| BackgroundSchizophrenia is a mental illness which involves the disability of sensory perception, thought, emotion, behavior and cognitive function. Compared with adult patients, childhood onset schizophrenia patients usually onset hidden, have a slow course of disease, an untypical mental symptoms, more common disease and more prominent abnormal neurodevelopment. Some scholars described the schizophrenia as a disease of abnormal brain connections, and draw the neurodevelopmental disorders model of abnormal brain connections. Because of abnormal brain development and brain dysfunction, schizophrenia patients presence widespread of cognitive impairment, and have more behavior problems in the early period. Some scholars regared cognitive impairment as one of the important symptoms in schizophrenia. Obsessive-compulsive disorder is also associated with abnormal neurological development, and it is one of common disease in schizophrenia children, as high as 23%. It is often considered as obsessive-compulsive symptom in schizophrenia children in the currently clinical work. The differences between the childhood onset schizophrenia patients with or without obsessive-compulsive symptom were less reported, for this, we conducted the following research.Objectives1.To investigation behavior characteristics and cognitive function in the schizophrenia patients with or without compulsion symptoms, and to compare the correlativity between cognitive function and behavior characteristics in the two groups of patients.2. To compare the resting state of brain function in patients with or without obsessive-compulsive symptoms.Methods1. According to the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL), the 149 patients were divided into two groups,70 childhood onset schizophrenia who had obsessive-compulsive symptoms in one group and 79 patients in the other group.2. All the children (patients group and control group) were retrospectively surveyed with the achenbach’s child behavior check-list (CBCL) to assess their social competence and behavioral characteristics at the age from 6 to 10 years.3. The cognitive function was estimated with WISC, Stroop color and word test, visual spatial memory test, trail making test digit span test and maze test in all the children.4. Using functional magnetic resonance imaging (fMRI) 3.0 system to check the whole brain resting state fMRI of 51 cases of children patients with schizophrenia and 30 cases of control group children, then analysis of data processing, at last get the data of low frequency amplitude ampitude of low-frequency luctuation (ALFF) and the functional connectivity in the brain.Results1. The comparison of CBCL in the two patients groups and the control groupNonparametric test showed that the scores of depression, social withdrawal, aggression, splitting force, physical complaints, behavioral problems total scores, school situation and the social ability total scores (χ2=7.08,8.52,11.89,32.29,63.03, 33.90,18.63,8.58) were statistically significant different in the three groups(P<0.05). Compared to the control group, the score of aggression and behavioral problems total scores were higher in the two groups of patients, while the social ability total scores were lower, the differences were statistically significant(P<0.05). Compared to the control group, the scores of the depression, social withdrawal, the splitting force and physical complaints in the group of patients who had obsessive-compulsive symptoms were higher, while the score of school situation was lower, the differences were statistically significant(P<0.05). Compared to the patients group who had not obsessive-compulsive symptoms, the scores of splitting force, physical complaints, school situation and behavior problems total scores were higher in the group of patients who had obsessive-compulsive symptoms, the differences were statistically significant(P<0.05).2. The comparison of cognitive function in the two patients groups and the control group2.1 The comparison of WISC in the three groupsVariance analysis showed that all the test scores(F=57.55,26.56, 34.56,24.84, 6.08,18.08,47.51,99.78,31.91) were statistically significant differrent in the three groups(P<0.05). Compared to the control group, all the test scores were lower in the two patients group, the differences were statistically significant (P<0.05). Compared to the patients group who had not obsessive compulsive symptoms, the scores of common sense, and building blocks were lower in the group of patients who had obsessive-compulsive symptoms, the differences were statistically significant(P<0.05).2.2 The comparison of other cognitive function in the three groupsVariance analysis showed that all the test scores(F=63.91,49.86,84.16,193.34, 218.97,115.93,159.22,63.3,12.30) were statistically significant different. Compared to the control group, all the tests scores were lower, the differences were statistically significant (P<0.05). Compared to the patients group who had not obsessive-compulsive symptoms, the test scores of words, color, color words, BVMT-R1, BVMT-R2, BVMT-R3 and digit span were lower in the group of patients who had obsessive-compulsive symptoms, the differences were statistically significant(P<0.05).3. The correlativity between the cognitive function and CBCL scoresSpearman correlation analysis showed that the correlativity between the cognitive function and CBCL scores in the group of patients who had obsessive-compulsive symptoms were:aggressive and BVMTR-T1 (rs=0.25) was positively correlated; physical complaints was positively correlated with common sense, arrangement (rs=0.29, 0.28), and negatively correlated with color word (rs=-0.32); activity ability was positively correlated with common sense, understanding, similarity, vocabulary (rs=0.35,0.35,0.22,0.22); social ability was positively correlated with similarity, arrangement, jigsaw (rs=0.26,0.28,0.26), and negatively correlated with BVMTR-T2 (rs=-0.24); social skills was positively correlated with common sense, similarity, charting, arrangement (rs=0.27,0.31,0.27, 0.25); the test of multiple correlation coefficient were statistically significant(P<0.05).Spearman correlation analysis showed that the correlativity between the cognitive function and CBCL scores in the group of patients who had not obsessive-compulsive symptoms were:hyperactivity was positively correlated with color, color words, BVMTR-T2, BVMTR-T3,charting (rs=0.26,0.23,0.29, 0.29, 0.35), and was negative correlated with digit span, building blocks, jigsaw (rs=-0.23,-0.23,-0.34); aggressive was negatively correlated with wood and jigsaw (rs=-0.28,-0.34); splitting force was negatively correlation with vocabulary, encoding, building blocks, jigsaw (rs=-0.22,-0.32,-0.23,-0.34); discipline showed a negative correlation with understanding, similarity, vocabulary (rs=-0.25,-0.25,-0.24); behavior problems showed a negative correlation with vocabulary, building blocks, jigsaw (rs=-0.24,-0.31,-0.32); the school situation was positively correlated with coding (rs=0.27); the test of multiple correlation coefficient were statistically significant(P<0.05).4. The results of ALFFCompared to the control group, ALFF of BOLD signal in the brain resting state was higher in the patients group who had not obsessive-compulsive symptoms in these brain areas:right caudate nucleus, middle temporal gyrus, inferior parietal lobule, while in the area of left cerebellum posterior was lower(t=2.0086), the differences were statistically significant(P<0.05); ALFF of BOLD signal in the brain resting state was higher in the the patients group who had obsessive-compulsive symptoms in these brain areas:left cerebellum posterior lobe, frontal lobe, precuneus; right superior frontal gyrus(t=2.0227), the differences were statistically significant(P<0.05).Compared to the patients group who had not obsessive-compulsive symptoms, ALFF of BOLD signal in the brain resting state was higher in the the patients group who had obsessive-compulsive symptoms in these brain areas:left cerebellum posterior lobe, frontal lobe, supramarginal gyrus, precuneus; right inferior frontal gyrus, medial frontal gyrus; while in the area of right fusiform gyrus, corpus callosum, inferior parietal lobule were lower(t=2.0301), the differences were statistically significant(P<0.05).5. The results of functional connectivitySelecting the medial frontal gyrus (18,42,27) as a seed point. Compared to the control group, the functional connectivity of medial frontal gyrus and these brain areas were enhanced in the patients group who had not obsessive-compulsive symptoms:right middle occipital gyrus, frontal lobe; left inferior frontal gyrus, medial frontal gyrus; while in the areas of right brainstem, frontal lobe, lentiform nucleus and left lentiform nucleus, cingulate gyrus, precentral gyrus were weakened(t=2.0086), the differences were statistically significant(P<0.05); the functional connectivity of medial frontal gyrus and these brain areas were enhanced in the patients group who had obsessive-compulsive symptoms:right middle frontal gyrus, left frontal lobe, while in the areas of right cingulate gyrus, precuneus were weakened(t=2.0244), the differences were statistically significant(P<0.05).Compared to the patients group who had not obsessive-compulsive symptoms, the functional connectivity of medial frontal gyrus and these brain areas were enhanced in the patients group who had obsessive-compulsive symptoms:right lentiform nucleus, inferior parietal lobule, middle frontal gyrus, while in the areas of right cerebellum anterior lobe, precuneus were weakened(t=2.0322), the differences were statistically significant(P<0.05).Conclusions1. The schizophrenia children who had obsessive-compulsive symptoms had more behavioral problems in the early time, low cognitive function after they suffer from the disease; and cognitive function was related to behavioral problems and social competence in the two groups of patients.2. The abnormal brain changes of ALFF and functional connectivity were differences in the two schizophrenia patients groups with or without obsessive-compulsive symptoms. |
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