Ana Fresán

A forced five-dimensional factor analysis and concurrent validity of the Positive and Negative Syndrome Scale in Mexican schizophrenic patients

UNLABELLED The heterogeneity of schizophrenic symptomatology is well documented. The positive-negative distinction is limited to cover the entire spectrum of schizophrenic psychopathology in order to describe the various clinical aspects of the disorder. METHOD We recruited 150 schizophrenic patients between May 2002 and September 2003. Diagnoses were based on a structured clinical interview. The Positive and Negative Syndrome Scale (PANSS) was used to evaluate general psychopathology and symptom severity. For the concurrent validity of the pentagonal model of the PANSS, the BPRS, the CDSS, the OAS and the MMSE were used. RESULTS The forced five-factor principal-component analysis explained 53.4% of the total variance. There were significant correlations between the clinical rating scales and the five components of the PANSS. DISCUSSION Our data support a pentagonal model underlying the multidimensional schizophrenic symptomatology as assessed by the PANSS. The five-factor structure of the PANSS in Mexican schizophrenic patients enables further elucidation of the various clinical aspects of schizophrenia.

Association study of MAO-A and DRD4 genes in schizophrenic patients with aggressive behavior.

Genes involved in dopamine neurotransmission are interesting candidates to be analyzed in schizophrenia and aggressive behavior. Therefore, we analyzed the functional polymorphisms of the dopamine receptor D4 (DRD4) and monoamine oxidase A (MAO-A) genes in a sample of 71 schizophrenic patients assessed with the Overt Aggression Scale to measure aggressive behavior. CLUMP analysis of the DRD4 48-bp repeat-exon III polymorphism in schizophrenic patients showed significant differences between the aggressive behavior and the nonaggressive groups (T1 = 18.77, d.f. = 6, p = 0.0046; T3 = 6.54, p = 0.0195). However, analysis of the promoter polymorphism of the MAO-A gene revealed no significant association between aggressive and nonaggressive patients. Finally, analysis of Overt Aggression Scale dimensions exhibited significant differences for the DRD4 and MAO-A genes. Our preliminary findings suggest that the DRD4 and MAO-A genes may be involved in aggressive schizophrenic patients.

Removing transgender identity from the classification of mental disorders: a Mexican field study for ICD-11

BACKGROUND The conceptualisation of transgender identity as a mental disorder has contributed to precarious legal status, human rights violations, and barriers to appropriate health care among transgender people. The proposed reconceptualisation of categories related to transgender identity in WHOs forthcoming International Classification of Diseases (ICD)-11 removes categories related to transgender identity from the classification of mental disorders, in part based on the idea that these conditions do not satisfy the definitional requirements of mental disorders. We aimed to determine whether distress and impairment, considered essential characteristics of mental disorders, could be explained by experiences of social rejection and violence rather than being inherent features of transgender identity, and to examine the applicability of other elements of the proposed ICD-11 diagnostic guidelines. METHODS This field study used a retrospective interview design in a purposive sample of transgender adults (aged >18 years or older) receiving health-care services at the Condesa Specialised Clinic in Mexico City, Mexico. Participants completed a detailed structured interview focusing on sociodemographic characteristics, medical history related to gender identity, and, during a specific period of adolescence, key concepts related to gender identity diagnoses as proposed for ICD-11 and from DSM-5 and ICD-10, psychological distress, functional impairment, social rejection, and violence. Data were analysed with descriptive statistics and univariate comparisons and multivariate logistic regression models predicting distress and dysfunction. FINDINGS Between April 1, 2014, and Aug 17, 2014, 260 transgender adults were approached and 250 were enrolled in the study and completed the interview. Most (n=202 [81%]) had been assigned a male sex at birth. Participants reported first awareness of transgender identity at a mean age of 5·6 years (SD 2·5, range 2-17), and 184 (74%) had used health interventions for body transformation, most commonly hormones (182 [73%)], with the first such intervention at a mean age of 25·0 years (SD 9·1, range 10-54). 84 (46%) of those who had used hormones did so initially without medical supervision. During adolescence, distress related to gender identity was very common, but not universal (n=208 [83%]), and average level of distress was quite high among those who reported it (79·9 on a scale of 0 [none at all] to 100 [extreme], SD 20·7, range 20-100). Most participants (n=226 [90%] reported experiencing family, social, or work or scholastic dysfunction related to their gender identity, but this was typically moderate (on a scale of 0 [not at all disrupted] to 10 [extremely disrupted], family dysfunction mean 5·3 [SD 3·9, range 0-10]; social dysfunction mean 5·0 [SD 3·8, range 0-10]; work or scholastic dysfunction mean 4·8 [SD 3·6, range 0-10]). Multivariate logistic regression models indicated that distress and all types of dysfunction were strongly predicted by experiences of social rejection (odds ratios [ORs] 2·29-8·15) and violence (1·99-3·99). A current male gender identity also predicted distress (OR 3·90). Of the indicators of gender incongruence, only asking to be treated as a different gender was a significant predictor, and only of work or scholastic dysfunction (OR 1·82). INTERPRETATION This study provides additional support for classifying health-related categories related to transgender identity outside the classification of mental disorders in the ICD-11. The reconceptualisation and related reclassification of transgender-related health conditions in the ICD-11 could serve as a useful instrument in the discussion of public health policies aimed at increasing access to appropriate services and reducing the victimisation of transgender people. FUNDING National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico.

Personality differences according to age and sex in a Mexican sample using the Temperament and Character Inventory-Revised.

OBJECTIVES The objectives of the study were to compare personality features according to age and sex cohorts in a community sample of Mexico City using the Temperament and Character Inventory-Revised (TCI-R) and to examine the TCI-R psychometric properties according to age and sex parameters. METHOD A total of 2076 adults filled out the Spanish version of TCI-R. RESULTS Younger subjects exhibited higher novelty seeking. Self-directedness and cooperativeness scores increased with age. Harm avoidance and self-transcendence were lower in younger adults when compared with older subjects. Women scored higher than men in harm avoidance and reward dependence. Men between 26 and 45 years old reported higher novelty seeking. Women older than 25 years scored higher in self-transcendence, and those older than 45 years exhibited higher cooperativeness scores. The identified TCI-R structure corresponded to the original one. Internal consistency of the higher-order dimensions was good in all age cohorts, in men and women, and in the total sample (αs >.80). CONCLUSION Our results give further support to personality specific dominant features in men and women. Differences in age cohorts may be explained by maturity and personal experiences acquired during life. The TCI-R psychometric properties and score distributions by age and sex cohorts may be useful for future studies with clinical samples and for cross-cultural comparison purposes.

Minimum effective doses of haloperidol for the treatment of first psychotic episode: a comparative study with risperidone and olanzapine

Minimum doses of haloperidol might show similar efficacy and side-effects compared to atypical antipsychotics. The objectives of this study were to compare the efficacy of minimum doses of haloperidol with standard doses of risperidone and olanzapine on a 6-month open trial in first psychotic episode patients and to examine the effect of compliance on their outcome. Forty-two patients were recruited and started on flexible doses of these drugs. Olanzapine was given with no cost to the patients. Efficacy and side-effects were monitored every 3 months using standardized assessments. Thirty patients completed the study. All treatment groups showed improvement in positive, negative and depressive symptoms. There were no differences in side-effects among them. The haloperidol group required higher doses of anticholinergics. The rate of treatment discontinuation was higher in the risperidone group due to the direct cost. Minimum doses of haloperidol might prove to be a good choice of treatment for patients with a first episode of psychosis.

Amoxapine as an Atypical Antipsychotic: A Comparative Study Vs Risperidone

Amoxapine is marketed as an antidepressant. However, its invitro profile, receptor occupancy and preclinical effects are very similar to atypical antipsychotics. Amoxapine has also shown efficacy as an atypical antipsychotic in open trials. The objective of this study was to compare the antipsychotic and side effect profile of amoxapine and risperidone in a randomised assignment, standardized dosing, double-blind trial of acutely psychotic patients with schizophrenia. A total of 48 schizophrenic patients were enrolled and randomized in a double-blind 6-week trial to receive either risperidone (up to 5 mg/day) or amoxapine (up to 250 mg/day). Positive, negative, affective symptoms and motor side effects were measured using standardized weekly assessments. Prolactin levels were also determined at baseline and at the end of the study. A total of 39 patients (amoxapine, n=22; risperidone, n=21) completed the trial. Both pharmacological treatments, amoxapine 228.0 mg/day (SD=34.6) and risperidone 4.5 mg/day (SD=0.7), showed equivalent improvement in positive, negative, and depressive symptoms. Amoxapine was associated with less EPS and less prolactin elevation than risperidone. These data support previous reports about the efficacy of amoxapine as an atypical antipsychotic. Since amoxapine is off-patent, it may be a valuable low-cost alternative to new atypical antipsychotics, particularly in low-income countries where the majority of the patients are still treated with typical antipsychotics.

Temperament and character in violent schizophrenic patients

UNLABELLED Preliminary evidence shows that personality traits are important in determining violent behavior in schizophrenia. As only some patients with schizophrenia show a greater risk for violence, this risk may therefore be considered as dynamic, varying as a function of the extent to which certain personality dimensions are present and the degree to which environmental events moderate or exacerbate their expression. OBJECTIVE To compare temperament and character dimensions between violent and non-violent schizophrenic patients and to determine which temperament and character dimensions are predictors of violent behavior in schizophrenia. METHOD We recruited 102 schizophrenic patients without concomitant substance abuse 4 months prior to the assessment. Diagnoses were based on the SCID-I. Personality dimensions were assessed with the Temperament and Character Inventory and violent behaviors with the Overt Aggression Scale. RESULTS Higher levels of the temperament dimension novelty seeking and a lower cooperativeness, as a character dimension, were risk factors for violent behavior in schizophrenic patients. DISCUSSION Our data indicate that schizophrenic patients will show a greater risk for violence according to certain personality configurations and the degree to which environmental events moderate or exacerbate their expression.

Survey on schizophrenia treatment in Mexico: perception and antipsychotic prescription patterns

BackgroundSince the introduction of antipsychotics, especially the so called atypicals, the treatment of schizophrenia has shown important improvements. At the present time, it is preferred to label clozapine and other antipsychotics sharing similar profiles as second-generation antipsychotics (SGAs). These medications have been proposed by some experts as a first line treatment for schizophrenia.It is critical to have reliable data about antipsychotic prescription in Mexico and to create management guidelines based on expert meetings and not only on studies carried out by the pharmaceutical industry. Only this approach will help to make the right decisions for the treatment of schizophrenia.MethodsA translated version of Rabinowitzs survey was used to evaluate antipsychotic prescription preferences and patterns in Mexican psychiatrists.The survey questionnaire was sent by mail to 200 psychiatrists from public institutions and private practice in Mexico City and Guadalajara, Mexico.ResultsRecommendations for antipsychotics daily doses at different stages of the treatment of schizophrenia varied widely.Haloperidol was considered as the first choice for the treatment of positive symptoms. On the contrary, risperidone was the first option for negative symptoms. For a patient with a high susceptibility for developing extrapyramidal symptoms (EPS), risperidone was the first choice.It was also considered that SGAs had advantages over typical antipsychotics in the management of negative symptoms, cognitive impairment and fewer EPS.Besides, there was a clear tendency for prescribing typical antipsychotics at higher doses than recommended and inadequate doses for the atypical ones.ConclusionsSome of the obstacles for the prescription of SGAs include their high cost, deficient knowledge about their indications and dosage, the perception of their being less efficient for the treatment of positive symptoms and the resistance of some Mexican physicians to change their prescription pattern. It is necessary to reach a consensus, in order to establish and standardize the treatment of schizophrenia, based on the information reported in clinical trials and prevailing economic conditions in Mexico.

The P50 auditory evoked potential in violent and non-violent patients with schizophrenia

BACKGROUND Emotionally driven violence is facilitated by increased arousal. It may be a consequence of an information-processing deficit and the cognitive attributions for the stimuli given by the subject. The aim of this study was to compare the P50 evoked potential responses of violent patients with schizophrenia with non-violent patients with schizophrenia and healthy controls. METHOD Patients were classified into violent and non-violent in accordance to the Overt Aggression Scale. P50 auditory evoked potentials of 32 unmedicated patients with schizophrenia (violent=14, non-violent=18) and 17 healthy controls were recorded during five runs of 30 click pairs. RESULTS Healthy controls exhibited a lower S2/S1 ratio when compared to violent (p<0.001) and non-violent (p=0.04) patients. Using a cutoff point of 0.50 for S2/S1 ratio to define abnormal gating a significant proportion of violent patients did not show P50 suppression (71.4%) in comparison to non-violent patients (38.9%) and healthy controls (23.5%) (p=0.02). CONCLUSIONS Violent behavior in patients with schizophrenia could be associated with a disturbed information sensory gating. Violence in patients with schizophrenia may be facilitated by an increased arousal which may in turn be the result of an information-processing deficit.

Personality features in ultra-high risk for psychosis: A comparative study with schizophrenia and control subjects using the Temperament and Character Inventory-Revised (TCI-R)

Several variables have been identified as risk factors for conversion to overt psychosis in ultra-high risk for psychosis (UHR) individuals. Although almost two-thirds of them do not experience a transition to psychosis, they still exhibit functional disabilities. Other subjective developmental features may be useful for a more precise identification of individuals at UHR. Avoidant behaviors are consistently reported in schizophrenia and in UHR individuals and may be the reflection of a pattern of personality. Thus, personality features in UHR individuals deserves further research. The objective of the present study was to compare temperament and character dimensions between UHR individuals, patients with schizophrenia and healthy controls. One hundred participants (25 UHR individuals, 25 schizophrenia patients and 50 control subjects) where evaluated with the Temperament and Character Inventory-Revised (TCI-R). Univariate ANOVAs followed by Bonferroni tests were used. UHR individuals and schizophrenia patients exhibited higher levels of Harm Avoidance (HA) when compared to control subjects. For HA1 Anticipatory worry vs Uninhibited optimism and HA4 Fatigability & asthenia, UHR and schizophrenia groups showed similar scores and both groups were higher compared to control subjects. With respect to Cooperativeness (CO), UHR and schizophrenia reported lower scores than control subjects, in particular CO2 Empathy vs Social disinterest and CO3 Helpfulness vs unhelpfulness. This study replicates and extends the consideration of HA as a psychopathological related endophenotype and gives us further information of the possible role of personality features in the expression of some of the social dysfunctions observed both in prodromal subjects and schizophrenia patients.