The Study On The Cognition Of First-episode Schizophrenia And The RTMS Intervention

ObjectiveSchizophrenia is one of the most common and harmful mental disorder.Clinical manifestations of positive symptoms,negative symptoms and cognitive impairment.Cognitive deficits are considered as the core feature.Event-related Potentials P300 as an index of cognitive function.In the present study,we aimed at the first-episode schizophrenia and compare the difference of cognition,P300 amplitude and P300 latency between patients and healthy controls.We also aim to find the correlation between P300 amplitude and cognitive function.Meanwhile,we divided patients into auditory verbal hallucination(AVH)group and non-auditory verbal hallucination(non-AVH)group based on the clinical assessment.And compare the cognition of the two groups.We give the repetitive transcranial magnetic stimulation(rTMS)to the AVH group and to explore the effect of repetitive transcranial magnetic stimulation on hallucination.MethodThere are two parts in the method.First part: 60 patients who see doctor for the first time in Shanghai mental health center and were diagnosed with schizophrenia were included.60 healthy participants were collected through advertising and internet who matched in age,sex and education year with schizophrenia patients.Evaluating the cognition of the two groups with MATRICS consensus cognitive battery and compare the difference in seven cognition domains of speed of information processing,attention/vigilance,working memory,verbal learning,visual learning,reasoning and problem solving and social cognition.Second part: Using Oddball paradigm stimulation,we recorder P300 of the patients(study group)and healthy controls(control group).The P300 amplitude and latency in F3,F4,Fz,C3,C4,Cz,P3,P4,Pz was compared.Correlations between P300 amplitude,P300 latency and cognitive function were analyzed.Second part: Exploratory research on the new intervention of rTMS.Depending on the clinical assessment we divided the patients into AVH group and non-AVH group.The difference of cognition between the two group were analyzed.8 first-episode schizophrenia patients with AVH were given the rTMS intervention.The symptom of AVH was assessed from pre to post intervention.The object of this stimulation was to explore the effect of rTMS on AVH.ResultThe results include two parts.The first part was the comparison of cognition.Compared with healthy control,there is a decrease in cognition of speed of information processing(t=-3.78,p=0.000),attention and vigilance(t=-3.15,p=0.002),working memory(t=-5.40,p=0.000),verbal learning(t=-4.63,p=0.000),visual learning(t=-5.88,p=0.000),reasoning and problem solving(t=-4.10,p=0.000)and social cognition(t=-3.95,p=0.000).The difference was statistically significant(p<0.01).The comparison of P300 amplitude and latency in 25 first-episode and healthy controls revealed that the patients had lower amplitude in F4(t=-2.28,p=0.027),Fz(t=-2.56,p=0.014),C3(t=-2.09,p=0.042),C4(t=-2.83,p=0.007),Cz(t=-2.87,p=0.006),P3(t=-2.71,p=0.009),P4(t=-3.93,p=0.000),Pz(t=-3.28,0.002).The difference was statistically significant.(p<0.05).There is no statistical significance in P300 latency between the two groups(p>0.05).Correlation between P300 amplitude and cognition found that there is significant positive correlation in Fz(r=0.442,p=0.035)、Cz(r=0.526,p=0.010)、Pz(r=0.509,r=0.013)and social cognition.There is a positive correlation between P300 latency and reasoning and problem solving in Fz(p=0.05,r=-0.414).There is significant negative correlation between P300 latency and attention and vigilance in Pz(p=0.025,r=-0.466).The second part is that there is statistical significance in cognition between AVH and non-AVH group in speed of information processing(t=2.52,p=0.015).After receiving the rTMS intervention,the symptom of AVH of 8 first-episode schizophrenia improved(t=2.69,p=0.044).ConclusionCompared with healthy control,there is a decrease in 7 cognitive domain and P300 amplitude in first-episode schizophrenia.Also there is some correlation between P300 and cognition.rTMS has some improvement effect for first-episode schizophrenia on AVH.