精神分裂症患者社会和躯体快感缺失与内部动机的关系

Correlation between social and physical anhedonia and intrinsic motivation in patients with schizophrenia

目的探讨精神分裂症患者社会和躯体快感缺失与内部动机间的关系。方法在3所精神病专科医院(合肥、芜湖、北海)选取125例门诊和住院疾病稳定期精神分裂症患者(患者组),同时招募101名社区健康对照者(对照组),所有被试均完成中文版修订社会快感缺失量表(Chinese version of revised social anhedonia scale,RSAS-C)、中文版修订躯体快感缺失量表(Chinese version of revised physical anhedonia scale,RPAS-C)和精神分裂症内部动机量表(intrinsic motivation inventory for schizophrenia research,IMI-SR)评估,患者组采用阳性与阴性症状量表(positive and negative syndrome scale,PANSS)和卡尔加里精神分裂症抑郁量表(Calgary depression scale for schizophrenia,CDSS)评估临床症状。采用SPSS 26.0软件进行数据处理,Mann-Whitney U检验和协方差分析比较组间快感缺失和内部动机的差异,Spearman相关分析和多元Logistic回归分析探讨患者快感缺失与内部动机水平间的关系。结果与对照组相比,患者组RSAS-C分[10.00(6.00,14.00)分比11.00(8.00,15.00)分,Z=-2.187,P<0.05]和RPAS-C分[12.00(7.50,20.00)分比16.00(10.00,23.00)分,Z=-3.026,P<0.01]较高,控制年龄、性别和受教育年限后,这种差别消失。患者IMI-SR选择性因子分[31.00(28.00,39.00)分]低于对照组[36.00(31.00,42.00)分],而价值性因子分[41.00(35.00,45.00)分]高于对照者[36.00(32.00,42.00)分],差异具有统计学意义(Z=-3.172,-3.387,均P<0.01),总分和兴趣性因子分与对照组差异无统计学意义(Z=-0.132,-1.370,均P>0.05)。Spearman相关分析显示,患者组RSAS-C和RPAS-C分与IMI-SR总分及其兴趣性、选择性和价值感因子分均呈负相关(r=-0.193~-0.364,均P<0.05),控制年龄、性别、受教育年限、奥氮平等效剂量、PANSS总分、阳性症状分、阴性症状分、一般精神病理分和CDSS分后,RSAS-C和RPAS-C评分与IMI-SR评分间仍存在相关性(r=-0.266~-0.336,均P<0.01);多元Logistic回归分析结果显示,RSAS-C评分对IMI-SR总分(B=-0.096,95%CI=0.836~0.998,P=0.025)和选择性因子分(B=-0.110,95%CI=0.823~0.974,P=0.010)具有负向影响。结论精神分裂症患者快感缺失与内部动机水平间存在关联,社会快感缺失水平越高,其参与认知活动的内部动机水平越低,提示认知康复治疗中改善患者社会快感缺失对提高内部动机水平具有意义。

Objective To explore the social and physical anhedonia and its relationship to intrinsic motivation in patients with schizophrenia.Methods One hundred and twenty-five stable schizophrenic patients from three psychiatric hospitals in Hefei,Wuhu and Beihai,and 101 healthy controls from same communities were recruited.All subjects completed Chinese version of revised social anhedonia scale(RSAS-C),Chinese version of revised physical anhedonia scale(RPAS-C)and intrinsic motivation inventory for schizophrenia research(IMI-SR),while positive and negative syndrome scale(PANSS)and Calgary depression scale for schizophrenia(CDSS)were used to assess the clinical symptoms of schizophrenic patients.All analyses were conducted by SPSS 26.0 software.The Mann-Whitney U test and covariance analysis were used for comparison between the groups,and Spearman correlation and multiple logistic regression analysis were used to explore the association between the anhedonia and intrinsic motivation in schizophrenics.Results Compared with controls,the RSAS-C(10.00(6.00,14.00)vs 11.00(8.00,15.00),Z=-2.187,P<0.05)and RPAS-C(12.00(7.50,20.00)vs 16.00(10.00,23.00),Z=-3.026,P<0.01)scores in patients were higher,but the differerce between the groups disappeared after controlling age,sex and years of education.The IMI-SR perceived choice subscore(31.00(28.00,39.00 vs 36.00(31.00,42.00),Z=-3.172,P<0.01)were lower,while value/usefulness subscores(41.00(35.00,45.00)vs 36.00(32.00,42.00),Z=-3.387,P<0.01)were higher in patients than those in controls,and there was no significant difference between the total score and interest/enjoyment subscore(both P<0.05).In patents,Spearman correlation analysis showed that the RSAS-C and RPAS-C scores were significant negatively correlated with the IMI-SR total scores and interest/enjoyment subscore,perceived choice and value/usefulness(r=-0.193--0.364,all P<0.05),which still existed after controlling age,sex,years of education,course of disease,antipsychotic dose,and scores of PANSS and CDSS.Logistic regression analysis showed that the score of RSAS-C(B=-0.096,95%CI=0.836-0.998,P=0.025)and perceived choice subscore(B=-0.110,95%CI=0.823-0.974,P=0.010)had negative effects on the IMI-SR total score.Conclusion There is a correlation between anhedonia and intrinsic motivation in patients with schizophrenia,the higher the social anhedonia,the lower the intrinsic motivation to participate in cognitive activities,suggesting that intervention for social anhedonia may have significance in improving the intrinsic motivation of patients with cognitive rehabilitation therapy.