精神分裂症患者前瞻性记忆及其与睡眠的关系

Relationship of prospective memory performance and sleep in patients with schizophrenia

目的:探讨精神分裂症患者前瞻性记忆(PM)及其与睡眠的关系。方法:选取符合美国精神障碍诊断与统计手册第4版(DSM-IV)诊断标准的精神分裂症门诊及住院患者55例,正常对照45例。采用剑桥前瞻性记忆量表评估前瞻性记忆功能,包括基于事件的PM(EBPM)和基于时间的PM(TBPM);采用威斯康星卡片分类测验(WCST)和Stroop测验检测对象的执行和注意功能;采用精神分裂症阳性与阴性症状量表(PANSS)评估患者的精神病性症状及阴性症状;采用匹兹堡睡眠质量指数量表(PSQI)评估睡眠质量。结果:精神分裂症组TBPM[(8.6±5.1)vs.(13.4±3.9),P<0.001]与EBPM得分[(10.1±4.2)vs.(14.4±2.9),P<0.001]均低于正常对照组,PSQI总分高于正常对照组[11.0(6.0,17.0)vs.9.0(5.0,14.0)];患者组与正常对照组相比,患者组入睡时间(Z=2.01,P=0.025)较长,睡眠障碍(Z=-2.71,P=0.004)较严重、催眠药物使用(Z=-4.75,P<0.001)多、日间功能障碍(Z=-3.72,P<0.001)严重。多重线性回归分析结果显示,TBPM与年龄(β=-0.26)、日间功能障碍(β=-0.71)呈负向关联,与教育程度(β=0.45)及睡眠效率(β=0.86)呈正向关联;EBPM分与年龄(β=-0.11)及PSQI日间功能障碍分(β=-0.09)呈负向关联,与受教育程度(β=0.32)、WSCT完成分类数(β=0.41)呈正向关联。结论:精神分裂症患者PM明显受损,并可能与睡眠紊乱相关。

Objective：To examine prospective memory （PM） and sleep correlates in schizophrenia. Methods： Fifty-five patients with schizophrenia and 45 normal controls were recruited as the study sample. The diagnosis was made according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition （DMS-IV）. PM, including time- and event-based PM （ TBPM and EBPM） performance was measured with the Chi- nese version of the Cambridge Prospective Memory Test （C-CAMPROMPT）. The Wisconsin Card Sorting Test （WCST） and Stroop Test were used to determine the attention and executive function of subjects. The Pittsburgh Sleep Quality Index （PSQI） was used to evaluate sleep quality. Patients＇clinical symptoms were evaluated with the Positive and Negative Symptom Scale （PANSS）. Results： Patients with schizophrenia got lower scores in PM [ （8.6 ±5.1） vs.（13.4±3.9）,P〈0.001] and EBPM [（10.1±4.2） vs. （14.4±2.9）,P〈0.001],andhigher PSQI scores than normal controls[ 11.0（6. 0, 17.0） vs. 9. 0（5.0, 14. 0）]. Compared with normal control, patients with schizophrenia had a longer time to go to sleep （Z =2. 01, P 〈0. 05）, more serious sleeping disorder （Z = -2. 71, P 〈 0. 01）, more hypnotic drug use （Z = - 4. 75, P 〈 0. 01） and more daytime dysfunction （ Z = - 3.72, P 〈 0. 01）. Multiple linear regression analyses revealed that older age （β = -0. 26）, daytime dysfunction （β = -0. 71）, lower educational level （β =0. 45） and lower scores of sleeping efficiency （β=-0. 86） contributed to TBPM impairment, while older age （β= -0. 11）, daytime dysfunction （β=- 0. 09）, lower educational level （β = 0. 32） and higher scores of Wisconsin Card Sorting Test （number of categoriescompleted） （β = 0.41） contributed to EBPM deficit in schizophrenia. Conclusion： Patient with schizophrenia may have impaired prospective memory, which may be related to sleeping abnormalities.