不同类型童年期应激与精神分裂症症状谱的相关性研究  

A Study on the Correlation between Different Types of Childhood Stress and the Spectrum of Schizophrenia Symptoms

作　　者：刘卫青 徐一凡 马晓倩[5] 贺莹[5] 陈晓岗[5] LIU Weiqing;XU Yifan;MA Xiaoqian(Clinical Research Center for Mental Disorders,Shanghai Pudong New Area Mental Health Center,School of Medicine,Tongji University,Shanghai 200124,China)

机构地区：[1]上海市浦东新区精神卫生中心(同济大学附属精神卫生中心),同济大学精神疾病临床研究中心,上海200124 [2]日本理化学研究所脑科学中心 [3]昆明医科大学第一附属医院精神科 [4]成都市第四人民医院情绪障碍中心 [5]中南大学湘雅二医院精神科

出　　处：《国际精神病学杂志》2024年第2期366-371,共6页Journal Of International Psychiatry

基　　金：国家重点研发计划(2021YFE0191400);浦东新区卫健委学科建设项目(PWZzk2022-19);浦东新区卫健委学科带头人项目(PWRd2021-06);浦东新区科技发展基金事业单位民生科研专项(PKJ2021-Y17)。

摘　　要：目的探讨不同性质或不同来源的童年期应激是否与精神分裂症不同症状维度之间具有特异性的关联。方法我们在106名精神分裂症患者和56名健康对照中使用儿童期虐待问卷(CTQ)、童年期社会挫败问卷(CSDQ)、社会支持评定量表(SSRS)及罗森伯格自尊量表(Rosenberg self-esteem scale,SES)对童年期经历的不同来源和性质的创伤或应激进行了全面评定,同时使用阳性和阴性症状量表(PANSS)评定患者的临床症状,从而探讨与精神分裂症阳性症状、阴性症状和一般病理症状关系最密切的童年期应激类型。结果患者组在所有不同性质、来源童年期应激维度上的评分均高于对照组(P<0.001);在不同应激维度与症状的特异性关联方面发现与阳性症状显著相关的应激维度包括:CTQ中的性虐待(SA,r=0.266,P<0.01),CSDQ总分(r=0.240,P<0.05)及其中的社会地位挫败(r=0.247,P<0.05)、家庭关系挫败(r=0.233,P<0.05);与阴性症状显著相关/负相关的应激维度包括:CTQ总分(r=0.198,P<0.05)及其性虐待(SA,r=0.218,P<0.05),CSDQ中的社会地位挫败(r=0.193,P<0.05),SSRS得分(r=-0.279,P<0.01),SES得分(r=-0.242,P<0.05);与一般病理症状显著相关/负相关的应激维度包括:CTQ总分(r=0.239,P<0.05)及其躯体忽视(PN,r=0.264,P<0.01)、SA(r=0.211,P<0.05),CSDQ总分(r=0.248,P<0.05)及其中的中的社会交往挫败(r=0.246,P<0.05),SSRS得分(r=-0.207,P<0.05),SES得分(r=-0.208,P<0.05);PANSS总分则与除CTQ中的躯体虐待、情感虐待和情感忽视外的大部分童年期应激维度呈显著负相关。结论不同性质与来源的童年期应激维度可能通过不同的机制导致不同的精神分裂症症状易感性,即:家庭关系挫败可能特异性导致阳性症状;躯体忽视和社会交往挫败可能特异性导致一般病理症状;社会地位挫败使个体对阳性和阴性症状更易感;SA使个体对精神分裂症症状全面易感。本研究结果有助于精神分裂症的发病机制研Objective To investigate whether childhood stress of different nature or from different sources is specifically associated with different dimensions of schizophrenia symptoms.Methods We comprehensively assessed childhood trauma or stress from different sources and natures in 106 schizophrenia patients and 56 healthy controls using the Childhood Trauma Questionnaire(CTQ),Childhood Social Defeat Questionnaire(CSDQ),Social Support Rating Scale(SSRS),and Rosenberg Self-Esteem Scale(SES).Concurrently,we assessed the clinical symptoms of patients using the Positive and Negative Syndrome Scale(PANSS)to explore the types of childhood stress most closely related to positive symptoms,negative symptoms,and general pathological symptoms of schizophrenia.Results The patient group scored higher than the control group on all dimensions of childhood stress of different natures and sources(P<0.001).In terms of the specific correlation between different stress dimensions and symptoms,significant correlations were found between the following stress dimensions and positive symptoms:sexual abuse in CTQ(SA,r=0.266,P<0.01),total score of CSDQ(r=0.240,P<0.05)and its components of social status defeat(r=0.247,P<0.05),and family relationship defeat(r=0.233,P<0.05).Stress dimensions significantly correlated/negatively correlated with negative symptoms included:total score of CTQ(r=0.198,P<0.05)and its sexual abuse(SA,r=0.218,P<0.05),social status defeat in CSDQ(r=0.193,P<0.05),SSRS score(r=-0.279,P<0.01),SES score(r=-0.242,P<0.05).Stress dimensions significantly correlated/negatively correlated with general pathological symptoms included:total score of CTQ(r=0.239,P<0.05)and its physical neglect(PN,r=0.264,P<0.01),SA(r=0.211,P<0.05),total score of CSDQ(r=0.248,P<0.05)and its social interaction defeat(r=0.246,P<0.05),SSRS score(r=-0.207,P<0.05),SES score(r=-0.208,P<0.05).The PANSS total score was significantly negatively correlated with most childhood stress dimensions except for physical abuse,emotional abuse,and emotional neglect in CTQ.C

关 键 词：精神分裂症 童年期应激 阳性症状 阴性症状 社会挫败 

分 类 号：R749.3[医药卫生—神经病学与精神病学]