Hostname: page-component-78c5997874-g7gxr Total loading time: 0 Render date: 2024-11-19T04:15:19.544Z Has data issue: false hasContentIssue false

Are There More Than Two Syndromes in Schizophrenia?

A Critique of the Positive-Negative Dichotomy

Published online by Cambridge University Press:  02 January 2018

Victor Peralta
Affiliation:
Psychiatric Unit of the “Virgen del Camino” Hospital, Pamplona, Spain
Jose De Leon*
Affiliation:
Psychiatric Unit of the “Virgen del Camino” Hospital, Pamplona, Spain
Manuel J. Cuesta
Affiliation:
Medical College of Pennsylvania/EPPI, 2300 Henry Avenue, Philadelphia, PA 19129, USA
*
Correspondence

Abstract

A sample of 115 DSM–III–R schizophrenics was studied by means of the SANS and SAPS. A factor analysis from the nine subscales and two symptoms (inappropriate affect and poverty of content) and a review of the previous factor analyses suggest that schizophrenic symptoms cannot be appropriately classified into positive and negative syndromes. The low internal consistency of the SAPS suggests that the positive symptoms are not a homogeneous syndrome. Our results fit better with Liddle's model of three syndromes (negative, delusion-hallucination and disorganisation syndromes). It is argued that we are far from a valid classification of schizophrenic symptoms and the positive-negative dichotomy appears to be an oversimplification.

Type
Papers
Copyright
Copyright © 1992 The Royal College of Psychiatrists 

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

American Psychiatric Association (1980) Diagnostic and Statistical Manual of Mental Disorders (3rd edn) (DSM–III). Washington, DC: APA.Google Scholar
American Psychiatric Association (1987) Diagnostic and Statistical Manual of Mental Disorders (3rd edn, revised) (DSM–III–R). Washington, DC: APA.Google Scholar
Andreasen, N. C. (1982) Negative symptoms in schizophrenia: definition and reliability. Archives of General Psychiatry, 39, 784788.Google Scholar
Andreasen, N. C. (1983) Comprehensive Assessment of Symptoms and History (CASH). Iowa: University of Iowa College of Medicine.Google Scholar
Andreasen, N. C. (1984). Scale for the Assessment of Positive Symptoms (SAPS). Iowa City, IA: University of Iowa.Google Scholar
Andreasen, N. C. (1990) Methods for assessing positive and negative symptoms. Modern Problems in Pharmacopsychiatry, 24, 7388.CrossRefGoogle ScholarPubMed
Andreasen, N. C. & Olsen, S. (1982) Negative and positive schizophrenia: definition and validation. Archives of General Psychiatry, 39, 789794.Google Scholar
Andreasen, N. C., Flaum, M. & Swayze, V. W. (1990) Positive and negative symptoms in schizophrenia. Archives of General Psychiatry, 47, 615621.CrossRefGoogle ScholarPubMed
Barnes, T. R. E. & Liddle, P. F. (1990) Evidence for the validity of negative symptoms. Modern Problems in Pharmacopsychiatry, 24, 4372.Google Scholar
Bilder, R. M., Mukhergee, S. & Rieder, R. O. (1985) Symptomatic and neuropsychological components of defect state. Schizophrenia Bulletin, 11, 409419.CrossRefGoogle Scholar
Bleuler, E. (1950) Dementia Praecox and the Group of Schizophrenias (trans. Zinkin, J.). New York: International University Press.Google Scholar
Cornblatt, B. A., Lenzenweger, M. F. & Dworkin, R. H. (1985) Positive and negative schizophrenic symptoms, attention and information processing. Schizophrenia Bulletin, 11, 397408.Google Scholar
Craig, T. J., Richardson, M. A. & Pass, R. (1985) Measurement of mood and affect in schizophrenic inpatients. American Journal of Psychiatry, 142, 12721277.Google ScholarPubMed
Crow, T. J. (1980) Molecular pathology of schizophrenia: more than a disease process? British Medical Journal, 280, 6668.Google Scholar
De Leon, J., Wilson, W. H. & Simpson, G. M. (1989) Measurement of negative symptoms in schizophrenia. Psychiatric Developments, 7, 211234.Google Scholar
Endicott, J. & Spitzer, R. L. (1978) A diagnostic interview: the Schedule for Affective Disorders and Schizophrenia. Archives of General Psychiatry, 35, 837866.Google Scholar
Gibbons, R. D., Lewine, R. R. J. & Davis, J. M. (1985) An empirical test of a Kraepelinian versus a Bleulerian view of negative symptoms. Schizophrenia Bulletin, 11, 390396.Google Scholar
Gorsuch, R. L. (1983) Factor Analysis. Hillsdale, NJ: Lawrence Erlbaum.Google Scholar
Green, S. B., Lissitz, R. W. & Mulaik, S. A. (1977) Limitations of coefficient alpha as an index of test unidimensionality. Education and Psychological Measurement, 37, 827838.Google Scholar
Guy, W. & Ban, T. A. (1979) The AMDP-System. New York: Springer-Verlag.Google Scholar
Hattle, J. (1985) Methodology review: assessing unidimensionality of test and items. Applied Psychological Measurement, 9, 139164.Google Scholar
Hoffman, W. F., Labs, S. M. & Casey, O. E. (1987) Neuroleptic-induced Parkinsonism in older schizophrenics. Biological Psychiatry, 22, 427439.Google Scholar
Kay, S. R., Opler, L. A. & Fiszbem, A. (1986) Significance of positive and negative syndromes in chronic schizophrenia. British Journal of Psychiatry, 149, 439448.Google Scholar
Kay, S. R. & Opler, L. A. (1987) The positive-negative dimension in schizophrenia: its validity and significance. Psychiatric Developments, 5, 79103.Google ScholarPubMed
Kim, J. & Mueller, C. W. (1978) Introduction to Factor Analysis. Beverly Hills, CA: Sage Publications.Google Scholar
Kulahara, P., Avasthi, A., Chandiramani, K., et at (1989) Negative and depressive symptoms in schizophrenia. British Journal of Psychiatry, 154, 207211.CrossRefGoogle Scholar
Kulahara, P. & Chandiramani, K. (1990) Positive and negative subtypes of schizophrenia, a follow-up study from India. Schizophrenia Research, 3, 107116.CrossRefGoogle Scholar
Landmark, I. (1982) A manual for the assessment of schizophrenia. Acta Psychiatrica Scandinavica, 65 (suppl. 298).Google Scholar
Liddle, P. F. (1987a) The symptoms of chronic schizophrenia: a reexamination of the positive-negative dichotomy. British Journal of Psychiatry, 151, 145151.Google Scholar
Liddle, P. F. (1987b) Schizophrenic syndromes, cognitive performance and neurological dysfunction. Psychological Medicine, 17, 4957.Google Scholar
Lindenmayer, J. P. & Kay, S. R. (1987) Affective impairment in young acute schizophrenics: its structure, course and prognostic significance. Acta Psychiatrica Scandinavica, 75, 287296.Google Scholar
Mayer, M., Alpert, M., Stastny, P., et al (1985) Multiple contributions of clinical presentation of flat affect in schizophrenia. Schizophrenia Bulletin, 11, 420426.Google Scholar
Moscarelli, M., Maffei, L., Cesana, B. M., et al (1987) An international perspective on assessment of negative and positive symptoms in schizophrenia. American Journal of Psychiatry, 144, 15951598.Google ScholarPubMed
Nie, N. H., Hull, N. C. & Jenkins, J. G. (1975) Statistical Package for the Social Sciences (2nd edn). New York: McGraw-Hill.Google Scholar
Peralta Martin, V. & Cuesta Zorita, M. J. (1990) Sintomas esquizofrenicos positivos y negativos: un reanalisis del modelo dicotomico de la esquizofrenia. Actas Luso-Espanolas de Neurologia y Psiquiatria, 18, 266273.Google Scholar
Sommers, A. A. (1985) Negative symptoms: conceptual and methodological problems. Schizophrenia Bulletin, 11, 366380.Google Scholar
Spitzer, R. L., Endicott, J. & Robins, E. (1978) Research Diagnostic Criteria (RDC) for a Selected Group of Functional Disorders (3rd edn). New York: New York State Psychiatric Institute.Google Scholar
Tantam, D., Montague, L., Ring, N., et al (1988) Negative symptoms in the first episode, and their subsequent evolution. Abstracts of Proceedings of Meetings of the Royal College of Psychiatrists, Psychiatric Bulletin (suppl. 1), 44.Google Scholar
Walker, E. F., Harvey, P. D. & Perlman, D. (1988) The positive/negative symptom distinction in psychoses. A replication and extension of previous findings. Journal of Nervous and Mental Diseases, 176, 359363.Google Scholar
Submit a response

eLetters

No eLetters have been published for this article.