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Three syndromes in schizophrenia: validity in young patients with recent onset of illness

Published online by Cambridge University Press:  09 July 2009

O. Gureje*
Affiliation:
Department of Psychiatry, University College Hospital, Ibadan, Nigeria
Y. A. Aderibigbe
Affiliation:
Department of Psychiatry, University College Hospital, Ibadan, Nigeria
O. Obikoya
Affiliation:
Department of Psychiatry, University College Hospital, Ibadan, Nigeria
*
1Address for correspondence: Dr Oye Gureje, Department of Psychiatry. University College Hospital, PMB 5116, Ibadan, Nigeria.

Synopsis

The heterogeneity of schizophrenia constitutes an impediment in the identification of reliable biological markers of the illness and aetiological factors. The two syndrome concept of the illness has proved a powerful stimulus in this endeavour. There is however evidence now to regard this construct as inadequate and in need of refinement. Using a sample of young patients with early onset of illness who fulfilled the Research Diagnostic Criteria for schizophrenia, we have shown that three rather than two dimensions better describe the pathology of the illness. The results of factor analysis showed these syndromes, termed disorganization, positive, and negative syndromes, to account for 65% of the total variance of the psychopathology of the disorder. The negative syndrome was associated with disturbed pre-morbid functioning while the disorganization syndrome bore significant association with early onset of illness, poorer socio-educational attainment, and impairment on neuropsychological tests, especially those designed to evaluate frontal lobe functioning. The positive syndrome was not associated with any of the assessed variables. These results provide strong support for the validity of the three-syndrome construct even among a sample of non-institutionalized patients.

Type
Original Articles
Copyright
Copyright © Cambridge University Press 1995

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References

Andreasen, N. C. (1979). The clinical assessment of thought, language and communication. I. The definition of terms and assessment of their reliability. Archives of General Psychiatry 36, 13151320.CrossRefGoogle ScholarPubMed
Andreasen, N. C. (1982). Negative symptoms in schizophrenia: definitions and reliability. Archives of General Psychiatry 39, 784789.CrossRefGoogle ScholarPubMed
Andreasen, N. C. (1989). Neural mechanisms of negative symptoms. British Journal of Psychiatry 155 (suppl. 7), 9398.CrossRefGoogle Scholar
Andreasen, N. C. & Olsen, S. A. (1982). Negative vs positive schizophrenia: definition and validation. Archives of General Psychiatry 39, 789794.CrossRefGoogle Scholar
Andreasen, N. C., Flaum, M., Swayze, V. W. II, Tyrell, G. & Arndt, S. (1990). Positive and negative symptoms in schizophrenia: a critical reappraisal. Archives of General Psychiatry 47, 615621.CrossRefGoogle ScholarPubMed
Arndt, S., Alliger, R. A. & Andreasen, N. C. (1991). The distinction of positive and negative symptoms: the failure of a two-dimensional model. British Journal of Psychiatry 158, 317322.CrossRefGoogle ScholarPubMed
Barnes, T. R. E. & Liddle, P. F. (1990). Evidence for the validity of negative symptoms. Modern Problems in Pharmacopsychiatry 24, 4372.CrossRefGoogle ScholarPubMed
Bellack, A. S., Morrison, R. L., Wixted, J. T. & Mueser, K. T. (1990). An analysis of social competence in schizophrenia. British Journal of Psychiatry 156, 809818.CrossRefGoogle ScholarPubMed
Bellak, L. & Strauss, J. S. (1979). The heuristic need for subgroups in schizophrenia. Schizophrenia Bulletin 5, 441442.CrossRefGoogle Scholar
Benton, A. L. & Hamsher, K. D. S.Multilingual Aphasia Examination. University of Iowa: Iowa City.Google Scholar
Bleuler, E. (1911). Dementia Praecox oder die Gruppe der Schizophrenien. Deuticke: Leipzig.Google Scholar
Brown, K. W. & White, T. (1992). Syndromes of chronic schizophrenia and some clinical correlates. British Journal of Psychiatry 161, 317322.CrossRefGoogle ScholarPubMed
Buchanan, R. W., Kirkpartrick, B., Heinrichs, D. W. & Carpenter, W. T. (1990). Clinical correlates of the deficit syndrome of schizophrenia. American Journal of Psychiatry 147, 290294.Google ScholarPubMed
Cannon-Spoor, H. E., Potkin, S. G. & Wyatt, R. J. (1982). Measurement of pre-morbid adjustment in chronic schizophrenia. Schizophrenia Bulletin 8, 470484.CrossRefGoogle Scholar
Cannon, T. D., Mednick, S. A. & Parnas, J. (1990). Antecedents of predominantly negative- and predominantly positive-symptom schizophrenia in a high-risk population. Archives of General Psychiatry 47, 622932.CrossRefGoogle ScholarPubMed
Carpenter, W. T. & Heinrichs, D. W. (1981). Treatment-relevant subtypes of schizophrenia. Journal of Nervous and Menial Diseases 169, 113119.CrossRefGoogle ScholarPubMed
Carpenter, W. T., Bartko, J. J., Langsner, C. A. & Strauss, J. S. (1976). Another view of schizophrenia subtypes: a report from the International Pilot Study of Schizophrenia. Archives of General Psychiatry 33, 508516.CrossRefGoogle ScholarPubMed
Creese, I., Burt, D. R. & Snyder, S. H. (1976). Dopamine receptor binding predicts clinical and pharmacological potencies of anti-psychotic drugs. Science 198, 481483.CrossRefGoogle Scholar
Crow, T. J. (1980). Molecular pathology of schizophrenia: more than one disease process? British Medical Journal 280, 6668.CrossRefGoogle ScholarPubMed
Dworkin, R. H., Lenzenweger, M. F., Moldin, S. O. et al. (1988). A multidimensional approach to the genetics of schizophrenia. American Journal of Psychiatry 145, 10771083.Google Scholar
Fenton, W. S. & McGlashan, T. H. (1991). Natural history of schizophrenia subtypes. I. Longitudinal study of paranoid, hebephrenic and undifferentiated schizophrenia. Archives of General Psychiatry 48, 969977.CrossRefGoogle ScholarPubMed
Grove, W. M. & Andreasen, N. C. (1982). Simultaneous test of many hypotheses in exploratory research. Journal of Nervous and Mental Disease 170, 38.CrossRefGoogle ScholarPubMed
Gur, R. E., Mozley, P. D., Resnick, S. M., Levick, S., Erwin, R., Saykin, A. J. & Gur, R. C. (1991). Relations among clinical scales in schizophrenia. American Journal of Psychiatry 148, 472478.Google ScholarPubMed
Gureje, O. (1988). Topographic subtypes of tardive dyskinesia in schizophrenic patients aged less than 60 years: relationship to demographic, clinical, treatment and neuropsychological variables. Journal of Neurology, Neurosurgery and Psychiatry 51, 15251530.CrossRefGoogle ScholarPubMed
Gureje, O. (1989). Correlates of positive and negative schizophrenic syndromes in Nigerian patients. British Journal of Psychiatry 155, 628632.CrossRefGoogle ScholarPubMed
Jones-Gotman, M. & Milner, B. (1977). Design fluency: the invention of nonsense drawings after focal cortical lesions. Neuropsychologia 15. 653674.CrossRefGoogle ScholarPubMed
Kay, S. R. (1990). Significance of the positive–negative distinction in schizophrenia. Schizophrenia Bulletin 16, 635652.CrossRefGoogle ScholarPubMed
Kendler, K. S. & Hays, P. (1982). Schizophrenia with premorbid inferiority feelings: a distinct subgroup? Archives of General Psychiatry 39. 643647.CrossRefGoogle ScholarPubMed
Kraepelin, E. (1919). Psychiatrie, 8th edn. (Translated by Barclay, R. M., 1919 from vol. 3. part 2 as Dementia Praecox and Paraphrenia.) Livingstone: Edinburgh.Google Scholar
Lezak, M. D. (1983). Neuropsychological Assessment. Oxford University Press: New York.Google Scholar
Liddle, P. F. (1987 a). The symptoms of chronic schizophrenia: a re-examination of the positive–negative dichotomy. British Journal of Psychiatry 151, 145151.CrossRefGoogle ScholarPubMed
Liddle, P. F. (1987 b). Schizophrenic syndromes, cognitive performance and neurological dysfunction. Psychological Medicine 17, 4957.CrossRefGoogle ScholarPubMed
Liddle, P. F. & Morris, D. L. (1991). Schizophrenic syndromes and frontal lobe performance. British Journal of Psychiatry 158, 340345.CrossRefGoogle ScholarPubMed
Lindemayer, J. P., Kay, S. R. & Oplear, L. A. (1984). Positive and negative subtypes in acute schizophrenia. Comprehensive Psychiatry 25. 455464.CrossRefGoogle Scholar
McGhie, A. & Chapman, J. (1961). Disorders of attention and perception in early schizophrenia. British Journal of Medical Psychology 34, 103116.CrossRefGoogle ScholarPubMed
McGlashan, S. T. H. & Fenton, W. S. (1991). The positive–negative distinction in schizophrenia: review of natural history validators. Archives of General Psychiatry 48, 985993.Google Scholar
Mirsky, A. F. (1977). Behavioural and electrographic measures of attention in children at risk for schizophrenia. Journal of Abnormal Psychology 86, 2733.Google Scholar
Mirsky, A. F. & Duncan, C. C. (1986). Etiology and expression of schizophrenia: neurobiological and psychosocial factors. Annual Review of Psychology 37, 291319.CrossRefGoogle ScholarPubMed
Mortimer, A. M., Lund, C. E. & McKenna, P. J. (1990). The positive–negative dichotomy in schizophrenia. British Journal of Psychiatry 157, 4149.CrossRefGoogle ScholarPubMed
Nelson, H. E. (1976). A modified card sorting test sensitive to frontal lobe defects. Cortex 12, 313324.CrossRefGoogle ScholarPubMed
Newcomb, F. (1969). Missile Wounds of the Brain. Oxford University Press: Oxford.Google Scholar
Overall, J. E. & Gorham, D. R. (1962). The brief psychiatric rating scale. Psychological Reports 10, 700812.CrossRefGoogle Scholar
Owen, F., Cross, A. J., Crow, T. J., Longen, A., Poulter, M. & Riley, G. J. (1978). Increased dopamine receptor sensitivity and monoamine metabolites in schizophrenic patients and healthy volunteers. Lancet ii, 223225.CrossRefGoogle Scholar
Peralta, V., de Leon, J. & Cuesta, M. J. (1992). Are there more than two syndromes in schizophrenia? A critique of the positive–negative dichotomy. British Journal of Psychiatry 161, 335343.CrossRefGoogle ScholarPubMed
Pogue-Geile, M. F. & Harrow, M. (1984). Negative and positive symptoms in schizophrenia and depression: a follow-up. Schizophrenia Bulletin 10, 371387.CrossRefGoogle Scholar
Randrup, A. & Munkvad, I. (1965). Special antagonism of amphetamine-induced abnormal behavior: inhibition of stereotyped activity with increase of some normal activity. Psychopharmacologia 7, 416422.CrossRefGoogle Scholar
Reitan, R. M. (1958). The relation of the trail making test to organic brain damage. Journal of Consulting Psychology 19, 393394.CrossRefGoogle Scholar
Shakow, D. (1963). Psychological deficit in schizophrenia. Behavioural Science 8, 275305.CrossRefGoogle ScholarPubMed
Spitzer, R. L., Endicott, J. & Robins, E. (1978). Research Diagnostic Criteria (RDC) for a Selected Group of Functional Disorders (3rd edn.). New York State Psychiatric Institute: New York.Google Scholar
Walker, E. & Lewine, R. J. (1988). The positive/negative symptom distinction in schizophrenia. Validity and etiological relevance. Schizophrenia Research 1, 315328.CrossRefGoogle ScholarPubMed
Wechsler, D. A. (1945). Standardized memory scale for clinical use. Journal of Psychology 19, 8795.CrossRefGoogle Scholar
Weinberger, D. R., Wagmer, R. L. & Wyatt, R. J. (1983). Neuropathological studies of schizophrenia: a selective review. Schizophrenia Bulletin 9, 193212.CrossRefGoogle ScholarPubMed
Withers, E. & Hinton, J. (1971). Three forms of the clinical test of the sensorium and their reliability. British Journal of Psychiatry 119, 18.CrossRefGoogle Scholar
World Health Organization – Alcohol, Drug and Mental Health Administration (1987). Composite International Diagnostic Interview. World Health Organization: Geneva.Google Scholar