Presence Of Positive Symptoms Research Articles

Religious delusions and schizophrenia in a patient with non-convulsive epileptic activity in the left temporal lobe

Schizophrenia is a psychiatric disorder characterized by the presence of positive symptoms (delusions and hallucinations), negative symptoms (flattened affect, alogia, avolition, abulia, anhedonia) and cognitive symptoms (affected working memory and attention, deficits in abstract thinking)‌(1). Delusion is a false belief based on incorrect inference about external reality that is firmly sustained despite what almost everyone else believes and despite what constitutes incontrovertible and obvious proof or evidence to the contrary. The belief is not one ordinarily accepted by other members of the person’s culture or subculture (e.g., it is not an article of religious faith). Religious delusions are a common symptom in schizophrenia patients, and the prevalence and the intensity of these symptoms vary depending on the society to which the patients belong to. For a religious belief to be classified as a delusion, the idea must be idiosyncratic, not representing the idea of a cult or subculture(2). The purpose of this paper is to show the difficulty of setting boundaries between religious delusions and religious belief. In the case of patients who are members of conservative religious cults, the differentiation between belief and delusion is hard to assess, this making the diagnosis, the therapeutic process and the recognition of relapse very difficult.

Diagnostic Agreement between Physicians and a Consultation-Liaison Psychiatry Team at a General Hospital: An Exploratory Study across 20 Years of Referrals.

Consultation–liaison psychiatry (CLP) manages psychiatric care for patients admitted to a general hospital (GH) for somatic reasons. We evaluated patterns in psychiatric morbidity, reasons for referral and diagnostic concordance between referring doctors and CL psychiatrists. Referrals over the course of 20 years (2000–2019) made by the CLP Service at Modena GH (Italy) were retrospectively analyzed. Cohen’s kappa statistics were used to estimate the agreement between the diagnoses made by CL psychiatrist and the diagnoses considered by the referring doctors. The analyses covered 18,888 referrals. The most common referral reason was suspicion of depression (n = 4937; 32.3%), followed by agitation (n = 1534; 10.0%). Psychiatric diagnoses were established for 13,883 (73.8%) referrals. Fair agreement was found for depressive disorders (kappa = 0.281) and for delirium (kappa = 0.342), which increased for anxiety comorbid depression (kappa = 0.305) and hyperkinetic delirium (kappa = 0.504). Moderate agreement was found for alcohol or substance abuse (kappa = 0.574). Referring doctors correctly recognized psychiatric conditions due to their exogenous etiology or clear clinical signs; in addition, the presence of positive symptoms (such as panic or agitation) increased diagnostic concordance. Close daily collaboration between CL psychiatrists and GH doctors lead to improvements in the ability to properly detect comorbid psychiatric conditions.

M243. EFFECTIVENESS AND SATISFACTION WITH A SCHIZOPHRENIA RECOVERY DAY PROGRAM

BackgroundSchizophrenia is a complex disorder typically defined by the presence of positive symptoms that include hallucinations, delusions, and disorganisation in speech and behaviour, negative symptoms of avolition and social withdrawal, and a decline in functioning. Despite an ability to treat clinical symptoms, functional recovery in schizophrenia remains poor. The Recovery Day Program at the Royal Ottawa Mental Health Centre is a multi-disciplinary intervention tailored to help people living with schizophrenia attain recovery goals, lead more satisfying lives, engage in activities, develop a social network and assist in community reintegration. Eligibility criteria are: 18 years of age or older, meet DSM V criteria for Schizophrenia Spectrum illness, have clinical needs that cannot be met in the community, have housing, require intensive recovery support/integration into community, be able to engage in day hospital programming and develop recovery goals. Maximum number of day clients in Day Program is 20. Client admissions began in June 2016. As of November 2019, there have been 50 admissions with 29 discharges. Age range of clients was 20–60 years (mean 36.5). Clients were invited to provide feedback on their experience with the Day Program for program evaluation and improvement of service.MethodsA qualitative and quantitative evaluation of functional outcomes and patient satisfaction was conducted. Measures were administered at admission and discharge: The Illness Management and Recovery Scale (IMRS), a custom-generated activity and goal attainment scale, Quality of Life Scale, The World Health Organization Disability Assessment Schedule 2.0, the Modified Global Assessment of Functioning Scale and the Clinical Global Impression Scale. The Ontario Perception of Care Survey for Mental Health and Addictions (OPOC) was administered during a two month period from January 2019.ResultsDischarge results were available for 29 individuals out of 50 admissions. Clients identified goals in areas including vocational, social, educational, symptom management, optimizing independence, minimizing substance use, managing finances and stable housing; group and individual interventions targeted these areas. Interventions occur at the hospital and in the community. Results of the activity summary identify significant change in community integration in the following areas: employment (admission 5% and discharge 47%), unpaid/volunteer work (admission 11% and discharge 42%), course or study (admission 0% and discharge 32%), social/recreation/group activities (admission 63% and discharge 100%). Results show a significant increase in IMRS scores over time. Goal achievement was statistically significant according to the goal attainment scale (mean at intake 3.4 and at discharge 8.6). Results show that goal importance did not change over time.Open ended questions about day programming were added to the OPOC. Of 15 respondents, the average length of time in the Program was 16 months. Majority of respondents attended as much as they liked, while those unable to attend as much as they wanted, identified that increased attendance may have been helpful to achieving their goals.DiscussionOverall, clients were very satisfied with services provided. There were significant achievements in goal attainment over time with targeted interventions provided in functional domains including employment, unpaid/volunteer work, course of study and social/recreation activities. Our data suggest that a medium term, intensive day program increases functional outcomes and personal satisfaction for individuals with a Schizophrenia Spectrum disorder. Further study would be important to assess how these changes are sustained over time.

Frequency and characterization of depression in schizophrenia

Context and Aims: The prevalence of depression in schizophrenia has been reported to be varying according to the stage of illness (early vs. chronic) and state (acute or postpsychotic). The presence of positive symptoms, extrapyramidal side effects, and insight have been said to predispose depression in a stable patient with schizophrenia. However, not many Indian studies have examined depression in patients with stable schizophrenic symptoms. Thus, we aimed to study the prevalence of depression and its correlates in a sample of stable patients with schizophrenia. Subjects and Methods: Eighty subjects of both genders, attending a tertiary care center, were consecutively taken up for the assessment. A semistructured pro forma was administered for all the subjects after getting informed consent. Positive and Negative Symptom Scale, Calgary Depression Scale for Schizophrenia (CDSS), Hamilton Depression (HAMD) Rating Scale, Extrapyramidal Symptom Rating Scale, Schedule for Assessment of Insight (SAI), and Global Assessment of Functioning Scale (GAF) were used to assess the patients. Results: In this study population, 34.5% had depressive symptoms. The study group had mild depression associated with schizophrenic psychopathology. The study populations did not have significant extrapyramidal symptoms during the assessment. The CDSS score and HAMD score had a significant positive correlation with SAI score. HAMD score had a negative correlation with GAF. Conclusions: This study demonstrates that patients with schizophrenia have significant depressive symptoms. These depressive symptoms appear to be independent of extrapyramidal symptoms and correlate positively to schizophrenic psychopathology. Poor insight may have led to low severity of reported depressive symptoms.

Predictors of Hospitalization of Individuals With First-Episode Psychosis: Data From a 2-Year Follow-Up of the RAISE-ETP.

Despite treatment advances in other domains, inpatient psychiatric hospitalization rates for individuals with first-episode psychosis remain high. Even with early intervention services, a third or more of individuals are hospitalized over the first 2 years of treatment. Reducing hospitalization is desirable from the individual's perspective and for public health reasons because hospitalization costs are a major component of treatment costs. Univariate and multivariate baseline and time-varying covariate analyses were conducted to identify predictors of hospitalization in the Recovery After an Initial Schizophrenia Episode-Early Treatment Program (RAISE-ETP) study, a 2-year cluster randomized trial for participants experiencing a first episode of psychosis who were outpatients at study entry. The trial compared an early intervention treatment model (NAVIGATE) with usual community care at 34 clinics across the United States. RAISE-ETP enrolled 404 participants of whom 382 had one or more postbaseline assessments that included hospitalization data. Thirty-four percent of NAVIGATE and 37% of usual-care participants were hospitalized during the trial. Risk analyses revealed significant predictors of hospitalization to be the number of hospitalizations before study entry; duration of untreated psychosis; and time-varying days of substance misuse, presence of positive symptoms, and beliefs about the value of medication. These results indicate that hospital use may be decreased by reducing the duration of untreated psychosis and prior hospitalizations, minimizing residual symptoms, preventing substance misuse, and facilitating adherence to medication taking. Addressing these factors could enhance the impact of first-episode early intervention treatment models and also enhance outcomes of people with first-episode psychosis treated using other models.

How Do Maternal Subclinical Symptoms Influence Infant Motor Development during the First Year of Life?

An unavoidable reciprocal influence characterizes the mother-child dyad. Within this relationship, the presence of depression, somatization, hostility, paranoid ideation, and interpersonal sensitivity symptoms at a subclinical level and their possible input on infant motor competences has not been yet considered. Bearing in mind that motor abilities represent not only an indicator of the infant's health-status, but also the principal field to infer his/her needs, feelings and intentions, in this study the quality of infants' movements were assessed and analyzed in relationship with the maternal attitudes. The aim of this research was to investigate if/how maternal symptomatology may pilot infant's motor development during his/her first year of life by observing the characteristics of motor development in infants aged 0–11 months. Participants included 123 mothers and their infants (0–11 months-old). Mothers' symptomatology was screened with the Symptom Checklist-90-Revised (SCL-90-R), while infants were tested with the Peabody Developmental Motor Scale-Second Edition. All dyads belonged to a non-clinical population, however, on the basis of SCL-90-R scores, the mothers' sample was divided into two groups: normative and subclinical. Descriptive, t-test, correlational analysis between PDMS-2 scores and SCL-90-R results are reported, as well as regression models results. Both positive and negative correlations were found between maternal perceived symptomatology, Somatization (SOM), Interpersonal Sensitivity (IS), Depression (DEP), Hostility (HOS), and Paranoid Ideation (PAR) and infants' motor abilities. These results were further verified by applying regression models to predict the infant's motor outcomes on the basis of babies' age and maternal status. The presence of positive symptoms in the SCL-90-R questionnaire (subclinical group) predicted good visual-motor integration and stationary competences in the babies. In particular, depressive and hostility feelings in mothers seemed to induce an infant motor behavior characterized by a major control of the environmental space. When mothers perceived a higher level of hostility and somatization, their babies showed difficulties in sharing action space, such as required in the development of stationary positions and grasping abilities. In a completely different way, when infants can rely on a mother with low-perceived symptoms (normative group) his/her motor performances develop with a higher degree of freedom/independence. These findings suggest, for the first time, that even in a non-clinical sample, mother's perceived-symptoms can produce important consequences not in infant motor development as a whole, but in some specific areas, contributing to shape the infant's motor ability and his/her capability to act in the world.

From ADHD to psychosis… executive functions and time

IntroductionCognitive impairment is present from the early stages of psychotic disorders. Alterations are found mainly in areas of attention, memory work and executive functions. During adolescence, ADHD patients often suffer from secondary disorders to lack of efficient procurement processes information by the poor development of executive functions.ObjectiveEvaluation of a patient whose diagnosis of ADD evolve to acute psychotic episode.MethodReview by clinical and psychometric tests developments in executive functions disorders.ResultsTwelve years old patient who comes to the hospital since 2012, was initially diagnosed with literacy difficulties and low academic performance, after MFF-20 speaks of Learning Disabilities. It presents lack of motivation, apathy, difficulty in scheduling and organization and adherence to schedules, so they diagnosed ADD. It is given treatment with methylphenidate and atomoxetine, presenting erratic path.After a year without treatment and the presence of a major stressful life event, at 17, has a first episode, consisting in mutiste attitude, phenomena of self-referenciality, experiences of control, enforcement and dissemination of ideas and auditory hallucination imperative type.ConclusionsThe presence of emocional dysregulation and alterations in the executive functions atribuyen to ADD, in this case, were premorbid symtomatology of a first psychotic episode. The presence of positive symptoms allows to clarify the diagnosis.Disclosure of interestThe authors have not supplied their declaration of competing interest.

The Evaluation of Olfactory Function in Patients With Schizophrenia.

The aim of this study was to compare olfactory threshold, smell identification, intensity and pleasantness ratings between patients with schizophrenia and healthy controls, and (2) to evaluate correlations between ratings of olfactory probes and illness characteristics. Thirty one patients with schizophrenia and 31 control subjects were assessed with the olfactory n-butanol threshold test, the Iran smell identification test (Ir-SIT), and the suprathreshold amyl acetate odor intensity and odor pleasantness rating test. All olfactory tasks were performed unirhinally.Patients with schizophrenia showed disrupted olfaction in all four measures. Longer duration of schizophrenia was associated with a larger impairment of olfactory threshold or microsmic range on the Ir-SIT (P = 0.04, P = 0.05, respectively). In patients with schizophrenia, female subjects’ ratings of pleasantness followed the same trend as control subjects, whereas male patients’ ratings showed an opposite trend. Patients exhibiting high positive score on the positive and negative syndrome scale (PANSS) performed better on the olfactory threshold test (r = 0.37, P = 0.04). The higher odor pleasantness ratings of patients were associated with presence of positive symptoms.The results suggest that both male and female patients with schizophrenia had difficulties on the olfactory threshold and smell identification tests, but appraisal of odor pleasantness was more disrupted in male patients.

The Relationship of Perceived Family Criticism and Other Risk Factors to Violence Among Patients with Schizophrenia

Background Patients with schizophrenia in particular are reported to engage in violent acts that are more frequent and more severe compared with other psychiatric illnesses. The aim of this study was to identify the risk factors associated with violence among schizophrenic patients. Methods A convenience sample of 140 inpatient schizophrenic patients were recruited in this study. Schizophrenia was diagnosed using the structured clinical interview for DSM-IV axis l? disorders, clinical version (SCID-I-CV). Positive and Negative Syndrome Scale (PANSS) was applied to the patients. Presence of violence was assessed using the Modified Overt Aggression Scale (MOAS)and perceived family criticism was assessed using the Family Emotional Involvement and Criticism Scale (FEICS) Results of the 140 schizophrenic patients, 66 (47.1%) reported a presence of violence as a cause for their admission. Presence of positive symptoms and excitement, Male gender, non-compliance with treatment, presence of previous hospitalizations due to violence, and higher levels of perceived family criticism were found to be significantly associated with violence among schizophrenic patients. (OR= 2.1, 1.16, 1.27, 1.14, 1.34, 1.20 respectively). Conclusion Positive symptoms of schizophrenia, male gender, non-compliance with treatment, a history of violence and perceived family criticism were found to be associated with violence among schizophrenic patients in the current study. All these factors should be considered in the treatment regimen of schizophrenia to decrease violence among those patients.

Psychiatric features in gelastic epilepsy and hypothalamic hamartoma: long-term psychodiagnostic observations

IntroductionHypothalamic hamartomas (HHs) are developmental, non-neoplastic malformations involving the small hypothalamicarea located between the infundibular stalk and the mam-illary bodies [1]. A spectrum of clinical conditions can beenvisaged: (A) early-onset of laughter epileptic seizures(gelastic seizures, GS) in previously normal childrenevolving toward catastrophic generalized epilepsy withcognitive regression and severe behavioral problems withor without precocious puberty; (B) GS evolving towardsevere focal epilepsy with cognitive and behavioral dis-turbances of various severity; (C) late infancy onset GSevolving toward severe focal epilepsy with little or withoutassociated cognitive and behavioral signs [1]. Cognitive [2]and behavioral [3–5] problems have been reported and theyseem to be responsive to surgical treatment [6]. Althoughseveral studies assessed a high prevalence of psychiatricdisorders among patients with HH [4, 6–8], rate andspecificity of psychiatric comorbidity are still debated. Themost frequent psychiatric diagnosis among adults with HHis major depressive disorder and anxiety disorder [6]. Onlya few cases of comorbidity with psychosis [4, 8] or severepersonality disorders [6] have been reported. We describethe longitudinal psychiatric and neurological history of apatient with GS-HH and psychosis.Case descriptionThis 24-year-old right-handed tertiary schooled man wasthe product of a normal pregnancy. GS appeared atapproximately 3 years of age with simple smiles. When thepatient was six he experienced weekly brief (\60) dys-cognitive seizures and rare tonic–clonic seizures. He wasrelatively well controlled with carbamazepine until the ageof 12 years, when he started to experience daily episodes offace flushing and loud laugh without mirth, lasting a fewseconds as well as occasional tonic–clonic seizures. At thatage, interictal EEGs showed mild slowing of backgroundactivity. Sleep EEG did not show evidence of disrupted orabnormal activity. Imaging studies revealed homoge-neously non-enhancing soft tissue mass in the region of theleft mammillary body, measuring 10 mm. Valproate(1,300 mg/day) and lamotrigine (150 mg/day) finally suc-ceeded to control his seizures. Accordingly, the patient didnot need surgical treatment of the lesion. At psychiatricinterview, the patient was shy and inhibited, with poor eyecontact and fatuous, unmotivated smiles. The patient dis-tinguished previously experimented GS and this kind ofsmiles. The patient also displayed formal disturbances ofthought, deficits at the exam of reality, paranoid symptomsand interpretative/projective tendency. However, no mis-perceptions were found. The presence of positive symp-toms (delusion, thought disorders), negative symptoms(social withdrawal) and behavioral anomalies (inadequatesmiles) allowed us to diagnose paranoid schizophrenia.

910 – Schizophrenia and violence at home

Introduction There is good evidence from epidemiological studies that the diagnosis of schizophrenia is associated with an increased risk of violence.Some studies have linked the presence of positive symptoms, first psychotic episode, duration of untreated psychosis and lack of insight with violent behavior. Objective The primary objective was to identify factors related to violent behavior in patients diagnosed with psychotic disorder attended by our group, a multidisciplinary mobile outreach team (EMSE). Methodology We evaluated a total of 249 patients diagnosed with psychotic disorder between 2007 and 2012. We administered the following scales: PANSS, GAF (Global Assessment of Functioning), CGI (Clinical Global Impression), GEP (Severity of psychiatric illness scale, AVAT (Instrument to assess violent behavior in mental illness) and SUMD (Scale unawareness of mental disorders). To study the correlation between the scales and the score of the AVAT instrument we used the Pearson correlation. Clinical variables were also compared between aggressive and non-aggressive patients using Chisquare and Student's. Results There is a positive correlation between AVAT and PANSS-P (r = 0.544), ICG (r = 0.472), GEP (r = 0.515) and a negative correlation between AVAT and GAF (r = -0357). The correlation between AVAT and SUMD is positive (r = 0.119) but not statistically significant. Conclusion The presence of positive symptoms and clinical severity has been linked to increased aggressiveness and to predict the occurrence of violent behavior in the course of psychotic disorder. Unlike other studies, no correlation was observed with the lack of insight.

P03-214 - Anxiety sensitivity depending on presence of positive symptoms in psychosis

IntroductionAn important corpus of scientist evidence is linking psychotic activity and anxiety-related processes (Freeman and Garety, 2003).ObjectivesWe intended to assess differences in Anxiety Sensitivity dimensions between patients diagnosed by psychosis with and without positive symptoms.MethodsParticipants: 49 patients with DSM psychosis diagnosis (42 men and 7 women; mean age: 40), who attended a Mental Health Rehabilitation Service in 2008, of whom 24 patients had positive symptomatology.Design, materials and procedure: A Cross-sectional design (one measurement) for a co-relational method of comparison between groups.We used the Spanish validated Anxiety Sensitivity lndex-3 -ASI 3- (Sandîn et al, 2007), a 18-item Likert self-report that assesses fears of anxious symptoms. It presents a hierarchical structure (a general factor and three subscales -Physical, Cognitive and Social Concerns-). It's also used the first and third items (delusions and hallucinatory behaviour) of The Positive and Negative Syndrome Scale -PANSS- (Kay, Opler and Lindenmayer, 1988) to detect positive symptoms.ResultsPatients with positive symptoms showed a higher sensitivity to cognitive (z = -3.22, p < 0.01) and social anxiety (z = -2.66, p < 0.01), as well as higher punctuations in ASI-total (z = -2.91, p < 0.01), than patients without positive symptoms.ConclusionsPatients with positive symptoms show significant fears of symptoms of different anxious domains (ASI-total) with regard to patients without this kind of symptomatology. Specially, they are worried about the possibility that concentration difficulties and restlessness lead to mental incapacitation (ASI-cognitive) and about social reactions before their own publicly observable anxiety manifestations (ASI-social).

Autism and schizophrenia in high functioning adults: Behavioral differences and overlap

Several recent studies have demonstrated a genetical overlap between autism and schizophrenia. However, at a behavioral level it remains unclear which features can validly distinguish adults with autism from an adult schizophrenia group. To this end, the present study compared 21 individuals with the autistic disorder and 21 individuals with schizophrenia in self-reported features of autism and schizophrenia, as measured by the Autism-Spectrum Quotient (AQ) and the Schizotypal Personality Questionnaire (SPQ). The schizophrenia group was more likely to report positive symptoms and the adults with autism were more likely to report impairments in social skill. Overlap was found between the two groups in negative symptoms, disorganization, attention to detail and imagination. Thus, when discriminating between the two disorders, especially social skill and the presence of positive symptoms are relevant, whereas the presence of negative symptoms is not indicative.

Alcohol and Cannabis Use in Urban, African American, First-Episode Schizophrenia-Spectrum Patients

On the basis of limited prior research on associations between symptoms and substance use in first-episode psychosis, a retrospective chart review was conducted to test 2 hypotheses: (1) the presence of positive symptoms is associated with alcohol use prior to admission and (2) the absence of prominent negative symptoms is associated with cannabis use prior to admission. Eligible patients included those admitted for a first episode of psychosis in a public-sector, university-affiliated hospital that serves a predominantly African American, socially disadvantaged, urban population. The 72 patients included in the analysis were 18 to 40 years of age, and all were African American. Using a structured data collection instrument, discharge summaries of consecutively admitted patients from January 2002 to March 2005 were reviewed to extract data on basic demographic and clinical characteristics, the presence of 11 symptoms, and alcohol and cannabis use within 6 months prior to hospitalization. Alcohol use in the 6 months prior to hospitalization was associated with a higher frequency of positive psychotic symptoms among first-episode patients. Cannabis use was associated with a lower likelihood of having prominent negative symptoms. These associations remained even after controlling for relevant covariates in logistic regression models. Although the direction of causality cannot be established, the association between positive psychotic symptoms and alcohol use may represent a self-medication effect, whereas the association between lesser negative symptoms and cannabis use may result from the fact that interpersonal deficits and reduced hedonic capacity minimize drug-seeking activities.

Depression in Older Adults With Schizophrenia Spectrum Disorders: Prevalence and Associated Factors

Although depression is common in older adults with schizophrenia, it has not been well studied. The authors examine those factors that are related to depression in a multiracial urban sample of older persons with schizophrenia. The schizophrenia group consisted of 198 persons aged 55 or older who lived in the community and developed schizophrenia before age 45. Persons with substantial cognitive impairment were excluded from the study. A community comparison group (N = 113) was recruited using randomly selected census tract data. The authors adapted George's Social Antecedent Model of Depression, which consists of six categories comprising 16 independent variables, and used a dichotomous dependent variable based on a Center for Epidemiologic Studies Depression Scale cutoff score of > or = 16. The schizophrenia group had significantly more persons with clinical depression than the community comparison group (32% versus 11%, respectively; chi(2) = 28.23, df = 1, p = 0.001). Bivariate analysis revealed that eight of the 16 variables were significantly related to clinical depression in the schizophrenia group. In logistic regression, six variables retained significance: physical illness (odds ratio [OR] = 1.60, 95% confidence interval [CI], 1.17-2.18), quality of life (OR = 0.84, 95% CI, 0.76-0.93), presence of positive symptoms (OR = 1.12, 95% CI, 1.02-1.21), proportion of confidants (OR = 0.03, 95% CI, 0.01-0.39), copes by using medications (OR = 2.12, 95% CI, 1.08-4.13), and copes with conflicts by keeping calm (OR = 1.34, 95% CI, 1.03-1.74). Consistent with earlier studies of schizophrenia in older persons, the authors found physical health, positive symptoms, and several nonclinical variables to be associated with depression. Potential points for intervention include strengthening social supports, improving physical well-being, more aggressive treatment of positive symptoms, and increasing the recognition and treatment of depression.

Prosodic discrimination in patients with schizophrenia

Fifteen patients with prominent positive symptoms of schizophrenia and 15 normal controls performed verbal prosodic and pure musical discrimination tasks, with changes in pitch and timing parameters. The patients' performance was comparable to that of controls on the discrimination of terminal pitch changes, but significantly poorer on the more difficult internal pitch discrimination. The latter deficit was positively correlated with the severity of their positive symptoms. The results suggest that patients have a deficit in processing fundamental aspects of prosody, which is associated with the presence of positive symptoms.

Stability of personality traits in schizophrenia and schizoaffective disorder: a pilot project.

This study was performed in an effort to begin characterization of personality traits in schizophrenia. Specific concerns included personality profiles relative to normal adults, personality profile stability over time, and trait-state issues. The authors administered the NEO Personality Inventory as well as symptom ratings at two time points to 21 patients. Patients were all stabilized outpatients attending an adult continuing day treatment program and diagnosed with either schizophrenia or schizoaffective disorder. Personality profiles were determined for all patients. Compared with a normal adult sample, this sample's scores on three out of five of the personality domains assessed were not distinguishable from normal adults. Test-retest correlations were highly significant over an average 28.2-week time interval. In general, the presence of positive symptoms did not appear related to NEO-PI stability, while negative symptoms did show a relationship to the stability of personality profiles. These data suggest that personality profiles can be looked at in schizophrenia, that these profiles do appear stable over time, and that negative symptoms have a strong influence on profile stability and appear to be "trait-like."

Outcome of schizophrenia: the Madras longitudinal study.

The aim of the study was to determine the clinical outcome in a group of first-episode schizophrenic patients on a 10-year follow-up. The social, demographic and clinical variables associated with poor outcome and gender differences in outcome were other issues addressed. Ninety patients fulfilling Feighner's and ICD-9 criteria for schizophrenia, at Madras, India, were included for a 10-year follow-up. The Present State Examination and the Psychiatric and Personal schedule were administered at intake and at the end of every year. Clinical outcome was considered as a combination of the pattern of course and the presence of positive symptoms during year 10. After 10 years, 76 of the 90 patients included were followed up, giving a follow-up rate of 84%. The clinical outcome was good in nearly 75% of the patients with almost all symptoms showing a steep decline at the end of 10 years. Fifty-nine subjects were asymptomatic at the end of the follow-up period and 12 were ill during the entire 10th year. Sexual, religious and grandiose delusions and flat affect at inclusion predicted a poor clinical outcome. More males had a poor outcome and spent a longer time in a psychotic state. There is evidence of a good outcome in the majority of first-episode schizophrenic patients after 10 years in keeping with other reports from developing countries. Certain variables at inclusion predicted a poor clinical outcome and males had a poorer outcome than females.

Depression among aging persons with schizophrenia who live in the community

The study used the social antecedent model of depression in later life proposed by Linda K. George to develop a multifactorial model of predictors of depression among aging persons with schizophrenia living in the community. The SHORT-CARE and the Network Analysis Profile, along with supplemental items, were administered to 117 outpatients age 55 and older who received DSM-III-R diagnoses of schizophrenia before age 45. Bivariate and multivariate analyses examined associations between 27 variables derived from George's model and the presence of depression. A cutoff score for the depression scale of the SHORT-CARE was used to detect clinically significant depression. Forty-four percent of the sample had probable pervasive depression. Bivariate analysis indicated that 16 variables were significantly associated with depression, and logistic regression showed that six variables were strong predictors. Depression was associated with the presence of positive symptoms, physical limitations interfering with activities, younger age, diminished linkage of members of the social network, lower income, and a smaller proportion of social network members who provided sustenance such as food and money. An 11-variable model correctly classified 81 percent of cases. The level of depression among older outpatients with schizophrenia is approximately one and a half to three times the level in the general older population. Depression in this patient group is associated with nonclinical variables that are independent of psychoses and that resemble patterns found among general older populations. Several of the variables are potentially alterable and therefore afford opportunities to enhance the well-being of persons with schizophrenia who live in the community.

Positive or negative symptoms — which are more appropriate as diagnostic criteria for schizophrenia?

For over a decade there has been a consensus that the diagnosis of schizophrenia should rest upon the presence of positive symptoms. Recently it has been suggested to give negative symptoms, which have played a prominent role in research, more diagnostic importance again. This study investigated the usefulness of that suggestion. In a sample of 489 inpatients covering the whole range of psychiatric diagnoses, the frequencies and prevalences of positive and negative symptoms were determined. Analyses of variance were calculated to assess the diagnostic validity of the different classes of symptoms. The study demonstrates that positive symptoms are of much higher diagnostic value than negative symptoms. A change of diagnostic procedures giving more importance to negative symptoms is discouraged.