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A survey of delusional beliefs in psychiatric inpatients
hopelessness in a group of 44 psychotics, after his first admission. Using repeated-measures ANOVA, we have found that hopelessness is most prevalent at baseline, and that patients meeting DSM-IV criteria for schizophrenia are significantly more hopeless than the rest of psychotics. In order to study its prognostic value, we have analysed the following variables at baseline: age, sex, diagnosis, Ham-D, Beck's Hopelessness scale, SANS, SAPS and GAF; and readmissions and GAF at six months as dependent variables. Using a stepwise regression analysis, diagnosis, and especially depressive symptoms and hopelessness, were the best predictors of GAF at six months (F(3,35)=11.83, R2=0.503, p<0.00002). In a discriminant analysis, baseline GAF and hopelessness were also the best predictors of readmissions (Wilks' lambda=0.72; F(2,42)= 7.86; p<0.0013). Hopelessness is particularly severe in the schizophrenic group and its measure at baseline is associated with a bad evolution in a short term, while depressive symptoms are related to good outcome.
LACK OF GENDER DIFFERENCES IN AGE AT ONSET IN FAMILIAL SCHIZOPHRENIA
The literature on insight into illness suggests that a neuropsychologically mediated deficit in self-awareness may be one of the most common signs of schizophrenia. Self-awareness deficits have descriptive validity at the level of the phenomenology of schizophrenia, and prognostic validity in terms of the prediction of the course of illness. Various aspects of poor selfawareness are strongly correlated with neuropsychological dysfunction of the frontal lobes. However, the lack of empirical data contrasting diagnostic groups on degree of insight and the previous use of insight measures with questionable reliability and validity, limit the strength of this interpretation. In the present study we assessed insight into, or awareness of, multiple aspects of mental disorder using a measure with demonstrated reliability and validity. A sample of 412 patients with psychotic and mood disorders coming from geographically diverse regions were studied in conjunction with the DSM-IV Field Trial. The results indicated that poor insight is a prevalent feature of schizophrenia, it is associated with poorer psychosocial functioning, and is more common in patients with schizophrenia than in schizoaffective, and major depressive disorders with and without psychosis. The implication of these data for the nosology of schizophrenia will be discussed.
M a r t o g Albus a, Wolfgang M a i e r b
aDivision of Teaching and Research, State Mental Hospital Haar, Vockestr. 72. D-85529, Haar, Germany, and bDepartment of Psychiatry, University of Mainz, Germany Gender differences in age at onset with males having an earlier age at onset compared to females are one of the most consistent findings in the epidemiology of schizophrenia. However, the vast majority of studies focussing on gender differences have not considered the potential influence of genetic factors on age at onset. We investigated the impact of familial loading on gender differences in age at onset in patients with a sibling also affected with either DSM-III-R schizophrenia or chronic schizoaffective disorder. A total of 106 sib pairs with 38 male-male pairs, 29 female-female pairs and 39 mixed-sex pairs of siblings as well as 260 male and 221 female isolated cases with no relative of first, second, or third degree suffering from psychotic or major affective illness were investigated. We found no gender differences in age at onset in familial cases (male male pairs: 23.4+5.3 years; female female pairs: 23.3 + 5.4 years; mixed-sex sets: males 24.7 +6.7 years, females 24.0 + 6.4 years). In contrast, an earlier age at onset in males compared to females was observed in isolated cases (males 25.6+9.3 years, females 31.3+ 11.9 years). Our data strongly support the assumption that gender differences of age at onset of schizophrenia are not consistent across all subgroups of schizophrenics.
SELF-AWARENESS DEFICITS AND THEIR RELEVANCE TO THE NOSOLOGY OF SCHIZOPHRENIA Xavier F. A m a d o r
Columbia University College of Physicians and Surgeons and the New York State Psychiatric Institute, 722 West 168 Street, Unit2, New York, NY10032, USA
A SURVEY OF DELUSIONAL PSYCHIATRIC INPATIENTS
BELIEFS
IN
C.R. Blyler*, D.G. Vogel, T.C. M a n s c h r e c k
Columbia-Presbyterian Medical Center, 622 West 168 Street, New York, N Y 10032-3784, USA The prevalence and nature of delusions in psychiatric disorders, including schizophrenia, remain unclear and must be determined through the establishment of an empirical research framework. As a first step toward this goal, we have created a comprehensive interview for assessing current and past delusional beliefs based on currently available tools. Of 104 consecutive hospital admissions, 50 psychiatric patients agreed to be interviewed with the Blyler-Vogel Unusual Beliefs Interview (BVI). Eighty-six percent of subjects with SCID-based DSMIII-R diagnoses of psychotic disorders, and 36% of subjects with nonpsychotic diagnoses reported delusions. A full range of delusions was found in both groups, but psychotic subjects reported more delusions. We detected current delusions in 42% of subjects rated as "definitely not" delusional by clinicians. No specific type of delusion was especially likely to be missed by clinicians. The presence of undetected delusions was associated with being multiply diagnosed with depression combined with anxiety disorders, personality disorders, drug abuse/dependence, and/or eating disorders. We explored possible reasons that clinicians may have missed delusions. Given the diagnostic significance of delusional beliefs, finding effective means of detecting delusions would enhance clinical and research practice.
LACK OF GENDER DIFFERENCES IN AGE AT ONSET IN FAMILIAL SCHIZOPHRENIA
The literature on insight into illness suggests that a neuropsychologically mediated deficit in self-awareness may be one of the most common signs of schizophrenia. Self-awareness deficits have descriptive validity at the level of the phenomenology of schizophrenia, and prognostic validity in terms of the prediction of the course of illness. Various aspects of poor selfawareness are strongly correlated with neuropsychological dysfunction of the frontal lobes. However, the lack of empirical data contrasting diagnostic groups on degree of insight and the previous use of insight measures with questionable reliability and validity, limit the strength of this interpretation. In the present study we assessed insight into, or awareness of, multiple aspects of mental disorder using a measure with demonstrated reliability and validity. A sample of 412 patients with psychotic and mood disorders coming from geographically diverse regions were studied in conjunction with the DSM-IV Field Trial. The results indicated that poor insight is a prevalent feature of schizophrenia, it is associated with poorer psychosocial functioning, and is more common in patients with schizophrenia than in schizoaffective, and major depressive disorders with and without psychosis. The implication of these data for the nosology of schizophrenia will be discussed.
M a r t o g Albus a, Wolfgang M a i e r b
aDivision of Teaching and Research, State Mental Hospital Haar, Vockestr. 72. D-85529, Haar, Germany, and bDepartment of Psychiatry, University of Mainz, Germany Gender differences in age at onset with males having an earlier age at onset compared to females are one of the most consistent findings in the epidemiology of schizophrenia. However, the vast majority of studies focussing on gender differences have not considered the potential influence of genetic factors on age at onset. We investigated the impact of familial loading on gender differences in age at onset in patients with a sibling also affected with either DSM-III-R schizophrenia or chronic schizoaffective disorder. A total of 106 sib pairs with 38 male-male pairs, 29 female-female pairs and 39 mixed-sex pairs of siblings as well as 260 male and 221 female isolated cases with no relative of first, second, or third degree suffering from psychotic or major affective illness were investigated. We found no gender differences in age at onset in familial cases (male male pairs: 23.4+5.3 years; female female pairs: 23.3 + 5.4 years; mixed-sex sets: males 24.7 +6.7 years, females 24.0 + 6.4 years). In contrast, an earlier age at onset in males compared to females was observed in isolated cases (males 25.6+9.3 years, females 31.3+ 11.9 years). Our data strongly support the assumption that gender differences of age at onset of schizophrenia are not consistent across all subgroups of schizophrenics.
SELF-AWARENESS DEFICITS AND THEIR RELEVANCE TO THE NOSOLOGY OF SCHIZOPHRENIA Xavier F. A m a d o r
Columbia University College of Physicians and Surgeons and the New York State Psychiatric Institute, 722 West 168 Street, Unit2, New York, NY10032, USA
A SURVEY OF DELUSIONAL PSYCHIATRIC INPATIENTS
BELIEFS
IN
C.R. Blyler*, D.G. Vogel, T.C. M a n s c h r e c k
Columbia-Presbyterian Medical Center, 622 West 168 Street, New York, N Y 10032-3784, USA The prevalence and nature of delusions in psychiatric disorders, including schizophrenia, remain unclear and must be determined through the establishment of an empirical research framework. As a first step toward this goal, we have created a comprehensive interview for assessing current and past delusional beliefs based on currently available tools. Of 104 consecutive hospital admissions, 50 psychiatric patients agreed to be interviewed with the Blyler-Vogel Unusual Beliefs Interview (BVI). Eighty-six percent of subjects with SCID-based DSMIII-R diagnoses of psychotic disorders, and 36% of subjects with nonpsychotic diagnoses reported delusions. A full range of delusions was found in both groups, but psychotic subjects reported more delusions. We detected current delusions in 42% of subjects rated as "definitely not" delusional by clinicians. No specific type of delusion was especially likely to be missed by clinicians. The presence of undetected delusions was associated with being multiply diagnosed with depression combined with anxiety disorders, personality disorders, drug abuse/dependence, and/or eating disorders. We explored possible reasons that clinicians may have missed delusions. Given the diagnostic significance of delusional beliefs, finding effective means of detecting delusions would enhance clinical and research practice.