A Study Of Executive Function Impairment In First Relapsed Schizophrenia

Objective:We investigate the characteristics of executive function impairment of first relapsed schizophrenia,to explore the effect of antipsychotic intervention on executive function of first relapsed schizophrenia and the relationship between executive function and disease severity of first relapsed schizophrenia in order to provide theoretical basis and data reference for the treatment of executive dysfunction of first relapsed schizophrenia.Methods:In this study,a randomized,double-blind design was implemented.35 first relapsed schizophrenia patients(8 dropoff),all inpatients,in the age range of 18-50 years,were recruited from Mental Hospital of Yunnan Province from September 2019 to September 2020 and 30 healthy subjects as control group(1 dropoff).The definition of schizophrenia was according to the criteria of the International Classification of Diseases(ICD-10).The two groups were matched in age,sex and education.The 27 patients were randomly divided into two sties:single antipsychotic treatment group(n=14)and combination antipsychotic treatment group(n=13).Wisconsin sorting card test(WCST)which consists of 13 different dimensions was used to evaluate the executive function and the positive and negative symptom rating scale(PANSS)to evaluate mental symptoms of patients at baseline and 8 weeks after treatment with trained psychiatrists.Statistical analyses were done using Statistical Package for Social Sciences software(IBM SPSS 25.0).This study was approved by the Ethic Committee of the Mental Health Center affiliated to Kunming Medical University.Written informed consent for participation was obtained from all subjects across two groups.Results:(1)27 patients(14 in single antipsychotic treatment group and 13 in combination antipsychotic treatment group)completed the trial and 29 healthy controls completed the baseline test.At baseline,two groups did not significantly differ in age(x2=1.685,P=0.431),sex(F=0.422,P=0.657)and education(F=0.948,P=0.349).The executive function of the case group was significantly impaired and greatly lower than that of the healthy control group at baseline,and there were major differences in six dimensions of WCST test between the two groups(RA:z-score:-5.60,P<0.01;RC:t-score:-6.47,P<0.01;RE:t-score:10.06,P<0.01;RCP:t-score:-9.63,P<0.01;RP:t-score:6.66,P<0.01;NRPE:t-score:9.49,P<0.01).(2)After 8 weeks of treatment,there was still a important difference between the case and the control group(RA:z-score:-2.67,P<0.01;RE:z-score:-2.08,P<0.01;RCP:t-score:-2.64,P<0.01;RP:t-score:2.56,P<0.05;NREP:t-score:2.45,P<0.05).(3)T-test and Kruskal-Wallis test showed that the executive function of the case group was deeply improved in 9 dimensions of WCST test(RA:z-score:3.58,P<0.01;CC:z-score:-3.99,P<0.01;RC:t-score:-4.26,P<0.01;RE:z-score:-4.19,P<0,01;RCP;t-score:-7.57,P<0.01;RFP:t-score:-8.12,P<0.01;RP:t-score:4.39,P<0.01;NREP:t-score:8.11,P<0.01;FM:z-score:-2.11,P<0.05).(4)In the case group,the score of PANSS scale was deeply improved after treatment(positive score:t-score:1.15,P<0.001;negative score:t-score:6.35,P<0.001;general psychopathological score:t-score:11.90,P<0.001;total score:t-score:15.03,P<0.001).(5)After 8 weeks of treatment,there was significant difference in the executive function test between the single-drug group and the combination group(RA:z-score:-2.01,P<0.05;CC:z-score:-2.14,P<0.05;RE:z-score:-2.39,P<0.05;RCP:t-score:-2.85,P<0.05;RFP:t-score:-2.66,P<0.05;RP:t-score:2.84,P<0.01).(6)After 8 weeks of treatment,the improvement of executive function of combined therapy was better than that of single treatment in WCST(RA:z-score:-2.34,P<0.05;CC:z-score:-2.17,P<0.05;RE:z-score:-2.57,P<0.05;RCP:t-score:-2.77,P<0.05;RFP:z-score:-3.69,P<0.01).(7)After 8 weeks of treatment,there was no great difference in the reduced score of PANSS scale between the single antipsychotic treatment group and combination antipsychotic treatment group(P>0.05).(8)After 8 weeks of treatment,the improved scores of WCST executive function test and the positive and negative scores of PANSS were analyzed by Pearson correlation analysis,showing that there was no obvious correlation between the scores of executive function improvement and positive and negative scores of PANSS(P>0.05).(9)In order to investigate the influencing factors of executive function impairment in first relapsed schizophrenia,Logistic regression analysis showed that sex,education,marital,personality and smoking were not the risk factors of executive function impairment in first relapsed schizophrenia(all P>0.05).Conclusions:(1)There is executive function impairment in patients with first relapsed schizophrenia.(2)Executive function impairment may be the core and independent symptom of schizophrenia.(3)The improvement of executive function of patients with first relapsed schizophrenia after combined antipsychotic therapy was better than that of single antipsychotic therapy.