Favrod Jérôme, Nguyen Alexandra, Fankhauser Caroline, Ismailaj Alban, Hasler Jean-David, Ringuet Abel, Rexhaj Shyhrete, Bonsack Charles
School of nursing sciences, La Source, University of Applied Sciences and Arts of Western Switzerland, Avenue Vinet 30, 1004, Lausanne, Switzerland.
Community psychiatry service, Department of Psychiatry, University Hospital Center, Lausanne, Switzerland.
BMC Psychiatry. 2015 Sep 29;15:231. doi: 10.1186/s12888-015-0610-y.
Recent literature has distinguished the negative symptoms associated with a diminished capacity to experience (apathy, anhedonia) from symptoms associated with a limited capacity for expression (emotional blunting, alogia). The apathy-anhedonia syndrome tends to be associated with a poorer prognosis than the symptoms related to diminished expression. The efficacy of drug-based treatments and psychological interventions for these symptoms in schizophrenia remains limited. There is a clear clinical need for new treatments.
This pilot study tested the feasibility of a program to reduce anhedonia and apathy in schizophrenia and assessed its impact on 37 participants meeting the ICD-10 criteria for schizophrenia or schizoaffective disorders. Participants were pre- and post-tested using the Scale for the Assessment of Negative Symptoms (SANS) and the Calgary Depression Scale for Schizophrenia (CDSS). They took part in eight sessions of the Positive Emotions Program for Schizophrenia (PEPS)--an intervention that teaches participants skills to help overcome defeatist thinking and to increase the anticipation and maintenance of positive emotions.
Thirty-one participants completed the program; those who dropped out did not differ from completers. Participation in the program was accompanied by statistically significant reductions in the total scores for Avolition-Apathy and Anhedonia-Asociality on the SANS, with moderate effect sizes. Furthermore, there was a statistically significant reduction of depression on the CDSS, with a large effect size. Emotional blunting and alogia remain stable during the intervention.
Findings indicate that PEPS is both a feasible intervention and is associated with an apparently specific reduction of anhedonia and apathy. However, these findings are limited by the absence of control group and the fact that the rater was not blind to the treatment objectives.
PEPS is a promising intervention to improve anhedonia and apathy which need to be tested further in a controlled study.
ISRCTN registry ISRCTN74048461, registered 18 may 2015.
近期文献已将与体验能力下降相关的阴性症状（冷漠、快感缺乏）与表达能力受限相关的症状（情感迟钝、言语贫乏）区分开来。与表达能力下降相关的症状相比，冷漠 - 快感缺乏综合征往往预后更差。在精神分裂症中，基于药物的治疗和心理干预对这些症状的疗效仍然有限。临床上显然需要新的治疗方法。
这项试点研究测试了一项减轻精神分裂症患者快感缺乏和冷漠的项目的可行性，并评估了其对37名符合ICD - 10精神分裂症或分裂情感性障碍标准的参与者的影响。参与者在干预前后使用阴性症状评定量表（SANS）和卡尔加里精神分裂症抑郁量表（CDSS）进行测试。他们参加了八节精神分裂症积极情绪项目（PEPS）课程——这是一种干预措施，教授参与者技能以帮助克服失败主义思维，并增加对积极情绪的预期和维持。
31名参与者完成了该项目；退出者与完成者没有差异。参与该项目后，SANS上的意志缺乏 - 冷漠和快感缺乏 - 社交退缩总分在统计学上有显著降低，效应量中等。此外，CDSS上的抑郁症状在统计学上有显著降低，效应量较大。在干预期间，情感迟钝和言语贫乏保持稳定。
研究结果表明，PEPS既是一种可行的干预措施，且与快感缺乏和冷漠的明显特定减轻相关。然而，这些结果受到缺乏对照组以及评估者知晓治疗目标这一事实的限制。
PEPS是一种有前景的改善快感缺乏和冷漠的干预措施，需要在对照研究中进一步测试。
ISRCTN注册库ISRCTN74048461，于2015年5月18日注册。
