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Symptom and demographic profiles in first-episode psychosis
4
1. Diagnosis
K.E., Barnett, B.E., & Josiassen, R.C. (1998). Assessment of suicide in schizophrenia: Development of the Interview for Suicide in Schizophrenia. _Cognitive and Behavioral Practice, 5, 139-169.
THE EFFECTS OF ANTISPYCHOTIC MEDICATION
ON NEUROLOGICAL
EXAMINATION
ABNORMALITIES
IN
SCHIZOPHRENIA CUMULATIVE PREDICTION
RISK ASSESSMENT OF DEVELOPMENT
FOR OF
SCHIZOPHRENIA A. M. Freeman,* A. S. Kablinger, J. C. Patterson, M. E Glabus
Psychiatry, Louisiana State University Health Sciences Center, Shreveport, IA, USA In recent years, considerable attention has been directed toward discovering the endophenotype for schizophrenia. Some groups have focused on first-episode or prodromal schizophrenia. Others have studied first and second-degree family members of schizophrenia patients as well as normal individuals to ascertain intermediate or subthreshold individuals. Our group is studying clinical rating, biological markers, and risk factors in schizophrenics, their first-degree relatives and matched controls. Risk factors include such issues as maternal second trimester viral infections, obstetrical complications, head trauma in childhood, soft neurological signs, substance abuse (particularly marijuana) among others. Putative biological markers studies are eye-tracking abnormalities, pre-pulse inhibition deficits, genetic factors, and at this time most critically, structural and functional neuroimaging findings. Increased ventricular size, reduced neuropil, reduced amygdala and hippocampal size as well as altered connectivity, particularly between cortico-temporal, thalamic, and cerebellar sites on functional MRI wilt be among the findings we expect in attenuated form among the first-degree relatives. Our ultimate goal is to develop a mathematical statement of risk of schizophrenia in relatives that encompasses all of these areas. Preliminary data suggest unique differences between groups that may be useful in predicting risk.
G. Goldstein,* R. D. Sanders
Research, VA Pittsburgh HCS, Pittsburgh, PA, USA In previous research we factor analyzed a modified version of the Neurologic Evaluation Scale (NES), a structured neurological examination designed for use with patients with schizophrenia. Four factors were extracted assessing repetitive movements, information processing, gait and stability and the palmomental reflex. In this study, we administered the NES to 79 patients with schizophrenia on and off medication. We repeated the factor analysis under both conditions, essentially replicating the original analysis in the off-drug condition, but obtaining a very different solution in the on-drug condition that was largely uninterpretable. We also cluster analyzed the data in off and on drug conditions in order to evaluate heterogeneity in neurological status within the sample. A three cluster solution was obtained under both conditions. One cluster representing 60% of the sample had mean scores in the normal range; a second cluster had severe impairment, while the third had impairment only on the items that loaded on the information processing factor. An examination of the effect of medication indicated that patients with normal scores remained normal after being medicated. However, many of the patients in the impaired groups improved with medication. The conclusions were that (1) For unclear reasons medication makes the factor structure of the NES difficult to interpret while there is an easily interpreted structure off medication; (2) Neurological status in schizophrenia is heterogeneous, with a large proportion of patients having normal performance on the NES; (3) Medication does not worsen normal NES performance but may be associated with improvement of abnormal pertbrmance.
NEUROPSYCHOLOGICAL FIRST-EPISODE
SYMPTOM
AND DEMOGRAPHIC
FIRST-EPISODE
PROFILES IN
PSYCHOSIS
E. I. Gelber,* C. Kohler, W. Bilker, C. Brensinger, R. E. Gur
Psychiatry Residency Training Program, Box 356560, University of Washington, Seattle, WA, USA First-episode psychosis presents a diagnostic challenge because of symptomatic overlap between the various causes of psychosis. An early and accurate diagnosis is important for the implementation of appropriate treatment, for determining prognosis, and for identifying research participants. In an effort to facilitate early diagnosis, we followed a group of first-episode psychosis patients with a presumptive diagnosis of schizophrenia who were subsequently diagnosed at six-month follow-up with either schizophrenia (n=104) or other psychiatric diagnoses (n=19). The two groups (first-episode schizophrenia and first-episode non-schizophrenia) were compared on measures of demographics, symptoms, quality of life, premorbid adjustment and lateral dominance. Odds ratios were calculated for each variable and all significant variables were entered into a multivariate model. The model showed that higher levels of anhedonia (OR=2.28, p=.010) and bizarre behavior (OR=3.28, p=.024) increased the odds of a final diagnosis of schizophrenia.
STATUS OF THE
PRODROME
K. A. Hawkins,* T. McGlashan, R. Keefe, B. Christensen, J. Addington, E. Marquez, A. Breier
Psychiatry; Yale University, New Haven, CT, USA The study purpose was to determine the neuropsychological status of subjects diagnosed as prodromal to a first episode of psychosis. Subjects were examined within 2 weeks of being diagnosed as prodromal. Subjects aged 16 years or older in putatively prodromal states at four North American Sites (N = 36) exhibited neuropsychological performances that fall between the deficient level commonly reported for schizophrenia (both first episode and chronic schizophrenia samples, e.g., Goldberg et al 1990) and the performances of healthy subjects. Since neuropsychological decline may accompany a first episode of psychosis (possibly related to the typical lengthy duration of illness before treatment initiation), this finding lends hope to the notions (a) that the prevention of first-break psychosis by treatment in the prodrome could possibly result in a relative preservation of neuropsychological competence, (b) that the nem-opsychological decline associated with the first episode of psychosis might possibly be attenuated by the early identification and treatment of frank psychosis (facilitated by close monitoring of the prodrome), and (c) that the presence of neuropsychological weaknesses may possibly facilitate diagnosis of the true prodromal state. Pending analyses related to conversion prediction, early course, and the effect of treatment will be presented.
International Congress on Schizophrenia Research 2003
1. Diagnosis
K.E., Barnett, B.E., & Josiassen, R.C. (1998). Assessment of suicide in schizophrenia: Development of the Interview for Suicide in Schizophrenia. _Cognitive and Behavioral Practice, 5, 139-169.
THE EFFECTS OF ANTISPYCHOTIC MEDICATION
ON NEUROLOGICAL
EXAMINATION
ABNORMALITIES
IN
SCHIZOPHRENIA CUMULATIVE PREDICTION
RISK ASSESSMENT OF DEVELOPMENT
FOR OF
SCHIZOPHRENIA A. M. Freeman,* A. S. Kablinger, J. C. Patterson, M. E Glabus
Psychiatry, Louisiana State University Health Sciences Center, Shreveport, IA, USA In recent years, considerable attention has been directed toward discovering the endophenotype for schizophrenia. Some groups have focused on first-episode or prodromal schizophrenia. Others have studied first and second-degree family members of schizophrenia patients as well as normal individuals to ascertain intermediate or subthreshold individuals. Our group is studying clinical rating, biological markers, and risk factors in schizophrenics, their first-degree relatives and matched controls. Risk factors include such issues as maternal second trimester viral infections, obstetrical complications, head trauma in childhood, soft neurological signs, substance abuse (particularly marijuana) among others. Putative biological markers studies are eye-tracking abnormalities, pre-pulse inhibition deficits, genetic factors, and at this time most critically, structural and functional neuroimaging findings. Increased ventricular size, reduced neuropil, reduced amygdala and hippocampal size as well as altered connectivity, particularly between cortico-temporal, thalamic, and cerebellar sites on functional MRI wilt be among the findings we expect in attenuated form among the first-degree relatives. Our ultimate goal is to develop a mathematical statement of risk of schizophrenia in relatives that encompasses all of these areas. Preliminary data suggest unique differences between groups that may be useful in predicting risk.
G. Goldstein,* R. D. Sanders
Research, VA Pittsburgh HCS, Pittsburgh, PA, USA In previous research we factor analyzed a modified version of the Neurologic Evaluation Scale (NES), a structured neurological examination designed for use with patients with schizophrenia. Four factors were extracted assessing repetitive movements, information processing, gait and stability and the palmomental reflex. In this study, we administered the NES to 79 patients with schizophrenia on and off medication. We repeated the factor analysis under both conditions, essentially replicating the original analysis in the off-drug condition, but obtaining a very different solution in the on-drug condition that was largely uninterpretable. We also cluster analyzed the data in off and on drug conditions in order to evaluate heterogeneity in neurological status within the sample. A three cluster solution was obtained under both conditions. One cluster representing 60% of the sample had mean scores in the normal range; a second cluster had severe impairment, while the third had impairment only on the items that loaded on the information processing factor. An examination of the effect of medication indicated that patients with normal scores remained normal after being medicated. However, many of the patients in the impaired groups improved with medication. The conclusions were that (1) For unclear reasons medication makes the factor structure of the NES difficult to interpret while there is an easily interpreted structure off medication; (2) Neurological status in schizophrenia is heterogeneous, with a large proportion of patients having normal performance on the NES; (3) Medication does not worsen normal NES performance but may be associated with improvement of abnormal pertbrmance.
NEUROPSYCHOLOGICAL FIRST-EPISODE
SYMPTOM
AND DEMOGRAPHIC
FIRST-EPISODE
PROFILES IN
PSYCHOSIS
E. I. Gelber,* C. Kohler, W. Bilker, C. Brensinger, R. E. Gur
Psychiatry Residency Training Program, Box 356560, University of Washington, Seattle, WA, USA First-episode psychosis presents a diagnostic challenge because of symptomatic overlap between the various causes of psychosis. An early and accurate diagnosis is important for the implementation of appropriate treatment, for determining prognosis, and for identifying research participants. In an effort to facilitate early diagnosis, we followed a group of first-episode psychosis patients with a presumptive diagnosis of schizophrenia who were subsequently diagnosed at six-month follow-up with either schizophrenia (n=104) or other psychiatric diagnoses (n=19). The two groups (first-episode schizophrenia and first-episode non-schizophrenia) were compared on measures of demographics, symptoms, quality of life, premorbid adjustment and lateral dominance. Odds ratios were calculated for each variable and all significant variables were entered into a multivariate model. The model showed that higher levels of anhedonia (OR=2.28, p=.010) and bizarre behavior (OR=3.28, p=.024) increased the odds of a final diagnosis of schizophrenia.
STATUS OF THE
PRODROME
K. A. Hawkins,* T. McGlashan, R. Keefe, B. Christensen, J. Addington, E. Marquez, A. Breier
Psychiatry; Yale University, New Haven, CT, USA The study purpose was to determine the neuropsychological status of subjects diagnosed as prodromal to a first episode of psychosis. Subjects were examined within 2 weeks of being diagnosed as prodromal. Subjects aged 16 years or older in putatively prodromal states at four North American Sites (N = 36) exhibited neuropsychological performances that fall between the deficient level commonly reported for schizophrenia (both first episode and chronic schizophrenia samples, e.g., Goldberg et al 1990) and the performances of healthy subjects. Since neuropsychological decline may accompany a first episode of psychosis (possibly related to the typical lengthy duration of illness before treatment initiation), this finding lends hope to the notions (a) that the prevention of first-break psychosis by treatment in the prodrome could possibly result in a relative preservation of neuropsychological competence, (b) that the nem-opsychological decline associated with the first episode of psychosis might possibly be attenuated by the early identification and treatment of frank psychosis (facilitated by close monitoring of the prodrome), and (c) that the presence of neuropsychological weaknesses may possibly facilitate diagnosis of the true prodromal state. Pending analyses related to conversion prediction, early course, and the effect of treatment will be presented.
International Congress on Schizophrenia Research 2003