P. Oulis

Five-factor model of schizophrenic psychopathology: how valid is it?

Abstract Aim of the study was to examine the consistency of the five-factor model of schizophrenic symptoms, assess its validity and evaluate its dimensional factor structure using confirmatory factor (CFA) analysis. ¶A sample of 258 randomly assigned DSM-III R patients with schizophrenic disorders were studied by means of the structured clinical interview for the Greek validated Positive and Negative Syndrome Scale (PANSS) and were rated on its 30 items. Patients’ scores were subjected to principal component analysis (PCA) with varimax rotation. Internal consistency for each of the components was determined by the use of Cronbach’s alpha. External validity of the model derived was investigated by searching for possible relationships between the components and sociodemographic characteristics with the aid of canonical correlation analysis. Confirmatory factor analysis (CFA) was also performed. Using the scree plot criterion PCA revealed a five-factor model. These factors were interpreted as representing – in a decreasing order of relative importance – the following dimensions of schizophrenic psychopathology: negative, excitement, depression, positive and cognitive impairment. The model was comparable with six previous factor analytic studies. Internal consistency was quite satisfactory whereas external validity was found to be not so powerful. CFA did not show that the proposed model yields an adequate factor structure.

Beck Depression Inventory in the Detection of Depression among Neurological Inpatients

The validity of the Beck Depression Inventory (BDI) was assessed in a group of 150 neurological inpatients using Receiver Operating Characteristic analysis and DSM- III-R as external criterion. As regards depressive disorders as a whole, it was found that the best trade-off between sensitivity and specificity was the cutoff score of 20. The discriminating ability of the BDI for major depressive disorder was quite satisfactory at the cutoff score of 29 contrary to the dysthymic disorder in which the discriminating power of the BDI was not acceptable. In conclusion, the use of the BDI in neurological settings is useful with cutoff scores depending on the research purposes.

Clinical Subtypes of Schizophrenic Disorders: A Cluster Analytic Study

Two hundred and fifty-five psychiatric inpatients with a definite diagnosis of DSM-IV schizophrenic disorder were examined by means of the Structured Clinical Interview and rated on the 30 main items of the Positive and Negative Syndrome Scale (PANSS). Patients’ scores were subjected to a cluster analysis, using Ward’s method. Cluster analysis indicated the existence of five groups. The first group (n = 46) comprised patients with overall psychopathology of minimal severity, the second group (n = 39) patients with severe positive symptoms along with symptoms of psychomotor excitement, the third group (n = 58) patients with severe positive psychopathology only, the fourth group (n = 34) patients with severe positive negative depressive and cognitive symptoms and, finally, the fifth group (n = 78) patients with severe negative symptoms only. Patients in the first and third groups were older and their illnesses were of longer duration compared to those of the remaining groups. With respect to DSM-IV clinical types of schizophrenic disorders, the paranoid type predominated in the second and the third groups, whereas the disorganized and catatonic types were markedly overpresented in the fifth group.

GABAPENTIN AS MONOTHERAPY IN THE TREATMENT OF ACUTE MANIA

Two cases of mania treated with gabapentin, a new anticonvulsant, are presented. After 2 weeks of treatment a moderate improvement of both patients was observed. The antimanic effect of gabapentin awaits confirmation by systematic, well designed studies.

Clinical Features of Delusional Beliefs in Schizophrenic and Unipolar Mood Disorders: A Comparative Study

We assessed comparatively 13 clinical features of delusions in a sample of 132 deluded inpatients of both sexes with schizophrenic (n = 89) or unipolar mood disorders (n = 43). Patients with schizophrenic disorders exhibited higher levels of severity than those with unipolar depression with respect to the features of vagueness-illogicality, bizarreness, systematization, conviction, duration and affective incongruence, whereas the reverse held true with respect to the feature of emotional impact. Furthermore, the two diagnostic groups were compared to each other with respect to patients’ scores on five dimensions of their delusions obtained through factor analysis, namely emotional and behavioral impact, cognitive disintegration, delusional certainty, volitional dyscontrol and affective inappropriateness. Schizophrenic patients exhibited higher levels of severity than depressives on the second and fifth dimensions, whereas the reverse held true with respect to the fourth one. Our results suggest that particular features of delusions as well as broader dimensions thereof, may assist in the differential diagnosis of unipolar depression with psychotic features from schizophrenic disorders.

Clinical Homogeneity of DSM-IV Schizophrenic Disorders

We investigated the lifetime fulfillment of five subcriteria of diagnostic criterion A in 94 inpatients with a definite diagnosis of DSM-IV schizophrenic disorder. Among the five diagnostic features captured by criterion A, only delusions were found to be almost universal, whereas of the remaining four, only hallucinations and negative symptoms occurred in more than half of all the cases. Overall, almost 60% of the 28 possible patterns of combination among the five subcriteria were found to be fulfilled although 60% of the cases were accounted for by only 4 patterns, which were also identified by means of a cluster analysis, as accounting for the totality of the cases. The first cluster was characterized by the fulfillment of subcriteria 1,2 and 5, the second by subcriteria 1 and 2, the third by subcriteria 1 and 5 and the fourth by subcriteria 1,2, and 3. The substantial clinical heterogeneity of the DSM-IV category of schizophrenic disorders with respect to their diagnostically characteristic features captured in criterion A is traced to the polythetic character of its five subcriteria.

Clinical Dimensions of Delusional Beliefs: A Factor-Analytic Study

We investigated the factorial composition as well as the demographic, anamnestic and clinical correlates of 13 features of delusional beliefs in a sample of 127 psychiatric inpatients with active delusions at the time of their assessment: Six factors were extracted, jointly accounting for 67.3% of the variance, which were interpreted as the dimensions of cognitive disintegration, volitional dyscontrol, doxastic strength, distress, incongruence and expansiveness, respectively. Moreover, most factors exhibited distinctive profiles of demographic, anamnestic or clinical correlates. Overall, our findings provide supportive evidence for both the clinical multidimensionality of delusional beliefs at the factor-analytic level and the – at least partial – external validity of the factorial solution obtained.

Prolactin secretion in response to haloperidol challenge in delusional (psychotic) and non-delusional depression.

Certain studies on measures related to central neurotransmitter activity have demonstrated that in delusional (psychotic) depression there is a dopaminergic dysregulation which distinguishes it from non-psychotic depression. A neuroendocrinologic method to check the degree of DA receptor responsivity is by measuring the prolactin responses to acute intramuscular administration of haloperidol. We studied this possibility by applying the haloperidol test in seven delusional and ten non-delusional depressed patients. All patients met DSM-IV criteria for a major depressive episode, single or recurrent, with or without psychotic features. After a three-week washout period, 5 mg of haloperidol were injected i.m. and blood samples were taken at 0, 30, 60, 90 and 120 minutes. In both trials, significant time effects were observed (elevated prolactin levels, F = 11.36, P = 0.000). However, the prolactin responses to haloperidol did not differ significantly between the two patient groups (F = 0.12, P = 0.97). These data do not show a difference in D(2) receptor responsivity, at least at the hypothalamus-pituitary level, between psychotic and non-psychotic depression.

EPA-0988 – Cognitive and affective theory of mind in schizophrenia and euthymic bipolar disorder

Introduction There is substantial evidence that patients with schizophrenia present with impaired Theory of Mind (ToM). ToM impairment has been also reported in euthymic bipolar disorder (BD). However, data from direct comparisons of patients with schizophrenia and BD on ToM abilities are limited. Objectives It has been suggested that different aspects of mentalizing processing, such as epistemic and emotional mental representations, i.e. cognitive and affective ToM, must be separately examined. Aims The aim of the study was to compare ToM ability and both its cognitive and affective components between schizophrenic and euthymic BD patients. Methods Fifty three BD type I euthymic patients, 54 patients with schizophrenia and 53 healthy controls (HC) completed a multi-facet battery of ToM tasks, including False belief task, Hinting task and Faux Pas Recognition Test (FP). Besides the overall ability to recognize Faux Pas, two specific components of ToM – cognitive and affective – were assessed with FP. The three groups were matched for gender, age and education. Results BD and schizophrenia patients showed no impairment in the False belief task. Schizophrenia patients performed significantly lower than HC and BD patients in Hinting task, FP recognition and affective ToM. Both patient groups were impaired in cognitive ToM. However, only BD patients with a history of psychosis performed significantly lower than HC in affective ToM. Conclusions In contrast to schizophrenia patients, euthymic BD patients show a specific deficit only in cognitive but not in affective ToM. Further research on the impact of these deficits on social and occupational functioning is warranted.

1551 – Is there delusional anorexia nervosa?

Introduction Lack of insight is a major obstacle in treating patients with anorexia nervosa (AN). In everyday practice, clinicians often describe as delusional AN patients who strongly deny their emaciation. Objectives Despite their diagnostic and clinical significance the level of delusionality of body image beliefs in eating disorders (EDs) has not yet been systematically investigated. Aims In the present study we assessed for the first time the delusionality of body image beliefs in AN subtypes and BN. We hypothesized that body image beliefs would be delusional only in a subgroup of AN patients and that the patients with restrictive AN would demonstrate the higher levels of delusionality. Methods We used the Brown Assessment of Beliefs Scale (BABS) to assess the degree of delusionality of body image beliefs in seventy-two participants: 39 with AN and 33 with BN. We also investigated the relationship between body image delusionality and other clinical characteristics in AN. Results Only patients with anorexia nervosa (28.8%) had delusional body image beliefs, whereas overvalued ideas appeared to be frequent in both AN and BN. Body image delusionality in AN was associated with restrictive eating pathology, early onset of the disorder and body dissatisfaction. Conclusions Results suggest that a delusional variant of anorexia nervosa represents the one end of a continuum of insight among patients with eating disorders. Delusionality constitutes a clinical feature independent of weight loss or eating pathology and thus a distinct component of AN psychopathology, contributing to treatment resistance and illness chronicity.