A subscale for negative symptoms from the Comprehensive Psychopathological Rating Scale (CPRS): a comparison with the Schedule for Assessment of Negative Symptoms (SANS)

The Comprehensive Psychopathological Rating Scale (CPRS) was used to determine symptomatology in 145 schizophrenic patients. In 40 of these patients the Schedule for Assessment of Negative Symptoms (SANS) was also applied in order to determine which items in the CPRS represent negative schizophrenic symptoms. Of the patients, 115 were drug-free and 30 were treated with major transquilizers at the time of the rating. A principal component analysis with oblique solution and Varimax rotation grouped the items from CPRS into ten factors. These factors were subsequently correlated to the total scores of the SANS. When a factor showed a positive correlation with the SANS, the individual items within the factor were examined for correlation to both the subscales and the total SANS scores. Of the 33 items, 5 used in the CPRS showed a positive correlation with the SANS and were therefore considered to represent negative symptomatology in schizophrenia. These items were withdrawal, reduced speech, lack of appropriate emotions, slowness of movements and indecision. The items were grouped as a negative symptom subscale in the CPRS.     

Comparison of AMP system and comprehensive psychopathological rating scale with regard to contents

Using a sample of 170 patients the psychopathological contents of the AMP system and the Comprehensive Psychopathological Rating Scale (CPRS) were compared by canonical correlations. The nine primary AMP scales predict 86% of the variance of the three CPRS scales. 64% of the variance of the nine AMP scales is explained by the CPRS scales. The secondary scales are nearly equivalent. The univariate analysis showed that all AMP scales with the exception of the 'hostility syndrome' and the 'catatonic syndrome' correlate highly with one of the psychopathological CPRS scales.     

Anxiety symptoms and suicidal feelings in a population sample of 70-year-olds without dementia

ABSTRACT Background: The role of anxiety in late-life suicidal behavior has received relatively little attention. The aim was to explore the association between anxiety symptoms and suicidal feelings in a population sample of 70-year-olds without dementia, and to test whether associations would be independent of depression. Methods: Face-to-face interviews (N = 560) were carried out by psychiatric nurses and past month symptoms were rated with the Comprehensive Psychopathological Rating Scale (CPRS). The Brief Scale for Anxiety (BSA) was derived from the CPRS to quantify anxiety symptom burden. Past month suicidal feelings were evaluated with the Paykel questions. Results: Anxiety symptom burden was associated with suicidal feelings and the association remained after adjusting for major depression. One individual BSA item (Inner tension) was independently associated with suicidal feelings in a multivariate regression model. The association did not remain, however, in a final model in which depression symptoms replaced depression diagnosis. Conclusions: Results from this population study suggest an association between anxiety and suicidal feelings in older adults. The role of anxiety and depression symptoms needs further clarification in the study of suicidal behavior in late life.     

Patterns of response to neuroleptic treatment: factors influencing the amelioration of individual symptoms in psychotic patients

Fifty-three patients with acute psychotic disorders (diagnosed according to DSM-III) were treated with thioridazine alone and observed during periods of up to 2 months. The amelioration of paranoid ideas and hallucinations (target symptoms) and of concentration difficulties, disorientation, reduced appetite, and reduced sleep (additional symptoms) was studied by repeated psychopathology ratings (CPRS). The patients were classified as "fast, slow or partial responders" according to the therapeutic effect registered on each target symptom. Paranoid ideas disappeared completely after less than 3 weeks of treatment in 28% of the patients (fast responders) and after more than 3 weeks in 32% (slow responders). Hallucinations disappeared significantly faster than paranoid ideas; 47% of the patients were completely free from hallucinations after less than 2 weeks of treatment (fast responders) and 38% after more than 2 weeks (slow responders). The following factors were significantly correlated to positive treatment effects of thioridazine: 1) diagnosis involving a brief history of psychotic symptoms before admission; 2) a low CPRS score for paranoid ideas on admission; 3) presence of disorientation on admission; 4) normal appetite on admission, and 5) rapidly reached optimal serum concentration of the drug.     

The Comprehensive Psychopathological Rating Scale in patients with dementia of Alzheimer type and multiinfarct dementia

ABSTRACT– Eighteen patients with the clinical diagnosis dementia of Alzheimer type (AD/SDAT) and 20 patients with the clinical diagnosis multiinfarct dementia (MID) were interviewed using a subscale to the Comprehensive Psychopathological Rating Scale (CPRS), consisting of items measuring psychopathological symptoms and signs commonly seen in patients with dementia. The aim of the investigation was to evaluate whether a difference in psychopathology between AD/SDAT and MID could be observed during a semistructured psychiatric interview using the CPRS. In both groups the duration of illness was similar and the dementia mild to moderate. All patients were subjected to somatic, psychiatric, laboratory, neurophysiologic and neuroradiologic examinations in order to obtain the correct clinical diagnoses. The results show that patients with AD/SDAT have a more variable psychopathology than patients with MID. Patients with MID were rated lower on all items used, especially those concerning verbal and personal contact. This might explain the generally accepted opinion that patients with MID have better contact with their surroundings and better preservation of their personality, even though they have the same degree of dementia as patients with AD/SDAT.     

Suicidal intent and psychiatric symptoms among inpatient suicide attempters

The objective of this study was to investigate associations between suicidal intent and psychiatric symptoms, and to study the usefulness of the Suicidal Intent Scale (SIS) and the Comprehensive Psychopathological Rating Scale (CPRS) for suicide risk assessment in an inpatient population. One hundred and ninety-six suicide attempters, of whom 15 eventually committed suicide, were admitted to a psychiatric ward. They were assessed by means of the SIS and the CPRS. Cox regression analyses were performed in order to adjust the relationships between the individual CPRS subscales and suicide for age and gender. The patients who later completed suicide had higher scores on the CPRS than the patients who did not complete suicide. We found no associations between symptoms and suicidal intent. The severity of psychopathology, in terms of high CPRS scores, shows a stronger association with future suicide than the level of suicidal intent (SIS) among inpatient suicide attempters. Suicidal intent is evidently scored regardless of psychiatric symptoms.     

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.     

Quality of life in patients with treated and clinically stable Wilson's disease

Health‐related quality of life (HRQoL) in Wilson's disease (WD) has not been extensively studied. Therefore, the purpose of this cross‐sectional study was to identify clinical and demographic factors influencing HRQoL in 60 treated, clinically stable patients with WD using a generic questionnaire, the Medical Outcomes Study Short‐Form 36‐Item Health Survey (SF‐36). The level of disability and grading of WD multisystemic manifestations were assessed by the Global Assessment Scale for WD (GAS for WD). The Mini Mental State Examination (MMSE) and the 21‐item Hamilton Depression Rating Scale (HDRS) scoring were also applied by the same trained interviewers. Lower scores on the SF‐36 domains were found in patients with neurological compared with those with a predominantly hepatic form of WD. The HRQoL of patients with WD and psychiatric symptoms was also lower than that of those without them. Finally, significant inverse correlations were obtained between the various SF‐36 domains and all the following: period of latency from the first symptoms/signs appearance and treatment initiation, MMSE and HDRS scores, and different domains of the GAS for WD. © 2011 Movement Disorder Society     

Symptoms at index admission as predictor for 1-5 year outcome in schizophrenia

A total of 107 drug-free schizophrenic patients (76 males and 31 females) were consecutively admitted to an emergency ward and rated for psychotic symptoms by means of 32 items from the Comprehensive Psychopathological Rating Scale (CPRS). They were followed prospectively with ratings of social functioning by use of Strauss-Carpenter's outcome scale at 1, 3 and 5 years after index admission with the aim of determining possible early symptoms that are predictors of social outcome. In total, 59 of the patients were first admissions and had never been treated. At index admission, no difference was found in total CPRS scores between first-admission patients and chronic readmitted patients, or between male and female subjects. When subscales for positive symptoms (flights of ideas, feeling controlled, disrupted thoughts, auditory hallucinations, ideas of persecution) and negative symptoms (indecision, withdrawal, reduced speech, lack of appropriate emotions, slowness of movements) from the CPRS were applied, no relationship between the two subscales and outcome scores was found. However, in patients with a duration of the disorder of less than 24 months before index admission, high scores on both negative and positive subscales were significantly correlated with a poor 5-year outcome. No correlation was found in the group with a duration of illness of more than 24 months before index admission. It is concluded that symptoms at index admission have a predictive value for outcome in schizophrenic patients. Negative symptoms measured by use of a subscale of the CPRS have a predictive value for outcome up to 5 years after index admission, but high scores on both positive and negative symptoms are more strongly associated with a poor outcome. The duration of the symptoms before admission, as well as the kind of neuroleptic treatment given (clozapine vs. classical neuroleptics), seem to be important factors for prediction of outcome. Our data support the view that early negative symptoms in particular have a predictive value for the prognosis in schizophrenia for up to 5 years.     

Four-dimensional structure underlying scales for depression anxiety and retardation: emergence of trapped anger and scale improvements

Improvement of rating scales for anxiety and depression has insufficiently been based on their underlying multidimensional structure. The aim of this study was to detect the underlying symptom structure of 3 scales for anxiety, depression, and retardation from the Comprehensive Psychopathological Rating Scale (CPRS), to test its validity, and to investigate whether the scales developed from this structure have lower item overlap than the original scales. All items (N = 21) of the 3 subscales (Brief Anxiety Scale [BAS], Montgomery Asberg Depression Rating Scale [MADRS], and Motivational Inhibition) were selected. Principal components analysis was performed on the scores of 334 outpatients. Correlations between factor-regression scores on the CPRS components and scores on the Mood and Anxiety Symptom Questionnaire dimensions were analyzed. New rating scales based on the CPRS components were developed and compared with the original scales. Four CPRS components were found: depression, retardation, anxiety, and trapped anger. Each had a specific correlational pattern with the Mood and Anxiety Symptom Questionnaire dimensions. Overlap between the 4 new scales was lower than that between the original scales. A 4-dimensional symptom structure underlies CPRS scales for anxiety, depression, and retardation. This structure results in the detection of a scale for trapped anger and improvement of the 3 original scales.     

Structure of schizophrenic symptomatology and its changes over time: prospective factor-analytical study

A representative sample of 156 new schizophrenic patients (DSM-III) were examined at the time of their first treatment contact for psychosis, and reexamined 2 and 5 years thereafter. The symptom variables, assessed by the Comprehensive Psychopathological Rating Scale (CPRS), were factored and compared with each other. The following major dimensions were found: (i) a fairly stable negative dimension with affective and speech impoverishment and withdrawal; (ii) a delusional dimension; (iii) hallucinatory dimensions; (iv) a disorganization dimension; and (v) a depressive dimension with unreal experiences. The negative dimension was more prevalent in unmarried patients. Neither the two-syndrome model of negative and positive symptoms nor the three-syndrome model of psychomotor poverty, disorganization and reality distortion proved to be satisfactory. In a representative sample of schizophrenic patients, the syndrome structure described by symptom dimensions appears to be more complex and varies considerably according to the duration of the illness.     

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.     

On the validity of the German Version of the Comprehensive Psychopathological Rating Scale

Summary The construct validity of the German Version of the Comprehensive Psychopathological Rating Scale (CPRS) was investigated in a longitudinal study on 60 hospitalised RDC-schizoaffective patients. The validation included tests of hypotheses about means in cross-section and, in therapy, the course of schizoaffective psychoses. Thus, it is assumed that differences in diagnosis (RDC-schizodepressives versus RDC-schizomanics) are reflected by significantly higher scores on the respective subscales of the CPRS. Furthermore, the subscales of the CPRS should be sensitive to therapeutic change. In addition, correlations were tested using instruments of similar or different validity claim (Hamilton Depression Scale, Mania Rating Scale, Brief Psychiatric Rating Scale). All hypotheses about means could be confirmed. The convergent and discriminant validity of the CPRS is discussed on the basis of multiple-indicator matrices computed for each of the three points of measurement.     

Correlation of subjective well-being in schizophrenic patients with gait parameters, expert-rated motor disturbances, and psychopathological status

INTRODUCTION: Subjective well-being of schizophrenic patients can be impaired by symptoms of the disease and by adverse effects of antipsychotic medication. We assessed the correlations of subjective well-being with objectively measured gait parameters, expert-rated motor disturbances, and psychopathological status in 25 conventionally treated, 25 atypically treated, and 16 drug-naive patients. METHODS: Main variables were the SWN scores (Subjective Well-being under Neuroleptic Treatment Scale), the ESRS scores (Extrapyramidal Symptoms Rating Scale), and the PANSS scores (Positive and Negative Syndrome Scale). Gait parameters were determined by using an ultrasonic system for gait analysis. RESULTS: In conventionally treated patients, the SWN total score significantly correlated with stride length ( R(2) = 0.39; P < 0.01), whereas in atypically treated and drug-naive patients, it significantly correlated with the PANSS score (atypically treated: R(2) = 0.25, P < 0.05; drug-naive: R(2) = 0.64, P < 0.01), mainly due to the correlations with the "negative symptoms" and the "general psychopathology" sub-scores. Correlations with stride length were significant not only in the "physical functioning" sub-score of the SWN but also in all other sub-scores. Correlations of the SWN scores with ESRS scores were weak. CONCLUSION: Under conventional antipsychotic treatment, subjective well-being particularly depends on major side effects, whereas in atypically treated and drug-naive schizophrenic patients, it is mainly influenced by psychopathological status. Motor adverse effects of conventional antipsychotic treatment cannot be considered as isolated physical side effects but have severe implications for other aspects of the patients' well-being.     

Asthma severity and psychopathology in a tertiary care department for children and adolescent

 The purpose of this study was to evaluate the relationships between severe asthma, type and incidence of psychiatric problems in a pediatric population. A group of 92 children and adolescents (63 boys and 29 girls) (mean age 11.7) was investigated over one year by a pediatric pneumology/allergy service unit. The psychopathological problems of two groups were compared: “mild” (n=12) and “moderate/severe” (n=80) persistent asthma as defined by the National Heart Lung and Blood Institute (NIH). Various questionnaires were completed by the patients including the CBCL and the CPRS. The patients were examined by an experienced psychologist using the French version of the revised semi-structured diagnostic interview Kiddie-SADS. Twelve cases with intermittent or mild persistent asthma and 80 cases with moderate and severe persistent asthma were found. The child gender ratio and the social class of the parents did not differ significantly across groups. Moderate/severe asthma was more often associated with DSM-IV psychiatric disorders. Similarly, there were more symptoms in the severe group as indicated by several questionnaires. The hyperactivity index (CPRS) was higher for the severely affected group, who also exhibited fewer daytime activities. Social skills, school skills, and self esteem were, overall, on a similar level as those of the mildly affected group. Severe persistent asthma and moderate persistent asthma were not significantly different for the prevalence of psychiatric disorders and symptoms, even if children with severe asthma had a trend toward being diagnosed with more DSM-IV anxiety disorders and higher STAIC scores. Both of them had significantly higher total CBCL scores and CPRS hyperactivity index than intermittent and mild asthma. Moderate and severe persistent asthma appears to be associated with both incidence and particular categories of psychiatric problems, particularly anxiety disorders and anxious/depression symptoms. These observations suggest that it would be valuable to pay more attention to psychopathological problems of children suffering from severe asthma. Received: 24 February 1997 Accepted: 7 December 1997     

A new self-rating scale for depression and anxiety states based on the Comprehensive Psychopathological Rating Scale

Self-assessment scales have long been used in psychiatric research even if their validity has often been questioned, one reason being poor the concordance of expert ratings. In clinical practice the use of rating scales is restricted, since they are considered to be time-consuming and perhaps even to disrupt the clinician's rapport with the patient. In the present study, a self-assessment scale, the CPRS Self-rating Scale for Affective Syndromes (CPRS-S-A), was constructed by re-phrasing in a self-rating format 19 items from the original Comprehensive Psychopathological Rating Scale (CPRS) and covering depression, anxiety and obsessional symptoms. In a group of 30 patients with depression syndromes and anxiety syndromes, the CPRS-S-A and the original CPRS were both used on 2 occasions. The patient's Global Assessment of Functioning scores ranged from 30 to 76 (mean 58), which suggests a moderate severity of illness, as does the fact that the majority were outpatients. There was a high degree of concordance between the instruments for most items and for the scores on the subscales for both diagnostic groups (i.e., the Montgomery-Åsberg Depression Rating Scale and the Brief Anxiety Scale, which are both subscales drawn from the CPRS). The time taken to complete the CPRS-S-A varied from 5 to 30 min (mean 19 min for depressive and 16 min for anxiety patients on the first occasion, 13 min for both groups on the second), and the self-rating procedure was readily accepted by both groups of patients. The CPRS-S-A would thus seem to be a promising instrument for quantitative rating of symptoms in ambulatory patients, both in clinical practice and in research.     

Can winter depression be prevented by Ginkgo biloba extract? A placebo-controlled trial

OBJECTIVE: The aim was to test the hypothesis that the Ginkgo biloba extract PN246, in tablet form (brand name Bio-Biloba), may prevent the symptoms of winter depression (WD) in patients with seasonal affective disorder (SAD). METHOD: A total of 27 SAD patients were randomized to receive double-blind placebo or Bio-Biloba for 10 weeks or until they developed symptoms of WD, starting in a symptom-free phase about 1 month before expected WD symptoms. An extended Montgomery-Asberg Depression Rating Scale was completed before and immediately after termination of medication. The patients also self-rated some key symptoms on a visual analogue scale every 2 weeks during the trial. RESULTS: There were no significant differences between the treatment groups in the number of patients who developed treatment-requiring WD, or in the development of single key symptoms during the trial. CONCLUSION: We did not find that Ginkgo biloba was able to prevent the development of the symptoms of winter depression.     

The applicability and the inter-rater reliability of the Comprehensive Psychopathological Rating Scale in an elderly clinical population

BACKGROUND: Psychopathological rating scales are developed and tested on a relatively young population. Their applicability and psychometric performance in the elderly (aged above 60-65 years) are mostly unknown. It is unknown how factors related to ageing or mild cognitive dysfunction influence the applicability and the reliability of these scales. We tested the applicability and the inter-rater reliability of the Dutch version of the Comprehensive Psychopathological Rating Scale (CPRS) on an elderly (age > 60 years) inpatient population. METHODS: The applicability and reliability (expressed by differently weighted Kappa coefficients) of the CPRS was assessed by investigating 62 consecutively referred patients in a ward for elderly patients with acute psychiatric problems that were primarily functional in nature. The results are compared with those found in a younger population. RESULTS: The applicability and reliability of the CPRS on the elderly can be categorised as sufficient to good and is comparable with results for a younger population. We did not find any specific factors influencing the practicality, or the reliability of the CPRS when applied to an elderly group of people with a mild cognitive dysfunction. CONCLUSIONS: The CPRS does not loose its clinical relevance with age, as the applicability and the reliability of the CPRS is not influenced by ageing or mild cognitive dysfunction. The CPRS can detect a broad range of symptoms and due to its psychometric properties it is a useful instrument for measuring an elderly or young population.     

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.     

Cognitive functions and psychopathological symptoms in early-onset schizophrenia

Type and extent of objectively tested cognitive impairments (attention, verbal fluency, nonverbal reasoning) and their association with self-ratings (Paranoia Depression Scale; Frankfurt Complaint Questionnaire) and clinical assessments (Brief Psychiatric Rating Scale, Scales for the Assessment of Positive Symptoms and Negative Symptoms) of psychopathological symptoms were studied in a sample of 74 adolescents primarily suffering from chronic schizophrenia (DSM-III-R; mean duration of illness = 3.4 years), including 15 patients with a very early onset (<14 years). Special consideration was given to the differentiation between positive and negative symptoms. In cross-sectional analyses, the schizophrenic adolescents were remarkably impaired in both cognitive functions (attention, reasoning) and psychopathological measures (BPRS, SANS, SAPS). However, factor analysis yielded orthogonal factors for cognitive and psychopathological parameters, and canonical correlation analyses did not find a significant correlation between these two areas. As the degree of objectively measured cognitive impairment in chronic schizophrenic adolescents cannot be predicted by the severity of individual psychopathological symptoms, a multidimensional evaluation of the symptomatology seems to be appropriate. Moreover, premorbid disturbances (motor and/or language developmental disorders) and onset characteristics (age, pattern, subdiagnosis), and their relationship to cognitive impairments were investigated. Premorbid disturbances were confirmed as risk factors for the subsequent occurrence of cognitive impairments. Accepted: 23 August 1999