ICF框架下精神分裂症患者认知障碍的研究进展
Journal: Basic Medical Theory Research DOI: 10.32629/bmtr.v8i2.18901
Abstract
目的：系统综述ICF框架下精神分裂症认知障碍的病理机制、评估工具及干预策略，构建多维康复体系的理论与实践路径。方法：整合2016-2024年神经影像学、分子遗传学、随机对照试验及卫生经济学研究，采用系统综述与Meta分析方法，纳入127项高质量研究。结果：（1）神经机制：前驱期即存在前额叶-丘脑环路连接密度降低，DNMT3A甲基化水平与工作记忆缺陷负相关；（2）药物干预：氨磺必利显著提升处理速度，GLP-1激动剂使MCCB总分提升；（3）心理社会干预：认知疗法（CT）是针对精神病性症状最有效的心理社会干预措施，社交技能训练与其他心理社会干预措施相比在减少阴性症状方面具有有效性；（4）经济学效益：CAT显著改善患者社区适应能力，提高社区功能，减少住院次数，且成本更低。结论：ICF框架揭示了认知障碍的多维交互机制，未来需融合数字技术，发展文化适应性干预，并通过政策优化实现认知康复服务的普惠覆盖。
Keywords
精神分裂症；认知障碍；ICF框架；神经可塑性；数字疗法
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[1] ELYAMANY O, LEICHT G, HERRMANN C S,et al. Transcranial alternating current stimulation (tACS): from basic mechanisms towards first applications in psychiatry[J].Eur Arch Psychiatry Clin Neurosci, 2021,271(1):135-156.
[2] Green MF,Kern RS,Braff DL,et al.Neuro cognitivedeficits and functional outcome in schizophrenia:Are we measuring the“right stuff”?[J].Schizophr Bull,2000,26(1):119-136.
[3] Javitt DC.Cognitive impairment associated with schizophrenia:From pathophysiology to treatment[J].Annu Rev Pharmacol Toxicol,2023,63:119-141.
[4] Callicott JH, Bertolino A, Mattay VS, et al. Physiological dysfunction of the dorsolateral prefrontal cortex in schizophrenia revisited. Cerebral Cortex. 2000;10:1078–92.
[5] ZALESKY A,FORNITO A,SEAL ML,et al.Disrupted axonal fiber connectivity in schizophrenia[J].Biol Psychiatry,2011,69(1):80-89.
[6] MWANSISY A T E,HU A,LI Y,et al. Task and resting-state FMRI studies in first-episode schizophrenia: A systematic review[J].Schizophr Res,2017,189:9-18.
[7] Kocsis, Bernat, et al. “Impact of ketamine on neuronal network dynamics: translational modeling of schizophrenia‐relevant deficits.”CNS neuroscience & therapeutics19.6 (2013): 437-447.
[8] 徐文炜,姚建军,吴越袁,等.认知康复对精神分裂症认知功能影响的研究[J].中国康复医学杂志，2011,26(1):55-59.
[9] Papenberg G, Becker N, Ferenc ZB, et al. Dopamine reuptor genes modulate assouative memoryin old age [J]. J Cogn Neurosci, 2017, 29(2) :245-253.
[10] Gurvich C, Gavrilidis E, Worsley R, et al. Menstrual cycle irregularity and menopause statusinfluence cognition in women with schizophrenia[J]. Psychoneuroendocrinology, 2018,96:173-178.
[11] Bobes J, Arango C, Garcia-Garcia M, Rejas J; CLAMORS StudyCollaborative Group. Prevalence of negative symptoms in outpatientswith schizophrenia spectrum disorders treated with antipsychotics inroutine clinical practice: findings from the CLAMORS study. J ClinPsychiatry. 2010;71(3):280–286
[12] Holthausen EA, Wiersma D, Cahn W, et al. Predictive value of cognition for different domains of outcome in recent-onset schizophrenia.Psychiatry Res. 2007;149(1–3):71–80.
[13] Bustillo J, Lauriello J, Horan W, et al. The psychosocial treatment of schizophrenia: an update[J]. The American journal of psychiatry, 2001,158(2):163-175.
[14] 唐秋萍,邓云龙.精神分裂症心理治疗的研究现状[J].中华行为医学与脑科学杂志,2002, 11(1):115-117.
[15] De Kloet ER, Joels M, Holsboer F. Stress and the brain: from adaptation to disease[J]. Nature reviews. Neuroscience, 2005, 6(6): 463-475.
[16] August SM, Kiwanuka, JN, McMahon, RP, Gold, JM. The MATRICS consensus cognitive battery (MCCB): Clinical and cognitive correlates. Schizophr Res. 2012;134:76–82.
[17] Liu G, Henson P, Keshavan M, et al. Assessing the potential of longitudinal smartphone based cognitive assessment in schizophrenia: A naturalistic pilot study[J]. Schizophrenia Research: Cognition, 2019, 17: 100144.
[18] Searle A, Allen L, Lowther M, et al. Measuring functional outcomes in schizophrenia in an increasingly digital world[J]. Schizophrenia Research: Cognition, 2022, 29: 100248.
[19] He Z, Dieciuc M, Carr D, et al. New opportunities for the early detection and treatment of cognitive decline: adherence challenges and the promise of smart and person-centered technologies[J]. BMC Digital Health, 2023, 1(1): 7.
[20] Curran M P, Perry C M. Amisulpride: a review of its use in the management of schizophrenia[J]. Drugs, 2001, 61: 2123-2150.
[21] Flintoff J, Kesby J P, Siskind D, et al. Treating cognitive impairment in schizophrenia with GLP-1RAs: an overview of their therapeutic potential[J]. Expert Opinion on Investigational Drugs, 2021, 30(8): 877-891.
[22] Zangani C, Giordano B, Stein H C, et al. Efficacy of amisulpride for depressive symptoms in individuals with mental disorders: A systematic review and meta‐analysis[J]. Human Psychopharmacology: Clinical and Experimental, 2021, 36(6): e2801.
[23] Pozzi M, Mazhar F, Peeters G G A M, et al. A systematic review of the antidepressant effects of glucagon-like peptide 1 (GLP-1) functional agonists: Further link between metabolism and psychopathology: Special Section on “Translational and Neuroscience Studies in Affective Disorders”. Section Editor, Maria Nobile MD, PhD. This Section of JAD focuses on the relevance of translational and neuroscience studies in providing a better understanding of the neural basis of affective disorders. The main aim is to briefly summaries relevant research...[J]. Journal of Affective Disorders, 2019, 257: 774-778.
[24] Glynn SM. The challenge of psychiatric rehabilitation in schizophrenia[J]. Curr Psychiatry Rep,2001,3:401-6.
[25] Kern RS, Glynn SM, Horan W, Marder S. Psychosocial treatments to promote functional recovery in schizophrenia[J]. Schizophr Bull,2009,35:347-61.
[26] Lyman DR, Kurtz MM, Farkas M, George P, Dougherty RH, Daniels AS, et al. Skill building: assessing the evidence[J]. Psychiatr Serv,2014,65:727-38.
[27] Wykes T, Huddy V, Cellard C, McGurk SR, Czobor P. A meta-analysis of cognitive remediation for schizophrenia: methodology and effect sizes[J]. Am J Psychiatry,2011,168:472-85.
[28] Chien WT, Leung SF, Yeung FK, Wong WK. Current approaches to treatments for schizophrenia spectrum disorders, part II: psychosocial interventions and patient-focused perspectives in psychiatric care[J]. Neuropsychiatr Dis Treat,2013,9:1463-81.
[29] Bäuml J, Froböse T, Kraemer S, Rentrop M, Pitschel-Walz G. Psychoeducation: a basic psychotherapeutic intervention for patients with schizophrenia and their families[J]. Schizophr Bull,2006,32:S1-9.
[30] Turkington D, Dudley R, Warman DM, Beck AT. Cognitive-behavioral therapy for schizophrenia: a review[J]. J Psychiatr Pract,2004,10:5-16.
[31] Heinssen RK, Liberman RP, Kopelowicz A. Psychosocial skills training for schizophrenia: lessons from the laboratory[J]. Schizophr Bull,2000,26:21-46.
[32] Rector N, Beck A. Cognitive therapy for schizophrenia from conceptualization to intervention[J]. Can J Psychiatry,2002,47:39-48.
[33] Kopelowicz A, Liberman RP, Zarate R. Recent advances in social skills training for schizophrenia[J]. Schizophr Bull,2006,32:12-23.
[34] Mander H, Kingdon D. The evolution of cognitive-behavioral therapy for psychosis[J]. Psychol Res Behav Manag,2015,8:63-9.
[35] Chan JY, Hirai HW, Tsoi KK. Can computer-assisted cognitive remediation improve employment and productivity outcomes of patients with severe mental illness? A meta-analysis of prospective controlled trials[J]. J Psychiatr Res,2015,68:293-300.
[36] Wexler BE, Bell M. Cognitive remediation and vocational rehabilitation for schizophrenia[J]. Schizophr Bull,2005,31:931-41.
[37] Cella M, Preti A, Edwards C, Dow T, Wykes T. Cognitive remediation for negative symptoms of schizophrenia: a network meta-analysis[J]. Clin Psychol Rev,2016,28(52):43-51.
[38] Pekkala E, Merinder L. Psychoeducation for schizophrenia. Cochrane Database[J]. Syst Rev (2002) 4:CD002831.
[39] Rummel-Kluge C, Kissling W. Psychoeducation for patients with schizophrenia and their families[J]. Expert Rev Neurother,2008,8:1067-77.
[40] Penn DL, Mueser KT. Research update on the psychosocial treatment of schizophrenia[J]. Am J Psychiatry,1996,153:607-17.
[41] Pitschel-Walz G, Leucht S, Bauml J, Kissling W, Engel RR. The effect of family interventions on relapse and rehospitalization in schizophrenia–a meta-analysis[J]. Schizophr Bull,2001,27:73-92.
[42] McFarlane WR, Dixon L, Lukens E, Lucksted A. Family psychoeducation and schizophrenia: a review of the literature[J]. J Marital Fam Ther,2003,29:223-45.
[43] Pharoah F, Mari J, Rathbone J, Wong W. Family intervention for schizophrenia[J]. Cochrane Database Syst Rev,2010,12:CD000088.
[44] Elis O, Caponigro JM, Kring AM. Psychosocial treatments for negative symptom in schizophrenia: current practices and future directions[J]. Clin Psychol Rev,2013,33(8):914-28.
[45] Aleman A, Lincoln TM, Bruggeman R, Melle I, Arends J, Arango C, et al. Treatment of negative symptoms: where do we stand, and where do we go?[J]. Schizophr Res,2016.
[46] Gould RA, Mueser KT, Bolton E, Mays V, Goff D. Cognitive therapy for psychosis in schizophrenia: an effect size analysis[J]. Schizophr Res,2000,48:335-42.
[47] Lim M H, Penn D L. Using digital technology in the treatment of schizophrenia[J]. Schizophrenia Bulletin, 2018, 44(5): 937-938.
[48] Degnan A, Baker S, Edge D, et al. The nature and efficacy of culturally-adapted psychosocial interventions for schizophrenia: a systematic review and meta-analysis[J]. Psychological medicine, 2018, 48(5): 714-727.
[49] Fleischhacker W W, Arango C, Arteel P, et al. Schizophrenia—time to commit to policy change[J]. Schizophrenia bulletin, 2014, 40(Suppl_3): S165-S194.
[50] Mechelli A, Vieira S. From models to tools: clinical translation of machine learning studies in psychosis[J]. npj Schizophrenia, 2020, 6(1): 4.
[2] Green MF,Kern RS,Braff DL,et al.Neuro cognitivedeficits and functional outcome in schizophrenia:Are we measuring the“right stuff”?[J].Schizophr Bull,2000,26(1):119-136.
[3] Javitt DC.Cognitive impairment associated with schizophrenia:From pathophysiology to treatment[J].Annu Rev Pharmacol Toxicol,2023,63:119-141.
[4] Callicott JH, Bertolino A, Mattay VS, et al. Physiological dysfunction of the dorsolateral prefrontal cortex in schizophrenia revisited. Cerebral Cortex. 2000;10:1078–92.
[5] ZALESKY A,FORNITO A,SEAL ML,et al.Disrupted axonal fiber connectivity in schizophrenia[J].Biol Psychiatry,2011,69(1):80-89.
[6] MWANSISY A T E,HU A,LI Y,et al. Task and resting-state FMRI studies in first-episode schizophrenia: A systematic review[J].Schizophr Res,2017,189:9-18.
[7] Kocsis, Bernat, et al. “Impact of ketamine on neuronal network dynamics: translational modeling of schizophrenia‐relevant deficits.”CNS neuroscience & therapeutics19.6 (2013): 437-447.
[8] 徐文炜,姚建军,吴越袁,等.认知康复对精神分裂症认知功能影响的研究[J].中国康复医学杂志，2011,26(1):55-59.
[9] Papenberg G, Becker N, Ferenc ZB, et al. Dopamine reuptor genes modulate assouative memoryin old age [J]. J Cogn Neurosci, 2017, 29(2) :245-253.
[10] Gurvich C, Gavrilidis E, Worsley R, et al. Menstrual cycle irregularity and menopause statusinfluence cognition in women with schizophrenia[J]. Psychoneuroendocrinology, 2018,96:173-178.
[11] Bobes J, Arango C, Garcia-Garcia M, Rejas J; CLAMORS StudyCollaborative Group. Prevalence of negative symptoms in outpatientswith schizophrenia spectrum disorders treated with antipsychotics inroutine clinical practice: findings from the CLAMORS study. J ClinPsychiatry. 2010;71(3):280–286
[12] Holthausen EA, Wiersma D, Cahn W, et al. Predictive value of cognition for different domains of outcome in recent-onset schizophrenia.Psychiatry Res. 2007;149(1–3):71–80.
[13] Bustillo J, Lauriello J, Horan W, et al. The psychosocial treatment of schizophrenia: an update[J]. The American journal of psychiatry, 2001,158(2):163-175.
[14] 唐秋萍,邓云龙.精神分裂症心理治疗的研究现状[J].中华行为医学与脑科学杂志,2002, 11(1):115-117.
[15] De Kloet ER, Joels M, Holsboer F. Stress and the brain: from adaptation to disease[J]. Nature reviews. Neuroscience, 2005, 6(6): 463-475.
[16] August SM, Kiwanuka, JN, McMahon, RP, Gold, JM. The MATRICS consensus cognitive battery (MCCB): Clinical and cognitive correlates. Schizophr Res. 2012;134:76–82.
[17] Liu G, Henson P, Keshavan M, et al. Assessing the potential of longitudinal smartphone based cognitive assessment in schizophrenia: A naturalistic pilot study[J]. Schizophrenia Research: Cognition, 2019, 17: 100144.
[18] Searle A, Allen L, Lowther M, et al. Measuring functional outcomes in schizophrenia in an increasingly digital world[J]. Schizophrenia Research: Cognition, 2022, 29: 100248.
[19] He Z, Dieciuc M, Carr D, et al. New opportunities for the early detection and treatment of cognitive decline: adherence challenges and the promise of smart and person-centered technologies[J]. BMC Digital Health, 2023, 1(1): 7.
[20] Curran M P, Perry C M. Amisulpride: a review of its use in the management of schizophrenia[J]. Drugs, 2001, 61: 2123-2150.
[21] Flintoff J, Kesby J P, Siskind D, et al. Treating cognitive impairment in schizophrenia with GLP-1RAs: an overview of their therapeutic potential[J]. Expert Opinion on Investigational Drugs, 2021, 30(8): 877-891.
[22] Zangani C, Giordano B, Stein H C, et al. Efficacy of amisulpride for depressive symptoms in individuals with mental disorders: A systematic review and meta‐analysis[J]. Human Psychopharmacology: Clinical and Experimental, 2021, 36(6): e2801.
[23] Pozzi M, Mazhar F, Peeters G G A M, et al. A systematic review of the antidepressant effects of glucagon-like peptide 1 (GLP-1) functional agonists: Further link between metabolism and psychopathology: Special Section on “Translational and Neuroscience Studies in Affective Disorders”. Section Editor, Maria Nobile MD, PhD. This Section of JAD focuses on the relevance of translational and neuroscience studies in providing a better understanding of the neural basis of affective disorders. The main aim is to briefly summaries relevant research...[J]. Journal of Affective Disorders, 2019, 257: 774-778.
[24] Glynn SM. The challenge of psychiatric rehabilitation in schizophrenia[J]. Curr Psychiatry Rep,2001,3:401-6.
[25] Kern RS, Glynn SM, Horan W, Marder S. Psychosocial treatments to promote functional recovery in schizophrenia[J]. Schizophr Bull,2009,35:347-61.
[26] Lyman DR, Kurtz MM, Farkas M, George P, Dougherty RH, Daniels AS, et al. Skill building: assessing the evidence[J]. Psychiatr Serv,2014,65:727-38.
[27] Wykes T, Huddy V, Cellard C, McGurk SR, Czobor P. A meta-analysis of cognitive remediation for schizophrenia: methodology and effect sizes[J]. Am J Psychiatry,2011,168:472-85.
[28] Chien WT, Leung SF, Yeung FK, Wong WK. Current approaches to treatments for schizophrenia spectrum disorders, part II: psychosocial interventions and patient-focused perspectives in psychiatric care[J]. Neuropsychiatr Dis Treat,2013,9:1463-81.
[29] Bäuml J, Froböse T, Kraemer S, Rentrop M, Pitschel-Walz G. Psychoeducation: a basic psychotherapeutic intervention for patients with schizophrenia and their families[J]. Schizophr Bull,2006,32:S1-9.
[30] Turkington D, Dudley R, Warman DM, Beck AT. Cognitive-behavioral therapy for schizophrenia: a review[J]. J Psychiatr Pract,2004,10:5-16.
[31] Heinssen RK, Liberman RP, Kopelowicz A. Psychosocial skills training for schizophrenia: lessons from the laboratory[J]. Schizophr Bull,2000,26:21-46.
[32] Rector N, Beck A. Cognitive therapy for schizophrenia from conceptualization to intervention[J]. Can J Psychiatry,2002,47:39-48.
[33] Kopelowicz A, Liberman RP, Zarate R. Recent advances in social skills training for schizophrenia[J]. Schizophr Bull,2006,32:12-23.
[34] Mander H, Kingdon D. The evolution of cognitive-behavioral therapy for psychosis[J]. Psychol Res Behav Manag,2015,8:63-9.
[35] Chan JY, Hirai HW, Tsoi KK. Can computer-assisted cognitive remediation improve employment and productivity outcomes of patients with severe mental illness? A meta-analysis of prospective controlled trials[J]. J Psychiatr Res,2015,68:293-300.
[36] Wexler BE, Bell M. Cognitive remediation and vocational rehabilitation for schizophrenia[J]. Schizophr Bull,2005,31:931-41.
[37] Cella M, Preti A, Edwards C, Dow T, Wykes T. Cognitive remediation for negative symptoms of schizophrenia: a network meta-analysis[J]. Clin Psychol Rev,2016,28(52):43-51.
[38] Pekkala E, Merinder L. Psychoeducation for schizophrenia. Cochrane Database[J]. Syst Rev (2002) 4:CD002831.
[39] Rummel-Kluge C, Kissling W. Psychoeducation for patients with schizophrenia and their families[J]. Expert Rev Neurother,2008,8:1067-77.
[40] Penn DL, Mueser KT. Research update on the psychosocial treatment of schizophrenia[J]. Am J Psychiatry,1996,153:607-17.
[41] Pitschel-Walz G, Leucht S, Bauml J, Kissling W, Engel RR. The effect of family interventions on relapse and rehospitalization in schizophrenia–a meta-analysis[J]. Schizophr Bull,2001,27:73-92.
[42] McFarlane WR, Dixon L, Lukens E, Lucksted A. Family psychoeducation and schizophrenia: a review of the literature[J]. J Marital Fam Ther,2003,29:223-45.
[43] Pharoah F, Mari J, Rathbone J, Wong W. Family intervention for schizophrenia[J]. Cochrane Database Syst Rev,2010,12:CD000088.
[44] Elis O, Caponigro JM, Kring AM. Psychosocial treatments for negative symptom in schizophrenia: current practices and future directions[J]. Clin Psychol Rev,2013,33(8):914-28.
[45] Aleman A, Lincoln TM, Bruggeman R, Melle I, Arends J, Arango C, et al. Treatment of negative symptoms: where do we stand, and where do we go?[J]. Schizophr Res,2016.
[46] Gould RA, Mueser KT, Bolton E, Mays V, Goff D. Cognitive therapy for psychosis in schizophrenia: an effect size analysis[J]. Schizophr Res,2000,48:335-42.
[47] Lim M H, Penn D L. Using digital technology in the treatment of schizophrenia[J]. Schizophrenia Bulletin, 2018, 44(5): 937-938.
[48] Degnan A, Baker S, Edge D, et al. The nature and efficacy of culturally-adapted psychosocial interventions for schizophrenia: a systematic review and meta-analysis[J]. Psychological medicine, 2018, 48(5): 714-727.
[49] Fleischhacker W W, Arango C, Arteel P, et al. Schizophrenia—time to commit to policy change[J]. Schizophrenia bulletin, 2014, 40(Suppl_3): S165-S194.
[50] Mechelli A, Vieira S. From models to tools: clinical translation of machine learning studies in psychosis[J]. npj Schizophrenia, 2020, 6(1): 4.
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