Maria Margariti

Comparison of four scales measuring depression in schizophrenic inpatients.

Several scales have been used to diagnose and evaluate depression in schizophrenia. However, the association between different depression scales and between depression scales and negative symptoms has not been studied adequately. Sixty-four consecutively admitted schizophrenic patients to Eginition Hospital, Department of Psychiatry, Athens, were assessed on the following scales: the Calgary Depression Scale for Schizophrenia (CDSS), the Hamilton Depression Rating Scale (HDRS), the Expanded Brief Psychiatric Rating Scale-Depression subscale (EBPRS-D), the Positive and Negative Syndrome Scale-Depression subscale (PANSS-D) and the Negative Symptoms subscale (PANSS-N). The depression scales were found to be highly intercorrelated with the exception of the comparison between the EBPRS-D and the PANSS-D. Out of the four depression scales studied, only CDSS and EBPRS-D can discriminate between depression and a PANSS-Negative Symptoms subscale score or negative item scores.

Approaching delusional misidentification syndromes as a disorder of the sense of uniqueness.

Co-occurrence of the different types of delusional misidentification syndromes (DMS) implies a common pathogenetic substrate. Until now, theoretical explanations have strained to produce a collective approach, but have been trammeled by the initial definition of the syndromes (Capgras/Fregoli) that originated from the attribution of causal significance to the element of familiarity towards the misidentified object. In this article, we present two cases illustrating the co-occurrence of the syndromes and we attempt to propose a new approach to DMS. We hypothesize that a common potential pathogenetic factor underlying DMS could be a disorder of the sense of uniqueness. The ability to attribute uniqueness to the self and to surrounding people, objects, or places is a principal property of the adaptable mind that acts as a matrix for the identification process. We propose that although the term ‘identity’ encompasses the concept of uniqueness, this must be accomplished somewhere in a model of semantic processing of identity. Our approach is questioning the current view that this sequential stage is the PIN stage in the functional model of face recognition by Bruce and Young, and we attempt to see the disordered sense of uniqueness within the evolved form of the model of face recognition and delusional misidentification introduced by Ellis and Lewis. We propose that such a disturbance could result in an unstable identification process, vulnerable to discrepancies in perceptual, emotional, or memory input caused by psychotic or organic mental states, thus resulting in a breakdown of the identification process that inevitably leads to a delusion of denial of identity, or to a delusion of ‘doubles’.

Physical anhedonia in the acute phase of schizophrenia

BackgroundThe aim of the current study is to investigate the relationship between physical anhedonia and psychopathological parameters, pharmacological parameters or motor side-effects in a sample of inpatients with schizophrenia in an acute episode of their illness.MethodEighty one patients with schizophrenia, consecutively admitted, with an acute episode of their illness, at the Eginition Hospital, Department of Psychiatry, University of Athens, during a one-year period were investigated regarding possible relationships between physical anhedonia, social-demographic data and clinical parameters as well as motor side-effects, induced by antipsychotic agents. All patients were assessed using the Chapman Revised Physical Anhedonia Scale (RPAS), the Positive and Negative Syndrome Scale (PANSS), the Rating Scale for Extrapyramidal Side-Effects (EPSE), the Barnes Akathisia Rating Scale (BARS) and the Abnormal Involuntary Movement Scale (AIMS). Simple cross tabulations were initially employed. Subsequently, multiple regression analysis was performed.ResultsBoth positive and negative symptoms were associated with physical anhedonia. A positive association between physical anhedonia and the non-paranoid sub-category of schizophrenia was also proved.ConclusionAccording to these results, it seems that in the acute phase of schizophrenia, physical anhedonia may be a contributing factor to patients psychopathology.

The Greek version of the Calgary Depression Scale for Schizophrenia

The aim of this study was to evaluate the reliability and validity, as well as the specificity, of the Greek version of the Calgary Depression Scale for Schizophrenia (CDSS). Schizophrenic inpatients consecutively admitted at the Eginition Hospital, University of Athens, were included in the study. Patients were assessed on admission using the CDSS, the Hamilton Depression Rating Scale (HDRS), the Positive and Negative Syndrome Scale (PANSS), the Rating Scale for Extrapyramidal Side Effects (RSESE), the Rating Scale for Drug-Induced Akathisia (RSDIA) and the Abnormal Involuntary Movement Scale (AIMS). The CDSS was found to have a high inter-rater reliability, as well as test-retest reliability or split-half reliability. The internal consistency of the CDSS was good (a=0.87). There were positive correlations between the CDSS and the HDRS, or the depression cluster of the PANSS. The mean score on the CDSS showed no significant correlations with that of the PANSS negative subscale (r=0.123); a negative but not significant correlation with that of the PANSS positive subscale (r=-0.036); a weak correlation with that of the PANSS general psychopathology subscale (r=0.218); and no significant correlations with that of the RSESE (r=0.197), the RSDIA (r=0.160) or the AIMS (r=0.031). Our results give further support to the reliability, the validity, and the specificity of the CDSS.

Association of Physical and Social Anhedonia with Depression in the Acute Phase of Schizophrenia

Background/Aims: Researchers have shown interest in the association between anhedonia and depression in schizophrenia. The aim of the current study was to investigate the relationship between physical and social anhedonia with depression in a sample of inpatients with schizophrenia in the acute phase of their illness. Methods: Sixty-two patients with acute schizophrenia consecutively admitted at the Eginition Hospital, Department of Psychiatry, University of Athens were assessed using the revised Physical Anhedonia Scale, the revised Social Anhedonia Scale and the Calgary Depression Scale for Schizophrenia. Results: The Calgary Depression Scale for Schizophrenia score correlated with both physical anhedonia and social anhedonia ratings. The revised Social Anhedonia Scale score significantly correlated to self-depreciation, guilty ideas of reference, pathological guilt, early wakening, suicidality and observed depression. The revised Physical Anhedonia Scale score significantly correlated with depressive mood, self-depreciation, pathological guilt and observed depression. Self-depreciation, pathological guilt and observed depression were correlated with both social and physical anhedonia. Conclusion: Depression in schizophrenia and anhedonia may overlap, and it could therefore be difficult to clinically differentiate them, especially in acute schizophrenia patients.

Quality of life in schizophrenia spectrum disorders: Associations with insight and psychopathology

Therapeutic interventions in chronic mental illness face the important challenge to pursuit the quality of life (QOL) of patients. Insight into chronic mental illness, though a prerequisite for treatment adherence and a positive therapeutic outcome, has shown adverse associations with subjective QOL. This study aims to explore the contribution of psychopathological symptoms on the ambiguous role of insight on QOL. Seventy-two outpatients with schizophrenia spectrum disorders were assessed using the positive and negative syndrome scale, the scale to assess unawareness of mental disorder, and the WHOQOL-100 instrument for the assessment of quality of life. Insight was found to associate inversely with quality of life. Among psychopathological symptoms, depressive symptoms were the strongest negative contributor on QOL. Mediation analysis revealed that the effects of awareness of the consequences of illness on QOL were largely mediated by depressive symptoms (full mediation for the effect on physical and psychological domain and partial mediation for the effect on independence and environment domain of the QOL). Our results suggest that the inverse relationship between insight and subjective quality of life is partially mediated by depressive symptoms. We discuss theoretical and therapeutic implications of the findings, in conjunction with similar recent research data.

Treatment of severe neuroleptic-induced tardive torticollis

BackgroundThe aim of this paper is to describe a case of severe neuroleptic-induced tardive torticollis successfully treated with a combination of clozapine, clonazepam and botulinum toxin-A.Case ReportThe patient, a 30-year old man with a seven-year history of delusional disorder experienced severe right torticollis with painful tightness of the neck and elevation of the shoulder. At this time he was receiving haloperidol 20 mg, trifluoperazine 5 mg, zuclopenthixol 20 mg and biperidine 4 mg daily. The combination therapy with clozapine and clonazepam and the long-term use of botulinum toxin-A resulted in a complete remission of dystonic movements.ConclusionsThe present observations provide evidence indicating that this combination therapy may be of benefit in patients with severe neuroleptic-induced tardive torticollis.

1st International Experts’ Meeting on Agitation: Conclusions Regarding the Current and Ideal Management Paradigm of Agitation

Agitation is a heterogeneous concept without a uniformly accepted definition, however, it is generally considered as a state of cognitive and motor hyperactivity characterized by excessive or inappropriate motor or verbal activity with marked emotional arousal. Not only the definition but also other aspects of agitated patients’ care are still unsolved and need consensus and improvement. To help the discussion about agitation among experts and improve the identification, management, and treatment of agitation, the 1st International Experts’ Meeting on Agitation was held in October 2016 in Madrid. It was attended by 20 experts from Europe and Latin America with broad experience in the clinical management of agitated patients. The present document summarizes the key conclusions of this meeting and highlights the need for an updated protocol of agitation management and treatment, the promotion of education and training among healthcare professionals to improve the care of these patients and the necessity to generate clinical data of agitated episodes.

Contents Vol. 41, 2008

R. Bentall, Manchester C.E. Berganza, Guatemala City D. Bhugra, London C. Brewin, London Y.-F. Chen, Ginan D. Clark, London H. Fabisch, Graz K. Fabisch, Graz P. Falkai, Homburg/Saar H.J. Freyberger, Greifswald/Stralsund N. Ghaemi, Atlanta, Ga. C. Haasen, Hamburg A. Heerlein, Santiago P. Henningsen, München P. Hoff , Zürich Y. Kim, Tokyo A. Marneros, Halle/Saale M. Musalek, Wien F. Poustka, Frankfurt/Main J. Raboch, Prague P. Salkovskis, London I.M. Salloum, Miami, Fla. F. Schneider, Aachen J.C. Soares, Chapel Hill, N.C. J.S. Strauss, New Haven, Conn. E. Vieta, Barcelona M. Weisbrod, Karlsbad Official Journal of the World Psychiatric Association (WPA),