Aggression and psychopathology in treatment-resistant inpatients with schizophrenia and schizoaffective disorder.
Aggression and psychopathology in treatment-resistant inpatients with schizophrenia and schizoaffective disorder.
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难治性住院精神分裂症和分裂情感障碍患者的攻击行为和精神病理学。
DOI：
10.1016/j.jpsychires.2004.04.010
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发表时间：
2005
期刊：
影响因子：
--
通讯作者：
Lieberman,JeffreyA
中科院分区：
文献类型：
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作者：
Nolan,KarenA;Volavka,Jan;Czobor,Pal;Sheitman,Brian;Lindenmayer,Jean-Pierre;Citrome,LeslieL;McEvoy,Joseph;Lieberman,JeffreyA
积极的精神病症状，如威胁/“控制-优先”妄想或命令幻觉，与精神分裂症患者的攻击性有关。然而，回溯性的数据收集阻碍了对精神病理学对攻击行为的直接影响的评估。在这项研究中，我们前瞻性地和时间上密切地监测了157名被诊断为慢性精神分裂症或分裂情感障碍的难治性住院患者的攻击行为和精神病理学，这些患者参与了一项为期14周的双盲临床试验。攻击行为采用显性攻击量表(OAS)评定。采用阳性与阴性症状量表(PANSS)评定精神病理学。在基线时，在研究过程中具有攻击性的受试者只在两个PANSS项目上有较高的得分：敌意和不良的冲动控制。在研究期间，攻击性被试的PANSS阳性分量表得分显着高于攻击性受试者。PANSS总分在攻击性事件发生后3天内得分较高，阳性和一般精神病理学分量表得分也较高。然而，在一个较小的样本中，在攻击性事件发生前3天内获得PANSS评分的人中，只有PANSS积极子量表的得分显著高于后者。这些在慢性耐药住院患者中的发现支持了阳性症状可能导致攻击性的观点。
Positive psychotic symptoms, such as threat/“control-override” delusions or command hallucinations, have been related to aggression in patients with schizophrenia. However, retrospective data collection has hampered evaluation of the direct influence of psychopathology on aggressive behavior. In this study, we monitored aggressive behavior and psychopathology prospectively and in close temporal proximity in 157 treatment-resistant inpatients diagnosed with chronic schizophrenia or schizoaffective disorder participating in a 14-week double-blind clinical trial. Aggressive behavior was rated with the overt aggression scale (OAS). Psychopathology was assessed using the positive and negative syndrome scale (PANSS). At baseline, subjects who would be aggressive during the study had higher scores on only two PANSS items: hostility and poor impulse control. During the study PANSS positive subscale scores were significantly higher in aggressive subjects. Total PANSS scores were higher within 3 days of an aggressive incident, as were positive and general psychopathology subscale scores. However, in a smaller subsample for whom PANSS ratings were available within 3 days before aggressive incidents, only scores on the PANSS positive subscale were significantly higher. These findings in chronic, treatment resistant inpatients support the view that positive symptoms may lead to aggression.