One Time Clare College Research Associate, Cambridge, UK,
Psychiatr Danub. 2024 Sep;36(Suppl 2):40-51.
Schizophrenia is a complex psychiatric disorder characterized by heterogeneous symptom trajectories that significantly impact patient outcomes. We believe that the study of the trajectories of Schizophrenia is useful in assessing treatment options and outcomes. While the Positive and Negative Syndrome scale is usually used on one occasion to measure symptoms at a single time, if measured repeatedly , the PANSS is also useful in measuring trajectories. In order to illustrate and promote this serial use, we have reviewed papers which describe the delineation of Trajectories of Symptoms in Schizophrenia based on PANSS scores. This review integrates findings from longitudinal studies focusing on the trajectories of positive symptoms, negative symptoms, the relation between positive and negative symptoms and cognition, soft neurological signs, and treatment response in schizophrenia.
Studies were identified from the PUBMED database .Studies included in this review employed diverse methodologies such as trajectory analyses, longitudinal assessments, and clinical trials. Data were extracted from a range of patient cohorts, including those with first-episode psychosis and chronic schizophrenia.
Longitudinal studies consistently demonstrate variability in the trajectories of positive symptoms, with most patients experiencing early stable remission, though a subgroup exhibits persistent or fluctuating symptomatology. Negative symptoms, on the other hand, often show poor improvement over time, correlating with impaired social and neurocognitive functioning. Cognitive deficits also vary, with some domains showing improvement while others, such as logical memory, deteriorate in certain patient subgroups. The relationship between positive and negative symptom trajectories highlights their complex relationship, influencing overall functioning and treatment outcomes. Antipsychotic medications demonstrate varied responses across patient cohorts, with distinct trajectory patterns observed based on medication type and patient-specific factors such as co-morbid substance abuse and duration of untreated psychosis.
Understanding the longitudinal trajectories of symptoms in schizophrenia is crucial for optimizing therapeutic strategies and improving patient outcomes. Personalised interventions tailored to individual symptom profiles and early clinical responses are recommended to enhance treatment efficacy and promote recovery. The PANSS scale can be used to delineate Trajectories of various symptom Groups in Schizophrenia.
精神分裂症是一种复杂的精神疾病，其特征是症状轨迹具有异质性，这对患者的结局有很大影响。我们认为研究精神分裂症的轨迹对评估治疗方案和结局是有用的。虽然阳性和阴性症状量表（PANSS）通常用于一次测量某个时间点的症状，但如果反复测量，PANSS 也可用于测量轨迹。为了说明和促进这种连续使用，我们回顾了描述基于 PANSS 评分的精神分裂症症状轨迹的论文。这篇综述整合了关注阳性症状、阴性症状、阳性和阴性症状与认知、软神经体征以及精神分裂症治疗反应之间关系的轨迹的纵向研究的结果。
从 PUBMED 数据库中确定研究。本综述纳入的研究采用了多种方法，如轨迹分析、纵向评估和临床试验。数据来自一系列患者队列，包括首发精神病和慢性精神分裂症患者。
纵向研究一致表明阳性症状轨迹存在变异性，大多数患者早期稳定缓解，但有一部分患者表现出持续或波动的症状。另一方面，阴性症状随时间改善较差，与社会和神经认知功能受损相关。认知缺陷也存在差异，一些领域有所改善，而其他领域，如逻辑记忆，在某些患者亚组中恶化。阳性和阴性症状轨迹之间的关系突出了它们之间的复杂关系，影响整体功能和治疗结局。抗精神病药物在不同的患者队列中表现出不同的反应，根据药物类型和患者特定因素（如合并物质滥用和未治疗精神病的持续时间）观察到不同的轨迹模式。
了解精神分裂症症状的纵向轨迹对于优化治疗策略和改善患者结局至关重要。建议根据个体症状特征和早期临床反应制定个性化干预措施，以提高治疗效果并促进康复。PANSS 量表可用于描绘精神分裂症中各种症状组的轨迹。
