健康与遗传心理学研究室知识库

精神分裂症患者的阴性症状严重影响患者的社会功能及生活质量，是致残的主要预测原因，因此，阴性症状的评估和干预对于精神分裂症的研究非常重要。最新研究显示，阴性症状可以汇聚成动机与愉悦及表达两个维度。阴性症状临床评估访谈（CAINS）是在这种评估要求下发展的新型临床评估工具，且在国外研究中验证了其具有良好的信效度， 但其在中国文化背景下的适用性需要进一步的验证。阴性症状存在于精神分裂症谱系的不同阶段，且不同阶段阴性症状的严重程度是有差异的，但目前尚未见到 CAINS 在精神分裂症谱系中区分度的研究。而且，是否能基于 CAINS 评分对精神分裂症患者进行分类需要进行探讨，特别是通过深入研究不同阴性症状类型的患者在行为任务上的表现能进一步验证CAINS 的有效性和稳定性。本论文将从三个研究探讨CAINS 中文版的信效度及在精神分裂症谱系中的区分度。
研究一旨在验证 CAINS 中文版的心理测量学特性，共招募 185 位精神分裂症患者，各项指标表明，CAINS 中文版具有良好的结构效度、效标效度、内部一致性信度、重测信度、评分者一致性信度，可以作为从动机/愉悦、表达两个维度来评估我国精神分裂症阴性症状的有效工具，通过大样本量的验证，为临床应用提供参考和依据。
研究二探讨CAINS 中文版在精神分裂症谱系中的区分度，招募了 44位精神分裂症患者、43位未患病的一级家属及 44位健康对照组，并通过筛查招募了 37位高社会快感缺失大学生及 36 位对照组大学生，结果显示，精神分裂症患者在动机/愉悦、表达上均存在严重缺损，未患病的一级家属在动机/愉悦、表达上的评分均显著低于精神分裂症患者，而且，未患病的一级家属在动机/愉悦因子上的评分显著高于对照组；高社会快感缺失大学生在动机/愉悦上的评分均显著高于对照组大学生。
研究三检验是否可以根据 CAINS 两因子上的评分把精神分裂症患者聚类为不同阴性症状表现的亚型，结果表明，精神分裂症患者可以聚类成以动机/愉悦缺损为主的患者组（n=38）和非阴性症状患者组（n=74），以动机/愉悦缺损为主的患者在 PANSS 的阴性症状及 SANS 的情感迟钝、言语减少、动机缺乏及快感缺失上缺损更严重，两组患者在 PANSS 的阳性症状、一般病理及 SANS 的注意障碍评分上没有显著差异； 在自我报告上，通过这两组患者和健康对照组 （n=80）的对比发现，两组患者在情绪表达上出现类似程度的缺损，非阴性症状组患者愉悦体验正常，但以动机/愉悦缺损为主的患者在愉悦体验上存在缺损，且表现出更多抑郁、压力和焦虑。此外，部分患者和对照组完成了期待性和即时性愉快体验任务，通过分析发现，动机/愉悦缺损为主的患者（n=15）、非阴性症状组患者（n=25）及健康对照组（n=23）三组间在愉悦度及唤醒度的评分上均没有差异；在动机强度上，相对于健康对照组，精神分裂症患者按键速度较慢，但两组患者间没有差异；在情绪与行为一致性上，动机/愉悦缺损为主的患者出现缺损，其他患者和健康对照组间没有显著差异。
总体看来，通过大样本的验证，本研究结果表明，CAINS 中文版包括动机/愉悦、表达两个因子，其信效度结果符合心理测量学的要求。而且，本研究发现CAINS 的因子分具有辨别精神分裂症患者、未患病一级家属、高危大学生及健康对照组的敏感性。此外，根据 CAINS 的两因子分，可以把以动机/愉悦为主的精神分裂症患者和非阴性症状的精神分裂症患者区分开。这些结果表明，CAINS中文版是可以稳定有效地评估我国精神分裂症患者阴性症状的临床评估工具。

Negative symptoms are main predictive factors of schizophrenia disability and seriously affect the social function and quality of life of patients with schizophrenia. Therefore, the development and validation of negative symptoms of schizophrenia is one of the prioritized areas for schizophrenia research. Recent theoretical and clinical findings suggest that negative symptoms can converge into two factors, namely the “motivation-anheodnia” and the “expression”. The Clinical Assessment Interview for Negative Symptoms (CAINS) was developed in accordance with this theoretical framework and has been validated with good psychometrics traits in Caucasian samples. However, very little is known about the clinical utility of the CAINS in the Chinese settings. Negative symptoms are present and varied in different stages of schizophrenia. Discriminant validity of the CAINS in different stages of schizophrenia is worthy of investigating. However, it is still unclear whether patients with schizophrenia could be effectively categorized by CAINS. The present dissertation aimed to examine the reliability and validity of the Chinese version of CAINS in schizophrenia spectrum disorders.
Study 1 aimed to examine psychometrics traits of the Chinese version of the CAINS. One hundred and eighty-five patients with schizophrenia were recruited. The findings showed a stable two-factor structure, namely “notivation-pleasrue” and “expression”. Significant correlations were also found between these two factor subscores with negative sympotms captured by the conventional clinical ratings as well as the self-reported experience of pleasure. The Chinese version demonstrated impressive psychometric properties in terms of Cronbach alpha coefficients, test-retest reliability, and interrater reliability.
Study 2 aimed to explore the discrimination of the CAINS in 44 patients with schizophrenia, 43 non-psychotic first-degree relatives, 37 at-risk individulas with schizotypy from 44 healthy controls.. People with schizophrenia exhibited significantly higher CAINS subscale scores than first-degree relatives and controls. In addition, first-degree relatives had higher “motivation/pleasure” scores than controls. The “motivation/pleasure” subscale scores of individuals with social anhedonia were also significantly higher than healthy controls.
Study 3 adopted cluster analysis of the CAINS factor scores to examine whether CAINS factor scores could successfully classify schizophrenia patients into different subtypes based on their negative symptom manifestations. The results suggested a 2-cluster solution comprising a amotivation-anhedonia group (n = 38) and a group of without negative symptom manifestations (n = 74). Validaiton of the cluster solution showed that schizophrenia patients with amotivation-anhedonia showed more deficits in negative symptoms, experiential pleaure ability as well as depressive sympotms than those without negative sympotms deficits and healthy controls..
Taken together, the present findings suggested that the Chinese version of the CAINS demonstrated a robust two-factor structure of “amotivation-anhedonia” and “expression” factors of negative symptoms in schizophrenia. Impressive reliability and validity of the Chinese version of the CAINS was also demonstrated. The present study also showed the sensitivity of the CAINS factor scores to discriminate patients with schizophrenia, non-psychotic first-degree relatives, at-risk individuals with schizotypy from healthy controls. The use of the CAINS score could also effectively classify subytpes of schizophrenia patients with specific amotivation and anhedonia from those with general negative sympotms manifestations. These all support the Chinese version of the CAINS is an effective and valid clinical tool for assessing negative symptoms for schizophrenia in the Chinese setting.