急性期精神分裂症缓解后的认知功能及相关因素  

Cognitive function and factors associated with remission in first episode schizophrenia

作　　者：周福春[1] 王传跃[1] 项玉涛[1] 姜涛[1] 周晶晶[1] 黄晶[1] 

机构地区：[1]首都医科大学附属北京安定医院,精神疾病诊断与治疗北京市重点实验室,北京100088

出　　处：《中国心理卫生杂志》2013年第8期613-618,共6页Chinese Mental Health Journal

基　　金："十一五"国家科技支撑计划(2007BAI17B04);北京市科技计划(D101107047810001)

摘　　要：目的:考察首发精神分裂症患者急性期临床缓解率,并且探索认知和临床因素对急性期临床缓解的预测作用。方法:选取符合美国精神障碍诊断与统计手册第4版(DSM-IV)精神分裂症诊断标准的55名门诊和住院首发患者,给予利培酮(2～6 mg/d)、奥氮平(10～20 mg/d)或阿立哌唑(10～30mg/d)治疗8周,分别在基线、第4周末和第8周末使用阳性与阴性症状量表(PANSS)评估患者的疾病严重程度和疗效,基线期使用霍普金斯词语学习测验修订版(HVLT-R)、词语流利测验(VFL)、范畴流利测验(VFC)、彩色连线测验(CTT-1和CTT-2)、STROOP色词测验(SCWT)、威斯康星卡片分类测验(WCST-PE和WCST-CC)来评估与记忆和执行功能相关的认知功能指标,使用SCID筛查来确定未治疗精神病期(DUP)。8周末满足PANSS量表的8个核心条目评分均小于或等于3的患者被认为"缓解"。结果:共有30名(54.5%)患者在治疗8周末达到临床缓解。单因素分析表明,达到缓解的患者具有较短的未治疗精神病期(DUP)[(8.1±7.7)vs.(17.0±12.1),P<0.01],较高的HVLT-R分数[(20.4±6.6)vs.(19.1±6.1),P<0.05]和较少的阴性症状[(20.5±7.4)vs.(25.0±5.5),P<0.05]。多元logistic回归分析表明,HVLT-R得分高(OR=1.15)和DUP较短(OR=0.91)是临床缓解的独立预测因素。结论:在基线期记忆功能较好和未治疗精神病期较短的患者更易达到缓解,未发现临床缓解与本研究所用抗精神病药种类、剂量的相关性。Objective： To explore the remission rate in individuals with first episode of schizophrenia （FES） and predictive value of cognitive factors,along with demographic and clinical characteristics related to remission. Methods： Fifty-five FES patients were enrolled in the present study.The diagnoses were made according to the Diagnostic and Statistical Manual of Mental Disorders,Fourth Edition （DSM-IV） established by administering the Structural Clinical Interview for DSM-IV （SCID-DSM-IV） augmented by a review of medical records.All patients were assigned to the treatment of either risperidone （2-6 mg/d）,or olanzapine （10-20 mg/d） or aripiprazole （10-30 mg/d） for 8 weeks,and their psychotic symptoms were evaluated with the Positive and Negative Symptom Scale （PANSS） at baseline,week 4 and week 8.The Hopkins Verbal Learning Test-revised （HVLT-R）,Verbal Fluency Test （VFT）,Color Trails Test （CTT）,Stroop Color Word Test （SCWT）,Wisconsin Card Sorting Test （WCST-CC;WCST-PE） were administrated to assess the cognitive function associated with memory and executive function.Stepwise multiple logistic regression analyses were used to identify predictors of remission.Receiver operating-characteristic （ROC） curves with area under the curve （AUC） values were calculated for remission showing the predicted probabilities from the final logistic model.Patients were classified as remitters at 8-weeks if they got a PANSS score of ≤3 in 8 core items. Results： Thirty patients （54.5%） remitted at the end of the study.Univariate analyze showed that shorter duration of untreated psychosis （DUP）[（8.1±7.7） vs.（17.0±12.1）,P〈0.01],higher HVLT-R score[（20.4±6.6） vs.（19.1±6.1）,P〈0.05] and less severe negative symptoms[（20.5±7.4） vs.（25.0±5.5）,P〈0.05] were associated with remission.In stepwise multiple logistic regression analyses,DUP （OR=0.91） and HVLT-R score （OR=1.15） predicted remission. Conclusion： This study shows that the FES

关 键 词：首发精神分裂症 认知功能 缓解 临床观察 

分 类 号：R749.3[医药卫生—神经病学与精神病学] B842.1[医药卫生—临床医学]