Mental Health Department, Servicio Navarro de Salud, Spain; Instituto de Investigación Sanitaria de Navarra (IdiSNa), Spain.
Mental Health Department, Servicio Navarro de Salud, Spain; Instituto de Investigación Sanitaria de Navarra (IdiSNa), Spain.
Schizophr Res. 2018 Oct;200:85-91. doi: 10.1016/j.schres.2017.08.039. Epub 2017 Aug 30.
To examine the covariation between negative symptoms and motor signs in a broad sample of drug-naïve subjects with schizophrenia-spectrum psychoses before and after inception of antipsychotic medication.
One-hundred and eighty-nine antipsychotic-naïve subjects with DSM-IV schizophrenia-spectrum psychoses were assessed for negative symptoms including affective flattening, alogia, avolition/apathy and anhedonia/associality, and motor signs including catatonia, parkinsonism and dyskinesia. We examined the association between negative and motor features at baseline, 4-weeks after inception of antipsychotic treatment and that of their mean change over the treatment period, such as their trajectories and treatment response pattern.
At the drug-naïve state, motor signs were strongly related to affective flattening and alogia (p<0.01); at 4-weeks, most negative and motor features were significantly interrelated (p<0.01); mean change of motor signs and negative symptoms tended to be unrelated. This association pattern was irrespective of levels of positive symptoms. Ratings of negative symptoms, excepting affective flattening, improved after treatment (p<0.001) while motor ratings showed divergent trajectories with catatonia improving (p<0.001), parkinsonism worsening (p<0.001) and dyskinesia remaining unchanged (p>0.01). Although to a different extent, motor and negative features showed drug-responsive, drug-worsening, of drug-unchanged patterns of response to antipsychotic medication. The main predictors of negative and motor features in treated subjects were their corresponding baseline ratings (p<0.001).
Negative and motor features are differentiated, but to some extent, overlapping domains that are meaningfully influenced by antipsychotic medication. At the drug-naïve state, motor signs and the diminished expression domain of negative symptoms may share underlying neurobiological mechanisms.
在抗精神病药物治疗开始之前和之后，在广泛的未经药物治疗的精神分裂症谱系精神病患者样本中，检查阴性症状和运动体征的变化。
对 189 名符合 DSM-IV 精神分裂症谱系精神病的抗精神病药物初治患者进行评估，评估内容包括阴性症状（情感迟钝、言语贫乏、意志减退/淡漠和快感缺失/社交退缩）和运动体征（紧张症、帕金森病和运动障碍）。我们检查了基线时、抗精神病药物治疗开始后 4 周时阴性和运动特征之间的关联，以及它们在治疗期间的平均变化，如轨迹和治疗反应模式。
在药物初治状态下，运动体征与情感迟钝和言语贫乏密切相关（p<0.01）；4 周时，大多数阴性和运动特征均显著相关（p<0.01）；运动体征和阴性症状的平均变化趋势无相关性。这种关联模式与阳性症状的水平无关。除了情感迟钝，阴性症状的评分在治疗后有所改善（p<0.001），而运动评分则表现出不同的轨迹，紧张症有所改善（p<0.001），帕金森病恶化（p<0.001），运动障碍无变化（p>0.01）。尽管程度不同，但运动和阴性特征对抗精神病药物治疗表现出药物反应、药物恶化或药物不变的反应模式。治疗患者中阴性和运动特征的主要预测因素是其相应的基线评分（p<0.001）。
阴性和运动特征是不同的，但在某种程度上是重叠的，这两个特征都受到抗精神病药物的显著影响。在药物初治状态下，运动体征和阴性症状的表达减弱可能与潜在的神经生物学机制有关。
