SANS Scores Research Articles

A controlled trial of modified electroconvulsive therapy in Schizophrenia in a Nigeria Teaching Hospital

The efficacy of ECT in the treatment of Schizophrenia was investigated in a double blind controlled trial. The ICD-10 criteria for Schizophrenia were fulfilled by the 20 patients who entered the trial. Consecutive individuals who satisfied the inclusion criteria were randomly allocated to a course of (bilateral) six real or simulated ECTs each as applicable. Sixteen patients completed the ECT treatment and 20 weeks follow up period. Analysis of measures of clinical change (BPRS and SANS Scores) showed that both groups of patients improved, but the improvement of patients receiving ECT was not significantly greater than that of the control group.

Duration of untreated psychosis may predict acute treatment response in first-episode schizophrenia

There is growing evidence for a relationship between the duration of untreated psychosis (DUP) and the prognosis in schizophrenia. The objective of this study is to evaluate whether DUP and premorbid level of social functioning are related to treatment response in acute treatment of first-episode schizophrenia. Seventy-nine first-episode schizophrenia patients were assessed with BPRS, SAPS, and SANS on admission and discharge during their first hospitalisation. Percentage of the difference between admission and discharge in total scores of all scales were taken as measures of absolute symptom reduction. The median DUP was 6 months (mean=8.6). DUP was correlated with reduction in BPRS and SAPS scores but not SANS scores. Patients with a short DUP ( n=41) also showed a higher reduction in BPRS, and SAPS scores than those with a long DUP. Premorbid Adjustment Scale (PAS) scores were inversely correlated with age at onset and positively correlated with BPRS scores at admission. We did not find any relationship between PAS scores and response to treatment. Our findings suggest that DUP may be an important predictor of response in acute treatment of first-episode schizophrenia and thus, attempts for early diagnosis may also have a positive effect on acute treatment response.

The effects of olanzapine on neurocognitive functioning in medication-refractory schizophrenia

Neurocognitive deficits are an enduring characteristic of schizophrenia, and remain prominent in patients whose positive symptoms have decreased after treatment with typical neuroleptics. Recent research has reported that olanzapine improves cognitive functioning in relapsing schizophrenia followed in an outpatient setting. Whether olanzapine will have an effect on improving cognitive function in chronic schizophrenics who have been hospitalized for long periods of time, and have shown a poor response to other conventional and atypical neuroleptics, has not been established. This study investigated cognitive function in chronic medication refractory schizophrenics who were treated with olanzapine or haloperidol in a double-blind study for 8 wk, and followed in an open olanzapine study for several additional months. Patients were evaluated with psychopathology rating scales and a battery of neuropsychological tests at baseline, end of double-blind and end of open-label phases of the study. At the end of the double-blind phase there were no significant differences between olanzapine and haloperidol, except for a trend for improvement on the Wisconsin Card Sort Test on olanzapine, which was significant at traditional but not corrected significance levels. After an additional 3 months of treatment with olanzapine doses of 20-40 mg/d, our statistical analysis showed significant improvement on overall neuropsychological test performance and specific cognitive tasks assessing verbal memory. However, these open-label results are difficult to interpret definitively because of the lack of a comparison drug group and the olanzapine dose escalation over time. Neurocognitive changes were not correlated with changes in psychopathology as assessed by PANSS or SANS scores.

Plasma homovanillic acid in untreated schizophrenia — relationship with symptomatology and sex

Plasma homovanillic acid (pHVA) concentrations are considered to reflect, in part, central dopamine metabolism and thus may be of value in assessing the role of dopamine neurotransmission in schizophrenia. Furthermore, some recent studies have suggested a relationship of pHVA with symptomatology. We have undertaken a study of pHVA in a large cohort of unmedicated DSM-IV schizophrenic patients in order to assess the relationship of pHVA to various clinical parameters. pHVA in 58 drug-free patients (10.11±0.52 ng/ml) was significantly elevated in comparison with 62 matched control subjects (8.77±0.39 ng/ml). pHVA was found to be higher in patients with a more negative syndrome. No significant correlation of pHVA with overall SAPS or SANS scores was apparent in the patients although, within the SANS subscales, a significant relationship to anhedonia-asociality was apparent. Interestingly, the male drug-free patients showed a correlation of pHVA with negative symptoms defined by SANS and several SANS subscales, while females showed no significant relationship with any SANS subscales. The results may suggest that an increased dopaminergic turnover is apparent in (male) schizophrenic patients with predominantly negative symptoms, providing some support for reports that this change in neuronal activity may be related to the neuropathological abnormalities seen in the disease, which may themselves differ between males and females. Such neuronal deficits of developmental or degenerative origin may thus result in an elevation/disinhibition of central dopamine metabolism in schizophrenia.

Smooth pursuit eye movements in chronic schizophrenics and healthy volunteers using a quantitative objective measure for detecting saccadic intrusions

An electro-oculogram based eye tracking system (the Cardiff System for the Generation and Analysis of Saccades) was used to quantify smooth pursuit eye movements (SPEM) and saccadic intrusions in 20 chronic schizophrenic patients and 16 normal, healthy controls. Statistically significant differences were found between the two groups at all four target frequencies tested (0·2, 0·25, 0·33 and 0·5 Hz) in three measures of SPEM dysfunction (position error, velocity error and saccadic intrusions). Of the patients' position errors, 50–70 per cent were greater than the 95th percentile for controls. Velocity errors gave a similar range of SPEM dysfunction (50–65 per cent) but the frequency of saccadic intrusion abnormality was more variable (20–60 per cent). Position error and saccadic intrusions, at the fastest target speed, correlated with total BPRS scores. Extrapyramidal symptoms (Simpson and Angus) and abnormal involuntary movements also correlated with saccadic intrusions at 0·5 Hz. There were no significant correlations between SPEM dysfunction and age, duration of illness, negative symptoms (total SANS score) or current dose of antipsychotic drug treatment. Copyright © 1999 John Wiley & Sons, Ltd.

NMDA receptor hypofunction and schizophrenia

famotidine 20 mg twice a day as adjunctive therapy in an open-label study. SPEM were recorded for 60 seconds at baseline, after 3 weeks on famotidine, and 1 week after discontinuation, using a 0.4 Hz/10 degree amplitude stimulus. SPEM outcome measures included In signal/noise, saccade number, and percent error. We found no statistically significant effect of famotidine on any of our outcome measures, although there was considerable intersubject variability. To determine if SPEM changes meaningfully reflect clinical response, we are currently analyzing the correlation of SPEM findings with BPRS and SANS scores, as well as the heterogeneity of the responses. Further studies might explore the utility of SPEM as a potentially valuable and noninvasive tool for the monitoring of response to novel pharmacologic therapies for schizophrenia.

Positive and Negative Symptom Course in Chronic Community-Based Patients

The long-term symptom profile of chronic out-patients was studied. 242 out-patients receiving neuroleptic medications (109 with schizophrenia and 133 non-schizophrenics), were studied for positive (SAPS) and negative (SANS) symptoms at baseline and at 24 months to investigate whether these symptom groups changed over outpatient maintenance treatment. Overall and within groups, negative symptoms decreased and positive symptoms increased. While the sums of the SANS scores for the schizophrenic patients were initially higher, their mean SANS score dropped more over time (P < 0.001), to show no difference from non-schizophrenics at follow-up. Positive symptoms increased in both groups, although schizophrenics were higher at both times; sub-scales within the SANS showed different patterns of change. Support is found for a multidimensional view of both positive and negative symptoms and for a reconsideration of the notion of 'progressive downward course' in schizophrenia.

Fluvoxamine augmentation in chronic schizophrenia: An open exploratory study

AbstractThe effect of augmenting standard antipsychotic treatment with the specific serotonergic reuptake inhibitor (SSRI) fluvoxamine was examined in severely disabled chronic schizophrenic inpatients using an open, naturalistic protocol. Fluvoxamine in doses ranging from 25 to 200 mg was added to the antipsychotic medication which was kept constant. Patients were followed for the duration of treatment (to date up to 7·5 months). Assessment included BPRS SANS SAPS and CGI scales (CGI only in the most severely disturbed), and global impressions of occupational and social functioning. Fourteen (74%) of the 19 patients studied showed improvement using 15 per cent change in SANS score or CGI improvement score &gt; = 1 as criterion. The symptom constellation appeared to influence the rate and timing of response. Ten patients experienced exacerbations, some within 2 months of starting treatment, others after 5–6 months. The findings suggest that SSRI augmentation may be effective in severely disabled schizophrenics.

Symptom segregation in chronic schizophrenia: the significance of thought disorder

Forty-two schizophrenics in chronic stages were evaluated using the standard and modified SANS for negative symptoms, and the SADS for positive symptoms. The results of principal components analysis of the two scales were then compared. Analysis of the modified scale scores showed that thought disorder belonged to a unique syndrome orthogonal to both the positive and negative syndromes, which was designated disorganization syndrome. Cluster analysis of the modified scores revealed two major clusters, one of which consisted of the subjects with high disorganization syndrome scores. This subgroup was not identified using the standard SANS scores for analysis. The disorganization syndrome included thought disorder, bizarre behavior, and attentional impairment. Similarities between Hecker's hebephrenia and the disorganization syndrome detected in the present study were noted.

Effect of neuroleptic treatment on polysomnographic measures in schizophrenia

To study the effects of neuroleptic therapy on sleep EEG variables in schizophrenia, as well as the clinical correlates of these variables, we performed polysomnographic (PSG) studies on 14 schizophrenic inpatients before and during neuroleptic therapy. Sleep continuity measures improved after 3 weeks of neuroleptic therapy, showing decreased sleep latency and improved sleep efficiency. REM latency increased with treatment, although half the patients continued to exhibit REM latencies less than 60 min. Other sleep stages and measures of REM sleep (density, activity, number of periods) did not appear to change with neuroleptic treatment. At baseline, REM latency had strong negative correlations with BPRS and SANS scores, but with 3 weeks of such treatment, this association disappeared. Further work is needed to distinguish direct medication effects from the effects of the changing clinical state on PSG measures.

Low-dose zotepine in the maintenance treatment of schizophrenia.

Zotepine is new tricyclic neuroleptic with a pharmacological profile comparable to substances such as thioridazine and chlorpromazine. Its chemical structure is related to clozapine and fluperlapine. Ten patients (8 men and 2 women) fulfilling DSM III criteria for residual schizophrenia participated in an open clinical trial that lasted 8 months. The effects of low-dose maintenance therapy with Zotepine were evaluated using the Brief Psychiatric Rating Scale and the Scale for the Assessment of Negative Symptoms. Eight patients dropped out of the study within the first 6 months, 5 because of acute psychotic relapse, 3 due to compliance problems. Psychotic relapse appeared to be indicated by increasing BPRS and SANS scores recorded 1 month before relapse. Apart from minor sedation, no side effects, especially none of the extrapyramidal motor type, were observed. Even though Zotepine does not seem to possess sufficient prophylactic properties against psychotic relapse, preliminary results suggest that it might play an important role as a supplement to conventional neuroleptics in the near future.