Research Diagnostic Criteria For Schizophrenia Research Articles

Adults with psychosis or psychotic experiences may report adverse life events prior to the onset of symptoms but direction of causality cannot be inferred

Question: Are stressful events during adulthood associated with the onset of psychosis? Outcomes: First-episode psychosis or subclinical psychotic experiences. Outcome criteria were not further specified a priori. The observational studies...

The Rorschach in the Diagnosis of Chronic Schizophrenia

The fundamental objective of this work consists in the verification of diagnostic precision using the Rorschach test in patients previously diagnosed a chronic schizophrenics, using Research Diagnostic Criteriafor Schizophrenia, RDC. The results add more than 125 new items to the differential diagnostic of schizophrenia, and provide a more holtstic understanding of the personality of the chronic schizophrenic.

BPRS symptom factors and sleep variables in schizophrenia

To examine the relationship of clinical symptoms to sleep architecture, polysomnography and clinical ratings were carried out in 20 male psychiatric in-patients who met Research Diagnostic Criteria for schizophrenia. Clinical symptoms were assessed by the Brief Psychiatric Rating Scale (BPRS). Four BPRS sub-factors, i.e., ‘Thinking Disturbance’, ‘Withdrawal/Retardation’, ‘Hostility/Suspiciousness’, and ‘Anxiety/Depression’ were correlated with five components of sleep architecture, namely, sleep onset latency, total sleep time, total slow wave sleep minutes (the summation of visually scored stages 3 and 4), total REM minutes, and REM latency. Partial correlations were computed to control for the effects of age. Of the 20 correlation coefficients computed, only one was statistically significant after Bonferroni correction, namely, sleep onset latency was positively correlated with the ‘Thinking Disturbance’ factor. This finding is consistent with studies showing that psychotic exacerbation is associated with reduced sleep efficiency. In contrast to this cross-sectional design, longitudinal studies are more likely to clarify the relationship of sleep architecture to changes in clinical state.

Sexuality, pregnancy, and childrearing among women with schizophrenia-spectrum disorders.

This study compared sexuality, reproduction, and childrearing characteristics of women with schizophrenia-spectrum disorders with those of women without serious mental illness. A semistructured interview was given to 46 women meeting Research Diagnostic Criteria for schizophrenia or schizoaffective disorder and to 50 control subjects without major mental illness who were matched for age, race, education, employment status, and religion. Compared with the control subjects, the women with schizophrenic disorders had more lifetime sexual partners, were less likely to have a current partner, and were more likely to have been raped and to have engaged in prostitution. Despite being at high risk for HIV infection, as a group they were less likely to have been tested for HIV. They reported wanting sex less often than did control subjects and rated their physical and emotional satisfaction with sex lower. They had fewer planned pregnancies, more unwanted pregnancies, and more abortions and were more often victims of violence during pregnancy. They were more likely to have lost custody of children and to report that they were unable to meet their children's basic needs and less likely to have another caregiver helping them raise their children. Both groups reported high rates of substance abuse during pregnancy. Health care delivery systems could better meet the needs of women with severe mental illness by providing social skills training, family planning, and more consistent screening for pregnancy, HIV, and battering. In addition, barriers to care for pregnant women with severe mental illness and substance abuse should be reduced, and parenting training should be incorporated into psychosocial rehabilitation programs for mentally ill parents.

Slow wave sleep and computed tomographic measures of brain morphology in schizophrenia

To test the hypothesis that slow wave sleep in schizophrenia is inversely correlated with ventricular system volume, polysomnography and computed tomographic (CT) brain imaging were carried out in 14 psychiatric patients who met Research Diagnostic Criteria for schizophrenia ( n = 11) or schizoaffective disorder ( n = 3). Three measures of ventricular system volume were analyzed: (1) raw ventricular volume expressed in cm 3; (2) ventricle-to-brain ratio; and (3) ventricular volume corrected for normal variation in age and head size expressed as a standardized ( z) score. All three quantifications of ventricular volume were significantly and inversely correlated with visually scored measures of stage 3 and stage 4 sleep. This finding suggests that the etiology of slow wave sleep deficits in schizophrenia is related either directly or indirectly to underlying brain dysmorphology.

Three syndromes in schizophrenia: validity in young patients with recent onset of illness

The heterogeneity of schizophrenia constitutes an impediment in the identification of reliable biological markers of the illness and aetiological factors. The two syndrome concept of the illness has proved a powerful stimulus in this endeavour. There is however evidence now to regard this construct as inadequate and in need of refinement. Using a sample of young patients with early onset of illness who fulfilled the Research Diagnostic Criteria for schizophrenia, we have shown that three rather than two dimensions better describe the pathology of the illness. The results of factor analysis showed these syndromes, termed disorganization, positive, and negative syndromes, to account for 65% of the total variance of the psychopathology of the disorder. The negative syndrome was associated with disturbed pre-morbid functioning while the disorganization syndrome bore significant association with early onset of illness, poorer socio-educational attainment, and impairment on neuropsychological tests, especially those designed to evaluate frontal lobe functioning. The positive syndrome was not associated with any of the assessed variables. These results provide strong support for the validity of the three-syndrome construct even among a sample of non-institutionalized patients.

Predicting the "revolving door" phenomenon among patients with schizophrenic, schizoaffective, and affective disorders

A subpopulation of chronically mentally ill patients, sometimes referred to as "revolving door" patients, are frequently readmitted to psychiatric units. This study examined the relationships among demographic features, diagnostic characteristics, and frequency of hospitalization of patients from four state hospitals. Two semistructured, standardized instruments, the Schedule for Affective Disorders and Schizophrenia and a life events history, were administered to 135 inpatients who met the Research Diagnostic Criteria for schizophrenia (N = 56), schizoaffective disorder (N = 33), unipolar major depressive disorder (N = 23), and bipolar disorder (N = 23). Criminal history was assessed by arrest records. The main outcome measure was the number of hospitalizations. Chi-square and trend test analyses indicated that substance abuse and noncompliance with medication regimens were significantly associated with higher frequencies of hospitalization. A multiple regression model, which included alcohol/drug problems, medication noncompliance, and six sociodemographic and diagnostic variables (age, gender, race, marital status, years of education, and diagnosis) accounted for a significant proportion of the ability to predict frequency of hospitalization. Half of this predictability was due to the relationship of substance abuse and medication noncompliance with number of hospitalizations. Alcohol/drug problems and noncompliance with medication were the most important factors related to frequency of hospitalization. Preventing these behaviors through patient education may reduce rehospitalization rates.

Patterns of neuropsychological deficit in cases of schizophrenia spectrum disorder with and without a family history of psychosis

This study was designed to identify the types of neuropsychological deficits that are unique to familial and nonfamilial forms of schizophrenia. Seventy-two patients who met Research Diagnostic Criteria for schizophrenia or schizoaffective disorder, mainly schizophrenic, were divided into two groups on the basis of the presence or absence of a family history of psychosis. The two groups were then compared for differences on six neuropsychological parameters as well as for differences in psychotic symptoms. Multivariate analyses indicated that schizophrenic patients with a family history of psychosis showed significantly higher levels of overall neuropsychological deficit and significantly greater deficits on tests of motor-control and abstraction and problem-solving. Factor analyses indicate that schizophrenic patients with a family history of psychosis show a pattern of specific neuropsychological deficits, while schizophrenic patients without a family history show a pattern of more consistent cognitive deficits. The results of this study indicate that recent-onset schizophrenic patients with and without a family history of psychosis show distinctly different patterns of neuropsychological dysfunction. These data suggest that abnormalities in the dorsolateral prefrontal cortex and nonprimary motor areas may be associated with an increased familial risk for psychotic disorder.

Altered interleukin-2 production in schizophrenia: Association between clinical state and autoantibody production

Mitogen-stimulated interleukin-2 (IL-2) production was measured in 122 patients who met Research Diagnostic Criteria for schizophrenia and 98 normal control subjects. The presence of autoantibodies against seven common antigens was also determined. There was no relationship between the presence of circulating autoantibodies and IL-2 production in control subjects. In patients, however, autoantibody-positive, acutely ill patients had significantly lower IL-2 production as compared with other patients and control subjects. Never- medicated patients showed the same trends for decreased IL-2 production in association with autoantibodies. These data suggest that decreased IL-2 production is associated with acute illness in schizophrenic patients who produce autoantibodies, a trait known to be associated with increased vulnerability to autoimmune disease.

Season of birth and neuropsychological impairment in schizophrenia.

Repeated studies suggest a relationship between winter birth and increased incidence of schizophrenia. Furthermore, there may be seasonal fluctuations in schizophrenia risk factors (e.g., influenza epidemics) and the severity of biological anomalies (e.g., enlarged cerebral ventricles in neuroimaging studies). In order to assess whether winter-born schizophrenics show greater neuropsychological impairment, 112 males meeting Research Diagnostic criteria for schizophrenia were administered the Luria-Nebraska Neuropsychological Battery, a thorough measure of higher cortical functioning deficit. Sixty-four of these 112 patients were also administered the Wechsler Adult Intelligence Scale-Revised, the Benton Visual Retention Test, and the Rey Auditory Verbal Learning Test. Despite the use of several definitions of winter and nonwinter birth, there was no evidence of elevated rates of neuropsychological dysfunction among winter-born patients on any measure. The current study contains certain limitations (e.g., variable medication status at testing), but the results suggest no strong season of birth relationship with neuropsychological impairment in a reasonably large, research-diagnosed sample of schizophrenic patients.

An open study of remoxipride in the long-term treatment of schizophrenia-

An open non-comparative multicentre study was carried out to evaluate the safety and tolerability of remoxipride over a treatment period of 12 months. The efficacy of the drug in controlling psychotic symptoms was also monitored. Eighty-five men and women aged 18-69 who met the Research Diagnostic Criteria for schizophrenia were entered into the study and after withdrawal of previous antipsychotic medication, treated orally with remoxipride 75-300 mg b.i.d. The treatment was well tolerated and most of the adverse symptoms reported were reduced in incidence at the last rating compared to baseline. Sleep problems (insomnia and increased sleep) and increased thirst showed an increase in incidence during treatment. The incidence of extrapyramidal side effects was low and less than at baseline; there was no evidence that remoxipride produced an increase in abnormal involuntary movements, the median weight of the group did not alter and remoxipride produced no significant effect on cardiovascular, clinical chemistry and haematology variables. It appeared effective in controlling psychotic symptoms and produced some improvement on over one third of the patients despite the fact that the majority of patients entered were not in a productive phase of their illness. The results indicate that remoxipride will be well tolerated and effective when given for the maintenance treatment of schizophrenia.

Community care for patients with schizophrenia one year after hospital discharge.

To document the circumstances and care of patients with schizophrenia who had recently been discharged from local psychiatric inpatient services, and to establish the extent to which misgivings about community care might be justified. Cross sectional surveys with review of case notes. Follow up interviews with questionnaires administered one year after discharge. Two inner London districts (West Lambeth and Lewisham) with high levels of social deprivation and at different stages of developing community services. 90 and 50 patients in the two services respectively, aged 18 to 65, who satisfied the Research Diagnostic Criteria for schizophrenia and who were discharged from inpatient services. Diagnosis elicited by present state examination, global social disability rating, use of services during the three months before interview. 89 of the 140 patients (64%) had been ill for five or more years, yet few were former long stay inpatients. 55% (50/91; 95% confidence interval 45% to 65%) of those interviewed had current psychotic mental states and 22% (27/124; 16% to 31%) were functioning socially at very poor or severely maladjusted levels. 86% (107/124) were unemployed. The majority of patients had seen a mental health or social service professional, yet only 16% (20/124) were in specialised accomodation (excluding hospitals) and only 23% (17/73) of those eligible had used day care. Small numbers of people had experienced homelessness (two) or imprisonment (four over six months). Many schizophrenic patients leaving local psychiatric inpatient care have active symptomatology and profound social disabilities. Community care was characterised by high rates of contact with service professionals but little supported accommodation or day activity. This group of clients may require dedicated provision, which would actively encourage them to use services protected from the demands of those with less severe illness.

Gender Differences in the Specificity of Alcoholism Transmission among the Relatives of Opioid Addicts

Gender differences in the specificity of drug versus alcohol transmission were examined among 201 opioid addicts and their 877 first-degree relatives using direct interviews and a structured family history method based on the Schedule for Affective Disorders and Schizophrenia Research Diagnostic Criteria. A strong association of parental alcoholism with alcoholism among the proband addicts was found, suggesting some specificity for drug versus alcohol abuse. We also found that among the 477 siblings, those with alcoholism alone did not have parents with drug abuse and those parents with drug abuse did not have children with alcoholism alone. Rates of parental alcoholism were higher in alcoholic female than in alcoholic male probands, suggesting greater female "loading" was needed in order to become alcoholic. This increased loading in women was also found among the siblings, but alcoholic parents appeared to transmit a nonspecific tendency for either drug or alcohol abuse to their female children. Thus, it may take a greater "dose" of parental transmission for a woman to become a substance abuser, and transmission of alcoholism may be specific in men, but not in women.

Gender and schizophrenia: age at onset and sociodemographic attributes

A consecutive series of 214 patients (125 males, 89 females) who met the Research Diagnostic Criteria for schizophrenia were studied to determine gender differences in age at onset of the illness and sociodemographic attributes. The immediate family's first awareness of psychotic symptoms or signs and age at first presentation in hospital were used as indices of onset; male patients had a significantly earlier age of onset than females. By the time they were 30 years of age, 83% of male patients had already become ill and only 66% of females had done so. Significantly more females than males were married at the time of first contact with hospital. Married males did not differ from married females in age at onset of illness, suggesting that patients who marry may have late onset.

Evidence for a Pseudo-autosomal Locus for Schizophrenia Using the Method of Affected Sibling Pairs

A susceptibility locus for schizophrenia in the 'pseudo-autosomal' region has been proposed on the basis of the reported excess of sex-chromosome aneuploidies (e.g. XXY and XXX) among patients with schizophrenia and the finding that schizophrenic sib-pairs are more often of the same than of the opposite sex. This hypothesis has been tested in 83 sibships with two or more siblings fulfilling Research Diagnostic Criteria for schizophrenia or schizoaffective disorder. Alleles at the pseudo-autosomal telomeric locus DXYS14, which is unlinked with sex, were analysed using the method of affected sib-pairs. Affected sibs shared alleles at DXYS14 more frequently than expected by random Mendelian assortment, supporting genetic linkage between DXYS14 and schizophrenia.

Leucocyte arylsulphatase A activity and subtypes of chronic schizophrenia

Previous studies have suggested that arylsulphatase A (ASA - the biochemical marker of metachromatic leucodystrophy) deficiency may be present in a sizeable proportion of patients with chronic psychosis. This study surveyed leucocyte ASA activity in a group of chronic psychotic patients and compared ASA activity in 3 subgroups fulfilling Research Diagnostic Criteria for schizophrenia (undifferentiated), paranoid schizophrenia and schizoaffective psychosis. Three of 45 patients had significantly reduced ASA activity but none had metachromatic leucodystrophy. Although ASA levels did not differ significantly between the groups, schizophrenics without a family history of schizophrenia had significantly lower ASA levels than those with. The implications of these findings are discussed.

A double‐blind comparative trial of remoxipride and haloperidol in the treatment of schizophrenia

AbstractA multicentre parallel group study was carried out to compare the efficacy and safety of remoxipride, a new antipsychotic drug, with haloperidol in the treatment of acute schizophrenia. Patients were randomly assigned to the two groups and assessments were made under double‐blind conditions. Treatment was preceded by a washout period and lasted 6 weeks. Eighty‐nine consecutively admitted men and women meeting the Research Diagnostic Criteria for schizophrenia in an acute phase of the illness were treated with remoxipride 75–300 mg b.d. or haloperidol 5–20 mg b.d. The main assessments were changes in scores on the Brief Psychiatric Rating Scale, Krawiecka Rating Scale and Clinical Global Impression. Both neuroleptics produced clinical improvement but there were no significant differences in overall efficacy measurements between the two drugs. There were relatively few unwanted side‐effects. There were significantly less extra‐pyramidal symptoms and blurred vision with remoxipride, and less constipation with haloperidol. The results indicate that remoxipride is an effective antipsychotic drug with a low incidence of extrapyramidal side‐effects.

Remoxipride and haloperidol in the acute phase of schizophrenia: a double‐blind comparison

The efficacy and safety of remoxipride in the treatment of schizophrenia were compared with those of haloperidol in a multicentre double-blind 6-week study which was randomized with a parallel group design and was preceded by a washout period. Eighty-nine consecutively admitted men and women meeting the Research Diagnostic Criteria for schizophrenia in an acute phase of the illness were treated with remoxipride 75-300 mg twice daily or haloperidol 5-20 mg twice daily. The efficacy assessments were the Brief Psychiatric Rating Scale, Krawiecka Rating Scale, and Clinical Global Impression. Both antipsychotic drugs produced clinical improvement with no significant differences between the efficacy of the two drugs. There were relatively few side effects. There were significantly fewer extrapyramidal symptoms and instances of blurred vision with remoxipride and less constipation with haloperidol. The results indicate that remoxipride is as effective an antipsychotic as haloperidol. Remoxipride has an advantage over haloperidol in respect to extrapyramidal side effects.

Psychiatric morbidity of a long stay hospital population with chronic schizophrenia and implications for future community care.

In the United Kingdom there are plans to close most mental hospitals over the next 10 years. There is continuing uncertainty about the effectiveness of community psychiatric services that will be expected to cope with mental hospital inpatients after discharge, most of whom have schizophrenia. A survey was conducted to assess the severity of illness among such patients and implications for their future care. All 222 patients in non-psychogeriatric long stay wards of a mental hospital who met research diagnostic criteria for schizophrenia were interviewed by two psychiatrists with the comprehensive psychopathological rating scale to establish the prevalence of psychiatric symptomatology. A complete interview was not possible for 28 patients, mainly for reasons related to their schizophrenia. Despite energetic pharmacological and social treatments almost half of the 194 patients interviewed had enduring florid psychotic symptoms that presented as one or more delusions or auditory hallucinations, or both, and a sizable proportion showed behaviour that would set them apart in a community setting. The results illustrate a problem that is still imperfectly understood by policy makers and administrators in central and local government and in health authorities who are responsible for planning and implementing services for psychiatric care in the community.

Dexamethasone suppression test in schizophrenic patients before and during neuroleptic treatment.

The dexamethasone suppression test (DST) was performed in 21 drug-free schizophrenic patients. The patients satisfied DSM-III and Research Diagnostic Criteria for schizophrenia and were in an acute phase of the disease. In 15 of the patients the DST was repeated after about 5 weeks of treatment with neuroleptics. DST compliance was checked by analysis of dexamethasone concentrations in plasma. In the acute phase 71% (at 04 p.m.) of the patients were nonsuppressors. After neuroleptic treatment the frequency of abnormal responders had decreased to 20%. The decrease in nonsuppressors was not due to alteration of the dexamethasone concentration between the two test occasions. Prolactin levels were markedly increased at the second test occasion compared with the first. There were no significant relationships between cortisol levels, cortisol suppression and prolactin levels. The high frequency of nonsuppressors among schizophrenic patients in the acute phase of the disease indicates that acute stress may be a confounding factor in the outcome of DST.