Positive and negative symptoms in schizophrenia: where are the data?
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Biomedical subjects
Publications and source records attributed to V Peralta.
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A study was carried out on a group of 95 schizophrenic patients (DSM-III-R criteria) under the age of 35, 23 of whom were cannabis abusers in the past year. The objective of the study was to evaluate the effect of cannabis on positive and negative schizophrenic symptoms, evaluated using Andreasen's Scales for the Assessment of Positive and Negative Symptoms (SAPS and SANS). There were no statistically significant differences between the groups on the SAPS; the group of cannabis abusers had higher scores except for the delusions subscale. On the SANS nonabusers scored higher, with a significant difference on the alogia subscale. The results suggest that the consumption of cannabis by schizophrenic patients could attenuate negative symptoms, which would support the self-medication hypothesis of cannabis abuse.
The relationship between the self-perceived cognitive disorders (SPCD) assessed using the Frankfurt Complaint Questionnaire (FCQ) and 21 definitions of schizophrenia was studied in a sample of 118 consecutively admitted patients. The FCQ total score was significantly associated (p < 0.05) with the presence of Schneider's, Yusin's and Present State Examination criteria of schizophrenia. A significant association, in this case negative, was also found between the FCQ total score and the presence of the DSM-III-R criteria of schizophrenia. The results suggest that the SPCDs are more associated with Schneider-related criteria than with chronic or deficit models of schizophrenia. It was also found that the female sex as well as the presence of insight were significantly associated with a greater number of SPCDs.
A sample of 115 DSM-III-R schizophrenics was studied by means of the SANS and SAPS. A factor analysis from the nine subscales and two symptoms (inappropriate affect and poverty of content) and a review of the previous factor analyses suggest that schizophrenic symptoms cannot be appropriately classified into positive and negative syndromes. The low internal consistency of the SAPS suggests that the positive symptoms are not a homogeneous syndrome. Our results fit better with Liddle's model of three syndromes (negative, delusion-hallucination and disorganisation syndromes). It is argued that we are far from a valid classification of schizophrenic symptoms and the positive-negative dichotomy appears to be an oversimplification.
The relationship between premorbid personality and schizophrenic symptoms assessed by the Scales for the Assessment of Positive and Negative Symptoms was explored in 115 DSM-III-R schizophrenics. The frequencies of normal, schizoid-schizotypal and other DSM-III-R personality disorders were 44%, 39% and 17%. Affective flattening and alogia were significantly more frequently present and severe in the schizoid-schizotypal group than in the rest of the patients. There were no differences in positive symptoms. It is suggested that, in some cases, negative symptoms are merely the persistence or exacerbation of schizoid traits present prior to the emergence of schizophrenic symptoms. These results should be cautiously interpreted because the premorbid personality was diagnosed in a retrospective way and the negative symptoms were assessed cross-sectionally.
Using the 'polydiagnostic approach' method, the relationship between basic symptoms (BS) and Bleulerian and Schneiderian types of schizophrenia is studied. Eighty-six schizophrenic patients (RDC criteria) were studied using the Frankfurt Complaint Questionnaire for the evaluation of the BS. The patients were classified according to the type of symptoms predominant in Schneiderian (n = 32), Bleulerian (n = 12) and mixed (n = 42) schizophrenics. The patients with Schneiderian and mixed schizophrenia displayed more BS than those having Bleulerian schizophrenia. Significant differences (p less than or equal to 0.05) were found on the subscales of Perception (simple), Language, Memory, Motoric and Loss of automatism, in factors 1, 2 and 4, and in the total score. The results suggest that, from the perspective of the BS, Schneiderian schizophrenia is different from Bleulerian and that the BS may have the same production mechanisms as Schneider's FRS, the difference between them being in the different degree of phenomenological expression.
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The Thought, Language and Communication Scale (TLC) was studied in a sample composed of 115 DSM-III-R schizophrenic patients admitted to an acute inpatient unit. A principal component analysis with varimax rotation was performed to explore the possibility of the existence of syndromes within the formal thought disturbances. Seven factors were found to have eigen values greater than 1 and five showed appropriate internal consistency. The first factor, or disorganization factor, was close to the Scale for the Assessment of Positive Symptoms (SAPS) formal thought disturbance subscale. The second, or negative factor (perseveration, poverty of speech and content), was moderately correlated with poor premorbid functioning and poor response to neuroleptic treatment. The third and fourth factors were, respectively, formed by stilted speech plus word approximations, and neologisms plus clanging. The fifth factor (distractibility and blocking), as well as the first two factors, were correlated to the Scale for the Assessment of Negative Symptoms (SANS) attention subscale.
In a sample of 71 Research Diagnostic Criteria (RDC) schizophrenic patients, the relationship among the basic symptoms measured by the Frankfurt Complaint Questionnaire and Andreasen and Olsen's types of schizophrenia was studied. The results do not support an overlap between negative and basic symptoms; rather, basic symptoms appear to be more frequent in patients with positive symptoms. Basic symptoms were consistently correlated to formal thought disturbances, but the values were only moderate (r = .3).