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Fleming LM, Lemonde AC, Benrimoh D, Gold JM, Taylor JR, Malla A, Joober R, Iyer SN, Lepage M, Shah J, Corlett PR. Using dimensionality-reduction techniques to understand the organization of psychotic symptoms in persistent psychotic illness and first episode psychosis. Sci Rep 2023; 13:4841. [PMID: 36964175 PMCID: PMC10039017 DOI: 10.1038/s41598-023-31909-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 03/17/2023] [Indexed: 03/26/2023] Open
Abstract
Psychotic disorders are highly heterogeneous. Understanding relationships between symptoms will be relevant to their underlying pathophysiology. We apply dimensionality-reduction methods across two unique samples to characterize the patterns of symptom organization. We analyzed publicly-available data from 153 participants diagnosed with schizophrenia or schizoaffective disorder (fBIRN Data Repository and the Consortium for Neuropsychiatric Phenomics), as well as 636 first-episode psychosis (FEP) participants from the Prevention and Early Intervention Program for Psychosis (PEPP-Montreal). In all participants, the Scale for the Assessment of Positive Symptoms (SAPS) and Scale for the Assessment of Negative Symptoms (SANS) were collected. Multidimensional scaling (MDS) combined with cluster analysis was applied to SAPS and SANS scores across these two groups of participants. MDS revealed relationships between items of SAPS and SANS. Our application of cluster analysis to these results identified: 1 cluster of disorganization symptoms, 2 clusters of hallucinations/delusions, and 2 SANS clusters (asocial and apathy, speech and affect). Those reality distortion items which were furthest from auditory hallucinations had very weak to no relationship with hallucination severity. Despite being at an earlier stage of illness, symptoms in FEP presentations were similarly organized. While hallucinations and delusions commonly co-occur, we found that their specific themes and content sometimes travel together and sometimes do not. This has important implications, not only for treatment, but also for research-particularly efforts to understand the neurocomputational and pathophysiological mechanism underlying delusions and hallucinations.
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Affiliation(s)
- Leah M Fleming
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Interdepartmental Neuroscience Department, Yale University, New Haven, CT, USA
| | | | - David Benrimoh
- Department of Psychiatry, McGill University Montreal, Qubec, Canada
| | - James M Gold
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Jane R Taylor
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Department of Psychology, Yale University, New Haven, CT, USA
- Department of Neuroscience, Yale University, New Haven, CT, USA
- Wu Tsai Institute, Yale University, New Haven, CT, USA
| | - Ashok Malla
- Department of Psychiatry, McGill University Montreal, Qubec, Canada
- The Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Qubec, Canada
| | - Ridha Joober
- Department of Psychiatry, McGill University Montreal, Qubec, Canada
- The Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Qubec, Canada
| | - Srividya N Iyer
- Department of Psychiatry, McGill University Montreal, Qubec, Canada
- The Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Qubec, Canada
| | - Martin Lepage
- Department of Psychiatry, McGill University Montreal, Qubec, Canada
- The Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Qubec, Canada
| | - Jai Shah
- Department of Psychiatry, McGill University Montreal, Qubec, Canada
- The Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Qubec, Canada
| | - Philip R Corlett
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.
- Department of Psychology, Yale University, New Haven, CT, USA.
- Wu Tsai Institute, Yale University, New Haven, CT, USA.
- Connecticut Mental Health Center, 34 Park St, New Haven, CT, 06519, USA.
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2
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Karvelis P, Paulus MP, Diaconescu AO. Individual differences in computational psychiatry: a review of current challenges. Neurosci Biobehav Rev 2023; 148:105137. [PMID: 36940888 DOI: 10.1016/j.neubiorev.2023.105137] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/04/2023] [Accepted: 03/14/2023] [Indexed: 03/23/2023]
Abstract
Bringing precision to the understanding and treatment of mental disorders requires instruments for studying clinically relevant individual differences. One promising approach is the development of computational assays: integrating computational models with cognitive tasks to infer latent patient-specific disease processes in brain computations. While recent years have seen many methodological advancements in computational modelling and many cross-sectional patient studies, much less attention has been paid to basic psychometric properties (reliability and construct validity) of the computational measures provided by the assays. In this review, we assess the extent of this issue by examining emerging empirical evidence. We find that many computational measures suffer from poor psychometric properties, which poses a risk of invalidating previous findings and undermining ongoing research efforts using computational assays to study individual (and even group) differences. We provide recommendations for how to address these problems and, crucially, embed them within a broader perspective on key developments that are needed for translating computational assays to clinical practice.
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Affiliation(s)
- Povilas Karvelis
- Krembil Centre for Neuroinformatics, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada.
| | - Martin P Paulus
- Laureate Institute for Brain Research, Tulsa, OK, USA; Oxley College of Health Sciences, The University of Tulsa, Tulsa, OK, USA
| | - Andreea O Diaconescu
- Krembil Centre for Neuroinformatics, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada; Department of Psychology, University of Toronto, Toronto, ON, Canada
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3
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Moffa G, Kuipers J, Carrà G, Crocamo C, Kuipers E, Angermeyer M, Brugha T, Toumi M, Bebbington P. Longitudinal symptomatic interactions in long-standing schizophrenia: a novel five-point analysis based on directed acyclic graphs. Psychol Med 2023; 53:1371-1378. [PMID: 34348816 PMCID: PMC10009394 DOI: 10.1017/s0033291721002920] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 04/29/2021] [Accepted: 07/01/2021] [Indexed: 11/05/2022]
Abstract
BACKGROUND Recent network models propose that mutual interaction between symptoms has an important bearing on the onset of schizophrenic disorder. In particular, cross-sectional studies suggest that affective symptoms may influence the emergence of psychotic symptoms. However, longitudinal analysis offers a more compelling test for causation: the European Schizophrenia Cohort (EuroSC) provides data suitable for this purpose. We predicted that the persistence of psychotic symptoms would be driven by the continuing presence of affective disturbance. METHODS EuroSC included 1208 patients randomly sampled from outpatient services in France, Germany and the UK. Initial measures of psychotic and affective symptoms were repeated four times at 6-month intervals, thereby furnishing five time-points. To examine interactions between symptoms both within and between time-slices, we adopted a novel technique for modelling longitudinal data in psychiatry. This was a form of Bayesian network analysis that involved learning dynamic directed acyclic graphs (DAGs). RESULTS Our DAG analysis suggests that the main drivers of symptoms in this long-term sample were delusions and paranoid thinking. These led to affective disturbance, not vice versa as we initially predicted. The enduring relationship between symptoms was unaffected by whether patients were receiving first- or second-generation antipsychotic medication. CONCLUSIONS In this cohort of people with chronic schizophrenia treated with medication, symptoms were essentially stable over long periods. However, affective symptoms appeared driven by the persistence of delusions and persecutory thinking, a finding not previously reported. Although our findings as ever remain hostage to unmeasured confounders, these enduring psychotic symptoms might nevertheless be appropriate candidates for directly targeted psychological interventions.
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Affiliation(s)
- Giusi Moffa
- Department of Mathematics and Computer Science, University of Basel, Basel, Switzerland
- Division of Psychiatry, University College London, 149 Tottenham Court Road, London W1T 7NF, UK
| | | | - Giuseppe Carrà
- Division of Psychiatry, University College London, 149 Tottenham Court Road, London W1T 7NF, UK
- Department of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, Monza 20900, Italy
| | - Cristina Crocamo
- Department of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, Monza 20900, Italy
| | - Elizabeth Kuipers
- Department of Psychology, IoPPN, King's College London, London SE5 8AF, UK
| | - Matthias Angermeyer
- Department of Psychiatry, University of Leipzig, Johannisallee 20, 04137 Leipzig, Germany
| | - Traolach Brugha
- Department of Health Sciences, College of Life Sciences, University of Leicester, Centre for Medicine, University Road, Leicester LE1 7RH, UK
| | - Mondher Toumi
- Laboratoire de Santé Publique, Université de la Méditerranée, Marseille, France
| | - Paul Bebbington
- Division of Psychiatry, University College London, 149 Tottenham Court Road, London W1T 7NF, UK
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4
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Grindey A, Bradshaw T. Do different adverse childhood experiences lead to specific symptoms of psychosis in adulthood? A systematic review of the current literature. Int J Ment Health Nurs 2022; 31:868-887. [PMID: 35306711 DOI: 10.1111/inm.12992] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 02/18/2022] [Accepted: 03/05/2022] [Indexed: 11/28/2022]
Abstract
Previous research has demonstrated significant associations between adverse childhood experiences (ACEs) and risks of psychosis. Further research has examined underlying mechanisms to understand the relationship between these variables. This review aimed to explore the associations between various ACEs and the development of different psychotic symptoms in adulthood. The Cochrane Library, Cinahl, PsychINFO, Medline, Embase, and Web of Science were searched from January 1980 to November 2021 to ensure a systematic review of relevant literature. Poverty, fostering, adoption, childhood emotional and physical neglect, and childhood physical (CPA), sexual (CSA), and emotional abuse (CEA) significantly correlated with delusions. Significant relationships were found between hallucinations and CSA and CPA. Paranoia correlated with violent adversities including CPA, assault, and witnessing killing. Limited associations were identified for thought disorder and negative symptoms. The findings of this review indicate that there may be a degree of specificity between various ACEs and psychotic symptoms, but these findings are subject to some limitations. The findings also demonstrate the importance of inquiring about and addressing ACE in clinical practice to develop formulations and treatment plans for individuals with psychosis.
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Affiliation(s)
- Ashleigh Grindey
- Home Based Treatment Team, Salford, UK.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Tim Bradshaw
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
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Carrà G, Crocamo C, Bartoli F, Angermeyer M, Brugha T, Toumi M, Bebbington P. Influence of positive and negative symptoms on hedonic and eudaemonic well-being in people with schizophrenia: A longitudinal analysis from the EuroSc study. Schizophr Res 2022; 244:21-28. [PMID: 35567870 DOI: 10.1016/j.schres.2022.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 01/11/2022] [Accepted: 04/30/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Subjective well-being in people with schizophrenia is likely to be impaired by positive and negative psychotic symptoms. However, these may impact differentially on hedonic (satisfaction and interest in life) and eudaemonic (optimal psychological and social functioning) components. AIMS We hypothesized that positive symptoms would influence the hedonic component, while negative symptoms would be linked to eudaemonic well-being. METHODS We tested this using longitudinal data (N = 1208) from the EUROSC study. Measures were repeated after 6, 12, 18 and 24 months. Hedonic and eudaemonic features were identified using the Quality of Life Interview. Positive and negative symptoms were assessed with the Positive and Negative Syndrome Scale. We used latent variable structural equation modelling to investigate the impact of positive and negative symptoms at each of the four data points on well-being components 6 months later, controlling for depressed mood. RESULTS The measurement model yielded acceptable fit. People with higher scores on positive symptoms at a given time-point were more likely to report lower scores for hedonic components six months later (6-, 12-, and 24-month), whereas we found no significant paths from negative symptoms to hedonic or eudaemonic features. CONCLUSIONS Although we found a longitudinal influence of positive symptoms on hedonic well-being, negative symptoms had no effect on either hedonic or eudaemonic components. While symptom reduction strategies may be helpful for hedonic well-being, the amelioration of eudaemonic features may require targeted psychosocial programmes to help individuals attain more rewarding lives.
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Affiliation(s)
- Giuseppe Carrà
- Division of Psychiatry, University College London, 149 Tottenham Court Road, London W1T 7NF, UK; Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, Monza 20900, Italy
| | - Cristina Crocamo
- Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, Monza 20900, Italy.
| | - Francesco Bartoli
- Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, Monza 20900, Italy
| | - Matthias Angermeyer
- Department of Psychiatry, University of Leipzig, Leipzig, Johannisallee 20, 04137 Leipzig, Germany
| | - Traolach Brugha
- Department of Health Sciences, College of Life Sciences, University of Leicester, University Road, Leicester LE1 7RH, UK
| | - Mondher Toumi
- Laboratoire de Santé Publique, Université de la Méditerranée, Marseille, France
| | - Paul Bebbington
- Division of Psychiatry, University College London, 149 Tottenham Court Road, London W1T 7NF, UK
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6
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Jiang Z, Luskus M, Seyedi S, Griner EL, Rad AB, Clifford GD, Boazak M, Cotes RO. Utilizing computer vision for facial behavior analysis in schizophrenia studies: A systematic review. PLoS One 2022; 17:e0266828. [PMID: 35395049 PMCID: PMC8992987 DOI: 10.1371/journal.pone.0266828] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 03/28/2022] [Indexed: 12/22/2022] Open
Abstract
Background Schizophrenia is a severe psychiatric disorder that causes significant social and functional impairment. Currently, the diagnosis of schizophrenia is based on information gleaned from the patient’s self-report, what the clinician observes directly, and what the clinician gathers from collateral informants, but these elements are prone to subjectivity. Utilizing computer vision to measure facial expressions is a promising approach to adding more objectivity in the evaluation and diagnosis of schizophrenia. Method We conducted a systematic review using PubMed and Google Scholar. Relevant publications published before (including) December 2021 were identified and evaluated for inclusion. The objective was to conduct a systematic review of computer vision for facial behavior analysis in schizophrenia studies, the clinical findings, and the corresponding data processing and machine learning methods. Results Seventeen studies published between 2007 to 2021 were included, with an increasing trend in the number of publications over time. Only 14 articles used interviews to collect data, of which different combinations of passive to evoked, unstructured to structured interviews were used. Various types of hardware were adopted and different types of visual data were collected. Commercial, open-access, and in-house developed models were used to recognize facial behaviors, where frame-level and subject-level features were extracted. Statistical tests and evaluation metrics varied across studies. The number of subjects ranged from 2-120, with an average of 38. Overall, facial behaviors appear to have a role in estimating diagnosis of schizophrenia and psychotic symptoms. When studies were evaluated with a quality assessment checklist, most had a low reporting quality. Conclusion Despite the rapid development of computer vision techniques, there are relatively few studies that have applied this technology to schizophrenia research. There was considerable variation in the clinical paradigm and analytic techniques used. Further research is needed to identify and develop standardized practices, which will help to promote further advances in the field.
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Affiliation(s)
- Zifan Jiang
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, GA, United States of America
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, United States of America
- * E-mail:
| | - Mark Luskus
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States of America
| | - Salman Seyedi
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Emily L. Griner
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Ali Bahrami Rad
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Gari D. Clifford
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, GA, United States of America
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, United States of America
| | - Mina Boazak
- Animo Sano Psychiatry, PLLC, Durham, NC, United States of America
| | - Robert O. Cotes
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States of America
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7
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Amin MM, Effendy E, Camellia V, Saragih M, Kamil A, Harsono R. Validity and reliability of the Indonesian version of the Scale for the Assessment of Negative Symptoms. Front Psychiatry 2022; 13:1045635. [PMID: 36741563 PMCID: PMC9896781 DOI: 10.3389/fpsyt.2022.1045635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 12/28/2022] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Negative symptoms have long been conceptualized as a core aspect of schizophrenia. Despite widespread recognition of the status of these symptoms as independent dimensions of schizophrenia, they are sometimes difficult to distinguish from depression or cognitive impairment. Therefore, objective assessment of schizophrenia symptoms is critical by obtaining a valid and reliable Indonesian version of the SANS instrument. This study aimed to determine the content validity, concurrent, internal consistency reliability, inter-rater, cut-off value, sensitivity, and specificity of the SANS instrument. METHODS This is a diagnostic study using the cross-sectional method to determine the relationship between the SANS and PANSS instruments on the negative symptom subscale. It was located at the Prof. Dr. M. Ildrem Mental Hospital of North Sumatera Province. RESULTS Of the 400 subjects, 67.5% were males, and the median age of the subjects was 37 years (18-45). The results of the content validity test were good (mean I-CVI=1.00), and the concurrent validity test comparing the SANS and PANSS instruments on the negative symptom subscale obtained significant results (p < 0.001) with a strong correlation (r = 0.763). Additionally, the consistency reliability test had a very high internal score (Cronbach alpha = 0.969), the overall inter-rater reliability test was "very good" (ICC = 0.985), and the cut-off value was 10.5 with sensitivity and specificity values of 72.9 and 77.9%, respectively. CONCLUSION The Indonesian version of the SANS instrument is valid and reliable for measuring negative symptoms in people with schizophrenia in Indonesia.
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Affiliation(s)
- Mustafa M Amin
- Department of Psychiatry, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
| | - Elmeida Effendy
- Department of Psychiatry, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
| | - Vita Camellia
- Department of Psychiatry, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
| | - Munawir Saragih
- Department of Psychiatry, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
| | - Ahmad Kamil
- Department of Mechanical Engineering, Faculty of Engineering, Universitas Sumatera Utara, Medan, Indonesia
| | - Rusly Harsono
- Pediatric Critical Care Medicine, School of Medicine, Stanford University, Stanford, CA, United States
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8
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Grot S, Giguère CÉ, Smine S, Mongeau-Pérusse V, Nguyen DD, Preda A, Potvin S, van Erp TGM, Fbirn, Orban P. Converting scores between the PANSS and SAPS/SANS beyond the positive/negative dichotomy. Psychiatry Res 2021; 305:114199. [PMID: 34536695 DOI: 10.1016/j.psychres.2021.114199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 08/27/2021] [Accepted: 08/28/2021] [Indexed: 10/20/2022]
Abstract
Previous work provided conversion equations for overall indices of positive and negative symptomatology between the Positive and Negative Syndrome Scale (PANSS) and the Scales for the Assessment of Positive/Negative Symptoms (SAPS/SANS). Our objective was to provide such conversion equations for subdomains of positive and negative symptomatology in order to better account for the diversity of symptom profiles in schizophrenia. Symptoms severity was assessed using both the PANSS and SAPS/SANS in 205 patients with schizophrenia. Two exploratory factor analyses combining items from both scales were first performed separately in the positive and negative symptom domains. Positive factors were termed 'Hallucinations', 'Delusions' and 'Disorganization', while negative factors were associated with 'Expressivity', 'Amotivation' and 'Cognition', consistent with current descriptions of symptom dimensions in schizophrenia. For each factor, linear regression analyses were conducted on 80% of the data to obtain conversion equations from the PANSS to the SAPS/SANS and vice versa. Reliability was then evaluated on the 20% remaining data, with good to excellent intra-class correlation coefficients between the original and predicted scores for all but the cognition factor. These findings show that symptom severity scores can be converted with good accuracy between clinical scales beyond the positive/negative symptom dichotomy.
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Affiliation(s)
- Stéphanie Grot
- Research Center of the Montreal Mental Health University Institute, Montreal, Quebec, Canada; Department of Psychiatry and Addictology, University of Montreal, Montreal, Quebec, Canada
| | - Charles-Édouard Giguère
- Research Center of the Montreal Mental Health University Institute, Montreal, Quebec, Canada
| | - Salima Smine
- Research Center of the Montreal Mental Health University Institute, Montreal, Quebec, Canada
| | | | - Dana Diem Nguyen
- Department of Pediatrics, University of California Irvine, Irvine, California, USA
| | - Adrian Preda
- Department of Psychiatry and Human Behavior, University of California Irvine, Irvine, California, USA
| | - Stéphane Potvin
- Research Center of the Montreal Mental Health University Institute, Montreal, Quebec, Canada; Department of Psychiatry and Addictology, University of Montreal, Montreal, Quebec, Canada
| | - Theo G M van Erp
- Clinical Translational Neuroscience Laboratory, Department of Psychiatry and Human Behavior, University of California Irvine, Irvine, California, USA; Center for the Neurobiology of Learning and Memory, University of California Irvine, Irvine, California, USA
| | - Fbirn
- Function Biomedical Informatics Research Network, USA
| | - Pierre Orban
- Research Center of the Montreal Mental Health University Institute, Montreal, Quebec, Canada; Department of Psychiatry and Addictology, University of Montreal, Montreal, Quebec, Canada.
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Galderisi S, Mucci A, Dollfus S, Nordentoft M, Falkai P, Kaiser S, Giordano GM, Vandevelde A, Nielsen MØ, Glenthøj LB, Sabé M, Pezzella P, Bitter I, Gaebel W. EPA guidance on assessment of negative symptoms in schizophrenia. Eur Psychiatry 2021; 64:e23. [PMID: 33597064 PMCID: PMC8080207 DOI: 10.1192/j.eurpsy.2021.11] [Citation(s) in RCA: 79] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background During the last decades, a renewed interest for negative symptoms (NS) was brought about by the increased awareness that they interfere severely with real-life functioning, particularly when they are primary and persistent. Methods In this guidance paper, we provide a systematic review of the evidence and elaborate several recommendations for the conceptualization and assessment of NS in clinical trials and practice. Results Expert consensus and systematic reviews have provided guidance for the optimal assessment of primary and persistent negative symptoms; second-generation rating scales, which provide a better assessment of the experiential domains, are available; however, NS are still poorly assessed both in research and clinical settings. This European Psychiatric Association (EPA) guidance recommends the use of persistent negative symptoms (PNS) construct in the context of clinical trials and highlights the need for further efforts to make the definition of PNS consistent across studies in order to exclude as much as possible secondary negative symptoms. We also encourage clinicians to use second-generation scales, at least to complement first-generation ones. The EPA guidance further recommends the evidence-based exclusion of several items included in first-generation scales from any NS summary or factor score to improve NS measurement in research and clinical settings. Self-rated instruments are suggested to further complement observer-rated scales in NS assessment. Several recommendations are provided for the identification of secondary negative symptoms in clinical settings. Conclusions The dissemination of this guidance paper may promote the development of national guidelines on negative symptom assessment and ultimately improve the care of people with schizophrenia.
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Affiliation(s)
- S Galderisi
- Department of Psychiatry, Campania University Luigi Vanvitelli, Naples, Italy
| | - A Mucci
- Department of Psychiatry, Campania University Luigi Vanvitelli, Naples, Italy
| | - S Dollfus
- CHU de Caen, Service de Psychiatrie, 14000Caen, France.,Normandie Univ, UNICAEN, ISTS EA 7466, GIP Cyceron, 14000Caen, France.,Normandie Univ, UNICAEN, UFR de Médecine, 14000Caen, France
| | - M Nordentoft
- Copenhagen Research Centre for Mental Health (CORE), Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark.,Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, Glostrup, Denmark
| | - P Falkai
- Department of Psychiatry, University of Munich, Munich, Germany
| | - S Kaiser
- Division of Adult Psychiatry, Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | - G M Giordano
- Department of Psychiatry, Campania University Luigi Vanvitelli, Naples, Italy
| | - A Vandevelde
- CHU de Caen, Service de Psychiatrie, 14000Caen, France.,Normandie Univ, UNICAEN, ISTS EA 7466, GIP Cyceron, 14000Caen, France.,Normandie Univ, UNICAEN, UFR de Médecine, 14000Caen, France
| | - M Ø Nielsen
- Department of Clinical Medicine, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark.,Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, Glostrup, Denmark.,Center for Neuropsychiatric Schizophrenia Research, CNSR, Glostrup, Denmark
| | - L B Glenthøj
- Copenhagen Research Centre for Mental Health (CORE), Copenhagen University Hospital, Copenhagen, Denmark.,Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, Glostrup, Denmark
| | - M Sabé
- Division of Adult Psychiatry, Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | - P Pezzella
- Department of Psychiatry, Campania University Luigi Vanvitelli, Naples, Italy
| | - I Bitter
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | - W Gaebel
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
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10
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Opoka SM, Ludwig L, Mehl S, Lincoln TM. An experimental study on the effectiveness of emotion regulation in patients with acute delusions. Schizophr Res 2021; 228:206-217. [PMID: 33453692 DOI: 10.1016/j.schres.2020.11.054] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 08/28/2020] [Accepted: 11/29/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Patients with psychotic disorders report to apply more maladaptive and less adaptive emotion-regulation (ER) strategies compared to healthy controls. However, few studies have used experimental designs to investigate the success in ER and the results of those at hand are equivocal. AIM This study investigated whether patients with delusions show problems in downregulating negative affect via cognitive ER-strategies. METHOD Patients with schizophrenia spectrum disorders and acute delusions (n = 78) and healthy controls (n = 41) took part in an ER-experiment, in which they were instructed to downregulate anxiety and sadness via three ER-strategies (reappraisal, distraction, acceptance) or not to regulate their emotions (control-condition). ER-success was measured as the change in subjective emotion-intensity and physiological indicators (skin conductance and heart rate) from before to after regulation and was analyzed with mixed-repeated-measures ANOVAs. RESULTS We found a significant effect of the ER-strategy in the sense that the subjective emotion-intensity was significantly lower after applying the reappraisal- and distraction-strategies than after the just view-condition (p's < .001). This effect was not found for the acceptance strategy (p = .060). There was no ER-strategy ∗ time ∗ group interaction-effect F(4.918, 575.416) = 0.778, p = .564, ƞ2partial = 0.007. In all conditions, skin conductance decreased from pre- to post regulation (p < .001). CONCLUSION Our results indicate that patients with acute delusions can successfully apply cognitive ER-strategies. Before pursuing the relevant clinical implications of this finding, further research is needed to explore the role that the type of instruction has on ER-success and the extent to which the findings can be generalized to real life settings.
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Affiliation(s)
- Sandra M Opoka
- Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Movement Sciences, Universität Hamburg, 20146 Hamburg, Germany.
| | - Lea Ludwig
- Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Movement Sciences, Universität Hamburg, 20146 Hamburg, Germany
| | - Stephanie Mehl
- Department of Psychiatry and Psychotherapy & Center for Mind, Brain and Behavior (CMBB), Faculty of Medicine, Philipps-University of Marburg, 35039 Marburg, Germany; Faculty of Health and Social Work, Frankfurt University of Applied Sciences, 60318 Frankfurt am Main, Germany
| | - Tania M Lincoln
- Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Movement Sciences, Universität Hamburg, 20146 Hamburg, Germany
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11
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Kølbæk P, Dines D, Hansen J, Opler M, Correll CU, Mors O, Østergaard SD. Standardized training in the rating of the six-item Positive And Negative Syndrome Scale (PANSS-6). Schizophr Res 2021; 228:438-446. [PMID: 33578367 DOI: 10.1016/j.schres.2020.12.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 11/19/2020] [Accepted: 12/29/2020] [Indexed: 10/22/2022]
Abstract
The six-item Positive And Negative Syndrome Scale (PANSS-6) allows for a brief assessment of the severity of core symptoms of schizophrenia. However, implementing the PANSS-6 in clinical practice requires that staff members' ratings are accurate and reliable. We aimed to investigate whether such accuracy and reliability can be obtained via a brief video-based training program. One-hundred-and-four staff members from a psychiatric hospital in Denmark participated in the training. Participants performed a baseline PANSS-6 rating based on a video of a patient being interviewed using the Simplified positive And Negative Symptoms interview (SNAPSI). Subsequently, a theoretical introduction video was displayed followed by five successive videotaped SNAPSI patient interviews. After each SNAPSI video, individual ratings were conducted before a video providing the gold standard rating was displayed. The accuracy of ratings was estimated by calculating the proportion of participants not deviating from the gold standard rating with >2 points on individual items or >6 points on the PANSS-6 total score. Reliability was tested after each step in the training by means of Gwet's Agreement Coefficient (Gwet). By the end of the training, 72% of the participants rated within the acceptable deviations of the gold standard, ranging from 60% (nurses) to 91% (medical doctors & psychologists). The reliability improved (Gwet baseline vs. endpoint) for all PANSS-6 items, except for Blunted affect. In conclusion, the majority of the staff members conducted accurate PANSS-6 ratings after a brief standardized training program, supporting the implementation of PANSS-6 in clinical settings to facilitate measurement-based care.
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Affiliation(s)
- Pernille Kølbæk
- Psychosis Research Unit, Aarhus University Hospital - Psychiatry, Palle Juul-Jensens Boulevard 175, 8200 Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200 Aarhus N, Denmark.
| | - David Dines
- Psychosis Research Unit, Aarhus University Hospital - Psychiatry, Palle Juul-Jensens Boulevard 175, 8200 Aarhus, Denmark
| | - Johanna Hansen
- Psychosis Research Unit, Aarhus University Hospital - Psychiatry, Palle Juul-Jensens Boulevard 175, 8200 Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200 Aarhus N, Denmark
| | - Mark Opler
- MedAvante-ProPhase Inc, NY, USA, 3 Park Avenue, 28(th) Floor, New York, NY 10016, USA; The PANSS Institute, 3 Park Avenue, New York, NY 10016, USA
| | - Christoph U Correll
- Division of Psychiatry Research, The Zucker Hillside Hospital, 75-59 263rd Street, Glen Oaks, NY 11004, USA; Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell School of Medicine, 500 Hofstra Blvd, Hempstead, NY 11549, USA; Department of Child and Adolescent Psychiatry and Psychotherapy, Charite Universitätsmedizin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Ole Mors
- Psychosis Research Unit, Aarhus University Hospital - Psychiatry, Palle Juul-Jensens Boulevard 175, 8200 Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200 Aarhus N, Denmark
| | - Søren D Østergaard
- Psychosis Research Unit, Aarhus University Hospital - Psychiatry, Palle Juul-Jensens Boulevard 175, 8200 Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200 Aarhus N, Denmark; Department of Affective Disorders, Aarhus University Hospital - Psychiatry, Palle Juul-Jensens Boulevard 175, 8200 Aarhus, Denmark
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EEG Source Network for the Diagnosis of Schizophrenia and the Identification of Subtypes Based on Symptom Severity-A Machine Learning Approach. J Clin Med 2020; 9:jcm9123934. [PMID: 33291657 PMCID: PMC7761931 DOI: 10.3390/jcm9123934] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 11/26/2020] [Accepted: 12/02/2020] [Indexed: 12/12/2022] Open
Abstract
A precise diagnosis and a comprehensive assessment of symptom severity are important clinical issues in patients with schizophrenia (SZ). We investigated whether electroencephalography (EEG) features obtained from EEG source network analyses could be effectively applied to classify the SZ subtypes based on symptom severity. Sixty-four electrode EEG signals were recorded from 119 patients with SZ (53 males and 66 females) and 119 normal controls (NC, 51 males and 68 females) during resting-state with closed eyes. Brain network features (global and local clustering coefficient and global path length) were calculated from EEG source activities. According to positive, negative, and cognitive/disorganization symptoms, the SZ patients were divided into two groups (high and low) by positive and negative syndrome scale (PANSS). To select features for classification, we used the sequential forward selection (SFS) method. The classification accuracy was evaluated using 10 by 10-fold cross-validation with the linear discriminant analysis (LDA) classifier. The best classification accuracy was 80.66% for estimating SZ patients from the NC group. The best classification accuracy between low and high groups in positive, negative, and cognitive/disorganization symptoms were 88.10%, 75.25%, and 77.78%, respectively. The selected features well-represented the pathological brain regions of SZ. Our study suggested that resting-state EEG network features could successfully classify between SZ patients and the NC, and between low and high SZ groups in positive, negative, and cognitive/disorganization symptoms.
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Carrà G, Crocamo C, Bartoli F, Angermeyer M, Brugha T, Toumi M, Bebbington P. The mediating role of depression in pathways linking positive and negative symptoms in schizophrenia. A longitudinal analysis using latent variable structural equation modelling. Psychol Med 2020; 50:566-574. [PMID: 30846005 DOI: 10.1017/s0033291719000321] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND The interaction between positive, negative and depressive symptoms experienced by people with schizophrenia is complex. We used longitudinal data to test the hypothesis that depressive symptoms mediate the links between positive and negative symptoms. METHODS We analyzed data from the European Schizophrenia Cohort, randomly sampled from outpatient services in France, Germany and the UK (N = 1208). Initial measures were repeated after 6 and 12 months. Depressive symptoms were identified using the Calgary Depression Scale for Schizophrenia (CDSS), while positive and negative symptoms were assessed with the Positive and Negative Syndrome Scale (PANSS). Latent variable structural equation modelling was used to investigate the mediating role of depression assessed at 6 months in relation to the longitudinal association between positive symptoms at baseline and negative symptoms at 12 months. RESULTS We found longitudinal associations between positive symptoms at baseline and negative symptoms at 12 months, as well as between both of these and CDSS levels at 6 months. However depression did not mediate the longitudinal association between PANSS scores; all the effect was direct. CONCLUSIONS Our findings are incompatible with a mediating function for depression on the pathway from positive to negative symptoms, at least on this timescale. The role of depression in schizophrenic disorders remains a challenge for categorical and hierarchical diagnostic systems alike. Future research should analyze specific domains of both depressive and negative symptoms (e.g. motivational and hedonic impairments). The clinical management of negative symptoms using antidepressant treatments may need to be reconsidered.
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Affiliation(s)
- Giuseppe Carrà
- Division of Psychiatry, University College London, 149 Tottenham Court Road, LondonW1T 7NF, UK
- Department of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, Monza20900, Italy
| | - Cristina Crocamo
- Department of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, Monza20900, Italy
| | - Francesco Bartoli
- Department of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, Monza20900, Italy
| | - Matthias Angermeyer
- Department of Psychiatry, University of Leipzig, Johannisallee 20, 04137 Leipzig, Germany
| | - Traolach Brugha
- Department of Health Sciences, University of Leicester, College of Medicine, Biological Sciences and Psychology, University of Leicester, Centre for Medicine, University Road, LeicesterLE1 7RH, UK
| | - Mondher Toumi
- Laboratoire de Santé Publique, Université de la Méditerranée, Marseille, France
| | - Paul Bebbington
- Division of Psychiatry, University College London, 149 Tottenham Court Road, LondonW1T 7NF, UK
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14
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Just SA, Haegert E, Kořánová N, Bröcker AL, Nenchev I, Funcke J, Heinz A, Bermpohl F, Stede M, Montag C. Modeling Incoherent Discourse in Non-Affective Psychosis. Front Psychiatry 2020; 11:846. [PMID: 32973586 PMCID: PMC7466436 DOI: 10.3389/fpsyt.2020.00846] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 08/04/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Computational linguistic methodology allows quantification of speech abnormalities in non-affective psychosis. For this patient group, incoherent speech has long been described as a symptom of formal thought disorder. Our study is an interdisciplinary attempt at developing a model of incoherence in non-affective psychosis, informed by computational linguistic methodology as well as psychiatric research, which both conceptualize incoherence as associative loosening. The primary aim of this pilot study was methodological: to validate the model against clinical data and reduce bias in automated coherence analysis. METHODS Speech samples were obtained from patients with a diagnosis of schizophrenia or schizoaffective disorder, who were divided into two groups of n = 20 subjects each, based on different clinical ratings of positive formal thought disorder, and n = 20 healthy control subjects. RESULTS Coherence metrics that were automatically derived from interview transcripts significantly predicted clinical ratings of thought disorder. Significant results from multinomial regression analysis revealed that group membership (controls vs. patients with vs. without formal thought disorder) could be predicted based on automated coherence analysis when bias was considered. Further improvement of the regression model was reached by including variables that psychiatric research has shown to inform clinical diagnostics of positive formal thought disorder. CONCLUSIONS Automated coherence analysis may capture different features of incoherent speech than clinical ratings of formal thought disorder. Models of incoherence in non-affective psychosis should include automatically derived coherence metrics as well as lexical and syntactic features that influence the comprehensibility of speech.
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Affiliation(s)
- Sandra A Just
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte (Psychiatric University Clinic at St. Hedwig Hospital), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Erik Haegert
- Applied Computational Linguistics, UFS Cognitive Science, University of Potsdam, Potsdam, Germany
| | - Nora Kořánová
- Applied Computational Linguistics, UFS Cognitive Science, University of Potsdam, Potsdam, Germany
| | - Anna-Lena Bröcker
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte (Psychiatric University Clinic at St. Hedwig Hospital), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Ivan Nenchev
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte (Psychiatric University Clinic at St. Hedwig Hospital), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Jakob Funcke
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte (Psychiatric University Clinic at St. Hedwig Hospital), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Andreas Heinz
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte (Psychiatric University Clinic at St. Hedwig Hospital), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Felix Bermpohl
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte (Psychiatric University Clinic at St. Hedwig Hospital), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Manfred Stede
- Applied Computational Linguistics, UFS Cognitive Science, University of Potsdam, Potsdam, Germany
| | - Christiane Montag
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte (Psychiatric University Clinic at St. Hedwig Hospital), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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Hunt GE, Siegfried N, Morley K, Brooke‐Sumner C, Cleary M. Psychosocial interventions for people with both severe mental illness and substance misuse. Cochrane Database Syst Rev 2019; 12:CD001088. [PMID: 31829430 PMCID: PMC6906736 DOI: 10.1002/14651858.cd001088.pub4] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Even low levels of substance misuse by people with a severe mental illness can have detrimental effects. OBJECTIVES To assess the effects of psychosocial interventions for reduction in substance use in people with a serious mental illness compared with standard care. SEARCH METHODS The Information Specialist of the Cochrane Schizophrenia Group (CSG) searched the CSG Trials Register (2 May 2018), which is based on regular searches of major medical and scientific databases. SELECTION CRITERIA We included all randomised controlled trials (RCTs) comparing psychosocial interventions for substance misuse with standard care in people with serious mental illness. DATA COLLECTION AND ANALYSIS Review authors independently selected studies, extracted data and appraised study quality. For binary outcomes, we calculated standard estimates of risk ratio (RR) and their 95% confidence intervals (CIs) on an intention-to-treat basis. For continuous outcomes, we calculated the mean difference (MD) between groups. Where meta-analyses were possible, we pooled data using a random-effects model. Using the GRADE approach, we identified seven patient-centred outcomes and assessed the quality of evidence for these within each comparison. MAIN RESULTS Our review now includes 41 trials with a total of 4024 participants. We have identified nine comparisons within the included trials and present a summary of our main findings for seven of these below. We were unable to summarise many findings due to skewed data or because trials did not measure the outcome of interest. In general, evidence was rated as low- or very-low quality due to high or unclear risks of bias because of poor trial methods, or inadequately reported methods, and imprecision due to small sample sizes, low event rates and wide confidence intervals. 1. Integrated models of care versus standard care (36 months) No clear differences were found between treatment groups for loss to treatment (RR 1.09, 95% CI 0.82 to 1.45; participants = 603; studies = 3; low-quality evidence), death (RR 1.18, 95% CI 0.39 to 3.57; participants = 421; studies = 2; low-quality evidence), alcohol use (RR 1.15, 95% CI 0.84 to 1.56; participants = 143; studies = 1; low-quality evidence), substance use (drug) (RR 0.89, 95% CI 0.63 to 1.25; participants = 85; studies = 1; low-quality evidence), global assessment of functioning (GAF) scores (MD 0.40, 95% CI -2.47 to 3.27; participants = 170; studies = 1; low-quality evidence), or general life satisfaction (QOLI) scores (MD 0.10, 95% CI -0.18 to 0.38; participants = 373; studies = 2; moderate-quality evidence). 2. Non-integrated models of care versus standard care There was no clear difference between treatment groups for numbers lost to treatment at 12 months (RR 1.21, 95% CI 0.73 to 1.99; participants = 134; studies = 3; very low-quality evidence). 3. Cognitive behavioural therapy (CBT) versus standard care There was no clear difference between treatment groups for numbers lost to treatment at three months (RR 1.12, 95% CI 0.44 to 2.86; participants = 152; studies = 2; low-quality evidence), cannabis use at six months (RR 1.30, 95% CI 0.79 to 2.15; participants = 47; studies = 1; very low-quality evidence) or mental state insight (IS) scores by three months (MD 0.52, 95% CI -0.78 to 1.82; participants = 105; studies = 1; low-quality evidence). 4. Contingency management versus standard care We found no clear differences between treatment groups for numbers lost to treatment at three months (RR 1.55, 95% CI 1.13 to 2.11; participants = 255; studies = 2; moderate-quality evidence), number of stimulant positive urine tests at six months (RR 0.83, 95% CI 0.65 to 1.06; participants = 176; studies = 1) or hospitalisations (RR 0.21, 95% CI 0.05 to 0.93; participants = 176; studies = 1); both low-quality evidence. 5. Motivational interviewing (MI) versus standard care We found no clear differences between treatment groups for numbers lost to treatment at six months (RR 1.71, 95% CI 0.63 to 4.64; participants = 62; studies = 1). A clear difference, favouring MI, was observed for abstaining from alcohol (RR 0.36, 95% CI 0.17 to 0.75; participants = 28; studies = 1) but not other substances (MD -0.07, 95% CI -0.56 to 0.42; participants = 89; studies = 1), and no differences were observed in mental state general severity (SCL-90-R) scores (MD -0.19, 95% CI -0.59 to 0.21; participants = 30; studies = 1). All very low-quality evidence. 6. Skills training versus standard care At 12 months, there were no clear differences between treatment groups for numbers lost to treatment (RR 1.42, 95% CI 0.20 to 10.10; participants = 122; studies = 3) or death (RR 0.15, 95% CI 0.02 to 1.42; participants = 121; studies = 1). Very low-quality, and low-quality evidence, respectively. 7. CBT + MI versus standard care At 12 months, there was no clear difference between treatment groups for numbers lost to treatment (RR 0.99, 95% CI 0.62 to 1.59; participants = 327; studies = 1; low-quality evidence), number of deaths (RR 0.60, 95% CI 0.20 to 1.76; participants = 603; studies = 4; low-quality evidence), relapse (RR 0.50, 95% CI 0.24 to 1.04; participants = 36; studies = 1; very low-quality evidence), or GAF scores (MD 1.24, 95% CI -1.86 to 4.34; participants = 445; studies = 4; very low-quality evidence). There was also no clear difference in reduction of drug use by six months (MD 0.19, 95% CI -0.22 to 0.60; participants = 119; studies = 1; low-quality evidence). AUTHORS' CONCLUSIONS We included 41 RCTs but were unable to use much data for analyses. There is currently no high-quality evidence to support any one psychosocial treatment over standard care for important outcomes such as remaining in treatment, reduction in substance use or improving mental or global state in people with serious mental illnesses and substance misuse. Furthermore, methodological difficulties exist which hinder pooling and interpreting results. Further high-quality trials are required which address these concerns and improve the evidence in this important area.
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Affiliation(s)
- Glenn E Hunt
- The University of SydneyDiscipline of PsychiatryConcord Centre for Mental HealthHospital RoadSydneyNSWAustralia2139
| | - Nandi Siegfried
- South African Medical Research CouncilAlcohol, Tobacco and Other Drug Research UnitTybergCape TownSouth Africa
| | - Kirsten Morley
- The University of SydneyAddiction MedicineSydneyAustralia
| | - Carrie Brooke‐Sumner
- South African Medical Research CouncilAlcohol, Tobacco and Other Drug Research UnitTybergCape TownSouth Africa
| | - Michelle Cleary
- University of TasmaniaSchool of Nursing, College of Health and MedicineSydney, NSWAustralia
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Akter L, Srabony FA, Deeba F, Roy S. Adaptation of the scale for the assessment of positive symptoms and scale for the assessment of negative symptoms of schizophrenia in Bangladesh. ASIA PACIFIC JOURNAL OF COUNSELLING AND PSYCHOTHERAPY 2019. [DOI: 10.1080/21507686.2019.1634602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Liza Akter
- Department of Clinical Psychology, University of Dhaka, Dhaka, Bangladesh
| | | | - Farah Deeba
- Department of Clinical Psychology, University of Dhaka, Dhaka, Bangladesh
| | - Sanjit Roy
- Department of Population Sciences, University of Dhaka, Dhaka, Bangladesh
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Wilson SM, Thompson AC, Currence ED, Thomas SP, Dedert EA, Kirby AC, Elbogen EB, Moore SD, Calhoun PS, Beckham JC. Patient-Informed Treatment Development of Behavioral Smoking Cessation for People With Schizophrenia. Behav Ther 2019; 50:395-409. [PMID: 30824254 PMCID: PMC6400295 DOI: 10.1016/j.beth.2018.07.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 07/09/2018] [Accepted: 07/22/2018] [Indexed: 11/21/2022]
Abstract
The objective of this study was to use qualitative methodology to tailor and refine an existing smoking cessation intervention for the population of people who use cigarettes and are diagnosed with schizophrenia, schizoaffective, or psychotic disorder. Successive cohort design methodology was used to iteratively modify the treatment in response to qualitative participant, therapist, and consultant feedback on the intervention. Qualitative methodology for participant feedback included analysis of semistructured interviews with participants, visualization of app utilization data, and stakeholder feedback from study therapists and consultants. Using the successive cohort design, a tailored multicomponent mobile health smoking cessation intervention was developed. The intervention included mobile contingency management (i.e., financial compensation for confirmed abstinence from smoking), pharmacotherapy for smoking cessation, cognitive-behavioral counseling sessions, and the Stay Quit app for relapse prevention. Two cohorts (N = 13) were completed in the study; after each cohort, the treatment protocol was revised. The intervention is described, as well as the qualitative findings from each cohort and subsequent changes made to the intervention based upon patient and provider feedback. Metrics of patient engagement included treatment adherence (40% in Cohort 1 and 63% in Cohort 2). Both participants and therapists reported that the intervention was helpful. Over one third of participants self-reported abstinence at posttreatment. Since qualitative methodology is often underutilized in mental health treatment development, this study demonstrates the utility of the successive cohort design for treatment development of behavior change interventions for at-risk, vulnerable populations.
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Affiliation(s)
- Sarah M Wilson
- Duke University School of Medicine; Center for Health Services Research in Primary Care; VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center; Durham Veterans Affairs Health Care System.
| | | | | | | | - Eric A Dedert
- Duke University School of Medicine; VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center; Durham Veterans Affairs Health Care System
| | - Angela C Kirby
- Duke University School of Medicine; VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center; Durham Veterans Affairs Health Care System
| | - Eric B Elbogen
- Duke University School of Medicine; VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center; Durham Veterans Affairs Health Care System
| | - Scott D Moore
- Duke University School of Medicine; VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center; Durham Veterans Affairs Health Care System
| | - Patrick S Calhoun
- Duke University School of Medicine; Center for Health Services Research in Primary Care; VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center; Durham Veterans Affairs Health Care System
| | - Jean C Beckham
- Duke University School of Medicine; VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center; Durham Veterans Affairs Health Care System
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18
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Carrà G, Crocamo C, Angermeyer M, Brugha T, Toumi M, Bebbington P. Positive and negative symptoms in schizophrenia: A longitudinal analysis using latent variable structural equation modelling. Schizophr Res 2019; 204:58-64. [PMID: 30177344 DOI: 10.1016/j.schres.2018.08.018] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 07/06/2018] [Accepted: 08/13/2018] [Indexed: 01/29/2023]
Abstract
BACKGROUND Recent network models of schizophrenia propose it is the consequence of mutual interaction between its symptoms. While cross-sectional associations between negative and positive symptoms are consistent with this idea, they may merely reflect their involvement in the diagnostic process. Longitudinal analyses however may allow the identification of possible causal relationships. The European Schizophrenia Cohort (EuroSC) provides data suitable for this purpose. METHODS EuroSC includes 1208 patients randomly sampled from outpatient services in France, Germany and the UK. Initial measures were repeated after 12 and 24 months. Latent variable structural equation modelling was used to investigate the direction of effect between positive and negative symptoms assessed with the Positive and Negative Syndrome Scale, controlling for the effects of depressed mood and antipsychotic medication. RESULTS The structural model provided acceptable overall fit [χ2 (953) = 2444.32, P < 0.001; CFI = 0.909; RMSEA = 0.046 (90% CI: 0.043, 0.048); SRMR = 0.052]. Both positive and negative symptoms were persistent, and strongly auto-correlated. There were also persistent cross-sectional associations between positive and negative symptoms. While the path from latent positive to negative symptoms from T1 to T2 approached conventional levels of statistical significance (P = 0.051), that from T2 to T3 did not (P = 0.546). Pathways in the reverse direction were uniformly non-significant. CONCLUSIONS There was no evidence that negative symptoms predict later positive symptoms. The prediction of negative symptoms by positive symptoms was ambiguous. We discuss implications for conceptualization of schizophrenic processes.
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Affiliation(s)
- Giuseppe Carrà
- Division of Psychiatry, University College London, 149 Tottenham Court Road, London W1T 7NF, UK; Department of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, Monza 20900, Italy
| | - Cristina Crocamo
- Department of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, Monza 20900, Italy.
| | - Matthias Angermeyer
- Department of Psychiatry, University of Leipzig, Johannisallee 20, 04137 Leipzig, Germany
| | - Traolach Brugha
- Department of Health Sciences, College of Life Sciences, University of Leicester, University Road, Leicester LE1 7RH, UK
| | - Mondher Toumi
- Laboratoire de Santé Publique, Université de la Méditerranée, Marseille, France
| | - Paul Bebbington
- Division of Psychiatry, University College London, 149 Tottenham Court Road, London W1T 7NF, UK
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Holm T, Thomsen DK, Bliksted V. Themes of unfulfilled agency and communion in life stories of patients with schizophrenia. Psychiatry Res 2018; 269:772-778. [PMID: 30380593 DOI: 10.1016/j.psychres.2018.08.116] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 08/28/2018] [Accepted: 08/28/2018] [Indexed: 10/28/2022]
Abstract
We examined themes of agency and communion in life stories of individuals with schizophrenia. Twenty-four individuals diagnosed with schizophrenia and 24 control participants matched on age, gender, and education described their life stories in a free format. The life stories were coded for the presence of agency and communion themes and whether or not the themes captured fulfillment of agency and communion needs. In addition, the temporal macrostructure was coded. Individuals with schizophrenia described their life stories with similar levels of temporal macrostructure as controls, but they expressed more themes focusing on unfulfilled agency and communion needs. We suggest possible avenues for using these insights to improve recovery in schizophrenia.
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Affiliation(s)
- Tine Holm
- Psychosis Research Unit, Aarhus University Hospital Risskov, Denmark.
| | | | - Vibeke Bliksted
- Psychosis Research Unit, Aarhus University Hospital Risskov, Denmark; Department of Clinical Medicine, Aarhus University, Denmark
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20
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Preda A, Nguyen DD, Bustillo JR, Belger A, O'Leary DS, McEwen S, Ling S, Faziola L, Mathalon DH, Ford JM, Potkin SG, van Erp TGM. A positive take on schizophrenia negative symptom scales: Converting scores between the SANS, NSA and SDS. Schizophr Res 2018; 201:113-119. [PMID: 29935887 PMCID: PMC7039318 DOI: 10.1016/j.schres.2018.06.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2017] [Revised: 03/30/2018] [Accepted: 06/08/2018] [Indexed: 10/28/2022]
Abstract
AIMS To provide quantitative conversions between commonly used scales for the assessment of negative symptoms in schizophrenia. METHOD Linear regression analyses generated conversion equations between symptom scores from the Scale for the Assessment of Negative Symptoms (SANS), the Schedule for the Deficit Syndrome (SDS), the Positive and Negative Syndrome Scale (PANSS), or the Negative Symptoms Assessment (NSA) based on a cross sectional sample of 176 individuals with schizophrenia. Intraclass correlations assessed the rating conversion accuracy based on a separate sub-sample of 29 patients who took part in the initial study as well as an independent sample of 28 additional subjects with schizophrenia. RESULTS Between-scale negative symptom ratings were moderately to highly correlated (r = 0.73-0.91). Intraclass correlations between the original negative symptom rating scores and those obtained via using the conversion equations were in the range of 0.61-0.79. CONCLUSIONS While there is a degree of non-overlap, several negative symptoms scores reflect measures of similar constructs and may be reliably converted between some scales. The conversion equations are provided at http://www.converteasy.org and may be used for meta- and mega-analyses that examine negative symptoms.
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Affiliation(s)
- Adrian Preda
- Department of Psychiatry and Human Behavior, University of California Irvine, Irvine, CA, USA.
| | - Dana D Nguyen
- Department of Pediatrics, University of California Irvine, Irvine, CA, USA
| | - Juan R Bustillo
- Department of Psychiatry, University of New Mexico, Albuquerque, NM, USA
| | - Aysenil Belger
- Department of Psychiatry and Psychology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Daniel S O'Leary
- Department of Psychiatry, University of Iowa, Iowa City, IA, USA
| | - Sarah McEwen
- Department of Psychiatry, University of California, San Diego, La Jolla, CA 92093, USA
| | - Shichun Ling
- Department of Psychiatry and Human Behavior, University of California Irvine, Irvine, CA, USA
| | - Lawrence Faziola
- Department of Psychiatry and Human Behavior, University of California Irvine, Irvine, CA, USA
| | - Daniel H Mathalon
- Department of Psychiatry, UCSF, San Francisco, San Francisco, CA, USA
| | - Judith M Ford
- Department of Psychiatry, UCSF, San Francisco, San Francisco, CA, USA; San Francisco Veterans Affairs Medical Center, San Francisco, CA 94121, USA
| | - Steven G Potkin
- Department of Psychiatry and Human Behavior, University of California Irvine, Irvine, CA, USA
| | - Theo G M van Erp
- Clinical Translational Neuroscience Laboratory, Department of Psychiatry and Human Behavior, University of California Irvine, Irvine, CA, USA
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21
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Schubmehl S, Sussman J. Perspective on Pimavanserin and the SAPS-PD: Novel Scale Development as a Means to FDA Approval. Am J Geriatr Psychiatry 2018; 26:1007-1011. [PMID: 30072306 DOI: 10.1016/j.jagp.2018.06.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 06/06/2018] [Indexed: 10/14/2022]
Abstract
In 2016, pimavanserin, a 5-hydroxytryptamine 2A inverse agonist, became the first U.S. Food and Drug Administration (FDA) approved medication for Parkinson disease psychosis (PDP) after demonstrating modest clinical improvement in a single positive trial as assessed by a novel PDP scale, the Scale for the Assessment of Positive Symptoms for Parkinson's Disease Psychosis (SAPS-PD). This followed three trials that demonstrated negative findings on established measures of psychosis widely used in PDP research, including the Brief Psychiatric Rating Scale, the Scale for the Assessment of Positive Symptoms, the Parkinson Psychosis Rating Scale, and the Clinical Global Impression-Severity Scale. This review article provides an overview of the scale construction of the SAPS-PD, a measure which has yet to be established as valid, reliable, or sensitive to change in PDP. Furthermore, this article reviews analyses completed by an FDA statistical reviewer that call into question whether pimavanserin demonstrated a clinically significant difference from placebo on the SAPS-PD. These findings underscore concerns regarding the clinical efficacy of pimavanserin.
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22
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Carrà G, Battaglia C, Hinton M, Sheridan Rains L, Crocamo C, Johnson S. Social network confidants, duration of untreated psychosis and cannabis use in people with first episode psychosis: An exploratory study. Early Interv Psychiatry 2018; 12:942-946. [PMID: 28858430 DOI: 10.1111/eip.12476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 05/02/2017] [Accepted: 07/11/2017] [Indexed: 12/16/2022]
Abstract
AIM Reduced social network (SN) might be associated with a longer duration of untreated psychosis (DUP) in people with first episode psychosis (FEP). We aimed at exploring the specific role of SN confidants on DUP, taking into account cannabis misuse, which is known to influence DUP and might be associated with social functioning. METHODS People with FEP recently referred to an inner London Early Intervention Service were assessed with standardized instruments exploring SN characteristics, DUP and cannabis misuse. RESULTS Taking into account cannabis misuse, we found an association between confidants and DUP (P = 0.020), with the higher the number of confidants, the shorter the DUP. CONCLUSIONS Confidants may provide access to, and perceptions of, social support and this may increase early engagement for people with FEP, reducing DUP and possibly improving outcomes. Future research should identify correlates of small networks of confidants, which could inform early detection community initiatives.
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Affiliation(s)
- Giuseppe Carrà
- Division of Psychiatry, University College London, London, UK.,Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Claudia Battaglia
- Department of Neurosciences and Neurorehabilitation, Bambino Gesù Children's Hospital, Rome, Italy
| | - Mark Hinton
- Camden and Islington Early Intervention Service, London, UK
| | | | - Cristina Crocamo
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Sonia Johnson
- Division of Psychiatry, University College London, London, UK.,Camden and Islington Early Intervention Service, London, UK
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23
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Kølbæk P, Blicher AB, Buus CW, Feller SG, Holm T, Dines D, O'Leary KM, Sørensen RS, Opler M, Correll CU, Mors O, Bech P, Østergaard SD. Inter-rater reliability of ratings on the six-item Positive and Negative Syndrome Scale (PANSS-6) obtained using the Simplified Negative and Positive Symptoms Interview (SNAPSI). Nord J Psychiatry 2018; 72:431-436. [PMID: 30037286 DOI: 10.1080/08039488.2018.1492014] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PURPOSE The six-item version of the Positive And Negative Syndrome Scale (PANSS-6) is a brief rating scale focusing on core symptoms of schizophrenia. In order to facilitate rating of PANSS-6 and selected items from other common psychiatric rating scales, we recently developed the Simplified Negative and Positive Symptoms Interview (SNAPSI). The objective of the present study was to test the inter-rater reliability of PANSS-6 ratings obtained using the SNAPSI. MATERIALS AND METHODS Using the SNAPSI, seven raters (psychiatrists, first-year psychiatry residents and psychologists) performed a total of 56 PANSS-6 ratings of 12 in- or outpatients with schizophrenia. As a measure of inter-rater reliability, we calculated the intra-class correlation coefficient (ICC, ≥0.75 = excellent, 0.40-0.74 = fair to good, <0.40 = poor) for the PANSS-6 total score and individual item scores. Furthermore, for the PANSS-6 total scores obtained by the six noncertified PANSS raters, we calculated the median deviation from the PANSS-6 total scores obtained by the only certified PANSS rater. RESULTS The ICC for the PANSS-6 total score was 0.74 (F = 2.84, p = .03). The ICCs for the six individual PANSS-6 items ranged from 0.45 (N6 - Lack of spontaneity & flow of conversation) to 0.76 (P3 - Hallucinatory behavior). The PANSS-6 total scores obtained by the six noncertified PANSS raters deviated by a median of 12.7% (interquartile range: 6.2-20.0) from the PANSS-6 total scores obtained by the certified PANSS rater. CONCLUSIONS We found a good level of inter-rater reliability of PANSS-6 ratings obtained using the SNAPSI for seven raters with varying levels of clinical and research experience.
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Affiliation(s)
- Pernille Kølbæk
- a Psychosis Research Unit , Aarhus University Hospital , Risskov , Denmark.,b Department of Clinical Medicine , Aarhus University , Aarhus , Denmark
| | - Anne B Blicher
- a Psychosis Research Unit , Aarhus University Hospital , Risskov , Denmark
| | - Chanette W Buus
- a Psychosis Research Unit , Aarhus University Hospital , Risskov , Denmark
| | - Sandra G Feller
- a Psychosis Research Unit , Aarhus University Hospital , Risskov , Denmark
| | - Tine Holm
- a Psychosis Research Unit , Aarhus University Hospital , Risskov , Denmark
| | - David Dines
- a Psychosis Research Unit , Aarhus University Hospital , Risskov , Denmark
| | - Kathrine M O'Leary
- a Psychosis Research Unit , Aarhus University Hospital , Risskov , Denmark
| | - Rune S Sørensen
- a Psychosis Research Unit , Aarhus University Hospital , Risskov , Denmark
| | - Mark Opler
- c MedAvante-ProPhase Inc , NY , USA.,d Department of Psychiatry, New York University School of Medicine , NY , USA
| | - Christoph U Correll
- e Division of Psychiatry Research , The Zucker Hillside Hospital , Glen Oaks , NY , USA.,f Department of Psychiatry and Molecular Medicine , Hofstra Northwell School of Medicine , Hempstead , NY , USA.,g Department of Child and Adolescent Psychiatry and Psychotherapy , Charité Universitätsmedizin , Berlin , Germany
| | - Ole Mors
- a Psychosis Research Unit , Aarhus University Hospital , Risskov , Denmark.,b Department of Clinical Medicine , Aarhus University , Aarhus , Denmark
| | - Per Bech
- h Psychiatric Research Unit , Psychiatric Centre North Zealand, Copenhagen University Hospital , Hillerød , Denmark
| | - Søren D Østergaard
- a Psychosis Research Unit , Aarhus University Hospital , Risskov , Denmark.,b Department of Clinical Medicine , Aarhus University , Aarhus , Denmark.,i Aarhus Institute of Advanced Studies , Aarhus University , Denmark
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24
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Verma M, Bhargav H, Varambally S, Raghuram N, Bn G. Effect of integrated yoga on anti-psychotic induced side effects and cognitive functions in patients suffering from schizophrenia. JOURNAL OF COMPLEMENTARY & INTEGRATIVE MEDICINE 2018; 16:jcim-2017-0155. [PMID: 29944467 DOI: 10.1515/jcim-2017-0155] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 05/02/2018] [Indexed: 12/17/2022]
Abstract
Background Twenty one (12 females) subjects, diagnosed with schizophrenia by a psychiatrist using ICD-10, in the ages 52.87 + 9.5 years and suffering since 24.0 ± 3.05 years were recruited into the study from a schizophrenia rehabilitation center in Bengaluru. Methods All subjects were taking anti-psychotic medications and were in stable state for more than a month. Psychiatric medications were kept constant during the study period. Assessments were done at three points of time: (1) baseline, (2) after one month of usual routine (pre) and (3) after five months of validated Integrated Yoga (IY) intervention (post). Validated 1 h Yoga module (consisting of asanas, pranayama, relaxation techniques and chantings) was practiced for 5 months, five sessions per week. Antipsychotic-induced side effects were assessed using Simpson Angus Scale (SAS) and Udvalg for Kliniske Undersogelser (UKU) side effect rating scale. Cognitive functions (using Trail making Test A and B), clinical symptoms and anthropometry were assessed as secondary variables. Comparisons between "pre" and "post" data was done using paired samples t-tests after subtracting baseline scores from them respectively. Results At the end of five months, significant reduction in drug-induced Parkinsonian symptoms (SAS score; p=0.001) and 38 items of UKU scale was observed along with significant improvement in processing speed, executive functions and negative symptoms of schizophrenia patients. No side effects of Yoga were reported. Conclusions The present study provides preliminary evidence for usefulness of Integrated Yoga intervention in managing anti-psychotic-induced side effects.
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Affiliation(s)
- Meghnath Verma
- School of Yoga and Life Sciences, S-VYASA Yoga University, No.19, EknathBhavan, Gavipuram circle, Kempegowda Nagar, Bangalore560019, Karnataka, India
| | - Hemant Bhargav
- NIMHANS, Integrate Centre for Yoga, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Hosur Road, Lakkasandra, Bengaluru560029, India
| | - Shivarama Varambally
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Hosur Road, Lakkasandra, Bengaluru560029, Karnataka, India
| | - Nagarathna Raghuram
- School of Yoga and Life Sciences, S-VYASA Yoga University, No.19, EknathBhavan, Gavipuram circle, Kempegowda Nagar, Bangalore560019, Karnataka, India
| | - Gangadhar Bn
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Hosur Road, Lakkasandra, Bengaluru560029, Karnataka, India
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25
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Aboraya A, Leucht S, Nasrallah HA, Samara M, Haro JM, Elshazly A, Zangeneh M. A novel approach to measuring response and remission in schizophrenia in clinical trials. Schizophr Res 2017; 190:123-128. [PMID: 28314680 DOI: 10.1016/j.schres.2017.03.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 03/02/2017] [Accepted: 03/05/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Pharmaceutical companies conduct clinical trials to show the efficacy and safety of new medications for the treatment of schizophrenia. After the new medications are marketed, clinicians treating patients with schizophrenia discover that a considerable number of patients do not respond to these new medications. The goals of the review are to examine the methodology and design of recent antipsychotic clinical trials, identify common flaws, and propose guidelines to fix the flaws and improve the quality of future clinical trials of antipsychotic medications. METHODS A review of recent antipsychotic clinical trials was conducted using a PubMed search. Ten recent trials published in the past four years were reviewed and their methods analyzed and critiqued. RESULTS The authors identified six major methodological flaws that may explain the suboptimal response in many patients after a drug is approved. Most of the flaws are related to eligibility criteria, the misuse of the Positive and Negative Syndromes Scale (PANSS) and the lack of consensus on how to define remission, response and exacerbation in schizophrenia. Proposed guidelines for a more rigorous use of the PANSS are presented and recommendations are proposed for using uniform criteria for remission, response and exacerbation in schizophrenia. CONCLUSIONS The authors recommend using standardized diagnostic interviews to screen patients for eligibility criteria and using the PANSS according to the author's recommendations and the proposed guidelines. Uniform criteria to define remission, response and exacerbation are recommended for clinical trials examining the efficacy and safety of antipsychotic drugs in schizophrenia.
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Affiliation(s)
- Ahmed Aboraya
- Chief of Psychiatry, William R. Sharpe, Jr. Hospital. Clinical Professor of Psychiatry, West Virginia School of Osteopathic Medicine. Adjunct faculty, School of Public Health, West Virginia University (WVU), USA.
| | - Stefan Leucht
- Dept. of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Germany Ismaningerstr. 22, 81675 München, Germany
| | - Henry A Nasrallah
- The Sydney Souers Professor and Chairman Department of Psychiatry and Behavioral Neuroscience Saint Louis University School of Medicine St. Louis MO, USA
| | - Myrto Samara
- Department of Psychiatry and Psychotherapy, Technische Universität München, München, Germany
| | - Josep Maria Haro
- Parc Sanitari Sant Joan de Déu Dr. Antoni Pujadas, 42 08830 - Sant Boi de Llobregat Barcelona, Spain
| | - Ahmed Elshazly
- Atlanticare Regional Medical Center 1925 Pacific Ave Atlantic City, NJ, USA
| | - Masood Zangeneh
- Editor-in-Chief, International Journal of Mental Health & Addiction Consultant, Kuwait Center for Autism, Kuwait
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26
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Kim DW, Lee SH, Shim M, Im CH. Estimation of Symptom Severity Scores for Patients with Schizophrenia Using ERP Source Activations during a Facial Affect Discrimination Task. Front Neurosci 2017; 11:436. [PMID: 28824360 PMCID: PMC5540885 DOI: 10.3389/fnins.2017.00436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 07/14/2017] [Indexed: 11/13/2022] Open
Abstract
Precise diagnosis of psychiatric diseases and a comprehensive assessment of a patient's symptom severity are important in order to establish a successful treatment strategy for each patient. Although great efforts have been devoted to searching for diagnostic biomarkers of schizophrenia over the past several decades, no study has yet investigated how accurately these biomarkers are able to estimate an individual patient's symptom severity. In this study, we applied electrophysiological biomarkers obtained from electroencephalography (EEG) analyses to an estimation of symptom severity scores of patients with schizophrenia. EEG signals were recorded from 23 patients while they performed a facial affect discrimination task. Based on the source current density analysis results, we extracted voxels that showed a strong correlation between source activity and symptom scores. We then built a prediction model to estimate the symptom severity scores of each patient using the source activations of the selected voxels. The symptom scores of the Positive and Negative Syndrome Scale (PANSS) were estimated using the linear prediction model. The results of leave-one-out cross validation (LOOCV) showed that the mean errors of the estimated symptom scores were 3.34 ± 2.40 and 3.90 ± 3.01 for the Positive and Negative PANSS scores, respectively. The current pilot study is the first attempt to estimate symptom severity scores in schizophrenia using quantitative EEG features. It is expected that the present method can be extended to other cognitive paradigms or other psychological illnesses.
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Affiliation(s)
- Do-Won Kim
- Department of Biomedical Engineering, Chonnam National UniversityYeosu, South Korea
| | - Seung-Hwan Lee
- Psychiatry Department, Ilsan Paik Hospital, Inje UniversityGoyang, South Korea
| | - Miseon Shim
- Psychiatry Department, Ilsan Paik Hospital, Inje UniversityGoyang, South Korea.,Department of Biomedical Engineering, Hanyang UniversitySeoul, South Korea
| | - Chang-Hwan Im
- Department of Biomedical Engineering, Hanyang UniversitySeoul, South Korea
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27
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Herold CJ, Schmid LA, Lässer MM, Seidl U, Schröder J. Cognitive Performance in Patients with Chronic Schizophrenia Across the Lifespan. GEROPSYCH-THE JOURNAL OF GERONTOPSYCHOLOGY AND GERIATRIC PSYCHIATRY 2017. [DOI: 10.1024/1662-9647/a000164] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Abstract. Chronic schizophrenia involves neuropsychological deficits that primarily strike executive functions and episodic memory. Our study investigated these deficits throughout the lifespan in patients with chronic schizophrenia and in healthy controls. Important neuropsychological functions were tested in 94 patients and 66 healthy controls, who were assigned to three age groups. Compared with the healthy controls, patients performed significantly poorer on all tests applied. Significant age effects occurred on all tests except the digit span forward, with older subjects scoring well below the younger ones. With respect to cognitive flexibility, age effects were more pronounced in the patients. These findings underline the importance of cognitive deficits in chronic schizophrenia and indicate that diminished cognitive flexibility shows age-associated differences.
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Affiliation(s)
- Christina Josefa Herold
- Section of Geriatric Psychiatry, Department of General Psychiatry, University of Heidelberg, Heidelberg, Germany
| | - Lena Anna Schmid
- Section of Geriatric Psychiatry, Department of General Psychiatry, University of Heidelberg, Heidelberg, Germany
| | - Marc Montgomery Lässer
- Section of Geriatric Psychiatry, Department of General Psychiatry, University of Heidelberg, Heidelberg, Germany
| | - Ulrich Seidl
- Center for Mental Health, Klinikum Stuttgart, Stuttgart, Germany
| | - Johannes Schröder
- Section of Geriatric Psychiatry, Department of General Psychiatry, University of Heidelberg, Heidelberg, Germany
- Institute of Gerontology, University of Heidelberg, Heidelberg, Germany
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28
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Shim M, Hwang HJ, Kim DW, Lee SH, Im CH. Machine-learning-based diagnosis of schizophrenia using combined sensor-level and source-level EEG features. Schizophr Res 2016; 176:314-319. [PMID: 27427557 DOI: 10.1016/j.schres.2016.05.007] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Revised: 04/25/2016] [Accepted: 05/05/2016] [Indexed: 11/30/2022]
Abstract
Recently, an increasing number of researchers have endeavored to develop practical tools for diagnosing patients with schizophrenia using machine learning techniques applied to EEG biomarkers. Although a number of studies showed that source-level EEG features can potentially be applied to the differential diagnosis of schizophrenia, most studies have used only sensor-level EEG features such as ERP peak amplitude and power spectrum for machine learning-based diagnosis of schizophrenia. In this study, we used both sensor-level and source-level features extracted from EEG signals recorded during an auditory oddball task for the classification of patients with schizophrenia and healthy controls. EEG signals were recorded from 34 patients with schizophrenia and 34 healthy controls while each subject was asked to attend to oddball tones. Our results demonstrated higher classification accuracy when source-level features were used together with sensor-level features, compared to when only sensor-level features were used. In addition, the selected sensor-level features were mostly found in the frontal area, and the selected source-level features were mostly extracted from the temporal area, which coincide well with the well-known pathological region of cognitive processing in patients with schizophrenia. Our results suggest that our approach would be a promising tool for the computer-aided diagnosis of schizophrenia.
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Affiliation(s)
- Miseon Shim
- Department of Biomedical Engineering, Hanyang University, Seoul, South Korea
| | - Han-Jeong Hwang
- Department of Medical IT Convergence Engineering, Kumoh National Institute of Technology, Gumi, South Korea
| | - Do-Won Kim
- Berlin Institute of Technology, Machine Learning Group, Marchstrasse 23, Berlin 10587, Germany
| | - Seung-Hwan Lee
- Psychiatry Department, Ilsan Paik Hospital, Inje University, Goyang, South Korea
| | - Chang-Hwan Im
- Department of Biomedical Engineering, Hanyang University, Seoul, South Korea.
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29
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Carrà G, Johnson S, Crocamo C, Angermeyer MC, Brugha T, Azorin JM, Toumi M, Bebbington PE. Psychosocial functioning, quality of life and clinical correlates of comorbid alcohol and drug dependence syndromes in people with schizophrenia across Europe. Psychiatry Res 2016; 239:301-7. [PMID: 27046394 DOI: 10.1016/j.psychres.2016.03.038] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 01/27/2016] [Accepted: 03/23/2016] [Indexed: 10/22/2022]
Abstract
Little is known about the correlates of comorbid drug and alcohol dependence in people with schizophrenia outside the USA. We tested hypotheses that dependence on alcohol/drugs would be associated with more severe symptoms, and poorer psychosocial functioning and quality of life. The EuroSC Cohort study (N=1204), based in France, Germany and the UK, used semi-structured clinical interviews for diagnoses, and standardized tools to assess correlates. We used mixed models to compare outcomes between past-year comorbid dependence on alcohol/drugs, controlling for covariates and modelling both subject and country-level effects. Participants dependent on alcohol or drugs had fewer negative symptoms on PANSS than their non-dependent counterparts. However, those dependent on alcohol scored higher on PANSS general psychopathology than those who were not, or dependent only on drugs. People with schizophrenia dependent on drugs had poorer quality of life, more extrapyramidal side effects, and scored worse on Global Assessment of Functioning (GAF) than those without dependence. People with alcohol dependence reported more reasons for non-compliance with medication, and poorer functioning on GAF, though not on Global Assessment of Relational Functioning. In people with schizophrenia, comorbid dependence on alcohol or drugs is associated with impaired clinical and psychosocial adjustment, and poorer quality of life.
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Affiliation(s)
- Giuseppe Carrà
- Division of Psychiatry (Formerly Mental Health Sciences), University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London W1T 7NF, UK.
| | - Sonia Johnson
- Division of Psychiatry (Formerly Mental Health Sciences), University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London W1T 7NF, UK.
| | - Cristina Crocamo
- Department of Public Health, Experimental and Forensic Medicine, Unit of Biostatistics and Clinical Epidemiology, University of Pavia, Via Forlanini 2, 27100 Pavia, Italy.
| | - Matthias C Angermeyer
- Department of Psychiatry, University of Leipzig, Johannisallee 20, 04137 Leipzig, Germany.
| | - Traolach Brugha
- Department of Health Sciences, University of Leicester, 22-28 Princess Road West, Leicester LE1 6TP, UK.
| | - Jean-Michel Azorin
- SHU Psychiatrie Adultes, Hôpital Sainte Marguerite, 13274 Marseille Cedex 9, France.
| | - Mondher Toumi
- Chair of Market Access, University Claude Bernard Lyon I, UFR d'Odontologie 11, Rue Guillaume Paradin, 69008 Lyon, France.
| | - Paul E Bebbington
- Division of Psychiatry (Formerly Mental Health Sciences), University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London W1T 7NF, UK.
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30
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Fernandez-Garcimartin H, Bagney A, Moreno-Ortega M, Dompablo M, Torio I, Lobo A, Jimenez-Arriero MA, Palomo T, Rodriguez-Jimenez R. Is it possible to combine different psychotic symptom scales in bipolar disorder? Psychiatry Res 2014; 220:1090-3. [PMID: 25468627 DOI: 10.1016/j.psychres.2014.10.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Revised: 10/12/2014] [Accepted: 10/20/2014] [Indexed: 10/24/2022]
Abstract
It has been suggested that data on positive and negative psychotic symptoms in patients with schizophrenia as assessed using different scales may be combined. For the first time, we assessed correlations between the positive syndrome subscale of the Positive and Negative Syndrome Scale (PANSS-P) and the Scale for the Assessment of Positive Symptoms (SAPS), and between the negative syndrome subscale of the Positive and Negative Syndrome Scale (PANSS-N) and the Scale for the Assessment of Negative Symptoms (SANS) in patients with bipolar disorder. We also aimed to confirm these correlations in patients with schizophrenia. This cross-sectional study was conducted with a group of 94 patients (40 diagnosed with bipolar disorder, 54 with schizophrenia). Assessments were carried out using the PANSS, SAPS and SANS. Large significant correlations were found between the PANSS-P and SAPS, and between the PANSS-N and SANS, in both the bipolar disorder group and the schizophrenia group. These results confirm previous findings regarding correlations between these scales in schizophrenia, and support the hypothesis that similar correlations exist in bipolar disorder. Therefore, our data support the potential usefulness in collaborative research of combining results from different scales for the assessment of psychotic symptoms in patients with bipolar disorder.
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Fulford D, Pearson R, Stuart BK, Fisher M, Mathalon DH, Vinogradov S, Loewy RL. Symptom assessment in early psychosis: the use of well-established rating scales in clinical high-risk and recent-onset populations. Psychiatry Res 2014; 220:1077-83. [PMID: 25278477 PMCID: PMC4258147 DOI: 10.1016/j.psychres.2014.07.047] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Revised: 07/22/2014] [Accepted: 07/23/2014] [Indexed: 11/17/2022]
Abstract
Symptom assessment in early psychosis research typically relies on scales validated in chronic schizophrenia samples. Our goal was to inform investigators who are selecting symptom scales for early psychosis research. We described measure characteristics, baseline scores, and scale inter-relationships in clinical-high-risk (CHR) and recent-onset psychotic disorder (RO) samples using the Positive and Negative Syndrome Scale, Brief Psychiatric Rating Scale, Scale for the Assessment of Positive Symptoms, and Scale for the Assessment of Negative Symptoms; for the CHR group only, we included the Scale of Prodromal Symptoms. For investigators selecting symptom measures in intervention or longitudinal studies, we also examined the relationship of symptom scales with psychosocial functioning. In both samples, symptom subscales in the same domain, across measures, were moderately to highly intercorrelated. Within all measures, positive symptoms were not correlated with negative symptoms, but disorganized symptoms overlapped with both positive and negative symptoms. Functioning was significantly related to negative and disorganized, but not positive, symptoms in both samples on most measures. Findings suggest strong overlap in symptom severity ratings among the most common scales. In recent-onset samples, each has strengths and weaknesses. In CHR samples, they appear to add little information above and beyond the SOPS.
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Affiliation(s)
- Daniel Fulford
- Department of Psychiatry, University of California, 401 Parnassus Avenue, Box PAR-0984, San Francisco, CA 94143, United States; Palo Alto Medical Foundation Research Institute, Palo Alto, CA, United States
| | - Rahel Pearson
- Department of Psychiatry, University of California, 401 Parnassus Avenue, Box PAR-0984, San Francisco, CA 94143, United States
| | - Barbara K Stuart
- Department of Psychiatry, University of California, 401 Parnassus Avenue, Box PAR-0984, San Francisco, CA 94143, United States
| | - Melissa Fisher
- Department of Psychiatry, University of California, 401 Parnassus Avenue, Box PAR-0984, San Francisco, CA 94143, United States; San Francisco VA Healthcare System, San Francisco, CA, United States
| | - Daniel H Mathalon
- Department of Psychiatry, University of California, 401 Parnassus Avenue, Box PAR-0984, San Francisco, CA 94143, United States; San Francisco VA Healthcare System, San Francisco, CA, United States
| | - Sophia Vinogradov
- Department of Psychiatry, University of California, 401 Parnassus Avenue, Box PAR-0984, San Francisco, CA 94143, United States; San Francisco VA Healthcare System, San Francisco, CA, United States
| | - Rachel L Loewy
- Department of Psychiatry, University of California, 401 Parnassus Avenue, Box PAR-0984, San Francisco, CA 94143, United States.
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Greenstein D, Kataria R, Gochman P, Dasgupta A, Malley JD, Rapoport J, Gogtay N. Looking for childhood-onset schizophrenia: diagnostic algorithms for classifying children and adolescents with psychosis. J Child Adolesc Psychopharmacol 2014; 24:366-73. [PMID: 25019955 PMCID: PMC4162429 DOI: 10.1089/cap.2013.0139] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE Among children <13 years of age with persistent psychosis and contemporaneous decline in functioning, it is often difficult to determine if the diagnosis of childhood onset schizophrenia (COS) is warranted. Despite decades of experience, we have up to a 44% false positive screening diagnosis rate among patients identified as having probable or possible COS; final diagnoses are made following inpatient hospitalization and medication washout. Because our lengthy medication-free observation is not feasible in clinical practice, we constructed diagnostic classifiers using screening data to assist clinicians practicing in the community or academic centers. METHODS We used cross-validation, logistic regression, receiver operating characteristic (ROC) analysis, and random forest to determine the best algorithm for classifying COS (n=85) versus histories of psychosis and impaired functioning in children and adolescents who, at screening, were considered likely to have COS, but who did not meet diagnostic criteria for schizophrenia after medication washout and inpatient observation (n=53). We used demographics, clinical history measures, intelligence quotient (IQ) and screening rating scales, and number of typical and atypical antipsychotic medications as our predictors. RESULTS Logistic regression models using nine, four, and two predictors performed well with positive predictive values>90%, overall accuracy>77%, and areas under the curve (AUCs)>86%. CONCLUSIONS COS can be distinguished from alternate disorders with psychosis in children and adolescents; greater levels of positive and negative symptoms and lower levels of depression combine to make COS more likely. We include a worksheet so that clinicians in the community and academic centers can predict the probability that a young patient may be schizophrenic, using only two ratings.
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Affiliation(s)
- Deanna Greenstein
- Child Psychiatry Branch, National Institute of Mental Health (NIMH)/National Institutes of Health (NIH), Bethesda, Maryland
| | - Rachna Kataria
- Child Psychiatry Branch, National Institute of Mental Health (NIMH)/National Institutes of Health (NIH), Bethesda, Maryland
| | - Peter Gochman
- Child Psychiatry Branch, National Institute of Mental Health (NIMH)/National Institutes of Health (NIH), Bethesda, Maryland
| | - Abhijit Dasgupta
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, (NIAMS)/NIH, Bethesda, Maryland
| | - James D. Malley
- Center for Information Technology (CIT)/NIH, Bethesda, Maryland
| | - Judith Rapoport
- Child Psychiatry Branch, National Institute of Mental Health (NIMH)/National Institutes of Health (NIH), Bethesda, Maryland
| | - Nitin Gogtay
- Child Psychiatry Branch, National Institute of Mental Health (NIMH)/National Institutes of Health (NIH), Bethesda, Maryland
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Talaei A, Hedjazi A, Rezaei Ardani A, Fayyazi Bordbar MR, Talaei A. The Relationship between Meteorological Conditions and Homicide, Suicide, Rage, and Psychiatric Hospitalization. J Forensic Sci 2014; 59:1397-402. [DOI: 10.1111/1556-4029.12471] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2012] [Revised: 07/05/2013] [Accepted: 07/28/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Ali Talaei
- Psychiatry and Behavioral Sciences Research Center; Mashhad University of Medical Sciences; Mashhad Iran
| | - Arya Hedjazi
- Legal Medicine Research Center; Legal Medicine Organization; Tehran Iran
| | - Amir Rezaei Ardani
- Psychiatry and Behavioral Sciences Research Center; Mashhad University of Medical Sciences; Mashhad Iran
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van Erp TGM, Preda A, Nguyen D, Faziola L, Turner J, Bustillo J, Belger A, Lim KO, McEwen S, Voyvodic J, Mathalon DH, Ford J, Potkin SG. Converting positive and negative symptom scores between PANSS and SAPS/SANS. Schizophr Res 2014; 152:289-94. [PMID: 24332632 PMCID: PMC3966195 DOI: 10.1016/j.schres.2013.11.013] [Citation(s) in RCA: 96] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Revised: 11/02/2013] [Accepted: 11/10/2013] [Indexed: 11/19/2022]
Abstract
The Scale for the Assessment of Positive Symptoms (SAPS), the Scale for the Assessment of Negative Symptoms (SANS), and the Positive and Negative Syndrome Scale for Schizophrenia (PANSS) are the most widely used schizophrenia symptom rating scales, but despite their co-existence for 25 years no easily usable between-scale conversion mechanism exists. The aim of this study was to provide equations for between-scale symptom rating conversions. Two-hundred-and-five schizophrenia patients [mean age±SD=39.5±11.6, 156 males] were assessed with the SANS, SAPS, and PANSS. Pearson's correlations between symptom scores from each of the scales were computed. Linear regression analyses, on data from 176 randomly selected patients, were performed to derive equations for converting ratings between the scales. Intraclass correlations, on data from the remaining 29 patients, not part of the regression analyses, were performed to determine rating conversion accuracy. Between-scale positive and negative symptom ratings were highly correlated. Intraclass correlations between the original positive and negative symptom ratings and those obtained via conversion of alternative ratings using the conversion equations were moderate to high (ICCs=0.65 to 0.91). Regression-based equations may be useful for conversion between schizophrenia symptom severity as measured by the SANS/SAPS and PANSS, though additional validation is warranted. This study's conversion equations, implemented at http:/converteasy.org, may aid in the comparison of medication efficacy studies, in meta- and mega-analyses examining symptoms as moderator variables, and in retrospective combination of symptom data in multi-center data sharing projects that need to pool symptom rating data when such data are obtained using different scales.
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Affiliation(s)
- Theo G M van Erp
- Department of Psychiatry and Human Behavior, University of California, Irvine, Irvine, CA 92617, United States
| | - Adrian Preda
- Department of Psychiatry and Human Behavior, University of California, Irvine, Irvine, CA 92617, United States
| | - Dana Nguyen
- Department of Psychiatry and Human Behavior, University of California, Irvine, Irvine, CA 92617, United States
| | - Lawrence Faziola
- Department of Psychiatry and Human Behavior, University of California, Irvine, Irvine, CA 92617, United States
| | - Jessica Turner
- Mind Research Network, Albuquerque, NM 87106, United States; Departments of Psychiatry & Neuroscience, University of New Mexico, Albuquerque, NM 87131, United States
| | - Juan Bustillo
- Departments of Psychiatry & Neuroscience, University of New Mexico, Albuquerque, NM 87131, United States
| | - Aysenil Belger
- Departments of Psychiatry and Psychology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, United States
| | - Kelvin O Lim
- Department of Psychiatry, University of Minnesota, Minneapolis, MN 55454, United States
| | - Sarah McEwen
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA 90095, United States
| | - James Voyvodic
- Brain Imaging and Analysis Center, Duke University Medical Center, Durham, NC 27710, United States
| | - Daniel H Mathalon
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA 94143, United States; Mental Health Service, San Francisco Veterans Affairs Medical Center, San Francisco, CA, 94121, United States
| | - Judith Ford
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA 94143, United States; Mental Health Service, San Francisco Veterans Affairs Medical Center, San Francisco, CA, 94121, United States
| | - Steven G Potkin
- Department of Psychiatry and Human Behavior, University of California, Irvine, Irvine, CA 92617, United States
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Hunt GE, Siegfried N, Morley K, Sitharthan T, Cleary M. Psychosocial interventions for people with both severe mental illness and substance misuse. Cochrane Database Syst Rev 2013:CD001088. [PMID: 24092525 DOI: 10.1002/14651858.cd001088.pub3] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Even low levels of substance misuse by people with a severe mental illness can have detrimental effects. OBJECTIVES To assess the effects of psychosocial interventions for reduction in substance use in people with a serious mental illness compared with standard care. SEARCH METHODS For this update (2013), the Trials Search Co-ordinator of the Cochrane Schizophrenia Group (CSG) searched the CSG Trials Register (July 2012), which is based on regular searches of major medical and scientific databases. The principal authors conducted two further searches (8 October 2012 and 15 January 2013) of the Cochrane Database of Systematic Reviews, MEDLINE and PsycINFO. A separate search for trials of contingency management was completed as this was an additional intervention category for this update. SELECTION CRITERIA We included all randomised controlled trials (RCTs) comparing psychosocial interventions for substance misuse with standard care in people with serious mental illness. DATA COLLECTION AND ANALYSIS We independently selected studies, extracted data and appraised study quality. For binary outcomes, we calculated standard estimates of relative risk (RR) and their 95% confidence intervals (CI) on an intention-to-treat basis. For continuous outcomes, we calculated the mean difference (MD) between groups. For all meta-analyses we pooled data using a random-effects model. Using the GRADE approach, we identified seven patient-centred outcomes and assessed the quality of evidence for these within each comparison. MAIN RESULTS We included 32 trials with a total of 3165 participants. Evaluation of long-term integrated care included four RCTs (n = 735). We found no significant differences on loss to treatment (n = 603, 3 RCTs, RR 1.09 CI 0.82 to 1.45, low quality of evidence), death by 3 years (n = 421, 2 RCTs, RR 1.18 CI 0.39 to 3.57, low quality of evidence), alcohol use (not in remission at 36 months) (n = 143, 1 RCT, RR 1.15 CI 0.84 to 1.56,low quality of evidence), substance use (n = 85, 1 RCT, RR 0.89 CI 0.63 to 1.25, low quality of evidence), global assessment of functioning (n = 171, 1 RCT, MD 0.7 CI 2.07 to 3.47, low quality of evidence), or general life satisfaction (n = 372, 2 RCTs, MD 0.02 higher CI 0.28 to 0.32, moderate quality of evidence).For evaluation of non-integrated intensive case management with usual treatment (4 RCTs, n = 163) we found no statistically significant difference for loss to treatment at 12 months (n = 134, 3 RCTs, RR 1.21 CI 0.73 to 1.99, very low quality of evidence).Motivational interviewing plus cognitive behavioural therapy compared to usual treatment (7 RCTs, total n = 878) did not reveal any advantage for retaining participants at 12 months (n = 327, 1 RCT, RR 0.99 CI 0.62 to 1.59, low quality of evidence) or for death (n = 493, 3 RCTs, RR 0.72 CI 0.22 to 2.41, low quality of evidence), and no benefit for reducing substance use (n = 119, 1 RCT, MD 0.19 CI -0.22 to 0.6, low quality of evidence), relapse (n = 36, 1 RCT, RR 0.5 CI 0.24 to 1.04, very low quality of evidence) or global functioning (n = 445, 4 RCTs, MD 1.24 CI 1.86 to 4.34, very low quality of evidence).Cognitive behavioural therapy alone compared with usual treatment (2 RCTs, n = 152) showed no significant difference for losses from treatment at 3 months (n = 152, 2 RCTs, RR 1.12 CI 0.44 to 2.86, low quality of evidence). No benefits were observed on measures of lessening cannabis use at 6 months (n = 47, 1 RCT, RR 1.30 CI 0.79 to 2.15, very low quality of evidence) or mental state (n = 105, 1 RCT, Brief Psychiatric Rating Scale MD 0.52 CI -0.78 to 1.82, low quality of evidence).We found no advantage for motivational interviewing alone compared with usual treatment (8 RCTs, n = 509) in reducing losses to treatment at 6 months (n = 62, 1 RCT, RR 1.71 CI 0.63 to 4.64, very low quality of evidence), although significantly more participants in the motivational interviewing group reported for their first aftercare appointment (n = 93, 1 RCT, RR 0.69 CI 0.53 to 0.9). Some differences, favouring treatment, were observed in abstaining from alcohol (n = 28, 1 RCT, RR 0.36 CI 0.17 to 0.75, very low quality of evidence) but not other substances (n = 89, 1 RCT, RR -0.07 CI -0.56 to 0.42, very low quality of evidence), and no differences were observed in mental state (n = 30, 1 RCT, MD 0.19 CI -0.59 to 0.21, very low quality of evidence).We found no significant differences for skills training in the numbers lost to treatment by 12 months (n = 94, 2 RCTs, RR 0.70 CI 0.44 to 1.1, very low quality of evidence).We found no differences for contingency management compared with usual treatment (2 RCTs, n = 206) in numbers lost to treatment at 3 months (n = 176, 1 RCT, RR 1.65 CI 1.18 to 2.31, low quality of evidence), number of stimulant positive urine tests at 6 months (n = 176, 1 RCT, RR 0.83 CI 0.65 to 1.06, low quality of evidence) or hospitalisations (n = 176, 1 RCT, RR 0.21 CI 0.05 to 0.93, low quality of evidence).We were unable to summarise all findings due to skewed data or because trials did not measure the outcome of interest. In general, evidence was rated as low or very low due to high or unclear risks of bias because of poor trial methods, or poorly reported methods, and imprecision due to small sample sizes, low event rates and wide confidence intervals. AUTHORS' CONCLUSIONS We included 32 RCTs and found no compelling evidence to support any one psychosocial treatment over another for people to remain in treatment or to reduce substance use or improve mental state in people with serious mental illnesses. Furthermore, methodological difficulties exist which hinder pooling and interpreting results. Further high quality trials are required which address these concerns and improve the evidence in this important area.
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Affiliation(s)
- Glenn E Hunt
- Discipline of Psychiatry, The University of Sydney, Concord Centre for Mental Health, Hospital Road, Sydney, NSW, Australia, 2139
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Poole NA, Crabb J, Osei A, Hughes P, Young D. Insight, psychosis, and depression in Africa: a cross-sectional survey from an inpatient unit in Ghana. Transcult Psychiatry 2013; 50:433-41. [PMID: 23740893 DOI: 10.1177/1363461513483263] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Few studies of the relationship of insight to psychopathology have been conducted in non-Western populations. This study examined the relationships between insight and depression, anxiety, and positive and negative symptoms on patients with schizophrenia resident in a psychiatric hospital in Ghana. A sample of 49 participants, (37 men and 12 women), with DSM-IV defined schizophrenia took part in semistructured interviews consisting of the Hamilton Rating Scales for Depression (HAM-D) and Anxiety (HAM-A); the Schedule for the Assessment of Insight - Expanded Version (SAI-E) and the Positive and Negative Syndrome Scale (PANSS). Bivariate correlations between variables were examined and those significantly correlated with an insight domain were included in multiple regression models. Variables associated with the total insight score were age, gender, anxiety symptoms, depression symptoms, and treatment compliance. In the final model, HAM-D positively predicted total SAI-E score, whilst PANSS-pos was negatively associated with total SAI-E score. The results are broadly consistent with those found in Western samples regarding insight and depressive symptoms. Implications of these results for competing theories of insight in psychoses are discussed. Patients able to identify themselves as ill may be aware of their affective symptoms.
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Cotton SM, Lambert M, Schimmelmann BG, Mackinnon A, Gleeson JFM, Berk M, Hides L, Chanen AM, Scott J, Schöttle D, McGorry PD, Conus P. Differences between first episode schizophrenia and schizoaffective disorder. Schizophr Res 2013; 147:169-174. [PMID: 23528796 DOI: 10.1016/j.schres.2013.02.036] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Revised: 02/24/2013] [Accepted: 02/26/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND The diagnostic and clinical overlap between schizophrenia and schizoaffective disorder is an important nosological issue in psychiatry that is yet to be resolved. The aim of this study was to compare the clinical and functional characteristics of an epidemiological treated cohort of first episode patients with an 18-month discharge diagnosis of schizophrenia (FES) or schizoaffective disorder (FESA). METHODS This study was part of the larger First Episode Psychosis Outcome Study (FEPOS) which involved a medical file audit study of all 786 patients treated at the Early Psychosis Prevention and Intervention Centre between 1998 and 2000. Of this cohort, 283 patients had an 18-month discharge diagnosis of FES and 64 had a diagnosis of FESA. DSM-IV diagnoses and clinical and functional ratings were derived and validated by two consultant psychiatrists. RESULTS Compared to FES patients, those with FESA were significantly more likely to have a later age of onset (p=.004), longer prodrome (p=.020), and a longer duration of untreated psychosis (p<.001). At service entry, FESA patients presented with a higher illness severity (p=.020), largely due to the presence of more severe manic symptoms (p<.001). FESA patients also had a greater number of subsequent inpatient admissions (p=.017), had more severe depressive symptoms (p=.011), and higher levels of functioning at discharge. DISCUSSION The findings support the notion that these might be considered two discernable disorders; however, further research is required to ascertain the ways and extent to which these disorders are discriminable at presentation and over time.
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Affiliation(s)
- S M Cotton
- Orygen Youth Health Research Centre, Melbourne Australia; Centre for Youth Mental Health, The University of Melbourne, Australia.
| | - M Lambert
- Psychosis Early Detection and Intervention Centre (PEDIC), Department for Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Germany
| | - B G Schimmelmann
- University Hospital of Child and Adolescent Psychiatry, University of Bern, Switzerland
| | - A Mackinnon
- Orygen Youth Health Research Centre, Melbourne Australia; Centre for Youth Mental Health, The University of Melbourne, Australia
| | - J F M Gleeson
- School of Psychology, Australian Catholic University, Australia
| | - M Berk
- Orygen Youth Health Research Centre, Melbourne Australia; Centre for Youth Mental Health, The University of Melbourne, Australia; Deakin University, Geelong, Australia; Florey Institute for Neuroscience and Mental Health, Parkville, Australia
| | - L Hides
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - A M Chanen
- Orygen Youth Health Research Centre, Melbourne Australia; Centre for Youth Mental Health, The University of Melbourne, Australia
| | - J Scott
- Centre for Clinical Research, University of Queensland, Brisbane, Australia
| | - D Schöttle
- Psychosis Early Detection and Intervention Centre (PEDIC), Department for Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Germany
| | - P D McGorry
- Orygen Youth Health Research Centre, Melbourne Australia; Centre for Youth Mental Health, The University of Melbourne, Australia
| | - P Conus
- Treatment and Early Intervention in Psychosis Program (TIPP), Département de Psychiatrie CHUV, Université de Lausanne, Clinique de Cery, 1008 Prilly, Switzerland
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Blunted cortisol awakening response in men with first episode psychosis: relationship to parental bonding. Psychoneuroendocrinology 2013; 38:229-40. [PMID: 22770984 DOI: 10.1016/j.psyneuen.2012.06.002] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2011] [Revised: 06/02/2012] [Accepted: 06/04/2012] [Indexed: 11/20/2022]
Abstract
Early life adversity has been associated with an increased risk for the development of mental health problems, including psychotic disorders, perhaps mediated by a changed regulation of the Hypothalamic Pituitary Adrenal (HPA) axis. Aim of the present study was to confirm our previous finding of an attenuated cortisol awakening response (CAR) in men with first episode psychosis (FEP) and to explore a possible link between a blunted CAR and early adversity as indicated by perceived parental bonding. Fifty-eight patients (38 men, 20 women; mean age 23.25±3.86) with a FEP and 33 healthy community controls (16 men, 17 women; mean age 22.91±3.64) participated in the study. Saliva samples for assessment of the CAR were collected immediately, 30 and 60min after awakening. Complete cortisol samples were available in a reduced sample of 56 patients (37 men) and 30 controls (13 men). Parental bonding during the first 16 years of life was assessed retrospectively with the Parental Bonding Inventory. Results showed a significantly blunted CAR in male compared to female patients, confirming our previously reported findings. We also found a lower CAR in the total FEP group compared to controls, which failed to reach significance after controlling for time of awakening. A significantly lower percentage of patients than controls reported optimal maternal parenting. Within the patient group, significantly fewer male than female patients reported optimal maternal and paternal parenting. Only in patients, unfavorable paternal parenting was related to a blunted CAR. Dysregulation of the HPA axis in male patients might be a consequence of non-optimal parenting and contribute to the less favorable course of psychosis in men compared to women.
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Madigan K, Brennan D, Lawlor E, Turner N, Kinsella A, O'Connor JJ, Russell V, Waddington JL, O'Callaghan E. A multi-center, randomized controlled trial of a group psychological intervention for psychosis with comorbid cannabis dependence over the early course of illness. Schizophr Res 2013. [PMID: 23187069 DOI: 10.1016/j.schres.2012.10.018] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Patients who experience the onset of psychotic illness with a comorbid diagnosis of cannabis dependence experience poor clinical outcomes. Few studies have identified interventions that reduce cannabis use and improve clinical outcome in this population. AIMS We undertook a multi-center, randomized controlled trial of a group psychological intervention for psychosis with comorbid cannabis dependence to determine whether there was any impact on cannabis use symptoms, global functioning, insight, attitudes to treatment and subjective quality of life. METHOD Across three centers, we compared a group psychological intervention, based on cognitive behavioral therapy and motivational interviewing, with treatment as usual among patients experiencing their first psychotic episode or early in the course of psychotic illness. Substance misuse and indices of clinical outcome were assessed at baseline, 3months and 1year. RESULTS At 3month and 1year follow-ups, there was no evidence for an intervention effect on cannabis use, symptoms, global functioning insight or attitude to treatment. However, the intervention improved subjective quality of life at 3months and this effect was sustained at 1year. CONCLUSIONS Over the early phase of psychotic illness, group psychological interventions for those with comorbid cannabis dependence improved subjective quality of life. However, this was not associated with reduction in use of cannabis or improvement in clinical outcomes.
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Affiliation(s)
- Kevin Madigan
- St. John of God Adult Mental Health Services, Cluain Mhuire Family Centre, Blackrock, Co. Dublin, Ireland; DETECT Early Intervention in Psychosis Service, Blackrock, Co. Dublin, Ireland.
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Mojtabai R, Corey-Lisle PK, Ip EHS, Kopeykina I, Haeri S, Cohen LJ, Shumaker S. The Patient Assessment Questionnaire: initial validation of a measure of treatment effectiveness for patients with schizophrenia and schizoaffective disorder. Psychiatry Res 2012; 200:857-66. [PMID: 22840524 DOI: 10.1016/j.psychres.2012.06.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2011] [Revised: 06/06/2012] [Accepted: 06/10/2012] [Indexed: 11/29/2022]
Abstract
Investigation of patients' subjective perspective regarding the effectiveness - as opposed to efficacy - of antipsychotic medication has been hampered by a relative shortage of self-report measures of global clinical outcome. This paper presents data supporting the feasibility, inter-item consistency, and construct validity of the Patient Assessment Questionnaire (PAQ)-a self-report measure of psychiatric symptoms, medication side effects and general wellbeing, ultimately intended to assess effectiveness of interventions for schizophrenia-spectrum patients. The original 53-item instrument was developed by a multidisciplinary team which utilized brainstorming sessions for item generation and content analysis, patient focus groups, and expert panel reviews. This instrument and additional validation measures were administered, via Audio Computer-Assisted Self-Interviewing (ACASI), to 300 stable, medicated outpatients diagnosed with schizophrenia or schizoaffective disorder. Item elimination was based on psychometric properties and Item-Response Theory information functions and characteristic curves. Exploratory factor analysis of the resulting 40-item scale yielded a five factor solution. The five subscales (General Distress, Side Effects, Psychotic Symptoms, Cognitive Symptoms, Sleep) showed robust convergent (β's=0.34-0.75, average β=0.49) and discriminant validity. The PAQ demonstrates feasibility, reliability, and construct validity as a self-report measure of multiple domains pertinent to effectiveness. Future research needs to establish the PAQ's sensitivity to change.
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Affiliation(s)
- Ramin Mojtabai
- Johns Hopkins University, School of Public Health, Mental Health Department, Baltimore, MD, USA
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41
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Sarlon E, Heider D, Millier A, Azorin JM, König HH, Hansen K, Angermeyer MC, Aballéa S, Toumi M. A prospective study of health care resource utilisation and selected costs of schizophrenia in France. BMC Health Serv Res 2012; 12:269-76. [PMID: 22909284 PMCID: PMC3459707 DOI: 10.1186/1472-6963-12-269] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Accepted: 07/23/2012] [Indexed: 11/12/2022] Open
Abstract
Background Schizophrenia is among the most burdensome and costly illnesses worldwide. To estimate the cost of schizophrenia in France, a longitudinal study was carried out between 1998 and 2002. The main objective of this study was to describe and update the cost of schizophrenia in a longitudinal, representative sample of French patients. The second objective was to identify cost drivers in the treatment of schizophrenia. Methods Based on a cohort of 288 French schizophrenic patients during 2 years of prospective follow-up, this study collected clinical, patient reported outcomes, quality of life, functioning, patient management, care giver involvement and resource utilisation data every 6 months. For each service, information was collected on the type of service, the frequency of attendance and type of intervention provided to the patient. Unit costs were based on available French databases. Mean service use and costs over the five time points were estimated using between-effects regression models. Results In the total sample of 288 patients aged 18-64 years, the mean total cost (€ 3 534) was mainly accounted for by the cost of inpatient treatment (€ 1 390) and day care (€ 1 331). The estimate of the annual cost for direct medical health care for all French schizophrenic patients was € 1 581 million, including € 621 million for inpatient treatment and € 595 million for day care (77%). The costs for medication accounted for 16.1% of total annual costs. The remaining costs (6.9%) included visits to psychiatrists, general practitioners, other physicians and psychologists. The direct resource allocation showed inpatient treatment as the main direct cost. Unemployment was identified as a major indirect cost of schizophrenia treatment. Positive and depressive schizophrenia symptoms at baseline and relapse occurrence during the follow-up period were associated with a higher cost of treatment. Health satisfaction or negative symptoms of schizophrenia at baseline were associated with lower costs. Conclusion Several cost drivers were identified. Based on the results obtained in France, we suggest further analysis of mechanisms that influence the service-specific costs for schizophrenia in other areas of the world.
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Affiliation(s)
- Emmanuelle Sarlon
- National Institue of Health and Medical Research, INSERM, U669, Paris, France
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42
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Depression and Anxiety Following Psychosis: Associations with Mindfulness and Psychological Flexibility. Behav Cogn Psychother 2012; 41:34-51. [DOI: 10.1017/s1352465812000239] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background: Individuals experiencing psychosis can present with elevated levels of depression and anxiety. Research suggests that aspects of depression and anxiety may serve an avoidant function by limiting the processing of more distressing material. Acceptance and Commitment Therapy suggests that avoidance of aversive mental experiences contributes to psychological inflexibility. Depression and anxiety occurring in the context of psychosis have a limiting effect on quality of life. No research to date has investigated how levels of psychological flexibility and mindfulness are associated with depression and anxiety occurring following psychosis. Aims: This study investigated associations psychological flexibility and mindfulness had with depression and anxiety following psychosis. Method: Thirty participants with psychosis were recruited by consecutive referral on the basis that they were experiencing emotional dysfunction following psychosis. The Hospital Anxiety and Depression Scale (HADS), Positive and Negative Syndrome Scale (PANSS), Acceptance and Action Questionnaire (AAQ-II) and the Kentucky Inventory of Mindfulness Skills (KIMS) were used. A cross-sectional correlational design was used. Results: The depression and anxiety subscales of the HADS both had significant correlations with psychological flexibility (as assessed by the AAQ-II) and aspects of mindfulness (as assessed by the KIMS). Hierarchical regression analyses indicated that psychological flexibility, but not mindfulness, contributed significantly to models predicting 46% of variance in both depression and anxiety scores. Conclusions: Although aspects of mindfulness are associated with depression and anxiety following an episode of psychosis, psychological flexibility appears to account for a larger proportion of variance in depression and anxiety scores in this population.
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Lyne JP, Kinsella A, O'Donoghue B. Can we combine symptom scales for collaborative research projects? J Psychiatr Res 2012; 46:233-8. [PMID: 22056401 DOI: 10.1016/j.jpsychires.2011.10.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2011] [Revised: 09/04/2011] [Accepted: 10/10/2011] [Indexed: 11/26/2022]
Abstract
Collaborative research projects have the potential to answer important research questions, which may otherwise require huge resources, funding, and time to complete. There are several scales for measuring psychotic symptoms in schizophrenia and other psychotic disorders, with the Scale for Assessment of Positive Symptoms (SAPS), Scale for Assessment of Negative Symptoms (SANS), Positive and Negative Symptom Scale (PANSS), and the Brief Psychiatric Rating Scale (BPRS) being among the most commonly used. High quality research efforts have used these three scales in different projects, and in order to merge study efforts, some means of combining data from these scales may be necessary. We reviewed correlations in published studies for these three scales, finding them to be highly correlated, however on comparison of the three scales there were considerable clinical differences between them. The paper discusses potential methods for combining the scales in collaborative research, including use of the recently developed standardised remission criteria for schizophrenia.
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Affiliation(s)
- John P Lyne
- DETECT Services, Avila House, Block 5 Blackrock Business Park, Co. Dublin, Ireland.
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44
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Benoit A, Bodnar M, Malla AK, Joober R, Lepage M. The structural neural substrates of persistent negative symptoms in first-episode of non-affective psychosis: a voxel-based morphometry study. Front Psychiatry 2012; 3:42. [PMID: 22586412 PMCID: PMC3346965 DOI: 10.3389/fpsyt.2012.00042] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2012] [Accepted: 04/19/2012] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVES An important subset of patients with schizophrenia present clinically significant persistent negative symptoms (PNS). Identifying the neural substrates of PNS could help improve our understanding and treatment of these symptoms. METHODS This study included 64 non-affective first-episode of psychosis (FEP) patients and 60 healthy controls; 16 patients displayed PNS (i.e., at least one primary negative symptom at moderate or worse severity sustained for at least six consecutive months). Using voxel-based morphometry (VBM), we explored for gray matter differences between PNS and non-PNS patients; patient groups were also compared to controls. All comparisons were performed at p < 0.05, corrected for multiple comparisons. RESULTS PNS patients had smaller gray matter in the right frontal medial-orbital gyrus (extending into the inferior frontal gyrus) and right parahippocampal gyrus (extending into the fusiform gyrus) compared to non-PNS patients. Compared to controls, PNS patients had smaller gray matter in the right parahippocampal gyrus (extending into the fusiform gyrus and superior temporal gyrus); non-PNS patients showed no significant differences to controls. CONCLUSION Neural substrates of PNS are evident in FEP patients. A better understanding of the neural etiology of PNS may encourage the search for new medications and/or alternative treatments to better help those affected.
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Affiliation(s)
- Audrey Benoit
- Brain Imaging Group, Douglas Mental Health University Institute Verdun, QC, Canada
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45
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Martinotti G, Hatzigiakoumis DS, Vita OD, Clerici M, Petruccelli F, Giannantonio MD, Janiri L. Anhedonia and Reward System: Psychobiology, Evaluation, and Clinical Features. ACTA ACUST UNITED AC 2012. [DOI: 10.4236/ijcm.2012.37125] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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A feasibility study of Acceptance and Commitment Therapy for emotional dysfunction following psychosis. Behav Res Ther 2011; 49:901-7. [DOI: 10.1016/j.brat.2011.09.003] [Citation(s) in RCA: 111] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Revised: 08/02/2011] [Accepted: 09/09/2011] [Indexed: 11/20/2022]
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47
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Mairs H, Lovell K, Campbell M, Keeley P. Development and pilot investigation of behavioral activation for negative symptoms. Behav Modif 2011; 35:486-506. [PMID: 21746764 DOI: 10.1177/0145445511411706] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Negative symptoms cause functional impairment and impede recovery from psychosis, not least, because of limited developments in empirically validated treatments. This article details a pilot evaluation of a behavioral activation (BA) treatment with eight people presenting with psychosis and marked negative symptoms. The rationale for this development was that BA is effective in treating depression, a condition that shares overlapping features with negative symptoms. Results provide preliminary support for feasibility and effectiveness of BA for negative symptoms in terms of treatment adherence, retention, and initial outcomes. However, additional advantages may accrue from revisions to the BA treatment.
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48
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Seter C, Giovannetti T, Kessler RK, Worth S. Everyday action planning in schizophrenia. Neuropsychol Rehabil 2011; 21:224-49. [DOI: 10.1080/09602011.2010.544519] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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49
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Onwuameze OE, Schultz SK, Paradiso S. An initial study of modifiable and non-modifiable factors for late-life psychosis. Int J Psychiatry Med 2011; 42:437-51. [PMID: 22530403 PMCID: PMC3626263 DOI: 10.2190/pm.42.4.g] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To determine rates of psychotic symptoms and associated modifiable and non-modifiable factors among elderly long term nursing home residents without prior history of psychiatric illness. METHOD A cross-sectional design using the Scale for the Assessment of Positive Symptoms (SAPS) to measure psychotic symptoms, the Folstein's Mini-Mental State Exam (MMSE), and Mattis Dementia Rating Scale (DRS) to evaluate cognitive impairment. Frequency and rates of global psychotic symptoms and hallucinations, delusions, formal thought disorder, and bizarre behavior were calculated. Logistic regression was used to examine modifiable (e.g., medication use) and non-modifiable clinical characteristics (e.g., older age) associated with late-life psychosis. RESULTS There were 15.9% of subjects reporting delusions and 7.3% reporting hallucinations. History of stroke, poorer cognition, and receiving multiple medications showed significant association with late-life psychosis. Only stroke (OR = 9.12; 95% CI: 1.58-52.74) and receiving different classes of medications (benzodiazepines, neuroleptics, and antidepressants) (OR = 13.17; 95% CI: 2.10-85.82) remained significantly associated with psychosis after adjusting for Mattis DRS total score. Further analyses excluding subjects with MMSE scores of 24 or lower (n = 24) showed essentially the same results but subjects with better cognitive function suffered a less severe form of psychosis, essentially constituted by one symptom type (i.e., visual hallucinations). CONCLUSIONS Rates of late-life psychosis in this sample of nursing home residents without previous psychiatric history were high. Simultaneous use of medications including antidepressants, sedatives, and stimulants may be a clinically relevant modifiable factor to be targeted in prevention studies. Severity and type of psychosis is dependent on the severity of cognitive impairment.
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Affiliation(s)
- Obiora E Onwuameze
- University of Iowa Carver College of Medicine, Department of Psychiatry, Iowa City, Iowa 52242, USA
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Hemmerle MJ, Röpcke B, Eggers C, Oades RD. [Evaluation of a two-year intensive outpatient care programme for adolescents with schizophrenia]. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2010; 38:361-9. [PMID: 20809472 DOI: 10.1024/1422-4917/a000060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The Trialog project offers patients with early-onset schizophrenia (EOS) a two-year programme of residential outpatient care following discharge from a clinic. The programme aims to support their further recovery and independence and encompasses interactive and psycho-educational multifamily care, coping with persistent symptoms, development of socio-emotional competence, independent house keeping, and support of school and vocational training. METHODS To evaluate psychopathology along with social and neuropsychological function for 12 participants over a period of 2 years. Their progress was compared with that of 12 EOS patients who did not attend Trialog following discharge. RESULTS Participants showed a significantly greater decrease of positive and negative symptoms, as opposed to an increase in positive symptoms in the comparison group. Measures of social function, neuropsychological indicators of memory, (selective) attention, and psychomotor speed improved more than in the comparison subjects. Neither group showed changes in measures of intelligence or in the subjective quality of life. CONCLUSIONS First analyses raise hope that monitoring participant performance in the programme of the "Trialog project" will improve the treatment and care of EOS-patients in the critical first years following the onset of schizophrenia.
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