Theory of mind impairments in individuals at ultra-high risk for psychosis

目的：探讨精神分裂症超高危人群心理推测能力受损情况及与临床症状的相关关系。方法2014年4月1日至2015年3月30日在北京大学第六医院门诊采用方便入组的方法，共纳入27例精神分裂症超高危人群（超高危组）；同期在社区招募健康志愿者25名（对照组）。采用精神病风险综合征定式访谈(Structured Interview for Prodromal Syndromes, SIPS)、PANSS、错误信念任务、失言觉察任务、暗示任务、眼区情感识别任务等对2组进行临床评估及心理推测能力评估。通过卡方检验、t检验及非参数检验比较2组人群心理推测能力的差异，通过Pearson相关、Spearman相关分析超高危组心理推测能力与临床症状之间的相关关系。结果超高危组SIPS总分为(27.2±10.5)分，PANSS总分为（48.6±9.1）分。控制智商后，超高危组失言觉察任务[0.80(0.60,0.88)分与0.90(0.85,0.92)分, Z=-3.64，P<0.01]、暗示任务[18(17,19)分与19(19,20)分, Z=-3.02, P<0.01]和眼区情感识别任务[（22.7±3.3）分与（23.8±3.4）分, F=4.40, P<0.05]得分均低于对照组，效应值分别为1.16、0.79、0.33，2组间错误信念任务差异无统计学意义（χ2=0.03，P=1.00）。其中暗示任务与SIPS中阴性症状条目社交兴趣缺乏（r=-0.63，P<0.01）和概念丰富度（r=-0.52，P<0.01）呈负相关，经校正后相关关系仍具有统计学意义。结论精神分裂症超高危人群心理推测能力显著受损，受损可能与阴性症状呈负性相关。Objectives To determine deficits in theory of mind in individuals at ultra-high risk for psychosis (UHR), and to explore the relations between theory of mind and symptom severity. Methods 27 ultra-high-risk patients in clinics of the Peking University Sixth Hospital and 25 normal controls in community were enrolled from April 1st, 2014 to March 30th, 2015. The Structured Interview for Prodromal Syndromes(SIPS), Positive and Negative Syndrome Scale (PANSS) were used to evaluate all of the individuals in both groups. Theory of mind was assessed with the false belief task,the hinting task, the reading the mind in the eyes test(eye task)and the faux pas task. Chi square test, t test and non parametric test were used to compare all of the theory of mind tasks between the two groups. Pearson correlation and Spearman correlation were used to analyze the correlations between theory of mind and psychopathology in the UHR. Results The total scores of SIPS and PANSS in the UHR group were 27.2 ± 10.5 and 48.6 ± 9.1. The performance of faux pas task(0.80(0.60,0.88) vs. 0.90(0.85,0.92), Z=-3.64, P<0.01),hinting task (18(17,19) vs. 19(19,20), Z=-3.02, P<0.01)and eye task(22.7±3.3 vs. 23.8±3.4, F=4.40, P<0.05)in UHR remained significantly poorer as compared with the control group when controlled for IQ. Effect sizes were 1.16, 0.79 and 0.33 respectively. The two groups were compared at the false belief task. In the UHR group, there were still statistically correlations between two negative symptoms and the hinting task after correction, which were the item of avolition(r=-0.63,P<0.01)and item of reduced ideational richness(r=-0.52,P<0.01). Conclusion There are possible deficits in higher order theory of mind in UHR, and the negative correlation might exist between higher order theory of mind and negative symptoms.北京市科委重点项目(D121100005012004)Fund programKey Project of Beijing Municipal Science and Technology Commission中文核心期刊要目总览(PKU)中国科技核心期刊(ISTIC)中国科学引文数据库(CSCD)6378-3834