Mitropoulou Vivian, Harvey Phillip D, Zegarelli Gayle, New Antonia S, Silverman Jeremy M, Siever Larry J
Clinical Research Center, Box 1027, Mt. Sinai School of Medicine, One Gustave Levy Place, New York, NY 10029, USA.
Am J Psychiatry. 2005 Oct;162(10):1896-903. doi: 10.1176/appi.ajp.162.10.1896.
Cognitive deficits consistently have been reported in schizophrenia patients and in patients with schizotypal personality disorder. For this study, the authors wanted to identify which of the domains of cognitive impairment represent "core" deficits of schizophrenia, comparing subjects with schizotypal personality disorder to two comparison groups: healthy volunteers and patients with personality disorders unrelated to schizophrenia.
Three groups completed a neuropsychological battery: patients with DSM-III-R schizotypal personality disorder (N=82); patients with DSM-III-R personality disorders unrelated to schizophrenia (i.e., a personality disorder other than schizotypal, schizoid, or paranoid [N=44]); and healthy volunteers (N=63). The battery included the California Verbal Learning Test, Trailmaking Test parts A and B, the Dot test of working memory, the Stroop Color and Word Test, the Paced Auditory Serial Addition Test, the WMS visual reproduction test, and the WAIS-R vocabulary and block design.
Normative standards for performance that controlled for age, gender, and education were created from the scores of the healthy volunteers. Overall, schizotypal personality disorder patients performed significantly worse than the healthy volunteers and those with personality disorders unrelated to schizophrenia. Specifically, patients with schizotypal personality disorder demonstrated impaired performance on the Paced Auditory Serial Addition Test, WMS visual reproduction test, Dot test, and California Verbal Learning Test. In addition, in a regression analysis, performance on the Paced Auditory Serial Addition Test demonstrated the largest effect size. Indeed, it accounted for unique variance above and beyond all other cognitive measures, since controlling for Paced Auditory Serial Addition Test performance abolished group differences across all other measures.
Patients with schizotypal personality disorder demonstrated moderate cognitive impairment compared with healthy volunteers (significant for seven out of 11 measures). These differences reached statistical significance for tasks of working memory, episodic memory, and delayed recall. Working memory performance accounted for the group differences. This study supports the view that working memory represents a core deficit of schizophrenia spectrum disorders.
一直有报道称精神分裂症患者及分裂型人格障碍患者存在认知缺陷。在本研究中，作者希望通过将分裂型人格障碍患者与两个对照组进行比较，确定认知损害的哪些领域代表精神分裂症的“核心”缺陷，这两个对照组分别是健康志愿者和与精神分裂症无关的人格障碍患者。
三组完成了一套神经心理学测试：DSM-III-R 分裂型人格障碍患者（N = 82）；与精神分裂症无关的 DSM-III-R 人格障碍患者（即除分裂型、分裂样或偏执型人格障碍之外的其他人格障碍患者 [N = 44]）；以及健康志愿者（N = 63）。该测试包括加利福尼亚言语学习测验、连线测验 A 部分和 B 部分、工作记忆点测验、斯特鲁普颜色和文字测验、听觉连续加法测验、韦氏记忆量表视觉再现测验以及韦氏成人智力量表修订版词汇和积木图案测验。
根据健康志愿者的得分建立了针对年龄、性别和教育程度进行校正的表现规范标准。总体而言，分裂型人格障碍患者的表现明显比健康志愿者以及与精神分裂症无关的人格障碍患者差。具体来说，分裂型人格障碍患者在听觉连续加法测验、韦氏记忆量表视觉再现测验、点测验和加利福尼亚言语学习测验中的表现受损。此外，在回归分析中，听觉连续加法测验的表现显示出最大的效应量。实际上，它解释了所有其他认知测量之外的独特方差，因为控制听觉连续加法测验的表现消除了所有其他测量中的组间差异。
与健康志愿者相比，分裂型人格障碍患者表现出中度认知损害（11 项测量中有 7 项具有显著性）。这些差异在工作记忆、情景记忆和延迟回忆任务中具有统计学意义。工作记忆表现解释了组间差异。本研究支持工作记忆是精神分裂症谱系障碍核心缺陷的观点。
