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Abstract
The symptom heterogeneity of schizophrenia is consistent with Wittgenstein’s analogy of a language game. From the perspective of precision medicine, this study aimed to estimate the symptom presentation and identify the psychonectome in Asian patients, using data obtained from the Research on Asian Psychotropic Prescription Patterns for Antipsychotics. We constructed a network structure of the Brief Psychiatric Rating Scale (BPRS) items in 1438 Asian patients with schizophrenia. Furthermore, all the BPRS items were considered to be an ordered categorical variable ranging in value from 1–7. Motor retardation was situated most centrally within the BPRS network structure, followed by depressive mood and unusual thought content. Contrastingly, hallucinatory behavior was situated least centrally within the network structure. Using a community detection algorithm, the BPRS items were organized into positive, negative, and general symptom clusters. Overall, DSM symptoms were not more central than non-DSM symptoms within the symptom network of Asian patients with schizophrenia. Thus, motor retardation, which results from the unmet needs associated with current antipsychotic medications for schizophrenia, may be a tailored treatment target for Asian patients with schizophrenia. Based on these findings, targeting non-dopamine systems (glutamate, γ-aminobutyric acid) may represent an effective strategy with respect to precision medicine for psychosis.
Highlights
In psychiatric taxonomy, schizophrenia has been conceptualized as a unitary disease entity
18 Brief Psychiatric Rating Scale (BPRS) items were organized into three meaningful symptom clusters, including the positive (CON–MAN–GRA–HOS–SUS–hallucinatory behavior (HAL)–UNC–thought content (THO)–EXC–DIS), negative (EMO–motor retardation (MOT)–BLU), and general symptom clusters (SOM–ANX–GUI–TEN–depressive mood (DEP))
It can be proposed that motor retardation may be the dimensionally defined core constitute of the psychonectome underpinned by the neural network in Asian patients with schizophrenia
Summary
Schizophrenia has been conceptualized as a unitary disease entity. The etiopathology, symptomatology, and clinical courses of schizophrenia are heterogeneous [1,2,3]. To explain the heterogeneity of the clinical features of schizophrenia, several models describing the etiology, pathophysiology, and illness have been proposed. Regarding the traditional ‘single common pathway’ construct, it is presumed that the interactions among multiple etiological factors produce neurobiological alterations, which lead to the broadly similar phenotypic expression of ‘single’ schizophrenia through the ‘final common pathophysiological process.’. In the ‘single schizophrenia with many domains’ model, it is presumed that the interactions among multiple etiological factors lead to the multiple concurrent pathophysiological dimension. In the ‘many schizophrenias’ model, it is presumed that the interactions among multiple etiological factors lead to different types of the disease with a similar array of symptoms. Precision medicine is required to disentangle the symptom heterogeneity of schizophrenia [2]
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