Unit for Social and Community Psychiatry, WHO Collaborating Centre for Mental Health Services Development, Queen Mary University of London, London, UK.
Department of Psychiatry, School of Medicine, University of California, 401 Parnassus Ave, San Francisco, CA, 94143, USA.
Eur Arch Psychiatry Clin Neurosci. 2018 Sep;268(6):603-609. doi: 10.1007/s00406-017-0813-y. Epub 2017 Jun 2.
There has been a debate in the literature about the distinction between primary and secondary negative symptoms of schizophrenia. Our aim was to study the associations between negative symptoms and potential sources of secondary negative symptoms over time. A sample of 275 participants with at least mid-moderate negative symptoms was randomized into body psychotherapy or Pilates class in a previous study. No significant differences were found between groups over time and changes in the symptom domains were modest. The present investigation considers the longitudinal correlation between variables of interest at baseline, 3 and 9 months follow-up. Measures were the Clinical Assessment Interview for Negative Symptoms (CAINS), the Positive and Negative Symptom Scale (PANSS), the Calgary Depression Scale (CDSS) and the Simpson-Angus Extrapyramidal side-effects Scale (SAS). Mixed models were computed to test the longitudinal association between these variables. In a sensitivity analysis, the dosages of antipsychotic, illness duration and allocated intervention were taken into account. Overall, the course of extrapyramidal side-effects, depressive and positive symptoms was significantly related to the course of negative symptoms. Only extrapyramidal effects were longitudinally correlated to expressive negative symptoms. The sensitivity analyses showed unaltered results for positive symptoms and depression but a lack of association between extrapyramidal effects and the CAINS outcomes. In conclusion, the unambiguous interpretation between primary and secondary negative symptoms may lead to refined treatment approaches for schizophrenia and to increased effects of the interventions.
文献中一直存在关于精神分裂症原发性和继发性阴性症状之间区别的争论。我们的目的是研究阴性症状与继发性阴性症状的潜在来源之间的关联随时间的变化。在之前的一项研究中，我们对至少中度阴性症状的 275 名参与者进行了随机分组，分别接受躯体心理治疗或普拉提课程。结果发现两组之间在随访时间上没有显著差异，症状领域的变化也不大。本研究考虑了在基线、3 个月和 9 个月随访时感兴趣变量之间的纵向相关性。评估工具为阴性症状临床评估访谈量表（CAINS）、阳性和阴性症状量表（PANSS）、卡尔加里抑郁量表（CDSS）和辛普森-安格斯锥体外系副作用量表（SAS）。混合模型用于检验这些变量之间的纵向关联。在敏感性分析中，还考虑了抗精神病药物的剂量、疾病持续时间和分配的干预措施。总体而言，锥体外系副作用、抑郁和阳性症状的病程与阴性症状的病程显著相关。只有锥体外系副作用与表达性阴性症状呈纵向相关。敏感性分析显示阳性症状和抑郁的结果没有改变，但锥体外系副作用与 CAINS 结果之间缺乏关联。总之，对原发性和继发性阴性症状进行明确的区分可能会为精神分裂症提供更精细的治疗方法，并提高干预措施的效果。
