Calgary Depression Rating Scale Research Articles

Sex Differences Between Female and Male Individuals in Antipsychotic Efficacy and Adverse Effects in the Treatment of Schizophrenia.

Antipsychotics are core treatments for people living with psychotic disorders. Understanding individualised factors that influence both efficacy and adverse responses will improve outcomes. The objective of this study was to examine sex differences in antipsychotic-related efficacy and tolerability. This was a secondary analysis of data from phase 1 and 1a of Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE); participants with schizophrenia were randomly assigned to double-blinded treatment with oral olanzapine, quetiapine, risperidone, ziprasidone or perphenazine. Measures included Positive and Negative Syndrome Scale (PANSS), Clinical Global Impressions (CGI) scale and Calgary Depression Rating Scale, as well as self-reported side effects, medication compliance, dosage, weight measurements and various blood parameters. There were 1460 participants including 380 female and 1080 male individuals. Very few differences existed between male and female participants in response, adverse reactions, compliance or antipsychotic dosage. However, significantly more female participants than male participants reported constipation (28% vs 16%), dry mouth (50% vs 38%), gynecomastia/galactorrhea (11% vs 3%), incontinence/nocturia (16% vs 8%) and self reportedweight gain (37% vs 24%) [all p < 0.001]. Within the risperidone treatment group, there was a significantly greater increase in prolactin levels (p < 0.001) among female participants (n = 61) than male participants (n = 159). No overall differences in clinician-rated measures, weight gain or otherlaboratory indicators were found. While overall sex differences were limited across efficacy and tolerability for antipsychotic treatment, there were some specific findings with risperidone. Further examination of sex differences within antipsychotic trials will be important to improve efficacy and reduce adverse responses across as well as individualising care for people with schizophrenia.

Psychological/Personal recovery and its correlates in patients with first episode psychosis.

Recovery in psychosis is a multidimensional construct. The numbers of studies specially focusing on the recovery aspects in patients with first episode psychosis (FEP) are limited, with no study from India. Further, no study has looked specifically into the variables that affect recovery process in patients with FEP and little is known about factors which influence recovery in patients with FEP. To evaluate psychological recovery and its correlates in patients with FEP, currently in clinical remission. One hundred three patients of FEP in clinical remission were assessed on Recovery Assessment Scale (RAS), Positive and Negative Syndrome Scale for Schizophrenia, Calgary Depression Rating Scale for Schizophrenia, Negative Symptom Assessment 16, Rosenberg Self-esteem Scale, Social and Occupational Functioning Assessment Scale, the Alcohol, Smoking and Substance Involvement Screening Test, Beck Cognitive Insight Scale, Internalized Stigma of Mental Illness Scale, the Everyday discrimination Scale, Subjective Scale to Investigate Cognition in Schizophrenia and social cognitive deficits in theory of mind was evaluated on the Social Cognition Rating Tools in Indian Setting-Theory of Mind. The needs of the participants were assessed on the Camberwell Assessment of Needs - Research version and Supplemental Assessment of Needs. Coping, social support, medication adherence were also assessed by standardized scales. The mean weighted score was highest for goal and success orientation subscale followed by seeking and relying on social support, personal confidence and hope, overcome the illness and awareness and control over the illness as assessed by 41 items of the RAS. The main factors identified to affect psychological recovery in patients with FEP were duration of untreated psychosis, greater psychopathology, lower self-esteem, total unmet need, feeling of discrimination and stigmatization. The present study suggests that treatment of FEP should be started at the earliest and issues such as residual psychopathology, lower self-esteem, total unmet need, feeling of discrimination and stigma during the remission phase should be addressed by psychosocial interventions to promote psychological recovery in patients with first episode psychosis.

Clinical insight and cognitive functioning as mediators in the relationships between symptoms of psychosis, depression, and suicide ideation in first-episode psychosis

First-episode psychosis (FEP) is a particularly high-risk period for suicide. Literature suggests poor cognitive functioning may serve as a protective factor, while investigations of clinical insight reveal a complex relationship with suicide outcomes. This study examined the mediating role of cognition and clinical insight in the relationships between positive and negative symptoms, depression, and subsequent suicide ideation among individuals in FEP. Data were obtained from the Recovery After an Initial Schizophrenia Episode project. Participants (n = 404) included adolescents and adults in FEP between the ages of 15 and 40. Measurement utilized the Calgary Depression Rating Scale, Positive and Negative Syndrome Scale, and Brief Assessment of Cognition in Schizophrenia. Structural equation modeling was used to examine the mediation model. The likelihood of experiencing suicide ideation was significantly decreased when working memory was stronger (b = −0.034, SE = 0.02, OR = 0.967, p < .05), and significantly increased when clinical insight was stronger (b = 0.191, SE = 0.08, OR = 1.21, p < .01), positive symptoms were greater (b = 0.422, SE = 0.20, OR = 1.52, p < .05) and depressive symptoms were greater (b = 0.545, SE = 0.15, OR = 1.70, p < .001). Clinical insight and working memory functioned as mediators in the relationships between depression, positive symptoms, negative symptoms, and suicide ideation. Findings suggest it is essential that clinicians have awareness of insight being a risk factor for suicide ideation and balance therapeutic efforts to strengthen clinical insight and cognition in psychosocial treatments with suicide risk assessment and prevention methods.

Course of insight, depression and suicidality in inpatients with first-episode schizophrenia who received group psychoeducation.

We aimed to investigate whether gaining insight through psychoeducation for first-episode schizophrenia is associated with increased suicidality. We conducted a secondary analysis of a prospective cohort study that included inpatients with first-episode schizophrenia who attended a group psychoeducation program during their admission. The group psychoeducation program consisted of four weekly sessions provided by a multidisciplinary team. The primary outcome was the correlation between changes in insight and suicidality. We also examined whether change in insight was associated with changes in hopelessness and depression. We measured insight using the Birchwood Insight Scale. Suicidality, hopelessness and depression were measured using the Calgary Depression Rating Scale for Schizophrenia. A total of 125 people participated in the educational program. The Spearman's correlation coefficient between changes in insight and suicidality was -0.14 (95% confidence interval, -0.31 to 0.04; p=.12). Similarly, gain in insight did not significantly correlate with change in depression (0.01, 95% confidence interval, -0.17 to 0.18; p=.93) and change in hopelessness (0.01, 95% confidence interval, -0.16 to 0.19; p=.88). We observed almost no association between gaining insight and suicidality after a group psychoeducation program in inpatients with first-episode schizophrenia.

Depressive symptoms and chronic peripheral inflammation are associated with impaired functional remission in schizophrenia independently of psychotic remission.

BackgroundWhile psychotic remission in schizophrenia (SZ) has been defined by consensus and associated with a rank of clinical predictive factors, there is a lack of data of factors associated with functional remission. ObjectivesTo identify clinical and biological factors associated with impaired functional remission in a non-selected chronic stabilized SZ outpatients. MethodsThis study was a cross-sectional study carried out on all admitted SZ stabilized outpatients in an academic daily care psychiatric hospital. Functional remission was defined by a global assessment of functioning score ≥61. Psychotic remission was defined according to international criteria. Depression was assessed with the Calgary Depression Rating scale for Schizophrenia. Sociodemographic variables, tobacco status, clozapine treatment and obesity were reported. Chronic peripheral inflammation was defined by a highly sensitive C-reactive protein serum level ≥3 mg/L and metabolic syndrome according to international recommendations. Results273 patients were included, among them 51 (18.7%) were classified in the functional remission group. In the multivariate analysis, higher rate of functional remission was associated with psychotic remission (adjusted Odd ratio = 18.2, p <0.001), lower depressive symptoms (aOR=0.8, p = 0.018) and lower peripheral inflammation (aOR=0.4, p = 0.046). No association of functional remission with age, gender, illness duration, second-generation antipsychotics, clozapine treatment, tobacco smoking, obesity or metabolic syndrome has been found. ConclusionDepressive symptoms and chronic peripheral inflammation are associated with impaired functional remission in SZ independently of psychotic remission. Future intervention studies should determine if improving depressive symptoms and chronic peripheral inflammation may improve SZ patients reaching functional remission.

S105. DIGITAL BIOMARKERS FOR THE ASSESSMENT OF COGNITIVE, BEHAVIORAL AND FUNCTIONAL OUTCOMES IN INDIVIDUALS WITH SCHIZOPHRENIA

BackgroundAn individual’s mental health is best captured by considering the overall associations of biological, behavioral, and social functions that comprise the framework of individual experience. As such, accessing data on various health indicators concurrently can influence prediction of disease progression or change in response to treatment. Data generated passively by smartphones to measure human behavior has generated significant research interest and has increasingly been utilized in psychiatric disorders. In schizophrenia, passive and continuous assessment of how an individual uses their mobile device may give rise to clinically useful markers that can be used to improve treatment processes, adapt treatment choices, identify early risk for relapse to initiate clinical intervention, and develop new clinical models. A promising approach is to leverage current advances in mobile technology, data analytics and machine learning to enable automated and fast phenotyping of digital data. . In this context, the workflow for phenotyping (passive data collection → data storage and curation → trait extraction → machine learning/classification → models/apps for decision support) has to be carefully designed and efficiently executed to minimize resource usage and maximize utility. Digital phenotyping can be used in conjunction with standard care to reduce time to recognition and acknowledgement that worsening of a symptom needs to be addressed, to reduce time to receiving appropriate level of care, to increase ability to analyze and collect data from a variety of sources to improve mental health needs assessment and delivery of services, and to advance outcome measurement through comparison of passive and active data sets.AimThe aim of this pilot study is to test whether a smartphone digital phenotyping application can help detect early signs of treatment failure or response in individuals with chronic schizophrenia after discharge from hospital.Methods17 individuals with DSM-5 schizophrenia were provided with a smartphone and digital phenotyping app, MindStrong Health app, following discharge from an inpatient psychiatric facility. The participants were followed for 6 months with monthly rater administered evaluations assessing neurocognition (Brief Assessment of Cognition in Schizophrenia (BACS)), symptomatology (PANSS; CGI-S/I), quality of life (SF-36), healthcare utilization, alcohol/drug use, level of clinical insight and depression (Calgary Depression Rating Scale, CDSS). Digital phenotyping data included gestures (swipes, taps, other), orientation (the way the phone is pointing), acceleration (sudden movements of the phone), keystroke patterns with characters encoded, number of calls made, number of emails sent, number of text messages sent, and location information from the GPS. Predictive models were built using multiple machine learning techniques - random forest plots, linear regression and gradient boosting, to predict the target scores based on phone usage patterns.ResultsOf the 17 enrolled participants, 10 provided analyzable data (i.e., had at least 22 target days with data). There was a gradual reduction of passive data generation due to either non-use of the smart phone or due to non-recharging of the device. The mean PANSS score was 80.12 (14.56). BACS scores corresponding to motor speed (token motor task), verbal fluency (category instances, letter fluency), and attention and processing speed (symbol coding) were found to be highly correlated with a composite digital phenotyping marker while scores on the PANSS or CDSS were not.DiscussionThe study provides a basis for using smartphone-base mobile apps to use as an augmentation within clinical practice to gather further information on patients outside the clinic setting, focusing on their behavior in the ‘real world.’ In particular, the cognitive data derived from the digital device correlated well with rater administered traditional cognitive ratings. Collecting digital data can provide a much needed window into the lives of patients in between normally scheduled visits, while minimizing costs and inconvenience to the patient. Studies with larger sample sizes are required to assess relationships with relapse, rehospitalizations and treatment failure.

T141. EFFECTS OF MENSTRUAL CYCLE ON RESTING STATE FUNCTIONAL CONNECTIVITY IN SCHIZOPHRENIA: A FUNCTIONAL MRI STUDY

BackgroundThe menstrual cycle is a favorable model for examining the influence of ovarian hormones on cognition, emotion and brain functions. Ovarian hormones have substantial effects on task-related brain activity, but their impacts on functional connectivity at rest have been investigated by a few studies conducted with healthy individuals and these pre-existing findings are inconsistent. As for schizophrenia, different influences of ovarian hormones were reported. For instance, the estrogen hypothesis of schizophrenia has suggested that estrogen plays a neuroprotective role in the pathophysiology of this disorder. The present study investigates resting state functional connectivity (RS-FC) alterations related to menstrual cycle phase and/or hormone levels in patients with schizophrenia and healthy controls and aims to contribute to the understanding of the effects of ovarian hormones on the pathogenesis of schizophrenia and brain functions.MethodsThe study was conducted with 13 women with schizophrenia (the mean of age: 32 ± 7.67) and 13 healthy women (the mean of age: 30.08 ± 7.27). Resting state functional Magnetic Resonance Imaging (fMRI) scanning, as well as hormonal and clinical assessments, were applied to each participant twice, during two menstrual cycle phases: early follicular (Days 2–6; low estrogen/progesterone) and mid-luteal (Days 20–22; high estrogen/progesterone). The serum hormone levels of estradiol, progesterone, prolactin (only in the patients), follicle-stimulating and luteinizing were assessed. The clinical assessment interviews included the Brief Psychiatric Rating Scales, the Clinical Global Impression (only for the patients), the Global Assessment of Functioning and the Calgary Depression Rating Scale for Schizophrenia (for both groups).ResultsOur findings revealed that no cycle phase-related alterations existed in RS-FC in both groups. However, specific correlations between each hormone and RS-FC were found in both cycle phases for two groups. In the patients, estrogen was positively correlated with the auditory network (AN) connectivity in the left amygdala at the early follicular phase. In the controls, the positive correlations to progesterone were found in the precuneus for the connectivity of the posterior default mode network (DMN) and the left-frontoparietal network (FPN) during the early follicular phase. Also, progesterone was negatively correlated with the executive control network (ECN) connectivity in the right superior frontal gyrus at the mid-luteal phase in the controls. Furthermore, the patients had lower progesterone levels during the mid-luteal phase compared to the controls (p<0.05). The severity of the psychotic symptoms of the patients didn’t change between the cycle phases.DiscussionTo our knowledge, this is the first study to examine the influence of the menstrual cycle on the brain’s RS-FC in schizophrenia. Our results indicated that the effects of the menstrual cycle on RS-FC were more prominent in the controls rather than the patients with schizophrenia; and that the findings for the patient group may be associated with the additional mechanisms responsible from schizophrenia. This might imply that differentiating the menstrual cycle effects is difficult in a complex disorder such as schizophrenia. The results obtained from the controls are consistent with the previous findings indicating that the menstrual cycle effects might be associated with the connectivity of the DMN and cognition-related networks. Moreover, our results suggested that estrogen might have a modulating effect on the intrinsic functional connectivity changes in the patients, while progesterone, might mediate to that in the controls.

Abnormal C-reactive protein blood levels as a specific biomarker of major depression and non-remission under antidepressants in schizophrenia

BackgroundC-reactive protein (CRP) is a general marker of peripheral inflammation and has been shown to be a good marker of neuroinflammation. CRP has been found to be elevated in patients with mood disorders (especially unipolar disorders (UD) and in schizophrenia (SZ)) but also to be lowered by antidepressants. ObjectiveThe objectives were (i) to determine the prevalence of major depression, antidepressant prescription and remission under antidepressant in a stabilized population of SZ and UD patients consulting in a daily hospital, and (ii) to determine if CRP was a marker of major depression and remission under antidepressant in these SZ and UD populations. MethodsAbnormal CRP was defined by a CRP blood level ≥ 3 mg/L. Depressive symptoms were assessed by the Calgary Depression Rating Scale score. The clinicians were blinded of the CRP status of the patient. Results411 patients were included (272 SZ and 139 UD). 171 (41.6%) were diagnosed with current major depression (74 (27.2%) for SZ and 97 (69.8%) for UD). 86 SZ (31.6%) and 119 UD (85.6%) were treated by antidepressant. Only 28/74 (37.8%) of the SZ subjects with major depression were administered antidepressants vs. 87/97 (89.7%) for UD. The non-remission rate under antidepressant was 28/86(32.6%) for SZ and 87/119 (73.1%) for UD. Overall, 105 (40.1%) of SZ and 39 (28.1%) of UD patients were found to have abnormal CRP blood levels. Abnormal CRP levels were significantly associated with increased MDD and more strongly with increased rates of non-remission under antidepressants in SZ patients, independently of age, gender, psychotic symptomatology, functioning, tobacco smoking and metabolic syndrome. This result was not replicated in UD patients, which suggests that CRP may be a specific marker of major depression and remission under antidepressant in SZ patients. ConclusionThe development of biomarkers in psychiatry may orientate specific etiologic therapies in patients with mental disorders. The present findings suggest that major depression is frequent in SZ patients and that increased CRP levels are associated with non-remission under antidepressants in this population. Anti-inflammatory strategies may be particularly useful in this specific population.

The Persian version of the Calgary Depression Scale for Schizophrenia (CDSS-P).

Determining depression symptoms in schizophrenic patients is a challenging process because of a degree of similarity between depression symptoms and negative symptoms and the extrapyramidal side effects of neuroleptic drugs, but it is crucial to evaluate and measure depression among patients with schizophrenia for a better clinical outcome. The Calgary Depression Scale for Schizophrenia (CDSS) is a valid and reliable instrument used for the evaluation of depression in schizophrenia. This study aimed to determine the psychometric properties of the Persian version of CDSS in a sample of people with schizophrenia. Clinical interviews were conducted with 95 schizophrenic patients (40 inpatients and 55 outpatients), who were assessed with the Positive and Negative Syndrome Scale (PANSS), Hamilton Depression Rating Scale (HDRS-17 and HDRS-24 items), and the Calgary Depression Rating Scale (CDSS). Then an exploratory factor analysis was conducted to determine correlations between scales, Cronbach's alpha, and cutoff scores. The factor analysis led to the extraction of a unifactorial solution. The CDSS had significant relationships with PANSS Negative and PANSS General. However, it had no significant relationship with PANSS Positive and the PANSS Total. The CDSS also had significant relationships with HDRS-17 and HDRS-24. In addition, Cronbach's alpha of total score, test-retest reliability, and cutoff score were estimated at 0.86, 0.82, and 8 (sensitivity = 0.79 and specificity = 0.84), respectively. The findings support the CDSS unifactorial approach. Results also showed that the CDSS Persian version had acceptable psychometric properties; thus, it could be employed to evaluate depression among schizophrenic patients.

An increase in plasma brain derived neurotrophic factor levels is related to n-3 polyunsaturated fatty acid efficacy in first episode schizophrenia: secondary outcome analysis of the OFFER randomized clinical trial

RationaleN−3 polyunsaturated fatty acids (n−3 PUFA) influence multiple biochemical mechanisms postulated in the pathogenesis of schizophrenia that may influence BDNF synthesis.ObjectivesA randomized placebo-controlled study was designed to compare the efficacy of a 26-week intervention composed of either 2.2 g/day of n−3 PUFA or olive oil placebo, with regard to symptom severity in first-episode schizophrenia patients. The secondary outcome measure of the study was to describe the association between n−3 PUFA clinical effect and changes in peripheral BDNF levels.MethodsSeventy-one patients aged 16–35 were enrolled in the study and randomly assigned to the following study arms: 36 to the EPA + DHA group and 35 to the placebo group. Plasma BDNF levels were assessed three times, at baseline and at weeks 8 and 26 of the intervention. BDNF levels were determined in plasma samples using Quantikine Human BDNF ELISA kit. Plasma BDNF level changes were further correlated with changes in the severity of symptoms in different clinical domains.ResultsA significantly greater increase in plasma BDNF levels was observed in the intervention compared to the placebo group (Cohen’s d = 1.54). Changes of BDNF levels inversely correlated with change in depressive symptoms assessed using the Calgary Depression Rating Scale in Schizophrenia (Pearson’s r = − 0.195; p = 0.018).ConclusionsThe efficacy of a six-month intervention with n−3 PUFA observed in first-episode schizophrenia may be related to an increase in BDNF levels, which may be triggered by the activation of intracellular signaling pathways including transcription factors such as cAMP-reactive element binding protein.

F37. EXAMINATION OF SOCIAL DECISION MAKING IN PATIENTS WITH SCHIZOPHRENIA USING ULTIMATUM GAME

Decision making in a social situation is an essential aspect for optimal societal functioning. Despite its importance, only a few studies have examined social decision making in schizophrenia (SCZ), a disorder with impairments in several sub-domains of social cognition. One important reason is the difficulty in examining social decision making in lab setting due to its interactive nature. Neuroeconomic paradigms permit simulation of social interaction in a lab setting. In this study we examined social decision making in SCZ using a valid neuroeconomic paradigm, Ultimatum Game (UG) in comparison with healthy volunteers (HV). Thirty male patients with Structured Clinical Interview for DSM-IV (SCID-I) diagnosed SCZ (age=30 + 7.08 years) and thirty male HV (age=28.48 + 3.73 years) participated in the study. Clinical severity was assessed using Positive and Negative Syndrome Scale, Scale for the Assessment of Negative Symptoms, and Calgary Depression Rating Scale. Participants played a previously validated version of Ultimatum game (Güth,W. et.al. J. Econ. Behav. Organ. (1982)) Participants played the role of a responder and had to either accept or reject offers made by an anonymous proposer for sum of money Rs.10/- in each trial. In each trial, one of the six split possibilities (proposer: responder - 9:1, 8:2, 7:3, 6:4, 5:5, 4:6) were offered as split. A total of 48 trials were played with each split played 8 times. The order of splits was randomized. For analysis, the offers were grouped into fair offers (6:4, 5:5, 4:6) or unfair offers (9:1, 8:2, 7:3) as per the previous studies. Data was analyzed using SPSS v 24. Since the data was not normally distributed, Mann-Whitney test was used to examine group differences. The groups were matched in age (p=0.48). SCZ had significantly lower acceptance rates for fair offers (median=15.00, range = 13.75 to 16.00) compared to HV (median =16, range = 15 to 16) (U= 311.50; p=0.02). However, there was no significant difference between SCZ (median =13.50, range = 4.00 to 19.75) and HV (median = 11.50, range =6.50 to 26.25) for unfair offers (U= 431.50; p= 0.78). When individual offers were analyzed, lower acceptance rate for 6:4 split was significantly higher (U=291; p=0.01) in SCZ (median =4.00, range =3.00 to 7.00) compared to HV (median =8.00, range =4.75 to 8.00) but not for 5:5 (U=344; p=0.06) or 4:6 (U=349.50; p=0.07). There was no significant correlation between rejection rates and clinical severity scores on PANSS, SANS or CDS. The results of the study suggest significantly higher rate of lower acceptance in SCZ for slightly unequal offers. While healthy volunteers refused unfair offers but accepted slightly unequal offers as fair, SCZ refused these offers. This indicates SCZ may have a higher threshold to accept division as fair as there was no significant difference when the split was equal or favorable to respondent. Whether these deficits are primary or secondary to deficits in other domains of social cognition, like theory of mind, need to be examined in the future. Considering the importance of economic interactions and social decision making in recovery, findings of the study could have implication in rehabilitation and functional recovery.

Hypovitaminosis D is associated with negative symptoms, suicide risk, agoraphobia, impaired functional remission, and antidepressant consumption in schizophrenia.

Hypovitaminosis D has been associated with, respectively, major depressive disorder, schizophrenia (SZ), and cognitive disorders in the general population, and with positive and negative symptoms and metabolic syndrome in schizophrenia. The objective was to determine the prevalence of hypovitaminosis D and associated factors in a non-selected multicentric sample of SZ subjects in day hospital. Hypovitaminosis D was defined by blood vitamin D level < 25nM. Depressive symptoms were assessed by the Calgary Depression Rating Scale Score and Positive and Negative Syndrome Scale Score. Anxiety disorders and suicide risk were evaluated by the Structured Clinical Interview for Mental Disorders. Functioning was evaluated with the Functional Remission of General Schizophrenia Scale. Hypovitaminosis D has been found in 27.5% of the subjects. In multivariate analysis, hypovitaminosis D has been significantly associated with, respectively, higher suicide risk (aOR = 2.67 [1.31-5.46], p = 0.01), agoraphobia (aOR = 3.37 [1.66-6.85], p < 0.0001), antidepressant consumption (aOR = 2.52 [1.37-4.64], p < 0.001), negative symptoms (aOR = 1.04 [1.01-1.07], p = 0.04), decreased functioning (aOR = 0.97[0.95-0.99], p = 0.01), and increased leucocytosis (aOR = 1.17 [1.04-1.32], p = 0.01) independently of age and gender. No association with alcohol use disorder, metabolic syndrome, peripheral inflammation, insulin resistance, or thyroid disturbances has been found (all p > 0.05). Despite some slight abnormalities, no major cognitive impairment has been associated with hypovitaminosis D in the present sample (all p > 0.05 except for WAIS similarities score). Hypovitaminosis D is frequent and associated with suicide risk, agoraphobia and antidepressant consumption in schizophrenia, and more slightly with negative symptoms. Patients with agoraphobia, suicide risk and antidepressant consumption may, therefore, benefit in priority from vitamin D supplementation, given the benefit/risk profile of vitamin D. Further studies should evaluate the impact of vitamin D supplementation on clinical outcomes of SZ subjects.

Toward a transdiagnostic tool to evaluate depressive symptoms across mental disorders: Validation of the Calgary depression rating scale in patients with major depressive disorder

The severity of depressive symptoms across two discrete mental disorders should be evaluated with the same psychometrically validated tools. In patients with schizophrenia the Calgary Depression Rating Scale (CDSS) is recommended for evaluating depressive symptoms. The aim of this study was to validate the CDSS in patients with major depressive disorder. The CDSS exhibit satisfactory psychometric properties for evaluating depressive symptoms in major depressive disorder. Clinicians and researchers now have a validated scale at their disposal to evaluate depressive symptoms in various mental disorders using a transdiagnostic approach.

Evaluaton of regional cerebral blood flow alterations by limbic activation in patients with schizophrenia

The aim of study is to evaluate the functions of limbic system in schizophrenia by performing procaine administration and using single photon emission computed tomography (SPECT). 22 patients and 19 controls were included in the study. Patients were evaluated with Positive and Negative Syndrome Scale (PANSS), Brief Psychiatric Rating Scale (BPRS), Hamilton Rating Scale for Depression (HAM-D) and Hamilton Rating Scale for Anxiety (HAM-A), Calgary Depression Rating Scale for Schizophrenia (CDSS) and the controls were evaluated with BPRS, HAM-D and HAM-A. The regional cerebral blood flow (rCBF) values were measured by SPECT. The rCBF following placebo and the alteration ratios of the rCBF following procaine of patients compared to controls. The rCBF following placebo in bilateral frontal, bilateral superior temporal, bilateral parahippocampus, thalamus, insula and alteration ratios of rCBF following procaine in bilateral anterior cingulate cortex (ACC) and left thalamus of patients were lower. Poor limbic activation to procaine was observed in the ACC and left thalamus of patients with schizophrenia. These findings support that the ACC and thalamus are crucial role in pathophysiology of schizophrenia.

Factor analysis of symptom dimensions (psychotic, affective and obsessive compulsive symptoms) in schizophrenia

To carryout factor analysis of symptom profile of patients with schizophrenia assessed by using positive and negative syndrome scale (PANSS), Calgary depression rating scale (CDSS), Young mania rating scale (YMRS) and YBOCS checklist. 181 patients of schizophrenia were assessed on PANSS, CDSS, YMRS and YBOCS checklist. Factor analysis of PANSS yielded 3 factor structure (positive, negative, anxiety). When the items of CDSS were added to the PANSS items, total number of factors increased to 4 with depression emerging as a separate factor. Addition of YMRS to PANSS and CDSS led to emergence of 5 factor model. Further addition of YBOCS checklist led to emergence of a 7 factor model (positive, depressive, obsessive compulsive, negative, manic, anxiety and obsessive compulsive-2), which explained 49.85% variance of the data. Positive symptoms emerged as the factor-1. Depressive symptoms loaded on the factor-2, negative symptoms loaded on to factor-4, manic symptoms loaded onto factor-5 and anxiety symptoms loaded onto factor-6. OC symptoms loaded onto factor 3 and 7. Present study suggests that when multiple scales are used for assessment of various symptoms of schizophrenia, the symptoms separate out into 7 factors. This finding suggests that clinical assessment of schizophrenia should not be limited to core psychotic symptoms only and structured instruments must be used to elicit other symptoms too while monitoring the clinical picture of patients with schizophrenia.

Possible Facilitative Effects of Repeated Anodal Transcranial Direct Current Stimulation on Functional Outcome 1 Month Later in Schizophrenia: An Open Trial.

https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000018556, UMIN000015953.

High C-reactive protein levels are associated with depressive symptoms in schizophrenia

BackgroundDepressive symptoms are frequently associated with schizophrenia symptoms. C - Reactive protein (CRP), a marker of chronic inflammation, had been found elevated in patients with schizophrenia and in patients with depressive symptoms. However, the association between CRP level and depressive symptoms has been poorly investigated in patients with schizophrenia. The only study conducted found an association between high CRP levels and antidepressant consumption, but not with depressive symptoms investigated with the Calgary Depression Rating Scale for Schizophrenia (CDSS). ObjectivesThe aim of this study was to evaluate CRP levels and depressive symptoms in patients with schizophrenia, and to determine whether high CRP levels are associated with depressive symptoms and/or antidepressant consumption, independently of potential confounding factors, especially tobacco-smoking and metabolic syndrome. MethodsThree hundred and seven patients with schizophrenia were enrolled in this study (mean age = 35.74 years, 69.1% male gender). Depressive symptoms was investigated with the CDSS. Patients were classified in two groups: normal CRP level (≤ 3.0mg/L) and high CRP level (> 3.0mg/L). Current medication was recorded. Results124 subjects (40.4%) were classified in the high CRP level group. After adjusting for confounding factors, these patients were found to have higher CDSS scores than those with normal CRP levels in multivariate analyses (p = 0.035, OR = 1.067, 95% CI = 1.004–1.132). No significant association between CRP levels and antidepressants consumption was found. LimitationsThe size sample is relatively small. The cut-off point for high cardiovascular risk was used to define the two groups. CRP was the sole marker of inflammation in this study and was collected at only one time point. The design of this study is cross-sectional and there are no conclusions about the directionality of the association between depression and inflammation in schizophrenia. ConclusionThis study found an association between high rates of CRP levels and depressive symptoms in patients with schizophrenia, but no association with antidepressant consumption. Further studies are needed to investigate the impact of inflammation in schizophrenia.

A state-independent network of depressive, negative and positive symptoms in male patients with schizophrenia spectrum disorders

Depressive symptoms occur frequently in patients with schizophrenia. Several factor analytical studies investigated the associations between positive, negative and depressive symptoms and reported difficulties differentiating between these symptom domains. Here, we argue that a network approach may offer insights into these associations, by exploring interrelations between symptoms. The aims of current study were to I) construct a network of positive, negative and depressive symptoms in male patients with schizophrenia to investigate interactions between individual symptoms; II) identify the most central symptoms within this network and III) examine group-level differences in network connectivity between remitted and non–remitted patients.We computed a network of depressive, positive and negative symptoms in a sample of 470 male patients diagnosed with a psychotic disorder. Depressive symptoms were assessed with the Calgary Depression Rating Scale for Schizophrenia, while psychotic symptoms were assessed with the Positive and Negative Syndrome Scale. Networks of male patients who fulfilled remission criteria (Andreasen et al., 2005) and non–remitters for psychosis were compared.Our results indicate that depressive symptoms are mostly associated with suicidality and may act as moderator between psychotic symptoms and suicidality. In addition, ‘depressed mood’, ‘observed depression’, ‘poor rapport’, ‘stereotyped thinking’ and ‘delusions’ were central symptoms within the network. Finally, although remitted male patients had a similar network structure compared to non-remitters the networks differed significantly in terms of global strength. In conclusion, clinical symptoms of schizophrenia were linked in a stable way, independent of symptomatic remission while the number of connections appears to be dependent on remission status.

Scales for assessment of depression in schizophrenia: Factor analysis of calgary depression rating scale and hamilton depression rating scale

This study aimed to evaluate the factor structure of Calgary depression rating scale (CDSS) and Hamilton Depression Rating Scale (HDRS) among patients with schizophrenia in acute and remission phase of illness by using exploratory factor analysis. For this, 267 patients with schizophrenia were assessed on CDSS and HDRS. Exploratory factor analysis of CDSS yielded 2 factor models for the whole sample, patients in clinical remission and patients not in clinical remission phase of schizophrenia. Factor analysis of HDRS yielded 3 factor models; however, there was significant difference in the factor structure between those in clinical remission and those not in clinical remission phase of schizophrenia. CDSS total score did not correlate with PANSS positive and negative subscale scores. In contrast, HDRS total score correlated positively with PANSS positive subscale score, PANSS negative subscale score and PANSS general psychopathology subscale score. To conclude, present study suggests while CDSS items separate out into 2 factors, which are stable across different stages of illness, whereas HDRS factor structure appears to be less stable across different stages of illness. Correlation analysis suggests that rating on HDRS may be affected by positive and negative symptoms of schizophrenia, whereas CDSS do not correlate with positive and negative symptoms of schizophrenia.

103. Adjunctive Aripiprazole Treatment for Psychiatric Symptoms in Premenopausal Women: Results: From the Daamsel Clinical Trial

Abstract Women have been largely underrepresented in clinical trials in schizophrenia yet have a different presentation of symptoms, such as higher affective symptoms compared to men. Thus, adjunctive antipsychotic treatment, particularly low-dose aripiprazole, in women may be an effective strategy, particularly for its effects on anxious or depressive symptoms. Premenopausal women with schizophrenia or bipolar disorder were recruited for a randomized double-blind, 16-week trial of adjunct aripriprazole (5 to 15 mg day). The primary study population was those with symptomatic hyperprolactinemia (these results reported elsewhere). Stable participants were evaluated biweekly for psychiatric symptoms using the Brief Psychiatric Rating Scale (BPRS), the Scale for the Assessment of Negative Symptoms (SANS), the Calgary Depression Rating Scale (CDS), and the Clinical Global Improvement (CGI). The Psychological General Well Being Index (PGWB) and the Repeatable Battery for Assessment of Neurological Symptoms (RBANS) were performed monthly and end of study, respectively. Forty-four women were randomized and received medication (N = 24 aripiprazole and N = 20 placebo). Four aripiprazole participants discontinued (2 clinical worsening, 1 patient choice, and 1 nonadherence) and 3 discontinued in the placebo group (patient choice, medication nonadherence and administrative pharmacy error). There were no significant treatment differences in BPRS, SANS, CDS, or CGI scores between the aripiprazole and placebo groups ( > .05). Robust response on the total BPRS (>30% response) was noted in (12%) in the aripiprazole group vs. none in the placebo group ( = .12). There were no differences in RBANS or PGWB index scores and no differences in side effects noted. This clinical trial suggests that adjunct treatment aripiprazole to treat symptomatic hyperprolactinemia in clinically stable women does not significantly improve psychiatric symptoms in most patients. However, 12% of women had robust symptom improvements (>30%) in BPRS scores, and 10% had worsening of BPRS scores leading to discontinuation. No significant improvements were noted in any other clinical ratings such as anxiety, depression or cognition. Nonetheless, adjunct aripriprazole is a safe strategy for stable patients when added for symptomatic hyperprolatinemia, and future work should help distinguish which factors may predict robust symptoms improvements and which women may have clinical worsening that occur in about 10%–12% of patients using this strategy.