Predictive capacity of prodromal symptoms in first-episode psychosis of recent onset

BACKGROUND

Both the nature and number of a wide range of prodromal symptoms have been related to the severity and type of psychopathology in the psychotic phase. However, at present there is an incomplete picture focused mainly on the positive pre-psychotic dimension.

AIM

To characterize the prodromal phase retrospectively, examining the number and nature of prodromal symptoms as well as their relationship with psychopathology at the onset of first-episode psychosis.

METHODS

Retrospective study of 79 patients experiencing a first-episode psychosis of less than 1 year from the onset of full-blown psychosis. All patients were evaluated with a comprehensive battery of instruments including socio-demographic and clinical questionnaire, IRAOS interview, PANSS, stressful life events scale (PERI) and WAIS/WISC (vocabulary subtest). Bivariate associations and multiple regression analysis were performed.

RESULTS

Regression models revealed that several prodromal dimensions of IRAOS (delusions, affect, language, behaviour and non-hallucinatory disturbances of perception) predicted the onset of psychosis, with positive (22.4% of the variance) and disorganized (25.6% of the variance) dimensions being the most widely explained.

CONCLUSION

In addition to attenuated positive symptoms, other symptoms such as affective, behavioural and language disturbances should also be considered in the definitions criteria of at-high-risk people.

[Differences in the subjective effects of drugs in patients with a first psychotic episode. Preliminary results]

INTRODUCTION

The study of the subjective effects of abuse substances may facilitate comprehension of the high prevalence of substance abuse in psychosis.

OBJECTIVE

To assess the subjective effects of psychoactive substances in psychotic patients with substance use disorder in a prospective open study with a 6 month evaluation.

METHODS

Thirty patients consecutively admitted for the first time to a psychiatric hospital because of a psychotic disorder (DSM-IV) were included. Sociodemographic data, substance use history, drug urine test, and severity of psychotic symptoms measured by BPRS, SANS and SAPS were evaluated. The subjective effects of drugs were assessed with the short form of the ARCI questionnaire. Patients were re-assessed at six months followup.

RESULTS

Sixty-three percent of patients were male, mean age 29.2 years. A total of 46.6% presented at least one substance use disorder. Differences between substance users group and non-substance users group were only related to sex (more male in substance user group), and no other sociodemographic and clinical differences were found. The main abuse drugs found were: 86% cannabis, 17% cocaine, 17% alcohol, 3% heroin and 3% hypnosedatives. Fifty percent only consumed cannabis. The psychotic patients with substance use disorder showed higher punctuation in MBG scale (euphoria scale); no differences in other ARCI scales were found. At six months follow-up, 83.3% patients were re-assessed and no differences were found.

CONCLUSIONS

The psychotic patients with substance use disorder showed a higher subjective effect of euphoria than non-substance user psychotics, suggesting that drug use is mainly related to obtaining euphoria-like effects than sedatives in this group.

Gender differences in a sample of schizophrenic outpatients

Our objective was to study gender differences in schizophrenia, comparing clinical, social, and illness course characteristics. A sample of 239 schizophrenic (DSM-IV criteria) outpatients were administered the following instruments: service use and demographic questionnaires, the Positive and Negative Symptom Scale (PANSS), the Disability Assessment Scale (DAS), and the Global Assessment of Functioning (GAF) scale. The female to male ratio was 1/2. Men had an earlier age at onset. Women were more likely to be married and to live independently, and there were more unemployed men. Social functioning was slightly better in women (lower DAS scoring). No differences were found in symptomatological variables (global or separate PANSS scales), nor in type of schizophrenia. Course of illness in the past year appeared to be similar, except for longer hospital stays in men. We conclude that schizophrenic women had a significantly better social functioning, despite the lack of remarkable symptomatic differences between genders.

[Comparative study of the needs of patients with schizophrenia by gender]

OBJECTIVES

To evaluate the gender differences in the needs of the people with schizophrenia who live in the community.

METHOD

We randomly selected 231 patients with schizophrenia who were receiving treatment in one of the five mental health care centres that participated in the study. Patients were evaluated with a socio-demographic questionnaire, the Positive and Negative Syndromes Scale (PANSS) and Camberwell Assessment of Need (CAN) questionnaire. The CAN evaluate 22 needs, that we could be grouped into five subscales: service needs, basic needs, functioning need, health needs and social needs. All needs were evaluated by the professional and the user independently.

RESULTS

Professionals detected more needs in men than in women, but users did not report such difference. Both professionals and users detected more service needs for women (p< 0.005) and more basic needs for men (p< 0,01-0.005). Only professionals detected more functioning needs in men (p< 0.05).

CONCLUSIONS

Professionals detect more needs than users and detect more needs for men than for women. Women have less needs in food, personal care, home care, and daily activities. These gender differences should be taken into account when designing treatment programs for schizophrenia.

[Symptomatology and gender in schizophrenia]

OBJECTIVE

To study the possible symptomatological gender differences in a sample of schizophrenic outpatients.

METHOD

A sample of 239 schizophrenic patients (DSM-IV criteria) was administered a demographic questionnaire and the Positive and Negative Syndrome Scale (PANSS). The PANSS symptoms were grouped in accordance with Kay's five factors model.

RESULTS

The ratio women/men was 1/2. Women had a later age at onset. Women were more likely to be married and to live independently, as well to be occupationally active. Both groups were similar in subtype of schizophrenia. No differences were found in PANSS' results; in global or grouped scores.

CONCLUSION

No symptomatological differences were found between women and men with schizophrenia.

[Gender differences in schizophrenia. A literature review]

Gender differences in schizophrenia have been the subject of extensive research in the last two decades. The study of these differences can help us improve the understanding of schizophrenia as well as find new treatment options. Recent studies have challenged the classical view that incidence and prevalence rates of schizophrenia are similar in men and in women. As regards disorder onset, most studies agree that it is earlier in men. Also, most studies suggest that women have a better premorbid functioning and, especially in short-term follow-up studies, a more benign course. Data on clinical characteristics are often conflicting, but most studies point to a greater severity of negative symptoms in men. Research on treatment response, both pharmacological and psychosocial, indicates as well differences between men and women. Results of neuropsychological studies are very conflicting. By contrast, brain imaging studies suggest gender differences in morphologic and in functional images. As regards family studies, most of them agree that schizophrenic women are more likely than men to have family history of the illness.

Predictors of tuberculosis transmission in prisons: an analysis using conventional and molecular methods

OBJECTIVE

To determine the tuberculosis (TB) transmission patterns within the prison system in Catalonia, conventional epidemiological techniques were combined with DNA fingerprinting of Mycobacterium tuberculosis.

METHODS

IS6110- and polymorphic GC-rich repeat sequence (PGRS)-based restriction fragment length polymorphism (RFLP) were combined with epidemiological studies to assess the relatedness of isolates from all patients with confirmed TB at five prisons in the province of Barcelona (Catalonia, Spain), between 1 July 1994 and 31 December 1996. Risk factors for transmission were analysed to a logistic regression. The extent of drug-resistant TB was also assessed.

RESULTS

The incidence of TB during the study period was 2775 cases per 100,000 inmate years. Of the 247 culture-positive cases, 126 (51%) appeared to have active TB as a result of recent transmission. Using conventional epidemiological methods, 14 active chains of transmission were identified in prison involving 65 isolates (52% of clustered patients). A lengthy history of imprisonment [odds ratio (OR) 2.8, 95% confidence interval (CI) 1.52-5.11] and pulmonary TB (OR 2.36, 95% CI 1.17-4.75) were independently associated with clustering. Low rates of both initial (2.9%) and acquired drug resistance (5.8%) were identified and there was no evidence of the transmission of drug-resistant TB.

CONCLUSION

In the prison system studied, the recent transmission of TB contributes substantially to the overall incidence of the disease. Both lengthy incarcerations and delays in identifying inmates with pulmonary symptoms play a key role in this recent transmission. Directly observed therapy (DOT) is a critical control strategy for reducing the emergence of drug resistance and for avoiding the transmission of resistant organisms.

[Non-steroid anti-inflammatory agents and gastrointestinal protection: adequate prescription in primary care?]

OBJECTIVES

To find the frequency of prescription of gastro-intestinal protectors (GIP) at the same time as non-steroidal anti-inflammatory drugs (NSAID). To find certain characteristics linked to their use in primary care. To evaluate how correctly they are prescribed.

DESIGN

A crossover descriptive study.

SETTING

A base urban health area.

PATIENTS

Patients over 14, who attended in 1994, who had a medical history and were treated with NSAID.

MEASUREMENTS AND INTERVENTIONS

1,115 medical histories were obtained by simple randomised sampling, of whom 205 were under treatment with NSAID. A questionnaire was used to evaluate: age, sex, NSAID treatment, GIP, history of peptic ulcer, corticoid or acenocoumarol treatment, tobacco, alcohol and related pathology. After a complete bibliographic review, some criteria were fixed for when it is correct to give GIP-NSAID.

RESULTS

The prevalence of NSAID prescription was 18.39%. 34 patients treated with NSAID received GIP at the same time. Aceclophenac was the most widely prescribed NSAID; and H2 antihistamines, the drugs most commonly used as GIP.

[Characteristics of infantile asthma in patients seen in primary care]

OBJECTIVE

To compare an asthmatic and non-asthmatic group of children by looking at determined characteristics.

DESIGN

Study of cases and paired one-to-one controls by age and gender.

SETTING

Primary Care.

PATIENTS AND OTHER PARTICIPANTS

Children aged 0 to 13 and attended at one particular Paediatrics clinic were studied (1,100 children). All those children diagnosed with asthma in accordance with the standard procedure in the Health District were considered as cases (142). The control group was chosen at random from the age and gender files.

MEASUREMENTS AND MAIN RESULTS

A telephone poll with closed questions was carried out by three researchers who were "blind" to whether they were dealing with case or control. Statistically significant differences were found for family background of allergic Rhinitis (cases, 43.2%; controls, 30.4%; p = 0.04), atopic eczema (cases, 36.3%; controls, 14.7%; p < 0.001) and bronchial asthma (cases, 59.8%; controls, 33.3%; p < 0.001). Statistically significant differences were also found for personal case histories of allergic Rhinitis (cases, 36.3%; controls, 2%; p < 0.001) and atopic eczema (cases, 23.5%; controls, 10.7%; p = 0.021); and in the presence of animals (dog and/or cat) in the home (cases, 13.7%; controls, 25.5%; p = 0.04). No statistically significant differences were found for background of breast-feeding, age of starting school, present passive smoking or the existence of older siblings.

CONCLUSIONS

The results obtained show that the association of atopic illnesses, such as Rhinitis and Eczema, and the existence of family background of asthma and atopy are more common in the asthmatic patient.