Schedule For Assessment Of Insight Research Articles

The Relationship of Perceived Social Support with Level of Insight and Treatment Adherence in Individuals Diagnosed with Schizophrenia and Bipolar Disorder

Purpose: This study aims to examine the relationship between perceived social support, insight, and treatment adherence in patients with schizophrenia and bipolar disorder. 
 Materials and Methods:This study was conducted with 110 individuals, 55 of whom were bipolar and 55 patients with schizophrenia, who received inpatient treatment in the last 1 year, were in remission. Sociodemographic and clinical data form, Young Mania Rating Scale (YMDS), Clinical Global Impressions Scale (CGI), Schedule for Assessment of Insight (SAI), Morisky Medication Adherence Scale (MMAS), and Multidimensional Scale of Perceived Social Support (MSPSS) were administered to the participants. 
 Results: The mean age was 40.47±12.96 for bipolar patients and 40.45±11.71 for schizophrenics. Perceived family, friend, significant others support, and total support was found to be higher (p=0.000, p=0.000, p=0.004, p=0.000, respectively) in bipolar patients, and the highest support was perceived from family, followed by friends and significant people. Although the groups did not differ in terms of treatment adherence (p=0.083), the insight score was significantly higher in bipolar patients (p=0.001). Groups were evaluated with hierarchical regression analysis in terms of factors affecting perceived social support. Gender, years of education, insight, and treatment adherence were found to be predictive of social support (p=0.04, p=0.01, p

Exploring the "Insight Paradox" in Treatment-Resistant Schizophrenia: Correlations Between Dimensions of Insight and Depressive Symptoms in Patients Receiving Clozapine.

There remains a lack of clarity as to the possible cross talk of insight into illness and depressive symptoms in treatment-resistant schizophrenia. We therefore set our primary aim to evaluate relationship between insight dimensions and depressive symptoms in patients with treatment-resistant schizophrenia receiving clozapine. This was a cross-sectional, non-interventional study, conducted in daily clinical practice conditions. Patients in outpatient clinics between March 2020 and May 2020 with treatment-resistant schizophrenia (based on Treatment Response and Resistance in Psychosis), with no comorbid psychiatric disorder, and with no body mass index greater than 40.0 kg/m2 were included. We collected sociodemographic variables, scores of insight dimensions (treatment compliance, illness recognition, and symptom relabeling with the Schedule for Assessment of Insight), and depressive symptoms with Calgary Depression Score for Schizophrenia. Linear regression models were used to investigate variables associated with depressive symptoms as the outcome of interest. The final analysis sample comprised 55 patients with treatment-resistant schizophrenia, with a mean age of 42.48 (SD = 9.18) years and a predominance of the male sex (n = 42, 76.9%). Model 1 [Calgary Depression Score for Schizophrenia ~ (Schedule for Assessment of Insight + Positive and Negative Syndrome Scale)] displayed that 48% of the variation in the Calgary Depression Score for Schizophrenia can be explained by Schedule for Assessment of Insight-composite and Positive and Negative Syndrome Scale-composite (P < .001). More effectively, model 2 [Calgary Depression Score for Schizophrenia ~ (Schedule for Assessment of Insight-illness recognition + Positive and Negative Syndrome Scale-general psychopathology)] revealed that 51% of the variation in the Calgary Depression Score for Schizophrenia can be explained by the sub-scales (P < .001). We further designed a new model in which Global Assessment of Functioning scores were the response variable to explore the link between awareness into illness and functionality (Global Assessment of Functioning ~ Schedule for Assessment of Insight-illness recognition). In this model, awareness of illness did not explain a significant proportion of variance in functionality scores (R 2 = 0.045, F(1,52) = 2.48, P = 0.121). The treatment compliance part of insight was not one of the significant explanatory variables of depressive symptoms, but it explained the variance in functioning, in contrast to the illness recognition dimension of insight. If our findings were replicated in treatment-resistant schizophrenia, they would suggest that promoting treatment compliance dimension of insight instead of recognition of illness could not increase depressive symptoms.

Evaluation of Abnormal Movements among Senior Schizophrenics: A Local Study with Reference to Tardive Dyskinesia

Introduction: Tardive dyskinesia (TD) includes involuntary choreiform or athetoid movements of the jaw, lower face, tongue, and extremities, developing in association with the use of an antipsychotic medication, and may develop in about 20 to 40 percent of patients who require long-lasting hospitalization. In the present study, the prevalence of this condition has been measured among an elderly group of schizophrenic patients. Methods: One hundred and one elderly schizophrenic patients, who were hospitalized in the chronic section of a community psychiatric hospital, were selected for the present cross-sectional study. Abnormal Involuntary Movement Scale (AIMS) was employed to screen for patients with schizophrenia who also had TD. Scale for Assessment of Positive Symptoms, Scale for Assessment of Negative Symptoms, Schedule for Assessment of Insight, and Clinical Global Impressions – Severity of illness, as well, had been used as ancillary scales for evaluation of severity of general psychopathology of schizophrenia, and comparing the TD patients with the group of patients without TD, for probing the intervening parameters. Results: While abnormal movements were clear in 38.61% (n=39) of elderly schizophrenic patients, only seven of them (6.93 %) could be diagnosed as TD, based on the above-mentioned criteria. All of them were using conventional antipsychotic medications, accompanied with anticholinergic medications. Among TD patients, three cases had only abnormal facial and oral movements, one patient had atypical facial and oral movements as well as anomalous extremity movements, one patient had irregular facial and oral movements in addition to unusual trunk movements, and lastly, two patients had nonstandard extremity movements. In addition, around 71% of patients with TD were aware of their unusual movements. Between-group analysis did not show any significant difference between patients with TD and patients without TD in age, duration of illness, positive symptoms, negative symptoms, insight, and general psychopathology. Conclusion: According to the findings of the present study, the prevalence of Tardive Dyskinesia among elderly schizophrenic patients, who were using typical antipsychotic medications, is very lower than what has been indicated thus far.

Abstract- Poster

Background:Stigma acts as a barrier in help seeking behavior of patients affected with psychiatric illness. Insight and stigma both are vital in influencing adherence to treatment and recovery.Aim:This study was an attempt to compare Internalized stigma, Insight and treatment adherence among patients of schizophrenia and alcohol dependence.Materials and Methods:The study was conducted at institute of mental health and hospital Agra. 30 patients with a diagnosis of schizophrenia and 30 with alcohol dependence syndrome as per International Classification of Diseases-10 diagnostic criteria were recruited from the out patient department. Sociodemographic and illness-related information were recorded in detail. Internalized Stigma of Mental Illness (Ritsher · 2003) schedule for assessment of Insight (Davis 1990) and medication adherence rating scale (Thompson etal,2000) were administered to both the groups.Results:The data will be analyzed and shared during presentation.

Relationship Between Cognitive and Clinical Insight at Different Durations of Untreated Attenuated Psychotic Symptoms in High-Risk Individuals

Background: This study examines whether cognitive insight is impaired in high-risk individuals with attenuated psychotic symptoms (APS) and explores the relationship between cognitive and clinical insight at different durations of untreated attenuated psychotic symptoms (DUAPS).Methods: The Structured Interview for Psychosis high-risk Syndrome (SIPS) was used to identify APS individuals. APS (n = 121) and healthy control (HC, n = 87) subjects were asked to complete the Beck Cognitive Insight Scale (BCIS). Clinical insight of APS individuals was evaluated using the Schedule for Assessment of Insight (SAI). APS individuals were classified into four subgroups based on DUAPS, including 0–3, 4–6, 7–12, and >12 months. Power analysis for significant correlation was conducted using the WebPower package in R.Results: Compared with HC subjects, APS individuals showed poorer cognitive insight, with lower scores on BCIS self-reflectiveness and composite index (BCIS self-reflectiveness minus BCIS self-certainty). Only when DUAPS was longer than 12 months did the significant positive correlation between cognitive and clinical insight obtain the power about 0.8, including the associations between self-reflectiveness and awareness of illness, self-reflectiveness and the total clinical insight, and composite index and awareness of illness. The positive associations of composite index with awareness of illness within 0–3 months DUAPS and with the total score of SAI when DUAPS > 12 months were significant but failed to obtain satisfactory power.Conclusions: APS individuals may have impaired cognitive insight, demonstrating lower self-reflectiveness. The correlation between cognitive and clinical insight is associated with the duration of untreated attenuated psychotic symptoms.

A Comparative Study between Lithium and Extended-release Carbamazepine in Acute Mania: A Double-blind Clinical Trial

Background: Recently, numerous large clinical trials have been performed to evaluate the effectiveness and tolerability of extended-release formulations of carbamazepine in bipolar disorder. Objective: In the current study, we compared lithium with a prolonged-release form of carbamazepine (Tegretol CR) to evaluate its efficiency and safety in a group of patients with a diagnosis of acute mania. Methods: Fifty patients with the diagnosis of acute mania were selected for a three-week, doubleblind study, and were randomly administered lithium carbonate or tegretol CR. The main outcome measured in the present evaluation was the Manic State Rating Scale (MSRS), which was scored at baseline and weekly intervals up to the third week. Moreover, insight and overall illness severity and improvement were assessed using the Schedule for Assessment of Insight (SAI), the Clinical Global Impressions-Global Improvement scale (CGI-I), and the Clinical Global Impressions Severity Scale (CGI-S), respectively. The statistical significance was defined with a p-value ≤0.05, and the treatment efficacy was analyzed by independent samples t-test and repeated measures analysis of variance (ANOVA). Results: Despite the fact that the mean total score of MSRS improved significantly with respect to both lithium carbonate and tegretol CR at the end of the third week, the between-group analysis showed a significant advantage of lithium, regarding both frequency and intensity of symptoms, at the end of the study. The mean total score of SAI, as well, showed significant improvement caused by both of them. Nevertheless, while the CGI-I demonstrated significant improvement in participants taking lithium and tegretol CR, the CGI-S showed significant progress only with lithium. Besides, Cohen’s effect size analysis showed a large improvement of MSRS by lithium and medium improvement by tegretol CR. Post-hoc power analysis showed an intermediate power of 0.42 on behalf of the current evaluation. Conclusion: While both lithium carbonate and tegretol CR were found to be valuable for the improvement of manic symptoms, management with lithium appears to be more helpful.

The Association Between Psychopathology and Clinical Insight in Patients With Schizophrenia

In Taiwan, few studies have explored the associations between insight and psychopathological dimensions in people with schizophrenia. We aimed to investigate the relationships of clinical insight with different dimensional symptoms in patients with schizophrenia, in addition to clinical variables. This cross-sectional study recruited 90 patients from an acute psychiatric ward from December 2017 to May 2019. We assessed the insight of participants using the Schedule for Assessment of Insight in Psychosis (SIP) and psychopathology using the Positive and Negative Syndrome Scale and its five-factor model. A higher SIP score indicates a poorer insight. In regression analyses, patients' age (t = 3.277, p = 0.002), family history (t = -2.773, p = 0.007), Clinical Global Impressions Scale- Improvement (t = 2.268, p = 0.026), and negative (t = 2.667, p = 0.009), disorganized (t = 2.021, p = 0.047), excited (t = 3.087, p = 0.003), and depressed symptoms (t = -3.950, p ＜ 0.001) were significantly associated with the SIP score. In conclusion, patients with greater insight in the acute phase were associated with younger age, a positive family history, greater improvement of symptoms, less-severe negative symptoms, less-severe disorganized symptoms, less-severe excited symptoms, and more-severe depressed symptoms, but not with cognitive or executive function.

Resilience and Associated Factors in Schizophrenia.

Resilience in schizophrenia has been associated with multiple clinical variables that, to the best of our knowledge, do not include impulsiveness, aggression and also personality and insight with possible influences, which remain as poorly investigated topics. This study investigated the relationships of resilience with depression, aggression, impulsivity, personality and insight in order to assess the factors that explain resilience in schizophrenia. The study included 139 individuals with clinically stable schizophrenia. Data were acquired by means of the Resilience Scale for Adults (RSA), the Positive and Negative Syndrome Scale (PANSS), the Calgary Depression Scale for Schizophrenia (CDSS), the Schedule for Assessment of Insight (SAI), the Eysenck Personality Questionnaire Revised-Abbreviated (EPQR-A), the Barratt Impulsiveness Scale, 11th version (BIS-11) and the Buss-Perry Aggression Questionnaire (BPAQ). Correlations of the scores of the RSA with the scores of the other psychometric scales and the demographic and clinical data were evaluated. Linear regression analysis was used to determine the factors predicting resilience. The PANSS total and general psychopathology scores and scale scores on depression, impulsiveness and aggression were negatively correlated with resilience scores. Attentional impulsiveness, neuroticism and depression predicted low levels of resilience. There were no significant correlations between insight and the total or subdimension scores of resilience except for the subdimension structural style. Treatments focusing only on clinical remission in schizophrenia are not sufficiently effective. Interventions for enhancing resilience in schizophrenia should consider depressive symptoms, attentional impulsivity and personality traits such as neuroticism.

Effects of Exercise on Resilience, Insight and Functionality in Patients with Chronic Schizophrenia in a Psychiatric Nursing Home Setting: A Randomized Controlled Trial

To our knowledge, there are no studies on the effects of exercise in patients with severe schizophrenia-related disability or in nursing home settings. Again, the literature search on the influence of exercise on insight and resilience gives no results except mind-body exercises. The aim of this study was to investigate the effects of exercise on psychotic symptoms, depression, functionality, insight and resilience in patients with severe schizophrenia-related disability living in nursing home setting. Thirty-nine patients with schizophrenia were recruited. Exercise group with 20 patients who continued resistance exercise for 60 min, 2 days a week, for 3 months; and treatment as usual (TAU) group with 19 patients. All patients were administered Scale for the Assessment of Positive Symptoms, Scale for the Assessment of Negative Symptoms (SANS), Calgary Depression Scale for Schizophrenia (CDSS), Schedule for Assessment of Insight (SAI), Functional Remission of General Schizophrenia Scale (FROGS), Resilience Scale for Adults (RSA) at baseline and 3 months after. There were no significant differences between the groups for baseline and third month scores. In both groups significant decrease in SANS scores, significant increase in scores of FROGS total and social functioning, daily life skills subscale and RSA perception of the self were observed. In exercise group, significant decrease in CDSS scores, and significant increase in SAI awareness of illness, FROGS health and treatment, occupational functioning scores were found. Exercise combined with TAU may be effective in increasing awareness of illness and alleviating depression in chronic schizophrenia.

S41. RANDOMISED CONTROLLED TRIAL OF METACOGNITIVE TRAINING COMPARED WITH PSYCHOEDUCATION IN PATIENTS WITH SCHIZOPHRENIA SPECTRUM DISORDERS: EFFECTS ON INSIGHT

BackgroundInsight in schizophrenia spectrum disorders (SSD) has been linked with positive outcomes. However, the effect size of previous treatments on insight has been relatively small to date. The metacognitive basis of insight in SSD has led to speculation that metacognitive training (MCT) may improve insight and clinical outcomes in SSD.MethodsDesign: Single-center, assessor-blind, parallel-group, randomised controlled trial (RCT).Sample: Participants are recruited from the outpatient clinic of Hospital Universitario Fundación Jiménez Díaz (Madrid, Spain) over June-December 2019. Inclusion criteria: i) age: 18–64 years, both inclusive, at the study inception; ii) diagnosis: SSD based on the Mini International Neuropsychiatric Interview (Sheehan et al., 1998) and iii) IQ>70 according to the Wechsler Adults Intelligence Scale-IV (Wechsler, 1981). Those with organic and drugs-induced psychosis, poor level of Spanish and/or lack of cooperativeness are excluded.Intervention: Participants are randomised to receive eight weekly group sessions of MCT or group psychoeducation (PSE) and they will be assessed at: T0) at baseline; T1) after treatment and T2) at 1-year follow-up, although follow-up data are not available yet.Co-primary outcome measures: clinical and cognitive insight dimensions, which will be measured by the Schedule for Assessment of Insight (Expanded version) (SAI-E) (Kemp & David, 1997), and the Beck Cognitive Insight Scale (BCIS) (Beck et al., 2004), respectively.Secondary outcome measures: i)Symptom severity-Positive and Negative Syndrome Scale (Kay et al., 1987); ii)Functioning-General Assessment of Functioning (Endicott et al., 1976), World Health Organization Disability Scale (WHO, 2012) and Satisfaction Life Domains Scale (Carlson et al., 2009), and only at follow-up (T2) iii)Suicidal Behaviour and iv) Hospitalizations.Power calculations: To reach a power of β=80% and detect a between-group difference of two points on the SAI-E total scores, which is considered to be clinically meaningful -effect size of 0.33-, the estimated sample size at the end of the study is n=126.Statistics: Student’s T-test and Mann-Whitney U tests were used as appropriate to compare between-group differences before- and after-treatment, i.e., the changes from baseline to post-treatment scores.The protocol of the study is registered at ClinicalTrials.gov (NCT04104347).Resultsn=49 subjects have been assessed at baseline so far (26 males, age: 47.0±10.2 years, diagnosis of schizophrenia -F20-ICD10-, n=36, 73.5%).Fifteen individuals (MCT: n=8; controls: n=7) have completed the treatment and the post-treatment assessment (T1).‘After-treatment-T1 - baseline-T0’ scores difference means/medians between-group differences (MCT vs. PSE) were: SAI-E total insight 1.00 vs. -2.00, p=0.050; SAI-E illness awareness 0.62±2.20 vs. -0.43±1.62, p=0.316; SAI-E symptom relabelling 0.37±3.38 vs. -1.86±2.34, p=0.167; SAI-E treatment compliance 0.00 vs. 0.00, p>0.05,ns; BCIS self-reflectiveness 0.50±3.78 vs. -1.43±2.22, p=0.259, BCIS self-certainty 1.62±2.97 vs. 0.00±2.44, p=0.298 and BCIS Composite Index -1.13±5.62 vs. -2.17±3.49, p=0.698.DiscussionThis is the first RCT testing the effect of group MCT on insight (as primary outcome) in a sample of unselected patients with SSD in comparison with psychoeducation. Two main findings emerged from the results. First, MCT appears to improve clinical and cognitive insight in SSD. Second, MCT was shown to be superior to PSE in changing insight.Whether the above MCT-related insight improvement is maintained at longer-term and whether this has an impact on clinical and social outcomes are yet to be established, which will be properly looked at in this trial.

Resilience and insight in euthymic patients with bipolar disorder

BackgroundThe relationship between resilience and insight may be of potential importance for coping with stress in bipolar disorder (BD). The aim of this study was to investigate if there was a relation between insight and resilience in euthymic patients with BD and also to analyze the associations between resilience, impulsivity, aggression, alcohol use and affective temperament. Methods142 patients with BD type I in remission period were involved. Resilience Scale for Adults-Turkish version, Schedule for Assessment of Insight, Temperament Evaluation of Memphis, Pisa, Paris and San Diego Autoquestionnaire, Barratt Impulsiveness Scale, Buss-Perry Aggression Questionnaire, Michigan Alcoholism Screening Test were used. ResultsTotal insight scores were negatively correlated with the scores of perception of future. As distinct from other subscales of resilience, family cohesion had independent significant associations with insight in relabelling of psychotic experiences and attention impulsivity. There was no relationship between total insight and total resilience scores. Resilience scores were negatively correlated with number of depressive episodes and number of suicide attempts. Degree of aggression, degree of impulsivity, scores of depressive and hyperthymic temperament significantly predicted resilience. LimitationsRecruitment of patients from a tertiary centre limits the generalizability of the findings. Conclusions: Better insight was related to negative perception of the future and did not have significant associations with total resilience. Number of depressive episodes, number of past suicide attempts correlated with resilience, emphasizing the importance of interventions to increase resilience in BD.

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.

Aripiprazole Versus Lithium in Management of Acute Mania: a Randomized Clinical Trial

This study aimed to compare aripiprazole with lithium for the effectiveness of treating Iranian male patients with acute mania. A total of 30 male in-patients with bipolar I disorder who presented with relapse or new emergence of an episode of acute mania were equally randomised to receive 4 weeks of aripiprazole (5 mg uncoated tablets) or lithium carbonate (300 mg uncoated tablets) according to standard practice guidelines and titration protocols. The Manic State Rating Scale (MSRS) was used to determine the severity of manic symptoms at baseline (week 0) and up to week 4. The Bech-Rafaelsen Mania Scale (BRMS), Schedule for Assessment of Insight (SAI), and Clinical Global Impressions-Global Improvement scale (CGI-G) were used to determine the severity of manic symptoms, insight, and overall illness severity, respectively. All outcome measures were recorded by a single experienced psychiatrist. The frequency and intensity of manic symptoms (MSRS score) in both groups decreased significantly from baseline to week 4. In the aripiprazole and lithium groups, the intensity of manic symptoms decreased by ≥25% in 5 and 7 patients and by >50% in 1 and 5 patients, respectively. Between-group analysis showed that lithium was more effective at weeks 3 and 4 in decreasing the frequency and intensity of manic symptoms. The lithium group achieved greater improvement in symptoms than the aripiprazole group in terms of BRMS score, SAI score, and CGI-G. Lithium is more effective than aripiprazole in improving manic symptoms.

The effect of the severity of nicotine dependence on psychopathology, insight and illness severity in schizophrenia patients

Aim: Compared to the general healthy population, the prevalence of smoking is found to be much higher among people with schizophrenia. Our study aims to determine the prevalence of nicotine dependence and investigate the effects of the severity of nicotine dependence on psychopathology, illness severity and insight in a population of people with schizophrenia. Material and Methods: A cross-sectional study was carried out in a psychotic disorders outpatient clinic at Bakirkoy Training and Research Hospital. Four hundred and ten schizophrenia patients were administered by the Positive and Negative Symptom Scale (PANNS), Schedule for Assessment of Insight, Clinical Global Impression Severity of Illness (CGI-S) and the Turkish version of Fagerstrom Test for Nicotine Dependence (FTND). Results: The prevalence of nicotine dependence among the patients was 47.3%. The one-way analysis of variance revealed that subjects with severe nicotine dependence scored more in the positive subscale of PANNS and CGI-S compared with patients with mild-moderate nicotine dependence. Those with severe nicotine dependence were also prescribed higher doses of antipsychotic. Conclusions: Our findings indicate an association between nicotine dependence, positive symptoms and severity of illness. Identifying this relationship can be helpful in the management of smoking cessation treatment in patients with schizophrenia.

Pilot randomised controlled trial of culturally adapted cognitive behavior therapy for psychosis (CaCBTp) in Pakistan

BackgroundEvidence for efficacy of cognitive-behavioural therapy (CBT) in treatment of schizophrenia is growing. CBT is effective and cost efficient in treating positive and negative symptoms. To effectively meet the needs of diverse cultural groups, CBT needs to be adapted to the linguistic, cultural and socioeconomic context. We aimed to assess the feasibility, efficacy and acceptability of a culturally adapted CBT for treatment of psychosis (CaCBTp) in a low-income country.MethodsRater-blind, randomised, controlled trial of the use of standard duration CBT in patients with psychosis from a low-income country. Participants with a ICD-10 diagnosis of psychosis were assessed using Positive and Negative Syndrome Scale for Schizophrenia (PANSS), Psychotic Symptom Rating Scales (PSYRATS), and the Schedule for Assessment of Insight (SAI) (baseline, 3 months and 6 months). They were randomized into the intervention group (n = 18) and Treatment As Usual (TAU) group (n = 18). The intervention group received 12 weekly sessions of CaCBTp.ResultsThe CaCBTp group had significantly lower scores on PANSS Positive (p = 0.02), PANSS Negative (p = 0.045), PANSS General Psychopathology (p = 0.008) and Total PANSS (p = 0.05) when compared to TAU at three months. They also had low scores on Delusion Severity Total (p = 0.02) and Hallucination Severity Total (p = 0.04) of PSYRATS, as well as higher scores on SAI (p = 0.01) at the same time point. At six months only the improvement in PANSS positive scores (p = 0.045) met statistical significance..ConclusionsIt is feasible to offer CaCBTp as an adjunct to TAU in patients with psychosis, presenting to services in a lower middle-income country.Trial registrationClinicaltrials.gov identifier NCT02202694 (Retrospectively registered).

Metabolic syndrome and adverse clinical outcomes in patients with bipolar disorder.

BackgroundMetabolic syndrome (MetS) is highly prevalent among patients with bipolar disorder. MetS may cause complications in the brain, but studies investigating MetS-associated clinical psychiatric outcomes remain scant.MethodsWe enrolled clinically stable outpatients with bipolar disorder aged 18–65 years and performed anthropometric and fasting biochemical assessments to investigate MetS prevalence. We then performed clinical assessments by using the Young Mania Rating Scale for manic symptoms, the Montgomery–Åsberg Depression Rating Scale for depressive symptoms, the Positive and Negative Symptom Scale for psychotic symptoms, the Involuntary Movement Scale for tardive dyskinesia, the Barnes Akathisia Rating Scale for akathisia, the Udvalg for Kliniske Undersogelser for general side effects, the Schedule for Assessment of Insight for insight, the Global Assessment of Functioning scale for global functioning, and the Wisconsin Card Sorting Test (WCST) for cognitive executive function.ResultsIn total, 143 patients were enrolled and had a MetS prevalence of 29.4%. The patients treated with atypical antipsychotics plus mood stabilizers (36.3%) and atypical antipsychotics alone (36.0%) had a significantly higher prevalence of MetS than did those treated with mood stabilizers alone (10.5%; p = 0.012). According to multivariate regression analyses adjusted for age, sex, smoking status, bipolar disorder subtype (I or II), pharmacological treatment duration, and psychiatric medication, compared with patients without MetS, those with MetS had significantly more previous hospitalizations (p = 0.036), severer tardive dyskinesia (p = 0.030), poorer insight (p = 0.036), poorer global function (p = 0.046), and more impaired executive function (conceptual level response on the WCST; p = 0.042).ConclusionsOur results indicated that patients with comorbid bipolar disorder and MetS have more adverse clinical outcomes than those without, with more hospitalizations, severer tardive dyskinesia, poorer insight, poorer global function, and more impaired executive function. Monitoring MetS is crucial for assessing not only physical burden, but also psychiatric outcomes.

Schizophrenia - Insight, Depression: A correlation study

Background: Schizophrenia is one of the severe forms of mental illness which demands enormous personal and economical costs. Recent years have attracted considerable interest in the dual problem of depression in schizophrenia and its relation to insight. Most clinicians believe that poor insight in patients with schizophrenia, though problematic for treatment adherence, may be protective with respect to suicide. Aims and objectives: Our study was aimed to find out the correlation between insight and depression in schizophrenic population. Materials and Methods: Present study was a cross sectional, single centred, correlation study done in total of 60 subjects. Subjects aged between 20 to 60years, diagnosed to have schizophrenia as per ICD-10 and who have given written consent been considered for the study. Subjects who had other psychiatric disorders such as mood disorder, schizoaffective disorder, mental retardation, epilepsy or detectable organic disease and co morbid substance abuse were excluded from the study. Schizophrenics with acute exacerbation were also excluded from the study. For insight assessment, schedule for assessment of insight (SAI), a three item rating scale was used. For the assessment of depressive symptoms, a nine item rating scale, Calgary Depression Rating Scale (CDRS) was administrated. Results: Insight and depression were strongly correlated in schizophrenic population with a Pearson correlation coefficient of 0.758. The correlation between insight and depression was high in subjects with less duration of illness. Conclusions: Our study suggests that poor insight may protect against depression in the early stages of recovery from schizophrenia. The correlation between insight and depression was high in subjects with less duration of illness.

Adjunctive Depot Antipsychotic in Treatment-Resistant Schizophrenia

Objectives: Since according to some studies, atypical antipsychotics were connected with better results and lesser adverse effects in comparison with conventional ones, at the present time the later kind of medications are the preferred category of antipsychotics in clinical management of schizophrenia. But such a maneuver has not decreased hitherto the dilemma of treatment —resistance. The objective of the present assessment included evaluation of the effectiveness of adjunctive flupentixol decanoate in schizophrenic patient, who had responded inadequately to aripiprazole. Method: 24 male inpatients with diagnosis of schizophrenia, who had displayed poor response to aripiprazole, were entered into an eight-week, single-blind evaluation for random assignment to current antipsychotic treatment (aripiprazole) or aripiprazole plus adjunctive flupentixol decanoate. While the Scale for Assessment of Negative Symptoms (SANS) and the Scale for Assessment of Positive Symptoms (SAPS) were used as the primary outcome measures, the Clinical Global Impressions-Severity Scale (CGI-S), the Schedule for Assessment of Insight (SAI), and finally the Simpson-Angus Scale (SAS) were used as ancillary measures. Results: According to the results, while the mean total scores of CGI-S, SAI and SAPS in the augmented group dropped significantly in comparison with the aripiprazole group (p<0.007, p<0.03, p<0.001, respectively), with around 19.55% decrement of SAPS in the augmented group, the reduction in the mean total score of SANS was not significant in between -group analysis (P<0. 07). In addition, the mean total score of SAS was meaningfully improved in the target group (P< 0. 0000). The effect size (ES) analysis also revealed a great improvement with flupentixol augmentation regarding SAPS, SAI and CGI-S. Conclusion: While occurrence of extra-pyramidal adverse effects should not be overlooked by clinicians, addition of flupentixol decanoate to aripiprazole can be helpful for a number of poorly responsive schizophrenic patients. Keywords: Aripiprazole, extra-pyramidal, flupenthixol decanoate, poor response, treatment resistant, schizophrenia.

A Comparison Between Quetiapine and Aripiprazole for Treatment of Schizophrenia: A Double Blind Contrast

Objective: Schizophrenia is usually characterized by abnormal social behavior, lack of insight, and positive and negative symptoms. While there is increasing evidence that atypical antipsychotics have advantages over conventional ones, few long-term studies have directly compared the atypical antipsychotics with each other. Therefore, in the present assessment, the efficacy and safety of aripiprazole had been compared with quetiapine. Method: 50 schizophrenic patients entered into two comparable groups for participation in a twelve-week, double-blind study, for random assignment to quetiapine or aripiprazole. The main outcome scales included the Scale for Assessment of Negative Symptoms (SANS) and the Scale for Assessment of Positive Symptoms (SAPS). Also, the Clinical Global Impressions-Severity Scale (CGI-S), the Simpson Angus Scale (SAS), and finally the schedule for Assessment of Insight (SAI) had been used as the auxiliary ones. Results: While both of aripiprazole and quetiapine demonstrated important efficacy in alleviation of positive symptoms (p<0. 04 & p<0. 01, respectively), their efficacy was not so with respect to negative cluster of symptoms (p<0. 07 & p<0.06, respectively). CGI-S and SAI, as well, revealed significant improvement with aripiprazole (p<0.05 & p<0.05, respectively) and quetiapine (p<0.05 & p<0. 04, respectively) at the end of the assessment. In contrast, in neither of groups any significant increase in SAS was detectible. Conclusion: Based on the outcomes of the current study, no significant difference was evident between aripiprazole and quetiapine regarding improvement of positive and negative symptoms of schizophrenia. Keywords: Aripiprazole, dopamine, quetiapine, schizophrenia, second generation antipsychotics, serotonin.

Quetiapine versus aripiprazole in the management of schizophrenia.

Current evidence supports the use of various second-generation antipsychotics for pharmacotherapy of schizophrenia. While in a systematic review, generally no difference in efficacy was found between atypical antipsychotics, other studies have found quetiapine less effective than aripiprazole. This article reviews the efficacy and tolerability of aripiprazole versus quetiapine in the context of recommended management strategies for schizophrenia. Fifty female inpatients, meeting the diagnosis of schizophrenia, were randomly entered into two groups (n = 25 in each group) to participate in a 12-week, double-blind study for random assignment to quetiapine or aripiprazole. The primary outcome measures were Scale for Assessment of Positive Symptoms and Scale for Assessment of Negative Symptoms. The schedule for Assessment of Insight (SAI), Clinical Global Impressions Severity Scale (CGI-S) and the Simpson Angus Scale (SAS) were also used as secondary measures. Both quetiapine and aripiprazole showed significant effectiveness in the improvement of positive symptoms. The effectiveness for negative symptoms was also noteworthy with both drugs, although not to a significant level during this study. In addition, significant improvement was found on assessment with CGI-S and SAI for quetiapine and aripiprazole. SAS did not show any important increment in extrapyramidal side effects at the end of the examination. According to the findings, quetiapine and aripiprazole had similar effectiveness and tolerability with respect to management of schizophrenia.