Häfner Heinz, Maurer Kurt, Trendler Günter, an der Heiden Wolfram, Schmidt Martin, Könnecke Regina
Schizophrenia Research Unit, Central Institute of Mental Health, J5, D-68159 Mannheim, Germany.
Schizophr Res. 2005 Sep 1;77(1):11-24. doi: 10.1016/j.schres.2005.01.004.
We studied descriptive and causal associations between schizophrenia, depressive symptoms and episodes of depression.
Untreated psychotic, depressive and negative symptoms were assessed retrospectively from onset until first admission using the IRAOS in a population-based sample of 232 first episodes of schizophrenia. A representative subsample of 130 patients, studied retrospectively until onset and followed up prospectively over 6 months after first admission, were compared with 130 age- and sex-matched healthy population controls and with 130 equally matched first admissions for unipolar depressive episodes.
The lifetime prevalence of depressive mood (>or=2 weeks) at first admission for schizophrenia was 83%. The most frequent initial symptom of schizophrenia was depressive mood, appearing more than 4 years before first admission and followed by negative symptoms and functional impairment. Showing considerable overlap in symptoms and functional impairment at their initial stages, schizophrenia and unipolar depression became clearly distinguishable with the emergence of psychotic symptoms. In the first psychotic episode 71% presented clinically relevant depressive symptoms, 23% fulfilled the ICD-10 criteria for a depressive episode. With remitting psychosis the prevalence of depression, too, decreased. The high frequency of depressive symptoms at the prepsychotic prodromal stage and their increase and decrease with the psychotic episode suggests that depression in schizophrenia might be expression of an early, mild stage of the same neurobiological process that causes psychosis.
The high prevalence of depression in the population and the diversity of its causes prompted us to speculate about a hierarchical model of preformed dimensional patterns of psychopathology.
我们研究了精神分裂症、抑郁症状与抑郁发作之间的描述性及因果关联。
在一个基于人群的232例精神分裂症首发患者样本中，使用IRAOS从起病至首次入院对未治疗的精神病性、抑郁及阴性症状进行回顾性评估。对130例患者的代表性亚样本进行回顾性研究直至起病，并在首次入院后进行6个月的前瞻性随访，将其与130例年龄和性别匹配的健康人群对照以及130例同样匹配的单相抑郁发作首次入院患者进行比较。
精神分裂症首次入院时抑郁情绪（≥2周）的终生患病率为83%。精神分裂症最常见的初始症状是抑郁情绪，出现在首次入院前4年多，随后是阴性症状和功能损害。精神分裂症和单相抑郁在初始阶段症状和功能损害有相当程度的重叠，但随着精神病性症状的出现变得明显可区分。在首次精神病性发作时，71%表现出临床相关的抑郁症状，23%符合ICD - 10抑郁发作标准。随着精神病性症状缓解，抑郁患病率也下降。精神病前前驱期抑郁症状的高频率及其随精神病性发作的增减表明，精神分裂症中的抑郁可能是导致精神病的同一神经生物学过程早期、轻度阶段的表现。
人群中抑郁的高患病率及其病因的多样性促使我们推测精神病理学预成维度模式的分层模型。
