Russo Manuela, Repisti Selman, Blazhevska Stoilkovska Biljana, Jerotic Stefan, Ristic Ivan, Mesevic Smajic Eldina, Uka Fitim, Arenliu Aliriza, Bajraktarov Stojan, Dzubur Kulenovic Alma, Injac Stevovic Lidija, Priebe Stefan, Jovanovic Nikolina
Unit for Social and Community Psychiatry, World Health Organisation Collaborating Centre for Mental Health Services Development, Bart's and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom.
Clinical Centre, Psychiatric Clinic, University of Montenegro, Podgorica, Montenegro.
Front Psychiatry. 2021 Dec 14;12:785144. doi: 10.3389/fpsyt.2021.785144. eCollection 2021.
Negative symptoms are core features of schizophrenia and very challenging to be treated. Identification of their structure is crucial to provide a better treatment. Increasing evidence supports the superiority of a five-factor model (alogia, blunted affect, anhedonia, avolition, and asociality as defined by the NMIH-MATRICS Consensus); however, previous data primarily used the Brief Negative Symptoms Scale (BNSS). This study, including a calibration and a cross-validation sample ( = 268 and 257, respectively) of participants with schizophrenia, used the Clinical Assessment Interview for Negative Symptoms (CAINS) to explore the latent structure of negative symptoms and to test theoretical and data-driven (from this study) models of negative symptoms. Exploratory factor analysis (EFA) was carried out to investigate the structure of negative symptoms based on the CAINS. Confirmatory factor analysis (CFA) tested in a cross-validation sample four competing theoretical (one-factor, two-factor, five-factor, and hierarchical factor) models and two EFA-derived models. None of the theoretical models was confirmed with the CFA. A CAINS-rated model from EFA consisting of five factors (expression, motivation for recreational activities, social activities, vocational, and close/intimate relationships) was an excellent fit to the data (comparative fix index = 0.97, Tucker-Lewis index = 0.96, and root mean square error of approximation = 0.07). This study cannot support recent data on the superiority of the five-factor model defined by the NMIH-MATRICS consensus and suggests that an alternative model might be a better fit. More research to confirm the structure of negative symptoms in schizophrenia, and careful methodological consideration, should be warranted before a definitive model can put forward and shape diagnosis and treatment of schizophrenia.
阴性症状是精神分裂症的核心特征，且极难治疗。明确其结构对于提供更好的治疗至关重要。越来越多的证据支持五因素模型（由美国国立精神卫生研究所-测量与治疗研究共识定义的言语贫乏、情感迟钝、快感缺失、意志缺乏和社交退缩）的优越性；然而，之前的数据主要使用简明阴性症状量表（BNSS）。本研究纳入了精神分裂症患者的校准样本和交叉验证样本（分别为268例和257例），使用阴性症状临床评估访谈（CAINS）来探究阴性症状的潜在结构，并检验阴性症状的理论模型和数据驱动模型（来自本研究）。基于CAINS进行探索性因子分析（EFA）以研究阴性症状的结构。在交叉验证样本中，验证性因子分析（CFA）检验了四个相互竞争的理论模型（单因素、双因素、五因素和层次因子模型）以及两个EFA衍生模型。没有一个理论模型通过CFA得到证实。一个由EFA得出的、CAINS评分的五因素模型（表达、娱乐活动动机、社交活动、职业以及亲密关系）与数据拟合良好（比较拟合指数=0.97，塔克-刘易斯指数=0.96，近似均方根误差=0.07）。本研究不支持美国国立精神卫生研究所-测量与治疗研究共识所定义的五因素模型优越性的近期数据，并表明另一种模型可能更合适。在提出明确的模型以指导精神分裂症的诊断和治疗之前，需要更多研究来证实精神分裂症阴性症状的结构，并进行仔细的方法学考量。
