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Nonsocial and social cognition in schizophrenia: current evidence and future directions. ​

文献信息 ​

DOI10.1002/wps.20624
PMID31059632
期刊World psychiatry : official journal of the World Psychiatric Association (WPA)
影响因子65.8
JCR 分区Q1
发表年份2019
被引次数248
关键词精神分裂症、脑网络组织、儿童逆境、认知、认知增强
文献类型Journal Article
ISSN1723-8617
页码146-161
期号18(2)
作者Michael F Green, William P Horan, Junghee Lee

一句话小结 ​

本研究回顾了精神分裂症中认知障碍的多维特征及其对治疗和预后的影响，包括非社交和社交认知缺陷的类型、神经成分及其与功能结果的关系，并探讨了改善认知障碍的干预措施和新兴研究领域。此研究为深入理解精神分裂症的复杂性提供了新的视角，可能会影响疾病的定义和诊断方式。

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精神分裂症 · 脑网络组织 · 儿童逆境 · 认知 · 认知增强

摘要 ​

精神分裂症中的认知障碍涉及广泛的非社交和社交认知领域。这是该疾病的核心特征之一，对治疗和预后具有重要影响。近年来，我们对精神分裂症中认知障碍的原因、后果和干预措施的理解有了显著的进展。在此，我们回顾了一系列主题，包括：a) 精神分裂症中非社交认知、社交认知和感知缺陷的类型；b) 精神分裂症中的缺陷与其他障碍中的缺陷的相似性和差异性；c) 精神分裂症前驱期和整个生命周期中的认知障碍；d) 非社交和社交认知的神经成分的神经影像学研究，以及e) 非社交和社交认知与功能结果之间的关系。本文还回顾了为改善精神分裂症认知障碍而进行的重大努力，包括新型精神药理学、认知修复、社交认知训练和其他替代方法。在最后一部分，我们考虑了一些新兴领域，这些领域有潜力为未来提供洞见，包括动机与认知的交互、童年逆境的影响、元认知、神经炎症的作用、计算建模、远程数字技术的应用以及评估大脑网络组织的新方法。对认知障碍的研究为接近、审视和理解精神分裂症的广泛特征提供了一种途径，最终可能影响我们如何定义和诊断这一复杂的疾病。

英文摘要 ​

Cognitive impairment in schizophrenia involves a broad array of nonsocial and social cognitive domains. It is a core feature of the illness, and one with substantial implications for treatment and prognosis. Our understanding of the causes, consequences and interventions for cognitive impairment in schizophrenia has grown substantially in recent years. Here we review a range of topics, including: a) the types of nonsocial cognitive, social cognitive, and perceptual deficits in schizophrenia; b) how deficits in schizophrenia are similar or different from those in other disorders; c) cognitive impairments in the prodromal period and over the lifespan in schizophrenia; d) neuroimaging of the neural substrates of nonsocial and social cognition, and e) relationships of nonsocial and social cognition to functional outcome. The paper also reviews the considerable efforts that have been directed to improve cognitive impairments in schizophrenia through novel psychopharmacology, cognitive remediation, social cognitive training, and alternative approaches. In the final section, we consider areas that are emerging and have the potential to provide future insights, including the interface of motivation and cognition, the influence of childhood adversity, metacognition, the role of neuroinflammation, computational modelling, the application of remote digital technology, and novel methods to evaluate brain network organization. The study of cognitive impairment has provided a way to approach, examine and comprehend a wide range of features of schizophrenia, and it may ultimately affect how we define and diagnose this complex disorder.

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主要研究问题 ​

  1. 在精神分裂症中，如何有效区分非社交和社交认知缺陷的评估方法？
  2. 有哪些新兴的治疗策略可以针对精神分裂症患者的社交认知缺陷进行干预？
  3. 在精神分裂症的前驱期，非社交认知和社交认知的缺陷有何不同表现？
  4. 童年逆境如何影响精神分裂症患者的认知功能，特别是社交认知方面？
  5. 计算模型在理解精神分裂症患者的认知缺陷中发挥了怎样的作用？

核心洞察 ​

研究背景和目的 ​

精神分裂症的认知障碍涉及广泛的非社会和社会认知领域，是该疾病的核心特征之一，影响治疗和预后。近年来，对精神分裂症认知障碍的成因、后果和干预措施的理解有了显著增长。本文旨在综述精神分裂症中的非社会和社会认知障碍的类型、与其他疾病的比较、认知障碍在不同生命周期阶段的表现、神经成像研究，以及与功能结果的关系。

主要方法/材料/实验设计 ​

研究采用文献综述的方法，系统回顾相关的认知障碍类型、神经成像结果及干预措施。以下是研究的技术路线示意图：

Mermaid diagram

关键结果和发现 ​

  1. 非社会认知障碍：包括注意力、工作记忆、学习和记忆、处理速度、推理和问题解决等领域，精神分裂症患者在这些领域的表现通常低于健康对照组。
  2. 社会认知障碍：情感处理和心智化能力显著受损，影响患者的社会功能。
  3. 神经成像结果：精神分裂症患者在执行认知任务时，关键脑区的激活模式异常，显示出前额叶和颞顶交界区的低激活及功能连接性受损。
  4. 干预措施：虽然药物治疗在缓解症状方面有效，但对认知功能的改善效果有限；认知修复和社会认知训练显示出更好的潜力。

主要结论/意义/创新性 ​

精神分裂症的认知障碍是该疾病的核心特征，影响患者的社会功能和生活质量。理解这些障碍的神经机制和发展有效的干预措施对于改善患者的功能性结果至关重要。未来的研究需要关注认知与动机、儿童逆境、元认知等新兴领域。

研究局限性和未来方向 ​

  1. 局限性：现有研究主要集中于非社会认知，社会认知的研究仍较少；许多干预措施的有效性缺乏大规模临床试验的验证。
  2. 未来方向：未来研究应探索认知与动机的交互作用、儿童逆境对认知的影响、元认知的作用等。此外，采用计算模型和脑网络组织分析等新方法可能为理解精神分裂症的认知障碍提供新的视角。

参考文献 ​

  1. Social cognition and the human brain. - Adolphs - Trends in cognitive sciences (1999)
  2. Neurocognitive deficits and functional outcome in schizophrenia: are we measuring the "right stuff"? - M F Green;R S Kern;D L Braff;J Mintz - Schizophrenia bulletin (2000)
  3. Studies of cognitive change in patients with schizophrenia following novel antipsychotic treatment. - P D Harvey;R S Keefe - The American journal of psychiatry (2001)
  4. Dysfunction of early-stage visual processing in schizophrenia. - P D Butler;I Schechter;V Zemon;S G Schwartz;V C Greenstein;J Gordon;C E Schroeder;D C Javitt - The American journal of psychiatry (2001)
  5. Six-year follow-up study of cognitive and functional status across the lifespan in schizophrenia: a comparison with Alzheimer's disease and normal aging. - J I Friedman;P D Harvey;T Coleman;P J Moriarty;C Bowie;M Parrella;L White;D Adler;K L Davis - The American journal of psychiatry (2001)
  6. The neurocognitive effects of low-dose haloperidol: a two-year comparison with risperidone. - Michael F Green;Stephen R Marder;Shirley M Glynn;Susan R McGurk;William C Wirshing;Donna A Wirshing;Robert P Liberman;Jim Mintz - Biological psychiatry (2002)
  7. Correlates of change in functional status of institutionalized geriatric schizophrenic patients: focus on medical comorbidity. - Joseph I Friedman;Philip D Harvey;Susan R McGurk;Leonard White;Michael Parrella;Tenko Raykov;Thomas Coleman;David N Adler;Kenneth L Davis - The American journal of psychiatry (2002)
  8. Cognitive correlates of job tenure among patients with severe mental illness. - James M Gold;Richard W Goldberg;Scot W McNary;Lisa B Dixon;Anthony F Lehman - The American journal of psychiatry (2002)
  9. Segmental set. - D SHAKOW - Archives of general psychiatry (1962)
  10. Neurocognitive function and outcome in first-episode schizophrenia: a 10-year follow-up of an epidemiological cohort. - John Stirling;Colin White;Shon Lewis;Richard Hopkins;Digby Tantam;Alice Huddy;Linda Montague - Schizophrenia research (2003)

引用本文的文献 ​

  1. The meaning of group differences in cognitive test performance. - Paul M Grant;Michael W Best;Aaron T Beck - World psychiatry : official journal of the World Psychiatric Association (WPA) (2019)
  2. Innovative methods for improving cognition, motivation and wellbeing in schizophrenia. - Barbara J Sahakian;George Savulich - World psychiatry : official journal of the World Psychiatric Association (WPA) (2019)
  3. Cognitive impairment as a diagnostic criterion and treatment target in schizophrenia. - Michael Davidson - World psychiatry : official journal of the World Psychiatric Association (WPA) (2019)
  4. Cognitive impairment and psychosis in schizophrenia: independent or linked conditions? - Abraham Reichenberg;Eva Velthorst;Michael Davidson - World psychiatry : official journal of the World Psychiatric Association (WPA) (2019)
  5. Why are there no approved treatments for cognitive impairment in schizophrenia? - Richard S E Keefe - World psychiatry : official journal of the World Psychiatric Association (WPA) (2019)
  6. The need to develop personalized interventions to improve cognition in schizophrenia. - Peter Falkai;Andrea Schmitt - World psychiatry : official journal of the World Psychiatric Association (WPA) (2019)
  7. Cognition and disability in schizophrenia: cognition-related skills deficits and decision-making challenges add to morbidity. - Philip D Harvey;Martin T Strassnig - World psychiatry : official journal of the World Psychiatric Association (WPA) (2019)
  8. Nonsocial and social cognitive function in psychosis: interrelationships, specificity and innovative approaches. - Deanna M Barch - World psychiatry : official journal of the World Psychiatric Association (WPA) (2019)
  9. Cognition in schizophrenia: a marker of underlying neurodevelopmental problems? - Ingrid Melle - World psychiatry : official journal of the World Psychiatric Association (WPA) (2019)
  10. Linking resting-state networks and social cognition in schizophrenia and bipolar disorder. - Amy M Jimenez;Philipp Riedel;Junghee Lee;Eric A Reavis;Michael F Green - Human brain mapping (2019)

... (238 更多 篇文献)

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