精神分裂症血清肌酸磷酸激酶活性研究

目的：探讨精神分裂症患者血清肌酸磷酸激酶（CPK）活性与病情的关系。方法：对195例精神分裂症患者于治疗前、治疗4和8周末分别进行CPK检测，同时以简明精神病量表（BPRS）、阴性症状量表（SANS）和阳性症状量表（SAPS）评定其情严重度。选取同期本地区健康体检者69名为对照组。结果：精神分裂症在发病期的CPK活性极显著高于对照组，治疗后显著下降，4周末已降至正常范围；在发病期的CPK值与BPRS总分、思维障碍因子分、激活性因子分和SAPS因子分呈显著正相关，好转后相关性降低，至8周末已无相关性；病例组CPK变化值与BPRS总分减分值、激活性因子的减分值和SAPS总分的减分值呈显著正相关。结论：精神分裂症患者在发病期的CPK活性显著升高，与病情关系密切，与阳性症状相平等，这可能是精神分裂症的神经－免疫、代谢相互作用的结果。     

氯氮平对精神分裂症患者血清白细胞介素6的影响

目的：探讨女性首发精神分裂症患者氯氮平治疗前后血清白细胞介素6(IL-6)变化及其与氯氮平血药浓度的关系。方法：采用酶联免疫吸附法测定20例精神分裂症患者治疗前及治疗第1、2、4周血清IL-6，同时用高效液相色谱法测定血清氯氮平浓度，以20名女性健康者血清IL-6作对照，用阳性与阴性症状量表(PANSS)评定治疗前与治疗第4周患者的精神症状。结果：患者组治疗前血清IL-6显著高于正常对照组，治疗第1、2、4周IL-6显著低于对照组；患者组治疗后各时点IL-6与氯氮平血清浓度无显著相关；氯氮平治疗4周后，PANSS减分率与IL-6减分率无显著相关。结论：女性首发精神分裂症患者IL-6水平与健康女性差异显著，氯氮平可显著降低女性精神分裂症患者IL-6水平，精神分裂症症状改善与IL-6变化无显著相关。     

左旋咪唑涂布剂对精神分裂症患者免疫指标与疗效的关系

目的：探讨左旋咪唑涂布剂对精神分裂症患者免疫指标与疗效的关系。方法：将101例患者随机分成两组，均以固定剂量氟哌啶醇治疗，研究组辅以左旋咪唑涂布剂治疗，对照组予蒸馏水涂抹。治疗前后分别查免疫球蛋白及补体成分，用简明精神病评定量表(BPRS)、阳性症状量表(SAPS)、阴性症状量表(SANS)、临床疗效总评量表(CGI)和副反应量表(TESS)综合评定。结果：治疗后免疫球蛋白G(IgG)下降明显，且两组差异显著。各量表的减分率与治疗前IgG呈显著正相关。SANS减分率与治疗前后IgG差值呈显著正相关。结论：临床症状改善与IgG水平相关，且以阴性症状为主。     

精神分裂症抑郁症状及其相关因素的研究

为了探讨精神分裂症患者抑郁症状发生率及其相关因素，对１５９例精神分裂症患者在疗前和疗后８周进行了阳性症状量表，阴性症状量表和Ｈａｍｉｌｔｏｎ抑郁量表评定，并对抑郁症状的相关因素进行了分析。结果显示：精神分裂症患者的抑郁症状发生率为６０．３８％；抑郁症状与阳性症状，住院次数和自杀未遂发生率有显著相关，而与阴性症状和疗铲无明显相关。     

文拉法辛治疗精神分裂症伴抑郁症状对照研究

目的:比较抗精神病药合用文拉法辛与单用抗精神病药对精神分裂症阳性、阴性及抑郁症状的影响。方法:经利培酮治疗4周后好转的精神分裂症患者,经汉密尔顿抑郁量表(HAMD)评估伴有抑郁症状的63例患者随机分为两组,单用抗精神病药组(单用组)与抗精神病药合用文拉法辛组(合用组),疗程8周。结果:经治疗后,两组间阳性症状减分率差异无显著性,阴性症状减分率差异有显著性。合用组在治疗第1、2、4、8周末HAMD评分比单用组为低。结论:抗精神病药合用文拉法辛对精神分裂症伴抑郁症状疗效高,有益于阴性症状的改善,对于阳性症状稳定性无明显负面影响。     

医院内职业康复对精神症状的影响

目的：评估医院内职业康复对慢性精神分裂症患者精神症状的影响。方法：83例慢性精神病住院患者随机分为康复组和对照组,对康复组病例施行医院内职业康复,在治疗前、后以简明精神病评定量表（BPRS）、阳性症状评定量表（SAPS）、阴性症状评定量表（SANS）、住院病人护士观察量表（NOSIE－30）评估。疗程6个月。结果：康复组BRPS总分及缺乏活力和思维障碍两个因子的减分值显著大于对照组;SAPS总分减分值两组间差异无显著性;康复组SANS总分及其各因子分的减分值均显著大于对照组;康复组NOSIE－30总分及社会兴趣因子的减分值显著大于对照组。结论：医院内职业康复对于慢性精神分裂症患者的精神症状有一定的影响,尤其有助于改善阴性症状。     

精神分裂症伴发抑郁症状及其临床特征

目的 了解急性期住院精神分裂症患者伴发抑郁症状的发生率、临床特征及其相关因素。方法 对符合CCMD-3诊断标准的精神分裂症患者75例，分别于入院3天内评定PA．NSS、HAMD、TESS量表。结果 急性期抑郁发生率为30．7％，抑郁组与非抑郁组性别、婚姻、文化、年龄无显著性差异，抑郁组平均住院次数、偏执型精神分裂症所占比例多于非抑郁组。治疗前汉密顿抑郁量表总分与阴性量表、思维障碍症状群、反应缺乏症状群负相关，与一般精神病理量表、抑郁症状群正相关。结论 精神分裂症抑郁症状急性期较常见、较严重，偏执型精神分裂症更易出现抑郁症状。     

精神分裂症认知障碍与精神症状的关系

目的：探索精神分裂症认知障碍特点及其与阴性、阳性症状间的关系。方法：比较32例未用过抗精神病药的精神分裂症患者及15例正常受试者的事件相关电位(ERPs)和威斯康星卡片分类测验(WCST)成绩，并进行相关分析。结果：精神分裂症患者多个位点N2和P3波潜伏期延长，P3波幅降低。WCST中分类完成数偏少，持续错误数和总错误数增加。N2潜伏期和波幅与阳性症状与阴性症状量表(PANSS)阳性症状分呈负相关，而WCST总错误数与PANSS总分和阴性症状分正相关。结论：精神分裂症病人存在中枢信息处理障碍、认知障碍，与阴性、阳性症状之间具有一定的内在联系。     

精神分裂症的抑郁症状

为了探讨精神分裂症抑郁症状发生率及其相关因素，对159例精神分裂症患者在疗前和疗后8周进行了阳性症状量表（SAPS）、阴性症状量表（SANS）和Hamilton抑郁量表（HAMD）评定，并对抑郁症状的相关因素进行了分析。结果显示，精神分裂症患者的抑郁症状发生率为60.38%；抑郁症状与阳性症状（SAPS总分）、住院次数和自杀未遂发生率有显著相关，而与阴性症状（SANS总分）和疗效无明显相关。作者认为抑郁症状是精神分裂症症状的组成部分，一般不需合并抗抑郁剂治疗。     

5-羟色胺1A受体基因C（-1019）G多态性与精神分裂症的关联分析

目的:探讨云南地区汉族人群中5-羟色胺1A(5-HT1A)受体基因C(-1019)G多态性与精神分裂症的关联,及其对症状组成、前额叶执行功能的可能影响. 方法:应用阳性与阴性症状量表(PANSS)、简明精神病评定量表(BPRS)、外显攻击量表(OAS)等评定患者症状,威斯康星卡片分类测验(WCST)评定精神分裂症和正常人前额叶执行功能.142例精神分裂症患者和84名正常对照分别用聚合酶链式反应-限制性片段长度多态性(PCR-RFLP)方法进行基因分型. 结果:云南地区汉族人群中,5-HT1A受体基因启动子区C(-1019)G多态性在精神分裂症和正常人之间的各量表分差异有显著性(P=0.001).C(-1019)G多态性对PANSS中因子被动淡漠性社会退缩(N4)(P=0.010)、言语缺乏主动性和流畅性(N6)(P=0.004)、阴性症状总分(NT)(P=0.013)、紧张(G4)(P=0.005)、自发社交回避(G16)(P=0.013),以及BPRS中的因子4激活性(P=0.026)等条目得分的形成影响有显著性.C(-1019)G多态性与WCST各条目不相关. 结论:云南地区汉族人群中,5-HT1A受体基因启动子区C(-1019)G多态性与精神分裂症显著相关,对精神分裂症症状组成可能起一定作用,但与WCST反映的前额叶执行功能状态并无显著相关.     

Anhedonia in depression and schizophrenia: a reexamination.

The purpose of this study was to utilize factor analysis to help determine whether anhedonia is a symptom of both depression and schizophrenia. Measures of depression, positive and negative symptoms of schizophrenia, and anhedonia were administered to a group of schizophrenic patients (N = 54) and to a group of patients with major depressive disorder (N = 27). The correlation matrix among the various scales was subjected to an oblique exploratory factor analysis. Three factors were extracted, accounting for three quarters of the variance. The first measured depression, the second measured positive symptoms, and the third measured negative symptoms. Anhedonia loaded significantly on the first factor but not on the third, suggesting that it is a symptom of depression rather than schizophrenia. These results were corroborated by means of confirmatory factor analysis. We conclude that anhedonia is a symptom of depression and that it only appears to be a symptom of schizophrenia because it is a component of emotional blunting which is indeed a negative symptom of schizophrenia.     

Depressive factors and their relationships with other symptom domains in schizophrenia, schizoaffective disorder, and psychotic depression

Relationships among different symptom domains were investigated in patients with acute exacerbation of schizophrenia with depressive symptoms, psychotic depression, or schizoaffective disorder, depressive subtype. Scores for depression and depressive factors were correlated with positive, negative, and extrapyramidal symptoms within diagnostic categories. No between-group differences in the relationship of different symptom domains could be found, and no substantial relationship between depression and positive symptoms could be revealed in any diagnostic subgroup. Only the retardation factor of depression showed a significant overlap with negative symptoms; depressive core symptoms did not. Core symptoms of depression were independent from other symptoms in all investigated diagnostic groups. Depression seems to represent a heterogeneous symptom domain with unique relationships of components to positive and negative symptoms across nosological borders. A more differentiated assessment, analysis, and treatment of depressive symptoms is therefore recommended for patients with combined depressive and psychotic symptoms.     

Predictors of subjective and objective quality of life in outpatients with schizophrenia

Aim: In recent years, greater attention has been given to quality of life (QOL) in schizophrenia and several studies reported that negative and depressive symptoms and cognitive dysfunction are related to patient QOL. But because a variety of QOL measures have been used in the previous studies, there seems to be no unanimous predictors for subjective and objective QOL. The purpose of the present study was to elucidate the relationship between clinical variables and subjective and objective QOL in outpatients with schizophrenia, using schizophrenia disease‐specific QOL measures. Particular attention was paid to cognitive function as a predictor of QOL. Methods: Schizophrenia symptoms of the Positive and Negative Syndrome Scale (PANSS) were divided into five factors: positive factor, negative factor, cognitive factor, emotional discomfort, and hostility. The study sample consisted of 84 schizophrenia outpatients. Subjective and objective QOL were assessed with Schizophrenia Quality of Life Scale (SQLS) and the Quality of Life Scale (QLS), respectively. Results: Subjective QOL correlated significantly with emotional discomfort, positive factor, negative factor, extrapyramidal symptoms and cognitive factor, while objective QOL correlated with negative factor, cognitive factor, emotional discomfort, extrapyramidal symptoms, and dose of antipsychotics. Total score and three of four subscales in the QLS correlated significantly with cognitive factor, while cognitive factor had a significant correlation with only one of three scales of SQLS. Stepwise regression showed that subjective QOL was significantly predicted by emotional discomfort and extrapyramidal symptoms, while negative factor was the most important predictor of objective QOL. Conclusion: Cognitive dysfunction had a greater influence on objective QOL than subjective QOL. Treating depressive and negative symptoms and extrapyramidal symptoms might contribute to enhanced subjective and objective QOL.     

Relationship between depressive symptoms and quality of life in Nigerian patients with schizophrenia

Purpose

Quality of life (QOL) in patients with schizophrenia is influenced by various factors such as depressive symptoms. This study assessed the relationship between depressive symptoms and QOL in outpatients with schizophrenia in Nigeria and evaluated the associated socio-demographic and clinical factors.

Methods

One hundred patients with 10th edition of the International Classification of Diseases diagnosis of schizophrenia participated in this study. Socio-demographic and clinical factors such as depression were assessed with Zung Self-rating Depression Scale and symptoms of schizophrenia with the Positive and Negative Syndrome Scale of schizophrenia (PANSS). The level of functioning was assessed with the Global Assessment of Functioning Scale. QOL was assessed using the brief version of the World Health Organisation Quality of Life Scale.

Results

There were 27 (27.0 %) patients with depression. The depressed patients reported significant lower scores in all QOL domains when compared with the non-depressed group. All QOL domains were significantly negatively correlated with the total PANSS and all its subscales (except for psychological domain with total PANSS and social relationship and environmental domains with PANSS positive). Severity of depressive symptoms was significantly negatively correlated with all QOL domains. Functioning was significantly positively correlated with all QOL domains except in the environmental domain. Multiple regression analysis showed that depressive symptoms predicted all QOL domains except the social relationship domain while negative symptoms predicted social relationship and environmental domains.

Conclusion

Depression is a common occurrence during the course of schizophrenia. Depressive and negative symptoms have a significant impact on the QOL of patients with schizophrenia.     

The five symptom dimensions and depression in schizophrenia

The aim of this study was to investigate the relationship between the five-factor model of psychopathology and depression in schizophrenia. Symptoms were rated using the Positive and Negative Syndrome Scale (PANSS) and the Montgomery and Asberg Depression Rating Scale (MADRS) in 105 chronic patients with schizophrenia. Principal-component analysis (PCA) produced a five-factor solution for the PANSS (psychomotor poverty, disorganisation, reality distortion, excitement, and depression), and a two-factor solution for the MADRS (psychological and behavioural depression). The PANSS depression factor was highly associated with the MADRS psychological depression factor but not with MADRS behavioural depression. By contrast, the PANSS excitement factor showed a strong positive correlation with the behavioural depression factor but not with psychological depression. These MADRS factors were not associated significantly with the core PANSS factors, including psychomotor poverty. It is suggested that depression exists as an independent domain, differentiated from negative symptoms, in the structure of schizophrenia symptomatology.     

Relationships between depression and psychotic symptoms of schizophrenia during an acute episode and stable period

The aim of the present study is to explore the relationship between depression and psychotic symptoms of schizophrenia over the course of illness. Sixty-eight patients meeting DSM-IV criteria for schizophrenia were enrolled, 27 in an acute episode, 41 when stable. Assessments were performed using the Calgary Depression Scale for Schizophrenia (CDSS) for depression and the Positive and Negative Syndrome Scale (PANSS) for psychotic symptoms. When considering patients in an acute episode (52% depressed), the CDSS score was correlated only with the PANSS positive sub-scale score. For patients in the stable period (38% depressed), the CDSS score was correlated with positive as well as negative and general psychopathology sub-scale scores. Hence, the relationship between depression and other symptoms of schizophrenia appear to differ during different stages of illness.     

Quality of life in schizophrenia: contributions of anxiety and depression

A number of studies have demonstrated a strong relationship between quality of life in schizophrenia and general psychopathology measures, and moreover, that the positive, negative, and disorganized symptoms are less related to quality of life. The current investigation examined the relationship between quality of life and symptomatology in 63 stabilized outpatients diagnosed with schizophrenia or schizoaffective disorder. Consistent with other findings, more severe depression, as rated on the Brief Psychiatric Rating Scale (BPRS) was associated with lower general life satisfaction and lower satisfaction with daily living, finances, health, and social life. In addition, higher anxiety ratings on the BPRS were associated with less satisfaction with global quality of life, daily activities, family, health and social relationship, even when controlling for positive symptoms, negative symptoms, or depression. No other symptoms of schizophrenia were as strongly associated with subjective quality of life. Anxiety was also significantly correlated with a number of positive and negative symptoms while depression was substantially less related. These findings, suggest that more precise analyses of general psychopathology, and anxiety in particular, may be necessary to further clarify the factors involved in quality of life in schizophrenia. In addition, these findings suggest future directions for theories of affect and treatment in schizophrenia.     

精神分裂症的阴性症状与抑郁症的症状比较

目的　比较精神分裂症的阴性症状和抑郁症的症状差异。方法　用SANS和HAMD量表评定 4 8例精神分裂症的阴性症状和 4 5例抑郁症的症状 ,评定结果进行统计学处理。结果　SANS总分两组无显著性差异 (P >0 0 5 ) ;思维贫乏分量表分精神分裂症组明显高于抑郁症组 (P <0 0 1)。HAMD总分抑郁症组明显高于精神分裂症组 (P <0 0 1) ,其中尤以抑郁情绪、罪恶感、自杀、早醒和体重减轻突出。结论　精神分裂症的阴性症状与抑郁症的症状之间存在明显的差异 ,而且是鉴别诊断的要点之一     

Assessment of Trait and State Aspects of Depression in Schizophrenia

Depression and negative symptoms can be difficult to distinguish in schizophrenia. Assessments for negative symptoms usually account for the longitudinal nature of these symptoms, whereas instruments available to measure depression mainly assess current or recent symptoms. This construct difference may confound comparison of depressive and negative symptoms in schizophrenia because both domains may have trait-like aspects. We developed an instrument to measure both longitudinal “trait” as well as recent “state” symptoms of depression and tested this instrument (Maryland Trait and State Depression [MTSD] scale) in a sample of 98 individuals with schizophrenia or schizoaffective disorder and 115 community participants without psychotic illness. Exploratory factor analysis of the MTSD revealed 2 factors accounting for 73.4% of the variance; these 2 factors corresponded with “trait” and “state” depression inventory items. Neither MTSD-state nor MTSD-trait was correlated with negative symptoms as measured with the Brief Negative Symptom Scale (r = .07 and −.06, respectively) in schizophrenia patients. MTSD state and trait scores were significantly correlated with the Brief Psychiatric Rating Scale depression subscale (r = .58 and .53, respectively) as well as the Profile of Mood States depression subscale (r = .57 and .44). Persons with schizophrenia had significantly greater trait depressive symptoms than controls (P = .031). Individuals with schizoaffective disorder had significantly higher trait depression (P = .001), but not state depression (P = .146), compared with schizophrenia patients. Trait depressive symptoms are prominent in schizophrenia and are distinct from negative symptoms.Key words: BNSS, schizoaffective disorder, symptom domain     

Relationships between exploratory eye movement dysfunction and clinical symptoms in schizophrenia

Aim: Many psychophysiological tests have been widely researched in the search for a biological marker of schizophrenia. The exploratory eye movement (EEM) test involves the monitoring of eye movements while subjects freely view geometric figures. Suzuki et al. (2009) performed discriminant analysis between schizophrenia and non‐schizophrenia subjects using EEM test data; consequently, clinically diagnosed schizophrenia patients were identified as having schizophrenia with high probability (73.3%). The aim of the present study was to investigate the characteristics of schizophrenia patients who were identified as having schizophrenia on EEM discriminant analysis (SPDSE) or schizophrenia patients who were identified as not having schizophrenia on EEM discriminant analysis (SPDNSE). Methods: The data for the 251 schizophrenia subjects used in the previous discriminant‐analytic study were analyzed, and the demographic or symptomatic characteristics of SPDSE and SPDNSE were investigated. As for the symptomatic features, a factor analysis of the Brief Psychiatric Rating Scale (BPRS) rating from the schizophrenia subjects was carried out. Results: Five factors were found for schizophrenia symptoms: excitement/hostility; negative symptoms; depression/anxiety; positive symptoms; and disorganization. SPDSE had significantly higher factor scores for excitement/hostility, negative symptoms and disorganization than SPDNSE. Furthermore, the BPRS total score for the SPDSE was significantly higher than that for the SPDNSE. Conclusion: SPDSE may be a disease subtype of schizophrenia with severe symptoms related to excitement/hostility, negative symptoms and disorganization, and EEM parameters may detect this subtype. Therefore, the EEM test may be one of the contributors to the simplification of the heterogeneity of schizophrenia.