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NONDEFICIT CATEGORIZATION FROM THE SCALE FOR THE ASSESSMENT OF NEGATIVE SYMPTOMS (SANS)
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Abstracts of the 3rd Biennial Schizophrenia International Research Conference / Schizophrenia Research 136, Supplement 1 (2012) S1–S375
Results: From January 2007 to December 2011 668 patients with schizophrenia-spectrum disorders were admitted to our in- or outpatient facilities in Gouda, the Netherlands. Refusals and logistic issues were the main reasons for missing data. For 385 patients we were able to assess reliably the presence or absence of MetS. The results with the predictive values for this diagnostic test will be presented at the conference. Discussion: The study population is a representative real life sample of patients with schizophrenia-spectrum disorders in a specified catchment area in Western Europe. Our findings will provide clues about the validity of this non-invasive metabolic screening method. It will aid in answering the clinically relevant question whether diastolic blood pressure and waist circumference can be used as a pretreatment screening tool for MetS. This may not only have financial implications, but would also lower the burden for patients to have blood drawn, which in turn, will increase the percentage of completed screenings. Lastly, at facilities where laboratory testing is not at hand, like in third-world countries, this non-invasive screening tool offers the opportunity to still monitor MetS in this vulnerable population. References: [1] Lin C, Bai Y, Chen J et al.Easy and low-cost identification of metabolic syndrome in patients treated with second-generation antipsychotics: artificial neuronal network and logistic regression models. J Clin Psychiatry 2010;71(3): 225-234. [2] Expert Panel on Detection. Evaluation, and Treatment of High Blood Cholesterol in Adults: Executive Summary of the third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA 285;24862497, 2001.
Poster #69 DEFICIT AND NONDEFICIT SCHIZOPHRENIA: BOUNDARIES REVISITED Clarissa R. Dantas, Bruno R. Barros, Claudio E.M. Banzato University of Campinas (UNICAMP), Campinas, SP, Brazil Background: According to the instructions of the golden standard instrument for the categorization of schizophrenic patients into deficit or nondeficit, the Schedule for the Deficit Syndrome (SDS), cases in which the secondary nature of negative symptoms cannot be ruled out must be assigned as nondeficit. In a previous study we have targeted patients who presented persistent negative symptoms that could not be unequivocally judged as either primary or secondary to other factors, which we called “ambiguous”, and compared them to definite deficit and definite nondeficit patients. We found that the ambiguous nondeficit group is very similar to the definite deficit group in several psychopathological and clinical features, suggesting thus that the boundaries between deficit and nondeficit schizophrenia may be problematic somehow. Herein we took a step further and tested the categorization by comparing the deficit and nondeficit groups after assigning the ambiguous cases successively to one group and then to the other. Methods: We studied 85 outpatients with schizophrenia who were first categorized into three groups: definite deficit, ambiguous and definite nondeficit by the SDS. Then we grouped together definite nondeficit and ambiguous patients and compared them to definite deficit (as ruled by SDS), and subsequently we grouped definite deficit and ambiguous patients and compared them to definite nondeficit. Patients’ symptoms severity (general psychopathology, positive, negative and depressive symptoms) was assessed with BPRS, SAPS, SANS and Calgary. Insight was assessed with the Schedule for the Assessment of Insight – Expanded Version (SAI-E) and quality of live was assessed with the Quality of Life Scale (QLS). Independently and blinded for the psychopathological assessment and deficit/nondeficit categorization, patients were cognitively assessed with a comprehensive battery of neuropsychological tests, which was reduced through principal component analysis to a single “cognitive factor” accounting for 56.2% of variance. Results: The categorization by the SDS rules rendered deficit and nondeficit group profiles similar to those described in the literature regarding clinical and psychopathological variables. However, both groups differed significantly only in BPRS, SANS and QLS scores, when analysis was controlled for gender, years of education, age at illness onset and duration of disease. The deficit group scored higher in BPRS and SANS and lower in QLS. Performing the alternative categorization, with ambiguous cases being assigned to the deficit group, the same significant psychopathological differences (BPRS, SANS, and QLS) were obtained. A further difference was
unsurprisingly found in Calgary, as depression is one of the putative causes of secondary negative symptoms and a reason for assigning patients as ambiguous. The alternative categorization rendered two groups with sharper clinical boundaries, as significant differences were found regarding years of education, age at illness onset, duration of schizophrenia and number of hospitalizations. The enlarged deficit group presented lower education, earlier illness onset, longer duration of schizophrenia and higher number of hospitalizations. Discussion: The presence of prominent and persistent negative symptoms by itself seems to be enough to separate a clinically homogeneous group of schizophrenic patients. Although the distinction between primary and secondary negative symptoms has relevance for clinical care and research, it is doubtful whether a finer-grained version of it can work as a hinge for a categorization such as deficit/nondeficit schizophrenia.
Poster #70 PREDICTING DEFICIT/NONDEFICIT CATEGORIZATION FROM THE SCALE FOR THE ASSESSMENT OF NEGATIVE SYMPTOMS (SANS) Bruno R. Barros, Claudio E.M. Banzato, Clarissa R. Dantas University of Campinas - UNICAMP Campinas, Sao Paulo, Brazil Background: Deficit schizophrenia, a subtype defined by the presence of prominent, persistent and primary negative symptoms, has been proposed to represent a homogeneous disease separate from other, nondeficit, forms of schizophrenia. The Schedule for the Deficit Syndrome (SDS) is considered the golden standard instrument for the categorization into deficit and nondeficit forms. In some situations, such as data-mining studies, it may be necessary to use proxy case-identification tools instead of “gold-standard” assessments. In this study we attempted to predict the deficit/nondeficit categorization performed through SDS by using patients’ scores on the Scale for the Assessment of Negative Symptoms (SANS) and the Scale for the Assessment of Positive Symptoms (SAPS). Methods: We studied 85 outpatients with schizophrenia (according to DSM-IV diagnostic criteria) who were categorized into deficit/nondeficit syndrome groups by the SDS. First, a univariated logistic regression analysis was performed using all items from SANS and SAPS in order to discriminate deficit from nondeficit patients. Then we performed a multiple logistic regression including all items from SANS and SAPS. Results: Criteria for the deficit syndrome of schizophrenia were met by 29 (34.1%) patients and 56 (65.9%) were considered nondeficit. The mean SAPS scores was 5.0 (±3.9)and the mean SANS scores was 10.4 (±6.6). No items from SAPS showed discriminative power in the univariated analysis, while most of SANS’s items did. The only 4 items (out of 25) from SANS that did not discriminate deficit from nondeficit patients were: “Inappropriate Affect”, “Poverty of Content of Speech”, “Grooming and Hygiene”, and “Inattentiveness during Mental Status Testing”. The multiple logistic regression analysis yielded a simple model comprising 3 single items from SANS: “Paucity of Expressive Gestures”, “Poverty of Speech” and “Recreational Interests and Activities”. The model accuracy was c=0.89. Discussion: It is important to mention that our sample consisted of clinically stabilized patients, meeting the recommendation for SDS categorization. Thus, SAPS scores were low and distributed along a narrow range, which might have accounted to some extent for its lack of predictive power. Interestingly the SANS’s items that did not predicted the deficit/nondeficit categorization are the ones whose pertinence to the domain of negative symptoms has been challenged. The multivariate logistic regression model obtained is quite appealing for its high accuracy, simplicity and also because the three items retained belong to three different SANS subscales.
Abstracts of the 3rd Biennial Schizophrenia International Research Conference / Schizophrenia Research 136, Supplement 1 (2012) S1–S375
Results: From January 2007 to December 2011 668 patients with schizophrenia-spectrum disorders were admitted to our in- or outpatient facilities in Gouda, the Netherlands. Refusals and logistic issues were the main reasons for missing data. For 385 patients we were able to assess reliably the presence or absence of MetS. The results with the predictive values for this diagnostic test will be presented at the conference. Discussion: The study population is a representative real life sample of patients with schizophrenia-spectrum disorders in a specified catchment area in Western Europe. Our findings will provide clues about the validity of this non-invasive metabolic screening method. It will aid in answering the clinically relevant question whether diastolic blood pressure and waist circumference can be used as a pretreatment screening tool for MetS. This may not only have financial implications, but would also lower the burden for patients to have blood drawn, which in turn, will increase the percentage of completed screenings. Lastly, at facilities where laboratory testing is not at hand, like in third-world countries, this non-invasive screening tool offers the opportunity to still monitor MetS in this vulnerable population. References: [1] Lin C, Bai Y, Chen J et al.Easy and low-cost identification of metabolic syndrome in patients treated with second-generation antipsychotics: artificial neuronal network and logistic regression models. J Clin Psychiatry 2010;71(3): 225-234. [2] Expert Panel on Detection. Evaluation, and Treatment of High Blood Cholesterol in Adults: Executive Summary of the third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA 285;24862497, 2001.
Poster #69 DEFICIT AND NONDEFICIT SCHIZOPHRENIA: BOUNDARIES REVISITED Clarissa R. Dantas, Bruno R. Barros, Claudio E.M. Banzato University of Campinas (UNICAMP), Campinas, SP, Brazil Background: According to the instructions of the golden standard instrument for the categorization of schizophrenic patients into deficit or nondeficit, the Schedule for the Deficit Syndrome (SDS), cases in which the secondary nature of negative symptoms cannot be ruled out must be assigned as nondeficit. In a previous study we have targeted patients who presented persistent negative symptoms that could not be unequivocally judged as either primary or secondary to other factors, which we called “ambiguous”, and compared them to definite deficit and definite nondeficit patients. We found that the ambiguous nondeficit group is very similar to the definite deficit group in several psychopathological and clinical features, suggesting thus that the boundaries between deficit and nondeficit schizophrenia may be problematic somehow. Herein we took a step further and tested the categorization by comparing the deficit and nondeficit groups after assigning the ambiguous cases successively to one group and then to the other. Methods: We studied 85 outpatients with schizophrenia who were first categorized into three groups: definite deficit, ambiguous and definite nondeficit by the SDS. Then we grouped together definite nondeficit and ambiguous patients and compared them to definite deficit (as ruled by SDS), and subsequently we grouped definite deficit and ambiguous patients and compared them to definite nondeficit. Patients’ symptoms severity (general psychopathology, positive, negative and depressive symptoms) was assessed with BPRS, SAPS, SANS and Calgary. Insight was assessed with the Schedule for the Assessment of Insight – Expanded Version (SAI-E) and quality of live was assessed with the Quality of Life Scale (QLS). Independently and blinded for the psychopathological assessment and deficit/nondeficit categorization, patients were cognitively assessed with a comprehensive battery of neuropsychological tests, which was reduced through principal component analysis to a single “cognitive factor” accounting for 56.2% of variance. Results: The categorization by the SDS rules rendered deficit and nondeficit group profiles similar to those described in the literature regarding clinical and psychopathological variables. However, both groups differed significantly only in BPRS, SANS and QLS scores, when analysis was controlled for gender, years of education, age at illness onset and duration of disease. The deficit group scored higher in BPRS and SANS and lower in QLS. Performing the alternative categorization, with ambiguous cases being assigned to the deficit group, the same significant psychopathological differences (BPRS, SANS, and QLS) were obtained. A further difference was
unsurprisingly found in Calgary, as depression is one of the putative causes of secondary negative symptoms and a reason for assigning patients as ambiguous. The alternative categorization rendered two groups with sharper clinical boundaries, as significant differences were found regarding years of education, age at illness onset, duration of schizophrenia and number of hospitalizations. The enlarged deficit group presented lower education, earlier illness onset, longer duration of schizophrenia and higher number of hospitalizations. Discussion: The presence of prominent and persistent negative symptoms by itself seems to be enough to separate a clinically homogeneous group of schizophrenic patients. Although the distinction between primary and secondary negative symptoms has relevance for clinical care and research, it is doubtful whether a finer-grained version of it can work as a hinge for a categorization such as deficit/nondeficit schizophrenia.
Poster #70 PREDICTING DEFICIT/NONDEFICIT CATEGORIZATION FROM THE SCALE FOR THE ASSESSMENT OF NEGATIVE SYMPTOMS (SANS) Bruno R. Barros, Claudio E.M. Banzato, Clarissa R. Dantas University of Campinas - UNICAMP Campinas, Sao Paulo, Brazil Background: Deficit schizophrenia, a subtype defined by the presence of prominent, persistent and primary negative symptoms, has been proposed to represent a homogeneous disease separate from other, nondeficit, forms of schizophrenia. The Schedule for the Deficit Syndrome (SDS) is considered the golden standard instrument for the categorization into deficit and nondeficit forms. In some situations, such as data-mining studies, it may be necessary to use proxy case-identification tools instead of “gold-standard” assessments. In this study we attempted to predict the deficit/nondeficit categorization performed through SDS by using patients’ scores on the Scale for the Assessment of Negative Symptoms (SANS) and the Scale for the Assessment of Positive Symptoms (SAPS). Methods: We studied 85 outpatients with schizophrenia (according to DSM-IV diagnostic criteria) who were categorized into deficit/nondeficit syndrome groups by the SDS. First, a univariated logistic regression analysis was performed using all items from SANS and SAPS in order to discriminate deficit from nondeficit patients. Then we performed a multiple logistic regression including all items from SANS and SAPS. Results: Criteria for the deficit syndrome of schizophrenia were met by 29 (34.1%) patients and 56 (65.9%) were considered nondeficit. The mean SAPS scores was 5.0 (±3.9)and the mean SANS scores was 10.4 (±6.6). No items from SAPS showed discriminative power in the univariated analysis, while most of SANS’s items did. The only 4 items (out of 25) from SANS that did not discriminate deficit from nondeficit patients were: “Inappropriate Affect”, “Poverty of Content of Speech”, “Grooming and Hygiene”, and “Inattentiveness during Mental Status Testing”. The multiple logistic regression analysis yielded a simple model comprising 3 single items from SANS: “Paucity of Expressive Gestures”, “Poverty of Speech” and “Recreational Interests and Activities”. The model accuracy was c=0.89. Discussion: It is important to mention that our sample consisted of clinically stabilized patients, meeting the recommendation for SDS categorization. Thus, SAPS scores were low and distributed along a narrow range, which might have accounted to some extent for its lack of predictive power. Interestingly the SANS’s items that did not predicted the deficit/nondeficit categorization are the ones whose pertinence to the domain of negative symptoms has been challenged. The multivariate logistic regression model obtained is quite appealing for its high accuracy, simplicity and also because the three items retained belong to three different SANS subscales.