THE NEGATIVE DIMENSION AT THE ONSET OF SCHIZOPHRENIA - CORRELATIONS WITH PREMORBID AND PRODROMAL PHASES - Dimensiunea negativa la debutul schizofreniei - corelatii cu etapele premorbide si prodromale - Camelia Petcu, Cristina Dude

Camelia Petcu*, Cristina Dude**

 

Abstract

Objective: The differentiation of the negative symptoms at the onset of schizophrenia could facilitate the establishment of an adequate diagnosis and of an effective treatment, which could influence the long-term prognosis of the disorder.

Method: The presenting paper is a part of an ampler research which was realized on 139 patients having the diagnosis of schizophrenia, evaluated during the first admission in the psychiatric hospital and a subsequent episode, through clinical interview and clinical evaluation scales. There was made the correlation of the negative dimension between the two disease episodes and also with vulnerability factors from the premorbid and prodromal phases.

Results: The negative symptomatology statistically significantly correlated to: socio-professional disinsertion, some vulnerability factors, the residual negative symptoms, depression, neuroleptics’ side effects. There was a predominance of higher scores for negative symptoms items in the second episode toward the first. The prodrome, having especially negative-type manifestations and a duration of at least a year, was observed in the most of the patients.

 Conclusions: The data obtained suggest that there can be described a premorbid negative dimension, which includes the negative-type personality traits, the primary negative and defective symptoms during the episodes which interfere with the negative symptoms secondary to the antipsychotic therapy and with the depressive manifestations, the negative dimension being the most temporally stable. The negative syndrome represents a valuable psychopathologic diagnostic dimension, especially for the early evolution stages.

Key words: schizophrenia, negative symptoms, premorbid phase, prodromal phase.

 

Rezumat

Obiective: Diferentierea simptomelor negative la debutul schizofreniei ar putea facilita stabilirea unui diagnostic adecvat si a unui tratament eficient, care ar putea influenta prognosticul pe termen lung al schizofreniei.

Metode: Lucrarea de fata face parte dintr-un studiu mai amplu realizat pe un lot de 139 de pacienti cu diagnosticul de schizofrenie evaluati la prima internare la psihiatrie si într-un episod ulterior, prin interviu clinic si scale clinice de evaluare. S-a realizat corelarea dimensiunii negative între cele 2 episoade de boala si cu factori de vulnerabilitate din  perioadele premorbida si prodromala.

Rezultate: S-au observat o serie de corelatii semnificative statistic între simptomatologia negativa si dezinsertia socio-profesionala, unii factori de vulnerabilitate, simptomele negative reziduale, depresie, efectele adverse ale neurolepticelor. S-au constatat o predominanta a scorurilor mai mari pentru itemii de simptome negative la al doilea episod fata de primul si prezenta prodromului, mai ales cu manifestari de tip negativ si durata de cel putin un an, la marea majoritate a pacientilor.

Concluzii: Datele obtinute sugereaza faptul ca se poate descrie o dimensiune negativa premorbida, care include trasaturile de personalitate de tip negativ, simptomele negative si deficitare primare din cursul episoadelor, care interfera cu simptomele negative secundare terapiei antipsihotice si cu manifestarile depresive, dimensiunea negativa fiind cea mai stabila temporal. Sindromul negativ reprezinta o dimensiune psihopatologica diagnostica valoroasa, mai ales pentru etapele precoce de evolutie.

Cuvinte cheie: schizofrenie, simptome negative,  faza premorbida,  faza prodromala

 

* Asistent Universitar Dr.  Universitatea de Medicina si Farmacie “Carol Davila” Bucuresti, medic primar psihiatru Spitalul Clinic “Prof. Dr. Alexandru Obregia” Bucuresti

** medic rezident psihiatrie Spitalul Clinic “Prof. Dr. ”Alexandru Obregia” Bucuresti, cristinadude@yahoo.com

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