The structure of psychosis - Latent class analysis of probands from the Roscommon family study
The structure of psychosis - Latent class analysis of probands from the Roscommon family study
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DOI：
10.1001/archpsyc.55.6.492
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发表时间：
1998-06-01
影响因子：
--
通讯作者：
Walsh, D
中科院分区：
文献类型：
--
作者：
Kendler, KS;Karkowski, LM;Walsh, D
背景：精神疾病的病因学结构仍然存在争议，仍然受到历史和经验观点的影响。方法：应用潜在类分析对343名患有广义精神分裂症和情感疾病的先证者(n=343)进行详细的症状和结果评估，这些先证者来自爱尔兰罗斯康姆县的一个基于人口的精神病学登记。942名一级亲属通过个人访谈和/或查阅住院记录进行评估。结果：发现了6个类别，所有类别都与当前或历史上的病因学概念大体相似。按出现频率依次为：(1)典型精神分裂症，(2)抑郁症，(3)分裂样障碍，(4)双相分裂狂，(5)分裂抑郁，(6)青春症。这些类别在潜在类别分析中没有使用的许多历史和临床变量上有所不同。与对照组的亲属相比，抑郁和精神分裂抑郁先证者的亲属患抑郁症的几率显著增加。双相情感障碍发病率的显著增加仅限于双相情感障碍先证者的亲属。除重度抑郁症外，所有先证者的亲属患精神分裂症和精神分裂症谱系障碍的风险显著增加。这种增加在双相-精神分裂症先证者中是适度的，在精神分裂症、分裂样和分裂抑郁先证者中是相当大的，在青春期先证者中是显著的。结论：这些结果表明精神病综合征的相对复杂的类型学既不符合单一模型，也不符合克拉佩林二分法。精神病的家族易感性延伸到几个症状上，在那些有分裂样症状的人中最为明显。家族对抑郁和躁狂情感性疾病的易感性在某种程度上是更具体的。
Background: The nosologic structure of psychotic illness, still influenced as much by historical as empirical perspectives, remains controversial.Methods: 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.Results: 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.Conclusions: 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.