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Deficit and negative subtypes in schizophrenia: Clinical and biological differences
33
is currently one of the more important models for explaining the heterogeneity of schizophrenia, particularly with reference to negative symptoms. Some studies have suggested that in contrast to nondeficit schizophrenic patients where both positive and negative symptoms improve during acute antipsychotic treatment, negative symptoms do not change in deficit schizophrenic patients despite improvement in positive symptoms in the course of acute antipsychotic treatment. In an effort to replicate these findings, we studied 106 DSM-III-R schizophrenic inpatients at medication-free baseline and about four weeks after initiating clinically-determined antipsychotic treatment with typical antipsychotics. At baseline, the Schedule for the Deficit Syndrome (SDS) was used to classify patients as defcit (n = 26) or nondeficit (n = 80) patients. Deficit patients had significantly higher positive and negative symptom scores than nondeficit patients. Both groups showed a significant improvement in both positive and negative symptoms, although there was a significantly lesser improvement in both these symptom dimensions in the deficit group. Improvement in negative symptoms was correlated with improvement in positive symptoms in both these groups. In a related study, we observed similar improvement with clozapine in negative symptoms in deficit and nondeficit schizophrenic patients. These data indicate that deficit schizophrenia is not distinguished from nondeficit schizophrenia by an absence of secondary negative symptoms. These data are not inconsistent with the dichotomous characterization of deficit and nondeficit schizophrenia; however, these data are also consistent with a dimensional view of deficit in schizophrenia.
DEFICIT AND NEGATIVE SUBTYPES SCHIZOPHRENIA: CLINICAL AND BIOLOGICAL DIFFERENCES
IN
S. Dollfus, P. Brazo, I. N k a m , F. T h i b a u t , F. Moity, S. Langlois, R. Gourrevitch, D. Dassa, P. Denise, D. Levillain, I. Halbecq, P. Delamillieure, A. Van Der Elst, L. Segard, F. Assouly-Besse, T. Vasse, O. Etard, J.D. Guelfi, C. Launay, F. Petitjean, M. Petit Groupe de Recherche ( UPRES JE2014) et Programme Hoapitalier de Recherche Clinique (P. H. R. C. ) (S. DollJi~s, CHU de Caen; M. Petit, Universit6 de Rouen), France The deficit syndrome is defined by primary and enduring negative symptoms (Carpenter et al., 1988) while the negative syndrome is defined by negative symptoms (not necessarily primary) no associated with positive ones. The aim of this study included in a National Research Program (Programme Hospitalier de Recherche Clinique, PHRC) was to test that deficit syndrome could be characterized by clinical and biological impairments while negative syndrome could not. Methods. Patients were categorized into deficit (D) and non deficit (ND) subtype with the Schedule of Deficit Syndrome (SDS; Kirkpatrick et al., 1989) and into negative (N) and non negative (NN) subtypes with the Positive And Negative Syndrome Scale (PANSS; Kay et al., 1987). Neurological Evaluation Scale (NES; Buchanan et al., 1989), oculomotor
tasks (reflexive saccades, antisaccades, smooth pursuit), frontal neuropsychological tests, and clinical variables (sex, age of onset, season births) were assessed in a large cohort of schizophrenic patients. Results. Some impairments were significantly more severe in D than in ND patients (antisaccade paradigm, Wisconsin Card Sorting test and NES) while no significant difference was observed between N and NN patients. Conclusion. These results show that deficit subtype should be distinguished from negative subtype in schizophrenia.
PREVALENCE CORRELATES
AND CLINICAL OF PSYCHIATRIC
COMORBIDITY IN PATIENTS PSYCHOTIC DISORDERS
WITH
G.B. Cassano, S. Pini, T. Mastrocinque, M. Saettoni, A. Papasogli, L. Dell'Osso Institute g / Psychiatry, University g/' Pisa, via Roma 67, 56100 Pisa, Italy Background. The aim of this study was to explore patterns and clinical correlates of psychiatric comorbidity in patients with schizophrenia spectrum disorders and mood spectrum disorders with psychotic features. Method. Ninety-six consecutively hospitalized patients with current psychotic symptoms were recruited and included in this study. Index episode psychotic diagnosis and psychiatric comorbidity were assessed using the SCID-P. Psychopathology was assessed by the SCID-P, BPRS, SANS and SCL-90. Awareness of illness was assessed with the SUMD. Results. The total lifetime prevalence of psychiatric comorbidity in the entire cohort was 57.3% (58.1% in schizophrenia spectrum disorders and 56.9°/,, in mood spectrum psychoses). Overall, panic disorder (24%), obsessive/compulsive disorder (24%), social phobia (17.7'7,,), substance abuse ( 11.5%), alcohol abuse (10.4%) and simple phobia (7.3%) were the most frequent comorbidities. Within the group of mood spectrum disorders, negative symptoms were found to be significantly more frequent among patients with psychiatric comorbidity than among those without comorbidity, while such a difference was not detected within the group of schizophrenia spectrum disorders. Social phobia, substance abuse disorder and panic disorder comorbidity showed the greatest association with psychotic features. An association between earlier age at first hospitalization and comorbidity was found only in patients with unipolar psychotic depression. Patient self-reported psychopathology was significantly more severe in schizophrenia spectrum patients with comorbidity than in those without, while such a difference was less pronounced in mood spectrum psychoses. Conclusions. Psychiatric comorbidity is a relevant phenomenon in both schizophrenia spectrum and mood spectrum psychoses and is likely to negatively affect the phenomenology and severity of psychotic illness.
is currently one of the more important models for explaining the heterogeneity of schizophrenia, particularly with reference to negative symptoms. Some studies have suggested that in contrast to nondeficit schizophrenic patients where both positive and negative symptoms improve during acute antipsychotic treatment, negative symptoms do not change in deficit schizophrenic patients despite improvement in positive symptoms in the course of acute antipsychotic treatment. In an effort to replicate these findings, we studied 106 DSM-III-R schizophrenic inpatients at medication-free baseline and about four weeks after initiating clinically-determined antipsychotic treatment with typical antipsychotics. At baseline, the Schedule for the Deficit Syndrome (SDS) was used to classify patients as defcit (n = 26) or nondeficit (n = 80) patients. Deficit patients had significantly higher positive and negative symptom scores than nondeficit patients. Both groups showed a significant improvement in both positive and negative symptoms, although there was a significantly lesser improvement in both these symptom dimensions in the deficit group. Improvement in negative symptoms was correlated with improvement in positive symptoms in both these groups. In a related study, we observed similar improvement with clozapine in negative symptoms in deficit and nondeficit schizophrenic patients. These data indicate that deficit schizophrenia is not distinguished from nondeficit schizophrenia by an absence of secondary negative symptoms. These data are not inconsistent with the dichotomous characterization of deficit and nondeficit schizophrenia; however, these data are also consistent with a dimensional view of deficit in schizophrenia.
DEFICIT AND NEGATIVE SUBTYPES SCHIZOPHRENIA: CLINICAL AND BIOLOGICAL DIFFERENCES
IN
S. Dollfus, P. Brazo, I. N k a m , F. T h i b a u t , F. Moity, S. Langlois, R. Gourrevitch, D. Dassa, P. Denise, D. Levillain, I. Halbecq, P. Delamillieure, A. Van Der Elst, L. Segard, F. Assouly-Besse, T. Vasse, O. Etard, J.D. Guelfi, C. Launay, F. Petitjean, M. Petit Groupe de Recherche ( UPRES JE2014) et Programme Hoapitalier de Recherche Clinique (P. H. R. C. ) (S. DollJi~s, CHU de Caen; M. Petit, Universit6 de Rouen), France The deficit syndrome is defined by primary and enduring negative symptoms (Carpenter et al., 1988) while the negative syndrome is defined by negative symptoms (not necessarily primary) no associated with positive ones. The aim of this study included in a National Research Program (Programme Hospitalier de Recherche Clinique, PHRC) was to test that deficit syndrome could be characterized by clinical and biological impairments while negative syndrome could not. Methods. Patients were categorized into deficit (D) and non deficit (ND) subtype with the Schedule of Deficit Syndrome (SDS; Kirkpatrick et al., 1989) and into negative (N) and non negative (NN) subtypes with the Positive And Negative Syndrome Scale (PANSS; Kay et al., 1987). Neurological Evaluation Scale (NES; Buchanan et al., 1989), oculomotor
tasks (reflexive saccades, antisaccades, smooth pursuit), frontal neuropsychological tests, and clinical variables (sex, age of onset, season births) were assessed in a large cohort of schizophrenic patients. Results. Some impairments were significantly more severe in D than in ND patients (antisaccade paradigm, Wisconsin Card Sorting test and NES) while no significant difference was observed between N and NN patients. Conclusion. These results show that deficit subtype should be distinguished from negative subtype in schizophrenia.
PREVALENCE CORRELATES
AND CLINICAL OF PSYCHIATRIC
COMORBIDITY IN PATIENTS PSYCHOTIC DISORDERS
WITH
G.B. Cassano, S. Pini, T. Mastrocinque, M. Saettoni, A. Papasogli, L. Dell'Osso Institute g / Psychiatry, University g/' Pisa, via Roma 67, 56100 Pisa, Italy Background. The aim of this study was to explore patterns and clinical correlates of psychiatric comorbidity in patients with schizophrenia spectrum disorders and mood spectrum disorders with psychotic features. Method. Ninety-six consecutively hospitalized patients with current psychotic symptoms were recruited and included in this study. Index episode psychotic diagnosis and psychiatric comorbidity were assessed using the SCID-P. Psychopathology was assessed by the SCID-P, BPRS, SANS and SCL-90. Awareness of illness was assessed with the SUMD. Results. The total lifetime prevalence of psychiatric comorbidity in the entire cohort was 57.3% (58.1% in schizophrenia spectrum disorders and 56.9°/,, in mood spectrum psychoses). Overall, panic disorder (24%), obsessive/compulsive disorder (24%), social phobia (17.7'7,,), substance abuse ( 11.5%), alcohol abuse (10.4%) and simple phobia (7.3%) were the most frequent comorbidities. Within the group of mood spectrum disorders, negative symptoms were found to be significantly more frequent among patients with psychiatric comorbidity than among those without comorbidity, while such a difference was not detected within the group of schizophrenia spectrum disorders. Social phobia, substance abuse disorder and panic disorder comorbidity showed the greatest association with psychotic features. An association between earlier age at first hospitalization and comorbidity was found only in patients with unipolar psychotic depression. Patient self-reported psychopathology was significantly more severe in schizophrenia spectrum patients with comorbidity than in those without, while such a difference was less pronounced in mood spectrum psychoses. Conclusions. Psychiatric comorbidity is a relevant phenomenon in both schizophrenia spectrum and mood spectrum psychoses and is likely to negatively affect the phenomenology and severity of psychotic illness.