Acute Symptoms Of Schizophrenia Research Articles

Reliability, validity and ability to detect change of the clinician-rated Personal and Social Performance scale in patients with acute symptoms of schizophrenia

ABSTRACTObjective: To describe the measurement properties of the Personal and Social Performance scale (PSP), a clinician-reported measure of severity of personal and social dysfunction, in subjects with acute symptoms of schizophrenia.Methods: Pooled data from three paliperidone extended-release clinical studies (n = 1665) and data from a separate noninterventional, cross-sectional, validation study (n = 299) were analyzed.Results: The PSP showed good interrater (intraclass correlation coefficient [ICC] = 0.87) and test–retest (ICCs > 0.90) reliability. Pearson correlation coefficient for association between baseline PSP and Positive and Negative Syndrome Scale (PANSS) total scores was −0.32 for subjects assessed by the same rater and −0.29 for subjects assessed by different raters, suggesting low overlap in measurement constructs between the PANSS and PSP. Spearman Rank correlation coefficient for association between baseline PSP and Clinical Global Impression-Severity (CGI-S) scores was −0.51 with the same rater and −0.15 with different raters. Hypothesized relationships between the PSP and the PANSS or CGI-S based on levels of disease severity were prospectively defined. These hypotheses were confirmed by analyses showing statistically significant differences between baseline mean PSP scores in subjects grouped by severity rating on the CGI-S (mild or less vs. at least moderate) (p < 0.001) and the PANSS (‘low symptom severity’ vs. ‘high symptom severity’) (p = 0.005). The PSP was sensitive to change based on statistically significant correlations between change in the PSP and change in the CGI-S (p < 0.001) and the PANSS (p < 0.001). Limitations of analyses include pooling data across studies, interrater reliability assessment in the validation study only, post hoc assessment of test–retest reliability in the paliperidone ER studies, different raters for the PSP and PANSS not specified in the paliperidone ER studies, PSP validity assessment based on the PANSS and the CGI-S as comparators rather than another social function instrument.Conclusion: These initial reliability and validity assessments suggest the PSP has promise as a measure of social functioning in patients with acute symptoms of schizophrenia.

P.3.c.028 Comparative efficacy of risperidone oral concentrate and intramuscular haloperidol in acute symptoms of schizophrenia

P.3.c.028 Comparative efficacy of risperidone oral concentrate and intramuscular haloperidol in acute symptoms of schizophrenia

Consciousness, schizophrenia and scientific theory.

The positive symptoms of acute schizophrenia are, of their very nature, aberrations of conscious experience. A recent theory of the mechanisms underlying their occurrence spans four levels: neuroanatomical, neurochemical, cognitive and the symptoms themselves. The theory is capable of being tested in animals and human subjects, and it has passed a number of experimental tests at both levels with success. Implications of the theory for the scientific treatment of consciousness are considered. Although the theory permits useful questions relating to consciousness to be put and even to some extent to be answered, it leaves the most basic issue--the theoretical link between the occurrence of conscious experience and the neural substrate of the brain--unresolved, as do all similar theories so far.

Gender-specific associations of depression with positive and negative symptoms in acute schizophrenia

This clinical study analyzed gender-specific relationships of depression with other psychopathological and clinical variables in hospitalized patients with schizophrenia. During clinical routine treatment 119 inpatients with acute schizophrenia (DSM-IV) were investigated with the Calgary Depression Rating Scale for Schizophrenia (CDSS), the Clinical Global Impressions (CGI), and the Positive and Negative Syndrome Scale (PANSS). Depression scores of 77 male and 42 female patients (mean age 31.6 ± 10.3 years) were related to background variables and to positive and negative symptom scores. Mean CDSS (5.8 ± 5.6) and PANSS scores (total 76.9 ± 22.1, positive symptoms 17.6 ± 7.6, negative symptoms 20.5 ± 7.8) were not significantly different between males and females. In females, depression was independently associated with higher negative symptom scores ( P < 0.01) and younger age ( P < 0.05) whereas in males positive symptoms ( P < 0.05) and short hospitalization ( P < 0.05) were the main factors associated with depression. The study revealed gender-specific differences in the relationship of depression with negative and positive symptoms.

Influence of antipsychotic medication on pain perception in schizophrenia

A number of clinical observations indicate that pain processing might be disturbed in psychotic disorders such as schizophrenia. Only a few studies have investigated pain perception in schizophrenia. The main objective of this study was the investigation of thresholds of warmth perception (WP), thermal pain onset (TPO) and thermal pain tolerance (TPT) in acute schizophrenic patients and the influence of antipsychotic medication on the patients' responses. We investigated 23 schizophrenic subjects who had been not received antipsychotic treatment for 8 weeks, and we then reassessed them 3 days later after the introduction of neuroleptics. Acute symptoms of schizophrenia were measured using the Scales for the Assessment of Positive and Negative Symptoms. Thresholds were determined by a contact thermode on both volar wrists. Schizophrenic patients showed significantly increased thresholds of WP and TPO relative to healthy controls. Antipsychotics did not alter pain thresholds. We found no correlation between pain perception and psychometric scales. Our findings demonstrate altered warmth and heat pain perception in acute schizophrenia. We believe that our findings can be attributed to information-processing abnormalities of the disorder and that they are not specific to pain processing, per se, since both WP and TPO were significantly different. Future studies should evaluate attentional deficits in schizophrenia in relation to pain perception.

Rapid dose titration of quetiapine for the treatment of acute schizophrenia and acute mania: a case series

To quickly reduce symptoms and to optimize long-term outcome, patients with an acute episode of schizophrenia or mania require prompt treatment intervention. The atypical antipsychotic quetiapine ('Seroquel') has been approved for the treatment of schizophrenia and manic episodes associated with bipolar disorder. For patients with acute symptoms such as aggression or agitation, higher doses of quetiapine than the recommended initiation schedule are often required. This report presents the tolerability findings from rapid initiation with high-dose quetiapine for eight patients who were consecutively admitted with acute symptoms of schizophrenia (n 5) or mania (n 3). The results from this case series show that quetiapine treatment could be safely titrated at a more rapid rate and to doses greater than that described in the current prescribing information. For most patients, rapid dose escalation was well tolerated; no serious side effects were observed and vital clinical parameters were unchanged; one patient experienced transient somnolence. In conclusion, these results suggest that rapid dose escalation of quetiapine could be a useful treatment approach for acutely ill patients with schizophrenia and bipolar mania in order to improve acute symptoms and support the need for randomized controlled trials. However, dose adjustments should be considered with respect to each patient's individual level of tolerability.

Hallucinogens and Drosophila: linking serotonin receptor activation to behavior

The similarity of mode of action, behavior, and gene response between Drosophila melanogaster and mammalian systems, combined with the power of genetics, have recently made the fly an attractive system to study underlying mechanisms of drug abuse, addiction, and mental disorders. The present studies define the behavioral and molecular effects of the powerful hallucinogen lysergic acid diethylamide in Drosophila. Pharmacological activation of serotonin receptors in the fly by lysergic acid diethylamide induces behaviors not unlike those observed in mammalian systems. These include alterations in visual processing abilities, reduced locomotor activity, and altered gene expression within the brain. Many of these effects are due to activation of the same serotonin receptor subtypes that are thought to be the primary mediators of hallucinogenic drug effects in humans as well as the acute symptoms of schizophrenia. We suggest that Drosophila can be used as a genetically tractable model system to define the molecular events leading from serotonin receptor activation to behavior, possibly revealing new targets for hallucinogenic agents and for the treatment of neuropsychiatric disorders such as schizophrenia.

Efficacy of risperidone on affective symptoms in acute schizophrenia

Efficacy of risperidone on affective symptoms in acute schizophrenia

Latent dimensions of depressive and negative symptoms in acute schizophrenia: Treatment effects of high dose amisulpride vs. flupentixol

Latent dimensions of depressive and negative symptoms in acute schizophrenia: Treatment effects of high dose amisulpride vs. flupentixol

Wed-P68 - Improvement of negative symptoms in acute schizophrenia with Amisulpride

An abstract is not available for this content so a preview has been provided. As you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

Differential treatment effects of amisulpride versus flupentixol on latent dimensions of depressive and negative symptoms in acute schizophrenia

Differential treatment effects of amisulpride versus flupentixol on latent dimensions of depressive and negative symptoms in acute schizophrenia

P.2.115 Depressive symptoms in acute schizophrenia: Evaluation and outcome under new antipsychotics

P.2.115 Depressive symptoms in acute schizophrenia: Evaluation and outcome under new antipsychotics

A factor analytic study of symptoms in acute schizophrenia.

The three-syndrome model of schizophrenic phenomenology has been well established in chronic illness. We report an attempt to replicate this concept in a sample of acutely unwell schizophrenic patients. Factor analysis was performed using PSE data collected within a week of admission from 114 patients who met DSMIII(R) diagnostic criteria for schizophrenia. Four main factors accounted for 58% of the variance. The first two factors closely resembled Liddle's disorganisation and psychomotor poverty syndromes. Hallucinations and delusions loaded separately under the third and fourth factors. To examine the validity of these four syndromes, the relationships between factor scores and other clinical data were examined. The disorganisation syndrome was associated with a history of multiple past admissions and a longer lifetime duration of in-patient treatment.

Dopamine release in the nucleus accumbens: The perspective from aberrations of consciousness in schizophrenia

Studies of the cognitive abnormalities that underlie positive symptoms in acute schizophrenia, and animal experiments that attempt to model similar cognitive abnormalities and to elucidate the brain mechanisms underlying them, suggest that the release of dopamine from A 10 terminals in the nucleus (n.) accumbens, in interaction with the projection to n. accumbens from the retrohippocampal region, is closely related to stimulus salience and perhaps to the heightened states of awareness reported by schizophrenics.

Antipsychotic profile and side-effect liability of haloperidol, risperidone, and ocaperidone as predicted from their differential interaction with amphetamine in rats

Motor activity effects of haloperidol, risperidone, and ocaperidone were studied in rats challenged with amphetamine. At a low dose of amphetamine, the compounds were about equipotent in reducing amphetamine-induced hyperactivity to normal values (lowest ED50s: 0.015–0.023 mg/kg). Haloperidol completely blocked motility at a slightly higher dose (0.14 mg/kg). In contrast, much higher doses of risperidone and ocaperidone were required for complete blockade of motility (ED50s: 2.0 and 1.7 mg/kg, respectively). With increasing dose of amphetamine, risperidone became considerably less potent than haloperidol in reducing hyperactivity; ocaperidone remained at least as potent as haloperidol in this respect. Moreover, risperidone lost, while ocaperidone maintained, its high margin towards complete blockade of motility. The compounds were also equipotent (lowest ED50s: 0.0075–0.0089 mg/kg) in reversing amphetamine-induced behavioral withdrawal (stationary stereotypy) to more environment directed behavior (active exploration). However, this ‘disinhibitory’ effect was maintained over a much wider dose range with risperidone than with haloperidol and ocaperidone. The observed differences in interaction with amphetamine are presumably related to relative serotonin 5HT2/dopamine D2 antagonistic activity and suggest important differences in therapeutic profile and side-effect liability of the compounds. The implications for distinct clinical applications of the compounds are discussed: risperidone might be the drug of choice for maintenance therapy of chronic schizophrenics, especially for patients with mild positive symptoms and type II patients with predominant negative symptoms and ocaperidone for therapeutic treatment of the pronounced positive symptoms in acute schizophrenia or during exacerbations of chronic schizophrenia. © 1992 Wiley-Liss, Inc.

Plasma concentrations of remoxipride and haloperidol in relation to prolactin and short-term therapeutic outcome in schizophrenic patients

Plasma concentrations of remoxipride and haloperidol as well as prolactin (PRL) were determined in 20 patients with acute symptoms of schizophrenia. Ten patients received remoxipride and ten patients haloperidol for a period of 6 weeks. A significant linear correlation was found between the plasma level of remoxipride and the dosage applied ( P < 0.02) as well as between the corresponding haloperidol dosage and plasma concentration ( P < 0.05). In both patient groups a significantly reduction in psychopathology was observed during the trial period ( P < 0.001). In the haloperidol group this was associated with a clearcut elevation of plasma PRL, whereas in the remoxipride group after an initial rise for 4 weeks, the mean PRL level returned to baseline at the end of the study.

Neuroleptic effects on positive and negative symptoms in acute schizophrenia : Michael P. McDonald, B.A. (by invitation), Sukdeb Mukherjee, M.D., David B. Schnur, M.D. (by invitation), Giovanni Caracci, M.D. (by invitation) New York State Psychiatric Institute, New York, NY 10032

Neuroleptic effects on positive and negative symptoms in acute schizophrenia : Michael P. McDonald, B.A. (by invitation), Sukdeb Mukherjee, M.D., David B. Schnur, M.D. (by invitation), Giovanni Caracci, M.D. (by invitation) New York State Psychiatric Institute, New York, NY 10032

A Case of Resistant Schizophrenia

In an era when it is generally believed that the acute symptoms of schizophrenia can be controlled pharmacologically, the case of a young man who has remained almost continuously floridly psychotic for 13 years, despite treatment, is disquieting. Conventional psychiatric treatment appears to be rendered impotent. It is in this context that it may be of interest to report a summary of the proceedings of a Special Problems Conference held at the Institute of Psychiatry on 18 February 1985 to discuss such a case.

Serum and cerebrospinal fluid levels of fluphenazine–relationship to treatment response in schizophrenic patients

AbstractSerum and cerebrospinal fluid (CSF) concentrations of fluphenazine (FPZ) were measured during nine weeks of FPZ medication in 28 patients with acute symptoms of schizophrenia. A significant correlation was found between the serum and CSF FPZ values (r = 0·70, p &lt; 0·001) throughout the entire study. Patients exhibiting marked clinical improvement (MCI) had higher levels of serum and CSF FPZ than did patients showing only slight clinical improvement (SCI) or those with no treatment response (NTR). The differences between the MCI and the NTR group were at most observation points statistically significant (p &lt; 0·05). The figures of the SCI group formed an intermediate curve between the serum and CSF FPZ curve of the MCI and the NTR patients.The serum and the CSF levels of FPZ were not significantly related to such variables as age, sex, duration of illness, number of previous psychotic episodes, or subtype of schizophrenia.

Serum and cerebrospinal fluid prolactin patterns during neuroleptic treatment in schizophrenic patients.

Serum and CSF prolactin (PRL) concentrations were determined during eight weeks of fluphenazine medication in 28 patients with acute symptoms of schizophrenia. In both sexes a good correlation between the serum and CSF PRL values was found (r = 0.57, p less than 0.01). Throughout the entire study, first admission (FA) patients had significantly higher levels of serum and CSF PRL than the re-entry (RE) schizophrenics (0.05 greater than p less than 0.001). In addition, in FA patients, a gradual increase of the serum and CSF PRL concentrations was observed, whereas in the RE group an adaptive secretion pattern of PRL could be detected. In both patient groups, female patients exhibited significantly higher PRL serum and CSF levels than the male patients (0.05 greater than p less than 0.001). The tolerance phenomenon in the RE groups was more marked in the female than in the male patients. No correlation between clinical outcome and PRL response to fluphenazine treatment was observed. The prognostic significance of the differences in the PRL secretion pattern is discussed.