首发未服药精神分裂症患者治疗前后冷执行功能状况

Cool executive function before and after the treatment in drug-naive, first-episode schizophrenia patients

目的:探讨首发未服药精神分裂症患者治疗前后冷执行功能状况及影响因素。方法:经SCID会谈后纳入首发未服药精神分裂症患者(患者组)21例和健康对照(对照组)25例,分别于治疗前和治疗8周后进行连线测验A-B任务和河内塔测验,记录连线测验反应时间和错误个数、河内塔测验反应时间和操作步骤,用PANSS量表评定症状严重程度,SPSS软件分析比较记录指标的差异,多元回归分析患者组测验成绩与年龄、受教育年限、阳性症状分、阴性症状分、一般精神病理分和PANSS总分的相关性。结果:与对照组相比,治疗前患者组在河内塔测验、连线测验A-B的反应时间均长(P=0.013;P=0.000;P=0.001);患者组在连线测验B中的错误个数比对照组多(P=0.015);患者组河内塔测验的操作步骤和连线测验A错误个数与对照组比较差异无统计学意义。治疗后,患者组连线测验A任务中的反应时间比治疗前减少(P=0.002);多元回归分析发现,患者组连线测验B的反应时间与阴性症状存在依存关系(β=7.198,P=0.012),两者呈正相关(r=0.535,P=0.018);连线测验B的错误个数与阳性症状存在依存关系(β=0.382,P=0.024),两者呈正相关(r=0.489,P=0.012),未发现其他变量间有统计学意义。结论 :精神分裂症患者的冷执行功能受到一定程度的损害,尤其是影响认知的灵活性与注意转移能力,症状是冷认知功能最重要的影响因素,早期控制症状是保护冷认知功能的重要途径。

Objective To explore the cool execution function （CEF）and its influence factors before and after treatment in drug-naive, first-episode schizophrenics. Methods Twenty-one drug-naive, first-episode schizophrenics （patients group） and 25 healthy persons （control group） were interviewed by using the SCID. The severity of clinical symptoms was respectively assessed in patient group before treatment and after 8 weeks using the Positive and Negative Syndrome Scale （PANSS）. The Trail-Marking Test A-B （TMT A-B） and Hanoi Tower Test （HIT） were conducted to assess cool executive function. Reaction time and the number of errors of TMT A-B＇s and HTT＇s reaction time and operative steps were recorded. Results Before treatment, the patient group＇s reaction time was longer in HTT and TMT A-B than that in the control group＇s （P = 0.013;P = 0.000;P = 0.001 ）, respectively. Error number of TMT-B in the patient group was more than that in the control group （P = 0.015） ; The operative steps of HTT and error number of TMT A were no statistical difference than those in the control group. After treatment, reaction time of TMT A reduced significantly than before treatment （P = 0.002）; Before and after treatment, patients＇ reaction time of HTT and TMT B, operative steps of HTT and the error number of TMT A-B were all no statistical difference. Running multiple linear regression, reaction times of TMT- B was positively correlated with negative symptoms （β= 7.198,P = 0.012）, and the error number of it was positively correlated with positive symptoms （β= 0.382,P = 0.024）. Conclusions CEF in patients with drug- naive, first-episode schizophrenia is affected in a certain degree, especially the flexibility and attention transfer. Symptoms is the most serious influence factors. Treatment in sympotoms earlier is the important way to protect cool cognition.