切换至 "中华医学电子期刊资源库"

中华诊断学电子杂志 ›› 2023, Vol. 11 ›› Issue (01) : 28 -32. doi: 10.3877/cma.j.issn.2095-655X.2023.01.006

神经精神疾病诊治

精神分裂症认知功能损害的特点、机制及干预方式研究进展
姚珍珍1, 陈昂昂2, 周亚楠2, 赵高峰2, 张申帅1, 翟金国2, 陈敏1,()   
  1. 1. 272067 济宁医学院精神卫生学院
    2. 272051 济宁,山东省戴庄医院精神科
  • 收稿日期:2022-07-17 出版日期:2023-02-26
  • 通信作者: 陈敏
  • 基金资助:
    山东省医药卫生科技发展计划项目(202103090715;202003090370)

Research progress on the characteristics, mechanism and intervention of cognitive impairment in schizophrenia

Zhenzhen Yao1, Angang Chen2, Yanan Zhou2, Gaofeng Zhao2, Shenshuai Zhang1, Jinguo Zhai2, Min Chen1,()   

  1. 1. College of Mental Health, Jining Medical University, Jining 272067, China
    2. Department of Psychiatry, Shandong Daizhuang Hospital, Jining 272051, China
  • Received:2022-07-17 Published:2023-02-26
  • Corresponding author: Min Chen
引用本文:

姚珍珍, 陈昂昂, 周亚楠, 赵高峰, 张申帅, 翟金国, 陈敏. 精神分裂症认知功能损害的特点、机制及干预方式研究进展[J]. 中华诊断学电子杂志, 2023, 11(01): 28-32.

Zhenzhen Yao, Angang Chen, Yanan Zhou, Gaofeng Zhao, Shenshuai Zhang, Jinguo Zhai, Min Chen. Research progress on the characteristics, mechanism and intervention of cognitive impairment in schizophrenia[J]. Chinese Journal of Diagnostics(Electronic Edition), 2023, 11(01): 28-32.

精神分裂症是一种高发病率、高致残率的重大精神疾病,认知功能损害作为核心症状之一,通常先于精神病性症状出现,多数难以缓解。研究发现,精神分裂症患者的认知功能损害广泛存在,易受到遗传风险、异常的自我体验等多种因素的影响,常导致社会功能衰退从而影响预后,目前其病理生理学机制尚不明确,多数研究认为其与大脑功能网络、促炎细胞因子与抗炎细胞因子平衡紊乱及应激有关。通过抗精神病药物、认知矫正和其他手段能够改善精神分裂症患者的认知功能。为进一步认识精神分裂症认知功能损害的机制并为未来研究及诊治提供新思路,笔者主要对精神分裂症认知功能损害的特征、机制及治疗进行综述。

Schizophrenia is a serious mental illness with high incidence and high disability rate. As one of the core symptoms, cognitive impairment usually appears before psychotic symptoms, and most of them are difficult to alleviate. It has been found that the cognitive impairment of schizophrenia is widespread, which is easily influenced by genetic risk, abnormal self-experience and other factors. These factors frequently often cause a loss in social function and have an impact on the prognosis. At present, its pathophysiological mechanism is yet understood fully, although most studies agree that stress, a disordered balance of proinflammatory and anti-inflammatory cytokines, and the brain functional network are all relevant factors. Antipsychotics, cognitive therapy, and other techniques can help schizophrenia patients with their cognitive function. This study summarizes the studies on cognitive impairment in schizophrenia in order to better understand the process of cognitive impairment in schizophrenia and to provide fresh concepts for future research, diagnosis, and treatment.

[1]
Sheffield JM, Karcher NR, Barch DM.Cognitive deficits in psychotic disorders:a lifespan perspective[J].Neuropsychol Rev201828(4):509-533.DOI:10.1007/s11065-018-9388-2.
[2]
Nuechterlein KH, Green MF, Kern RS, et al. The MATRICS Consensus Cognitive Battery,part 1:test selection,reliability,and validity[J].Am J Psychiatry2008165(2):203-213.DOI:10.1176/appi.ajp.2007.07010042.
[3]
Mihaljević-Peleš A, Bajs Janović M, Šagud M, et al. Cognitive deficit in schizophrenia:an overview[J].Psychiatr Danub201931(Suppl 2):139-142.
[4]
Zanelli J, Reichenberg A, Sandin S,et al.Dynamic and static cognitive deficits in schizophrenia and bipolar disorder after the first episode[J].Schizophr Bull202248(3):590-598.DOI:10.1093/schbul/sbab150.
[5]
Wang DM, Du YX, Zhu RR,et al.The relationship between cognitive impairment and superoxide dismutase activity in untreated first-episode patients with schizophrenia[J].World J Biol Psychiatry202223(7):517-524.DOI:10.1080/15622975.2021.2013093.
[6]
Xie YJ, Xi YB, Cui LB,et al.Functional connectivity of cerebellar dentate nucleus and cognitive impairments in patients with drug-naive and first-episode schizophrenia[J].Psychiatry Res2021(300):113937.DOI:10.1016/j.psychres.2021.113937.
[7]
Hintze B, Rowicka M, Barczak A.Are executive functions deficits in early-onset chronic schizophrenia more severe than in adult-onset chronic schizophrenia?[J].Clin Neuropsychiatry202219(1):54-63.DOI:10.36131/cnfioritieditore20220108.
[8]
陈声云,刘雅茜,张桂灿,等.稳定期精神分裂症患者神经认知功能损害特征及影响因素分析[J].国际精神病学杂志202047(5):904-909.DOI:10.13479/j.cnki.jip.2020.05.015.
[9]
Van Haren N, Van Dam DS, Stellato RK.Change in IQ in schizophrenia patients and their siblings:a controlled longitudinal study[J].Psychol Med201949(15):2573-2581.DOI:10.1017/S0033291718003537.
[10]
Zanelli J, Mollon J, Sandin S,et al.Cognitive change in schizophrenia and other psychoses in the decade following the first episode[J].Am J Psychiatry2019176(10):811-819.DOI:10.1176/appi.ajp.2019.18091088.
[11]
Fett AJ, Velthorst E, Reichenberg A,et al.Long-term changes in cognitive functioning in individuals with psychotic disorders:findings from the suffolk county mental health project[J].JAMA Psychiatry202077(4):387-396.DOI:10.1001/jamapsychiatry.2019.3993.
[12]
Sosin D, Ivashchenko D, Sozaeva Z,et al.Cognitive impairment in patients with treatment resistant schizophrenia:associations with DRD2,DRD3,HTR2A,BDNF and CYP2D6 genetic polymorphisms[J].Neurology,Psychiatry and Brain Research201933(6):48-55.DOI:10.1016/j.npbr.2019.06.003.
[13]
Hubbard L, Tansey KE, Rai D,et al.Evidence of common genetic overlap between schizophrenia and cognition[J].Schizophr Bull201642(3):832-842.DOI:10.1093/schbul/sbv168.
[14]
Koch E, Nyberg L, Lundquist A,et al.Sex-specific effects of polygenic risk for schizophrenia on lifespan cognitive functioning in healthy individuals[J].Transl Psychiatry202111(1):520.DOI:10.1038/s41398-021-01649-4.
[15]
Perkins DO, Olde Loohuis L, Barbee J,et al.Polygenic risk score contribution to psychosis prediction in a target population of persons at clinical high risk[J].Am J Psychiatry2020177(2):155-163.DOI:10.1176/appi.ajp.2019.18060721.
[16]
Shafee R, Nanda P, Padmanabhan JL,et al.Polygenic risk for schizophrenia and measured domains of cognition in individuals with psychosis and controls[J].Transl Psychiatry20188(1):78.DOI:10.1038/s41398-018-0124-8.
[17]
He Q, Jantac Mam-Lam-Fook C, Chaignaud J,et al.Influence of polygenic risk scores for schizophrenia and resilience on the cognition of individuals at-risk for psychosis[J].Transl Psychiatry202111(1):518.DOI:10.1038/s41398-021-01624-z.
[18]
Germine L, Robinson EB, Smoller JW,et al.Association between polygenic risk for schizophrenia,neurocognition and social cognition across development[J].Transl Psychiatry20166(10):e924.DOI:10.1038/tp.2016.147.
[19]
Su X, Qiao L, Liu Q, et al. Genetic polymorphisms of BDNF on cognitive functions in drug-naive first episode patients with schizophrenia[J].Sci Rep202111(1):20057.DOI:10.1038/s41598-021-99510-7.
[20]
Poddar I, Callahan PM, Hernandez CM,et al.Chronic oral treatment with risperidone impairs recognition memory and alters brain-derived neurotrophic factor and related signaling molecules in rats[J].Pharmacol Biochem Behav2020(189):172853.DOI:10.1016/j.pbb.2020.172853.
[21]
Park S, Nasrallah HA.The varieties of anomalous self experiences in schizophrenia:splitting of the mind at a crossroad[J].Schizophr Res2014152(1):1-4.DOI:10.1016/j.schres.2013.11.036.
[22]
Trask CL, Matsui MM, Cohn JR,et al.Anomalous self-experiences in cognition are negatively associated with neurocognitive functioning in schizophrenia[J].Cogn Neuropsychiatry202126(5):307-320.DOI:10.1080/13546805.2021.1935225.
[23]
Hernández-García M, Gómez-García M, Sotelo E,et al.Anomalous self-experiences are related to general cognition deficits in schizophrenia[J].Eur Arch Psychiatry Clin Neurosci2021271(4):707-712.DOI:10.1007/s00406-020-01213-z.
[24]
Kaneko K.Negative symptoms and cognitive impairments in schizophrenia:two key symptoms negatively influencing social functioning[J].Yonago Acta Med201861(2):91-102.DOI:10.33160/yam.2018.06.001.
[25]
Tominaga T, Tomotake M, Takeda T,et al.Relationship between social and cognitive functions in people with schizophrenia[J].Neuropsychiatr Dis Treat2018(14):2215-2224.DOI:10.2147/NDT.S171207.
[26]
Yeo BT, Krienen FM, Sepulcre J,et al.The organization of the human cerebral cortex estimated by intrinsic functional connectivity[J].J Neurophysiol2011106(3):1125-1165.DOI:10.1152/jn.00338.2011.
[27]
Gordon EM, Laumann TO, Marek S,et al.Default-mode network streams for coupling to language and control systems[J].Proc Natl Acad Sci USA2020117(29):17308-17319.DOI:10.1073/pnas.2005238117.
[28]
Smallwood J, Bernhardt BC, Leech R,et al.The default mode network in cognition:a topographical perspective[J].Nat Rev Neurosci202122(8):503-513.DOI:10.1038/s41583-021-00474-4.
[29]
Khalil M, Hollander P, Raucher-Chéné D,et al.Structural brain correlates of cognitive function in schizophrenia:a meta-analysis[J].Neurosci Biobehav Rev2022(132):37-49.DOI:10.1016/j.neubiorev.2021.11.034.
[30]
Chumakov E, Dorofeikova M, Tsyrenova K,et al.A cross-sectional study on associations between BDNF,CRP,IL-6 and clinical symptoms,cognitive and personal performance in patients with paranoid schizophrenia[J].Front Psychiatry2022(13):943869.DOI:10.3389/fpsyt.2022.943869.
[31]
Baek SH, Kim H, Kim JW,et al.Association between peripheral inflammatory cytokines and cognitive function in patients with first-episode schizophrenia[J].J Pers Med202212(7).DOI:10.3390/jpm12071137.
[32]
Kogan S, Ospina LH, Kimhy D.Inflammation in individuals with schizophrenia-implications for neurocognition and daily function[J].Brain Behav Immun2018(74):296-299.DOI:10.1016/j.bbi.2018.09.016.
[33]
Xiu MH, Yang GG, Tan YL,et al.Decreased interleukin-10 serum levels in first-episode drug-naïve schizophrenia:relationship to psychopathology[J].Schizophr Res2014156(1):9-14.DOI:10.1016/j.schres.2014.03.024.
[34]
Thibaut F. Neuroinflammation: new vistas for neuropsychiatric research[J].Dialogues Clin Neurosci201719(1):3-4.DOI:10.31887/DCNS.2017.19.1/fthibaut.
[35]
Rokita KI, Dauvermann MR, Mothersill D,et al.Current psychosocial stress,childhood trauma and cognition in patients with schizophrenia and healthy participants[J].Schizophr Res2021(237):115-121.DOI:10.1016/j.schres.2021.08.030.
[36]
孔令明,朱晓丽,牛威,等.精神分裂症患者外周血lncRNA、童年期慢性应激与认知功能障碍的关系[J].中华行为医学与脑科学杂志202130(11):1005-1010.DOI:10.3760/cma.j.cn371468-20210619-00334.
[37]
Piotrowski P, Kotowicz K, Rymaszewska J,et al.Allostatic load index and its clinical correlates at various stages of psychosis[J].Schizophr Res2019(210):73-80.DOI:10.1016/j.schres.2019.06.009.
[38]
Zhou Y, Huang J, Zhang P,et al.Allostatic load effects on cortical and cognitive deficits in essentially normotensive,normoweight patients with schizophrenia[J].Schizophr Bull202147(4):1048-1057.DOI:10.1093/schbul/sbaa196.
[39]
Azimi Sanavi M, Ghazvini H, Zargari M,et al.Effects of clozapine and risperidone antipsychotic drugs on the expression of CACNA1C and behavioral changes in rat 'Ketamine model of schizophrenia[J].Neurosci Lett2022(770):136354.DOI:10.1016/j.neulet.2021.136354.
[40]
Rogóz Z, Kamińska K, Lech MA,et al.N-acetylcysteine and aripiprazole improve social behavior and cognition and modulate brain BDNF levels in a rat model of schizophrenia[J].Int J Mol Sci202223(4).DOI:10.3390/ijms23042125.
[41]
Wu Z, Liu Q, Zhang Y,et al.Superoxide dismutase,BDNF,and cognitive improvement in drug-naive first-episode patients with schizophrenia:a 12-week longitudinal study[J].Int J Neuropsychopharmacol202225(2):128-135.DOI:10.1093/ijnp/pyab065.
[42]
Setién-Suero E, Ortiz-García de la Foz V, Suárez-Pinilla P,et al.Different neurocognitive profiles of risperidone and aripiprazole in the FIRST episode of psychosis:a 3-year follow-up comparison[J].Prog Neuropsychopharmacol Biol Psychiatry2021(110):110309.DOI:10.1016/j.pnpbp.2021.110309.
[43]
Joshi YB, Thomas ML, Braff DL,et al.Anticholinergic medication burden-associated cognitive impairment in schizophrenia[J].Am J Psychiatry2021178(9):838-847.DOI:10.1176/appi.ajp.2020.20081212.
[44]
Lindenmayer JP, Insel BJ, Khan A,et al.Effects of clozapine on neurocognitive functions in schizophrenia:a naturalistic comparison to non-clozapine antipsychotics[J].Innov Clin Neurosci202118(10-12):40-46.
[45]
Singh A, Kumar V, Pathak H,et al.Effect of antipsychotic dose reduction on cognitive function in schizophrenia[J].Psychiatry Res2022(308):114383.DOI:10.1016/j.psychres.2021.114383.
[46]
Zhu X, Fan H, Zou Y,et al.Computerized or manual? Long term effects of cognitive remediation on schizophrenia[J].Schizophr Res2022(239):47-54.DOI:10.1016/j.schres.2021.11.019.
[47]
Katsumi A, Hoshino H, Fujimoto S, et al. Effects of cognitive remediation on cognitive and social functions in individuals with schizophrenia[J].Neuropsychol Rehabil201929(9):1475-1487.DOI:10.1080/09602011.2017.1409639.
[48]
Buonocore M, Spangaro M, Bechi M,et al.Cognitive remediation in schizophrenia:what happens after 10 years?[J].Schizophr Res Cogn2022(29):100251.DOI:10.1016/j.scog.2022.100251.
[49]
Khonsari NM, Badrfam R, Mohammdi MR,et al.Effect of aerobic exercise as adjunct therapy on the improvement of negative symptoms and cognitive impairment in patients with schizophrenia:a randomized,case-control clinical trial[J].J Psychosoc Nurs Ment Health Serv202260(5):38-43.DOI:10.3928/02793695-20211014-03.
[50]
Wen N, Chen L, Miao X,et al.Effects of high-frequency rTMS on negative symptoms and cognitive function in hospitalized patients with chronic schizophrenia:a double-blind,sham-controlled pilot trial[J].Front Psychiatry2021(12):736094.DOI:10.3389/fpsyt.2021.736094.
[1] 张晓燕, 肖东琼, 高沪, 陈琳, 唐发娟, 李熙鸿. 转录因子12过表达对脓毒症相关性脑病大鼠大脑皮质的保护作用及其机制[J]. 中华妇幼临床医学杂志(电子版), 2023, 19(05): 540-549.
[2] 陆美琪, 赵洁, 单菲, 王兴蕾, 姜笃银. 药物相关坏疽性脓皮病的研究进展[J]. 中华损伤与修复杂志(电子版), 2023, 18(05): 447-450.
[3] 张潇尹, 于洋. 牙龈卟啉单胞菌介导慢性肾病发生发展的研究进展[J]. 中华口腔医学研究杂志(电子版), 2023, 17(05): 328-334.
[4] 叶晓琳, 刘云飞, 庞明泉, 王海久, 任利, 侯立朝, 于文昊, 王志鑫, 樊海宁. 肝再生细胞来源及调控机制的研究进展[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 96-99.
[5] 李凤仪, 李若凡, 高旭, 张超凡. 目标导向液体干预对老年胃肠道肿瘤患者术后血流动力学、胃肠功能恢复的影响[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 29-32.
[6] 熊风, 林辉煌, 陈晓波. 铥激光在泌尿外科中的临床应用及研究进展[J]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(05): 533-536.
[7] 王蕾, 王少华, 牛海珍, 尹腾飞. 儿童腹股沟疝围手术期风险预警干预[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 768-772.
[8] 董玉花, 魏红花, 孔荷香, 周莉, 孙小花. 主动性个性化心理干预在成人腹股沟疝围手术期患者护理中的应用[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(05): 652-656.
[9] 闵筱兰, 周洁超, 陈振添. 健康管理联合心理干预用于腹腔镜腹股沟疝手术患儿术后效果观察[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(05): 657-661.
[10] 唐英俊, 李华娟, 王赛妮, 徐旺, 刘峰, 李羲, 郝新宝, 黄华萍. 人脐带间充质干细胞治疗COPD小鼠及机制分析[J]. 中华肺部疾病杂志(电子版), 2023, 16(04): 476-480.
[11] 任加发, 邬步云, 邢昌赢, 毛慧娟. 2022年急性肾损伤领域基础与临床研究进展[J]. 中华肾病研究电子杂志, 2023, 12(05): 276-281.
[12] 张坤淇, 张睿, 徐佳, 康庆林. 漂浮膝损伤的诊治进展[J]. 中华老年骨科与康复电子杂志, 2023, 09(04): 252-256.
[13] 金刚, 李英真, 施维, 李博. 帕金森病在病理生理学中的研究进展[J]. 中华脑科疾病与康复杂志(电子版), 2023, 13(05): 315-319.
[14] 李田, 徐洪, 刘和亮. 尘肺病的相关研究进展[J]. 中华临床医师杂志(电子版), 2023, 17(08): 900-905.
[15] 李静, 张玲玲, 邢伟. 兴趣诱导理念用于小儿手术麻醉诱导前的价值及其对家属满意度的影响[J]. 中华临床医师杂志(电子版), 2023, 17(07): 812-817.
阅读次数
全文


摘要