Symptom dimensions in the course of childhood-onset schizophrenia

The symptom dimensions of childhood-onset schizophrenia (COS) are described by focussing on the clinical features of 44 patients at onset of illness during the first episode and at follow-up investigation 42 years after onset. All subjects were re-diagnosed according to DSM IV. The symptomatology was evaluated with the Positive and Negative Symptom Scale (PANSS) at onset and at follow-up. Two principal component factor analyses with varimax-rotation were applied to the complete items set of the PANSS. The frequencies of positive, negative, and global symptoms were compared longitudinally in an ANOVA-repeated measures design. The factor analysis revealed 5 orthogonal symptom dimensions (factors) at onset of psychosis: Cognition, social withdrawal, antisocial behaviour, excitement, and reality distortion. At follow-up a five-factor solution was found, too, but different dimensions emerged: a positive, negative, excitement, cognitive, and anxiety/depression component which fits to the 5-factor model of White et al. (1997). The first psychotic episode of EOS is accompanied with more unspecific symptoms such as social withdrawal and antisocial behavior. In the later stages of (COS) the structure of symptom dimensions changes to that known from adult-onset schizophrenia (AOS). The results indicate that COS and AOS are comparable nosological entities and that more than 3 dimensions are required to describe the relevant clinical symptom structure. Positive and global symptoms decreased significantly during the course of illness. The frequencies of negative symptoms did not change which demonstrates their disabling impact.     

Early-onset schizophrenia

The study describes the psychopathological and social outcome of patients treated for schizophrenia in adolescence (mean age at onset 16.0 years/SD 1.52) after a mean follow-up period of 15.4 years (10.2-21.2 years). Out of 55 patients consecutively admitted to hospital, 47 (85 %) could be traced and 39 (71 %) could be re-examined.At follow-up, 33/39 patients (85 %) had had at least one readmission. Full remission of global psychopathological symptoms [Clinical Global Impression (CGI) 相似文献   

Relationship between psychopathology and cognitive functioning in schizophrenia

The purpose of this study was to delineate the relationship between positive, negative, cognitive, depressive, and excitement symptom dimensions of schizophrenia and cognitive functioning. Fifty-eight patients with schizophrenia (DSM-IV criteria) were assessed using the Positive and Negative Syndrome Scale (PANSS) and a battery of neuropsychological tests (executive function/abstraction, verbal and spatial working memory, verbal and nonverbal memory/learning, attention, visuospatial ability, and psychomotor speed). The cognitive symptom dimension correlated with executive functions, attention, verbal memory, and spatial ability. Severity of the negative symptom dimension was related to impairment in the structure of the semantic knowledge system, verbal memory, and auditory attention. In contrast, severity of the positive symptom dimension correlated only with impairment in the structure of the semantic knowledge system, and psychomotor speed. Finally, severity of the depressive and excitement symptom dimension was not associated with cognition. Correlations between symptom dimensions and cognitive measures were at best modest. Severity of cognitive and negative symptoms was mainly correlated with deficits on executive functions, semantic memory, and verbal memory, while positive symptoms only with semantic memory. These correlations were modest, suggesting that psychopathology and cognitive deficits in schizophrenia are caused, at least partially, by distinct pathophysiological processes.     

以阳性、阴性症状为主的首发精神分裂症患者血清蛋白因子水平与PANSS评分的相关性

目的探讨以阳性、阴性症状为主的首发精神分裂症患者血清白细胞介素-6(IL-6)、钙结合蛋白S100β(S100β)、神经营养因子-3(NT-3)三种蛋白因子的浓度水平差异以及与其阳性与阴性症状量表(PANSS)评分中阳性症状、阴性症状、认知、兴奋及抑郁情绪评分之间的相关性。方法以2014年1月-2015年11月于昆明医科大学第一附属医院精神科门诊及住院的首发精神分裂症患者为患者组,选取同期来自本院体检中心的健康体检者为对照组。采用酶联免疫吸附技术(ELISA)测定44例以阳性症状为主的首发精神分裂症患者(阳性组)、38例以阴性症状为主的首发精神分裂患者(阴性组)和78名健康对照者(对照组)血清中蛋白因子IL-6、S100β、NT-3的浓度,通过PANSS对患者组和对照组的阳性症状、阴性症状、认知功能、兴奋症状及抑郁情绪进行定量评估。结果 1三组血清IL-6浓度比较,差异有统计学意义(F=31.34,P0.01),两两比较,对照组IL-6浓度低于阳性组和阴性组,阳性组低于阴性组,差异均有统计学意义(P均0.05);2三组S100β浓度比较,差异有统计学意义(F=9.19,P0.05),两两比较,阳性组、阴性组的S100β浓度均高于对照组(P均0.05),两患者组间比较差异无统计学意义(P0.05);3三组NT-3浓度比较,差异有统计学意义(F=10.45,P0.05),两两比较,阳性组、阴性组NT-3浓度均低于对照组(P均0.05),两患者组间比较差异无统计学意义(P0.05)。阳性组血清NT-3浓度与兴奋评分呈正相关(r=0.38,P0.05)。结论以阴性症状为主的首发精神分裂症患者的神经炎症反应较以阳性症状为主的患者更强烈,以阳性症状为主的首发精神分裂症患者的异常兴奋可能与其细胞营养不足有关,以阳性症状为主的首发精神分裂症的病理机制可能与以阴性症状为主的首发精神分裂症不尽相同。     

Psychopathological characteristics and treatment response of first episode compared with multiple episode schizophrenic disorders

Objective The aim was to investigate the hypothesis that patients with first episode schizophrenic disorders have a more favorable treatment response than those with multiple episodes. Method A total of 400 inpatients from an ongoing multi-centre, follow-up program who fulfilled ICD-10 criteria for schizophrenic disorders (F2) were assessed at admission to and discharge from hospital using the Positive and Negative Syndrome Scale (PANSS). Results At admission, first episode patients (n = 121) showed higher levels of positive symptoms (PANSS positive subscore) and lower ones of negative symptoms (PANSS negative subscore) than multiple episode patients (n = 279), whereas the global disease severity (PANSS total score) was comparable. Analyses of covariance revealed that treatment response (adjusted symptom levels at discharge) was more favorable in first-episode patients, with respect to both positive and negative symptoms. Conclusion The results are compatible with the hypothesis that treatment response becomes less favorable during the course of schizophrenic illness. This finding might be associated with progressive neurobiological alterations. The study was performed within the framework of the German Research Network on Schizophrenia, which is funded by the German Federal Ministry for Education and Research BMBF (grant 01 GI 0233).     

Four symptom dimensions in outpatients with schizophrenia

OBJECTIVE: The aim of this study was to assess the dimensional structure of the Positive and Negative Symptoms Scale (PANSS) to identify the psychopathological profiles of outpatients with schizophrenia. METHOD: Two hundred and thirty-one persons with schizophrenia (DSM-IV criteria) were randomly selected from a register that included all patients under treatment in 5 mental health care centers in Spain. Patients were evaluated with a sociodemographic and clinical questionnaire, the PANSS, the Disability Assessment Scale short version, and the Global Assessment Functioning Scale. A principal component analysis with oblimin rotation was used to examine the factor structure of the PANSS. Different statistical analyses were done to compare the resulting factors with clinical, disability, and social functioning variables. RESULTS: Mean age of patients included was 39.6 years and approximately 65% were male. Four principal components, each of them with eigenvalues greater than 1.5, accounted for 56.22% of the variance. After oblimin rotation, these factors were identified as the Negative (32.48%), Excitement (11.29%), Affective (7.45%), and Positive (5.01%) components. Significant positive correlation between age and the negative dimension was found. Also, we observed significant negative correlations between global assessment functioning and negative and positive dimensions. Total disability was significantly positively related to all dimensions. CONCLUSION: Positive and negative dimensions are common in all principal component analysis results, but we also found affective and excitement dimensions. The present finding suggests that further investigation of symptom dimensions may help to improve symptom-specific treatments; future research should focus on the design of new treatment programs considering these results.     

Relationships between depression and psychotic symptoms of schizophrenia during an acute episode and stable period

The aim of the present study is to explore the relationship between depression and psychotic symptoms of schizophrenia over the course of illness. Sixty-eight patients meeting DSM-IV criteria for schizophrenia were enrolled, 27 in an acute episode, 41 when stable. Assessments were performed using the Calgary Depression Scale for Schizophrenia (CDSS) for depression and the Positive and Negative Syndrome Scale (PANSS) for psychotic symptoms. When considering patients in an acute episode (52% depressed), the CDSS score was correlated only with the PANSS positive sub-scale score. For patients in the stable period (38% depressed), the CDSS score was correlated with positive as well as negative and general psychopathology sub-scale scores. Hence, the relationship between depression and other symptoms of schizophrenia appear to differ during different stages of illness.     

Oxidative mechanisms in schizophrenia and their relationship with illness subtype and symptom profile

Aim:  The aim of the present study was to investigate the differences in the antioxidant–oxidant balance (AO-OB) between schizophrenic patients and healthy individuals and to explore the relationship of AO-OB with illness subtypes and symptom profiles.
Methods:  After a 15-day drug-free period, schizophrenia patients ( n  = 50) in a clinical sample, and age- and sex-matched healthy subjects ( n  = 49) were enrolled. Total antioxidant potentials (TAOP) and total peroxide levels (TPEROX) of all participants were measured and the oxidative stress index (OSI) was calculated. The assessment included structured measurements, including the Positive and Negative Syndrome Scale (PANSS), and the Brief Psychiatric Rating Scale (BPRS).
Results:  TAOP had a significant positive correlation with age at onset of schizophrenia ( P  = 0.013), a negative correlation with the PANSS negative subscale scores ( P  = 0.008), a negative correlation with the PANSS total scores ( P  < 0.001), and a significant negative correlation with BPRS scores ( P  = 0.001). OSI had a significant negative correlation with age at onset ( P  = 0.046) and a significant positive correlation with PANSS negative subscale ( P  = 0.015). A multiple regression model indicated a significant linear combination of age, gender, duration of illness, subtype of schizophrenia, and PANSS scores, in which only the subtype of schizophrenia made a statistically significant contribution to predicting mean OSI ( F [5,35] = 2.44, P  = 0.04).
Conclusion:  Several parameters in the pathogenesis of schizophrenia, such as age of onset, level of negative symptoms, and subtype of illness, but not the presence of the illness itself, are associated with the level of oxidative stress.     

Experimental models of schizophrenia

The Kraepelinian subtypes, developed early in the century, recognize the heterogeneity of schizophrenia but do not reliably predict differences in response to classical neuroleptics. The newer distinction of positive and negative syndromes in schizophrenia carry promise as an approach to identifying meaningful clinical and neurobiological dimensions. The present review summarizes the supportive evidence from a series of investigations using the Positive and Negative Syndrome Scale (PANSS), and a hypothesis on the pathophysiology of negative and positive symptoms is advanced. Our data suggest that: (a) positive and negative syndromes in schizophrenia represent stable, independent dimensions and not co-exclusive subtypes; (b) both are unrelated to the progression of illness; (c) they are differentially related to fundamental aspects of schizophrenia, including premorbid adjustment, cognitive development, family psychiatric history, the cognitive and neuropsychiatric profiles, dopaminergic functions, drug response, and subsequent course; (d) together with depression and excitement, they comprise the fundamental symptomatic components of schizophrenia, which, in their interaction, can account for the specific Kraepelinian subtypes. We have proposed that negative symptoms represent the core pathology in schizophrenia and may be understood as a variant of parkinsonism, hence characterized by dopaminergic deficiency and increased cholinergic activity. This view is supported by the striking overlap with Parkinsonism in regard to clinical features, neurochemistry, pharmacology, neuropathology, and neuroradiology. Positive symptoms are thought to reflect increased dopaminergic activity, which may arise as a compensatory adaptive mechanism to overcome the progressive dopamine loss in the maturing brain. The early onset of schizophrenia by comparison to Parkinson's disease may explain why schizophrenia entails more pronounced positive symptoms, development deficits, and cognitive, social, and emotional impairments. We describe evidence that pineal calcification, which may reflect disturbance of melatonin functions, appears to be a nongenetic factor in schizophrenia associated with perinatal injury. This may in part underlie the negative syndrome and its response to antipsychotic compounds with serotonergic (5-HT) antagonism.     

Psychopathological syndromes of schizophrenia: evaluation of the dimensional structure of the positive and negative syndrome scale

The Positive and Negative Syndrome Scale (PANSS) was originally designed as a rating system that provides balanced representation of positive and negative symptom features. Evidence from recent factor-analytic studies suggests that a five-dimensional solution appears to best fit the psychopathological data as assessed with the PANSS. To investigate the dimensional structure, we administered the PANSS to 253 inpatients with schizophrenia. In accordance with former studies, principal components analyses yielded five orthogonal dimensions: hostile excitement; negative, cognitive, and positive syndrome; and depression. When compared with questionnaires measuring subjective nonpsychotic experiences of schizophrenia, paranoid mood, and depression, the correlation pattern verifies the PANSS components. In addition, we investigated a subsample of 70 male patients with a Continuous Performance Test (CPT), a Span of Apprehension Task, and a Modality Shift Effect (MSE) paradigm; the CPT was significantly associated with the cognitive syndrome, and the MSE correlated with the negative syndrome.     

Predictors of symptomatic remission in patients with first-episode schizophrenia: A 16 years follow-up study

Objective

Recent views on schizophrenia outcome and treatment suggest that symptomatic remission is possible, and a definition of remission has been proposed by the Remission in Schizophrenia Working Group (RSWG).This study evaluated whether patients who achieved remission after several years of illness (R) showed psychopathological differences at the onset of their disorder compared to non-remitted (NR) patients.

Method

Forty-eight patients with first-episode schizophrenia were evaluated with the Positive and Negative Symptoms Scale (PANSS) both at the onset of illness and after a mean period of 16 years. Patients were defined as R or NR according to the RSWG criteria.

Results

Eighteen patients (37.5%) were classified as R at follow-up. At onset, R patients showed a lower illness severity, less severe negative and general psychopathology symptoms compared to NR. Furthermore, they underwent fewer psychotic episodes than NR over the course of follow-up. Remission was predicted by lower severity of negative and general psychopathology symptoms at onset and by lesser number of psychotic episodes during follow-up.

Conclusions

The symptomatic remission may be a viable outcome in schizophrenia, particularly for patients with a mild illness and less severe negative symptoms at onset and with few psychotic episodes over time.     

阿立哌唑与奎硫平治疗首发精神分裂症对照分析

目的:评价阿立哌唑与奎硫平对治疗首发精神分裂症患者的有效性和安全性。方法:对85例首发精神分裂症患者,随机分为阿立哌唑组及奎硫平组进行治疗,分别在治疗前及治疗2,4,8周末采用阳性与阴性症状量表(PANSS)评定临床疗效,用治疗中出现的症状量表(TESS)评定药物不良反应。结果:阿立哌唑能有效治疗首发精神分裂症的阳性症状及阴性症状,疗效与奎硫平相当,不良反应较奎硫平更少。结论:阿立哌唑是一种有效而安全的新型抗精神病药。     

Comparative study of neuropsychological correlates in schizophrenia with onset in childhood, adolescence and adulthood

Childhood onset schizophrenia (COS) patients have marked neuropsychological deficits in areas of attention, working memory and executive functions. Similar deficits have been found in studies on Adolescent onset (AdOS) and Adult onset schizophrenia (AOS). In this study we compared the neuropsychological profile of COS with AdOS and AOS to test the hypothesis that earlier the onset greater is the severity of illness and greater are the neuropsychological deficits. A sample of 15 patients of COS was compared with 20 patients each of AdOS and AOS group. Assessment of neuropsychological profile was done using standard neuropsychological battery for Indian population. Nahor Benson Test and Bender Visual Motor Gestalt Test were used to assess perceptuomotor functioning. COS patients showed significantly greater deficits on scales of IQ, memory and perceptuomotor skills as compared to AdOS that in turn had greater deficits than AOS. The persistence of differences across the three groups inspite of controlling for education and age suggest that these deficits may have been present even before the onset of illness and was not the result of poor academic achievements. These findings also point towards a brain damage in schizophrenia that occurs on a continuum of severity with COS being the most virulent, AOS being the least and AdOS falling in between these two extremes.     

The relationship between insight and symptoms in schizophrenia

We examined the relationship between insight and the positive, negative, active, dysphoric, and autistic dimensions of symptoms in patients with a diagnosis of schizophrenia. Ninety-six patients with a diagnosis of schizophrenia were assessed using the Scale to Assess Unawareness of Mental Disorder, Revised Version (SUMD-R) and the Positive and Negative Syndrome Scale (PANSS). The PANSS data were analyzed based on a five-factor model defined by White et al (1997). The percentage of patients having a lack of awareness was 32.7% for illness, 58.2% for symptoms, 18.4% for treatment response, and 41.8% for social consequences. Lack of awareness of symptoms was significantly correlated with all five symptom factors. Lack of awareness of the illness and its social consequences was only correlated with the positive dimension. Lack of awareness of achieved effects of medication was correlated with the autistic preoccupation factor. There was no correlation between current misattributions for symptoms and PANSS factors. We conclude that poor insight is a common feature of schizophrenia and has a complex relationship to other symptoms of the illness. Our results suggest that (1) unawareness of symptoms is related to severity of illness; (2) insight into illness and its social consequences is more closely tied to positive symptoms than other aspects of insight; and (3) insight into the effects of medication is more closely related to cognitive impairment. Treatment studies that measure insight could answer the question of whether these deficits in awareness improve along with positive and cognitive symptoms.     

舒必利联合舍曲林治疗首发精神分裂症研究

目的：评估舒必利联合舍曲林治疗首发精神分裂症的临床疗效及对患者生活质量的影响。方法：将首发精神分裂症患者66例随机分为联合治疗组和舒必利组。联合治疗组使用舒必利联合舍曲林治疗,舒必利组单用舒必利治疗。于治疗前及治疗8周末采用阳性与阴性症状量表（PANSS）评估疗效,采用健康状况调查问卷（SF-36）评估生活质量,以及治疗中出现的症状量表（TESS）评估不良反应。结果：治疗8周末,联合治疗组的PANSS总分、阴性症状、一般精神病理、反应缺乏、抑郁以及SF-36总分、生理机能、生理职能、生活活力、社会功能、情感职能5个领域均显著优于舒必利组,两组不良反应无差异。结论：舒必利联合舍曲林治疗能提高首发精神分裂症的临床疗效,改善生活质量。     

Validated five-factor model of Positive and Negative Syndrome Scale for schizophrenia in Chinese population

The Positive and Negative Syndrome Scale (PANSS) is the most widely used instrument to assess the severity of symptoms of schizophrenia. Most studies have showed that PANSS measures five dimensions of symptomatology of schizophrenia. However, few studies have ever investigated the structure of PANSS in Chinese schizophrenia population. We recruited two large independent study samples including 903 and 942 Chinese schizophrenia patients and examined the underlying structure of PANSS. By building a confirmatory factor analysis (CFA) model based on the factor loadings of the exploratory factor analysis (EFA) and by testing the CFA model in an independent validation sample, we found that PANSS scores consisted of five factors, which were positive factor, negative factor, excitement factor, depression factor, and cognitive factor. The items loaded on these factors were similar to the consensus items published in previous studies except for PANSS items P2 conceptual disorganization, P5 grandiosity, N5 abstract thinking, and G11 poor attention. This difference might be due to the influence of culture on clinical presentation of schizophrenia. By elucidating the structure, symptoms of Chinese schizophrenia patients could possibly be deconstructed and investigated in future studies.     

Preliminary analysis of positive and negative syndrome scale in ketamine-associated psychosis in comparison with schizophrenia

ObjectiveStudies of the effects of the N-methyl-d-aspartate (NMDA) glutamate receptor antagonist, ketamine, have suggested similarities to the symptoms of schizophrenia. Our primary goal was to evaluate the dimensions of the Positive and Negative Syndrome Scale (PANSS) in ketamine users (acute and chronic) compared to schizophrenia patients (early and chronic stages).MethodWe conducted exploratory factor analysis for the PANSS from four groups: 135 healthy subject administrated ketamine or saline, 187 inpatients of ketamine abuse; 154 inpatients of early course schizophrenia and 522 inpatients of chronic schizophrenia. Principal component factor analyses were conducted to identify the factor structure of the PANSS.ResultsFactor analysis yielded five factors for each group: positive, negative, cognitive, depressed, excitement or dissociation symptoms. The symptom dimensions in two schizophrenia groups were consistent with the established five-factor model (Wallwork et al., 2012). The factor structures across four groups were similar, with 19 of 30 symptoms loading on the same factor in at least 3 of 4 groups. The factors in the chronic ketamine group were more similar to the factors in the two schizophrenia groups rather than to the factors in the acute ketamine group. Symptom severities were significantly different across the groups (Kruskal–Wallis χ²(4) = 540.6, p < 0.0001). Symptoms in the two ketamine groups were milder than in the two schizophrenia groups (Cohen's d = 0.7).ConclusionOur results provide the evidence of similarity in symptom dimensions between ketamine psychosis and schizophrenia psychosis. The interpretations should be cautious because of potential confounding factors.