Gerald Shugar

Development, use, and factor analysis of a self-report inventory for mania

This report describes the development and initial psychometric evaluation of a 47-item self-report inventory for mania developed by the authors. Twenty-five subjects with a diagnosis of mania and 82 subjects with other diagnoses were tested during a hospital admission. The manic group scored significantly higher than the nonmanic group. The questionnaire correctly classified 71% of subjects. Manic patients who lacked insight endorsed as many items as manic patients with insight. A reliability analysis indicated that the items comprising the questionnaire are homogeneous. Test-retest reliability was high. A rotated factor analysis produced two factors, energized dysphoria and hedonistic euphoria. The authors discuss diagnostic, research, and clinical implications and applications of the Self-Report Manic Inventory.

Prevalence and clinical significance of catatonic symptoms in mania

OBJECTIVE The study investigates the prevalence, clinical characteristics and implications of catatonic symptoms in mania. METHODS Sixty-one in patients with DSM-III-R bipolar disorder, manic or mixed episode established by SCID were assessed for the presence of catatonia by a 21-item rating scale. Associated symptoms, comorbidity and severity of the manic episode were also systematically assessed. RESULTS Nineteen patients fulfilled criteria for catatonic mania exhibiting between 5 and 16 catatonic symptoms. Catatonic manics had more mixed episodes, more severe manic symptoms, more general psychopathology, a higher prevalence of comorbidity, longer hospitalization and lower GAF-scores than the non-catatonics. CONCLUSIONS The results indicate that catatonic symptoms are a marker of a more severe course and outcome in mania.

Comparative evaluation of two self-report Mania Rating Scales.

Two brief patient-rated scales, the Internal State Scale (ISS) and the Self-Report Manic Inventory (SRMI), have been shown to reliably diagnose mania. In the current study we further evaluated the utility of these scales relative to each other and to the observer-rated Young Mania Rating Scale (YMRS), for quantifying the severity of manic/hypomanic symptoms cross-sectionally and over time, in 20 patients with rapid-cycling bipolar disorder. The self-report scales correlated well with each other and with the YMRS, but each covered a somewhat different domain of the manic syndrome. The SRMI and the ISS were more sensitive than the YMRS to the mood fluctuations in the euthymic to hypomanic range observed in our subjects. Used in tandem, the two self-report scales may find application in clinical research with outpatients with bipolar disorder, and as an adjunct to clinical monitoring in this patient population.

An investigation of the self-report manic inventory as a diagnostic and severity scale for mania

The initial study on the Self-Report Manic Inventory (SRMI) reported that it reliably diagnosed mania. In the current study, we replicated the initial study on the SRMI. We also evaluated its ability to quantify manic symptomatology and to measure change during inpatient treatment. The findings show that manic patients are capable of reporting their symptoms, regardless of their insight into their condition. They also confirm that the SRMI is a reliable diagnostic instrument and that it performs consistently over time when used with a 1-week time format. The SRMI is also sensitive to clinical improvement in hospitalized patients undergoing treatment. The SRMI correlated well with the Young Mania-Rating Scale (YMRS), which served as an external validator of SRMI scores at the beginning and end of hospitalization. Factor analysis produced two groups of manic subjects who closely resemble the hedonistic euphoric type and the energized dysphoric type initially reported by Shugar et al.

Thought disorder and verbal recall in acutely psychotic patients

This study examined the relationship between thought disorder and verbal recall in schizophrenic, manic, and schizoaffective inpatients. Based on previous research, it was predicted that subjects who demonstrated only positive thought-disorder would differ from those with positive and negative thought-disorder in terms of their ability to encode short descriptive passages. Unlike controls, who were able to encode organized material better than unorganized material, neither thought-disorder group improved its encoding when the material to be remembered was more organized. Both thought-disorder groups remembered more when the material was less organized. These findings raise a number of issues with regard to the interrelationship among thought disorders, psychiatric diagnoses, and information-processing deficits.

Electroconvulsive therapy for schizophrenia in Ontario: A report on therapeutic polymorphism ☆

Abstract The authors used a computerized data bank from 208 general hospitals and 3 community psychiatric hospitals, as well as reports from 10 provincial psychiatric hospitals, to analyze ECT use for schizophrenia in Ontario. In the year reviewed, 1977 courses of ECT were administered, 481 (24.3%) to schizophrenic patients. Of 57 hospitals with ECT capacity, 41 used ECT for schizophrenia. Utilization rates varied widely among hospitals. From 0.6% to 32.8% of discharged schizophrenics received ECT. Schizoaffectives had significantly higher ECT rates than all other subtypes. No subtype had a significantly lower rate. Females received more ECT than males. While ECT use peaked in the fifth and sixth decades, age was not a significant determinant of ECT use. ECT was used when drugs failed to achieve a satisfactory response. Its use generally resulted in discharge from hospital. Our findings indicate that there is very little uniformity or standardization in the utilization of ECT for schizophrenia.

Prevalence of obsessive—compulsive disorder in schizophrenia and significance of motor symptoms

To investigate the differences between schizophrenic subjects with and without obsessive-compulsive disorder (OCD), the authors systematically assessed 76 schizophrenic subjects for OCD. Subjects with and without OCD were then compared with regard to motor symptoms, including catatonia, and several measures of psychopathology. Treatment strategies were evaluated retrospectively. The 12 subjects with OCD (15.8%) had more motor symptoms, including catatonia, than non-OCD schizophrenic subjects. Some differences were found with regard to psychopathological symptoms. Treatment strategies also differed in the two groups. The high prevalence of motor symptoms in these subjects supports the hypothesis of a basal ganglia-frontal lobe connection linking OCD with schizophrenia.