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Correlação entre desempenho cognitivo e sintomas positivos e negativos da esquizofrenia
Osmar Jose Tavares Gouveiade Melo
DATA DE PUBLICAÇÃO
FrOln the end of the 1970s onwards research work on the cognitive deficit in schizophrenic patients began to take into account the distinction between positive and negative syrnptoms. The purpose of the present paper is to verify the relationship between the cognitive perfonnance and current c1inical symptoms - both positive and negative - of chronically hospitalized schizophrenic patients. The initial presupposition was the existence of a cognitive deficit in schizophrenia associated with the primary negative syrnptOlns. subsequent to the onset of the disease, a deficit related to the patient s age at onset. progressive, and unaffected by the [onn of treatment employed. The 50 subjects studied between August 1992 and January 1993 were divided into two groups: Group A, 25 chronically hospitalized schizophrenic patients~ and Group B, a control group of 25 nonnal subjects. Both groups consisted of males aged between 30 and 40 years, with an educational leveI ranging fiom a minimum of nine years basic instruction to a maximum of successful completion of secondary school studies. all of whom were fiom the Greater Recife area or nearby regions and the same socio-economic leveI. The Positive and Negative .Syndrome Scale (P ANSS) was used for evaluating the positive and negative symptoms of sehizophrenia. Cognitive perfonnance was assessed by the Mini-Mental S tate (MMS). The results were subjected to statistical analysis using the Chi-Square (X2) test for Independence and the tests of Behrens-Fischer.. and MannWhitney. The patients with a predOlninance of current negative symptoms presented lower scores on the MMS. The higher the negative score, the lower was that ofthe MMS. Conversely. the patients with a predominance of current positive symptons tended to achieve higher scores. An analysis of the scores of the positive symptoms alone is not predictive of the possible result of the MMS. The joint analysis of positive and negative symptoms revealed that the MMS results depend not on the positive scores but on the negative ones. The MMS scores of the entire group of patients were significantly lqwer than those of the control group, but the scores of the "positive valence" subgroup were similar to those of the control group. The diíference found originated in the "negative valence" subgroup. The fact that on1y patients th a minÜnum of nine years basic education prior to falling ill were included in this study made it possible to estime their congnitive perfonnance prior to the disease. The lower scores of the patients with --negative valence" suggest that there was a cognitive decline in this subgroup. The MMS scores presented no significant correlations with any of the following: age at the onset of the disorder, duration of the aihnent and the fonns of treatlnent employed. A depressive mood. the presence of productive psychotic symptoms. the effects of dmgs and institutionalisln had no influence on the correlation that exists between 10w MMS scores and predOlninantly negative sYlnptoms. The negative symptoms analysed here should thus be regarded as primary ones and not secondary to any of the aforelnentioned conditions. The hypothesis proposed was part~ally confinned. since the results failed to show any correlation between the cognitive deficit and age at onset or the length of morbid progression