Tamminga C A, Buchanan R W, Gold J M
Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore 21228, USA.
Int Clin Psychopharmacol. 1998 Mar;13 Suppl 3:S21-6. doi: 10.1097/00004850-199803003-00004.
Schizophrenia is a lifelong illness, with symptoms beginning in late adolescence/early adulthood and persisting throughout the rest of the patient's life. Positive psychotic symptoms may fluctuate during the course of the illness, but negative symptoms, especially primary negative symptoms, and cognitive dysfunction are relatively constant. The negative symptoms of schizophrenia are both primary (associated with the illness) and secondary (due to depression, neuroleptic-induced parkinsonism or acute psychosis). While secondary negative symptoms may be reduced by treating the causative agent, primary negative symptoms are viewed as enduring, persisting between psychotic episodes. Conventional antipsychotics treat the positive symptoms of schizophrenia, but they have little effect on primary negative and cognitive symptoms. Primary negative symptoms are often associated with poor premorbid function, the male sex, and low IQ (Intelligence Quotient). In addition, most studies find that negative symptoms are associated with a poor overall outcome. Several studies, including our own, have suggested that primary negative symptoms are functionally localized to the frontal and parietal cortices. These kinds of data raise the possibility that primary negative symptoms may have a pathophysiological basis distinct from positive psychosis. Cognitive impairment also appears to be a relatively independent aspect of schizophrenia. Impairment may be evident in a subtle form from early childhood, and often precedes the development of psychotic symptoms. Additional impairment accrues with the onset of psychotic illness with little evidence, in the vast majority of cases, of progression over the course of the illness. Cognitive impairment is only modestly related to psychotic symptom severity and type. However, the extent, and perhaps specific types of cognitive impairment, appear to be predictive of functional outcome.
精神分裂症是一种终身性疾病，症状始于青春期后期/成年早期，并在患者的余生中持续存在。阳性精神病性症状在疾病过程中可能会波动，但阴性症状，尤其是原发性阴性症状和认知功能障碍则相对恒定。精神分裂症的阴性症状既有原发性的（与疾病相关），也有继发性的（由抑郁、抗精神病药物引起的帕金森综合征或急性精神病所致）。虽然通过治疗病因可以减轻继发性阴性症状，但原发性阴性症状被认为是持久的，在精神病发作之间持续存在。传统抗精神病药物可治疗精神分裂症的阳性症状，但对原发性阴性和认知症状几乎没有效果。原发性阴性症状通常与病前功能差、男性以及低智商有关。此外，大多数研究发现阴性症状与总体预后不良有关。包括我们自己的研究在内的几项研究表明，原发性阴性症状在功能上定位于额叶和顶叶皮质。这类数据增加了原发性阴性症状可能具有与阳性精神病不同的病理生理基础的可能性。认知障碍似乎也是精神分裂症一个相对独立的方面。从幼儿期开始，认知障碍可能以一种微妙的形式表现出来，并且往往先于精神病性症状的出现。随着精神病性疾病的发作，会出现额外的认知障碍，在绝大多数情况下，几乎没有证据表明在疾病过程中会进展。认知障碍与精神病性症状的严重程度和类型仅有适度的关联。然而，认知障碍的程度以及可能的特定类型似乎可以预测功能结局。
