精神分裂症高危人群认知功能及转化风险因素的观察
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摘要
目的:探索精神分裂症高危人群的认知损害特点,以及与疾病转化相关的风险因素。方法:纳入40例通过SIPS量表筛查的精神分裂症临床高危个体(CHR)、40例首发精神分裂症患者、54例精神分裂症遗传高危个体(GHR)及67例健康对照。对所有被试者进行认知及嗅觉功能评估,并对CHR进行为期2年的随访之后观察其临床结局。结果:CHR及GHR均存在多项认知功能损害,CHR认知损害更为严重;五项SOPS条目总分(P5交流紊乱,N5概念丰富度,N6职业功能,D3专注和注意困难、D4个人卫生障碍得分之和)是CHR转化的危险因素(OR值=1.563,P=0.048),嗅觉是CHR转化的保护性因素(OR值=0.447,P=0.036)。结论:精神分裂症在早期即存在多项认知损害,嗅觉和认知功能是疾病早期预警信号。
Objective: To investigate the characteristics of cognitive deficits in high-risk individuals for schizophrenia and explore risk factors of the transition to psychosis. Methods: Participants included 40 clinical high risk(CHR) individuals, 40 first-episode schizophrenia(FES), 54 Genetic high risk(CHR) individuals and 67 healthy controls(HC). The CHR patients were screened by the Structured Interview for Prodromal Syndromes(SIPS). All participants were evaluated with the cognitive and olfactory functions. Follow-up interview for 2 years was adopted to observe the clinical outcomes of all CHR subjects. Results: Both the CHR and GHR group showed cognitive impairments on multiple domains, and the cognitive impairment of CHR group were more severe. The Scale of Prodromal Symptoms item scores(including P5 Conceptual Disorganization, N5 Decreased Ideational Richness, N6 Deterioration in Role functioning, D3 Trouble with Focus and Attention,D4 Impairment in Personal Hygiene) was a risk factor for CHR transformation(OR=1.563, P=0.048), and olfactory was a protective factor for CHR transformation(OR=0.447,P=0.036). Conclusion: Cognitive impairments have existed in the early stage of schizophrenia. Olfactory and cognitive functions are early risky signs of this disease.
Objective: To investigate the characteristics of cognitive deficits in high-risk individuals for schizophrenia and explore risk factors of the transition to psychosis. Methods: Participants included 40 clinical high risk(CHR) individuals, 40 first-episode schizophrenia(FES), 54 Genetic high risk(CHR) individuals and 67 healthy controls(HC). The CHR patients were screened by the Structured Interview for Prodromal Syndromes(SIPS). All participants were evaluated with the cognitive and olfactory functions. Follow-up interview for 2 years was adopted to observe the clinical outcomes of all CHR subjects. Results: Both the CHR and GHR group showed cognitive impairments on multiple domains, and the cognitive impairment of CHR group were more severe. The Scale of Prodromal Symptoms item scores(including P5 Conceptual Disorganization, N5 Decreased Ideational Richness, N6 Deterioration in Role functioning, D3 Trouble with Focus and Attention,D4 Impairment in Personal Hygiene) was a risk factor for CHR transformation(OR=1.563, P=0.048), and olfactory was a protective factor for CHR transformation(OR=0.447,P=0.036). Conclusion: Cognitive impairments have existed in the early stage of schizophrenia. Olfactory and cognitive functions are early risky signs of this disease.
引文
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2 Seidman LJ,Giuliano AJ,Meyer EC,et al.Neuropsychology of the prodrome to psychosis in the NAPLS consortium:relationship to family history and conversion to psychosis.Archives of General Psychiatry,2010,67(6):578-588
3 Chan RC,Di X,Mcalonan GM,et al.Brain anatomical abnormalities in high-risk individuals,first-episode,and chronic schizophrenia:an activation likelihood estimation meta-analysis of illness progression.Schizophrenia Bulletin,2011,37(1):177-188
4 Faraone SV,Green AI,Seidman LJ,et al.“Schizotaxia”:clinical implications and new directions for research.Schizophrenia Bulletin,2001,27(1):1-18
5 Brewer WJ,Wood SJ,Phillips LJ,et al.Generalized and Specific Cognitive Performance in Clinical High-Risk Cohorts:A Review Highlighting Potential Vulnerability Markers for Psychosis.Schizophrenia Bulletin,2005,32(3):538-555
6 Semple D,Smyth R,Burns J,et al.Oxford Handbook of Psychiatry(3nd Edition).2013
7 Cannon TD,Yu C,Addington J,et al.An Individualized Risk Calculator for Research in Prodromal Psychosis.American Journal of Psychiatry,2016,173(10):980-988
8 Jung MH,Jang JH,Kang D,et al.The Reliability and Validity of the Korean Version of the Structured Interview for Prodromal Syndrome.Psychiatry Investigation,2010,7(4):257
9 Miller TJ,Mcglashan TH,Rosen JL,et al.Prospective diagnosis of the initial prodrome for schizophrenia based on the Structured Interview for Prodromal Syndromes:preliminary evidence of interrater reliability and predictive validity.American Journal of Psychiatry,2002,159(5):863-865
10姚静,郭兰婷,孙锦华,等.精神分裂症高危人群分裂型人格特征的研究.中国临床心理学杂志,2006,14(6):596-598
11 First Mb SRGM.Structured Clinical Interview for DSM-IVAxis I Disorders.New York:New York State Psychiatric Institute,1996
12曹爱爱,吴彦,彭代辉.精神分裂症认知功能成套测验在精神科中的应用.精神医学杂志,2015,4:314-316
13廖力维,丁烨,吴旭,等.计算机化认知矫正训练对精神分裂症的随机对照试验.中国临床心理学杂志,2016,24(5):954-957
14房宏捷,路月玲,杜巧荣.精神分裂症患者的Stroop测验研究.临床医药实践,2010,19(2):103-105
15李丹,徐彩娟,周燕玲,等.残留型精神分裂症患者的社会功能与精神病性症状及认知功能的相关性.中国临床心理学杂志,2018,26(2):128-130
16 Saito S,Ayabekanamura S,Takashima Y,et al.Development of a Smell Identification Test Using a Novel Stick-Type Odor Presentation Kit.Chemical Senses,2006,31(4):379-391
17郑丽娜,王继军,张天宏,等.中文版精神病高危症状量表的信度和效度.中国心理卫生杂志,2012,26(8):571-576
18 Pantelis C,Wood SJ,Proffitt TM,et al.Attentional set-shifting ability in first-episode and established schizophrenia:Relationship to working memory.Schizophrenia Research,2009,112(1-3):104-113
19 Nguyen AD,Pelavin PE,Shenton ME,et al.Olfactory sulcal depth and olfactory bulb volume in patients with schizophrenia:an MRI study.Brain Imaging and Behavior,2011,5(4):252-261
20 Turetsky BI,Hahn C,Arnold SE,et al.Olfactory Receptor Neuron Dysfunction in Schizophrenia.Neuropsychopharmacology,2009,34(3):767-774
21 Roalf DR,Quarmley M,Calkins ME,et al.Temporal Lobe Volume Decrements in Psychosis Spectrum Youths.Schizophrenia Bulletin,2016.w112
22 Turetsky BI,Hahn C,Borgmann-Winter K,et al.Scents and Nonsense:Olfactory Dysfunction in Schizophrenia.Schizophrenia Bulletin,2009,35(6):1117-1131
23 Humphrey T.The development of the human amygdala during early embryonic life.J Comp Neurol,1968,132(1):135-165
24 Turetsky BI,Moberg PJ,Roalf DR,et al.Decrements in Volume of Anterior Ventromedial Temporal Lobe and Olfactory Dysfunction in Schizophrenia.Archives of General Psychiatry,2003,60(12):1193-1200
25 Brewer WJ,Wood SJ,Mcgorry PD,et al.Impairment of olfactory identification ability in individuals at ultra-high risk for psychosis who later develop schizophrenia.American Journal of Psychiatry,2003,160(10):1790-1794
26 Cornblatt BA,Carrion RE,Auther A,et al.Psychosis Prevention:A Modified Clinical High Risk Perspective From the Recognition and Prevention(RAP)Program.American Journal of Psychiatry,2015,172(10):986-994
27 Addington J,Liu L,Perkins DO,et al.The Role of Cognition and Social Functioning as Predictors in the Transition to Psychosis for Youth With Attenuated Psychotic Symptoms.Schizophrenia Bulletin,2017,43(1):57-63
2 Seidman LJ,Giuliano AJ,Meyer EC,et al.Neuropsychology of the prodrome to psychosis in the NAPLS consortium:relationship to family history and conversion to psychosis.Archives of General Psychiatry,2010,67(6):578-588
3 Chan RC,Di X,Mcalonan GM,et al.Brain anatomical abnormalities in high-risk individuals,first-episode,and chronic schizophrenia:an activation likelihood estimation meta-analysis of illness progression.Schizophrenia Bulletin,2011,37(1):177-188
4 Faraone SV,Green AI,Seidman LJ,et al.“Schizotaxia”:clinical implications and new directions for research.Schizophrenia Bulletin,2001,27(1):1-18
5 Brewer WJ,Wood SJ,Phillips LJ,et al.Generalized and Specific Cognitive Performance in Clinical High-Risk Cohorts:A Review Highlighting Potential Vulnerability Markers for Psychosis.Schizophrenia Bulletin,2005,32(3):538-555
6 Semple D,Smyth R,Burns J,et al.Oxford Handbook of Psychiatry(3nd Edition).2013
7 Cannon TD,Yu C,Addington J,et al.An Individualized Risk Calculator for Research in Prodromal Psychosis.American Journal of Psychiatry,2016,173(10):980-988
8 Jung MH,Jang JH,Kang D,et al.The Reliability and Validity of the Korean Version of the Structured Interview for Prodromal Syndrome.Psychiatry Investigation,2010,7(4):257
9 Miller TJ,Mcglashan TH,Rosen JL,et al.Prospective diagnosis of the initial prodrome for schizophrenia based on the Structured Interview for Prodromal Syndromes:preliminary evidence of interrater reliability and predictive validity.American Journal of Psychiatry,2002,159(5):863-865
10姚静,郭兰婷,孙锦华,等.精神分裂症高危人群分裂型人格特征的研究.中国临床心理学杂志,2006,14(6):596-598
11 First Mb SRGM.Structured Clinical Interview for DSM-IVAxis I Disorders.New York:New York State Psychiatric Institute,1996
12曹爱爱,吴彦,彭代辉.精神分裂症认知功能成套测验在精神科中的应用.精神医学杂志,2015,4:314-316
13廖力维,丁烨,吴旭,等.计算机化认知矫正训练对精神分裂症的随机对照试验.中国临床心理学杂志,2016,24(5):954-957
14房宏捷,路月玲,杜巧荣.精神分裂症患者的Stroop测验研究.临床医药实践,2010,19(2):103-105
15李丹,徐彩娟,周燕玲,等.残留型精神分裂症患者的社会功能与精神病性症状及认知功能的相关性.中国临床心理学杂志,2018,26(2):128-130
16 Saito S,Ayabekanamura S,Takashima Y,et al.Development of a Smell Identification Test Using a Novel Stick-Type Odor Presentation Kit.Chemical Senses,2006,31(4):379-391
17郑丽娜,王继军,张天宏,等.中文版精神病高危症状量表的信度和效度.中国心理卫生杂志,2012,26(8):571-576
18 Pantelis C,Wood SJ,Proffitt TM,et al.Attentional set-shifting ability in first-episode and established schizophrenia:Relationship to working memory.Schizophrenia Research,2009,112(1-3):104-113
19 Nguyen AD,Pelavin PE,Shenton ME,et al.Olfactory sulcal depth and olfactory bulb volume in patients with schizophrenia:an MRI study.Brain Imaging and Behavior,2011,5(4):252-261
20 Turetsky BI,Hahn C,Arnold SE,et al.Olfactory Receptor Neuron Dysfunction in Schizophrenia.Neuropsychopharmacology,2009,34(3):767-774
21 Roalf DR,Quarmley M,Calkins ME,et al.Temporal Lobe Volume Decrements in Psychosis Spectrum Youths.Schizophrenia Bulletin,2016.w112
22 Turetsky BI,Hahn C,Borgmann-Winter K,et al.Scents and Nonsense:Olfactory Dysfunction in Schizophrenia.Schizophrenia Bulletin,2009,35(6):1117-1131
23 Humphrey T.The development of the human amygdala during early embryonic life.J Comp Neurol,1968,132(1):135-165
24 Turetsky BI,Moberg PJ,Roalf DR,et al.Decrements in Volume of Anterior Ventromedial Temporal Lobe and Olfactory Dysfunction in Schizophrenia.Archives of General Psychiatry,2003,60(12):1193-1200
25 Brewer WJ,Wood SJ,Mcgorry PD,et al.Impairment of olfactory identification ability in individuals at ultra-high risk for psychosis who later develop schizophrenia.American Journal of Psychiatry,2003,160(10):1790-1794
26 Cornblatt BA,Carrion RE,Auther A,et al.Psychosis Prevention:A Modified Clinical High Risk Perspective From the Recognition and Prevention(RAP)Program.American Journal of Psychiatry,2015,172(10):986-994
27 Addington J,Liu L,Perkins DO,et al.The Role of Cognition and Social Functioning as Predictors in the Transition to Psychosis for Youth With Attenuated Psychotic Symptoms.Schizophrenia Bulletin,2017,43(1):57-63
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