首发精神分裂症患者心灵理论损伤的研究

摘要

背景 心灵理论(又称心理理论)是社会认知中最重要的认知成分之一,现在已经成为认知神经科学界关注的热点之一.目前的研究均证实精神分裂症患者存在心灵理论的损害,并且这种损害和其精神病性症状有一定的相关性.然而目前的研究大多集中在慢性或是服过药的精神分裂症患者中,尚不能完全排除药物的影响.因此本研究采用两种不同的心灵理论任务,并结合神经心理学背景测查对首发、未服药的精神分裂症患者进行了测试.以了解这种心灵理论的损害是否可以在首发、未服药的精神分裂症患者中得到重复.临床上以阴性症状为主的精神分裂症患者往往表现出更为明显的认知功能的损害,因此本研究还对以阴性症状为主的精神分裂症患者(阴性亚组)和以阳性症状为主的精神分裂症患者(阳性亚组)的心灵理论任务成绩及神经心理学背景测查成绩进行了比较.方法 对52例首发、未服药、能合作的精神分裂症患者和64名健康被试进行了眼区任务和失言觉察任务的心灵理论能力测查,采用言语流畅性和数字广度(包括顺背数字和倒背数字)任务对所有研究对象进行了神经心理学背景测试.采用阳性症状和阴性症状量表(PANSS)对精神分裂症患者的精神病性症状进行了评定.52例精神分裂症患者按照PANSS量表的复合量表分(阳性症状总分减阴性症状总分)进行了分组(复合量表分＞0者为阳性亚组,＜0者为阴性亚组),其中27例为阳性亚组,25例为阴性亚组.结果 在需要心灵理论认知成分加工的心理状态阅读任务和失言觉察问题得分上,以及言语流畅性成绩中精神分裂症组的成绩显著低于健康对照组,精神分裂症患者阴性亚组的心理状态阅读任务和言语流畅性成绩显著低于阳性亚组.心灵理论成绩和阴性症状总分呈显著负相关并和言语流畅性成绩呈显著正相关.结论 首发、未服药的精神分裂症患者存在心灵理论能力的损害,并且这种损害可能与其额叶功能的障碍有关.两种不同亚型的精神分裂症患者可能存在着不同形式的心灵理论的损害.%Background The disability of theory of mind (ToM) has been confirmed in chronic or acute medicated schizophrenic patients.The role of ToM ability in first-episode, drug-naive schizophrenic patients was investigated in this study.Methods ToM was assessed with the Eyes task and Faux pas task in first-episode, drug-naive schizophrenic patients( n =52)compared with healthy controls ( n =64). Verbal Fluency Test (VFT) and Digit Span Test (DST) were also examined in two groups. Psychiatric symptoms were evaluated by the Positive and Negative Syndrome Scale (PANSS).Results The tests that involved the ToM ability (I. E. Mind reading and Faux pas questions) were impaired in the schizophrenic group. The schizophrenia performed worse than the normal controls on the VFT. The schizophrenic negative subgroup performed worse than the positive subgroup in Mind reading and VFT. There was a significantly positive correlation between the performances of the tests that involved the ToM ability and the scores of VFT in schizophrenic patients. There was a significantly negative correlation between the performances of the tests that involved the ToM ability and negative symptom scores in the patients.Conclusions The patients with schizophrenia exhibit ToM deficit that is probably associated with the frontal lobe dysfunction.The performance of ToM dysfunction might be different between negative subjects and positive ones.