氯氮平与利培酮对精神分裂症患者社会认知的影响

发布时间：2018-05-15 22:34

本文选题：精神分裂症 + 社会认知　；参考：《安徽医科大学》2013年硕士论文

【摘要】：目的：精神分裂症是一种常见的复杂的重性精神疾病，其社会认知功能受损严重，主要包括情绪认知、失言识别、眼区情绪识别等。社会认知的神经基础涉及前额叶、眶额叶和扣带回等脑区，而神经心理学、神经电生理及神经影像学等研究都发现精神分裂症患者上述脑区也存在结构性的或者功能性的受损。精神分裂症发病期间会引起c-fos原癌基因快速、短暂地表达，并表达在相应的脑功能区。c-fos的异常表达将产生广泛的病理作用，造成精神分裂症患者脑组织功能性或器质性的特征性的改变。先前有研究发现氯氮平、利培酮等药物可以通过调节c-fos基因表达而改善精神分裂症患者的社会认知，但是研究结果并不一致。因此，本研究的目的是：其一，运用神经心理学的方法检测精神分裂症患者是否存在社会认知功能障碍；其二，分别对不同的患者进行氯氮平、利培酮药物治疗，探讨其社会认知是否有改善，并且观察两种药物的疗效是否相同。方法：本研究对66例符合美国精神疾病诊断与统计手册第4版（DSM-IV）精神分裂症诊断标准的患者，及32名性别构成、年龄及受教育年限相匹配的正常对照组被试进行研究。患者组被试被随机分配为氯氮平治疗组和利培酮治疗组，前者为34例，后者为32例。治疗前对所有被试进行简易精神状态检查（MMSE）、词汇流畅检测（VF）、数字广度（DS）等神经心理学背景测试；治疗前和治疗后分别对患者组被试进行阳性与阴性症状量表测试（PANSS）；治疗前和治疗后分别对所有被试进行失言识别测试（faux pas）和眼区情绪识别任务测试。结果：三组被试的简易精神状态检测、词汇流畅性检测以及数字广度得分比较，差异均无统计学意义（P＞0.05）。治疗前，faux pas测试患者组被试在失言1、失言2、失言3以及失言4上与对照组比较，均表现较差，差异有统计学意义（P＜0.05）；患者组被试识别喜、惊、恐、悲、厌、怒六种基本眼区情绪与对照组比较，均表现较差，差异有统计学意义（P＜0.05）。其中，氯氮平组患者识别恐、厌两种情绪及利培酮组患者识别惊、恐两种情绪表现更差，差异更显著（P＜0.01）。治疗后，患者组被试在失言识别上的表现有改善，但是还是较差：氯氮平组患者在失言1、失言3以及失言4上与对照组比较，均表现较差，差异有统计学意义（P＜0.05）；利培酮组患者在失言2、失言3以及失言4上与对照组比较，均表现较差，差异有统计学意义（P＜0.05）。患者组被试识别基本眼区情绪有改善，但仍然存在差异。其中，氯氮平组患者识别恐、厌、怒三种情绪及利培酮组患者识别惊、恐、厌三种情绪较差，差异有统计学意义（P＜0.05）。结论：精神分裂症患者存在社会认知功能受损，其在失言识别及眼区情绪识别上表现较差。经过药物治疗后，其社会认知功能只是部分改善，说明社会认知功能受损可能是精神分裂症患者的特质性改变。另外，氯氮平和利培酮对社会认知功能都有改善作用，，但是其改善作用体现在不同的方面。
[Abstract]:Objective: schizophrenia is a common and complex mental illness. Its social cognitive function is badly damaged, including emotional cognition, loss of speech recognition, and eye area emotion recognition. The neural basis of social cognition involves the frontal lobe, the frontal lobe and cingulate gyrus, and neuropsychology, neurophysiology and neuroimaging. It is found that there is also structural or functional impairment in the above-mentioned brain areas of schizophrenic patients. During the onset of schizophrenia, the c-fos proto oncogene can be expressed rapidly and briefly, and the abnormal expression of.C-fos in the corresponding brain function area will produce a wide range of pathological effects, resulting in the function of brain tissue in schizophrenic patients or Qualitative changes. Previous studies have found that clozapine, risperidone, and other drugs can improve the social cognition of schizophrenic patients by regulating the expression of c-fos gene, but the results are not consistent. Social cognitive impairment; second, different patients were treated with clozapine and risperidone to explore whether the social cognition was improved and the efficacy of the two drugs was observed to be the same.
Methods: in this study, 66 patients with schizophrenia diagnosed with the fourth version of the American psychiatric diagnostic and Statistical Manual (DSM-IV), and 32 normal control groups with matched age and year of education were studied. The patients were randomly assigned to the clozapine treatment group and the risperidone treatment group, the former was 34. For example, the latter was 32. Before and after treatment, all subjects were treated with simple mental state examination (MMSE), lexical fluency test (VF), digital breadth (DS) and other neuropsychological background tests. Before and after treatment, positive and negative symptom scale test (PANSS) were performed on the patients group, and all the subjects were lost before and after treatment, respectively. Speech recognition test (Faux Pas) and eye area emotion recognition task test.
Results: there was no significant difference between the three groups of simple mental state detection, vocabulary fluency detection and digital breadth score comparison (P > 0.05). Before treatment, the patients in the faux pas test group were 1, 2, 3 and 4, and the difference was statistically significant (P < 0.05). The six kinds of basic eye area mood in the group were compared with the control group, and the difference was statistically significant (P < 0.05). Among them, the patients in the clozapine group identified the fear, the two kinds of emotions and the risperidone group, and the two mood tables were worse, and the difference was more significant (P < 0.01). After treatment, the patients group was lost. The performance of the speech recognition was improved, but it was still poor: the patients in the clozapine group were 1, 3 and 4, and the difference was statistically significant (P < 0.05). The patients in the risperidone group were 2, the lost 3 and the loss of the words 4 compared with the control group, the difference was statistically significant (P < 0.05). In the patients group, the subjects identified the improvement in the basic eye area mood, but there were still differences. Among them, the patients in the clozapine group identified the three emotions and the risperidone group to recognize the horror, the fear, and the three kinds of bad mood, and the difference was statistically significant (P < 0.05).
Conclusion: Patients with schizophrenia have impaired social cognitive function and poor performance in the recognition of loss of speech and recognition of eye areas. After medications, the social cognitive function is only partially improved, indicating that the impairment of social cognitive function may be the idiosyncratic change of schizophrenic patients. Knowledge function has improvement effect, but its improvement effect is reflected in different aspects.

【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R749.3

【参考文献】