- Email: [email protected]
The Peters et al. Delusions Inventory (PDI): New norms for the 21-item version
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in self-awareness may be due in part to neuropsychological dysfunction of the frontal lobes. Our data indicate that neuropsychological dysfunction of the frontal lobes is strongly associated with poor insight both on and off of medication. Historically, unawareness in schizophrenia has been thought to be caused by denial, or psychological defensiveness. However, this hypothesis has never been tested. The research on self-deception in affective disorders provides a theoretical framework and methodology for such a test. Our data indicate that self-deceptive enhancement is related to misattributions about illness but that defensiveness in general appears to play a more minor role in poor insight than do neuropsychological deficits. Though the relationship between defensiveness and depression has been studied in samples of nonclinical subjects as well as patients with affective disorders, there has been no direct study of this relationship in patients with schizophrenia. Our results support the hypothesis that self-deceptive enhancement is associated with decreased depression in patients with schizophrenia.
IV.C. Catatonia IV.C.1 'CATATONIC SCHIZOPHRENIA' IS NOT 'SCHIZOPHRENIA' Max Fink Department of Psychiatry, SUNY at Stony Brook, Stony Brook, NYl1794-8101, U.S.A. For more than a century, patients with psychosis and motor signs identified by Kahlbaum as 'catatonia' have been classified as "schizophrenia, catatonic type', In DSM-III, this was the only diagnosis that could be ascribed to someone with catatonic signs, as the signs were not recognized as part of any other diagnosis. This was so, despite numerous observations that catatonia was prominent in patients with systemic disorders [like lupus erythematosus and infections], affective disorders [especially mania], and toxic states [as in the neuroleptic malignant syndrome]. Catatonia, once thought to be rare, is recognized increasingly, comprising 7-9% of adult psychiatric in-patient populations. Less than 1/3 meet conventional criteria for schizophrenia. The administration of neuroleptic drugs, usually considered the initial and primary treatment of schizophrenia, is often detrimental to those with catatonia. The development of catatonia screening and rating instruments and effective treatment protocols enables the separation of patients with signs of catatonia from those identified, studied, and treated as a type of schizophrenia. Present treatment eschews neuroleptics and administers benzodiazepines in high doses, and when these fail, electroconvulsive therapy. These experiences may be of interest to researchers in schizophrenia as they encourage a different view of the pathophysiology of these disorders.
IV.C.2 SCHIZOPHRENIA AND ITS CATATONIC SUBTYPE INSTABILITY D U R I N G L O N G TERM FOLLOW-UP N. M i m i c a
University Department of Psychiatry, Psychiatric Hospital Vrap6e, Bolni~ka cesta 32, HR-IO090 Zagreb, Croatia The study presents data about schizophrenia, and its catatonic subtype instability during the long-term follow up. As a base for forming this sample of schizophrenics the Croatian Psychotics Case Register (CPCR), which has been run in Croatian National Institute of Public Health since 1962, was used. The Register was formed on the basis of obligatory reports of hospitalized psychotic patients. The representative sample of schizophrenics, for epidemiological-clinical followup, was formed in 1972 from the evidence of 8068 patients younger than 55 years, and without additional diagnosis of mental retardation. This sample comprised 402 patients (207 males and 195 females), who were followed up until 1990/91. It was found that diagnosis of schizophrenia, catatonic type (V/295.2), according to valid ICD classification, was made in 59 (14.7%) cases, once or several times in their life. Among these patients there were 28 males and 31 females. In order to obtain data on the stability of subtype diagnosis of these schizophrenics every hospitalization and diagnosis at discharge was noted. It was found that diagnosis of catatonic schizophrenia was made after first hospitalization in 31 (52.6%) cases, in 18 (30.5%) schizophrenics after second or third hospitalization, and remaining 10 (16.9%) patients received this diagnosis after fourth hospitalization or later. During the course of illness the majority of schizophrenic patients change their types of clinical picture and at the end of this follow-up in only 11 (18.6%) cases the diagnosis of catatonic schizophrenia was made.
IV.D. Delusions IV.D. 1 THE PETERS et al. D E L U S I O N S I N V E N T O R Y (PDI): N E W N O R M S F O R T H E 21-ITEM VERSION E.R. Peters a n d P.A. G a r e t y
Department of Psychology, Institute of Psychiatry, London SE5, U.K. The original 40-item PDI was designed to measure delusional ideation in the normal population, using the PSE as a template. The multidimensionality of delusions was incorporated by including measures of distress, preoccupation and conviction. Good psychometric properties were reported on a sample of
119
272 (Peters et al, 1995). Individual items were endorsed by 1 in 4 adults on average. The range of scores between the normal sample and 20 deluded inpatients overlapped considerably, consistent with the continuous view of psychosis. The two samples were differentiated by their ratings on the distress, preoccupation and conviction scales, confirming the necessity for multidimensional analysis of delusional thinking. A 21-item version of the PDI was constructed on the basis of principal component analysis. New norms and psychometric properties are reported. Avenues of research using the PDI include its use as a selection instrument to investigate the experimental correlates of delusional beliefs, to assist in the longitudinal identification of at-risk individuals, to explore the relationship between delusional ideas and religious sects, and finally as a measure of therapeutic change.
IV.E. S c h i z o t y p y IV,E. 1 DIMENSIONS OF SCHIZOTYPY R.S. H o p k i n s
University Department of Psychiatry, Manchester University, Withington Hospital Manchester M20 8LR, U.K. Background. Schizotypal dimensions resemble attenuated syndromes of schizophrenia. A new inventory, measuring four such dimensions, has been derived from several schizotypy scales. The reliability and validity of these measures requires replication. Method. The inventory was completed by a non-patient group. Items were grouped, in terms of similarity, into eighteen facets, four or five per scale. A factor analysis of facet scores was performed. Results. Scale reliability ranged from alpha 0.76 to 0.90, facet reliability from 0.46 to 0.76 (average 0.62). Factor analysis generally replicated expected factor loadings. The factors extracted represented Unusual Experiences, Cognitive Disorganisation, Introvertive Anhedonia and Impulsive Nonconformity. The facet Thought Disorder loaded most highly with Unusual Experiences, rather than with Cognitive Disorganisation as expected. Conclusion. Although generally replicating the factor structure, the present findings suggest that the facet Thought Disorder is misplaced. The remaining facets of Cognitive Disorganisation measure anxiety and depression. Given that clinical thought disorder does not correlate with anxiety/depression, it is suggested that Cognitive Disorganisation is a misnomer for this scale. More empirical research is required before links between superficially similar schizotypal and schizophrenic dimensions can be made.
IV.E.2 I N C R E A S E D S C H I Z O T Y P Y SCORES IN N O R M A L SUBJECTS F O L L O W I N G T H E O R A L A D M I N I S T R A T I O N OF DAMPHETAMINE N.S. Gray, A.D. Pickering a n d J.A. G r a y
Riverside Forensic Services, Henry Rollin Unit, Horton Hospital, Long Grove Road, Epsom, Surrey KT19, and Department of Psychology, Institute of Psychiatry, De Crespigny Park, London SE5 8RQ, U.K. The dimensional view of schizophrenia states that psychotic symptoms can be measured along a continuum in the normal population. These sub-clinical psychotic-type experiences in normal subjects are termed schizotypal traits and are thought to reflect a fairly stable dimension of personality. The schizotypal framework views schizophrenia as representing an extreme end of the normal continuum and not as a discrete syndrome. The hypothesised relationship between schizotypy and schizophrenia is supported by findings that behavioural tasks sensitive to cognitive abnormalities characteristic of schizophrenia are also found to be abnormal in normal subjects with high schizotypal scores. Recent preliminary findings also suggest an association between schizotypy and dopamine D2 binding. A psychopharmacological study is presented where a measure of schizotypy (Eysenck's Psychoticism scale) was found to be significantly increased following a single oral dose of 5 mg or 10 mg D-amphetamine in normal subjects (F(2,57) = 3.34, p<0.04; N=60). These results suggest that schizotypy not only reflects sub-clinical schizophrenic phenomenology but also may suggest a similar underlying neurochemistry. In addition, the results indicate that measures of schizotypy in normal subjects may not reflect stable traits but may rather measure a state variable that is prone to fluctuation, just as schizophrenic symptoms themselves may fluctuate over time.
IV.E.3 SYNDROMES OF SCHIZOTYPY AND AGE AT SEXUAL MATURITY J.H. Gruzelier a n d J. Kaiser
Laboratory of Neuro-Psychophysiology, Department of Psychiatry, Charing Cross and Westminster Medical School University of London, St. Dunstan's Road, W6 8RP, U.K. Developmental regressive events such as pruning of synapses are implicated in schizophrenia with both over- and underconnectivity models proposed (Randall, Feinberg, Hoffman). Saugstad (1989; 1994) theorised that extremes of normal variation at puberty distinguish affective psychoses (early maturation) from schizophrenia (late maturation). In normal students we have found a three-factor structure of schizotypy traits
in self-awareness may be due in part to neuropsychological dysfunction of the frontal lobes. Our data indicate that neuropsychological dysfunction of the frontal lobes is strongly associated with poor insight both on and off of medication. Historically, unawareness in schizophrenia has been thought to be caused by denial, or psychological defensiveness. However, this hypothesis has never been tested. The research on self-deception in affective disorders provides a theoretical framework and methodology for such a test. Our data indicate that self-deceptive enhancement is related to misattributions about illness but that defensiveness in general appears to play a more minor role in poor insight than do neuropsychological deficits. Though the relationship between defensiveness and depression has been studied in samples of nonclinical subjects as well as patients with affective disorders, there has been no direct study of this relationship in patients with schizophrenia. Our results support the hypothesis that self-deceptive enhancement is associated with decreased depression in patients with schizophrenia.
IV.C. Catatonia IV.C.1 'CATATONIC SCHIZOPHRENIA' IS NOT 'SCHIZOPHRENIA' Max Fink Department of Psychiatry, SUNY at Stony Brook, Stony Brook, NYl1794-8101, U.S.A. For more than a century, patients with psychosis and motor signs identified by Kahlbaum as 'catatonia' have been classified as "schizophrenia, catatonic type', In DSM-III, this was the only diagnosis that could be ascribed to someone with catatonic signs, as the signs were not recognized as part of any other diagnosis. This was so, despite numerous observations that catatonia was prominent in patients with systemic disorders [like lupus erythematosus and infections], affective disorders [especially mania], and toxic states [as in the neuroleptic malignant syndrome]. Catatonia, once thought to be rare, is recognized increasingly, comprising 7-9% of adult psychiatric in-patient populations. Less than 1/3 meet conventional criteria for schizophrenia. The administration of neuroleptic drugs, usually considered the initial and primary treatment of schizophrenia, is often detrimental to those with catatonia. The development of catatonia screening and rating instruments and effective treatment protocols enables the separation of patients with signs of catatonia from those identified, studied, and treated as a type of schizophrenia. Present treatment eschews neuroleptics and administers benzodiazepines in high doses, and when these fail, electroconvulsive therapy. These experiences may be of interest to researchers in schizophrenia as they encourage a different view of the pathophysiology of these disorders.
IV.C.2 SCHIZOPHRENIA AND ITS CATATONIC SUBTYPE INSTABILITY D U R I N G L O N G TERM FOLLOW-UP N. M i m i c a
University Department of Psychiatry, Psychiatric Hospital Vrap6e, Bolni~ka cesta 32, HR-IO090 Zagreb, Croatia The study presents data about schizophrenia, and its catatonic subtype instability during the long-term follow up. As a base for forming this sample of schizophrenics the Croatian Psychotics Case Register (CPCR), which has been run in Croatian National Institute of Public Health since 1962, was used. The Register was formed on the basis of obligatory reports of hospitalized psychotic patients. The representative sample of schizophrenics, for epidemiological-clinical followup, was formed in 1972 from the evidence of 8068 patients younger than 55 years, and without additional diagnosis of mental retardation. This sample comprised 402 patients (207 males and 195 females), who were followed up until 1990/91. It was found that diagnosis of schizophrenia, catatonic type (V/295.2), according to valid ICD classification, was made in 59 (14.7%) cases, once or several times in their life. Among these patients there were 28 males and 31 females. In order to obtain data on the stability of subtype diagnosis of these schizophrenics every hospitalization and diagnosis at discharge was noted. It was found that diagnosis of catatonic schizophrenia was made after first hospitalization in 31 (52.6%) cases, in 18 (30.5%) schizophrenics after second or third hospitalization, and remaining 10 (16.9%) patients received this diagnosis after fourth hospitalization or later. During the course of illness the majority of schizophrenic patients change their types of clinical picture and at the end of this follow-up in only 11 (18.6%) cases the diagnosis of catatonic schizophrenia was made.
IV.D. Delusions IV.D. 1 THE PETERS et al. D E L U S I O N S I N V E N T O R Y (PDI): N E W N O R M S F O R T H E 21-ITEM VERSION E.R. Peters a n d P.A. G a r e t y
Department of Psychology, Institute of Psychiatry, London SE5, U.K. The original 40-item PDI was designed to measure delusional ideation in the normal population, using the PSE as a template. The multidimensionality of delusions was incorporated by including measures of distress, preoccupation and conviction. Good psychometric properties were reported on a sample of
119
272 (Peters et al, 1995). Individual items were endorsed by 1 in 4 adults on average. The range of scores between the normal sample and 20 deluded inpatients overlapped considerably, consistent with the continuous view of psychosis. The two samples were differentiated by their ratings on the distress, preoccupation and conviction scales, confirming the necessity for multidimensional analysis of delusional thinking. A 21-item version of the PDI was constructed on the basis of principal component analysis. New norms and psychometric properties are reported. Avenues of research using the PDI include its use as a selection instrument to investigate the experimental correlates of delusional beliefs, to assist in the longitudinal identification of at-risk individuals, to explore the relationship between delusional ideas and religious sects, and finally as a measure of therapeutic change.
IV.E. S c h i z o t y p y IV,E. 1 DIMENSIONS OF SCHIZOTYPY R.S. H o p k i n s
University Department of Psychiatry, Manchester University, Withington Hospital Manchester M20 8LR, U.K. Background. Schizotypal dimensions resemble attenuated syndromes of schizophrenia. A new inventory, measuring four such dimensions, has been derived from several schizotypy scales. The reliability and validity of these measures requires replication. Method. The inventory was completed by a non-patient group. Items were grouped, in terms of similarity, into eighteen facets, four or five per scale. A factor analysis of facet scores was performed. Results. Scale reliability ranged from alpha 0.76 to 0.90, facet reliability from 0.46 to 0.76 (average 0.62). Factor analysis generally replicated expected factor loadings. The factors extracted represented Unusual Experiences, Cognitive Disorganisation, Introvertive Anhedonia and Impulsive Nonconformity. The facet Thought Disorder loaded most highly with Unusual Experiences, rather than with Cognitive Disorganisation as expected. Conclusion. Although generally replicating the factor structure, the present findings suggest that the facet Thought Disorder is misplaced. The remaining facets of Cognitive Disorganisation measure anxiety and depression. Given that clinical thought disorder does not correlate with anxiety/depression, it is suggested that Cognitive Disorganisation is a misnomer for this scale. More empirical research is required before links between superficially similar schizotypal and schizophrenic dimensions can be made.
IV.E.2 I N C R E A S E D S C H I Z O T Y P Y SCORES IN N O R M A L SUBJECTS F O L L O W I N G T H E O R A L A D M I N I S T R A T I O N OF DAMPHETAMINE N.S. Gray, A.D. Pickering a n d J.A. G r a y
Riverside Forensic Services, Henry Rollin Unit, Horton Hospital, Long Grove Road, Epsom, Surrey KT19, and Department of Psychology, Institute of Psychiatry, De Crespigny Park, London SE5 8RQ, U.K. The dimensional view of schizophrenia states that psychotic symptoms can be measured along a continuum in the normal population. These sub-clinical psychotic-type experiences in normal subjects are termed schizotypal traits and are thought to reflect a fairly stable dimension of personality. The schizotypal framework views schizophrenia as representing an extreme end of the normal continuum and not as a discrete syndrome. The hypothesised relationship between schizotypy and schizophrenia is supported by findings that behavioural tasks sensitive to cognitive abnormalities characteristic of schizophrenia are also found to be abnormal in normal subjects with high schizotypal scores. Recent preliminary findings also suggest an association between schizotypy and dopamine D2 binding. A psychopharmacological study is presented where a measure of schizotypy (Eysenck's Psychoticism scale) was found to be significantly increased following a single oral dose of 5 mg or 10 mg D-amphetamine in normal subjects (F(2,57) = 3.34, p<0.04; N=60). These results suggest that schizotypy not only reflects sub-clinical schizophrenic phenomenology but also may suggest a similar underlying neurochemistry. In addition, the results indicate that measures of schizotypy in normal subjects may not reflect stable traits but may rather measure a state variable that is prone to fluctuation, just as schizophrenic symptoms themselves may fluctuate over time.
IV.E.3 SYNDROMES OF SCHIZOTYPY AND AGE AT SEXUAL MATURITY J.H. Gruzelier a n d J. Kaiser
Laboratory of Neuro-Psychophysiology, Department of Psychiatry, Charing Cross and Westminster Medical School University of London, St. Dunstan's Road, W6 8RP, U.K. Developmental regressive events such as pruning of synapses are implicated in schizophrenia with both over- and underconnectivity models proposed (Randall, Feinberg, Hoffman). Saugstad (1989; 1994) theorised that extremes of normal variation at puberty distinguish affective psychoses (early maturation) from schizophrenia (late maturation). In normal students we have found a three-factor structure of schizotypy traits