Ungvari Gabor S, Goggins William, Leung Siu-Kau, Lee Edwin, Gerevich Jozsef
Department of Psychiatry, School of Public Health, Chinese University of Hong Kong, and Castle Peak Hospital, Hong Kong, China.
Prog Neuropsychopharmacol Biol Psychiatry. 2009 Feb 1;33(1):81-5. doi: 10.1016/j.pnpbp.2008.10.010. Epub 2008 Oct 28.
No reports have yet been published on catatonia using latent class analysis (LCA). This study applied LCA to a large, diagnostically homogenous sample of patients with chronic schizophrenia who also presented with catatonic symptoms. A random sample of 225 Chinese inpatients with DSM-IV schizophrenia was selected from the long-stay wards of a psychiatric hospital. Their psychopathology, extrapyramidal motor status and level of functioning were evaluated with standardized rating scales. Catatonia was rated using a modified version of the Bush-Francis Catatonia Rating Scale. LCA was then applied to the 178 patients who presented with at least one catatonic sign. In LCA a four-class solution was found to fit best the statistical model. Classes 1, 2, 3 and 4 constituted 18%, 39.4%, 20.1% and 22.5% of the whole catatonic sample, respectively. Class 1 included patients with symptoms of 'automatic' phenomena (automatic obedience, Mitgehen, waxy flexibility). Class 2 comprised patients with 'repetitive/echo' phenomena (perseveration, stereotypy, verbigeration, mannerisms and grimacing). Class 3 contained patients with symptoms of 'withdrawal' (immobility, mutism, posturing, staring and withdrawal). Class 4 consisted of 'agitated/resistive' patients, who displayed symptoms of excitement, impulsivity, negativism and combativeness. The symptom composition of these 4 classes was nearly identical with that of the four factors identified by factor analysis in the same cohort of subjects in an earlier study. In multivariate regression analysis, the 'withdrawn' class was associated with higher scores on the Scale of Assessment of Negative Symptoms and lower and higher scores for negative and positive items respectively on the Nurses' Observation Scale for Inpatient Evaluation's (NOSIE). The 'automatic' class was associated with lower values on the Simpson-Angus Extrapyramidal Side Effects Scale, and the 'repetitive/echo' class with higher scores on the NOSIE positive items. These results provide preliminary support for the notion that chronic schizophrenia patients with catatonic features can be classified into 4 distinct syndromal groups on the basis of their motor symptoms. Identifying distinct catatonic syndromes would help to find their biological substrates and to develop specific therapeutic measures.
尚未有关于使用潜在类别分析（LCA）研究紧张症的报告发表。本研究将LCA应用于大量诊断明确的慢性精神分裂症患者样本，这些患者同时伴有紧张症症状。从一家精神病院长期住院病房中随机选取了225名符合DSM-IV精神分裂症诊断标准的中国住院患者。使用标准化评定量表对他们的精神病理学、锥体外系运动状态和功能水平进行评估。采用改良版的布什-弗朗西斯紧张症评定量表对紧张症进行评分。然后将LCA应用于178名至少出现一种紧张症体征的患者。在LCA中，发现四类解决方案最符合统计模型。第1、2、3和4类分别占整个紧张症样本的18%、39.4%、20.1%和22.5%。第1类包括有“自动”现象（自动服从、被动服从、蜡样屈曲）症状的患者。第2类包括有“重复/模仿”现象（持续言语、刻板动作、言语重复、特殊姿势和鬼脸）的患者。第3类包含有“退缩”症状（不动、缄默、姿势、凝视和退缩）的患者。第4类由“激越/抗拒”患者组成，他们表现出兴奋、冲动、违拗和攻击性症状。这4类的症状构成与早期一项研究中同一队列受试者通过因素分析确定的四个因素几乎相同。在多变量回归分析中，“退缩”类与阴性症状评定量表得分较高以及住院患者护士观察量表（NOSIE）的阴性和阳性项目得分分别较低和较高相关。“自动”类与辛普森-安格斯锥体外系副作用量表得分较低相关，“重复/模仿”类与NOSIE阳性项目得分较高相关。这些结果为以下观点提供了初步支持：即具有紧张症特征的慢性精神分裂症患者可根据其运动症状分为4个不同的综合征组。识别不同的紧张症综合征将有助于找到其生物学基础并制定具体的治疗措施。
