青少年精神分裂症首次发病患者药物治疗前后认知功能的特点分析

Cognitive function in first-episode adolescent-onset schizophrenia before and after treatment

目的 探讨首次发病青少年精神分裂症患者认知功能的特点以及与精神症状的相关性.方法 采用中文版认知功能成套测验——共识版中的连线测验A、范畴流畅、符号编码、韦氏记忆量表-第三版空间广度测验、霍普金斯词汇学习测验-修订版、简易视觉空间记忆测验-修订版、持续操作测验-相对配对、迷宫测评25例青少年精神分裂症患者（患者组）治疗前后的信息处理速度、工作记忆、言语学习、视觉学习、注意/警觉性、推理和问题解决的功能;使用PANSS评估患者治疗前后精神症状,认知功能与PANSS各因子分进行相关性分析.同时对29名健康青少年对照者（对照组）进认知功能测评.结果 患者组治疗前连线测验A完成时间显著长于对照组[（57.1±31.5）分与（40.9±15.0）分,t=-2.44,P＜0.05];符号编码[（38.8±11.0）分与（56.2±10.3）分,t=5.88,P＜0.01]、范畴流畅性[（14.9±4.1）分与（18.5±4.8）分,t=2.88,P＜0.05]、韦氏记忆量表-第三版空间广度测验[（17.0±3.3）分与（19.6±2.3）分,t=3.12,P＜0.05]、霍普金斯词汇学习测验-修订版[（19.6±5.6）分与（26.7±4.9）分,t=4.89,P＜0.01]、简易视觉空间记忆测验-修订版[（21.3±6.2）分与（28.9±5.3）分,t=4.55,P＜0.01]、迷宫[（9.3±6.1）分与（14.4±6.1）分,t=2.29,P＜0.05]的得分均显著低于对照组,持续操作测验-相对配对总分与对照组相比差异无统计学意义;患者组治疗前后认知功能差异无统计学意义;患者组治疗前认知功能与PANSS各因子分之间无相关性.结论 首次发病青少年精神分裂症患者发病初期存在广泛的认知功能损害,认知功能独立于精神症状,不随精神症状的缓解而改善.

Objective The aim of this study was to investigate the feature of cognitive function in first-episode adolescent-onset schizophrenia,and to explore the correlation between cognitive function and clinical symptoms.Method Twenty-five first-episode drug-naive patients with adolescent-onset schizophrenia at baseline and after a 12-week treatment were assessed with the speed of proceeding,working memory,verbal learning,visual learning,attention/vigilance,and reasoning and problem solving,using the Measurement and Treatment Research to Improve Cognition in Schizophrenia Consensus Cognitive Battery.The PANSS was used to evaluate clinical symptoms.The correlation between cognitive function and clinical symptoms in schizophrenia was assessed.The cognitive function was also examined in twenty-nine healthy controls at baseline.Results Compared with the controls,the patients showed significant differences in the speed of proceeding （57.1±31.5 vs.40.9± 15.0,t=-2.44,P〈0.05;38.8± 11.0 vs.56.2± 10.3,t=5.88,P〈0.01;14.9±4.1 vs.18.5±4.8,t=2.88,P〈0.05）,working memory （17.0±3.3 vs.19.6±2.3,t=3.12,P〈0.05）,verbal learning （19.6±5.6 vs.26.7±4.9,t=4.89,P〈0.01）,visual learning （21.3±6.2 vs.28.9±5.3,t=4.55,P〈0.01）,and reasoning and problem solving （9.3±6.1 vs.14.4±6.1,t=2.29,P〈0.05）,except for attention/vigilance at baseline.There were no significant differences in all cognitive function test scores between baseline and 12 week treatment （all P〉0.05）.No significant correlations were found between all cognitive function tests scores and PANSS score.Conclusion There are extensive,but not all,cognitive impairment in first-episode drug-naive patients with adolescent-onset schizophrenia.The cognitive impairment of patients may be independent to psychiatric symptoms.