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Depressive symptoms in stable chronic schizophrenia: Prevalence and relationship to psychopathology and medication status
S4-1l8
P.3 Psychotic disorders and antipsychotics
activity. As some case reports have suggested that it may alleviate the symptoms of tardive dyskinesia in some patients, we decided to test its efficacy in the treatment of two patients with a prolonged history of psychosisand associatedbuccolinguomasticatory dyskinesia. The patients were elderly females aged 77 and 81 years respectively. One patients had a history of more than 50 years of schizophrenia and the other had numerous phases of psychotic depression. Both were admitted to the index hospitalization period because of exacerbation of the psychoticsymptoms.Before admissionpatient I had used haloperidol I mg/day and thioridazine 25 mg in the evening. The other patient had used haloperidol 1.5 mg/day, together with 50 mg sulpiride and 15 mg rnianserin. As both had moderate symptoms of tardive dyskinesia predominantly affecting the jaw and tongue their previous neuroleptics were discontinued and risperidone was stepwise instituted up to 2 mg (patient 1) and 6 milligrams(patient 2) daily. Duringthe 4-weekhospitalizationperiod there was a gradual and progressive alleviation in psychotic symptoms as well as a decline of abnormal movements. The risperidone treatmentwas nor associated with emergenceof Parkinsonism. Risperidone is not totally free of extrapyramidal side-effects and also a case report exists about the development tardive dyskinesia during rlsperidone treatment (Addington et al, 1995). On the other hand some patients have benefitted from risperidone as their tardive dyskinesia has alleviated after changing the neuroleptic medication to risperidone. Our results are in line with the previoussuggestionsthat risperidone mayhave a beneficial effect on tardive buccolinguomasticatory dyskinesia without inducingsignificantParkinsonism (Chouinard 1995). References
Addington, D.E., Toews, JA, Addington, 1.M. (1995) Risperidone and tardive dyskinesia. Journal of Clinical Psychiatry 56,484-485. Chouinard G (1995) Effects ofrisperidone intardive dyskinesia: Ananalysis ofthe Canadian multicentre risperidone study. Journal ofClinical Psychopbannacology 15, 36S-44S.
IP.3.048I schizophrenic Bizarre delusions and ageof onset in patients D.G. Dikeos, G.N. Papadimitriou, E.G. Daskalopoulou, C.N. Stefanis. AthensUniversity Department of Psychiatry and University Mental Health Research Institute, Eginition Hospital, 72 Vas Sofias Ave., Athens. Greece In recent years there has been a considerable effort to delineate clinical subtypes of schizophrenia corresponding to distinct underlying genotypes. Among the clinical characteristics used in the attempt to "cut the schizophrenia pie" presence or absence of specific symptoms,as well as age of illness onset, course and treatmentresponse have been suggested [I] . The aim of this study was to investigate whetherany clinicalvariables discriminateamong groups of schizophrenic patients. As part of an ongoing genetic study of schizophrenia, 42 familial cases were personally examined with the use of the Schedules for the Clinical Assessment in Neuropsychiatry (SCAN) for lifetime occurrence of symptoms. In addition, 15 schizophrenic patients with no family history of major psychiatric disorders were interviewed. Bizarre delusions were defined according to the DSM-lli-R, while the age of onset was considered as the age of the first appearance of clinically significant symptoms, and as the age of the first contact with psychiatric services. A cluster analysis was carried out by the computer programme SPAD.N. The clinical characteristics of the patients used as active variables were the psychopathology scores (calculated by the addition of individual items ratings), age of onset, frequency of hospitalizations and measures of impairment The demographic and family characteristics, as well as specificsymptomatology were used as descriptive variables. Two clusters of schizophrenic patients were identified by the analysis; one contained patients with severe and the other with mild symptomatology. The first cluster included the majority of patients that exhibited high scores of psychopathology, an earlier age of onset (firstcontact with psychiatricservices; p < 0.001) and the presence of bizarre delusions(p < 0.005). The majority of patients in the secondcluster had lower scores of psychopathology, later age of onset and no history of hospitalizations (p < 0.005).
Our results show that the presence of bizarre delusions is a clinical characteristic associated with the most severeform of schizophrenia The group of most severely affected patients who exhibit bizarre delusions are also characterized by an earlier age of onset. These findings are in accordance with previous studies showing that bizarre delusions are associated withmore severepositivesymptomsof schizophreniaand have predictive power and high sensitivity and specificity for the diagnosis [2]. Since the familial loading is considered to exert an impact on the age of illness onset [3], it is possible that bizarre delusions may be a clinical characteristic probably identifying a subgroup of schizophrenic patients who share greater genetic vulnerability for the development of the disorder. References
[I] Stefanis, C.N., Dikeos, D.G. and Papadimitriou, G.N. (1995) Clinical strategies ingenetic research. In: Mendlewicz, J. and Papadimitriou, G.N. (Ells), Genetics of Mental Disorders. I: Theoretical Aspects. Bailliere's Clinical Psychiatry, Bailliere Tindall, London, pp. 1-18. [2] Goldman, D.,Hien, D.A., Haas, G.L., Sweeney, 1.A. and Frances, A.J. (1992) Bizarre delusions andDSM-III-R schizophrenia. Am. 1.Psychiatry 149, 494499. [3] Albus, M., Scherer, J., Hueber, S., Lechleuthner, T., Kraus, G., Zausinger, S. andBurkes, S.(1994) Theimpact of familial loading on gender differences in age at onset of schizophrenia. Acta Psychiatr, Scand. 89, 132-134.
IP.3.049I Depressive symptoms in stable chronic
schizophrenia: Prevalence and relationship to psychopathology and medication status
C. Mulholland 1, D. Baynes 3, R. Montgomery 3. G. Lynch 3, G. MacAynn 3, C. Kelly3, SJ. Cooper', DJ. King.'. 1 Department of Mental Health. The Queen 's Universityof Belfast, Whitla Medical Building, 97 Lisbum Road, Belfast. BT9 7BL, UK; 2 Department of Therapeutics and Pharmacology; The Queen's University of Belfast, Whitla Medical Building, 97 LisbumRoad, Belfast, B1'9 7BL, UK; 3 Holywe/l Hospital, 60 Steeple Road, AntrimBT4I 2RJ, UK Depression is a common and important symptom in schizophrenia. It is most commonly associated with the acute phase of the illness. Less work has been done to establish its prevalence in stable chronic patients. This study was set out to exploreits prevalencein a stablechronicgroup living in the community and to examine the links between depressive symptoms and other psychopathology, demographic variables, medication and side-effects. A total of 122patients were assessedon a numberof psychiatricrating scales (Brief Psychiatric Rating Scale [BRPS]; Scale for the Assessment of Negative Symptoms [SANS]; Clinical Global Impression Scale (CGIS] ; Beck DepressionInventory [BOI]; Hamilton Depression Rating Scale (HDRS]; Barnes' Akathisia Scale [BAS]; Extrapyramidal Rating Scale [EPS]; Barnes' Akathisia Scale [BAS]; Extrapyramidal Rating Scale [EPS];Significant Others Scale [SOS].) The presenceof absence of clinically significant depressive symptoms was decided on the basis of a score of three or greater on Item 9 (the depressiveitem), of the BPRS. Of the 122 patients, 12 were depressed, giving a point prevalence of 9.8%. Depressive symptoms were significantly associated with the total BPRS score (p < 0.0001 ), and with the anxiety/depression (P < 0.0001), hostility/suspiciousness (P < 0.00( 1) and positivesymptom(P =0.0012) subscales of the BPRS. Depressive symptoms were also significantly associated with scores on the BD! (P < 0.0001), the HDRS (P < 0.0001), the CGIS (P < 0.0001) and the SOS, a measure of perceived social support (P = 0.0003). Whilsttherewas no associationbetweendepressive symptomsand total doses of antipsychotic or anticholinergic medication or extrapyramidal symptoms,there was an association with scores on the BAS (P =0.0107). There were no significant associations with negative symptoms (SANS score), alcohol use or demographic variables. These findings suggest that depressive symptomsin schizophreniaare associated with positive symptoms, with akathisia and with a perceived lack of social support. It raises questions as to how best to assess and differentiate depressive symptomsand antipsychotic induced dysphoria.
P.3 Psychotic disorders and antipsychotics
activity. As some case reports have suggested that it may alleviate the symptoms of tardive dyskinesia in some patients, we decided to test its efficacy in the treatment of two patients with a prolonged history of psychosisand associatedbuccolinguomasticatory dyskinesia. The patients were elderly females aged 77 and 81 years respectively. One patients had a history of more than 50 years of schizophrenia and the other had numerous phases of psychotic depression. Both were admitted to the index hospitalization period because of exacerbation of the psychoticsymptoms.Before admissionpatient I had used haloperidol I mg/day and thioridazine 25 mg in the evening. The other patient had used haloperidol 1.5 mg/day, together with 50 mg sulpiride and 15 mg rnianserin. As both had moderate symptoms of tardive dyskinesia predominantly affecting the jaw and tongue their previous neuroleptics were discontinued and risperidone was stepwise instituted up to 2 mg (patient 1) and 6 milligrams(patient 2) daily. Duringthe 4-weekhospitalizationperiod there was a gradual and progressive alleviation in psychotic symptoms as well as a decline of abnormal movements. The risperidone treatmentwas nor associated with emergenceof Parkinsonism. Risperidone is not totally free of extrapyramidal side-effects and also a case report exists about the development tardive dyskinesia during rlsperidone treatment (Addington et al, 1995). On the other hand some patients have benefitted from risperidone as their tardive dyskinesia has alleviated after changing the neuroleptic medication to risperidone. Our results are in line with the previoussuggestionsthat risperidone mayhave a beneficial effect on tardive buccolinguomasticatory dyskinesia without inducingsignificantParkinsonism (Chouinard 1995). References
Addington, D.E., Toews, JA, Addington, 1.M. (1995) Risperidone and tardive dyskinesia. Journal of Clinical Psychiatry 56,484-485. Chouinard G (1995) Effects ofrisperidone intardive dyskinesia: Ananalysis ofthe Canadian multicentre risperidone study. Journal ofClinical Psychopbannacology 15, 36S-44S.
IP.3.048I schizophrenic Bizarre delusions and ageof onset in patients D.G. Dikeos, G.N. Papadimitriou, E.G. Daskalopoulou, C.N. Stefanis. AthensUniversity Department of Psychiatry and University Mental Health Research Institute, Eginition Hospital, 72 Vas Sofias Ave., Athens. Greece In recent years there has been a considerable effort to delineate clinical subtypes of schizophrenia corresponding to distinct underlying genotypes. Among the clinical characteristics used in the attempt to "cut the schizophrenia pie" presence or absence of specific symptoms,as well as age of illness onset, course and treatmentresponse have been suggested [I] . The aim of this study was to investigate whetherany clinicalvariables discriminateamong groups of schizophrenic patients. As part of an ongoing genetic study of schizophrenia, 42 familial cases were personally examined with the use of the Schedules for the Clinical Assessment in Neuropsychiatry (SCAN) for lifetime occurrence of symptoms. In addition, 15 schizophrenic patients with no family history of major psychiatric disorders were interviewed. Bizarre delusions were defined according to the DSM-lli-R, while the age of onset was considered as the age of the first appearance of clinically significant symptoms, and as the age of the first contact with psychiatric services. A cluster analysis was carried out by the computer programme SPAD.N. The clinical characteristics of the patients used as active variables were the psychopathology scores (calculated by the addition of individual items ratings), age of onset, frequency of hospitalizations and measures of impairment The demographic and family characteristics, as well as specificsymptomatology were used as descriptive variables. Two clusters of schizophrenic patients were identified by the analysis; one contained patients with severe and the other with mild symptomatology. The first cluster included the majority of patients that exhibited high scores of psychopathology, an earlier age of onset (firstcontact with psychiatricservices; p < 0.001) and the presence of bizarre delusions(p < 0.005). The majority of patients in the secondcluster had lower scores of psychopathology, later age of onset and no history of hospitalizations (p < 0.005).
Our results show that the presence of bizarre delusions is a clinical characteristic associated with the most severeform of schizophrenia The group of most severely affected patients who exhibit bizarre delusions are also characterized by an earlier age of onset. These findings are in accordance with previous studies showing that bizarre delusions are associated withmore severepositivesymptomsof schizophreniaand have predictive power and high sensitivity and specificity for the diagnosis [2]. Since the familial loading is considered to exert an impact on the age of illness onset [3], it is possible that bizarre delusions may be a clinical characteristic probably identifying a subgroup of schizophrenic patients who share greater genetic vulnerability for the development of the disorder. References
[I] Stefanis, C.N., Dikeos, D.G. and Papadimitriou, G.N. (1995) Clinical strategies ingenetic research. In: Mendlewicz, J. and Papadimitriou, G.N. (Ells), Genetics of Mental Disorders. I: Theoretical Aspects. Bailliere's Clinical Psychiatry, Bailliere Tindall, London, pp. 1-18. [2] Goldman, D.,Hien, D.A., Haas, G.L., Sweeney, 1.A. and Frances, A.J. (1992) Bizarre delusions andDSM-III-R schizophrenia. Am. 1.Psychiatry 149, 494499. [3] Albus, M., Scherer, J., Hueber, S., Lechleuthner, T., Kraus, G., Zausinger, S. andBurkes, S.(1994) Theimpact of familial loading on gender differences in age at onset of schizophrenia. Acta Psychiatr, Scand. 89, 132-134.
IP.3.049I Depressive symptoms in stable chronic
schizophrenia: Prevalence and relationship to psychopathology and medication status
C. Mulholland 1, D. Baynes 3, R. Montgomery 3. G. Lynch 3, G. MacAynn 3, C. Kelly3, SJ. Cooper', DJ. King.'. 1 Department of Mental Health. The Queen 's Universityof Belfast, Whitla Medical Building, 97 Lisbum Road, Belfast. BT9 7BL, UK; 2 Department of Therapeutics and Pharmacology; The Queen's University of Belfast, Whitla Medical Building, 97 LisbumRoad, Belfast, B1'9 7BL, UK; 3 Holywe/l Hospital, 60 Steeple Road, AntrimBT4I 2RJ, UK Depression is a common and important symptom in schizophrenia. It is most commonly associated with the acute phase of the illness. Less work has been done to establish its prevalence in stable chronic patients. This study was set out to exploreits prevalencein a stablechronicgroup living in the community and to examine the links between depressive symptoms and other psychopathology, demographic variables, medication and side-effects. A total of 122patients were assessedon a numberof psychiatricrating scales (Brief Psychiatric Rating Scale [BRPS]; Scale for the Assessment of Negative Symptoms [SANS]; Clinical Global Impression Scale (CGIS] ; Beck DepressionInventory [BOI]; Hamilton Depression Rating Scale (HDRS]; Barnes' Akathisia Scale [BAS]; Extrapyramidal Rating Scale [EPS]; Barnes' Akathisia Scale [BAS]; Extrapyramidal Rating Scale [EPS];Significant Others Scale [SOS].) The presenceof absence of clinically significant depressive symptoms was decided on the basis of a score of three or greater on Item 9 (the depressiveitem), of the BPRS. Of the 122 patients, 12 were depressed, giving a point prevalence of 9.8%. Depressive symptoms were significantly associated with the total BPRS score (p < 0.0001 ), and with the anxiety/depression (P < 0.0001), hostility/suspiciousness (P < 0.00( 1) and positivesymptom(P =0.0012) subscales of the BPRS. Depressive symptoms were also significantly associated with scores on the BD! (P < 0.0001), the HDRS (P < 0.0001), the CGIS (P < 0.0001) and the SOS, a measure of perceived social support (P = 0.0003). Whilsttherewas no associationbetweendepressive symptomsand total doses of antipsychotic or anticholinergic medication or extrapyramidal symptoms,there was an association with scores on the BAS (P =0.0107). There were no significant associations with negative symptoms (SANS score), alcohol use or demographic variables. These findings suggest that depressive symptomsin schizophreniaare associated with positive symptoms, with akathisia and with a perceived lack of social support. It raises questions as to how best to assess and differentiate depressive symptomsand antipsychotic induced dysphoria.