Clinical Global Impression-Severity Scale Research Articles

Aripiprazol Versus Quetiapine in Treatment of Non-affective Acute Psychosis: A Double-Blind, Randomized - Controlled Clinical Trial

<i>Objective</i>: The primary objective of this study was to assess the efficacy of Quetiapine versus Aripiprazol in treating non-affective acute psychosis. <i>Methods</i>: This study is double blind, randomized-controlled clinical trial (RCT). A total number of 90 hospitalized patients with the diagnosis of acute psychosis were selected. The patients were treated with Quetiapine (mean: 500 mg/day) or Aripiprazol (mean: 20 mg/day), in a 4 weeks period. The positive and negative symptoms scale (PANSS) and clinical global impression severity scale (CGIS-s) were used in the first and the last day of trial. <i>Results</i>: This study reveals that both of these drugs can substantially reduce the severity of symptoms in acute psychosis. Aripiprazol reduced positive symptoms and general symptoms scores and total scores more than Quetiapine. Differences in reducing negative scores were not significant and both drugs had the same therapeutic effect. In this sense, there was no difference in reducing negative symptoms in acute psychosis between Aripiprazol and Quetiapine. <i>Conclusion</i>: According to some differences with similar studies, study on larger sample pool and in longer period in future researches can be advised.

Three-dimensional stereotactic surface projection in the statistical analysis of single photon emission computed tomography data for distinguishing between Alzheimer's disease and depression.

AIMTo evaluate usefulness of single photon emission computed tomography (SPECT) with three-dimensional stereotactic surface projection (3D-SSP) in distinguishing between Alzheimer’s disease (AD) and depression.METHODSWe studied 43 patients who presented with both depressive symptoms and memory disturbance. Each subject was evaluated using the following: (1) the Minimal Mental State Examination; (2) the Hamilton Rating Scale for Depression; (3) Clinical Global Impression-Severity scale (CGI-S); and (4) SPECT imaging with 3D-SSP.RESULTSThe MMSE scores correlated significantly with the maximum Z-scores of AD-associated regions. CGI-S scores correlated significantly with the maximum Z-scores of depression-associated regions. Factor analysis identified three significant factors. Of these, Factor 1 could be interpreted as favouring a tendency for AD, Factor 2 as favouring a tendency for pseudo-dementia, and Factor 3 as favouring a depressive tendency.CONCLUSIONWe investigated whether these patients could be categorized as types: Type A (true AD), Type B (pseudo-dementia), Type C (occult AD), and Type D (true depression). The factor scores in factor analysis supported the validity of this classification. Our results suggest that SPECT with 3D-SSP is highly useful for distinguishing between depression and depressed mood in the early stage of AD.

Group Therapy for Japanese University Students with Autism Spectrum Disorder

Autism spectrum disorder (ASD) is characterized by social impairment and circumscribed and repetitive behavior and interests. This study aimed to examine the effectiveness of group therapy, which was designed to enhance university-related behavior, in Japanese university students with high-functioning ASD, based on their specific social, communication and emotional needs. The participants included 11 students with ASD aged between 19 and 24 (mean 21.0) years. A single-group, pre-post-intervention design was implemented in the study. The Clinical global Impressions-Severity scale, Beck Depression Inventory, State Trait Anxiety Inventory, and Rosenberg Self-Esteem Inventory Scale were completed before and after group therapy. The results showed significant post intervention improvements in depressive symptom, anxiety, and self-esteem, indicating that the group therapy was effective for students with ASD.

Evaluation of mean platelet volume, neutrophil lymphocyte ratio, platelet lymphocyte ratio and red cell distribution width in panic disorder

Objective: Assessment of the systemic inflammatory response of the neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) is shown as a new biomarker. Red cell distribution width (RDW) is the size of red blood cells and have been found related to adverse events in many diseases. Mean platelet volume (MPV) indicates platelet volume and platelet volume is a potential indication of platelet activity. The aim of our study is to investigate hematological changes in patients with panic disorder (PD) through readily available markers such as NLR, PLR, RDW and MPV. Methods: Thirty-nine patients between the ages of 18 and 75 who were diagnosed with PD according to DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) and forty healthy control subjects were included in the study. MPV, NLR, PLR and RDW were measured and recorded for groups. Hamilton Depression Scale, Hamilton Anxiety Scale, Clinical Global Impressions Scale (CGI-S) and Panic Disorder Severity Scale were applied to the patients. Results: There were no statistically significant differences between groups in terms of sociodemographic characteristics. No significant correlation was found between NLR, PLR and RDW values and clinical scales. MPV was negatively correlated with the severity of panic disorder. There was no correlation between MPV and other variables. Conclusion: Our study is the first study to examine NLR, PLR and RDW associations in PD patients. There are studies showing that increased sympathetic activity leads to increased MPV. In our study, the MPV value did not differ between PD and control group. However, there was a negative correlation between the severity of panic disorder and MPV.

Symptomatic Remission Determines Functional Improvement and Quality of Life in Schizophrenia.

Schizophrenia is a chronic illness that negatively affects the quality of life and psychosocial functions. Defined criteria to assess remission in schizophrenia are considered to be useful in the long-term follow-up of patients and in discriminating diagnostic factors. This study investigated the quality of life and functionality in schizophrenia patients in symptomatic remission (R-Sch) and not in remission (Non-R-Sch). Sociodemographic data were collected for 40 R-Sch and 40 Non-R-Sch patients, and the following scales were administered: the Clinical Global Impression-Severity (CGI-S) Scale; Positive and Negative Syndrome Scale (PANSS), World Health Organization Quality of Life Questionnaire-Short Form, Turkish Version (WHOQOL-BREF-TR), Quality of Life Scale for Schizophrenia Patients (QLS), and Global Assessment of Functioning Scale (GAF). The total and all subscale scores of PANSS and the CGI-S score were significantly lower in the R-Sch group than in the Non-R-Sch group, whereas the GAF scores and all subscales of QLS and WHOQOL-BREF-TR were significantly higher. This study demonstrates that improvement in symptoms in schizophrenia patients improves quality and functionality in all areas of life, suggesting that an improvement in symptoms is the most important determinant of functional recovery in the treatment of schizophrenia.

Genome-wide association study of paliperidone efficacy.

Clinical response to the atypical antipsychotic paliperidone is known to vary among schizophrenic patients. We carried out a genome-wide association study to identify common genetic variants predictive of paliperidone efficacy. We leveraged a collection of 1390 samples from individuals of European ancestry enrolled in 12 clinical studies investigating the efficacy of the extended-release tablet paliperidone ER (n1=490) and the once-monthly injection paliperidone palmitate (n2=550 and n3=350). We carried out a genome-wide association study using a general linear model (GLM) analysis on three separate cohorts, followed by meta-analysis and using a mixed linear model analysis on all samples. The variations in response explained by each single nucleotide polymorphism (hSNP) were estimated. No SNP passed genome-wide significance in the GLM-based analyses with suggestive signals from rs56240334 [P=7.97×10 for change in the Clinical Global Impression Scale-Severity (CGI-S); P=8.72×10 for change in the total Positive and Negative Syndrome Scale (PANSS)] in the intron of ADCK1. The mixed linear model-based association P-values for rs56240334 were consistent with the results from GLM-based analyses and the association with change in CGI-S (P=4.26×10) reached genome-wide significance (i.e. P<5×10). We also found suggestive evidence for a polygenic contribution toward paliperidone treatment response with estimates of heritability, hSNP, ranging from 0.31 to 0.43 for change in the total PANSS score, the PANSS positive Marder factor score, and CGI-S. Genetic variations in the ADCK1 gene may differentially predict paliperidone efficacy in schizophrenic patients. However, this finding should be replicated in additional samples.

Validity of remission and recovery criteria for schizophrenia and major depression: comparison of the results of two one-year follow-up naturalistic studies.

The objective of the present study was the application and comparison of common remission and recovery criteria between patients with the diagnosis of schizophrenia and major depressive disorder (MDD) under inclusion of other outcome parameters. Patients with schizophrenia and MDD who were treated as inpatients at the beginning of the study were examined within two naturalistic follow-up trials from admission to discharge of an inpatient treatment period and the one-year follow-up assessment. PANSS criteria of the Remission in Schizophrenia Working Group (RSWG) for schizophrenia and HAMD criteria of the ACNP Task Force in MDD for depressive patients as well as the Clinical Global Impression-Severity Scale (CGI-S) were applied as symptomatic outcome measures additionally to functional outcome parameters. Data of 153 schizophrenia patients and 231 patients with a MDD episode have been included in the analysis. More depressive than schizophrenia patients reached a threshold score of ≤3 on the CGI-S, indicating symptomatic remission at discharge and at the one-year follow-up. In contrast similar proportions of patients reaching symptomatic remission at discharge from inpatient treatment and at the one-year follow-up in the schizophrenia and in the MDD group were found when disease-related consensus criteria (RSWG vs. ACNP Task Force) were used. Functional remission and recovery rates were significantly lower in schizophrenia than in depressive patients at the one-year follow-up visit. Common outcome criteria for remission and recovery in schizophrenia and major depression were not directly comparable. However, our results indicated a significantly poorer outcome in schizophrenia than in depressive patients according to terms of remission and recovery.

Adjunctive memantine in clozapine-treated refractory schizophrenia: an open-label 1-year extension study.

In a recent placebo-controlled, double-blind crossover trial (n = 52), significant beneficial effects on memory (d = 0.30) and negative symptoms (d = 0.29) were found after 12 weeks of memantine augmentation in patients with clozapine-refractory schizophrenia. In this open-label 1-year extension study we report the long-term effects and tolerability of memantine add-on therapy to clozapine. Completers of the first trial who experienced beneficial effects during 12 weeks of memantine treatment received memantine for 1 year. Primary endpoints were memory and executive function using the Cambridge Neuropsychological Test Automated Battery, the Positive and Negative Syndrome Scale (PANSS), and the Clinical Global Impression Severity Scale (CGI-S). Of 31 randomized controlled trial completers who experienced beneficial effects from memantine, 24 received memantine for 1 year. The small improvement in memory found in the memantine condition in the placebo-controlled trial remained stable in the extension study. Executive function did not improve. After 26 weeks of memantine add-on therapy to clozapine, PANSS negative symptoms (r = 0.53), PANSS positive symptoms (r = 0.50) and PANSS total symptoms (r = 0.54) significantly improved. Even further significant improvement in all these measures was observed between 26 weeks and 52 weeks of memantine, with effect sizes varying from 0.39 to 0.51. CGI-S showed a non-significant moderate improvement at 26 weeks (r = 0.36) and 52 weeks (r = 0.34). Memantine was well tolerated without serious adverse effects. In the 1-year extension phase the favourable effect of adjunctive memantine on memory was sustained and we observed further improvement of negative, positive and overall symptoms in patients with clozapine-treated refractory schizophrenia.

Transdiagnostic group CBT for anxiety disorders: the unified protocol in mental health services

Comorbidity among the anxiety disorders is common and may negatively impact treatment outcome. Potentially, transdiagnostic cognitive-behavioral treatments (CBT) deal more effectively with comorbidity than standard CBT. The present study tested the effectiveness of The Unified Protocol (UP) applied to Mental Health Services. Pre-post-treatment effects were examined for psychiatric outpatients with anxiety disorders receiving UP treatment in groups. Forty-seven patients (mean-age = 34.1 (SD = 9.92), 77% females) with a principal diagnosis of anxiety were included. We found significant and clinically meaningful changes in the primary outcomes Clinical Global Impression Severity Scale (CGI-S; d = 1.36), Hamilton Anxiety Scale (HARS; d = .71), and WHO-5 Well-being Index (WHO-5; d = .54). Also, comorbid depressive symptoms and levels of positive and negative affect changed significantly after treatment. Patients with high levels of comorbidity profited as much as patients with less comorbidity; however, these patients had higher scores after treatment due to higher symptom burden at onset. Patients with comorbid depression profited more from treatment than patients without comorbid depression. The treatment effects found in the present study correspond to treatment effects of other TCBT studies, other UP group studies, and effectiveness studies on standard CBT for outpatients. The results indicate that the UP can be successfully applied to a MHS group setting, demonstrating positive effects on anxiety and depressive symptoms for even highly comorbid cases.

Self-stigma and quality of life in patients with depressive disorder: a cross-sectional study.

BackgroundSelf-stigma is a maladaptive psychosocial phenomenon that can affect many areas of patients’ lives and have a negative impact on their quality of life (QoL). This study explored the association between self-stigma, QoL, demographic data, and the severity of symptoms in patients with depressive disorder.Patients and methodsPatients who met the International Classification of Diseases, 10th revision, research criteria for depressive disorder were enrolled in this cross-sectional study. All outpatients completed the following measurements: the Quality of Life Enjoyment and Satisfaction Questionnaire, the Internalized Stigma of Mental Illness Scale, demographic questionnaire, and the objective and subjective Clinical Global Impression-Severity scales that measure the severity of disorder. A total of 81 depressive disorder patients (with persistent affective disorder – dysthymia, major depressive disorder, or recurrent depressive disorder) and 43 healthy controls participated in this study.ResultsCompared with the healthy control group, a lower QoL was observed in patients with depressive disorder. The level of self-stigma correlated positively with total symptom severity score and negatively with QoL. Multiple regression analysis revealed that the overall rating of objective symptom severity and score of self-stigma were significantly associated with QoL.ConclusionThis study suggests a lower QoL in patients with depressive disorder in comparison with healthy controls and a negative impact of self-stigma level on QoL in patients suffering from depressive disorders.

Validation of the Warwick-Edinburgh Mental Well-Being Scale (WEMWBS) in French psychiatric and general populations.

The Warwick-Edinburgh Mental Well-Being Scale (WEMWBS) has been validated in general population samples in many countries. Interest in using this measure in clinical populations is growing, particularly for tertiary prevention and mental health promotion. This paper reports validation of the French WEMWBS in healthy and chronic remitted schizophrenia populations. The French WEMWBS was administered to 319 workers, 75 students and 121 patients. For non-patients, self-reported Trait- and State-Anxiety, Mindfulness, Positive and Negative Affect and the General Health Questionnaire were completed. For patients, the Positive and Negative Syndrome Scale, Clinical Global Impression Severity Scale, Birchwood Insight Scale, Social Adjustment Scale, and Global Assessment of Functioning scale were completed. Test-retest reliability and responsiveness to intervention was assessed at 6 months. Whatever the sample, response frequencies showed normal distributions, and internal consistency was good (Cronbach's α). Scree plots of eigenvalues suggested a single factor in the samples. The one-dimensional solution yielded suboptimal fit indices. Construct validity was confirmed. Significant improvement in scores was observed before and after intervention. Test-retest variation was non-significant. Impairment of insight and cognition in the assessed patients implies that attention must be paid before applying WEMWBS to all patients. Nevertheless, WEMWBS proved valid and reliable in a further European population, suggesting transcultural validity for both monitoring and evaluation of interventions in healthy as well as chronic remitted schizophrenia populations.

Validity and Reliability of the Arabic Version of the Positive and Negative Syndrome Scale

Background: The Positive and Negative Syndrome Scale (PANSS) is widely used for patients with schizophrenia. This scale is reliable and valid. The PANSS was translated and validated in several languages. Objective: The aim of this study was to translate and validate the PANSS in the Arab population. Subjects and Methods: The PANSS was translated into formal Arabic language using the back-translation method. 101 Arab patients with schizophrenia and 98 Arabs with no diagnosis of any mental disorder were recruited. The Arabic version of the Mini International Neuropsychiatric Interview (MINI-6) was used as a diagnostic tool to confirm the diagnosis of schizophrenia or rule out any diagnosis for the healthy control group. Reliability of the scale was assessed by calculating internal consistency, interrater reliability and test-retest reliability. Construct validity was assessed using the Arabic version of the MINI-6. PANSS total scores were correlated with the Clinical Global Impression-Severity scale. Results: Our findings showed that the internal consistency was good (0.92). Scores on the PANSS of the patients were much higher than those of the healthy controls. The PANSS showed good interrater reliability and test-retest reliability (0.92 and 0.75, respectively). In comparison with the MINI-6, the PANSS showed good sensitivity and specificity, which implies good construct validity of this version. Conclusion: In conclusion, the Arabic version of the PANSS is a reliable and valid instrument for the assessment of patients with schizophrenia in the Arab population.

A Novel Strategy for Continuation ECT in Geriatric Depression: Phase 2 of the PRIDE Study.

The randomized phase (phase 2) of the Prolonging Remission in Depressed Elderly (PRIDE) study evaluated the efficacy and tolerability of continuation ECT plus medication compared with medication alone in depressed geriatric patients after a successful course of ECT (phase 1). PRIDE was a two-phase multisite study. Phase 1 was an acute course of right unilateral ultrabrief pulse ECT, augmented with venlafaxine. Phase 2 compared two randomized treatment arms: a medication only arm (venlafaxine plus lithium, over 24 weeks) and an ECT plus medication arm (four continuation ECT treatments over 1 month, plus additional ECT as needed, using the Symptom-Titrated, Algorithm-Based Longitudinal ECT [STABLE] algorithm, while continuing venlafaxine plus lithium). The intent-to-treat sample comprised 120 remitters from phase 1. The primary efficacy outcome measure was score on the 24-item Hamilton Depression Rating Scale (HAM-D), and the secondary efficacy outcome was score on the Clinical Global Impressions severity scale (CGI-S). Tolerability as measured by neurocognitive performance (reported elsewhere) was assessed using an extensive test battery; global cognitive functioning as assessed by the Mini-Mental State Examination (MMSE) is reported here. Longitudinal mixed-effects repeated-measures modeling was used to compare ECT plus medication and medication alone for efficacy and global cognitive function outcomes. At 24 weeks, the ECT plus medication group had statistically significantly lower HAM-D scores than the medication only group. The difference in adjusted mean HAM-D scores at study end was 4.2 (95% CI=1.6, 6.9). Significantly more patients in the ECT plus medication group were rated "not ill at all" on the CGI-S compared with the medication only group. There was no statistically significant difference between groups in MMSE score. Additional ECT after remission (here operationalized as four continuation ECT treatments followed by further ECT only as needed) was beneficial in sustaining mood improvement for most patients.

Comparing Efficacy and Side Effects of Memantine vs. Risperidone in the Treatment of Autistic Disorder.

Introduction: This study was aimed to compare the efficacy and side effects of memantine, an antagonist of the NMDA receptor of glutamate, with risperidone given the fact that glutamate has been noted for its possible effects in the pathogenesis of autism. Risperidone, an atypical antipsychotic, has been approved by FDA for the management of irritability associated with autism. Methods: 30 children, aged 4-17 years, entered an 8-week, randomized trial. Patients were randomly assigned to receive either risperidone or memantine. Autism Behavior Checklist (ABC), Childhood Autism Rating Scale (CARS), Clinical Global Impressions - Improvement (CGI-I) and Clinical Global Impression-Severity (CGI-S) scales were used to assess behavioral symptoms of the patients. Results: Both risperidone and memantine reduced the scores of 4 subscales of ABC as well as the 10-item and the total score of CARS significantly. However, differences between the 2 drugs in the scores of each evaluating scale were not found to be significant. Relatively, larger number of patients on risperidone showed "very much improvement" when assessed by CGI-I scale when compared with those on memantine. Discussion and conclusion: The present study suggests that memantine may have beneficial effects in the treatment of many core symptoms of autism. Therefore, memantine may be considered as a potential medication in the treatment of those autistic children who do not respond or cannot tolerate side effects of risperidone.

A Comparison Between Quetiapine and Aripiprazole for Treatment of Schizophrenia: A Double Blind Contrast

Objective: Schizophrenia is usually characterized by abnormal social behavior, lack of insight, and positive and negative symptoms. While there is increasing evidence that atypical antipsychotics have advantages over conventional ones, few long-term studies have directly compared the atypical antipsychotics with each other. Therefore, in the present assessment, the efficacy and safety of aripiprazole had been compared with quetiapine. Method: 50 schizophrenic patients entered into two comparable groups for participation in a twelve-week, double-blind study, for random assignment to quetiapine or aripiprazole. The main outcome scales included the Scale for Assessment of Negative Symptoms (SANS) and the Scale for Assessment of Positive Symptoms (SAPS). Also, the Clinical Global Impressions-Severity Scale (CGI-S), the Simpson Angus Scale (SAS), and finally the schedule for Assessment of Insight (SAI) had been used as the auxiliary ones. Results: While both of aripiprazole and quetiapine demonstrated important efficacy in alleviation of positive symptoms (p<0. 04 & p<0. 01, respectively), their efficacy was not so with respect to negative cluster of symptoms (p<0. 07 & p<0.06, respectively). CGI-S and SAI, as well, revealed significant improvement with aripiprazole (p<0.05 & p<0.05, respectively) and quetiapine (p<0.05 & p<0. 04, respectively) at the end of the assessment. In contrast, in neither of groups any significant increase in SAS was detectible. Conclusion: Based on the outcomes of the current study, no significant difference was evident between aripiprazole and quetiapine regarding improvement of positive and negative symptoms of schizophrenia. Keywords: Aripiprazole, dopamine, quetiapine, schizophrenia, second generation antipsychotics, serotonin.

Adjunctive Depot Antipsychotic in Treatment-Resistant Schizophrenia

Objectives: Since according to some studies, atypical antipsychotics were connected with better results and lesser adverse effects in comparison with conventional ones, at the present time the later kind of medications are the preferred category of antipsychotics in clinical management of schizophrenia. But such a maneuver has not decreased hitherto the dilemma of treatment —resistance. The objective of the present assessment included evaluation of the effectiveness of adjunctive flupentixol decanoate in schizophrenic patient, who had responded inadequately to aripiprazole. Method: 24 male inpatients with diagnosis of schizophrenia, who had displayed poor response to aripiprazole, were entered into an eight-week, single-blind evaluation for random assignment to current antipsychotic treatment (aripiprazole) or aripiprazole plus adjunctive flupentixol decanoate. While the Scale for Assessment of Negative Symptoms (SANS) and the Scale for Assessment of Positive Symptoms (SAPS) were used as the primary outcome measures, the Clinical Global Impressions-Severity Scale (CGI-S), the Schedule for Assessment of Insight (SAI), and finally the Simpson-Angus Scale (SAS) were used as ancillary measures. Results: According to the results, while the mean total scores of CGI-S, SAI and SAPS in the augmented group dropped significantly in comparison with the aripiprazole group (p<0.007, p<0.03, p<0.001, respectively), with around 19.55% decrement of SAPS in the augmented group, the reduction in the mean total score of SANS was not significant in between -group analysis (P<0. 07). In addition, the mean total score of SAS was meaningfully improved in the target group (P< 0. 0000). The effect size (ES) analysis also revealed a great improvement with flupentixol augmentation regarding SAPS, SAI and CGI-S. Conclusion: While occurrence of extra-pyramidal adverse effects should not be overlooked by clinicians, addition of flupentixol decanoate to aripiprazole can be helpful for a number of poorly responsive schizophrenic patients. Keywords: Aripiprazole, extra-pyramidal, flupenthixol decanoate, poor response, treatment resistant, schizophrenia.

The Efficacy and Safety of Clonazepam in Patients with Anxiety Disorder Taking Newer Antidepressants: A Multicenter Naturalistic Study.

ObjectiveThis study compared the efficacy and tolerability of clonazepam with other benzodiazepines in patients with anxiety disorders.MethodsInclusion criteria were as follows: age >20 years, diagnosis of anxiety disorder according to the Diagnostic and Statistical Manual of Mental Disorders 4th edition, text revision (DSM-IV-TR) criteria, taking only one type of antidepressant, and prescribed one of three oral benzodiazepines (alprazolam, clonazepam, or lorazepam). At baseline and week 6, clinical benefit was evaluated using the Clinical Global Impression-Severity Scale (CGI-S), Clinical Global Impression-Anxiety Scale (CGI-anxiety), and Clinical Global Impression-Sleep Scale (CGI-sleep).ResultsAmong 180 patients, no differences in demographic characteristics among the three benzodiazepine groups were noted. After six weeks of treatment, all benzodiazepine groups showed significant improvements in CGI-S, CGI-anxiety, and CGI-sleep scores (p<0.001). There were no differences in mean changes in CGI-S, CGI-anxiety and CGI-sleep among the three benzodiazepine groups. The incidence of side effects was significantly lower in the clonazepam group than with the other benzodiazepines. The incidences of adverse events for the clonazepam, alprazolam, and lorazepam groups were 26.7% (n=20), 48.4% (n=31), and 43.9% (n=18), respectively.ConclusionThe present study suggests that clonazepam is as efficacious as other benzodiazepines for the treatment of various anxiety disorders. Furthermore, the safety profile of clonazepam was superior to the other benzodiazepines in this study.

Adjunctive Low-frequency Repetitive Transcranial Magnetic Stimulation over the Right Dorsolateral Prefrontal Cortex in Patients with Treatment-resistant Obsessive-compulsive Disorder: A Randomized Controlled Trial.

ObjectiveThe present study aimed to evaluate the efficacy of low frequency (LF) repetitive transcranial magnetic stimulation (rTMS) over the right dorsolateral prefrontal cortex (DLPFC) for the treatment of obsessive-compulsive disorder (OCD).MethodsTwenty-seven patients with treatment resistant OCD were randomly assigned to 3 week either active (n=14) or sham (n=13) rTMS. The active rTMS parameters consisted of 1 Hz, 20-minute trains (1,200 pulses/day) at 100% of the resting motor threshold (MT). OCD symptoms, mood, and anxiety were assessed at baseline and every week throughout the treatment period.ResultsA repeated-measures analysis of variance (ANOVA) was used to evaluate changes on the Yale-Brown Obsessive Compulsive Scale (YBOCS). Our results revealed a significant reduction in YBOCS scores in the active group compared with the sham group after 3 weeks. Similarly, a repeated-measures ANOVA revealed significant effect of time and time×group interaction on scores on the Hamilton Depression Rating Scale and the Clinical Global Impression-Severity scale. There were no reports of any serious adverse effects following the active and sham rTMS treatments.ConclusionLF rTMS over the right DLPFC appeared to be superior to sham rTMS for relieving OCD symptoms and depression in patients with treatment-resistant OCD. Further trials with larger sample sizes should be conducted to confirm the present findings.

Traumatismes et résiliences chez les enfants de 3 à 6 ans dans trois quartiers de Port-au-Prince après le séisme de 2010 en Haïti

The paper describes an action research for indicative assessment of psychological problems of young children following the 2010 earthquake in Haiti, and the interest of using the Creole version of the questionnaire PSYCa 3-6. The survey took place in Port-au-Prince, and the evaluators were trained to a proper standardized administration of the questionnaire. BackgroundThe mental health needs of young children in natural disaster contexts often remain unaddressed. The lack of a rapid and simple tool for screening combined with few mental health professionals available to accurately diagnose and provide appropriate care mean that young children remain without care. Here, we present the results of psychological screening of young children aged 3 to 6 using the questionnaire PSYCa 3-6. MethodsThis study was conducted in Port-au-Prince, Haiti. The scale was translated into Haitian Creole using corroboration of independent translations and submitted twice to the parents at home, at the end of 2011 and again at the beginning of 2013. At the first stage 166 children 3 to 6 years old were included 49 of whom were included at the second stage. The results and diagnostic properties were assessed comparing the PSYCa 3-6 to the Clinical Global Impression Severity Scale as the gold standard. ResultsBoys were more prone to psychological disturbances than girls. The size and position among the siblings increased the score of psychological disturbance. The neighborhood and the perception of environmental violence had a significant impact on the score of psychological disturbance. The significant improvement in scores between the two examinations showed moderate resiliency whose main factors seemed to be the social support received by the family, the rapid return to school, faith and religious practice.

Psychometric properties of the Overall Anxiety Severity and Impairment Scale (OASIS) among psychiatric outpatients

BackgroundThe Overall Anxiety Severity and Impairment Scale (OASIS) is a brief, transdiagnostic measure used to assess anxiety severity and related interference. The OASIS has demonstrated strong psychometric properties in previous investigations, however, it has yet to be validated using a transdiagnostic clinician-rated measure. MethodsWe evaluated the factor structure, convergent and discriminant validity, and illness severity cut-scores of the OASIS in a sample of outpatients (N=202). ResultsA confirmatory factor analysis indicated an unidimensional structure provided the best fit. The OASIS demonstrated good convergent validity and internal consistency. Using the Clinical Global Impression-Severity Scale (CGI-S), ROC curves showed OASIS scores of 6, 10 and 12 to indicate moderate, marked and severe illness severity, respectively. ConclusionsThe OASIS is a unidimensional self-report measure with good convergent validity and data from the current study provide illness severity cut-scores.