精神分裂症患者童年创伤与认知功能的相关性

Correlation of childhood trauma and cognitive function in patients with schizophrenia

目的探讨精神分裂症患者童年创伤与认知功能的关系。方法选取安徽省精神卫生中心住院和门诊的精神分裂症患者62例(患者组)和社区健康对照63例(对照组)。采用童年创伤问卷(childhood trauma questionnaire,CTQ)、威斯康星卡片分类测验(Wisconsin card sorting test,WCST)、注意网络功能测验(attention network test,ANT)、言语流畅性测验(verbal fluency test,VFT)和数字广度测验(digit span test,DST)对所有被试进行评估。采用SPSS 17.0软件进行统计学分析,正态分布的计量资料组间比较采用t检验;非正态分布的计量资料组间比较采用Mann-WhitneyU检验。CTQ分与认知功能分间的关系采用Spearman相关分析。结果患者组CTQ总分、情绪虐待、躯体虐待、性虐待、情绪忽视和躯体忽视因子分[48.50(37.75,57.00)分,9.00(6.00,12.25)分,7.00(5.00,9.25)分,5.50(5.00,7.25)分,13.00(9.00,16.25)分,11.00(8.00,13.00)分]均高于对照组[34.00(30.00,37.00)分,6.00(5.00,7.00)分,5.00(5.00,5.00)分,5.00(5.00,5.00)分,9.00(6.00,11.00)分,7.00(6.00,10.00)分],差异有统计学意义(Z=-4.781^-6.724,均P<0.01)。与对照组相比,患者组WCST完成分类数减低,而错误应答数、持续应答数和持续性错误数升高(Z=-5.655^-6.060,均P<0.01);ANT正确率降低,而反应时增长(Z=-5.796,-6.094,均P<0.01);VFT和DST分均降低(Z=-3.492^-8.499,均P<0.01)。相关分析显示,患者组CTQ性虐待分与WCST完成分类数(r=-0.384)呈负相关,与错误应答数(r=0.360)、持续应答数(r=0.394)及持续性错误数(r=0.381)间呈正相关(均P<0.01);CTQ躯体忽视分与ANT正确率(r=-0.400)和执行控制分(r=-0.417)间呈负相关,情绪忽视分与VFT分间呈负相关(r=-0.345)(均P<0.01),控制年龄、受教育年限和PANSS总分后,这种相关性仍存在。结论精神分裂症患者早年经历创伤性事件较多,存在广泛的认知功能缺陷,童年创伤对患者认知灵活性、注意、记忆和言语功能具有负性影响,但患者童年创伤与注意网络执行控制间的正性关联尚需进一步验证和探讨。

Objective:To explore the relationship between the childhood trauma and neruocognition in patients with schizophrenia.Methods:Sixty-two patients with schizophrenic were selected from Anhui mental health center,and sixty-three community health controls were selected.All subjects were assessed with the childhood trauma questionnaire(CTQ),Wisconsin card sorting Test(WCST),attention network test(ANT),verbal fluency test(VFT)and digit span test(DST).SPSS 17.0 was used for statistical analysis.t-test was used to compare the measurement data of normal distribution and Mann-Whitney U test was used to compare the measurement data of non-normal distribution.Spearman correlation analysis was used to analyze the relationship between CTQ score and cognitive function score.Results:Compared with health controls(34.00(30.00,37.00),6.00(5.00,7.00),5.00(5.00,5.00),5.00(5.00,5.00),9.00(6.00,11.00),7.00(6.00,10.00)),the total score of CTQ,subscores of emotional abuse,physical abuse,sexual abuse,emotional neglect and physical neglect in patients with schizophrenia were significantly increased(48.50(37.75,57.00),9.00(6.00,12.25),7.00(5.00,9.25),5.50(5.00,7.25),13.00(9.00,16.25),11.00(8.00,13.00))(Z=-4.781--6.724,all P<0.01).Compared with the control group,the number of WCST classification completed in the patient group was lower,while the number of wrong answers,continuous answers and persistent errors increased(Z=-5.655--6.060,all P<0.01).The correct rate of ant decreased,but the reaction time increased(Z=-5.796,-6.094,all P<0.01).VFT and DST scores were decreased(Z=-3.492--8.499,both P<0.01).In patients with schizophrenia,CTQ sexual abuse subscore were negatively correlated with completed categories scores(r=-0.384)and positively correlated with total errors(r=0.360),perseverative responses(r=0.394)and perseverative errors(r=0.381)on WCST(all P<0.01).CTQ physical neglect scores were negatively correlated with the ANT correct ratio(r=-0.400)and conflict resolution(r=-0.417)(all P<0.01).CTQ emotional neglect scores were negatively correlated with VFT scores(r=-0.345)(P<0.01).The significant associations remained after controlling for age,education and PANSS scores.Conclusion:Patients with schizophrenia experience more traumatic events in their early years and have extensive cognitive defects.The childhood trauma has negative effects on cognitive flexibility,attention,memory and speech function in patients with schizophrenia.However,the positive correlation between childhood trauma and executive conflict of attention network needs to be further verified and explored.