首发精神病人的“冷”和“热”认知探讨： 横向与纵向研究

“Cool” and “hot” components are qualitatively different cognitive abilities. Theconventional neuropsychological studies examined only emotion-independent (“cool”) cognitive functions; the empirical evidence in this area, however, explained poorly the negative symptoms of psychosis, and accounted little for patients’ functional outcome. More refined paradigms to examine cool and hot cognition are necessary. Prospective memory, i.e. the ability to remember to carry things out in the future, correlates better than the conventional cool cognitions with drug adherence, but is seldom studied in patients with first-episode psychosis. Recently, Heerey & Gold (2007) developed an interesting paradigm to measure the translation of emotional salience into motivated behaviour, based on the important distinction between   wanting and liking as two qualitative different affective states. Huang et al. (2009) developed   an ecologically valid paradigm to measure facial emotion perception in different social   contexts. Emotion-volition coupling and facial emotion perception, two important types of emotion-dependent (“hot”) cognition, may be conceptualised as frameworks with which negative symptoms of ahedonia, avolition, and asociality could be explained. However,   emotion-volition coupling is rarely studied in the literature, and evidence for facial emotion misperception in patients with first-episode psychosis is scarce. We conducted four cross-sectional studies and one longitudinal study to assess the above-mentioned types of cool and hot cognition. Participants with first-episode psychosis were recruited from an early psychosis intervention programme, in order to minimise the potential   confounds of long-term medication, institutionalisation, and social isolation effects on one’s cognitive abilities. In Study 1, we demonstrated that patients with first-episode psychosis     experienced severe subjective dysexecutive symptoms in everyday life, and anticipated less  future pleasure, as compared to healthy individuals. In Study 2, we found severe prospective memory impairments in patients with first-episode psychosis, and demonstrated that such   deficit persisted even after other conventional cool cognitive abilities were controlled for. In Study 3, we demonstrated that patients with first-episode psychosis had a weaker connection between emotion experiences and motivated behaviour. Though the patient groups did not have a general “abulia”, their motivated behaviour corresponded poorly to their subjective   emotional salience, as compared to healthy individuals. In Study 4, the findings suggested that patients with first-episode psychosis were insensitive to angry emotion, when subjected to    ambiguous and ecologically valid facial expressions. Taken together, our findings in  cross-sectional  studies suggested that there were ignificant impairments of prospective memory, emotion-volition coupling, and facial emotion perception in first-episode psychosis.   In Study 5, we collected 12-month longitudinal data of a part of the cohort with first-episode   psychosis. The mixed models of Analysis of Variance (ANOVA) and Analysis of Covariance   (ANCOVA) found that the main effect of time was significant for the conventional cool cognitive abilities, and prospective memory, but not for emotion-volition decoupling. The results therefore seem to suggest that cool cognition improved over the time, whereas hot cognition persisted. The relative longitudinal stability of deficits in hot cognition seemed to parallel with the group’s persistent negative symptoms.  The findings in this dissertation have strong clinical implication. Clinicians are recommended to detect early the deficits in  cool and hot cognitions in patients with first-episode psychosis. Our findings concerning the apparent dissociation between cool and    hot cognition over a 12-month period are subjected to methodological constraints, due to learning effect resulted from repetition of the identical behavioural paradigms. Further studies   should control for practice effect by conducting parallel sequential assessments on the healthy comparison group.