Research On Intracortical Inhibition Defects Of Schizophrenia In Different Stages And Its Relationship With Clinical Symptoms

Objectives:This study evaluated the intracortical inhibition,clinical symptoms,and various environmental stress factors of schizophrenia in different stages,and explored whether the intracortical inhibition defects are stably present in the various stages of schizophrenia;And further explore the correlation between intracortical inhibition defects and cognitive function and other clinical symptoms,in order to explore the mechanism of cerebral cortex inhibition defects in schizophrenia,and point out the direction for the development of more effective cognitive deficit treatment measures.Methods:A total of 122 schizophrenia were recruited in this study,including 36 first-episode untreated schizophrenia(first-episode group),46 relapsed schizophrenia(relapse group),and remission-stage schizophrenia(remission group))40 cases,and 56 cases of healthy controls(control group)matching gender,age,and years of education.Patients with schizophrenia were diagnosed through the 10th Revision of the International Statistical Classification of Diseases(ICD-10).After enrollment,general information was collected,and the Positive and Negative Syndrome Scale(PANSS),the cognitive function test(MCCB),stress-related questionnaires,social support and self-esteem scales were assessed.Using paired-pulse transcranial magnetic stimulation combined with electromyography(ppTMS-EMG)to elicit and record the subject’s intracortical inhibition function index:Short-interval intracortical inhibition(SICI)and Long-interval intracortical inhibition(LICI).SPSS 22.0 was used for statistical analysis,one-way analysis of variance or non-parametric test was used to compare the differences of various variables between different groups according to the normal distribution of variables,and the partial correlation analysis of control variables was used to compare the correlation between different variables.Results:1.The lower the values measured by SICI and LICI,the more severe the damage to inhibition in the cortex.Compared with the control group,the SICI and LICI of each schizophrenia group were significantly decreased(p<0.001),but there was no significant difference in SICI and LICI between the patient groups(p>0.05).Whether taking medicines(first episode group VS(relapse group+remission group))have no significant effect in the SICI(p=0.589)and LICI(p=0.180)of schizophrenia;There was no significant difference between SICI(p=0.090)and LICI(p=0.174)among acute phase(first episode group+relapse group)and remission phase(remission group)schizophrenia.2.The higher the T score measured by MCCB,the better the function of the cognitive domain.Compared with the healthy control group,the T scores of information processing speed(SOP),working memory(WM,reasoning and problem solving(RPS),and social cognition(SC)of all patient groups were generally reduced(p<0.05)),only the T scores of vocabulary learning(VRB)(p=0.001)and visual learning(VIS)(p<0.001)of the relapse group were statistically different from those of the control group;when comparing the patient groups,the SOP,VRB,VIS,and RPS T scores of the remission group were higher than those of the relapse group,and the difference was statistically significant(p<0.05).The VIS T score of the first episode group was higher than that of the relapse group,-and the difference was statistically significant(p=0.013),The difference between the other groups is not obvious(p>0.05).Compared with the healthy control group,the scores of the four environmental stress factor questionnaires for schizophrenia in each disease stage were statistically different(p<0.001);except for the difference in total CSDS scores between the first episode group and the remission group had a significant difference(p=0.024),there is no significant difference between the other patient groups(p>0.05).3.The SICI of the patient group was negatively correlated with the total score of PANSS(r=-0.403,p<0.001),the score of positive symptoms(t=-0.307,p=0,001),the score of negative symptoms(r=-0.374,p<0.001),the scores of general psychopathological symptoms(r=-0.351,p<0.001),and positively correlated with SOP(r=0.632,p<0.001),VRB(r=0.373,p<0.001),VIS(r=0.450,p<0.001),WM(r=0.534,p<0.001),RPS(r=0.452,p<0.001),SC(r=0.328,p<0.001)T scores with different degrees;the LICI of the patient group was negatively correlated with PANSS total score(r=-0.203,p=0.026),positive symptom score(r=-0.194,p=0.033),general psychopathological symptom score(r=-230,p=0.011),positively correlated with SC T score(r=0.212,p=0.020).LICI had no statistical correlation with negative symptom score and the other five cognitive function T scores;There was no statistical correlation between the SICI and LICI of the patient group and the medication dose,CTQ,CSDS,social support scale,and RSES total score.4.With SICI,LICI,PANSS positive symptoms,PANSS negative symptoms,general psychopathological symptoms,equivalent conversion of chlorpromazine dose,CTQ,CSDS,social support scale,RSES as independent variables.The 6 cognitive functions in the acute phase and the remission phase were used as dependent variables,and the multiple linear stepwise regression method is used to analyze the results.The results show that the influencing factors of various cognitive fields in different stages are different.The influencing factors of SOP in the acute stage are mainly SICI and positive symptoms,in the remission period,it becomes SICI and negative symptoms;the influencing factors of VRB in the acute period are mainly SICI and positive symptoms;the influencing factors of VIS in each disease stage are mainly SICI,and the correlation of them in the remission period was higher;the influencing factors of WM in the acute phase are mainly SICI and positive symptoms,and in the remission phase are closely related to negative symptoms,medications and childhood trauma stress factors;RPS in the acute phase is SICI,negative symptoms and medications Mainly,in the remission period,it is only prompted to be closely related to negative symptoms;SC is closely related to positive symptoms and self-esteem scale scores in the acute stage,and shows correlation with SICI in remission.Conclusion:1.The intracortical inhibition of schizophrenia is generally impaired,and it exists throughout the course of the disease after the onset of schizophrenia,and is not affected by antipsychotic drugs.2.The intracortical inhibition defects of schizophrenia is significantly correlated with the severity of various clinical symptoms.The more obvious defect of intracortical inhibition,the more serious the clinical symptoms.3.The SICI of schizophrenia is closely related to cognitive function,and the degree of correlation of different cognitive dimensions is different.The degree of correlation from high to low is information processing speed,working memory,reasoning and problem-solving ability,visual learning,vocabulary Learning,social cognition;research suggests that SICI may be a reliable biological marker for schizophrenia and cognitive deficits,and may affect different cognitive domains through different neural circuits.4.Clinical symptoms,SICI and some environmental factors are the main factors affecting the severity of cognitive deficits in schizophrenia,and the main influencing factors of cognitive function are different in different disease states.These results point the way for us to develop a new type of cognitive deficit intervention method.