Keefe Richard S E, Poe Margaret P, McEvoy Joseph P, Vaughan Adam
Duke University Medical Center, Box 3270, Durham, NC 27710, USA.
Psychopharmacology (Berl). 2003 Sep;169(3-4):383-9. doi: 10.1007/s00213-003-1476-0. Epub 2003 May 21.
The absence of a relationship between cognitive deficit treatment response and positive symptom treatment response is often assumed, and few data have shed light on this issue. Most of these data have been collected using standard neuropsychological measures, which are ill-designed to assess the types of neurocognitive disturbances associated with psychotic symptoms. This study investigates the effect of treatment on source monitoring performance and its relation to the reduction of certain psychotic symptoms associated with the inability to identify self-generated mental events, known as "autonoetic agnosia".
To determine whether risperidone, olanzapine, and haloperidol were differentially effective in reducing autonoetic agnosia and whether changes in this aspect of cognition were related to reduction of specific symptoms of psychosis.
From a cohort of 49 patients diagnosed with schizophrenia by DSM-IV criteria and randomly assigned to double-blind treatment with risperidone, olanzapine, or haloperidol, 16 patients were identified with symptoms believed to reflect autonoetic agnosia ("target symptoms") as assessed with the Schneiderian Symptom Rating Scale, and then evaluated during a baseline period, and then at 1, 2, and 3 weeks. Autonoetic agnosia was assessed as the ability of a patient to distinguish self-generated words from both experimenter-generated words and pictorially presented words.
Analysis of patients from all treatment groups found a significant reduction in the number of "target" Schneiderian symptoms. Discrimination for items from the self-generated and heard sources significantly improved with treatment, as did the number of self-generated items that patients remembered as coming from the heard source ("self-hear errors"). The correlation between improvement in recognition of self-generated items and reduction in target Schneiderian symptoms after 2 weeks of treatment suggested a modest relationship between symptom improvement and changes in autonoetic agnosia.
While the differences between medications were not statistically significant, antipsychotic medication in general was associated with improvements in symptoms and cognitive deficits that may underlie autonoetic agnosia. Improvement of autonoetic agnosia was a weak predictor of positive symptom improvement in a limited sample.
人们常常假定认知缺陷治疗反应与阳性症状治疗反应之间不存在关联，且鲜有数据能阐明这一问题。这些数据大多是通过标准神经心理学测量方法收集的，而这些方法在设计上并不适合评估与精神症状相关的神经认知障碍类型。本研究调查了治疗对源监测表现的影响及其与某些因无法识别自我产生的心理事件（即“自知力失认症”）而产生的精神症状减轻之间的关系。
确定利培酮、奥氮平和氟哌啶醇在减轻自知力失认症方面是否有不同效果，以及认知方面的这种变化是否与精神病特定症状的减轻有关。
从一组49名根据《精神疾病诊断与统计手册》第四版（DSM-IV）标准诊断为精神分裂症且被随机分配接受利培酮、奥氮平或氟哌啶醇双盲治疗的患者中，通过施奈德症状评定量表评估，确定16名有被认为反映自知力失认症的症状（“目标症状”）的患者，然后在基线期进行评估，随后在第1、2和3周进行评估。自知力失认症通过患者区分自我产生的单词与实验者产生的单词以及图片呈现的单词的能力来评估。
对所有治疗组患者的分析发现，施奈德“目标”症状的数量显著减少。治疗后，对自我产生和听到来源的项目的辨别能力显著提高，患者将自我产生的项目误记为来自听到来源的数量（“自我听觉错误”）也有所改善。治疗2周后，自我产生项目识别能力的提高与施奈德目标症状减少之间的相关性表明，症状改善与自知力失认症变化之间存在适度关联。
虽然药物之间的差异无统计学意义，但一般而言，抗精神病药物与症状改善以及可能是自知力失认症基础的认知缺陷改善有关。在有限样本中，自知力失认症的改善对阳性症状改善的预测作用较弱。
