童年期虐待对首发精神分裂症患者认知功能的影响

孙棋圻 申变红 李强健

[摘要] 目的 探讨童年期虐待对首发精神分裂症患者认知功能的影响。 方法 选择2019年1～12月在我院诊断治疗的首发精神分裂症患者50例为研究对象，另选择同期在我院的健康志愿者50例为对照组。采用BACS SC、HVLT-R、BVMT-R、WMS-Ⅲ SST、Stroop色-词测验、WCST对两组认知功能进行调查。采用儿童期虐待问卷对两组儿童期不良应激事件进行调查。多重线性回归分析童年虐待对认知功能的影响。 结果 （1）精神分裂症组BACS SC、HVLT-R、BVMT-R、WMS-Ⅲ SST、Stroop色-词测验、WCST总正确数、完成分类数得分均显著低于对照组，差异有统计学意义（P<0.05）。WCST总错误数、持续错误数、持续应答数显著高于对照组，差异有统计学意义（P<0.05）。（2）精神分裂症组童年虐待各维度以及总分得分均显著高于对照组，差异有统计学意义（P<0.05）。（3）多重线性回归分析显示：躯体忽视、情感虐待对简易视觉空间记忆测验有负向影响（P<0.05）;情感虐待对霍普金斯词语学习测验有负向影响（P<0.05）;躯体忽视，情感虐待对空间广度测验有负向影响（P<0.05）;躯体忽视对Stroop-色词有负向影响（P<0.05）;躯体忽视对符号编码测验有负向影响（P<0.05）;躯体忽视与WCST错误应答数有正向关联（P<0.05）;躯体忽视与WCST完成分类数有负向关联（P<0.05）。 结论 首发精神分裂症患者存在一定程度的认知功能障碍，童年期虐待经历对患者认知功能障碍有一定的影响。

[关键词] 首发;精神分裂症;认知功能;童年期虐待

[中图分类号] R749.3          [文獻标识码] B          [文章编号] 1673-9701（2020）16-0107-04

Influence of childhood abuse on cognitive function in patients with first-episode schizophrenia

SUN Qiqi   SHEN Bianhong   LI Qiangjian

Department of Psychiatry， Hangzhou Seventh People's Hospital， Hangzhou   310013， China

[Abstract] Objective To investigate the effect of childhood abuse on cognitive function in patients with first-episode schizophrenia. Methods Fifty patients with first- episode schizophrenia diagnosed and treated in our hospital from January to December 2019 were selected as the research subjects， and 50 healthy volunteers in our hospital during the same period were selected as the control group. BACS SC， hopkins verbal learning test-revised（HVLT-R）， brief visuospatial memory test-revised（BVMT-R）， WMS-Ⅲ SST， stroop color-word test， and wisconsin card sorting test（WCST） were used to investigate the cognitive function of the two groups. A childhood abuse questionnaire was used to investigate adverse childhood incidents in both groups. Multiple linear regression analysis was performed to analyze the influence of childhood abuse on cognitive function. Results （1） The BACS SC， HVLT-R， BVMT-R， WMS-Ⅲ SST， Stroop color-word test， and WCST total positive number and completed classification number in the schizophrenia group were significantly lower than those in the control group， and the differences were statistically significant（P<0.05）. The total errors， persistent errors and persistent responses of WCST in the schizophrenia group were significantly higher than those of the control group（P<0.05）. （2） The dimensions of childhood abuse and total scores in the schizophrenia group were significantly higher than those in the control group， and the differences were statistically significant（P<0.05）. （3） Multiple linear regression analysis showed that physical neglect and emotional abuse had a negative influence on the BVMT-R（P<0.05）. Emotional abuse had a negative effect on the HVLT-R（P<0.05）. Physical neglect and emotional abuse had a negative effect on the WMS-Ⅲ SST（P<0.05）. Physical neglect had a negative effect on the Stroop-color word（P<0.05）. Physical neglect had a negative effect on the BACS SC（P<0.05）. Physical neglect was positively correlated with the number of WCST error responses（P<0.05）. Physical neglect was negatively correlated with the number of WCST completed classifications（P<0.05）. Conclusion There is a certain degree of cognitive dysfunction in patients with first-episode schizophrenia. Childhood abuse experience has a certain influence on patients' cognitive dysfunction.

[Key words] First-episode; Schizophrenia; Cognitive function; Childhood abuse

精神分裂症病因不明，患者可表现为感知、思维、情感、行为等多方面的障碍，以及精神活动不协调，精神活动与环境不协调等，青壮年高发。我国终生患病率为6.55‰，城市患病率高于农村。认知功能是高级脑功能，包括注意、记忆、知觉及思维等过程[1，2]。精神分裂症患者可存在不同程度的认知功能障碍，尤其是在注意功能、言语记忆、执行功能方面[3]。有研究显示患者的认知功能障碍与阴性症状相关，但也有研究显示与阳性症状有关，也有研究认为患者的认知功能障碍独立于精神症状，是精神分裂症的第三种症状，与阴性症状、阳性症状均没有直接关系[4，5]。既往有研究显示，童年期虐待经历是引起精神疾病的重要因素之一[6]。本文分析童年期虐待经历对首发精神分裂症患者认知功能的因素，以期为临床诊断治疗提供参考，现报道如下。……