PYRAMIDICAL MODEL OF SCHIZOPHRENIA
PYRAMIDICAL MODEL OF SCHIZOPHRENIA
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DOI：
10.1093/schbul/16.3.537
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发表时间：
1990-01-01
影响因子：
6.6
通讯作者：
SEVY, S
中科院分区：
文献类型：
--
作者：
KAY, SR;SEVY, S
精神分裂症的异质性和缺乏全面评估症状（包括积极和消极方面）的标准化方法，阻碍了精神分裂症的研究和治疗。因此，为了研究症状特征，我们对240名住院精神分裂症患者标准化并实施了一个操作良好的30项精神病学症状量表。主成分分析表明，不相关但非排他综合征的金字塔状三角形模型包含了精神病理学的频谱。消极、积极和抑郁的特征构成三角形基底的不同点，兴奋构成单独的垂直轴。配对综合征可以解释偏执（阳性抑郁）、混乱（阳性-阴性）和紧张（阴性抑郁）诊断亚型的症状。该模型的横向位置表明精神分裂症的极化维度，包括预后轴（抑郁-认知功能障碍）。研究结果表明：(1)阴性和阳性综合征表现出因子效度和与抑郁症的区别，但单独来看，不足以适应症状的全部多样性；(2)精神分裂症亚型源于不相关但共同发生的维度之间的混合，这些维度可能定义了精神病理学的基本要素；(3)金字塔模型具有启发式价值。结果有助于澄清精神分裂症的异质性，并阐明了综合征特异性治疗的途径。
Research and treatment of schizophrenia have been impeded by its heterogeneity and the lack of well-standardized methods for a comprehensive assessment of symptoms, including positive and negative dimensions. To study symptom profiles, therefore, we standardized and administered a well-operationalized 30-item psychiatric symptom scale to 240 schizophrenic inpatients. Principal component analysis suggested a pyramidlike triangular model of uncorrelated but nonexclusive syndromes that encompassed the spectrum of psychopathology. Negative, positive, and depressive features constituted divergent points of a triangular base, and excitement made up a separate vertical axis. Paired syndromes could account for symptoms of the paranoid (positive-depressive), disorganized (positive-negative), and catatonic (negative-depressive) diagnostic subtypes. The transversal positions in this model suggested polarized dimensions in schizophrenia, including a prognostic axis (depression-cognitive dysfunction). The findings imply that (1) negative and positive syndromes show factorial validity and distinction from depression but, alone, are insufficient to accomodate the full diversity of symptoms; (2) schizophrenic subtypes derive from a hybrid between unrelated but co-occurring dimensions that may define the fundamental elements of psychopathology; and (3) the pyramidical model is of heuristic value. The results help to clarify the heterogeneity of schizophrenia and to illuminate the path toward syndrome-specific treatments.