Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong.
Schizophr Res. 2011 Dec;133(1-3):22-8. doi: 10.1016/j.schres.2011.09.006. Epub 2011 Oct 2.
Negative symptoms are a core feature of schizophrenia. The evolution and trajectory of primary negative symptoms were under-studied. We aimed at evaluating the prevalence and stability of primary negative symptoms, and factors associated with persistent primary negative symptoms in a first-episode sample.
Ninety-three Hong Kong Chinese aged 18 to 55 years presenting with first-episode schizophrenia-spectrum disorder were studied. Data on premorbid adjustment, socio-demographics, and baseline clinical and cognitive profiles were obtained. Psychopathological and vocational reassessments were conducted at 12, 24 and 36 months. Primary negative symptoms were defined as the presence of clinically significant negative symptoms excluding depression and extra-pyramidal signs.
At baseline, 25.8% of subjects exhibited primary negative symptoms. A quarter of patients had their initial primary negative symptoms status retained 12 months after treatment initiation. In both Year 2 and Year 3 of study period, around 70% of subjects had their primary negative symptoms status maintained for 12 months. At the end of three-year follow-up, 23.7% were categorized as having persistent primary negative symptoms. Male sex, unemployment at intake, prolonged duration of untreated psychosis, poorer premorbid academic and social functioning, poorer insight and worse vocational outcome were found to be associated with persistent primary negative symptoms.
Clinical status of primary negative symptoms in first-episode schizophrenia-spectrum disorder was unstable in the initial year of treatment. Baseline symptom assessment may not reliably predict development of persistent primary negative symptoms. Studying negative symptoms should take into account the longitudinal perspective, especially in the early course of psychotic disorders.
阴性症状是精神分裂症的核心特征。原发性阴性症状的演变和轨迹研究较少。我们旨在评估首发精神分裂症谱系障碍患者原发性阴性症状的患病率和稳定性，以及与持续性原发性阴性症状相关的因素。
对 93 名年龄在 18 至 55 岁的香港中文首发精神分裂症谱系障碍患者进行了研究。收集了发病前适应情况、社会人口统计学、基线临床和认知特征的数据。在 12、24 和 36 个月进行了心理病理和职业评估。原发性阴性症状的定义为存在临床显著的阴性症状，不包括抑郁和锥体外系症状。
在基线时，25.8%的患者存在原发性阴性症状。四分之一的患者在开始治疗后 12 个月保留了最初的原发性阴性症状状态。在研究期间的第 2 年和第 3 年，约 70%的患者在 12 个月内保持了原发性阴性症状状态。在 3 年随访结束时，23.7%的患者被归类为持续性原发性阴性症状。男性、发病时失业、未治疗的精神病持续时间延长、较差的发病前学业和社会功能、较差的洞察力和较差的职业预后与持续性原发性阴性症状有关。
首发精神分裂症谱系障碍患者在治疗初始一年内原发性阴性症状的临床状态不稳定。基线症状评估可能无法可靠地预测持续性原发性阴性症状的发展。研究阴性症状时应考虑到纵向观点，尤其是在精神障碍的早期阶段。
