精神分裂症患者之自殺行為與執行功能反應抑制缺失

Response Inhibition Deficits of Executive Function and Suicidal Behavior in Schizophrenic Patients

蘇宗偉(Tsung-Wei Su)

指導教授 ： 李明濱

國立臺灣大學/醫學院/臨床醫學研究所/碩士(2007年)

https://doi.org/10.6342/NTU.2007.00898

摘要

主題：精神分裂症患者具有工作記憶的缺失，本研究主要在驗證精神分裂症工作記憶的功能缺損對於精神分裂症患者自殺行為的相關性。

方法：研究個案選取了30位精神分裂症的個案，詢問其自殺史並施予活性與負性症狀量表(Positive and Negative Symptoms Scale, PANSS)精神病理的評量後，以Mini-Mental State Exam(MMSE)、數字記憶廣度測驗(Digit Span)、空間記憶廣度(Spatial Span)、與克氏持續度表現測驗第二版(Conners’ Continuous Performance Test version II; CPT II)檢視其整體認知情況與各項工作記憶分項。所有的個案都經過結構性臨床會談(Structured Clinical Interview for DSM-IV-TR Axis I disorders; SCID)為其精神分裂症診斷做再次確定，並排除性別、年齡、教育程度與情緒症狀因素的影響。

結果：(1)精神分裂症患者有自殺行為史者(N=11)其CPT II中commission error rate (49.7±21.1%)較無自殺行為史者(N=19; 29.3±14.8%; p<0.01)高，detectability (0.51±0.35)較無自殺史者(0.81±0.34; p<0.05)低。(2)病人的整體精神症狀的嚴重程度，與MMSE分數、CPT II中omission error rate、response style相關。(3)語言工作記憶與教育程度相關，而空間工作記憶與CPT II中omission error rate及hit reaction time相關。

結論：本研究認為精神分裂症患者過去的自殺行為與工作記憶中執行功能的反應抑制缺損有關。精神分裂症有自殺行為史者其CPT II的commission error rate較高、精神病理症狀嚴重者其omission error rate較高。

關鍵字

自殺 ； 精神分裂症 ； 工作記憶 ； 反應抑制 ； 憂鬱症

並列摘要

Objective: Schizophrenic patients have working memory impairment. This study tested the impaired working memory may be associated with suicidal behavior in schizophrenic patients.

Method: The subjects were 30 schizophrenic persons with or without past suicidal behavior. All subjects were interviewed with Structured Clinical Interview for DSM-IV-TR Axis I disorders and evaluated with a sociodemographic and clinical questionnaire, the Positive and Negative Symptoms Scale (PANSS). They were also assessed with a battery of neuropsychological tests. General cognitive function was measured with Mini-Mental Status Examination (MMSE). Verbal working memory was measured with the WAIS digit span tests, spatial working memory was measured with WMS spatial span, and the Conners’ Continuous Performance Test, version II (CPT II) was used to test executive function.

Results: (1) In previous suicidal attempters group (N=11), there were higher CPT II commission error rate (49.7±21.1%) and lower detectability value (0.51±0.35) compared to the no suicidal history group. (N=19; 29.3±14.8%, p<0.01; 0.81±0.34; p<0.05) (2) The severity of psychopathological symptoms in PANSS rating showed significant correlation with MMSE scores, and omission error rates, response criterion in CPT II. (3) Spatial working memory showed significant correlation to omission error rates and hit reaction time in CPT II, while verbal working memory depend on education years

Conclusion: We postulated that response inhibition deficits of executive function in working memory were correlated to the past suicidal behaviors in schizophrenic patients. Regarding executive function of working memory, previous suicidal attempters had higher commission error rates, and the severity of psychopathology was correlated to higher omission error rates in CPT II results.

並列關鍵字

suicide ； schizophrenia ； working memory ； response inhibition ； depressive disorder

參考文獻

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