精神分裂症的阴性症状

精神分裂症的阴性症状北京回龙观医院（１０００８５）杨甫德，吉中孚，刘华清本文拟对精神分裂症的阴性症状作一概述，以期引起精神医学界同仁对阴性症状给予更多的关注。１阴性症状的生物学基础在７０年代未，Ｃｈｏｕｉｎａｒｄ就对阴性症状进行了生物学的解释，认为脑...     

电针治疗精神分裂症阴性症状的疗效比较

作者对以阴性症状为主的精神分裂症采用电针治疗,并与舒必利静脉注射进行疗效对比分析。现报道如下：     

精神分裂症阴性症状与抑郁的相关性

目的：探讨精神分裂症阴性症状与抑郁的关系。方法：对符合CCMD-2-4诊断标准的精神分裂症50例住院患者的症状，为阳性症状和阴性症状量表（PANSS）进行评定，并对阴性症状和抑郁症状作多因素相关分析。结果：因子中N7与G6正相关，N1、N3、N4、N6与抑郁总分负相关，N5、N7、减分与G6减分正相关。结论：阴性症状部分因子与抑郁相关，但并非继发于抑郁。     

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。     

精神分裂症的阴性症状与额叶功能障碍

目的：探讨精神分裂症阴性症状与额叶功能的关系。方法：应用９９ｍＴＣ－乙撑双半胱氨酸二乙酯ＳＰＥＣＴ技术，以范畴测验为心理作业任务，测量９例高阴性症状与１３例低阴性症状的精神分裂症患者静息状态与心理作业时的局部脑血流（ｒＣＢＦ），并与１０例正常对照组比较。结果：静息状态时，阴性症状与左下额叶ｒＣＢＦ呈显著负相关，低阴性组左下额叶血流灌注增高。心理作业时，阴性症状与右上额叶ｒＣＢＦ呈显著负相关，高阴性组右上额叶血流灌注低于低阴性组。两病例组左、右额叶ｒＣＢＦ均低于正常对照组。结论：精神分裂症阴性症状可能与左下额叶及右上额叶功能障碍有关     

精神分裂症阴性症状的研究进展

精神分裂症是一种病因未明的异质性疾病,其临床表现多样,几乎涵盖了精神科的全部症状群。20世纪80年代,英国精神病学家Crow 提出将精神分裂症分为阳性症状与阴性症状两型［1］。阳性症状与阴性症状的划分,更有利于精神分裂症病因学、发病机制等方面的研究。精神分裂症的阴性症状主要表现为思维贫乏、情感淡漠、愉快感缺乏／社会退缩、意志缺乏、注意障碍,阴性症状较阳性症状更易影响患者的生活质量,增加功能性疾病,增加经济负担,且预后更差［2－3］。     

帕罗西汀治疗精神分裂症阴性症状

我们以单用抗精神病药和抗精神病药合用帕罗西汀治疗以阴性症状为主的精神分裂症,进行临床对照,报告如下。     

精神分裂症患者记忆力与阴性症状相关性分析

文献报道精神分裂症患者存在较严重的记忆受损[1],有人认为与某些症状群有关,其中包括阴性症状[2].我们对此进行研究.     

EPA guidance on treatment of negative symptoms in schizophrenia

Negative symptoms of schizophrenia remain a major therapeutic challenge. The progress in the conceptualization and assessment is not yet fully reflected by treatment research. Nevertheless, there is a growing evidence base regarding the effects of biological and psychosocial interventions on negative symptoms. The importance of the distinction between primary and secondary negative symptoms for treatment selection might seem evident, but the currently available evidence remains limited. Good clinical practice is recommended for the treatment of secondary negative symptoms. Antipsychotic treatment should be optimized to avoid secondary negative symptoms due to side effects and due to positive symptoms. For most available interventions, further evidence is needed to formulate sound recommendations for primary, persistent, or predominant negative symptoms.However, based on currently available evidence recommendations for the treatment of undifferentiated negative symptoms (including both primary and secondary negative symptoms) are provided. Although it has proven difficult to formulate an evidence-based recommendation for the choice of an antipsychotic, a switch to a second-generation antipsychotic should be considered for patients who are treated with a first-generation antipsychotic. Antidepressant add-on to antipsychotic treatment is an option. Social skills training is recommended as well as cognitive remediation for patients who also show cognitive impairment. Exercise interventions also have shown promise. Finally, access to treatment and to psychosocial rehabilitation should be ensured for patients with negative symptoms. Overall, there is definitive progress in the field, but further research is clearly needed to develop specific treatments for negative symptoms.     

氯氮平合并丙咪嗪治疗衰退期精神分裂症阴性症状的对照研究

目的　评价氯氮平合并丙咪嗪对衰退期精神分裂症阴性症状的治疗效果。方法　将 38例以阴性症状为主的衰退期精神分裂症患者随机分成两组 ,进行为期 12周的对照研究。分别用氯氮平合并丙咪嗪(治疗组 )和氯氮平 (对照组 )治疗。采用BPRS、SANS和TESS评定标准进行评定。结果　无论治疗组还是对照组治疗前后SANS评分差异无显著性 (P >0 .0 5 )。两组治疗前后SANS评分差异无显著性 (P >0 .0 5 )。结论　氯氮平合并丙咪嗪对衰退期精神分裂症阴性症状的疗效与单用氯氮平疗效相仿 ,丙咪嗪对改善阴性症状无效     

Negative symptoms: A review of schizophrenia, melancholic depression and Parkinson's disease

Negative symptoms generally refer to a reduction in normal functioning. In schizophrenia they encompass apathy, anhedonia, flat affect, avolition, social withdrawal and, on some accounts, psychomotor retardation. Negative symptoms have been identified in other psychiatric disorders, including melancholic depression, and also in neurological disorders, such Parkinson's disease. Achieving a better understanding of negative symptoms constitutes a priority in mental health. Primarily, negative symptoms represent an unrelenting, intractable and disabling feature for patients, often amounting to a severe burden on families, carers and the patients themselves. Identifying and understanding subgroups within disorders may also contribute to the clinical care and scientific understanding of the pathophysiology of these disorders. The purpose of this paper is to review the current literature on negative symptoms in schizophrenia and explore the idea that negative symptoms may play an important role not only in other psychiatric disorders such as melancholic depression, but also in neurological disorders, such as Parkinson's disease. In each disorder negative symptoms manifest with similar motor and cognitive impairments and are associated with comparable neuropathological and biochemical findings, possibly reflecting analogous impairments in the functioning of frontostriatal-limbic circuits.     

Computerized measurement of negative symptoms in schizophrenia

Accurate measurement of negative symptoms is crucial for understanding and treating schizophrenia. However, current measurement strategies are reliant on subjective symptom rating scales, which often have psychometric and practical limitations. Computerized analysis of patients' speech offers a sophisticated and objective means of evaluating negative symptoms. The present study examined the feasibility and validity of using widely-available acoustic and lexical-analytic software to measure flat affect, alogia and anhedonia (via positive emotion). These measures were examined in their relationships to clinically-rated negative symptoms and social functioning. Natural speech samples were collected and analyzed for 14 patients with clinically-rated flat affect, 46 patients without flat affect and 19 healthy controls. The computer-based inflection and speech rate measures significantly discriminated patients with flat affect from controls, and the computer-based measure of alogia and negative emotion significantly discriminated the flat and nonflat patients. Both the computer and clinical measures of positive emotion/anhedonia corresponded to functioning impairments. The computerized method of assessing negative symptoms offered a number of advantages over the symptom scale-based approach.     

Positive and negative symptoms of schizophrenia and linguistic performance

Selected subjects from a group of first onset schizophrenics (aged under 30 years) were taken from a previous study and placed in one of two groups depending upon whether they had exclusively positive symptoms (n = 9) or a mixture of positive and negative symptoms (n = 9). Their linguistic profiles were compared with those of a group of controls (n = 10) matched for educational attainment and parental social class. Both groups of schizophrenics had significantly lower integrity scores, suggesting that they made more syntactic and semantic errors. Those patients who presented with negative symptoms tended to have speech of lower syntactic complexity than the other two groups, although the difference just failed to reach statistical significance. It is suggested that syntactic and semantic errors are state dependent features associated with positive symptoms, whereas low syntactic complexity may be a more enduring feature associated with the presence of negative symptoms.     

精神分裂症记忆与阳性、阴性症状的研究

目的探讨精神分裂症患者记忆特点及与阳性、阴性症状的关系。方法采用修正的加工分离记忆实验程序测试精神分裂症患者记忆变化情况,用PANSS评定精神分裂症患者阳性、阴性症状分。结果精神分裂症外显记忆与对照组比较明显受损(P0.05),其文字概念和图像概念实验类型驱动的内隐记忆成绩与对照组比较也受损(P0.05);阳性症状为主的患者外显记忆成绩均高于阴性症状为主的患者组(P0.05);阳性症状为主的患者内隐记忆成绩与以阴性症状为主的患者组之间的差异无统计学意义(P0.05);阳性症状与外显记忆无显著相关关系(P0.05),阴性症状与外显记忆呈显著负相关关系(P0.01);阳性症状、阴性症状与内隐记忆均无显著相关关系(P0.05)。结论精神分裂症外显记忆严重受损,而内隐记忆不同程度的受损;外显记忆与阳性症状无相关性,与阴性症状有显著相关;内隐记忆与阳性、阴性症状均无明显相关性。     

氯氮平联合美金刚治疗精神分裂症阴性症状对照研究

目的:探讨氯氮平联合美金刚治疗精神分裂症阴性症状的疗效及安全性. 方法:将64例以阴性症状为主的慢性精神分裂症患者随机分成两组,每组32例,两组在服用原有抗精神病药(氯氮平)的基础上,研究组联合美金刚治疗,对照组联合安慰剂治疗,观察12周.于治疗前、治疗8周及12周采用阳性与阴性症状量表(PANSS)、阴性症状量表(SANS)评定临床疗效. 结果:治疗8周及12周时研究组和对照组PANSS总分、阴性因子分及SANS总分较治疗前显著下降(P＜0.05或P＜0.01)),研究组较对照组下降更为显著(P＜0.05或P＜0.01). 结论:氯氮平联合美金刚治疗与单用氯氮平相比,可显著缓解精神分裂症患者的阴性症状.