Smulevich A B, 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. 2021;121(2):122-130. doi: 10.17116/jnevro2021121021122.
Pioneers of nosology in psychiatry considered mental deficit as a basic disorder obligated to all clinical forms of illness, as did E. Kraepelin in the concept of dementia praecox and E. Bleuler in the concept of schizophrenia. At the present stage of studies, this position is clearly articulated in the «deficit schizophrenia» concept of J. Klosterkotter. Negative disorders are considered in categorical approach to interpret psychopathological dimensions of schizophrenia as coordinated, strongly bound with positive syndromes (concept of «dialectical unity» of A.V. Snezhnevskiy, 1964) and classified as syndromes according to systematics of positive disorders. However, distinguished types of negative disorders are determined in terms of positive syndromes or characterological changes (asthenic, pseudopsychopathic deficit). Within a new paradigm (dimensional approach to schizophrenia), which differs from the categorical approach, negative disorders are considered as a distinct domain, primary in relation to other psychopathological phenomena of schizophrenia). A concept of primary persistent negative symptoms serves as basis of the current concept of schizophrenic deficit. Factor analysis revealed two domains of negative disorders: 1) emotional blunting: blunted affect, alogia; 2) avolition: apathy, anhedonia, asociality.
精神病学中疾病分类学的先驱们认为精神缺陷是所有临床疾病形式的一种基本病症,早发性痴呆概念中的E. 克雷佩林以及精神分裂症概念中的E. 布鲁勒都是如此。在当前的研究阶段,这一观点在J. 克洛斯特科特的“缺陷型精神分裂症”概念中得到了明确阐述。在将精神分裂症的精神病理学维度解释为相互协调且与阳性症状紧密相连(A.V. 斯涅日涅夫斯基1964年提出的“辩证统一”概念)的分类方法中,阴性症状被视为一种综合征,并根据阳性症状的分类系统进行分类。然而,不同类型的阴性症状是根据阳性症状或性格变化(无力型、假性精神病态缺陷)来确定的。在与分类方法不同的新范式(精神分裂症的维度方法)中,阴性症状被视为一个独特的领域,相对于精神分裂症的其他精神病理学现象而言是原发性的。原发性持续性阴性症状的概念是当前精神分裂症缺陷概念的基础。因素分析揭示了阴性症状的两个领域:1)情感迟钝:情感平淡、言语减少;2)意志缺失:冷漠、快感缺失、社交退缩。