Saykin A J, Shtasel D L, Gur R E, Kester D B, Mozley L H, Stafiniak P, Gur R C
Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia.
Arch Gen Psychiatry. 1994 Feb;51(2):124-31. doi: 10.1001/archpsyc.1994.03950020048005.
Medication and chronicity have complicated past attempts to characterize the neuropsychological performance of patients with schizophrenia. There have been inconsistencies regarding the pattern, selectivity, and sources of observed deficits. Our objective was to comprehensively examine neuropsychological function in patients with schizophrenia who had never been exposed to neuroleptic medication, and who were experiencing their first episode (FE) of psychosis.
Subjects were consecutive recruitments that included 37 patients with FE schizophrenia who were never exposed to neuroleptics. These subjects were compared with 65 unmedicated, previously treated (PT) patients and 131 healthy controls.
The patients groups had nearly identical profiles showing generalized impairment, particularly in verbal memory and learning, attention-vigilance, and speeded visual-motor processing and attention. Verbal memory and learning accounted for most of the variance between patients and controls and removing this effect substantially attenuated all other differences. By contrast, both the FE group and PT group continued to show highly significant deficits in verbal memory and learning after controlling for attention, abstraction, and all other functions. Some functions not typically implicated in schizophrenia (spatial cognition, fine motor speed, and visual memory) were more impaired in the PT group than in the FE group.
Verbal memory, as a primary neuropsychological deficit present early in the course of schizophrenia, implicates the left temporal-hippocampal system. Neuropsychological evaluations before treatment permit differentiation of primary deficits from changes secondary to medication or chronicity. This is essential for developing a neurobehavioral perspective on schizophrenia.
药物治疗和疾病慢性化使过去对精神分裂症患者神经心理表现的特征描述变得复杂。在观察到的缺陷模式、选择性和来源方面一直存在不一致之处。我们的目标是全面检查从未接触过抗精神病药物且正经历首次精神病发作（FE）的精神分裂症患者的神经心理功能。
连续招募研究对象，其中包括37例从未接触过抗精神病药物的首次发作精神分裂症患者。将这些研究对象与65例未接受药物治疗的既往治疗过的（PT）患者以及131名健康对照进行比较。
患者组具有几乎相同的概况，表现出广泛性损害，尤其是在言语记忆和学习、注意力警觉性以及快速视觉运动加工和注意力方面。言语记忆和学习在患者与对照之间的差异中占大部分，去除这种影响后，所有其他差异均大幅减弱。相比之下，在控制了注意力、抽象能力和所有其他功能后，首次发作组和既往治疗组在言语记忆和学习方面仍表现出高度显著的缺陷。一些通常与精神分裂症无关的功能（空间认知、精细运动速度和视觉记忆）在既往治疗组中比在首次发作组中受损更严重。
言语记忆作为精神分裂症病程早期出现的主要神经心理缺陷，与左侧颞叶 - 海马系统有关。治疗前的神经心理评估有助于区分原发性缺陷与药物或慢性化继发的变化。这对于从神经行为角度理解精神分裂症至关重要。
