Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan.
Schizophr Res. 2013 May;146(1-3):231-7. doi: 10.1016/j.schres.2013.02.009. Epub 2013 Mar 9.
The functional outcome of schizophrenia is affected by multiple factors such as cognitive function and clinical symptoms. The complex relationship among cognitive function (both neuro- and social-cognitions), clinical symptoms, and functional outcome remains unclear. The current study employed structural equation modeling (SEM) to examine whether clinical symptoms mediate the relationship between cognitive function and functional outcome in a large cohort of patients with schizophrenia.
Three hundred and two Han-Chinese patients with chronically stable schizophrenia received evaluation of cognitive function (using the Measurement and Treatment Research to Improve Cognition in Schizophrenia [MATRICS] Consensus Cognitive Battery, including 7 domains covering neurocognition and social cognition), clinical symptoms (including positive, negative and depressive symptoms), and functional outcome as assessed by Global Assessment of Functioning Scale and Quality of Life Scale.
SEM identified clinical symptoms as a mediator between cognitive function (including all 7 domains of MATRICS) and functional outcome in schizophrenia. The relationship between cognitive function and functional outcome was significant in the basic model. In the mediation model, the link between cognitive function and functional outcome was mediated by clinical symptoms, mainly negative symptoms.
This study suggests that clinical symptoms, mainly negative symptoms, mediate the influence of neurocognition and social cognition on functional outcome of schizophrenia. Future studies should explore the impact on other functional outcomes in different ethnicities and various illness phases.
精神分裂症的功能结局受认知功能和临床症状等多种因素的影响。认知功能（神经认知和社会认知）、临床症状和功能结局之间的复杂关系尚不清楚。本研究采用结构方程模型（SEM）来检验认知功能和临床症状是否在一个较大的精神分裂症患者队列中调节认知功能和功能结局之间的关系。
302 名汉族慢性稳定期精神分裂症患者接受认知功能评估（使用精神分裂症认知治疗与研究改善认知[MATRICS]共识认知成套测验，包括涵盖神经认知和社会认知的 7 个领域）、临床症状（包括阳性、阴性和抑郁症状）以及功能结局（采用总体功能评估量表和生活质量量表评估）。
SEM 确定了临床症状在精神分裂症患者认知功能（包括 MATRICS 的所有 7 个领域）和功能结局之间的中介作用。在基本模型中，认知功能与功能结局之间存在显著关系。在中介模型中，认知功能与功能结局之间的联系由临床症状（主要是阴性症状）介导。
本研究表明，临床症状（主要是阴性症状）介导了神经认知和社会认知对精神分裂症功能结局的影响。未来的研究应在不同种族和不同疾病阶段探索对其他功能结局的影响。
