Reichenberg Abraham, Harvey Philip D, Bowie Christopher R, Mojtabai Ramin, Rabinowitz Jonathan, Heaton Robert K, Bromet Evelyn
Department of Psychiatry, Emory University School of Medicine, One Gustave L. Levy Place, New York, NY 10029, USA.
Schizophr Bull. 2009 Sep;35(5):1022-9. doi: 10.1093/schbul/sbn044. Epub 2008 May 20.
Mounting evidence suggests that compromised neurocognitive function is a central feature of schizophrenia. There are, however, schizophrenia patients with a normal neuropsychological (NP) performance, but estimates of the proportion of NP normal patients vary considerably between studies. Neurocognitive dysfunction is also a characteristic of other psychotic disorders, yet there are inconsistencies in the literature regarding the similarity to impairments in schizophrenia. NP normality in psychotic affective disorders has not been systematically studied.
Data came from the Suffolk County Mental Health Project, an epidemiological study of first-admission patients with psychotic disorders. Respondents with a diagnosis of schizophrenia (N = 94) or schizoaffective disorder (N = 15), bipolar disorder (N = 78), and major depressive disorder (N = 48) were administered a battery of NP tests assessing 8 cognitive domains 2 years after index admission. Patients' performance profile was compared, and their NP status was classified based on 3 previously published criteria that vary in their stringency.
The 4 diagnostic groups had comparable NP performance profile patterns. All groups demonstrated impairments in memory, executive functions, and attention and processing speed. However, schizophrenia patients were more impaired than the other groups on all cognitive domains. Results were not attenuated when IQ was controlled. Prevalence of NP normality ranged between 16% and 45% in schizophrenia, 20% and 33% in schizoaffective disorder, 42% and 64% in bipolar disorder, and 42% and 77% in depression, depending on the criterion employed.
Evidence suggests that differences in NP performance between schizophrenia and psychotic affective disorders are largely quantitative. NP impairment is also common in psychotic affective disorders. A significant minority of schizophrenia patients are NP normal.
越来越多的证据表明，神经认知功能受损是精神分裂症的核心特征。然而，有一些精神分裂症患者的神经心理学（NP）表现正常，但不同研究对NP正常患者比例的估计差异很大。神经认知功能障碍也是其他精神障碍的特征，但关于与精神分裂症损害的相似性，文献中存在不一致之处。精神情感性障碍中的NP正常情况尚未得到系统研究。
数据来自萨福克郡心理健康项目，这是一项对首次入院的精神障碍患者进行的流行病学研究。对诊断为精神分裂症（N = 94）或分裂情感性障碍（N = 15）、双相情感障碍（N = 78）和重度抑郁症（N = 48）的受访者在首次入院2年后进行了一系列NP测试，评估8个认知领域。比较了患者的表现概况，并根据3个先前发表的严格程度不同的标准对他们的NP状态进行了分类。
4个诊断组具有可比的NP表现概况模式。所有组在记忆、执行功能、注意力和处理速度方面均表现出损害。然而，精神分裂症患者在所有认知领域的损害都比其他组更严重。控制智商后结果并未减弱。根据所采用的标准，精神分裂症患者中NP正常的患病率在16%至45%之间，分裂情感性障碍为20%至33%，双相情感障碍为42%至64%，抑郁症为42%至77%。
有证据表明，精神分裂症和精神情感性障碍之间NP表现的差异在很大程度上是数量上的。NP损害在精神情感性障碍中也很常见。相当一部分精神分裂症患者的NP是正常的。
