Kendler K S, Karkowski L M, Walsh D
Department of Psychiatry, Medical College of Virginia, Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond 23298-0126, USA.
Arch Gen Psychiatry. 1998 Jun;55(6):492-9. doi: 10.1001/archpsyc.55.6.492.
The nosologic structure of psychotic illness, still influenced as much by historical as empirical perspectives, remains controversial.
Latent class analysis was applied to detailed symptomatic and outcome assessments of probands (n=343) with broadly defined schizophrenia and affective illness ascertained from a population-based psychiatric registry in Roscommon County, Ireland. First-degree relatives (n=942) were assessed by personal interview and/or review of hospital record.
Six classes were found, all of which bore substantial resemblance to current or historical nosologic constructs. In order of decreasing frequency, they were (1) classic schizophrenia, (2) major depression, (3) schizophreniform disorder, (4) bipolar-schizomania, (5) schizodepression, and (6) hebephrenia. These classes differed on many historical and clinical variables not used in the latent class analysis. Compared with relatives of controls, significantly increased rates of major depression were seen in relatives of depressed and schizodepressed probands. Significantly increased rates of bipolar illness were restricted to relatives of bipolar-schizomanic probands. The risks for schizophrenia and schizophrenia spectrum disorders were significantly increased in relatives of all proband classes except major depression. This increase was moderate for bipolar-schizomanic probands, substantial for schizophrenic, schizophreniform, and schizodepressed probands, and marked for hebephrenic probands.
These results suggest a relatively complex typology of psychotic syndromes consistent neither with a unitary model nor with a Kraepelinian dichotomy. The familial vulnerability to psychosis extends across several syndromes, being most pronounced in those with schizophrenialike symptoms. The familial vulnerability to depressive and manic affective illness is somewhat more specific.
精神病性疾病的分类结构，仍在很大程度上受到历史观点和实证观点的影响，一直存在争议。
对从爱尔兰罗斯康芒郡基于人群的精神病学登记处确定的患有广义精神分裂症和情感性疾病的先证者（n = 343）进行详细的症状和结局评估，并应用潜在类别分析。通过个人访谈和/或查阅医院记录对一级亲属（n = 942）进行评估。
发现了六个类别，所有类别都与当前或历史的分类结构有很大相似性。按出现频率递减顺序，它们分别是：（1）经典型精神分裂症，（2）重度抑郁症，（3）精神分裂症样障碍，（4）双相-精神分裂躁狂症，（5）分裂症抑郁症，（6）青春型精神分裂症。这些类别在潜在类别分析中未使用的许多历史和临床变量上存在差异。与对照组亲属相比，抑郁症和分裂症抑郁症先证者的亲属中重度抑郁症的发生率显著增加。双相情感障碍的发生率显著增加仅限于双相-精神分裂躁狂症先证者的亲属。除重度抑郁症外，所有先证者类别的亲属中精神分裂症和精神分裂症谱系障碍的风险均显著增加。对于双相-精神分裂躁狂症先证者，这种增加是中等程度的；对于精神分裂症、精神分裂症样和分裂症抑郁症先证者，增加幅度较大；对于青春型精神分裂症先证者，增加幅度明显。
这些结果表明，精神病综合征的类型相对复杂，既不符合单一模型，也不符合克雷佩林二分法。家族性精神病易感性跨越多种综合征，在具有精神分裂症样症状的患者中最为明显。家族性抑郁和躁狂情感性疾病易感性则更为特异。
