童年期虐待对精神分裂症患者的精神症状及药物疗效的研究

Childhood maltreatment on psychiatric symptoms and drug efficacy in patients with schizophrenia

目的探究童年虐待对精神分裂症患者临床症状及抗精神病药物早期疗效的影响。方法选择73例精神分裂症患者,依据儿童虐待问卷(CTQ)评估结果分为轻度虐待组(n=42)及重度虐待组(n=31),在基线期及抗精神病药物治疗3周后,用阳性和阴性症状量表(PANSS)及临床总体印象量表(CGI)对两组患者进行施测和对比,分析儿童虐待经历与精神症状的相关性及对抗精神病药物早期治疗的反应。结果重度虐待组PANSS阳性因子评分(P=0.026)和认知缺陷因子评分(P=0.042)明显高于轻度虐待组;且阳性因子与CTQ评分中情感虐待因子呈显著正相关(r=0.257,P=0.028),认知缺陷因子与情感忽视因子呈显著正相关(r=0.283,P=0.015)。经过抗精神病药物治疗后,重度虐待组PANSS阴性因子减分率明显低于轻度虐待组(P=0.035),且与CTQ躯体虐待因子(r=-0.302,P=0.011)相关性最高,呈显著负相关。结论精神分裂症患者经历童年期虐待的严重程度与阳性症状及认知缺陷更为相关,且更多的童年虐待经历会影响抗精神病药物对阴性症状的改善,提示预后不佳。

Objective To explore the effect of childhood maltreatment on clinical symptoms and early efficacy of antipsychotics in patients with schizophrenia.Methods Totally 73 schizophrenic patients were divided into mild maltreatment group(n=42)and severe maltreatment group(n=31)according to the Child Trauma Questionnaire(CTQ).The Positive and Negative Symptom Scale(PANSS)and Clinical Global Impression(CGI)were measured and compared between the two groups at baseline and 3 weeks after antipsychotic treatment to analyze the correlation between child maltreatment experience and mental symptoms and the response to early treatment of antipsychotics.Results PANSS positive factor score(P=0.026)and cognitive deficit factor score(P=0.042)were significantly higher in severe abuse group than in mild abuse group.The positive factor was significantly positively correlated with emotional abuse factor in CTQ score(r=0.257,P=0.028),and the cognitive deficit factor was significantly positively correlated with emotional neglect factor(r=0.283,P=0.015).After antipsychotic treatment,the reduction rate of PANSS negative factor in severe abuse group was significantly lower than that in mild abuse group(P=0.035),and had the highest correlation with CTQ physical abuse factor(r=-0.302,P=0.011).Conclusion The severity of childhood maltreatment experienced by schizophrenic patients is more related to positive symptoms and cognitive deficits,and more childhood maltreatment experience will affect the improvement of negative symptoms by antipsychotics,suggesting a poor prognosis.