[Comparative evaluation of quality of life in patients with schizophrenia treated with conventional versus atypical neuroleptics: results of a transversal study]

AIM

The World Health Organization has defined quality of life as "the perception of an individual, his/her place in life, in the context of the culture and the system of values in which he/she lives and in relation to his/her objectives, expectations, standards and concerns". The quality of life of the schizophrenic patients has been largely studied for the evaluation of their medical, social and therapeutic needs. The impact of neuroleptics, in particular atypical neuroleptics, on the subjective quality of life of these patients remains to be specified. The aim of this study was to compare the subjective quality of life of schizophrenic patients treated with classical neuroleptics (CN) or atypical neuroleptics (AN).

METHODS

One hundred patients meeting DSM IV criteria for the diagnosis of schizophrenia (American Psychiatric Association, 1994) were included in the study. Sixty-four schizophrenic patients were treated with CN and thirty-six with AN. The symptomatology of the patients was assessed using the Positive And Negative Syndrome Scale, (PANSS, Kay et al., 1987) and the Schedule for the Deficit Syndrome (SDS, Kirkpatrick et al., 1989). The extra-pyramidal symptoms were assessed using the Extrapyramidal Symptom Rating Scale (Chouinard et al., 1980). The Subjective quality of life was studied using the Lehman Quality of Life Interview (QOLI, Lehman, 1988) translated and validated in France.

RESULTS

The patients treated by CN did not differ from the patients treated by AN in terms of severity of the positive and negative symptoms. The patients treated with AN presented significantly less extrapyramidal side effects than the patients treated with CN. No significant difference in terms of quality of life was found between both groups of patients.

CONCLUSION

The kind of neuroleptic (CN vs AC) does not seem to influence the quality of subjective life of schizophrenic patients.

["Polydipsia, intermittent hyponatremia and psychoses" syndrome: a diagnosis and therapeutic management of a case]

Polydipsia can be defined as an impulsive behavior leading to absorption of large amounts of water (4 to 20 litres a day), without any underlying organic disease. Its prevalence in a population of chronic psychiatric patients can be as high as 6 to 17%. Schizophrenia represents 80% of cases reported. Some patients with polydipsia may develop hyponatremia, leading to a PIP syndrome (Polydipsia intermittent hyponatremia and psychosis). Hyponatremia or water intoxication appears when three conditions are present: an abnormal regulation of thirst, an inappropriate ADH secretion and/or an excessive renal sensitivity to ADH, with an increased sensitivity of the central nervous system to hyponatremia. The clinician must first identify patients at risk to develop water intoxication and start treatment before any severe physical complication occurs. Pharmacological treatments aiming at an increase of renal free-water excretion--do not show a constant efficacy in the correction of hyponatremia, they have no action on polydipsia. The new atypical neuroleptics such as clozapine and risperidone seem to open new perspectives in the treatment of polydipsia. Controlled studies should be performed in this field.

Identifying subtypes of schizophrenia by cluster analyses

The existence of two subtypes of schizophrenia (positive and negative) is well established. The evidence in favor of other subtypes, particularly a disorganized subtype, is still the subject of some debate. The aim of the study reported in this article is to investigate the possibility of further subtypes of schizophrenia by applying a particular method of cluster analysis to a particular set of data. Ward's method of cluster analysis was applied to the Positive and Negative syndrome Scale (PANSS) scores of 138 patients, defined as having schizophrenia by one of four diagnostic criteria. The validity of the cluster solution was assessed both by examining differences between clusters on a number of clinical characteristics recorded for each patient and by comparing the results obtained from the PANSS with those derived from a cluster analysis using two other instruments (the Scale for the Assessment of Negative Symptoms and the Scale for the Assessment of Positive Symptoms). Results from the cluster analysis suggest the existence of at least four subtypes of schizophrenia: positive, negative, mixed, and disorganized. A fifth subtype includes patients with few symptoms, suggesting the simple schizophrenia named by Bleuler. Evidence for the validity of these subtypes was provided by the differences observed between the clusters on a number of clinical characteristics and by the similarity of the cluster solution obtained from the different instruments. In conclusion, the negative-positive dichotomy in schizophrenia is an oversimplification, and the existence of a more complex structure needs to be taken into account in future research.

[A contribution of brain imaging techniques to the diagnosis of psychiatric emergencies]

This study was performed in the psychiatric emergency unit of René-Dubos General Hospital (Pontoise, France). Two cases of female patients with motor deficiencies suggesting a diagnosis of conversion disorder because of preceding psychological stressors and lability of symptoms, are presented. In both cases, the diagnosis was reconsidered after the use of RMI for multiple sclerosis in one case, HIV related encephalopathy in the other. Recent studies have shown that organic diseases with a psychiatric presentation represent 1,2 to 4% of patients examined in emergency setting. Criteria for the diagnosis of conversion disorders are discussed (they are classified as dissociative disorders in ICD-10 and as somatoform disorders in DMS-IV). A diagnosis of conversion disorder should not be made before a thorough clinical and neurological evaluation has been performed.

[French translation of the Chapman Social and Physical Anhedonia Questionnaire: validation of the French translation in controls and schizophrenic patients]

Whereas Chapman's social and physical scales are the most used instruments for the assessment of anhedonia in schizophrenia, no French translation has been still validated by the authors. Therefore, the aim of this study was first to translate into French the both scales, and after back translation, to obtain the agreement of the original authors. Second, the aim was to establish values and to establish the cut-off beyond of which French subjects could be considered as anhedonic. One hundred and twenty-three subjects were included: 72 control subjects without mental disorders and 51 stable schizophrenic patients defined by the DSM III-R, ICD 9, ICD 10, RDC or Feighner criteria. According to the literature, schizophrenic patients had higher scores for both scales than control subjects (p < 0.001; Student t test). The social anhedonia scores are different due to cultural variations. The distribution of physical anhedonia scores in control subjects or in schizophrenic patients differed from normal distributions (respectively, p < 0.05; p < 0.0001; Shapiro-Wilks test). The distribution of social anhedonia scores differed from normal distributions (p < 0.01) only in schizophrenic patients but not in control subjects. By maximising the Younden indice [Sensitivity + Specificity -1], the cut-off of the physical anhedonia score was 18 (Younden indice = 0.45), and the cut-off of the social anhedonia score was 12 (Younden indice = 0.24). In using this cut-off, the French physical anhedonia scale had a good positive predictive value (evaluated by logistic regression) for schizophrenia. Therefore, a patient with a physical anhedonia score beyond 18 have a probability of 64% to be schizophrenic. In contrast, the social anhedonia scale was less discriminant for schizophrenia. Indeed, patient with a social anhedonia score beyond 12 have a probability of 52% to be schizophrenic. This French version of Chapman's anhedonia scales could be considered as an useful instrument to assess anhedonia, in particular physical anhedonia, in schizophrenic patients.

[Depressive symptoms and negative symptoms during schizophrenia]

Taking into account the wellknown frequency of depressive and extrapyramidal symptoms in schizophrenia and the rare studies about their evolution, several questions can be raised: How do these different symptoms move? Are there specific characters of each of them? First, stability of negative symptoms evaluated by the Scale for the Assessment of Negative Symptoms (SANS) was studied among 57 schizophrenic patients at admission and at discharge. The course of negative symptoms was compared to that of depressive MADRS (Montgomery et Asberg Depression Rating Scale) and akinetic symptoms (Extrapyramidal Symptom Rating Scale). All the subscores of the SANS decreased significantly but 4 items belonging to the affective flattening subscale and one item belonging to the alogia subscale did not vary significantly, showing the necessity of taking into account the individual items of the SANS rather than the subscale scores to evaluate the course of negative symptoms. Changes in all the SANS subscores except the alogia and anhedonia subscores were associated with variations in scores of other scales. Correlations between the changes of negative symptoms and the changes of depressive symptoms showed the necessity to do more specific scales, for example, scales for depression in schizophrenia. Langlois-Théry et al. (1994) evaluated among 53 schizophrenic patients stabilized with neuroleptic treatment, depressive symptomatology with Echelle de Ralentissement Dépressif (ERD, Widlöcher, 1983) and MADRS, negative symptomatology (Positive and Negative Syndrome Scale) and akinesia (ESRS), to determinate whether ERD composed of 3 subscores (motor, ideic and subjective) could be able to evaluate the depressive symptomatology, independently of the measures of negative and akinetic symptomatology.(ABSTRACT TRUNCATED AT 250 WORDS)

[Polydiagnostic approach to schizophrenia. Validation of a computerized checklist (Diagnostic and Prognostic Scales)]

With a polydiagnostic approach of schizophrenia in mind, the authors present, in french language, a computer-diagnostic instrument, essential for any research at the present time. This includes a 183-item checklist constructed from 14 diagnostic systems for schizophrenia and from Chronic Hallucinatory Psychosis (CHP), a typically french diagnostic entity, not recognized by English-speaking countries which do not individualize it from schizophrenia. This study tested the reliability in interviewing the patients simultaneously by 2 examiners with the checklist. The interrater agreement was excellent (Kappa from 0.75 to 1) for schizophrenic diagnoses under the systems CATEGO, DSM III-R, Feighner, ICD9, Langfeldt, Pull, Schneider and Taylor-Abrams. It was good (Kappa from 0.40 to 0.75) for the 6 other schizophrenic systems, Bleuler (k = 0.52; p > 0.01), Carpenter with a cut-off at 6 (k = 0.52; p < 0.05), ICD10 (k = 0.70; p < 0.01), New-Haven (k = 0.58), RDC (k = 0.59; p < 0.01), Vienne (k = 0.68; p < 0.01), and the Chronic Hallucinatory Psychosis (Pull) (k = 0.71; p < 0.01). The validity of the computer program was tested by the concordance (Cohen's Kappa) between the diagnoses established by a medical examiner and by computer, both obtained from the same collected data (the checklist). The tests show that the concordances were excellent for the 15 diagnoses for schizophrenia and CHP (Kappa form 0.75 to 1) and always above those obtained by the tests of interreliability.

Potentiation by low doses of selected neuroleptics of food-induced conditioned place preference in rats

Numerous data support the hypothesis that dopamine (DA) plays a crucial role in reward-related processes and in incentive learning in animals and man. The possibility that various neuroleptics exhibiting a high affinity for the dopaminergic D2 (and D3) receptors could reinforce DA transmission was studied using the conditioned place preference paradigm (CPP) in rats. This was done by examining the ability of these compounds to potentiate the reinforcing properties of food in hungry rats subjected to a version of the CPP paradigm which consisted of repeated pairings of food with a single environmental cue, the floor texture of an open field. During the test session when food was no longer available in the open field, the increase in the time spent by drug-free rats on the food-paired texture was assumed to indicate the perceived rewarding value of the food. This time was significantly lengthened when the specific D2 (D3)-receptor antagonists sulpiride (4 mg/kg), amisulpride (0.5, 1 mg/kg) or pimozide (0.03, 0.06 mg/kg) were administered before the food conditioning sessions. Larger doses of these compounds as well as haloperidol, metoclopramide and the non-specific D1-D2 antagonist, chlorpromazine, regardless of the doses tested, did not exhibit this effect, but rather reduced the food-induced CPP, an action usually associated with neuroleptics. The positive effects of amisulpride was reversed by a D1 receptor antagonist, SCH 23390 (0.01 mg/kg). These results suggest that, as with amphetamine (0.5 mg/kg), some D2-specific neuroleptics enhance the incentive value of food in a narrow range of low doses, an effect proposed to reflect a "prohedonic" property.(ABSTRACT TRUNCATED AT 250 WORDS)