Dollfus S, Everitt B, Ribeyre J M, Assouly-Besse F, Sharp C, Petit M
C.H.U. Côte de Nacre, Centre Esquirol, Caen, France.
Schizophr Bull. 1996;22(3):545-55. doi: 10.1093/schbul/22.3.545.
The existence of two subtypes of schizophrenia (positive and negative) is well established. The evidence in favor of other subtypes, particularly a disorganized subtype, is still the subject of some debate. The aim of the study reported in this article is to investigate the possibility of further subtypes of schizophrenia by applying a particular method of cluster analysis to a particular set of data. Ward's method of cluster analysis was applied to the Positive and Negative syndrome Scale (PANSS) scores of 138 patients, defined as having schizophrenia by one of four diagnostic criteria. The validity of the cluster solution was assessed both by examining differences between clusters on a number of clinical characteristics recorded for each patient and by comparing the results obtained from the PANSS with those derived from a cluster analysis using two other instruments (the Scale for the Assessment of Negative Symptoms and the Scale for the Assessment of Positive Symptoms). Results from the cluster analysis suggest the existence of at least four subtypes of schizophrenia: positive, negative, mixed, and disorganized. A fifth subtype includes patients with few symptoms, suggesting the simple schizophrenia named by Bleuler. Evidence for the validity of these subtypes was provided by the differences observed between the clusters on a number of clinical characteristics and by the similarity of the cluster solution obtained from the different instruments. In conclusion, the negative-positive dichotomy in schizophrenia is an oversimplification, and the existence of a more complex structure needs to be taken into account in future research.
精神分裂症存在两种亚型（阳性和阴性）这一点已得到充分证实。支持其他亚型，尤其是紊乱型亚型存在的证据仍存在一些争议。本文所报告研究的目的是通过对一组特定数据应用一种特定的聚类分析方法，来探究精神分裂症进一步细分亚型的可能性。将沃德聚类分析方法应用于138例患者的阳性与阴性症状量表（PANSS）评分，这些患者根据四项诊断标准之一被确诊为患有精神分裂症。通过检查各聚类在为每位患者记录的多项临床特征上的差异，以及将从PANSS获得的结果与使用其他两种工具（阴性症状评估量表和阳性症状评估量表）进行聚类分析得出的结果相比较，来评估聚类结果的有效性。聚类分析结果表明精神分裂症至少存在四种亚型：阳性、阴性、混合型和紊乱型。第五种亚型包括症状较少的患者，这表明了布洛伊勒所称的单纯型精神分裂症。这些亚型有效性的证据来自于各聚类在多项临床特征上观察到的差异，以及从不同工具获得的聚类结果的相似性。总之，精神分裂症中的阴性 - 阳性二分法过于简单化，在未来研究中需要考虑到更复杂结构的存在。
