Waddington J L, Scully P J, Youssef H A
Department of Clinical Pharmacology, Royal College of Surgeons in Ireland, Dublin, Ireland.
Schizophr Res. 1997 Feb 7;23(2):107-18. doi: 10.1016/S0920-9964(96)00111-9.
Though conceptualised originally as a deteriorating disorder, some contemporary studies have been interpreted as challenging these foundations; more radically, it has been proposed that schizophrenia may be a 'static encephalopathy' of neurodevelopmental origin. The argument offered here is that schizophrenia is indeed a neurodevelopmental disorder, but that this is not in itself antithetical to later disease progression. Rather, the onset of psychosis may reflect the maturationally-mediated triggering of an active disease process that is associated with progressive deterioration unless attenuated by antipsychotic drugs. A developmental trajectory is proposed to link first or early second trimester dysplasia to the chronic course of the illness; from this, it is argued that schizophrenia is inherently a progressive disorder but that antipsychotic drugs may act to ameliorate this progressive component and thus confer on the disease course some of the characteristics of a 'static encephalopathy'. The 'true' natural history of an illness cannot be determined from studies in treated populations.
尽管精神分裂症最初被概念化为一种进行性疾病，但一些当代研究被解读为对这些基础提出了挑战；更激进的观点认为，精神分裂症可能是一种神经发育起源的“静态脑病”。本文提出的观点是，精神分裂症确实是一种神经发育障碍，但这本身并不与疾病后期进展相矛盾。相反，精神病的发作可能反映了由成熟介导的、与进行性恶化相关的活跃疾病过程的触发，除非使用抗精神病药物加以缓解。本文提出了一条发育轨迹，将妊娠早期或妊娠中期早期的发育异常与疾病的慢性病程联系起来；据此认为，精神分裂症本质上是一种进行性疾病，但抗精神病药物可能会起到改善这种进行性成分的作用，从而赋予疾病病程一些“静态脑病”的特征。一种疾病的“真正”自然史无法从对接受治疗人群的研究中确定。
