Clinical dimensions of auditory hallucinations in schizophrenic disorders

BACKGROUND: Auditory hallucinations occupy, along with delusional beliefs, the center stage of active or "positive" psychotic clinical psychopathology. During the last decade, several sets of auditory hallucinations' clinical features were subjected to multivariate statistical analyses to disclose major dimensions of psychotic patients' overall hallucinatory experience and behavior. However, these studies failed, to a large extent, to provide satisfactory external validations of the thereby extracted factors. METHODS: We investigated the major clinical dimensions of verbal auditory hallucinations in a sample of 100 inpatients with schizophrenic disorders. Patients (61 men and 39 women) were examined before the initiation of antipsychotic treatment and their assessment included 18 major clinical features of auditory hallucinations. Brief Psychiatric Rating Scale, Hamilton Depression Rating Scale, Global Assessment Scale, and Mini-Mental State Examination were used as external validators. RESULTS: Principal component analysis resulted in the extraction of 5 factors interpreted as the dimensions of severity of auditory hallucinations, emotional and behavioral impact, rate of their intrusion in self-consciousness, delusional elaboration, and similarity to ordinary auditory perception, respectively. The second and third factors extracted in our study correlated with short duration of illness, whereas the first, fourth, and fifth ones correlated with chronicity. Our second factor correlated with clinical severity of patients' current mental state, the fifth factor with severity of their cognitive impairment, and the first and fourth ones with lower clinical depression despite patients' chronicity. CONCLUSION: The findings of our study contribute to the further elucidation of the major clinical dimensions of auditory hallucinations and the testing of their external validity.     

The Relationship between Hopelessness and Clinical Characteristics of Hospitalized Patients with Recent Suicide Attempt

This study aimed to assess hopelessness in 170 hospitalized individuals with recent suicide attempt and examine its association with patients’ characteristics, with a view to improving awareness in health professionals and especially nurses, who are among the first to take care of these patients. Participants completed Beck Hopelessness Scale and Beck Depression Inventory. More than half (51.18%) experienced moderate-to-severe hopelessness. A multiple linear regression analysis showed that age, attempted suicide method, past suicide attempt, and psychiatric diagnosis contributed statistically significantly to hopelessness prediction. Hopelessness assessment could efficiently help health professionals to minimize both inpatient suicide and suicidal acts after discharge.     

Self-esteem and aggression in women: differences between female prisoners and women without criminal records

Contradictory findings have been reported regarding the association between self-esteem and aggression. Most studies have dealt with non-criminal populations. This study aimed to explore the relationship between self-esteem and aggression and investigate possible differences in self-esteem and aggression between female inmates and women without criminal records (non-criminals) in the prefecture of Attica, Greece. One hundred fifty-seven female inmates in the Attica’s Korydallos Female Prison and 150 non-criminals from Attica’s general population completed the Buss & Perry Aggression Questionnaire and Rosenberg’s Self-esteem Scale between February 2012 and April 2014. Lower self-esteem was associated with higher aggression among women independent of criminality. Self-esteem was lower in inmates (Mean = 18.06, SD = 6.19) than in non-criminals (Mean = 21.65, SD = 4.90, p < .001). Female prisoners presented higher aggression than non-criminals (unadjusted Mean = 78.40, SD = 23.60 versus Mean = 68.82, SD = 14.95, p < .001). However, after adjusting for age, education and self-esteem, this difference was no longer statistically significant (p = .127). Further studies, especially in female offenders, should be conducted to broaden our understanding of female aggression with a view to developing and promoting focused therapeutic procedures.     

Investigation of serum BDNF levels in drug-naive patients with schizophrenia

The role of brain-derived neurotrophic factor (BDNF) is to promote and modulate the neuronal responses across neurotransmitter systems in the brain. Therefore, abnormal BDNF signaling may be associated with the pathophysiology of schizophrenia. Decreased BDNF levels in the brain and the serum of patients with psychotic disorders have been reported. In the present study, we assessed serum BDNF levels in a group of 14 drug-naive first-episode patients with schizophrenia (FEP), compared to 15 healthy controls. The serum BDNF levels in the sample of FEP patients was significantly reduced compared to normal controls (23.92+/-5.99 ng/ml vs. 30.0+/-8.43 ng/ml, F=5.01, df=1, p=.034). Negative correlations were shown between serum BDNF levels of the patients and the PANSS Positive and Negative subscale scores. Our findings indicate that BDNF levels at the onset of schizophrenia may reflect associated pathophysiological processes as well as the severity of positive and negative psychotic symptoms.     

Psychotic (delusional) major depression in late life: a clinical study.

BACKGROUND: Psychotic (delusional) major depression (PMD) in the elderly is a common condition in inpatient settings. There is evidence that late age onset depressives are more likely to be psychotic. OBJECTIVES: The aim of this study was to investigate the frequency, sociodemographic, and clinical characteristics of PMD in hospitalized elderly depressives. METHODS: The sample consisted of 118 elderly patients consecutively admitted at three different clinics. All patients fulfilled DSM-IV criteria for major depression disorder and were diagnosed on the basis of Structured Clinical Interview for DSM-IV (SCID). The subjects were also assessed using the Hamilton Rating Scale for Depression, the Mini Mental State Examination (MMSE) and a physical health rating scale. RESULTS: PMD was positively associated with age of depression onset over 60 [corrected]. The PMD patients were also more severely depressed, more psychomotorically retarded and referred more past psychotic depressive episodes. Furthermore, age at onset influenced the type of delusions, so that PMD patients with age [corrected] over 60 at onset expressed delusions of hypochondriacal and nihilistic content more frequently. CONCLUSIONS: The results of our study demonstrated that PMD in the elderly has a later age at onset.     

Suicide and seasonality

Christodoulou C, Douzenis A, Papadopoulos FC, Papadopoulou A, Bouras G, Gournellis R, Lykouras L. Suicide and seasonality. Objective: Seasonal variation of deaths by suicide offers an important pathway in the study of possible suicide determinants of suicide and consequently suicide prevention. Method: We conducted a review of the literature on suicide seasonality, assessing articles published between 1979 and 2009. Results: The majority of the studies confirm a peak in spring, mainly for men, older individuals, and violent methods of suicide. A secondary peak during autumn is observed. There is no common seasonality pattern for suicide methods. However, there are also certain studies that did not confirm seasonal variation. Inconsistent results with reduced, unchanged, and even increased suicide seasonality have been reported. Aspects on the association between seasonality and suicides are discussed. Except sex, age, and method of suicide, other parameters were taken into account to find more specific characteristics of seasonality in suicides as well. The influence of clinical, bioclimatic, sociodemographic as well as biological factors seems to affect the seasonal variation. Conclusion: Studies from both the Northern and the Southern hemisphere report a seasonal pattern for suicides. These studies are not only an important source of epidemiological data for suicides but also represent a global effort to uncover hidden parameters of this self‐destructive behaviour.     

Psychotic (delusional) depression and completed suicide: a systematic review and meta-analysis

Background

It remains unclear whether psychotic features increase the risk of completed suicides in unipolar depression. The present systematic review coupled with a meta-analysis attempts to elucidate whether unipolar psychotic major depression (PMD) compared to non-PMD presents higher rates of suicides.

Methods

A systematic search was conducted in Scopus, PubMed, and “gray literature” for all studies providing data on completed suicides in PMD compared to non-PMD, and the findings were then subjected to meta-analysis. All articles were independently extracted by two authors using predefined data fields.

Results

Nine studies with 33,873 patients, among them 828 suicides, met our inclusion criteria. PMD compared to non-PMD presented a higher lifetime risk of completed suicides with fixed-effect pooled OR 1.21 (95% CI 1.04–1.40). In a sub-analysis excluding a very large study (weight?=?86.62%), and comparing 681 PMD to 2106 non-PMD patients, an even higher pooled OR was found [fixed-effect OR 1.69 (95% CI 1.16–2.45)]. Our meta-analysis may provide evidence that the presence of psychosis increases the risk of suicide in patients suffering from severe depression. The data are inconclusive on the contribution of age, mood congruence, comorbidity, and suicide method on PMD’s suicide risk. The lack of accurate diagnosis at the time of suicide, PMD’s diagnostic instability, and the use of ICD-10 criteria constitute the main study limitations.

Conclusions

The presence of psychosis in major depression should alert clinicians for the increased risk of completed suicide. Thus, the implementation of an effective treatment both for psychotic depression and patients’ suicidality constitutes a supreme priority.

     

Clinical correlates of age of onset in psychotic depression

The issue whether the clinical characteristics of unipolar psychotic major depression (PMD) vary according to the age of onset remains still unclear. Thus, the aim of this study was to assess comparatively a broad set of clinical characteristics of three groups of PMD patients, namely young early-onset (n = 30), elderly early-onset (n = 34) and elderly late-onset (n = 35). Ninety-nine inpatients suffering from DSM-IV unipolar PMD were assessed on the basis of Structured Clinical Interview for DSM-IV (SCID-IV), Hamilton Rating Scale for Depression (HRSD) and a physical impairment rating scale. The elderly late-onset patients suffered from overall more severe depression compared to both early-onset ones, more psychic anxiety compared to elderly early-onset patients and more gastrointestinal symptoms compared to young early-onset patients. Additionally, they expressed significantly more frequently delusions of somatic content and higher scores on the HRSD item of hypochondriasis than their young early-onset counterparts. The group of elderly early-onset PMD patients was found to hold an intermediate position between the young early-onset and elderly late-onset PMD patients with regard to hypochondriacal ideation, gastrointestinal symptoms and delusions of somatic, guilt, and paranoid content. Their stability of delusional content across successive episodes was found to extend into old age. Nevertheless, they expressed additional somatic delusions. Overall, the findings of the present study suggest considerable differences between young early-onset, elderly early-onset and elderly late-onset PMD patients with respect to their clinical features.