认知障碍和临床症状对偏执型精神分裂症患者残疾的影响：一项保加利亚临床样本研究。
Impact of Cognitive Disturbances and Clinical Symptoms on Disability in Patients with Paranoid Schizophrenia: A Study of a Bulgarian Clinical Sample.
机构信息
Department of Psychiatry and Medical Psychology, Faculty of Public Health, Medical University, 5800 Pleven, Bulgaria.
Department of Social Medicine and Health Management, Faculty of Public Health, Medical University, 5800 Pleven, Bulgaria.
出版信息
Int J Environ Res Public Health. 2023 Jan 30;20(3):2459. doi: 10.3390/ijerph20032459.
UNLABELLED
The study aimed to assess the impact of clinical symptoms and cognitive impairment on disability in patients with paranoid schizophrenia (PS).
METHODS
108 patients with schizophrenia were included (66 male and 42 female). Their average age was 38.86 ± 10.02 years and the disease duration was 12.80 ± 8.20 years, with mean disease onset of 24 years. Clinical symptoms were assessed with the PANSS, and cognitive performance was measured using a seven-item neurocognitive battery. The disability level of the subjects was assessed using the World Health Organization-Disability Assessment Schedule 2.0 (WHO-DAS 2.0). The relation between the variables studied was assessed using Spearman's rank correlation coefficient () at a probability level of < 0.05.
RESULTS
An increase in symptom severity resulted in worsening of the "participation in society" ( = 0.56, < 0.01), "life activities-household" ( = 0.55, < 0.01), and "getting along with people" ( = 0.59, < 0.01) WHO-DAS 2.0 domains. Positive symptoms (13.89 ± 3.48) correlated strongly with "getting along with people" ( = 0.55, < 0.01), "life activities-household" ( = 0.58, < 0.01), and "participation in society" ( = 0.62, < 0.01), and negative symptoms (14.25 ± 4.16) with "participation in society" ( = 0.53, < 0.01) and "life activities-household" ( = 0.48, < 0.01). Symptoms of disorganization (15.67 ± 4.16) had the highest impact on "life activities-household" ( = 0.81, < 0.01), "getting along with people" ( = 0.56, < 0.05), and "participation in society" ( = 0.65, < 0.01). Episodic memory ( = -0.28, < 0.01) was remotely related to comprehension and communication. The information processing speed ( = 0.38, < 0.01), visual memory ( = -0.30, < 0.01), and focused executive functions showed moderate correlations with all domains on the WHO-DAS 2.0 scale ( = 0.38, < 0.01). Attention ( = -0.33, < 0.01) was moderately related to community activities. Semantic ( = -0.29, < 0.01) and literal ( = -0.27, < 0.01) verbal fluency demonstrated weak correlations with "cognition-understanding", "getting along with people", and "participation in society".
CONCLUSION
Symptoms of disorganization and disturbed executive functions contribute most to disability in patients with schizophrenia through impairment of real-world functioning, especially in social interactions and communication. Severe clinical symptoms (negative and disorganization-related ones) as well as deficits in executive function, verbal memory, and verbal fluency cause the biggest problems in the functional domains of interaction with other people and participation in society.
目的
评估偏执型精神分裂症（PS）患者的临床症状和认知障碍对残疾的影响。
方法
纳入 108 例精神分裂症患者（男 66 例，女 42 例）。他们的平均年龄为 38.86±10.02 岁，病程为 12.80±8.20 年，平均发病年龄为 24 岁。采用 PANSS 评估临床症状，采用 7 项神经认知成套测验评估认知表现。采用世界卫生组织残疾评定量表 2.0（WHO-DAS 2.0）评估受试者的残疾水平。采用 Spearman 秩相关系数（）评估研究变量之间的关系，概率水平为 <0.05。
结果
症状严重程度的增加导致“参与社会”（=0.56，<0.01）、“家庭生活活动”（=0.55，<0.01）和“与人相处”（=0.59，<0.01）WHO-DAS 2.0 领域恶化。阳性症状（13.89±3.48）与“与人相处”（=0.55，<0.01）、“家庭生活活动”（=0.58，<0.01）和“参与社会”（=0.62，<0.01）高度相关，阴性症状（14.25±4.16）与“参与社会”（=0.53，<0.01）和“家庭生活活动”（=0.48，<0.01）相关。紊乱症状（15.67±4.16）对“家庭生活活动”（=0.81，<0.01）、“与人相处”（=0.56，<0.05）和“参与社会”（=0.65，<0.01）的影响最大。情节记忆（=-0.28，<0.01）与理解和交流有微弱的关联。信息处理速度（=0.38，<0.01）、视觉记忆（=0.30，<0.01）和专注执行功能与 WHO-DAS 2.0 量表的所有领域（=0.38，<0.01）呈中度相关。注意力（=-0.33，<0.01）与社区活动中度相关。语义（=-0.29，<0.01）和字面（=-0.27，<0.01）流畅性与“认知理解”、“与人相处”和“参与社会”呈弱相关。
结论
紊乱症状和执行功能障碍对精神分裂症患者的残疾影响最大，通过损害现实世界的功能，尤其是在社交互动和交流方面。严重的临床症状（阴性和与紊乱相关的症状）以及执行功能、言语记忆和言语流畅性缺陷导致与他人互动和参与社会的功能领域出现最大问题。
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