精神分裂症患者听觉认知加工的源检测能力研究

Study on source monitoring ability of auditory cognitive process in patients with schizophrenia

目的比较精神分裂症患者与正常人源检测能力的差异，探讨精神分裂症患者幻听症状可能的认知加工机制。方法选取符合ICD．10精神分裂症诊断标准的患者50例（幻听22例，无幻听28例），选取年龄、受教育程度与之相匹配的健康对照26例（正常对照组）。对精神分裂症患者进行阳性与阴性症状量表（PANSS）评定，然后对所有受试者使用现实性源检测范式进行测试。比较精神分裂症组与正常对照组的再认和平均条件化源辨别测量（ACSIM）。结果精神分裂症幻听组和精神分裂症非幻听组ACSIM[（0．37±0．14），（0．43±0.13）]显著低于正常组[（0．56±0．17）]（P〈0．05），幻听组和非幻听组将想象的归源为听到的错误率[（0．63±0．25），（0．59±0．20）]高于健康对照组（0．42±0．01）（P〈0．05），幻听组与非幻听组患者组ACSIM与PANSS量表阳性分量表评分呈显著负相关（r=-0．35，-0．39）（P〈0．05）。结论精神分裂症患者的源检测能力受损，患者的一些症状（如妄想、幻想）可能与内部信息的外部归源偏差有关。

Objective To explore the cognitive processing mechanism of auditory hallucinations in schizophrenia. Methods Total 50 patients who were diagnosed as schizophrenia according to ICD-10（ including 22 case with halucination（ Sch-AVH group） ,28 cases without hallucination（ Sch-nonAVH group） ） and 26 normal controls（ control group） were enrolled in the study.PANSS was used to assess patients＇ psychiatric symptoms.Then all subjects were detected using source monitoring paradiam and the ACSIM was compared between patients group and control group. Results There were significant differences between patients group （ Sch-AVH group （ 0.37±0,14）, Sch-nonAVH group （ 0.43±0.13 ） ） and control group （0.56±0.17） on ACSIM （P〈0.01）, but there was not significant difference between Sch-AVH group and Sch-nonAVH group （P〉 0.05）. Patients group （0.63±0.25）, （0.59±0.20） more often remembered imagined words as listened than control group （0.42±0.01 ） （P〈 0.05 ）. There were significant negative correlations between PANSS positive subscale scores and ACSIM scores in Sch-AVH group and Sch-nonAVH group（-0.35,-0.39） （P〈0.05）. Conclusion Source monitoring is impaired in patients with schizophrenia, and some of the symptoms （ such as delusions,hallucinations） may be related to a failure of reality discrimination, whereby inner speech is mistaken for an external event and misattributed to an external source.