Observation Scale For Inpatient Evaluation Research Articles

Improvement patterns in schizophrenic “nonresponders” treated with clozapine: A Systematic Study Over 1 Year

Forty-four chronic schizophrenic inpatients with unsatisfactory response to conventional neuroleptics were switched to clozapine in flexible dosage and followed up systematically for up to 1 year with the Positive and Negative Syndrome Scale (PANSS), Nurses Observation Scale for Inpatient Evaluation (NOSIE), Clinical Global Impressions (CGI), and the UKU side effect rating scale. Thirty-nine patients were evaluable; 35 completed 6 months, and 25 completed 1 year. There was a highly significant reduction in PANSS, NOSIE, and CGI scores already after 3 weeks. After 6 months there was a mean reduction of total PANSS score of about 50%, and about half of the patients obtained at least 50% reduction. Positive symptoms showed a significantly greater improvement than negative ones. Least improvement was seen in cognitive disturbance. Depression and guilt feeling were favourable prognostic factors, whereas cognitive disturbances were unfavourable predictors of overall improvement. The side effect spectrum was dom...

Psychosis in advanced Parkinson's disease

Psychosis, linked to chronic levodopa and other antiparkinsonian drug treatments, is a common and incapacitating complication of advanced Parkinson's disease (PD). The psychosis may be due, in part, to overstimulation of central serotonergic (5-HT) receptors. We treated 16 PD patients who had psychosis of 6 to 60 months' duration with the 5-HT3 receptor antagonist ondansetron (12 to 24 mg daily) in an open-label, short-term (4 to 8 weeks) trial. There was marked to moderate improvement (p < 0.01) in measures of visual hallucinations, paranoid delusions, confusion, and the associated global functional impairment in all but one of the patients, and there was moderate improvement in the Brief Psychiatric Rating Scale and the Nurse's Observation Scale for Inpatient Evaluation; the Mini-Mental State Examination scores remained unaltered. Ondansetron did not cause any worsening in basic PD symptoms or levodopa efficacy and was well tolerated with no major side effects. Our study suggests that pharmacologic blockade of central 5-HT receptors may become a strategy to attenuate PD psychosis without inducing motor deterioration or suppression of antiparkinsonian action of levodopa, and it lends support to the hypothesis that serotonergic mechanisms are pathogenetically important in the emergence of psychosis in PD.

Symptom severity and number of previous psychiatric admissions as predictors of readmission.

The study examined factors predicting early readmission (within 30 days of discharge) to a state hospital. A total of 189 patients with acute symptoms who were admitted to a state hospital were evaluated at discharge using the Brief Psychiatric Rating Scale (BPRS) and the Nurses Observation Scale for Inpatient Evaluation (NOSIE). Patients who were readmitted within 30 days were compared with those who were not on BPRS and NOSIE ratings and on other variables, including length of stay, number of previous admissions, demographic characteristics, and diagnosis. Scores on the thought disorder factor and self-neglect question on the BPRS and the number of previous admissions were significantly higher among patients who where readmitted within 30 days of discharge. The variables correctly predicted readmission for 86 percent of cases in the study. The characteristics of high scores at discharge on the BPRS thought disorder factor and the BPRS item on self-neglect, along with a high number of previous admission, may be helpful in identifying patients at risk for readmission to inpatient psychiatric settings.

Comparison of Standard Locked-Ward Treatment Versus Open-Ward Rehabilitation Treatment for Chronic Schizophrenic Patients

A priority for psychiatric rehabilitation workers in China is to develop less-restrictive methods for managing the estimated 2500 chronically institutionalised patients who are symptomatically stable and have adequate psychosocial functioning but have no family members who are able or willing to take them home. We transferred 45 chronic schizophrenic male in-patients to an open-door rehabilitation ward where they were given as much freedom as possible and encouraged to take part in occupational, social, and recreational activities. The Nurses Observation Scale for Inpatient Evaluation (NOSIE) was used to compare the psychosocial functioning of the 43 patients who completed the year-long trial with that of 43 similar patients who received standard in-patient treatment on a locked ward. Over the year, the experimental group showed a significant improvement in overall functioning, whereas the control group showed no improvement. These findings suggest that open-door rehabilitation wards situated within the hospital can mobilise latent psychosocial functioning and may be a good method for re-introducing chronic schizophrenic patients in China back into the community.

Can estradiol modulate schizophrenic symptomatology?

Using epidemiologic data, in an earlier study we formulated the hypothesis that estrogens can delay the onset of schizophrenia in females by raising the vulnerability threshold for this disease. In animal experiments, Häfner and colleagues found evidence that chronic estradiol treatment reduces the sensitivity of dopamine (D2) receptors in the brain. In the clinical study presented in this article, as a further step we examined the antipsychotic properties of estradiol in human females by testing whether schizophrenic symptomatology varies with estradiol serum levels throughout the menstrual cycle. We examined 32 acutely admitted female schizophrenia patients (Present State Examination/CATEGO diagnosis, ICD-9) with a history of regular menstrual cycles, ages 18 to 43 (mean = 30.5), during their hospital stays (3-8 weeks), analyzing hormonal parameters and applying various rating scales for psychopathology every 7 days. In all patients, estradiol serum levels were markedly reduced as compared with the normal population, and fluctuations throughout the cycle were dampened. Nevertheless, a significant association emerged between estradiol levels, on the one hand, and psychopathology scores, on the other--that is, the psychiatric symptomatology as assessed by the clinical psychiatrist (Brief Psychiatric Rating Scale, p < or = 0.01), behavior on the ward as assessed by the nursing staff (Nurses' Observation Scale for Inpatient Evaluation p < or = 0.01), paranoid tendencies and general well-being as assessed by the patients themselves (Paranoid-Depressivitäts-Skala paranoid score p < or = 0.05; Befindlichkeits-Skala p < or = 0.05). Psychopathology seems to improve when estradiol levels rise, and vice versa. These findings can be interpreted as further evidence for a protective effect of estrogens in schizophrenia, possibly due to the known anti-dopaminergic activities of these hormones.

Acutely Psychotic Patients Receiving High-Dose Haloperidol Therapy

Despite the trend towards lower neuroleptic dosing in the treatment of psychosis, there continue to be patients who are administered doses that are higher than recommended. Thirty-six acutely psychotic patients receiving parenteral haloperidol were evaluated by the Brief Psychiatric Rating Scale, the Schedule for Affective Disorders and Schizophrenia-Change Version, and the Nurses' Observation Scale for Inpatient Evaluation, as well as by drug levels in plasma. Patients were compared on the basis of total haloperidol dose in the first 24 hours: regular dose (RD: 10-30 mg) and high dose (HD: 40-80 mg). At baseline, patients in the HD group scored significantly higher on the Brief Psychiatric Rating Scale factor Hostile-Suspiciousness and the Nurses' Observation Scale for Inpatient Evaluation factor Irritability. Assignment to regular-dose and HD groups could not be accounted for on the basis of age, gender, weight, or duration of illness. Moreover, drug levels in plasma indicated that the HD patients did not require higher doses on the basis of differences in haloperidol levels.

Methylphenidate Augmentation Therapy

Eight schizophrenic inpatients participated in a 2-week double-blind crossover study to test the efficacy of methylphenidate treatment for patients on a stabilized neuroleptic dose. All were young men with a childhood history of hyperactivity. The instruments used, the Brief Psychiatric Rating Scale, Scale for Assessment of Positive Symptoms, Scale for Assessment of Negative Symptoms, and Nurses Observation Scale for Inpatient Evaluation, showed no significant differences between stimulant and placebo conditions. One patient suffered a repeated pressor effect and was removed from the protocol. However, staff and self-report found some improvement in 3 patients and a slight worsening in 1.

Group behavioral therapy with depressed geriatric inpatients: An assessment of incremental efficacy

Fifty-three clinically depressed geriatric inpatients assigned either to behavioral group therapy plus standard hospital treatment (n=27) or a standard hospital treatment comparison group (n=26) were assessed two weeks apart at pretest and posttest using the Beck Depression Inventory (BDI), the Hamilton Rating Scale for Depression (HRSD), and the Depression Scale of the Nurses' Observation Scale for Inpatient Evaluation (NOSIE-D). Patients in both groups received standard hospital programs (including pharmacotherapy); but, in addition, the experimental group participated in eight 90-minute sessions of behavioral group therapy. Both groups improved on BDI scores and HRSD ratings, but MANOVAs did not support the statistical incremental efficacy of behavioral group therapy. However, a greater percentage of patients in behavioral group therapy were exhibiting normal BDI scores and HRSD ratings at posttest. Clinical implications of these findings are discussed.

Effects of the menstrual cycle on therapeutic response in schizophrenic patients

ogy varied with phases of the cycle and the estradiol serum level. There was a significant excess of admissions within the perimenstrual phase (i.e., the 2 premenstrual and 7 menstrual days), which corresponds to the low estrogen phase, as compared to the other phases of the cycle (~10.05). All patients were examined during their entire hospital stay (minimum 4 weeks, maximum 8 weeks) analysing hormonal parameters and applying the following scales for psychopathology every 7 days: Brief Psychiatric Rating Scale (BPRS), Nurses Observation Scale for Inpatient Evaluation (NOSIE), Paranoidskala von Zerssen (PS) and Befindlichkeitsskala von Zerssen (BFS) for general well-being. Most patients had a disturbed menstrual cycle, and hormonal parameters indicated a disturbance of the gonadal axis, probably due to neuroleptic treatment. Nevertheless, there emerged a significant correlation between estradiol serum levels on the one hand and all psychopathology scores on the other, when cross correlations in between the different profiles were calculated over the whole inpatient period (one sample Wilcoxon test): BPRS I 0.01, NOSIE I 0.01, PSI 0.05, BFS I 0.05. Psychopathology seems to improve, when estradiol levels rise, and vice versa. These results, together with our findings in the animal study and in the epidemiological project indicate that estradiol might be a worthwhile candidate for further research on schizophrenia.

Psychometric evaluation of the Nurses Observation Scale for Inpatient Evaluation in the Netherlands

The interrater reliability, temporal stability and factorial, convergent, discriminant and predictive validity of the Nurses Observation Scale for Inpatient Evaluation (NOSIE-30) were investigated in a heterogeneous group of psychiatric inpatients in the Netherlands (n = 179). Data in support of the scale's dimensional structure (recoverability of Anglo-American subscale structure in this Dutch sample and distinctiveness of subscales), discriminatory power and convergent validity are presented. Interrater reliability was satisfactory at global scale level. However, 3 subscales (irritability, psychosis and depression) were found to lack interrater reliability. Although temporal stability coefficients were high, large score changes are presupposed to show that pre- versus posttherapy differences are attributable to real change rather than error. NOSIE-30 had limited predictive value.

Relationships between clinical effects and monoamine metabolites and amino acids in sulpiride-treated schizophrenic patients

Twenty-four acutely ill schizophrenic patients (DSM-III-R), 18-42 years old, were treated for 6 weeks with sulpiride. Sulpiride was administered in three different daily dosages (400, 800 or 1200 mg) according to a double dummy blind randomized administration schedule. The psychopathology of the patients was rated by the Comprehensive Psychopathological Rating Scale (CPRS) and the Nurse's Observation Scale for Inpatient Evaluation (NOSIE). The monoamine metabolites homovanillic acid (HVA), 5-hydroxy-indoleacetic acid (5-HIAA), 4-hydroxy-3-methoxy-phenylglycol (HMPG) and the amino acids tyrosine, tryptophan, glutamate and glutamine were measured in serum before and once a week during sulpiride treatment. There were no significant correlations between the CPRS or the NOSIE morbidity scores and the biochemical measures before drug treatment. HVA levels were not correlated to rating scores during treatment, but after 6 weeks HVA had decreased significantly in the patients with a good response but not in the patients with a poor response. A negative relationship between 5-HIAA levels and depressive and negative symptoms was found. Non-responders according to the subscale for depression had low 5-HIAA levels throughout the treatment. An increase of tryptophan was correlated to improvement in the early part of treatment. High levels of glutamate or glutamine were found in non-responders before treatment. During treatment an increase of the glutamate level was correlated to improvement. Low levels of glutamine were related to improvement according to global and NOSIE (total) rating scores. Peripheral biochemical measures may be a valuable tool in the study of pathophysiological mechanisms and treatment effects in patients with schizophrenia.

Effects of phosphatidylserine therapy in geriatric patients with depressive disorders

The effects of phosphatidylserine (BC-PS) on cognitive, affective and behavioural symptoms were studied in a group of 10 elderly women with depressive disorders. Patients were treated with placebo for 15 days, followed by BC-PS (300 mg/day) for 30 days. The Hamilton Rating Scale for Depression, Gottfries-Bråne-Steen Rating Scale, Nurse's Observation Scale for Inpatient Evaluation and Buschke Selective Reminding Test were administered before and after placebo and after BC-PS therapy, to monitor changes in depression, memory and general behaviour. At the same time, basal plasma levels of noradrenaline, MHPG, DOPAC, HVA and 5-HIAA, and GH/beta-endorphin/beta-lipotropin responses to clonidine stimulation were measured. BC-PS induced consistent improvement of depressive symptoms, memory and behaviour. No changes in amine metabolite levels or in hormonal responses to alpha 2-adrenoceptor stimulation were observed.

The brief psychiatric rating scale (BPRS) and the nurses' observation scale for inpatient evaluation (NOSIE) in the evalution of positive and negative symptoms

Positive and negative a priori symptom scales were operationalized with the BPRS and the NOSIE. Acutely and consecutively admitted psychiatric patients (N = 247) were rated with these scales. Research questions dealt with the psychometric properties of the scales. It was found that the positive symptom scales had sufficient internal consistency; the negative scales did not. Diagnostic groups could be distinguished better with the positive symptom (PS) than with the negative symptom (NS) scales. The outcome of this research suggests that the positive and negative symptoms distinction is less meaningful in cross-sectional research, in which acute patients are rated, than in longitudinal research.

CBM 36‐733 (2‐Methyl‐alpha‐ergokryptine) In primary degenerative dementia: Results of a european multicentre trial

AbstractOne hundred and seventeen inpatients and outpatients with primary degenerative dementia participated in a multicentre, placebo‐controlled, parallel‐group, therapeutic study with CBM 36‐733 (2‐methyl‐alpha‐ergokryptine) lasting eight weeks. The daily dose of CBM 36‐733 was 2.0 mg, after a slow increase over 10 days. The assessment of effects relied on factors derived from the SCAG (Sandoz Clinical Assessment Geriatric) scale and the NOSIE (Nurses' Observation Scale for Inpatient Evaluation), a battery of pscyhometric tests, and overall evaluation of efficacy and tolerability (plus laboratory analyses). CBM 36‐733 was well tolerated and positive changes were seen with regard to the ‘Apathy’ factor of the SCAG scale and in psychometric tests measuring psychomotor speed, attention, and some aspects of memory. Longer‐term studies are now required to determine the clinical relevance and duration of improvements that can be achieved with CBM 36‐733 in patients suffering from primary degenerative dementia.

Examining the Affect of Chronic Schizophrenic Male Patients Towards 'Three Occupational Therapy Activities

This descriptive research paper attempts to examine the affect (feeling-mood) of a selected sampling of eight chronic schizophrenic patients towards some activities. These activities, commonly'utilized in the occupational therapy setting, included crafts (leather wrist bands), cooking (mini pizzas), and sensory integration (parachute play). The patients' ratings of the activities were measured via a semantic differential (SD). Through the SD, the patients of this study expresses some liking for all three activities, but rated cooking, first, sensory integration, second, and crafts, third. Also, due to the questionable accuracy of the psychiatric patient's ability to report his feelings, a pair of staff observers rated the patient during the activity using the Nurses' Observation Scale for Inpatient Evaluation. Some support was indicated of the relationship between what the patients reported to have felt, and what behaviors the raters observed of the patients during the activities.

The Effectiveness of an Occupational Therapy Program in an Inpatient Geropsychiatric Setting

Twelve patients in an inpatient geropsychiatric facility participated in a specifically designed program of occupational therapy and psychosocial groups. A matched set of twelve patients participated in the regular treatment program of the facility, but not in the special program. All subjects were rated on the Comprehensive Occupational Therapy Evaluation, the Nurses Observation Scale for Inpatient Evaluation, and the Brief Psychiatric Rating Scale before and after the four-month program. Participants in the special program showed significant improvement on ratings of interpersonal effectiveness, and clinically demonstrated increased responsibility for the group attendance and appropriateness in group participation. No significant differences were noted on overall ratings of psychiatric dysfunction. Implications of the study for group leaders and for further research are discussed.

Spontaneous fluctuations of electrical skin conductance and the actual clinical state in schizophrenics.

The present paper examines in a group of 48 schizophrenics, whether spontaneous fluctuations (SF) in electrical skin conductance show a relationship to psychiatric symptomatology. Subjects participated in an experiment that delivered nonsignal auditory stimuli. Their clinical state was assessed by the Brief Psychiatric Rating Scale (BPRS) and the Nurses' Observation Scale for Inpatient Evaluation (NOSIE). An additional set of factors with a possible influence on SF rates was also taken into account. A stepwise regression analysis showed BPRS Activation and NOSIE Manifest Psychosis to be of significance, the BPRS subscale displaying a positive and the NOSIE subtest a negative partial correlation to SF frequency. Results are discussed with regard to their implication for experiments using tonic electrodermal measurement; they are also compared with the literature on phasic electrodermal arousal.

A double-blind study with ceruletide in chronic schizophrenic patients: Biochemical and clinical results

We evaluated ceruletide, a cholecystokininlike peptide, in a double-blind, placebo-controlled study of 20 male chronic schizophrenic patients. After baseline investigations, 10 patients received 0.3 μg/kg body weight ceruletide, and 10 patients received placebo (normal saline) intramuscularly once weekly for 3 consecutive weeks. Psychopathology was rated on the Brief Psychiatric Rating Scale and the Nurses' Observation Scale for Inpatient Evaluation. Blood was drawn on the same days for estimation of norepinephrine, epinephrine, β- endorphin, cortisol, and prolactin. There were no significant changes in biochemical parameters. With regard to psychopathology, no significant differences in behavioral ratings were found between the ceruletide- and placebo-treated groups. Furthermore, there were no changes in either positive or negative symptoms of schizophrenia secondary to ceruletide. Contrary to uncontrolled studies, we failed to show antipsychotic properties of ceruletide.

Two self-rating scales for depression in Hmong refugees: Assessment in clinical and nonclinical samples

An exploratory cross-cultural study was undertaken of two widely used self-rating scales: the Zung and the Depression Scale on the 90 Item Symptom Checklist, or SCL-Depression. Both scales were translated into Hmong and tested in two samples of Hmong refugees in the U.S.A. One sample ( n=86) consisted of a field survey of all Hmong people living in Minnesota. Of the 86, 15 sought treatment and were diagnosed as having major depression during the year following their self rating, so that a comparison of patients' scores with nonpatients' scores was possible. The other sample consisted of another 51 Hmong psychiatric patients with major depression. This second group was also assessed by four psychiatric rating scales (i.e. Hamilton Depression Scale, brief Psychiatric Rating Scale, Inpatient Multidimensional Rating Scale, and Nurse's Observation Scale for Inpatient Evaluation) and two measures of treatment intensity (i.e. number of visits, duration of treatment). In the general Hmong population ( n=86), both self-rating scales were highly intercorrelated, and strongly associated with patient status. In the patient sample ( n=51), only the SCL-Depression showed any correlations with psychiatric rating scales or with treatment variables. This is contrary to the anticipated outcome, as it had been expected that the Zung would perform better than the SCL-Depression. In addition, duration of treatment was inversely correlated with the SCL-Depression, also opposite to our prediction. Probable causes for these unexpected results are presented. An item analysis was undertaken, comparing 71 Hmong survey subjects who were not treated for depression with 51 Hmong psychiatric patients who were treated for depression. Most Zung and SCL-Depression items showed significantly higher symptom levels in the depressed patients. However, non-depressed controls unexpectedly reported significantly higher symptom levels on certain items. No significant differences were observed on several Zung and SCL items. These unexpected findings are discussed in light of the refugee's adjustment and experience.

Hemodialysis in the treatment of a group of schizophrenic patients

The aim of the study was to examine the possible therapeutic effects of hemodialysis in a group of therapy resistant schizophrenic patients. Eleven patients diagnosed as schizophrenics according to the Feighner and DSM III criteria fulfilled the inclusion and exclusion criteria for the study. One patient was administered active hemodialysis in an open study for about two years. The remaining ten patients entered a double-blind crossover study with active and sham treatment. Seven of these patients completed the full program, four of whom belonged to a large family with a high incidence of schizophrenia. All patients were on antipsychotic medication throughout the study. For the psychopathological evaluations the Comprehensive Psychopathological Rating Scale (CPRS) and the Nurses' Observation Scale for Inpatient Evaluation (NOSIE-30) were used. Samples of blood, urine, cerebrospinal fluid and spent dialysate were obtained for examination. This study did not demonstrate a therapeutic effect of hemodialysis when compared to sham procedure. Although in some patients improvement of the clinical condition was observed, there were only small changes in the nuclear symptoms of schizophrenia. Improvement occurred during the first treatment period irrespective of the type of treatment administered. Possible factors for this improvement, such as method of selection, medication, psychological mechanisms in relation to the treatment or care, and attention provided by the staff are discussed. Many therapy resistant schizophrenic patients had to be rejected because of their poor compliance, unwillingness to participate and difficulties in maintaining an adequate blood access route. The conclusion is, that the results of the present study do not justify the use of hemodialysis in its present form as treatment of schizophrenic patients.