Italian National Institute of Health, Center of Epidemiology, Surveillance and Health Promotion, Mental Health Unit, Italy.
Psychiatry Res. 2012 Aug 15;198(3):386-94. doi: 10.1016/j.psychres.2011.12.051. Epub 2012 Mar 15.
Previous studies failed to identify a consistent factor structure of the BPRS-24 in schizophrenia. Our aims were to examine the fit of all previously published factor models and then to explore unobserved population heterogeneity and identify salient latent classes. Two hundred thirty-nine patients with ICD-10 schizophrenia admitted to a random sample of all Italian public and private acute inpatient units during an index period were administered the BPRS-24. Confirmatory factor analysis (CFA) was used to test all factor models derived in previous studies. Then, factor mixture analysis (FMA) with heteroscedastic components was carried out to explore unobserved population heterogeneity. No previously reported factor solution showed adequate fit in CFA. FMA indicated the presence of three heterogeneous groups and yielded a 5-factor solution (Depression, Positive Symptoms, Disorganization, Negative Symptoms, Activation). Group 1 was characterized by higher Disorganization, lower Activation, lower psychosocial functioning, greater lifetime number of admissions, more frequent history of compulsory admission. Group 2 displayed lower Disorganization. Group 3 showed higher Activation and more frequent history of recent self-harming behavior. Our finding that a reliable factor structure for the BPRS-24 could be obtained only after assuming population heterogeneity suggests that the difficulty in identifying a consistent factor structure may be ascribed to the clinical heterogeneity of schizophrenia. As compared with clinical subtypes, the psychopathological dimensions displayed much greater discriminatory power between groups identified by FMA. Though preliminary, our findings corroborate that a dimensional approach to psychopathology can facilitate the assessment of the clinical heterogeneity of schizophrenia.
先前的研究未能确定 BPRS-24 在精神分裂症中的一致因素结构。我们的目的是检验所有先前发表的因素模型的拟合度，然后探索未观察到的人群异质性并确定显著的潜在类别。在一个索引期内，将 239 名符合 ICD-10 精神分裂症标准的患者随机分配到意大利所有公立和私立急性住院单位，对其进行 BPRS-24 评估。采用验证性因子分析（CFA）检验所有先前研究中得出的因素模型。然后，采用具有异方差分量的因子混合分析（FMA）来探索未观察到的人群异质性。没有先前报道的因素解决方案在 CFA 中表现出足够的拟合度。FMA 表明存在三个异质组，并产生了 5 因素解决方案（抑郁、阳性症状、混乱、阴性症状、激活）。第 1 组的混乱程度较高，激活程度较低，心理社会功能较低，一生中入院次数较多，强制入院次数较多。第 2 组的混乱程度较低。第 3 组的激活程度较高，近期自残行为的历史更频繁。我们发现，只有在假设人群异质性的情况下，才能获得 BPRS-24 的可靠因素结构，这表明难以确定一致的因素结构可能归因于精神分裂症的临床异质性。与临床亚型相比，FMA 确定的组之间的心理病理维度具有更大的区分能力。尽管初步的，我们的研究结果证实，一种对精神病理学的维度方法可以促进对精神分裂症临床异质性的评估。
