Goldberg T E, Weinberger D R
Clinical Brain Disorders Branch, IRP, NIMH, NIH, Washington, DC 20032, USA.
Schizophr Res. 1995 Oct;17(2):147-52. doi: 10.1016/0920-9964(95)00060-y.
In this paper we consider the generally accepted view that schizophrenia is 'heterogeneous'. We point out that the view derives from prima facie evidence from clinical presentation, studies of course, and factor analysis. However, upon closer examination internal contradictions are apparent, e.g., subtypes change, different groupings of symptoms cooccur in the same individual. Another type of paradigm, depending on careful study of case controls (e.g., monozygotic twins discordant for schizophrenia) and distributions, indicates that abnormalities in neurocognition, regional cerebral blood flow, and regional neuroanatomy may be present in nearly every patient, irrespective of absolute level or diagnostic subtype. These results suggest that a simple model in which patients vary along a severity dimension might parsimoniously explain much of the variance. Thus, while it is possible and even probable that schizophrenia may have many etiologies, phenocopies may represent the expression of a unitary pathogenesis of greater or lesser impact.
在本文中，我们探讨了关于精神分裂症具有“异质性”这一普遍接受的观点。我们指出，该观点源于临床表现、病程研究及因子分析的初步证据。然而，经仔细审视，内部矛盾显而易见，例如，亚型会发生变化，不同症状组合会出现在同一个体中。另一种范式，基于对病例对照（如患精神分裂症不一致的同卵双胞胎）的仔细研究及分布情况表明，几乎每位患者都可能存在神经认知、局部脑血流量及局部神经解剖结构异常，而与绝对水平或诊断亚型无关。这些结果表明，一个简单的模型，即患者在严重程度维度上存在差异，可能简洁地解释大部分变异情况。因此，虽然精神分裂症可能有多种病因，甚至很有可能如此，但表型模拟可能代表了一种影响程度或大或小的单一发病机制的表现。
