Deister A, Marneros A
Psychiatric Department, University of Bonn, Federal Republic of Germany.
Eur Arch Psychiatry Clin Neurosci. 1993;242(4):184-90. doi: 10.1007/BF02189961.
The long-term stability of subtypes of schizophrenic disorders in 148 narrowly defined schizophrenic patients according to four diagnostic systems was compared. The patients were investigated longitudinally for 23 years on average (range 10-50 years). Patients who experienced only one episode and those who were permanently hospitalised were excluded on methodological grounds. Of the remaining 100 patients, a total of 461 episodes were classified into various subtypes according to the criteria of DSM-III-R, ICD-10, the positive/negative dichotomy, and Schneider's first-rank symptoms. It was found that long-term stability of subtype in schizophrenic disorder was not the rule but the exception. The frequency of stable course was found to be depend on the type of the initial episode. In most cases a subtype change occurred within the first few years of the illness with no clear direction. In later stages of the illness the relative frequency of episodes predominated by negative symptomatology increased. The findings were similar for DSM-III-R, ICD-10 and positive/negative dichotomy. Only in patients beginning without first-rank symptoms were more stable than non-stable courses found. The results of this study do not support the assumption that stable subtypes are nosological or etiopathogenetic subentities of schizophrenic disorders.
比较了148例根据四种诊断系统狭义定义的精神分裂症患者中精神分裂症亚型的长期稳定性。患者平均接受了23年的纵向研究（范围为10 - 50年）。出于方法学原因，排除了仅经历一次发作的患者和长期住院的患者。在其余100例患者中，根据DSM-III-R、ICD-10、阳性/阴性二分法和施奈德一级症状标准，共461次发作被分类为各种亚型。结果发现，精神分裂症亚型的长期稳定性并非普遍规律而是例外情况。发现稳定病程的频率取决于首发发作的类型。在大多数情况下，亚型变化发生在疾病的最初几年内，且没有明确的方向。在疾病后期，以阴性症状为主的发作相对频率增加。DSM-III-R、ICD-10和阳性/阴性二分法的结果相似。只有首发无一级症状的患者比病程不稳定的患者更稳定。本研究结果不支持稳定亚型是精神分裂症的疾病分类学或病因学亚实体这一假设。
