精神分裂症认知功能神经心理学评定的研究进展

目的 探讨精神分裂症患者认知功能损害影响患者社会功能转归和疾病的预后.方法 通过查阅近年来国内外文献,对精神分裂症患者认知功能障碍从表现、评测方法到治疗等方面作一综述.结果 认知功能损害在精神分裂症病人的神经心理损害中有一定特征性,精神分裂症患者神经心理测验中都发现有额叶功能损害.认知障碍的病理学基础是前额叶-纹状体-丘脑-颞叶(称为额-颞叶系统)相互之间的连接功能紊乱,其中海马功能障碍起着重要作用;自知力与认知损害有密切联系,改善认知功能不但能改善病人的症状,对治疗的反应,还可改善社会问题的处理技巧,提高心理社会技巧,促进社会功能,提高生活质量,最终将促进病人整体功能的恢复.结论 如何正确评测及改善患者的认知功能对临床工作有重要指导意义.利培酮和氯氮平是目前广泛用于临床治疗精神分裂症的非经典抗精神病药物,均为多巴胺受体拮抗剂和5- HT2A受体拮抗剂,不但能保持患者的认知功能水平,不继续恶化,而且还能改善其认知功能.认知行为治疗比一般支持治疗有效,并可减少复发和住院次数,减少社会的医药卫生负担.

The Current Developments on Neuropsychological Assessment of Cognitive Function in Schizophrenia

Objective To explore the current development upon the impact of schizophrenia patients' cognitive dysfunctions on their social function and prognosis. Methods The related literatures in recent years were collected which were focused on the presentation, assessment, and clinical treatment of cognitive dysfunction in schizophrenia. Results There were certain neuropsychological characteristics in the cognitive function impairments in schizophrenia patients. Neuropsychological assessment studies suggested that there existed functional impairments in prefrontal lobes of schizophrenia patients. It is assumed that the pathological basis of cognitive functional impairments in schizophrenia lies in integrating dysfunction in prefrontal-striatum-thalamus-temporal pathway (called prefrontal-temporal system) and among them, dysfunctions in hippocampus play an important role. It is also suggested that Insight to illness has a close connection with cognition impairment. Improvement of cognitional function in patients may promote process of recovery and treatment effects, improve abilities to cope with life events so as to maintain a psychosocial function, enhance the life quality and promote schizophrenia patient's overall function ultimately. Conclusion Accurate assessment and effective intervention for cognitive dysfunctions in Schizophrenia are clinically significant. Risperdal and clozapine are non-classical antipsychotic drugs widely used in treating schizophrenia. Both of them are DA and 5-HT2A receptor antagonists. They can not only maintain patient's cognitive level and prevent it from deteriorating but also improve their cognitive function. The effect of Cognitive Therapy is better than other regular supportive therapies and can decrease the chances of relapse and re-administration. At the same time the social burden from mental health care can be mitigated.