Department of Basic Medical Sciences, Neuroscience and Sense Organ, Unit of Child and Adolescent Psychiatry, University of Bari "Aldo Moro", Piazza Giulio Cesare 11, 70124, Bari, Italy.
Department of Educational Science, Psychology, Communication, University of Bari "Aldo Moro", Piazza Giulio Cesare 11, 70124, Bari, Italy.
Eur Child Adolesc Psychiatry. 2018 Feb;27(2):171-179. doi: 10.1007/s00787-017-1026-7. Epub 2017 Jul 26.
Despite the growing interest in a dimensional approach to the assessment of symptoms and clinically relevant phenomena in schizophrenia spectrum disorders, very few studies, to date, have examined the dimensional structure of symptoms in early onset first episode psychosis. In the present study, we assessed a sample of 60 children and adolescents of both sexes with first episode schizophrenia spectrum psychosis. A principal component analysis (PCA) of the Positive and Negative Syndrome Scale (PANSS) was performed and the factors obtained were used to carry out a cluster analysis. Sex, age of onset before or after 13, markers of early neurodevelopmental impairment and intellectual disabilities were considered as variables to characterized potential clinical subtypes, applying a one-way analysis of variance. Four factors were extracted ("negative symptoms", "delusions", "conceptual disorganization" and "paranoid/hostility"), each of them identifying a discrete clinical subtype of patients. No difference was found among the groups about sex and age of onset; delayed speech/language development was significantly associated with the "delusions" subtype and both "conceptual disorganization" and "delusions" subtypes showed a lower intelligence quotient (IQ). The four factors model we presented highlights "negative symptoms" as the most consistent factor; among positive symptoms, unusual thought content and conceptual disorganization resulted more distinctive of psychosis, at this age range, than perceptual abnormalities. Evolutionary trajectories of the four clinical subtypes we obtained seem to be influenced by cognitive and neurodevelopmental impairment rather than sex and age of onset.
尽管人们对精神分裂症谱系障碍的症状和临床相关现象的维度评估方法越来越感兴趣，但迄今为止，很少有研究检查过早期首发精神病的症状的维度结构。在本研究中，我们评估了 60 名患有首发精神分裂症谱系精神病的男女儿童和青少年样本。对阳性和阴性症状量表（PANSS）进行了主成分分析（PCA），并使用获得的因子进行了聚类分析。性别、13 岁前或后发病、早期神经发育损伤和智力障碍的标志物被认为是特征潜在临床亚型的变量，采用单因素方差分析。提取了四个因子（“阴性症状”、“妄想”、“概念混乱”和“偏执/敌意”），每个因子都确定了一个离散的患者临床亚型。各组在性别和发病年龄方面没有差异；言语/语言发育延迟与“妄想”亚型显著相关，“概念混乱”和“妄想”两个亚型的智商均较低。我们提出的四个因素模型突出了“阴性症状”作为最一致的因素；在阳性症状中，异常思维内容和概念混乱在这个年龄段比感知异常更能突出精神病。我们获得的四个临床亚型的进化轨迹似乎受到认知和神经发育损伤的影响，而不是性别和发病年龄。
