The clinical course of depressive symptoms in schizophrenia

A sample of 31 schizophrenic patients free of anti-psychotic drugs was examined on admission to hospital. 14 (45%) exhibited depressed mood. The course of depressive symptoms and psychotic symptoms was followed weekly while the patients received increasing doses of haloperidol in a standardised regime. In 11 of the 14 patients there was a close correspondence between the course of depressive and psychotic symptoms, suggesting that in these cases, depression was an integral part of the schizophrenic illness. In the other three cases, clinical course of the various symptoms gave some support to the concepts of 'pharmacogenic' and 'post-psychotic depression', although it was not possible to choose between them.     

Long-term clinical course of patients with acute polymorphic psychotic disorder without symptoms of schizophrenia

Few studies have investigated the long-term course of patients with acute polymorphic psychotic disorder, despite the clinical relevance. The present study focused on the frequency of acute polymorphic psychotic disorder without symptoms of schizophrenia (F23.0) and the prognosis of patients with the disorder over a long period. A total of 388 inpatients with nonaffective psychosis were examined and cases with F23.0 were retrospectively investigated regarding clinical course over 12 years with reference to clinical charts. A total of 16 cases were diagnosed with F23.0 according to first episode. After 12 years, five cases were rediagnosed with schizophrenia, and one case with borderline-type emotionally unstable personality disorder, although the diagnosis of F23.0 was not changed in 10 older patients. Of the four cases with >2 repeated episodes of F23.0, the same clinical picture as in the first episode was observed in three, while one case showed continuous residual symptoms. F23.0 does not represent a homogeneous clinical entity. In some cases, diagnosis changes to schizophrenia, but others display repeated episodes of F23.0.     

Prevalence and clinical correlates of psychotic symptoms in Alzheimer's disease

Psychotic symptoms occur commonly in Alzheimer's disease (AD), predict a more rapid rate of cognitive decline and increase the risk of aggressive behaviour. Seventy patients with probable AD, recruited from an old age psychiatry service, were assessed to determine the prevalence and clinical correlates of delusions and hallucinations. Psychiatric symptoms were measured using the Behavioural Pathology in Alzheimer's Disease Rating Scale (BEHAVE-AD), Hamilton Rating Scale for Depression (HRSD) and the Depressive Signs Scale (DSS). Thirty-four per cent of the sample experienced delusions and 11% hallucinations in the previous month. Men were more likely than women to have experienced psychotic symptoms. Psychotic and non-psychotic groups did not differ in age, age at illness onset, dementia severity, HRSD or DSS scores. This study confirms the high prevalence of psychotic symptoms in AD patients encountered in clinical practice, and suggests that psychosis and depression represent independent behavioural disturbances in AD. © 1998 John Wiley & Sons, Ltd.     

Neural correlates of clinical symptoms and cognitive dysfunctions in obsessive-compulsive disorder

Although results from neuropsychological and neuroimaging studies have postulated the involvement of the frontal lobe and the subcortical brain regions in the pathophysiology of obsessive-compulsive disorder (OCD), neuroimaging studies have provided little evidence that cognitive abnormalities in patients with OCD are related to dysfunctions in these areas. This study was designed to determine whether the clinical features and cognitive deficits of OCD might be taken to reflect frontal-subcortical dysfunction. Fourteen patients with OCD and 14 case-matched normal subjects completed clinical and cognitive evaluation, including four sets of neuropsychological tests that assessed the executive functions and visual memory. Cerebral glucose metabolic rates were measured by using positron emission tomography (PET) with 18F-fluorodeoxyglucose. Behavioral and PET data were analyzed using statistical parametric mapping for group differences and behavioral-metabolic correlates. The right orbitofrontal cortex showed increased metabolic activity and the left parieto-occipital junction showed decreased metabolic activity in patients. Metabolism in the right hippocampus, the left putamen and the right parietal region was associated with the severity of obsessive-compulsive symptoms. Correlations between metabolic rates and neuropsychological test scores in the prefrontal cortex and the putamen occurred only in the patient group. These results suggest that patients with OCD have distinct features of brain metabolic activities for performing cognitive tasks as well as presenting obsessive-compulsive symptoms. In particular, the frontal-subcortical circuits might mediate not only symptomatic expression but also cognitive expression in patients with OCD.     

精神病性症状在精神分裂症中的诊断价值

目的 探索精神病性症状（PS）在精神分裂症中的诊断价值。方法 采用临床流行病学方法，在患者入院后3周内以半定式、盲法评定精神病性症状。分别按CCMD-2-R（金标准）和PS进行诊断，并计算诊断试验指标及与金标准的一致性。结果 PS诊断精神分裂症敏感性为89.6%，特异性为46.2%，准确度为73.7%，Kappa值0.39。各项PS以2项参数效度相对较好（Kappa值为0.37），其中又以偏执型精神分裂症诊断较为理想（Kappa值为0.61）。结论 作者认为，仅就PS则下精神分裂症诊断的观点比较片面，仍需综合结合病史、临床资料具体分析，并进行鉴别诊断。     

Obsessive-compulsive symptoms in schizophrenia: prevalance and clinical correlates

Obsessive-compulsive symptoms (OCS) have been observed in a substantial proportion of schizophrenic patients. In this study, the rate of occurrence of OCS and obsessive-compulsive disorder (OCD) in schizophrenic patients, and also the interrelationship between OCS and schizophrenic symptoms and depressive symptoms were assessed. A total of 100 subjects with a diagnosis of schizophrenia from the 4th edition of the Diagnostic and Statistical Manual (DSM-IV) were evaluated by the structured and clinical interview for axis-1 DSM-IV disorders-patient edition (SCID-P), the Positive and Negative Syndrome Scale (PANSS), Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), and the Calgary Depression Rating Scale for Schizophrenia. The prevalance of OCS in individuals meeting criteria for schizophrenia was 64%. A total of 30 of these patients (Y-BOCS total score > or =7) also met the DSM-IV criteria for OCD. The total score on Y-BOCS was significantly correlated with total score on PANSS, Positive-PANSS score, General-PANSS score and total score on Calgary Depression Rating Scale for Schizophrenia. OCS and OCD relatively frequent in schizophrenic patients and OCS are significantly correlated with the severity of psychosis, positive symptoms, and depressive symptoms in schizophrenic patients. These findings provide further evidence for the importance of OCS in schizophrenia.     

Panic symptoms in schizophrenia: comorbidity and clinical correlates

The aim of the present study was to investigate the prevalence of panic attack (PA) and panic disorder (PD) in patients with schizophrenia and detect the clinical features. Forty-nine patients with schizophrenia were included in the study. Positive and Negative Syndrome Scale (PANSS), Hamilton Depression Rating Scale (HDRS), Clinical Global Impression (CGI), Extrapyramidal Symptom Rating Scale (ESRS) and Bandelow Panic and Agoraphobia Rating Scale were administered. Fifteen patients were found to have PA and seven patients had PD. Patients with panic symptoms had higher scores of PANSS, HDRS, CGI and ESRS. Comorbid panic symptoms in schizophrenia may be related to positive symptoms, extrapyramidal side-effects and depression.     

Obsessive and compulsive symptoms in schizophrenia: clinical and neurocognitive correlates

Although research suggests that the presence of obsessive and compulsive symptoms in schizophrenia is associated with graver levels of psychosocial dysfunction, it is unclear whether it is also related to clinical features of illness. Accordingly, the present study compared the symptom levels and neurocognitive function of participants with schizophrenia who had and did not have significant obsessive or compulsive symptoms. Analyses of variance revealed that participants with significant levels of either obsessive or compulsive symptoms (N = 21) had higher levels of positive and emotional discomfort symptoms on the Positive and Negative Syndrome Scale (PANSS) and performed more poorly on the Wisconsin Card Sorting Test, a measure of executive function, than participants without obsessions or compulsions (N = 25). ANCOVAs controlling for level of obsessions also revealed that participants with significant levels of compulsions (N = 12) in particular had higher levels of negative and positive symptoms on the PANSS than participants without compulsions (N = 34). The impact of obsessive-compulsive phenomena on the course and outcome of schizophrenia is discussed.     

Lateralized cognitive dysfunction and psychotic symptoms in schizophrenia

Our understanding of hemispheric asymmetries in schizophrenia can be attributed to extensive neuropsychological and neuroimaging research on this topic; however, it has yet to be determined whether lateralized cognitive dysfunction represents a single core trait in schizophrenia or whether the lateralized impairments are domain specific. To test whether lateralized deficits are core features in schizophrenia we examined performance across a wide range of lateralized cognitive domains including attention, fluency, recognition memory, perception, and arousal. We also examined the relationship between lateralized impairments and psychotic and affective symptoms to determine whether abnormal hemispheric asymmetries were possibly state-related. The sample consisted of 43 subjects with schizophrenia and 66 normal healthy comparison subjects without psychiatric illness. Schizophrenia subjects exhibited abnormal right hemisphere performance on a test of recognition memory and abnormal left hemisphere performance on a measure of arousal. These findings suggest that lateralized cognitive disturbances in schizophrenia do not represent a single core lateralized deficit. Regarding the symptom analyses, severity of positive symptoms was related to right hemisphere cognitive impairment (including fluency and recognition memory), whereas severity of negative symptoms was related to left hemisphere cognitive impairment (including fluency). Overall, our findings suggest that lateralized dysfunction can occur in both hemispheres in schizophrenia, and that the positive psychotic symptoms may relate more to right hemisphere impairment, whereas negative psychotic symptoms may related more to left hemisphere impairment.     

Cerebral correlates of psychotic symptoms in Alzheimer's disease

BACKGROUND: Psychotic symptoms are produced by distributed neuronal dysfunction. Abnormalities of reality testing and false inference implicate frontal lobe abnormalities. OBJECTIVES: To identify the functional imaging profile of patients with Alzheimer's disease manifesting psychotic symptoms as measured by single photon emission computed tomography (SPECT). METHODS: Twenty patients with Alzheimer's disease who had SPECT and clinical evaluations were divided into two equal groups with similar mini mental status examination (MMSE), age, sex, and the range of behaviours documented by the neuropsychiatric inventory (NPI), except delusions and hallucinations. SPECT studies, registered to a probabilistic anatomical atlas, were normalised across the combined group mean intensity level, and subjected to a voxel by voxel subtraction of the non-psychotic minus psychotic groups. Subvolume thresholding (SVT) corrected random lobar noise to produce a three dimensional functional significance map. RESULTS: The significance map showed lower regional perfusion in the right and left dorsolateral frontal, left anterior cingulate, and left ventral striatal regions along with the left pulvinar and dorsolateral parietal cortex, in the psychotic versus non-psychotic group. CONCLUSION: Patients with Alzheimer's disease who manifest psychosis may have disproportionate dysfunction of frontal lobes and related subcortical and parietal structures.     

The temporal relationship between depressive and psychotic symptoms in recent-onset schizophrenia

The authors examined the temporal relationship between onset of depressive and psychotic symptoms in 27 patients with recent-onset schizophrenia or schizo-affective disorder. Ratings on the Brief Psychiatric Rating Scale were collected every 2 weeks for at least 1 year to specify onset of relapse or exacerbation. Six time periods were defined in relation to onset of psychotic symptoms, and the number of depressive periods was determined for each time period. Onset of depressive periods was concurrent with onset of psychosis more often than expected but was not associated with any other time period. The authors found no distinctive postpsychotic pattern of onset for depression.     

New results in the experimental psychopathology of visual dysfunctions in schizophrenia

New theories of schizophrenia put a special emphasis on cognitive deficits, including executive functions, attention, verbal memory, and psychomotor speed. Dysfunctions of low level visual processing are less known. In this paper, the author summarizes recent results from two new tasks and integrates them with the relevant literature of schizophrenia. First, the relationship between the precortical magno (M) and parvocellular (P) pathways was investigated with a new contrast categorization task assessing low level perception, memory, and abstraction. Patients with schizophrenia showed a generalized dysfunction, which suggests contrast-independent memory and abstraction problems. In contrast, siblings were selectively impaired on the task variant that included the 10-15% contrast range, the transition zone between M and P pathway contrast sensitivity. In a second paradigm, the author investigated intrinsic lateral connectivity in the primary visual cortex, the main target of M and P pathways. Using Gabor patches, a reduced facilitation effect of collinear flankers was demonstrated in schizophrenia, which suggests impaired lateral connections in the primary visual cortex. These results are closely related to backward masking and smooth pursuit eye movement abnormalities. As a neurobiological basis of these phenomena, N-methyl-D-aspartate (NMDA) glutamate receptors and integrated synaptic networks may be of special relevance.     

Prevalence and clinical correlates of psychotic symptoms in Parkinson disease: a community-based study.

BACKGROUND: Hallucinations and delusions are frequent in patients with Parkinson disease (PD) and may have severe clinical consequences for those patients and their caregivers. However, the prevalence and clinical features of these symptoms have not been studied in a representative sample. OBJECTIVE: To study the prevalence and clinical correlates of psychosis in a population-based sample of patients with PD. METHOD: Total ascertainment of patients with PD in a defined geographical area in Norway was attempted through a detailed community study. Clinical evaluation consisted of a neurologic examination and assessments of depression and cognition. Psychosis was assessed with the thought disorder subscale of the Unified Parkinson's Disease Rating Scale. RESULTS: A total of 245 patients with PD were identified, 235 (95.9%) of whom participated in this study. Twenty-three patients (9.8%) had hallucinations with insight retained, and another 14 patients (6.0%) had more severe hallucinations or delusions. Psychotic symptoms were associated with age, stage and diagnostic subgroup of PD, severity of depression, and cognitive impairment. Type, duration, and dose of antiparkinson drug therapy did not differ between those patients with PD who had or did not have psychosis. In a polychotomous logistic regression analysis, severity of depression, cognitive impairment, and impairment of activities of daily living were the only significant concomitants of psychosis. CONCLUSIONS: Hallucinations and delusions are common in patients with PD. More advanced and widespread brain changes seem to increase the risk for developing psychosis in patients with PD receiving levodopa therapy.     

Coping with psychotic symptoms in the early phases of schizophrenia

How people diagnosed with schizophrenia cope with positive symptoms after their first hospitalization is explored, along with the relationship of their coping strategies to their psychosocial functioning. The strategies most frequently endorsed were cognitive in type, while those considered most helpful were behavioral. Respondents identifying an active strategy as most helpful displayed better psychosocial functioning at 24-month follow-up.     

Prevalence and correlates of psychotic symptoms among Asian males

Purpose  

Psychotic symptoms have been reported at varying rates in the general population in the West. We studied the association of psychotic symptoms with educational attainment and other psychiatric disorders in 23,248 male pre-enlistees for National Service in Singapore.     

The validity of using patient self-report to assess psychotic symptoms in schizophrenia

Brief, reliable and valid measures of psychosis can be very useful in both clinical practice and research, and for identifying unmet treatment needs in persons with schizophrenia. This study examines the concurrent validity and receiver operating characteristics of the psychosis scale of the Revised Behavior and Symptom Identification Scale (BASIS-R). The study was conducted with 71 adults with schizophrenia who were randomly sampled from a large mental health clinic. Study participants at the West Los Angeles Veterans Healthcare Center were assessed using the BASIS-R, a subjective, self-report measure, and the UCLA Brief Psychiatric Rating Scale (BPRS), a clinician-rated measure administered by highly trained research staff. The psychosis scale of the BASIS-R shows good concurrent validity with the psychosis items on the BPRS. Using the BPRS as the gold standard for measuring psychosis, receiver operating characteristics suggest that both the weighted and unweighted versions of the BASIS-R psychosis scale adequately identify psychosis that is moderate or greater or severe. The performance of the two versions was similar. Unweighted scores are easier to calculate, and we therefore recommend cutoff scores based on the unweighted BASIS-R. We identified a cutoff score of 0.5 to best detect moderate or greater psychosis, and a cutoff score of 1.0 to best detect severe or extremely severe psychosis. The BASIS-R has potential as an assessment tool and screening instrument in schizophrenia.     

The prevalence and correlates of trauma-related symptoms in schizophrenia spectrum disorder

Research has suggested that many with schizophrenia have been exposed to significant trauma, both after and before the onset of their illness. Less clear is how commonly significant levels of trauma symptoms are found in schizophrenia, how often they co-occur, and what their relationship is with positive and negative symptoms. To examine these issues, we concurrently assessed trauma history, trauma symptoms using the Trauma Symptom Inventory, and symptoms using the Positive and Negative Syndrome Scale. Participants were 68 individuals with schizophrenia spectrum disorders who provided reliable reports of at least one traumatic event from an original sample of 81 individuals. Results revealed that two thirds of participants reported clinically significant trauma symptoms that included at least intrusive experiences, defensive avoidance, or dissociation. Greater levels of depression and disturbance of volition were significantly correlated with greater levels of anxious arousal, intrusive experiences, defensive avoidance, dissociation, and total number of significantly elevated trauma scales. Delusions were correlated with intrusive experiences, dissociation, and number of significantly elevated trauma scales, whereas hallucinations were correlated with irritability and total number of significantly elevated trauma scales. Results suggest that trauma symptoms may be commonly experienced in schizophrenia and linked with the phenomenology of the disorder.