Gender Difference in the Prodromal Symptoms of First-episode Schizophrenia

To investigate the gender difference of early symptoms appearing before the onset of the psychotic symptoms in patients with first-episode schizophrenia, we reviewed the medical records of 63 patients (38 males, 25 females), who were hospitalized for first-episode schizophrenia. The frequency and duration of prodromal and psychotic symptoms, Clinical Global Impression scale scores, Global Assessment of Functioning (GAF) scale scores at admission, and other clinical characteristics were recorded for all patients. Overall, the most common prodromal symptoms were attenuated positive symptoms (89%), followed by mood symptoms (86%). Negative symptoms were the most common in male patients (97.4%), whereas attenuated positive symptoms were the most common in female patients (84%). Male patients demonstrated more frequent negative, cognitive, and obsessive-compulsive symptoms than female patients did and also showed a tendency of having negative symptoms for the longer period. Correlational analysis showed a significant negative correlation between the duration of negative symptoms and GAF scores at admission in male patients. Our findings suggest that different patterns of prodromal symptoms between male and female begin before the onset of the psychosis. Further prospective studies should be needed.     

Spatial working memory and problem solving in schizophrenia: the effect of symptom stabilization with atypical antipsychotic medication

Reasoning and problem solving in the spatial domain are important aspects of executive function that are reliably impaired in schizophrenia, and the Groton Maze Learning Test(c) (GMLT) provides a valid measure of spatial working memory. In the current study, 34 patients with first-episode schizophrenia and 20 matched controls were assessed for baseline spatial working memory abilities using this hidden maze learning test. Approximately one month after baseline assessment, allowing for symptoms to stabilize in response to treatment with therapeutic doses of atypical antipsychotic medications for individuals with schizophrenia, all participants were again assessed with the GMLT. Prior to pharmacologic intervention, patients with schizophrenia showed significant impairments in performance of all aspects of the GMLT, including measures of learning efficiency and error monitoring. One month of treatment was associated with a reliable improvement in these domains, although impairments in accuracy and error monitoring on this spatial working memory test persisted despite symptomatic improvement. These results indicate that impairments in spatial working memory are present at the earliest stages of the illness, and that such deficits in performance remain present, albeit ameliorated, after treatment with atypical antipsychotic medication.     

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。     

Predictors of change in social networks,support and satisfaction following a first episode psychosis: A cohort study

BackgroundDiminished social networks are common in psychosis but few studies have measured these comprehensively and prospectively to determine how networks and support evolve during the early phase. There is little information regarding perceived support in the early phase of illness. The aim of this study was to describe social support, networks and perceived satisfaction, explore the clinical correlates of these outcomes and examine whether phases of untreated psychosis are linked with social network variables to determine potential opportunities for intervention.MethodsDuring the study period, we assessed 222 people with first-episode psychosis at entry into treatment using valid and reliable measures of diagnosis, positive and negative symptoms, periods of untreated psychosis and prodrome and premorbid adjustment. For follow-up we contacted participants to conduct a second assessment (n = 158). There were 97 people who participated which represented 61% of those eligible. Social network and support information obtained at both time points included the number of friends, self-reported satisfaction with support and social network size and clinician’s evaluation of the degree of support received through networks. Mixed effects modelling determined the contribution of potential explanatory variables to social support measured.ResultsA number of clinical variables were linked with social networks, support and perceived support and satisfaction. The size of networks did not change over time but those with no friends and duration of untreated psychosis was significantly longer for those with no friends at entry into treatment (n = 129, Median = 24.5 mths, IQR = 7.25–69.25; Mann-Whitney U = 11.78, p = 0.008). Social support at baseline and at one year was predicted by homelessness (t = −2.98, p = 0.001, CI −4.74 to −1.21), duration of untreated psychosis (t = −0.86, p = 0.031, CI −1.65 to −0.08) and premorbid adjustment (t = −2.26, p = 0.017, CI −4.11 to −0.42). Social support improved over time but the duration of untreated psychosis was not linked with the rate of improvement in this outcome.ConclusionsImproved social support could indicate greater reliance on social support or becoming more adept at mobilising resources to meet social needs. Particularly vulnerable groups with very long duration of untreated psychosis confirm the need for earlier intervention or targeted social network interventions to preserve social connectedness.     

药物维持治疗联合家庭干预对首发精神分裂症患者的影响

目的:探讨药物维持治疗联合家庭干预对缓解期首发精神分裂症患者的影响。方法:选择经过急性期治疗后病情稳定的精神分裂症患者60例,将其随机等分为家庭干预组和对照组,对照组予以单纯药物维持治疗,家庭干预组予以药物维持治疗和家庭干预。采用社会支持量表(SSRS)、简明精神病量表(BPRS)及自知力与治疗态度问卷(ITAQ)分别于患者入组时和治疗1年后采用盲法评定两组患者的精神病性症状严重程度、自知力和社会支持情况。结果:1年后家庭干预组患者再住院率、BPRS评分低于对照组(P0.05),主观支持、支持利用度、ITAQ评分高于对照组(P0.05),两组客观支持评分差异无统计学意义(P0.05)。结论:与单纯的药物维持治疗相比,药物维持治疗联合家庭干预可以有效地降低患者1年内的再住院率,更好地维持患者病情稳定,促进自知力的恢复,提高主观支持和支持利用度。     

缓解期首发精神分裂症患者的家庭功能状况与疾病严重程度的调查研究

目的调查研究缓解期精神分裂症患者的家庭功能情况及其与疾病严重程度间的关系。方法对2012年度中山市第三人民医院首次诊断为精神分裂症患者80例进行问卷调查,调查的时间为临床病情稳定后1周,采用简明精神病量表（BPRS）和自知力与治疗态度问卷（ITAQ）评价患者疾病严重程度,家庭亲密度与适应性量表中文版（FACESII-CV）评价患者家庭功能情况,进行相关分析研究。结果研究对象的实际家庭亲密度评分与ITAQ评分的相关系数r=0.47,P〈0.05相关系数可信,呈显著正相关;而其与BPRS评分的相关系数r=-0.53,P〈0.05相关系数可信,呈显著负相关。研究对象的实际家庭适应性评分与ITAQ评分的相关系数r=0.44,P〈0.05相关系数可信,呈显著正相关;而其与BPRS评分的相关系数r=-0.48,P〈0.05相关系数可信,呈显著负相关。结论缓解期首发精神分裂症患者的家庭功能状况与疾病严重程度关系密切。     

奥氮平和阿立哌唑对首发精神分裂症患者血脂影响的对比研究

目的:探讨奥氮平和阿立哌唑对首发精神分裂症患者脂代谢影响的差异,评价药物的安全性。方法:将127例首发精神分裂症住院患者随机分为奥氮平组(63例)和阿立哌唑组(64例),于治疗前及治疗后第8周末测定患者血总胆固醇(TC)、甘油三酯(TG)水平。结果:经治疗8周后,奥氮平组患者TC、TG升高明显,P<0.05或P<0.01;阿立哌唑组患者TC、TG升高不明显,P>0.05。结论:阿立哌唑对患者的血脂影响较小,奥氮平治疗首发精神分裂症患者可引起血脂明显异常,在治疗过程中应采取必要的干预措施。     

奥氮平与阿立派唑对首发精神分裂症糖代谢影响的对照研究

目的:了解奥氮平与阿立派唑对首发精神分裂症糖代谢的影响。方法:共调查首次发病的住院精神分裂症患者172例,随机给予奥氮平或阿立派唑治疗。分别在两类药物治疗前、治疗后第12周末进行空腹血糖以及口服葡萄糖耐量试验测定。结果:在172例住院首发精神分裂症患者中,奥氮平组86例,糖代谢异常发生率33.7%,糖尿病发生率16.3%;阿立派唑组86例,糖代谢异常发生率3.5%,糖尿病发生率0%。奥氮平与阿立派唑相比引起精神分裂症患者糖代谢异常有显著性差异(P=0.000)。结论:奥氮平比阿立派唑引起精神分裂症患者糖代谢异常的发生率高,应定期监测血糖。     

首发精神分裂症患者家属心理健康与分裂症知晓情况的关系

目的 分析首发精神分裂症患者家属心理健康状况及其与分裂症知晓情况的关系。方法 197例解放军第二六一医院精神科病房2009年4月~2011年7月住院的首发分裂症患者家属于患者入院时进行精神分裂症知识问卷和症状自评量表（SCL-90-R）评定。研究指标为家属分裂症知识知晓情况和心理健康情况。采用独立样本t检验比较家属自评SCL-90-R得分与国内最新常模的差异,并用Pearson相关检验分析患者家属心理健康与精神分裂症知晓情况的关系。结果 首发精神分裂症患者家属精神分裂症知识4个纬度均与SCL-90-R 9因子评分呈显著负相关（r=-0.11~-0.35,P〈0.01）,且SCL-90各维度得分均低于常模,差异有高度统计学意义（t=16.38~35.78,P〈0.01）。结论 首发精神分裂症患者家属精神分裂症知识的知晓情况在一定程度上影响其心理健康水平,对家属进行精神分裂症知识健康教育,提高其对精神分裂症的认识可能有助于改善其心理健康。     

阿立哌唑治疗首发精神分裂症的疗效评价与安全性分析

目的评估阿立哌唑治疗首发精神分裂症的临床疗效和安全性。方法将80例首发精神分裂症患者随机分为阿立哌唑组和利培酮组（各40例）,治疗前后分别评定阳性及阴性症状量表（PANSS）,以PANSS减分率评定疗效,副反应量表（TESS）及实验室相关检查评定药物副反应。结果治疗8周后,两组PANSS各项评分较治疗前均显著降低（P〈0．05）,两组PANSS各项评分减分比较差异均无统计学意义（P〉0．05）;阿立哌唑组总有效率为72．5％,对照组总有效率为70．0％,两组总有效率比较差异无统计学意义（P〉0．05）;两组均未发生严重相关不良事件。结论阿立哌唑是一种安全有效的抗精神病药物,对首发精神分裂症的疗效与利培酮相当。