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Schizophrenia and schizophreniform disorder: Is there a critical difference?
is applied in a cross-sectional and longitudinal study on the course of negative symptoms in schizophrenic patients and alcoholics.’ The examination is video-taped to get reliable measurements of items and sub-scales. A first cross-sectional sample includes schizophrenic patients, alcoholics and healthy controls. First results show a prevalence of soft signs in schizophrenics and controls comparable to findings of Buchanan (1989). A sub-sample of chronic schizophrenic patients shows marked neuro-functional deficits, which suggests a connection of soft signs with the deficit syndrome (Carpenter 1988). Data will be presented on correlations of soft signs with negative symptoms (SAN& PANNS), neuropsychological deficits (Wisconsin Card Sorting Test, Tower of London, Petrides, Weigl) and medication and side-effects (AIMS, Simpson-Angus Scale). The next goal of the study is to clarify the predictive value of neurological soft signs. Buchanan RW, Heinrichs DW: The Neurological Evaluation Scale (NES). Psychiatry Research 1989, 27, 335350; Carpenter WT Jr., Heinrichs DW, Wagman AMI: Deficit and nondeficit forms of schizophrenia: the concept. Am J Psychiatry 1988; 145578-583; Kolakowska T, Williams AO, Jambor K, Ardern M: III. Neurological Soft Signs, Cognitive Impairment and their Clinical Significance. Br J Psychiatry 1985; 146:348-357; Quitkin F, Rifkin A, Klein DF: Neurologic soft signs in schizophrenia and character disorder. Archives of General Psychiatry 1976; 33~845-853. ‘The authors are grateful to S. Honicke, R. Prior, R. Schlencker, P. Werther for invaluable help in collecting and scoring the data. The study was supported by a grant of the BMFT (Bundesministerium fiir Forschung und Technologie). The testing was carried out at the BKH Haar (Dir. Prof. W. Bender) and the PLK Reichenau (Dir. Dr. P. Gerking).
Schizophrenia difference? K.H. Nuechterlein:,
and schizophreniform J. Ventura,
I.R.H. Falloon,
disorder: Is there a critical
D. Fogelson,
M. Gitlin
UCLA Dept. Psych. & Biobehav. Sciences, 300 UCLA Medical Plazu, W22Ot.JLosAngeles, C490024-6968
USA.
With DSM-IV on the horizon, the question ofwhether the DSM-III-R schizophrenia criterion of a six-month minimum duration of illness yields a meaningful distinction is particularly salient. Some previous research has suggested that schizophreniform disorder may have a more benign course and that it may not even be a variant of schizophrenia. Schizophreniform disorder is commonly diagnosed during the first period of psychosis, but does this initial diagnosis reflect critical differences in the subsequent disorders? To address these issues, we examined data from patients with a first onset of major psychosis during the prior two years, 28 of whom met DSM-III-R criteria for schizophrenia and 15 of whom met DSM-III-R criteria for schizophreniform disorder. Patients were recruited from consecutive admissions to four public hospitals in Los Angeles metropolitan area. All were treated during an initial one-year outpatient period with 12.5 mg of fluphenazine decanoate every two weeks, rated systematically for psychiatric symptoms every two weeks and for social and occupational outcome every three months, and assessed for information-processing anomalies with the Continuous Performance Test (CPT) and forced-choice span of apprehension task. At the beginning of the period on standardized medication, schizophrenic patients had significantly lower target detection rates than schizophreniform patients on a degraded-stimulus CPT and a memory-load CPT, tasks that may tap enduring vulnerability factors for schizophrenia. The schizophrenic patients showed a similar tendency to have lower target detection rates on the degraded-stimulus CPTat the end of one year. The one-year course of the schizophreniform and schizophrenic patients was, however, not distinguishable by psychotic relapse rate, duration of positive or negative symptoms, social functioning, or occupational functioning. By the end of the one-year, standardized-medication period, 14 of the 15 patients initially diagnosed as having schizophreniform disorder had shown sufficient continuing symptoms to meet criteria for DSM-III-R schizophrenia. These results suggest that the early clinical course of patients initially diagnosed as having schizophreniform disorder is usually very similar to that of patients with an initial diagnosis of schizophrenia. Perhaps the six-month criterion is not optimal and a shorter duration criterion should be considered. Possible information-processing differences between the two disorders initially are intriguing. They may indicate presence of a
266 more severe vulnerability component in cases diagnosed as schizophrenia during their first episode or reflect underlying deficits that gradually worsen during initial phases of schizophrenia.
Neuropsychological deficit and symptomatology: heterogeneity of positive symptoms D.S. O’Leary*, N.C. Andreasen,
Evidence for the
M.C. Kesler, and S. Arndt
Mental Health Clinical Research Center, Department of Psychiatry, University of Iowa, Iowa City, 0152242,
USA
The positive-negative symptom dichotomy has strongly influenced recent conceptualizations of the nature of schizophrenia. Several studies have now shown that negative symptoms are significantly associated with one another but that intercorrelations among positive symptoms are less strong. A recent factor analytic study by our group on the SANS/SAPS found three factors rather than the two suggested by the positive-negative distinction (Arndt, Alliger & Andreasen, Br J Psychiatry, in press). Negative global scores made up one clear factor but positive globals split, with hallucinations and delusions making up one factor and positive formal thought disorder (PFTD) and bizarre behavior forming another. The present study explores the possibility that positive symptoms may be differentially related to cognitive performance. Data will be reported from three independent samples of schizophrenics (DSM-III criteria) studied at the University of Iowa Psychiatric Hospital. All patients received a comprehensive neuropsychological battery. Severity of negative symptoms was found to be related to a wide range of cognitive deficits including lower IQ scores and poorer performance on measures of attention and memory. Severity of hallucinations and delusions, in contrast, was not significantly related to deficiencies on any measure in the battery. Patients with high ratings on PFTD and bizarre behavior showed a pattern of cognitive disorganization that was less consistent across the three studies than the generalized deficit associated with negative symptoms. The results support previous findings that negative symptoms are associated with cognitive deficit that may reflect underlying brain pathology. Florid positive symptoms show no evidence of association with cognitive impairment. We will discuss the possibility that the cognitive disorganization associated with PFTD and bizarre behavior reflects a neuropathological process independent of that associated with negative symptoms.
Negative schizophrenia
as a variant of parkinsonism
R. Sandyk Department of Psychiatry, Albefl Einsteirl College of MedicinelMontejiore Medical Center, Bronx, NY 10461, USA.
Current models of schizophrenia suggest that it comprises two distinct facets of psychopathology, positive and negative. The latter is viewed as a core feature and is associated with poor neuroleptic response and outcome. Based on clinical, neuroradiological, and pharmacological similarities, we have recently proposed that negative symptoms in schizophrenia may be a variant of parkinsonism, both sharing common pathophysiological mechanisms. To empirically investigate this association, we examined in 46 neuroleptic-stabilized chronic schizophrenic patients (42 men, 4 women; mean age = 33.1 years, SD =8.3) the association of drug-induced parkinsonian symptoms with positive and negative features of schizophrenia. Parkinsonism was evaluated on Alpert’s Extrapyramidal Rating Scale (ERS), which evaluates parkinsonian symptoms along seven dimensions that include gait, rigidity, tremor, abnormal movements, facial expression, restlessness, and bradykinesia. Positive and negative symptoms were blindly and independently rated according to the 4-item SAPS and S-item SANS of Andreasen. The prediction that parkinsonism would correlate with negative symptoms alone was tested with unidirectional Pearson product-moment analysis. The results indicated a significant association of ERS with global negative symptoms (r = 0.27; p < 0.05) and, among individual items of the negative scale, with alogia (r - 0.31, p < 0.05) and avolition-apathy (r = 0.29, p < 0.05). By contrast, the ERS was unrelated to the global positive symptom rating and each of the constituent items. The findings were thus consistent with the hypothesis of a specific relationship between negative features of schizophrenia and parkinsonism. Furthermore, these data are significant for a broader conceptualization of the schizophrenic illness and Parkinson’s disease, and have potential implications for the pharmacologic and neurosurgical
Schizophrenia difference? K.H. Nuechterlein:,
and schizophreniform J. Ventura,
I.R.H. Falloon,
disorder: Is there a critical
D. Fogelson,
M. Gitlin
UCLA Dept. Psych. & Biobehav. Sciences, 300 UCLA Medical Plazu, W22Ot.JLosAngeles, C490024-6968
USA.
With DSM-IV on the horizon, the question ofwhether the DSM-III-R schizophrenia criterion of a six-month minimum duration of illness yields a meaningful distinction is particularly salient. Some previous research has suggested that schizophreniform disorder may have a more benign course and that it may not even be a variant of schizophrenia. Schizophreniform disorder is commonly diagnosed during the first period of psychosis, but does this initial diagnosis reflect critical differences in the subsequent disorders? To address these issues, we examined data from patients with a first onset of major psychosis during the prior two years, 28 of whom met DSM-III-R criteria for schizophrenia and 15 of whom met DSM-III-R criteria for schizophreniform disorder. Patients were recruited from consecutive admissions to four public hospitals in Los Angeles metropolitan area. All were treated during an initial one-year outpatient period with 12.5 mg of fluphenazine decanoate every two weeks, rated systematically for psychiatric symptoms every two weeks and for social and occupational outcome every three months, and assessed for information-processing anomalies with the Continuous Performance Test (CPT) and forced-choice span of apprehension task. At the beginning of the period on standardized medication, schizophrenic patients had significantly lower target detection rates than schizophreniform patients on a degraded-stimulus CPT and a memory-load CPT, tasks that may tap enduring vulnerability factors for schizophrenia. The schizophrenic patients showed a similar tendency to have lower target detection rates on the degraded-stimulus CPTat the end of one year. The one-year course of the schizophreniform and schizophrenic patients was, however, not distinguishable by psychotic relapse rate, duration of positive or negative symptoms, social functioning, or occupational functioning. By the end of the one-year, standardized-medication period, 14 of the 15 patients initially diagnosed as having schizophreniform disorder had shown sufficient continuing symptoms to meet criteria for DSM-III-R schizophrenia. These results suggest that the early clinical course of patients initially diagnosed as having schizophreniform disorder is usually very similar to that of patients with an initial diagnosis of schizophrenia. Perhaps the six-month criterion is not optimal and a shorter duration criterion should be considered. Possible information-processing differences between the two disorders initially are intriguing. They may indicate presence of a
266 more severe vulnerability component in cases diagnosed as schizophrenia during their first episode or reflect underlying deficits that gradually worsen during initial phases of schizophrenia.
Neuropsychological deficit and symptomatology: heterogeneity of positive symptoms D.S. O’Leary*, N.C. Andreasen,
Evidence for the
M.C. Kesler, and S. Arndt
Mental Health Clinical Research Center, Department of Psychiatry, University of Iowa, Iowa City, 0152242,
USA
The positive-negative symptom dichotomy has strongly influenced recent conceptualizations of the nature of schizophrenia. Several studies have now shown that negative symptoms are significantly associated with one another but that intercorrelations among positive symptoms are less strong. A recent factor analytic study by our group on the SANS/SAPS found three factors rather than the two suggested by the positive-negative distinction (Arndt, Alliger & Andreasen, Br J Psychiatry, in press). Negative global scores made up one clear factor but positive globals split, with hallucinations and delusions making up one factor and positive formal thought disorder (PFTD) and bizarre behavior forming another. The present study explores the possibility that positive symptoms may be differentially related to cognitive performance. Data will be reported from three independent samples of schizophrenics (DSM-III criteria) studied at the University of Iowa Psychiatric Hospital. All patients received a comprehensive neuropsychological battery. Severity of negative symptoms was found to be related to a wide range of cognitive deficits including lower IQ scores and poorer performance on measures of attention and memory. Severity of hallucinations and delusions, in contrast, was not significantly related to deficiencies on any measure in the battery. Patients with high ratings on PFTD and bizarre behavior showed a pattern of cognitive disorganization that was less consistent across the three studies than the generalized deficit associated with negative symptoms. The results support previous findings that negative symptoms are associated with cognitive deficit that may reflect underlying brain pathology. Florid positive symptoms show no evidence of association with cognitive impairment. We will discuss the possibility that the cognitive disorganization associated with PFTD and bizarre behavior reflects a neuropathological process independent of that associated with negative symptoms.
Negative schizophrenia
as a variant of parkinsonism
R. Sandyk Department of Psychiatry, Albefl Einsteirl College of MedicinelMontejiore Medical Center, Bronx, NY 10461, USA.
Current models of schizophrenia suggest that it comprises two distinct facets of psychopathology, positive and negative. The latter is viewed as a core feature and is associated with poor neuroleptic response and outcome. Based on clinical, neuroradiological, and pharmacological similarities, we have recently proposed that negative symptoms in schizophrenia may be a variant of parkinsonism, both sharing common pathophysiological mechanisms. To empirically investigate this association, we examined in 46 neuroleptic-stabilized chronic schizophrenic patients (42 men, 4 women; mean age = 33.1 years, SD =8.3) the association of drug-induced parkinsonian symptoms with positive and negative features of schizophrenia. Parkinsonism was evaluated on Alpert’s Extrapyramidal Rating Scale (ERS), which evaluates parkinsonian symptoms along seven dimensions that include gait, rigidity, tremor, abnormal movements, facial expression, restlessness, and bradykinesia. Positive and negative symptoms were blindly and independently rated according to the 4-item SAPS and S-item SANS of Andreasen. The prediction that parkinsonism would correlate with negative symptoms alone was tested with unidirectional Pearson product-moment analysis. The results indicated a significant association of ERS with global negative symptoms (r = 0.27; p < 0.05) and, among individual items of the negative scale, with alogia (r - 0.31, p < 0.05) and avolition-apathy (r = 0.29, p < 0.05). By contrast, the ERS was unrelated to the global positive symptom rating and each of the constituent items. The findings were thus consistent with the hypothesis of a specific relationship between negative features of schizophrenia and parkinsonism. Furthermore, these data are significant for a broader conceptualization of the schizophrenic illness and Parkinson’s disease, and have potential implications for the pharmacologic and neurosurgical