Chen Eric Yu-Hai, Hui Christy Lai-Ming, Dunn Eva Lai-Wah, Miao May Yin-King, Yeung Wai-Song, Wong Chi-Keung, Chan Wah-Fat, Tang Wai-Nang
Department of Psychiatry, University of Hong Kong, Queen Mary Hospital, Pokfulam Road, Hong Kong.
Schizophr Res. 2005 Sep 1;77(1):99-104. doi: 10.1016/j.schres.2005.02.020.
Cognitive predictors of relapse have been extensively explored only in few long term longitudinal studies of first-episode schizophrenia.
This study prospectively followed 93 patients with first-episode schizophrenia, schizophreniform disorder, and schizoaffective disorder for 3 years after their first-episode illness. Cognitive domains including verbal intelligence, verbal and visual memory, verbal fluency, and Wisconsin Card Sorting Test performance were investigated as potential predictors of relapse.
We found that by the first year 21% patients had relapsed, by the second year 33% had relapsed, and by the third year 40% had relapsed. There was a significant difference in the relapse rate between patients with good adherence and patients with poor adherence to medication regimes. A multiple logistic regression analysis revealed that after controlling for medication adherence, perseverative error in the Wisconsin Card Sorting Test was the only cognitive function that significantly predict relapse with an odds ratio of 2.4.
Cognitive flexibility in set shifting is related to tendency towards relapse in first-episode schizophrenic patients. Other cognitive factors appear not to be related to relapse. Possible mechanisms included the link between prefrontal dysfunction and sub-cortical dopamine system stability, as well as the effects of executive dysfunction on insight impairment and adherence behavior.
复发的认知预测因素仅在少数关于首发精神分裂症的长期纵向研究中得到广泛探讨。
本研究对93例首发精神分裂症、分裂样障碍和分裂情感性障碍患者在首次发病后进行了3年的前瞻性随访。对包括言语智力、言语和视觉记忆、言语流畅性以及威斯康星卡片分类测验表现在内的认知领域进行了调查，以作为复发的潜在预测因素。
我们发现，到第一年时21%的患者复发，到第二年时33%的患者复发，到第三年时40%的患者复发。依从性好的患者和依从性差的患者在复发率上存在显著差异。多元逻辑回归分析显示，在控制药物依从性后，威斯康星卡片分类测验中的持续性错误是唯一能显著预测复发的认知功能，比值比为2.4。
首发精神分裂症患者在任务转换中的认知灵活性与复发倾向有关。其他认知因素似乎与复发无关。可能的机制包括前额叶功能障碍与皮质下多巴胺系统稳定性之间的联系，以及执行功能障碍对洞察力损害和依从行为的影响。
