R. Brugnoli, F. Pacitti, A.Iannitelli, P.Pancheri - Vol. 7, Marzo 2001, num.1
Testo Immagini Bibliografia Summary Riassunto Indice
La comune matrice delle psicosi maggiori
The common matrix of major psychoses
Background
In the last years, research on the psychopathological dimensions of the
schizophrenic spectrum and the depressive disorders led to the identification
of a variable number of factors. Whereas many are the studies on the dimensions
of schizophrenia and mood disorders, few studies showed a dimensional overlap
between the two psychopathological areas and no study used diagnosis-specific
rating scales on samples with different than target diagnoses. The objective
of this study was to re-examine the factor structure emerging from the analysis
of two patient samples, one affected by schizophrenic spectrum disorders and
the other from depressive disorders, using for both samples the same assessment
tools (Hamilton Depression Rating Scale [HAM-D] and Positive And Negative
Syndrome Scale [PANSS]).
Materials and Method
We studied a sample of 254 patients, 131 with a schizophrenic and 123
with a depressive spectrum diagnosis according to the DSM-IV criteria. Patients
were referred to the Outpatient facility of the III Psychiatric Clinic of
the University of Rome, "La Sapienza". The entire sample was assessed through
the completion of the PANSS e the HAM-D. Data were analysed through factorial
analysis based on symptom correlation according to their level of severity
(between-symptoms co-variance).
Results
In the group of schizophrenic spectrum disorders, factorial analysis yielded
four factors for the PANSS, Impoverishment, Reality distortion, Depression/Anxiety,
Excitement and four also for the HAM-D, Anxiety, Insomnia, Depression, Reality
distortion. In the group of depressive spectrum disorders four factors were
extracted from the HAM-D, i.e., Depression, Anxiety, Reality distortion, Insomnia
and three from the PANSS, i.e., Impoverished affect, Reality distortion and
Anxiety. The factor structure analysis of the combined PANSS and HAM-D items
led to the identification of four factors in the group with schizophrenic
spectrum disorders, i.e., Impoverishment, Reality distortion, Affect/Mood,
Anxiety and four factors in the group with depressive spectrum disorders,
Impoverished affect, Reality distortion, Depression and Anxiety. The factor
structure analysis of the combined items of the two scales in the overall
sample led to the identification of four factors: Impoverishment, Reality
distortion, Anxiety and Depression.
Conclusions
Factorial analysis identified four factors that allow to analyse and represent
the two syndrome cluster groups as if they belong to the same psychopathological
area. The results of this study show that all identified dimensions for schizophrenia
are present in mood disorders and vice versa. What is different is the relative
"weight" of every factor in the two syndrome areas. It is the different degree
of association of these dimensions and the different "load" on the patient
of each of these that determines the specific clinical picture. All these
considerations confirm the importance of a dimensional approach to psychopathology
based on dimensional co-morbidity, as opposed to a categorical approach.