Awareness of illness moderates self-assessment of psychotic symptoms

2021 ◽  
pp. 000486742110574
Author(s):  
Luis Martinez Agulleiro ◽  
Renato de Filippis ◽  
Stella Rosson ◽  
Bhagyashree Patil ◽  
Lara Prizgint ◽  
...  
Keyword(s):  
Mental Disorders ◽  
Confidence Interval ◽  
Rating Scale ◽  
Psychotic Symptoms ◽  
Schizophrenia Spectrum Disorders ◽  
Brief Psychiatric Rating Scale ◽  
Schizophrenia Spectrum ◽  
Psychiatric Rating ◽  
Spectrum Disorders ◽  
Psychiatric Rating Scale

Objective: Self-reports or patient-reported outcome measures are seldom used in psychosis due to concerns about the ability of patients to accurately report their symptomatology, particularly in cases of low awareness of illness. The aim of this study was to assess the effect of insight on the accuracy of self-reported psychotic symptoms using a computerized adaptive testing tool (CAT-Psychosis). Methods: A secondary analysis of data drawn from the CAT-Psychosis development and validation study was performed. The Brief Psychiatric Rating Scale and the Scale of Unawareness of Mental Disorders were administered by clinicians. Patients completed the self-reported version of the CAT-Psychosis. Patients were median-split regarding their insight level to compare the correlation between the two psychosis severity measures. A subgroup sensitivity analysis was performed only on patients with schizophrenia spectrum disorders. Results: A total of 159 patients with a psychotic disorder who completed both CAT-Psychosis and Scale of Unawareness of Mental Disorders were included. For the whole sample, CAT-Psychosis scores showed convergent validity with Brief Psychiatric Rating Scale ratings ( r = 0.517, 95% confidence interval = [0.392, 0.622], p < 0.001). Insight was found to moderate this correlation (β = –0.511, p = 0.005), yet agreement between both measures remained statistically significant for both high ( r = 0.621, 95% confidence interval = [0.476, 0.733], p < 0.001) and low insight patients ( r = 0.408, 95% confidence interval = [0.187, 0.589], p < 0.001), while psychosis severity was comparable between these groups (for Brief Psychiatric Rating Scale: U = 3057, z = –0.129, p = 0.897; disorganization: U = 2986.5, z = –0.274, p = 0.784 and for CAT-Psychosis: U = 2800.5, z = –1.022, p = 0.307). Subgroup of patients with schizophrenia spectrum disorders showed very similar results. Conclusions: Insight moderates the correlation between self-reported and clinician-rated severity of psychosis, yet CAT-Psychosis remains valid in patients with both high and low awareness of illness.

scholarly journals Alysis Reliability Study: Rearranging Phenomenology into Etiology in Mental Disorders

2022 ◽  
Author(s):  
Abraham Peled
Keyword(s):  
Mental Disorders ◽  
Negative Symptoms ◽  
Rating Scale ◽  
Psychiatric Patients ◽  
Depression And Anxiety ◽  
Guiding Principle ◽  
Brief Psychiatric Rating Scale ◽  
Psychiatric Rating ◽  
Psychiatric Rating Scale ◽  
Positive And Negative Symptoms

‘Alysis’ )abbreviation of Neuroanalysis(, - is the chosen definition for the rearrangement of psychiatric phenomology to approximate the hypothesized etiology of mental disorders. Currently the relevant scales such as Positive and Negative Symptoms Scale (PANSS) for schizophrenia and the Hamilton scales for depression and anxiety, and Mania Rating Scale have no specific guiding principle in the order of items. ‘Alysis’ is a reorganization of multiple known scales to fit a future brain-related diagnostic approach to mental disorders. Due to the regrouping of items from different scales and reorganizing them according to a brain-related hypothetic order, it is necessary to reassess the reliability of the new ‘Alysis’ rearrangement. In this work the new ‘Alysis’ format is described and then using t-scores analysis, compared to the widely-used Brief Psychiatric Rating Scale (BPRS) scale for mental disorders. It is shown that ‘Alysis’ is reliable thus can be a good diagnostic platform to go ahead and generate personalized testable-predictions about brain-related diagnostics for psychiatric patients.

Clozapine as a treatment tool: only in resistant schizophrenic patients?

1997 ◽  
Vol 12 (S5) ◽  
pp. 347s-351s ◽  
Author(s):  
GB Cassano ◽  
A Ciapparelli ◽  
M Villa
Keyword(s):  
Rating Scale ◽  
Response To Treatment ◽  
Schizophrenia Spectrum Disorders ◽  
Treatment Resistant ◽  
Schizophrenia Spectrum ◽  
Baseline Evaluation ◽  
Schizophrenic Patients ◽  
Psychiatric Rating ◽  
Affective Components ◽  
Psychiatric Rating Scale

SummaryEvidence indicates that clozapine is effective in the management of treatment-resistant schizophrenia and in affective psychoses. To examine whether affective components within the boundaries of the schizophrenia spectrum imply specific psychopathological characteristics of response to treatment, 60 patients with a treatment-resistant schizophrenia spectrum disorder who were treated with clozapine (75–600 mg/d) were evaluated in a naturalistic, open, follow-up study. The group comprised 41 patients with and 19 without bipolar features (43 men and 17 women, mean age 34.3 years). Patients were evaluated with the Brief Psychiatric Rating Scale (BPRS) during the first year of treatment. The results show a significant improvement in scores in both groups (P < 0.001) compared with the baseline evaluation. A higher percentage of responders was seen in the ‘affective’ group. No typical psychopathological characteristic or symptom cluster predicting the response to treatment was identified. During the study, 15 patients discontinued treatment: six for lack of efficacy, five for non-compliance and four for adverse events. The study confirms the efficacy of clozapine in the treatment of schizophrenia spectrum disorders, particularly in patients with bipolar features.

Commentary

2008 ◽  
Vol 13 (6) ◽  
pp. 8-8
Author(s):  
Richard T. Katz
Keyword(s):  
Mental Illness ◽  
Behavioral Disorders ◽  
Rating Scale ◽  
Behavioral Disorder ◽  
Sixth Edition ◽  
Diagnostic And Statistical Manual ◽  
Brief Psychiatric Rating Scale ◽  
Psychiatric Rating ◽  
Psychiatric Rating Scale ◽  
Mental And Behavioral Disorders

Abstract The author, who is the editor of the Mental and Behavioral Disorders chapter of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, comments on the previous article, Assessing Mental and Behavioral Disorder Impairment: Overview of Sixth Edition Approaches in this issue of The Guides Newsletter. The new Mental and Behavioral Disorders (M&BD) chapter, like others in the AMA Guides, is a consensus opinion of many authors and thus reflects diverse points of view. Psychiatrists and psychologists continue to struggle with diagnostic taxonomies within the Diagnostic and Statistical Manual of Mental Disorders, but anxiety, depression, and psychosis are three unequivocal areas of mental illness for which the sixth edition of the AMA Guides provides M&BD impairment rating. Two particular challenges faced the authors of the chapter: how could M&BD disorders be rated (and yet avoid an onslaught of attorney requests for an M&BD rating in conjunction with every physical impairment), and what should be the maximal impairment rating for a mental illness. The sixth edition uses three scales—the Psychiatric Impairment Rating Scale, the Global Assessment of Function, and the Brief Psychiatric Rating Scale—after careful review of a wide variety of indices. The AMA Guides remains a work in progress, but the authors of the M&BD chapter have taken an important step toward providing a reasonable method for estimating impairment.

scholarly journals Acoustic speech markers for schizophrenia-spectrum disorders: a diagnostic and symptom-recognition tool

2021 ◽  
pp. 1-11
Author(s):  
J. N. de Boer ◽  
A. E. Voppel ◽  
S. G. Brederoo ◽  
H. G. Schnack ◽  
K. P. Truong ◽  
...  
Keyword(s):  
Negative Symptoms ◽  
Structured Interview ◽  
Diagnostic Value ◽  
Spectrum Disorder ◽  
Psychotic Symptoms ◽  
Schizophrenia Spectrum Disorders ◽  
Schizophrenia Spectrum Disorder ◽  
Speech Technology ◽  
Schizophrenia Spectrum ◽  
Spectrum Disorders

Abstract Background Clinicians routinely use impressions of speech as an element of mental status examination. In schizophrenia-spectrum disorders, descriptions of speech are used to assess the severity of psychotic symptoms. In the current study, we assessed the diagnostic value of acoustic speech parameters in schizophrenia-spectrum disorders, as well as its value in recognizing positive and negative symptoms. Methods Speech was obtained from 142 patients with a schizophrenia-spectrum disorder and 142 matched controls during a semi-structured interview on neutral topics. Patients were categorized as having predominantly positive or negative symptoms using the Positive and Negative Syndrome Scale (PANSS). Acoustic parameters were extracted with OpenSMILE, employing the extended Geneva Acoustic Minimalistic Parameter Set, which includes standardized analyses of pitch (F0), speech quality and pauses. Speech parameters were fed into a random forest algorithm with leave-ten-out cross-validation to assess their value for a schizophrenia-spectrum diagnosis, and PANSS subtype recognition. Results The machine-learning speech classifier attained an accuracy of 86.2% in classifying patients with a schizophrenia-spectrum disorder and controls on speech parameters alone. Patients with predominantly positive v. negative symptoms could be classified with an accuracy of 74.2%. Conclusions Our results show that automatically extracted speech parameters can be used to accurately classify patients with a schizophrenia-spectrum disorder and healthy controls, as well as differentiate between patients with predominantly positive v. negatives symptoms. Thus, the field of speech technology has provided a standardized, powerful tool that has high potential for clinical applications in diagnosis and differentiation, given its ease of comparison and replication across samples.

Problèmes méthodologiques posés par la classification des formes de schizophrénie: recherche de corrélations ou de relations d'appartenance?

1987 ◽  
Vol 2 (3) ◽  
pp. 174-187
Author(s):  
Monique de Bonis ◽  
Paul de Boeck ◽  
Marie-Odile Lebeaux
Keyword(s):  
Rating Scale ◽  
Brief Psychiatric Rating Scale ◽  
Psychiatric Rating ◽  
Psychiatric Rating Scale

RésuméLe présent travail comporte une critique de la méthodologie employée pour définir une typologie des schizophrènes et une étude empirique de la distinction entre forme productive et forme déficitaire.Après avoir souligné que les études factorielles visant l’identification de deux types de schizophrènes reposaient sur des choix méthodologiques discutables: recherche de corrélations entre variables, alors qu’il s’agit de découvrir des corrélations entre sujets; préférence pour des relations symétriques, alors que les liaisons sont probablement d’ordre asymétrique, les auteurs présentent deux études empiriques.La première réalisée sur un échantillon de 99 schizophrènes s’appuie sur la factorisation des estimations de la symptomatologie (BPRS* á 42 items) à l’aide de la méthode factorielle en plan Q et d’une analyse des correspondances. La seconde a porté sur un sous-échantillon de 52 schizophrènes à l’aide d’une nouvelle méthode d’analyse hiérarchique (HICLAS). Les résultats de ces analyses aboutissent aux conclusions suivantes. Les résultats des analyses factorielles montrent: • qu’il existe plus de deux formes de schizophrènie et qu’à l’intérieur des classes formées par les individus l’opposition déficitaire -productif est stable quelle que soit la métrique utilisée; • que cette opposition repose principalement, pour ce qui est de la forme déficitaire sur 3 symptômes: l’émoussement affectif, le retrait affectif et le ralentissement, et pour ce qui est de la forme productive sur l’humeur expansive, l’attitude manipulatoire, l’excitation, la dramatisation et la labilit émotionnelle; • que contrairement aux travaux antérieurs ni les hallucinations ni la désorganisation conceptuelle ne permettent d’établir la différence entre les deux groupes de malades sans doute parce qu’elles sont communes à tous les schizophrènes; • qu’il n’y a pas de correspondance entre les diagnostics cliniques et les formes décrites; et, • que les malades les plus déficitaires (situés aux extrêmités du pole factoriel) se différencient des malades productifs essentiellement par des variables liées au sexe (plus d’hommes que de femmes dans le premier cas), un statut marital de célibat plus fréquent, et des antécédents psychiatriques plus importants. Les résultats des analyses factorielles soulignent d’une part que les types mixtes sont plus fréquents que les types purs et, d’autre part qu’il suffit de moins de 10 symptômes pour réaliser une opposition satisfaisante entre forme productive et forme déficitaire (Tableau 3, figure 1).Toutes ces conclusions sont valables aussi pour l’analyse hiérarchique. Mais de plus, cette méthode permet d’individualiser un groupe de malades “purs” dans la forme déficitaire seulement, groupe disjoint des autres individus sur la base d’un très petit nombre de symptômes. A côté de ces types purs figurent des types mixtes, qui possédent à la fois des symptômes déficitaires et des symptômes productifs suivant des combinaisons hiérarchiques précises, c’est-à-dire avec une dominance de l’une ou de l’autre forme. Il existe aussi des formes résiduelles dans lesquelles aucune hiérarchie ne peut être mise au jour (Tableau 4).En conclusion on a insisté, outre les problèmes méthodologiques négligés dans les précédentes recherches, sur l’existence d’une dissymétrie entre la forme déficitaire et la forme productive, dans la mesure où c’est seulement la forme déficitaire qui présente une grande singularité et sur l’importance des symptômes liés à la vie affective et à son appauvrissement qui ont un pouvoir discriminatif plus élevé que les symptômes productifs.*BPRS = Brief Psychiatric Rating Scale

Study of the Clinical Utility of Radioreceptor Assay in Outpatients with Schizophrenia Receiving High Doses of Neuroleptics

1993 ◽  
Vol 38 (8) ◽  
pp. 534-540 ◽  
Author(s):  
Marie-A. Gagné ◽  
Hugues Cormier ◽  
Gérard Leblanc ◽  
Daniel Lévesque ◽  
Thérèse Di Paolo
Keyword(s):  
Plasma Levels ◽  
Rating Scale ◽  
Radioreceptor Assay ◽  
High Dose ◽  
Progressive Reduction ◽  
Brief Psychiatric Rating Scale ◽  
Scale Scores ◽  
Psychiatric Rating ◽  
Psychiatric Rating Scale ◽  
High Doses

A radioreceptor assay (RRA) was used to determine the neuroleptic plasma levels of 32 outpatients with schizophrenia receiving a high dose of neuroleptics (the equivalent of 18 mg or more of oral haloperidol per day) and undergoing a 50% partial and progressive reduction (ten percent each month for five months) in their medication. Plasma levels of neuroleptics were measured three times: before (T1) and immediately after the 50% reduction (T2) and five months later (T3). A linear correlation was observed between neuroleptic plasma levels obtained by RRA and the neuroleptic doses prescribed at T1 and T3. Furthermore, neuroleptic plasma levels were significantly lower at T3 than at T1. Concurrent evaluations of psychopathology were done using the Brief Psychiatric Rating Scale, and the results indicated that no correlation exists between neuroleptic plasma levels and the total rating scale scores at T1 but a significant correlation was observed at T3.

Effects of Neuroleptic Reduction in Schizophrenic Outpatients Receiving High Doses

1994 ◽  
Vol 39 (4) ◽  
pp. 223-229 ◽  
Author(s):  
Gérard Leblanc ◽  
Hugues Cormier ◽  
Marie-Andrée Gagné ◽  
Sylvie Vaillancourt
Keyword(s):  
Negative Symptoms ◽  
Rating Scale ◽  
High Dose ◽  
Clinical Effects ◽  
Relative Paucity ◽  
Brief Psychiatric Rating Scale ◽  
Psychiatric Rating ◽  
Psychiatric Rating Scale ◽  
High Doses ◽  
Schizophrenic Outpatients

This paper presents an open study which evaluated the clinical effects of a partial and progressive reduction in neuroleptic medication in 32 outpatients suffering from schizophrenia who were receiving high doses (equivalent of ≥ 18 mg of oral haloperidol per day; EHL). After an observation period of twelve weeks, each subject's dose of neuroleptics was reduced by 50% at the rate of 10% every four weeks. Patients were receiving a mean of 62 mg per day EHL at the beginning of the study and 30 mg per day EHL at the completion of the study. After the reduction, the following was observed: 1. a significant but modest change in psychopathology: a decrease in negative symptoms and in the total score on Brief Psychiatric Rating Scale; and 2. a significant increase in tardive dyskinesia symptoms. Six subjects relapsed but five of them recovered without increasing their reduced medication. Results of this study are discussed in the context of trying to find a minimal maintenance dose in the treatment of schizophrenia. The relative paucity of change despite a large reduction in medication argues for réévaluation of dosage in patients on high or very high doses of neuroleptics. The results suggest that many patients taking high doses could be maintained on significantly lower doses of neuroleptics. With gradual reduction of medication it would seem that many patients who are receiving a high dose of neuroleptic can achieve a lower dose than their current maintenance level.

The Efficacy of Electroconvulsive Therapy in the Treatment of Schizophrenia

1987 ◽  
Vol 151 (2) ◽  
pp. 152-155 ◽  
Author(s):  
K. R. Abraham ◽  
P. Kulhara
Keyword(s):  
Electroconvulsive Therapy ◽  
Rating Scale ◽  
Double Blind Trial ◽  
Double Blind ◽  
Blind Trial ◽  
Brief Psychiatric Rating Scale ◽  
Psychiatric Rating ◽  
Psychiatric Rating Scale ◽  
To Receive

The efficacy of ECT was investigated in a double-blind trial. Twenty-two patients with schizophrenia received trifluoperazine and were randomly allocated to receive eight real or eight simulated ECTs. In the first eight weeks, the group receiving real ECTs showed significantly more improvement as measured on the Brief Psychiatric Rating Scale. However, the groups showed no significant differences from the twelfth week onwards. The superiority of real ECT was not confirmed at the end of six months.

Sign in / Sign up

Export Citation Format

Share Document