Xu Ke, Krystal John H, Ning Yuping, Chen Da Chun, He Hongbo, Wang Daping, Ke Xiaoyin, Zhang Xifan, Ding Yi, Liu Yuping, Gueorguieva Ralitza, Wang Zuoheng, Limoncelli Diana, Pietrzak Robert H, Petrakis Ismene L, Zhang Xiangyang, Fan Ni
Department of Psychiatry, Yale School of Medicine, 300 George St, New Haven, CT, USA; United States Department of Veterans Affairs, VA Connecticut Healthcare System, West Haven, CT, USA.
Guangzhou Brain Hospital, The Affiliated Brain Hospital of Guangzhou Medical University, 36 Mingxin Road, Liwan District, Guangzhou, Guangdong Province 510370, China.
J Psychiatr Res. 2015 Feb;61:64-72. doi: 10.1016/j.jpsychires.2014.12.012. Epub 2014 Dec 24.
Studies of the effects of the N-methyl-d-aspartate (NMDA) glutamate receptor antagonist, ketamine, have suggested similarities to the symptoms of schizophrenia. Our primary goal was to evaluate the dimensions of the Positive and Negative Syndrome Scale (PANSS) in ketamine users (acute and chronic) compared to schizophrenia patients (early and chronic stages).
We conducted exploratory factor analysis for the PANSS from four groups: 135 healthy subject administrated ketamine or saline, 187 inpatients of ketamine abuse; 154 inpatients of early course schizophrenia and 522 inpatients of chronic schizophrenia. Principal component factor analyses were conducted to identify the factor structure of the PANSS.
Factor analysis yielded five factors for each group: positive, negative, cognitive, depressed, excitement or dissociation symptoms. The symptom dimensions in two schizophrenia groups were consistent with the established five-factor model (Wallwork et al., 2012). The factor structures across four groups were similar, with 19 of 30 symptoms loading on the same factor in at least 3 of 4 groups. The factors in the chronic ketamine group were more similar to the factors in the two schizophrenia groups rather than to the factors in the acute ketamine group. Symptom severities were significantly different across the groups (Kruskal-Wallis χ(2)(4) = 540.6, p < 0.0001). Symptoms in the two ketamine groups were milder than in the two schizophrenia groups (Cohen's d = 0.7).
Our results provide the evidence of similarity in symptom dimensions between ketamine psychosis and schizophrenia psychosis. The interpretations should be cautious because of potential confounding factors.
对N-甲基-D-天冬氨酸（NMDA）谷氨酸受体拮抗剂氯胺酮作用效果的研究表明，其与精神分裂症症状存在相似性。我们的主要目标是评估氯胺酮使用者（急性和慢性）与精神分裂症患者（早期和慢性阶段）在阳性和阴性症状量表（PANSS）各维度上的表现。
我们对四组对象的PANSS进行了探索性因素分析：135名接受氯胺酮或生理盐水注射的健康受试者、187名氯胺酮滥用住院患者、154名早期精神分裂症住院患者以及522名慢性精神分裂症住院患者。通过主成分因素分析来确定PANSS的因素结构。
因素分析在每组中均产生了五个因素：阳性、阴性、认知、抑郁、兴奋或解离症状。两个精神分裂症组的症状维度与已确立的五因素模型一致（Wallwork等人，2012年）。四组的因素结构相似，30个症状中有19个在至少4组中的3组中负荷于同一因素。慢性氯胺酮组的因素与两个精神分裂症组的因素更为相似，而非与急性氯胺酮组的因素相似。各组间症状严重程度存在显著差异（Kruskal-Wallis χ(2)(4) = 540.6，p < 0.0001）。两个氯胺酮组的症状比两个精神分裂症组的症状更轻（Cohen's d = 0.7）。
我们的结果为氯胺酮所致精神病与精神分裂症所致精神病在症状维度上的相似性提供了证据。由于存在潜在的混杂因素，解释时应谨慎。
