Nociceptive Reflex in Patients With Schizophrenia: A Case-Control Study

Hosna S. Elshony, Lamyaa G. Al Hamrawy
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Abstract

Background: Diminished pain sensitivity has been reported in patients in the acute phase of psychosis, as well as in stable patients. The cause of hypoalgesia in those patients is unknown. The aim of this study was to investigate the sensory thresholds, pain modalities, or other factors contributing to the perception or expression of physical pain in patients with schizophrenia (SCZ). Methods: This case-control study was conducted on 24 patients with SCZ and 12 healthy controls. Patients with SCZ were assessed by the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Positive and Negative Symptom Scale and Schizophrenia Cognition Rating Scale. All participants were subjected to full medical and neurological examination and nociceptive reflex. Results: There was no significant difference between cases and controls in nociceptive threshold, while it showed a significant difference at the subjective pain threshold as the case group needed a higher intensity of current to perceive as painful. There was a significant positive correlation between age, duration of SCZ and number of episodes and the nociceptive reflex. Also, there was a significant positive correlation between the negative symptoms of SCZ and cognitive impairment on one arm and the subjective pain threshold on the other arm. Conclusion: The pain insensitivity in patients with SCZ is not related to physiological changes in the nociceptive pathway, but rather may be related to change in the experience and expression of pain. Older age, longer duration of disease, more frequent episodes, negative symptoms, and cognitive impairment, but not antipsychotic medications, all are positively correlated with the increase in subjective pain threshold. J Neurol Res. 2021;11(1-2):20-26 doi: https://doi.org/10.14740/jnr656
精神分裂症患者的伤害性反射:一项病例对照研究
背景:在精神病急性期和病情稳定的患者中都有疼痛敏感性降低的报道。这些患者痛觉减退的原因尚不清楚。本研究的目的是探讨精神分裂症(SCZ)患者的感觉阈值、疼痛方式或其他因素对身体疼痛的感知或表达的影响。方法:选取24例SCZ患者和12例健康对照者进行病例-对照研究。采用《精神障碍诊断与统计手册(第四版)》结构化临床访谈、阳性与阴性症状量表和精神分裂症认知评定量表对SCZ患者进行评估。所有参与者都接受了全面的医学和神经学检查以及伤害反射。结果:病例组与对照组在痛觉阈值上无显著差异,但在主观痛觉阈值上有显著差异,病例组需要更高强度的电流才能感知到痛觉。年龄、SCZ病程、发作次数与伤害反射呈显著正相关。同时,SCZ阴性症状与单臂认知功能障碍、另臂主观疼痛阈值存在显著正相关。结论:SCZ患者的疼痛不敏感与痛觉通路的生理变化无关,而可能与疼痛体验和表达的改变有关。年龄越大,病程越长,发作越频繁,阴性症状和认知障碍,但抗精神病药物除外,均与主观痛阈升高呈正相关。中华神经科学杂志。2021;11(1-2):20-26 doi: https://doi.org/10.14740/jnr656
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