Clinician-Rated Dimensions Of Psychosis Symptom Severity Research Articles

The Impact of Long-acting Paliperidone in Reducing Hospitalizations and Clinical Severity in Recent Onset Schizophrenia: A Mirror-image Study in Real-world Clinical Setting.

ObjectiveSchizophrenia is a debilitating disease that disrupts the lives of many affected individuals and exerts a toll on the health system. Only few studies assessed once-monthly injectable formulation of paliperidone palmitate (PP-1M) and other long-acting antipsychotics in recent onset schizophrenia (ROS). To evaluate whether PP-1M is efficacious in reducing frequency and length of hospitalizations and psychosis symptom severity in patients with ROS.MethodsThis mirror-image study included 112 patients, suffering from ROS admitted in a psychiatric ward and successively treated with PP-1M for 1-year. Other psychotic disorders were excluded. We collected socio-demographic data of all subjects included, number and days of hospitalization, as well as Clinical Global Impression-Severity scale (CGI-S) and Clinician-Rated Dimensions of Psychosis Symptom Severity (CRDPSS) scores at the initiation and after 1-year of PP treatment.ResultsAfter 1-year PP-1M treatment, mean scores of both CGI and CRDPSS significantly decreased (p < 0.001), as well as the mean number of hospitalizations (p = 0.002) and total hospitalization days (p < 0.001) in comparison with those of the previous year.ConclusionOur results suggest that PP-1M can be considered as an important therapeutic option in patients with ROS. Its use led to a meaningful reduction in the patient’s use of hospital services, as well as a significant clinical improvement of psychotic symptoms in our sample.

The factor structure and clinical utility of clinician-rated dimensions of psychosis symptom severity in patients with recent-onset psychosis: Results of a 1-year longitudinal follow-up prospective cohort study

The classic subtype classification of schizophrenia has been removed, and DSM-5 now includes the Clinician-Rated Dimensions of Psychosis Symptom Severity (CRDPSS). In the present study, a factor analysis of the CRDPSS was performed, and we assessed whether patient classification using the derived factor structure helps predict the clinical course. The participants were 390 patients with recent-onset psychosis enrolled in the Korean Early Psychosis Cohort Study (KEPS). Two factors were identified: psychotic (including delusions, hallucinations, disorganization, and abnormal psychomotor behavior) and negative-cognitive (including negative symptoms and impaired cognition). Patients were grouped based on the factor structure and changes in clinical course were monitored over 1 year. The negative-cognitive group demonstrated longer duration of untreated psychosis, earlier onset, and a higher rate of psychiatric comorbidities. Baseline Positive and Negative Syndrome Scale (PANSS) total and Clinical Global Impression-Severity (CGI-S) scores were higher in psychotic group, but group differences were not observed after 2 months. Conversely, the PANSS negative scale score was significantly higher in negative-cognitive group throughout follow-up, and CGI-S score was reversed at 12 months. The findings indicate that the factor structure derived herein for the CRDPSS could be helpful for predicting the clinical course of recent-onset psychosis patients.

Effects of aripiprazole long-acting injectable antipsychotic on hospitalization in recent-onset schizophrenia.

Recent-onset schizophrenia (ROS) represents a critical period that can greatly influence the clinical course of schizophrenia. The use of long-acting injectable antipsychotics (LAIs) in this period is increasingly being considered as a first-line treatment option. Aripiprazole LAI (ALAI) is the newest of all LAI's available on the market, with limited data on its effects on hospitalization rates after first episode of schizophrenia. It was our goal to evaluate whether ALAI has an effect on hospitalization rates, number of bed days and clinical improvement in patients with ROS. This mirror-image study included 138 inpatients suffering from schizophrenia. We collected sociodemographic data on all individuals, number of hospitalization days, hospitalization rates as well as Clinical Global Impression Scale-severity of illness (CGI-S) and Clinician-Rated Dimensions of Psychosis Symptom Severity (CRDPSS) scores at the initiation of ALAI and at the end of a 1 year follow up. Mean number of hospitalizations and hospitalization days in the year after starting ALAI significantly decreased compared to the year before (p = 0.005 and p < 0.001). Mean scores on both CGI and CRDPSS also significantly decreased after initiating ALAI (p < 0.001). Results suggest that ALAI is an important therapeutic option in patients with ROS. It leads to reduced usage of hospital services, potentially reducing the socio-economic healthcare burden.

Exploration of symptom dimensions and duration of untreated psychosis within a staging model of schizophrenia spectrum disorders.

AimClinical staging of schizophrenia entails a new method that identifies clusters of symptoms and variation in level of remission, with the goal to create a framework for early intervention. Additionally, duration of untreated psychosis (DUP) may influence symptom severity in the first episode of psychosis (FEP) and could necessitate refining of the staging model. However, consistent evidence concerning variation in symptom severity and DUP between stages is missing. Therefore, we evaluated the clinical validity of the staging model by investigating differences in symptom severity across stages in schizophrenia spectrum disorders. Second, we assessed if a prolonged DUP is associated with higher symptom severity in FEP.MethodsWe performed a cross‐sectional study of 291 acutely admitted patients with a schizophrenia spectrum disorder. Patients were assigned to clinical stages following the definition of McGorry. Symptom severity was evaluated with the new DSM‐5 Clinician‐Rated Dimensions of Psychosis Symptom Severity (CRDPSS). In FEP, we determined the DUP.ResultsSignificantly higher severity scores of CRDPSS items hallucinations (H = 14.34, df = 4, P‐value = .006), negative symptoms (H = 19.678, df = 4, P‐value = .001) and impaired cognition (H = 26.294, df = 4, P‐value = <.001) were found in more advanced stages of disease. Moreover, patients with FEP and a DUP longer than 1 year showed significantly more severe negative symptoms (U = 314 000, P = .015) compared to patients with a DUP shorter than 1 year.ConclusionsThe present study found supporting evidence for the clinical validity of the staging model in schizophrenia spectrum disorders. In addition, we found support for refining the stage “first episode” with information concerning the DUP.

M95. DSM-5 CLINICIAN-RATED DIMENSIONS OF PSYCHOSIS SYMPTOM SEVERITY: PSYCHOMETRIC PROPERTIES

BackgroundIn DSM-5, a number of “emerging measures” are included for further research and clinical evaluation. These patient assessment measures were developed to be administered at the initial patient interview and to monitor treatment progress. One of these instruments is the Clinician-Rated Dimensions of Psychosis Symptom Severity (CRDPSS). Using this instrument, a clinician can rate the severity of eight symptom dimensions of psychotic disorders. The psychometric properties and the applicability of the instrument in clinical practice have not yet been investigated. The current study aims to investigate the internal consistency, factor structure and external validity with other assessment instruments.MethodsThe CRDPSS measures eight symptom dimensions, namely Hallucinations, Delusions, Disorganized speech, Abnormal psychomotor behavior, Negative Symptoms, Impaired Cognition, Depression and Mania. Items are scored on a five-point scale ranging from “Not present” to “Present and Severe”. This interview has been applied in the Psychosis Recent Onset GRoningen Survey (PROGR-S), a diagnostic protocol for patients with a suspected recent-onset psychotic disorder (n = 164 in the current analysis). Besides the CRDPSS, scores on the Positive and Negative Syndrome Scale (PANSS), Health of Nations Outcome Measure (HoNOS), the Mongomery Asberg Depression Rating Scale (MADRS), Cambridge Cambridge Neuropsychological Test Automated Battery (CANTAB) and mini-Structural Clinical Assessment in Neuropsychiatry (mini-SCAN) were used for current analyses. The Crohnbach Alpha was calculated to investigate internal consistency, exploratory factor analysis was applied, and the convergent validity was investigated by calculating non-parametric correlations of the CRDPSS with similar items or subscales of the other instruments.ResultsThe Cronbach’s alpha of the CRDPSS was 0.36, indicating low internal consistency. Factor analysis resulted in three Factors: 1. Delusions/Mania, 2. Abnormal psychomotor behavior/Negative Symptoms/Impaired cognition, 3. Hallucinations/Depression. For hallucinations, Delusions, and Depression a Kendall’s tau of 0.35 – 0.45 was observed with the other instrument scores and for Impaired cognition tau = 0.6, indicating a weak to moderate association. Negative symptoms resulted in tau < 0.2 and for the other instruments tau < 0.1, but in these cases the measure of the other instruments was of questionable quality.DiscussionThe internal consistency of the CRDPSS was poor and factor analysis resulted in factors that differed to some extent from previous findings. Moreover, the convergent validity with other instruments was poor to moderate. In conclusion, based on first analyses the reliability and clinical applicability of the CRDPSS appears limited. Future studies should investigate inter-rater reliability, test-retest reliability, use more optimal measures to investigate convergent validity and use larger samples.

Psychometric properties of the DSM-5 Clinician-Rated Dimensions of Psychosis Symptom Severity

ObjectiveThe Clinician-Rated Dimensions of Psychosis Symptom Severity (CRDPSS) was presented in the DSM-5 as a new scale to assess the dimensional aspects of psychosis in daily clinical practice. However, agreement in CRDPSS-ratings among raters in clinical practice remains unknown. We examined the inter-rater reliability (IRR) and convergent validity of the CRDPSS. MethodConsecutively recruited outpatients with recent onset schizophrenia spectrum disorders were included between January 2015 and July 2018. We collected multiple CRDPSS measurements of 335 participants, of whom 179 PANSS measurements were available. IRR was determined by comparing the CRDPSS-ratings of psychiatrists with a vis-à-vis contact and CRDPSS observations based on a detailed clinical presentation. IRR was expressed in Krippendorff's alpha and we estimated convergent validity by studying associations with PANSS factors by Spearman's rank correlation coefficient. ResultsInter-rater reliability scores measured in Krippendorff's alpha were low (0.35–0.64) for all items of the CRDPSS, except the item delusions (0.74). A three-factor model was found: ‘deficit/motor symptoms’, ‘positive symptoms’ and ‘mood symptoms’. Positive associations between CRDPSS factors with PANSS factors were found. ConclusionThis study demonstrated that the IRR of the CRDPSS between raters in clinical practice was insufficient. We did find some supporting evidence for convergent validity of the CRDPSS, but these results should be interpreted carefully due to low IRR. Consequently, general implementation in clinical practice should be done with caution and we recommend assessors to be trained.

Problematic smartphone use and related factors in young patients with schizophrenia.

The present study aimed to examine smartphone use in young patients with schizophrenia and to explore factors that may affect the severity of problematic smartphone use. A total of 148 schizophrenia patients aged 18 to 35years completed self-administered questionnaires exploring sociodemographic characteristics; Smartphone Addiction Scale (SAS), the Big Five Inventory-10 (BFI-10), the Hospital Anxiety and Depression Scale (HADS), the Perceived Stress Scale (PSS), and the Rosenberg Self-Esteem Scale (RSES). All were also assessed using the Clinician-Rated Dimensions of Psychosis Symptom Severity (CRDPSS) Scale and the Personal and Social Performance (PSP) Scale. The mean subject age was 27.5±4.5years. No significant differences in the SAS scores occurred between gender, jobs, and level of education. The Pearson r-correlation test showed that the SAS scores were significantly positively correlated with HADS anxiety, PSS, and BFI-10 neuroticism scores; it was negatively correlated with RSES, BFI-10 agreeableness, and conscientiousness scores. In the stepwise linear regression analysis, the severity of PSU was significantly associated with both high anxiety and low agreeableness. Our results suggest that specific groups of patients with schizophrenia may require special care to prevent problematic smartphone use.

Contribution of stress and coping strategies to problematic Internet use in patients with schizophrenia spectrum disorders

IntroductionInternet use is already high and increasing rapidly among people with psychotic disorders, but there have been few studies on problematic Internet use (PIU) among patients with schizophrenia spectrum disorders. This study aimed to measure the prevalence of PIU and identify the factors associated with PIU among patients with schizophrenia spectrum disorders. MethodsA cross-sectional survey was performed that included 368 outpatients with schizophrenia spectrum disorders: 317 with schizophrenia, 22 with schizoaffective disorder, 9 with schizophreniform disorder, and 20 with other schizophrenia spectrum and psychotic disorders. The severity of psychotic symptoms and levels of personal and social functioning were assessed by the Clinician-rated Dimensions of Psychosis Symptom Severity (CRDPSS) scale and the Personal and Social Performance (PSP) scale, respectively. PIU was evaluated using Young's Internet Addiction Test (IAT). Additionally, the Hospital Anxiety and Depression Scale (HADS), Perceived Stress Scale (PSS), Rosenberg Selfesteem Scale (RSES), and Brief Coping Orientation to Problems Experienced (COPE) Inventory were administered. ResultsPIU was identified in 81 (22.0%) of the 368 patients with schizophrenia spectrum disorders. Subjects with PIU were significantly younger and more likely to be male. Scores on the HADS, PSS, and dysfunctional coping dimension of the Brief COPE Inventory were significantly higher, and RSES scores were significantly lower, in the PIU group. Logistic regression analysis indicated that PIU in patients was significantly associated with scores on the PSS and dysfunctional coping dimension of the Brief COPE Inventory. ConclusionsPatients with schizophrenia spectrum disorders and PIU were significantly more likely to have high levels of perceived stress and dysfunctional coping strategies. Patients with schizophrenia spectrum disorders who also engage in PIU may benefit from interventions that help them to develop appropriate skills for coping with stress.

S110. THE CLINICAL IMPLICATION OF CLINICIAN-RATED DIMENSIONS OF PSYCHOSIS SYMPTOM SEVERITY (CRDPSS) FOR DIAGNOSIS BY DSM-5

BackgroundThe most recently published the 5th edition of the DSM proposed a dimensional approach with continuous of schizophrenia and other psychoses. The newly proposed Clinician-Rated Dimensions of Psychosis Symptom Severity (CRDPSS) in the DSM was recommended to be evaluated in all disorders with psychotic symptoms in eight dimensions; Hallucinations, Delusions, Disorganized speech, Abnormal psychomotor behavior, Negative symptoms, Impaired cognition, Depression, Mania. The purpose of this study is to examine if Clinician-Rated Dimensions of Psychosis Symptom Severity (CRDPSS) can usefully be used for the Non-Affective Psychoses (NP) and Affective Psychoses (AP).MethodsParticipants in the study were 175 diagnosed with Schizophrenia, or Schizophreniform Disorder, Schizoaffective Disorder, mood disorder with psychotic symptoms (Major Depressive Disorder, Bipolar Disorder) based on DSM-5 diagnostic criteria and were assigned to either the NP (n = 154) or AP (n = 21) group. CRDPSS was performed jointly by a psychiatrist and a psychiatric resident to assess the severity of the psychotic symptoms of all the participants. And WHO Disability Assessment Schedule 2.0 (WHODAS 2.0) was responded to all participants. Independent T-test was conducted to determine whether there was a difference in CRDPSS profile and WHODAS 2.0 scores between the two groups. In addition, a linear discriminant analysis was performed to determine whether the CRDPSS profile can discriminate between the two groups.ResultsDemographics and WHODAS 2.0 had no statistically significant differences between the two groups. On the other hand, Patients in the NP group had higher Hallucination (p < .05) and Negative symptoms (p < .001), however, lower Mania (p < .001). As a result of constructing a linear discriminant function for NP and AP, the correct classification rate of CRDPSS to discriminate between two groups was 84%.DiscussionThe results of this study are the first to distinct effectively that Non-Affective psychoses and Affective psychoses by CRDPSS profile. There was no difference in the level of functional disability between groups NP and AP, but only CRDPSS profile could discriminate both groups. Hallucinations, Negative symptoms, and Mania were the major contributors to the distinction between the two groups. This is consistent with the previous studies that these are important in distinguishing Schizophrenia and Bipolar Disorder from each other. CRDPSS provides a new perspective that can be viewed from an integrated perspective, the NP and AP. Regarding the result of this study that it is more important to identify the score profile than the combined score of CRDPSS, because patients exhibit very heterogeneous profile of symptoms.

F95. ASSESSING MANIC SYMPTOMS IN PATIENTS WITH SCHIZOPHRENIA USING THE YOUNG MANIA RATING SCALE

BackgroundVan Os and Kapur have proposed that the discrete categorical dichotomy of schizophrenia versus bipolar disorder be changed to a dimensional conceptualization. It is also known that manic symptoms can contribute to the clinical course and prognosis of schizophrenia. Hence, a domain for mania has been included in the Clinician-Rated Dimensions of Psychosis Symptom Severity (CRDPSS) in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5). However, the psychometric properties of the Young Mania Rating Scale (YMRS) have been little studied in subjects with schizophrenia.MethodsOne hundred and sixty-six inpatients with schizophrenia (diagnosed with DSM-5,2 age ≥ 18 years and ≤ 65 years, and length of hospital stay ≥ 2 weeks) were enrolled from two mental hospitals in Korea. The Institutional Review Board approved the study protocol, and informed consent was given by all study subjects before the start of the study. The Korean version of the YMRS was used to evaluate the severity of manic symptoms. In addition, the domain for mania in the CRDPSS was used to evaluate presence or absence of manic symptoms (0–1, absence; 2–4, presence).ResultsThe average age and age-at-onset of the subjects were 46.5 (SD = 11.2) and 25.2 (SD = 13.2) years, respectively. Half were men (51.5%), and most were unmarried (79.1%), religiously affiliated (61.5%) and educated below high school graduate level (73.0%). The mean chlorpromazine equivalent dose of prescribed antipsychotics was 921.1 (SD = 952.0) mg. The mean total score on the YMRS was 7.3 (SD = 6.9) and the mean item scores were: 0.2 (SD = 0.4) for elevated mood, 0.1 (SD = 0.4) for increased motor activity, 0.1 (SD = 0.4) for sexual interest, 0.1 (SD = 0.4) for sleep, 0.4 (SD = 0.8) for irritability, 0.6 (SD = 1.2) for speech, 0.8 (SD = 1.1) for language, 2.0 (SD = 3.3) for content, 0.2 (SD = 0.7) for aggressive behavior, 1.0 (SD = 1.0) for appearance, and 1.8 (SD = 1.7) for insight. The Cronbach α for the 11 YMRS items was 0.66, which is considered an acceptable level of internal consistency. Moreover, only 4% (n = 7) of the 166 subjects had manic symptoms as assessed by the mania domain in the CRDPSS. A receiver operating characteristic curve (ROC) showed that the optimal cut-off score distinguishing schizophrenia patients with and without manic symptoms was 10 with a sensitivity of 88.3% and specificity of 75.6% (area under curve = 0.803, P = 0.012).DiscussionSince a 10 point total score on the YMRS represents a mild level of Clinical Global Impression (CGI) severity of mania, we may conclude that our threshold on the YMRS for identifying manic symptoms in patients with schizophrenia is reasonable. Hence it may be useful to investigate the evaluation of manic symptoms in patients with schizophrenia from the perspective of deconstructing psychoses.

Religiosity in Acute Psychiatric Inpatients: Relationship With Demographics, Clinical Features, and Length of Stay.

This study examined the relationship between religiosity in 175 psychiatric inpatients as measured by the subscales of the Duke University Religion Index (DUREL) and sociodemographic (age, sex, and race), clinical (primary diagnosis, suicidality, and psychotic symptoms), and outcome (length of stay [LOS] and readmission rates) measures. Psychosis was assessed by Clinician-Rated Dimensions of Psychosis Symptom Severity (CRDPSS) scale. Bivariate and multivariate analyses were used to examine the association between the DUREL subscales and the outcome measures. High scorers on the nonorganized religiosity subscale were less likely to have psychosis (47% vs. 52%; p < 0.05) but had greater psychosis severity (mean ± SD, 14.5 ± 5 vs.12.4 ± 6; p < 0.05), as measured by the CRDPSS scale, and significantly longer LOS (mean ± SD, 8.3 ± 3.8 vs. 6.9 ± 3.4; p < 0.05). Conversely, they were less likely to report previous suicide attempts than low scorers (p < 0.05). These results suggest that a brief measure of religious activities may identify psychiatric inpatients at greater risk for psychosis, suicidality, and longer hospitalizations.

Using the Young Mania Rating Scale for Identifying Manic Symptoms in Patients with Schizophrenia.

Dear Editor: Van Os and Kapur1 have proposed that the discrete categorical dichotomy of schizophrenia versus bipolar disorder should be changed to a dimensional conceptualization. It is also known that manic symptoms can contribute to the clinical course and prognosis of schizophrenia. Hence, a domain for mania has been included in the Clinician-Rated Dimensions of Psychosis Symptom Severity (CRDPSS) in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5).2,3 However, the psychometric properties of the Young Mania Rating Scale (YMRS) have little been studied in subjects with schizophrenia. As described elsewhere,4 166 inpatients with schizophrenia (diagnosed with DSM-5,2 age ≥18 years and ≤65 years, and length of hospital stay ≥2 weeks) were enrolled from two mental hospitals in Korea. The Institutional Review Board of Yong-In Mental Hospital (receipt number: 2013-49) approved the study protocol, and informed consent was given by all study subjects before the start of the study. The Korean version of the YMRS was used to evaluate the severity of manic symptoms,5 and the domain for mania in the CRDPSS was used to evaluate presence or absence of manic symptoms (0–1, absence; 2–4, presence).3 The average age and age-at-onset of the subjects were 46.5 (SD=11.2) and 25.2 (SD=13.2) years, respectively. Half were men (51.5%), and most were unmarried (79.1%), religiously affiliated (61.5%) and educated below high school graduate level (73.0%). The mean chlorpromazine equivalent dose of prescribed antipsychotics was 921.1 (SD=952.0) mg. The mean total score on the YMRS was 7.3 (SD=6.9) and the mean item scores were: 0.2 (SD=0.4) for elevated mood, 0.1 (SD=0.4) for increased motor activity, 0.1 (SD=0.4) for sexual interest, 0.1 (SD=0.4) for sleep, 0.4 (SD=0.8) for irritability, 0.6 (SD=1.2) for speech, 0.8 (SD=1.1) for language, 2.0 (SD=3.3) for content, 0.2 (SD=0.7) for aggressive behavior, 1.0 (SD=1.0) for appearance, and 1.8 (SD=1.7) for insight. The Cronbach α for the 11 YMRS items was 0.66, which is considered as an acceptable level of internal consistency. Moreover, only 4% (n=7) of the 166 subjects had manic symptoms as assessed by the mania domain in the CRDPSS. As shown in Fig. 1, a receiver operating characteristic curve showed that the optimal cut-off score distinguishing schizophrenia patients with and without manic symptoms was 10 with a sensitivity of 88.3% and specificity of 75.6% (area under curve=0.803, p=0.012). Fig. 1 Receiver operating characteristic curve for total score on the Young Mania Rating Scale in schizophrenia patients with and without manic symptoms (cut-off=10, sensitivity=88.3%, specificity=75.6%) Since a 10 point total score on the YMRS represents a mild level of Clinical Global Impression severity of mania,6 we may conclude that our threshold on the YMRS for identifying manic symptoms in patients with schizophrenia is reasonable. Hence, it may be useful to evaluate manic symptoms in patients with schizophrenia from the perspective of deconstructing psychoses.