2 0 0 0 統合失調症認知機能簡易評価尺度日本語版(BACS-J)
- 著者
- 兼田 康宏 住吉 太幹 中込 和幸 沼田 周助 田中 恒彦 上岡 義典 大森 哲郎 Richard S.E. Keefe
- 出版者
- 医学書院
- 巻号頁・発行日
- pp.913-917, 2008-09-15
はじめに 統合失調症患者の社会機能に及ぼす影響に関しては,その中核症状ともいえる認知機能障害が精神症状以上に重要な要因であると考えられつつある4,5)。統合失調症の認知機能障害は広範囲な領域に及び,なかでも注意・遂行機能・記憶・言語機能・運動機能の領域が注目されている。認知機能の評価においては,認知の各領域を評価するいくつかの検査を目的に応じて組み合わせて(神経心理学的テストバッテリー,NTB)行われている。しかしながら,NTBは通常専門的かつ高価で時間を要する。そこで,統合失調症患者の認知機能を幅広く簡便に評価し得る尺度は日常臨床および研究において大変有用であろう。統合失調症認知機能簡易評価尺度(The Brief Assessment of Cognition in Schizophrenia;BACS)は最近Keefeら7)によって開発されたもので,言語性記憶,ワーキング・メモリ(作動記憶),運動機能,注意,言語流暢性,および遂行機能を評価する6つの検査で構成され,所要時間約30分と実用的な認知機能評価尺度である。我々はその有用性に着目し,臨床応用のために,原著者の許可を得たうえで,日本語版(BACS-J)を作成したのでここに紹介する。日本語訳にあたっては,まず2名が独立して仮日本語訳を作成し,その後訳者2名に第3者を加えた計3名で協議したうえで日本語訳を作成し,さらにその後,原文を知らない者2名に独立して日本語訳のback-translationを行わせ,この英文のそれぞれを原著者に確認してもらった。なお,BACS-Jの信頼性,妥当性については,すでに検討されている6)。
1 0 0 0 OA 統合失調症の認知機能障害と機能的アウトカム
- 著者
- 兼田 康宏 H. Y. Meltzer
- 出版者
- 日本生物学的精神医学会
- 雑誌
- 脳と精神の医学 (ISSN:09157328)
- 巻号頁・発行日
- vol.20, no.2, pp.83-88, 2009-06-25 (Released:2010-06-25)
- 参考文献数
- 34
Objectives: There is general agreement that cognitive impairment, a core feature of schizophrenia, has a key influence on functional outcome in schizophrenia. The authors tested the hypotheses that specific types of cognitive function in patients with schizophrenia would be associated with social function, particularly work status. In addition, we investigated the relation between cognitive function and quality of life (QoL) in patients with schizophrenia.Study 1: Work function and cognitive assessment data were collected in 59 treatment-resistant patients with schizophrenia or schizoaffective disorder. Forty-seven of 59 (79.7%) patients were unemployed at baseline. Over a 12 months period, 23 (48.9%) of the patients achieved employment. Controlling for the duration of the illness and baseline scores, an analysis of covariance (ANCOVA) indicated the one and only significant time by group (remained unemployed vs. gained employment) interaction for verbal working memory as assessed by the Consonant Trigram Test (CTT) score. This interaction was due to significantly greater improvement in the patients who gained employment compared with those who remained unemployed. In addition, a logistic regression analysis with a forward stepwise procedure indicated that the CTT score at 12 months, followed by the CTT score at baseline and the duration of the illness, was the strong predictor of gaining employment.Study 2: Work function and cognitive assessment data were collected in a sample of 152 patients with schizophrenia or schizoaffective disorder from the research clinic in Nashville. Thirty-two of 152 (21.1%) patients were employed. The age and duration of the illness were significantly less in employed patients. Comparison of those employed and unemployed groups showed significantly better Continuous Performance Test (CPT), CTT, Spatial Working Memory Test (SWMT), Brief Psychiatric Rating Scale (BPRS) Total and Positive scores in the employed group. A logistic regression analysis with a forward stepwise procedure indicated that the CTT score was the strongest predictor of employment status.Study 3: Subjects were forty-six stabilized outpatients with schizophrenia. Subjective QoL and cognitive function were assessed using the Schizophrenia Quality of Life Scale (SQLS) and Brief Assessment of Cognition in Schizophrenia (BACS), respectively. Depressive symptoms were assessed with the Calgary Depression Scale for Schizophrenia (CDSS). Although the CDSS scores significantly correlated with the scores of all three SQLS subscales, among three SQLS subscales, only the Symptom/Side Effect subscale scores significantly correlated with the BACS Symbol Coding Task scores.Conclusions: As predicated, neurocognitive performance was more importantly associated with employment status than clinical symptoms in patients with schizophrenia, and thus treatment that enhances cognitive function may lead to better employment outcome in these populations. Meanwhile, subjective QoL was more importantly associated with depressive symptoms than cognitive function, and therefore treatment for depressive symptoms may be important to improve QoL in patients with schizophrenia.