Intensity Of Negative Symptoms Research Articles

Leki przeciwpsychotyczne II generacji w terapii objawów negatywnych schizofrenii

Farmakoterapia schizofrenii jest trudnym i złożonym procesem, szczególnie w kontekście objawów negatywnych. Konieczne jest właściwe rozpoznanie grup pacjentów, a w szczególności indywidualnych pacjentów ― w zależności czy objawy negatywne są pierwotne, czy wtórne, przeważające czy znaczące, czy też przeważające i przetrwałe. Piśmiennictwo dotyczące oceny skuteczności różnych leków przeciwpsychotycznych II generacji w leczeniu objawów negatywnych jest niejednorodne, a ocena objawów negatywnych, oparta na różnych metodologiach, dotyczy przede wszystkim różnorodnych grup pacjentów, którzy najprawdopodobniej w zróżnicowany sposób reagują na badane leki, w zależności od tego, czy wykazują znaczące, przeważające lub też przeważające i przetrwałe objawy negatywne. Dodatkowo zdecydowana większość badań dotyczy ogólnej populacji chorych na schizofrenię, wśród których oceniano między innymi nasilenie objawów negatywnych. W związku z tym ocena tych badań i ich porównanie między sobą jest praktycznie niemożliwe. Wybór leku przeciwpsychotycznego II generacji, który wykazywałby zdecydowaną przewagę nad innymi, jest również trudny. W ramach niniejszego opracowania wykonano przegląd literatury dotyczącej badań randomizowanych bezpośrednio porównujących kluczowe leki przeciwpsychotyczne II generacji stosowane w terapii objawów negatywnych. W większości analizowanych badań nie wykazano istotnych statystycznie różnic pomiędzy analizowanymi lekami (porównanie risperidonu, amisulprydu, arypiprazolu, olanzapiny pomiędzy sobą). Tylko w pojedynczych badaniach wykazano przewagę olanzapiny nad risperidonem w ocenie wpływu obu tych leków na objawy negatywne. Należy jednak podkreślić, że wyniki cechowały się ograniczoną wiarygodnością w zakresie możliwości wnioskowania o bezpośrednim wpływie leków na objawy negatywne. Przyczynę takiego stanu rzeczy należy upatrywać między innymi w tym, że w badaniach tych nie korygowano uzyskiwanych efektów o czynniki zakłócające, których wpływ na objawy negatywne został potwierdzony. Natomiast w grupie chorych z przeważającymi i przetrwałymi objawami negatywnymi stwierdza się przewagę kariprazyny nad risperidonem. Uzupełniająca analiza opracowań wtórnych dla analizowanych leków wykazała wyższą skuteczność leków II generacji nad lekami I generacji i placebo w różnych grupach pacjentów z objawami negatywnymi. Należy jednak podkreślić, że badania ze względu na swoją niejednorodność są trudne do porównania. Dodatkowym problemem, który pojawia się w kontekście badań klinicznych, a także codziennej praktyki, jest właściwa diagnoza i odróżnienie pierwotnych objawów negatywnych od wtórnych objawów negatywnych.

Cross-cultural adaptation, reliability, and content validity of the Brief Negative Symptom Scale (BNSS) for use in Brazil

Abstract Background The Brief Negative Symptom Scale (BNSS) assesses the presence and intensity of negative symptoms in schizophrenia. Objectives This study aimed to carry out the BNSS cross-cultural adaptation to the Brazilian Portuguese language and verify its content validity and reliability. Methods This is a methodological study that followed these steps: (1) implementation of the cross-cultural adaptation and translation protocol, (2) BNSS adapted content validation, and (3) reliability assessment. Six experts participated in the adaptation process. The sample consisted of 30 individuals diagnosed with schizophrenia and assisted at the Brazilian Psychosocial Care Center (CAPS), in Joao Pessoa, Paraiba, Brazil, which was the research setting. Results The cross-cultural adaptation was successful due to the values obtained for each aspect evaluated, such as semantic (0.922), idiomatic (0.910), experiential (0.961), and conceptual equivalence (0.974). The same happened with content validity regarding clarity of language (0.935), practical relevance (0.974), and theoretical relevance (0.948). Cronbach’s alpha coefficient was 0.884 for the entire instrument, and the items ranged from 0.865 to 0.882. Discussion The BNSS adaptation process has shown to be satisfactory for use in the Brazilian context, constituting a useful clinical tool for teaching and research.

Mindfulness improves psychological quality of life in community-based patients with severe mental health problems: A pilot randomized clinical trial

ObjectiveTo examine the effectiveness of group mindfulness-based intervention (MBI) in patients diagnosed with severe mental illness. The primary outcome was health-related psychological quality of life. Secondary measures were environmental, social and physical health related quality of life, frequency and intensity of psychotic symptoms and daily-life mindfulness. MethodForty-four patients from a public community rehabilitation center for people with severe mental illness were recruited, and randomly allocated to Integrated Rehabilitation Treatment (IRT) or IRT plus MBI. Measures included PANSS interview, WHOQOL-BREF, and Mindfulness Attention Awareness Scale. MBI comprised 26 one-hour weekly sessions. Intention-to-treat analysis was used. ResultsOne patient did not complete IRT+MBI and two did not complete IRT. At baseline there were no statistical group differences in demographic characteristics or primary and secondary outcomes. At post-treatment interaction between treatment and time in health-related psychological quality of life was statistically significant, and simple effect analysis showed significant differences for between and within subject factor in favor of MBI. Interaction was also significant in PANSS negative symptoms, simple effects showed a statistical trend in within subject factor. Time factor was significant in environmental and physical quality of life. ConclusionsData suggest mindfulness added to IRT may enhance psychological quality of life in people with severe mental illness from a public community center. Results also suggest that mindfulness may impact frequency and intensity of negative symptoms.

Correlates of Insight in Patients with Schizophrenia

Introduction Increasing evidence supports the important role of illness state and individual characteristics in insight among patients with schizophrenia (SCZ). Aim of the study To determine factors predicting the lack of insight among patients with SCZ. Methods It was a cross-sectional, descriptive and analytical study, involving 40 patients with DSM-IV diagnosis of SCZ followed in the outpatient psychiatry department at the Hedi Chaker University Hospital of Sfax inTunisia . The SAIQ (Self Appraisal of Illness Questionnaire) was used to measure 3 domains of insight (need for Treatment, Worry, and Presence/Outcome of Illness) and the PANSS (Positive and Negative Syndrome Scale) was used to measure the intensity of psychotic symptoms. Results The average age of our patients was 41 years (21-64 years). The mean duration of disease was 14 years and the number of hospitalization was 2.5. The scores of insight were independent from sociodemographic factors. The lack of insight in SAIQ was significantly correlated with a greater number of hospitalizations (p = 0.03). The worry subscale was associated with a longer duration of disease (p = 0.04) while the presence/outcome of illness subscale was associated with the intensity of negative symptoms (p = 0.03). There was no correlation between insight and positive syndrome. Conclusion Our results show that the lack of insight is closely related to negative symptoms and the duration of the illness in patients with SCZ. Therefore, interventions to better the insight should focus on early diagnosis and psychosocial therapy to improve negative symptoms.

Extrapyramidal symptoms during treatment of first schizophrenia episode: Results from EUFEST

The European First Episode Schizophrenia Trial (EUFEST) included first-episode schizophrenia patients, assessing the efficacy of five antipsychotic drugs (haloperidol, amisulpride, olanzapine, quetiapine and ziprasidone) over one year. Baseline frequency of extrapyramidal symptoms (EPS) in this group of patients (n=490) was as follows: parkinsonism 10.8%, akathisia 10.0%, dystonia 1.8%, and dyskinesia 0.6%. The frequency of parkinsonism at baseline was greater in patients with a brief prior exposure to antipsychotics (≤2 weeks) compared with antipsychotic-naïve ones, and was positively correlated with the intensity of negative symptoms and negatively with depressive symptoms. After one month of treatment, the increase of parkinsonism was highest in patients receiving haloperidol (+13%), that of akathisia in patients treated with ziprasidone (+14%), and 10.1% of the patients were taking anticholinergic drugs, most frequently in the haloperidol group (24%). In 291 patients remaining on treatment after one year, both parkinsonism and akathisia had decreased: the frequency of parkinsonism was 3%, highest in the haloperidol group (9.1%), that of akathisia was 3%, highest in the quetiapine group (7.5%), and 4% of patients were taking anticholinergic drugs, most frequently those receiving haloperidol (10.5%). The results obtained suggest that in first-episode schizophrenia patients during the first year of antipsychotic treatment (in this case amisulpride, haloperidol in low doses, olanzapine, quetiapine and ziprasidone), EPS were present as manageable clinical problems.

1027 – Interests of a program of physical activity in patients with schizophrenia: a pilot study

Compared to the general population, patients with schizophrenia have excess mortality linked to an increase of vascular cardio risk factors and a more sedentary lifestyle. Despite recent recommendations for physical activity, very few studies are devoted to the impact of this type of measurement in schizophrenic patients. We present a study comparing 12 patients with schizophrenia, sedentary, followed in day care hospital, benefiting from a program of physical activity (PAP) with a control group of 8 patients with schizophrenia, which follow standard activities. The PAP runs on 12 weeks 3 sessions structured, by week, for 45 minutes. In pre and post PAP, (V1 and V2), clinical (BMI, waist circumference (TT), blood pressure), biological (glucose, total cholesterol, HDL, LDL, triglycerides), psychiatric (PANSS) and physical evaluations were conducted. Patients, 15 men and 5 women, are aged 43,00 ± 9.00 years. Compared with controls, the PAP show a significant reduction in weight (p = 0. 001), BMI (p = 0. 006) and TT (p = 0. 002). A significant decrease in the intensity of negative symptoms have been tested between control and PAP group. A significant increase in aerobic capacity, muscular strength of lower limbs and flexibility was tested PAP and control. Attendance to the PAP, on the set of sessions in summer of 100%. These results are in favour of developping physical activity for its effect on biological and clinical factors; this exploratory study has to be tested in a more straight methodology with a larger number of patients.

P02-66 - General approach to forensic evaluation of different forms of schizotypal disorders

BackgroundSchizotypal disorder comprises a wide spectrum of schizophrenic disorders from personality to sub-psychotic disorders. As a result, psychiatric evaluation of this psychopathology is ambiguous and a challenge to forensic psychiatry.AimsThe aim of study was to define criteria for forensic evaluation of schizotypal disorder according the form of disease by examining 82 patients who committed crimes and who had been diagnosed “schizotypal personality disorder”(12), “schizotypal disorder” (pseudopsychopatic (38), pseudoneurotic (13), schizophrenia with bare symptoms (16), schizophrenic reaction (3)ResultsThere was evidence of different forms of schizotypal disorders related to the degree of responsibility for the crime committed (9 patients with schizotypal personality disorders) compared with (46 patients with mild forms of schizophrenia) considered not responsible. The sample of patients were considered as having diminished responsibility (27 patients with different forms of mild schizophrenia). The criteria for psychiatric evaluation were: intensity of negative symptoms, quasi-psychotic symptoms during period of crime, dynamic aspects of disease, connection between psychopathology and character, motives, causes of crime, level of critical and prognostic abilities, intensity of personality disorders, level of social function and adjustment.ConclusionForensic conclusion depends on the form of schyzotypal disorder. The patients with schizoptypal personality disorder demonstrate integrity of cognitive sphere and singularity of emotions, rather high level of social adjustment. That's why the are mostly considered as responsible. The patients with mild forms of schizophrenia show pathology in sphere of thinking and emotions, social problems, so forensic conclusion can be different from irresponsibility to diminished responsibility.

Cognitive and Physiological Determinants of Symptom Perception and Interpretation

The purpose of the current study was to test the aspects of MacGregor and Fleming's model of symptom reporting and illness interpretation. Participants were randomly assigned to cognitive cue (Chemical or No Chemical), sensory cue (Odor or No Odor), and somatic arousal (Exercise or No Exercise) conditions. The findings suggested that although somatic arousal primarily determines whether one experiences symptoms, and expectations—or one's mental model—determine the nature of the attribution regarding the cause of the symptoms, it appears that both the attribution about the cause of the symptoms and the amount of somatic arousal experienced combine to produce the intensity of negative symptoms.

Negative symptoms of schizophrenia could explain discrepant data on the association between the 5-HT 2A receptor gene and response to antipsychotics

Pharmacogenetic studies assessing the role of 5-HT 2A receptor gene in antipsychotic efficacy yielded conflicting data. Phenotypical heterogeneity of schizophrenia might explain such discrepancies. For example, negative symptoms are known to reflect severity of illness and to restrain therapeutic response. On this basis, we re-assessed the possible influence of the −1438A/G polymorphism of the 5-HT 2A receptor gene on the clinical efficacy of atypical antipsychotics with focus on several relevant dimensions. One hundred and sixteen French schizophrenic subjects treated for at least 1 month by atypical antipsychotics were screened for treatment response according to the May and Dencker scale. Gender, age at onset, duration and severity of illness, intensity of negative and positive symptoms at discharge were investigated. The intensity of negative symptoms at discharge was the only variable explaining May and Dencker score ( p < 0.001), and was significantly associated with the AA genotype of the −1438A/G polymorphism of the 5-HT 2A receptor gene ( p = 0.03). However, the A allele was not independently associated with refractoriness to atypical antipsychotics. Accordingly, the score reached in the Scale for the Assessment of Negative Symptoms (SANS) appeared as a confounding factor between therapeutic response and the −1438A/G polymorphism of the 5-HT 2A receptor gene, at least in our sample. This data indicate that negative symptoms are worth being systematically assessed in pharmacogenetic studies aimed at analysing candidate genes in schizophrenia.