Hostname: page-component-cd9895bd7-fscjk Total loading time: 0 Render date: 2024-12-28T19:54:11.220Z Has data issue: false hasContentIssue false
  • English
  • Français

La relación entre factores predisponentes, función premórbida y dimensiones de síntomas en la psicosis: un enfoque integrado

Published online by Cambridge University Press:  12 May 2020

Almudena Guerra ,
Paul Fearon ,
Pak Sham ,
Peter Jones ,
Shon Lewis ,
Ignacio Mata  and
Robin Murray
Almudena Guerra
Affiliation:
Gerencia Torribera, Santa Coloma de Gamanera, Barcelona, España
Paul Fearon
Affiliation:
Instituto de Psiquiatría, Londres, Reino Unido
Pak Sham
Affiliation:
Instituto de Psiquiatría, Londres, Reino Unido
Peter Jones
Affiliation:
Departamento de Psiquiatría, Universidad de Cambridge, Reino Unido
Shon Lewis
Affiliation:
MRCPsych, Departamento Universitario de Psiquiatría, Hospital Withington, Manchester, Reino Unido
Ignacio Mata
Affiliation:
Hospital Virgen del Camino, Pamplona, España
Robin Murray
Affiliation:
Instituto de Psiquiatría, Londres, Reino Unido
Get access

Resumen

Antecedentes:

Cada vez más datos indican que la psicosis se puede enfocar más significativamente desde un punto de vista dimensional que como estados cualitativos discretos, y que se pueden identificar grupos de síntomas específicos. Si es así, factores de riesgo particulares y factores premórbidos pueden predecir estos grupos de síntomas.

Propósitos:

(I) Explorar, utilizando el análisis de componentes principales, si se pueden aislar factores específicos para los síntomas psicóticos. (II) Establecer los predictores de los diferentes factores de síntomas utilizando técnicas de regresión múltiple.

Método:

Se seleccionó a 189 pacientes hospitalizados con enfermedad psicótica y se obtuvo de ellos y de sus madres información sobre los antecedentes familiares, los factores premórbidos y los síntomas actuales.

Resultados:

Se identificaron siete componentes de síntomas distintos. El análisis de regresión no identificó ningún predictor evolutivo de la depresión o la manía. Los antecedentes familiares de esquizofrenia y el mal funcionamiento escolar a pesar de un CI premórbido normal predecían las ideas delirantes/alucinaciones (F = 6,5; P < 0,001); el comienzo temprano de la enfermedad, el retraso evolutivo y los antecedentes familiares de psicosis predecían los síntomas negativos (F = 4,1; P = 0,04). De modo interesante, la combinación de antecedentes familiares de trastorno bipolar y CI premórbido bajo predecía la desorganización (F = 4,9; P < 0,003), y las complicaciones obstétricas (CO) y el mal funcionamiento escolar predecían la paranoia (F = 4,2; P < 0,01).

Conclusión:

Las ideas delirantes y las alucinaciones, los síntomas negativos y la paranoia parecían tener un origen evolutivo, aunque se asociaban con problemas infantiles diferentes. Por otra parte, ni la manía ni la depresión se asociaban con disfunción en la infancia. Nuestro hallazgo más sorprendente fue que la desorganización parecía surgir cuando una predisposición familiar a la manía se combinaba con CI premórbido bajo.

Keywords

dimensiónfactorintegradopremórbidopsicosissíntoma
Type
Artículo original
Information
European Psychiatry (Ed. Española) , Volume 10 , Issue 2 , March 2003 , pp. 81 - 91
Copyright
Copyright © European Psychiatric Association 2003

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Bibliografía

Andreasen, N. C.Rice, J. P.Endicott, J., et al.The familial history approach to diagnosis. How useful is it? Arch Gen Psychiatry 1986;43:421-9.CrossRefGoogle Scholar
Brown, R.Colter, N.Corsellis, JAN, et al.Postmortem evidence of structural brain changes in schizophrenia: differences in brain weight, temporal horn area, and parahippocampal gyrus compared with affective disorder. Arch, Gen Psychiatry 1986;43:36–42.CrossRefGoogle ScholarPubMed
Cannon-Spoor, H. E.Potkin, S. G.Wyatt, R. J.Measurement of premorbid adjustment in chronic schizophrenia. Schizophr Bull 1982;3:470-84.CrossRefGoogle Scholar
Castle, D. J.Murray, R. M.The neuro-developmental basis of sex differences in schizophrenia. Psychol Med 1991;21 (3):565-75.CrossRefGoogle Scholar
Crow, T. J.Done, D. J.Sacker, A.Childhood precursora of psychosis as clues to its evolutionary origins. Eur Arch Psychiatry Clin. Neurosci 1995;245:61-9.CrossRefGoogle Scholar
Fananas, L.van Os, J.Hoyos, C., et al.Dermatoglyphic a-b ridge count as a possible marker for developmental disturbance in schizophrenia: replication in two samples. Schizophr Res 1996;20:307-14.CrossRefGoogle ScholarPubMed
Feinberg, I.Schizophrenia: caused by a fault in programmed synaptic elimination during adolescence? J Psychiatry Res 1982;17:319-34.Google ScholarPubMed
Fish, B.Marcus, J.Hans, S. L., et al.Infants at risk for schizophrenia: sequelae of a genetic neurointegrative defect. Arch Gen Psychiatry 1992;49:221-35.CrossRefGoogle ScholarPubMed
Foerster, A.Lewis, S. W.Owen, M. J., et al.Low birth weight and a family history of schizophrenia predict poor premorBid functioning in psychosis. Schizophr Res 1991;5:13–20.CrossRefGoogle Scholar
Foerster, A.Lewis, S. W.Owen, M. J., et al.Pre-morbid adjustment and personality in psychosis: effects of sex and diagnosis. Br J Psychiatry 1991;158:171-6.CrossRefGoogle ScholarPubMed
Geddes, J. R.Verdoux, H.Takei, N., et al.Schizophrenia and complications of pregnancy and labor: an individual patient data meta-analysis. Schizophr Bull 1999;25(3):413.Google ScholarPubMed
Johnstone, E. C.Frith, C. D.Validation of three dimensions of schizophrenic symptoms in a large unselected sample of patients. Psychol Med 1996;26:669-79.CrossRefGoogle Scholar
Jones, P. B.Bebbington, P.Foerster, A., et al.Premorbid social under achievement in schizophrenia: results from the Camberwell collaborative psychosis study. Br J Psychiatry 1993;162:65–71.Google Scholar
Jones, P. B.Rodgers, B.Murray, R. M., et al.Child developmental risk factors for adult schizophrenia in the British birth cohort. Lancet 1994;344:1398-402.CrossRefGoogle Scholar
Jones, P. B.Done, D. J.From birth to onset: a developmental perspective of schizophrenia in two national birth cohorts. In: Keshavan, M. S.Murray, R., editors. Neurodevelopment and Adult Psychopathology. Cambridge: Cambridge University Press; 1997, p. 119-36.Google Scholar
Kelly, J.Murray, R. M.A century of schizophrenia is enough. In: Maj, M.Sartorius, N., editors. Evidence and Experience in Psychiatry, Schizophrenia, vol. 2. WPA. Wiley; 1999.Google Scholar
Keshavan, M. S.Anderson, S.Pettegrew, J. W.Is schizophrenia due to excessive synaptic pruning in the prefrontal cortex? The Feinberg hypothesis revisited. J Psychiatric Res 1994;28(3):239-65.CrossRefGoogle ScholarPubMed
Lañe, A.Kinsella, A.Murphy, P., et al.The anthropometric assessment of dysmorphic features in schizophrenia as an index of its developmental origins. Psychol Med 1997:27(5):1155-61.CrossRefGoogle ScholarPubMed
Lewis, S. W.Murray, R. M.Obstetric complications, neurodevelopmental deviance, and risk of schizophrenia. J Psychiatric Res 1987;4:413-21.Google Scholar
Liddle, P. F.The symptoms of chronic schizophrenia. A reexamination of the positive-negative dichotomy. Br J Psychiatry 1987;151:145-51.CrossRefGoogle Scholar
Murray, R. M.Lewis, S. W.Is schizophrenia a neurodevelopmental disorder? Br Med J 1987;295:681-2.CrossRefGoogle ScholarPubMed
Murray, R. M.O'Callaghan, E.Castle, D. J., et al.A neurodevelopmental approach to the classification of schizophrenia. Schizophr Bull 1992;2:319-32.CrossRefGoogle Scholar
Nelson, H. E.National Adult Reading Test. Test Manual. Windsor, Berks: NFER-Nelson; 1982.Google Scholar
O'Callaghan, E.Larkin, C.Waddington, J. L.Obstetric complications in schizophrenia and the validity of maternal recall. Psychol Med 1990;20:89–94.CrossRefGoogle ScholarPubMed
Peralta, V.de Leon, J.Cuesta, M. J.Are there more than two syndromes in schizophrenia? A critique of the positivenegative dichotomy. Br J Psychiatry 1992;161:335-43.CrossRefGoogle Scholar
Perneger, T. V.What's wrong with Bonferroni adjustments. Br Med J 1998;316:1236-8.Google ScholarPubMed
Pogue-Geile, M. F.Developmental aspects of schizophrenia. In, Keshavan, M. S.Murray, R., editors. Neurodevelopment and Adult Psychopathology. Cambridge: Cambridge University Press; 1997, p. 137-54.Google Scholar
Sham, P. C.Jones, P. B.Russell, A., et al.Age at onset, sex, and familial psychiatric morbidity in schizophrenia. Camberwell collaborative psychosis study. Br J Psychiatry 1994;l65:Google Scholar
Spitzer, R. L.Endicott, J.Robbins, E.Research diagnostic criteria (RDC) for a selected group of functional psychoses. 3 rd ed. New York: Biometrics Research Division, New York State Psychiatric Institute; 1978.Google Scholar
Stewart, A. L.Rifkin, L.Amess, P. N., et al.Brain structure and neurocognitive and behavioural function in adolescents who were born very preterm. Lancet 1999;353(9l65):1653-7.CrossRefGoogle ScholarPubMed
van Os, J.Fahy, T. A.Jones, P. B., et al.Psychopathological syndromes in the functional psychoses: associations with course and outcome. Psychol Med 1996;26:161-76.CrossRefGoogle ScholarPubMed
van Os, J.Jones, P. B.Lewis, G., et al.Developmental precursora of affective illness in a general population birth cohort. Arch Gen Psychiatry 1997;54:625-31.CrossRefGoogle Scholar
van Os, J.Bijl, R.Ravelli, A.Strauss (1969) revisited: a psychosis continuum in the general population? Schizophr Res 2000;4l:18.Google Scholar
Walsh, C.Asherson, P.Casde, D., et al.Age of onset of schizophrenia in multiply affected families is early and shows no sex difference. In: Holliday, S. G.Ancil, R. J.MacEwan, G. W., editors. Schizophrenia: Breaking Down the Barriers. New york: John Wiley; 1996, p. 81–97.Google Scholar
Weinberger, D. R.Implications of normal brain development for the pathogenesis of schizophrenia. Arch Gen Psychiatry 1987;44:660-9.CrossRefGoogle ScholarPubMed
Wing, J. K.Cooper, J. E.Sartorius, N.The measurement and classification of psychiatric symptoms. Cambridge: Cambridge University Press; 1974.Google Scholar
Wright, I. C.Rabe-Hesketh, S.Woodruff, P. W.David, A. S.Murray, R. M.Bullmore, E. T.Meta-analysis of regional brain volumes in schizophrenia. Am J Psychiatry 2000;157(1):l6–25.Google Scholar
Wykes, T.Can the psychiatrist learn from the psycholinguist? Detecting coherence in the disordered speech of manics and schizophrenics. Psychol Med 1981;11(3):641-2.CrossRefGoogle Scholar