PAIN SENSITIVITY AND AFFECTIVE DEFICITS IN SCHIZOPHRENIA

长期以来，情感缺陷一直被认为是 精神分裂症。情感扁平化是唯一的负面症状 包括在每个主要评级标准中，用于评估负面 症状，并基于对研究的有效性的回顾 阳性症状和阴性症状的区别，麦格拉珊和 Fenton(1992)最近建议将平坦影响包括在 DSM-IV中精神分裂症的定义标准。鉴于这一认识 情感缺陷在精神分裂症中的重要性，这是 令人惊讶的是，这些症状的特征一直不太好 描述。最近有人认为，目前的方法是 情感扁平化被社交和神经运动缺陷所混淆 在精神分裂症中也很普遍(德沃金，1992)。如果 情感缺陷的神经生物学和心理过程 是应该理解的，检查情感扁平化的方法 相对不受社会和神经运动过程的困扰 发展起来的。精神分裂症患者疼痛不敏感的调查 研究情感扁平化就是这样一种方法。对……不敏感 据报道，精神分裂症患者经常出现疼痛，但 这一现象从未被系统地研究过。初级阶段 这项拟议研究的目的是仔细描述疼痛的特征。 精神分裂症的不敏感及其与情感性的关系 展平并检查这两个变量之间的关系 以及社交和神经运动缺陷。这将使测试成为可能 认为疼痛麻木不仁是情绪化的表现的假设 精神分裂症患者的扁平化，这一点相对独立于 社会和神经运动过程。此外，数据将使它 有可能评估不同情感测量方法的程度 缺陷与社会和神经运动缺陷混为一谈，这将 不仅使情感的概念更加清晰 扁平化在精神分裂症中的作用，但也会提高结构效度 关于其评估的方法。拟议中的研究还具有 对精神分裂症患者福利的重要影响； 大量的临床报告表明，疼痛不敏感是非常 对精神分裂症患者的健康有害，并可能危及生命 后果，以及疼痛麻木不仁也可能解释各种自我 精神分裂症患者的伤害性行为， 包括无家可归的精神分裂症患者行为的某些方面。一个 更完整地描述疼痛、不敏感和情感 精神分裂症患者的扁平化不仅有助于调查 他们潜在的神经生物学和心理过程，但 也应该能够开发出更有效的方法来 改善这些重要症状及其负面后果 精神分裂症患者的健康和福祉。

Affective deficits have long been considered a prominent feature of schizophrenia. Affective flattening is the only negative symptom included in every major rating scale for the assessment of negative symptoms, and based on a review of research addressing the validity of the distinction between positive and negative symptoms, McGlashan and Fenton (1992) recently suggested that flat affect be included among the defining criteria for schizophrenia in DSM-IV. Given this recognition of the importance of affective deficits in schizophrenia, it is surprising that the characteristics of these symptoms have not been well described. It has recently been argued that current approaches to affective flattening are confounded by the social and neuromotor deficits that are also prevalent in schizophrenia (Dworkin, 1992). If the neurobiological and psychological processes underlying affective deficits are to be understood, approaches for examining affective flattening that are relatively unconfounded by social and neuromotor processes must be developed. The investigation of pain insensitivity in schizophrenia is one such approach to examining affective flattening. Insensitivity to pain has been reported frequently in individuals with schizophrenia, but this phenomenon has never been systematically investigated. The primary aims of the proposed research are to carefully characterize pain insensitivity in schizophrenia and its relationship to affective flattening and to examine the relationships between these two variables and social and neuromotor deficits. This will make it possible to test the hypothesis that pain insensitivity is a manifestation of affective flattening in schizophrenia, one which is relatively independent of social and neuromotor processes. In addition, the data will make it possible to evaluate the extent to which different measures of affective deficits are confounded with social and neuromotor deficits, which will not only lead to greater clarity in the conceptualization of affective flattening in schizophrenia but will also improve the construct validity of approaches to its assessment. The proposed research also has important implications for the welfare of individuals with schizophrenia; numerous clinical reports have suggested that pain insensitivity is very detrimental to health in schizophrenia and can have life-threatening consequences, and pain insensitivity may also account for various self- injurious behaviors that are found in individuals with schizophrenia, including some aspects of the behavior of homeless schizophrenics. A more complete characterization of pain insensitivity and affective flattening in schizophrenia will not only facilitate the investigation of their underlying neurobiological and psychological processes, but should also make it possible to develop more effective methods for ameliorating these important symptoms and their negative consequences for the health and well-being of individuals with schizophrenia.