Clinical Global Impression-severity score as a reliable measure for routine evaluation of remission in schizophrenia and schizoaffective disorders

ObjectifsÉvaluer la tolérance, la sécurité d’emploi et la réponse à un traitement mensuel par palmitate de paliperidone (PP) à doses flexibles chez des patients adultes atteints de schizophrénie, non-aigus mais symptomatiques, après échec d’un traitement par antipsychotiques oraux.MéthodesAnalyse d’un groupe de patients atteints de schizophrénie, non-aigus mais symptomatiques, inclus dans une étude internationale, ouverte, prospective de six mois, évaluant la symptomatologie clinique : PANSS (Positive and Negative Syndrome Scale) et CGIS-S (Clinical Global Impression-Severity Scale), les événements indésirables (EIs) et le changement de poids.RésultatsCinq cent quatre-vingt-treize patients (population en intention de traiter) : 63,1 % d’hommes, âge moyen 38,4 ± 11,8 ans, 78,6 % souffrant de schizophrénie paranoïde. La principale raison de la substitution d’un antipsychotique oral par le PP était un manque d’efficacité (24,3 %). 74,5 % des patients ont terminé l’étude de six mois. Les raisons les plus fréquentes d’arrêt précoce étaient : le choix du patient (9,3 %), des effets indésirables (EIs) (6,1 %), les perdus de vue (3,0 %) et le manque d’efficacité (2,5 %). Le score total moyen à l’échelle PANSS a diminué de 71,5 ± 14,6 à l’inclusion à 59,7 ± 18,1 à la fin de l’étude (soit une différence de −11,7 ± 15,9 points ; 95 % IC 95 % [−13,0 ; −10,5] ; p <0,0001). 64,0 % des patients ont eu une amélioration supérieure ou égale à 20 % du score total à la PANSS et le pourcentage de patients légèrement malades ou moins (CGI-S) est passé de 31,8 à 63,2 %. Les EIs touchant plus de 5 % des patients sont : douleur au site d’injection (12,3 %), insomnie (8,6 %), anxiété (6,7 %), trouble psychotique (6,1 %) et céphalées (5,6 %). Le changement moyen de poids a été de 1,2 ± 5,0 kg (IC 95 % [0,7 ; 1,6]).ConclusionsCes résultats confirment la bonne tolérance et l’efficacité thérapeutique du PP à doses flexibles chez des patients non aigus atteints de schizophrénie, après échec d’un traitement par antipsychotiques oraux.

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Retrospective Case Review of Lamotrigine Use for Affective Instability of Borderline Personality Disorder

CNS Spectrums ◽

10.1017/s1092852900020927 ◽

2007 ◽

Vol 12 (3) ◽

pp. 207-210 ◽

Cited By ~ 5

Author(s):

Wendy Weinstein ◽

Katrina L. Jamison

Keyword(s):

Borderline Personality Disorder ◽

Personality Disorder ◽

Clinical Global Impression ◽

Borderline Personality ◽

Retrospective Case ◽

Clinical Global Impression Severity ◽

Severity Scores ◽

Affective Instability ◽

Final Score ◽

Initial Score

ABSTRACTIntroduction: The diagnosis of borderline personality disorder is complex as is its pharmacologic treatment. Lamotrigine may offer promise in the treatment of this condition.Objective: To assess the use of lamotrigine to treat symptoms of affective instability in patients with borderline personality disorder.Methods: Charts of patients treated with lamotrigine in a private practice during the period of 2003–2004 were reviewed. Patients were included in the analysis if they had been given a clinical diagnosis of borderline personality disorder as defined in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition-Text Revision, had continued to display affective instability while taking their previous medications before being treated with lamotrigine; had received a Clinical Global Impression-Severity score before and after lamotrigine therapy; had been treated with lamotrigine, as monotherapy or adjunctive therapy, at a dose ranging from 50–200 mg/day; and continued to take lamotrigine for at least 3 months.Results: The charts of 13 patients were reviewed and included in the analysis. All patients were female, 19–43 years of age, and had reported continuing symptoms of affective instability despite treatment with two to seven psychotropic drugs, including, but not limited to, fluoxetine, paroxetine, escitalopram, buproprion, and clonazepan. The duration of lamotrigine treatment, before the end of the period covered by the chart review was 3–15 months. The patients had initial Clinical Global Impression-Severity scores of 5 or 6 and a final scores of 1 or 2, except for one patient with an initial score of 3 and a final score of 1 and one patient with an initial score of 6 and a final score of 7.Conclusion: Lamotrigine seems to be a safe and effective option for the treatment of patients with symptoms of affective instability associated with borderline personality disorder.

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Negative aspects of self-stigma in patients with schizophrenia spectrum disorders

European Psychiatry ◽

10.1016/j.eurpsy.2017.02.437 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S390-S390

Author(s):

K. Vrbova ◽

J. Prasko ◽

M. Ociskova ◽

M. Holubova ◽

D. Kamaradova ◽

...

Keyword(s):

Clinical Global Impression ◽

The Self ◽

Subjective Rating ◽

Negative Consequences ◽

Schizophrenia Spectrum Disorders ◽

Severity Scale ◽

Clinical Global Impression Severity ◽

Schizophrenia Spectrum ◽

Spectrum Disorders ◽

The Difference

IntroductionMost individuals diagnosed with schizophrenia must cope with some form of stigmatization. Different types of public stigma, self-stigma and label avoidance, may have negative consequences for these individuals.ObjectivesThe aim of the study was to search the degree of self-stigma in schizophrenia and its association with the clinical and demographic factors.MethodsOne hundred and ninety-seven stabilized outpatients diagnosed with schizophrenia spectrum disorders participated in the study. The mean age of the sample was 40 years. All individuals completed the Internalized Stigma of Mental Illness Scale (ISMI) and a demographic questionnaire. The disorder severity was assessed both by a psychiatrist (objCGI-S: the objective version of Clinical Global Impression – Severity scale) and by the patients (subjCGI-S: the subjective version of Clinical Global Impression – Severity scale).ResultsThe total score of the ISMI positively correlated with the severity of the disorder measured by the objCGI-S and the subjCGI-S. Additionally, the self-stigma positively correlated with the treatment duration, and the number of hospitalizations. The regression analysis identified these regressors as the most relevant to the self-stigma – the number of hospitalizations, the severity of the disorder rated by a psychiatrist, and the difference between the objective rating and the subjective rating of the severity of the disorder.ConclusionsOutpatients with psychosis, who have undergone a higher number of hospitalizations, dispose of a higher severity of the disorder and show a bigger discrepancy between their rating of the severity and the psychiatric rating, display a greater degree of self-stigma.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Első lépés egy egységes szemlélet felé: az Alkohol Megvonási Skála bevezetése a hazai betegellátási gyakorlatba

Orvosi Hetilap ◽

10.1556/650.2019.31424 ◽

2019 ◽

Vol 160 (30) ◽

pp. 1184-1192

Author(s):

Bence András Lázár ◽

Ildikó Katalin Pribék ◽

Csenge Kovács ◽

Ildikó Demeter ◽

János Kálmán ◽

...

Keyword(s):

General Hospital ◽

Clinical Global Impression ◽

Alcohol Withdrawal ◽

Repeated Measures ◽

Withdrawal Syndrome ◽

Alcohol Withdrawal Syndrome ◽

Withdrawal Symptoms ◽

Severity Scale ◽

Clinical Global Impression Severity ◽

Severity Scores

Abstract: Introduction and aim: The available literature and protocols have unequivocally suggested that the Clinical Institute Withdrawal Assessment of Alcohol, Revised is a psychometric scale for identifying and following the signs of alcohol withdrawal. However, there has not been any validated tool for the identification of withdrawal symptoms in Hungarian general hospital settings. The aim of the present study was to evaluate the validity and the reliability of the Hungarian version of this scale among patients hospitalized with alcohol withdrawal syndrome. Method: The translation of the scale into Hungarian was done by ‘back translation’ method, followed by testing the face validity. The empirical phase was performed in the Department of Psychiatry, University of Szeged. Patients admitted with alcohol withdrawal syndrome (n = 30) were recruited from the inpatient units of the clinic. Clinical Institute Withdrawal Assessment of Alcohol, Revised and Clinical Global Impression – Severity Scale were recorded every two days. Statistical comparisons of data were performed with repeated-measures ANOVA. Cronbach’s alpha, item-total correlation, convergent and discriminant validity were determined. Results: Significant decrease of the total scores of Clinical Institute Withdrawal Assessment of Alcohol, Revised and Clinical Global Impression – Severity Scale was observed between the six measurements (F = 202.46, p<0.001; F = 503.04, p<0.001). Cronbach alpha values were above 0.7 during the first 3 measurement days. The withdrawal and severity scores recorded the same day showed positively significant correlations (>0.45). Conclusion: Our findings demonstrate that the Clinical Institute Withdrawal Assessment of Alcohol, Revised is a reliable and valid psychometric tool for the detailed analysis of withdrawal symptoms in Hungarian general hospital settings. Orv Hetil. 2019; 160(30): 1184–1192.

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Palmitate de palipéridone à doses flexibles – Réponse thérapeutique, tolérance et sécurité d’emploi: une étude prospective chez des patients en période d’exacerbation aiguë d’un trouble schizophrénique après échec d’un traitement par antipsychotiques oraux

European Psychiatry ◽

10.1016/j.eurpsy.2013.09.285 ◽

2013 ◽

Vol 28 (S2) ◽

pp. 107-107

Author(s):

A. Schreiner ◽

P. Bergmans ◽

P. Cherubin ◽

E. Rancans ◽

Y. Bez ◽

...

Keyword(s):

Clinical Global Impression ◽

Étude Prospective ◽

Clinical Global Impression Severity ◽

Syndrome Scale ◽

La Substitution ◽

Negative Syndrome

ObjectifsÉvaluer la tolérance, la sécurité d’emploi et l’efficacité de doses flexibles de PP chez des patients adultes en période d’exacerbation aiguë d’une schizophrénie, après échec d’un traitement par antipsychotiques oraux.MéthodesÉtude internationale, prospective, ouverte, de six mois.Critères d’évaluationPositive and Negative Syndrome Scale (PANSS), Clinical Global Impression-Severity (CGI-S), événements indésirables (EI), changement de poids.RésultatsDeux cent douze patients (population en intention de traiter) : âge moyen 36,4 ± 12,1 ans, 59,0 % d’hommes, 85,4 % souffrant de schizophrénie paranoïde ont été inclus. La principale raison de la substitution d’un antipsychotique oral par le PP était un manque d’efficacité (45,8 %). 70,3 % des patients ont terminé l’étude de six mois. Les raisons les plus fréquentes d’arrêt précoce ont été : le choix du patient (9,4 %), des EI (9,0 %), les perdus de vue (4,7 %), le manque d’efficacité (2,8 %). Le score total moyen à la PANSS initiale (98,5 ± 20,1) a diminué, et ce dès j8, pour atteindre 67,4 ± 24,0 à la fin de l’étude (diminution de −31,0 ± 29,0, p < 0,0001). 66,7 % des patients ont eu une amélioration de plus de 30 % du score PANSS total et le pourcentage de patients jugés manifestement malades ou pire (CGI-S) a diminué de 75,1 % à 20,5 %. Les EIs (≥ 5 % patients) : douleur au site d’injection (13,7 %), insomnie (10,8 %), trouble psychotique (10,4 %), céphalées (6,1 %) et anxiété (6,1 %). Le changement moyen de poids a été de 2,6 ± 5,6 kg (IC 95 % [1,8; 3,4]).ConclusionsCes résultats confirment que le PP à doses flexibles est bien toléré et permet une réponse clinique précoce et cliniquement significative chez des patients en période d’exacerbation aiguë de leur trouble schizophrénique, après échec d’un traitement par antipsychotiques oraux.

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Association of Insight, Internalized Stigma, and Experienced Stigma in Schizoaffective Disorders

PsycEXTRA Dataset ◽

10.1037/e640982010-001 ◽

2010 ◽

Author(s):

Wendy Y. Tse ◽

Chien Y. Chen ◽

Lawrence H. Yang

Keyword(s):

Internalized Stigma ◽

Schizoaffective Disorders

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Mono-, Kombinations- und Augmentationstherapie depressiver Patienten mit Agomelatin

Nervenheilkunde ◽

10.1055/s-0037-1616456 ◽

2016 ◽

Vol 35 (12) ◽

pp. 847-856

Author(s):

M.-L. Escafit-Schülke ◽

H.-P. Volz

Keyword(s):

Clinical Global Impression ◽

Anxiety Symptoms

Zusammenfassung Gegenstand und Ziel: Die Subgruppenanalyse der nicht interventionellen Studie VIVRE (Valdoxan® ImproVes depRession with anxiEty symptoms) evaluierte die Verbesserung von Angstsymptomen der Depression und sozialer Funktionsfähigkeit unter Agomelatin, abhängig von der antidepressiven bzw. psychotropen Komedikation. Methoden: Patienten von 4 Subgruppen (A–D) erhielten über 12 Wochen Agomelatin in Monotherapie (A, n = 965), Kombinationstherapie (B, n = 187), Augmentationstherapie (C, n = 549) oder in Kombinations- plus Augmentationstherapie (D, n = 190). Der klinische Verlauf wurde mit Clinical-Global-Impression (CGI), Patient-Global-Impressions (PGI), COVI- und Sheehan-Disability-Skala (SDS) dokumentiert. Ergebnisse: Die depressive Symptomatik verbesserte sich bei mehr als drei Viertel der Patienten aller Subgruppen mit Response-/Remissionsraten (CGI-I/S) von 83,0%/44,1% (A), 75,3%/23,2% (B), 86,1%/42,2% (C) und 70,3%/26% (D). Die Angstsymptome der Depression (COVI) verbesserten sich bei 92,7% (A), 91,3% (B), 94,8% (C) und 89,8% (D) und die soziale Funktionsfähigkeit (SDS) bei 94,3% (A), 93,2% (B), 95,8% (C) und 93,1% (D) der Patienten. Schlussfolgerung: Verbesserung von depressiven Symptomen, Angstsymptomen bei Depression und sozialer Funktionsfähigkeit konnten unter Agomelatin sowohl als Mono-, Kombinations- bzw. Augmentationstherapie bei guter Verträglichkeit im Praxisalltag beobachtet werden.

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Disseminierte intravasale Gerinnung und Fibrinolyse in der Frühphase nach Polytrauma

Hämostaseologie ◽

10.1055/s-0038-1655291 ◽

1995 ◽

Vol 15 (02) ◽

pp. 79-86

Author(s):

L. Lampl ◽

M. Helm ◽

M. Tisch ◽

K. H. Bock ◽

E. Seifried

Keyword(s):

Injury Severity Score ◽

Severity Score ◽

Injury Severity ◽

Tissue Type ◽

Disseminierte Intravasale Gerinnung

ZusammenfassungGerinnungsstörungen nach einem Polytrauma werden eine große Bedeutung für die weitere Prognose der Patienten beigemessen. In einer prospektiv angelegten Studie wurden bei 20 polytraumatisierten Patienten Gerinnungsund Fibrinolyseparameter analysiert, um deren Veränderungen während der präklinischen Phase zu definieren. Die Blutentnahmen wurden zum frühestmöglichen Zeitpunkt am Unfallort und bei Klinikübergabe durchgeführt. Die gewonnenen Proben wurden mit Hilfe eines speziell konzipierten »Kleinlabors« noch vor Ort verarbeitet, um möglichst native Meßwerte zu erhalten. Die Patienten wurden dem Schweregrad der Verletzung entsprechend kategorisiert und hatten einen Verletzungsschweregrad nach NACA > IV und einen Injury Severity Score (ISS) > 20. Die Ergebnisse zeigen, daß bereits in der sehr frühen Phase nach Eintritt des Traumas schwerwiegende Veränderungen des Gerinnungsund Fibrinolysesystems eintreten. Die frühzeitige Thrombingenerierung führt zu einer Verbrauchskoagulopathie und reaktiven Hyperfibrinolyse. Zusätzlich erzeugt die Freisetzung von endothelständigem Tissue-type-Plasminogenaktivator eine primäre Hyperfibrinolyse. Die Veränderungen des Gerinnungsund Fibrinolysesystems in der frühen präklinischen Phase nach Polytrauma können zu schwerwiegenden klinischen Komplikationen wie Blutungen, thromboembolischen Komplikationen und zur Ausbildung von Schockorganen führen.

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Reliability of the Mangled Extremity Severity Score in the Management of Peripheral Vascular Injuries in Children: A Retrospective Review

International Journal of Angiology ◽

10.1055/s-0040-1720970 ◽

2020 ◽

Author(s):

Ahmed Mousa ◽

Ossama M. Zakaria ◽

Mai A. Elkalla ◽

Lotfy A. Abdelsattar ◽

Hamad Al-Game'a

Keyword(s):

Severity Score ◽

Vein Graft ◽

Bypass Surgery ◽

Age Groups ◽

Vascular Injuries ◽

Peripheral Vascular ◽

Group Iii ◽

Mangled Extremity ◽

Group I ◽

End To End

AbstractThis study was aimed to evaluate different management modalities for peripheral vascular trauma in children, with the aid of the Mangled Extremity Severity Score (MESS). A single-center retrospective analysis took place between 2010 and 2017 at University Hospitals, having emergencies and critical care centers. Different types of vascular repair were adopted by skillful vascular experts and highly trained pediatric surgeons. Patients were divided into three different age groups. Group I included those children between 5 and 10 years; group II involved pediatrics between 11 and 15 years; while children between 16 and 21 years participated in group III. We recruited 183 children with peripheral vascular injuries. They were 87% males and 13% females, with the mean age of 14.72 ± 04. Arteriorrhaphy was performed in 32%; end-to-end anastomosis and natural vein graft were adopted in 40.5 and 49%, respectively. On the other hand, 10.5% underwent bypass surgery. The age groups I and II are highly susceptible to penetrating trauma (p = 0.001), while patients with an extreme age (i.e., group III) are more susceptible to blunt injury (p = 0.001). The MESS has a significant correlation to both age groups I and II (p = 0.001). Vein patch angioplasty and end-to-end primary repair should be adopted as the main treatment options for the repair of extremity vascular injuries in children. Moreover, other treatment modalities, such as repair with autologous vein graft/bypass surgery, may be adopted whenever possible. They are cost-effective, reliable, and simple techniques with fewer postoperative complication, especially in poor/limited resources.

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