|Other Abstract||Patients with schizophrenia have emotional, cognitive and interpersonal disorders before and after the onset of the disease. Social cognitive impairment is a common and important clinical feature of patients with schizophrenia. In patients with schizophrenia, social cognitive impairment is significantly associated with social interaction, independent life, work activities and recovery. Alexithymia is an important aspect of social cognition, which is characterized by cognitive-affective disorder, that is, it is difficult for a person to identify and express feelings. Previous studies have shown that the incidence and severity of alexithymia in patients with schizophrenia are significantly higher than those in the general population. A few of small sample studies of patients with schizophrenia have shown that alexithymia is closely related to clinical symptoms, cognitive function and negative behavior of patients with schizophrenia. However, the conclusions of the existing studies are not consistent, and gender, which widely affects the emotional processing process, is not taken into account. At the same time, because the existing studies are all small sample studies, the validity of the research results is also open to question. Therefore, using a large sample to systematically explore the relationships between alexithymia and clinical symptoms, cognitive function and suicidal behavior in patients with schizophrenia will further confirm the effect of alexithymia on patients with schizophrenia. It provides a new direction or possibility for reducing the severity of symptoms, cognitive deficits and suicidal behavior.
In study 1，the Positive and Negative Syndrome Scale (PANSS) and Toronto alexithymia scale (TAS-20) were used to evaluate the clinical symptoms and the severity of alexithymia of 818 patients with chronic schizophrenia, in order to explore the relationship between alexithymia and clinical symptoms in patients with schizophrenia. According to the total score of TAS-20, all patients were divided into alexithymia group, critical state group or non-alexithymia group, and the severity of clinical symptoms were compared among the three groups. There were significant differences in the scores of other clinical symptoms except positive symptoms among these groups. The results of correlation analysis showed that the positive symptoms score was only positively correlated with DIF (difficulty identifying feelings), while the depression factor was not correlated with EOT (externally oriented thinking). The scores of global PANSS, negative symptoms, general psychopathology symptoms and cognitive factor were positively correlated with the total score and all subscale scores of TAS一20. In this sample, the proportion of male patients with alexithymia was 35.3%, which was significantly higher than that of the female patients (26.5%). In women, except that the score of positive symptoms was only related to the DIF, and the score of depression factor was not related to EOT, the other clinical symptoms indexes were positively correlated with all the indexes of alexithymia. However, in male patients, the
total score of PANSS and general pathological symptoms score were not related to the DIF and EOT, while the score of depression factor was only positively correlated with DIF and EOT.
In study 2, on the basis of study1，the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) were used to measure cognitive function in patients with schizophrenia, aiming to explore the relationship between alexithymia and cognitive function in patients with schizophrenia. The results showed that there were significant differences in all dimensions of cognitive function among the non-alexithymia group, the critical state group and the alexithymia group, and the cognitive function of the three groups decreased gradually. The relationship between alexithymia and clinical symptoms and the relationship between alexit场mia and cognitive function were opposite. Except for immediate memory and visuospatial skills were not related with DIF. The total score of RBANS and scores of other factors were negatively correlated with the total score and all factor scores of TAS-20. There was consistency between male and female patients, like there were significant differences in RBANS total score and immediate memory among the three groups of male and female patients.
Study 3 used the Bake Scale for Suicide Ideation (BSI) to evaluate the severity of suicidal ideation in patients with schizophrenia and to explore the effect of alexithymia on suicidal ideation in patients with schizophrenia. The results showed that the DIF of alexithymia was related to suicidal ideation and the severity of suicidal ideation. It was found that the total score of alexithymia was related to depression factor, and depression factors were positively correlated with the intensity of suicidal ideation in women. In male patients, no correlations were found between the total score of alexit场mia and the depression factor or the severity of suicidal ideation. Furthermore, it was found that gender could moderate the relationship, mediated by depressive symptoms, between alexithymia and the severity of suicidal ideation.
To sum up, this study showed that:(1)about 32.27% of the patients with schizophrenia had alexithymia, and the incidence of alexithymia in male patients was significantly higher than that in female patients; (2) the severity of alexithymia in patients with schizophrenia was positively correlated with the severity of clinical symptoms except positive symptoms, and the relationship between alexithymia and clinical symptoms in female patients was more extensive. (3) there was a negative correlation between the severity of alexithymia and cognitive function in patients with schizophrenia, and there were several similar correlations between alexit场mia and cognitive function between male and female patients. (4) alexithymia could be a risk factor for suicidal behaviors in patients with schizophrenia. Gender moderated the effect of alexithymia on suicidal behaviors.|