Neuropsychology of first-episode schizophrenia: Initial characterization and clinical correlates
Neuropsychology of first-episode schizophrenia: Initial characterization and clinical correlates
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DOI：
10.1176/appi.ajp.157.4.549
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发表时间：
2000-04-01
影响因子：
17.7
通讯作者：
Lieberman, JA
中科院分区：
文献类型：
--
作者：
Bilder, RM;Goldman, RS;Lieberman, JA
目的：神经心理障碍是精神分裂症的重要治疗目标。关于首次精神病发作治疗后缺陷的严重程度和模式以及这些缺陷与综合征特征之间的关系的信息仍然有限。方法：对94例精神病初步稳定后首发精神分裂症患者和36名健康志愿者进行41项个体测试的综合神经心理学评估。神经心理缺陷的概况和缺陷的性别和利手性的关系进行了检查。神经心理缺陷与广泛的历史和临床特征，包括结果的相关性进行了探讨。结果：患者有较大的广泛性神经心理缺陷（与健康志愿者相比有1.5个标准差）。除了普遍的缺陷，患者在记忆和执行功能方面也有细微的相对缺陷（与他们自己的平均情况相比，小于0.5个标准差）。学习/记忆功能障碍患者与健康个体的最大区别；在考虑了这种差异之后，只有运动缺陷进一步区分了这两组。神经心理能力较高的患者仅存在记忆缺陷，而神经心理能力较低的患者同时存在记忆和执行缺陷。在运动速度方面，没有观察到男性在正常优势之外的性别差异。右旋患者有较轻的全身缺陷。残留症状的严重程度与更大的全身性缺陷相关。执行力和注意力缺陷与整体功能障碍和不良预后最相关。结论：结果表明，在临床稳定的首发患者中存在较大的广泛性缺陷和更细微的差异缺陷。即使在不太严重的广泛性缺陷患者中也观察到学习/记忆缺陷，但其模式与遗忘综合征不同，可能反映了不同的机制。执行力和注意力缺陷是严重残疾患者的标志，可能预示着相对较差的预后。未能形成典型的大脑优势模式可能会增加更大的广泛性缺陷的风险。
Objective: Neuropsychological impairments are well documented in schizophrenia and are important targets of treatment. Information about the severity and pattern of deficits after treatment for the first psychotic episode and about relationships between these deficits and syndromal characteristics remains limited. Method: Comprehensive neuropsychological assessments including 41 individual tests were given to 94 patients with first-episode schizophrenia after initial stabilization of psychosis and to a comparison group of 36 healthy volunteers. Profiles of neuropsychological deficits and the relationship of deficits to sex and handedness were examined. Correlations of neuropsychological deficit with a broad range of historical and clinical characteristics, including outcome, were explored. Results: Patients had a large generalized neuropsychological deficit (1.5 standard deviations compared to healthy volunteers). Patients also had, superimposed on the generalized deficit, subtle relative deficits (less than 0.5 standard deviation compared to their own average profile) in memory and executive functions. Learning/memory dysfunction best distinguished patients from healthy individuals; after accounting for this difference, only motor deficits further distinguished the groups. Patients with higher neuropsychological ability had only memory deficits, and patients with lower ability had both memory and executive deficits. No sex differences were observed beyond the normal advantage for men in motor speed. Dextral patients had less severe generalized deficit. Severity of residual symptoms was associated with greater generalized deficit. Executive and attentional deficits were most linked to global functional impairment and poor outcome. Conclusions: The results document a large generalized deficit, and more subtle differential deficits, in clinically stabilized first-episode patients. Learning/memory deficits were observed even in patients with less severe generalized deficit, but the pattern was unlike the amnestic syndrome and probably reflects different mechanisms. Executive and attentional deficits marked the more severely disabled patients, and may portend relatively poor outcome. Failure to develop typical patterns of cerebral dominance may increase the risk for greater generalized deficit.