Silverman J M, Siever L J, Horvath T B, Coccaro E F, Klar H, Davidson M, Pinkham L, Apter S H, Mohs R C, Davis K L
Psychiatry Service, Bronx VA Medical Center, NY 10468.
Am J Psychiatry. 1993 Mar;150(3):435-42. doi: 10.1176/ajp.150.3.435.
The possible heterogeneity of the schizophrenia-related personality disorder traits associated with DSM-III criteria for schizotypal personality disorder was investigated using the family history method. A familial relationship to schizophrenia was hypothesized for schizophrenia-related personality disorder traits without coexisting affective personality disorder traits, pure schizophrenia-related personality disorder traits. Alternatively, a familial relationship with borderline personality disorder was hypothesized for schizophrenia-related personality disorder traits with comorbid affective personality disorder traits.
Criteria for schizophrenia-related and affective personality disorder traits were used to assess the 588 nonpsychotic first-degree relatives of 55 chronic schizophrenic probands and 67 probands with personality disorders. The probands with one or more DSM-III personality disorders were categorized as having schizotypal personality disorder without borderline personality disorder (pure schizotypal personality disorder), borderline personality disorder without schizotypal personality disorder (pure borderline personality disorder), both disorders, or neither.
The morbid risk of all cases of schizophrenia-related personality disorder traits was higher in relatives of probands with schizophrenia and pure schizotypal personality disorder than in relatives of probands with neither schizotypal nor borderline personality disorder; however, it differed only slightly from that observed in the relatives of probands with both schizotypal and borderline personality disorders and pure borderline personality disorder. In contrast, the risk of pure schizophrenia-related personality disorder traits was higher in relatives of probands with schizophrenia and pure schizotypal personality disorder, while the risk of coexisting schizophrenia-related and affective personality disorder traits was lower in both of these groups than among the relatives of probands with both schizotypal and borderline personality disorders and pure borderline personality disorder.
These results offer preliminary indications that schizotypal personality disorder features present without comorbid affective personality disorder traits may more specifically characterize the personality characteristics familially related to schizophrenia. Furthermore, they indicate that schizotypal personality disorder features as currently defined are found in relatives of patients other than those with schizophrenia or schizotypal personality disorder.
采用家族史方法研究与精神分裂症相关的人格障碍特质的可能异质性,这些特质与精神分裂症型人格障碍的DSM-III标准相关。对于不存在共病情感性人格障碍特质的精神分裂症相关人格障碍特质,即纯精神分裂症相关人格障碍特质,假定其与精神分裂症存在家族关系。另外,对于存在共病情感性人格障碍特质的精神分裂症相关人格障碍特质,假定其与边缘型人格障碍存在家族关系。
使用精神分裂症相关和情感性人格障碍特质的标准,对55名慢性精神分裂症先证者和67名患有精神障碍的先证者的588名非精神病性一级亲属进行评估。患有一种或多种DSM-III人格障碍的先证者被分类为患有无边缘型人格障碍的精神分裂症型人格障碍(纯精神分裂症型人格障碍)、无精神分裂症型人格障碍的边缘型人格障碍(纯边缘型人格障碍)、两种障碍都有或两种障碍都没有。
精神分裂症相关人格障碍特质所有病例的患病风险,在先证者患有精神分裂症和纯精神分裂症型人格障碍的亲属中,高于在先证者既无精神分裂症型人格障碍也无边缘型人格障碍的亲属中;然而,它与在先证者患有精神分裂症型人格障碍和边缘型人格障碍以及纯边缘型人格障碍的亲属中观察到的风险仅略有不同。相比之下,纯精神分裂症相关人格障碍特质的风险在先证者患有精神分裂症和纯精神分裂症型人格障碍的亲属中更高,而在这两组中,共病精神分裂症相关和情感性人格障碍特质的风险均低于在先证者患有精神分裂症型人格障碍和边缘型人格障碍以及纯边缘型人格障碍的亲属中。
这些结果提供了初步迹象,表明不存在共病情感性人格障碍特质的精神分裂症型人格障碍特征可能更具体地表征与精神分裂症存在家族关系的人格特征。此外,它们表明,目前定义的精神分裂症型人格障碍特征在除精神分裂症或精神分裂症型人格障碍患者之外的患者亲属中也存在。