The psychopathological factors of refractory schizophrenia Fatores psicopatológicos da esquizofrenia refratária

OBJECTIVES: The heterogeneity of clinical manifestations in schizophrenia has lead to the study of symptom clusters through psychopathological assessment scales. The objective of this study was to elucidate clusters of symptoms in patients with refractory schizophrenia which may also help to assess the patients' therapeutical response. METHODS: Ninety-six treatment resistant patients were evaluated by the anchored version Brief Psychiatric Rating Scale (BPRS-A) as translated into Portuguese. The inter-rater reliability was 0.80. The 18 items of the BPRS-A were subjected to exploratory factor analysis with Varimax rotation. RESULTS: Four factors were obtained: Negative/Disorganization, composed by emotional withdrawal, disorientation, blunted affect, mannerisms/posturing, and conceptual disorganization; Excitement, composed of excitement, hostility, tension, grandiosity, and uncooperativeness, grouped variables that evoke brain excitement or a manic-like syndrome; Positive, composed of unusual thought content, suspiciousness, and hallucinatory behavior; and Depressive, composed of depressive mood, guilt feelings, and motor retardation, clearly related to depressive syndrome. CONCLUSIONS: The study reproduced the four factors described in the literature, either in refractory or non-refractory patients. The BPRS-A allowed the distinction of psychopathological factors, which are important in the evaluation of treatment response of patients with schizophrenia.OBJETIVOS: A heterogeneidade das manifestações clínicas na esquizofrenia tem levado ao estudo de agrupamentos sintomatológicos através de escalas de avaliação psicopatológica. O objetivo do presente trabalho foi a elucidação de agrupamentos psicopatológicos em pacientes com esquizofrenia refratária que também podem auxiliar na avaliação da resposta terapêutica dos pacientes. MÉTODOS: Noventa e seis pacientes com diagnóstico de esquizofrenia refratária foram avaliados através da Escala Breve de Avaliação Psiquiátrica, versão ancorada e traduzida para o português (BPRS-A). A confiabilidade foi de 0,80. Os 18 sintomas foram submetidos à análise fatorial exploratória com rotação Varimax. RESULTADOS: Quatro fatores foram obtidos: Negativo/Desorganização, composto por retraimento afetivo, desorientação, afeto embotado, maneirismo & postura e desorganização conceitual; Excitação, formado por excitação, hostilidade, tensão, idéias de grandeza e falta de cooperação; Positivo, contendo os itens delírio, desconfiança