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Do loneliness and social exclusion breed paranoia? An experience sampling investigation across the psychosis continuum 孤独和社会排斥会滋生偏执狂吗?精神病连续体的经验抽样调查
IF 2.8 Q2 PSYCHIATRY Pub Date : 2023-09-01 DOI: 10.1016/j.scog.2023.100282
Victoria Bell , Eva Velthorst , Jorge Almansa , Inez Myin-Germeys , Sukhi Shergill , Anne-Kathrin Fett

Background

The role of loneliness and social exclusion in the development of paranoia is largely unexplored. Negative affect may mediate potential associations between these factors. We investigated the temporal relationships of daily-life loneliness, felt social exclusion, negative affect, and paranoia across the psychosis continuum.

Method

Seventy-five participants, including 29 individuals with a diagnosis of non-affective psychosis, 20 first-degree relatives, and 26 controls used an Experience Sampling Method (ESM) app to capture the fluctuations in loneliness, feelings of social exclusion, paranoia, and negative affect across a 1-week period. Data were analysed with multilevel regression analyses.

Results

In all groups, loneliness and feelings of social exclusion were independent predictors of paranoia over time (b = 0.05, p < .001 and b = 0.04, p < .05, respectively). Negative affect predicted paranoia (b = 0.17, p < .001) and partially mediated the associations between loneliness, social exclusion, and paranoia. It also predicted loneliness (b = 0.15, p < .0001), but not social exclusion (b = 0.04, p = .21) over time. Paranoia predicted social exclusion over time, with more pronounced effects in controls (b = 0.43) than patients (b = 0.19; relatives: b = 0.17); but not loneliness (b = 0.08, p = .16).

Conclusion

Paranoia and negative affect worsen in all groups following feelings of loneliness and social exclusion. This highlights the importance of a sense of belonging and being included for mental well-being. Loneliness, feeling socially excluded, and negative affect were independent predictors of paranoid thinking, suggesting they represent useful targets in its treatment.

背景孤独和社会排斥在多疑症发展中的作用在很大程度上尚未被探索。负面影响可能介导这些因素之间的潜在关联。我们调查了精神病连续体中日常生活孤独感、社会排斥感、负面影响和偏执狂的时间关系。方法75名参与者,包括29名被诊断为非情感性精神病的患者、20名一级亲属和26名对照者,使用经验抽样方法(ESM)应用程序来捕捉1周内孤独感、社会排斥感、偏执狂和负面影响的波动。数据采用多水平回归分析。结果在所有组中,随着时间的推移,孤独感和社会排斥感是偏执狂的独立预测因素(分别为b=0.05,p<;.001和b=0.04,p<;.05)。负面影响预测了妄想症(b=0.17,p<;.001),并部分介导了孤独、社会排斥和妄想症之间的关联。它还预测了孤独感(b=0.15,p<;.0001),但没有预测社会排斥(b=0.04,p=.21)。随着时间的推移,偏执狂预测了社会排斥,对照组(b=0.43)的影响比患者(b=0.19;亲属:b=0.17)更明显;而不是孤独(b=0.08,p=.16)。结论在孤独感和社会排斥感之后,所有组的偏执和负面情绪都会恶化。这突出了归属感和被包容对心理健康的重要性。孤独感、被社会排斥感和负面影响是偏执思维的独立预测因素,这表明它们是治疗偏执思维的有用靶点。
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引用次数: 3
Sustained attention deficits in schizophrenia: Effect of memory load on the Identical Pairs Continuous Performance Test 精神分裂症患者的持续注意缺陷:记忆负荷对同一对连续性能测试的影响
IF 2.8 Q2 PSYCHIATRY Pub Date : 2023-09-01 DOI: 10.1016/j.scog.2023.100288
Jenna Dutterer, Sonia Bansal, Benjamin Robinson, James M. Gold

Background

Sustained attention and vigilance impairments are well documented in people with schizophrenia (PSZ). The processes implicated in this impairment remain unclear. Here we investigated whether vigilance performance varied as a function of working memory load, and also examined the role of attentional lapsing that might arise from a loss of task set resulting in mind wandering.

Method

We examined Continuous Performance Test Identical Pairs (CPT-IP) data from a cumulative sample of 247 (PSZ) and 238 healthy control (HC) participants collected over a series of studies.

Results

PSZ performed more poorly that HC across conditions with signal/noise discrimination (d′) decreasing with increasing working memory load across both groups However, there was a significant interaction of group and load suggesting that performance of PSZ was more negatively impacted by increasing load. We also found that PSZ has a significantly higher rate of attention lapsing than did HC.

Discussion

Our results suggest that difficulties maintaining task set and working memory limitations are implicated in the impairments observed on the Identical Pairs CPT. Difficulties with task set maintenance appear to explain the majority of between-group variance, with a more subtle impact of increasing working memory load.

背景精神分裂症(PSZ)患者存在持续的注意力和警惕障碍。这一减值涉及的过程尚不清楚。在这里,我们调查了警惕性表现是否随着工作记忆负荷的变化而变化,并研究了注意力缺失的作用,注意力缺失可能是由于任务集的丧失而导致的走神。方法我们检查了一系列研究中收集的247名(PSZ)和238名健康对照(HC)参与者的累积样本中的连续性能测试相同对(CPT-IP)数据。结果PSZ在信号/噪声辨别(d′)随工作记忆负荷的增加而降低的条件下表现比HC差。然而,组和负荷之间存在显著的相互作用,表明负荷的增加对PSZ的表现产生了更大的负面影响。我们还发现PSZ的注意力丢失率明显高于HC。讨论我们的结果表明,维持任务集和工作记忆限制的困难与在相同对CPT上观察到的损伤有关。任务集维护的困难似乎解释了组间差异的大部分,工作记忆负荷增加的影响更为微妙。
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引用次数: 0
Verbal and visual learning ability in patients with treatment-resistant schizophrenia: A 1-year follow-up study 难治性精神分裂症患者的语言和视觉学习能力:一年随访研究
IF 2.8 Q2 PSYCHIATRY Pub Date : 2023-09-01 DOI: 10.1016/j.scog.2023.100283
Urska Arnautovska , Kathryn Vitangcol , James P. Kesby , Nicola Warren , Susan L. Rossell , Erica Neill , Anthony Harris , Cherrie Galletly , David Castle , Dan Siskind

Objective

In the general population, repeated cognitive testing produces learning effects with potential for improved test performance. It is currently unclear whether the same effect of repeated cognitive testing on cognition pertains to people living with schizophrenia, a condition often associated with significant cognitive impairments. This study aims to evaluate learning ability in people with schizophrenia and—considering the evidence that antipsychotic medication can additionally impair cognitive performance—explore the potential impact of anticholinergic burden on verbal and visual learning.

Method

The study included 86 patients with schizophrenia, treated with clozapine, who had persisting negative symptoms. They were assessed at baseline, weeks 8, 24 and 52 using Positive and Negative Syndrome Scale, Hopkins Verbal Learning Test–Revised (HVLT-R) and Brief Visuospatial Memory Test-R (BVMT-R).

Results

There were no significant improvements in verbal or visual learning across all measurements. Neither the clozapine/norclozapine ratio nor anticholinergic cognitive burden significantly predicted participants' total learning. Premorbid IQ was significantly associated with verbal learning on the HVLT-R.

Conclusions

These findings advance our understanding of cognitive performance in people with schizophrenia and demonstrate limited learning performance in individuals with treatment-refractory schizophrenia.

目的在一般人群中,重复的认知测试会产生学习效果,并有可能提高测试成绩。目前尚不清楚重复认知测试对认知的同样影响是否适用于精神分裂症患者,这种情况通常与严重的认知障碍有关。本研究旨在评估精神分裂症患者的学习能力,并考虑到抗精神病药物会额外损害认知能力的证据,探索抗胆碱能负荷对言语和视觉学习的潜在影响。方法对86例精神分裂症患者进行氯氮平治疗,并有持续的阴性症状。在基线、第8周、第24周和第52周使用阳性和阴性综合征量表、霍普金斯言语学习测试-修订版(HVLT-R)和短暂视觉空间记忆测试-R(BVMT-R)对他们进行评估。氯氮平/去氯氮平的比例和抗胆碱能认知负荷都不能显著预测参与者的总学习。病态前智商与HVLT-R上的言语学习显著相关。结论这些发现促进了我们对精神分裂症患者认知表现的理解,并证明了难治性精神分裂症个体的学习表现有限。
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引用次数: 1
Feasibility of six-month outpatient cognitive remediation in schizophrenia: Experience from the randomized controlled integrated social cognition and social skills therapy study 精神分裂症六个月门诊认知修复的可行性:随机对照综合社会认知和社会技能治疗研究的经验
IF 2.8 Q2 PSYCHIATRY Pub Date : 2023-09-01 DOI: 10.1016/j.scog.2023.100285
Tim Schuster , Agnes Lowe , Karolin Weide , Daniel Kamp , Mathias Riesbeck , Andreas Bechdolf , Anke Brockhaus-Dumke , René Hurlemann , Ana Muthesius , Stefan Klingberg , Martin Hellmich , Sabine Schmied , Andreas Meyer-Lindenberg , Wolfgang Wölwer , the ISST study group

Patients with schizophrenia often have cognitive impairments that contribute to diminished psychosocial functioning. Cognitive remediation therapy (CRT) has proven efficacy and is recommended by evidence-based treatment guidelines. Important moderators of efficacy include integration of CRT into a psychiatric rehabilitation concept and patient attendance at a sufficient number of therapy sessions. These conditions can probably best be met in an outpatient setting; however, outpatient treatment is prone to higher rates of treatment discontinuation and outpatient settings are not as well protected as inpatient ones and less closely supervised.

The present study investigated the feasibility of outpatient CRT in schizophrenia over a six-month period. Adherence to scheduled sessions and safety parameters were assessed in 177 patients with schizophrenia randomly assigned to one of two matched CRT programs.

Results showed that 58.8 % of participants completed the CRT (>80 % of scheduled sessions) and 72.9 % completed at least half the sessions. Predictor analysis revealed a high verbal intelligence quotient as favorable for good adherence, but this factor had only low general predictive power. During the six-month treatment phase, serious adverse events occurred in 15.8 % (28/177) of the patients, which is a comparable rate to that reported in the literature.

Our findings support the feasibility of six-month outpatient CRT in schizophrenia in terms of adherence to scheduled sessions and safety.

Trial registration number

NCT02678858, DRKS00010033.

精神分裂症患者通常有认知障碍,导致心理社会功能下降。认知修复疗法(CRT)已被证明有效,并被循证治疗指南推荐。疗效的重要调节因素包括将CRT纳入精神康复概念,以及患者参加足够数量的治疗。这些条件可能最好在门诊环境中得到满足;然而,门诊治疗容易出现更高的治疗中断率,门诊环境不如住院环境得到很好的保护,监督也不那么严密。本研究调查了在六个月内门诊CRT治疗精神分裂症的可行性。177名精神分裂症患者被随机分配到两个匹配的CRT项目中的一个,他们对计划治疗的依从性和安全性参数进行了评估。结果显示,58.8%的参与者完成了CRT(>;80%的预定会话),72.9%的参与者至少完成了一半的会话。预测因子分析显示,高语言智商有利于良好的依从性,但这一因素的总体预测能力较低。在六个月的治疗阶段,15.8%(28/177)的患者发生了严重不良事件,这一比率与文献中报道的比率相当。我们的研究结果支持精神分裂症六个月门诊CRT在坚持预定疗程和安全性方面的可行性。试验注册号NCT02678858,DRKS00010033。
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引用次数: 1
Neurocognitive function and mortality in patients with schizophrenia spectrum disorders 精神分裂症谱系障碍患者的神经认知功能与死亡率
IF 2.8 Q2 PSYCHIATRY Pub Date : 2023-09-01 DOI: 10.1016/j.scog.2023.100284
Christine Mohn , Anna-Karin Olsson , Iris van Dijk Härd , Lars Helldin

Individuals with schizophrenia spectrum disorders (SSD) have significantly lower life-expectancy than healthy people. Previously, we have identified baseline neurocognitive function in general and verbal memory and executive function in particular as related to mortality nearly two decades later. In this study, we aim to replicate these findings with a larger and age-matched sample. The patient group consisted of 252 individuals, 44 of whom were deceased and 206 alive. Neurocognition was assessed with a comprehensive battery. Results showed that the deceased group, compared to the living group, had significantly more severe neurocognitive deficits across nearly all domains. There were no differences in sex, remission status, psychosis symptoms, or function level between the groups. Immediate verbal memory and executive function were the strongest predictors of survival status. These results were nearly identical to our previous studies, and we conclude that baseline neurocognitive function is an important predictor for mortality in SSD. Clinicians should be mindful of this relationship in patients with significant cognitive deficits.

精神分裂症谱系障碍患者的预期寿命明显低于健康人。此前,我们已经确定了一般的基线神经认知功能,尤其是语言记忆和执行功能与近20年后的死亡率有关。在这项研究中,我们的目标是用更大的、年龄匹配的样本来复制这些发现。患者组由252人组成,其中44人死亡,206人活着。神经认知是用一个综合的电池来评估的。结果显示,与在世组相比,死亡组在几乎所有领域都有明显更严重的神经认知缺陷。两组之间在性别、缓解状态、精神病症状或功能水平方面没有差异。即时言语记忆和执行功能是生存状态的最强预测因素。这些结果与我们之前的研究几乎相同,我们得出结论,基线神经认知功能是SSD死亡率的重要预测因素。临床医生应该注意有严重认知缺陷的患者的这种关系。
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引用次数: 0
Eye movements and the perceptual span in disordered reading: A comparison of schizophrenia and dyslexia 阅读障碍中的眼动与知觉广度:精神分裂症和阅读障碍的比较
IF 2.8 Q2 PSYCHIATRY Pub Date : 2023-06-27 DOI: 10.1016/j.scog.2023.100289
Veronica Whitford , Narissa Byers , Gillian A. O'Driscoll , Debra Titone

Increasing evidence of a common neurodevelopmental etiology between schizophrenia and developmental dyslexia suggests that neurocognitive functions, such as reading, may be similarly disrupted. However, direct comparisons of reading performance in these disorders have yet to be conducted. To address this gap in the literature, we employed a gaze-contingent moving window paradigm to examine sentence-level reading fluency and perceptual span (breadth of parafoveal processing) in adults with schizophrenia (dataset from Whitford et al., 2013) and psychiatrically healthy adults with dyslexia (newly collected dataset). We found that the schizophrenia and dyslexia groups exhibited similar reductions in sentence-level reading fluency (e.g., slower reading rates, more regressions) compared to matched controls. Similar reductions were also found for standardized language/reading and executive functioning measures. However, despite these reductions, the dyslexia group exhibited a larger perceptual span (greater parafoveal processing) than the schizophrenia group, potentially reflecting a disruption in normal foveal-parafoveal processing dynamics. Taken together, our findings suggest that reading and reading-related functions are largely similarly disrupted in schizophrenia and dyslexia, providing additional support for a common neurodevelopmental etiology.

越来越多的证据表明,精神分裂症和发育性阅读障碍之间存在一种常见的神经发育病因,这表明神经认知功能,如阅读,也可能受到类似的干扰。然而,尚未对这些障碍的阅读表现进行直接比较。为了填补文献中的这一空白,我们采用了一种基于凝视的移动窗口范式来检查患有精神分裂症的成年人(数据集来自Whitford et al.,2013)和患有阅读障碍的精神健康成年人(新收集的数据集)的句子级阅读流畅性和感知广度(副心加工的广度)。我们发现,与匹配的对照组相比,精神分裂症和阅读障碍组在句子水平的阅读流利性方面表现出类似的下降(例如,阅读速度较慢,退步较多)。标准化语言/阅读和行政职能措施也出现了类似的减少。然而,尽管有这些减少,阅读障碍组比精神分裂症组表现出更大的感知跨度(更大的中央凹旁加工),这可能反映了正常中央凹旁处理动力学的中断。总之,我们的研究结果表明,在精神分裂症和阅读障碍中,阅读和阅读相关功能在很大程度上受到了类似的破坏,这为一种常见的神经发育病因提供了额外的支持。
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引用次数: 0
Preface to themed collection: Cognition in China from 2020 to 2022 主题集前言:《2020-2022年的中国认知》
IF 2.8 Q2 PSYCHIATRY Pub Date : 2023-06-01 DOI: 10.1016/j.scog.2023.100279
Philip D. Harveyc
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引用次数: 0
Evaluating construct and criterion validity of NeuroScreen in assessing neurocognition among hospitalized Ugandan first-episode psychosis patients 评估NeuroScreen在乌干达住院首发精神病患者神经认知方面的结构和标准有效性
IF 2.8 Q2 PSYCHIATRY Pub Date : 2023-06-01 DOI: 10.1016/j.scog.2022.100276
Nana Asiedu , Emmanuel Kiiza Mwesiga , Dickens Akena , Corey Morrison , Joy Louise Gumikiriza-Onoria , Angel Nanteza , Juliet Nakku , Nastassja Koen , Noeline Nakasujja , Wilber Ssembajjwe , Christopher M. Ferraris , Anthony F. Santoro , Dan J. Stein , Reuben N. Robbins

Introduction

Neurocognitive impairment (NCI) is commonly exhibited among patients experiencing their first episode of psychosis. However, there are few resources in many low-income countries, such as Uganda, that allow for the administration of extensive neurocognitive test batteries for the detection of NCI. NeuroScreen is a brief tablet-based neurocognitive assessment battery that can be administered by all levels of healthcare staff. We examined the validity of NeuroScreen to assess neurocognition and detect NCI in first-episode psychosis (FEP) patients in Uganda.

Methods

We enrolled 112 participants FEP patients and matched controls at Butabika Mental Referral Hospital. Each participant completed NeuroScreen and a traditionally administered neurocognitive battery: the MATRIC Consensus Cognitive Battery (MCCB). We examined correlations between participant performance on NeuroScreen and the MCCB. A ROC curve determined sensitivity and specificity of NeuroScreen to detect NCI as determined by MCCB criterion.

Results

There was a large, statistically significant correlation between overall performance on NeuroScreen and the MCCB [r(112) = 0.64, p < .001]. Small to large correlations were found between tests in the MCCB and NeuroScreen batteries. The ROC curve of NeuroScreen performance to detect MCCB-defined NCI had an area under curve of 0.80 and optimal sensitivity and specificity of 83 % and 60 %, respectively.

Conclusion

There was a moderate positive correlation between overall performance on both batteries. NeuroScreen shows promise as a valid assessment battery to assess neurocognition and detect NCI in FEP patients in Uganda. Further studies of NeuroScreen in healthy individuals and in a range of mental disorders are recommended.

引言神经认知障碍(NCI)通常表现在经历第一次精神病发作的患者中。然而,在乌干达等许多低收入国家,很少有资源允许管理广泛的神经认知测试组来检测NCI。NeuroScreen是一个简短的基于平板电脑的神经认知评估组,可以由各级医护人员进行管理。我们检验了NeuroScreen在乌干达首次精神病(FEP)患者中评估神经认知和检测NCI的有效性。每个参与者都完成了NeuroScreen和一个传统管理的神经认知电池:MATRIC共识认知电池(MCCB)。我们研究了参与者在NeuroScreen上的表现和MCCB之间的相关性。ROC曲线确定了根据MCCB标准确定的NeuroScreen检测NCI的敏感性和特异性。结果NeuroScreen的整体表现与MCCB之间存在很大的统计学显著相关性[r(112)=0.64,p<;.001]。MCCB和NeuroScreen电池的测试之间存在小到大的相关性。NeuroScreen检测MCCB定义的NCI的ROC曲线下面积为0.80,最佳灵敏度和特异性分别为83%和60%。结论两种电池的整体性能之间存在中度正相关。NeuroScreen有望成为乌干达FEP患者评估神经认知和检测NCI的有效评估组。建议对健康个体和一系列精神障碍进行进一步的神经筛查研究。
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引用次数: 0
The role of the insula in cognitive impairment of schizophrenia 脑岛在精神分裂症认知障碍中的作用
IF 2.8 Q2 PSYCHIATRY Pub Date : 2023-06-01 DOI: 10.1016/j.scog.2022.100277
Susanna Gebhardt , Henry A. Nasrallah

Cognitive impairment is one of the core clinical symptom domains of schizophrenia. Research shows that cognitive deficits in this neuropsychiatric syndrome is associated with neurodevelopmental pathology affecting multiple brain regions such as the dorsolateral prefrontal cortex, the hippocampus and the parietal lobe. The insula is a relatively small structure that is highly connected with several brain regions as well as multiple brain networks. A large number of studies have reported the involvement of the insula in many of the psychotic and nonpsychotic manifestations of schizophrenia. Here we review the role of the insula as a hub across key neurocircuits which have been implicated in the various cognitive pathologies in schizophrenia. Structural and functional abnormalities in the right and left insulae may serve as a biomarker for susceptibility to schizophrenia.

认知障碍是精神分裂症的核心临床症状领域之一。研究表明,这种神经精神综合征的认知缺陷与影响多个大脑区域的神经发育病理有关,如前额叶背外侧、海马体和顶叶。脑岛是一个相对较小的结构,与几个大脑区域以及多个大脑网络高度连接。大量研究报道了脑岛参与精神分裂症的许多精神病和非精神病表现。在这里,我们回顾了脑岛作为关键神经回路中枢的作用,这些神经回路与精神分裂症的各种认知病理有关。左右脑岛的结构和功能异常可能是精神分裂症易感性的生物标志物。
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引用次数: 2
Spatial and non-spatial feature binding impairments in visual working memory in schizophrenia 精神分裂症患者视觉工作记忆的空间和非空间特征结合障碍
IF 2.8 Q2 PSYCHIATRY Pub Date : 2023-06-01 DOI: 10.1016/j.scog.2023.100281
Antigoni Belekou , Mohammad Zia Ul Haq Katshu , Neil Michael Dundon , Giovanni d'Avossa , Nikolaos Smyrnis

Working memory (WM) impairments are well recognized in schizophrenia patients (PSZ) and contribute to poor psycho-social outcomes in this population. Distinct neural networks underlay the ability to encode and recall visual and spatial information raising the possibility that profile of visual working memory performance may help pinpoint dysfunctional neural correlates in schizophrenia. This study assessed the resolution and associative aspects of visual working memory deficits in schizophrenia and whether these deficits arise during encoding or maintenance processes. A total of 60 participants (30 PSZ and 30 healthy controls) matched in age, gender and education assessed on a modified object in place (OiPT), a delayed non-match-to-sample (DNMST) and a delayed spatial estimation (DSET) task. Patients demonstrated lower accuracy than controls in binding visual features of the same object and recognizing novel objects as well as lower precision recalling the location of a memorized target. Moreover, response choice set size affected recognition accuracy more in PSZ than controls. However, delay duration affected spatial recall precisions, binding, and recognition accuracy equally in the two groups. Our results suggest that visual working memory (vWM) impairments in schizophrenia predominantly reflect spatial and non-spatial binding deficits, with largely preserved discrete feature information. Moreover, these impairments likely arise more during encoding than during maintenance. These binding deficits may reflect impaired effective neural functional connectivity observed in schizophrenia.

工作记忆(WM)障碍在精神分裂症患者(PSZ)中得到了很好的识别,并导致该人群的不良心理社会结果。独特的神经网络具有编码和回忆视觉和空间信息的能力,这增加了视觉工作记忆表现的特征可能有助于确定精神分裂症中功能失调的神经相关性的可能性。这项研究评估了精神分裂症患者视觉工作记忆缺陷的分辨率和联想方面,以及这些缺陷是否发生在编码或维持过程中。共有60名参与者(30名PSZ和30名健康对照)在年龄、性别和教育程度上匹配,评估了一项改良的原地对象(OiPT)、一项延迟不匹配样本(DNMST)和一项延迟空间估计(DSET)任务。与对照组相比,患者在绑定同一物体的视觉特征和识别新物体方面表现出较低的准确性,以及回忆记忆目标位置的精度较低。此外,与对照组相比,PSZ中的响应选择集大小对识别精度的影响更大。然而,延迟时间对两组的空间回忆精度、绑定和识别精度的影响相同。我们的研究结果表明,精神分裂症患者的视觉工作记忆(vWM)损伤主要反映了空间和非空间结合缺陷,并在很大程度上保留了离散特征信息。此外,这些损伤可能在编码期间比在维护期间出现得更多。这些结合缺陷可能反映了在精神分裂症中观察到的有效神经功能连接受损。
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引用次数: 1
期刊
Schizophrenia Research-Cognition
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