McGlashan T H, Fenton W S
Yale Psychiatric Institute, New Haven, CT 06520-7378.
Schizophr Bull. 1993;19(1):71-84. doi: 10.1093/schbul/19.1.71.
It is important to elaborate what we know about the symptomatic, syndromal, and functional course of schizophrenia in order to test models for this illness. The sample of schizophrenic patients from the Chestnut Lodge followup study was subtyped using classical (modified DSM-III-R) criteria and deficit/nondeficit (Schedule for the Deficit Syndrome) criteria. During the first 5 years of manifest illness, the subtype phenomenologies were moderately stable. Instability consisted of a drift toward disorganization (hebephrenia) and nonspecificity (undifferentiated) among the classical subtypes, and toward the deficit subtype within that categorization. Over the same time, positive symptoms were relatively stable, but negative symptoms became significantly worse. Such changes probably reflect "deterioration" because they were associated with poorer functional outcome an average of 15 years later. These data dovetail with other reports in the literature and suggest a hierarchy of symptomatic/syndromal progression in early manifest schizophrenia that may reflect active deterioration processes at work. We suggest that any theory of schizophrenic pathophysiology must account for these patterns of symptom course.
为了验证针对精神分裂症的模型，详细阐述我们对精神分裂症的症状、综合征及功能病程的了解很重要。来自栗树屋随访研究的精神分裂症患者样本，使用经典（修订版DSM-III-R）标准以及缺陷/非缺陷（缺陷综合征量表）标准进行了亚型分类。在明显患病的头5年里，亚型现象学相对稳定。不稳定表现为经典亚型中向紊乱（青春型精神分裂症）和非特异性（未分化型）的转变，以及在该分类中向缺陷亚型的转变。在同一时期，阳性症状相对稳定，但阴性症状明显恶化。这些变化可能反映了“衰退”，因为平均15年后它们与较差的功能转归相关。这些数据与文献中的其他报告相吻合，并提示了早期明显精神分裂症症状/综合征进展的层次结构，这可能反映了正在起作用的主动衰退过程。我们认为，任何关于精神分裂症病理生理学的理论都必须解释这些症状病程模式。
