Ma Chin-Chao, Kao Yu-Chen, Tzeng Nian-Sheng, Chao Che-Yi, Chang Chuan-Chia, Chang Hsin-An
Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Department of Psychiatry, Tri-Service General Hospital Beitou Branch, National Defense Medical Center, Taipei, Taiwan.
Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Department of Psychiatry, Tri-Service General Hospital Songshan Branch, National Defense Medical Center, Taipei, Taiwan.
Asian J Psychiatr. 2020 Oct;53:102171. doi: 10.1016/j.ajp.2020.102171. Epub 2020 May 16.
Varying degrees of impaired clinical insight in schizophrenia differentially impact medication adherence and clinical outcomes, prompting in-depth investigations of the deficits. Research is scarce on the differences in peripheral physiological markers between varying degrees of impaired insight. The aims of this study were to examine the differences in (1) resting-state high-frequency heart rate variability (HF-HRV) and (2) crucial clinical outcomes between schizophrenia patients with varying degrees of insight impairment as measured by the Positive and Negative Syndrome Scale (PANSS) item G12 (lack of judgment and insight). The study recruited a sample of 95 stabilized schizophrenia patients with insight impairment. Patients were divided into 2 groups of either minimal insight impairment (n = 25, PANSS G12 = 2-3) or moderate-to-severe insight impairment (n = 70, PANSS G12 ≥ 4). Patients with moderate-to-severe insight impairment displayed lower HF-HRV, clinician-rated psychosocial function, medication adherence, and working memory capacity, and higher self-reported psychosocial function and life quality, but comparable cognitive insight compared to those with minimal insight impairment. A logistic regression model predicted moderate-to-severe insight impairment based on HF-HRV values at the optimal cut-off point of 3.655, with the sensitivity and specificity 84% and 72%, respectively. HF-HRV seems a peripheral marker sensitively reflecting central pathophysiology implicated in insight impairment of schizophrenia.
精神分裂症患者不同程度的临床洞察力受损对药物依从性和临床结局有不同影响，这促使人们对这些缺陷进行深入研究。关于不同程度洞察力受损患者外周生理指标差异的研究较少。本研究的目的是探讨：（1）静息状态下高频心率变异性（HF-HRV）；（2）通过阳性和阴性症状量表（PANSS）项目G12（缺乏判断力和洞察力）测量的不同程度洞察力受损的精神分裂症患者之间关键临床结局的差异。该研究招募了95名病情稳定的有洞察力受损的精神分裂症患者样本。患者被分为两组，即轻度洞察力受损组（n = 25，PANSS G12 = 2-3）或中度至重度洞察力受损组（n = 70，PANSS G12≥4）。与轻度洞察力受损患者相比，中度至重度洞察力受损患者的HF-HRV、临床医生评定的社会心理功能、药物依从性和工作记忆能力较低，而自我报告的社会心理功能和生活质量较高，但认知洞察力相当。逻辑回归模型根据HF-HRV值在最佳临界点3.655预测中度至重度洞察力受损，敏感性和特异性分别为84%和72%。HF-HRV似乎是一个外周标志物，能敏感地反映精神分裂症洞察力受损所涉及的中枢病理生理学。
