伴和不伴有凶杀行为精神分裂症患者额叶执行功能的随访观察  

Follow-up study on executive function of frontal lobe in schizophrenics with and without homicide behaviors

作　　者：王红星[1] 马辛[1] 甄文凤[1] 

机构地区：[1]首都医科大学附属北京安定医院,北京100088

出　　处：《中华行为医学与脑科学杂志》2010年第2期136-139,共4页Chinese Journal of Behavioral Medicine and Brain Science

基　　金：北京市科技计划项目（Z09050600630903）,首都医学发展科研基金（2005-536）,北京市科技新星计划（2006A35）

摘　　要：目的随访伴和不伴有凶杀行为的精神分裂症患者额叶执行功能的特点。方法采用威斯康星卡片分类测试（Wisconsin Card Sorting Test，WCST）对22例伴有凶杀行为的精神分裂症患者（凶杀组）和21例非凶杀行为的精神分裂症患者（非凶杀组）进行WCST测试，并且随访3个月。同时，应用阳性和阴性症状量表（PANSS）评定患者的精神症状。结果（1）人组时，凶杀组的完成第一个分类所需应答数高于非凶杀组[（28．64±32．73）分，（11．71±8．10）分，P=0．027]。治疗3月后，凶杀组和非凶杀组间的WCST指标均差异无显著性（均P〉0．05）。（2）与入组时相比，治疗3个月时凶杀组WCST所有指标均差异无显著性（P〉0．05），非凶杀组在3个月时仅概念化水平提高[（46．80±27．04）分，（65．02±21．32）分，P=0．048]。与人组时比较，凶杀组在3个月时的阳性量表分、一般精神病理量表分、PANSS总分及思维障碍、偏执、抑郁、攻击等症状群分降低（P〈0．05）；非凶杀组在3个月时的阳性量表分、阴性量表分、一般精神病理量表分、PANSS总分及思维障碍、激活性、偏执、攻击等症状群分降低（P〈0．01）。（4）入组时凶杀组WCST与PANSS各指标均无相关性（P〉0．05）；非凶杀组仅完成第一个分类所需应答数与激活性呈正相关（r=0．481，P=0．027）。治疗3个月时，凶杀组不能维持完整分类数与阴性量表分（r=-0．694，P=0．018）、PANSS总分（r=-0．635，P=0．036）、攻击分（r=-0．702，P=0．016）呈负相关；非凶杀组不能维持完整分类数与思维障碍呈正相关（r=0．557，P=0．048）。结论伴和不伴有凶杀行为的精神分裂症患者存在执行功能障碍，伴有凶杀行为的精神分裂症患者的抽象概括能力缺陷较不伴有凶杀行为的精神分裂症患者更严重。Objective To explore the characteristics of executive function and the changes of executive function in schizophrenics with and without homicide behaviors during follow-up. Methods Twenty-two schizophrenics with homicide behaviors （homicide group ） and twenty-one schizophrenics without homicide behaviors （ without-homicide group） were examined by Wisconsin Card Sorting Test（ WCST）, and followed up 3 months. All patients＇ clinical symptoms were evaluated by positive and negative symptom scale（PANSS） at the same time. Results （ 1 ） At the baseline, homicide group showed higher score in complete I st Category （ R1 st） than without- homicide group （ （28.64± 32.73 ） vs （ 11.71 ± 8. 10）, P = 0. 027 ） and no difference on other index. （ 2 ） No difference on WCST in homicide group between at the baseline and at three-month treatment （P〉 0.05 ）. Without- homicide group at the baseline showed higher score in conceptual level responses than that of at three-month treatment （ （46.80 ±27.04） vs. （65.02 ±21.32）, P = 0. 048 ）. （ 3 ） Homicide group at three-month treatment showed lower scores in positive scale, general psychopathology scale, PANSS total, thought disorder, activation, paranoid, aggressive than that of at the baseline （P 〈 0.05 ）. Without-homicide group at three-month treatment showed lower scores in positive scale, negative scale, general psychopathology scale, PANSS total, thought disorder, activation, aggressive than that of at the baseline （P 〈 0.01 ）. （4） At the baseline, there was no correlation between WCST and PANSS in homicide group, only R1st score correlated with activation positively in without-homicide group （P 〈 0.05 ）. At three-month treatment, homicide group showed the score of failure to maintain set negatively correlated with negative scale, PANSS total, and aggressive （P 〈 0.05 ）. Conclusions Schizophrenics with homicide and without-homicide behaviors show executive function deficits. Homicide group s

关 键 词：精神分裂症 凶杀行为 威斯康星卡片分类测试 执行功能 

分 类 号：R749.3[医药卫生—神经病学与精神病学] R749.16[医药卫生—临床医学]