Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02215, United States.
Schizophr Res. 2011 Dec;133(1-3):250-4. doi: 10.1016/j.schres.2011.09.005. Epub 2011 Oct 12.
There is increasing evidence for phenomenological, biological and genetic overlap between schizophrenia and bipolar disorder, bringing into question the traditional dichotomy between them. Neurobiological models linked to dimensional clinical data may provide a better foundation to represent diagnostic variation in neuropsychiatric disorders.
To capture the interaction between psychosis and affective symptoms dimensionally, we devised a brief descriptive scale based on the type and relative proportions of psychotic and affective symptoms over the illness course. The scale was administered to a series of 762 patients with psychotic disorders, including schizophrenia, schizoaffective and psychotic bipolar disorder assessed as part of the Bipolar-Schizophrenia Network for Intermediate Phenotypes (B-SNIP) study.
The resulting Schizo-Bipolar Scale scores across these disorders showed neither a clear dichotomy nor a simple continuous distribution. While the majority of cases had ratings close to prototypic schizophrenia or bipolar disorder, a large group (45% of cases) fell on the continuum between these two prototypes.
Our data suggest a hybrid conceptualization model with a representation of cases with prototypic schizophrenia or bipolar disorder at the extremes, but a large group of patients on the continuum between them that traditionally would be considered schizoaffective. A dimensional approach, using the Schizo-Bipolar Scale, characterized patients across a spectrum of psychopathology. This scale may provide a valuable means to examine the relationships between schizophrenia and psychotic bipolar disorder.
精神分裂症和双相情感障碍之间在现象学、生物学和遗传学上存在越来越多的重叠，这对它们之间的传统二分法提出了质疑。与维度临床数据相关的神经生物学模型可能为代表神经精神障碍的诊断变异性提供更好的基础。
为了从维度上捕捉精神病和情感症状之间的相互作用，我们设计了一个简短的描述性量表，该量表基于疾病过程中精神病和情感症状的类型和相对比例。该量表被用于一系列 762 名精神障碍患者，包括精神分裂症、分裂情感性障碍和伴有精神病性症状的双相情感障碍，这些患者是双相-精神分裂症网络中间表型研究（B-SNIP）的一部分。
在这些疾病中，所得的精神分裂-双相量表评分既没有明显的二分法，也没有简单的连续分布。虽然大多数病例的评分接近典型的精神分裂症或双相情感障碍，但有一大组（45%的病例）落在这两个原型之间的连续体上。
我们的数据表明，一种混合概念化模型，以典型的精神分裂症或双相情感障碍的病例为极端表现，但在它们之间有一大组患者处于连续体上，传统上这些患者被认为是分裂情感性障碍。使用精神分裂-双相量表的维度方法，对一系列精神病病理学患者进行了特征描述。该量表可能为研究精神分裂症和精神病性双相情感障碍之间的关系提供一种有价值的手段。
