Best Michael W, Gupta Maya, Bowie Christopher R, Harvey Philip D
Department of Psychology, Queen's University, Ontario, Canada.
Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, USA ; Research Service Bruce Carter VA Medical Center, Miami, FL.
Schizophr Res Cogn. 2014 Jun 1;1(2):90-95. doi: 10.1016/j.scog.2014.03.002.
Many individuals with schizophrenia experience remission of prominent positive symptoms but continue to experience impairments in real world functioning. Residual negative and depressive symptoms may have a direct impact on functioning and impair patients' ability to use the cognitive and functional skills that they possess (competence) in the real world (functional performance).
136 individuals (100 men, 36 women) with schizophrenia were classified as having primarily positive symptoms, primarily negative symptoms, primarily depressive symptoms, or undifferentiated symptom profiles. Performance based measures of cognition and adaptive and interpersonal functional competence were used, along with ratings of real world behavior by high contact clinicians. Assessments were performed at baseline and at an 18-month follow-up.
The relationships between neurocognition and capacity / performance were not moderated by symptom group s > .091; neurocognition predicted capacity and performance for all groups s < .001. The relationship between adaptive competence and adaptive performance was moderated by symptom group, s < .01, such that baseline competence only predicted future performance ratings for participants with primarily positive or undifferentiated symptoms, and not for individuals with primarily negative or depressive symptoms. This same moderation effect was found on the relationship between interpersonal competence and interpersonal performance, s < .002.
Residual negative and depressive symptoms are distinct constructs that impede the use of functional skills in the real world. Depressive symptoms are often overlooked in schizophrenia but appear to be an important factor that limits the use of functional ability in real world environments.
许多精神分裂症患者的显著阳性症状会有所缓解，但在现实世界中的功能仍持续受损。残留的阴性和抑郁症状可能会直接影响功能，并损害患者在现实世界中运用自身所具备的认知和功能技能（能力）的能力（功能表现）。
136名精神分裂症患者（100名男性，36名女性）被分为主要表现为阳性症状、主要表现为阴性症状、主要表现为抑郁症状或症状不典型的类型。采用基于表现的认知、适应性和人际功能能力测量方法，以及与患者有密切接触的临床医生对其现实世界行为的评分。在基线和18个月随访时进行评估。
神经认知与能力/表现之间的关系不受症状组的影响（s>.091）；神经认知可预测所有组的能力和表现（s<.001）。适应性能力与适应性表现之间的关系受症状组影响（s<.01），即基线能力仅能预测主要表现为阳性或症状不典型的参与者未来的表现评分，而不能预测主要表现为阴性或抑郁症状的个体。在人际能力与人际表现之间的关系上也发现了同样的调节效应（s<.002）。
残留的阴性和抑郁症状是不同的结构，会阻碍在现实世界中运用功能技能。抑郁症状在精神分裂症中常被忽视，但似乎是限制在现实世界环境中运用功能能力的一个重要因素。
