Donald Addington

A depression rating scale for schizophrenics

Scales for assessing depression are well developed for non-psychotic populations but have been criticized for being inappropriate for psychotic populations. As a result we have developed a new rating scale for the measurement of depression in schizophrenia based on items selected from the Hamilton Depression Rating Scale and the Present State Examination. The selection was based on a three stage procedure first factor analysis then measures of internal consistency and finally face validity. Ratings of depression were made on 50 acutely ill schizophrenics meeting DSM-III criteria for schizophrenia assessed at two points in time. Our results indicate that several items from both scales form a superior instrument for measuring depression in schizophrenia. The eleven items generated a Cronbachs alpha of 0.84 at time one and 0.89 at time 2.

Reliability and validity of a depression rating scale for schizophrenics

The Calgary Depression Scale (CDS) is a nine item structured interview scale, in which each item has a four point measure, each point anchored by descriptors. The scale has been specifically developed to assess depression in schizophrenics. This article describes the testing of the reliability and validity of the CDS. The scale is assessed and compared to three established measures, the Hamilton Depression Rating Scale (HDRS) the Beck Depression Inventory (BDI) and a depression measure derived from the Brief Psychiatric Rating Scale (BPRS). Confirmatory factor analysis demonstrated that the CDS is unidimensional, measuring the same construct in both in- and outpatients. The scale has high internal consistency, significant strong correlations with scores on the Hamilton, Beck and BPRS depression measures, and the presence of a major depressive episode. All items of the CDS significantly discriminate between the presence and absence of a major depressive episode. It is concluded that the CDS is a parsimonious reliable scale which is suitable for assessing depression across both the acute and residual stages of schizophrenia.

Facial affect recognition and information processing in schizophrenia and bipolar disorder

This study assessed facial affect recognition and visual attention in a sample of 40 individuals with schizophrenia, at hospitalization and 3 months later during an out-patient phase of relative remission. Secondly, at the out-patient phase the performance of the individuals with schizophrenia on tasks of visual attention, facial affect recognition and facial recognition was compared to the performances of a non-psychiatric control group and a bipolar group on these tasks. Attention was measured with the Continuous Performance Test and the Span of Apprehension task. Facial affect recognition was measured with a discrimination task and an identification task. A measure of facial recognition was also used. The schizophrenia patients performed more poorly on measures of facial affect recognition and facial recognition than both control groups. Despite a significant improvement in symptoms over time, there was no change in facial affect recognition for the schizophrenia subjects. For the schizophrenia subjects there were significant associations between attention tasks and the facial tasks. These results suggest that for individuals with schizophrenia, deficits in facial affect recognition are stable deficits that are related to other impairments in neurocognition. This has implications for psychosocial treatments.

Medication adherence of individuals with a first episode of psychosis

Objective:  To determine rates of adherence to antipsychotic medication in first episode patients and the correlates of adherence in this group.

Facial affect recognition: A mediator between cognitive and social functioning in psychosis?

BACKGROUND Facial affect recognition has been implicated in the relationship between cognition and social functioning. This 1-year longitudinal study tested the hypothesis that facial affect recognition mediates the relationship between cognitive and social functioning. METHOD Three groups were included: 50 first-episode of psychosis (FE) subjects, 53 multi-episode schizophrenia subjects (ME) and 55 non-psychiatric controls (NPC). Subjects were assessed on two facial affect recognition tasks, a comprehensive cognitive battery and a measure of social functioning. FE subjects were assessed on admission to a comprehensive FE program and 1 year later. The ME and NPC groups had two assessments 1 year apart. RESULTS Both the FE and ME subjects were clearly impaired relative to NPCs in cognition, social functioning and facial affect recognition. There were significant associations among facial affect recognition, cognition and social functioning in all three groups. For ME and FE subjects, but not NPCs, there was evidence that facial affect recognition did partially mediate the relationship between cognitive and social functioning. CONCLUSION This study provides some first steps in understanding the complex relationship between cognition and outcome and has potential implications for the design of remediation strategies.

Neurocognitive and social functioning in schizophrenia: a 2.5 year follow-up study

In our previous study we demonstrated that, in 80 schizophrenia subjects, verbal ability, verbal memory and executive functioning were significantly associated with social problem solving. The objective of this present study was to assess the longitudinal stability of the relationship between social and neurocognitive functioning in schizophrenia. This 2.5 year longitudinal cohort study re-assessed community functioning, social problem solving and symptoms in 65 of the 80 original subjects to determine the predictive ability of neurocognitive functioning. Neurocognition was not re-assessed at this follow-up. Positive and negative symptoms were assessed with the Positive and Negative Syndrome Scale. Social functioning was assessed using the Social Functioning Scale, the Quality of Life Scale, and the Assessment of Interpersonal Problem-Solving Skills (AIPSS). Verbal ability, verbal memory and vigilance were significant predictors of social problem solving as assessed by the AIPSS. Results suggest that the association between neurocognition and social functioning remains consistent over time.

Specificity of the Calgary Depression Scale for schizophrenics

This study sought to determine the specificity of the Calgary Depression Scale (CDS), a depression rating scale for schizophrenics. The specificity is the degree to which the scale assesses depression rather than negative or extrapyramidal symptoms. Subjects were 100 outpatients (OP) and 50 inpatients (IP) meeting DSM-III-R criteria for schizophrenia. Negative symptoms were assessed with the Positive and Negative Syndrome Scale (PANSS); extrapyramidal symptoms were assessed with the Simpson Angus Scale (SA) and depression with the CDS. Results were that the CDS showed no correlation with SA, but weak (0.33) statistically significant correlations with the PANSS negative symptom score in inpatients but not outpatients. Confirmatory factor analysis using Lisrel 6.0 showed that the model hypothesizing specificity of depression, negative symptoms and extrapyramidal symptoms, was significant, with a goodness of fit index of 0.89 and a root mean square residual of 0.07. It is concluded that the CDS achieves a useful degree of separation between measures of depression, negative and extrapyramidal symptoms in subjects with schizophrenia, when combined with the other measures used in this study.

Substance misuse at presentation to an early psychosis program.

Abstract.Background:Substance misuse is a significant problem in schizophrenia. The purpose of this study was to examine the prevalence and correlates of substance misuse in individuals with a first episode of psychosis at the time they first present for treatment.Method:The first 357 consecutive admissions to a comprehensive early psychosis program were included. Assessment measures were the Positive and Negative Syndrome Scale, the Calgary Depression Scale for Schizophrenia, the Quality of Life Scale, the Case Manager Rating Scale and the Premorbid Adjustment Scale.Results:Forty-four percent of the sample, the majority of whom used alcohol or cannabis, met diagnostic criteria for substance abuse/dependence. The prevalence was significantly higher than in the general population. Substance misuse was significantly associated with male gender, young age and age of onset.Conclusions:This study confirms the high rates of substance misuse, in particular cannabis, in first-episode psychosis. Implications for treatment are addressed.

The first episode of psychosis: the experience of relatives

Objective: The aim was to determine the extent of and the correlates of the distress and impact of care families of patients with first episode psychosis were experiencing when they first came for treatment.

Social Functioning in Individuals at Clinical High Risk for Psychosis

Poor social functioning is a hallmark of schizophrenia. The purpose of this study was to examine social functioning in individuals at clinical high risk for psychosis. Social functioning was assessed in a sample of 86 clinical high risk (CHR) individuals and compared to that of 50 first-episode of psychosis (FE) subjects, 53 multi-episode schizophrenia subjects (ME) and 55 non-psychiatric controls (NPC). Subjects were assessed on the Social Functioning Scale (SFS), the Role Functioning subscale of the Quality of Life Scale (QLS-role), and the premorbid functioning scale. On the SFS, the CHR group did not differ significantly from the FE and ME groups and all were impaired relative to the NPCs. On QLS-role, the CHR group performed significantly better than the ME patients and significantly worse than NPCs. CHR subjects did not differ from patients in terms of premorbid functioning. This study demonstrates that even at the pre-psychotic phase of the illness, these young people are demonstrating significant deficits in social functioning, supporting that social deficits are present long before the onset of psychotic symptoms.