Does premorbid IQ have a pathoplastic effect on symptom presentation in schizophrenic and bipolar disorders?

INTRODUCTION: The poor premorbid IQ has been considered as a predisposing factor for the development of schizophrenia and other psychoses as well as predictive of poor long-term outcome. We hypothesise that premorbid IQ could influence symptom expression during an index episode (i.e. a short-term outcome). AIM OF THE STUDY: We studied 48 patients with schizophrenic disorder and 56 with bipolar disorder during an 'index episode' using the test di intelligenza breve (TIB) for the premorbid IQ evaluation, and the positive and negative syndrome scale (PANSS). RESULTS: Using the premorbid IQ as a criterion variable (i.e. low versus high IQ groups) the one-way ANOVA analysis showed that low IQ schizophrenic patients had more PANSS positive symptoms and "thought disturbances" than both high and low IQ bipolars. The low IQ schizophrenic patients showed more cognitive symptoms than bipolar patients with high IQ. Furthermore, no PANSS differences were seen between high IQ schizophrenics and low IQ bipolars. In the total and bipolar groups the correlation coefficients between TIB scores and PANSS scales reached statistical significance for the cognitive cluster only. No correlations were seen in the schizophrenic group. CONCLUSION: This categorisation (i.e. low versus high IQ) adds clinically relevant knowledge to patients who, in spite of having similar symptom profile (i.e. high IQ schizophrenic patients and low IQ bipolar patients), fall into different diagnostic categories.     

精神分裂症儿茶酚氧位甲基转移酶功能基因多态性研究

目的 :分析儿茶酚氧位甲基转移酶 (COMT)功能基因多态性与精神分裂症患者精神症状严重程度和抗精神病药急性期治疗疗效的相关性。　方法 :采用多聚酶链反应 限制性内切酶片断长度多态性技术 (PCR RFLP)方法分析 138例首次治疗的精神分裂症患者COMT基因缬氨酸 (Val) 15 8蛋氨酸(Met)功能多态性 ;采用阳性症状和阴性症状量表 (PANSS)评定患者治疗前后精神症状 ,并分析等位基因和基因型与临床指标、治疗前PANSS分值及治疗 10周后PANSS减分率的相关性。　结果 :COMTVal15 8Met基因型在患者组和男女亚组的分布频率均符合Hardy Weinberg定律 ;等位基因和基因型在治疗显效组和未显著进步组分布频率差异均无显著性 ;各基因型亚组及是否携带Met等位基因亚组的临床指标差异均无显著性 ;基因型与治疗前PANSS总分和阴性症状分显著相关 ,而与PANSS总减分率和各分值减分率无显著相关。　结论 :COMTVal/Val基因型主要与首次治疗精神分裂症患者阴性症状相关 ,支持COMTVal等位基因是精神分裂症脑前额皮质多巴胺功能低下的遗传影响因子的研究发现。     

Validity of the depressive dimension extracted from principal component analysis of the PANSS in drug-free patients with schizophrenia

Depressive symptoms frequently occur during the course of schizophrenia. This study explored the relationships between the schizophrenia symptomatology and three measures of depression. Eighty-one drug-free inpatients with acute schizophrenia were assessed with the positive and negative syndrome scale (PANSS), the Calgary depression scale for schizophrenia (CDSS), and the Hamilton rating scale for depression (HAM-D). The depressive subscale of PANSS (PANSS-D) was also considered as a third scale for measuring depression. A principal component analysis (PCA) of PANSS items identified five clinical dimensions of schizophrenia called 'negative', 'positive', 'anxio-depressive', 'excitement', and 'disorganisation and others'. Our anxio-depressive dimension (PANSS-ad) was strictly identical with the PANSS-D. Scores on CDSS and HAM-D were highly inter-correlated and highly correlated with the PANSS-ad. Furthermore, while scores on CDSS were correlated only with this dimension, scores at HAM-D were also positively correlated with the negative dimension and negatively correlated with the excitement dimension. In conclusion, our results suggest that PANSS evaluation itself may be sufficient to give a correct approximation of the depression in patients with schizophrenia. However, depression scales are of course needed to assess specifically depressive symptoms in patients with schizophrenia; hence, the CDSS could be a more specific instrument than HAM-D.     

Smoking and Serum Lipid Profiles in Schizophrenia

Schizophrenia is associated with a high prevalence of cigarette-smoking and abnormal lipid profiles. The purpose of this study was to determine whether the profiles differ between schizophrenic smokers and non-smokers and whether the lipid profiles are related to psychopathological symptoms. Serum lipid profiles were measured in 130 male inpatients with DSM-IV-defined schizophrenia:104 smokers and 26 non-smokers. Symptoms were assessed using the Positive and Negative Syndrome Scale(PANSS). Our results showed that positive PANSS symptoms were fewer in smokers than in non-smokers, while the negative symptoms were fewer in those who smoked more cigarettes. Total protein and globulin levels were significantly lower in the smokers than in the non-smokers.However, there was no significant difference in total cholesterol, triglycerides, high-density lipoprotein cholesterol(HDL-c), low-density lipoprotein cholesterol,apolipoprotein A1,or apolipoprotein B between the smokers and non-smokers. However, the PANSS positive subscale had a significant negative correlation with the HDL-c levels(a protective factor) in the smokers but not in the non-smokers. Our findings suggest that schizophrenic patients who smoke have fewer psychotic symptoms, but contrary to expectation, smoking does not alter lipid profile levels.     

The dexamethasone suppression test in affective illnesses and schizophrenia: relationship with psychotic symptoms

The authors studied the dexamethasone suppression test (DST) on a series of 112 inpatients including 65 patients with major depressive disorder (21 bipolars: 4 with, 17 without psychotic symptoms; 44 unipolars: 13 with, 31 without psychotic symptoms), 15 patients with depressive disorder, 10 schizoaffective and 22 schizophrenic patients. Using different diagnostic criteria, they confirm the best performances of the DST in depression for the diagnosis of a major depressive disorder, primarily endogenous. They also examined the potential influence of psychotic symptoms, suicidal behavior and family history of affective illness on the DST. The only significant difference found is in the cortisol plasma level at 4 p.m. in bipolar patients with psychotic symptoms. That fact and the high rate of abnormality of the DST in schizoaffective and schizophrenic patients indicate that psychotic symptoms per se may play a role in a dysregulation of the hypothalamo-pituitary adrenal axis.     

Posttraumatic stress disorder symptoms related to psychosis and acute involuntary hospitalization in schizophrenic and delusional patients.

The aims of this study were: a) to assess the prevalence of posttraumatic stress disorder (PTSD) after an acute psychotic episode in schizophrenic and delusional patients, b) to explore which psychotic symptoms and aspects of treatment were associated with traumatization, and c) to compare the extent of the traumatic impact of psychosis and involuntary hospitalization. Forty-six schizophrenic and delusional patients were assessed with the Positive and Negative Syndrome Scale (PANSS), the Impact of Event Scale-Revised (IES-R), and the Clinician-Administered PTSD Scale (CAPS) at weeks 1 and 8 after acute psychiatric admission. Traumatic symptoms related to psychosis and coercive measures were scored separately. The prevalence of PTSD was found to be 11%. Sixty-nine percent of traumatic symptoms were related to psychosis and 24% to hospitalization. High PANSS score at week 8 was the strongest risk factor for the development of PTSD. Particularly positive and depressive/anxious symptomatology were associated with psychosis-related traumatic symptoms at both weeks 1 and 8. These data suggest that, in general, schizophrenic and delusional symptoms are more traumatic than the coercive measures used to control them.     

Perseveration and over-switching in schizophrenia

Perseveration and switching in positive and negative schizophrenic patients are usually seen as manifestations of attention disorders. They may be closely related to each other, but have not been investigated in an integrated fashion. Such integrated investigation could contribute to the neurophysiological understanding of the relationship between the regional and the pharmacological deficit in schizophrenia. This study has developed a new tool-the Combined Attention Test (CAT)-for the simultaneous measuring of perseveration and switching. Forty-one unmedicated schizophrenic patients were tested. Using the Positive and Negative Sorting Scale (PANSS), subjects were classified into the two experimental groups: positive and negative schizophrenics. The control group consisted of 24 healthy subjects. Schizophrenic patients with positive symptoms tended to switch more than schizophrenic patients with negative symptoms and normal subjects; schizophrenic patients with negative symptoms tended to perseverate more than schizophrenic patients with positive symptoms and normal subjects. Over-switching is discussed as a specific symptom related to positive schizophrenia.     

精神分裂症患者自评与他评症状量表差异的相关因素分析

目的:探讨精神分裂症患者自评与他评量表差异及与人口学资料、自知力、临床症状的相关因素分析。方法:对236例精神分裂症患者进行症状自评量表(SCL-90)精神病性症状分量表自评及阳性和阴性症状量表(PANSS)量表他评。比较自评与他评量表高差异与低差异两组间人口学资料、自知力、临床症状,并进行回归分析。结果:SCL-90精神病性症状分量表与PANSS总分有相关性(r=0.343,P0.05);受教育年限、阳性症状分和疾病认识分的差异进入Logistic回归模型。结论:阳性症状、疾病认识、受教育年限是患者自评与他评症状差异的相关因素。自评量表可以多角度地评估精神分裂症患者的症状。     

Psychopathology and personality traits in psychotic patients and their first-degree relatives

Personality dimensions have been associated with symptoms dimensions in schizophrenic patients (SP). In this paper we study the relationships between symptoms of functional psychoses and personality dimensions in SP and their first-degree relatives (SR), in other psychotic patients (PP) and their first-degree relatives (PR), and in healthy controls in order to evaluate the possible clinical dimensionality of these disorders. Twenty-nine SP, 29 SR, 18 PP, 18 PR and 188 controls were assessed using the temperament and character inventory (TCI-R). Current symptoms were evaluated with positive and negative syndrome scale (PANSS) using the five-factor model described previously (positive [PF], negative [NF], disorganized [DF], excitement [EF] and anxiety/depression [ADF]). Our TCI-R results showed that patients had different personality dimensions from the control group, but in relatives, these scores were not different from controls. With regard to symptomatology, we highlight the relations observed between harm avoidance (HA) and PANSS NF, and between self-transcendence (ST) and PANSS PF. From a personality traits-genetic factors point of view, schizophrenia and other psychosis may be initially differentiated by temperamental traits such as HA. The so-called characterial traits like ST would be associated with the appearance of psychotic symptoms.     

精神分裂症患病同胞的性别差异研究

目的：探讨精神分裂症患病同胞临床表现及预后的性别差异。方法：于1981年至2001年对51例精神分裂症异性患病同胞进行回顾性对照研究,其中男性25例,女性26例。对男女两组的有关情况进行比较。采用阳性与阴性症状量表（PANSS）评定精神症状。结果：男性患者病前社会功能差于女性,PANSS总分显著高于女性,阴性症状差异更为明显,住院时间男性明显多于女性。经5年随访,社会功能缺陷量表（SDSS）评定显示,男性残疾程度较女性严重,男性婚姻状况明显差于女性。结论：精神分裂症患病同胞在社会功能,精神症状等方面存在性别差异。     

Impact of psychosis in bipolar disorder during manic episodes*

Abstract

Objectives: To evaluate the effect of psychosis on prognosis as measured by the course of a manic episode, symptoms severity and time to remission and identify existing differences in positive and negative symptoms between psychotic and non-psychotic patients.

Study design: 40 bipolar patients presenting with a diagnosis of acute mania were enrolled (18 psychotic patients and 22 non-psychotic patients) in this cross-sectional study. Subjects were required to complete two self-reported questionnaires, the Young Mania Rating Scale (YMRS) for manic symptoms, and Positive and Negative Symptoms Scale (PANSS) for psychotic symptoms. Rating scales were administered at baseline and then again after three weeks of pharmacologic treatment.

Results: There were no differences in socio-demographic characteristics between psychotic and non-psychotic subjects. Psychosis was associated with higher scores on the YMRS and PANSS (increased symptoms severity), compared to non-psychotic patients. Both groups demonstrated clinical improvement and remission, with scores amongst psychotic patients remaining higher. Groups were similar in symptomatology except with regards to psychotic symptoms (the content, insight, delusions, hallucinations, grandiosity, poor rapport and unusual thoughts).

Conclusions: Psychosis can be considered a severity index in bipolar disorder, with decreased severity and overall clinical improvement and remission taking place in response to pharmacotherapy.     

精神分裂症病人家庭照料者的应付行为及其相关因素的研究

目的：探讨城乡精神分裂症病人家庭照料者的应付行为及有关影响因素。方法：调查城乡病人及其与其同住6个月以上家庭照料者各50例。调查工具分别为家庭应付行为问卷（FCQ）、GHQ-28、PANSS、WHO/DAS。结果：总体应付行为父母好于配偶、子女及其他照料者。家庭照料者的应付行为与病人的精神症状尤其是“阴性症状”、社会功能有着显著正相关，也与照料者本身的心理健康水平呈正相关。结论：精神分裂症家庭照料者多数存在不良的应付行为，对精神分裂症病人及其家庭照料者进行家庭干预，不仅有利于病人精神症状的缓解、社会功能的恢复，对照料者本身也有着积极作用。     

87例流浪精神障碍患者临床分析

目的：对比住院的流浪与非流浪精神障碍患者临床特点差异。方法：选择2006年住院的87例流浪精神障碍患者作为流浪者组,男52例,女35例;在同期入院的其他精神障碍患者中随机选取90例作为对照组,男59例,女31例;比较分析两组有关情况,并作护士用住院病人观察量表（NOSIE）与阳性与阴性症状量表（PANSS）评定。结果：两组在入院原因,出入院方式,诊断,住院时间,疗效,NOSIE和PANSS评分等方面均有显著差异。结论：流浪精神障碍患者精神症状较重,多伴发躯体疾病,阳性症状突出,生活自理能力低,疗效较差,医院负担重。     

复发精神分裂症患者的精神病治疗前期间与家庭功能及精神症状的相关分析

目的了解复发精神分裂症患者精神病治疗前期间（DUP）与复发、家庭功能及精神症状之间的关系及其临床意义。方法选用精神分裂症首发症状评定量表（SOS）回顾性调查600例复发精神分裂症患者DUP,并选用家庭关怀度指数量表（APGAR）及阳性与阴性症状量表（PANSS）评定患者的家庭功能情况及精神症状。结果（1）DUP与复发次数、第一次复发时间呈强正线性相关（r值分别为0.085、0.266,P值分别为0.038、0.000）,与第二次、第三次复发时间呈负线性相关（r值分别为-0.160、-0.196,P值均为0.000）;（2）精神分裂症患者DUP与APGAR总分及适应度、合作度、成长度、情感度和亲密度五个因子均呈正相关（P〈0.05）;（3）DUP与PANSS总分、阴性症状分和一般精神病理分呈正相关（R值分别为0.155、0.144、0.082;P值分别为0.000、0.000、0.045）,与阳性症状分无关;（4）DUP与年龄呈正相关（r=0.141,P=0.001）,与病程和受教育程度无关（r值分别为0.009、0.024,P值分别为0.821、0.565）。结论DUP越长复发次数越多,阴性症状的严重程度越重;良好的家庭支持可缩短DUP。     

Heart rate dynamics and their relationship to psychotic symptom severity in clozapine-treated schizophrenic subjects

The analysis of heart rate variability (HRV) has proven to be useful in evaluating the neuroautonomic dysfunctions associated with various clinical conditions. The purpose of this study was to investigate the linear and non-linear dynamic measures of HRV, and to evaluate their relationship with the psychotic symptom severity, in clozapine-treated schizophrenic subjects. Fifty schizophrenic patients treated with clozapine as monotherapy and 50 normal control subjects were evaluated for HRV analysis. The HRV measurements were obtained from a 30-min resting electrocardiogram (ECG). The severity of psychotic symptoms was assessed using the Positive and Negative Syndrome Scale (PANSS). In the patient group, the complexity and symbolic dynamics measures as well as the time and frequency domain measures of HRV were significantly lower than in the control group (P<0.01). The intermediate-term fractal scaling component value was significantly higher in the patient group (P<0.01). The PANSS total score and the positive symptom subscale score had significant negative correlations with the sample entropy (SampEn) value (P<0.01). In conclusion, schizophrenic patients treated with clozapine had markedly different heart rate dynamics compared to normal control subjects. The severity of psychotic symptoms was associated with the SampEn value, suggesting that the non-linear complexity measure might be useful in assessing the neuroautonomic dysfunction in schizophrenia.     

Olfactory identification and preference in bipolar disorder and schizophrenia

Olfactory identification deficit appears to be an enduring feature of schizophrenia, but it is unclear whether it is specific to schizophrenia or present in psychotic disorders in general. The aim of the present study was to compare olfactory identification and olfactory preference in schizophrenia and bipolar disorder. Individuals with schizophrenia or bipolar disorder and demographically matched healthy participants were given the University of Pennsylvania Smell Identification Test (UPSIT) to assess olfactory identification ability. To examine olfactory hedonic judgment, participants were also asked to indicate their preference for each UPSIT item on a 5-point rating scale, immediately after odor identification. Clinical symptoms and social competence were also assessed. Both schizophrenic and bipolar groups showed olfactory identification deficits compared with the healthy controls, but schizophrenic patients were more impaired than bipolar patients on the UPSIT accuracy. Interestingly, both bipolar and schizophrenic patients rated odors to be more pleasant than did healthy controls, but all groups preferred odors that they could correctly identify to unidentified smells. Restricted range of preference ratings was associated with the severity of negative symptoms in schizophrenia, and with mania in bipolar disorder. Social competence was associated with better olfactory identification performance. These findings suggest that olfactory identification and preference are compromised in bipolar disorder as well as in schizophrenia, but the precise nature of these abnormalities needs to be further elucidated.     

Correlates of symptom dimensions in schizophrenia obtained with the Spanish version of the Manchester scale

In the last decade, a significant number of studies have been published which suggest a multifactorial psychopathological structure in schizophrenia. Seventy-eight acute and chronic schizophrenic patients diagnosed in accordance with DSM-III-R criteria were studied with the Manchester Scale, Premorbid Adjustment Scale, Family History-RDC Interview, Digit Span, Mini-Mental State and computerized tomography (CT). A factorial analysis of the symptoms as recorded with the Spanish version of the Manchester Scale was carried out. Three factors ('positive', 'negative' and 'disorganization') accounted for 79% of the total variance. Poor premorbid adjustment was associated with high scores for the 'positive' dimension. The 'disorganization' dimension was significantly associated with lower scores in the Mini-Mental and attention test than the rest. However, CT did not differentiate between these symptom dimensions. This study of a sample of mostly outpatients corroborates the hypothesis of three clinical dimensions in schizophrenia.     

Evaluation and interpretation of symptom structures in patients with schizophrenia

Seventy Japanese DSM-III-R schizophrenic patients were assessed for 30 clinical symptoms using the Positive and Negative Syndrome Scale (PANSS) of Kay et al. Principal component analysis was applied to the full item set of this scale and disclosed 5 orthogonal independent symptom groups: negative, hostile/excited, thought-disordered, delusional/hallucinatory and depressive components. Our results provided further support of the contention that more than 2 (i.e., positive and negative) dimensions are required to account for structures of the schizophrenic symptoms.     

Comparisons of methamphetamine psychotic and schizophrenic symptoms: a differential item functioning analysis

The concept of negative symptoms in methamphetamine (MA) psychosis (e.g., poverty of speech, flatten affect, and loss of drive) is still uncertain. This study aimed to use differential item functioning (DIF) statistical techniques to differentiate the severity of psychotic symptoms between MA psychotic and schizophrenic patients. Data of MA psychotic and schizophrenic patients were those of the participants in the WHO Multi-Site Project on Methamphetamine-Induced Psychosis (or WHO-MAIP study) and the Risperidone Long-Acting Injection in Thai Schizophrenic Patients (or RLAI-Thai study), respectively. To confirm the unidimensionality of psychotic syndromes, we applied the exploratory and confirmatory factor analyses (EFA and CFA) on the eight items of Manchester scale. We conducted the DIF analysis of psychotic symptoms observed in both groups by using nonparametric kernel-smoothing techniques of item response theory. A DIF composite index of 0.30 or greater indicated the difference of symptom severity. The analyses included the data of 168 MA psychotic participants and the baseline data of 169 schizophrenic patients. For both data sets, the EFA and CFA suggested a three-factor model of the psychotic symptoms, including negative syndrome (poverty of speech, psychomotor retardation and flatten/incongruous affect), positive syndrome (delusions, hallucinations and incoherent speech) and anxiety/depression syndrome (anxiety and depression). The DIF composite indexes comparing the severity differences of all eight psychotic symptoms were lower than 0.3. The results suggest that, at the same level of syndrome severity (i.e., negative, positive, and anxiety/depression syndromes), the severity of psychotic symptoms, including the negative ones, observed in MA psychotic and schizophrenic patients are almost the same.     

Duration of untreated psychosis predicts treatment outcome in an early psychosis program

For patients first presenting with a non-affective psychotic disorder, the duration of untreated psychosis (DUP; the time between the onset of positive psychotic symptoms and the initiation of appropriate treatment) varies widely, from a few weeks to several years. A number of studies report that a longer DUP is associated with poorer clinical outcomes. We studied DUP and its association with clinical outcomes in a group of patients with schizophrenia and related psychotic disorders treated in the naturalistic clinical setting of an early psychosis program. DUP was determined for 19 patients with a non-affective psychotic disorder (schizophrenia, schizoaffective disorder or schizophreniform disorder) and no previous treatment for psychosis, by use of the IRAOS, a retrospective structured interview carried out with patients and their families. Positive and Negative Syndrome Scale (PANSS) and Global Assessment of Function (GAF) ratings were available at baseline and 6month follow-up. For analysis, patients were categorized into a short DUP (n=9) or long DUP (n=10) group. The median DUP (57weeks) was used as the dividing point. At baseline, the two groups did not differ significantly on positive symptoms or total PANSS ratings. However, negative symptoms were more severe in the long DUP group at baseline (P=0.029), and the long DUP group had a significantly higher mean rating for the passive/apathetic social withdrawal item of the PANSS (P=0.024). At 6month follow-up, the long DUP group had significantly higher ratings for positive symptoms (P=0.028) and had lower GAF scores (P=0.044). Significantly more (P=0.033) long DUP patients had enduring positive psychotic symptoms. The results confirm both the wide range of DUP among patients first presenting with schizophrenia and related psychotic disorders and the association of long DUP, defined as greater than approximately 1year, with a poorer clinical outcome. This study highlights the importance of collecting data regarding DUP and supports the view that patients with a long DUP are likely to be less responsive to treatment in general and will require greater resources and more intensive interventions.