快感缺乏的不同成分在精神分裂症谱系障碍中的受损特点

Severity of different factors of anhedonia in patients with schizophrenia spectrum disorders

目的:探索快感缺乏的不同成分(消费性快感缺乏和抽象性消费快感)在精神分裂症谱系障碍(超高危、急性期和稳定期)中的严重程度和特点。方法:选取符合精神病风险综合征诊断标准的22例超高危患者(超高危组)、符合美国精神障碍诊断与统计手册第4版诊断标准的23例精神分裂症首次发病的急性期患者(急性期组)和18例精神分裂症稳定期患者(稳定期组),以及22例正常对照。采用阳性和阴性症状量表(PANSS)评价阳性症状严重程度、阴性症状量表(SANS)评价阴性症状严重程度、愉快情绪体验量表(TEPS)评价快感缺乏严重程度。采用ANOVA检验或非参数检验及其两组间差异的比较分析4组快感缺乏的特点,采用Pearson相关分析快感缺乏自评与他评之间的相关性。结果:超高危组、急性期组患者TEPS消费性快感缺乏得分[(37±9),(34±8)vs.(44±9),P<0.01]和抽象性消费快感缺乏得分[(24±6),(21±7)vs.(28±6),P<0.01]高于正常对照。稳定期组患者与正常对照的TEPS消费性快感缺乏得分和抽象性消费快感缺乏得分的差异无统计学意义(P>0.05)。4组TEPS期待性快感缺乏得分差异无统计学意义(P>0.05)。超高危组和急性期组中,TEPS消费性快感缺乏得分和期待性快感缺乏得分与SANS快感缺乏得分相关无统计学意义(P>0.05)。稳定期组中,TEPS消费性快感缺乏得分和期待性快感缺乏得分与SANS快感缺乏得分高度负相关(r=-0.60^-0.80,均P<0.05)。结论:急性期精神分裂症患者和超高危人群,而非稳定期患者,可能存在明显的消费性快感缺乏而非期待性快感缺乏。快感缺乏的自评和他评结果在急性期精神分裂症患者和超高危人群中可能缺乏一致性,而在稳定期患者中具有一致性。

Objective： To explore the severity and characteristic of different factors （consummatory anhedonia and anticipatory anhedonia） of anhedonia in schizophrenia spectrum disorders （ultra-high-risk, acute and stable）. Methods： Twenty-two ultra-high-risk individuals according to the Structured Interview for Prodromal Syndromes, 23 acute schizophrenia patients, 18 stable schizophrenia patients according to diagnostic and statistical manual of mental disorder-Wand 22 healthy controls were enrolled. The Positive and Negative Syndrome Scale （PANSS） for positive symptom, the Scale for the Assessment of Negative Symptoms（SANS） for negative symptom and the Temporal Ex- perience of Pleasure Scale （TEPS） for anhedonia were administered to the participants. ANOVA test was used to compare the anhedonia of the four groups, and the Pearson correlation was used to evaluate the correlation between self report and clinician rating. Results： Consummatory anhedonia and abstract consummatory anhedonia of TEPS in ultra-high-risk group and acute group were higher than controls [ （37 ＋ 9）, （34 ＋ 8） vs. （44 ＋ 9）, P 〈 0. 01], [（24 ＋ 6）, （21 ＋7） vs. （28 ＋6）, P 〈0.01], which have significant differences. There was no significant difference in the consummatory anhedonia and abstract consummatory anhedonia of TEPS between stable group and control group（P 〉 0. 05）. There was no significant difference in anticipatory anhedonia among four groups（P 〉 0.05）. There was no significant correlation between TEPS and the anhedonia subscale of SANS in the ultra-high-risk group and the acute group（P 〉 0.05）. Consummatory anhedonia and anticipatory anhedonia of TEPS were significantly correlated with anhedonia subscale of SANS （r = -0. 6 - -0. 8） in stable group. Conclusions： Consummatory anhedonia, but not anticipatory anhedonia, may be in ultra-high-risk and acute phrase of schizophrenia individuals, whose self report are not consistent with clinician rating. Consummatory anhedonia may not be in stable patients, whose self report are consistent with clinician rating.