Sobin C, Blundell M L, Weiller F, Gavigan C, Haiman C, Karayiorgou M
Laboratory of Human Neurogenetics, The Rockefeller University, New York, NY 10021, USA.
J Psychiatr Res. 2000 Jan-Feb;34(1):15-24. doi: 10.1016/s0022-3956(99)00023-0.
OCD patients represent a heterogeneous mix of clinical phenotypes, likely reflecting a wide range of genetic vulnerabilities. In other medical illnesses, neurobiologically-based traits with a genetic component that are associated with the target disorder have been successfully used to detect patients with a specific genetic liability to disease. The overlap between symptoms of OCD and Schizophrenia suggested that schizotypal traits could have the potential to distinguish a relatively homogeneous subtype of OCD. We obtained schizotypy scores for 119 affected adult probands who met lifetime criteria for DSM-IV OCD. Five subscales from the Structured Interview of Schizotypy were used to assess ideas of reference, suspiciousness, magical thinking, illusions and psychotic-like thought. Selected for their obvious face validity with the cardinal signs of schizophrenia, Cronbach's alpha suggested that these subscales also provided a reliable measure of positive sign schizotypy (0.83). Fifty percent of our OCD sample had mild to severe positive schizotypy signs. t- and chi2 tests of significance suggested seven variables that distinguished OCD patients with schizotypy, including earlier age of onset, greater number of comorbid diagnoses and increased rates of learning disability, aggressive and somatic obsessions and counting and arranging compulsions. Three of these seven variables, including learning disabilities, counting compulsions and history of specific phobia, significantly increased the odds of schizotypy among patients with lifetime OCD. These findings enhanced the validity of the schizotypy construct in OCD. Whether this schizotypy subtype can distinguish a subgroup of patients with relatively homogeneous genetic characteristics waits further investigation.
强迫症患者呈现出临床表型的异质性混合，这可能反映了广泛的遗传易感性。在其他医学疾病中，具有遗传成分且与目标疾病相关的基于神经生物学的特征已成功用于检测对疾病具有特定遗传易感性的患者。强迫症和精神分裂症症状之间的重叠表明，分裂型特质有可能区分出相对同质的强迫症亚型。我们对119名符合DSM-IV强迫症终身标准的成年患者进行了分裂型特质评分。使用分裂型特质结构化访谈中的五个分量表来评估牵连观念、猜疑、奇幻思维、幻觉和类精神病思维。因其与精神分裂症的主要症状具有明显的表面效度而被选中，克朗巴哈系数表明这些分量表也提供了对阳性症状分裂型特质的可靠测量（0.83）。我们的强迫症样本中有50%具有轻度至重度的阳性分裂型特质症状。t检验和卡方显著性检验表明，有七个变量可区分有分裂型特质的强迫症患者包括发病年龄较早、共病诊断数量较多以及学习障碍、攻击性和躯体强迫观念以及计数和排列强迫行为的发生率增加。这七个变量中的三个，包括学习障碍、计数强迫行为和特定恐惧症病史，显著增加了终身患强迫症患者出现分裂型特质的几率。这些发现增强了分裂型特质结构在强迫症中的有效性。这种分裂型特质亚型是否能区分出具有相对同质遗传特征的患者亚组还有待进一步研究。
