Zanello Adriano, Perrig Lisa, Huguelet Philippe
Département de Psychiatrie, Hôpitaux Universitaires de Genève, 8, rue du XXXI Décembre, 1207 Genève, Switzerland.
Psychiatry Res. 2006 May 30;142(1):67-78. doi: 10.1016/j.psychres.2003.07.009. Epub 2006 Apr 24.
Subjects with schizophrenia have cognitive alterations. The functional consequences of these deficits need to be fully determined, in order to implement more effective rehabilitation programs for patients with schizophrenia. This research explores the relationships between cognitive functioning and social problem-solving skills in a group of 20 chronic schizophrenic patients compared with those found in a group of 20 healthy subjects. The following cognitive domains were evaluated: verbal memory (Rey Auditory-Verbal Test; RAVLT), visuo-spatial organization and visuo-spatial memory (Rey-Osterrieth complex figure test; RF), executive functioning (semantic verbal fluency test; VF, design fluency task; DF and Wisconsin Card Sorting Test; WCST), attention (d 2 cancellation test) and general intellectual ability (Standard Progressive Matrices of Raven; SPM). Social problem-solving skills were assessed with a video-based test; the Assessment of Interpersonal Problem-Solving Skills (AIPSS). As a group, patients performed significantly worse than control subjects on every cognitive variable and on AIPSS receiving, processing and sending constructs. Among schizophrenic patients, correlations between AIPSS constructs and neuropsychological tests were observed for VF, DF, d2 and SPM whilst these associations were not replicated in healthy subjects. However, in the whole sample, after adjusting for age, gender and education, SPM displayed significant associations with all three AIPSS constructs. Moreover, after taking SPM into account, neither diagnostic groups (patients versus control) nor cognitive variables, except d2, provided an additional contribution to AIPSS performance. Cognitive impaired performances, mainly frontal, have a deleterious effect on social problem-solving skills in the schizophrenic group. It is suggested that alterations in social problem-solving skills may reflect social anxiety and/or " theory of mind " impairment. These factors may explain the lack of association among healthy subjects. The results support the inclusion of cognitive remediation programs designed to enhance social skills for patients where a cognitive deficit is clearly ascertained.
精神分裂症患者存在认知改变。为了为精神分裂症患者实施更有效的康复计划，需要充分确定这些缺陷的功能后果。本研究探讨了20名慢性精神分裂症患者与20名健康受试者在认知功能和社会问题解决技能之间的关系。评估了以下认知领域：言语记忆（雷伊听觉言语学习测验；RAVLT）、视觉空间组织和视觉空间记忆（雷伊-奥斯特里赫复杂图形测验；RF）、执行功能（语义言语流畅性测验；VF、设计流畅性任务；DF和威斯康星卡片分类测验；WCST）、注意力（d2删除测验）和一般智力能力（瑞文标准渐进矩阵测验；SPM）。使用基于视频的测试评估社会问题解决技能；人际问题解决技能评估（AIPSS）。作为一个群体，患者在每个认知变量以及AIPSS的接收、处理和发送结构方面的表现明显比对照组差。在精神分裂症患者中，观察到AIPSS结构与神经心理学测试之间在VF、DF、d2和SPM方面存在相关性，而在健康受试者中未发现这些关联。然而，在整个样本中，在调整年龄、性别和教育程度后，SPM与所有三个AIPSS结构均显示出显著关联。此外，在考虑SPM后，除d2外，诊断组（患者与对照组）和认知变量对AIPSS表现均未提供额外贡献。认知功能受损表现，主要是额叶方面的，对精神分裂症组的社会问题解决技能有有害影响。有人认为，社会问题解决技能的改变可能反映了社交焦虑和/或“心理理论”受损。这些因素可能解释了健康受试者之间缺乏关联的原因。结果支持纳入旨在为明确确定存在认知缺陷的患者增强社交技能的认知康复计划。
