急性而短暂的精神病性障碍患者的探究性眼球轨迹运动

Exploratory eye tracking movement in patients with acute and transient psychotic disorders

目的:研究急性而短暂的精神病性障碍(ATPD)患者探究性眼球轨迹运动及其对疾病转归的临床意义。方法:对符合国际疾病和相关健康问题统计分类第十版(ICD-10)诊断标准的来自病房或门诊的34例ATPD患者、33例精神分裂症患者及29例正常对照进行探究性眼球轨迹运动检查并分析眼动参数。三组受试年龄、性别和受教育程度均匹配。用阳性和阴性症状量表(PANSS)评定患者的精神症状。ATPD患者在入组时及入组1个月后各行1次眼动检查,另外两组均行1次眼动检查。对ATPD患者进行随访以了解诊断变化。结果:ATPD患者眼动参数反应性探究分、认知性探究分均低于正常对照(P<0.05),判别分析(discriminant analysis,D分)值高于正常对照。经至少1个月随访,18例ATPD患者改诊为精神分裂症,其中首次D分值为正分占72.22%;这18例患者首次D分值高于正常对照和16例改诊为其他精神障碍者(P<0.05),而与精神分裂症患者差异无统计学意义。结论:急性而短暂的精神病性障碍患者探究性眼球轨迹运动存在异常;判别分析值正分可能为急性而短暂的精神病性障碍转归为精神分裂症提供一种有价值的预测指标。

Objective： To investigate the characteristics of exploratory eye tracking movement in patients with acute and transient psychotic disorders （ATPD） and assess its clinical significance. Methods： Thirty-four patients with ATPD and 33 schizophrenic patients diagnosed according to the International Classification of Diseases and Related Health Problem, Tenth Revision （ICD-10） criteria, and 29 healthy controls were tested for exploratory eye tracking movement. Parameters of exploratory eye tracking movement were analyzed subsequently. The groups were matched in age, gender and education. Symptoms of each patient were accessed with the Positive and Negative Syndrome Scale. The exploratory eye tracking movement in ATPD group was tested twice respectively on visit and a month later, while the other groups were tested only once. The 34 patients with ATPD were followed up after at least one month to know about their illness states. Results： In patients with ATPD, the responsive search score and cognitive search score were significantly lower than healthy controls[ （9.0 ± 1.8） vs. （ 10. 5 ± 1.4） ], [ （ 5.8± 0. 8） vs. （6. 7 ± 0. 7）, Ps 〈 0. 05 ], while the discriminant analysis value was significantly higher than healthy controls [（ 1.0 ± 1.7） vs. （ -0. 5 ± 1.3）, P 〈0. 05]. Moreover, 18 patients with ATPD were shifted to diagnosis of schizophrenia after at least 1-month follow-up, in which the discriminant analysis value were significantly higher than healthy controls, and 16 patients with ATPD who were shifted to diagnosis of other mental diseases except for schizophrenia [ （ 1.54 ± 1.88） vs. （ - 0.48 ± 1.30） vs. （0. 34 ± 1.28）, P 〈 0. 05]. No significant difference in tracking of exploratory eye movement was found between schizophrenic patients and 18 patients who were shifted to diagnosis of schizophrenia, and the 18 patients could be discriminated from 16 non-schizophrenics with a sensitivity of 72. 2%. Conclusion： This study indicates that the exploratory eye tracking movement is abnormal in patients with acute and transient psychotic disorders, and patients with a positive discriminant analysis value have a higher possibility to change to diagnosis of schizophrenia from diagnosis of acute and transient psychotic disorders.