Tandon R, DeQuardo J R, Taylor S F, McGrath M, Jibson M, Eiser A, Goldman M
Schizophrenia Program, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109-0120, USA.
Schizophr Res. 2000 Oct 27;45(3):191-201. doi: 10.1016/s0920-9964(99)00163-2.
Negative symptoms have been associated with poor response to neuroleptics, enlarged ventricles, cognitive impairment, and poor outcome in schizophrenia. These associations appear, however, to be dependent on the phase of study, suggesting that acute-phase (phasic) negative symptoms may be pathophysiologically distinct from enduring negative symptoms that persist through the residual phase. To compare correlates of enduring and phasic negative symptoms, we studied 60 drug-free schizophrenic patients (DSM-III-R and SADS/RDC) at baseline, 4 weeks after neuroleptic treatment, and assessed the 1 year outcome. We rated positive and negative symptoms at baseline and 4 weeks after treatment. At baseline, premorbid function, neuropsychological function, ventricle-brain ratio (VBR) and symptom response to an anticholinergic agent were assessed, and a two-night sleep EEG and 1mg dexamethasone suppression test (DST) were conducted. Phasic negative symptoms were defined as the change in negative symptoms (baseline to 4 weeks) and enduring negative symptoms as severity of negative symptoms at 4 weeks. Patients had varying proportions of phasic and enduring symptoms; the two did not define distinct subgroups. Phasic negative symptoms were significantly correlated with global treatment response, positive symptom treatment response, response to anticholinergic agent, baseline post-dexamethasone cortisol, and shortened REM latency. Enduring negative symptoms were significantly correlated with residual positive symptoms and global psychopathology, VBR, poor performance on neuropsychological testing, decreased slow-wave sleep, poor premorbid function, and poor 1 year outcome. These data suggest that phasic negative symptoms and enduring negative symptoms may be caused by different pathophysiological mechanisms.
阴性症状与精神分裂症患者对抗精神病药物反应不佳、脑室扩大、认知障碍及预后不良相关。然而，这些关联似乎取决于研究阶段，这表明急性期（发作性）阴性症状在病理生理学上可能与残留期持续存在的持续性阴性症状不同。为比较持续性和发作性阴性症状的相关因素，我们在基线、抗精神病药物治疗4周后对60例未用药的精神分裂症患者（DSM-III-R和SADS/RDC）进行了研究，并评估了1年的预后。我们在基线和治疗后4周对阳性和阴性症状进行了评分。在基线时，评估病前功能、神经心理功能、脑室脑比（VBR）及对抗胆碱能药物的症状反应，并进行两晚的睡眠脑电图和1mg地塞米松抑制试验（DST）。发作性阴性症状定义为阴性症状的变化（基线至4周），持续性阴性症状定义为4周时阴性症状的严重程度。患者发作性和持续性症状的比例各不相同；二者并未界定出不同的亚组。发作性阴性症状与总体治疗反应、阳性症状治疗反应、对抗胆碱能药物的反应、基线地塞米松后皮质醇及快速眼动睡眠潜伏期缩短显著相关。持续性阴性症状与残留阳性症状和总体精神病理学、VBR、神经心理测试表现不佳、慢波睡眠减少、病前功能差及1年预后不良显著相关。这些数据表明，发作性阴性症状和持续性阴性症状可能由不同的病理生理机制引起。
