Jenkins Lisanne M, Bodapati Anjuli S, Sharma Rajiv P, Rosen Cherise
a Department of Psychiatry , University of Illinois at Chicago , Chicago , IL , USA.
b Jesse Brown Veterans Affairs Medical Center , Chicago , IL , USA.
J Clin Exp Neuropsychol. 2018 Feb;40(1):84-94. doi: 10.1080/13803395.2017.1321106. Epub 2017 May 31.
The recent dramatic increase in research investigating auditory verbal hallucinations (AVHs) has broadened the former narrow focus on schizophrenia to incorporate additional populations that experience these symptoms. However, an understanding of potential shared mechanisms remains elusive. Based on theories suggesting a failure of top-down cognitive control, we aimed to compare the relationship between AVHs and cognition in two categorical diagnoses of psychosis, schizophrenia and psychotic bipolar disorder.
A total of 124 adults aged 21-60 participated, of whom 76 had present-state psychosis (schizophrenia, n = 53; bipolar disorder with psychosis, n = 23), and 48 were non-clinical controls. Diagnosis and hallucination presence was determined using the Structured Clinical Diagnostic Interview for DSM-IV TR. AVHs severity was assessed using the Positive and Negative Syndrome Scale. Participants also completed the MATRICS cognitive battery.
The bipolar disorder with psychosis group performed better than the schizophrenia group for cognitive domains of Processing speed, Attention, Working memory (WM), and Visual memory. Hierarchical binary logistic regression found that WM significantly predicted presence of AVHs in both psychotic groups, but diagnosis did not significantly increase the predictive value of the model. A hierarchical multiple linear regression found that schizophrenia diagnosis was the only significant predictor of hallucination severity.
The findings of this study-the first, to our knowledge, to compare the relationship between AVHs and MATRICS domains across schizophrenia and bipolar disorder with psychosis-support theories that deficits in WM underly the genesis of AVHs. WM potentially represents a shared mechanism of AVHs across diagnoses, supporting dimensional classifications of these psychotic disorders. However, non-cognitive factors predictive of hallucination severity may be specific to schizophrenia.
近期对听觉言语幻觉（AVH）研究的急剧增加，拓宽了以前对精神分裂症的狭隘关注，将经历这些症状的其他人群纳入其中。然而，对潜在共同机制的理解仍然难以捉摸。基于暗示自上而下认知控制失败的理论，我们旨在比较精神分裂症和伴有精神病性症状的双相情感障碍这两种精神病性分类诊断中AVH与认知之间的关系。
共有124名年龄在21至60岁之间的成年人参与，其中76人患有现患精神病（精神分裂症，n = 53；伴有精神病性症状的双相情感障碍，n = 23），48人为非临床对照。使用《精神疾病诊断与统计手册》第四版修订版（DSM-IV TR）的结构化临床诊断访谈来确定诊断和幻觉的存在。使用阳性和阴性症状量表评估AVH的严重程度。参与者还完成了MATRICS认知测试组合。
在处理速度、注意力、工作记忆（WM）和视觉记忆等认知领域，伴有精神病性症状的双相情感障碍组的表现优于精神分裂症组。分层二元逻辑回归发现，WM在两个精神病性组中均显著预测AVH的存在，但诊断并未显著增加模型的预测价值。分层多元线性回归发现，精神分裂症诊断是幻觉严重程度的唯一显著预测因素。
据我们所知，本研究首次比较了精神分裂症和伴有精神病性症状的双相情感障碍中AVH与MATRICS领域之间的关系，支持了WM缺陷是AVH产生基础的理论。WM可能代表了不同诊断中AVH的共同机制，支持这些精神病性障碍的维度分类。然而，预测幻觉严重程度的非认知因素可能是精神分裂症所特有的。
