精神分裂症首发及前驱期认知功能研究

摘要

目的 测试首发精神分裂症及前驱期患者的认知功能,了解精神分裂症不同时期的认知功能及相关影响因素.方法 选择2017年5月～2018年2月就诊于南京医科大学附属脑科医院的患者,包括首次发病的精神分裂症患者28例(首发组)、精神分裂症前驱期(前驱期组,UHR)24例,并招募38例性别、年龄、受教育水平相匹配的健康对照者(对照组),所有被试均采用韦氏智力检测评估智力水平(IQ)及成套认知测验(MCCB)评估认知功能,比较三组被试者认知功能的差异,同时进行相关性分析.结果 三组被试的一般智力、信息处理速度、词语记忆和学习、工作记忆、推理和问题解决、视觉记忆和学习、注意/警觉性、社会认知等得分比较差异均有统计学意义(P＜0.05);与对照组比较,首发组、前驱期组的一般智力、信息处理速度、词语记忆和学习、工作记忆、推理和问题解决、视觉记忆和学习、注意/警觉性、社会认知等各项认知测验得分均较低(P＜0.05);与前驱期组比较,首发组的信息处理速度、词语记忆和学习、工作记忆、视觉记忆和学习、社会认知等认知测验得分均较低(均P＜ 0.05),且前驱期组的阳性症状分与阴性症状与Matrics公认认知成套测试(TMT)、迷宫(NAB)得分呈负相关(P＜0.05),TMT、符号编码测试(BACS)、Fluency、空间广度(WMS)、NAB、简易视觉空间记忆测验(BVMT-R)、持续操作测验-相同配对(CPT-IP)得分呈负相关(P＜0.05),IQ与TMT、BACS、Fluency、HVLT-R、NAB、CPT-P得分呈正相关(P＜0.05).结论 精神分裂症前驱期即存在明显的认知功能受损,认知功能的损害可能开始于发病前,且认知功能随着疾病进展而加重.%Objective To evaluate the cognitive function of patients with the first episode schizophrenia and Ultra-high-risk for psychosis and figure out the cognitive function of schizophrenia in different periods and related factors.Methods Twenty-eight patients with first episode schizophrenia (first episode group) and 24 patients with ultra-high-risk for psychosis (UHR group) were treated in Affiliated Nanjing Brain Hospital of Nanjing Medical University from May 2017 to February 2018 were selected,and 38 well-matched healthy controls (control group) were assessed with the Wechsler Adult Intelligence Scale for intelligence and MATRICS Consensus Cognitive Battery (MCCB) for cognitive function,the differences of cognitive function among the three groups were compared,while the correlation analysis was carried out.Results The difference of the scores of IQ,speed of processing,verbal learning,working memory,reasoning,visual learning,social cognition and attention/vigilance in three groups was significant (P ＜ 0.05).Compared with the control group,both the first episode group and UHR group showed worse performance in IQ,speed of processing,verbal learning,working memory,reasoning,visual learning,social cognition and attention/vigilance (P ＜ 0.05),compared with the UHR group,first episode group showed worse performance in speed of processing,verbal learning,working memory,visual learning,social cognition (P ＜ 0.05).The positive symptoms of UHR group were negatively correlated with the scores of TMT and NAB,the negative symptoms were negatively correlated with the scores of TMT,BACS,Fluency,WMS,NAB,BVMT-R,CPT-IP,(P ＜ 0.05) IQ were positively correlated with the scores of TMT,BACS,Fluency,HVLT-R,NAB,CPT-IP (P ＜ 0.05).Conclusion Widespread cognitive impairments exist in ultrahigh-risk psychosis and the impairments may start before the onset of the disease,and cognitive function will aggravate with the progression of the disease.