Smulevich A B, Kluschnik T P, Lobanova V M, Voronova E I
Mental health research center, Moscow, Russia.
Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.
Zh Nevrol Psikhiatr Im S S Korsakova. 2020;120(6. Vyp. 2):13-22. doi: 10.17116/jnevro202012006213.
The authors consider current and own conceptions about correlations of the processes underlying the pathogenesis of schizophrenia presented by negative and positive disorders. With growth of academic psychiatry, evaluation of a correlation between positive and negative dimensions has changed dramatically: on the one hand presenting in clinical unity - simultaneous psychopathologic structures, and on the other hand being clinically and pathogenetically heterogenic in dimensional structure. According to our clinical and biological findings and an analysis of fundamental neurobiological studies, positive and negative disorders present in the clinical picture of schizophrenia as two separate psychopathological and pathogenetic structures. A new paradigm of the correlation between positive and negative structures - the interaction between positive and deficit symptoms - reveals psychopathological functions differentiated for each of dimensional structures. Negative disorders act as «transformers» modifying characteristics of primary transnosological positive disorders to the level of psychopathological structures preferable for schizophrenia; positive disorders, in their turn, act as «moderators» augmenting, amplifying manifestations of negative symptoms. This psychopathological construct of the correlation between dimensional structures paves a way for the development of a new concept of psychopharmacological treatment of schizophrenic deficit: both negative symptoms and amplifying positive symptoms are considered as «target symptoms» for pharmacological interventions.
作者们探讨了当前以及自身对于由阴性和阳性障碍所呈现的精神分裂症发病机制相关过程之间关联的概念。随着学术精神病学的发展,对阳性和阴性维度之间关联的评估发生了巨大变化:一方面,在临床整体中呈现为同时存在的精神病理结构;另一方面,在维度结构上临床和发病机制存在异质性。根据我们的临床和生物学发现以及对基础神经生物学研究的分析,阳性和阴性障碍在精神分裂症的临床表现中呈现为两种独立的精神病理和发病结构。阳性和阴性结构之间关联的一种新范式——阳性症状与缺陷症状之间的相互作用——揭示了每个维度结构所特有的精神病理功能。阴性障碍充当“变压器”,将原发性跨诊断学阳性障碍的特征改变为精神分裂症更倾向的精神病理结构水平;阳性障碍则反过来充当“调节者”,增强、放大阴性症状的表现。这种维度结构之间关联的精神病理构建为精神分裂症缺陷的精神药理学治疗新概念的发展铺平了道路:阴性症状以及增强的阳性症状都被视为药物干预的“目标症状”。