Max Schmauss

Predictors of Relapse in the Year After Hospital Discharge Among Patients With Schizophrenia

OBJECTIVE Relapse and its predictors were examined among patients with schizophrenia in the year after hospital discharge. METHODS The sample included 200 patients with schizophrenia participating in a German multicenter study. Relapse was defined as a worsening of psychopathological symptoms or rehospitalization in the year after hospital discharge. Predictors examined were variables related to course of illness and to response and remission at discharge. RESULTS Fifty-two percent of participants had a relapse. Patients whose symptoms were not in remission at discharge were more likely to have a relapse, as were those who had more severe symptoms and more side effects at discharge. Those who experienced a relapse were less likely to be taking a second-generation antipsychotic at discharge, less likely to have a positive attitude toward treatment adherence, and less likely to be employed. CONCLUSIONS The high rate of relapse among patients with schizophrenia highlights the need to improve current treatment strategies.

New results in depression research

In what case do you like reading so much? What about the type of the new results on depression research book? The needs to read? Well, everybody has their own reason why should read some books. Mostly, it will relate to their necessity to get knowledge from the book and want to read just to get entertainment. Novels, story book, and other entertaining books become so popular this day. Besides, the scientific books will also be the best reason to choose, especially for the students, teachers, doctors, businessman, and other professions who are fond of reading.

Evaluating Depressive Symptoms in Schizophrenia: A Psychometric Comparison of the Calgary Depression Scale for Schizophrenia and the Hamilton Depression Rating Scale

Background: The aim of this study was to compare two measures of depression in patients with schizophrenia and schizophrenia spectrum disorder, including patients with delusional and schizoaffective disorder, to conclude implications for their application. Sampling and Methods: A total of 278 patients were assessed using the Calgary Depression Scale for Schizophrenia (CDSS) and the Hamilton Depression Rating Scale (HAMD-17). The Positive and Negative Syndrome Scale (PANSS) was also applied. At admission and discharge, a principal component analysis was performed with each depression scale. The two depression rating scales were furthermore compared using correlation and regression analyses. Results: Three factors were revealed for the CDSS and HAMD-17 factor component analysis. A very similar item loading was found for the CDSS at admission and discharge, whereas results of the loadings of the HAMD-17 items were less stable. The first two factors of the CDSS revealed correlations with positive, negative and general psychopathology. In contrast, multiple significant correlations were found for the HAMD-17 factors and the PANSS subscores. Multiple regression analyses demonstrated that the HAMD-17 accounted more for the positive and negative symptom domains than the CDSS. Conclusions: The present results suggest that compared to the HAMD-17, the CDSS is a more specific instrument to measure depressive symptoms in schizophrenia and schizophrenia spectrum disorder, especially in acutely ill patients.

Quality of life and subjective well-being in schizophrenia and schizophrenia spectrum disorders: Valid predictors of symptomatic response and remission?

Abstract Objectives. To examine quality of life and subjective well-being as predictors of symptomatic treatment outcome. Methods. Biweekly PANSS ratings were performed in 285 inpatients with schizophrenia spectrum disorders within a multicenter trial by the German Research Network on Schizophrenia. Quality of life and subjective well-being were assessed using the Medical Outcomes Study-Short Form 36-Item Health Survey (SF-36), the Subjective Well-being Under Neuroleptic Treatment Scale (SWN-K) and the Adjective Mood Scale (AMS). Response was defined as an initial 20% PANSS total score reduction and remission according to the consensus criteria. Correlation analysis, logistic regression and CART-analysis were performed. Results. In total, 81% of the sample achieved symptom response and 48% symptom remission. The statistical analyses revealed early improvement within the first two treatment weeks in the SWN-K scale to be a significant predictor for symptomatic response. Concerning symptomatic remission the SF-36 and SWN-K baseline scores as well as SWN-K early improvement showed significant predictive value. Conclusions. These results highlight the importance of the patients self-perception and especially of early improvement of quality of life and subjective well-being for symptomatic treatment outcome.

Outcome of suicidal patients with schizophrenia: results from a naturalistic study

Schennach‐Wolff R, Jäger M, Seemüller F, Obermeier M, Schmauss M, Laux G, Pfeiffer H, Naber D, Schmidt LG, Gaebel W, Klosterkötter J, Heuser I, Maier W, Lemke MR, Rüther E, Klingberg S, Gastpar M, Möller H‐J, Riedel M. Outcome of suicidal patients with schizophrenia: results from a naturalistic study.

Prediction of symptom remission in schizophrenia during inpatient treatment

Objective: Standardized consensus criteria for remission in schizophrenia were recently proposed. The present study applied the symptom-severity component of these criteria to a sample of inpatients in order to determine the rates of remission during inpatient treatment and to explore predictors of remission. Method: A total of 288 inpatients from a multi-centre follow-up programme who fulfilled ICD-10 criteria for schizophrenia were included in the present analyses. PANSS ratings at admission and at discharge from hospitalization were used to examine remission status. Clinical and sociodemographic variables at admission were tested for their ability to predict remission at discharge. Results: In total, 55% of the sample achieved symptom remission during inpatient treatment; 84% percent showed remission with respect to ‘reality distortion’, 85% with respect to ‘disorganization’ and only 65% with respect to ‘negative symptoms’. Logistic regression analysis revealed that the global functioning (GAF) in the year before admission, the total score of the Strauss–Carpenter Prognostic Scale and the PANSS negative subscore at admission were predictive for symptom remission. The regression model showed a predictive value of about 70% and explained 36% of the observed variance. Conclusion: The results highlight the impact of negative symptoms for the course and treatment response of schizophrenic illness.

The "DGPPN-Cohort": A national collaboration initiative by the German Association for Psychiatry and Psychotherapy (DGPPN) for establishing a large-scale cohort of psychiatric patients.

The German Association for Psychiatry and Psychotherapy (DGPPN) has committed itself to establish a prospective national cohort of patients with major psychiatric disorders, the so-called DGPPN-Cohort. This project will enable the scientific exploitation of high-quality data and biomaterial from psychiatric patients for research. It will be set up using harmonised data sets and procedures for sample generation and guided by transparent rules for data access and data sharing regarding the central research database. While the main focus lies on biological research, it will be open to all kinds of scientific investigations, including epidemiological, clinical or health-service research.

Efficacy of flupentixol and risperidone in chronic schizophrenia with predominantly negative symptoms.

The study investigated the non-inferiority of flupentixol compared to risperidone in the treatment of negative symptoms. In addition, the effects of flupentixol on mood and cognitive symptoms were explored. In a randomized, double-blind multicenter study, 144 non-acute schizophrenia patients with predominant negative symptoms were treated with a flexible dose of either flupentixol (4-12 mg/d) or risperidone (2-6 mg/d) for up to 25 weeks. In addition to a non-inferiority analysis, a principal component analysis (PCA) of the PANSS was performed post hoc. Regarding negative symptoms, flupentixol proved to be non-inferior to risperidone. Both drugs improved depressed mood with effect sizes favoring flupentixol. PCA suggested a five-factor structure. Effect sizes for the cognitive factor were up to 0.74 for flupentixol and up to 0.80 for risperidone. EPS scores were rather low and Parkinsonism improved in both groups, but anticholinergic drugs were prescribed significantly more frequently in the flupentixol group, which generally showed significantly more adverse events. Results indicate that the 1st generation antipsychotic flupentixol improves negative, affective and cognitive symptoms in chronic schizophrenia comparable to risperidone. Further studies should confirm the latter using neuropsychological performance tests and should investigate whether tolerability improves with a markedly lower dose range.

Effects of alpha 2-receptor blockade in addition to tricyclic antidepressants in therapy-resistant depression.

It was investigated whether yohimbine, a primarily α2-receptor blocking agent, may have an antidepressant effect when given in addition to tricyclic antidepressants. After at least two unsuccessful preliminary antidepressant treatments for a minimum of 4 weeks each, patients received, in addition to tricyclics, yohimbine in increasing doses for 7 days. None of the five patients investigated demonstrated any improvement in depressive symptomatology and four of the five suffered from such side effects as severe anxiety, inner restlessness, psychomotor agitation, and tremor. During intravenous administration of 2.5 and 20 mg yohimbine, significant increases in norepinephrine values and systolic blood pressure were observed. It was concluded that a combination of yohimbine and tricyclic antidepressants seems to have little indication due to yohimbines lack of efficacy and the high incidence of side effects in the treatment of severely depressed inpatients.

Polypharmazie in der Behandlung der Schizophrenie

Die Frage, ob eine Polypharmazie in der Behandlung der Schizophrenie Vorteile gegenuber einer Monotherapie hat, ist nach wie vor ungeklart. Die klinische Praxis zeigt jedoch, dass entgegen plausibler Empfehlungen, Einzelsubstanzen optimal einzusetzen, uberaus haufig Kombinationstherapien durchgefuhrt werden (Freudenreich und Goff 2002, Chakos et al. 2006, Faries et al. 2005, Ganguly et al. 2004, Kane 2004). Als eine mogliche Ursache gilt die therapieresistenz, die trotz der Einfuhrung moderner, so genannter atypischer Antipsychotika in bis zu 30% der Falle festzustellen ist (Naber 2000).