首发精神分裂症患者症状群因子分析研究

目的　探讨首发精神分裂症患者治疗前存在的独立症状群及其治疗后的变化。方法　对首发精神分裂症患者 ,在治疗前后分别评定简明精神病评定量表、阴性症状评定量表、汉密尔顿抑郁量表和测查 7种认知功能 ,然后进行因子分析。结果　首发精神分裂症患者的认知症状、阴性症状、情感症状在治疗前、后完全独立 ,无明显变化 ;而阳性症状的独立性在治疗前、后则不稳定 ,因子负荷分别在执行功能、情感症状因子上。结论　在首发精神分裂症患者中情感症状、认知症状是独立存在的 ,与治疗干预、阴性症状及阳性症状关系不肯定 ,应重视对两者的评估和治疗。     

Body image, symptoms and insight in chronic schizophrenia

Historically, schizophrenics' body image problems were regarded as related particularly to delusions and hallucinations. However, during the 1980s, the predominant view of the phenomenology of the disorder broadened to include negative symptoms; deviations in schizophrenics' body image underlie various behaviors or allegations concerning the body and should be refocused. The present study attempted to detect body image deviations in chronic schizophrenia using the Body Image Questionnaire (BIQ), which comprises three hypothetical components (anatomical, functional and other psychological components), and to clarify their related clinical characteristics in symptoms and insight. The BIQ was administered to 93 chronic schizophrenics (diagnosed according to DSM IV; 44 men and 49 women) and 177 normals (78 men and 99 women) adults. The combined data of the three BIQ components in schizophrenic and normal subjects were factor-analyzed separately, and factor scores obtained were compared between schizophrenic and normal groups. The factor scores that differentiated groups were further compared between schizophrenic subgroups, determined by high or low scores for positive symptoms assessed by Scale for the Assessment of Positive Symptoms, negative symptoms by Scale for the Assessment of Negative Symptoms and insight by the Schedule for Assessing Insight. Significant differences between diagnostic groups were found in five of nine factor scores. Dullness in movement, powerlessness, unusually strong gastrointestinal function, lifelessness and fragility proved to be the deviated body images in chronic schizophrenic patients. Powerlessness and lifelessness proved to be related to positive and negative symptoms, and unusually strong gastrointestinal function and fragility to insight.     

Exploration of dimensions of psychopathology in neuroleptic-naïve patients with recent-onset schizophrenia/schizophreniform disorder

Previous studies have suggested that schizophrenic psychopathology segregates into three orthogonal dimensions, viz., psychosis, negative and disorganization. Most of these reports were based on studies on medicated patients with varying degrees of chronicity. The present study aimed at exploring the dimensionality of psychopathology rated on the Scale for the Assessment of Negative Symptoms (SANS) and the Scale for the Assessment of Positive Symptoms (SAPS) in a sample of 43 neuroleptic-na?ve patients with recent-onset schizophrenia/schizophreniform disorder. Principal Components Analysis (PCA) of SANS and SAPS global ratings, excluding inattention but including inappropriate affect as a separate global rating, revealed that the symptoms segregated into three dimensions, viz., negative (affective flattening, alogia, avolition anhedonia and inappropriate affect), psychosis (delusions and hallucinations) and disorganization (positive formal thought disorder and bizarre behavior). Cumulatively these three dimensions explained 74.07% of the variance. The results suggest that the three dimensions of schizophrenic psychopathology are valid even in neuroleptic-na?ve, recent-onset patients with schizophrenia/schizophreniform disorder. PCA of the SANS and SAPS individual items revealed similar findings, but psychotic symptoms loaded under two components, thus yielding a four-factor solution; however, this observation needs to be confirmed in a larger sample of neuroleptic-na?ve schizophrenic patients.     

Family history of schizophrenia and the relationship of stress to symptoms: preliminary findings

OBJECTIVE: It has been hypothesized that patients with a diagnosis of schizophrenia who have a positive family history for schizophrenia will show greater reactivity of their symptoms to increasing levels of stress or negative affect than will patients without such a family history. In the past this hypothesis has only been tested through manipulations of negative affect in laboratory settings. In this paper we test this hypothesis using longitudinal clinical data. METHOD: Data were derived from an earlier longitudinal study using monthly assessments of daily stressors (Hassles Scale) and symptom measures (the Scale for the Assessment of Positive Symptoms and the Scale for the Assessment of Negative Symptoms). We compared longitudinal stress to symptom relations in 12 patients with schizophrenia for whom a positive family history of schizophrenia could be identified with 12 matched schizophrenic patients without any known family history of psychiatric illness. RESULTS: There was evidence that patients with a family history of schizophrenia demonstrated a stronger relation between stress and total score on the Scale for the Assessment of Positive Symptoms. This difference appears to have primarily reflected a greater reactivity to stress of reality distortion symptoms in the positive family history group. The two groups did not differ in apparent reactivity to stress of the disorganization and psychomotor poverty dimensions of symptomatology. CONCLUSIONS: The results of this study provide support from a naturalistic, longitudinal clinical study for the hypothesis that reactivity to stress of some symptoms of schizophrenia may vary as a function of family history of the disorder.     

Smooth pursuit eye tracking dysfunction and negative symptoms in schizophrenia

This study examined the hypothesis that negative symptoms are associated with abnormalities of smooth pursuit in schizophrenic patients. The pursuit eye movements of 25 subjects with schizophrenia and 25 matched normal control subjects were recorded using an infrared eye tracking system and quantified using the log of signal-to-noise ratio (1n S/N). The severity of negative symptoms within the schizophrenic group was rated using the Scale for the Assessment of Negative Symptoms. Previous findings of pursuit abnormalities among schizophrenic patients as a group were replicated. There was, however, no significant association between the eye tracking dysfunction and the severity of negative symptoms.     

The factor structure for positive and negative symptoms in South African Xhosa patients with schizophrenia

Most studies investigating the symptom dimensions of schizophrenia utilising the Scale for the Assessment of Negative Symptoms (SANS) and the Scale for the Assessment of Positive Symptoms (SAPS) favour a three factor model. This study sought to investigate the factor structure of both the global and individual items of the SANS and SAPS in a large sample of South African Xhosa patients with schizophrenia. A total of 422 subjects participated. Both principal components and factor analytical procedures were applied. For the global items, a two-factor solution representing positive and negative symptoms accounted for 59.9% of the variance. Alternatively, the three-dimensional model of negative, psychotic and disorganisation factors was supported by a five-factor solution if the more heterogeneous items of attention and alogia were ignored. Analysis of the individual items yielded a five-factor solution with the negative symptoms splitting into diminished expression and disordered relating, and the positive symptoms separating into factors for psychosis, thought disorder and bizarre behaviour. Our findings are very similar to those from other parts of the world, providing evidence that the factor structure for the symptoms of schizophrenia is relatively resistant to cultural influences. This is particularly true for negative symptoms.     

The possible pathophysiological role of plasma nitric oxide and adrenomedullin in schizophrenia

Evidence is accumulating for a possible role of nitric oxide (NO) in schizophrenia. Adrenomedullin (AM) induces vasorelaxation by activating adenylate cyclase and also by stimulating the release of NO. AM immune reactivity is present in the brain consistent with a role as neurotransmitter. We aimed to examine plasma levels of nitrite (a metabolite of NO) and AM in schizophrenic patients. Eighty-two patients with schizophrenia and 21 healthy control subjects were included in this study. DSM-IV diagnosis of chronic schizophrenia was established on the basis of independent structured clinical interviews and review of records by two qualified psychiatrists which included the Brief Psychiatric Rating Scale (BPRS), The Scale for the Assessment of Negative Symptoms (SANS) and The Scale for the Assessment of Positive Symptoms (SAPS). Total nitrite and AM have been studied in plasma. The mean values of plasma nitrite and AM levels in schizophrenic group were significantly higher than control values, respectively (P=0.03, P<0.0001). AM levels of schizophrenic patients were three fold higher than controls. In correlation analyses, there were statistically significant positive correlations between AM level and SAPS-delusion subscale (r=0.27, P=0.04); SAPS-bizarre behavior subscale (r=0.28, P=0.03) and SAPS-total (r=0.36, P=0.005). There is no correlation between total nitrite and AM levels (r=0.11, P=0.31). Both NO and AM may have a pathophysiological role in schizophrenia, and clinically symptomatology and prognosis of schizophrenia. This subject needs further study including treatment response and subtypes of schizophrenia.     

The generalized pattern of neuropsychological deficits in outpatients with chronic schizophrenia with heterogeneous Wisconsin Card Sorting Test results

Forty schizophrenic outpatients and 40 normal subjects were assessed using extensive clinical (eg, Brief Psychiatric Rating Scale, Scale for the Assessment of Negative Symptoms and Scale for the Assessment of Positive Symptoms) and neuropsychological (extended Halstead-Reitan Battery) measures. The schizophrenic patients had multiple neuropsychological deficits on tests of complex conceptual reasoning, psychomotor speed, new learning and incidental memory, and both motor and sensory-perceptual abilities. Neuropsychological impairment correlated more strongly with negative than positive symptoms. Overall, the schizophrenic outpatients showed relatively modest increases in the number of perseverative responses on the Wisconsin Card Sorting Test of abstraction flexibility. A subgroup of these schizophrenic patients seemed to be particularly impaired on the Wisconsin Card Sorting Test. This pattern of results, in conjunction with previous studies, supports the idea that, while some schizophrenic patients may have fixed, frontally based dysfunctions, these dysfunctions may be most prominent, and even fixed, in deteriorated, kraepelinian patients. These data provide evidence for diffuse and far-reaching deficits in a majority of outpatients with chronic schizophrenia.     

Associations of serum brain-derived neurotrophic factor with cognitive impairments and negative symptoms in schizophrenia

Brain-derived neurotrophic factor (BDNF) may be involved in the pathophysiology of schizophrenia. The aim of this study was to examine the associations of serum BDNF levels with the cognition and clinical characteristics in patients with schizophrenia. Sixty-three patients with schizophrenia and 52 age- and sex-matched healthy controls were examined with neuropsychological tests. Serum BDNF levels were determined by enzyme-linked immunosorbent assay (ELISA). There were no significant differences in serum BDNF levels between normal controls and patients with schizophrenia. Serum BDNF levels of normal controls showed negative correlations with verbal working memory, but this was not the case with schizophrenic patients. Meanwhile, serum BDNF levels of schizophrenic patients showed positive correlations with the scores of the Scale for the Assessment of Negative Symptoms (SANS) and the Information subtest scores of Wechsler Adult Intelligence Scale Revised (WAIS-R). Serum BDNF levels are related with the impairment of verbal working memory and negative symptoms in patients with schizophrenia.     

Symptomatic overlap of cocaine intoxication and acute schizophrenia at emergency presentation.

Cocaine intoxication and acute abstinence alter brain dopaminergic functioning, resulting in behavioral changes closely mimicking the positive and negative symptoms of schizophrenia. In emergency room settings, recent cocaine abuse can be mistaken for schizophrenia and may cause inappropriate diagnosis and in some instances medical mismanagement. Schizophrenia patients presenting with recent cocaine abuse may also present with significant diagnostic and treatment dilemmas. This study attempts to distinguish between cocaine and schizophrenic psychosis by examining patients who present with both recent cocaine abuse and acute schizophrenia (CA+SZ), cocaine intoxication without schizophrenic illness (CA), and acute schizophrenia with no comorbid substance abuse (SZ) within the first 24 hours after arrival at the Bellevue psychiatric emergency service. Clinical assessment included the Brief Psychiatric Rating Scale, the Schedule for the Assessment of Positive Symptoms, and the Schedule for the Assessment of Negative Symptoms. Both cocaine abusing groups were required to have positive urine toxicology screens for inclusion in the study. Multivariate analysis of variance showed the CA+SZ patients present with a clinical profile that overlaps with CA patients on mood and negative symptom dimensions and overlaps with SZ patients on most positive symptoms. CA+SZ patients differed from both groups, however, by presenting with significantly more hallucinatory experiences than cocaine abusing or schizophrenia patient counterparts. Despite considerable overlap, each group of patients presented with a discernible cross-sectional symptom pattern.     

Spatial selective attention and inhibition in schizophrenia patients during acute psychosis and at 4-month follow-up.

BACKGROUND: Attentional abnormalities may lie at the core of cognitive symptoms in schizophrenia, but it is unclear how they relate to symptoms. The major aim of our study was to understand the relation between spatial attention and clinical symptoms from acute to chronic state. METHODS: Thirty-six acutely psychotic schizophrenia patients and 42 matched control subjects were assessed on three spatial attention measures: target location detection, interference (concurrent inhibition of distractor), and negative priming (subsequent inhibition of distractor). Symptoms were assessed by the Positive and Negative Syndrome Assessment Scale. Four months later, the same subjects were re-tested, and symptoms were re-assessed. RESULTS: Symptoms were significantly reduced at the follow-up. Schizophrenia patients were slower at detecting target location than control subjects, but they improved significantly over time. Schizophrenia patients and control subjects did not differ on the interference task. Negative priming was abolished during acute psychosis, but 4 months later it was restored. Positive symptoms were correlated with reduced negative priming but not with interference, nor with target detection. Negative priming during acute psychosis was significantly correlated with the clinical symptoms at the follow-up. CONCLUSIONS: These results suggest that reduced negative priming may be associated with increased clinical, symptoms especially the positive symptoms.     

Relationship between neurological 'soft signs’and syndromes of schizophrenia

Past research on the importance of 'soft’neurological signs in schizophrenia has often not examined the relationship between specific groups of neurological signs and different dimensions of schizophrenia psychopathology. Gender differences in the reported relationships have never been explored. In this paper we describe a study of 100 DSM-III-R (65 male and 35 female) schizophrenic patients who were rated for neurological 'soft signs’with the Neurological Evaluation Scale (NES) (1), and for schizophrenic symptomatology with the Scale for Assessment of Negative Symptoms (SANS) and the Scale for Assessment of Positive Symptoms (SAPS). Following a factor analysis of NES items, differential relationships were examined between the five derived NES factors and three well-established dimensions of schizophrenic symptomatology, namely psychomotor poverty, disorganization and reality distortion. Our results failed to show any relationship between NES dimensions and either the reality distortion or disorganization dimensions. There was a modest but differentially significant relationship between psychomotor poverty and an extrapyramidal factor on the NES. This relationship was shown only by male subjects, and was influenced by duration of illness but not by age or neuroleptic medication. On the other hand, female subjects showed a significant relationship between psychomotor poverty and an NES factor reflecting attention and initiative, and between reality distortion and coordination/sequencing of motor activity. These relationships in female subjects were, relative to relationships for male subjects, more independent of the effect of medication and duration of illness.     

Opposite links of positive and negative symptomatology with memory errors in schizophrenia

We wished to confirm and extend a previous correlational study of our group, suggesting that positive symptoms in schizophrenia were linked to an increase in certain types of memory errors, and negative symptoms to a decrease in other types of errors. A post-hoc analysis was conducted in 33 schizophrenic patients and 40 normal control subjects on memory errors collected in a free recall task and two types of recognition tasks. The memory errors were intrusions and list errors in free recall, and decision bias towards false alarms in recognition, all assumed to reflect a source-monitoring failure. In a first analysis, the patient sample was split along the median for positive symptoms as rated by the Scale for the Assessment of Positive Symptoms (SAPS). In a second analysis, it was split along the median for negative symptoms as rated by the Scale for the Assessment of Negative Symptoms (SANS). Patients with high ratings of positive symptoms made more memory errors (intrusions, list errors, false alarms) than those with low ratings, supporting the hypothesis of a link between positive symptomatology and source-monitoring failure. On the other hand, patients with high ratings of negative symptoms made fewer of these errors than the other patients. Fewer errors were specifically associated with more affective flattening, alogia and anhedonia, whereas avolition was entirely unrelated to them.     

The incidence of negative symptoms in early schizophrenia, mania and other psychoses

Despite increasing interest in negative symptoms in schizophrenia there has been little work on their incidence in early schizophrenia or in other psychoses. This study examined 79 nondepressive psychotics within 2 years of onset of illness, diagnosed by Research Diagnostic Criteria and assessed for negative symptoms using the Scale for the Assessment of Negative Symptoms. Marked negative symptoms were observed in nearly half of patients diagnosed as suffering definite schizophrenia and were rarely found in other psychoses. Negative symptoms were not significantly correlated with positive symptoms, depression or exposure to neuroleptics, but were correlated with developing extrapyramidal side effects.     

Positive and negative symptoms in schizophrenia

Negative and positive symptoms were determined for 46 drug-free patients who met Research Diagnostic Criteria (RDC) and/or Feighner criteria for schizophrenia. A modified version of the Scale for the Assessment of Negative Symptoms (SANS) was completed for each patient based on items from the Schedule for Affective Disorders and Schizophrenia (SADS) and other scales. Positive symptoms were scored from the SADS as well as from the following four diagnostic systems: RDC, Schneider's first-rank symptoms, the 12-point Flexible system, and Langfeldt's criteria for poor prognosis schizophrenia. For all patients, there was no correlation of negative symptoms and positive symptoms defined by any diagnostic system. Within the paranoid and undifferentiated subtypes, there was a positive correlation of positive and negative symptoms. Patients moving from stable to exacerbated states had an increase in both positive and negative symptoms, and patients with a poor history of treatment response had both more positive and more negative symptoms than responsive patients in a stable state. These results do not support the view that subgroups of patients have predominantly either negative or positive symptoms.     

SPECT study of Chinese schizophrenic patients suggests that cerebral hypoperfusion and laterality exist in different ethnic groups.

Hypofrontality is a common finding in schizophrenia in many countries. To date, there have been few studies on Chinese patients with schizophrenia. We thus wondered whether hypofrontality exists in Chinese patients with schizophrenia. We investigated 45 patients with schizophrenia and 21 healthy controls using brain perfusion single photon emission computed tomography (SPECT). Subjects were also administered the Brief Psychiatric Rating Scale (BPRS), Scale for the Assessment of Positive Symptoms (SAPS), Scale for the Assessment of Negative Symptoms (SANS), Halstead-Reitan Neuropsychological Battery (HRNB) and the Wechsler Memory Scale-Revised (WMS-R). Images were analyzed using a semi-quantitative reading and a quantified region of interest analysis. We found that schizophrenic patients showed hypoperfusion in the frontal and temporal lobes and hyperperfusion in the basal ganglia. Schizophrenic patients with both negative and positive symptoms showed asymmetric perfusion in the temporal lobe. Schizophrenic patients with prominent negative symptoms also showed asymmetric perfusion in the prefrontal lobes. Negative symptoms showed a significantly negative correlation with regional cerebral blood flow (rCBF) in the left frontal lobe. Improved memory quotient (MQ) was significantly correlated with increased rCBF in the left temporal lobe. These findings from Chinese patients confirm a similar regional neuroanatomic dysfunction as in Western patients with the disease.     

Premorbid personality in psychoses

This study aimed to establish correlates of the dimensions of schizophrenia in the premorbid personality traits of patients. A sample of 112 patients of relatively recent illness onset who were admitted for a psychotic episode were assessed with a semistructured interview for schizophrenia. Positive and negative symptoms were evaluated with the Scale for the Assessment of Positive Symptoms and the Scale for the Assessment of Negative Symptoms at the time of hospital discharge; positive, negative, and disorganization scores were obtained from these scales. Premorbid personality was assessed blindly through a partially modified version of the Personality Assessment Schedule using interviews with the parents or a close relative. Schizoid traits were significantly associated with negative and positive dimensions. Sociopathic traits were related to the disorganization dimension. Trends toward significance were obtained between passive-dependent traits and the negative and disorganization dimensions, and between the schizotypal dimension and the positive dimension. Partial correlational analyses were used to control for the effect of the remaining personality dimensions on the above relationships. Schizoid premorbid traits were still significantly related to the negative dimension but to a lesser degree to the disorganization and positive dimensions. The association between sociopathic premorbid traits and the disorganization dimension remained significant. These results suggest the preexistence of a three-dimensional structure predisposing to psychoses within the premorbid personality; this structure is more evident in patients with short illness duration.     

Missing Peaks in Auditory Brainstem Responses and Negative Symptoms in Schizophrenia

Abstract: Auditory brainstem responses (ABRs) were examined in 30 schizophrenic patients and 29 normal subjects. The psychotic symptoms were assessed by the Brief Psychiatric Rating Scale (BPRS) and the Scale for Assessment of Negative Symptoms (SANS) in the patients. At least one of the waves I, II or III was found missing on either side at 80 dBHL (hearing level) in 8 (27%) of the patients but in only one (3%) of the normal subjects. There was a significant association between the missing peaks and the BPRS negative symptom cluster or the total score of the SANS. These results suggest that some schizophrenics, especially those with negative symptoms, have an abnormality of input processing of auditory information in the lower brainstem.     

Testing Definitions of Symptom Remission in First-Episode Psychosis for Prediction of Functional Outcome at 2 Years

Background: To determine the clinical relevance of different definitions of symptom remission for prediction of functional outcome in first-episode psychosis (FEP). Methods: One hundred forty-one individuals receiving treatment for an FEP at a specialized early intervention service had positive and negative symptoms and functional status rated every month over the first 2 years of treatment using the Scale for the Assessment of Positive Symptoms, Scale for the Assessment of Negative Symptoms, and Social and Occupational Functioning Assessment Scale. Subjects were classified according to 4 definitions of remission varying the criteria for severity (negative symptom inclusion/exclusion) and duration (3/6 mo sustained). Results: Positive symptom remission was achieved by 94% and 84% of subjects for 3 and 6 months, respectively, compared with 70% and 56% for positive and negative symptom remission, respectively. Linear regression analyses showed that only definitions of remission containing both positive and negative symptoms independently predicted functional outcome. This was confirmed by receiver operating characteristic analyses where remission based on positive and negative symptoms was marginally better than positive symptoms alone (difference in area under the curve; z = 1.94, P = .052). There was little difference between a time criterion of remission of positive and negative symptoms of 3 (sensitivity = 100%, specificity = 42%) or 6 (sensitivity = 90%, specificity = 57%) months. Discussion: Consistent with the consensus definition of remission in schizophrenia, severity of both positive and negative symptoms in defining remission in FEP is necessary although a 3-month criterion had equal predictive validity to the 6-month criterion.