SUNY Downstate Medical Center, Brooklyn, New York 11203, USA.
Am J Geriatr Psychiatry. 2013 Feb;21(2):100-7. doi: 10.1016/j.jagp.2012.10.009. Epub 2013 Jan 22.
To examine the prevalence of negative symptoms and associated factors in older adults with schizophrenia spectrum disorder living in the community.
The sample consisted of a multiracial sample of 198 persons aged 55 and more with a schizophrenia spectrum disorder that developed the disorder before the age of 45; 39% and 61% lived independently and in supported community residences, respectively. George's Social Antecedent Model of Psychopathology was used to examine 16 predictor variables of negative symptoms, based on scores of 4 or more on any of the PANSS negative symptom items.
Forty percent of the sample met the criteria for the presence of negative symptoms, and this decreased to 19% when potential secondary symptoms were excluded. In bivariate analysis, 10 variables were found to be significantly associated with the presence of negative symptoms, but when the model was tested in logistic regression analysis, only 3 variables retained significance: greater positive symptom scores (odds ratio [OR] = 1.26), lower cognitive scores (OR = 0.96), and fewer confidantes (OR = 0.80).
Negative symptoms do not dominate the clinical picture in later life, and levels of negative symptoms appear to be no higher than in younger schizophrenia populations. The relative paucity of significant variables and their modest effect sizes suggest that treatment for negative symptoms in later life will depend largely on strategies directed specifically at the negative symptoms.
调查社区居住的老年精神分裂症谱系障碍患者中阴性症状的流行情况及其相关因素。
该样本由 198 名年龄在 55 岁及以上、发病年龄在 45 岁之前的多民族精神分裂症谱系障碍患者组成;39%和 61%的患者分别独立生活和居住在支持性社区住所。采用乔治精神病病理的社会前因模型,根据 PANSS 阴性症状项目中任何一个项目得分为 4 或以上,检验 16 个阴性症状预测变量。
该样本中 40%符合存在阴性症状的标准,当排除潜在的次要症状时,这一比例降至 19%。在单变量分析中,有 10 个变量与阴性症状的存在显著相关,但当模型在逻辑回归分析中进行测试时,只有 3 个变量具有统计学意义:阳性症状评分较高(比值比[OR] = 1.26)、认知评分较低(OR = 0.96)和知己较少(OR = 0.80)。
阴性症状在晚年并不主导临床图景,且阴性症状的水平似乎并不高于年轻的精神分裂症患者。显著变量相对较少且效应大小适中,这表明晚年针对阴性症状的治疗将在很大程度上依赖于针对阴性症状的特定策略。