Study Of Personality Change In Schizophrenia

Objective: (l)This study was aimed at development of a rating scale reflecting personality change in schizophrenia. (2) To test reliability and validation of the rating scale by assessing personality change in schizophrenia patients.(3) To analyze relation between personality change and symptom dimensions of schizophrenia and to discuss whether the personality change was a independent dimension of schizophrenia .(4)To define feature of personality change at predromal, active , remissive and residual stages of the illness ,and to provide useful clue for early treatment of schizophrenia.Method: (1)According to terms of personality abnormality in schizophrenic patients, The Rating Scale for Personality Change in Schizophrenia was developed through referring Minnesota Multiphasic Personality Inventory and The Chinese Personality Scale, and classified by DSM-IV discription about personality disorder. 39 items were selected out to construct a questionnaire after primary assessment, score criteria :0~2.To assess every patient by three period: predromal, active and remissive stage. The rating scale in two different versions: patient version and family version. 291 schizophrenic patients and 505 normal controls were assessed using therating scale and Schizotypal Personality Questionnaire (SPQ ), and in which 96 family version were assessed.The test-retest reliability was tested with 30 schizophrenic patients and 30 normal controls. Two raters assessed 30 schizophrenic patients simultaneiously or successively. To analyze test-retest reliability, scorer reliability and validation of criteria by Pearson Product-Moment Correlation; Cronbach's a coefficients was verified by Reliability Analysis;Differention validity was confirmed by down limit of 20% patients. Compatible validity was compared with SPQ. Constructed validation and factor components of the rating scale were analyzed using factor analysis, and factors were extracted by principal components factor analysis, with varimax rotation, and factor scores were calculated by regression method. (2)166 active schizophrenic patients and 48 long-term hospitalized chronic patients were assessed using the rating scale, Schizotypal Personality Questionnaire(SPQ) and Positive and Negative Syndrome Scale (PANSS),in which 154 episode schizophrenic patients were assessed the family version. 82 remissive patients were assessed the rating scale and SPQ, in which 37 remissive patients were assessed the family version.260 normal controls were assessed the rating scale and SPQ. The symptom dimensions of 166 schizophrenic patients, personality traits of schizophrenia were analyzed using factor analysis. Patient version and family version, every factor of patient version and every factor of SPQ, general score of patient version and course of disease in schizophrenic patients, furthermore general score, every factor of patient version and the symptom dimensions of PANSS were analyzed by Pearson Product-Moment Correlation. The difference of general score and every factor of the ratingscale between active schizophrenic patients and remissive patients, active schizophrenic patients and long-term hospitalized chronic schizophrenic patients were compared by student's t test. The difference of general score and every factor of the rating scale between active schizophrenic patients and normal controls were compared by analysis of covariance.Results: (1) Test-retest reliability of normal controls was better than schizophrenic patients ,and correlation coefficient of every variable R was 0.42~1.00 (PO.01) ,besides pushing parent ,personal sanitation and stealing behavior. Scorer reliability of the rating scale was good ,and correlation coefficient of every variable R was 0.55-—1.00 (PO.01) .Consistency of variables was statistical significance byreliability analysis,andHotelling'sT-Squared=753.89,F=13.92,P<0.001,reliabil ity coefficient alpha =0.8907, standard item alpha 0.8909. Validation of criteria was better ,and correlation coefficient of every variable R was 0.30~ 0.74 (PO.01 ) ,besides self-indulgence ,stealing behavior and lack of obligation. Rating Scale of Personality Change for Schizophrenia was composed of ten factors, factor 1 included passiveness, idleness, laziness, not doing housework, indolence, personal sanitation, obviating obligation and poor competence, factor 2 included sociable difficulty, relating poor to people, social avoidance, social isolation and bluntness, factor 3 included beat other person,scold other person ,importunity ,hostility and poor rapport , factor 4 included emotion fluctuating , irascibility, dysphoria and lack of patience ,factor 5 included lying and deceiving ,factor 6 included indulging fantasy ,unconcern and lack of obligation ,factor 7 included ignoring criterion ,stealing behavior and offending discipline , factor 8 includedenmity and disadvantage, factor 9 included over dependence ,factor 10 was doubting illness. Correlation of general scores and every factor in predromal ,active of the rating scale had statistical significance, and correlation coefficient R was 0.34~0.82 between general scores and every factor (PO.01) . Differention validity : false negative rate 20.6%; false positive rate 14.7%, sensitivity 79.4%, specificity 85.3%, accuracy 83.7%o Compatible validity:significant correlation between general scores of SPQ and general scores and factors,correlation coefficient R was 0.21~0.50(P<0.05). DThe symptoms of active schizophrenia were divided into five symptom dimensions :psychomotorpoverty ,excitation ,cognition ,reality distortion and depression-anxiety .General scores ,factor land factor 2 scores of the rating scale were correlate slightly with psychomotor poverty, and correlation coefficient R was 0.22~0.34;factor 8 and reality distortion ,factor 10 and depression-anxiety were correlate slightly, correlation coefficient R between factor 8and reality distortion was 0.26 (P<0.01) , correlation coefficient R between factor 10 and depression-anxiety was 0.33 (PO.01) ,no significant association was found between other factors and symptom dimensions of schizophrenia. General scores ,factor 1 and factor 2of the rating scale in long-term hospitalized chronic patients revealed a significant positive association with negative symptoms , correlation coefficient R0.31 —0.49 (P<0.01) ,and no significant association with positive symptoms and general psychopathological symptoms; no significant association was found between other factors and positive symptoms, negative symptoms and general psychopathological symptoms. (3)Significant difference was foundbetween schizophrenic patients and normal controls in general scores and factor scores of the rating scale (PO.01) ,besides predromal factor 10,and significant difference was revealed between predromal and active stage in schizophrenic patients (P<0.01) . Significant difference were found between remissive patients and active patients in general scores, factor 1,factor 3,factor 4,factor 6,factor 7and factor 8(P<0.05), besides factor 2,factor 5,factor 9and factor 10.No significant difference were found between long-term hospitalized patients and active patients in general scores, factor 1,factor 2,factor 3 and factor 5(P>0.05), whereas significant difference were found in factor 4, factor 6, factor 7,factor 8,factor 9and factor 10(P<0.05). (4) Personality change might occur in the predromal,the active,and the residual stages. No significant association was found between personality change and course of disease in schizophrenia.Conclusion: Personality change was a independent symptom dimension in psychopathology of schizophrenia. The new instrument developed for assessment of personality change was useful to early detection and early treatment of schizophrenia.