精神病风险综合征与分裂样精神病临床对照研究

目的 探讨精神病风险综合征(PRS)与分裂样精神病(SFP)临床症状学结构的异同.方法 依据国际疾病分类第10版(ICD-10)及精神病风险综合征定式访谈(SIPS),从病历资料完整的住院患者中筛选出PRS患者71例及SFP患者39例,采用精神病高危症状量表(SOPS)和简明精神病评定量表(BPRS)评估两组疾病症状严重性.结果 两组患者起病形式存在显著性差异(x2=9.24,P=0.010),PRS组以亚急性发病常见(76％),SFP组以急性为主(61％);相关分析显示,SOPS总分与BPRS缺乏活力、思维障碍、敌对猜疑因子分及总分呈正相关(P＜0.01);SFP组SOPS阳性症状因子评分及总分均显著高于PRS组,BPRS总分及思维障碍、激活性因子评分均显著高于PRS组(P ＜0.05,P＜0.01).结论 精神病风险综合征与分裂样精神病是同源类疾病的不同状态,分裂样精神病阳性症状严重于精神病风险综合征.     

分裂样精神病研究进展

1993年《上海精神医学》呼吁对分裂样精神病(SFP)进行研究,几年来国内许多学者从各个角度对SFP进行了探讨,不乏经典之作,现综述如下。 一、SFP重新认识 SFP的诊断归属按DSM—Ⅲ—R、ICD—9、CCMD—2等诊断标准都归入精神分裂症(Sch)的一个亚型,其区别SFP与Sch仅病程不同而已;然而近来研究SFP与Sch并非病     

98例分裂样精神病阴、阳性症状的对比分析

关于分裂样精神病（简称SFP）的临床研究,国内外已有诸多报道,但其结果不一。本文作者就SFP的阴、阳性症状与精神分裂症作一比较分析,报道如下： 1对象和方法 1．1对象为2003年6月～2005年6月我院出院病例中符合CCMD-3C SFP诊断标准138例,经2～4年的随访观察,维持SFP诊断98例,其中,男40例,女58例;年龄为17～40岁,平均（25．1±6．2）岁;     

儿童青少年双相情感障碍的研究进展

由于儿童双相情感障碍 (以下简称情感障碍 )的症状受发育性因素影响 ,症状易重叠于其他儿童期障碍等原因 ,常给儿童精神科医师对其诊断带来一定的困难 ,易导致漏诊和误诊[1 ,2 ] 。然而 ,据报道 ,在情感障碍患者中有 2 0 %～ 54 %首次发病在青少年期 ,有近 1 0 %的病例在 1 2岁以前就已起病[2 ,3] ,故儿童情感障碍已并非罕见。为此 ,我们就儿童青少年双相情感障碍的研究进展进行综述。一、流行病学1 患病率 :由于采用的诊断标准与研究方法不一 ,致使报道的患病率也颇不一致 ,但大多数的意见认为其患病率至少不低于成人[1 ,2 ,4] 。Ｃａｒｌ…     

134例精神分裂症的4A与首级症状

迄今为止,有关精神分裂症的诊断依据仍建立在临床观察基础之上。不同地区使用的诊断标准不尽相同,但E.Bleuler提出的4A症状(以下简称4A)及K.Schneider提出的首级症状(以下简称FRS),在制定诊断标准时仍常被引用作为参考。为观察4A与FRS对国人精神分裂症的诊断意义,特以134例分裂症的临床资料作一分析、评价。 对象与方法 我们将4A与FRS的内容及其与精神分裂症的     

分裂样精神病205例随访调查

对205例分裂样精神病（SFP）进行了5－10年的随访调查,结果显示：91例（44.4%）改诊为精神分裂症,108例（52.6%）维持SFP诊断,6例（3%）改诊为情感性精神病。作认为通过5－10年的随访调查,仍有52.6%维持SFP诊断,因此,SFP是否可作为一个独立的疾病单元,还有待于进一步研究。     

分裂样精神病是什么?——呼吁进行研究

精神分裂样精神病(以下简称 SFP)这一名称在1930年代首先提出,到1950年代流行了一下,但1960年代出版的 ICD-8及DSM—Ⅱ均未将它列入正式分类。1975年出版的 ICD-9仅将它作为精神分裂症的“未标明型”的一个同义词列入而未作说明。在1950～1970年代,人们认为表现分裂症症状     

RT、MMPI在精神分裂症和情感性障碍病人中的测查对照研究

自1921年洛夏测验(以下简称RT)和1943年明尼苏达多相人格调查表(以下简称MMPI)问世以来,多将其应用于精神病学诊断和鉴别诊断,但其临床应用价值却报道不一。为探讨我地区精神病人对RT、MMPI的反应特点,近年来,我们同时用上述两种测验方法对65例精神分裂症和45例情感性障碍病人进行了测查,并与30名正常人进行了对照,现将结果分析报告如下。     

情感障碍与精神分裂症相互误诊各三例原因分析

例 1 男 ,32岁 ,农民。 1988年首次因话多、胡言乱语、行为率乱、到处乱跑而住院。入院时 ,医生以思维散漫、情感不协调、行为紊乱而诊断为精神分裂症 (以下均简称分裂症 )。半月后 ,患者情绪已较平稳 ,言谈、举止、情感都比较协调 ,医生讨论认为 ,不像分裂症 ,改诊断为躁狂症。第二次住院是 2 0 0 1年 ,兴奋症状较第一次住院时更为严重 ,整日不停地言语 ,无法与其交谈 ,声高气昂 ,听不懂他究竟在说些什么。在病室内不停地走动 ,一会儿与这个人握手 ,一会儿拍拍那个人的肩膀 ,有时甚至从这个床上蹦到那个床上 ,从一个房间翻跳到另一个房间 ,…     

不同阴性症状对精神分裂症诊断价值的比较研究

比较了情感平淡、思维贫乏、意志缺乏、愉快感缺乏及注射障碍５项阴性症状对精神分裂症的诊断价值发现，思维贫乏的特异性最高，情感平淡的敏感性，总效率和与ＣＣＭＤ－２诊断分裂症的一致性最高，但均不很理想，同时说明不同阴．性症状对精神分裂症的诊断价值有所不同。     

分裂样精神病2年随访研究

目的 探讨分裂样精神病（简称ＳＦＰ）的临床特征及转归。方法 对首次入院诊断ＳＦＰ的８９例患者进行２年随访，分别按照ＣＣＭＤ－２－Ｒ及ＤＳＭ－ＩＶ二种诊断标准作比较。结果 从诊断标准看，根据ＣＣＭＤ－２－Ｒ，改诊ＳＰ的５４例（６０．７％），维持ＳＦＰ的３１例（３４．８％），根据ＤＳＭ－ＩＶ，改诊ＳＰ的４８例（５３．９％），维持ＳＦＰ的３７例（４１．６％），两种标准间无显著差异。从临床特征看，ＳＦＰ患者与改诊ＳＰ患者比较，临床不具思维化声，维持治疗期疗效好，阴性症状改善明显等特点。结论 ＳＦＰ作为一个独立的疾病单元有其存在价值。     

分裂样精神病6年随访研究

目的：探讨分裂样精神病（简称ＳＦＰ）诊断归属及临床特征。方法：对经过６年随访仍维持ＳＦＰ诊断的４３例的临床资料进行分析,并与改诊为精神下（简称ＳＰ）６５例作比较。结果：１１５例患者中维持ＳＦＰ诊断４３例（３７．４％）,改诊为ＳＰ６５例（５６．５％）,改诊为情感性精神障碍７例（６．１％）。ＳＦＰ患者与改诊为ＳＰ患者比较,具有病前性格多外向,多社会心理因素诱发,检查合作程度高,阳性症状多,阴性症状少,     

分裂样精神病与精神分裂症阴性、阳性症状比较

目的：探讨分裂样精神病与精神分裂症阴性和阳性症状的特点。方法：对49例分裂样精神病与70例精神分裂症患者的阴性和阳性症状作对照研究。结果：两组患者阳性和阴性症状的发生率差异无显著性（P〉0.05）;分裂样精神病组中有妄想症状者明显多于精神分裂症组;而精神分裂症组中情感平淡、思维贫乏等阴性症状者明显多于分裂样精神病（P〈0.01）。结论：分裂样精神病与精神分裂症在阴性、阳性症状方面存在差异。     

Comorbid Moderate–Severe Depressive Symptoms and their Association with Quality of Life in Chinese Patients with Schizophrenia Treated in Primary Care

This study described the prevalence and correlates of comorbid moderate–severe depressive symptoms (comorbid depression thereafter) and their association with quality of life (QOL) in schizophrenia patients treated in primary care. 623 schizophrenia patients were enrolled. Patients’ socio-demographic and clinical characteristics including comorbid depression [defined as a total score of 18 or above on the Montgomery–Asberg Depression Rating Scale (MADRS)] were recorded. Depressive symptoms (defined as a total score of 9 or above on the MADRS) were present in 54.1?% of patients, while 17.7?% had comorbid depression. Analysis of covariance revealed that comorbid depression was significantly associated with lower mental QOL. Multiple logistic regression analysis revealed that more severe positive and negative symptoms, anxiety symptoms, use of first-generation antipsychotics and antidepressants, were independently associated with comorbid depression. Given the negative association between comorbid depression and QOL, attempts to address comorbid depression in schizophrenia patients treated in primary care should be made.     

Schneiderian first rank symptoms: reconfirmation of high specificity for schizophrenia

The prevalence of Schneiderian first-rank symptoms (FRS) in 294 consecutive admissions to a research unit was evaluated with reference to their diagnostic distribution (SADS/RDC). Thirty-five of 58 patients with schizophrenia had FRS, as compared to nine of 190 patients with major depressive disorder. All patients with two or more FRS received a diagnosis of schizophrenia. In the absence of organic or toxic etiology, the specificity of FRS for schizophrenia was 95% and their predictive value was 90%. These findings indicate that FRS should be regarded as strongly suggestive of schizophrenia in the absence of an organic syndrome.     

Cannabis and schizophrenia: impact on onset,course, psychopathology and outcomes

Cannabis consuming schizophrenic patients are younger at onset, are likely to have started abuse before onset of schizophrenia and show more prominent positive symptoms than nonabusers. It has been suggested that cannabis is a risk-factor for schizophrenia. Our aim was to assess prevalence and pattern of cannabis use in 125 chronic male schizophrenic subjects and its impact on socioepidemiological and clinical variables as well as which disorder precedes the other in onset. Assessment of consumption was made with a semi-structured clinical interview. Clinical status was assessed by means of the SANS, SAPS, PANSS and BPRS scales. Cannabis consumption was found in 54 subjects (43%), 66.7% of whom started it at least three years before onset of schizophrenia. Consumers were younger and with lower negative symptoms, specially abusers and polysubstance abusers. Family history positive for psychosis was more frequent in consumers, especially when consumption started before onset of schizophrenia. Subjects whose onset of schizophrenia preceded the beginning of cannabis abuse had more positive symptoms than those who started abuse before the onset of schizophrenia. On these grounds, our sample could be subdivided into two main groups, one that uses substances to counter distressing symptoms of schizophrenia and another in which cannabis might be one of the factors predisposing to the disease; the former had less negative symptoms than nonabusers. Our data support both heterogeneity of schizophrenia and genetic susceptibility to environmental agents.     

Schizophreniform disorder,delusional disorder and psychotic disorder not otherwise specified: clinical features,outcome and familial psychopathology

The relationship between DSM-III-R schizophreniform disorder, delusional disorder (DD) and psychotic disorder not otherwise specified (PD-NOS) and schizophrenia and affective illness (AI) remains uncertain. We explore this question in the Roscommon Family Study by examining symptoms, outcome and patterns of psychopathology in relatives. Probands were selected from a population-based case registry in the west of Ireland with an ICD-9 diagnosis of schizophrenia or AI. Personal interviews were conducted with 88% of traceable, living probands, a mean of 16 years after onset, and 86% of traceable, living first-degree relatives. Best-estimate diagnoses were made at follow-up. Schizophreniform disorder, DD and PD-NOS constituted 6.4%, 2.8% and 7.5%, respectively, of all probands with a registry diagnosis of schizophrenia. Probands with schizophreniform disorder had prominent positive psychotic symptoms, negligible negative symptoms and a good outcome, comparable to that seen in AI probands. Their relatives had an excess risk of schizophrenia spectrum illness but not AI. Probands with DD had prominent delusions but no other psychotic symptoms, few negative symptoms, fair to good outcome and an increased risk in relatives for alcoholism. Probands with PD-NOS had both moderate positive and negative psychotic symptoms, a poor to fair outcome and a substantially elevated risk in relatives of schizophrenia and schizophrenia spectrum disorders but not AI. These results suggest that i) DSM-III-R criteria for schizophreniform disorder define a good outcome disorder with prominent positive psychotic symptoms that probably has a familial relationship to schizophrenia, but not AI; ii) DD is a rare, monosymptomatic psychosis that may have a modest etiologic relationship with alcoholism, but probably not with schizophrenia or AI and iii) PD-NOS is probably heterogeneous but, of these 3 disorders, most closely resembles schizophrenia with respect to symptoms, outcome and familial psychopathology. These results should be seen as tentative given the small number of probands and relatives evaluated.     

Circumstances of suicide among individuals with schizophrenia

Very little is known about the circumstances surrounding suicides in people with schizophrenia. Between September 1989 and August 1998, 15 and 100 suicide victims with and without schizophrenia, respectively, were examined from the Maryland Brain Collection (MBC). Next-of-kin interview and medical record review following death collected demographic and clinical characteristics, family history, psychiatric symptoms, and variables surrounding the suicide. Individuals with schizophrenia exhibited significantly more lifetime depressive symptoms than those without schizophrenia. Jumping from a height was the most frequently used method among people with schizophrenia (40%), whereas gunshot wounds were most common among persons without schizophrenia (37%). A trend was noted for a smaller proportion of those with schizophrenia (20%) to plan the suicide, compared to 47% of those without the disorder. Suicide in schizophrenia is a significant clinical problem; thus, prior suicidal activity and depressive symptoms should be addressed because opportunities to intervene immediately before the act are limited.     

Specificity of Schneider's first rank symptoms for schizophrenia in Malay patients.

The frequency of Schneider's first rank symptoms (FRS) was studied in 221 Malay patients with functional psychosis. The prevalence of FRS in schizophrenia was 26.7%. The most common symptoms were voice arguing, passivity phenomena and somatic passivity. In the absence of organic brain dysfunction, the specificity of FRS for schizophrenia was 87.8%, and their positive predictive value was 90.6%. These findings indicate that although FRS is not pathognomonic of schizophrenia, their presence should be regarded as strongly suggestive of schizophrenia in the absence of organic etiology. FRS do not however occur with sufficient frequency to have potential diagnostic in schizophrenia.     

Dyspepsia and constipation in patients with schizophrenia spectrum disorders

Constipation and dyspepsia are disturbing gastrointestinal symptoms that are often ignored in research on physical comorbidities of schizophrenia. The aim was to assess dyspepsia and constipation in a sample of outpatients with schizophrenia spectrum psychoses. A general practitioner performed a thorough physical health check for 275 outpatients and diagnosed constipation and dyspepsia. This study assessed the possible contribution of several sociodemographic, lifestyle, and clinical variables to constipation and dyspepsia using logistic regression analysis. This study also assessed whether these symptoms were associated with abnormal laboratory findings. The prevalence of constipation was 31.3%, and of dyspepsia 23.6%. Paracetamol (OR =3.07, 95% CI =1.34–7.02) and clozapine use (OR =5.48, 95% CI =2.75–10.90), older age (OR =1.04, 95% CI =1.01–1.06), and living in sheltered housing (OR =2.49, 95% CI =1.16–5.33) were risk factors for constipation. For dyspepsia the risk factors were female sex (OR =2.10, 95% CI =1.15–3.83), non-steroidal anti-inflammatory drugs (OR =2.47, 95% CI =1.13–5.39), and diabetes medication (OR =2.42, 95% CI =1.12–5.25). Patients with dyspepsia had lower haemoglobin and haematocrit and higher glucose values than those without dyspepsia. Patients with constipation had lower thrombocyte values than patients without constipation. However, these findings were explained by factors pre-disposing to constipation and dyspepsia. Clozapine use markedly increases the risk of constipation and may lead to life-threatening complications. In addition, analgesics and diabetes medication were related to gastrointestinal symptoms. These medications and their association to gastrointestinal symptoms should be kept in mind when treating patients with schizophrenia.