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Ito M, Adachi N, Okazaki M, Hara K, Adachi T, Matsubara R, Sekimoto M, Kato M, Onuma T. Quantitative psychopathology of interictal psychosis in epilepsy; interaction between epilepsy-related and psychosis-general effects. Epilepsy Behav 2021; 123:108214. [PMID: 34375801 DOI: 10.1016/j.yebeh.2021.108214] [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: 05/16/2021] [Revised: 07/04/2021] [Accepted: 07/05/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE There is a historical debate whether psychopathology of epilepsy psychosis is unique to epilepsy or common to other psychoses. However, a large comprehensive studies on this issue are scarce. To clarify the characteristics of interictal psychosis (IIP), we evaluated psychopathology quantitatively. METHODS This study included 150 patients with IIP (epilepsy+/psychosis+), 187 patients with schizophrenia (SC: epilepsy-/psychosis+), 182 patients with epilepsy (EP: epilepsy+/psychosis-), and 172 non-clinical individuals (NC: epilepsy-/psychosis-). The IIP group comprised 127 chronic and 23 brief psychoses. Age, sex, and years of education, onset and duration of psychosis, and onset and duration of epilepsy were matched among the groups. The psychopathology was evaluated using the 16-item Brief Psychiatric Rating Scale (BPRS), which comprises three symptom factors namely negative symptoms (NS), positive symptoms (PS), and anxiety-depressive symptoms (ADS). RESULTS For overall 16-BPRS and NS factor scores, there were significant interactions between epilepsy-related (epilepsy+/-) and psychosis-general (psychosis+/-) effects. The EP exhibited higher scores than did the NC, whereas the IIP exhibited lower scores than did the SC. For PS and ADS factor scores, the IIP and SC exhibited a significant psychosis-general effect. Chronic IIP was associated with more serious psychopathologies than was brief IIP. However, limited with chronic IIP, there was a significant interaction between epilepsy-related and psychosis-general effects on the overall 16-BPRS and NS factor scores. CONCLUSION These findings demonstrate the first large quantitative evidence on the unique psychopathology of IIP which has been only narratively described. The psychopathology is associated with the interaction between epilepsy-related and psychosis-general effects.
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Affiliation(s)
- Masumi Ito
- Jozen Clinic, Sapporo, Japan; National Centre Hospital, National Centre of Neurology and Psychiatry, Kodaira, Japan
| | - Naoto Adachi
- Jozen Clinic, Sapporo, Japan; Adachi Mental Clinic, Sapporo, Japan.
| | - Mitsutoshi Okazaki
- National Centre Hospital, National Centre of Neurology and Psychiatry, Kodaira, Japan
| | | | | | | | - Masanori Sekimoto
- National Centre Hospital, National Centre of Neurology and Psychiatry, Kodaira, Japan; Musashino Kokubunji Clinic, Tokyo, Japan
| | - Masaaki Kato
- National Centre Hospital, National Centre of Neurology and Psychiatry, Kodaira, Japan; Musashino Kokubunji Clinic, Tokyo, Japan
| | - Teiichi Onuma
- National Centre Hospital, National Centre of Neurology and Psychiatry, Kodaira, Japan; Musashino Kokubunji Clinic, Tokyo, Japan
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Calati R, Nemeroff CB, Lopez-Castroman J, Cohen LJ, Galynker I. Candidate Biomarkers of Suicide Crisis Syndrome: What to Test Next? A Concept Paper. Int J Neuropsychopharmacol 2019; 23:192-205. [PMID: 31781761 PMCID: PMC7171927 DOI: 10.1093/ijnp/pyz063] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 11/25/2019] [Accepted: 11/27/2019] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND There has been increasing interest in both suicide-specific diagnoses within the psychiatric nomenclature and related biomarkers. Because the Suicide Crisis Syndrome-an emotional crescendo of several interrelated symptoms-seems to be promising for the identification of individuals at risk of suicide, the aim of the present paper is to review the putative biological underpinnings of the Suicide Crisis Syndrome symptoms (entrapment, affective disturbance, loss of cognitive control, hyperarousal, social withdrawal). METHODS A PubMed literature search was performed to identify studies reporting a link between each of the 5 Suicide Crisis Syndrome symptoms and biomarkers previously reported to be associated with suicidal outcomes. RESULTS Disturbances in the hypothalamic-pituitary-adrenal axis, with dysregulated corticotropin-releasing hormone and cortisol levels, may be linked to a sense of entrapment. Affective disturbance is likely mediated by alterations in dopaminergic circuits involved in reward and antireward systems as well as endogenous opioids. Loss of cognitive control is linked to altered neurocognitive function in the areas of executive function, attention, and decision-making. Hyperarousal is linked to autonomic dysregulation, which may be characterized by a reduction in both heart rate variability and electrodermal activity. Social withdrawal has been associated with oxytocin availability. There is also evidence that inflammatory processes may contribute to individual Suicide Crisis Syndrome symptoms. CONCLUSION The Suicide Crisis Syndrome is a complex syndrome that is likely the consequence of distinct changes in interconnected neural, neuroendocrine, and autonomic systems. Available clinical and research data allow for development of empirically testable hypotheses and experimental paradigms to scrutinize the biological substrates of the Suicide Crisis Syndrome.
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Affiliation(s)
- Raffaella Calati
- Department of Psychiatry, Mount Sinai Beth Israel, New York, New York,Icahn School of Medicine at Mount Sinai, New York, New York,Department of Psychology, University of Milan-Bicocca, Milan, Italy,Department of Adult Psychiatry, Nîmes University Hospital, Nîmes, France,Correspondence: Raffaella Calati, PsyD, PhD, Department of Psychology, University of Milan-Bicocca, Piazza dell’Ateneo Nuovo 1, 20126, Milan, Italy ()
| | - Charles B Nemeroff
- Department of Psychiatry, University of Texas Dell Medical School, Austin, Texas
| | - Jorge Lopez-Castroman
- Department of Adult Psychiatry, Nîmes University Hospital, Nîmes, France,INSERM, University of Montpellier, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France
| | - Lisa J Cohen
- Department of Psychiatry, Mount Sinai Beth Israel, New York, New York,Icahn School of Medicine at Mount Sinai, New York, New York
| | - Igor Galynker
- Department of Psychiatry, Mount Sinai Beth Israel, New York, New York,Icahn School of Medicine at Mount Sinai, New York, New York
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Shafer A, Dazzi F. Meta-analysis of the positive and Negative Syndrome Scale (PANSS) factor structure. J Psychiatr Res 2019; 115:113-120. [PMID: 31128501 DOI: 10.1016/j.jpsychires.2019.05.008] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 04/05/2019] [Accepted: 05/09/2019] [Indexed: 11/16/2022]
Abstract
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.
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Affiliation(s)
| | - Federico Dazzi
- Department of Human Sciences, Lumsa University, Rome, Italy
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Gossink FT, Vijverberg EG, Krudop W, Scheltens P, Stek ML, Pijnenburg YA, Dols A. Psychosis in behavioral variant frontotemporal dementia. Neuropsychiatr Dis Treat 2017; 13:1099-1106. [PMID: 28458550 PMCID: PMC5402723 DOI: 10.2147/ndt.s127863] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Dementia is generally characterized by cognitive impairment that can be accompanied by psychotic symptoms; for example, visual hallucinations are a core feature of dementia with Lewy bodies, and delusions are often seen in Alzheimer's disease. However, for behavioral variant of frontotemporal dementia (bvFTD), studies on the broad spectrum of psychotic symptoms are still lacking. The aim of this study was to systematically and prospectively subtype the wide spectrum of psychotic symptoms in probable and definite bvFTD. METHODS In this study, a commonly used and validated clinical scale that quantifies the broad spectrum of psychotic symptoms (Positive and Negative Symptom Scale) was used in patients with probable and definite bvFTD (n=22) and with a primary psychiatric disorder (n=35) in a late-onset frontal lobe cohort. Median symptom duration was 2.8 years, and the patients were prospectively followed for 2 years. RESULTS In total, 22.7% of bvFTD patients suffered from delusions, hallucinatory behavior, and suspiciousness, although the majority of the patients exhibited negative psychotic symptoms such as social and emotional withdrawal and blunted affect (95.5%) and formal thought disorders (81.8%). "Difficulty in abstract thinking" and "stereotypical thinking" (formal thought disorders) differentiated bvFTD from psychiatric disorders. The combined predictors difficulty in abstract thinking, stereotypical thinking, "anxiety", "guilt feelings," and "tension" explained 75.4% of variance in the diagnosis of bvFTD versus psychiatric diagnoses (P<0.001). CONCLUSION Delusions, hallucinatory behavior, and suspiciousness were present in one-fifth of bvFTD patients, whereas negative psychotic symptoms such as social and emotional withdrawal, blunted affect, and formal thought disorders were more frequently present. This suggests that negative psychotic symptoms and formal thought disorders have an important role in the psychiatric misdiagnosis in bvFTD; misdiagnosis in bvFTD might be reduced by systematically exploring the broad spectrum of psychiatric symptoms.
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Affiliation(s)
- Flora T Gossink
- Department of Old Age Psychiatry, GGZinGeest.,Alzheimer Center & Department of Neurology, VU University Medical Center, Amsterdam
| | - Everard Gb Vijverberg
- Alzheimer Center & Department of Neurology, VU University Medical Center, Amsterdam.,Department of Neurology, HagaZiekenhuis, The Hague, the Netherlands
| | - Welmoed Krudop
- Alzheimer Center & Department of Neurology, VU University Medical Center, Amsterdam
| | - Philip Scheltens
- Alzheimer Center & Department of Neurology, VU University Medical Center, Amsterdam
| | - Max L Stek
- Department of Old Age Psychiatry, GGZinGeest
| | - Yolande Al Pijnenburg
- Department of Old Age Psychiatry, GGZinGeest.,Alzheimer Center & Department of Neurology, VU University Medical Center, Amsterdam
| | - Annemiek Dols
- Department of Old Age Psychiatry, GGZinGeest.,Alzheimer Center & Department of Neurology, VU University Medical Center, Amsterdam
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Murphy SM, McDonell MG, McPherson S, Srebnik D, Angelo F, Roll JM, Ries RK. An economic evaluation of a contingency-management intervention for stimulant use among community mental health patients with serious mental illness. Drug Alcohol Depend 2015; 153:293-9. [PMID: 26026494 PMCID: PMC4509830 DOI: 10.1016/j.drugalcdep.2015.05.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2014] [Revised: 04/22/2015] [Accepted: 05/04/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND This study examines the cost-effectiveness of contingency-management (CM) for stimulant dependence among community mental health patients with serious mental illness (SMI) METHODS: Economic evaluation of a 12-week randomized controlled trial investigating the efficacy of CM added to treatment-as-usual (CM+TAU), relative to TAU without CM, for treating stimulant dependence among patients with a SMI. The trial included 176 participants diagnosed with SMI and stimulant dependency who were receiving community mental health and addiction treatment at one community mental health center in Seattle, Washington. Participants were also assessed during a 12-week follow-up period. Positive and negative syndrome scale (PANSS) scores were used to calculate quality-adjusted life-years (QALYs) for the primary economic outcome. The primary clinical outcome, the stimulant-free year (SFY) is a weighted measure of time free from stimulants. Two perspectives were adopted, those of the provider and the payer. RESULTS At 12-weeks neither the provider ($2652, p=0.74) nor the payer ($2611, p=0.99) cost differentials were statistically significant. This was also true for the payer at 24-weeks (-$125, p=1.00). QALYs gained were similar across groups, resulting in small, insignificant differences (0.04, p=0.23 at 12-weeks; 0.01, p=0.70 at 24 weeks). CM+TAU experienced significantly more SFYs, 0.24 (p<0.001) at 12 weeks and 0.20 (p=0.002) at 24 weeks, resulting in at least an 85% chance of being considered cost-effective at a threshold of $200,000/SFY. CONCLUSION Contingency management appears to be a wise investment for both the provider and the payer with regard to the clinical outcome of time free from stimulants.
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Affiliation(s)
- Sean M. Murphy
- Program of Excellence in Addictions Research, Washington State University, Spokane, Washington 99210, USA,Corresponding author at: Department of Health Policy & Administration, P.O. Box 1495, Spokane, WA 99210-1495. Phone: 509-358-7949. Fax: 509-358-7984509-358-7949.
| | - Michael G. McDonell
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington 98195, USA
| | - Sterling McPherson
- Program of Excellence in Addictions Research, Washington State University, Spokane, Washington 99210, USA
| | - Debra Srebnik
- King County Mental Health, Chemical Abuse and Dependency Services Division, Seattle, Washington 98104, USA
| | - Frank Angelo
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington 98195, USA
| | - John M. Roll
- Program of Excellence in Addictions Research, Washington State University, Spokane, Washington 99210, USA
| | - Richard K. Ries
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington 98195, USA
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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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Gold C, Mössler K, Grocke D, Heldal TO, Tjemsland L, Aarre T, Aarø LE, Rittmannsberger H, Stige B, Assmus J, Rolvsjord R. Individual music therapy for mental health care clients with low therapy motivation: multicentre randomised controlled trial. PSYCHOTHERAPY AND PSYCHOSOMATICS 2014; 82:319-31. [PMID: 23942318 DOI: 10.1159/000348452] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Accepted: 01/21/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Music therapy (MT) has been shown to be efficacious for mental health care clients with various disorders such as schizophrenia, depression and substance abuse. Referral to MT in clinical practice is often based on other factors than diagnosis. We aimed to examine the effectiveness of resource-oriented MT for mental health care clients with low motivation for other therapies. METHOD This was a pragmatic parallel trial. In specialised centres in Norway, Austria and Australia, 144 adults with non-organic mental disorders and low therapy motivation were randomised to 3 months of biweekly individual, resource-oriented MT plus treatment as usual (TAU) or TAU alone. TAU was typically intensive (71% were inpatients) and included the best combination of therapies available for each participant, excluding MT. Blinded assessments of the Scale for the Assessment of Negative Symptoms (SANS) and 15 secondary outcomes were collected before randomisation and after 1, 3 and 9 months. Changes were analysed on an intention-to-treat basis using generalised estimating equations in longitudinal linear models, controlling for diagnosis, site and time point. RESULTS MT was superior to TAU for total negative symptoms (SANS, d = 0.54, p < 0.001) as well as functioning, clinical global impressions, social avoidance through music, and vitality (all p < 0.01). CONCLUSION Individual MT as conducted in routine practice is an effective addition to usual care for mental health care clients with low motivation.
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Affiliation(s)
- Christian Gold
- GAMUT, Uni Health, Uni Research, Bergen, Norway. christian.gold @ uni.no
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Consistency of symptomatic dimensions of schizophrenia over 20 years. Psychiatry Res 2012; 200:115-9. [PMID: 22884215 DOI: 10.1016/j.psychres.2012.07.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2011] [Revised: 07/13/2012] [Accepted: 07/17/2012] [Indexed: 11/21/2022]
Abstract
Our goal was to analyze the consistency of the symptomatic dimensions of schizophrenia over the course of our 20-year prospective study. We investigated a sample of patients diagnosed with Diagnostic and Statistical Manual of Mental Disorders Third version (DSM III) schizophrenia and later re-diagnosed with Diagnostic and Statistical Manual of Mental Disorders Fourth version (DSM IV) at four intervals: three, seven, twelve and twenty years from their first hospitalization. The severity of symptoms was assessed using expanded version of Brief Psychiatric Rating Scale (BPRS - E). Exploratory factor analyses and then confirmatory factor analyses were conducted. A four-factor structure was found, with positive, negative, depressive and excitement factors. In the confirmatory factor analysis, the only symptomatic dimension confirmed at all follow-ups was the negative factor (emotional withdrawal, motor retardation, blunted affect and conceptual disorganization) as derived from the 20-year follow up in exploratory factor analysis. The positive syndrome derived from the three-year follow-up (hostility, suspiciousness, unusual thought content and hallucinations) was confirmed at the seven- and 20-year follow-ups. In the depressive syndrome the model from the 12-year follow-up (guilt, depression, suicidality, anxiety and somatic concern) was confirmed for the follow-ups after seven and 20 years. As regards the excitement syndrome, we confirmed the model from the three-year follow-up (motor hyperactivity, elated mood, conceptual disorganization, excitement) at the follow-ups at seven and 12 years.
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Wang Z, Kemp DE, Chan PK, Fang Y, Ganocy SJ, Calabrese JR, Gao K. Comparisons of the tolerability and sensitivity of quetiapine-XR in the acute treatment of schizophrenia, bipolar mania, bipolar depression, major depressive disorder, and generalized anxiety disorder. Int J Neuropsychopharmacol 2011; 14:131-42. [PMID: 20875219 PMCID: PMC3433839 DOI: 10.1017/s146114571000101x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Quetiapine extended-release (quetiapine-XR) has been studied in patients with schizophrenia, bipolar mania, bipolar depression, major depressive disorder (MDD), and generalized anxiety disorder (GAD). The purpose of this study was to compare the tolerability and sensitivity of quetiapine-XR among these psychiatric conditions. The discontinuation due to adverse events (DAEs) and reported somnolence in randomized, double-blind, placebo-controlled studies of quetiapine-XR in these psychiatric conditions were examined. The absolute risk reduction or increase and the number needed to treat to benefit (NNTB) or harm (NNTH) for DAEs and reported somnolence of quetiapine-XR ≥ 300 mg/d relative to placebo were estimated. Data from one study in schizophrenia (n=465), one in mania (n=316), one in bipolar depression (n=280), two in refractory MDD (n=624), two in MDD (n=669) and three in GAD (n=1109) were available. The risk for DAEs of quetiapine-XR relative to placebo was significantly increased in bipolar depression (NNTH=9), refractory MDD (NNTH=8), MDD (NNTH=9), and GAD (NNTH=5), but not in schizophrenia and mania. The risk for reported somnolence of quetiapine-XR relative to placebo was significantly increased in schizophrenia (600 mg/d NNTH=15 and 800 mg/d NNTH=11), mania (NNTH=8), bipolar depression (NNTH=4), refractory MDD (NNTH=5), MDD (NNTH=5) and GAD (NNTH=5). These results suggest that patients with GAD had the poorest tolerability during treatment with quetiapine-XR, but they had a similar sensitivity as those with bipolar depression and MDD. Patients with schizophrenia or mania had a higher tolerability and a lower sensitivity than those with bipolar depression, MDD, or GAD.
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Affiliation(s)
- Zuowei Wang
- Department of Psychiatry, Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
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Biancosino B, Picardi A, Marmai L, Biondi M, Grassi L. Factor structure of the Brief Psychiatric Rating Scale in unipolar depression. J Affect Disord 2010; 124:329-34. [PMID: 20053458 DOI: 10.1016/j.jad.2009.11.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2009] [Revised: 11/23/2009] [Accepted: 11/23/2009] [Indexed: 11/25/2022]
Abstract
BACKGROUND In clinical practice patients with unipolar depression present with a variety of symptom clusters that may combine together in many different ways. However, only few factor analytic studies used general psychopathology scales to investigate the symptom structure of unipolar depression. METHODS The study included 163 consecutive inpatients with an ICD-10 diagnosis of depressive disorder (ICD-10 codes F32 to F33). All patients were assessed with the 18-item version of the Brief Psychiatric Rating Scale (BPRS) within 3days from admission. Exploratory factor analysis with Varimax rotation was performed on BPRS items. RESULTS Four factors were extracted, explaining 52% of total variance. They were interpreted as Apathy, Dysphoria, Depression and Psychoticism. The distribution of factor scores was approximately normal for Apathy, while it displayed a slight negative skewness for Depression, a slight positive skewness for Dysphoria, and a marked positive skewness for Psychoticism. Patient sex, family history of depression, lifetime history of suicide attempt, and recent serious family conflict were not associated with any factor. Occupational status, age, and age at onset displayed a positive correlation with Apathy. Duration of illness and number of previous admissions were positively correlated with Dysphoria. LIMITATIONS Patients were not administered a structured diagnostic interview, and no detailed assessment of personality disorders was performed; also, patients were recruited only at a single site, which reduces the generalizability of the results. CONCLUSIONS Our findings suggest that in depressive disorders there are psychopathological dimensions other than depressed mood that are worthy of greater clinical attention and research. Dimensions such as apathy and dysphoria may play an important part in the clinical phenomenology of unipolar depression and deserve systematic and careful assessment in order to provide patients with the best possible treatment and improve clinical outcomes.
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Affiliation(s)
- Bruno Biancosino
- Section of Psychiatry, Department of Medical Sciences of Communication and Behaviour, University of Ferrara, 44100 Ferrara, Italy
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11
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Alvarez-Silva I, Alvarez-Silva S, Alvarez-Rodriguez J. Positive syndrome of schizophrenia and epilepsy. Med Hypotheses 2010; 74:294-6. [DOI: 10.1016/j.mehy.2009.09.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2009] [Revised: 08/30/2009] [Accepted: 09/05/2009] [Indexed: 11/28/2022]
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Eisenberg DP, Aniskin DB, White L, Stein JA, Harvey PD, Galynker II. Structural differences within negative and depressive syndrome dimensions in schizophrenia, organic brain disease, and major depression: A confirmatory factor analysis of the positive and negative syndrome scale. Psychopathology 2009; 42:242-8. [PMID: 19451757 PMCID: PMC2705906 DOI: 10.1159/000218522] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2007] [Accepted: 04/17/2008] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The emerging dimensional approach to classification and treatment of psychiatric disorders calls for better understanding of diagnosis-related variations in psychiatric syndromes and for proper validation of psychometric scales used for the evaluation of those syndromes. This study tested the hypothesis that negative and depressive syndromes as measured by the Positive and Negative Syndrome Scale (PANSS) are consistent across different diagnoses. METHOD We administered the PANSS to subjects with schizophrenia (n = 305), organic brain disease (OBD, n = 66) and major depressive disorder (MDD, n = 75). Confirmatory factor analysis (CFA) was used to establish if the PANSS items for negative symptoms and for depression fit the hypothesized factor structure and if the item factor loadings were similar among the diagnostic groups. RESULTS The negative and depressive symptom subscales fit well according to a variety of fit indexes for all groups individually after some modest model modification. However, multisample modeling procedures indicated that the pattern of factor loadings was significantly different among the groups in most cases. CONCLUSION The results of this study indicate diagnosis-related variations in the negative and depressive syndrome dimensions in schizophrenia, OBD and MDD. These results also validate limited use of the PANSS for evaluation of negative and depressive syndromes in disorders other than schizophrenia. Larger studies are warranted to further evaluate clinical and nosologic significance of diagnostic categories, dimensions and structures of psychiatric syndromes.
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