Zhang Li, Ran Xuemei, Li Ting, Ku Yixuan, Liu Li, Huang Tingming, Yan Wenjia
Outpatient, Shanghai Changning District Mental Health Center, Shanghai, China.
Institute of Cognitive Neuroscience, East China Normal University, Shanghai, China.
Gen Psychiatr. 2018 Dec 14;31(3):e100036. doi: 10.1136/gpsych-2018-100036. eCollection 2018.
Patients with schizophrenia have general cognitive impairments, and the impairment of working memory is considered to be the basis of cognitive impairments. The research on visual working memory, one of the subcomponents, is getting more and more attention. However, the influencing factors which cause the deficits of visual working memory in patients with schizophrenia have not been clearly explained. To provide evidence for cognitive impairment interventions, the present study explored the factors influencing the deficits of patients' visual working memory.
The present study discussed the relevant factors influencing the visual working memory of patients with schizophrenia by measuring the accuracy of the visual working memory of patients with schizophrenia and healthy controls.
Colour-recall paradigm was employed to measure the accuracy of the visual working memory of 61 healthy controls and 61 patients who met the International Classification of Diseases, Tenth Revision diagnostic criteria for schizophrenia. The age range of subjects was 18-50. Scale for the Assessment of Positive Symptoms (SAPS) and Scale for the Assessment of Negative Symptoms (SANS) were used to evaluate the patients' clinical symptoms.
Compared with the healthy control group, the accuracy of visual working memory of patients with schizophrenia was significantly impaired (=3.062, =0.003). The accuracy of visual working memory of patients with schizophrenia was not related to age (=0.023, =0.860), the age of onset (=-0.003, =0.979), the duration of illness (=-0.038, =0.769), education level (=-0.181, =0.162), continuous working time before illness (=-0.107, =0.413) or the daily dose of antipsychotic drugs (=0.062, =0.635); however, it was positively related to the number of hospitalisations (=0.471, <0.001). The total score of Scale for the Assessment of Positive Symptoms (SAPS) was negatively related to the accuracy of visual working memory (=-0.388, =0.005), while the total score of Scale for the Assessment of Negative Symptoms (SANS) (=0.416, =0.001), the total score of diminished emotional expressiveness (=0.352, =0.005) and the total score of attention disorder (=0.310, =0.015) were positively related to the accuracy of visual working memory. Patients using a single drug and those using multiple drugs were compared with each other. They were not significantly different in age (=0.010, =0.992), the number of hospitalisations (=0.656, =0.514), the duration of illness (=0.701, =0.486), the total score of SANS (=0.078, =0.938), the total score of SAPS (=1.815, =0.079) and the daily dose of antipsychotic drugs (=1.794, =0.078). However, in order to explore whether single or combined drug use would affect the accuracy of visual working memory of patients with schizophrenia, the present study also compared these two groups' different S0 values of the accuracy of visual working memory. The results showed that the accuracy of visual working memory of patients with schizophrenia with combined drug use was significantly better than that of patients with single drug use (=2.515, =0.015, independent sample t-test).
The present study indicates that the visual working memory of young adult patients with schizophrenia is impaired compared with the healthy people within the same age range. The impairment is more obvious in patients who have multiple hospitalisations and suffer from severe negative symptoms. The impairment in patients with more severe positive symptoms is not very obvious. Combined drug use is likely to alleviate the impairment.
精神分裂症患者存在一般认知障碍，工作记忆障碍被认为是认知障碍的基础。作为子成分之一的视觉工作记忆研究受到越来越多关注。然而，导致精神分裂症患者视觉工作记忆缺陷的影响因素尚未得到明确解释。为认知障碍干预提供依据，本研究探讨了影响患者视觉工作记忆缺陷的因素。
本研究通过测量精神分裂症患者和健康对照者视觉工作记忆的准确性，探讨影响精神分裂症患者视觉工作记忆的相关因素。
采用颜色回忆范式测量61名健康对照者和61名符合《国际疾病分类第十次修订本》精神分裂症诊断标准患者的视觉工作记忆准确性。受试者年龄范围为18 - 50岁。采用阳性症状评定量表（SAPS）和阴性症状评定量表（SANS）评估患者的临床症状。
与健康对照组相比，精神分裂症患者的视觉工作记忆准确性显著受损（=3.062，=0.003）。精神分裂症患者的视觉工作记忆准确性与年龄（=0.023，=0.860）、发病年龄（=-0.003，=0.979）、病程（=-0.038，=0.769）、教育程度（=-0.181，=0.162）、病前连续工作时间（=-0.107，=0.413）或抗精神病药物日剂量（=0.062，=0.635）无关；然而，它与住院次数呈正相关（=0.471，<0.001）。阳性症状评定量表（SAPS）总分与视觉工作记忆准确性呈负相关（=-0.388，=0.005），而阴性症状评定量表（SANS）总分（=0.416，=0.001）、情感平淡总分（=0.352，=0.005）和注意障碍总分（=0.310，=0.015）与视觉工作记忆准确性呈正相关。比较了使用单一药物和使用多种药物的患者。他们在年龄（=0.010，=0.992）、住院次数（=0.656，=0.514）、病程（=0.701，=0.486）、SANS总分（=0.078，=0.938）、SAPS总分（=（1.815，=0.079）和抗精神病药物日剂量（=1.794，=0.078）方面无显著差异。然而，为了探讨单一用药或联合用药是否会影响精神分裂症患者的视觉工作记忆准确性，本研究还比较了这两组患者视觉工作记忆准确性的不同S0值。结果显示，联合用药的精神分裂症患者的视觉工作记忆准确性显著优于单一用药患者（=2.515，=0.015，独立样本t检验）。
本研究表明，与同年龄范围的健康人相比，年轻成年精神分裂症患者的视觉工作记忆受损。在多次住院且有严重阴性症状的患者中，这种损害更为明显。阳性症状较重的患者的损害不太明显。联合用药可能会减轻这种损害。
