정신분열병의 양성증상 및 음성증상

Positive Symptoms and Negative Symptoms of Schizophrenia

The concept of positive and negative symptoms of schizophrenia introduced by Jackson in 1931, had been ignored by psychiatric professionals. Since Crow and Andreasen tried to prove clinical significance of the concept, it has drawn much clinical attention. Many previous authors attempted to prove this dichotomous concept by cross-sectional study which mostly resulted in affirmative conclusion. However, there is no longitudinal study with follow-up evaluation of the positive and negative symptoms of schizophrenia. The authors attempted to evaluate the validity of the dichotomous concept by cross-sectional study and the stability of the two dimensions by longitudinal study for 12 weeks. Subject of the study was 98 schizophrenics who had been admitted to the Seoul National Mental Hospital from March to July 1987. The subjects were divided into the three groups according to Andreasen’ s classification ; the postitive symptom group(n=35), the negative symptom group(n=18) and the mixed symptom group(n=45). The DSM-III-R was used for diagnostic criterion. Scale for the Assessment of the Positive Symptoms, Scale for the Assessment of the Negative Symptoms, Brief Psychiatric Rating Scale and Mini Mental State Examination were used for symptom evaluation. The results were as follows ; 1) Sociodemographic characteristics, present illness, previous treatment history and hereditary loading showed no significant difference among the three groups. Only premorbid social adjustment was poorer in the mixed symptom group. 2) The patterns of symptom change showed significant difference among the three groups. 3) During the 12 week follow-up, 33 % of the positive symptom group and 34 % of the negative symptom group were retained in their original group. 4) Sixty eight percent of all cases shifted in their symptom to the other groups. Fifty four percent of all cases shifted in their symptom according to Crow’ s hypothetical process of “positive mixed negative another mixed”, and only 15% shifted against the above process. 5) Symptom severity of the positive symptom decreased during the follow-up, whereas that of the negative symptom manifested unchanged. Frequency of positive symptom as a whole decreased and resulted in the increase of negative symptom. 6) Decrease of positive symptom was highly correlated to the decrease of dosage of antipsychotics. Consequently, it was suggested that dichotomous concept of schizophrenia, the positive symptom group and the negative symptom group, is course-related phenomenon rather thanoriginally separated entity.