青少年期首发精神分裂症患者的早期症状分析

对 8 8例首发于 2 0岁以下的精神分裂症患者的早期症状、治疗及转归做一粗略分析。对象　为本院 2 0 0 1年 1月至 2 0 0 2年 8月住院的、首发于 2 0岁以下缓慢及亚急性起病的精神分裂症患者 ,共 88例。均符合国际疾病分类第 10版精神和行为障碍中的精神分裂症诊断标准 ,早期症状持续 8周以上。其中男 4 5例 ,女4 3例。出现早期症状的年龄为 10～ 2 0岁 (其中 10～ 13岁9例 ,14～ 17岁 4 0例 ,18～ 2 0岁 39例 ) ,平均 (16 4± 2 5 )岁。现在年龄 12～ 30岁 ,平均 (19 9± 3 5 )岁。病程 8个月至 15年 ,中位数为 3年。方法　采用回顾性查阅…     

儿童期与青少年期起病的精神分裂症临床比较

目的：了解儿童期起病和青少年期起病精神分裂症临床特征及差异。方法：儿童期起病26例（儿童组）,青少年期起病68例（青少年组）;采用自编临床资料调查表对患者家属进行调查;采用病前适应性量表（PAS）对患者病前心理社会适应情况进行评定。结果：两组患者父母的生育年龄比较差异无显著性（t=-0.519,P〉0.05）;青少年组出现思维内容障碍64例（94.1%）明显高于儿童组18例（69.2%）,两组比较差异有显著性（χ^2=10.461,P〈0.05）;儿童组男性在同伴关系、学校适应性及PAS总分上均显著高于同组的女性（P均〈0.05）;青少年组男性在学业成绩上显著高于同组女性（t=2.548,P〈0.05）。儿童组男性学校适应能力较青少年组男性显著为差（P〈0.05）。有家族史的两组男性在同伴关系上差异有显著性（t=3.873,P〈0.05）。结论：早发型精神分裂症中思维内容障碍、心理社会适应不良与起病年龄有关。     

少儿期与成年期精神分裂症的临床特征比较

近年来 ,Ｔｏｕｒｅｔｔｅ综合征 (ＴＳ)患病人数有增加的趋势 ,为了解此症患儿的个性特征 ,本文采用艾森克个性问卷对 3 0名ＴＳ患儿与 3 0名正常儿童进行了个性测试的对照研究 ,现报道于后。1　对象与方法1 1　对象　患儿组 :为门诊的患儿共 3 0人 ,均符合ＣＣＭＤ—2—Ｒ中相应的诊断标准[1] 。其中 ,7～ 9岁 10人 ,10～ 12岁 14人 ,13～ 14岁 6人。男性 2 7人 ,女性 3人。 5人曾接受头颅ＣＴ检查 ,均未见异常。 18人检查ＥＥＧ ,有 3人轻度异常。对照组共3 0人 ,其性别、年龄、文化程度与患儿组相匹配 ,且均未发现躯体疾病。1 2　方法　…     

精神分裂症与分裂样精神障碍前躯症状对照分析

目的 为探讨精神分症和分裂样精神病前躯症状的诊断价值。方法 对８０例首次诊断为分裂样精神病，复发后改诊为精神分裂症的病人（ＳＣ组）与６０例诊断精神分例症的病人（ＳＣＦ组）的前躯症状进行了比较分析。结果 前躯症发生率，尤其是不恰当行为、性格改变、讲话离题、躲避亲人或与人疏远、敏感多疑、怪异想法、无端恐惧、强迫症状等发生率，ＳＣ组显著高于ＳＣＦ组。结论 提示精神分裂症与分裂样精神病的前躯症状确有差异。     

首发精神分裂症前驱期症状学分析

目的：探讨首发精神分裂症患者前驱期的症状学特征。方法：对71例符合中国精神疾病分类方案与诊断标准第2版修订本精神分裂症诊断标准的首次发作患者，按照自编精神分裂症前驱症状调查表的32条症状进行检查，并与62名正常成年人进行对比分析。结果：首发精神分裂症患者所有的前驱症状正常人在某些情况下也可能出现，但发生率以患者明显较高。其中灵敏度≥0．25、阳性预测值≥0．70的症状是：个人卫生形象变差；行为怪异；情感不适切；赘述或话不切题；孤僻等。结论：这些前驱期表现有助于理解精神分裂症早期的发病过程，并为早期识别和干预提供参考。     

首发儿童青少年精神分裂症患者父母的心理状态

目的:探究首发儿童青少年精神分裂症患者父母的心理状态。方法:招募首发儿童青少年精神分裂症患者的父母98名(研究组)与健康对照者98名(对照组)。对患儿父母采用Link病耻感系列量表评估病耻感;采用Herth希望量表(HHI)、心理弹性量表(CD-RISC)和社会支持评定量表(SSRS)评估其希望水平、心理弹性和社会支持。将病耻感各维度得分与中点分比较,并比较两组间的HHI、CD-RISC和SSRS评分。结果:患儿父母的贬低-歧视感知量表(PDD)总分、病耻感应对量表(CO)总分及各因子评分、病耻感情感体验量表(SRF)总分和误解因子评分显著高于中点分(P均0.05)。研究组HHI、CD-RISC及SSRS总分及各因子分均显著低于对照组(P均0.001)。结论:首发儿童青少年精神分裂症患者父母的病耻感较高,希望水平、心理弹性水平及社会支持水平都较低。     

奥氮平与利培酮治疗青少年首发精神分裂症对照研究

目的比较奥氮平与利培酮治疗青少年首发精神分裂症的疗效和安全性。方法对60例青少年期首发精神分裂症患者随机分为两组,分别给予奥氮平与利培酮治疗8周。于治疗前及治疗后1、2、6、8周末进行阳性和阴性症状量表(PANSS)及副反应量表(TESS)评定。结果奥氮平与利培酮总的疗效无显著性差异,均能快速起效,PANSS总分比较治疗第1周与第2周末奥氮平组显著低于利培酮组,利培酮组锥体外系反应显著多于奥氮平组。结论奥氮平与利培酮均是治疗首发青少年精神分裂症安全有效的非典型抗精神病药物,可根据患者的不同情况分别选择。     

儿童期与青少年期首发精神分裂症临床特征比较

目的 了解儿童期和青少年期起病的精神分裂症临床特征及差异.方法 选取2005年8月1日～2007年7月31日在安徽省精神卫生中心住院的147例首次发病、资料完整、均符合中国精神障碍分类与诊断标准第3版中的诊断标准确诊为精神分裂症的住院患者,按首发年龄(<18岁)分为儿童组(<13岁,59例)和青少年组(≥13岁,88例),采取回顾性研究方法,就两组临床资料进行对照分析.结果 两组起病形式与出院疗效相比结果差异有显著性(P<0.05).青少年组出现思维内容障碍高于儿童组,两组比较差异有显著性(x2=0.019,P<0.05).儿童组出现行为障碍及情感障碍高于青少年组,两组比较差异有显著性(P<0.05).结论 精神分裂症的起病形式、疗效及临床症状与发病年龄有关.     

精神分裂症与分裂样精神病前躯症状对照分析

为探讨精神分裂症和分裂样精神病前躯症状诊断价值,对80例首次诊断为分裂样精神病,复发后改诊为精神分裂症病人(SC组)与60例维持诊断分裂样精神病的病人(SCF组)的前躯症状进行了比较分析。结果显示：前躯症状的发生率,尤其是不恰当行为、性格改变、讲话离题、躲避亲人或与人疏远、敏感、多疑、怪异想法、无端恐惧、强迫症状等发生率SC组显高于SCF组。提示精神分裂症一分裂样精神病的前躯症状确有差异。     

The relationship of early premorbid adjustment with negative symptoms and cognitive functions in first-episode schizophrenia: A prospective three-year follow-up study

Premorbid adjustment is an important prognostic factor of schizophrenia. The relationships between sub-components of premorbid adjustment and outcomes on symptoms and cognition in first-episode schizophrenia were under-studied. In the current study, we prospectively followed up 93 patients aged 18–55 years presenting with first-episode schizophrenia-spectrum disorder. Psychopathological and cognitive assessments were conducted at baseline, clinical stabilization, 12, 24 and 36 months. Premorbid adjustment was sub-divided into discrete functional domains, developmental stages and premorbid-course types based on ratings of the Premorbid Adjustment Scale (PAS). The study focused on early developmental stages to minimize contamination by prodromal symptoms. Results indicated that gender differences in premorbid functioning were primarily related to early-adolescence adjustment and academic domain. Social domain was more strongly related to negative symptoms, while academic domain was more consistently linked to cognitive outcome (Wisconsin Card Sorting test and verbal fluency). Patients with stable-poor premorbid course had more severe negative symptoms and cognitive impairment. In conclusion, in a Chinese cohort of first-episode schizophrenia-spectrum disorder, sub-components of early premorbid adjustment were shown to be differentially related to clinical and cognitive measures. The results highlighted the importance of applying a more refined delineation of premorbid functioning in studying illness outcome.     

Short-term functional outcome and premorbid adjustment in clinical high-risk patients. Results of the EPOS project

PurposeIn patients with schizophrenia, premorbid psychosocial adjustment is an important predictor of functional outcome. We studied functional outcome in young clinical high-risk (CHR) patients and how this was predicted by their childhood to adolescence premorbid adjustment.MethodsIn all, 245 young help-seeking CHR patients were assessed with the Premorbid Adjustment Scale, the Structured Interview for Prodromal Syndromes (SIPS) and the Schizophrenia Proneness Instrument (SPI-A). The SIPS assesses positive, negative, disorganised, general symptoms, and the Global Assessment of Functioning (GAF), the SPI-A self-experienced basic symptoms; they were carried out at baseline, at 9-month and 18-month follow-up. Transitions to psychosis were identified. In the hierarchical linear model, associations between premorbid adjustment, background data, symptoms, transitions to psychosis and GAF scores were analysed.ResultsDuring the 18-month follow-up, GAF scores improved significantly, and the proportion of patients with poor functioning decreased from 74% to 37%. Poor premorbid adjustment, single marital status, poor work status, and symptoms were associated with low baseline GAF scores. Low GAF scores were predicted by poor premorbid adjustment, negative, positive and basic symptoms, and poor baseline work status. The association between premorbid adjustment and follow-up GAF scores remained significant, even when baseline GAF and transition to psychosis were included in the model.ConclusionA great majority of help-seeking CHR patients suffer from deficits in their functioning. In CHR patients, premorbid psychosocial adjustment, baseline positive, negative, basic symptoms and poor working/schooling situation predict poor short-term functional outcome. These aspects should be taken into account when acute intervention and long-term rehabilitation for improving outcome in CHR patients are carried out.     

精神分裂症患者发病年龄与临床特征的相关性研究

目的 探讨精神分裂症发病年龄与临床特征的关系。方法 对符合DSM-IV精神分裂症诊断标准的294例住院患者进行BPRS评估和BEAM检查，并收集其人口学资料和病史资料。结果 BPRS总分和迟滞因子分与发病年龄呈负相关，而BPRS总分、迟滞因子分和敌对猜疑因子分与未治疗期的长短呈正相关。发病年龄在性别和遗传因素中的差异无显著性，而在发病诱因、BEAM检查结果和诊断类型间的差别有统计学意义。结论 精神分裂症的临床特征与发病年龄明显相关，发病年龄越小病情越严重，阴性症状也越突出，提示在制定治疗康复方案方面，应有所区别。     

精神发育迟滞并发精神分裂症与精神分裂症症状特点比较

目的 探讨精神发育迟滞(MR)并发精神分裂症与精神分裂症症状特点比较。方法 100例MR并发精神分裂症患者按智商(IQ)≥50和IQ≤49分成两组进行临床特征分析,并与100例智力正常的精神分裂症患者比较。结果 MR并发精神分裂症患者IQ≥50和IQ≤49两组间临床症状差异无显著性(P>0.05);MR并发精神分裂症组与正常智力的精神分裂症组的一级症状、逻辑推理障碍、妄想、情感平淡、思维贫乏、愚蠢行为的差异有非常显著性(P<0.01)。结论 MR并发精神分裂症患者一级症状明显减少,有助于鉴别诊断。     

Remission after first-episode schizophrenia: results of a long-term follow-up

The aim of this study was to identify the rate and predictors of remission after first episode of schizophrenia (FES). Ninety-three FES patients were followed for at least 12 months and up to 12 years (mean = 58.4 months) including monthly assessments with the Brief Psychiatric Rating Scale-Expanded (BPRS), the Scale for the Assessment of Positive Symptoms (SAPS), and Scale for the Assessment of Negative Symptoms (SANS). We also administered the Premorbid Adjustment Scale (PAS). We used the remission criteria recently defined by Andreasen et al. (2005). Fifty-six (59.5%) patients met the remission criteria in the first 24 months of the follow-up period, but 40 (71.5%) of these patients could not maintain their status. However, 23 (57%) of these patients later met the remission criteria again. The remission group patients achieved a higher rate of employment both in the first year and overall. In the logistic regression analysis, lower negative and higher positive symptoms at admission, lower positive symptoms at month 3 of the follow-up, medication compliance in the first 6 months, and occupational status during the last month before admission were found related to remission status. Our findings suggest that the remission group has advantages in terms of occupational status and symptom severity compared with their counterparts who did not achieve or maintain a state of remission.     

白介素-6、10、12与精神分裂症临床特征的关系

目的 检测精神分裂症患者血浆IL-6、IL-10和IL-12水平,探讨其与精神分裂症临床特征的关系。方法 对57例精神分裂症患者和29例健康人,采用酶联免疫吸附法(ELSIA)检测其血浆IL-6、IL-10、IL-12水平,采用阳性和阴性症状评定量表(PANSS)评定患者的症状特征。结果 患者组血浆IL-12水平高于正常对照组(P<0.05),且与疾病的严重程度皇正相关;阴性症状组患者IL-6水平明显高于阳性症状组和正常对照组,而其IL-10水平则低于阳性症状组;急性或亚急性起病者血浆IL-10水平明显低于慢性起病组。 结论 精神分裂症存在细胞免疫异常,IL-12在精神分裂症的发病机制中起一定作用,IL-6和IL-10则与其部分临床特征有关。     

躯体化障碍与抑郁症的临床特征比较

目的：弄清躯体化障碍是否为一处陷匿形式的抑郁症。方法：按ＤＳＭ－Ⅳ诊断标准收集躯体化障碍５６例（Ａ组）、抑郁症５１例（Ｂ组）,对两级人列均用病史问卷及汉尔顿抑郁量表（ＨＡＭＤ）进行调查评定。结果：Ａ组躯体症状频率显著高于Ｂ组,抑郁症状频率和ＨＡＮＤ总分显著低于Ｂ组,两组在ＨＡＭＤ因子分析,疾病行为与态度、病程演变及发病背景方面存在显著差异。     

Premorbid functioning of patients with first-episode nonaffective psychosis: a comparison of deterioration in academic and social performance, and clinical correlates of Premorbid Adjustment Scale scores

BACKGROUND: Motivated by a previous study among male veterans [Allen, D.N., Frantom, L.V., Strauss, G.P., van Kammen, D.P., 2005. Differential patterns of premorbid academic and social deterioration in patients with schizophrenia. Schizophr. Res. 75, 389-397], the present analysis examined: (1) patterns of premorbid academic and social functioning during childhood, early adolescence, and late adolescence, and (2) associations between these premorbid functioning dimensions and a number of clinical variables. METHODS: Data on premorbid functioning were collected using the Premorbid Adjustment Scale (PAS) in 95 hospitalized first-episode patients. Analyses were similar to those conducted by Allen and colleagues (2005). RESULTS: Deterioration was evident in both academic and social functioning from childhood to early adolescence, along with a pronounced/accelerated deterioration in academic functioning from early adolescence to late adolescence, occurring in both male and female patients. Age at onset of prodromal symptoms was predicted by childhood/early adolescent/late adolescent academic functioning scores, and age at onset of psychotic symptoms was significantly associated only with childhood academic functioning. Severity of negative symptoms was predicted by childhood and late adolescent social functioning scores, and severity of general psychopathology symptoms was predicted by late adolescent academic functioning, as well as childhood and late adolescent social functioning scores. CONCLUSIONS: Consistent with prior findings, deterioration in premorbid functioning appears to be more pronounced in the academic than social dimension of the PAS. Some PAS scores are predictive of ages at onset of prodrome/psychosis and severity of psychotic symptoms. Ongoing research on premorbid adjustment in schizophrenia may have implications for future prevention goals.     

精神分裂症患者临床特征的性别差异

目的 比较男性和女性住院精神分裂症患者临床特征的差异.方法 采用自编项目调查表对458份符合国际疾病和相关健康问题分类第十版（ICD-10）诊断标准的出院精神分裂症患者病历进行不同性别的对比分析.结果 在住院精神分裂症患者中,男性患者的平均年龄低于女性患者,男性患者的已婚比例低于女性患者,男性患者的首发年龄比女性患者早,男性患者中出现被害妄想和夸大妄想的比率高于女性患者,而出现嫉妒妄想、情感淡漠和情感不协调的比率低于女性患者;在药物使用中,男性患者使用芮迭的比例高于女性患者,而使用齐拉西酮的比例低于女性患者,两组比较差异均有统计学意义（P＜0.05）.男性与女性患者在文化程度、家族史、起病形式、病程、病程特点、住院时间、是否单一用药及临床疗效方面的比较差异均无统计学意义（P＞0.05）.结论 男性和女性住院精神分裂症患者在临床特征方面存在较多差异,这提示在实际诊疗及制定精神康复计划时,不同性别应区别对待.     

Functional development in clinical high risk youth: Prediction of schizophrenia versus other psychotic disorders

This study evaluates premorbid social and academic functioning in clinical high-risk individuals as predictors of transition to schizophrenia versus another psychotic disorder. Participants were 54 individuals enrolled in phase one of the North American Prodrome Longitudinal Study who over two and a half years of follow-up met criteria for schizophrenia/schizophreniform disorder (n=28) or another psychotic disorder (n=26). Social and academic functioning in childhood, early adolescence, and late adolescence was assessed at baseline using the Cannon-Spoor Premorbid Adjustment Scale. Social maladjustment in late adolescence predicted significantly higher odds of transition to schizophrenia versus another psychotic disorder independent of childhood and early adolescent adjustment (OR=4.02) and conveyed unique risk over academic maladjustment (OR=5.64). Premorbid academic maladjustment was not associated with psychotic disorder diagnosis. Results support diagnostic specificity of premorbid social dysfunction to schizophrenia in clinical high-risk youth and underscore an important role for social maladjustment in the developmental pathology of schizophrenia and its prediction.