Department of Psychiatry, Box 3270, Duke University Medical Center, Durham, NC 27710, USA.
World Psychiatry. 2008 Feb;7(1):22-8. doi: 10.1002/j.2051-5545.2008.tb00142.x.
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 to healthy controls, and almost all patients with schizophrenia demonstrate cognitive decrements compared to their expected level if they had not developed the illness. Compared to patients with affective disorders, cognitive impairment in schizophrenia appears earlier, is more severe, and is more independent of clinical symptoms. Although the DSM-IV-TR and ICD-10 descriptions of schizophrenia include several references to cognitive impairment, neither the diagnostic criteria nor the subtypology of schizophrenia include a requirement of cognitive impairment. This paper forwards for consideration a proposal that the diagnostic 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, better treatment outcomes, and a clearer diagnostic signal for genetic and biological studies. Future research will need to address the validity of these possibilities. The reliable determination of cognitive impairment as part of a standard diagnostic evaluation will present challenges to diagnosticians with limited resources or insufficient expertise. 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，并且越来越多地被作为潜在的治疗靶点进行研究。与健康对照组相比，认知障碍的平均严重程度为重度至中度，并且几乎所有精神分裂症患者的认知能力都低于他们未患病时的预期水平。与情感障碍患者相比，精神分裂症患者的认知障碍出现得更早，更严重，并且与临床症状的相关性更低。尽管 DSM-IV-TR 和 ICD-10 对精神分裂症的描述包括对认知障碍的几次提及，但诊断标准或精神分裂症的亚型分类均不包括认知障碍的要求。本文提出了一个建议，即诊断标准包括一个特定的标准，即“认知功能水平表明存在持续严重的障碍，或考虑到患者的教育、家庭和社会经济背景，与病前水平相比有明显下降”。纳入这一标准可能会增加与情感精神病的“罕见性”，并提高临床医生对认知障碍的认识，从而可能导致更准确的预后、更好的治疗结果以及更明确的遗传和生物学研究的诊断信号。未来的研究需要解决这些可能性的有效性。将认知障碍可靠地确定为标准诊断评估的一部分，这将给资源有限或专业知识不足的诊断医生带来挑战。讨论了用于临床医生的认知评估方法，包括简短评估和基于访谈的评估。鉴于目前对认知治疗的发展的重视，精神分裂症中的认知评估是心理健康教育的重要组成部分。
