Kendler K S, McGuire M, Gruenberg A M, Walsh D
Department of Psychiatry, Medical College of Virginia, Richmond 23298-0710, USA.
Am J Psychiatry. 1995 May;152(5):755-64. doi: 10.1176/ajp.152.5.755.
The authors sought to assess whether the DSM-III-R category of schizoaffective disorder differs meaningfully from schizophrenia and affective illness in clinical features, outcome, and familial psychopathology. In addition, the authors evaluated the validity of two proposed subtyping systems for schizoaffective disorder: 1) bipolar versus depressive (based on presence or absence of a full manic syndrome in the past) and 2) good versus poor interepisode recovery.
In the epidemiologically based Roscommon Family Study, index probands with diagnoses of schizophrenia or affective illness were selected from a case registry. Personal interviews were conducted with 88% of traceable, living probands and 86% of traceable, living first-degree relatives.
Probands with schizoaffective disorder differed significantly from both those with schizophrenia and those with affective illness on lifetime psychotic symptoms as well as on outcome and negative symptoms assessed as follow-up. Relatives of probands with schizoaffective disorder had significantly higher rates of affective illness than relatives of schizophrenic probands and significantly higher rates of schizophrenia than relatives of probands with affective illness. Probands with bipolar and depressive schizoaffective disorder did not differ substantially with respect to psychotic symptoms, negative symptoms, outcome, or family history. Schizoaffective disorder probands with good interepisode recovery had fewer negative symptoms and a better outcome than those with poor recovery, but there were no significant differences in family history. Both the epidemiologic and family data are consistent with the hypothesis that schizoaffective disorder results from the co-occurrence of a high liability to both schizophrenia and affective illness.
On the basis of the validators examined, DSM-III-R criteria for schizoaffective disorder define a syndrome that differs meaningfully from both schizophrenia and affective illness. The division of schizoaffective disorder into bipolar and depressive subtypes was, however, not validated. The separation of schizoaffective disorder into subtypes based on level of interepisode recovery defined subtypes that differed clinically but not with respect to familial psychopathology.
作者试图评估精神分裂症伴情感障碍的DSM-III-R类别在临床特征、转归及家族精神病理学方面是否与精神分裂症和情感性疾病存在显著差异。此外，作者评估了两种针对精神分裂症伴情感障碍的拟议分型系统的有效性：1）双相型与抑郁型（基于既往是否存在完全躁狂综合征）；2）发作间期恢复良好型与恢复不良型。
在基于流行病学的罗斯康芒家族研究中，从病例登记处选取诊断为精神分裂症或情感性疾病的索引先证者。对88%可追踪到的在世先证者及86%可追踪到的在世一级亲属进行了个人访谈。
精神分裂症伴情感障碍的先证者在终生精神病性症状以及随访时评估的转归和阴性症状方面，与精神分裂症先证者和情感性疾病先证者均存在显著差异。精神分裂症伴情感障碍先证者的亲属患情感性疾病的比率显著高于精神分裂症先证者的亲属，患精神分裂症的比率显著高于情感性疾病先证者的亲属。双相型和抑郁型精神分裂症伴情感障碍的先证者在精神病性症状、阴性症状、转归或家族史方面无实质性差异。发作间期恢复良好的精神分裂症伴情感障碍先证者比恢复不良者的阴性症状更少，转归更好，但家族史方面无显著差异。流行病学和家族数据均与如下假设一致，即精神分裂症伴情感障碍是由对精神分裂症和情感性疾病的高易感性共同出现所致。
基于所检验的验证指标，精神分裂症伴情感障碍的DSM-III-R标准定义了一种与精神分裂症和情感性疾病均存在显著差异的综合征。然而，将精神分裂症伴情感障碍分为双相型和抑郁型亚型未得到验证。根据发作间期恢复水平将精神分裂症伴情感障碍分为不同亚型，所定义的亚型在临床上存在差异，但在家族精神病理学方面并无差异。
