精神分裂症患者元认知与共情及精神症状的相关性

The relationship among the metacognitive ability, empathy and psychotic symptoms in schizophrenic patients in a post-acute phase of illness

目的 探讨精神分裂症患者元认知能力与共情能力及精神症状的关系.方法 采用修订版元认知评估量表（MAS-A）和中文版人际反应指针量表（IRI-C）对77例处于疾病治疗稳定期的精神分裂症患者和34例神经症性障碍患者进行元认知和共情能力评估,86例正常者作IRI-C评估,精神分裂症患者作阳性和阴性症状量表（PANSS）评估.结果 精神分裂症患者MAS-A总分[（8.8±3.3）分]及其自我反省[（3.4±1.1）分]、理解他人[（2.5±1.0）分]、去中心化[（0.4±0.6）分]和控制分量表分[（2.4±1.1）分]均低于神经症性障碍患者[分别为：（12.7±3.4）分、（4.9±1.2）分、（3.3±0.9）分、（1.1±0.7）分、（3.3±1.2）分],差异具有统计学意义（均P＜0.01）.相关分析显示,精神分裂症患者元认知评分与共情评分之间呈正相关（r=0.229-0.305,P＜0.05）,与PANSS评分间呈负相关（r=-0.248--0.491,P＜0.05）,控制症状评分后,元认知评分与共情评分间的相关性仍然存在.结论 精神分裂症患者元认知能力受损,元认知损害与共情缺陷间存在关联,提示两者间可能存在共同的病理生理基础.

Objective To explore the relationship among the metacognitive ability,empathy and psychotic symptoms in schizophrenic patients.Methods Seventy-seven schizophrenic patients in a post-acute phase of illness and thirty-four patients with neuroses were assessed with the abbreviated-metacognition assessment scale （MAS-A） and the interpersonal reactivity index-C（IRI-C）,and eighty-six normal subjects were rated with the IRIC.Additionally,psychotic symptoms of the schizophrenic patients were assessed with the positive and negative syndrome scale（PANSS）.Results The MAS-A total score,the subscores in self-reflectivity,understanding of other＇ mind,decentration,mastery of MAS-A （respectively （8.8±3.3）,（3.4± 1.1）,（2.5± 1.0）,（0.4±0.6）,（2.4± 1.1）） were significantly lower in the schizophrenic patients group than those in the neurosis patients group （respectively （12.7±3.4）,（4.9± 1.2）,（3.3±0.9）,（1.1±0.7）,（3.3± 1.2）） （all P〈0.01）.Correlation analysis showed that the MAS-A scores were significantly negatively correlated with the PANSS scores （r=-0.248--0.491,P〈0.05）,and the MAS-A scores had significantly positively correlation with the IRI-C scores （r=0.229-0.305,P〈0.05）,the relationship were persisted when the scores of PANSS were statistically controlled.Conclusion The metacognitive ability of schizophrenic patients are impaired,and the correlation between impaired matacognition and empathy deficit suggests that they share the same physiopathologic basis.