Smith T E, Hull J W, Goodman M, Hedayat-Harris A, Willson D F, Israel L M, Munich R L
Department of Psychiatry, Weill Medical College of Cornell University, New York Presbyterian Hospital, White Plains 10605, USA.
J Nerv Ment Dis. 1999 Feb;187(2):102-8. doi: 10.1097/00005053-199902000-00006.
Impaired insight and neurocognitive deficits are commonly seen in schizophrenia. No study to date, however, has documented the relative influences of insight deficits, neurocognitive functioning, and psychotic symptoms on overall social adjustment in this population. This was done in a cohort of individuals recovering from acute exacerbations. Forty-six individuals with schizophrenia or schizoaffective disorder were recruited upon discharge from an inpatient unit. Symptom levels, neurocognitive functioning (information processing, memory, and executive functioning), and symptom awareness were documented, and social adjustment was assessed in three domains: treatment compliance, social behavior, and subjective quality of life. Cross-sectional data from initial assessments are reported. Sequential linear regression analyses identified differential associations between illness characteristics and outcome domains. Treatment compliance was most influenced by insight; social behavior deficits were associated with thought disorder and neurocognitive (working memory and visuo-spatial) impairments; and quality of life was associated with mood disturbances. Outcome is multidimensional in schizophrenia, and there are differential patterns of associations between illness characteristics and domains of social adjustment. Studies such as this can guide clinicians in determining the most appropriate treatments for specific individuals and should also guide researchers in efforts to clarify the processes that underlie treatment response and recovery in schizophrenia.
洞察力受损和神经认知缺陷在精神分裂症中很常见。然而，迄今为止，尚无研究记录洞察力缺陷、神经认知功能和精神病症状对该人群整体社会适应的相对影响。本研究针对一组从急性加重期恢复的个体进行。46例精神分裂症或分裂情感性障碍患者在从住院部出院时被招募。记录症状水平、神经认知功能（信息处理、记忆和执行功能）以及症状意识，并从治疗依从性、社会行为和主观生活质量三个方面评估社会适应情况。报告了初始评估的横断面数据。序贯线性回归分析确定了疾病特征与结果领域之间的差异关联。治疗依从性受洞察力影响最大；社会行为缺陷与思维障碍和神经认知（工作记忆和视觉空间）损害有关；生活质量与情绪障碍有关。精神分裂症的结果是多维度的，疾病特征与社会适应领域之间存在不同的关联模式。此类研究可为临床医生确定针对特定个体的最合适治疗方法提供指导，也应为研究人员努力阐明精神分裂症治疗反应和康复的潜在过程提供指导。
