Standardized assessment of psychopathology by relatives of mentally disordered patients. Preliminary results of using the positive and negative syndrome scale to compare schizophrenic and affective disorders

Meta-analysis of the positive and Negative Syndrome Scale (PANSS) factor structure

A meta-analysis of the results of 45 factor analyses (n = 22,812) of the Positive and Negative Syndrome Scale (PANSS) was conducted. Meta-analyses of the PANSS was conducted using both a co-occurrence similarity matrix and reproduced correlations. Both methods produced similar results. Five factors (Positive Symptoms, Negative Symptoms, Disorganization, Affect and Resistance) emerged clearly across both analyses. The factors and the items defining them were Positive Symptoms (P1 Delusions, G9 Unusual thought content, P3 Hallucinatory behavior, P6 Suspiciousness and persecution, P5 Grandiosity), Negative Symptoms (N2 Emotional withdrawal, N1 Blunted affect, N4 Passive apathetic social withdrawal, N6 Lack of spontaneity, N3 Poor rapport, G7 Motor retardation, G16 Active social avoidance), Disorganization often termed Cognitive (P2 Conceptual disorganization, G11 Poor attention, N5 Difficulty in abstract thinking, G13 Disturbance of volition, N7 Stereotyped thinking, G5 Mannerisms/posturing, G15 Preoccupation, G10 Disorientation), Affect often termed Depression-Anxiety (G2 Anxiety, G6 Depression, G3 Guilt feelings, G4 Tension, G1 Somatic concern) and a small fifth factor that might be characterized as Resistance or Excitement/Activity (P7 Hostility, G14 Poor impulse control, P4 Excitement, G8 Uncooperativeness). Items G1, G4, G10, P5, G5, G15 may not be core items for the PANSS factors and G12 lack of judgment is not a core item. Results of the PANSS meta-analyses were relatively similar to those for meta-analysis of both the BPRS and BPRS-E all of which contain the original 18 BPRS items. The PANSS is distinguished by a much larger number of items to clearly define and measure Negative Symptoms as well as a sufficient number of items to much more clearly identify a Disorganization factor than the BPRS or BPRS-E.

Acute psychopathology as a predictor of global functioning in patients with ICD-10 non-affective psychosis: a prospective study in 11 European countries

This prospective analysis aimed to study the influence of psychopathological dimensions on the global functioning of persons suffering from psychotic disorders, taking into account the role of a broad range of potential confounders. A large international cohort (n=1888) with ICD-10 non-affective psychosis was evaluated both at baseline during a hospital admission and three months after discharge. Trained interviewers administered a global functioning scale (GAF) and a psychopathological scale (BPRS) at baseline and follow-up). Baseline BPRS psychopathological dimensions were extracted using Principal Component Analysis. Results of multiple linear regression analyses demonstrated that affective symptoms (depressive or manic) prospectively predict a better global functioning, whilst agitation/cognitive symptoms determined poorer global functioning. Other predictors showing an independent effect on better global functioning were medication compliance, country of residence, female gender, married or coupled status, younger age and having a diagnosis of schizoaffective disorder rather than schizophrenia or other ICD-10 psychosis. A predicting model for global functioning in patients with psychosis is provided, showing that assessment of affective and agitation/cognitive symptoms should be emphasised during admission as they can be more informative than positive/negative symptoms in prospectively planning follow-up care that is geared towards a better functional recovery.

Zur faktoriellen Stabilität der deutschen Version des Questionnaire on the Opinions of the Family (QOF)

Zusammenfassung. Die Anzahl von standardisierten Untersuchungsinstrumenten, die Meinungen von Angehörigen zu Ursachen und sozialen Konsequenzen psychischer Störungen erfassen, ist sehr gering. Mit höherem methodischen Aufwand wurde bislang lediglich der in Italien für schizophrene Störungen konzipierte Questionnaire on the Opinions of the Family (QOF) entwickelt. In einem deutschen Forschungsprojekt konnte die Subskalenstruktur des italienischen QOF in einer Gruppe von Angehörigen (N = 161) von Patienten mit rezidivierend depressiven, bipolar affektiven oder schizophrenen Störungen nicht repliziert werden, was die Entwicklung einer ersten deutschen Version dieses Instrumentes (18 Items) veranlasste. Hiermit ließ sich eine 3-Faktoren-Lösung identifizieren, die die Angehörigenmeinungen in die Inhaltsbereiche “soziale Distanz“, “soziale Integration“ und “Orientierung auf Ressourcenoptimierung“ untergliedert. Die faktorielle Stabilität der deutschen QOF-Version wurde in einer weiteren unabhängigen Angehörigenstichprobe (N = 163) sowie an 59 Kontrollpersonen überprüft. Bezogen auf die Faktoren “soziale Distanz“ und “soziale Integration“ erwies sich die faktorielle Stabilität als hoch, wohingegen der dritte Faktor nun um drei Items ergänzt wurde, die soziale Restriktion reflektieren. Resultate aus beiden Teilstudien zum Ausprägungsgrad der Angehörigenmeinungen in den verschiedenen Inhaltsbereichen deuten auf krankheitsspezifische Einstellungsunterschiede hin. Validitätsprüfungen an Angehörigengruppen, deren soziodemographische Charakteristika von den bislang untersuchten Stichproben abweichen, sind notwendig.