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Análisis de componentes principales de la PANSS y la SANS-SAPS en esquizofrenia: su estabilidad en una fase aguda
Published online by Cambridge University Press: 12 May 2020
Abstract
Se pongan de acuerdo o no los estudios sobre la dicotomía positivo-negativo en esquizofrenia, la pertinencia de un tercer componente, la desorganización, es una cuestión polémica. La desorganización, expresada por los análisis de componentes principales de la Escala para la Evaluación de Síntomas Negativos y Síntomas Positivos (SANS-SAPS) y la Escala del Síndrome Positivo y Negativo (PANSS), se podría considerar como una dimensión tan permanente y determinante como los componentes positivo y negativo. Por tanto, el propósito del presente estudio era determinar si esta desorganización, junto con los componentes positivo y negativo, es estable y tiene la misma composición en las fases aguda y post-aguda de la enfermedad. Este estudio se llevó a cabo en 57 pacientes, definidos de manera general al menos por uno de cuatro criterios diagnósticos (American Psychiatric Association, Langfeldt, Carpenter y Schneider), establecidos con una lista informatizada y valorados con la SANS-SAPS y la PANSS. Se realizaron análisis de componentes principales (ACP) de estas escalas en la admisión y el alta del hospital.
El ACP de la SANS-SAPS mostró una solución de tres factores, sin variación por la fase de la enfermedad (aguda o postaguda), mostrando que los componentes negativo, positivo y de desorganización eran estables. El ACP de la PANSS produjo componentes negativo y positivo completamente estables en el tiempo y un componente de desorganización cuya composición variaba entre la admisión y el alta. En la admisión, incluía el elemento de desorganización conceptual, correlacionado negativamente con uno de depresión. En el alta, este componente incluía dos apartados adicionales, preocupación autista y manerismos, y aparecía un componente de depresión. La inestabilidad del ACP de la PANSS podría expresar el papel desempeñado por la fase de la enfermedad: en una fase aguda, el componente de desorganización estaba constituido por más elementos “positivos”, como grandiosidad, contenido inusual del pensamiento y evitación social activa, mientras que en la fase post-aguda, incluía elementos que reflejaban más la cronicidad de la enfermedad, como amaneramientos y preocupación autista. Por otra parte, en la fase post-aguda aparecía el elemento depresivo en un componente depresivo específico. Este resultado se podría deber al hecho de que los síntomas depresivos no se pueden expresar cuando los síntomas positivos son muy graves, lo que explica por qué no se mostraban componentes depresivos durante la fase aguda.
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