Andreasen Criteria Research Articles

Prevalence and risk factors related to traumatic dental injuries in Brazilian schoolchildren

The aim of this study was to investigate the risk factors associated with the occurrence of dental trauma in permanent anterior teeth of schoolchildren in Recife, Brazil. It included a random sample of 1046 boys and girls aged 12 attending both public and private schools. The sample size was calculated using a 95% confidence interval level; a statistical significance of 5% (alpha); a sample power of 80%; and an odds ratio of 1.55. The sample selection was carried out in two stages: first, schools were selected by simple sampling, and then children were chosen using a proportionality coefficient. Data were collected through clinical examinations and interviews, after examiner calibration. Dental trauma was classified according to Andreasen criteria. Overjet was considered a risk factor when it presented values higher than 5 mm. Lip coverage was classified as adequate or inadequate, while obesity was considered according to National Center for Health Statistics procedures for the assessment of nutritional status. Data were summarized and analyzed using the statistical software SPSS. The prevalence of dental injuries was 10.5%. Boys experienced more injuries than girls, 12.2% and 8.8%, respectively (P > 0.05). Children attending public schools presented more traumatic injuries than those from private schools, 11.4% and 9.5%, respectively, but there was no statistically significant difference (P > 0.05). There was a statistically significant difference between traumatic dental injuries and overjet (P < 0.05); between traumatic dental injuries and inadequate lip coverage (P = 0.000), and between obesity and dental trauma (P < 0.05). It was concluded that boys attending public schools and presenting an overjet size >5 mm, inadequate lip coverage, and obesity were more likely to have traumatic dental injuries in Recife, Brazil.

Risk factors related to traumatic dental injuries in Brazilian schoolchildren.

The aim of this pilot study was to analyse whether overjet, lip coverage and obesity represented risk factors associated with the occurrence of dental trauma in the permanent anterior teeth of schoolchildren in Recife, Brazil. It included a random sample of 116 boys and girls aged 12 years, attending both public and private schools. Data was collected through clinical examinations and interviews. Dental trauma was classified according to Andreasen's criteria (1994). Overjet was considered as risk factor when it presented values higher than 5 mm. Lip coverage was classified as adequate or inadequate, while obesity was considered according to National Center for Health Statistics (NCHS) procedures for the assessment of nutritional status. The prevalence of dental injuries was 23.3%. Boys experienced more injuries than girls, 30 and 16.1%, respectively (P >0.05). There was a statistically significant difference between traumatic dental injuries and overjet (P <0.05) and between traumatic dental injuries and lip coverage (P=0.000). No statistical significant differences were found when obesity and dental trauma were analysed (P <0.05). It was concluded that boys from lower social strata attending public schools, presenting an overjet size greater than 5 mm and an inadequate lip coverage, were more likely to have traumatic dental injuries in Recife, Brazil. Obesity was not a risk factor for dental trauma in this sample.

Treatment of Negative Symptoms in Schizophrenia with Amisulpride

The efficacy of low doses of certain neuroleptics in improving negative symptoms is still controversial. This study assessed the efficacy of amisulpride, a benzamide which increases dopaminergic transmission at low doses via presynaptic dopamine receptor blockade, on negative symptoms of schizophrenia. The study was designed as a parallel-group, double-blind, placebo-controlled trial. Patients had to fulfil DSM-III criteria for schizophrenia, Andreasen's criteria for negative schizophrenia, and to have a total score of at least 75 on the SANS; those treated with neuroleptics or antidepressants underwent a six-week placebo wash-out. One hundred and four in-patients were randomly assigned to amisulpride 100 mg/d, amisulpride 300 mg/d, or placebo for six weeks; 85 patients completed the study. Both amisulpride doses were significantly more effective than placebo on the primary evaluation criterion (SANS total score, MANOVA P < 0.02). No significant changes were found in positive symptoms or in extrapyramidal symptoms. Negative symptoms can be improved by low doses of amisulpride, favouring the hypothesis of dopaminergic hypofunction as one of the causes of negative symptoms.

Validity of the negative/positive dichotomy for schizophrenic disorders under long-term conditions

A total of 148 patients fulfilling the DSM-III symptomatological criteria of schizophrenia were classified according to Andreasen's criteria of positive, negative and mixed symptomatology. After excluding cases of permanent hospitalization and patients with monoepisodic course the remaining 100 patients had a total of 458 episodes. Of these episodes, 213 were identified as positive, 134 as negative and 111 as mixed. During the course of illness the proportion of negative episodes increased and the proportion of positive episodes decreased. The great majority of the patients (76%) had a bimorphous course, i.e. one showing both types of schizophrenic symptomatology, positive and negative. Only 6% of the patients had only negative episodes, and only 18% had only positive episodes. The shift from one type of episode to another is dependent on the length of illness. Stability was not greater later during the course of illness than at the beginning.

Lack of relationship of auditory gating defects to negative symptoms in schizophrenia

The differences between schizophrenic patients with positive and negative symptoms have been the subject of extensive investigations. Psychophysiologists have proposed that there are elementary auditory sensory processing deficits in schizophrenia, but their prevalence in particular positive or negative subtypes has not been described. Our previous studies have shown that schizophrenics have impaired auditory sensory gating relative to normal controls, as demonstrated by the P50 auditory evoked potential conditioning-testing paradigm. In this paradigm, schizophrenics fail to show the normally expected diminished response to the second or ‘test’ stimulus. In the present study we assessed the possible relationship of this defect to negative symptoms in 20 schizophrenic patients treated with neuroleptics. Nine patients met the Andreasen criteria for predominantly ‘negative schizophrenia’. 12 normal controls with no family history of schizophrenia were also studied electrophysiologically. Negative schizophrenics showed greater impairment than patients without such symptoms on the Trails B test of organic impairment, but there were no differences between groups on electrophysiological measurements of auditory sensory gating. Both schizophrenic groups showed impaired P50 auditory gating compared to normal controls. Both groups of schizophrenics also had a significantly diminished amplitude of the N100 waveform in the conditioning response, compared to normal controls. Auditory sensory processing defects in schizophrenia appear to be independent of negative symptoms.

Dexamethasone suppression test in positive and negative schizophrenia

Fifty-four inpatients with a DSM-III diagnosis of schizophrenia were studied. Patients were divided into positive and negative subtypes of schizophrenia according to Andreasen's criteria. Blood samples were obtained from all patients for 2 consecutive days to determine plasma cortisol concentrations before and after a single administration (1 mg, p.o.) of dexamethasone at 11 p.m. The results revealed a significant increase in plasma cortisol levels in schizophrenic patients, with 40% of the patients being nonsuppressors on the dexamethasone suppression test. A higher percentage (62.5%) of patients with the negative form of schizophrenia were nonsuppressors.

Determinants for clinical activity of neuroleptic drugs: chemical substances, doses, assessment tools

SummaryAs emphasized by Lecrubier in 1980, the major finding of the last thirty years of classical neuroleptic use in schizophrenia is not that they are antischizophrenic or antipsychotic agents, but that they act on positive symptoms whatever the cause. There is now a widely accepted attribution of this kind of therapeutic property to the post-synaptic dopaminergic blockade induced by most of the neuroleptics when administered at high doses. On the other hand, during the last decade, various authors have reported clear evidence for a disinhibitory action of some neuroleptics when used at low doses. From a clinical point of view, the literature on the therapeutic action of low doses of neuroleptics seems quite controversial. In order to assess the exact determinants for clinical activity of neuroleptics (such as patient type, selected substances, administered doses) two series of independent controlled studies were conducted.First series of studies: active drugs at low and high doses in schizophrenic patients(Tables 1 to 6)The first study was designed to assess the change of negative symptoms under low doses of neuroleptics. Sixty-two patients meeting the DSM III criteria of schizophrenia (subtypes: disorganized, catatonic or residual) were randomly assigned after a three-week washout period to six weeks’ treatment with either amisulpride (50 to 300 mg/day) or fluphenazine (2 to 12 mg/day), administered in keeping with a flexible dosage schedule. All patients had to meet the Andreasen criteria for negative symptoms (at least two of the following components had to be checked as present: anhedonia, alogia, affective flattening, avolition-apathy, attentional impairment). None of the patients presented one of the positive components to a marked degree: hallucinations, delusions, bizarre behavior, positive formal thought disorders. The evolution of symptomatology was assessed by means of the Brief Psychiatric Rating Scale (B.P.R.S.) and an ad hoc defective symptoms scale (D.S.A.S.), the sensitivity and reliability of which was previously tested in our department. The results show that the two groups (amisulpride versus fluphenazine) were initially highly comparable. Negative symptoms were severe, as evidenced by the D.S.A.S. scores, and by the presence of three items of the A6 criterion of the DSM III. The final global clinical assessment and the final D.S.A.S. scores both showed a significant improvement, with no statistically significant difference between the two treatments. Nevertheless, the scores of the “anergia” and “anxiety-depression” factors of the B.P.R.S. showed a significantly greater improvement in the amisulpride group.The second study, complementary to the first, aimed to check the efficacy of high doses of amisulpride on the productive symptoms of schizophrenia. In this case, only the B.P.R.S. was used due to the good correlation of this scale with the global severity of the positive symptomatology. After three weeks of treatment, consisting either of amisulpride at a high, flexible dosage (800 to 1200 mg/day) or of haloperidol (20 to 30 mg/day), each of the two groups of twenty patients showed a significant improvement. In particular, the “thought disorders” factor of the B.P.R.S. (which unfortunately does not correspond exactly to the “formal thought disorder” component of the Andreasen positive symptoms scale - S.A.P.S.) was greatly improved in both groups. Evolution of the other symptoms was however identical in the two groups.Second series of studies: active drugs versus placebo in schizophrenia(Figures 1 to 6)As we know, dopaminergic blocking agents are able to induce negative symptomatology. Consequently, to separate the secondary syndrome from the true deficit, a longer washout period than that previously described has to be imposed. On the other hand, the longitudinal course of schizophrenia must be taken into account for correct interpretation of changes in symptomatology; for example, patients with negative symptoms may abruptly present productive episodes, in particular during the neuroleptic withdrawal period. For optimal control of these two variables (natural history of the disease, the blunting effect of neuroleptics), 90 patients presenting either or both subtypes of schizophrenia were selected and included in a two-step, double-blind, controlled study. Patients with negative symptoms underwent a six-week washout period, after which they were treated either with low doses of amisulpride (100 or 300 mg/day) or a placebo. Patients with initial positive symptoms received mandatory high doses of amisulpride. According to the protocol, negative patients presenting productive symptoms during the washout period were to be systematically assigned to the highdose group. First results concerning 38 patients with a predominant negative symptomatology are presented here. A very clear improvement can be shown both for the SANS global mean score and for the sum of global ratings in the groups treated with low doses of amisulpride compared to the placebo group. The scores of the alogia, blunted affect and attentional impairment subscales decrease dramatically as well with the active drug.