Brief Psychiatric Rating Scale-Expanded Research Articles

Psychometric properties of the Clinical Assessment Interview for Negative Symptoms (CAINS) in patients with depression and its relationship to affective symptoms

BackgroundThere is a conceptual overlap between negative and depressive symptoms, requiring further exploration to advance the understanding of negative symptoms. The aim of this study was to examine psychometric properties of the Clinical Assessment Interview for Negative Symptoms (CAINS) in patients with depression, and to explore the relationship between the negative and affective symptoms domains.MethodsFifty-one patients with a depressive episode were included and interviewed with the CAINS and the Brief Psychiatric Rating Scale—Expanded (BPRS-E). Self-reported depressive symptoms were collected with the Montgomery-Asberg Depression Rating Scale (MADRS-S). Inter-rater agreement, internal consistency and validity measures were examined, as were correlations between negative and affective symptoms.ResultsThe intraclass correlation for the CAINS motivation and pleasure subscale (CAINS-MAP) was 0.98 (95% CI 0.96–0.99) and that for the expressional subscale (CAINS-EXP) was 0.81 (95% CI 0.67–0.89). Cronbach’s alpha was 0.71 (95% CI 0.57–0.82) for the CAINS-MAP and 0.86 (95% CI 0.79–0.92) for the CAINS-EXP. The correlation with the negative symptoms subscale of the BPRS-E was 0.35 (p = 0.011, blinded/different raters) or 0.55 (p < 0.001, not blinded/same rater). The CAINS-MAP correlated with the affective symptoms subscale of the BPRS-E (r = 0.39, p = 0.005) and the MADRS-S total score (r = 0.50, p < 0.001), but not with anxiety symptoms.ConclusionsNegative symptoms in depression can be assessed with the CAINS with good inter-rater agreement and acceptable internal consistency and validity. There are associations between negative and depressive symptoms that call for further exploration.

Minor physical anomalies may be related to treatment resistance in patients with schizophrenia

This study investigates the relationship between minor physical anomalies (MPA) and treatment resistance in schizophrenia (TRS). We evaluated 137 patients and 100 healthy controls by using a modified Waldrup MPA scale. Thirteen MPA items were found more frequently in the schizophrenia group than in the controls. The total MPA score was higher in TRS, and MPAs in the eye and mouth regions were more frequent in TRS (n = 57) than in non-TRS. Total MPA score was correlated to Brief Psychiatric Rating Scale-Expanded (BPRS-E) total and BPRS-positive scores in TRS. Our findings suggest that MPA might contribute to treatment resistance in schizophrenia.

The role of social acuity assessment in differentiating primary psychoses from drug-induced psychoses

IntroductionThe dual diagnosis among patients with primary psychotic disorders is frequent and causes diagnostic and treatment challenges. In clinical practice, differentiating between substance-induced psychoses and independent (primary) psychoses when the patient is actively using drugs of addiction, is difficult, especially in the acute phase of the psychosis.ObjectivesThe aim of the study is to identify clinical data relevant for differentiating between primary psychoses triggered by addictive drug misuse and substance-induced psychoses, using psychometric scales.MethodsThe study was conducted on 111 patients divided in four samples: 28 dual diagnosis psychotic patients (DD), 27 bipolar patients (BD), 25 schizoaffective patients (SCA) and 31 patients with schizophrenia (SCZ). The subjects were assessed using scales for the severity of psychiatric symptoms, cognitive functions and social acuity (theory of mind): BPRS-E (Brief Psychiatric Rating Scale – Expanded), MoCA (Montreal Cognitive Assessment), CBS (Cambridge Behavioral Scale), and RMET (Reading the Mind in the Eyes Test). The tests were performed when patients were in the remission phase of the psychosis.ResultsBPRS-E scores showed significant differences between DD subjects and patients from the other three samples (primary psychoses). CBS revealed significant differences between the DD subjects and patients with schizophrenia spectrum psychoses (SCA and SCZ). RMET identified significant differences between DD and BD patients.ConclusionsAlthough differentiating between substance-induced and primary psychoses remains a difficult task, social acuity assessment performed in remitted patients may be helpful in guiding the clinician to establish a more accurate diagnosis.

Social and Neurocognitive Deficits in Remitted Patients with Schizophrenia, Schizoaffective and Bipolar Disorder.

This study assesses the empathy level, cognitive performance and emotion recognition skills of remitted patients with schizophrenia, schizoaffective disorder and bipolar disorder, and also explores the relationship between impairments in the mentioned domains. The study was performed on 77 subjects divided into two groups: PAT sample (N = 37) included remitted patients with either schizophrenia, schizoaffective or bipolar disorder who were compared with healthy control subjects from the HC sample (N = 40). Along with sociodemographic and clinical data, empathy levels (using EQ (Empathy Quotient) scale), the ability to recognize another person’s emotional state (using RMET (Reading the Mind in the Eyes Test)), and cognitive performance (using MoCA (Montreal Cognitive Assessment) Scale) were investigated. The intensity of the psychiatric symptoms was measured with BPRS-E (Brief Psychiatric Rating Scale—Expanded). The remitted patients had lower EQ (p = 0.02) and RMET (p < 0.0001) scores than the healthy subjects. In the PAT group, RMET scores were positively correlated with MoCA total scores. Both EQ and RMET scores were negatively correlated with BPRS-E total scores. Psychiatric disorder was a significant predictor for deficits in emotion recognition. There were no significant differences in RMET, EQ and MoCA scores between patients with respect to diagnosis, the type of antipsychotic or the associated medication. In both samples, females had higher empathy levels (p = 0.04) and better emotion recognition abilities (p = 0.04) than males. Patients with schizophrenia, schizoaffective or bipolar disorder, currently in remission, displayed lower empathy levels and poorer emotion recognition skills than healthy subjects. Poor emotion recognition skills were associated with symptom severity and impairments in global cognition.

Involuntary psychiatric hospitalization among migrants in Italy: A matched sample study.

Immigrants in Europe appear to be at higher risk of psychiatric coercive interventions. Involuntary psychiatric hospitalization poses significant ethical and clinical challenges. Nonetheless, reasons for migration and other risk factors for involuntary treatment were rarely addressed in previous studies. The aims of this study are to clarify whether immigrant patients with acute mental disorders are at higher risk to be involuntarily admitted to hospital and to explore clinical and migratory factors associated with involuntary treatment. In this cross-sectional matched sample study, we compared the rates of involuntary treatment in a sample of first-generation immigrants admitted in a Psychiatric Intensive Care Unit of a large metropolitan academic hospital to their age-, gender-, and psychiatric diagnosis-matched native counterparts. Clinical, sociodemographic, and migratory variables were collected. The Brief Psychiatric Rating Scale-expanded (BPRS-E) and the Clinical Global Impression-Severity (CGI-S) scale were administered. McNemar test was used for paired categorical variables and a binary logistic regression analysis was performed. A total of 234 patients were included in the analysis. Involuntary treatment rates were significantly higher in immigrants as compared to their matched natives (32% vs. 24% respectively; p < .001). Among immigrants, involuntary hospitalization was found to be more frequent in those patients whose length of stay in Italy was less than 2 years (OR = 4.2, 95% CI [1.4-12.7]). Recently arrived immigrants appear to be at higher risk of involuntary admission. Since coercive interventions can be traumatic and negatively affect outcomes, strategies to prevent this phenomenon are needed.

Characteristics of Early Maladaptive Schemas in Individuals with Schizophrenia: A Comparative Study Relative to Major Depressive Disorder

Objectives This study aimed to investigate the characteristics of early maladaptive schemas and their associations with clinical symptoms in patients with schizophrenia. Methods Forty-eight patients with schizophrenia, 49 patients with major depressive disorder, and 50 healthy controls completed the Young Schema Questionnaire and symptom measures including the Brief Psychiatric Rating Scale-Expanded (BPRS-E). Results The schizophrenia group had significantly higher scores than the healthy controls and lower scores than the depression group in most schemas. Compared with healthy controls, the schizophrenia group exhibited higher scores in 10 schemas, i.e., mistrust, social isolation, failure, dependence, vulnerability to harm, enmeshment, insufficient self-control, subjugation, emotional inhibition, and negativity schemas (all p<0.001). Moreover, vulnerability to harm, enmeshment, subjugation, and negativity schemas were correlated with total scores of the BPRS-E (0.37≤r≤0.43, all p<0.05). Regarding the five BPRS domains, emotional deprivation schema showed significant relationships with negative (r=0.50, p=0.005) and disorganization (r=0.39, p=0.033) symptoms, while no schemas showed correlations with positive symptoms. Conclusion These results suggest that most schemas in patients with schizophrenia pertain to impaired autonomy and performance as well as disconnection and rejection domains and may improve our understanding and the treatment of schizophrenia from a perspective of schema therapy focused on these domains. Key Words: Early maladaptive schemas · Major depressive disorder · Schema therapy · Schizophrenia 중심 단어: 스키마 치료 · 조현병 · 주요 ìš°ìš¸ìž¥ì• Â· 초기 ë¶€ì ì‘ì  스키마

Validation of the Clinical Global Impression-Corrections Scale (CGI-C) by Equipercentile Linking to the BPRS-E.

Background: The Clinical Global Impression—Corrections (CGI-C) is an adaptation of the severity scale of the Clinical Global Impression for use in correctional facilities. Although it has been shown to have good inter-rater reliability, there have been no validation studies of this instrument.Method: We analyzed data from 726 initial assessments of persons detained in two correctional facilities and compared clinician's ratings for the CGI-C and modified Brief Psychiatric Rating Scale-Expanded (BPRS-E). We used equipercentile linkage and Spearman correlations to investigate concordance in the total sample, by diagnostic groups, and by gender.Results: We found that the CGI-C scores and BPRS-E scores among persons in remand settings were significantly correlated (ρ = 0.51, p < 0.001) and that correlations were the same for men and women. We found that points of equivalence can be reliably found between the two scales using equipercentile linkage, and that those with psychotic disorders had lower BPRS-E scores than those with mood/anxiety/situational stress for equivalent CGI-C scores.Conclusion: Overall, CGI-C ratings correspond well to BPRS-E ratings for both men and women remand prisoners across diagnoses, and the CGI-C appears to be a valid tool for the assessment of severity of symptoms in this setting.

Development and Validation of a Dynamic Risk Prediction Model to Forecast Psychosis Onset in Patients at Clinical High Risk

The prediction of outcomes in patients at Clinical High Risk for Psychosis (CHR-P) almost exclusively relies on static data obtained at a single snapshot in time (ie, baseline data). Although the CHR-P symptoms are intrinsically evolving over time, available prediction models cannot be dynamically updated to reflect these changes. Hence, the aim of this study was to develop and internally validate a dynamic risk prediction model (joint model) and to implement this model in a user-friendly online risk calculator. Furthermore, we aimed to explore the prognostic performance of extended dynamic risk prediction models and to compare static with dynamic prediction. One hundred ninety-six CHR-P patients were recruited as part of the "Basel Früherkennung von Psychosen" (FePsy) study. Psychopathology and transition to psychosis was assessed at regular intervals for up to 5 years using the Brief Psychiatric Rating Scale-Expanded (BPRS-E). Various specifications of joint models were compared with regard to their cross-validated prognostic performance. We developed and internally validated a joint model that predicts psychosis onset from BPRS-E disorganization and years of education at baseline and BPRS-E positive symptoms during the follow-up with good prognostic performance. The model was implemented as online risk calculator (http://www.fepsy.ch/DPRP/). The use of extended joint models slightly increased the prognostic accuracy compared to basic joint models, and dynamic models showed a higher prognostic accuracy than static models. Our results confirm that extended joint modeling could improve the prediction of psychosis in CHR-P patients. We implemented the first online risk calculator that can dynamically update psychosis risk prediction.

Men and women with borderline personality disorder resident in Dutch special psychiatric units in prisons: A descriptive and comparative study.

The overall prevalence of borderline personality disorder is well known, but characteristics of offender patients with the condition are less clear, especially among men. Describe characteristics of men and women with borderline personality disorder in special psychiatric units in Dutch prisons on three domains: prevalence of child abuse, comorbidity of borderline personality disorder with other disorders, and clinical symptoms. One hundred and sixty-seven people were assigned to this study based on a Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) diagnoses retrieved from records. Other DSM-5 diagnoses were also recorded. Two scales, the Dutch Historisch, Klinisch, Toekomst-Revisie and the international Brief Psychiatric Rating Scale-Expanded (BPRS-E) were used to record child abuse and clinical symptoms, respectively. Prevalence rates of child abuse were high, but the men and women did not differ in this respect. The male offender patients were more likely than the women to have a comorbid substance use disorder, whereas the women were more likely to have a comorbid anxiety disorder. Intellectual disability was the most common comorbid Axis II disorder. The women were more likely than the men to have committed a fatal/nearly fatal index offence and showed higher rates of distress or behavioural disturbance on all five BPRS-E factors. This study provides evidence of the importance of in-depth knowledge of presentations with borderline personality disorder specific to setting. Although we were unable to make direct comparisons with other samples, our figures suggest clinically relevant differences among offender patients from the more widely reported general samples. We also shed light on a sometimes underexposed group of men with borderline personality disorder and their clinical needs. More population-specific intervention and follow-up studies are now indicated.

Symptom Profile of Psychiatric Patients With Psychosis or Psychotic Mood Disorder in Prison.

There is evidence that psychiatric patients with psychotic or manic disorders who are incarcerated suffer from the same symptoms as psychiatric patients who are treated in the community. There are also indications that their symptoms might be more severe. The aim of this study was to examine the severity of psychotic and manic symptoms, as well as to collect information about the emotional functioning of patients admitted to a prison psychiatric ward. Incarcerated patients with a diagnosis of psychotic or a manic disorder were examined with the Brief Psychiatric Rating Scale-Expanded (BPRS-E). With the scores of 140 assessments, a symptom profile was created using the domains of the BPRS-E. This profile was compared with the clinical profile of three nonincarcerated patient groups described in literature with a diagnosis in the same spectrum. We found high scores on positive and manic psychotic symptoms and hostility, and low scores on guilt, depression, and negative symptoms. High scores on manic and psychotic symptoms are often accompanied by violent behavior. Low scores on guilt, depression, and negative symptoms could be indicative of externalizing coping skills. These characteristics could complicate treatment in the community and warrant further research along with clinical consideration.

The role of executive functions and psychiatric symptom severity in the Allen Cognitive Levels

This study examined the relationship between Allen Cognitive Level (ACL) and psychiatric symptom severity, level of nursing support required to complete activities of daily living (ADLs), and post-hospitalization discharge disposition in a sample of 193 acute psychiatric inpatients. A subsample of 31 participants with acute psychotic disorders were administered three measures of executive functioning in order to examine the convergent validity between ACL and basic sequencing and shifting, phonemic fluency, and visuospatial construction. Findings indicated significant moderate positive correlations between ACL and motor processing speed, basic sequencing and shifting, and phonemic fluency, and a nonsignificant relationship with visuospatial construction. A subsample of 166 participants were administered the Brief Psychiatric Rating Scale-Expanded (BPRS-E) to assess psychiatric symptom severity. Results indicated a significant weak negative correlation between ACL and total psychiatric symptomatology, as well as significant weak negative correlations with specific symptoms. In contrast with prior research, there was no significant correlation between ACL and level of nursing assistance required to complete ADLs. A logistic regression did not identify ACL as a contributing factor to post-hospitalization discharge disposition. These findings call into question the clinical utility of the ACLS-5 as an assessment of functional cognition for those experiencing acute psychiatric illness.

Factor structure of the Brief Psychiatric Rating Scale – Expanded (BPRS-E) in a large hospitalized sample

Meta-analytically derived models of the BPRS-E factor structure were tested on a large (n = 33,903) hospitalized sample using confirmatory factor analysis. A modified four factor model (Positive symptoms, Negative symptoms, Affect, and Activation) containing 12 core BPRS-E symptoms based on the meta-analytic models had excellent model fit. An additional five factor, 15 core symptom model, which added a Disorganization factor consistent with the pentagonal model of schizophrenic symptoms also had support with generally good fit. These factors demonstrated acceptable reliability as measured by coefficient alpha (M = 0.77). These factors were compared across three major diagnostic classes and indicated clinically relevant differences between these groups such as depressed patients having higher Affect scores (d = 1.03), manic-mixed episode patients having higher Activation scores (d = 0.83) and schizophrenic patients having higher Positive Symptom scores (d = 0.89) providing evidence for the validity of these factors. Further exploratory factor analyses provided support for the factors of Positive symptoms, Negative symptoms, Affect, and Activation with additional smaller and less robust factors corresponding to Resistance emerging as a fifth factor and Disorganization emerging as a sixth factor.

Negative symptom subgroups have different effects on the clinical course of schizophrenia after the first episode: A 24-month follow up study

ObjectiveThe aim of this study was to assess the factor structure of negative symptoms in first-episode schizophrenia (FES), and to examine the relationship of these factors with clinical course and functioning of patients during the two-year follow up. MethodWe assessed 174 drug-naïve patients with FES using Brief Psychiatric Rating Scale-Expanded (BPRS), Scale for the Assessment of Negative Symptoms (SANS), Scale for the Assessment of Positive Symptoms (SAPS), and Global Assessment of Functioning (GAF) and a cognitive battery at admission. The scales were repeated monthly during follow up. We recorded the patients’ functioning levels, remission, and work status after 12 and 24 months. ResultsA two-factor structure was found at the baseline, whereas one factor was found after 12 and 24 months. Expressive deficit (ED) factor consisted of alogia and blunted affect, and motivation-pleasure deficit (MPD) factor consisted of avolition and anhedonia. ED factor was related to earlier onset and remission, and it was negatively correlated with duration of education and cognitive test scores. MPD factor was related to duration of untreated psychosis, family history of schizophrenia, and work status, and it appeared as the only independent variable that contributed to the baseline GAF score in linear regression analysis. ConclusionOur findings suggest that the factors have different aetiologies and impacts on the clinical course of schizophrenia and functioning after FES.

Neuropsychological functioning in inpatients with major depression or schizophrenia.

BackgroundStudies that compare neuropsychological functioning in inpatients with mood disorder or schizophrenia come to heterogeneous results. This study aims at investigating the question whether there are different neuropsychological test profiles in stabilised post-acute inpatients with affective disorders or schizophrenia.MethodWe were interested in evaluating impairment in specific areas of cognitive functioning in patients with schizophrenia or depression. In clinical reality, patients with depression and schizophrenia are often treated together with little attention to their specific needs. 74 patients with major depression and 38 patients with schizophrenia were assessed in a comprehensive neuropsychological battery. All patients were in a post-acute stage of their illness, i.e. remission of acute symptoms.ResultsIn spite of a comparable mean score of psychopathological symptoms in the Brief Psychiatric Rating Scale-Expanded (BPRS-E) as well as in the Global Assessment Functioning Scale (GAF), patients with depressive disorder showed significantly better results in verbal and visual short-term memory, verbal fluency, visual-motor coordination, information processing in visual-verbal functioning and selective attention compared to patients with schizophrenia. No significant differences between both samples were found in practical reasoning, general verbal abstraction, spatial-figural functioning, speed of cognitive processing.ConclusionsThese results show that there are differences in scores in psychopathology (BPRS-E, GAF) in patients with affective disorders or schizophrenia and different neuropsychological test profiles in the post-acute stage of their illness.

Remission after first-episode schizophrenia: Results of a long-term follow-up

The aim of this study was to identify the rate and predictors of remission after first episode of schizophrenia (FES). Ninety-three FES patients were followed for at least 12 months and up to 12 years (mean = 58.4 months) including monthly assessments with the Brief Psychiatric Rating Scale-Expanded (BPRS), the Scale for the Assessment of Positive Symptoms (SAPS), and Scale for the Assessment of Negative Symptoms (SANS). We also administered the Premorbid Adjustment Scale (PAS). We used the remission criteria recently defined by Andreasen et al. (2005). Fifty-six (59.5%) patients met the remission criteria in the first 24 months of the follow-up period, but 40 (71.5%) of these patients could not maintain their status. However, 23 (57%) of these patients later met the remission criteria again. The remission group patients achieved a higher rate of employment both in the first year and overall. In the logistic regression analysis, lower negative and higher positive symptoms at admission, lower positive symptoms at month 3 of the follow-up, medication compliance in the first 6 months, and occupational status during the last month before admission were found related to remission status. Our findings suggest that the remission group has advantages in terms of occupational status and symptom severity compared with their counterparts who did not achieve or maintain a state of remission.

P.3.120 A reduction in hospital bed usage associated with risperidone long acting injection

The aim of this study was to assess the factor structure of negative symptoms in first-episode schizophrenia (FES), and to examine the relationship of these factors with clinical course and functioning of patients during the two-year follow up.We assessed 174 drug-naïve patients with FES using Brief Psychiatric Rating Scale-Expanded (BPRS), Scale for the Assessment of Negative Symptoms (SANS), Scale for the Assessment of Positive Symptoms (SAPS), and Global Assessment of Functioning (GAF) and a cognitive battery at admission. The scales were repeated monthly during follow up. We recorded the patients’ functioning levels, remission, and work status after 12 and 24 months.A two-factor structure was found at the baseline, whereas one factor was found after 12 and 24 months. Expressive deficit (ED) factor consisted of alogia and blunted affect, and motivation-pleasure deficit (MPD) factor consisted of avolition and anhedonia. ED factor was related to earlier onset and remission, and it was negatively correlated with duration of education and cognitive test scores. MPD factor was related to duration of untreated psychosis, family history of schizophrenia, and work status, and it appeared as the only independent variable that contributed to the baseline GAF score in linear regression analysis.Our findings suggest that the factors have different aetiologies and impacts on the clinical course of schizophrenia and functioning after FES.

Women Inmates' Mental Health Needs: Evidence of the Validity of the Jail Screening Assessment Tool (JSAT)

In British Columbia, Canada, the challenge of caring for mentally disordered inmates in jails has been met with a two-tiered assessment approach: screening followed by comprehensive assessments. Intake interviewers evaluate mental disorder and risk for violence, suicide, self-harm, and victimization. The screening and risk management procedures were published in the Jail Screening Assessment Tool (JSAT). The results of two prospective studies of mental health screening with the JSAT in two samples of women inmates are presented. The first study reports the prevalence of mental health needs among female inmates based on results from JSAT and the Brief Psychiatric Rating Scale-Expanded (BPRS-E). The second study tested the validity of referrals to the mental health program based on ~20 min. semi-structured intake interviews using the JSAT (includes the BPRS-E) compared to independent evaluations of mental disorder with the Structured Clinical Interview for DSM-IV Non-Patient Edition (SCID-I/NP). Results of both studies indicated a high rate of substance abuse and other serious mental illnesses among female inmates. In the second study, intake interviewers using the JSAT were in agreement with independent SCID assessments at a rate significantly better than chance; yielding a sensitivity of 70.6% and a specificity of 75.0%. These preliminary results suggest the JSAT is a potentially effective tool for identifying female inmates in need of mental health services and specialized placement.

A dimensional and categorical approach to the symptomatology of recent-onset schizophrenia.

Sixty-five patients with recent-onset schizophrenia were assessed with two widely used symptom scales, the Brief Psychiatric Rating Scale-Expanded (BPRS-E) and the Psychiatric Assessment Scale (Manchester scale). Principal components analysis of the BPRS-E scores yielded a four-dimensional structure: positive symptoms, negative symptoms, disorganization, and depression. With the Psychiatric Assessment Scale, three dimensions were found: the positive symptoms (delusions, hallucinations) and disorganization (incoherence) appeared in one dimension. A categorical analysis resulted in predominantly positive, negative, and disorganized clusters, but more than half of the sample could not be allocated to any of these groups.