Previous research has identified (1) a "deficit" subtype of schizophrenia characterized by enduring negative symptoms and diminished emotionality and (2) a "distress" subtype associated with high emotionality-including anxiety, depression, and stress sensitivity. Individuals in deficit and distress categories differ sharply in development, clinical course and behavior, and show distinct biological markers, perhaps signaling different etiologies. We tested whether deficit and distress subtypes would emerge from a simple but novel data-driven subgrouping analysis, based on Positive and Negative Syndrome Scale (PANSS) negative and distress symptom dimensions, and whether subgrouping was informative regarding other facets of behavior and brain function. PANSS data, and other assessments, were available for 549 people with schizophrenia diagnoses. Negative and distress symptom composite scores were used as indicators in 2-step cluster analyses, which divided the sample into low symptom (n = 301), distress (n = 121), and deficit (n = 127) subgroups. Relative to the low-symptom group, the deficit and distress subgroups had comparably higher total PANSS symptoms (Ps < .001) and were similarly functionally impaired (eg, global functioning [GAF] Ps < .001), but showed markedly different patterns on symptom, cognitive and personality variables, among others. Initial analyses of functional magnetic resonance imaging (fMRI) data from a 182-participant subset of the full sample also suggested distinct patterns of neural recruitment during working memory. The field seeks more neuroscience-based systems for classifying psychiatric conditions, but these are inescapably behavioral disorders. More effective parsing of clinical and behavioral traits could identify homogeneous target groups for further neural system and molecular studies, helping to integrate clinical and neuroscience approaches.

译文

:先前的研究已经发现(1)精神分裂症的“缺陷”亚型,其特征在于长期存在负面症状和情绪低落;(2)与情绪高昂相关的“窘迫”亚型,包括焦虑,抑郁和压力敏感性。处于赤字和窘迫类别的个体在发育,临床过程和行为上存在显着差异,并显示出不同的生物学标记,也许表明了不同的病因。我们基于正面和负面综合症量表(PANSS)的负面和困扰症状维度,测试了从简单但新颖的数据驱动亚组分析中是否会出现赤字和困扰亚型,以及该亚组是否在其他方面的行为和脑功能方面提供了信息。共有549例精神分裂症患者获得了PANSS数据和其他评估。消极和困扰症状综合评分被用作两步聚类分析的指标,将样本分为低症状(n = 301),困扰(n = 121)和缺陷(n = 127)亚组。相对于低症状组,缺陷和窘迫亚组的总PANSS症状相对较高(Ps <.001),并且功能受损(例如,整体功能[GAF] Ps <.001),但在症状,认知和人格变量等。来自完整样本的182名参与者子集的功能磁共振成像(fMRI)数据的初步分析还表明,在工作记忆过程中神经募集的独特模式。该领域正在寻求更多基于神经科学的系统来对精神疾病进行分类,但是这些都是不可避免的行为障碍。对临床和行为特征的更有效解析可以为进一步的神经系统和分子研究确定均一的目标人群,从而有助于整合临床和神经科学方法。

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