Keefe Richard S E, Fenton Wayne S
Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Box 3270, Durham, NC 27710, USA.
Schizophr Bull. 2007 Jul;33(4):912-20. doi: 10.1093/schbul/sbm046. Epub 2007 Jun 13.
Neurocognitive impairment is considered a core component of schizophrenia and is increasingly under investigation as a potential treatment target. On average, cognitive impairment is severe to moderately severe compared with healthy controls, and almost all patients with schizophrenia demonstrate cognitive decrements compared with their expected level if they had not developed the illness. Compared with patients with affective disorders, cognitive impairment in schizophrenia appears earlier, is more severe, and tends to be more independent of clinical symptoms. While the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, description of schizophrenia includes several references to cognitive impairment, neither the diagnostic criteria nor the subtypology of schizophrenia include a requirement of cognitive impairment. We forward for consideration a proposal that the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, criteria include a specific criterion of "a level of cognitive functioning suggesting a consistent severe impairment and/or a significant decline from premorbid levels considering the patient's educational, familial, and socioeconomic background." The inclusion of this criterion may increase the "point of rarity" with affective psychoses and may increase clinicians' awareness of cognitive impairment, potentially leading to more accurate prognosis and better treatment outcomes. Future research will need to address the validity of these possibilities. The reliable determination of cognitive impairment as part of a standard diagnostic evaluation may present challenges to diagnosticians with limited resources or insufficient expertise. Various cognitive assessment methods for clinicians, including brief assessments and interview-based assessments, are discussed. Given the current emphasis on the development of cognitive treatments, the evaluation of cognition in schizophrenia is an essential component of mental health education.
神经认知障碍被认为是精神分裂症的核心组成部分，并且作为一个潜在的治疗靶点正受到越来越多的研究。平均而言，与健康对照相比，认知障碍为重度到中度重度，并且几乎所有精神分裂症患者与其未患该病时的预期水平相比都表现出认知功能减退。与情感障碍患者相比，精神分裂症的认知障碍出现得更早、更严重，并且往往更独立于临床症状。虽然《精神障碍诊断与统计手册（第四版，修订本）》对精神分裂症的描述多次提及认知障碍，但精神分裂症的诊断标准和亚型分类均未将认知障碍列为一项要求。我们提出一项建议供大家考虑，即《精神障碍诊断与统计手册（第五版）》的标准应纳入一项具体标准：“考虑到患者的教育、家庭和社会经济背景，认知功能水平表明存在持续的重度损害和/或与病前水平相比有显著下降”。纳入这一标准可能会增加与情感性精神病的“鉴别要点”，并可能提高临床医生对认知障碍的认识，从而有可能带来更准确的预后和更好治疗效果。未来的研究需要探讨这些可能性的有效性。将认知障碍的可靠判定作为标准诊断评估的一部分，可能会给资源有限或专业知识不足的诊断医生带来挑战。文中讨论了供临床医生使用的各种认知评估方法，包括简短评估和基于访谈的评估。鉴于目前对认知治疗发展的重视，精神分裂症认知功能的评估是心理健康教育的一个重要组成部分。
