Department of Psychology, University of Georgia, 125 Baldwin Street, Athens, GA 30602.
Department of Psychology, Louisiana State University, Baton Rouge, LA.
Schizophr Bull. 2017 Jul 1;43(4):712-719. doi: 10.1093/schbul/sbx066.
In the DSM5, negative symptoms are 1 of the 5 core dimensions of psychopathology evaluated for schizophrenia. However, negative symptoms are not pathognomonic-they are also part of the diagnostic criteria for other schizophrenia-spectrum disorders, disorders that sometimes have comorbid psychosis, diagnoses not in the schizophrenia-spectrum, and the general "nonclinical" population. Although etiological models of negative symptoms have been developed for chronic schizophrenia, there has been little attention given to whether these models have transdiagnostic applicability. In the current review, we examine areas of commonality and divergence in the clinical presentation and etiology of negative symptoms across diagnostic categories. It was concluded that negative symptoms are relatively frequent across diagnostic categories, but individual disorders may differ in whether their negative symptoms are persistent/transient or primary/secondary. Evidence for separate dimensions of volitional and expressive symptoms exists, and there may be multiple mechanistic pathways to the same symptom phenomenon among DSM-5 disorders within and outside the schizophrenia-spectrum (ie, equifinality). Evidence for a novel transdiagnostic etiological model is presented based on the Research Domain Criteria (RDoC) constructs, which proposes the existence of 2 such pathways-a hedonic pathway and a cognitive pathway-that can both lead to expressive or volitional symptoms. To facilitate treatment breakthroughs, future transdiagnostic studies on negative symptoms are warranted that explore mechanisms underlying volitional and expressive pathology.
在 DSM5 中，阴性症状是评估精神分裂症的 5 个核心病理学维度之一。然而，阴性症状并非特异性的——它们也是其他精神分裂症谱系障碍、有时伴有共病精神病的障碍、不在精神分裂症谱系中的诊断以及一般“非临床”人群的诊断标准的一部分。尽管已经为慢性精神分裂症开发了阴性症状的病因学模型，但对于这些模型是否具有跨诊断适用性关注甚少。在当前的综述中，我们检查了在诊断类别中阴性症状的临床表现和病因学的共性和差异。得出的结论是，阴性症状在各个诊断类别中都相对常见，但各个障碍可能在其阴性症状是持续性/短暂性的还是原发性/继发性的方面存在差异。存在意志和表达症状的独立维度的证据，并且在精神分裂症谱系内外的 DSM-5 障碍中，可能存在通往相同症状现象的多种机制途径（即，等同终点）。基于研究领域标准（RDoC）构建提出了一种新的跨诊断病因学模型的证据，该模型提出了存在两种这样的途径——愉悦途径和认知途径——都可以导致表达或意志症状。为了促进治疗突破，需要进行未来的跨诊断阴性症状研究，以探索意志和表达病理学的机制。
