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[精神分裂症——认知功能障碍与疾病的病程及精神病理学特征有关吗?]

[Schizophrenic disorders--does cognitive dysfunction relate to characteristics of course and psychopathology of the illness?].

作者信息

Wciórka Jacek, Bembenek Anna, Hintze Beata, Kühn-Dymecka Aleksandra

机构信息

I Klinika Psychiatryczna IPiN w Warszawie.

出版信息

Psychiatr Pol. 2006 Sep-Oct;40(5):867-84.

Abstract

AIM

Because of their importance both for pathogenesis or clinical aspects of the disease and for patients' social functioning, cognitive dysfunctions are nowadays often considered as basic characteristics of schizophrenic disorders. This study was aimed at evaluation of the correlation between some indices of disordered cognitive functioning on the one hand and some variables describing course and psychopathology of schizophrenic disorders on the other.

METHOD

The study group consisted of 69 inpatients suffering from schizophrenia diagnosed according to both DSM-IV and ICD-10 criteria. Their mental state was rated by two clinical tools (scales: PANSS, KOSS). Also social functioning of patients in the year preceding current hospitalisation was rated by two scales (GAF, scale W). Cognitive dysfunctions were assessed by computer-aided tests from Dr. Schufried's Vienna Test System including measures of reaction time (RT), visual line pursuit (LVT), perseveration (PERSEV), and span of visual-spatial short term memory (CORSI). In statistical analysis simple nonparametric tests and rank correlation measures were applied.

RESULTS

Correlations were confirmed between cognitive dysfunctions and social functioning prior to hospitalisation, age, duration of illness and number of previous hospitalizations. Dysfunctions were less severe in first episode patients than in patients during relapses or the residuum stage of illness. Overall assessments of severity of illness do not correlate with cognitive dysfunctions, but detailed analysis of psychopathology revealed correlations of the latter with such psychopathological dimensions as deficit, disorganization and dysphoria. Reality distortion (positive) psychopathological dimension did not have any correlation with cognitive measures. All indices of cognitive dysfunction correlated with poorer outcome of treatment of the current episode. All correlations confirmed were only of weak or moderate level.

CONCLUSIONS

Cognitive dysfunctions correlate rather with unfavourable characteristics of the course of the illness. Results of psychopathological assessment hardly correlate with neuropsychological measures--cognitive dysfunctions are related rather to deficit (negative), disorganisation or dysphoria dimensions of a schizophrenic syndrome than to productive (reality distortion, positive) dimension of the syndrome.

摘要

目的

由于认知功能障碍对于疾病的发病机制或临床方面以及患者的社会功能都很重要,如今它常被视为精神分裂症的基本特征。本研究旨在评估一方面认知功能紊乱的某些指标与另一方面描述精神分裂症病程及精神病理学的某些变量之间的相关性。

方法

研究组由69名根据DSM-IV和ICD-10标准诊断为精神分裂症的住院患者组成。他们的精神状态通过两种临床工具(量表:阳性和阴性症状量表、简明精神病评定量表)进行评定。患者在本次住院前一年的社会功能也通过两种量表(大体功能评定量表、W量表)进行评定。认知功能障碍通过来自舒弗里德博士维也纳测试系统的计算机辅助测试进行评估,包括反应时间(RT)、视觉线追踪(LVT)、持续性(PERSEV)以及视觉空间短期记忆广度(CORSI)的测量。在统计分析中应用了简单非参数检验和等级相关测量方法。

结果

认知功能障碍与住院前的社会功能、年龄、病程以及既往住院次数之间的相关性得到了证实。首发患者的功能障碍比复发期或疾病残留期患者的功能障碍程度要轻。疾病严重程度的总体评估与认知功能障碍无相关性,但对精神病理学的详细分析显示,后者与诸如缺陷、紊乱和烦躁不安等精神病理学维度存在相关性。现实扭曲(阳性)精神病理学维度与认知测量无任何相关性。认知功能障碍的所有指标都与本次发作治疗的较差结局相关。所有得到证实的相关性仅为弱或中等程度。

结论

认知功能障碍与疾病病程的不良特征密切相关。精神病理学评估结果与神经心理学测量几乎无相关性——认知功能障碍更多地与精神分裂症综合征的缺陷(阴性)、紊乱或烦躁不安维度相关,而非与该综合征的阳性(现实扭曲)维度相关。

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