Harvey P D, Howanitz E, Parrella M, White L, Davidson M, Mohs R C, Hoblyn J, Davis K L
Department of Psychiatry, Mount Sinai School of Medicine and Franklin Delano Roosevelt Veterans Administration Medical Center, Montrose, NY 10029, USA.
Am J Psychiatry. 1998 Aug;155(8):1080-6. doi: 10.1176/ajp.155.8.1080.
Although many geriatric patients with schizophrenia have been referred to nursing home care, little is known about their characteristics. Across nursing home and chronic hospital settings, the authors directly assessed poor outcome geriatric patients with schizophrenia and contrasted their cognitive, symptomatic, and adaptive functioning to that of acutely admitted patients with a better outcome over the lifetime course of the illness.
The subjects were 97 chronically hospitalized patients with schizophrenia, 37 patients with chronic schizophrenia who lived in nursing homes, and 31 acutely admitted geriatric patients with schizophrenia. These patients were rated with the Positive and Negative Syndrome Scale, tested with a neuropsychological battery, evaluated with the Mini-Mental State examination, and rated on a scale of social and adaptive deficits, the Social Adaptive Functioning Evaluation scale.
Each group of patients proved discriminable from the other two: nursing home patients displayed the most severe adaptive deficits, and acutely admitted patients were the least cognitively impaired. Cognitive impairment was the strongest predictor of adaptive deficits for all three groups, and negative symptom differences among the groups were smaller than differences in cognitive impairment. Nursing home patients had the least severe positive symptoms, and the acutely ill and chronic hospital patients did not differ on positive symptoms.
Cognitive impairment is a predictor of both overall outcome and specific adaptive deficits. These data suggest that interventions aimed at cognitive impairment may have an impact on overall functional status. In comparison, positive symptom severity is less strongly correlated with overall adaptive outcome and is uncorrelated with specific deficits in adaptive skills.
尽管许多老年精神分裂症患者已被转至养老院护理，但对他们的特征了解甚少。在养老院和慢性病医院环境中，作者直接评估了预后较差的老年精神分裂症患者，并将他们的认知、症状及适应性功能与在疾病终生病程中预后较好的急性入院患者进行对比。
研究对象包括97名长期住院的精神分裂症患者、37名住在养老院的慢性精神分裂症患者以及31名急性入院的老年精神分裂症患者。这些患者接受了阳性和阴性症状量表评定、神经心理成套测验、简易精神状态检查评估，并通过社会适应性功能评估量表对社会和适应性缺陷进行评分。
每组患者都与其他两组有明显差异：养老院患者表现出最严重的适应性缺陷，急性入院患者的认知损害最轻。认知损害是所有三组患者适应性缺陷的最强预测因素，且各组间阴性症状差异小于认知损害差异。养老院患者的阳性症状最轻，急性病患者和长期住院患者在阳性症状方面无差异。
认知损害是总体预后和特定适应性缺陷的预测因素。这些数据表明，针对认知损害的干预可能会对整体功能状态产生影响。相比之下，阳性症状严重程度与总体适应性预后的相关性较弱，且与适应性技能的特定缺陷无关。
