Temperament and character in violent schizophrenic patients

Preliminary evidence shows that personality traits are important in determining violent behavior in schizophrenia. As only some patients with schizophrenia show a greater risk for violence, this risk may therefore be considered as dynamic, varying as a function of the extent to which certain personality dimensions are present and the degree to which environmental events moderate or exacerbate their expression.

OBJECTIVE

To compare temperament and character dimensions between violent and non-violent schizophrenic patients and to determine which temperament and character dimensions are predictors of violent behavior in schizophrenia.

METHOD

We recruited 102 schizophrenic patients without concomitant substance abuse 4 months prior to the assessment. Diagnoses were based on the SCID-I. Personality dimensions were assessed with the Temperament and Character Inventory and violent behaviors with the Overt Aggression Scale.

RESULTS

Higher levels of the temperament dimension novelty seeking and a lower cooperativeness, as a character dimension, were risk factors for violent behavior in schizophrenic patients.

DISCUSSION

Our data indicate that schizophrenic patients will show a greater risk for violence according to certain personality configurations and the degree to which environmental events moderate or exacerbate their expression.

[Interrater reliability of the Spanish version of Schedule for Affective Disorders and Schizophrenia for School-Age Children--Present and Lifetime version (K-SADS-PL)]

INTRODUCTION

The K-SADS-PL diagnostic interview is useful for the cross-sectional and longitudinal evaluation of psychopathology in children and adolescents. The objective of this article was to describe the interrater reliability of the Spanish version of the Schedule for Affective Disorders and Schizophrenia for School-Age Children--Present and Lifetime version (K-SADS-PL).

METHOD

The interview was translated, back-translated and adapted to Spanish. Forty psychiatric outpatients (aged 6 to 17 years) were evaluated. The interviews were videotaped and scored by three independent raters. All of them included both the child's and parent's interview. Interrater reliability was obtained for affective, anxiety and conduct disorders using the Cohen's kappa coefficient.

RESULTS

Kappa coefficients were between the good and excellent range for present and lifetime disorders (major depressive disorder kappa = 0.76, any anxiety disorder kappa = 0.84, attention deficit hyperactivity disorder kappa = 0.91 and conduct disorder, kappa = 1).

CONCLUSION

The Spanish version of the K-SADS-PL is a reliable instrument for the assessment of psychopathology in children and adolescents.

[Replication of a computer model of auditory hallucinations in schizophrenia]

INTRODUCTION

Abnormal synaptic pruning has been proposed by some authors as a theory to explain schizophrenia. It has been studied in different ways, some of which are computerized models.

METHODS

A PC computer with MATLAB version 5.3 and Neural Networks Toolbox programs were used. To reproduce the model we used Elman's network for neuronal unit and McGlashan and Hoffman's network.

RESULTS

The corrected percentage of detection improved as synapses were prunned. It increased from 68% to 91 %, reaching the highest detection level when 60% of the synapses were eliminated. Detection capacity was reduced when synaptic elimination continued and the program started detecting words in the absence of input. This was considered as a hallucination. When pruning reached from 80% to 95%, hallucinations occurred more frequently.

CONCLUSIONS

The computer simulation model provides a symptom formation model, and also a way of understanding pruning's adaptative utility. When the neuronal units were eliminated (instead of connections), there was only progressive worsening in word perception. This confirms the hypothesis proposed that schizophrenia pathophysiology underlies neuronal connections, not the neurons.

[Sociodemographic features related to violent behavior in schizophrenia]

INTRODUCTION

It has been proposed that some sociodemographic variables may predict violent behavior in schizophrenic patients. The aim of this study was to investigate the relationship of violent behavior with sociodemographic and clinical features in schizophrenic patients.

METHOD

We included 106 schizophrenic patients. Sociodemographic and clinical characteristics of each patient were recorded in a previously designed record. Violent behaviors were assessed with the Overt Aggression Scale (OAS).

RESULTS

From the total sample, 49.1 % of the patients were classified as violent. Marital status, alcohol abuse, number of previous psychiatric hospitalizations and age of first hospitalization were predictive variables for violent behavior in schizophrenia.

DISCUSSION

Predictive sociodemographic variables for violence in schizophrenia are easy to measure during the first interview with the patient and can be useful for the prevention of future violence.

A forced five-dimensional factor analysis and concurrent validity of the Positive and Negative Syndrome Scale in Mexican schizophrenic patients

The heterogeneity of schizophrenic symptomatology is well documented. The positive-negative distinction is limited to cover the entire spectrum of schizophrenic psychopathology in order to describe the various clinical aspects of the disorder.

METHOD

We recruited 150 schizophrenic patients between May 2002 and September 2003. Diagnoses were based on a structured clinical interview. The Positive and Negative Syndrome Scale (PANSS) was used to evaluate general psychopathology and symptom severity. For the concurrent validity of the pentagonal model of the PANSS, the BPRS, the CDSS, the OAS and the MMSE were used.

RESULTS

The forced five-factor principal-component analysis explained 53.4% of the total variance. There were significant correlations between the clinical rating scales and the five components of the PANSS.

DISCUSSION

Our data support a pentagonal model underlying the multidimensional schizophrenic symptomatology as assessed by the PANSS. The five-factor structure of the PANSS in Mexican schizophrenic patients enables further elucidation of the various clinical aspects of schizophrenia.

Premorbid adjustment and violent behavior in schizophrenic patients

We examined the influence of premorbid adjustment on violent behavior in schizophrenic patients. There is some evidence that poor premorbid adjustment predicts violent behavior, then we decided to examine this hypothesis further.

METHOD

We recruited 72 schizophrenic patients without concomitant substance abuse 6 months prior to the assessment. Diagnoses were based on the SCID-I. Premorbid adjustment was evaluated with the Premorbid Adjustment Scale and violent behaviors with the Overt Aggression Scale.

RESULTS

Violent schizophrenic patients showed an overall worse premorbid adjustment during childhood. In addition, the area of "peer relationships" was significantly diminished in several life period sections such as childhood, early and late adolescence in violent patients.

DISCUSSION

Our data indicate that difficulties in social relationships during early stages of life may increase the risk of future violent behavior among schizophrenic patients.

[Sensitivity and specificity of the Overt Aggression Scale in schizophrenic patients]

INTRODUCTION

Research focused on the assessment of violent behavior in schizophrenic patients has been hindered by the lack of clinical instruments adapted to the Mexican psychiatric population. This study aimed to obtain sensitivity and specificity data as well as the most adequate cutoff point of the Overt Aggression Scale (OAS).

METHOD

137 schizophrenic patients were included. A clinical evaluation was performed with the PANSS subscale of excitability and the OAS. Diagnosis of violent behavior was obtained with the PANSS and clinical consensus of two psychiatrists.

RESULTS

66.4% of the sample was considered as nonviolent patients. A cutoff point of 7 points in the OAS showed sensitivity of 0.80 and specificity of 0.97, with adequate positive and negative predictive power.

DISCUSSION

The objective assessment of violent behavior in schizophrenic patients can contribute to the development of new lines of research. Adaptation of the OAS for the assessment of violent behavior will encourage the development of better strategies for the detection and intervention of violent behavior in schizophrenia.

[Premorbid functioning by gender and its relationship with duration of untreated psychosis in first psychotic episode]

INTRODUCTION

There are two phenotypes proposed for the psychotic disorders based on premorbid functioning and probably related with the duration of untreated psychosis (DUP). The aim of this study was to compare the clinical features, premorbid functioning and its relationship with DUP by gender in a group of first episode psychosis patients.

METHODS

We included 77 patients in their first admission to a psychiatric facility. A clinical evaluation was performed with the PANSS, Calgary Depression Scale,Hamilton Depression Scale and Mania Rating Scale. Premorbid functioning was rated with the Premorbid Adjustment Scale.

RESULTS

There were no clinical differences between men and women. Men had greater impairment in their premorbid functioning. Patients with short DUP (< 28 weeks) showed better premorbid functioning compared to those with long DUP (> 28 weeks).

CONCLUSION

Duration of untreated psychosis is determined by premorbid functioning and it is possible that male patients, who show a higher frequency of poor premorbid functioning, have a longer delay in seeking treatment, that conditions a longer duration of untreated psychosis.

Lack of association of apolipoprotein E polymorphism in obsessive-compulsive disorder

Obsessive-compulsive disorder (OCD) could be considered a neurodevelopmental disorder, from several lines of evidence. One of the most widely studied genes in these disorders is the apolipoprotein E gene, particularly allele 4. We analyzed for association among patients with OCD versus normal controls and cognitively impaired patients. There were no significant differences between OCD probands compared with population controls. However, the cognitively impaired group showed a higher frequency of allele apolipoprotein E gene compared with normal controls and patients with OCD.