Bianchini V, Roncone R, Pollice R, Casacchia M
Dipartimento di Medicina Clinica, Sanità Pubblica, Scienze della Vita e dell'Ambiente, Università degli Studi dell'Aquila, Ospedale San Salvatore, L'Aquila, Italia.
Clin Ter. 2012 Jul;163(4):293-7.
Investigation on subjective symptoms in schizophrenia has traditionally been limited to delusions and hallucinations, not considering the persistence of many others disorders and difficulties as residual negative symptoms and cognitive deficits that instead greatly affect the clinical and functional prognosis. The aim of the study is to investigate the differences between the subjective experience of the patient and the objective assessment regarding the negative dimension symptoms in patients with schizophrenia.
We evaluated 58 patients with a diagnosis of schizophrenia consecutively admitted at the L'Aquila Psychiatric inpatient ward (Italy) from April to September 2010; all of them were taking psychopharmacological treatment. The instruments used were: the PANSS for assessment of clinical symptoms and VGF for the assessment of the global functioning, the SENS, the Insight Self-Report Scale and the Scale Geople to investigate respectively the negative dimension subjectively perceived, the insight and the social cognition.
The analysis of SENS showed a score of 95.43 (SD ± 9.1) in the awareness, pointing to a negative perception of the experience medium to high. The study of Social Cognition has shown the presence of a statistically significant discrepancy between the two evaluations (p <0.01). The inferential analysis between SENS and PANSS, reported significant correlations between the PANSS negative symptoms of the item of inability to feel the SENS (p <0.015). Finally, a positive correlation was found between the total score of SENS with GFR (p <0.02).
The knowledge of the subjective experiences of patients with schizophrenia can be difficult because of social withdrawal and resistance to treatment, due mostly to the subjective suffering that is not adequately understood. The results, in line with the recent literature, have shown that the perception of negative symptoms does not always find a parallel in the clinical assessment and how this is a significant correlation with the global functioning. In this perspective, it is therefore necessary to consider the point of view of the patient in order to predict the adherence to the treatment and the global functioning outcome.
传统上,对精神分裂症主观症状的研究仅限于妄想和幻觉,并未将许多其他障碍和困难的持续存在视为残留阴性症状和认知缺陷,而这些症状和缺陷却对临床和功能预后有极大影响。本研究的目的是调查精神分裂症患者在阴性维度症状方面,患者主观体验与客观评估之间的差异。
我们对2010年4月至9月连续入住意大利拉奎拉精神病住院病房的58例精神分裂症患者进行了评估;他们均接受精神药物治疗。所使用的工具包括:用于评估临床症状的阳性和阴性症状量表(PANSS)、用于评估整体功能的功能大体评定量表(VGF)、主观体验与客观评定差异量表(SENS)、自知力自评量表以及用于分别调查主观感知的阴性维度、自知力和社会认知的量表(Scale Geople)。
对SENS的分析显示,在意识方面得分为95.43(标准差±9.1),表明对体验的负面感知为中到高。社会认知研究表明,两种评估之间存在统计学上的显著差异(p<0.01)。SENS与PANSS之间的推断分析显示,PANSS中无法感受的项目的阴性症状与SENS之间存在显著相关性(p<0.015)。最后,发现SENS总分与GFR之间存在正相关(p<0.02)。
由于社交退缩和对治疗的抗拒,了解精神分裂症患者的主观体验可能会很困难,这主要是因为主观痛苦未得到充分理解。结果与近期文献一致,表明阴性症状的感知在临床评估中并不总是一致的,并且这与整体功能存在显著相关性。从这个角度来看,因此有必要考虑患者的观点,以便预测治疗依从性和整体功能结果。