Premorbid personality and positive and negative symptoms in schizophrenia.

The relationship between premorbid personality and schizophrenic symptoms assessed by the Scales for the Assessment of Positive and Negative Symptoms was explored in 115 DSM-III-R schizophrenics. The frequencies of normal, schizoid-schizotypal and other DSM-III-R personality disorders were 44%, 39% and 17%. Affective flattening and alogia were significantly more frequently present and severe in the schizoid-schizotypal group than in the rest of the patients. There were no differences in positive symptoms. It is suggested that, in some cases, negative symptoms are merely the persistence or exacerbation of schizoid traits present prior to the emergence of schizophrenic symptoms. These results should be cautiously interpreted because the premorbid personality was diagnosed in a retrospective way and the negative symptoms were assessed cross-sectionally.     

Analysis of positive and negative symptoms in schizophrenia. A study from a population of long-term outpatients

Sixty-seven schizophrenic chronic outpatients (DSM-III-R criteria) were examined to study the relationship between symptoms through intercorrelational and factor analysis. Three factors were identified and associated with clusters of symptoms: factor 1 (affective flattening, alogia, avolition-apathy and anhedonia-asociality), factor 2 (formal thought disorder and bizarre behaviour) and factor 3 (hallucinations and delusions). Strong associations between factor 1 and high functional impairment were found. In this population, the segregation of the symptoms could fit into a three-syndrome model, these results agree with findings obtained from samples in which acute symptoms predominated.     

Gender,premorbid characteristics and negative symptoms in schizophrenia

The interrelationships among gender, premorbid functioning, and negative symptoms were examined in a first-admission inpatient sample with DSM-III-R schizophrenia. Fifty-two subjects were assessed with the Schedule for the Assessment of Negative Symptoms (SANS) at baseline and 6-month follow-up. Three indicators of premorbid functioning were examined: the Premorbid Adjustment Scale, the Quick Test, and the GAF for the best month in the year prior to the baseline interview. Men and women had relatively similar ratings on each of the 5 SANS global subscales at both times; they were also relatively similar on most of the indicators of premorbid functioning. The men and women were categorized into low vs moderate-high negative symptom groups at baseline, and no differences in premorbid functioning were detected. When the sample was classified into those with and without consistent negative symptoms at baseline and 6-month follow-up, the enduring negative men and women had significantly poorer premorbid functioning in several areas than the consistently non-negative patients. Our findings support the importance of assessing negative symptoms longitudinally and suggest that gender is not strongly associated with negative symptoms and premorbid functioning in patients ascertained at early stages of schizophrenia.     

Gender differences in the incidence of definite schizophrenia and atypical psychosis--focus on negative symptoms of schizophrenia.

In a catchment area study of 101 first inceptions of schizophrenia, mania and atypical psychoses, women were significantly more likely to have atypical psychosis and men were more likely to have definite schizophrenia. Negative symptoms such as affective flattening and poverty of speech were already present in many cases, and were significantly increased in patients with definite schizophrenia (geometric mean 5.6) compared with those with atypical psychosis (geometric mean 3.2) and mania (geometric mean 1.5). Negative symptoms were also twice as severe in men (geometric mean 5.5) than women (geometric mean 2.6). There was a significant increase in negative symptom severity with longer illness and greater depression, but the diagnosis and the sex effects were not caused by these factors. We suggest that our findings are further support for the hypothesis that men have a greater biological vulnerability to negative symptoms and consequent social disability in the face of psychosis, particularly a schizophrenic psychosis, and that this may be one explanation for the apparently greater risk of definite schizophrenia and its poorer prognosis in men.     

The dexamethasone suppression test and negative symptoms of schizophrenia

The dexamethasone suppression test (DST) was administered to 28 subjects who met DSM-III criteria for chronic schizophrenia and shared similar environments. Samples were assayed for both plasma cortisol and dexamethasone levels. After controlling for other factors, the mean postdexamethasone cortisol level (MPDC) was correlated with the patients' score on the Scale for the Assessment of Negative Symptoms (SANS). A significant relationship emerged between these 2 parameters, suggesting that the social deterioration seen in chronic schizophrenia is at least partly related to a biological disease process as reflected by the DST. The importance of quantifying the level of dexamethasone in the DST is discussed.     

Positive or negative symptoms — which are more appropriate as diagnostic criteria for schizophrenia?

For over a decade there has been a consensus that the diagnosis of schizophrenia should rest upon the presence of positive symptoms. Recently it has been suggested to give negative symptoms, which have played a prominent role in research, more diagnostic importance again. This study investigated the usefulness of that suggestion. In a sample of 489 inpatients covering the whole range of psychiatric diagnoses, the frequencies and prevalences of positive and negative symptoms were determined. Analyses of variance were calculated to assess the diagnostic validity of the different classes of symptoms. The study demonstrates that positive symptoms are of much higher diagnostic value than negative symptoms. A change of diagnostic procedures giving more importance to negative symptoms is discouraged.     

Skin conductance nonresponding and nonhabituation in schizophrenic patients

Bilateral skin conductance (SC) and heart rate (HR) were measured for 18 RDC diagnosed schizophrenic patients during rest and during presentation of identical tones. Computed tomography scans were evaluated. All but two patients were on neuroleptic medication. Six patients were nonresponders, seven habituated to the tones and five were nonhabituators. Nonresponders had lower SC level, fewer SC spontaneous fluctuations and higher HR level than the other subgroups. On neuropsychological tests the performance of the habituator group was closest to that of healthy subjects. Nonresponders did not differ in clinical symptoms, anamnestic data or in the prevalence of psychiatric morbidity in their families. Seventeen percent of the nonresponders had poor premorbidity adjustment vs 80% of the nonhabituators. Nonhabituators had higher ranks in the following symptoms: Presence of commenting voices, and inability to feel. They also tended to have wider third ventricles than the other two subgroups. The results support earlier findings in our laboratory suggesting nonhabituators as an important subgroup among schizophrenic patients.     

Evaluation and interpretation of symptom structures in patients with schizophrenia

Seventy Japanese DSM-III-R schizophrenic patients were assessed for 30 clinical symptoms using the Positive and Negative Syndrome Scale (PANSS) of Kay et al. Principal component analysis was applied to the full item set of this scale and disclosed 5 orthogonal independent symptom groups: negative, hostile/excited, thought-disordered, delusional/hallucinatory and depressive components. Our results provided further support of the contention that more than 2 (i.e., positive and negative) dimensions are required to account for structures of the schizophrenic symptoms.     

Pseudoakathisia and negative symptoms in schizophrenic subjects.

The characteristics of schizophrenic subjects with pseudoakathisia were compared with those without. Those with pseudoakathisia displayed significantly more negative symptoms. This survived correction for other coexisting movement disorders.     

利培酮与舒必利治疗精神分裂症阴性症状Meta分析

目的：采用Meta分析方法比较利培酮与舒必利治疗精神分裂症阴性症状的临床疗效。方法：将利培酮与舒必利治疗精神分裂症阴性症状的16个中文的随机对照研究进行再分析。结果：16个研究的合并效应量（WMD）为-0．58（-1．37，0．21；P〉0．05）。阳性与阴性症状量表（PANSS）阴性因子（N）亚组的WMD为-0．84（-1．91，0．24；P〉0．05）；阴性症状评定量表（SANS）亚组的WMD为0．19，（-0．77，1．15；P〉0．05）。结论：利培酮与舒必利对精神分裂症阴性症状的疗效无显著差别。     

艾司西酞普兰对慢性精神分裂症阴性症状的作用

目的:观察艾司西酞普兰对慢性精神分裂症阴性症状的作用. 方法:以阴性症状为主的83例慢性精神分裂症患者随机分为研究组和对照组;两组在原有抗精神病药物的基础上,研究组加用艾司西酞普兰10～ 20 mg/d,共12周.于治疗前后分别进行阴性症状量表(SANS)、治疗中出现的症状量表(TESS)和洛文斯顿作业疗法用认知功能评定成套测验(LOTCA). 结果:12周后,研究组SANS总分及情感平淡、意志缺乏、兴趣缺乏评分明显低于对照组(P ＜0.05 ～0.01);LOTCA评分显著高于治疗前及对照组(t=-10.45,P=0.000;t =2.17,P=0.033);药物不良发生率两组间差异无统计学意义.结论:艾司西酞普兰对慢性精神分裂症阴性症状及认知功能有一定改善作用,不良反应轻微.     

Bizarre delusions and DSM-IV schizophrenia

The present study investigated whether schizophrenia patients with and without DSM-IV bizarre delusions, categorized as bizarre delusions of Schneiderian first rank symptoms (SBD) and as non-Schneiderian bizarre delusions (non-SBD), differed on demographic or clinical features, in view of the weight given to bizarre delusions in the diagnosis of schizophrenia. One hundred and twenty-nine in-patients with schizophrenia were assessed systematically for both types of bizarre delusions on the five domains of psychopathology of the Positive and Negative Syndrome Scale (PANSS; delusions/hallucinations, thought disorder/disorganization, excitement, negative symptoms and depressive symptoms) and for extrapyramidal side-effects. Inter-rater reliabilities for SBD and non-SBD were assessed and were exceptionally high (kappa value 0.85 and 0.92, respectively). Neither SBD nor non-SBD were associated with any demographic or non-PANSS clinical characteristics tested. However, the presence of non-SBD was significantly associated with more severe psychopathology in all five domains of the PANSS, whereas the presence of SBD was significantly associated with more severe psychopathology in three domains only: delusions/hallucinations, thought disorder/disorganization and depressive symptoms. However, patients with only SBD did not differ from patients with only non-SBD on any demographic or clinical variables, including five psychopathological domains. These findings suggest that, despite showing more severe symptoms, patients with DSM-IV bizarre delusions do not constitute a clinically distinguishable subgroup.     

Simple schizophrenia: an investigation of Bleuler's criteria based on the major twin studies of schizophrenia.

Schizophrenics fulfilling Bleuler's criteria for simple schizophrenia--no evidence of hallucinations, delusions, and catatonic behavior--were similar to schizophrenics with more typical forms of the disorder with respect to negative symptoms, premorbid social adjustment, and age at onset. These results support the validity of the simple schizophrenia subtype by providing evidence that schizophrenics without conspicuous positive symptoms are similar to those with such symptoms on these core features of the disorder.     

Ventricular enlargement, clinical correlates and treatment outcome in chronic schizophrenic inpatients.

The ventricle-brain ratio (VBR) of 42 chronic schizophrenic patients was compared with that of 42 age-matched medical controls. For the schizophrenics, the relationship of various clinical parameters to the VBR was assessed, and the outcome of 12 weeks of double-blind treatment with either risperidone or haloperidol. The results confirm that schizophrenic patients have slightly enlarged lateral ventricles compared with medical controls. Only for schizophrenics, an effect of age, but not of duration of illness, was noticed. This study does not support the validity of a clinical subdivision of chronic schizophrenic patients on the basis of the VBR. Neither negative, positive nor general psychopathological symptoms, as measured by the Positive and Negative Syndrome Scale for Schizophrenia (PANSS), were related to the VBR, nor were abnormal involuntary movements or extrapyramidal symptoms. No association between season of birth or a family history of major mental disorder and VBR could be demonstrated. Treatment response was predicted by the total PANSS score and the PANSS general psychopathology subscale score at baseline. There was a trend for patients with higher VBR to have a more or haloperidol). or haloperidol).     

帕罗西汀治疗精神分裂症的辅助作用

目的：探讨利培酮合并帕罗西汀治疗以阴性症状为主的精神分裂症的疗效和不良反应。方法：将80例以阴性症状为主的精神分裂症患者随机分为合用组（利培酮合并帕罗西汀治疗）与单用组（单用利培酮治疗）,每组各40例,疗程12周。用阳性与阴性症状量表（PANSS）评定疗效,治疗中出现的症状量表（TESS）评定不良反应。结果：治疗12周后合用组有效率显著高于单用组,PANSS总分和阴性症状分低于同期单用组,TESS评分无显著差异。结论：利培酮合并帕罗西汀治疗以阴性症状为主的精神分裂症有较好的疗效,不良反应少。     

Postpsychotic collapse in schizophrenia

The hospital records of 46 schizophrenic patients were studied retrospectively for postpsychotic collapse (PPC), defined in terms of underactivity. PPC was observed in 38 (83%) patients. The duration of PPC was strongly correlated with the duration of the acute psychotic phase after therapy started, and weakly correlated with the mean dose of antipsychotics per day in the acute psychotic phase, and with age of onset. The authors discuss PPC in terms of the effect of antipsychotics, of psychological reaction, and of understimulation in the hospital setting.     

Effortful cognitive resource allocation and negative symptom severity in chronic schizophrenia

BACKGROUND: The relationship between negative symptoms, early visual information-processing deficits, and effortful processing resource allocation was investigated. METHODS: Older patients with chronic schizophrenia (n = 58) and healthy controls (n = 71) participated. Pupillary responses were recorded during performance of the span of apprehension task (blocks of 3- and 10-letter arrays) as an index of resource allocation or mental effort during the task. RESULTS: Patients and controls showed larger pupillary responses in higher relative to lower processing loads both during array processing and just prior to array onset (preparation). Both groups, therefore, invested more cognitive effort preparing for and then processing larger arrays. A subgroup of patients with abnormally small pupillary responses and impaired performance showed greater negative symptom severity relative to a subgroup of patients with normal pupillary responses. Smaller pupillary responses in the patients were also significantly correlated with greater negative symptom severity, independent of positive symptom severity. Patients with reduced effortful resource allocation, therefore, exhibited greater negative symptomatology. A subgroup of patients with normal pupillary responses still showed impaired detection accuracy relative to controls, suggesting that reduced cognitive effort or resource allocation problems cannot account for impairments in early visual information processing in this subgroup. CONCLUSIONS: The study illustrates important relationships between cognitive effort and performance that can impact conclusions about the nature of cognitive impairments and associations between negative symptoms and neurocognition in schizophrenia.     

Sequential changes of skin conductance activity in rats after intraventricular administration of 6-hydroxydopamine

1. Thirty two male Wistar strain rats were trained to have their skin conductance activity recorded through the soles of their hind limbs, and sequential changes of this activity after the intraventricular administration of 6-OHDA (200 μg) were studied.

2. The intact rats showed SCR and its habituation to repeated auditory stimuli (500 Hz, 90 dB, 1 sec). The 6-OHDA treatment obliterated SCR and reduced the rate of spontaneous fluctuation in the early stage after the treatment. From the second day to one week after the treatment, with recovery of the spontaneous fluctuation rate, the SCR tended to reappear, and its habituation gradually slowed down. Two and three weeks after the treatment, the 6-OHDA rats usually showed habituation failure of SCR, but default of SCR was still observed at times.

3. These findings suggest that denervation of the catecholaminergic fibers by intraventricular 6-OHDA is responsible for the obliteration of SCR, and denervation supersensitivity, which develops later, may be the cause of its habituation failure.

4. The mechanisms underlying abnormal skin conductance activity of schizophrenia were discussed in line with the catecholamine hypothesis of this disease.     

利培酮联合帕罗西汀治疗慢性精神分裂症阴性症状

目的:探讨利培酮联合帕罗西汀治疗慢性精神分裂症阴性症状的临床疗效以及安全性.方法:将126例以阴性症状为主的慢性精神分裂症住院患者随机分为研究组(利培酮联合帕罗西汀治疗)和对照组(单用利培酮治疗),疗程12周,采用阳性和阴性症状量表(PANSS)和治疗中出现的症状量表(TESS)评定疗效和安全性. 结果:治疗后两组PANSS评分均较治疗前有显著降低(P＜0.05).治疗后4、8、12周末,研究组阴性因子分及情感迟钝、情感退缩、情感交流障碍及社会退缩因子分均显著低于对照组,差异具有统计学意义(P＜0.05或P＜0.01).两组不良反应均为轻至中度. 结论:利培酮联合帕罗西汀较单用利培酮治疗慢性精神分裂症阴性症状具有起效更快、疗效更好、依从性好的特点.     

Twin concordance for DSM-III-R schizophrenia.

The monozygotic (MZ)/dizygotic (DZ) concordance rates for schizophrenia and the relationship between schizophrenia and schizophrenic spectrum disorders were studied in a sample of 31 MZ and 28 DZ schizophrenic probands and their co-twins. All subjects were personally interviewed with structured diagnostic instruments and classified according to DSM-III-R criteria. The concordance rates of 48% for MZ twins and 4% for DZ twins indicate a genetic transmission of DSM-III-R schizophrenia. In addition to the schizophrenic co-twins, 3 MZ co-twins had a noneffective psychotic disorder, thus supporting the hypothesis that genes are involved in the development of Axis I schizophrenic spectrum disorders. Schizotypal and paranoid personality disorders were observed in both MZ and DZ co-twins. These disorders may be familially related to schizophrenia, but a genetic relationship was not confirmed for the Axis II spectrum disorders. A substantial number of MZ co-twins of schizophrenic probands had no mental disorder.