精神分裂症与分裂情感性障碍的核心特征与治疗

精神分裂症是一种严重的精神障碍,在普通人群中的患病率为0.5%~1.0%,在住院患者中,其比例更高。由于精神分裂症的不同亚型在治疗上并无区别,并且容易给临床诊断造成混乱,因此,DSM-5去除了精神分裂症的亚型。分裂情感性障碍的患病率约为精神分裂症的一半。其症状相当于既有精神分裂症的A组症状,同时又有心境症状,例如重性抑郁或躁狂。诊断此障碍必须符合两个关键标准:(1)在半数以上的病程中,除了存在精神分裂症诊断标准A的症状以外,还伴有重性抑郁发作或躁狂发作;(2)在没有心境发作至少2周(抑郁或躁狂)的情况下,存在持续的妄想或幻觉,即证明这些精神病性症状并非由心境发作所致。     

A family study of psychotic symptomatology in schizophrenia,schizoaffective disorder,unipolar depression,and bipolar disorder

Summary An evaluation was made of schizophrenics (140), schizoaffectives (40), unipolar depressives (59), and bipolars (30), and their relatives who had a chart diagnosis of psychosis or depressive neurosis. The purpose was to determine whether the psychosis (delusions and hallucinations) was transmitted independently of the illness itself. If this were true, there would be an excess of pairs of probands and relatives both positive for psychosis and pairs of relatives and probands both negative for psychosis when compared to relatives and probands who were not concordant for the variable. This was found to be true in schizophrenia and schizoaffective disorder and is probably the result of the simple transmission of an illness which includes the presence of psychotic symptoms in the definition. Thus, this would be a manifestation of the genetic propensity in schizophrenia. For the affective disorders there was no evidence that psychotic probands were more likely than the nonpsychotic to have psychotic relatives. So far the reason why some patients have psychosis and others not in the affective disorders remains unexplained.     

EEG coherence in a mental arithmetic task performance in first episode schizophrenia and schizoaffective disorder

Objectives

To evaluate the coherence values of the cortical bands in patients with first episode schizophrenia and schizoaffective disorder during the performance of a mental arithmetic task.

分裂情感性精神障碍的研究现状

分裂情感性精神障碍是一种分裂性症状和情感性症状同时存在又同样突出的精神障碍。本文对分裂情感性精神障碍的临床症状和诊断稳定性、流行病学、生物学研究、临床治疗方案的选择及治疗有效性等方面的研究进展进行了综述。     

Schizoaffective disorder and metabolic syndrome: A meta-analytic comparison with schizophrenia and other non-affective psychoses

People with psychotic disorders, including schizophrenia (SCZ), schizoaffective disorder (SD), or other non-affective psychoses (ONAP), have a higher risk of metabolic syndrome (MetS) than general population. However, previous meta-analyses failed to explore if people with SD are more likely to suffer from MetS than SCZ and ONAP.We carried out a systematic review and meta-analysis comparing rates of MetS in SD with those in SCZ or ONAP. We searched main electronic databases for relevant articles published up to January 2015, and for unpublished data, contacting corresponding authors, to minimize selective reporting bias. Odds ratios (ORs) based on random effects models, with 95% confidence intervals (CIs), and heterogeneity (I²), were estimated. We performed leave-one-out, quality-based, and subgroups analyses to check findings validity. Testing for publication bias, Egger's test estimates were reported.We included 7616 individuals (1632 with SD and 5984 with SCZ/ONAP) from 30 independent samples. SD, as compared with SCZ/ONAP, had a random-effect pooled OR (95%CI) for MetS of 1.41 (1.23–1.61; p < 0.001; I² = 5%). No risk of publication bias was found (p = 0.85). Leave-one-out, sensitivity, and subgroups analyses confirmed the association.To our knowledge, this is the first meta-analysis comparing MetS comorbidity between individuals with SD and those with SCZ or ONAP. SD subjects are more likely to suffer from MetS, with consistent findings across the studies included. However, the role of explanatory factors of this association, and the relative contribution of MetS subcomponents, deserve further research.     

家庭干预对分裂情感性精神障碍患者生活质量的影响研究

目的探讨家庭干预对分裂情感性精神障碍患者生活质量的影响。方法于2012年1月-2013年12月在苏州市广济医院精神科选取符合《中国精神障碍分类与诊断标准(第3版)》(CCMD-3)的135例分裂情感性精神障碍患者为研究对象,按照最小不平衡指数法分为对照组(n=67)和研究组(n=68),两组均采用盐酸氯丙嗪片治疗并进行常规处理,研究组同时进行每3个月1次的家庭干预,共8次。采用躁狂评定量表(YMRS)和汉密尔顿抑郁量表(HAMD)评定患者的不良情绪,采用生活质量综合评定问卷(GQOLI-74)评定患者的生活质量情况。结果干预后,两组YMRS评分和HAMD评分均较干预前下降(t=4.24~12.35,P均0.05),且研究组优于对照组(t=5.47,9.37,P均0.05);研究组躯体功能、心理功能、社会功能和总体生活质量评分均高于对照组(t=7.23~13.01,P均0.05)。结论家庭干预可改善分裂情感性精神障碍的症状,提高生活质量。     

Long-term outcome of schizoaffective and schizophrenic disorders: a comparative study

Summary The long-term outcome of 72 schizoaffective and 97 schizophrenic patients with a mean duration of illness of 25.6 years and 19.6 years respectively was investigated. The outcome was assessed using the WHO Disability Assessment Schedule (WHO/DAS), the Psychological Impairment Rating Schedule (PIRS) (also developed by the WHO), the Global Assessment Scale (GAS), and the Bonn Psychopathological Criteria of Outcome. The outcome of schizoaffective disorders was found to differ from that of schizophrenia in several ways: (a) schizoaffectives achieve a full remission significantly more frequently than schizophrenics (50% vs 10%); (b) the development of so-called characteristic schizophrenic residua is the exception in schizoaffective disorders, but is frequent in schizophrenia; (c) disability, psychological impairment and disturbances of the level of functioning are not only significantly less frequent in schizoaffective disorders but are also less intense than in the schizophrenic group. The factors influencing the outcome of the two disorders are different (see part 11), as are the social consequences (part III).Supported by the German Research Association (Deutsche Forschungsgemeinschaft) grants Ma 915-1/1 and Ma 915-1/2     

De novo cost-utility analysis of oral paliperidone in the treatment of schizoaffective disorder

ObjectivesThe aim of this analysis is to compare costs and effectiveness of paliperidone ER vs. placebo in the treatment of schizoaffective disorder (SAD) in the Czech Republic based on pooled clinical trial data.MethodsA de novo micro-simulation model was developed to assess the cost-utility analysis of paliperidone vs. placebo as there is lack of clinical data comparing paliperidone to other interventions. There are no studies primarily evaluating the efficacy of treatment of SAD with other antipsychotics. The model estimated effectiveness and costs of patients with SAD every week during 24-week time horizon. The effectiveness was defined as improvement of a patient's PANSS score where utilities were assigned to each modelled PANSS score. Based on the patient level data a linear mixed-effects model was used to estimate the regression equations of percentage decrease of PANSS score from the baseline. Utilities were computed using a regression function of patients' age, sex and PANSS score, which was adapted from a clinical study of patients with schizophrenia as there are no QoL data on SAD patients. Among relevant costs, reflecting the payer's perspective, costs of pharmacotherapy, concomitant medications and outpatient care were considered.ResultsThe average ICER of paliperidone compared to placebo reached 28,935 EUR/QALY. The probability of paliperidone being cost-effective compared to placebo was 99.5%.ConclusionsTreatment of SAD with paliperidone results in acceptable ICER and high probability of being cost-effective compared to placebo. Thus, it can be considered as a cost-effective treatment of patients with SAD in the Czech Republic.     

Aggression and psychopathology in treatment-resistant inpatients with schizophrenia and schizoaffective disorder

Positive psychotic symptoms, such as threat/"control-override" delusions or command hallucinations, have been related to aggression in patients with schizophrenia. However, retrospective data collection has hampered evaluation of the direct influence of psychopathology on aggressive behavior. In this study, we monitored aggressive behavior and psychopathology prospectively and in close temporal proximity in 157 treatment-resistant inpatients diagnosed with chronic schizophrenia or schizoaffective disorder participating in a 14-week double-blind clinical trial. Aggressive behavior was rated with the overt aggression scale (OAS). Psychopathology was assessed using the positive and negative syndrome scale (PANSS). At baseline, subjects who would be aggressive during the study had higher scores on only two PANSS items: hostility and poor impulse control. During the study PANSS positive subscale scores were significantly higher in aggressive subjects. Total PANSS scores were higher within 3 days of an aggressive incident, as were positive and general psychopathology subscale scores. However, in a smaller subsample for whom PANSS ratings were available within 3 days before aggressive incidents, only scores on the PANSS positive subscale were significantly higher. These findings in chronic, treatment resistant inpatients support the view that positive symptoms may lead to aggression.     

家庭支持干预对分裂情感性精神障碍患者生活质量的影响：6个月单盲随机对照研究

目的探讨分裂情感性精神障碍患者经家庭支持干预后生活质量的改善。方法将48例门诊分裂情感性精神障碍患者随机分为观察组（24例）和对照组（24例）,两组患者均给予常规抗精神病药物治疗,研究组在此基础上给予家庭干预6个月,干预前后分别采用简明健康测量量表（SF-36）和临床总体评定量表的疾病严重程度（CGI-SI）评定患者的生活质量和疾病严重程度。结果实施家庭支持干预6个月后,研究组的生活质量指标明显优于对照组[SF-36躯体功能分量表的均分（标准差）分别为73.3（6.2）分与66.8（6.4）分,t=4.67,P〈0.001;社会功能分量表的均分（标准差）分别为53.4（12.8）分与42.1（7.9）分,t=4.13,P〈0.001],研究组CGI-SI量表总分[均分（标准差）]低于对照组[分别为2.4（0.5）与2.9（0.9）,t=2.52,P=0.015]。结论家庭支持干预有助于提高分裂情感性精神障碍患者的生活质量。     

Slow wave sleep and computed tomographic measures of brain morphology in schizophrenia

To test the hypothesis that slow wave sleep in schizophrenia is inversely correlated with ventricular system volume, polysomnography and computed tomographic (CT) brain imaging were carried out in 14 psychiatric patients who met Research Diagnostic Criteria for schizophrenia (n = 11) or schizoaffective disorder (n = 3). Three measures of ventricular system volume were analyzed: (1) raw ventricular volume expressed in cm³; (2) ventricle-to-brain ratio; and (3) ventricular volume corrected for normal variation in age and head size expressed as a standardized (z) score. All three quantifications of ventricular volume were significantly and inversely correlated with visually scored measures of stage 3 and stage 4 sleep. This finding suggests that the etiology of slow wave sleep deficits in schizophrenia is related either directly or indirectly to underlying brain dysmorphology.     

White matter density in patients with schizophrenia, bipolar disorder and their unaffected relatives.

BACKGROUND: This study sought to assess white matter density in patients and relatives with histories of bipolar disorder and/or schizophrenia. METHODS: Subjects included those with schizophrenia from families affected by schizophrenia alone, those with bipolar disorder from families affected by bipolar disorder alone and those with bipolar disorder from families affected by both bipolar disorder and schizophrenia. Unaffected relatives of the three patient groups were also recruited. Subjects underwent an MRI brain scan which was analyzed using a white-matter optimized technique. RESULTS: Subjects with schizophrenia and bipolar disorder showed reduced white matter density in the anterior limb of the internal capsule which was not found in unaffected relatives. Reductions were found in frontal subgyral white matter density in affected subjects with a family history of schizophrenia only. CONCLUSIONS: Abnormal anterior internal capsule white matter may provide a structural substrate for both disorders.     

精神分裂症和强迫症的结构和功能磁共振成像比较研究进展

精神分裂症和强迫症是临床精神心理科常见的两种疾病,均给患者带来不同程度的痛苦体验和社会功能损害,二者共病率较高.现通过对这两种疾病结构和功能磁共振成像的比较研究进行综述,探索两种疾病相同和特异的生物学标志物,为后续相关研究提供影像学证据的参考.     

Background factors in patients with schizoaffective disorder as compared with patients with diabetes and healthy individuals

Family history and psychosocial background factors were studied in married patients with a DSM-III diagnosis of schizoaffective disorder (n=17, partnersn=16), married patients with diabetes (n=10, partnersn=10) and married healthy individuals (n=8, partnersn=8). The two latter groups were comparison control groups matched for gender and age to the patients with schizoaffective disorder. Affective disorder, not particularly schizoaffective disorder, was more common in first- and tended to be more common in second-degree relatives of patients with schizoaffective disorder as compared with controls. Poor parental relations, especially to the father, during the formative years were prominent in patients with schizoaffective disorder as compared with the controls. The same patients also more often than others gave a report of sexual enroachment, inside or outside the family, and corporal punishment during the growing-up years.     

Obstetric complications in schizophrenia, schizoaffective disorder and normal comparison subjects

Previous studies have indicated that obstetric complications (OCs) may be risk factors for schizophrenia, but findings are inconsistent, and data about other diagnostic groups are relatively scarce. We compared the obstetric histories of subjects with schizophrenia, major affective disorder and normal controls. Our subjects included 61 schizophrenia, 26 schizoaffective, 28 major affective disorder patients and 21 normal controls. OCs were rated on the McNeil–Sjöström Scale using data from mothers reports and for a subsample from hospital and birth certificate records. The frequency of OCs did not differ statistically between diagnostic groups at any stage or for the three stages combined. OCs of at least level 4 were found in 69% of schizophrenia patients, 62% of schizoaffective patients, 68% of major affective disorder patients and 71% of the normal comparison group. OCs of at least level 5 were found in 23% of schizophrenia patients, 23% of schizoaffective patients, 21% of the major affective disorder patients and 14% of the normal comparison group. Our findings indicate that the etiologic significance of OCs may not be specific to schizophrenia.     

Insight and recovery from psychosis in chronic schizophrenia and schizoaffective disorder patients

Impaired insight is an important contributing factor to poor treatment response and outcome in schizophrenia. Prior studies have attempted to identify the illness characteristics that underlie these deficits, with conflicting results regarding associations with symptoms and neurocognitive deficits. These inconsistencies may be a function of a number of methodological issues, which were addressed in this study. In a prospective, longitudinal study, 50 individuals with schizophrenia or schizoaffective disorder underwent baseline assessments upon discharge from an acute inpatient unit, and again at a 6-month follow-up. Unawareness of positive and negative symptoms were studied separately, with analyses focusing on changes in insight over time as well as associations with disorganized symptoms, depression, and card sorting deficits. Subjects showed greater insight for negative symptoms than for positive symptoms. Insight for positive symptoms improved only slightly over the follow-up period, while negative symptom awareness did not change. Insight for negative symptoms showed modest associations with card sorting deficits, while awareness for positive symptoms showed stronger associations with thought disorder, depression, and card sorting deficits. Awareness for positive symptoms in schizophrenia may be distinct from awareness of negative symptoms. Clinicians should also be aware of the multidetermined nature of impaired insight, and future research should aim to isolate distinct mechanisms that give rise to these deficits.     

Symptom dimensions in recent-onset schizophrenia and mania: a principal components analysis of the 24-item Brief Psychiatric Rating Scale

Previous four- and five-factor solutions of the 18-item Brief Psychiatric Rating Scale (BPRS) suggested the possibility of an affective dimension in psychosis. A principal components analysis was used to analyze psychiatric symptom data rated on an expanded 24-item version of the BPRS. BPRS data were collected during a period of acute psychotic and affective illness with 114 young adult, recent-onset schizophrenia and schizoaffective patients and 27 bipolar manic patients. Principal components analyses of the 18-item and 24-item BPRS indicated a four-factor solution was the most interpretable. Principal components analysis of the 24-item BPRS produced a clear mania factor characterized by high loadings from items added to the 18-item BPRS, which included elevated mood, motor hyperactivity, and distractibility. This factor solution suggests that the 24-item BPRS allows for an expanded assessment of affective symptoms relating to a manic dimension. Potentially important symptoms that were added to the traditional 18-item version, namely suicidality, bizarre behavior, and self-neglect, also make clear contributions to other factors.