Reliability and validity of the Chinese version of the Calgary Depression Scale for Schizophrenia

Correlation of allostatic load and perceived stress with clinical features in first-episode schizophrenia

BACKGROUND

Stress plays an important role in the etiology of schizophrenia. However, the mechanisms by which chronic physiological stress and perceived stress relate to the clinical features of schizophrenia may differ. We aimed to elucidate the relationships among chronic physiological stress indexed by allostatic load (AL), perceived stress, and clinical symptoms in individuals with first-episode schizophrenia (FES).

METHODS

Individuals with FES (n = 90, mean age = 28.26years old, 49%female) and healthy controls (111, 28.88, 51%) were recruited. We collected data of 13 biological indicators to calculate the AL index, assessed subjective stress with the Perceived Stress Scale-14 (PSS-14), and compared AL and perceived stress between groups. Patients with FES were also evaluated with the Positive and Negative Syndrome Scale (PANSS) and the Calgary Depression Scale for Schizophrenia (CDSS).

RESULTS

Individuals with FES had higher AL and PSS score than healthy controls. There were no significant correlations between AL and PSS score in either patients or controls. Among individuals with FES, the AL index was associated with the severity of positive symptoms, while the PSS score was positively associated with CDSS score. Both elevated AL and PSS were correlated with the occurrence of schizophrenia.

CONCLUSIONS

Physiological stress, as reflected by AL, may be more related to positive symptoms, while perceived stress appear to be associated with depressive symptoms in individuals with FES. Longitudinal studies are necessary to explore the relationships between interventions for different stressor types and specific clinical outcomes in FES.

A Digital System (YouXin) to Facilitate Self-Management by People With Psychosis in China: Protocol for a Nonrandomized Validity and Feasibility Study With a Mixed Methods Design

BACKGROUND

Psychosis is one of the most disabling mental health conditions and causes significant personal, social, and economic burden. Accurate and timely symptom monitoring is critical to offering prompt and time-sensitive clinical services. Digital health is a promising solution for the barriers encountered by conventional symptom monitoring approaches, including accessibility, the ecological validity of assessments, and recall bias. However, to date, there has been no digital health technology developed to support self-management for people with psychosis in China.

OBJECTIVE

We report the study protocol to evaluate the validity, feasibility, acceptability, usability, and safety of a symptom self-monitoring smartphone app (YouXin; Chinese name ) for people with psychosis in China.

METHODS

This is a nonrandomized validity and feasibility study with a mixed methods design. The study was approved by the University of Manchester and Beijing Anding Hospital Research Ethics Committee. YouXin is a smartphone app designed to facilitate symptom self-monitoring for people with psychosis. YouXin has 2 core functions: active monitoring of symptoms (ie, smartphone survey) and passive monitoring of behavioral activity (ie, passive data collection via embedded smartphone sensors). The development process of YouXin utilized a systematic coproduction approach. A series of coproduction consultation meetings was conducted by the principal researcher with service users and clinicians to maximize the usability and acceptability of the app for end users. Participants with psychosis aged 16 years to 65 years were recruited from Beijing Anding Hospital, Beijing, China. All participants were invited to use the YouXin app to self-monitor symptoms for 4 weeks. At the end of the 4-week follow-up, we invited participants to take part in a qualitative interview to explore the acceptability of the app and trial procedures postintervention.

RESULTS

Recruitment to the study was initiated in August 2022. Of the 47 participants who were approached for the study from August 2022 to October 2022, 41 participants agreed to take part in the study. We excluded 1 of the 41 participants for not meeting the inclusion criteria, leaving a total of 40 participants who began the study. As of December 2022, 40 participants had completed the study, and the recruitment was complete.

CONCLUSIONS

This study is the first to develop and test a symptom self-monitoring app specifically designed for people with psychosis in China. If the study shows the feasibility of YouXin, a potential future direction is to integrate the app into clinical workflows to facilitate digital mental health care for people with psychosis in China. This study will inform improvements to the app, trial procedures, and implementation strategies with this population. Moreover, the findings of this trial could lead to optimization of digital health technologies designed for people with psychosis in China.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/45170.

Study on correlations of BDNF, PI3K, AKT and CREB levels with depressive emotion and impulsive behaviors in drug-naïve patients with first-episode schizophrenia

BACKGROUND

The pathogenesis of schizophrenia is still unknown. Nearly a half of schizophrenic patients have depressive symptoms and even some impulsive behaviors. The definite diagnosis of schizophrenia is an immense challenge. Molecular biology plays an essential role in the research on the pathogenesis of schizophrenia.

OBJECTIVE

This study aims to analyze the correlations of serum protein factor levels with depressive emotion and impulsive behaviors in drug-naïve patients with first-episode schizophrenia.

METHODS

Seventy drug-naïve patients with first-episode schizophrenia and sixty-nine healthy volunteers from the health check center in the same period participated in this study. In both the patient group and control group, brain-derived neurotrophic factor (BDNF), phosphatidylin-ositol-3-kinase (PI3K), protein kinase B (AKT), and cAMP-response element binding protein (CREB) levels in the peripheral blood were tested by enzyme-linked immunosorbent assay (ELISA). The depressive emotion and impulsive behaviors were evaluated with Chinese versions of the Calgary Depression Scale for Schizophrenia (CDSS) and Short UPPS-P Impulsive Behavior Scale (S-UPPS-P), respectively.

RESULTS

The serum levels of BDNF, PI3K, and CREB in the patient group were lower than those in the control group, while AKT level, total CDSS score and total S-UPPS-P score were all higher. In the patient group, total CDSS score, and total S-UPPS-P score were both correlated negatively with BDNF, PI3K, and CREB levels but positively with AKT level, and the lack-of-premeditation (PR) sub-scale score was not significantly correlated with BDNF, PI3K, AKT, and CREB levels.

CONCLUSION

Our study results showed that the peripheral blood levels of BDNF, PI3K, AKT, and CREB in drug-naïve patients with first-episode schizophrenia were significantly different from those in the control group. The levels of these serum protein factors are promising biomarkers to predict schizophrenic depression and impulsive behaviors.

Reliability of the Calgary depression scale for schizophrenia: A meta-analysis

BACKGROUND

A challenge for clinicians working with individuals diagnosed with schizophrenia is distinguishing depressive symptoms from negative symptoms of schizophrenia. The Calgary Depression Scale for Schizophrenia (CDSS) was developed for this purpose. No review has previously explored its reliability across multiple studies using advanced statistical means.

OBJECTIVES

This meta-analysis aimed to quantify the CDSS' internal consistency, inter-rater reliability (IRR) and test-retest reliability.

METHOD

A systematic literature search was conducted to find articles reporting on the CDSS' reliability. Articles were screened against the inclusion and exclusion criteria, with data extracted from 40 studies. Overall meta-analytic effects were calculated, and for internal consistency and IRR coefficients subsequent analyses explored between-study variation. The small test-retest reliability dataset limited analysis.

FINDINGS

The internal consistency meta-analytic effect was 0.83 (95% CI:0.82-0.84). Higgins I² indicated an acceptable level of variation between studies' alpha estimates. This suggests all items in the CDSS are measuring the same construct (i.e. symptoms of depression). The IRR meta-analytic effect was 0.88 (95% CI:0.86-0.91), with Higgins I² indicating high levels of heterogeneity. This was not deemed problematic variance as it is within levels expected for psychometric measures and, therefore, considered acceptable for this literature. This reflects high level of agreement between different raters when using the CDSS on the same client.

CONCLUSIONS

This review suggests the CDSS has good internal consistency and excellent IRR. Further research will help understand its test-retest reliability.

Positive psychotherapy for psychosis in Hong Kong: A randomized controlled trial

Recovery-oriented practice has been advocated in mental health services in Hong Kong since 2009. Well-being has become an important area of focus for mental health services. Positive Psychotherapy for Psychosis (PPP) is a well-being-focused intervention for use in psychosis, with preliminary evidence from a randomized controlled trial in the United Kingdom of impact on well-being and symptomatology. The aim of this study was to test the effectiveness of PPP on the well-being of people with psychosis in Hong Kong. The study was a randomized controlled trial with two-arm parallel groups. Both groups received treatments as usual, and in addition the intervention group received a 13-session intervention based on a Cantonese Chinese translation of the PPP manual. Intention-to-treat analysis was used. The trial was registered (ANZCTR: ACTRN12620000464965). A total of 154 participants (78 intervention, 76 control) were recruited. As compared to control group, intervention group participants showed significant changes over time on the primary outcome of well-being assessed using the Chinese Short Warwick-Edinburgh Mental Well-being Scale (p = 0.001) and on secondary outcomes of hope (Agency subscale: p = 0.029) and self-efficacy (p = 0.001). Positive Psychotherapy for Psychosis was found to be an effective treatment in improving the well-being and other mental health outcomes for people with psychosis. It can be recommended for use in mental health services to promote recovery.

Plasma VEGF Concentrations and Ketamine's Effects on Suicidal Ideation in Depression With Suicidal Ideation

OBJECTIVES

Accumulating evidence supports a role for vascular endothelial growth factor (VEGF) in the pathogenesis of depression, but its relationship with the antisuicidal effects of ketamine is not clear. Our objective was to determine whether there was an association between the plasma VEGF (pVEGF) concentrations and the antisuicidal response to serial ketamine infusions.

METHODS

Six ketamine infusions (0.5 mg/kg) over a 12-day period were administered to sixty depressed individuals suffering from suicidal ideation. The Hamilton Depression Rating Scale (HAMD) suicide item, the Montgomery-Åsberg Depression Rating Scale (MADRS) suicide item, and the Beck Scale for Suicide Ideation (SSI-part I) were used to assess suicidal ideation at baseline, 1 day after the first infusion (day 1), 1 day following the last infusion (day 13), and again 2 weeks post-infusion (day 26). For this purpose, plasma was obtained at baseline, day 13 and 26.

RESULTS

The rates of antisuicidal response to ketamine were 61.7% (37/60), 81.7% (49/60), and 73.3% (44/60) at days 1, 13, and 26, respectively. The linear mixed model revealed significant time effects on suicidal ideation and pVEGF concentrations over time (all Ps < 0.05). Antisuicidal responders did not have significantly altered pVEGF concentrations compared with non-responders on day 13 and day 26 (all Ps > 0.05). No significant correlation was found between the baseline pVEGF concentration and suicidal ideation as measured by the SSI part 1, HAMD suicide item and MADRS suicide item on days 1, 13, and 26 (all ps > 0.05).

CONCLUSION

This preliminary finding does not support a role for VEGF in the antisuicidal effects of serial ketamine treatments in individuals with depression and suicidal ideation. Further research is needed to confirm and expand these findings.

Negative symptom dimensions and social functioning in Chinese patients with schizophrenia

OBJECTIVE

Negative symptoms can seriously affect social functioning in patients with schizophrenia. However, the role of various components of negative symptoms in social functioning remains unclear. This study aimed to explore the associations among three different dimensions of negative symptoms (i.e., communication, emotion, and motivation) and social functioning to identify potential therapeutic targets.

METHODS

This cross-sectional study enrolled 202 Chinese participants with schizophrenia. Negative symptoms were evaluated using the Negative Symptom Assessment (NSA). Social functioning was represented by the Personal and Social Performance Scale (PSP) total score and employment status. Correlation analysis was conducted to clarify the relationship between negative symptoms and the PSP total score. Regression analysis was performed to explore the determinants of the PSP total score and employment status, considering negative symptoms and possible confounders, such as demographic features, positive symptoms, cognitive symptoms, depressive symptoms, and extrapyramidal side effects.

RESULTS

The PSP total score was correlated with all three dimensions of negative symptoms (i.e., emotion, motivation, and communication; rs = -0.509, -0.662, and -0.657, respectively). Motivation, instead of emotion or communication, predicted both low PSP total scores and unemployment.

CONCLUSION

Social functioning in patients with schizophrenia was significantly related to motivation. Further studies should focus on motivation and consider it as a therapeutic target to improve patients' social functioning.

Insomnia, suicidal ideation, and psychopathology in Chinese patients with chronic schizophrenia

OBJECTIVES

Insomnia occurs frequently in the clinical course of schizophrenia. A growing literature has found associations between insomnia, suicidal ideation, and psychopathology in patients with schizophrenia. We explored these associations in a cross-sectional study of a large sample of patients with chronic schizophrenia in China. We hypothesized that insomnia would be associated with an increased odds of current suicidal ideation and higher current psychopathology scores.

METHODS

We recruited 328 inpatients with chronic schizophrenia, all of whom were prescribed psychotropics. We investigated relationships between current insomnia, suicidal ideation over the past two weeks, and current psychopathology for subjects using regression models.

RESULTS

After controlling for multiple potential confounding factors, current insomnia was an indicator of a significant, 2.5-fold increased odds of suicidal ideation (OR = 2.56, 95% CI 1.10-5.95, p = 0.029). Insomnia was also a significant indicator of lifetime suicide attempt (OR = 1.07) as well as higher Positive and Negative Syndrome Scale total (β = 0.134, p = 0.017), positive (β = 0.154, p = 0.006) and general (β = 0.145, p = 0.010) subscale scores.

CONCLUSION

Insomnia is associated with suicidal ideation, lifetime suicide attempt, and higher psychopathology scores in inpatients with chronic schizophrenia. Formal assessment of insomnia appears relevant to the clinical care of patients with schizophrenia as an indicator of suicidal thinking and behavior, depression, and symptom severity.

Depressive symptoms and their relationship with negative and other psychotic symptoms in early onset psychosis

The importance of depression in adult people with first-episode psychosis (FEP) has been demonstrated. However, it has hardly been studied in children and adolescents. There is a need to broaden knowledge of the relationship between psychotic symptoms and specific depression symptomatology. The aims of study were (a) to examine the frequency of presence and type of depressive symptoms in early onset FEP, and (b) to assess the relationship between depressive symptoms and psychotic symptomatology, and specifically negative symptoms. An observational cross-sectional study was performed in 62 FEP cases. Inclusion criteria were two or more psychotic symptoms, age 7-17 years old, first mental health service consultation, and fewer than 6 months from the first contact with the service. Participants were assessed with clinical and socio-demographic questionnaires: the Positive and Negative Syndrome Scale (PANSS) and the Children Depression Inventory (CDI). A Student t test was performed to compare psychotic symptoms in both groups: presence of depression and the absence of depression. A Pearson correlation was performed in order to relate subscales of the PANSS and each of the depression subscales and factors, as well the relation between negative and depressive symptoms. Our results show that a high percentage of people with an early onset of a FEP scored positively for depression. The most prevalent depressive symptoms were associated with schooling. The presence of depression was associated with negative, affective, and excited symptoms. Self-esteem, school problems, negative affect, and biological dysregulation were associated with psychotic symptoms. Finally, depressive items related to social functioning were more closely associated with negative symptoms of the PANSS. In conclusion, owing to the high incidence of depression in FEP in those suffering early onset of psychosis, there is a need for instruments to measure the depression more specifically in children and adolescent, and to uncover the clinical characteristics of depression in this population.

Exploring the Psychometric Properties and the Factor Structure of the Calgary Depression Scale for Schizophrenia Across the Schizotypy Continuum

This study evaluated the psychometric properties and factor structure of the Calgary Depression Scale for Schizophrenia (CDSS) across different levels of the schizotypy continuum. A combined sample of high-schizotypy, at-risk mental states, and patients with first-episode psychosis was assessed for depression and other clinical and functional outcomes. Additionally, experience sampling methodology was used to assess depressive and psychotic-like experiences in daily life. The CDSS exhibited solid internal consistency, validity, and discrimination between depressed and nondepressed participants. Confirmatory factor analyses and the associations of the resulting factors with clinical and functional measures supported a two-factor structure that included general depression and guilt factors. Furthermore, both factors of the CDSS were differentially related to positive and negative symptoms of psychosis in daily life. The CDSS appears to have two underlying psychopathological dimensions and to be a reliable and valid measure for assessing depression across the schizotypy continuum.

The impact of video gaming on cognitive functioning of people with schizophrenia (GAME-S): study protocol of a randomised controlled trial

BACKGROUND

Video gaming is a promising intervention for cognitive and social impairment in patients with schizophrenia. A number of gaming interventions have been evaluated in small-scale studies with various patient groups, but studies on patients with schizophrenia remain scarce and rarely include the evaluation of both clinical and neurocognitive outcomes. In this study, we will test the effectiveness of two interventions with gaming elements to improve cognitive and clinical outcomes among persons with schizophrenia.

METHODS

The participants will be recruited from different outpatient units (e.g., outpatient psychiatric units, day hospitals, residential care homes). The controlled clinical trial will follow a three-arm parallel-group design: 1) cognitive training (experimental group, CogniFit), 2) entertainment gaming (active control group, SIMS 4), and 3) treatment as usual. The primary outcomes are working memory function at 3-month and 6-month follow-ups. The secondary outcomes are patients' other cognitive and social functioning, the ability to experience pleasure, self-efficacy, and negative symptoms at 3-month and 6-month follow-ups. We will also test the effectiveness of gaming interventions on neurocognitive outcomes (EEG and 3 T MRI plus rs-fMRI) at a 3-month follow-up as an additional secondary outcome. Data will be collected in outpatient psychiatric services in Hong Kong. Participants will have a formal diagnosis of schizophrenia and be between 18 and 60 years old. We aim to have a total of 234 participants, randomly allocated to the three arms. A sub-sample of patients (N = 150) will be recruited to undergo an EEG. For neuroimaging assessment, patients will be randomly allocated to a subset of patients (N=126). We will estimate the efficacy of the interventions on the primary and secondary outcomes based on the intention-to-treat principle. Behavioural and EEG data will be analysed separately.

DISCUSSION

The study will characterise benefits of gaming on patients' health and well-being, and contribute towards the development of new treatment approaches for patients with schizophrenia.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03133143 . Registered on April 28, 2017.

Homocysteine, but not MTHFR gene polymorphism, influences depressive symptoms in patients with schizophrenia

BACKGROUND

Methylenetetrahydrofolate reductase (MTHFR) is the key enzyme of folate metabolism in the process of one-carbon cycle and its deficiency results in elevated homocysteine concentration. In this study, we hypothesized that MTHFR C677T polymorphism and homocysteine concentration may play important roles in the development of depressive symptoms in schizophrenia.

METHODS

We recruited 715 patients with stable schizophrenia, and among them, 197 schizophrenia patients under olanzapine monotherapy were enrolled for homocysteine concentration analysis. The Positive and Negative Syndrome Scale (PANSS) and Calgary Depression Scale for Schizophrenia (CDSS) were employed to evaluate psychiatric and depressive symptoms.

RESULTS

When the 715 schizophrenia patients were evaluated by CDSS, 326 individuals (45.6%) had depressive symptoms. No significant differences were observed in C677T genotype and allele distributions between the schizophrenia with or without depression groups. Schizophrenia patients with depression have higher levels of homocysteine than those without depression (P = 0.019). There was a positive correlation between the homocysteine levels and CDSS score (r = 0.22, P = 0.002).

CONCLUSION

Our findings suggested that higher levels of homocysteine may be a risk factor for the development of depressive symptoms in schizophrenia patients.

Revisiting the persistent negative symptoms proxy score using the Clinical Assessment Interview for Negative Symptoms

OBJECTIVE

The present study aimed to validate a severity cut-off of negative symptoms for persistent negative symptoms (PNS) identification using the Clinical Assessment Interview for Negative Symptoms (CAINS).

METHOD

A total of 206 patients with schizophrenia were recruited and divided into the PNS group (n = 57) and the Non-PNS group (n = 149) using PNS criteria based on the SANS and the SAPS. To determine the appropriate cut-offs on the CAINS in identifying PNS, Receiver Operating Characteristic (ROC) curve analysis was conducted in the PNS and Non-PNS groups.

RESULTS

Our results showed that the cutoffs for identifying PNS on the CAINS total score, the Motivation and Pleasure (MAP) subscale score and the Expression (EXP) subscale score were 25, 17, and 5 respectively. Area Under the Curve (AUC) analysis indicated excellent discrimination of the PNS group from the Non-PNS group using the cut-off for the CAINS total score. However, discrimination was somewhat better for the MAP subscale score than the EXP subscale score. The Positive Predictive Value (PPV) and Negative Predictive Value (NPV) of the MAP subscale were 81.54% and 97.16%.

CONCLUSION

We found that the cut-off scores derived from the CAINS to identify PNS are comparable to existing scales. The CAINS offers an alternative means in identifying PNS patients in clinical trials that overcomes methodological and conceptual limitations of older scales.

Reduced Serum Adiponectin Level and Risk of Poststroke Depression in Patients with Ischemic Stroke

BACKGROUND AND AIMS

Decreased adiponectin (APN) level has been indicated to be associated with depression. In the present study, we aimed to investigate whether serum APN could predict poststroke depression (PSD) at 3 months in patients with acute ischemic stroke.

METHOD

Patients with first-ever ischemic stroke and hospitalized within 24 hours of symptoms onset were enrolled prospectively during March 2017 to September 2017. Serum APN level was measured at admission by enzyme-linked immunosorbent assay. Neuropsychological evaluations were performed at the 3-month follow-up. PSD was diagnosed using the Chinese version of the Structured Clinical Interview for DSM-IV. The association between APN level and predict PSD was analyzed by binary logistic regression analysis.

RESULTS

Of the 255 acute ischemic stroke patients included, the median (interquartile range) APN level was 5.4 (3.0-7.5) μg/mL. PSD was observed in 69 patients, which accounted for 27.1% (95% confidence interval, 24.3%-29.9%) of the cohort. Patients with PSD showed lower level of APN (3.5 [2.5-6.3] μg/mL versus 6.2 [3.5-8.0] μg/mL, P = .001) at admission. Univariate logistic regression analysis indicated that patients with APN level in the first tertile compared with the third tertile were more likely to have PSD (odds ratio, 3.550; 95% confidence interval, 1.732-7.276; P = .008). The association remained significant even after multivariable adjustment for potential confounders.

CONCLUSIONS

This study demonstrated that decreased APN level at admission might be associated with PSD in patients after acute ischemic stroke.

Depressive symptoms in Chinese male inpatients with schizophrenia: Prevalence and clinical correlates

Depression is common in patients with schizophrenia and associated with serious consequences. However, previous studies have mixed findings on characteristics of depression in schizophrenia, partly because of the use of depressive symptom scales that are not specific to schizophrenia. This study examined the prevalence and correlates of depressive symptoms in Chinese patients with schizophrenia. A consecutive sample of 349 male inpatients with schizophrenia was recruited from the largest psychiatric specialty hospital in south-central China. Depressive symptoms and psychopathology of patients were assessed with the Calgary Depression Scale for Schizophrenia and the Positive and Negative Symptom Scale, respectively. Extrapyramidal side effects (EPSs) were assessed with the Simpson Angus Scale, the Barnes Akathisia Rating Scale, and the Abnormal Involuntary Movement Scale. Demographic and other clinical data were also collected. Depressive symptoms were present in 41.8% of male schizophrenia inpatients. Multiple logistic regression analysis revealed that early age at onset (OR [95%CI] = 1.12 [1.01,1.27], p = 0.049), more severe negative symptoms (OR [95%CI] = 1.05 [1.01,1.09], p = 0.034), more severe general psychopathological symptoms (OR [95%CI] = 1.06 [1.01,1.12], p = 0.041), akathisia (OR [95%CI] = 2.87 [1.45,5.69], p = 0.003), and dyskinesia (OR [95%CI] = 3.93 [1.36,11.33], p = 0.011) were significantly associated with depression. Appropriate antipsychotic medication treatment and reducing EPSs of antipsychotics may help prevent or relieve depression of patients with schizophrenia.

Clinical utility of the Calgary Depression Scale for Schizophrenia in individuals at ultra-high risk of psychosis

There is a pressing need for reliable and valid rating scales to assess and measure depression in individuals at ultra-high risk (UHR) of psychosis. The aim of this study was to examine the clinical utility of the Calgary Depression Scale for Schizophrenia (CDSS) in individuals at UHR of psychosis. 167 individuals at UHR of psychosis were included as participants in this study. The Structured Clinical Interview for DSM-IV Axis I Disorders, CDSS, Beck Anxiety Inventory and Global Assessment of Functioning were administered. A receiver operating characteristic (ROC) curve analysis and factor analyses were performed. Cronbach's alpha was computed. Correlations between CDSS factor scores and other clinical variables were examined. The median CDSS total score was 5.0 (IQR 1.0-9.0). The area under ROC curve was 0.886 and Cronbach's alpha was 0.855. A score of 7 on the CDSS yielded the highest sensitivity and specificity in detecting depression in UHR individuals. Exploratory factor analysis of the CDSS yielded two factors: depression-hopelessness and self depreciation-guilt, which was confirmed by confirmatory factor analysis. Further analysis showed that the depression-hopelessness factor predicted functioning; whereas the self depreciation-guilt factor was related to the severity of the attenuated psychotic symptoms. In conclusion, the CDSS demonstrates good psychometric properties when used to evaluate depression in individuals at UHR of psychosis. Our study results also support a two-factor structure of the CDSS in UHR individuals.

Validation of the Arabic Version of Calgary Depression Scale for Schizophrenia

BACKGROUND

Patients with schizophrenia commonly show both depressive and negative symptoms that can differentially affect the prognosis and course of treatment. The Calgary Depression Scale for Schizophrenia (CDSS) was designed to distinguish between depression and negative symptoms in patients with schizophrenia. The purpose of this study is to validate an Arabic version of the CDSS among patients with schizophrenia.

METHODS

The diagnosis of schizophrenia was confirmed using the Arabic Mini International Neuropsychiatric Interview 6 (MINI 6). A standardized translation back-translation process was adopted. One rater administered the Arabic CDSS to subjects with schizophrenia as well as to a control group who should not have any psychiatric disorder except for depression. Another rater, blinded to the results administered the already validated Arabic version of Beck Depression Inventory-II (BDI-II).

RESULTS

We recruited 102 patients and 102 controls subjects. The CDSS showed good internal consistency in the active group (Cronbach's alpha = 0.82). The Intraclass Coefficient correlations (ICC) for the inter-rater reliability (n = 21) was 0.90, p<0.05 and test-retest reliability (n = 19) was 0.85, p<0.001. When compared to the BDI-II, the cutoff score of 5 on the Arabic CDSS showed reasonable sensitivity and specificity of 72.75% and 67.95% respectively.

CONCLUSIONS

The psychometric properties of the Arabic version of CDSS demonstrate that it is a valid tool to assess the depressive symptoms in the Arab patients with schizophrenia.

Mismatch Negativity to Threatening Voices Associated with Positive Symptoms in Schizophrenia

Although the general consensus holds that emotional perception is impaired in patients with schizophrenia, the extent to which neural processing of emotional voices is altered in schizophrenia remains to be determined. This study enrolled 30 patients with chronic schizophrenia and 30 controls and measured their mismatch negativity (MMN), a component of auditory event-related potentials (ERP). In a passive oddball paradigm, happily or angrily spoken deviant syllables dada were randomly presented within a train of emotionally neutral standard syllables. Results showed that MMN in response to angry syllables and angry-derived non-vocal sounds was significantly decreased in individuals with schizophrenia. P3a to angry syllables showed stronger amplitudes but longer latencies. Weaker MMN amplitudes were associated with more positive symptoms of schizophrenia. Receiver operator characteristic analysis revealed that angry MMN, angry-derived MMN, and angry P3a could help predict whether someone had received a clinical diagnosis of schizophrenia. The findings suggested general impairments of voice perception and acoustic discrimination in patients with chronic schizophrenia. The emotional salience processing of voices showed an atypical fashion at the preattentive level, being associated with positive symptoms in schizophrenia.

Augmentation with antidepressants in schizophrenia treatment: benefit or risk

We focused on the application of antidepressants in schizophrenia treatment in this review. Augmentation of antidepressants with antipsychotics is a common clinical practice to treat resistant symptoms in schizophrenia, including depressive symptoms, negative symptoms, comorbid obsessive-compulsive symptoms, and other psychotic manifestations. However, recent systematic review of the clinical effects of antidepressants is lacking. In this review, we have selected and summarized current literature on the use of antidepressants in patients with schizophrenia; the patterns of use and effectiveness, as well as risks and drug-drug interactions of this clinical practice are discussed in detail, with particular emphasis on the treatment of depressive symptoms in schizophrenia.

Reliability and validity of the Thai version of the Calgary Depression Scale for Schizophrenia

AIM

The purpose of this study was to assess the reliability and validity of the Thai version of the Calgary Depression Scale for Schizophrenia (CDSS) for the evaluation of depression in patients with schizophrenia.

METHODS

Sixty patients with schizophrenia according to Diagnostic and Statistical Manual of Mental Disorders: Fourth Edition; Text Revision (DSM-IV-TR) criteria were recruited to the study The Thai version of the CDSS, the Montgomery-Åsberg Depression Rating Scale (MADRS), the Hamilton Depression Rating Scale, 17-item version (HDRS-17), and the Positive and Negative Syndrome Scale (PANSS) were administered. A major depressive episode diagnosed by a psychiatrist according to the DSM-IV-TR was used as a gold standard.

RESULTS

The internal consistency of the Thai version of the CDSS was very good (Cronbach's alpha = 0.869). The inter-rater reliability was found to be in substantial agreement with the intra-class correlation coefficient of 0.979. The test-retest reliability over a period of 3 days was high, with an intra-class correlation coefficient of 0.861. The Thai version of the CDSS showed significant correlations with the MADRS (r = 0.887), the HDRS-17 (r = 0.865), and the depression item of the Positive and Negative Syndrome Scale (PANSS-G6) (r = 0.833). The areas under the receiver operating characteristic curve of the CDSS, MADRS, HDRS-17, and PANSS-G6 against the DSM-IV-TR criteria for major depressive episode were 0.993, 0.954, 0.966, and 0.933, respectively. The optimal cut-off score to discriminate between depressed and non-depressed patients was 6/7, with a sensitivity of 92.31% and specificity of 97.87%.

CONCLUSION

The Thai version of the CDSS is a reliable and valid measure for the evaluation of depression in Thai patients with schizophrenia.

A systematic review of instruments to measure depressive symptoms in patients with schizophrenia

BACKGROUND

Depressive symptoms require accurate recognition and monitoring in clinical practice of patients with schizophrenia. Depression instruments developed for use in depressed patients may not discriminate depressive symptoms from negative psychotic symptoms.

OBJECTIVE

We reviewed depression instruments on their reliability and validity in patients with schizophrenia.

METHODOLOGY

A systematic literature search was carried out in three electronic databases. Psychometric properties were extracted for those instruments of which reliability, divergent, concurrent and predictive validity were reported in one or more publications.

RESULTS

Forty-eight publications described the reliability and validity of six depression instruments in patients with schizophrenia. The only self-report was the Beck Depression Inventory (BDI). The Brief Psychiatric Rating Scale-Depression subscale (BPRS-D), Positive and Negative Syndrome Scale-Depression subscale (PANSS-D), Hamilton Rating Scale for Depression (HAMD), Montgomery Asberg Depression Rating Scale (MADRS) and Calgary Depression Scale for Schizophrenia (CDSS) were clinician rated. All instruments were reliable for the measurement of depressive symptoms in patients with schizophrenia. The CDSS most accurately differentiated depressive symptoms from other symptoms of schizophrenia (divergent validity), correlated well with other depression instruments (concurrent validity), and was least likely to miss cases of depression or misdiagnose depression (predictive validity).

CONCLUSIONS

We would recommend to use the CDSS for the measurement of depressive symptoms in research and in daily clinical practice of patients with schizophrenia. A valid self-report instrument is to be developed for the use in clinical practice.