改良森田疗法对康复期精神病性障碍患者人格的影响

目的:观察改良森田疗法对康复期精神病性障碍患者人格的影响,为提高其长期疗效提供一些可行性措施。方法:通过前瞻性对照研究,将康复期精神分裂症、抑郁症患者随机分成研究组和对照组,研究组采用改良森田疗法联合药物治疗,对照组单用药物治疗,治疗1个月前后分别评定明尼苏达人格问卷(MMPI)、阳性和阴性症状量表(PANSS)、汉密尔顿抑郁量表(HAMD)。结果:研究组精神分裂症患者除D量表外,其他MMPI量表的T分均比治疗前显著降低,抑郁症患者除Mf、Ma量表外,其他量表T分也比治疗前显示降低(P均<0.05)。研究组治疗前后Hs、D、Hy、Pa、Pt、Sc、Si量表T分减分值与对照组比较,差异有统计学意义(P均<0.05)。结论:改良森田疗法有助于转变康复期精神病性障碍患者的某些异常人格特质。     

精神分裂症患者冲动伤人与其冲动性人格特征及相关因素的研究

目的探讨住院精神分裂症患者冲动伤人行为的发生率及患者的冲动性人格特点等相关因素。方法对195例住院精神分裂症患者冲动伤人行为进行调查,并用攻击性量表、冲动性量表和阳性与阴性症状量表对其行为特征及症状进行评定。结果195例精神分裂症患者住院前56例（28．72％）有冲动伤人行为,住院期间20例（10．26％）有冲动伤人行为。分析显示,有冲动行为患者的冲动性量表中行为分量表评分和攻击性量表总分及身体攻击性、指向自我的攻击性两因子分均明显高于无冲动行为患者（P〈0．05）。两组患者PANSS量表总分及因子分差异不显著。冲动性量表和攻击性量表总分及因子分与PANSS量表总分及因子分相关性不显著。结论精神分裂症患者冲动行为发生主要与其冲动性和攻击性人格特点有关,与患者精神病性症状直接关系不显著。     

社区精神分裂症患者攻击行为的相关因素研究

目的探讨社区精神分裂症患者攻击行为的相关因素,为社区预防精神分裂症的攻击行为提供参考。方法对象为成都市金牛区各社区的精神分裂症患者,年龄18～60岁。其中男性178例,女性122例。分别采用外显攻击行为量表、PANSS、生活事件量表、社会支持量表、MMPI及自编调查表对有攻击行为的患者进行评定、调查,内容包括时间、地点、攻击的对象、方式、原因以及攻击行为造成的危害等;统计方法采用方差分析、直线相关分析及多元回归分析。结果社区精神分裂症患者攻击行为与既往攻击行为史、精神病理分、生活事件量表分、社会支持量表分、MMPI的偏执等因子分相关,与性别、年龄等社会人口学指标无关。结论社区精神分裂症患者攻击行为的发生是偏执冲动人格、心理社会因素、精神症状交互作用的结果。预防或减少社区精神分裂症患者的攻击行为需患者家庭、社区、精神卫生工作者以及全社会的共同努力。     

神经症、心境障碍、精神分裂症患者MMPI测查结果分析

目的探讨神经症、心境障碍、精神分裂症的MMPI调查问卷模式,并剖析三组患者心理特征,以协助临床医师进行诊断和治疗。方法采用病例对照研究,三组304例患者MMPI测试结果进行分析,同时选取100名健康被试进行对照研究。结果神经症与心境障碍患者,各量表分之间无显著差异;心境障碍组和精神分裂症组的各量表T分之间,L／F／Hs／Hy／Mf／Pa／Ma无显著差异,K／D／Pd／Pt／Sc／Si存在显著差异;精神分裂症组在Pt、Sc、Ma和Si,T分有所偏低。结论MMPI在神经症、心境障碍、精神分裂症之间有特异的临床特征和测图模式．     

精神分裂症暴力违法无责任能力与有责任能力者MMPI测试比较分析

目的 比较精神分裂症暴力违法无责任能力与有责任能力者的人格特点和精神病理.方法 比较31例司法鉴定有责任能力与20例无责任能力者MMPI量表分.结果 精神分裂症暴力违法无责任能力组MMPI中的疑病症(Hs)、抑郁症(D)、癔症(Hy)、男性化、女性化(Mf)、偏执(Pa)、精神衰弱(Pt)、精神分裂症(Sc)量表分与有责任能力组相比有显著差异性.结论 精神分裂症暴力违法无责任能力组大多发生在患病急性期,与精神病理有关,无责任能力组较有责任能力组有更明显的莫名心理及躯体痛苦、自我中心、敏感多疑、敌意、情绪化、冲动好攻击等人格倾向.     

精神分裂症患者及其一级亲属性格特征的对照研究

目的探讨精神分裂症患者及其一级亲属的性格特征。方法选取住我院治疗处于缓解期的精神分裂症患者48例和一级亲属与正常组各79人，进行MMPI测查分析。结果精神分裂症患者及其一级亲属Hs、D、Hy、Pd、Pa、Pt、Sc量表分高于正常人，而患者和一级亲属间各量表分接近。结论精神分裂症患者及一级亲属具有明显的分裂性人格，两者的性格特征可能有着共同的遗传学基础。     

帕利哌酮缓释剂治疗首发与复发精神分裂症的临床疗效比较

目的比较帕利哌酮缓释剂治疗首发、复发精神分裂症患者的临床疗效。方法以28例首发精神分裂症患者（首发组）和32例复发再次住院的精神分裂症患者（复发组）为研究对象,分别给予帕利哌酮缓释剂治疗,于入院时、治疗2、4及8周末,采用阳性与阴性症状量表（PANSS）评定疗效。结果治疗前首发组与复发组PANSS总分、阳性症状量表分、阴性症状量表分及一般病理量表分差异均无统计学意义（P〉0.05）。治疗后第2、4和第8周末,首发组PANSS总分、阳性症状分量表分、阴性症状分量表分及一般病理量表分逐渐降低,差异有统计学意义（P〈0.05）;复发组PANSS总分、阳性症状分量表分及一般病理量表分逐渐降低,差异有统计学意义（P〈0.05）;而复发组阴性症状分量表分虽也逐渐降低,但至第4周后差异方有统计学意义。治疗8周末首发组显效率为46.43%,复发组显效率为43.75%,两组比较差异无统计学意义（χ2=0.043,P=0.835）。两组患者不良反应差异无统计学意义（P〉0.05）。结论帕利哌酮缓释剂治疗首发、复发精神分裂症患者阴阳性症状均具有良好的疗效,且安全性、依从性好,可在临床进一步推广应用。     

分级开放管理对男性精神分裂症长期住院患者生活质量的影响

目的研究不同分级开放管理对长期住院男性精神分裂症患者生活质量的影响。方法120例精神分裂症患者分为室内开放（A组）、院内开放（B组）、院外开放（C组）三组,每组40例,于基线时、开放3月末、开放6月末评定精神分裂症患者生活质量量表（SQLS中文版）、住院精神病患者社会功能评定量表（SSPI）、阳性和阴性症状量表（PANSS）、检测体重、胆固醇、甘油三脂、血糖,并记录开放后不良事件发生情况。结果A组、B组、C组开放3月末、6月末与基线生活质量总分及各因子分、社会功能总分、PANSS总分均有统计学差异（P〈0．05）。开放6月末B组、C组与A组生活质量总分、心理社会因子分、症状和副反应因子分、社会功能总分、PANSS总分、阳性症状分、阴性症状分均有显著统计学差异（P〈0．01）,C组与B组PANSS总分、阳性症状分、阴性症状分均有显著统计学差异（P〈0．01）,而三组基线、开放3月末生活质量、社会功能以及PANSS总分均无统计学差异（P〉0．05）。结论开放管理可以提高长期住院男性精神分裂症患者的生活质量和社会功能,促使其精神症状改善。     

利培酮口服液治疗急性期精神分裂症的疗效和安全性

目的了解利培酮口服液快速加量对急性期精神分裂症患者的疗效及安全性。方法对我院住院28名首次发作的精神分裂症患者,给予利培酮口服液快速加量治疗,进行1个月相应治疗方案的开放式研究。采用阳性和阴性症状量表（PANSS）,阳性和阴性症状量表兴奋因子分（PANSS2EC）评定疗效,副反应量表（TESS）、锥体外系副反应量表（RSESE）等观察不良反应和安全性。结果利培酮口服液快速加量治疗精神分裂症急性期的总有效率达89．2％,PANSS评分和CGI分治疗前后相比有统计学差异（P〈0．05）。结论利培酮口服液快速加量治疗急性期精神分裂症患者安全性良好,可适于临床应用。     

精神分裂症心理社会危险因素研究

目的探讨精神分裂症患者的心理社会危险因素。方法采用生活事件量表（LES）、社会支持评定量表（SSRS）及防御方式问卷（DSQ）对120例精神分裂症患者（病例组）以及121例正常志愿者（对照组）进行测查,并分析精神分裂症患者的心理社会危险因素。结果精神分裂症患者生活事件总频度和分值以及负性生活事件频度和分值均高于对照组（P〈0.01）,社会支持总分、主观社会支持因子分、客观支持因子分及社会支持利用度因子分均低于对照组（P〈0.01）,更多采用不成熟和中间型防御方式（P〈0.01）。Logistic回归分析显示负性事件总分、社会支持利用度、不成熟防御机制和中间型防御机制是影响精神分裂症发病的重要因素。结论负性生活事件、社会支持利用度、不成熟防御机制及中间型防御方式与精神分裂症的发病密切相关。     

Association among aggressiveness, neurocognitive function, and the Val66Met polymorphism of brain-derived neurotrophic factor gene in male schizophrenic patients

Background

The aim of this study was to investigate the association among aggressive behavior, neuropsychological function, and the Val66Met functional polymorphism of brain-derived neurotrophic factor (BDNF) gene in male schizophrenic patients.

Methods

We examined 51 male patients with schizophrenia who had committed homicide (ie, H-SCZ), 50 male patients with schizophrenia who had not committed homicide (ie, NH-SCZ), and 50 healthy male controls. Patients were evaluated using the Positive and Negative Syndrome Scale, Life History of Aggression, and the Overt Aggression Scale. In addition, patients were given neurocognitive function tests, including Korean-Wechsler Adult Intelligence Scale short form, the Korean version of the Rey Memory Test, the Stroop Test, and the Wisconsin Card Sorting Test. The Val66Met polymorphism of the BDNF gene was also genotyped in all schizophrenic patients.

Results

We observed no significant difference between patients in the H-SCZ and NH-SCZ groups, with regard to Positive and Negative Syndrome Scale scores. Total Life History of Aggression (P < .01) and Overt Aggression Scale scores for the most severe episode (P < .01) or for the previous month (P < .05) were higher in the H-SCZ group than in the NH-SCZ group. There were no significant differences in the genotype distribution or allelic frequency of the Val66Met polymorphism between the schizophrenic groups. In addition, we observed no significant differences between H-SCZ and NH-SCZ groups with regard to performance on neuropsychological tests. The Met allele of the Val66Met polymorphism was associated with poor intelligence quotient, memory quotient), learning, and delayed recall in the H-SCZ group. However, genotype did not seem to influence neurocognitive function in schizophrenic patients who had committed homicide.

Conclusions

The neurocognitive tests used in our study were unable to distinguish between violent and nonviolent schizophrenic patients. Furthermore, the Val66Met polymorphism was not associated with aggressiveness in patients with schizophrenia.     

Measurement of depression and negative symptoms in schizophrenia.

The validity of the Hamilton Depression Scale (HAM-D) as a measure of depressive symptomatology in schizophrenic patients is questionable since it was not developed for this purpose, nor has it been validated in a schizophrenic population. Accordingly, 80 schizophrenic inpatients were administered the HAM-D, the 18-item Brief Psychiatric Rating Scale (BPRS), and the Scale for the Assessment of Negative Symptoms (SANS) at drug-free baseline and after 4 weeks of neuroleptic treatment. The findings revealed that the HAM-D total score was nonspecific, while individual HAM-D subfactors provided a better index of various symptom complexes. The HAM-D contained a depressive factor that correlated strongly with the BPRS depression factor and a negative symptom factor that correlated strongly with the SANS and the BPRS negative symptom factor. These findings suggest the need to utilize specific assessment techniques rather than global measures when assessing depression in schizophrenia.     

Smoking in chronic schizophrenic inpatients in taiwan

OBJECTIVE: This study investigated the prevalence of smoking and its association with the clinical characteristics of Chinese inpatients with chronic schizophrenia. METHOD: Schizophrenic patients hospitalized in chronic wards were assessed using Brief Psychiatric Rating Scale (BPRS), Abnormal Involuntary Movements Scale (AIMS) and Folstein Mini-Mental Status Examination (MMSE) testing. RESULTS: Of 257 patients, 105 smoked and 4 had ceased. Males exhibited a higher prevalence of smoking than females (p < 0.001). Smoking was not significantly associated with age at onset (AAO), chlorpromazine equivalents, MMSE, AIMS, BPRS positive symptom subscale, BPRS negative symptom subscale or total BPRS scores. Smokers had higher BPRS general subscales. CONCLUSION: Compared to the general population, smoking prevalence was slightly higher in schizophrenic males, double in schizophrenic females, but no difference in refractory schizophrenic clozapine users. Smoking did not affect patient AAO or daily antipsychotic dose. Patients with a higher BPRS general subscale may smoke to relieve affective symptoms.     

Relationship of cognitive functioning, adaptive life skills, and negative symptom severity in poor-outcome geriatric schizophrenia patients

The authors assessed whether cognitive functioning and negative symptoms are related to functional outcome across severity of negative symptoms and examined relationships between symptom domains in patients with high versus low negative symptom severity. The interrelationships between cognitive functioning and functional skills in poor-outcome geriatric schizophrenic patients were compared between those who were in the first (n = 81) and the fourth quartiles (n = 127) of negative symptom severity based on the normative data in the Positive and Negative Syndrome Scale. It was found that negative symptoms and cognitive functioning were the strongest correlates of functional status in geriatric poor-outcome schizophrenic patients--regardless of negative symptom severity. Interestingly, the greater the severity of negative symptoms, the less strongly negative symptoms were related to functional outcome. The present findings demonstrate that the relationship of cognitive functioning to social and adaptive functioning remains significant despite differing levels of negative symptom severity.     

Perseveration and over-switching in schizophrenia

Perseveration and switching in positive and negative schizophrenic patients are usually seen as manifestations of attention disorders. They may be closely related to each other, but have not been investigated in an integrated fashion. Such integrated investigation could contribute to the neurophysiological understanding of the relationship between the regional and the pharmacological deficit in schizophrenia. This study has developed a new tool-the Combined Attention Test (CAT)-for the simultaneous measuring of perseveration and switching. Forty-one unmedicated schizophrenic patients were tested. Using the Positive and Negative Sorting Scale (PANSS), subjects were classified into the two experimental groups: positive and negative schizophrenics. The control group consisted of 24 healthy subjects. Schizophrenic patients with positive symptoms tended to switch more than schizophrenic patients with negative symptoms and normal subjects; schizophrenic patients with negative symptoms tended to perseverate more than schizophrenic patients with positive symptoms and normal subjects. Over-switching is discussed as a specific symptom related to positive schizophrenia.     

Cognitive sequelae of tardive dyskinesia

Severity and location of tardive dyskinesia (TD) symptoms and diagnosis were related to neurocognitive dysfunction as measured by the Wechsler Adult Intelligence Scale (WAIS) and the Wechsler Memory Scale using schizophrenic and affective patients. Diagnosis, severity, and location of TD symptoms were related to cognitive dysfunction. Total symptom severity correlated significantly negatively with 10 of 14 WAIS scores and with four of seven Wechsler Memory scores in the total group with combined schizophrenic and affective patients. The magnitude of the relationships between TD symptom severity and cognitive deficit was strongly affected by the location of the symptoms and the diagnosis of the patient. In the total group, severity of facial TD symptoms correlated significantly negatively with 11 of 14 WAIS scores and with all eight memory scores. TD symptoms in the extremities correlated significantly negatively with only two WAIS and two memory scores, whereas truncal TD symptoms did not correlate significantly negatively with any WAIS or memory scores. Patients diagnosed as schizophrenic showed significant negative correlations of total TD symptom severity with 12 of 14 WAIS scores and with seven of eight Wechsler Memory Scale scores. Patients diagnosed as having affective disorder showed only one significant correlation between total TD symptom severity and WAIS or memory scores. Length of institutionalization has been found to be related to TD symptoms in schizophrenic but not affective patients. In the present study, institutionalization was negatively correlated with severity of facial TD symptoms but not with severity of TD symptoms of the trunk or extremities.(ABSTRACT TRUNCATED AT 250 WORDS)     

Correlations of phosphomonoesters measured by phosphorus-31 magnetic resonance spectroscopy in the frontal lobes and negative symptoms in schizophrenia

Frontal lobe dysfunction has been linked to negative symptoms of schizophrenia. We used phosphorus-31 magnetic resonance spectroscopy (³¹P-MRS) to examine phosphorous metabolism in frontal brain regions in 26 schizophrenic patients compared with 26 sex- and age-matched control subjects. The relative signal intensities of phosphorous metabolites in frontal regions did not differ significantly between schizophrenic patients and control subjects. However, phosphomonoester levels were significantly decreased in frontal regions of 12 schizophrenic patients who had high scores on negative symptom subscales from the Brief Psychiatric Rating Scale (i.e., emotional withdrawal, motor retardation and blunted affect) compared with 14 patients with low negative symptom scores on the same subscales and control subjects. The correlations between negative symptoms and phosphorous metabolism in the frontal lobes support the “hypofrontality hypothesis” in schizophrenia.     

The concordance between symptom information gathered from remitted schizophrenic patients and their relatives

The concordance between symptom information gathered from remitted schizophrenic out-patients and the relatives with whom they live was assessed for different schizophrenic symptom clusters. It was hypothesized that the positive symptoms would show the greatest patient-relative concordance. Patients and relatives were also compared for levels of overall symptom reporting. It was hypothesized that long-term memory problems, anosognosia, and underreporting in order to appear healthy, would cause patients to report fewer symptoms than their relatives. An alternative hypothesis was that relatives would underreport symptoms to avoid “blame” for their relatives' illness, and because they did not have direct experience of the symptomatology. The 24-item version of the Brief Psychiatric Rating Scale (BPRS) was administered to 41 schizophrenic patients (chart diagnoses were validated by a DSM-III-R diagnostic checklist). Fourteen of the BPRS items were then used to glean information about patients' symptomatology from 41 relatives of the patients. Interviews with patients revealed significantly more symptomatology than interviews with patients' relatives for total and non-positive symptoms (both p-values < .01), but not positive symptoms. Intraclass correlations (ICC) between patients' and relatives' assessments were moderate for positive symptoms (ICC = .54, p < .01), low for total symptoms (ICC = .26, p = .05) and negligible for non-positive symptoms (.13, ns). Despite the potential for underreporting due to factors like anosognosia and long-term memory problems, patients are still the best source of information for schizophrenic symptomatology.     

Platelet-associated antibodies mediate protective autoimmune response in schizophrenia

The peripheral blood platelets of schizophrenic patients were isolated, and the level of the platelet-associated antibodies (SPAA) was correlated with the rating scores of discrete schizophrenic symptom clusters evaluated with the Brief Psychiatric Rating Scale. Irrespective of medication and gender, symptom-dependent correlations were established between the SPAA levels and the relevant psychometric scores. The results indicate a heterogeneous origin of schizophrenia and imply the involvement of an autoimmune arm as a predominantly protective immune response.     

Clinical efficacy of carbamazepine in affective, schizoaffective, and schizophrenic disorders

The therapeutic effects of carbamazepine (CBZ) were evaluated in 103 patients with affective disorders, 54 with schizophrenic disorders, and 26 with schizoaffective disorders by a multi-institutional open study. The rate of marked and moderate improvement was 72.8% in affective disorders, 54.6% in schizophrenic disorders, and 61.5% in schizoaffective disorders. Symptom items of the Clinical Psychopharmacology Research Group rating scale for mania showed significant improvement in the patients with affective disorders as well as in those of the other two groups. In the Brief Psychiatric Rating Scale as applied to patients with schizophrenic or schizoaffective disorders, symptom items related to affect and emotion showed significant improvement. The antimanic efficacy of CBZ was also noted in many poor responders to lithium. Side-effects were observed in 82 patients (44.8%), and abnormal laboratory findings in 37 patients (44.8%), and abnormal laboratory findings in 37 patients. The present study seems to confirm the usefulness of CBZ for the treatment of affective disorders and in some cases, of schizophrenic and schizoaffective disorders.