统计手册第4版(DSM-IV)诊断标准的SZ和BD患者各45例,根据他们在功能磁共振成像(fMRI)扫描时完成WM任务表现,选取WM相对完好的18例SZ和20例BD患者,并以25例正常对照为参照,比较三组执行WM任务时全脑血氧水平依赖(BOLD)信号的活动差异。结果:与正常对照组相比,SZ患者左内侧前额叶、左后扣带回的BOLD信号显著增强(P<0.05),而BD患者左内侧前额叶、左侧壳核的BOLD信号增强(P<0.05),且其左侧壳核的BLOD信号活动与其HAMD、BPRS总分呈正相关(r=0.48、0.52,均P<0.05)。结论:工作记忆相对完好时,精神分裂症患者显示内侧前额叶、后扣带回所属的默认网络抑制活动减弱,而双相障碍患者显示由内侧前额叶、壳核所构成的皮质-纹状体通路异常活动。     

精神分裂症患者n-back工作记忆神经机制异常的ERP研究

目的:比较精神分裂症患者与正常人在参量变化的工作记忆负荷水平下所诱发的ERP成分及其脑区分布差异,探讨精神分裂症患者工作记忆功能损害的神经机制。方法:精神分裂症患者以及正常对照各20名参加了n-back(n=0,1,2)工作记忆任务的ERP实验,同时记录行为数据及EEG,离线处理数据。结果:精神分裂症患者在1-back及2-back任务中行为表现明显较正常人差(P0.01)。正常人P3波幅随记忆负荷增长而成比例下降(0-back1-back2-back),而精神分裂症患者仅0-back的P3波幅显著高于1-back及2-back,(0-back1-back=2-back)。三种负荷条件下,精神分裂症组中央区的P3峰值均显著高于正常组,而2-back条件下的顶区P3峰值显著高于正常组。高记忆负荷与低记忆负荷的任务相减均得到一差异波N450成分。在顶区,精神分裂症患者的1-0差异波N450成分的波幅显著高于正常组,而2-1差异波N450成分的波幅显著低于正常组(P0.05)。结论:精神分裂症患者存在显著的工作记忆损害,其中短时贮存功能损害可能与患者顶叶的生理低效能及工作记忆容量下降有关。     

强迫症患者与精神分裂症患者的执行功能

目的:比较强迫症和精神分裂症患者执行功能损害的特点。方法:本研究为横断面研究。研究对象为符合中国精神障碍分类与诊断标准第3版诊断标准的强迫症(n=29)和精神分裂症门诊患者(n=30),以及年龄和教育程度匹配的正常对照(n=30)。所有被试接受威斯康星卡片、连线测验、河内塔测验、言语流畅性测验等神经心理学测验评定执行功能。结果:威斯康星卡片测验中,强迫症患者总操作时间短于精神分裂症患者(P0.05),与正常对照接近(P0.05);完成归类数目多于精神分裂症患者(P0.05),与正常对照接近(P0.05);错误应答数目少于精神分裂症患者(P0.05),与正常对照接近(P0.05);完成第一分类所需的应答需要的卡片数目多于精神分裂症患者和正常对照(P0.05)。连线测验中,强迫症患者在连线B的时间和错误数少于精神分裂症患者(均P0.05),与正常对照接近(P0.05)。河内塔测试中,强迫症患者的移动次数和出错次数与精神分裂症患者差异无统计学意义(均P0.05),但多于正常对照(均P0.05)。结论:强迫症总体执行功能水平比精神分裂症水平高,但是概念理解能力差。     

女性精神分裂症患者的性生活质量及相关因素

目的:从性满意度、性交流、性焦虑、性反应、性态度、性体像6个方面以及整体状况探讨女性精神分裂症患者的性生活质量及其相关因素。方法:以3所医院门诊就诊的符合CCMD-3精神分裂症诊断标准的女性精神分裂症患者180名作为研究组,按照年龄(±2岁)、城市所在地与精神分裂症组匹配,选择正常女性180名作为对照组,用女性性生活质量问卷,Olson婚姻质量问卷中的夫妻交流、婚姻满意度、性生活3个分量表进行测查。结果:除性焦虑因子外,患者性生活质量总分及其余各个因子分均低于正常对照组[如,性满意度因子,(20.8±4.4)vs.(25.1±4.8),P0.001]。多元逐步回归分析显示,提高患者总的性生活质量的因素依次为婚姻满意度高、有子女、使用非典型抗精神病药物(β=0.514,0.258,0.193,均P0.05);提高性满意度的因素按照作用大小依次为婚姻满意度高、使用非典型抗精神病药物(β=0.577,0.225,均P0.05);改善患者性交流的因素依次为受教育程度高、病程短、有子女(β=0.462,-0.351,0.298,均P0.05);改善患者性焦虑的因素依次为婚姻满意度高、年龄低(β=0.458,-0.206,均P0.001);提高患者性反应的因素依次为月经济收入高、病程短、使用非典型抗精神病药物(β=0.457,-0.200,0.158,均P0.05);改善患者性态度的因素依次为受教育程度高、疾病严重程度轻、夫妻交流多(β=0.469,-0.445,0.271,均P0.05);对患者性体像有利的因素依次为使用非典型抗精神病药物、婚姻满意度高、无子女(β=0.776,0.415,-0.196,均P0.05)。结论:促进患者婚姻家庭的和谐,选用对性功能影响小的非典型抗精神病药物维持治疗,可以提高患者的治疗依从性,使患者的性生活质量得到改善。     

精神分裂症患者及家属参与医疗决策的意愿

目的:了解精神分裂症患者及家属参与医疗决策的意愿。方法:选取符合国际疾病和相关健康问题统计分类第十版(ICD-10)诊断标准的精神分裂症患者162例及承担照护责任的家属120例,采用自编问卷,从信息需求、沟通意愿和决策意愿三方面调查患者及家属参与医疗决策的意愿,比较二者的差异。结果:在信息需求方面,患者主动了解疾病相关信息的比例低于家属[(40.1%~72.2%)vs.(65.0%~97.5%),均P<0.01];在沟通意愿方面,患者主动与医生沟通的比例也低于家属[(40.1%~80.2%)vs.(74.2%~91.7%),均P<0.05];在决策意愿方面,患者与家属选择"完全由医生决定"的比例均最高,两组比较,患者选择"医生提出建议,患者决定"的比例高于家属[(13.0%~22.8%)vs.(0.8%~1.7%),P<0.01],选择"医生提出建议,家属决定"的比例低于家属[(2.5%~8.6%)vs.(13.3%~23.3%),P<0.01]。结论:患者和家属在医疗决策方面表现均比较被动,但家属的信息需求、沟通意愿较患者主动,在决策意愿方面,二者的意见不完全一致。     

注意缺陷多动障碍儿童的工作记忆损害特征

目的:探讨注意缺陷多动障碍(ADHD)儿童工作记忆功能特征。方法:本研究为横断面研究。根据美国精神疾病诊断和统计手册第4版(DSM-IV),对符合ADHD诊断标准的未经治疗的100名门诊患儿及年龄、性别相匹配的100名正常儿童分别采用韦氏儿童智力测验量表中国修订本(C-WISC)及其中的顺背数字(反映言语存贮、加工)、倒背数字(反映言语存贮、加工、中央执行)、Corsi木块和空间n-Back任务(反映视空间存贮和中央执行)进行言语及空间工作记忆测试。结果:ADHD组儿童在顺背数字最高位数及总得分、倒背数字最高位数及总得分、Corsi木块最多木块数及总得分均低于对照组儿童,空间2-Back任务反应时短于对照组儿童(均P0.05)。结论:ADHD儿童存在工作记忆功能缺陷,此缺陷涉及言语环路、视空间存贮系统及中央执行。     

精神分裂症患者伴发代谢综合征的相关因素

目的:探索住院精神分裂症患者伴发代谢综合征的相关因素。方法:抽取5个地区5家医院的住院精神分裂症患者,调查伴发代谢综合征的相关因素。内容包括:年龄、病程、精神病药物与剂量、空腹血糖、血脂等。结果:资料完整的797例住院精神分裂症患者,伴发代谢综合征者共153例(19．2％)。病程长、服用氯氮平、服用药物时间长、高剂量用药患者MS发生率高(P<0．05、P<0．01);L0gistic回归分析显示:代谢综合征的危险因素有高龄、服用氯氮平、CRP浓度偏高、吸烟、服用抗精神病药物时间长。结论:影响住院精神分裂症患者伴发代谢综合征的相关因素有氯氮平、病程、用药时间、吸烟等。     

精神分裂症患者的前瞻性记忆与社会功能

目的:探讨精神分裂症患者的前瞻性记忆(PM)与社会功能的关系.方法:选取符合美国精神障碍诊断与统计手册第4版(DSM-Ⅳ)精神分裂症诊断标准的患者40例和健康对照30例.采用2项PM任务评估两组的前瞻性记忆功能,以简明精神病评定量表(BPRS)评估精神分裂症患者的精神病性症状,以加州大学圣地亚哥分校基于任务的生活能力测验简版(UPSA-B)评估精神分裂症患者的社会功能.结果:精神分裂症组基于事件的PM (EBPM)[(0.49±0.29)vs.(0.85 ±0.16)]和基于时间的PM(TBPM)[(0.62±0.31) vs.(0.93±0.11)]得分低于健康对照组(P＜0.01).相关分析显示精神分裂症患者EBPM(r=0.60,P＜0.01)、TBPM(r=0.50,P＜0.01)得分与UPSA-B得分正相关,与BPRS总分无统计学意义的相关.Linear回归分析显示,TBPM得分越高,UPSA得分越高(β=0.50,P＜0.01).结论:精神分裂症患者存在前瞻性记忆损伤,该损伤很可能与患者基本社会功能受损密切相关.     

Socioaffective factors modulate working memory in schizophrenia patients

Working memory deficit in schizophrenia is a core cognitive feature of the disorder and is reliably associated with abnormalities of the prefrontal circuitry. Working memory deficits are also associated with impaired social functioning and present a major obstacle toward successful rehabilitation in schizophrenia. Although the role of prefrontal cortex in working memory has been extensively investigated, the intricate relations among the prefrontal circuitry, working memory and social behaviors are not clearly understood. In this study, we manipulated social context and observed its effects on spatial working memory. In experiment 1, the effects of social and asocial reinforcements on spatial working memory were examined in schizophrenic patients and healthy controls. The results show that social but not asocial reinforcements facilitated spatial working memory in schizophrenic patients. In experiment 2, the effects of human voice reinforcements (with or without affect) on working memory was investigated. Voice reinforcements did not facilitate working memory relative to the no-reinforcement condition. There was no difference between high-affect vs flat-affect voice conditions. In experiment 3, the effects of direct and indirect social interactions on spatial working memory were studied. Direct but not indirect social interaction facilitated working memory in schizophrenic patients. These results suggest that social context might facilitate working memory in schizophrenic patients perhaps by activating frontal lobe systems. In addition, the possibility of improving cognitive functions such as working memory using seemingly non-cognitive methods might lead to potential remediation strategies.     

Fronto-striatal hypoactivation during correct information retrieval in patients with schizophrenia: an fMRI study

Working memory (WM) deficits are core symptoms of schizophrenia. Differing behavioral performance is known to represent a potent moderating variable when investigating the neural correlates of working memory in patients with schizophrenia compared with healthy controls. The present functional magnetic resonance imaging study examined performance-matched cerebral activity during correct WM retrieval by balancing the mean number of correct responses as well as the mean response times between patients and controls and analyzing remaining correct trials. Forty-one schizophrenia patients and 41 healthy controls performed an event-related Sternberg task allowing for analysis of correctly remembered trials. Correct retrieval was associated with activation in a bilateral fronto-parieto-occipital network comprising mainly the dorsolateral prefrontal cortex, ventrolateral prefrontal cortex and superior parietal cortex in controls and, to a weaker degree, in patients. Direct group comparison revealed significantly decreased activations in patients in the posterior (Brodmann area (BA) 31) and anterior (BA 32) cingulate cortex (ACC) and the medial caudate bilaterally when matching for performance. When matching for performance and response speed there was additional hypoactivation in the insula. Mean response times were negatively correlated with cingulate and caudate activation only in controls. Present findings suggest that during efficient WM retrieval processing patients exhibit only slightly impaired activation in a task-specific network containing mainly prefrontal and superior parietal areas. However, hypoactivation of areas predominantly responsible for cognitive control and response execution seems to remain even under performance-matched conditions. Given the relevant role of the caudate and the ACC in dopaminergically mediated executive processing, the results bear crucial implications for the psychopathology of schizophrenia.     

前瞻性记忆两种测量方法对老年精神分裂症患者诊断效度的比较

目的:探讨前瞻性记忆(PM)两种评估方法 (实验室范式和中文版剑桥前瞻性记忆测验)在老年及老年前期精神分裂症患者临床应用上的差异和诊断效度。方法:选取符合美国精神障碍诊断与统计手册第4版(DSM-IV)精神分裂症诊断标准的老年及老年前期患者50例,以及年龄、性别、受教育年限相匹配的正常被试50例。以双重任务前瞻性记忆实验室范式和计算机版中文剑桥前瞻性记忆测试量表(C-CAMPROMPT)分别评估基于事件的前瞻性记忆(EBPM)、基于时间的前瞻性记忆(TBPM);采用韦克斯勒成人智力记忆量表第四版中文版(WAIS-IV)、持续注意测验分别评估智力和注意力。结果:实验室范式和C-CAMPROMPT的结果均显示,患者组的前瞻性记忆总分PM[7(0,16)vs.12(0,16),14(4,34)vs.25(11,36)],EBPM[3(0,8)vs.6(0,8),7(2,16)vs.14(4,18)]和TBPM[3(0,8)vs.6(0,8),6(2,18)vs.12(4,18)]得分均低于对照组(均P﹤0.001)。患者组用两种方法评估EBPM与TBPM损害指数[-1.0(-2.2,1.0)vs.-1.0(-2.1,0.8),-1.9(-3.4,0.8)vs.-1.8(-2.9,1.6)]的差异均无统计学意义(均P0.05)。相关分析显示,实验室范式PM得分与年龄相关无统计学意义(P0.05);而C-CAMPROMPT的PM得分与年龄呈负相关(r=-0.36~-0.40,P﹤0.001)。实验室范式和C-CAM PROM PT的ROC曲线下面积分别为0.73和0.85;灵敏度分别为0.60和0.74;特异度分别为0.76和0.90。结论:两种方法均显示老年及老年前期精神分裂症患者的EBPM与TBPM损害程度相当,且均具有中等程度的诊断效度,但C-CAM PROM PT诊断效度略高,其成绩也可能更易受年龄老化的影响。     

Spatial working memory deficits in schizophrenia patients and their first degree relatives from Palau,Micronesia

Spatial working memory deficits associated with dorsolateral prefrontal dysfunction have been found in Caucasian samples of schizophrenia patients and their first‐degree relatives. This study evaluated spatial working memory function in affected and unaffected members of multiplex schizophrenia families from the Republic of Palau to determine whether the spatial working memory deficits associated with schizophrenia extend to this non‐Caucasian population. Palau is an isolated island nation in Micronesia with an elevated prevalence of schizophrenia and an aggregation of cases in large multigenerational families. Our objective was to evaluate the potential for spatial working memory function to serve as one of multiple endophenotypes in a genetic linkage study of these Palauan schizophrenia families. A spatial delayed response task requiring resistance to distraction and a sensorimotor control task were used to assess spatial working memory in 32 schizophrenia patients, 28 of their healthy first‐degree relatives, and 19 normal control subjects. Schizophrenia patients and their relatives were significantly less accurate than normal control subjects on the spatial delayed response task but not on the sensorimotor control task. On both tasks, patients and relatives were slower to respond than the normal controls. There were no age or gender effects on accuracy, and working memory performance in schizophrenia patients was not significantly correlated with medication dosage. In summary, spatial working memory deficits that have been found in Caucasian schizophrenia patients and relatives were confirmed in this isolated Pacific Island family sample. These results suggest that spatial working memory deficits may be a potentially useful addition to the endophenotypic characterization of family members to be used in a comprehensive genome wide linkage analysis of these Palauan families. © 2002 Wiley‐Liss, Inc.     

Working memory performance of older adults with insomnia

Older individuals suffering insomnia typically report declines in their cognitive performance beyond what they consider to be normal changes due to the aging process. Recent neuro‐imaging studies have demonstrated frontal lobe hypo‐activation among insomniac populations when compared with healthy, good sleepers. However, research is yet to confirm whether frontal lobe hypo‐activation translates into objective declines when performing tasks hypothesized to draw upon this brain region. This study aimed to investigate whether older insomnia sufferers demonstrate significantly impaired performance on a challenging working memory task when compared with age‐matched good sleepers. Forty‐nine older individuals (mean age = 69.43 years, SD = 4.83) suffering from sleep maintenance insomnia were compared with 49 age‐matched good sleepers. Cognitive performance was assessed using the Double Span Memory Task, a computer‐based working memory task that requires participants to indicate the names and/or spatial locations of increasingly longer sequences of visually presented objects. After controlling for general intelligence, the individuals suffering from insomnia did not perform differently when compared with the good sleepers on either the simpler or more cognitively demanding components of the task. Older individuals with insomnia did not display an observable impairment of working memory in this study relative to good sleepers. Despite the mixed results from previous research, this study adds weight to the absence of objective impairment in insomniacs, at least while performing short‐term demanding cognitive tasks.     

The general facilitation effect of implementation intentions on prospective memory performance in patients with schizophrenia

ABSTRACT

Introduction: Prospective memory (PM) refers to remembering to execute a planned intention in the future. It can be divided into event- and time-based, according to the nature of the PM cue. Event-based PM cues can be classified as focal or non-focal. Patients with schizophrenia (SCZ) have been found to be impaired in both event- and time-based PM. PM has been found to be improved by implementation intentions, which is an encoding strategy in the format of “if X then Y”. This study examined the effect of implementation intentions on a non-focal event-based and a time-based PM task in patients with SCZ.Methods: Forty-two patients with SCZ and 42 healthy controls were allocated to either an implementation intention or a control PM instruction condition and were asked to complete two PM tasks. Results: Implementation intentions was found to improve performance in both the non-focal event-based and time-based PM tasks in patients with SCZ and healthy controls, with no costs to the ongoing task. The improvement in time-based PM performance in the implementation intentions condition was partially mediated by the frequency of clock checking behaviour. Conclusions: Implementation intentions can facilitate PM performance in patients with SCZ and has the potential to be used as a clinical intervention tool.