Staging of Schizophrenia With the Use of PANSS: An International Multi-Center Study

INTRODUCTION

A specific clinically relevant staging model for schizophrenia has not yet been developed. The aim of the current study was to evaluate the factor structure of the PANSS and develop such a staging method.

METHODS

Twenty-nine centers from 25 countries contributed 2358 patients aged 37.21 ± 11.87 years with schizophrenia. Analysis of covariance, Exploratory Factor Analysis, Discriminant Function Analysis, and inspection of resultant plots were performed.

RESULTS

Exploratory Factor Analysis returned 5 factors explaining 59% of the variance (positive, negative, excitement/hostility, depression/anxiety, and neurocognition). The staging model included 4 main stages with substages that were predominantly characterized by a single domain of symptoms (stage 1: positive; stages 2a and 2b: excitement/hostility; stage 3a and 3b: depression/anxiety; stage 4a and 4b: neurocognition). There were no differences between sexes. The Discriminant Function Analysis developed an algorithm that correctly classified >85% of patients.

DISCUSSION

This study elaborates a 5-factor solution and a clinical staging method for patients with schizophrenia. It is the largest study to address these issues among patients who are more likely to remain affiliated with mental health services for prolonged periods of time.

The correlation between the level of 25-hydroxyvitamin D [25(OH)D] and residency of multiple sclerosis patients in Montenegro – higher levels only in men in the north of the country

Background/Aim. Multiple Sclerosis (MS) is a chronic neurological disease associated with low serum levels of 25-hydroxyvitamin D [25(OH)D]. The aim of this study was to determine the association between serum levels of 25(OH)D and the latitude as well as clinical MS severity and progression expressed by expanded disability status scale (EDSS) and multiple sclerosis severity score (MSSS). Methods. A total of 196 patients, from North and South of Montenegro, aged 18 to 65 years, with confirmed diagnosis of MS were recruited for the study. Serum samples were collected for 25(OH)D measurement. Control group consisted of 196 health controls, randomly selected from medical staff employed in health centers from three cities in North and Clinical Centre of Montenegro from the South. Results. The serum levels of 25(OH)D were significantly lower in MS patients compared to controls (p < 0.001). The serum levels of 25(OH)D were significantly different in regard to gender, with women showing lower levels. Although in the entire group of patients there was no statistical correlation between the levels of 25(OH)D and their residence, the significantly higher levels of 25(OH)D were detected in men from the North compared to women. The course of the disease had an impact on the 25(OH)D serum levels. 25(OH)D levels also significantly correlated with clinical parameters of both, disability (Spearman''s r = -0.23, p = 0.001) and progression (Spearman''s r = -0.25, p = 0.0004) of MS. Conclusion. Serum levels of 25(OH)D were associated with disability and progression in MS patients. Lower levels of 25(OH)D were detected in female patients from the North. The low level of 25(OH)D cannot be solely explained with unfavorable latitude and insufficient sun exposure, therefore further genetic analysis is needed.

Attempted suicide in Podgorica, Montenegro: higher rates in females and unemployed males

BACKGROUND

A change in suicide attempts is associated with comprehensive changes in mental and physical health and social environment. Attempted suicide and suicide are one of the biggest problems nowadays worldwide, not only in the field of mental health but also in the field of public health. The aim of the research was to determine the number of attempted suicides as well as the influence of clinical and demographic variables on the attempted suicide rate.

METHODS

The data on the attempted suicide were analysed in the period 2012-2016 based on the data from the Emergency Ward of the Clinical Centre of Montenegro in Podgorica. The rate of attempted suicides as well as the unemployment rate was calculated. The statistical analysis included descriptive statistics of the raw data and relative numbers, Chi-squared test, Fisher's test and Spearman coefficient.

RESULTS

The average age of males who attempted suicide was 38.35 ± 14.11, min 15 and max 88 years of age, and the age of women was 38.97 ± 16.81, min 16 and max 93 years of age. Women attempted suicide more frequently (p < 0.05). Female/male ratio during the investigation period slightly declined (1.93 in 2012 vs. 1.29 in 2016). The attempted suicide rates ranged from 103 per 100,000 residents in 2016 to 142 per 100,000 residents in 2015. Crude attempt rate was the highest in women in 2012 (102.42 per 100,000 residents) and for men in 2014 and 2015 (84.48 vs. 83.06 per 100,000 residents). Poisoning with psychotropic drugs was the dominant manner of attempt (93.2%), while the largest number of attempts was in the late spring and summer (May, June and July). Attempted suicide rate in man was associated with higher unemployment rate.

CONCLUSIONS

Although women make the majority of attempted suicide cases, there has been a decline in the value of the rate for women and a rise for men. The attempted suicide rates in Podgorica belong to lower rates compared to the WHO European multicentre study on parasuicide. Poisoning with psychotropic drugs was the predominant manner, while the highest number of attempted suicides was in the late spring and summer (May, June and July). Unemployment influences men to attempt suicide much more frequently.

Prevalence of epilepsy in Podgorica, Montenegro

The purpose of this study was to assess for the first time the prevalence of epilepsy in the capital of Montenegro and to describe the clinical and epidemiological profile of the disorder. A door-to-door screening was performed on population of 6 randomly selected areas of Podgorica (capital of Montenegro) using validated screening questionnaire. In phase 1, the screening by questionnaire of 4007 individuals identified 307 suspected cases of epilepsy. Four of them dropped out of further investigation just before entering the phase 2. In phase 2, the remaining 303 suspected cases were first examined by general practioner and then by an epileptologist, on two follow-up visits. The confirmation of epilepsy was based on clinical examination. Electroencephalogram (EEG), computed tomography (CT) and/or magnetic resonance imaging (MRI) were also used. 29 persons were diagnosed with epilepsy. An overall prevalence of 7.2 cases per 1000 inhabitants was calculated (CI 95% 5.0–10.0). Majority of them had been previously diagnosed (86.20%), 27 had active epilepsy and over a half of them were on polymedication (65.51%). Referring to the 27 patients with active epilepsy, the predominant seizure type was partial (all types) in 14 (48.27%) and undetermined in 2 (6.89%). Cause of epilepsy was determined in 10 patients. EEG abnormalities were found in almost all patients (89.65%). CT anomaly was determined in 9 whereas only 1 patient had an abnormal MRI finding. The estimated prevalence of epilepsy indicated higher rates compared to neighboring counties and the rest of the Europe, but limitations of the study (high rejection rate and stigma) should be taken into consideration.