Ventura Joseph, Hellemann Gerhard S, Thames April D, Koellner Vanessa, Nuechterlein Keith H
UCLA Department of Psychiatry and Biobehavioral Sciences, Los Angeles, CA 90095-6968, USA.
Schizophr Res. 2009 Sep;113(2-3):189-99. doi: 10.1016/j.schres.2009.03.035. Epub 2009 Jul 22.
Neurocognitive functioning in schizophrenia has received considerable attention because of its robust prediction of functional outcome. Psychiatric symptoms, in particular negative symptoms, have also been shown to predict functional outcome, but have garnered much less attention. The high degree of intercorrelation among all of these variables leaves unclear whether neurocognition has a direct effect on functional outcome or whether that relationship to functional outcome is partially mediated by symptoms.
A meta-analysis of 73 published English language studies (total n=6519) was conducted to determine the magnitude of the relationship between neurocognition and symptoms, and between symptoms and functional outcome. A model was tested in which symptoms mediate the relationship between neurocognition and functional outcome. Functional outcome involved measures of social relationships, school and work functioning, and laboratory assessments of social skill.
Although negative symptoms were found to be significantly related to neurocognitive functioning (p<.01) positive symptoms were not (p=.97). The relationship was moderate for negative symptoms (r=-.24, n=4757, 53 studies), but positive symptoms were not at all related to neurocogniton (r=.00, n=1297, 25 studies). Negative symptoms were significantly correlated with functional outcome (r=-.42, p<.01), and again the correlation was higher than for positive symptoms (r=-.03, p=.55). Furthermore, our findings support a model in which negative symptoms significantly mediate the relationship between neurocognition and functional outcome (Sobel test p<.01).
Although neurocognition and negative symptoms are both predictors of functional outcome, negative symptoms might at least partially mediate the relationship between neurocognition and outcome.
精神分裂症的神经认知功能因其对功能结局的有力预测而受到了广泛关注。精神症状，尤其是阴性症状，也已被证明可预测功能结局，但受到的关注要少得多。所有这些变量之间的高度相互关联使得神经认知对功能结局是否有直接影响，或者其与功能结局的关系是否部分由症状介导尚不清楚。
对73项已发表的英文研究（总计n = 6519）进行荟萃分析，以确定神经认知与症状之间以及症状与功能结局之间关系的强度。测试了一个模型，其中症状介导神经认知与功能结局之间的关系。功能结局涉及社会关系、学校和工作功能的测量以及社交技能的实验室评估。
虽然发现阴性症状与神经认知功能显著相关（p <.01），但阳性症状并非如此（p =.97）。阴性症状的相关性为中等（r = -.24，n = 4757，53项研究），但阳性症状与神经认知完全无关（r =.00，n = 1297，25项研究）。阴性症状与功能结局显著相关（r = -.42，p <.01），同样，其相关性高于阳性症状（r = -.03，p =.55）。此外，我们的研究结果支持一个模型，其中阴性症状显著介导神经认知与功能结局之间的关系（Sobel检验p <.01）。
虽然神经认知和阴性症状都是功能结局的预测因素，但阴性症状可能至少部分介导神经认知与结局之间的关系。
