认知矫正治疗前后慢性精神分裂症患者功能磁共振成像的对照研究  

Cognitive remediation therapy can renormalize brain activation related to working memory in patients with schizophrenia:a functional magnetic resonance imaging study

作　　者：谭淑平[1] 邹义壮[2] 金真[3] 屈英[4] 杨甫德[5] 肖广荣[4] 马永珩[4] 周东丰[1] 

机构地区：[1]北京大学精神卫生研究所,100083100096 [2]北京回龙观医院 [3]解放军第三○六医院放射科磁共振室暨教育部认知科学与学习重点实验室脑功能成像中心 [4]北京回龙观医院心理科 [5]北京回龙观医院科教办

出　　处：《中华精神科杂志》2007年第1期19-23,共5页Chinese Journal of Psychiatry

基　　金：首都医学发展科研基金(2002-3096)

摘　　要：目的探讨认知矫正治疗对精神分裂症患者工作记忆相关脑区活动的影响。方法对10例病情稳定的慢性精神分裂症患者进行为期6个月的认知矫正治疗,分别于治疗前后进行韦克斯勒记忆量表(WMS)测查及功能磁共振成像(fMRI)测量。结果 (1)WMS 测查:治疗后再认[(8.11±4.34)分]和再生[(10.22±3.35)分]以及 Benton 错误[(3.75±2.92)分]均较治疗前[分别为(5.78±2.95)分、(8.56±3.21)分和(8.00±6.28)分]改善,均 P<0.05。(2)fMRI:治疗前后的反应时和正确率比较,差异无统计学意义(P>0.05)。治疗后在高负荷条件下,背侧前额叶皮质(DLPFC)区域(Brodmann46区)的激活范围(x,y,z=-51,36,15;k=40,t=7.21)小于治疗前的激活范围(x,y,z=-48,24,24,k=154,t=12.72),治疗前后 DLPFC 区域激活(x,y,z=-24,36,18,k=12,t=3.75)的差异有统计学意义(P<0.005);在低负荷条件下,治疗前后 DLPFC 区域激活的差异无统计学意义(P>0.05)。结论认知矫正治疗能改善精神分裂症患者工作记忆相关脑区的活动。Objective To explore the effects of cognitive remediation therapy on brain activity related to working memory in patients with schizophrenia. Methods Ten chronic inpatients with schizophrenia in stable status was recruited in the study, with the sex ratio of 6 males： 4 females, average age of （40 ±5）, average years of education of （11 ± 2）, average disease duration of （21 ± 10） years, average intelligence quotient （IQ） of （84 ± 15 ）, and PANSS total score of （66 ± 11 ）. All patients received 6-month cognitive remediation therapy, and received examination of memory function and functional magnetic resonance imaging pre- and post therapy. Using block-design, subjects performed Sternberg number recognition task （remember two as lower load and five as higher load, digitals simultaneous and make judgment about whether the digital presented latter was that appeared previously） and direction judgment of arrows （toward to left or right） while proceeding blood-oxygen level dependent contrast functional magnetic resonance imaging （BOLD-fMRI）. Results A significant improvement of memory function occurred after treatment, as in Wechsler memory subscales： recognition （5.78 ±2.95 vs. 8.11 ±4. 34） and reproduction （ 8.56 ±3.21 vs. 10. 22 ± 3.35 ） and significant decrease of errors in Benton visual retardation test （ 8.00 ± 6. 28 vs. 3. 75 ± 2. 92）. fMRI results revealed： on higher load working memory condition, activated range in dorsolateral prefrontal cortex （ DLPFC, Brodmann 46） （ k = 40,z = 7.21 ） after treatment was significant smaller than that before treatment （k = 154, Z = 12.72）, and the activation areas in DLPFC region （ Brodmann 9, k = 12, z = 3.75 ） were different between pre- and post treatment. But on lower load working memory condition （ remember 2 digitals）, there was area between pre- and post treatment. Conclusion memory related brain＇s activity. no significant difference of activation in DLPFC Cognitive remediation therapy

关 键 词：精神分裂症 认知疗法 记忆 磁共振成像 

分 类 号：R749.3[医药卫生—神经病学与精神病学]