Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA.
Schizophr Bull. 2013 Jan;39(1):43-51. doi: 10.1093/schbul/sbr040. Epub 2011 May 27.
The deficit syndrome was proposed over 20 years ago as a separate negative symptom syndrome within schizophrenia with a distinct neurobiological pathophysiology and etiology. Recent research, however, has indicated that psychological factors such as negative attitudes and expectancies are significantly associated with the broad spectrum of negative symptoms. Specifically, defeatist beliefs regarding performance mediate between neurocognitive impairment and both negative symptoms and functional outcome. Additionally, asocial beliefs predict asocial behavior and negative expectancies regarding future pleasure are associated with negative symptoms. The present study explored whether these dysfunctional beliefs and negative expectancies might also be a feature of the deficit syndrome. Based on a validated proxy method, 22 deficit and 72 nondeficit patients (from a pool of 139 negative symptom patients) were identified and received a battery of symptom, neurocognitive, and psychological measures. The deficit group scored significantly worse on measures of negative symptoms, insight, emotion recognition, defeatist attitudes, and asocial beliefs but better on measures of depression, anxiety, and distress than the nondeficit group. Moreover, the deficit group showed a trend for higher scores on self-esteem. Based on these findings, we propose a more comprehensive formulation of deficit schizophrenia, characterized by neurobiological factors and a cluster of psychological attributes that lead to withdrawal and protect the self-esteem. Although the patients have apparently opted-out of participation in normal activities, we suggest that a psychological intervention that targets these negative attitudes might improve their functioning and quality of life.
缺陷综合征是 20 多年前提出的一种精神分裂症的特殊阴性症状综合征，具有独特的神经生物学发病机制和病因。然而，最近的研究表明，心理因素，如消极的态度和期望，与广泛的阴性症状显著相关。具体来说，关于表现的失败信念在神经认知障碍与阴性症状和功能结果之间起中介作用。此外，非社会性信念预测非社会性行为，对未来快乐的消极期望与阴性症状有关。本研究探讨了这些功能失调的信念和消极期望是否也可能是缺陷综合征的一个特征。基于经过验证的替代方法，确定了 22 名缺陷组和 72 名非缺陷组患者（来自 139 名阴性症状患者），并接受了一系列症状、神经认知和心理测量。缺陷组在阴性症状、洞察力、情绪识别、失败态度和非社会性信念方面的得分明显低于非缺陷组，但在抑郁、焦虑和痛苦方面的得分明显高于非缺陷组。此外，缺陷组在自尊方面的得分也呈上升趋势。基于这些发现，我们提出了一个更全面的缺陷型精神分裂症的概念，其特征是生物学因素和一系列心理特征，导致退缩和保护自尊。尽管这些患者显然选择不参与正常活动，但我们认为针对这些消极态度的心理干预可能会改善他们的功能和生活质量。
