Psychometric properties of French version of the Calgary depression scale for schizophrenics (CDSS)

The Calgary Depression scale for schizophrenia (CDSS) is a 9 items scale, simple, quick and easy to use. It allows a quantitative approach of the subjective (or cognitive) dimension of the depression, and was developed by Addington et al. (1-5). In this work, we studied the psychometric properties of the CDSS in a population of 95 schizophrenic patients, and 41 non schizophrenic depressed patients. The CDSS was compared with commonly used hetero-questionnaires as the Hamilton Depression Scale (HDRS), the Montgomery-Asberg Depression Scale (MADRS), the Widl?cher depressive slowness scale (ERD), and auto-questionnaires as the Beck Depression Inventory (BDI), and the Beck Hopelessness scale (H). In the schizophrenic group, psychotic symptoms were evaluated with the Positive and Negative Symptoms Scale (PANSS), and the extrapyramidal symptoms with the Extrapyramidal symptoms scale (EPRS). In the two populations, the CDSS has similar psychometric properties. The principal component analyses accounts for a unifactorial structure in both groups. In schizophrenics the total score of the CDSS is strongly correlated with the total scores of the HDRS, the MADRS, the ERD, and the G6 item of the PANSS. In non schizophrenic depressed patients, the total score of the CDSS is highly correlated to the total scores of the HDRS, the MADRS and the BDI, with a weaker correlation with the ERD and the H total scores. In these patients, a cut-point strictly superior to 13 may be proposed as a severity criterion for depression in these patients. The internal consistency is satisfactory in both groups, with a Cronbach's alpha of 0.82 in schizophrenics and 0.59 in non schizophrenic depressed subjects. In schizophrenics, items C4 (guilty ideas of reference) and C7 (early awakening) are not necessary to the constitution of the scale. In depressed patients, the deletion of item C6 (morning depression) might increase the internal consistency. Inte-raters agreement is high, with weighted kappas all superior to 0.75 in schizophrenics and to 0.61 in depressed patients. Stability over time is good, and the 72 hours test-retest total score of the CDSS is independent from negative and extrapyramidal symptoms. On the other hand, the positive sub-score and the positive factor of the PANSS are correlated to the CDSS total score. The validation of the CDSS is still not complete: sensitivity to change and stability of the factorial structure remain to be explored. Nevertheless, the CDSS is an interesting tool for a quantitative approach of the subjective dimension of depression in both schizophrenic and non schizophrenic patients.     

慢性精神分裂症患者的抑郁症状研究

目的:了解慢性精神分裂症患者的抑郁症状及其相关的影响因素。方法:对180名住院慢性精神分裂症患者测试卡尔加里精神分裂症抑郁量表(CDSS)、阳性症状量表(SAPS)、阴性症状量表(SANS)、治疗中出现的症状量表(TESS)及自编的相关因素调查表。结果:慢性精神分裂症患者的抑郁症状发生率为40.6%;有无抑郁发生的两组比较,在总病程、住院次数、文化程度、家庭经济水平、社会支持、自知力恢复及药物种类、剂量、时间及不良反应、阳性阴性症状和合并躯体疾病等方面差异有显著性。Logistic回归分析显示,精神分裂症患者出现抑郁症状的相关影响因素依次为:阴性症状、合并躯体疾病、抗精神病药的种类、社会支持、自知力及药物不良反应。结论:慢性精神分裂症患者抑郁症状发生率高、影响因素多,需从多方面对精神分裂症患者的抑郁进行预防和治疗。     

Evaluation of depression in schizophrenia: psychometric properties of a French version of the Calgary Depression Scale

The aim of this study was to determine the psychometric properties (especially validity and reliability) of the French language version of the Calgary Depression Scale for Schizophrenia (CDSS) in schizophrenic patients. Ninety-five subjects who met DSM-IV criteria for schizophrenia were enrolled. The studies of the internal structural validity and of the reliability (internal consistency) showed that some items from the CDSS (early awakening and guilty ideas of reference) must be discussed in the constitution of this scale. The total score of the CDSS was significantly correlated with the MADRS total score, the HDRS total score, and the depression item (G6) on the PANSS, which suggests that the CDSS is a valid instrument for the assessment of depression in schizophrenia. The existence of a significant correlation between the CDSS total score and the PANSS positive sub-scale suggests a possible relationship between positive and depressive symptoms in schizophrenia.     

Guilt and depression: Two different factors in individuals with negative symptoms of schizophrenia

ObjectiveDepression is common among schizophrenia patients and constitutes a major risk factor for suicide. Calgary Depression Scale (CDSS) is the most widely used instrument for measuring depression in schizophrenia. CDSS has never been examined in patients with predominant negative symptoms, thus possibly hindering both accurate assessment and understanding of the underlying mechanisms. The current study is the first to examine CDSS’ structure in this population.MethodsWe conducted Principal Component Analysis (n = 184) for the CDSS items. Thereafter, we correlated emerging factors with psychopathological, demographic and side effect variables. We assessed internal consistency and reliability of the emerging factors, as well as demographic correlations.ResultsThe analysis yielded two factors: depression-hopelessness and guilt. Factors distinctly correlated with separate variables. Removal of item #7 (early waking) improved internal consistency. The depression-hopelessness factor had an inverse correlation with negative symptoms, and positive correlation with neuroleptic side effects.ConclusionsCDSS structure indicated of two separate factors, i.e., depression-hopelessness and guilt, suggesting separate underlying processes. The validity of the scale might benefit from a two-fold structure and the removal/replacement of item #7 (early waking). A noteworthy inverse correlation was found between the depression factor and negative symptoms, as well as a positive correlation between depression factor and neuroleptic side effects.     

Comparison of depression symptoms between primary depression and secondary-to-schizophrenia depression

Objectives: This study exclusively aimed to clinically assess which symptom pattern discriminates primary depression from depression-secondary to-schizophrenia.

Methods: A total of 98 patients with primary depression and 71 patients with secondary-to-schizophrenia depression were assessed for identifying the clinical phenomena of depression. Diagnosis of schizophrenia was confirmed by Mini International Neuropsychiatric Interview. Each participant was, however, assessed by Patient Health Questionnaire-9 as well as Calgary Depression Scale for Schizophrenia (CDSS) for possible concurrent depressive symptoms.

Results: Depressed mood, loss of interest, reduced energy and pathological guilt were more common in primary depression, whereas sleep disturbance and guilty ideas of reference were more amounting towards the diagnosis of depression secondary-to-schizophrenia.

Conclusions: It is clinically hard to differentiate primary from secondary-to-schizophrenia depression, especially in the absence of obvious psychotic symptoms. However, the classical symptoms of depression like subjective depressed mood, anhedonia, reduced energy and pathological guilt are more prominent in the primary depression.     

Depression and subjective quality of life in chronic phase schizophrenic patients

OBJECTIVE: To evaluate the influence of depression on subjective quality of life in schizophrenic patients. METHOD: Sixty-seven schizophrenic patients in a stabilized phase were included. Schizophrenic symptoms were evaluated using the Positive and Negative Symptoms Scale (PANSS). The subjective quality of life was evaluated using the short version of the Lehman quality of life scale (QoLI). Depression was evaluated using the Calgary Depression Scale for Schizophrenia (CDSS) and extrapyramidal effects with the Extrapyramidal Symptoms Rating Scale (ESRS). RESULTS: The PANSS total score, PANSS general psychopathology subscore, PANSS depression factor, the total CDSS and some ESRS scores were negatively correlated with the overall life satisfaction score. The CDSS score was negatively correlated with all except one QoLI score. QoLI scores were significantly lower in depressed patients, and this result remained consistent for four QoLi dimensions when adjusted on ESRS and PANSS scores. When analysing the association between high depression scores and high parkinsonism scores with reduced quality of life, multivariate analysis showed that depression was the main explanatory factor: the CDSS total score explained 22% of the variance of the overall subjective quality of life score. The patient questionnaire at the ESRS explained 10.5% of the variance of the 'mental and physical health' QoLI score. CONCLUSION: In schizophrenic patients, depressive symptoms should be focused because of their strong association to overall subjective quality of life.     

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.     

Early maladaptive schemas predict positive symptomatology in schizophrenia: A cross-sectional study

Recent literature has shown the role of social factors, such as childhood negative experiences and attachment styles, in the genesis of psychotic symptoms. So far, despite this association with childhood negative experiences and a wide range of psychiatric disorders, no study has yet attempted to assess early maladaptive schemas (EMSs) in patients with schizophrenia as primary diagnosis. A sample of 48 patients diagnosed with schizophrenia and 44 control participants answered the schema questionnaire short form's French validation, and were assessed with the positive and negative syndrome scale as well as a scale of depression symptomatology. Results showed that, after controlling for depression, patients with schizophrenia achieved higher scores than control subjects on six EMSs. The EMSs were associated with positive, but not negative, symptomatology. After controlling for depression, only the Mistrust/Abuse schema was a significant predictor of positive symptoms accounting for a small portion (12.4%) of the variance. The results highlight the importance of focusing not only on the schizophrenic symptoms but also on the person and his or her subjective development of self. Therefore, these results suggest that Young's schema theory may be applied to schizophrenic patients.     

Pyramidical model of schizophrenia

Research and treatment of schizophrenia have been impeded by its heterogeneity and the lack of well-standardized methods for a comprehensive assessment of symptoms, including positive and negative dimensions. To study symptom profiles, therefore, we standardized and administered a well-operationalized 30-item psychiatric symptom scale to 240 schizophrenic inpatients. Principal component analysis suggested a pyramidlike triangular model of uncorrelated but nonexclusive syndromes that encompassed the spectrum of psychopathology. Negative, positive, and depressive features constituted divergent points of a triangular base, and excitement made up a separate vertical axis. Paired syndromes could account for symptoms of the paranoid (positive-depressive), disorganized (positive-negative), and catatonic (negative-depressive) diagnostic subtypes. The transversal positions in this model suggested polarized dimensions in schizophrenia, including a prognostic axis (depression-cognitive dysfunction). The findings imply that (1) negative and positive syndromes show factorial validity and distinction from depression but, alone, are insufficient to accommodate the full diversity of symptoms; (2) schizophrenic subtypes derive from a hybrid between unrelated but co-occurring dimensions that may define the fundamental elements of psychopathology; and (3) the pyramidical model is of heuristic value. The results help to clarify the heterogeneity of schizophrenia and to illuminate the path toward syndrome-specific treatments.     

Anhedonia in depression and schizophrenia: a reexamination.

The purpose of this study was to utilize factor analysis to help determine whether anhedonia is a symptom of both depression and schizophrenia. Measures of depression, positive and negative symptoms of schizophrenia, and anhedonia were administered to a group of schizophrenic patients (N = 54) and to a group of patients with major depressive disorder (N = 27). The correlation matrix among the various scales was subjected to an oblique exploratory factor analysis. Three factors were extracted, accounting for three quarters of the variance. The first measured depression, the second measured positive symptoms, and the third measured negative symptoms. Anhedonia loaded significantly on the first factor but not on the third, suggesting that it is a symptom of depression rather than schizophrenia. These results were corroborated by means of confirmatory factor analysis. We conclude that anhedonia is a symptom of depression and that it only appears to be a symptom of schizophrenia because it is a component of emotional blunting which is indeed a negative symptom of schizophrenia.     

Insight, quality of life, and functional capacity in middle-aged and older adults with schizophrenia

OBJECTIVE: The quality of life (QOL) for individuals with schizophrenia is determined by a number of factors, not limited to symptomatology. The current study examined lack of insight as one such factor that may influence subjective QOL or functional capacity. It was hypothesized that insight would significantly interact with symptom severity to influence subjective QOL. Insight was not expected to influence the relation between symptom severity and functional capacity. METHODS: Participants were middle-aged and older outpatients who met diagnostic criteria for schizophrenia or schizoaffective disorder, and subsyndromal depression. Insight, psychopathology, and subjective QOL were assessed via semi-structured interviews and functional capacity was assessed via performance-based measures. RESULTS: Insight interacts with negative symptom severity to predict subjective QOL. Severity of negative symptoms and insight contribute directly to functional capacity. CONCLUSIONS: Individuals with intact insight may be better able to manage their symptoms, resulting in improved QOL. Treatment implications for improving the QOL of middle age and older adults with schizophrenia are discussed.     

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.     

Relationship of psychopathological symptoms and cognitive function to subjective quality of life in patients with chronic schizophrenia

Aims:  The purpose of the present study was to examine the extent of the effects of psychopathological symptoms and cognitive function on quality of life (QOL) in patients with chronic schizophrenia.
Methods:  Data were obtained using the Japanese Schizophrenia Quality of Life Scale (JSQLS), Positive and Negative Syndrome Scale (PANSS), Wisconsin Card-Sorting Test (WCST) Keio version, and Continuous Performance Test (CPT) for 52 schizophrenia patients.
Results:  Stepwise regression analysis showed that PANSS depression/anxiety factors predicted JSQLS psychosocial conditions and motivation/energy, and that WCST Categories Achieved predicted JSQLS symptoms/side-effects.
Conclusions:  Psychopathological symptoms and cognitive function affect subjective QOL in patients with schizophrenia. If the final goal is treatment that improves QOL in a manner that patients themselves are aware of, clinicians probably need to consider a treatment strategy that improves depression/anxiety symptom.     

精神分裂症患者虚假记忆的研究

目的:探讨精神分裂症患者和正常者的虚假记忆,以及检验虚假记忆和妄想、幻觉症状之间的关联性。方法:测试40例精神分裂症患者(分裂症组)和40名正常者(对照组)的词汇再认和故事回忆虚假记忆任务;对分裂症组进行阳性与阴性症状量表(PANSS)评分。结果:分裂症组的虚假记忆任务成绩语义侵入数、错误再认数和故事回忆的正确率、错误率与对照组相比差异均有显著性(P均<0.05)。精神分裂症患者的虚假记忆指标与PANSS总分、阴性症状、阳性症状以及妄想症状、幻觉症状无显著相关性。结论:精神分裂症患者可能比正常者易产生虚假记忆,精神症状对精神分裂症患者虚假记忆的产生可能不起作用。     

The role of trauma and PTSD-related symptoms for dissociation and psychopathological distress in inpatients with schizophrenia

BACKGROUND: To investigate the relationship between dissociative experiences, psychopathological distress, a history of trauma and posttraumatic symptoms in adult schizophrenia. METHODS: Eighty-seven schizophrenic inpatients returned self-questionnaires [Dissociative Experience Scale (DES); Symptom Checklist (SCL-90-R); PTSD Symptom Scale (PDS)]. Based upon this self-rating, 14 of the participants fulfilled the cut-off definition of PTSD according to DSM-IV criteria, 43 had a history of trauma without a self-rated diagnosis of PTSD. DES scores were also compared to a convenience sample of 297 non-clinical controls. RESULTS: We found no significant impact of trauma alone but a significant influence of posttraumatic symptomatology on the level of current psychopathological distress (GSI) and the DES subscale absorption. However, in logistic regression, posttraumatic symptomatology was associated with GSI but not with DES. Schizophrenic patients even without trauma or posttraumatic symptoms had significantly higher scores in all three DES subscales than non-clinical controls. CONCLUSION: Pronounced posttraumatic symptoms in schizophrenia are associated with severe additional psychopathological distress whereas the increase in dissociation (absorption) in this group of patients may be secondary to the increase in symptom load. However, schizophrenia itself seems to be associated independently from trauma and pathological posttraumatic conditions with a broad range of dissociative symptoms.     

A comparative study on quality of life of patients of schizophrenia with and without depression

Depression in schizophrenia has been recognized as one of the important factors influencing the Quality of Life (QOL). For this study 60 patients with a clinical diagnosis of schizophrenia as per ICD-10 (DCR version) were divided into two groups (with and without depression) on the basis of their score on Calgary Depression Rating Scale for Schizophrenia (CDSS). Thereafter, all patients were assessed on Positive and Negative Syndrome Scale for Schizophrenia (PANSS) for psychopathology, on Lehman Quality of Life Interview (QOLI)-brief version for QOL, on World Health Organization Disability Assessment Schedule-II (WHODAS-II) for disability, on UKU Side Effect Rating Scale for side effects of drugs and on Social Support Questionnaire (SSQ) for perceived social support. The two (depressed and non-depressed schizophrenia) groups differed significantly on symptoms of general psychopathology of PANSS and disability as per WHODAS-II, with the depressed group scoring higher. In the total sample, positive symptoms and the symptoms of general psychopathology of PANSS had a strong negative correlation with all three (subjective, objective and combined) domains of QOL, whereas, disability and medication side effects had a negative correlation with subjective and combined domains of QOL. CDSS total score did not significantly correlate with QOL. General psychopathology symptoms of PANSS emerged as the sole significant predictor of subjective and combined QOL, while positive symptoms of PANSS emerged as the sole predictor of objective QOL. Hence, it can be concluded that general psychopathology on PANSS had significant effect whereas depression as rated on CDSS had no significant effect on QOL in patients with schizophrenia. Treatments to improve QOL in schizophrenia should focus on symptoms of general psychopathology of PANSS.     

Ego-pathology and common symptom factors in schizophrenia

The phenomenological construct of ego-pathology in schizophrenia has been widely referred to in psychopathological textbooks but was systematically assessed in very few empirical studies. This study investigated the association between ego-pathology (Ego-Pathology Inventory) and common symptom factors (Positive and Negative Symptom Scale) in paranoid schizophrenia patients within 3 days after admission and after 2 weeks of treatment. The predictive value of ego-pathology for short-term treatment outcome was also assessed. A factor analysis of all subscale scores revealed a four-factor solution: positive symptoms, negative symptoms, and two distinct ego-pathology factors, i.e., general and identity. Although the ego-pathology subscale "activity" loaded on the positive symptom factor, the other four subscales formed the two ego-pathology factors with no high loadings on other factors. High scores on ego-demarcation at admission predicted poor treatment outcome after 2 weeks. The findings suggest that ego-pathology might be used to capture additional and clinically meaningful symptom dimensions in schizophrenia.     

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.     

Prevalence and background factors of depression in first admitted schizophrenic patients

OBJECTIVE: The aim of this study was to investigate the prevalence and background factors of depression in first admitted schizophrenic patients. METHOD: The study is an analysis of 998 consecutively admitted schizophrenic patients with their first hospitalization. Patient's characteristics were prospectively assessed using standardized instruments at the time of first admission and discharge. RESULTS: High prevalence rates of depressive symptoms were found. Depressed schizophrenic patients were more likely to have suicidal tendencies, were older, more frequently married, less frequently single and unemployed and had more family members with psychiatric disorders other than schizophrenia than the non-depressed patients. Positive, negative and extrapyramidal symptoms do not have a substantial influence on depression in these patients. CONCLUSION: The study suggests that depression represents a distinct psychopathological dimension of the acute illness in first admitted schizophrenic patients. In particular, in light of the suicidal tendencies, recognition and treatment of depression is an important clinical task.