精神分裂症患者文化程度对疾病的影响

对两所医院精神分裂症患者２９７例及２００例的不同文化程度与疾病的关系进行分析，发现文化程度高低与临床症状有关，且文化程度高者自知力恢复好，其复发率亦低，两者之间存在着显著差异。说明精神分裂症患者的临床表现，康复期自知力恢复和病情复发发等情况与其文化程度有关。     

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。     

精神分裂症患者自杀与自知力的关系

目的本文探讨了258例精神分裂患者的自知力与自杀的关系。方法对258例符合CCDM-3诊断为精神分裂症的患者,用精神障碍自知力评估量表来评定患者对精神症状的自知程度,并分析自知力与自杀的关系。结果有自杀的精神分裂症患者对阴性症状和妄想的自知力明显好于没有自杀的患者。相反,对精神障碍的总体自知力程度并不能预测自杀。结论本文对自知力与自杀相关联的观念是支持的。     

影响精神分裂症患者自知力恢复的相关因素

目的　探讨影响精神分裂症患者自知力恢复的相关因素。方法　对８０ 例精神分裂症患者的自知力及其影响因素进行定量及半定量评估,并作多元逐步回归分析。结果　在α＝ ０－０５ 的水平上,进入回归方程的因子为阴性症状、药物剂量、服药依从性,标准化回归系数依次为１－３７８ ３,－１－０１０ ４,０－７８９ ７;治疗后各亚型自知力恢复程度不同（Ｐ＜ ０－０５）,青春型与单纯型的自知力与治疗态度问卷增分值分别为（１４－８３ ±６－４２）分和（３－７３ ±１－２９）分,差异有非常显著性（ Ｐ＜ ０－０１）。结论　影响精神分裂症自知力恢复的首要因子是阴性症状,其次为服药剂量与服药依从性;治疗后以青春型恢复最好,单纯型恢复最差     

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。     

60例精神分裂症患者自知力与住院时间的相关性分析

自知力缺乏是精神病，尤其是精神分裂症的临床特征之一，对诊断、鉴别诊断、疗效预测、治疗依从性及预后评价等方面都具有重要的意义。为探讨此症患者的自知力与住院时间长短的关系，我们对60例长期住院的精神分裂症患者进行了临床观察。现报告于后。     

有关精神分裂症自知力的研究

目的 初步探讨影响精神分裂症患者自知力的因素。 方法 以１９９７年９月到１０月全院所有新入院精神分裂症病例为研究对象，评定治疗前后的病情和自知力。 结果 自知力与疾病严重程度有明显相关；与文化、病程有一定相关；与性别、年龄、诊断类型以及各别精神症状没有明显关系。 结论 自知力是一个独立的症状概念，影响自知力的因素是多方面的，值得进一步研究。     

自知力教育对精神分裂症患者自知力恢复及服药依从性的研究

目的了解自知力教育对恢复精神分裂症患者自知力的作用。方法将精神分裂症９５例随机分成药物组４８例，自知力教育联合药物治疗组４７例，分别于入院时和出院时进行简明精神病评定量表（ＢＰＲＳ）和自知力与治疗态度问卷表（ＩＴＡＱ）测定。入院后１周内和入院后６周分别进行服药依从性评定。结果ＢＰＲＳ量表二次评定联合组与药物组差异无显著性（Ｐ＞０．０５），ＩＴＡＱ在入院时两组差异无显著性（Ｐ＞０．０５），但出院时联合组得分（１８．４＋３．５）高于药物组（１３．７＋３．８），Ｐ＜０．０１；服药依从性改善联合组优于药物组（Ｐ＜０．０１）。结论提示自知力教育是恢复精神分裂症患者自知力的有效方法。     

对躁狂发作患者自知力的研究

目的：了解躁狂发作患者的自知力特点及其影响因素。方法：对５４例躁狂发作患者的自知力进行半定量评估，并对其影响因素进行分析。结果：存在自知力障碍者占７４．１％，躁狂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。多元逐步回归分析显示，导致躁狂发作患者自知力障碍严重的主要因素有：随境转移表现较严重，智能低下，性格内向，情绪不稳，所伴有的妄想不具荒谬性等。结论：躁狂发作患者，相对于精神分裂症患者，其存在自知力障碍的比率较低，程度也较轻；对导致躁狂发作患者自知力障碍严重的主要因素作了分析     

多媒体干预对精神分裂症患者自知力的影响

目的探讨多媒体干预对精神分裂症患者自知力的影响。方法将80例首次住院精神分裂症患者随机分为两组,一组应用多媒体干预,另一组作对照,两组于治疗前和治疗后4周分别用自知力与治疗态度问卷表（ITAQ）和简明精神病评定量表（BPRS）进行评定和比较。结果两组治疗前后简明精神病评定量表（BPRS）评分均无差异,多媒体组治疗后自知力恢复明显优于对照组,两组治疗后自知力与治疗态度问卷表（ITAQ）评分有显著差异。结论多媒体干预可以促进精神分裂症患者自知力的康复。     

Cognitive impairments in patients with schizophrenia displaying preserved and compromised intellect

BACKGROUND: Although intellectual and neurocognitive deficits accompany schizophrenia, there are inconsistencies in the literature concerning issues of intellectual decline, premorbid deficits, a modal deficit pattern, and preserved abilities. METHODS: A battery of neuropsychological tests was administered once to 117 consecutively admitted patients with chronic schizophrenia and a group of 27 healthy control subjects to examine patterns of premorbid and current intellect (measured by means of reading scores and IQ, respectively) and the attendant cognitive profiles in schizophrenia using classification methods based on clinically derived (IQ levels) and atheoretical (cluster) techniques. RESULTS: Sixty patients (51%) with schizophrenia who displayed a general intellectual decline of 10 points or greater from estimated premorbid levels also exhibited deficits of executive function, memory, and attention. Twenty-eight patients (23%) with consistently low estimated premorbid intellect and current intellectual levels who displayed no evidence of IQ decline exhibited language and visual processing deficits in addition to deficits present in the intellectually declining group. The remaining 29 patients (25%) who displayed average estimated premorbid intellectual levels did not show IQ decline and exhibited a cognitive profile similar to normal, with the exception of executive function and attention impairment. Atheoretical analyses support the findings from clinically derived subgroups. CONCLUSIONS: These results suggest that IQ decline, although modal in schizophrenia, is not universally characteristic and that executive function and attention deficits may be core features of schizophrenia, independent of IQ variations.     

Intelligence quotient and neuropsychological profiles in patients with schizophrenia and in normal volunteers.

BACKGROUND: The objective of this study was to examine neuropsychological performance at different intelligence quotient (IQ) levels in schizophrenia. METHODS: Thirty-six patients with schizophrenia were matched with 36 normal control subjects in two IQ groups: low average (81-94) and average (95-119). Performance level (IQ group main effects) and profile shape (IQ group x function interactions) were compared. RESULTS: Current IQ was lower than estimated premorbid intellectual ability in both patient groups. Patients also displayed poorer neuropsychological function than same-IQ control subjects, suggesting neuropsychological dysfunction beyond their already compromised IQ. Patients had different profile shapes than control subjects, but profile shapes were consistent within patients and control subjects at each IQ level. Patients at both levels had higher verbal and lower performance IQ than control subjects. Abstraction-executive function was one of the lowest neuropsychological scores in both patient groups. Average IQ patients had nonsignificantly better overall neuropsychological performance than low average control subjects, but the effect size (.43) was quite small relative to the IQ difference (effect size = 2.57). CONCLUSIONS: Neuropsychological patterns in schizophrenia tend to be consistent at different IQ levels. Even schizophrenia patients with normal current IQs manifest substantial neuropsychological compromise relative to their level of general intellectual ability. The results strengthen the argument that neurocognitive deficits are core deficits of schizophrenic illness.     

DTNBP1 genotype influences cognitive decline in schizophrenia

OBJECTIVE: Intellectual decline is common in schizophrenia and predicts functional outcome. While many patients undergo intellectual decline that typically predates the onset of symptoms, few studies have investigated the underlying mechanism through which this occurs. The current study assessed the relationship between intellectual decline in schizophrenia and genetic variation in dysbindin-1 (DTNBP1). METHODS: We assessed cognitive decline in 183 Caucasian patients with schizophrenia using a proxy measure of premorbid IQ with which current general cognitive ability (g) was compared. We then tested for a relationship between the risk haplotype identified in previous work (CTCTAC) and intellectual decline. RESULTS: We found that carriers of the CTCTAC haplotype, demonstrated a significantly greater decline in IQ as compared with non-carriers (p=0.05). CONCLUSIONS: These data suggest that DTNBP1 influences the severity of intellectual decline in schizophrenia and may represent one underlying cause for heterogeneity in cognitive course.     

Premorbid intra-individual variability in intellectual performance and risk for schizophrenia: a population-based study

BACKGROUND: Some, but not most, schizophrenia patients have below-average intelligence years before they manifest psychosis. However, it is not clear if those whose intelligence falls within-normal-range nevertheless have cognitive abnormalities. We examined the association between intra-individual variability in intellectual performance and risk for schizophrenia in individuals with normal IQ. METHODS: 555,326 adolescents, mandatory assessed by the Israeli Draft Board were followed up over 8 to 17 years for psychiatric hospitalization by means of the Israeli National Psychiatric Hospitalization Case Registry. Data were available on 4 intelligence sub-tests, and on behavioral and psychosocial variables. Variability was computed from the variance of the four intelligence tests' standardized scores. RESULTS: There was a significant monotonic association between increased intra-individual variability in intellectual performance and risk of schizophrenia in individuals with within-normal-range IQ. Individuals with the highest variability were 3.8 times more likely to have schizophrenia [95%CI: 2.32-6.08; p < 0.0001] compared with individuals with the lowest variability. This association held after controlling for the effects of potential confounders. CONCLUSIONS: Despite within-normal-range premorbid IQ, apparently healthy adolescents who will later on manifest schizophrenia, nevertheless have cognitive abnormalities such as increased variability across intellectual tasks, possibly related to frontal lobe abnormalities.     

Intellectual functioning and memory deficits in schizophrenia

BACKGROUND: There is converging evidence about the existence of different subgroups of patients with schizophrenia in relation to intellectual ability (intelligence quotient [IQ]). Studying cognitive deficits in such patients in relation to IQ, and more specifically to memory, could help determine the patterns of preserved and impaired functioning in cognitive abilities in association with patterns of preserved and compromised intellect. This information could serve to delimit the possibilities of treatment and rehabilitation in those patients. METHODS: A total of 44 patients with schizophrenia completed a cognitive battery that included executive functioning, attention, speed of information processing, working memory, explicit memory, implicit memory, and everyday memory. Their IQ was also measured to identify 2 subgroups with an IQ of 85 as the cutoff point. Then, differences between the groups in the neurocognitive measures were studied. RESULTS: Performance in executive functioning, attention, working memory, and everyday memory, but not that in speed of information processing, explicit memory, and implicit memory, was associated with intellectual functioning. Patients performed at the same level in perceptual implicit memory but at a lower level in conceptual implicit memory as did healthy control subjects. DISCUSSION: Cognitive deficits in schizophrenia are associated with intellectual functioning. Implicit memory should not be considered as a unique entity. It is suggested that conceptual implicit memory deficit may be a core feature of schizophrenia.     

Does operational diagnosis of schizophrenia significantly impact intellectual deficits in psychotic disorders?

Background Evidence suggests that, as a group, patients with schizophrenia have intellectual deficits that may precede the manifestation of psychotic symptoms; however, how successfully intelligence tests are able to discriminate schizophrenia from other psychotic disorders has yet to be investigated in detail. Methods Using Wechsler Adult Intelligence Scale – Revised (WAIS‐R) data for 55 inpatients with schizophrenia and 28 inpatients with non‐schizophrenic psychotic disorders (NSPD) (schizophreniform disorder, brief psychotic disorder, delusional disorder, psychotic disorder due to a general medical condition, and psychotic disorders not otherwise specified), intelligence performance was compared between schizophrenia and NSPD and among different subtypes of schizophrenia. Results There were no significant differences in intelligence quotient (IQ), verbal IQ (VIQ) and performance IQ (PIQ) discrepancy, and subtest scores of WAIS‐R between the patients with schizophrenia and those with NSPD. These diagnostic groups were not discriminated well by any WAIS‐R variables. Schizophrenia patients with prominent negative symptoms, on the other hand, had a significantly larger IQ discrepancy (VIQ > PIQ) than those without prominent negative symptoms and NSPD patients. Intelligence performance in schizophrenia did not differ with respect to diagnostic subtypes and longitudinal courses. Conclusions The current study failed to show diagnostic usefulness of WAIS‐R in discriminating schizophrenia and other psychoses. A diagnosis of schizophrenia does not significantly impact intellectual deficits in psychotic disorders.     

Intelligence in schizophrenia: meta-analysis of the research

This article combines a review and meta-analysis of research on IQ in schizophrenia, with emphasis on areas of convergence in the findings, as well as questions that remain to be answered. Taken together, the findings suggest that early-onset and adult-onset schizophrenia are associated with intellectual deficits across the lifespan. Preschizophrenic children, adolescents, and young adults perform below matched controls on a variety of standardized measures of intelligence. Significant IQ deficits are also apparent after the onset of the disorder. Moreover, IQ is positively related to several indices of prognosis, and, among hospitalized patients, there is negative within-subject covariance between intellectual performance and symptom severity. Although there is fairly consistent evidence that Verbal IQ is higher than Performance IQ among schizophrenic patients, a more specific pattern of subtest performance is not apparent. A central question raised by the results is whether IQ is an independently determined factor that can serve to mitigate the vulnerability of individuals who are constitutionally predisposed to schizophrenia, or whether intellectual deficit is one manifestation of the constitutional predisposition to the disorder. The findings also raise the question of possible sex differences in the developmental determinants of schizophrenia: Meta-analyses revealed that premorbid IQ deficits are more prevalent among males than females.     

Cigarette smoking and white matter microstructure in schizophrenia

The majority of patients with schizophrenia smoke cigarettes. Both nicotine use and schizophrenia have been associated with alterations in brain white matter microstructure as measured by diffusion tensor imaging (DTI). The purpose of this study was to examine fractional anisotropy (FA) in smoking and non-smoking patients with schizophrenia and in healthy volunteers. A total of 43 patients (28 smoking and 15 non-smoking) with schizophrenia and 40 healthy, non-smoking participants underwent DTI. Mean FA was calculated in four global regions of interest (ROIs) (whole brain, cerebellum, brainstem, and total cortical) as well as in four regional ROIs (frontal, temporal, parietal and occipital lobes). The non-smoking patient group had a significantly higher intellectual quotient (IQ) compared with the patients who smoked, and our results varied according to whether IQ was included as a covariate. Without IQ correction, significant between-group effects for FA were found in four ROIs: total brain, total cortical, frontal lobe and the occipital lobe. In all cases the FA was lower among the smoking patient group, and highest in the control group. Smoking patients differed significantly from non-smoking patients in the frontal lobe ROI. However, these differences were no longer significant after IQ correction. FA differences between non-smoking patients and controls were not significant. Among smoking and non-smoking patients with schizophrenia but not healthy controls, FA was correlated with IQ. In conclusion, group effects of smoking on FA in schizophrenia might be mediated by IQ. Further, low FA in specific brain areas may be a neural marker for complex pathophysiology and risk for diverse problems such as schizophrenia, low IQ, and nicotine addiction.     

Relationship between insight, cognitive function, social function and symptomatology in schizophrenia

OBJECTIVE: To examine the nature and clinical correlates of insight in first-episode schizophrenia, and how these differ from findings in established schizophrenia. METHOD: Insight (and insight dimensions), clinical symptoms, neurocognitive function and social function were assessed in 94 patients with first-episode schizophrenia or schizophreniform disorder according to DSM-IV criteria. RESULTS: Greater global insight was associated with more severe depression. Poor overall insight was associated significantly with more severe negative and disorganisation symptoms as well as poor working memory, and at a trend level with lower current IQ. Patients with poor insight perceived themselves to have a better level of independent performance at daily living activities. CONCLUSION: In first-episode psychosis, the clinical correlates of poor insight are similar to those reported for established schizophrenia. Those patients with greater insight may be at risk of depression. The complex relationships between insight, positive and negative symptoms, neurocognitive dysfunction and social function may reflect the multidimensional nature of insight.