精神病超高危人群认知功能和心理状况的比较研究

发布时间：2018-01-13 20:36

本文关键词：精神病超高危人群认知功能和心理状况的比较研究　出处：《南方医科大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的：通过精神病超高危组、高危组、首发精神分裂症组、复发精神分裂症组认知功能和心理状况的比较,分析精神病超高危人群的神经认知功能和心理状况与其他人群的差异,寻找潜在的精神病理学相关的内表型指标,为实现亚临床特征(subclinical trait)或前驱期(prodromal)的早期识别、诊断及精神病超高危干预提供依据,改善不良预后,减少功能残疾。方法：分别收集符合入组和排除标准的40例精神分裂症一级亲属精神病超高危受试者、40例精神分裂症一级亲属高危组、40例首发精神分裂症患者、40例复发精神分裂症患者、40例健康对照组作为研究对象。所有研究对象入组后完成以下项目：(1)一般情况及精神病理症状：一般情况采用自制的一般人口学资料调查表；症状学评估采用Montgomery-Asberg抑郁量表(MADRS)、阳性和阴性症状量表(PANSS)。(2)社会心理评估：采用儿童期经历问卷、家庭亲密度和适应性量表、生活事件量表、社会支持量表、卢森堡自尊量表、应付方式量表等心理评估工具。(3)神经认知功能评估：采用连线测验(the Trail Making Test Part A, TMTA)、符号编码(Symbol coding Test)、霍普金斯词语学习测验修订版(Hopkins Verbal Learning Test-Revised, HVLT-R)、简易视觉记忆测验修订版(Brief Visuospatial Memory Test-Revised, BVMT-R)、Stroop色词测验(Stroop Color WordTest, Stroop C-W)、持续操作测验(Continuous Performance Test, CPT)等认知功能测验。主要比较精神病超高危组在认知功能及心理状况方面与其他各组的差异。结果：1.症状学比较结果：(1)抑郁症状比较结果：精神病超高危组抑郁情况好于首发精神分裂症组和复发精神分裂症组,差于高危组和健康对照组,具有统计学意义(p0.05);(2)PANSS量表比较结果：精神病超高危组情况要好于首发精神分裂症组和复发精神分裂症组,但比高危组和健康对照组差,具有统计学意义(p＜0.05)。2.社会心理学比较结果：(1)儿童期经历问卷结果表明,精神病超高危组在儿童期经历得分方面显著低于首发精神分裂症组、复发精神分裂症组、健康对照组,有统计学意义p0.05),与高危组之间不存在显著差异(p＜0.05)；(2)家庭亲密度和适应性量表结果表明,在亲密度得分方面,精神病超高危组、高危组、首发精神分裂症组、复发精神分裂症组四组之间不存在显著差异(p＜0.05),但是健康对照组显著高于其他各组。在适应性得分方面,精神病超高危组、健康对照组得分显著高于高危组、首发精神分裂症组和复发精神分裂症组, 具有统计学意义(p0.05)；(3)生活事件量表结果表明,生活事件量表各维度得分方面不存在显著的差异(p0.05)；(4)社会支持量表结果表明,精神病超高危组、高危组得分显著高于首发精神分裂症组和复发精神分裂症组得分,健康对照组得分最高,具有统计学意义(p＜0.05)；(5)卢森堡自尊量表结果表明,精神病超高危组得分与健康对照组得分没有显著差异(p＜0.05),但是显著高于高危组、首发精神分裂症组和复发精神分裂症组(p0.05)；(6)应付方式量表结果表明,在合理化维度五组间无统计学意义(p0.05),在解决问题维度,精神病超高危组、高危组和健康对照组得分显著高于复发精神分裂症组得分,复发精神分裂症组得分又显著高于首发精神分裂症组得分；在自责方面,精神病超高危组、高危组和健康对照组得分显著低于首发精神分裂症组和复发精神分裂症组得分；在求助方面,精神病超高危组、高危组和健康对照组得分显著低于首发精神分裂症组和复发精神分裂症组得分；在幻想方面,健康对照组得分显著低于其他几组的得分；在退避方面,健康对照组得分显著低于高危组、首发精神分裂症组和复发精神分裂症组得分。3.神经认知功能比较结果：(1)在连线测验(TMTA)方面方面,精神病超高危组得分显著短于首发精神分裂症组和复发精神分裂症组,但比高危组和健康对照组用时长,具有统计学意义(p0.05)；(2)在符号编码方面,精神病超高危组得分高于首发精神分裂症组和复发精神分裂症组,但低于高危组和健康对照组,具有统计学意义(P0.05)；(3)在霍普金斯语言学习(HYLT-R)方面,高危组和健康对照组得分较高,精神病超高危组、首发精神分裂症组和复发精神分裂症组得分较低,有统计学意义(p＜0.05)；(4)在简易视觉记忆测验(BVMT-R)方面,健康对照组得分最高,首发精神分裂症组和复发精神分裂症组得分最低,精神病超高危组和高危组介于前两者之间,具有统计学意义(p＜0.05)；(5)在Stroop色词测验方面,精神病超高危组成绩好于首发精神分裂症组和复发精神分裂症组,但是又比高危组和健康对照组差,具有统计学意义(p＜0.05)；(6)在持续操作测验(CPT)方面,精神病超高危组成绩好于首发精神分裂症组和复发精神分裂症组,但比高危组和健康对照组差,具有统计学意义(p＜0.05)。结论：1.精神病超高危人群出现精神病理症状,尚未达到精神病诊断标准。2.精神病超高危人群的家庭亲密度和个人内心领悟能力下降。3.精神病超高危人群出现广泛的认知功能受损,涉及信息处理速度、记忆力、注意力等方面。其中信息处理速度异常可能是精神分裂症内表型的预警因素。4.精神分裂症阳性家族史的高危人群的认知功能下降,提示可能存在遗传素质因素影响。
[Abstract]:Objective: through mental illness at ultra high risk group, high risk group, first-episode schizophrenia group, compare the recurrence function and psychological status of patients with mental cognitive division, difference analysis of people at ultra high risk of psychosis neurocognitive function and psychological status with other people, to find some endophenotype related psychopathology potential, to achieve sub the clinical features (subclinical trait) or prodromal period (prodromal) early identification, provide the basis for the diagnosis and intervention of mental illness at ultra high risk, improve the prognosis and reduce disability. Methods: 40 cases treated with row and spirit in addition to the standard of schizophrenia in the first-degree relatives of psychiatric ultra high-risk subjects, 40 cases first degree relatives of schizophrenia in high-risk group, 40 cases of patients with first-episode schizophrenia, 40 cases of recurrence in patients with schizophrenia and 40 healthy control group as the research object. All the research objects into the group after the completion of the project : (1) general and psychiatric symptoms: general situation using the self-made demographic data questionnaire; symptom assessment by Montgomery-Asberg Depression Scale (MADRS), positive and negative symptom scale (PANSS). (2) social psychological assessment: the childhood experience questionnaire, family cohesion and adaptability scale and the life events scale, social support scale, Luxemburg self esteem scale, coping style questionnaire and psychological assessment tools. (3) neurocognitive assessment: the connection test (the Trail Making Test Part A, TMTA), the symbol encoding (Symbol coding Test), the Hopki Verbal Learning Test revised (Hopkins Verbal Learning Test-Revised, HVLT-R), simple visual memory test revised (Brief Visuospatial Memory Test-Revised, BVMT-R), Stroop color word test (Stroop Color WordTest, Stroop C-W, continuous performance test (Continuou) S Performance Test, CPT) and other cognitive function test. The main difference between mental illness at ultra high risk group in the cognitive function and psychological status with other groups. Results: 1. symptom comparison: (1) comparison results: depressive symptoms at ultra high risk of psychosis group depression was better than the first onset schizophrenia group and recurrence the schizophrenia group, difference in high risk group and healthy control group, with statistical significance (P0.05); (2) the PANSS scale comparison results: psychotic super high risk group than in schizophrenia group and recurrent schizophrenia group, but high risk group and healthy control group difference was statistically significant (P < 0.05).2. (1): the social psychology of childhood experience questionnaire. The results show that the ultra high risk group mental illness in childhood experience score was significantly lower than the schizophrenia group, recurrent schizophrenia group and healthy control group, the Statistical significance of P0.05), and there is no significant difference between the high risk group (P < 0.05); (2) the family adaptability and cohesion scale results in cohesion scores, psychosis super high risk group, high risk group, schizophrenia group, recurrent schizophrenia group there is no significant difference between the four between the groups (P < 0.05), but the control group was significantly higher than the other groups. The adaptability scores, mental illness at ultra high risk group, healthy control group scored significantly higher than the high-risk group, schizophrenia group and recurrent schizophrenia group, with statistical significance (P0.05); (3) the results of life event scale show that life events scores have no significant difference (P0.05); (4) social support scale. The results showed that mental illness at ultra high risk group, high risk group scored significantly higher than the schizophrenia group and recurrent schizophrenia group scores of health Compared with the highest score, with statistical significance (P < 0.05); (5) the Luxemburg self esteem scale. The results show that the ultra high risk group and the scores of psychiatric health control group scores had no significant difference (P < 0.05), but significantly higher than the high-risk group, schizophrenia group and recurrent schizophrenia group (P0.05); (6) coping style questionnaire. The results show that the rationalization of the five groups had no statistical significance (P0.05), to solve the problem of dimension, mental illness at ultra high risk group, high risk group and healthy control group was significantly higher than that of the recurrence of schizophrenia group score, recurrent schizophrenia group score was significantly higher than that of first division and spirit in the score division; in the era, psychosis super high risk group, high risk group and healthy control group were significantly lower than the schizophrenia group and recurrent schizophrenia group score; in turn, psychosis super high risk group, high risk group and healthy controls Group had significantly lower scores of first-episode schizophrenia group and recurrent schizophrenia group score; in the fantasy, the healthy control group were significantly lower than that of other groups of scores; in the backoff, the healthy control group were significantly lower than the high-risk group, schizophrenia group and recurrent schizophrenia group.3. score comparison results of neurocognitive function: (1) in the connection test (TMTA) aspects of mental illness, ultra high-risk group scored significantly shorter in the schizophrenia group and recurrent schizophrenia group, but higher than the high-risk group and healthy control group in long time, with statistical significance (P0.05); (2) in the symbol encoding, mental disease ultra high risk group were higher than that of schizophrenia group and recurrent schizophrenia group, but lower than the high risk group and healthy control group, with statistical significance (P0.05); (3) study in Hopki language (HYLT-R), high risk group and healthy The control group scored higher, psychosis super high risk group, schizophrenia group and recurrent schizophrenia group lower scores was statistically significant (P < 0.05); (4) in a simple visual memory test (BVMT-R), healthy control group had the highest scores, schizophrenia group and recurrent schizophrenia the lowest score between group, mental illness at ultra high risk group and high risk group between the first two, with statistical significance (P < 0.05); (5) in the Stroop color word test, psychosis super high risk group is better than the schizophrenia group and recurrent schizophrenia group, but also than the high-risk group and healthy controls group difference was statistically significant (P < 0.05); (6) in the continuous performance test (CPT), psychosis super high risk group is better than the schizophrenia group and recurrent schizophrenia group, but higher than the high-risk group and healthy control group difference was statistically significant (P < 0.05). Conclusion: 1. people at ultra high risk of psychosis mental symptoms, psychiatric diagnosis has not yet reached the standard of.2. people at ultra high risk of psychosis family cohesion and inner personal comprehension ability decreased.3. people at ultra high risk of psychosis appear extensive cognitive impairments, information processing speed, memory, attention and cognitive function among high-risk groups. Early warning factors of information processing speed may be abnormal in schizophrenia phenotype.4. schizophrenia positive family history of the decline, indicating the effect of genetic quality factors.

【学位授予单位】：南方医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R749.3

【相似文献】