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Depressive symptoms and course identify two distinct clusters within very poor outcome schizophrenia
1. Diagnosis
7
syndrome among fully trained raters of the SIPS was tested, and diagnosis agreement among raters was 93% (kappa = 0.82). The SOPS intraclass correlation for prodromal symptoms was 0.93 for the total score and above 0.80 for all four subscales (positive, negative, disorganized, and general symptoms). In addition, the SOPS demonstratcd good construct validity and superior sensitivity to change compared to competing instruments such as the PANSS. Data from 21 trainees yielded a 76% agreement with the consensus diagnosis before a training workshop (kappa -- 0.52, in the fair range), and an 88% agreement after the training (kappa = 0.76, in the excellent range). The SIPS demonstrated predictive validity for the conversion to psychosis, predicting the onset of psychosis in 43% of identified prodromal cases within 6 months, 50% of cases within 12 months, 62% of cases within 18 months, and 67% of cases within 2 years. Discussion: Our studies show that a valid, high-risk, prodromally, symptomatic state can be identified with satisfactory psychometric precision using the SIPS and SOPS.
PSYCHOSOCIAL AND PSYCHPATHOLOGICAL ASSESSMENT IN CHRONIC PATIENTS AND THEIR FAMILY MEMBERS: A N INSIGHT INTO QUALITY OF LIFE (QOL) A. R Palha,* R. Curral, C. Silveira, S. Gon~alves
Department of Psychiatry, Oporto Medical School, Oporto, Portugal The concept of quality of life has acquired increasing significance in different areas of Medicine. It as an intuitive sense, since it appeals to the notion that the ultimate goal of medical intervention is to improve the well-being of patients. However research into the quality of life of individuals with chronic diseases has been limited because of the difficulties of defining and evaluating quality of life in this populations. To date, studies among psychiatric populations have primarly focused on the patients only, forgetting the family members on this evaluation. The authors are carrying out a study at the Consultation of Psychiatry Department of the University ! Hospital S. Joao, in order to assess the in an indirect form, the quality of life of two groups of chronic patients (schizophrenics and epileptics) and the family members with whom they live. The aim of this study is try to acknoledge and quantify some psychossocial and psychopathological variables in group of schizophrenic patients (n=24), a group of epilepsy patients (n=24), and a group of members related families (n=24+24), with whom they live. The instruments that have been used were: An Interview specially constructed by the authors The Warner Coomp Scale The Washington Psychosocial Adjustment Inventory (WPSI) The Symptom Checklist-90-R (SCL-90) The Family Adaptation and Cohesion Evaluation Scale (FACES III) The adapted version of WPSI to use in schizophrenic patients Tha authors will use results as a key for the evaluation of the efficacy of Mental Health Service
DEPRESSIVE SYMPTOMS AND COURSE IDENTIFY TWO DISTINCT CLUSTERS WITHIN VERY POOR OUTCOME SCHIZOPHRENIA M. Roy,* M. Cayer, C. Lehoux, R. Palmour, J. Trepanier, S. Pelletier, L. Ren6, R Szatmari, R. Bouchard, M. Merette, M. Maziade Psyclfiatry, Faculty of Medicine, Laval University, Quebec, QC, Canada Our goal was to use cluster analysis to identify distinct subgroups within a sample of SZ subjects sampled according to two severity
strata. We randomly sampled DSM-IV SZ subjects from 2 strata defined according to level of functioning. The lower functioning stratum included patients living on long-term psychiatric wards or in highly structured group housing facilities. The higher functioning stratum included patients living in the community without supervision. Clusters were identified using the proc cluster procedure implemented in SAS. We entered severity of positive, negative and disorganization symptoms assessed during the stabilized state, depressive symptoms assessed during acute episodes and premorbid adjustment. The clusters were then compared on current functioning and gender ratio. The best fit was provided by a 3 cluster solution (see table). Clusters 2 and 3 represent a split of our lower functioning stratum, while cluster 1 overlapped almost perfectly with our higher functioning stratum. Clusters 2 and 3 were both characterized, compared to cluster 1, by more severe positive, disorganization and negative symptoms, earlier onset and poorer current functioning. Cluster 3, compared to cluster 2, had more severe positive, negative and depressive symptoms as well as better premorbid functioning. Moreover, compared to cluster 1, cluster 3 was uniquely characterized by more severe depressive symptoms and better premorbid functioning. These results suggest dinstinct profiles within very poor outcome SZ. Cluster 2 fits the classic description of neurodevelopmental SZ. Cluster 3, which is uniquely characterized by a high level of dysphoria and a deteriorative course does not correspond to classic description of subtypes. We are currently testing the validity of these clusters through an assessment of neuropsychological performance and a family study of these probands. Supported by grants from CIHR and FRSQ to Roy and by a CIHR group grant to Maziade, Merette, Palmour and Szatmari. Clusters 1 Clusters 2 Clusters 3 Positive symptoms
0.79
1.69
2.12
Disorganization symptoms
1.04
2.54
2.70
Negative symptoms
1.67
3.26
2.91
Depressive symptoms
1.19
0.86
1.47
Age of onset
25.5
21.12
21.2
Premorbid functioning (SOFAS)
60.9
48.6
66.3
% female
24%
19%
30%
Current functioning (SOFAS)
52.0
32.7
33.8
HARM AVOIDANCE AND SCHIZOTYPAL TRAITS IN A SAMPLE OF SEVERE JUVENILE DELINQUENTS L. Servais,* E. Hoffmann, R Fossion, I. Pelc, E. Stillemans, J. Titeca Accueil-Orientation-Education, Institution Publique de Protection de la Jeunesse de Wauthier-Braine, Wauthier-Braine, Walonie, Belgium This study investigates the link between harm avoidance (HA) and schizotypal traits in severe juvenile offenders. Among 37 boys (mean age 16 years old) referred to a detention facility, 20 subjects who meet more than 2 criteria of the 7 (hetero-agressiveness) of conduct disorder DSMIV diagnosis are assessed with the Temperament and Character Inventory (TCI), the Fear Survey Schedule (FSSIII) and
International Congress on Schizophrenia Research 2003
7
syndrome among fully trained raters of the SIPS was tested, and diagnosis agreement among raters was 93% (kappa = 0.82). The SOPS intraclass correlation for prodromal symptoms was 0.93 for the total score and above 0.80 for all four subscales (positive, negative, disorganized, and general symptoms). In addition, the SOPS demonstratcd good construct validity and superior sensitivity to change compared to competing instruments such as the PANSS. Data from 21 trainees yielded a 76% agreement with the consensus diagnosis before a training workshop (kappa -- 0.52, in the fair range), and an 88% agreement after the training (kappa = 0.76, in the excellent range). The SIPS demonstrated predictive validity for the conversion to psychosis, predicting the onset of psychosis in 43% of identified prodromal cases within 6 months, 50% of cases within 12 months, 62% of cases within 18 months, and 67% of cases within 2 years. Discussion: Our studies show that a valid, high-risk, prodromally, symptomatic state can be identified with satisfactory psychometric precision using the SIPS and SOPS.
PSYCHOSOCIAL AND PSYCHPATHOLOGICAL ASSESSMENT IN CHRONIC PATIENTS AND THEIR FAMILY MEMBERS: A N INSIGHT INTO QUALITY OF LIFE (QOL) A. R Palha,* R. Curral, C. Silveira, S. Gon~alves
Department of Psychiatry, Oporto Medical School, Oporto, Portugal The concept of quality of life has acquired increasing significance in different areas of Medicine. It as an intuitive sense, since it appeals to the notion that the ultimate goal of medical intervention is to improve the well-being of patients. However research into the quality of life of individuals with chronic diseases has been limited because of the difficulties of defining and evaluating quality of life in this populations. To date, studies among psychiatric populations have primarly focused on the patients only, forgetting the family members on this evaluation. The authors are carrying out a study at the Consultation of Psychiatry Department of the University ! Hospital S. Joao, in order to assess the in an indirect form, the quality of life of two groups of chronic patients (schizophrenics and epileptics) and the family members with whom they live. The aim of this study is try to acknoledge and quantify some psychossocial and psychopathological variables in group of schizophrenic patients (n=24), a group of epilepsy patients (n=24), and a group of members related families (n=24+24), with whom they live. The instruments that have been used were: An Interview specially constructed by the authors The Warner Coomp Scale The Washington Psychosocial Adjustment Inventory (WPSI) The Symptom Checklist-90-R (SCL-90) The Family Adaptation and Cohesion Evaluation Scale (FACES III) The adapted version of WPSI to use in schizophrenic patients Tha authors will use results as a key for the evaluation of the efficacy of Mental Health Service
DEPRESSIVE SYMPTOMS AND COURSE IDENTIFY TWO DISTINCT CLUSTERS WITHIN VERY POOR OUTCOME SCHIZOPHRENIA M. Roy,* M. Cayer, C. Lehoux, R. Palmour, J. Trepanier, S. Pelletier, L. Ren6, R Szatmari, R. Bouchard, M. Merette, M. Maziade Psyclfiatry, Faculty of Medicine, Laval University, Quebec, QC, Canada Our goal was to use cluster analysis to identify distinct subgroups within a sample of SZ subjects sampled according to two severity
strata. We randomly sampled DSM-IV SZ subjects from 2 strata defined according to level of functioning. The lower functioning stratum included patients living on long-term psychiatric wards or in highly structured group housing facilities. The higher functioning stratum included patients living in the community without supervision. Clusters were identified using the proc cluster procedure implemented in SAS. We entered severity of positive, negative and disorganization symptoms assessed during the stabilized state, depressive symptoms assessed during acute episodes and premorbid adjustment. The clusters were then compared on current functioning and gender ratio. The best fit was provided by a 3 cluster solution (see table). Clusters 2 and 3 represent a split of our lower functioning stratum, while cluster 1 overlapped almost perfectly with our higher functioning stratum. Clusters 2 and 3 were both characterized, compared to cluster 1, by more severe positive, disorganization and negative symptoms, earlier onset and poorer current functioning. Cluster 3, compared to cluster 2, had more severe positive, negative and depressive symptoms as well as better premorbid functioning. Moreover, compared to cluster 1, cluster 3 was uniquely characterized by more severe depressive symptoms and better premorbid functioning. These results suggest dinstinct profiles within very poor outcome SZ. Cluster 2 fits the classic description of neurodevelopmental SZ. Cluster 3, which is uniquely characterized by a high level of dysphoria and a deteriorative course does not correspond to classic description of subtypes. We are currently testing the validity of these clusters through an assessment of neuropsychological performance and a family study of these probands. Supported by grants from CIHR and FRSQ to Roy and by a CIHR group grant to Maziade, Merette, Palmour and Szatmari. Clusters 1 Clusters 2 Clusters 3 Positive symptoms
0.79
1.69
2.12
Disorganization symptoms
1.04
2.54
2.70
Negative symptoms
1.67
3.26
2.91
Depressive symptoms
1.19
0.86
1.47
Age of onset
25.5
21.12
21.2
Premorbid functioning (SOFAS)
60.9
48.6
66.3
% female
24%
19%
30%
Current functioning (SOFAS)
52.0
32.7
33.8
HARM AVOIDANCE AND SCHIZOTYPAL TRAITS IN A SAMPLE OF SEVERE JUVENILE DELINQUENTS L. Servais,* E. Hoffmann, R Fossion, I. Pelc, E. Stillemans, J. Titeca Accueil-Orientation-Education, Institution Publique de Protection de la Jeunesse de Wauthier-Braine, Wauthier-Braine, Walonie, Belgium This study investigates the link between harm avoidance (HA) and schizotypal traits in severe juvenile offenders. Among 37 boys (mean age 16 years old) referred to a detention facility, 20 subjects who meet more than 2 criteria of the 7 (hetero-agressiveness) of conduct disorder DSMIV diagnosis are assessed with the Temperament and Character Inventory (TCI), the Fear Survey Schedule (FSSIII) and
International Congress on Schizophrenia Research 2003