Department of Psychiatry, Center for Behavioral Genomics, University of California, San Diego, CA, United States.
Schizophr Res. 2010 May;118(1-3):1-5. doi: 10.1016/j.schres.2010.01.009. Epub 2010 Feb 12.
We examined cognitive deficits before and after onset of schizophrenia in a longitudinal study that: 1) covers a long time interval; 2) minimizes test unreliability by including the identical measure at both childhood and post-onset cognitive assessments; and 3) minimizes bias by utilizing a population-based sample in which participants were selected neither for signs of illness in childhood nor for being at risk for schizophrenia.
Participants in the present study, Developmental Insult and Brain Anomaly in Schizophrenia (DIBS), were ascertained from an earlier epidemiologic study conducted in Oakland, CA. The original version of the Peabody Picture Vocabulary Test (PPVT), a test of receptive vocabulary, was administered at age 5 or 9 and repeated as part of the DIBS study at an average age of 40. There were 10 DIBS cases with DSM-IV schizophrenia or schizoaffective disorder and 15 demographically similar DIBS controls with both child and adult PPVT scores.
Cases scored significantly lower than controls in childhood (d=0.95) and adulthood (d=1.67). Residualized scores indicating the number of SDs above or below one's predicted adult score revealed a mean case-control difference of -1.51SDs, consistent with significant relative decline over time among the cases (p<0.0013).
In this prospective study, individuals who developed adult schizophrenia manifested impaired receptive vocabulary during childhood and further relative deterioration (or lack of expected improvement) between childhood and midlife. Limitations should also be acknowledged, including the small sample size and the fact that we cannot be certain when the continued deterioration took place.
我们在一项纵向研究中检查了精神分裂症发病前后的认知缺陷，该研究：1）涵盖较长的时间间隔；2）通过在儿童期和发病后认知评估中包含相同的测量方法，最大限度地减少测试不可靠性；3）通过利用基于人群的样本，最大限度地减少偏倚，在该样本中，参与者既不是因为儿童时期有疾病迹象，也不是因为有患精神分裂症的风险而被选择。
本研究中的参与者，精神分裂症的发育损伤和脑异常（DIBS），是从加利福尼亚州奥克兰进行的早期流行病学研究中确定的。Peabody 图片词汇测验（PPVT）的原始版本，一种接受性词汇测验，在 5 岁或 9 岁时进行，并作为 DIBS 研究的一部分在平均年龄为 40 岁时重复进行。有 10 名 DIBS 病例患有 DSM-IV 精神分裂症或分裂情感障碍，以及 15 名在儿童和成人 PPVT 评分方面具有相似人口统计学特征的 DIBS 对照者。
病例在儿童期（d=0.95）和成年期（d=1.67）的得分明显低于对照组。表示比其预期成年得分高出或低于一个标准差的残差得分显示，病例对照之间的平均差异为-1.51SD，与病例中随时间推移的显著相对下降一致（p<0.0013）。
在这项前瞻性研究中，发展为成年精神分裂症的个体在儿童时期表现出接受性词汇受损，并且在儿童期和中年之间进一步出现相对恶化（或缺乏预期的改善）。还应该承认存在局限性，包括样本量小以及我们无法确定持续恶化发生的时间。
