精神分裂症患者元认知能力在心理理论与社会功能间的中介作用

Metacognitive ability and its mediation effect on the relationship between the theory of mind and social function in schizophrenia

目的探讨精神分裂症患者元认知能力在心理理论与社会功能间关系中的作用。方法采用修订版元认知评估量表（MAS—A）和心理理论故事图片任务（ToM—PST）对74例疾病稳定期精神分裂症患者（分裂症组）和73例疾病稳定期神经症患者（神经症组）进行评估，分裂症组患者同时接受个体和社会功能量表（PSP）评估，比较分裂症组和神经症组患者元认知水平，分析精神分裂症患者元认知水平与心理理论水平和社会功能间的关系。结果与神经症组相比，分裂症组MAS-A总分[8．5（4．25）分vs13．0（4．0）分，P〈0．01]其及自我反省[3．0（1．5）分vs5．0（2．0）分，P〈0．01]、理解他人[2．5（1．0）分vs3．0（1．0）分，P〈0．01]、去中心化[0．5（1．0）分vs1．0（1．0）分，P〈0．01]和控制[2．5（1．25）分vs3．5（1．75）分，P〈0．01]因子分均减低，差异具有统计学意义。分裂症组ToM—PST总分较神经症组[48（12．25）分vs56（7．5）分]减低，差异具有统计学意义（P〈0．01）。相关分析显示，分裂症组MAS—A总分与TOM．PST总分（r=0．524，P〈0．01）和PSP总分（r=0．521，P〈0．01）间均呈正相关，ToM-PST总分与PSP总分间呈正相关（r=0．619，P〈0．01），均具有统计学意义。回归分析发现，分裂症组患者的元认知水平可预测社会功能水平（β=0．374，P〈0．01），在心理理论与社会功能间起部分中介作用。结论精神分裂症患者存在元认知损害，其元认知能力部分介导心理理论对社会功能的影响。

Objective To explore the role of the metacognitive ability in the relationship between theory of mind and social function in patients with schizophrenia. Methods 74 patients with schizophrenia in stable stage and 73 patients with neurosis in stable stage were evaluated by the revised Metacognitive As- sessment Scale （MAS-A） and the Theory of Mind-Picture Sequencing Task（ToM-PST） .In addition,schizo- phrenia patients were assessed with the Personal and Social Performance Scale （PSP）. The metacognitive a- bility were compared between the two groups and the relationships among metacognitive ability, theory of mind and social function was also studied. Results Compared with neurosis patients, the total score （8.5 （4.25） vs 13.0（4.0）, P〈0.01） ,and the subscores of self-reflectivity （3.0（1.5） vs 5.0（2.0）, P〈0.01） ,un- derstanding of others （2.5（1.0） vs 3.0（ 1.0）, P〈0.01 ） ,decentration （0.5（1.0） vs 1.0（ 1.0）, P〈0.01） and mastery （2.5（1.25） vs 3.5（1.75） , P〈0.01） of the MAS-A,and the ToM-PST total score （48（12.25） vs 56 （7.5）, P〈0.01 ）were significantly lower in schizophrenia patients. MAS-A total score was significantly positively correlated with ToM-PST total score（ r= 0.524, P〈0.01）and PSP total score（ r= 0.521, P〈0.01） .The ToM-PST total score also positively correlated with PSP total score （ r= 0.619, P〈0.01） in schizophrenia patients. Regression analysis indicated that metacognitive level predicted social function in schizophrenia （β= 0.374, P〈0.01） and partially mediated the relationship between theory of mind and social function. Conclusion Schizophrenic patients have deficits of metacognition which partially mediates the influence of theory of mind on social function.