| Ojective:The purpose of this study was to analyze the influencing factors of cognitive impairment in children and adolescents with first-episode schizophrenia.By establishing the hypothesis model of mediating effect,the mechanism of high-risk factors on cognitive impairment was discussed,so as to recognize the cognitive impairment of patients as early as possible and to prevent them.To further explore the effect of drug therapy and psychotherapy on cognitive function and provide scientific basis for improving the medical intervention of cognitive rehabilitation.1.The cognitive impairment of children and adolescents with first-episode schizophrenia was evaluated by a comparative study with the control group.2.By comparing the study with the control group,the predictors of cognitive impairment in children and adolescents with first-episode schizophrenia were determined,and a mediating hypothesis model was constructed to explore the mechanism of childhood trauma between parental rearing-pattern,adolescent life events and cognitive impairment.3.To compare the changes of cognitive function before and after treatment,to investigate the improvement of cognitive function impairment by drug therapy and dynamic psychotherapy.Methods:In this study,patients with the first-episode schizophrenia were selected between the ages of 12 and 17.At the same time,normal children and adolescents were selected as control group.The baseline questionnaire for both groups included general demographic data,EMBU,ASLEC,CTQ-SF,etc.For the study group,WAIS/WISC,MCCB,PANSS and CGI were assessed at baseline time,4th week and 8th week after treatment.For the control group,WAIS/WISC,MCCB only were assessed at baseline.The 110 patients in the study group met the ICD-10 diagnostic criteria for schizophrenia.And they did not use antipsychotics or drugs known to affect cognitive function before entering the group.For the first time and with a history of less than 1 year,Webster IQ>80,no other diseases that affected cognitive function,they volunteered to participate in this study.The control group included 110 normal subjects.They did not have diseases that affect cognitive function.They had not used drugs that affect cognitive function in the past 1 year.Webster IQ>80.They volunteered for the study.The criteria for withdrawal were severe drug reactions in the course of treatment or the participants willingness to withdraw.In the study group,80 inpatients were given drug treatment.The drug treatment reached an adequate dose and sufficient course of treatment,based on the principle of being as single as possible.Alipiprazole is 10-30mg per day,olanzapine is 10-20mg per day,quetiapine is 300-600mg per day,and risperidone is 4-6mg per day.Psychodynamic psychotherapy was performed on 30 outpatients,supplemented by drug therapy.The drug type was the same as that used by inpatients and the dose was 1/3-1/2 of the inpatient,and psychotherapy was once a week for 30 minutes to 50 minutes each time.The data were performed using SPSS24.0 software.All the tests were two-tailed and a P value less than 0.05 was considered to indicate a significant difference.The continuous variables were tested with t-test,the categorical variables were tested with Pearson'S Chi-square test.Pearson correlations were calculated to measure the correlations among the variables.Taking the factors of parental rearing style,childhood trauma,and adolescent life events as independent variables,the MCCB score as dependent variables was used to find out the predictors that affect cognitive function by multivariate linear regression method.Then,using above predictive factors as independent variables,MCCB score as a dependent variable,through path analysis,further explored whether parental rearing patterns and adolescent life events had an indirect impact on cognitive impairment through childhood trauma.Results:1.The study group included a total of 110 cases,and the final valid data was 92 cases(83.6%),and there were 67 cases in the drug group and 25 cases in the psychological group.The control group included 110 cases and the final valid data was 103cases(93.6%).All the patients of study group are Han Chinese,with 50 males and 42 females.The average age is 15.15±1.45,45 junior high school students,and 47 senior high school students.The patients of control group was also Han,with 53 men and 50 women.The average age was 14.97±1.73 years old,51 junior high school students,and 52 senior high school students.There was no difference between the study group and the control group in terms of ethnicity,gender,age,and educational level(P>0.05)2.The IQ score of the study group was significantly lower than that of the control group(88.85±22.88 vs108.1 8±14.92,P<0.01).All the other factors were lower than the control group except the knowledge factor(P<0.05)3.The MCCB score of the patients of study group was significantly lower than that of the control group(44.64±8.15 vs 62.70±7.68,P<0.01);Except that the original score of the connection test was significantly higher than that of the control group,the other factors were also lower than the control group,and the difference was statistically significant(P<0.05)4.The score of F1 was significantly lower than that of the control group(45.75±6.54vs54.59±10.72,P<0.01).F2 score was significantly higher than that of the control group(20.88±6.26vs±8.78±6.67,P<0.05),F5score was also significantly higher than that of the control group(11.3 9 ± 3.64vs9.77±3.50,P<0.05).The score of M1 was significantly lower than that of the control group(48.17±7.77vs59.45±9.89,P<0.01).M2 was significantly lower than that of the control group(34.07±6.44vs37.43±6.60,P<0.01).M4 score was also significantly higher than that of the control group(14.97±4.70vs12.5 0 ± 3.53,P<0.01)5.The total score of ASLEC in the study group was significantly higher than that of the control group(53.29 ± 18.51vs40.99±25.32,P<0.01).All the other factors scored higher than the control group,and the difference was statistically significant(P<0.05).6.The total score of CTQ-SF in the study group was significantly higher than that of the control group(46.90±11.47vs35.67±8.78,P<0.01).There was no significant difference in the score of somatic abuse factor,and all other factors scored higher than the control group(P<0.05)7.The MCCB score in the study group showed positive correlation with F1,F3 and F6(P<0.01).The MCCB score in the control group showed positive correlation with F1 and F6(P<0.01)?8.The MCCB score of the study group was positively correlated with M1 and M2(P<0.01).So did the control group.9.The MCCB score in the study group was negatively related to the total score of ASLEC,learning stress factor score,punishment factor score,and other factors score(P<0.05).The total MCCB score in the control group was negatively correlated with the health adaptation factor score(P<0.05)10.The MCCB score in the study group was negatively correlated with the total score of childhood trauma,physical abuse factor,emotional neglect factor,sexual abuse factor,and physical neglect factor(P<0.05).The total MCCB score of the control group was negatively correlated with the total score of childhood trauma and its various factors(P<0.01).11.Multi-factor linear regression analysis showed that F1,M1,M2,adolescent life events total score,childhood trauma total score entered the regression equation,and 38.4%of the variation was explained by them12.The total score of childhood trauma played a complete intermediary role between the total score of Fland MCCB.Between the total score of Ml and MCCB,the total score of childhood trauma had a part mediating effect 38.2%.Between the total score of M2/ASLEC and MCCB,the total score of childhood trauma also had a part mediating effect by 20.7%and 38.6%respectively.13.The total score of PANSS in the study group was significantly lower in the fourth and eighth weeks after treatment than in the baseline before treatment(P<0.05).The clinical efficacy evaluation of the fourth and eighth weeks after treatment showed that the negative degree of the disease was lower than that before treatment and the efficacy increased(P<0.05)14.After the treatment,the score of the 4th weekend in knowledge,comprehension,image arrangement,block pattern,graphic patchwork,or object patchwork were significantly higher than before the treatment,and the score of the eighth weekend were significantly higher than before the treatment in terms of knowledge,vocabulary,comprehension,filling or picture filling,image arrangement,block patterns,graphic patchwork or object patchwork,coding or digital symbols(P<0.05).15.The speech fluency and emotional management scores in the MCCB on the 4th weekend after treatment were higher than those before treatment and the language memory,spatial breadth,digital sequence,visual memory,verbal fluency,emotional management,continuous operation ability score and total score in the 8th weekend MCCB were all higher than before treatment(P<0.05)16.There was no significant difference in MCCB total score between the drug group and the psychological group baseline.And the total score of MCCB in the psychological group was significantly higher than that of the drug group after the fourth week(49.96±7.61vs45.76±8.85,P<0.05)and after the eighth week(53.40±7.98vs48.45±9.31,P<0.05).Conclusion:1.The cognitive impairment of children and adolescents with first-episode schizophrenia is more serious than that of normal children and adolescents,and the cognitive impairment is uneven,which needs to be paid enough attention.2.The cognitive function of children and adolescents with first-episode schizophrenia was obviously influenced by parental rearing style,adolescent life events and childhood trauma.Childhood trauma had a part mediating effect between parenting patterns,adolescent life events and cognitive impairment.3.Standard treatment can effectively improve the patient's cognitive function.Psychodynamic psychotherapy combined with drug therapy can reduce the dose of medication,and it is more effective in improving cognitive function than only using drug therapy. |
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