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Stability of neurological soft signs in chronic schizophrenics: Relationship to psychopathology, smoking, and atypical neuroleptics
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STABILITY OF NEUROLOGICAL SOFT SIGNS IN CHRONIC SCHIZOPHRENICS: RELATIONSHIP TO PSYCHOPATHOLOGY, SMOKING, AND ATYPICAL NEUROLEPTICS Robert C . Smith, Mohammed I. Hussain, Shabbir A. Chowdhury, Sobia M . Jafri
Dept Psychiatry. NYU MedicalSchool & Manhattan Psychiat. Cntr.• PO Box 316. Hewlett, N. Y. 11557. USA Neurological soft signs (NSS) have been shown to be much more prevalent in schizophrenics, both in chronically ill medicated patients and drug naive or neuroleptic free schizophrenics. Whether NSS scores are a stable trait or variable state characteristic in schizophrenia is unclear. We have investigated the stability of NSS in chronically hospitalized schizophrenic patients, rated two or more times over the course of 3 yrs with standard NSS and psychopathology scales. Total NSS scores were highly correlated (r's=0.76 to 0.86p<0.OOI), and changes in NSS scores at two time points were not significantly related to changes in BPRS, SAPS. and SANS scale scores. Component NSS subscale scores of motor sequencing and motor coordination tasks showed moderate stability over time. and changes were not correlated with changes in psychopathology scores. In a subsample of patients rated when they were treated with traditional neuroleptics and later with risperidone and/or clozapine, there were no significant effects of atypical neuroleptics to produce lower NSS scores. However. high NSS scores were associated with poorer clinical response to risperidone in chron ic nonresponders. NSS total score was negatively related to degree of smoking as measured by Fagestrom Tolerance Scale (FTS), and stability of NSS was positively correlated with FTS. Our finding that total NSS score was relatively stable over time, and did not vary with psychopathology or treatment with atypical neuroleptics, supports the suggestion that this measure may represent a trait characteristic in chronically hospitalized schizophrenics.
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COMPUTERIZED SELF·ASSESSMENT OF PSYCHOSIS SEVERITY [COSAPS] IN SCHIZOPHRENIA. A PRELIMINARY REPORT ON THE COSAPSQUESTIONNAIRE Robert G . Stern, Ronald Fudge, Cecile Sisson, Edward Alan, James Crichton, James Schmeidler, Miklos Losonczy
Psychiatry Service. F.D.R. Montrose v-4 Hospital. Montrose, NY 10548. USA This project attempted to develop for clinical and research purposes a computerized self-administered multiple choice questionnaire (COSAPS-Q) to reliably assess illness severity in patients with schizophrenia . The COSAPS questionnaire is
completed by patients using three keys of a conventional personal computer keyboard. The COSAPS·Q was designed in such a way, that the resulting severity of illness scores would be comparable to BPRS or PANSS scores obtained from rater administered interviews, and that scores would be sensitive to changes in symptom severity during inpatient or outpatient treatment periods. After a paper and pencil pilot trial a 77 questions (five multiple choice answers) DO~riven computerized version was developed. So far 37 patients with OSM IV schizophren ia, who have signed informed consent have completed the questionnaire . Mean (± SO) answering time per questionnaire item was 33.6±55 seconds. PANSS and CGI ratings were obtained to validate the instrument. Factor analysis revealed an optimal 4 factor solution explaining 59%of the variance. 44 Questionnaire items with a correlation coefficient >0.5 were then used to conduct a discriminant analysis by CGI. This analysis resulted in two statistically highly significant discriminant functions indicating that COSAPS scores could differentiate between CGI scores in the range 3-5.
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RATER GENDER AND SYMPTOM RATINGS OF PATIENTS WITH SCHIZOPHRENIA Charlie L. Swanson Jr., Bruce I. Turetsky, Warren Bilker, Ruben C. Gur, Raquel E. Gur
Schizophrenia Mental Health Clinical Research Center, University ofPennsylvania. Philadelphia. PA 19104, USA Sex differences have been reported in the presentation and outcome of patients with schizophrenia. Given the gender differences that have been reported in healthy controls in cognitive performance, emotion discrimination, and neuroanatomy, it is important to determine whether male and female clinicians assess psychopathology differently. We examined 258 ratings of patient videotapes from meetings of the clinical core of the MHCRC (current reliability across raters: BPRS total 0.91, SANS item averages 0.96. SANS global ratings 0.89. SAPS 0.93 and 0.99). However, when the ratings were grouped by sex of the rater and patient gender and examined by multivariate analyses of variance, female raters rated more psychopathology on global SANS/SAPS SCOres (HotellingLawley Trace T=0.062; F=2 .6; df=6,249; p=O.02) with significant differences for alogia and bizarre behavior; averaged item SANS/SAPS scores (T=0.12; F=5.0; df=6,249; p= 0.0001) with significant differences for affective flattening, alogia, hallucinations, delusions, bizarre behavior, and thought disorder; and BPRS specific/nonspecific SCores (T=O.047; F= 6.0; df=2,253; p-=0.OO3). There were no rater sex by patient sex interactions. Gender differences extend to ratings of patients by trained, reliable clinical investigators.
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STABILITY OF NEUROLOGICAL SOFT SIGNS IN CHRONIC SCHIZOPHRENICS: RELATIONSHIP TO PSYCHOPATHOLOGY, SMOKING, AND ATYPICAL NEUROLEPTICS Robert C . Smith, Mohammed I. Hussain, Shabbir A. Chowdhury, Sobia M . Jafri
Dept Psychiatry. NYU MedicalSchool & Manhattan Psychiat. Cntr.• PO Box 316. Hewlett, N. Y. 11557. USA Neurological soft signs (NSS) have been shown to be much more prevalent in schizophrenics, both in chronically ill medicated patients and drug naive or neuroleptic free schizophrenics. Whether NSS scores are a stable trait or variable state characteristic in schizophrenia is unclear. We have investigated the stability of NSS in chronically hospitalized schizophrenic patients, rated two or more times over the course of 3 yrs with standard NSS and psychopathology scales. Total NSS scores were highly correlated (r's=0.76 to 0.86p<0.OOI), and changes in NSS scores at two time points were not significantly related to changes in BPRS, SAPS. and SANS scale scores. Component NSS subscale scores of motor sequencing and motor coordination tasks showed moderate stability over time. and changes were not correlated with changes in psychopathology scores. In a subsample of patients rated when they were treated with traditional neuroleptics and later with risperidone and/or clozapine, there were no significant effects of atypical neuroleptics to produce lower NSS scores. However. high NSS scores were associated with poorer clinical response to risperidone in chron ic nonresponders. NSS total score was negatively related to degree of smoking as measured by Fagestrom Tolerance Scale (FTS), and stability of NSS was positively correlated with FTS. Our finding that total NSS score was relatively stable over time, and did not vary with psychopathology or treatment with atypical neuroleptics, supports the suggestion that this measure may represent a trait characteristic in chronically hospitalized schizophrenics.
~h
COMPUTERIZED SELF·ASSESSMENT OF PSYCHOSIS SEVERITY [COSAPS] IN SCHIZOPHRENIA. A PRELIMINARY REPORT ON THE COSAPSQUESTIONNAIRE Robert G . Stern, Ronald Fudge, Cecile Sisson, Edward Alan, James Crichton, James Schmeidler, Miklos Losonczy
Psychiatry Service. F.D.R. Montrose v-4 Hospital. Montrose, NY 10548. USA This project attempted to develop for clinical and research purposes a computerized self-administered multiple choice questionnaire (COSAPS-Q) to reliably assess illness severity in patients with schizophrenia . The COSAPS questionnaire is
completed by patients using three keys of a conventional personal computer keyboard. The COSAPS·Q was designed in such a way, that the resulting severity of illness scores would be comparable to BPRS or PANSS scores obtained from rater administered interviews, and that scores would be sensitive to changes in symptom severity during inpatient or outpatient treatment periods. After a paper and pencil pilot trial a 77 questions (five multiple choice answers) DO~riven computerized version was developed. So far 37 patients with OSM IV schizophren ia, who have signed informed consent have completed the questionnaire . Mean (± SO) answering time per questionnaire item was 33.6±55 seconds. PANSS and CGI ratings were obtained to validate the instrument. Factor analysis revealed an optimal 4 factor solution explaining 59%of the variance. 44 Questionnaire items with a correlation coefficient >0.5 were then used to conduct a discriminant analysis by CGI. This analysis resulted in two statistically highly significant discriminant functions indicating that COSAPS scores could differentiate between CGI scores in the range 3-5.
~7
RATER GENDER AND SYMPTOM RATINGS OF PATIENTS WITH SCHIZOPHRENIA Charlie L. Swanson Jr., Bruce I. Turetsky, Warren Bilker, Ruben C. Gur, Raquel E. Gur
Schizophrenia Mental Health Clinical Research Center, University ofPennsylvania. Philadelphia. PA 19104, USA Sex differences have been reported in the presentation and outcome of patients with schizophrenia. Given the gender differences that have been reported in healthy controls in cognitive performance, emotion discrimination, and neuroanatomy, it is important to determine whether male and female clinicians assess psychopathology differently. We examined 258 ratings of patient videotapes from meetings of the clinical core of the MHCRC (current reliability across raters: BPRS total 0.91, SANS item averages 0.96. SANS global ratings 0.89. SAPS 0.93 and 0.99). However, when the ratings were grouped by sex of the rater and patient gender and examined by multivariate analyses of variance, female raters rated more psychopathology on global SANS/SAPS SCOres (HotellingLawley Trace T=0.062; F=2 .6; df=6,249; p=O.02) with significant differences for alogia and bizarre behavior; averaged item SANS/SAPS scores (T=0.12; F=5.0; df=6,249; p= 0.0001) with significant differences for affective flattening, alogia, hallucinations, delusions, bizarre behavior, and thought disorder; and BPRS specific/nonspecific SCores (T=O.047; F= 6.0; df=2,253; p-=0.OO3). There were no rater sex by patient sex interactions. Gender differences extend to ratings of patients by trained, reliable clinical investigators.