Department of Psychiatry, School of Clinical Medicine, The Unversity of Hong Kong, Hong Kong SAR, China.
Castle Peak Hospital, Hong Kong.
Schizophr Res. 2024 Aug;270:459-464. doi: 10.1016/j.schres.2024.07.008. Epub 2024 Jul 13.
Recent operational criteria for treatment-resistant schizophrenia (TRS) recognized positive and negative symptoms. TRS patients may have heterogeneity in negative symptoms, but empirical data were lacking. We aimed to characterize TRS patients based on negative symptoms using cluster analysis, and to examine between-cluster differences in social functioning.
We administered the Clinical Assessment Interview of Negative symptoms (CAINS), Brief Negative Symptom Scale (BNSS), the Positive and Negative Syndrome Scale (PANSS) and the Social and Occupational Functional Assessment (SOFAS to 126 TRS outpatients. All patients also completed the Temporal Experience of Pleasure Scale (TEPS), the Emotion Expressivity Scale (EES), and the Social Functional Scale (SFS). A two-stage hierarchical cluster analysis was performed with the CAINS, TEPS and EES as clustering variables. We validated the clusters using ANOVAs to compare group differences in the BNSS, PANSS, SOFAS and SFS.
Clustering indices supported a 3-cluster solution. Clusters 1 (n = 46) and 3 (n = 16) exhibited higher CAINS scores than Cluster 2 (n = 64), and were negative-symptom TRS subtypes. Cluster 1 reported lower TEPS than Cluster 3; but Cluster 3 reported lower EES than Cluster 1. Upon validation, Clusters 1 and 3 exhibited higher BNSS scores than Cluster 2, but only Cluster 1 exhibited lower SOFAS and higher PANSS general symptoms than Cluster 2. Both Clusters 1 and 3 had higher self-report functioning than Cluster 2.
We provided evidence for heterogeneity of negative symptoms in TRS. Negative symptoms can characterize TRS patients and predict functional outcome.
最近的治疗抵抗性精神分裂症（TRS）的操作标准承认阳性和阴性症状。TRS 患者的阴性症状可能存在异质性，但缺乏经验数据。我们旨在使用聚类分析根据阴性症状对 TRS 患者进行特征描述，并检查社会功能方面的聚类间差异。
我们对 126 名 TRS 门诊患者进行了临床评估阴性症状访谈（CAINS）、简短阴性症状量表（BNSS）、阳性和阴性症状量表（PANSS）和社会和职业功能评估（SOFAS）。所有患者还完成了时间体验快感量表（TEPS）、情绪表达量表（EES）和社会功能量表（SFS）。使用 CAINS、TEPS 和 EES 作为聚类变量进行两阶段层次聚类分析。我们使用方差分析验证了聚类，以比较 BNSS、PANSS、SOFAS 和 SFS 组间差异。
聚类指标支持 3 聚类解决方案。簇 1（n=46）和簇 3（n=16）的 CAINS 评分高于簇 2（n=64），为阴性症状 TRS 亚型。簇 1 的 TEPS 评分低于簇 3；但簇 3 的 EES 评分低于簇 1。验证后，簇 1 和簇 3 的 BNSS 评分高于簇 2，但只有簇 1 的 SOFAS 评分低于簇 2，PANSS 一般症状评分高于簇 2。簇 1 和簇 3 的自我报告功能均高于簇 2。
我们为 TRS 中阴性症状的异质性提供了证据。阴性症状可以描述 TRS 患者并预测功能结局。
