Rosen Cherise, Marvin Robert, Reilly James L, Deleon Ovidio, Harris Margret S H, Keedy Sarah K, Solari Hugo, Weiden Peter, Sweeney John A
Center for Cognitive Medicine, University of Illinois, Chicago, USA.
Clin Schizophr Relat Psychoses. 2012 Oct;6(3):145-51. doi: 10.3371/CSRP.6.3.6.
This study sought to identify similarities and differences in symptom characteristics at initial presentation of first psychotic episodes in schizophrenia, bipolar disorder and unipolar depression.
The Structured Interview for DSM-IV (SCID) and Positive and Negative Syndrome Scale (PANSS) were administered to consecutive admission study-eligible patients (n=101) presenting for treatment during their first acute phase of psychotic illness. Forty-nine percent of patients met diagnostic criteria for schizophrenia, 29% for psychotic bipolar disorder and 22% for unipolar depression with psychosis. The PANSS was analyzed using five-factor scoring that included Positive, Negative, Cognitive, Excitement, and Depression factors, and composite cluster scores that assessed Anergia, Thought Disturbance, and Paranoia.
Schizophrenia and bipolar disorder patients demonstrated significantly more Positive symptoms, Thought Disturbance and Paranoia than unipolar depressed patients. Schizophrenia and unipolar depressed patients demonstrated significantly more Negative symptoms and Anergia than bipolar patients. Patients with schizophrenia reported more severe Cognitive Disorganization than patients with either bipolar disorder or uni-polar depression (p<.05).
Findings from this study demonstrate an informative pattern of similarities and differences in the phenomenology of psychotic disorders at first illness presentation. Commonalities in symptom profiles reflect considerable symptom overlap among psychotic disorders and, thus, the importance of multidimensional differential diagnosis for these conditions. The differences across disorders in Positive and Negative symptom severity, Thought Disorder, Paranoia, and Anergia, and especially the higher level of Cognitive Disorganization seen in schizophrenia patients, point to clinically informative differences across these disorders that are relevant to clinical diagnostic practice and models of psychopathology.
本研究旨在确定精神分裂症、双相情感障碍和单相抑郁症首次精神病性发作初始表现时症状特征的异同。
对连续入院的符合研究条件的患者（n = 101）进行《精神疾病诊断与统计手册第四版》结构化访谈（SCID）和阳性与阴性症状量表（PANSS）评估，这些患者处于精神病性疾病的首个急性期并前来接受治疗。49%的患者符合精神分裂症诊断标准，29%符合精神病性双相情感障碍诊断标准，22%符合伴有精神病性症状的单相抑郁症诊断标准。使用包括阳性、阴性、认知、兴奋和抑郁因子的五因子评分法以及评估无动力、思维紊乱和偏执的综合聚类分数对PANSS进行分析。
精神分裂症和双相情感障碍患者比单相抑郁症患者表现出显著更多的阳性症状、思维紊乱和偏执。精神分裂症和单相抑郁症患者比双相情感障碍患者表现出显著更多的阴性症状和无动力。精神分裂症患者报告的认知紊乱比双相情感障碍或单相抑郁症患者更严重（p <.05）。
本研究结果显示了首次发病时精神病性障碍现象学中异同的有益模式。症状概况的共性反映了精神病性障碍之间存在相当大的症状重叠，因此对于这些疾病进行多维度鉴别诊断很重要。不同障碍在阳性和阴性症状严重程度、思维障碍、偏执和无动力方面的差异，尤其是精神分裂症患者中更高水平的认知紊乱，表明这些障碍之间在临床上存在有益的差异，这与临床诊断实践和精神病理学模型相关。
