Symptoms, cognitive functioning, and adaptive skills in geriatric patients with lifelong schizophrenia: A comparison across treatment sites
Symptoms, cognitive functioning, and adaptive skills in geriatric patients with lifelong schizophrenia: A comparison across treatment sites
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DOI：
10.1176/ajp.155.8.1080
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发表时间：
1998-08-01
影响因子：
17.7
通讯作者：
Davis, KL
中科院分区：
文献类型：
--
作者：
Harvey, PD;Howanitz, E;Davis, KL
目的：尽管许多老年精神分裂症患者被转诊至疗养院护理，但对其特征知之甚少。在疗养院和慢性病医院环境中，作者直接评估了结局不佳的老年精神分裂症患者，并将他们的认知、症状和适应功能与在整个疾病过程中结局较好的急性入院患者进行了对比。方法：研究对象为97名长期住院的精神分裂症患者、37名住在疗养院的慢性精神分裂症患者和31名急性入院的老年精神分裂症患者。这些患者使用阳性和阴性综合症量表进行评级，使用神经心理学电池进行测试，使用简易精神状态检查进行评估，并根据社会和适应性缺陷量表（社会适应性功能评估量表）进行评级。结果：事实证明，每组患者都与其他两组患者有区别：疗养院患者表现出最严重的适应性缺陷，而急性入院患者的认知障碍最少。认知障碍是所有三组适应性缺陷的最强预测因子，并且各组之间的阴性症状差异小于认知障碍的差异。疗养院患者的阳性症状最轻，急症患者和慢性住院患者的阳性症状没有差异。结论：认知障碍是总体结果和特定适应性缺陷的预测因子。这些数据表明，针对认知障碍的干预措施可能会对整体功能状态产生影响。相比之下，阳性症状的严重程度与总体适应结果的相关性不太强，并且与适应技能的特定缺陷无关。
Objective: Although many geriatric patients with schizophrenia have been referred to nursing home care, little is known about their characteristics. Across nursing home and chronic hospital settings, the authors directly assessed poor outcome geriatric patients with schizophrenia and contrasted their cognitive, symptomatic, and adaptive functioning to that of acutely admitted patients with a better outcome over the lifetime course of the illness. Method: The subjects were 97 chronically hospitalized patients with schizophrenia, 37 patients with chronic schizophrenia who lived in nursing homes, and 31 acutely admitted geriatric patients with schizophrenia. These patients were rated with the Positive and Negative Syndrome Scale, tested with a neuropsychological battery, evaluated with the Mini-Mental State examination, and rated on a scale of social and adaptive deficits, the Social Adaptive Functioning Evaluation scale. Results: Each group of patients proved discriminable from the other two: nursing home patients displayed the most severe adaptive deficits, and acutely admitted patients were the least cognitively impaired. Cognitive impairment was the strongest predictor of adaptive deficits for all three groups, and negative symptom differences among the groups were smaller than differences in cognitive impairment. Nursing home patients had the least severe positive symptoms, and the acutely ill and chronic hospital patients did not differ on positive symptoms. Conclusions: Cognitive impairment is a predictor of both overall outcome and specific adaptive deficits. These data suggest that interventions aimed at cognitive impairment may have an impact on overall functional status. In comparison, positive symptom severity is less strongly correlated with overall adaptive outcome and is uncorrelated with specific deficits in adaptive skills.