宋宝华 戴红 杨胜良

[摘要] 目的 探討精神分裂症患者攻击行为的影响因素。 方法 将600例精神分裂症患者按照外显攻击行为量表（MOAS）评分分为攻击组和非攻击组（各300例），比较两组的简明精神病量表（BPRS）各因子分以及血清睾酮水平，分析比较两组BPRS各因子分与MOAS各因子分、血清睾酮水平的相关性。 结果 攻击组 BPRS 总分、激活性、思维障碍、敌对猜疑因子得分均明显高于非攻击组，缺乏活力因子得分明显低于非攻击组；攻击组MOAS加权总分及各分量表评分均明显高于非攻击组，差异有统计学意义（P<0.001）；攻击组BPRS 激活性、敌对猜疑因子得分与MOAS言语攻击因子得分呈明显的正相关，焦虑抑郁、思维障碍、激活性、敌对猜疑各因子得分和总分与MOAS自身攻击因子得分明显的正相关，总分与MOAS加权总分明显的正相关；攻击组男性、女性睾酮水平均高于非攻击组，差异有统计学意义；攻击组男性睾酮与MOAS的言语攻击、自身攻击分正相关，攻击组女性睾酮与MOAS的自身攻击因子分呈正相关。 结论 精神分裂症患者的攻击行为与患者血清睾酮及其精神症状均相关。

[关键词] 精神分裂症；攻击行为；MOAS；BPRS；睾酮

[中图分类号] R749.3 [文献标识码] B [文章编号] 1673-9701（2018）25-0116-04

[Abstract] Objective To explore the influencing factors of aggressive behavior in the patients with schizophrenia. Methods A total of 600 patients with schizophrenia were divided into attack group and non-attack groups（300 cases each） according to the score of the modified overt aggression scale（MOAS）. The scores of each factor of BPRS and serum testosterone levels were compared between the two groups. The correlations between the scores of each factor of BPRS and the scores of each factor of MOAS and serum testosterone levels were analyzed and compared between the two groups. Results The total scores of BPRS， activation， thinking disorder， and hostile suspicion factors in the attack group were significantly higher than those in the non-attack group. The lack of vitality score was significantly lower than that in the control group； the total weighted scores of the MOAS and scores of the subscales in the attack group were significantly higher than those in the non-attack group， and the differences were statistically significant （P<0.001）； there was a significant positive correlation between the scores of BPRS activation， hostile suspicion factors and MOAS verbal attack factors in the attack group. The scores of anxiety， depression， thinking disorder， activation， hostile suspicion factors， and total score were positively correlated with the score of MOAS self-attacking factor. The total score was positively correlated with the MOAS weighted total score； the testosterone levels in males and females in the attack group were higher than those in the non-attack group， and the difference was statistically significant； there was a positive correlation between male testosterone and the scores of MOAS verbal attacks and self-attacks in the attack group. The female testosterone in the attack group was positively correlated with the score of MOAS self-attack. Conclusion The attack behavior of the patients with schizophrenia is related to patients' serum testosterone and their psychiatric symptoms.

[Key words] Schizophrenia； Attack behavior； MOAS； BPRS； Testosterone

精神分裂症（schizophrenia）是精神科常见病、多发病，患病率为0.5%～1%[1]，常有感知、思维、情绪、行为等诸方面的障碍与精神活动的不协调，病程迁延不愈[2]。暴力攻击行为是精神分裂症患者的主要精神症状[3-4]。有研究[5]认为，5.2%的严重攻击行为是由精神障碍特别是精神分裂症所致。Witt等[6]研究结果表明精神疾病暴力攻击行为者中约有87.8%的患者诊断为精神分裂症。Fazel等[7]称精神病患者的暴力攻击行为发生率高，是正常人群4～6倍。精神分裂症患者的攻击行为成为研究者关注的重要课题。现有研究认为雄性激素尤其是睾酮与暴力攻击行为的形成和表达有关[8]。Mario等[9]研究认为入院前1个月的攻击行为、男性、物质滥用及阳性症状与入院后的攻击行为相关。因精神分裂症患者的攻击行为常突然发生、程度剧烈、形式残暴，难以预测，危害极大。……