Kraepelin Was Right: A Latent Class Analysis of Symptom Dimensions in Patients and Controls
Kraepelin Was Right: A Latent Class Analysis of Symptom Dimensions in Patients and Controls
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DOI：
10.1093/schbul/sbq103
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发表时间：
2012-05-01
影响因子：
6.6
通讯作者：
Ophoff, Roel A.
中科院分区：
文献类型：
--
作者：
Derks, Eske M.;Allardyce, Judith;Ophoff, Roel A.
患者和对照组的表型异质性可以解释为什么导致精神分裂症风险的遗传变异只能解释一小部分遗传性。本研究的目的是调查精神病患者，他们的亲属和社区对照样本中精神病症状的定量和定性差异。我们结合因素分析和潜在类别分析，分析4286名受试者的症状综合评估和历史终身评定症状的变化。在子样本中评估Wechsler成人智力量表-智商（N = 2663）和坎伯韦尔需要评估量表（N = 625）。5个连续维度（混乱、阳性、阴性、躁狂和抑郁）的变化由7个同质类（克雷佩利精神分裂症、情感性精神病、躁狂抑郁症、缺陷型无精神病、抑郁症、健康和无症状）的存在解释。85%的精神分裂症患者被分配到Kraepelinian精神分裂症类别（特征是5个维度的高分，低智商和不良结局），而15%的患者被分配到情感性精神病类别（相对较低的混乱和负分，正常智商和良好结局）。在双相情感障碍患者中（91%为双相I型），41%被分配到Kraepelinian精神分裂症类别，44%被分配到情感性精神病类别，10%被分配到躁狂抑郁症类别。在精神病患者和他们的亲属中，潜在的阶级成员资格与智力有关，但在社区对照组中则无关。总之，双相情感障碍的症状异质性比精神分裂症更明显。减少精神病患者和对照组的表型异质性可能有助于病因学研究。
Phenotypic heterogeneity within patients and controls may explain why the genetic variants contributing to schizophrenia risk explain only a fraction of the heritability. The aim of this study is to investigate quantitative and qualitative differences in psychosis symptoms in a sample including psychosis patients, their relatives, and community controls. We combined factor analysis and latent class analysis to analyze variation in Comprehensive Assessment of Symptoms and History lifetime-rated symptoms in 4286 subjects. The Wechsler Adult Intelligence Scale-Intelligence Quotient (N = 2663) and the Camberwell Assessment of Need rating scale (N = 625) were assessed in a subsample. Variation in 5 continuous dimensions (disorganization, positive, negative, mania, and depression) was accounted for by the presence of 7 homogeneous classes (Kraepelinian schizophrenia, affective psychosis, manic-depression, deficit nonpsychosis, depression, healthy, and no symptoms). Eighty-five percent of the schizophrenia patients was assigned to the Kraepelinian schizophrenia class (characterized by high scores on the 5 dimensions, low IQ, and poor outcome) while 15% was assigned to the affective psychosis class (relatively low disorganization and negative scores, normal IQ, and good outcome). In bipolar patients (91% bipolar I), 41% was assigned to the Kraepelinian schizophrenia class, 44% to the affective psychosis class, and 10% to the manic-depression class. Latent class membership was associated with intelligence in psychosis patients and in their relatives but not in community controls. In conclusion, symptom heterogeneity is more pronounced in bipolar disorder compared with schizophrenia. Reducing phenotypic heterogeneity within psychosis patients and controls may facilitate etiological research.