Abstract: OBJECTIVE: To characterize the affective dimensions of psychopathology in patients with a nonaffective psychosis and to examine their validity against a number of external variables. METHODS: Five-hundred and thirty-five patients with a lifetime DSM-IV diagnosis of nonaffective psychosis were assessed during the index episode for 22 affective symptoms. These symptoms were factor analyzed and the resulting factor scores were examined for associations with a number of risk factors, illness characteristics, index episode psychopathology and outcome variables. RESULTS: One-hundred and fifty-six patients (29.1%) met the criteria for a mood disorder during the index episode. Factor analysis of affective symptoms resulted in six factors (mania, core depression, anxiety, retarded depression, dysphoria and lability/mixed) explaining 56% of the variance. Regressions of clinical variables on the six factor scores (p < 0.01 after Bonferroni correction) revealed that mania was related to familial loading to bipolar disorder, shorter duration of the index episode and severity of disorganization symptoms; simple depression was related to suicidal behavior; anxiety was related to psychosocial stressors and reality-distortion symptoms; retarded depression was related to familial loading to major depression, poor premorbid adjustment and negative symptoms; dysphoria was related to violent behavior; lastly, the lability/mixed factor was related to better global functioning, shorter duration of the index episode, better response to treatment and episode polymorphism. CONCLUSIONS: These results extend the phenomenology of nonaffective psychoses beyond the existing literature to include six affective domains. The validity of each domain is supported by their differential association pattern with illness-related variables.

Abstract: OBJECTIVES: To demonstrate the ability of the Screen for Cognitive Impairment in Psychiatry (SCIP-S) to discriminate between cognitively-impaired individuals and those with adequate functioning in a sample of schizophrenic and bipolar patients, as well as in a control group. METHODS: The SCIP-S, together with a full neuropsychological battery, was administered to three groups: patients with schizophrenia, patients diagnosed with bipolar disorder I, and controls. The battery scores were used to perform a standardization with respect to the control group and this served to determine the comparison groups (cognitively impaired versus unimpaired) for each of the subtests of the SCIP-S. A full analysis of decision validity was conducted on the basis of receiver operating characteristic curves (sensitivity and specificity, +LR and -LR, PPV and NPV). RESULTS: All the subtests yielded adequate values for sensitivity and specificity with the proposed cut-off points, while the total score of the SCIP (<70) was associated with a sensitivity of 87.9 and specificity of 80.6. CONCLUSIONS: The SCIP-S shows adequate decision validity as a screening tool for cognitive deficit in patients diagnosed with schizophrenia or bipolar disorder.

Abstract: BACKGROUND: The relevance of persistent cognitive deficits to the pathogenesis and prognosis of bipolar disorders (BD) is understudied, and its translation into clinical practice has been limited by the absence of brief methods assessing cognitive status in Psychiatry. This investigation assessed the psychometric properties of the Spanish version of the Screen for Cognitive Impairment in Psychiatry (SCIP-S) for the detection of cognitive impairment in BD. METHODS: After short training, psychiatrists at 40 outpatient clinics administered the SCIP three times over two weeks to a total of 76 consecutive type I BD admissions. Experienced psychologists also administered a comprehensive battery of standard neuropsychological instruments to clinical sample and 45 healthy control subjects. RESULTS: Feasibility was supported by a brief administration time (approximately 15 minutes) and minimal scoring errors. The reliability of the SCIP was confirmed by good equivalence of forms, acceptable stability (ICC range 0.59 to 0.87) and adequate internal consistency (Chronbach's alpha of 0.74). Construct validity was granted by extraction of a single factor (accounting 52% of the variance), acceptable correlations with conventional neuropsychological instruments, and a clear differentiation between bipolar I and normal samples. Efficiency was also provided by the adequate sensitivity and specificity. LIMITATIONS: The sample size is not very large. The SCIP and the neurocognitive battery do not cover all potentially relevant cognitive domains. Also, sensitivity to change remains unexplored. CONCLUSION: With minimal training, physicians obtained a reliable and valid estimate of cognitive impairment in approximately 15 minutes from an application of the SCIP to type I BD patients.

Abstract: BACKGROUND: Cognitive impairment in schizophrenia-spectrum disorders is highly prevalent and notably influences functional outcomes. AIMS: To characterise the cognitive effectiveness of second-generation antipsychotic drugs. METHOD: One hundred consecutive and previously unmedicated patients with first-episode schizophrenia-spectrum disorders were admitted. Seventy-seven completed baseline, 1-month and 6-month psychopathological and neuropsychological assessments. Patients were randomised to risperidone or olanzapine treatment. Four final treatment allocation groups were defined since patients continued treatment in their normal setting: risperidone, olanzapine, mixed and no-antipsychotic groups. RESULTS: There were no differences in cognitive effectiveness between the four treatment groups. Reliable change index methods demonstrated that nearly a half of patients showed an improvement in Global Cognitive Score at the 6-month assessment. Improvement on the neuropsychological tests ranged from 17 to 54%. A strong predictor of cognitive response was poor performance on baseline neuropsychological tests; response was moderately influenced by a low premorbid scholastic performance and IQ. CONCLUSIONS: Cognitive improvement related to second-generation antipsychotic drugs appeared within the first 4 weeks of treatment and persisted at 6 months irrespective of treatment group. Greater cognitive dysfunction at baseline and lower premorbid cognitive background predicted cognitive improvement in our sample.

Abstract: Considerable effort has been focused on updating the clinical aspects of psychiatric classifications based on recent progress in the field of neurobiology. In this article, recent developments in the primary assessment methods within clinical psychiatry, which are based in phenomenological psychopathology, are reviewed as nosotaxies that are still embedded in clinical description. New directions for research on psychopathology are outlined to elicit better descriptions of subjective experience from patients. Finally, the known limitations of the Kraepelinian dichotomy are summarized, and future problems related to the inclusion of the new dimensional assessment methods in the next psychiatric classifications are described.

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Abstract: BACKGROUND: Schizoaffective disorder has long been considered as an intermediate condition between major mood disorders and schizophrenia, however, the nature of the relationship to these diagnoses remains unclear. We aimed at examining the nature of such a relationship in a mixed sample of psychotic disorders by using a dimensional and categorical approach to psychopathology. METHODS: Six-hundred and sixty psychotic inpatients were assessed for lifetime ratings of mania, depression, psychosis and incongruence, diagnosed according to Research Diagnostic Criteria, and classified as having nonaffective psychosis without mood syndromes (n=429), nonaffective psychosis with mood syndromes (n=101), schizoaffective disorder mainly schizophrenic (n=41), schizoaffective disorder mainly affective (n=42) or mood disorder with psychotic symptoms (n=47). We tested for associations of illness-related features including risk factors, premorbid, clinical and outcome variables with classes of disorders and lifetime ratings of psychopathology, and examined the relative contribution of categorical and dimensional representations of psychopathology in explaining disease characteristics. RESULTS: While categories at the extreme end of the psychotic spectrum meaningfully differed across a number of the illness-related variables, no substantial discontinuity was apparent between adjacent categories of psychotic disorders. Risk factors, premorbid adjustment, clinical features and impairment appeared to be present in a mostly monotonic continuous fashion from nonaffective psychoses to mood disorders with psychotic features. The overall association pattern of illness-related variables with mood and psychotic syndromes was largely independent of specific diagnostic categories, and the dimensional approach was neatly superior to the traditional diagnostic approach in explaining the characteristics of the illness. LIMITATIONS: This was a cross-sectional study with retrospective assessment of illness-related-variables and lifetime psychopathology. CONCLUSION: The results are compatible with the notion of the schizoaffective spectrum and with a continuum model of the psychotic illness.

Abstract: OBJECTIVE: The Screen for Cognitive Impairment in Psychiatry (SCIP) is a brief scale designed for detecting cognitive deficits in several psychotic and affective disorders. This study examined the psychometric properties of the Spanish version of the SCIP in a sample of outpatients suffering schizophrenia-spectrum disorders. METHODS: Psychometric properties were evaluated in a sample of 126 stable patients with schizophrenia. Men and women 18 to 55 years of age were recruited from consecutive admissions to 40 psychiatric outpatient clinics in Spain and asked to complete a series of cognitive measures at baseline, as well as three versions of the SCIP separated by one week intervals. A matched sample of 39 healthy controls was also subjected to the baseline examination. The feasibility, reliability and validity of the SCIP was examined; concurrent validity was assessed by means of a complete neuropsychological battery. RESULTS: Average time for SCIP administration was 16.02 (SD=5.01) minutes. Test-retest reliability intra-class correlation coefficients ranged from 0.74 to 0.90, with an internal consistency Cronbach's alpha value of 0.73. The three parallel forms of SCIP were shown to be equivalent. The SCIP scales were correlated with corresponding neuropsychological instruments, with Pearson's r between 0.38 and 0.60, p<0.01. The SCIP effectively discriminated between the patient and control samples. Factor analysis revealed one significant dimension, cognitive performance, that accounted for 49.8% of the total variance. CONCLUSIONS: The Spanish version of the SCIP is a simple, brief, valid and reliable tool for detection of cognitive impairment in patients with schizophrenia by minimally trained healthcare personnel.

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Abstract: The synaptic vesicular monoamine transporter (SVMT) plays a key role in monoaminergic neurotransmission determining the size of neurotransmitter vesicular pools available for exocytotic release. Recently, several lines of evidence have suggested that altered functions of SVMT may be involved in the pathogenesis of certain neuropsychiatric diseases, including psychotic and mood disorders. In the present study, we tested the potential involvement of SVMT gene variants in the etiology of schizophrenia and bipolar disorder. Five different SNPs (T440G, C1368T, T2666C, A2683C, and A745G) were included in the analysis covering a region of about 35 kb along the SVMT gene. Analyses were performed in a case-control sample consisting of 88 bipolar patients, 107 subjects with schizophrenia, and 164 controls. Two risk haplotypes for both schizophrenia and bipolar disorder in SVMT gene were identified. Particularly, 2666T-2683A-745G (TAG) and 2666C-2683C-745A (CCA) combinations were significantly more frequent in both bipolar and schizophrenic patients than in controls. UNPHASED package estimated haplotype effects for all patients yielded relative risks of 4.1 (95%CI: 1.83-9.21) for TAG combination and 2.336 (95%CI: 1.28-4.26) for CCA haplotype. Conversely, 2666T-2683C-745A (TCA) and 2666C-2683A-745G (CAG) haplotypes seemed to protect against these mental disorders, since the estimated frequency in control chromosomes was 12% whilst such haplotypes were not observed in any bipolar or schizophrenic subject (P < 0.0000). Our results strongly suggest that SVMT gene or certain regions of it may constitute a genetic substrate of susceptibility for both schizophrenia and bipolar disorder.

Abstract: Specific disorders within the psychosis syndrome have been proposed although no definitive validation of subtypes has been achieved. If there are subtypes of psychosis, latent discontinuity between clinical descriptors should be found. We applied for the first time taxometric analysis on characteristic schizophrenia symptoms. The sample consisted of 660 inpatients with an acute psychotic episode. Computed scores of the clinical dimensions included in the three-syndrome model of schizophrenia symptomatology were used as clinical descriptors or latent variables to be analyzed. Two taxometric analyses were used (MAXCOV and MAMBAC). Discrepancies between observed covariance curves and between the estimated base rates of indicators did not support a taxonic conjecture within psychosis based on the severity of 'Psychosis', 'Negative' and 'Disorganization' dimensions scores, which were used as indicators. However, no appropriate solution could be reached because the three clinical indicators of schizophrenia symptomatology used in this study showed a lack of consistency. The lack of a taxonic structure with symptomatological domains of psychosis suggested the existence of a dimensional solution for schizophrenia symptomatology within psychoses.

Abstract: BACKGROUND: Previous studies examining the relationship between psychopathological syndromes of the psychotic illness and familial liability to schizophrenia and mood disorders have obtained inconclusive results. The aim of this study is to further examine this issue by analyzing a large sample of psychotic probands and their first-degree relatives. METHODS: The sample was composed of 660 psychotic inpatients and their 2987 first-degree relatives. Probands were assessed for index episode and lifetime symptoms, while relatives were assessed for lifetime diagnosis of schizophrenia and major mood disorders. Associations between factor-analysis derived syndromes in probands and familial loading for schizophrenia and major mood disorders were tested. RESULTS: Familial morbid risk of schizophrenia was predicted by the negative syndrome in probands and familial morbid risk of mood disorders was predicted by mania, depression and catatonia syndromes in probands. This association pattern was relatively independent of type of symptom rating (index episode or lifetime) and probands' diagnosis of schizophrenia or major mood disorder. Familial loading for schizophrenia and mood disorders cut-across the DSM-IV categories of psychotic disorders in probands. CONCLUSION: From a dimensional perspective, the negative syndrome is related to familial liability to develop schizophrenia. Mania, depression and catatonia syndromes are related to the familial liability to develop major mood disorders. Categories of psychotic disorders are on a continuum of familial liability to schizophrenia and major mood disorders.

Abstract: Neuregulin 1 (NRG1) is one of the most exciting candidate genes for schizophrenia since its first association with the disorder in an Icelandic population. Since then, many studies have analyzed allele and haplotype frequencies in European and Asian populations in cases and controls yielding varying results. We investigated the association of NRG1 with psychosis in a total sample set of 575 individuals from 151 Spanish nuclear families. We tested eight SNPs across 1.2 Mb along NRG1 including regions previously associated to schizophrenia in association studies. After correction for multiple testing, the TDT analysis for each marker did not show a significant over-transmission of alleles from the parents to the affected offspring for any of the markers (P > 0.05). The haplotypic analysis with TRANSMIT and PDT did not show preferential transmission for any of the haplotypes analyzed in our sample. These results do not seem to suggest that the investigated NRG1 markers play a role in schizophrenia in the Spanish population, although the finding of a trend for association with one SNP in the 3'of the gene warrants further investigation.

Abstract: BACKGROUND: There are conflicting results about the correspondence between the diagnostic phenotype of schizophrenia and genetic factors. Using a polydiagnostic approach we examined the relationship between familial liability and alternative schizophrenia phenotypes. METHODS: The sample comprised of 660 psychotic probands and their 2987 first-degree relatives. Probands were assessed for 23 diagnostic systems of schizophrenia, 2 criteria for broadness of phenotype, 4 subtyping criteria and 16 clinical features, while relatives were assessed for familial morbid risk of schizophrenia. To quantify the predictive validity of familial liability against the alternative phenotypes we used the receiver operator characteristic curve analysis yielding an area under the curve (AUC) measure and logistic regression analysis. RESULTS: Although familial liability significantly predicted some diagnostic criteria for schizophrenia, their diagnostic performance was generally very poor (AUC .55 to .61 and OR 1.64 to 2.85). Overall, the most inclusive criteria performed better than the most restrictive ones. Subtyping schizophrenia according to both DSM-IV and negative or deficit subtypes was unrelated to familial liability. The best predictive ability of familial liability (AUC=.71, OR=4.54) was achieved against empirically-derived criteria consisting of (a) early onset or lack of a major mood syndrome and (b) presence of inappropriate affect, affective flattening or bizarre delusions. CONCLUSION: Familial liability does have poor predictive validity regarding diagnostic systems of schizophrenia, although some differences existed among systems. Liability to schizophrenia performed better in predicting broad than restrictive phenotypes of the disorder.

Abstract: The diagnosis of cycloid psychosis has a long tradition in European psychiatry. However, it has been poorly assimilated within the DSM IV and ICD-10 diagnostic systems. Leonhard set the basis for the current conceptualization of the disorder, and Perris and Brockington developed the first operational diagnostic criteria. However, the two conceptualizations of the disorder are not the same and differ across a number of meaningful variables. Cycloid psychosis is a useful concept in that it possesses both clinical and predictive validity. Despite the high prevalence of mood symptoms and syndromes, cycloid psychosis does not equal schizoaffective disorder. Although a substantial body of evidence suggests that cycloid psychosis differs meaningfully from typical schizophrenia, it is less clear whether it differs from major mood disorders or represents an independent nosological entity. The existence of putative subtypes is also likely, and the differentiation between affective and nonaffective subtypes has received some support.

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Abstract: BACKGROUND: The empirical validation of diagnostic criteria for schizophrenia remains a controversial issue within psychiatry and allied sciences. Most diagnostic criteria are still influenced to a large extent by historical and consensus-based perspectives. METHODS: A poly-diagnostic approach including a set of 23 operationalized diagnostic criteria were administered to probands with non-affective psychosis (n=169). In addition, participants completed a neuropsychological battery during a stable phase of the illness. Attentional, verbal and visual memory and executive functions were assessed. The control group was composed of 26 demographically matched healthy subjects. Analysis of variance was conducted taking neuropsychological performance as response variables and the 23 binary diagnostic systems as explanatory variables. RESULTS: Four out of the 23 operationalized diagnostic systems for schizophrenia (Feighner, French, Kraepelin and Langfeldt criteria) demonstrated high empirical validity for memory and executive functions scores (medium to moderate effect sizes). These 4 systems resemble classic nosological approaches based upon the 'outcome principle' concept, which suggests that schizophrenia leads to deterioration. However, diagnostic effectiveness of neuropsychological tests for the 23 operationalized diagnostic systems of schizophrenia was low (likelihood ratio <2). CONCLUSIONS: Neuropsychological functioning provides empirical validation to operationalized definitions of schizophrenia which are mainly based upon deterioration. It is suggested that some inconsistency of neurobiological studies in schizophrenia might result for using solely current consensus-based diagnostic systems. The implementation of poly-diagnostic strategies could contribute to improve the validity of the schizophrenia construct.

Abstract: Schizophrenia (SZ) is a prevalent and severe mental disorder. One of the most favored hypotheses for the etiology of SZ is the neurodevelopmental hypothesis. Brain-derived neurotrophic factor (BDNF), a member of the neurotrophin growth factor family, promotes the development, regeneration, and survival of neurons and has been linked to the neuropathology of SZ. The present study tested, in a sample of 94 nuclear families, the hypothesis that the BDNF gene Val66Met polymorphism is associated to SZ and its psychopathologic phenotype using a multidimensional symptom approach. Furthermore, considering a reported reduction of BDNF in the frontal cortex of patients with SZ, we studied the relationship between this polymorphism and prefrontal function. The transmission disequilibrium test (TDT) showed a preferential transmission of allele Val from heterozygous parents to the affected offspring (P = 0.002), suggesting a possible role of this gene in the vulnerability to SZ spectrum disorders. The findings remained essentially unchanged when the analysis was restricted to the subgroup of patients with SZ (P = 0.009) and when a multidimensional approach to the diagnosis was used. Quantitative transmission disequilibrium test (QTDT) analyses did not demonstrate a significant association between the prefrontal tests assessed (Wisconsin Card Sorting Test and Trail Making Test) and the transmission of the BDNF alleles. Our finding suggests that the investigated BDNF polymorphism plays an important role in the phenotype of psychosis, but not in the performance of tests of prefrontal cognitive functions analyzed in these patients.

Abstract: Studies addressing the relationship between a history of obstetric complications (OCs) and neurological abnormalities in schizophrenia have produced contradictory findings. Using a pre-posttreatment design in a neuroleptic-naive sample of psychotic patients, we examined the relationship of a history of OC to primary and drug-induced neurological signs. Fifty neuroleptic-naive non-affective psychotic inpatients were assessed for a history of OC by using the McNeil-Sjöström scale, and for neurological signs including parkinsonism, dyskinesia, akathisia and catatonia, which were rated before and after inception of neuroleptic treatment. A subsample of 28 patients were also examined for neurological soft-signs. Ratings of OCs were related to admission levels of parkinsonism, dyskinesia, akathisia and neurological soft-signs, but not to levels of catatonia. By obstetric period, pregnancy complications were related to levels of parkinsonism, dyskinesia, and neurological soft-signs, and neonatal complications were related to levels of akathisia. Drug-induced neurological signs were not associated with a history of OCs. We argue that the association pattern between a history of OCs and primary neurological signs from several domains suggests a causal link among these variables. Having a history of OCs does not convey a vulnerability for developing drug-induced neurological signs in the short term.

Abstract: BACKGROUND: It has been reported that lack of insight is significantly associated with cognitive disturbance in schizophrenia. This study examines the longitudinal relationships between insight dimensions and cognitive performance in psychosis. METHODS: Participants were 75 consecutively admitted inpatients with schizophrenia, affective disorder with psychotic symptoms or schizoaffective disorder. Assessments were conducted at two time points during the study: at the time of hospital discharge after an acute psychotic episode and at a follow-up time that occurred more than 6 months after discharge. A multidimensional approach of insight was chosen and three instruments for its assessment were used: the Scale to Assess Unawareness of Mental Disorder (SUMD), three items concerning insight on the Assessment and Documentation in Psychopathology (AMDP) system and the Insight and Treatment Attitudes Questionnaire. The neuropsychological battery included a wide range of tests that assessed global cognitive function, attention, memory, and executive functions. RESULTS: After conducting adequate statistical correction to avoid Type I bias, insight dimensions and cognitive performance were not found to be significantly associated at cross-sectional and longitudinal assessments. In addition, baseline cognitive performance did not explain changes in insight dimensions at follow-up. Similar results were found in the subset of patients with schizophrenia (n = 37). The possibility of a Type II error might have increased due to sample attrition at follow-up. CONCLUSION: These results suggest that lack of insight dimensions and cognitive functioning may be unrelated phenomena in psychosis.

Abstract: The objective was to ascertain the underlying factor structure of alternative definitions of schizophrenia, and to examine the distribution of schizophrenia-related variables against the resulting factor solution. Twenty-three diagnostic schemes of schizophrenia were applied to 660 patients presenting with psychotic symptoms regardless of the specific diagnosis of psychotic disorder. Factor analysis of the 23 diagnostic schemes yielded three interpretable factors explaining 58% of the variance, the first factor (general schizophrenia factor) accounting for most of the variance (36%). On the basis of the general schizophrenia factor score, the sample was divided in quintile groups representing 5 levels of schizophrenia definition (absent, doubtful, very broad, broad and narrow) and the distribution of a number of schizophrenia-related variables was examined across the groups. This grouping procedure was used for examining the comparative validity of alternative levels of categorically defined schizophrenia and an ordinal (i.e. dimensional) definition. Overall, schizophrenia-related variables displayed a dose-response relationship with level of schizophrenia definition. Logistic regression analyses revealed that the dimensional definition explained more variance in the schizophrenia-related variables than the alternative levels for defining schizophrenia categorically. These results are consistent with a unitary and dimensional construct of schizophrenia with no clear "points of rarity" at its boundaries, thus supporting the continuum hypothesis of the psychotic illness.

Abstract: BACKGROUND: A lengthy delay often exists between the onset of psychotic symptoms and the start of appropriate treatment. However, the causes of this long delay remain poorly understood, and there is a need to search for the factors involved in such a delay in order to reduce the time of untreated psychosis. This study aimed at examining the influence of premorbid social networks on the duration of untreated psychotic illness. METHOD: One hundred subjects with a first episode of schizophrenia or related psychotic disorders never treated with antipsychotics made up the study sample. Social support was assessed by means of the Sturtees's social support scale that comprises two subscales measuring close and diffuse social support. Duration of untreated illness was assessed according to three definitions: duration of untreated unspecific symptoms, duration of untreated psychotic symptoms, and duration of untreated continuous psychotic symptoms. We also examined the effect of putative confounding factors such as gender, residence (urban-rural), age at illness onset, years of education, and parental socio-economic status. RESULTS : Correlational analysis showed that poor diffuse social support, but not poor close social support, predicted long duration of untreated illness according to the three definitions; this association being mainly due to poor work/academic support. Logistic regression analysis confirmed such an association, but it was limited to duration of continuous psychotic symptoms (unadjusted OR=3.44, 95% CI=1.51-7.83); this association persisted after adjusting for the confounding variables (adjusted OR=3.39, 95% CI=1.39-8.29). We also found that subjects with low socio-economic status were depending on the definition of duration of untreated illness considered, between 2.7 and 4.3 times more likely to present with a long duration of untreated illness. CONCLUSION : Both poor diffuse social support and a low socio-economic status seem to be relevant factors of a prolonged duration of untreated psychosis.

Abstract: This article reviews the concept, nosological status, diagnostic features, associated clinical characteristics, and the etiopathological variables involved in cycloid psychosis. The concept of cycloid psychosis is based on sound psychopathological and course underpinnings, and despite the inclusion of some cycloid features in the current diagnostic systems such as ICD-10 and DSM-IV, these systems do not capture well the diagnostic construct of this disorder. Cycloid psychosis is a valid clinical constructs that can be easily differentiated from the boundary disorders on clinical grounds. It seems to be heterogeneous from the etiopathological point of view, in that a variety of factors seems to be involved to a different degree in most of the patients. Future studies should examine putative subtypes of the disorder in relation to etiological, pathophysiological and clinical variables.

Abstract: The neurodevelopmental hypothesis of schizophrenia suggests that adverse genetic loading in conjunction with environmental factors early in fetal life causes a disruption of neural development, decades before the symptomatic manifestation of the disease. Neurocognitive deficits have been observed early on the course of schizophrenia, and their association with an early developmental brain lesion has been postulated. Dermatoglyphics have been analyzed in schizophrenia as markers of prenatal brain injury because of their early fetal ontogenesis and susceptibility to the same environmental factors that can also affect cerebral development. The aim of our study was to conduct a comparative examination of neurocognitive functions and dermatoglyphic variables in 89 sibling pairs discordant for schizophrenia spectrum disorders. Therefore, we investigated the association between these two markers to explore the prenatal origin of cognitive deficits in schizophrenia. The affected siblings were significantly impaired on all the cognitive variables assessed (Wisconsin Card Sorting Test, Trail Making Test and Continuous Performance Test) and had a greater number of dermatoglyphic anomalies. These results suggest the influence of intrauterine environmental factors in the siblings affected with schizophrenia. However, we did not detect a significant association between these two vulnerability markers in the schizophrenic patients, suggesting the role of genetic or late environmental factors in the origin of the neurocognitive deficits found in these patients.

Abstract: Interleukin-1beta (IL-1beta), as well as other cytokines, has been classically implicated in the pathophysiology of major psychiatric disorders such as schizophrenia and major depression, and recent studies have implicated the IL-1beta gene and schizophrenia. Nevertheless, new approaches to this complex phenotype are necessary to clarify the risk conferred by this gene, either to the disorder or to its clinical manifestations. The aim of the present study was to explore the effect of a genetic polymorphism of the promoter region of the IL-1beta gene, in schizophrenia defined with: (i) a categorical diagnosis and (ii) a multidimensional symptom approach. We studied 356 individuals from 89 nuclear families consisting of one affected individual and the unaffected father, mother, and sib, in a family-based association study design. We find a trend for biased transmission of allele 2 from heterozygous parents to affected offspring, categorically defined (P = 0.07). This tendency was not observed in the healthy offspring. Using a multidimensional symptom approach to the diagnosis, the association was confirmed in psychotic patients showing the depressive symptom-dimension (P = 0.02).

Abstract: OBJECTIVE: Using a sample of sibling pairs discordant for psychosis, the authors attempted to replicate the findings of previous studies suggesting that the functional genetic polymorphism Val158Met in the catechol O-methyltransferase (COMT) gene influences prefrontal cognitive function and increases the risk for schizophrenia. METHOD: Eighty-nine sibling pairs discordant for psychosis were genotyped for this polymorphism and were assessed with the Wisconsin Card Sorting Test, a measure of prefrontal function. Additionally, the preferential transmission of alleles for this polymorphism was analyzed in a sample of 89 nuclear families in order to examine the genetic association. RESULTS: In the healthy siblings, a linear relationship was seen in which performance on the Wisconsin Card Sorting Test was associated in an allele dosage fashion with COMT genotype (i.e., fewer perseverative errors with higher number of methionine alleles). However, this association was not observed in patients. Furthermore, no evidence of genetic association with psychosis was detected. CONCLUSIONS: These results seem to confirm the role of COMT genotype in the modulation of executive functions related to frontal lobe function in healthy individuals but not in schizophrenia patients.

Abstract: The deficit syndrome is thought to be specific to and a subtype of schizophrenia; however, there are scarce or no data on the prevalence and characteristics of this syndrome in non-schizophrenic psychoses. The aim of this study was to explore the prevalence and correlates of different types of negative symptoms (NegS) in a mixed sample of psychotic disorders. Six-hundred and sixty psychotic inpatients were classified according to the presence and type of NegS into the following groups: no NegS, transitory NegS, persistent secondary NeS, persistent doubtful secondary NegS, and persistent primary NegS (i. e., deficit symptoms). Furthermore, the nosological status of this symptom classification such as its clinical and etiological correlates were examined. Depending on the diagnostic criteria used for diagnosing schizophrenia, the prevalence of the deficit syndrome in schizophrenia and in non-schizophrenic psychoses ranged from 14%-32% and 2%-22%, respectively. Deficit syndromes in both schizophrenic and non-schizophrenic patients shared most of the syndrome-related clinical features. Regarding the associated clinical pattern, the transitory NegS group was closer to the group without NegS than to the groups with enduring NegS. Patient groups with enduring primary and enduring secondary NegS did not show relevant clinical or etiological differences, thus, suggesting that the primary versus secondary issue may be less relevant than previously acknowledged. The deficit syndrome may be diagnosed irrespective of the specific categories of psychotic disorders.

Abstract: BACKGROUND: Despite its clinical relevance, the diagnosis of cycloid psychosis has been relatively neglected in the psychiatric literature and in the current nosological systems. This study examined the clinical validity and nosological status of the cycloid psychosis concept. METHOD: Six-hundred and sixty psychotic in-patients were assessed for psychosis-related variables and diagnosed according to DSM-III-R, DSM-IV, ICD-10 and the Perris & Brockington criteria forcycloid psychosis. The cycloid psychosis diagnosis (N = 68, 10.3%) was examined in regard to its discriminant validity, concordance with other psychotic disorders, and predictive validity in relation to schizophrenia and psychotic mood disorders. To address putative heterogeneity within cycloid psychosis, affective (N = 38) and non-affective (N = 30) subgroups were examined. RESULTS: Cycloid psychosis had good discriminant validity regarding other psychoses (95% of correctly classified cases) and poor concordance with individual diagnoses from the formal diagnostic systems (K < 0.22). Cycloid patients had levels of psychotic, disorganization and first-rank symptoms comparable to schizophrenia, and levels of affective symptoms in-between schizophrenia and mood disorders. Regarding most clinical variables and morbidity risk of mood disorders, cycloid psychosis was closer to mood disorders. Cycloid psychosis had higher psychosocial stressors than schizophrenia and mood disorders. Affective and non-affective groups of cycloid psychosis differed in a number of variables indicating an overall better outcome for the non-affective group. CONCLUSIONS: Cycloid psychosis does not correspond closely to any DSM-III-R, DSM-IV or ICD-10 category of psychosis, and more specifically this nosological concept is not well represented by the different formal definitions of remitting psychotic disorders. Cycloid psychosis seems to be an heterogeneous condition in that affective and non-affective subgroups can be differentiated.

Abstract: BACKGROUND: Dimensional frameworks for structuring psychopathology have been formulated in recent years to overcome classification problems of categorical approaches. However, few studies have addressed the dilemma of hierarchy within symptoms or dimensions in psychosis. METHODS: This study was designed to examine the hierarchical structure of psychopathological dimensions in first episode psychosis. The sample consisted of 94 first-episode patients psychosis. An exhaustive psychopathological assessment was carried out using the AMDP-system. Consecutive principal component analyses of AMDP symptoms, determining 'a priori' the number of factors to be extracted, were carried out. RESULTS: Following the track of the resulting factor analyses, a 'vertical hierarchical' framework was achieved. Our schema organized dimensions in a series of echelons in which lower tiers are subsumed as subsets of those assigned to higher ranks. In addition, a final model comprising 10 dimensions provided an 'horizontal' and multidimensional structure comprising all relevant psychopathological dimensions in first-episode psychosis. CONCLUSIONS: This study confirmed to a great extent the existence of a hierarchical organization within psychopathological dimensions in 'first-episode' psychosis. The present 'hierarchical and multidimensional' model of psychopathological dimensions allows for selection of the level of complexity of 'candidate phenotypes' to use in neurobiological research of psychosis.

Abstract: This study examined the concordance and predictive validity of two empirical and two operational classification systems of psychotic disorders. Latent class analysis (LCA) was applied to 16 index episode and to their corresponding 16 lifetime symptom ratings of 660 psychotic inpatients, who were also diagnosed according to DSM-IV and ICD-10 criteria. The resulting classes or diagnoses were validated against clinical (premorbid adjustment, treatment response, and course) and etiologic (morbidity risk of schizophrenia and major mood disorders) variables. LCA of index episode and lifetime ratings showed that five classes of psychotic disorders provided the best fit to the data: schizophrenia, psychosis, schizomania/schizobipolar, schizodepression, and mixed psychosis (cycloid psychosis for index episode ratings and atypical schizophrenia for lifetime ratings). The concordance between the empirical and operational classification systems was poor. Irrespective of the classification method used, the most powerful validators were the clinical ones, whereas the etiologic validators played a negligible role in validating the classes or diagnoses. Overall, DSM-IV and ICD-10 classifications had more clinical validity than empirical classifications, mainly because of circularity in operational definitions regarding treatment response and course of the disorders. With the exception of the category of schizophrenia, which showed some nosological stability across the four classification systems, the number and type of categories of psychosis were highly dependent upon the set of classification procedures. These results make clear the problems inherent in drawing well-defined boundaries between psychotic disorders.

Abstract: The study's aims were to empirically derive classes of disorders and dimensional syndromes within psychotic disorders on the basis of the three time frames of symptom assessment and to comparatively examine their external validity. The level of concordance among classes and among dimensions across the time frames was generally low. The external correlates of psychopathological syndromes differed as a function of both type of assessment and the dimensional or categorical approach used. The dimensional approach was more effective than the categorical approach in predicting a set of clinical variables, irrespective of the time frame used to assess the symptoms. It is concluded that classification of psychotic disorders is highly dependent upon the time frame considered to assess symptoms and that dimensional classifications do have higher predictive power than categorical ones.

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Abstract: It is well established that psychotic patients obtain higher scores on neurological soft-sign (NSS) examinations than normal controls, and also that their cognitive performance is poorer. The aims of the present study were to find threshold criteria that distinguish between normal individuals and patients suffering from psychosis, and to investigate the predictive power of NSS for cognitive impairment.The sample was composed of 56 patients suffering from psychosis and 26 normal controls. Neurological assessment was carried out by means of the Neurological Evaluation Scale (NES), and neuropsychological assessment comprised executive, memory, visuospatial abilities, and attention tests. Receiver operating characteristic analysis was used to assess the diagnostic and predictive efficiency of NSS.A total score of 3 or over on the NES scale, or presence of three or more NSS, proved to be good threshold points for defining 'abnormality' in psychosis patients in comparison with normal controls. NSS presented greater predictive power for cognitive impairment than psychopathological dimensions. Moreover, an NES total score of 8 or higher or, to a lesser extent, the presence of six or more NSS in this scale seemed to be valid cut-off points for predicting severe cognitive impairment in individuals with psychosis.NSS were highly efficient predictors of the presence of severe cognitive impairment related to psychosis. However, their ability to discriminate between individuals with psychosis and normal controls was modest.

Abstract: BACKGROUND: Broadening our knowledge of the relationship between personality and psychopathological dimensions in psychosis would provide insights into the nature of their underlying pathophysiology. Research, to date, has been carried out in chronic samples and the possibility that the personality assessment may have been contaminated by the psychotic episode cannot be ruled out. The aim of this study was to examine the relationships between personality and psychopathology in a 'first-episode psychosis' sample using a dimensional approach. METHOD: Premorbid personality dimensions of 94 consecutively admitted 'first-episode psychosis' patients were assessed through the information collected from parents or a close biological relative. A semi-structured interview (Premorbid Assessment Schedule; [Tyrer, P., 1988. Personality Disorders: Diagnosis, management and course. Wright, London]) was used by a rater, blind to the patients' psychopathological symptoms. Associations between dimensions of premorbid personality and psychopathology were examined through Pearson correlation coefficients. RESULTS: The negative dimension was strongly associated with higher scores on the schizoid dimension. Additionally, trends towards significant direct associations were found between the negative dimension and both the passive-dependent and the schizotypic dimensions, between the hostility/suspiciousness dimension and both sociopathic and passive-dependent dimensions, and between the manic dimension and the obsessional dimension. Canonical correlation analysis demonstrated that premorbid personality dimensions explained 17% of the variance of psychopathological dimensions. CONCLUSIONS: Our results suggest that premorbid personality dimensions may shape the expression of psychosis. Moreover, we hypothesize that certain personality dimensions, such as the schizoid dimension, should be considered nonspecific risk factors for expression of higher levels of negative symptomatology at the beginning of psychosis.

Abstract: During decades, both aetiology and treatment in Depressive Disorders relied on neurotransmitters' physiopathology or on abnormalities in their receptors function. However, recently evidences from research on neurobiological grounds suggest that there are multiple and complex systems involved in the pathophysiology of Depressive Disorders. Several neurobiological structures, such as the neural, immune and endocrine systems seems to interact among themselves and to influence on clinical manifestations of illness. Moreover, dysregulations on lower levels, such as intracellular and genetic systems might cause anomalies in protein expression, and in consequence might modulate receptors' disfunction and disturbances at the intramolecular level of signal transmission. The above disturbances at different levels of complexity are finally integrated within the frame of most recent theoretical approaches to Depressive Disorders. Specifically, recent theories implicating neuronal plasticity and survival-death cell mechanisms are described. The aim of this review is to integrate recent evidence on pathophysiological mechanisms of Depressive Disorders. New lines of treatment based upon these 'new pathophysiology' of depression will be wellcome.

Abstract: Depressive states are a prevalent condition in mental disorders other than depressive disorders, which raises the question of whether or not depression in non-depressive disorders and depressive disorders has the same clinical and biological meaning. The aim of this study was to test the hypothesis that depression in schizophrenia spectrum disorders and depressive disorders does have the same characteristics regarding gender distribution and family history of mood disorders in first-degree relatives. The study sample was made up of 660 psychotic patients who were assessed for alternative definitions of depressive states. The pattern of gender distribution and family antecedents of mood disorders in those patients having depressive symptoms or syndromes was very similar to that reported in depressive disorders, and more specifically to depression in patients with schizophrenia spectrum disorders. These data support the hypothesis that depressions in schizophrenia spectrum disorders do have the same biological meaning as in depressive disorders.

Abstract: Depressive disorders are a heterogeneous group of conditions in terms of their etiology, symptom composition and outcome, which has resulted in difficulties in the definition of the axial depressive syndrome and its clinical forms. This gives rise to a number of problems regarding their definition and delimitation from other mental disorders and from normality. As a result, changing and to some extent overlapping definitions of depressive disorders have been proposed over time. A definition of axial depressive syndrome is proposed based on the differentiation between disturbances of mood and affect. The two main classificatory approaches (categorical and dimensional) are examined with regard to their appropriateness in classifying depressive disorders. Although the two approaches possess pros and cons, the dimensional approach has a number of characteristics that makes it more appropriate than the categorical approach for classifying mental disorders in general and depressive disorders in particular. A multidimensional model for classifying depressive disorders is proposed. The model includes etiological, symptomatological and course/outcome components, each of which is composed of a number of dimensions that have clinical and therapeutical relevance.

Abstract: This study aimed to determine the effect of olanzapine and other antipsychotic drugs on cognitive functions after 6months of treatment. Baseline, 3month and 6month psychopathological and cognitive evaluations were made. Thirty-eight partially responsive outpatients with DSM-IV chronic schizophrenia diagnosis were included in the study. On the indication of their attending psychiatrists, 21 patients initiated treatment with olanzapine, and 17 remained on their previous treatment with other antipsychotic drugs. Cognitive assessments were blind to medication and psychopathological status.The olanzapine group presented a significantly greater improvement in negative symptomatology and verbal memory than the comparison group in repeated-measures of MANOVAs between baseline, 3month and 6month assessments. These differences remained statistically significant after covarying out gender, treatment with other atypical antipsychotics, biperidene doses and changes in positive and negative symptoms. In order to match previous differences between groups, cognitive baseline scores for each test were introduced as covariates, resulting in a significant improvement for the olanzapine group in negative symptomatology and the interference task of the Stroop test.We then re-analyzed the data, dividing the comparison group into two groups: risperidone-treated patients (n=9) and patients receiving conventional antipsychotic drugs (n=8). Post-hoc analyses between groups were carried out with baseline cognitive assessment as covariate. The olanzapine group improved significantly more than the risperidone group in negative symptomatology and in the interference task of Stroop test. The improvement in the number of categories of the Wisconsin Card Sorting Test was higher in risperidone patients than in those receiving olanzapine or conventional antipsychotic treatment. Conventional antipsychotic drugs did not present a significant improvement over atypical antipsychotic drugs in any cognitive function.In summary, in patients suffering from chronic schizophrenia, atypical antipsychotic agents were associated with slight differential improvements over time in attentional, verbal memory and executive functions compared with conventional neuroleptic drugs. No differential improvements were found in social functioning, verbal fluency, non-verbal domains of memory or visuo-motor abilities.

Abstract: Existing diagnostic criteria for catatonia have been based exclusively on theoretical assumptions. The present study aimed to develop empirical criteria for diagnosing catatonia. The same patient population (n=187) described in Part I (Peralta, V., Cuesta, M.J., Motor features in psychotic disorders. I. Factor structure and clinical correlates. Schizophr. Res., 00, 000-000) was used in this study. Fourteen catatonic signs with potential diagnostic value were cluster-analyzed to derive groups with and without a catatonic syndrome. Taking the cluster solution as the reference standard, the diagnostic value for individual signs was examined by means of multiple discriminant analysis, ROC analysis, and the parameters of sensibility, specificity, positive predictive power and negative predictive power. Cluster analysis divided the sample into a catatonic group (n=32) and a noncatatonic group (n=155). Discriminant analysis showed that 11 of the 14 potential diagnostic signs discriminated among groups: immobility/stupor, mutism, negativism, oppositionism, posturing, catalepsy, automatic obedience, echophenomena, rigidity, verbigeration and withdrawal. ROC analysis showed that any combination of three or more of these symptoms best fitted the cluster-derived catatonic syndrome. In conclusion, patients displaying three or more classical motor signs may be diagnosed with confidence as suffering from a catatonic syndrome.

Abstract: The dimensional structure of motor disorders remains largely unknown. This study aimed to ascertain the factor structure of motor signs and their clinical correlates in psychotic disorders. A sample of consecutive admissions of psychotic patients (n=187) was utilized to examine the factor structure of motor disorders as assessed by the Modified Rogers Scale (MRS). The relationship between motor dimensions and external variables was analyzed. A comparative examination of alternative factor solutions revealed that a six-factor structure, explaining 59% of the total variance, best fitted the 36 MRS items. This solution comprised the components of motor poverty, agitation, stereotypy/mannerisms, proskinetic, negativistic and dyskinetic. All the motor dimensions significantly improved over the psychotic episode. Motor dimensions differentially correlated with the syndromes of psychoses, with the association between motor poverty and the negative syndrome being particularly strong. Residual motor pathology, but not the acute one, was related to various clinical variables. Residual symptoms of motor poverty and stereotypy/mannerisms were associated with poor premorbid adjustment, more illness severity and a diagnosis of schizophrenia. It is concluded that the factor structure of motor disorders and its clinical correlates are rather more complex than generally acknowledged.

Abstract: During the last two decades, much effort has been made to precisely characterize the symptom dimensions of schizophrenia. A number of dimensional models have been proposed, the most popular of which has been a three-dimensional model consisting of psychotic, negative and disorganizational symptoms. This model, however, has been criticized as too simplistic, and more complex models have been proposed, although to date there has been no consensus as to the number and nature of dimensions necessary to account for the whole range of schizophrenic symptoms. In the present paper, the authors review the main methodological issues which have led to the current confusion about the number of dimensions underlying schizophrenic psychopathology. Among the main issues influencing the delimitation of dimensions are: statistical procedures for determining the number of factors, phase of the illness, level of analysis of symptoms (i.e., symptoms or groups of symptoms), and measurement instrument used. Studies analyzing either a broad range of symptoms or particular symptoms at a finer level have produced a rather complex picture of schizophrenic dimensions. There is evidence supporting the existence of eight major dimensions of psychopathology: psychosis, disorganization, negative, mania, depression, excitement, catatonia and lack of insight. The dimensional structure of symptoms becomes even more complex if one considers that these big dimensions can be further divided into more elementary components. A hierarchical approach for organizing the complex dimensional structure of schizophrenic symptoms is proposed.

Abstract: Previous factor analysis studies of psychotic symptomatology have demonstrated three psychopathological dimensions: positive, negative and disorganization. However, few studies have analyzed non-schizophrenic samples and most use a syndrome-level of analysis or only schizophrenic symptom scales. This study examined how many dimensions underlie psychosis, and whether within psychosis there is a hierarchical organization of dimensions.A total of 660 inpatients with an acute psychotic episode were studied. Psychopathology was measured through a wide psychopathological assessment using the Manual for the Assessment and Documentation of Psychopathology (AMDP-system).Principal component factor analysis was carried out on 64 psychopathological symptoms scoring 1 or higher in at least 10% of the sample. A 15-factor solution was obtained which failed to depict a psychosis model on clinical and methodological grounds. Further predetermined factor analyses ranging from 1 to 15 factors were carried out to examine alternative factor solutions. A 10-dimensional model was the best model on clinical, statistical and conceptual grounds. Moreover, the examination of the 1 to 10 dimensional models allowed us to infer a hierarchical model of psychopathological dimensions, which can be represented in the frame of a tree-structure. The model permitted transitions between psychiatric categories and psychopathological dimensions, and it was able to integrate previous factor solutions with different numbers of resulting dimensions.The findings have implications for the design of future studies and for the hierarchical conceptualization of psychopathological dimensions.

Abstract: Kahlbaum described catatonia as a disorder in which mood syndromes were the primary features and the characteristic symptoms were the motor signs. In the present study, we examined the relationship between motor features and other syndromes of psychosis, the clinical validity of Kahlbaum's concept of catatonia, its relationship to schizophrenia and mood disorder, and its nosological position in relation to DSM-III-R, DSM-IV and Leonhard's classification of endogenous psychoses. Patients with Kahlbaum's catatonia differed from patients with schizophrenia or mood disorder in various demographic and clinical variables. Positive and negative motor syndromes, although interrelated, showed a different correlational pattern with other psychotic syndromes. Catatonia did not appear to fit into any particular nosological category, although this issue largely depends on whether schizophrenia and mood disorders are broadly or restrictively defined. When definitions are more restrictive as in Leonhard's system, catatonia seems to be better accommodated as a "third psychosis", i.e. described by the concept of cycloid psychosis.

Abstract: A three-factor structure of schizophrenic symptoms has received considerable support, but there are no data on the factor structure of symptoms in neuroleptic-naive patients and how symptoms evolve after the inception of antipsychotic treatment. Seventy neuroleptic-naive patients with schizophrenia or related psychotic disorders were assessed with the Scales for the Assessment of Positive and Negative Symptoms before and after neuroleptic treatment. Ten global ratings of symptoms were subjected to factor analysis at the two time points and the factor solutions compared. A three-factor structure composed of psychotic, disorganization, and negative dimensions was found at the two assessment points. The negative and disorganization factors were highly correlated at each assessment and across assessments. While the symptom composition of the factors at the neuroleptic-naive assessment fitted that described in most previous studies, the composition of the negative and disorganization factors after neuroleptic treatment was somewhat different in that attention and inappropriate affect loaded on the negative factor instead of the disorganization factor. It is concluded that caution is warranted when using the three-factor model of schizophrenic symptoms as it may not be stable at different phases of the illness.

Abstract: OBJECTIVE: Personality and cognition are often considered as disparate constructs, both in normal individuals and in those with a psychosis. The goal of the present study was to analyze the relationship between dimensions of personality and cognitive performance in individuals with psychosis. METHODS: Sixty-one consecutively admitted patients with an acute psychotic episode were recruited for this study. Personality was assessed through a semistructured interview with a close relative using the Personality Assessment Schedule. A wide neuropsychological battery was applied, including attentional, executive, memory tasks and global cognition. Assessments took place when symptomatology was in remission. RESULTS: Higher scores on a passive-dependent dimension were significantly associated with poorer memory performance. Similarly, higher levels for a schizoid dimension were significantly associated with poorer executive performance. The results remained significant after partialling out the effect of gender, psychopathological dimensions and drug status. CONCLUSION: It is hypothesized that personality traits and cognitive performance are interrelated domains in psychosis.

Abstract:

Abstract: OBJECTIVE: The study examined the primary versus secondary character of negative symptoms in a group of first-episode, neuroleptic-naive psychotic patients before and after they started neuroleptic treatment. METHOD: Forty-seven inpatients with a first episode of schizophrenia or related psychotic disorders were examined for the presence of negative symptoms, psychosis, depression, and parkinsonism at admission to an inpatient psychiatric unit, before receiving neuroleptics, and at discharge an average 3.3 weeks later, after starting neuroleptic treatment. RESULTS: Although patients' mean scores on measures of positive, negative, and depressive symptoms decreased significantly over the treatment period, the mean rating of nonakinetic parkinsonism worsened. The mean rating of akinetic parkinsonism did not change significantly over the treatment period. Negative symptoms at admission were not predicted by positive or depressive symptoms at admission. Residual negative symptoms at discharge were mainly predicted by negative symptoms at admission (i.e., primary symptoms) and to a negligible degree by residual positive and depressive symptoms. Change in negative symptoms over the observation period was predicted to a marginal degree by change in depressive symptoms. CONCLUSIONS: Negative symptoms rated during a first psychotic episode before and after starting antipsychotic treatment are mainly primary in character and should be considered as a direct manifestation of the basic dysfunctions of schizophrenia.

Abstract: BACKGROUND: Many patients suffering from psychosis are unaware of their disorder and symptoms. AIMS: To investigate whether insight changes with time, and how it relates to patients' psychopathology, and to examine the correlations between insight scales in patients with psychoses. METHODS: Seventy-five consecutively admitted in-patients with schizophrenia, affective disorder with psychotic symptoms, or schizoaffective disorder were examined after remission of an acute episode and at follow-up (> 6 months). Three different scales were used to assess insight. RESULTS: To some extent, insight into past episodes improved over time in patients with psychosis, regardless of diagnosis. Few significant relationships between insight and psychopathology remained stable at follow-up. The higher the negative and disorganisation dimensions at baseline, the less did attitudes to treatment vary when tested at follow-up. No predictive value for variability of psychopathological dimensions was found for insight dimensions. The insight scales used were highly intercorrelated, suggesting that they measure the same construct. CONCLUSIONS: Insight and psychopathology seem to be semi-independent domains.

Abstract: Clinical and etiopathological heterogeneity in schizophrenia has been recognized long ago. The main hypothesis held in this report is that as long as we are not able to disentangle the heterogeneity question at the clinical level, it is not likely that heterogeneity at the etiological and pathophysiological levels may be solved. While the description of symptoms and signs of schizophrenia has remained mainly unchanged over the years, the way in which authors have articulated the varied phenomenological manifestations has been very unequal, thus rendering different views of schizophrenia across periods and countries. We still lack a global and comprehensive model to understand clinical heterogeneity in schizophrenia. In absence of compelling evidence for supporting either a categorical or a dimensional view, it is necessary to integrate and empirically compare competing approaches. The use of a polydiagnostic approach on the one hand, and a multidimensional approach on the other (the polydiagnostic-multidimensional paradigm), seems to be a promising strategy to better understand the heterogeneity of schizophrenia.

Abstract: BACKGROUND: We present the findings from the three-year follow-up of all first episodes of schizophrenia occurring during a two-year period in Cantabria (in Spain). AIMS: (a) To describe the clinical characteristics of the illness from the early stages of the disease, and (b) to study the long-term psychosocial adjustment and psychopathological evolution of these patients, identifying predictors for the course of the illness. METHOD: Of the original cohort of 86 patients, 76 (88.3%) were fully evaluated at three-year follow-up. Psychiatric assessment was performed (PSE-9 and SANS/SAPS). Social adjustment was evaluated using the Disability Assessment Schedule (DAS). Information regarding the clinical evolution and use of health resources was also gathered. RESULTS: The majority of patients with a first-contact diagnosis of schizophrenia failed to meet the criteria for a CATEGO diagnosis at follow-up. The SANS/SAPS assessments revealed a doubling in the proportion of patients with 'negative schizophrenia'. The pattern of clinical course was also evaluated, with 24 (31.5%) of the patients having a good outcome. Being male and having low social class tended to be associated with poor clinical outcome CONCLUSIONS: The outcome of schizophrenia is less pessimistic than was originally thought.

Abstract: BACKGROUND: Since low serum iron has been reported in a variety of neuropsychiatric motor disorders, this study was conducted to examine serum iron in patients with a catatonic disorder. METHODS: Forty catatonic and 40 noncatatonic psychotic patients were studied in relation to serum iron levels. The association of serum iron with other clinical variables was also examined. RESULTS: Catatonics had significantly lower mean serum iron than noncatatonics. Ferropenia (serum iron < 50 micrograms/dL) was significantly more prevalent in the catatonic (35%) than in the noncatatonic (7.5%) group. Severity of catatonic symptoms was inversely correlated with level of serum iron, this being due to the negative catatonic symptoms (r = -.34, p = .002). CONCLUSIONS: A subgroup of catatonic patients had ferropenia. Lower serum iron level was associated with both the presence of a categorically defined catatonic syndrome and the severity of the negative catatonic symptoms.

Abstract: Theoretical and empirical models of thought disorder (ThD) were tested through Confirmatory factor analysis (CFA). A sample of 253 DSM-III-R acute schizophrenic patients consecutively admitted was studied. A semistructured interview for schizophrenia was used for diagnosis, and ThD was assessed by means of the Thought, Language, and Communication scale (TLC). Nine ThD models comprising the 18 symptoms of the TLC were tested (ranging from a null model to a six-factor model). The six-dimension model achieved the best fit to the data, although no perfect fit was found. ThD dimensions included in this model were Disorganization, Negative, Idiosyncratic, Semantic, Attentional, and Referential dimensions. The TLC was close to capture adequately these underlying constructs. The Disorganization and the Negative dimensions received more validity on conceptual and psychometric grounds than the remaining dimensions. Thought Disorder multidimensional models fitted the data better than one-dimension models. Thought Disorder dimensions would be potential markers for biological, neurophysiological, and neuropsychological studies of schizophrenic disorder.

Abstract: The factor structure of psychotic symptoms as assessed by means of the Scales for the Assessment of Positive and Negative Symptoms (SAPS and SANS) was examined in a sample of 660 psychotic inpatients. Analyses were conducted at item-level. Principal-component analysis (PCA) was used to extract factors, the OBLIMIN procedure to rotate factors, and the eigen value greater-than-one criterion to determine the number of factors. PCA resulted in 11 interpretable factors explaining 64% of the total variance: poverty of affect/speech, thought disorder/inappropriate affect, bizarre delusions, social dysfunction, other delusions, paranoid delusions, bizarre behavior, nonauditory hallucinations, auditory hallucinations, manic thought disorder, and attention. Many of the factors were significantly intercorrelated. A second-order PCA resulted in four second-order factors, the first three roughly corresponding to the well-known psychosis, disorganization and negative dimensions. It is concluded that the factor structure of psychotic symptoms is more complex than is generally acknowledged, and that the dimensions of psychosis, disorganization and negative represent second-order dimensions. The subscale composition of the SAPS and SANS was not supported.

Abstract: This study aimed to establish correlates of the dimensions of schizophrenia in the premorbid personality traits of patients. A sample of 112 patients of relatively recent illness onset who were admitted for a psychotic episode were assessed with a semistructured interview for schizophrenia. Positive and negative symptoms were evaluated with the Scale for the Assessment of Positive Symptoms and the Scale for the Assessment of Negative Symptoms at the time of hospital discharge; positive, negative, and disorganization scores were obtained from these scales. Premorbid personality was assessed blindly through a partially modified version of the Personality Assessment Schedule using interviews with the parents or a close relative. Schizoid traits were significantly associated with negative and positive dimensions. Sociopathic traits were related to the disorganization dimension. Trends toward significance were obtained between passive-dependent traits and the negative and disorganization dimensions, and between the schizotypal dimension and the positive dimension. Partial correlational analyses were used to control for the effect of the remaining personality dimensions on the above relationships. Schizoid premorbid traits were still significantly related to the negative dimension but to a lesser degree to the disorganization and positive dimensions. The association between sociopathic premorbid traits and the disorganization dimension remained significant. These results suggest the preexistence of a three-dimensional structure predisposing to psychoses within the premorbid personality; this structure is more evident in patients with short illness duration.

Abstract: BACKGROUND: To study the interrelationship pattern of negative, depressive, parkinsonian and catatonic symptoms over an exacerbation phase of schizophrenia. METHOD: Forty-five inpatients with a DSM-IV diagnosis of schizophrenia or schizophreniform disorder were assessed at admission and discharge for negative, depressive, parkinsonian and catatonic symptoms. A subsample of patients unmedicated at admission (n=23) was specifically analyzed. RESULTS: Negative, parkinsonian and catatonic symptoms correlated significantly at both assessment points, as did their mean changes over the episode. At admission, depressive symptoms did not correlate with negative, parkinsonian or catatonic symptoms, but they did at discharge. Changes of depressive symptoms over the episode did not correlate with changes of the other groups of symptoms. In the patients who were unmedicated at admission, ratings of nonakinetic parkinsonism, unlike ratings of akinetic parkinsonism, worsened significantly after neuroleptic treatment. CONCLUSIONS: While negative, parkinsonian and catatonic symptoms are highly related features, depressive symptoms seem to be a relatively independent dimension of psychopathology in schizophrenia. Non-akinetic parkinsonian symptoms may be more useful than the akinetic symptoms in distinguishing primary from drug-induced negative symptoms.

Abstract: BACKGROUND: Despite the lack of consistent empirical support, modern diagnostic criteria of schizophrenia give particular emphasis to Schneider's first-rank symptoms (FRSs). AIMS: To examine the diagnostic significance of FRSs for schizophrenia by trying to overcome the limitations of previous studies. METHODS: This study examined the diagnostic accuracy of FRSs for schizophrenia in 660 in-patients with the full spectrum of functional psychotic disorders. Schizophrenia was diagnosed according to three criteria: DSM-III-R broad, DSM-III-R narrow and Feighner, the latter being considered as the gold standard because it does not give particular emphasis of FRSs. RESULTS: FRSs were highly prevalent in both schizophrenia and non-schizophrenic psychoses. The likelihood ratios (and 95% CI) of one or more FRSs for Feighner, DSM-III-R narrow and DSM-III-R broad schizophrenia were 1.06 (0.94-1.20), 1.23 (1.09-1.39) and 1.73 (1.44-2.08), respectively. These data indicate that FRSs do not significantly increase the likelihood of having schizophrenia. CONCLUSIONS: FRSs are not useful in differentiating schizophrenia from other psychotic disorders. Diagnostic systems for schizophrenia that are heavily based on these symptoms may arise from a tautological definition of the disorder.

Abstract: This study evaluated the prevalence and clinical correlates of abnormal subjective experiences across functional psychotic disorders. Patients were recruited from consecutive admissions with the following diagnoses; schizophrenia (n = 40), schizophreniform disorder (n = 40), schizoaffective disorder (n = 21), mood disorder (n = 18), brief reactive psychosis (n = 15), and atypical psychosis (n = 16). Subjective experiences were assessed using the Frankfurt Complaint Questionnaire (FCQ), and the clinical status was assessed with the Scales for the Assessment of Positive and Negative Symptoms (SAPS and SANS) and the Manual for the Assessment and Documentation of Psychopathology (AMDP). Neither the FCQ total score nor individual subjective experiences displayed significant differences across diagnoses. When the clinical predictors of subjective experiences were studied by multiple regression analyses, a different pattern resulted for individual psychotic disorders. In schizophrenic patients, subjective experiences were predicted by female gender, euphoria, lack of insight, greater illness severity, and more positive symptoms. The only predictors of subjective experiences in the schizophreniform disorder group were the negative symptoms. Within the affective disorders group, subjective experiences had no clinical predictors.

Abstract: BACKGROUND: The factor structure of four competing models of positive symptoms and their clinical validity was studied in a sample of 253 schizophrenia inpatients. METHODS: The following models were tested using confirmatory factor analysis: a one-dimension severity model, a two-dimension model comprising a psychosis factor and a disorganization factor, a four-dimension model based on the Scale for the Assessment of Positive Symptoms (SAPS) structure in subscales, and a five-dimension model derived from the previous one by further differentiating Schneiderian delusions from non-Schneiderian ones. RESULTS: More complex multifactorial models fit the data better than simpler models. The five-dimension model was the best adjusted (goodness of fit index = .844, nonnormed fit index = .812, normed fit index = .728). Whereas the one-dimension model did not display significant association with the clinical variables, multidimensional models were related to age at onset and illness severity. The two-dimension model captured well the clinical correlates of the more complex models. CONCLUSION: None of the tested models showed good fit to the data. The one-dimension model displayed both poor factor validity and poor external validity; therefore, research relying on the SAPS total score may reach misleading conclusions.

Abstract: BACKGROUND: The study's aim was to examine insight in mood disorders in relation to type of mood episode, psychotic state, and insight change over the episode. METHODS: Fifty four patients with a manic or major depressive episode were interviewed for insight assessment at admission and discharge. RESULTS: At admission, mania patients had more severe insight impairment that depressive ones, depressive patients with psychosis had poorer insight than those without psychosis, and mania patients had poor insight irrespective of the presence of psychotic symptoms. At discharge some insight impairment was observed in mania. CONCLUSION: Lack of insight was a prevalent condition in psychotic depression and mania. LIMITATIONS: A global insight measure was used. Ratings of insight were not blind to the ratings of other symptoms. CLINICAL RELEVANCE: Considering residual insight impairment in mania may be important to maximize compliance and to prevent relapse.

Abstract: This study aims to verify whether cognitive disturbances in schizophrenic patients are associated with illness duration, and to examine the influence of other covariates on neuropsychological disturbances. Sixty-nine consecutive admissions of schizophrenic patients (DSM-III-R, APA, 1987) were included to an acute psychiatric unit. Patients were evaluated by a semistructured interview and assessed with the Scale for the Assessment of Positive Symptoms (SAPS) and the Scale for the Assessment of Negative Symptoms (SANS). A wide neuropsychological battery, adapted to Spanish, was used. Variables were transformed to z-scores when their distribution was normal, or to log-values in the case of non-normal distributions. Pearson's correlation coefficients with a Bonferroni correction showed strong relationships between illness duration and cognitive performance in neuropsychological tests on visuomotor processes and delayed visual memory. In order to examine the influence of potential covariates on neuropsychological disturbances, stepwise multiple regression procedures were performed with each neuropsychological measure as a dependent variable, and years of education, age, gender, neuroleptic does in chlorpromazine equivalents, biperidene doses and illness duration as independent variables. The longer the illness duration, the poorer the performance on visuomotor process and delayed visual memory tasks. Moreover, the neuropsychological disturbances associated with illness duration were different from those related to aging, educational background, gender and treatment status. These findings suggest the existence of a relationship between cognitive decline in visuomotor and delayed visual memory functions and the length of schizophrenic illness.

Abstract: The present study investigated the relationships of psychopathological dimensions of schizophrenia with Insight in a sample of 100 acute schizophrenic patients. Lack of insight was significantly correlated with disorganized, excited and negative schizophrenic dimensions but not with other Positive and Negative Syndrome Scale dimensions. In addition, when insight was assessed through a multidimensional approach, a variety of relationships with the schizophrenic dimensions were found.

Abstract: Kahlbaum described catatonia as a disorder in which mood syndromes were the primary features and characteristic symptoms were the motor ones. However, after Kahlbaum this concept has not been taken into account and catatonia has been identified with motor features alone. In the present study, we assessed the clinical validity of Kahlbaum's concept of catatonia, its nosological position in relation to DSM-III-R, DSM-IV, and Leonhard's diagnostic criteria, and its relationships with schizophrenia and mood disorder. Of 567 patients consecutively admitted due to a functional psychotic disorder, 45 met criteria for catatonia according to Kahlbaum's concept (the Kahlbaum syndrome [KS]). Patients with the KS were differentiated from those with schizophrenia and mood disorders across a number of demographic and clinical variables, the differences being greater with the former than with the latter group. KS does not appear to fit any particular nosologic category, although this issue largely depends on whether schizophrenia and mood disorder are broadly or restrictively defined. When definitions of both disorders are most restrictive, as in the case of the Leonhard system, KS seems better accommodated as a "third psychosis". Overall, the data raise the possibility that KS is either a variant of mood disorder, or a distinct clinical entity.

Abstract: Schizophrenia is a disorder of extraordinary importance and complexity. Heterogeneity in the clinical presentation of schizophrenia is certain, which probably reflects heterogeneity in pathophysiology and etiology. Examination of various risk factors can give clues to the causes. Only genetic risk factors come anywhere near the effect size expected for a strong causal agent in schizophrenia. However, the existence of so many environmental risk factors cannot be ignored. Both psychosocial and biological environmental factors may interact with genetic vulnerability to increase the risk of schizophrenia.

Abstract: Global ratings from the Scale for the Assessment of Positive Symptoms and Scale for the Assessment of Negative Symptoms were subjected to principal-component analysis (PCA) in 80 schizophrenia patients, 76 patients with schizophreniform disorder, 80 patients with schizoaffective and mood disorders, and 78 patients with delusional, brief reactive, and atypical psychoses. The resulting factors were correlated with depressive, manic, and catatonic syndromes, and subjected to a multivariate analysis of variance across DSM-III-R diagnoses. PCAs revealed that psychosis, disorganization, and negative factors were also present in each of the nonschizophrenic groups. The disorganization factor tended to be related to the manic syndrome, and the negative factor to depressive and catatonic syndromes. Overall, the three factors had little diagnostic relevance in functional psychoses, although the negative factor was relatively more characteristic of schizophrenia. The data suggest that positive, negative, and disorganization factors are not specific to schizophrenia; this is consistent with a dimensional view of psychopathology in functional psychoses.

Abstract: In spite of the great number of studies that have proved the existence of cognitive disturbances in schizophrenic subjects, conflicting results have not allowed to glimpse a typical pattern of neuropsychological deficits in schizophrenia. On the contrary, these results have raised important controversies regarding the nature of such cognitive impairment. Thus, questions concerning the existence of generalized versus focal cognitive impairment or in relation lo the static versus progressive nature of these deficits remain unresolved. In the middle of these debates, the need for prospective research, which focuses on the neuropsychological deficits of schizophrenia and other psychotic disorders from the beginning of the illness, has been pointed out. In these lines we present the results obtained in our study in which 59 subjects, who were admitted in our hospital for presenting a first psychotic episode, were assessed. Measures of premorbid adjustment, obstetric complications and clinical symptoms were taken and correlated to measures of cognitive performance obtained by using a minibattery of neuropsychological tests at time of dismissal. Results showed, as in previous research, that neuropsychological deficits are already present in psychotic patients at the beginning of the illness. These deficits in our sample were related lo obstetric complications especially in males, and disturbances of premorbid adjustment occurred in early stages of development. These results support the neurodevelopmental hypothesis of schizophrenia.

Abstract: The Frankfurt Complaint Questionnaire (FCQ) is a self-assessment instrument designed to evaluate the subjective experiences (SE) of psychotic patients. It is composed of 98 yes-no items grouped in ten phenomenological subscales. The original validation of the FCQ included a factor analysis with a four-factor structure. No further studies of factor validity have been carried out. The present study aimed to replicate the factor structure of the FCQ in a Spanish sample. The sample was composed of 286 consecutively admitted patients due to a recrudescence of their psychotic symptoms. They were evaluated through a semistructured interview for schizophrenia and diagnosed according to DSM-III-R criteria. Organic mental disorders were excluded. Sixteen patients who failed to fulfill the FCQ were excluded. The sample finally comprised 270 patients. A factor structure of FCQ items comprising 25 factors was found. The first factor obtained the highest explained variance, and most items obtained their highest load on the first factor. These results strongly suggest a unidimensionality underlying FCQ items. A new scale composed of 18 items was derived from those with higher weights in the first factor. The new scale of SE was presented in a Likert format to demonstrate their frequency and intensity more clearly.

Abstract: The prevalence of abnormal subjective experiences is high in schizophrenic patients. This study starts from the hypothesis that these subjective disorders are associated with cognitive disturbances. In order to test this hypothesis a study was carried out on 40 patients who were diagnosed as suffering from schizophrenia according to RDC and DSM-III-R criteria. They were consecutively admitted due to a recrudescence of their symptomatology. Version 3 of the Frankfurt Complaint Questionnaire, adapted for Spanish by the authors, was used as an instrument for the assessment of subjective experiences. Eight patients refused to answer the questionnaire. A neuropsychological battery, including the Mini-Mental State, some subtests from the WAIS, Bender's visual-motor test, Rey's Complex Figure, and the Trail Making Test, was used. Frontal neurological signs were evaluated. The abnormal subjective experiences of schizophrenics presented a close association with neuropsychological disturbances and, to a lesser degree, of intensity with frontal neurological signs. Regression analyses by means of stepwise method and partial correlation analyses were undertaken. Many significant relationships between subjective experiences and cognitive disturbances persisted after controlling the influence of age, gender, education, lack of insight, neuroleptic doses, and biperidene doses.

Abstract: BACKGROUND. The aim was an investigation of the symptom composition of the negative syndrome of schizophrenia. METHOD. A hundred schizophrenic patients were assessed with various rating scales for positive and negative symptoms and typological criteria. A subgroup with a negative syndrome was defined, and a discriminant analysis performed using symptoms from the Scale for the Assessment of Negative Symptoms (SANS) as discriminant variables. RESULTS. The discriminant function classified 92% of patients correctly. All but four SANS symptoms (inappropriate affect, both attentional items and blocking) were significantly correlated with the discriminant function. CONCLUSIONS. With the exception of some items, the SANS seems to capture adequately the negative syndrome of schizophrenia.

Abstract: A higher prevalence of neurological signs (NS) has been described in schizophrenic patients when compared with controls or patients with other mental illnesses. This study, which includes a sample of 66 DSM-IIIR schizophrenics, was designed to assess the relationship between 7 frontal neurologic signs described by Luria and cognitive disturbances measured by an exhaustive neuropsychological battery. There was a statistically significant relationships between the frontal signs and the cognitive deficits (mean shared variance was 22%) which persisted after correcting for the influence of age, education, and duration of illness.

Abstract: The value of positive and negative symptoms for cross-sectional differential diagnosis was studied in a sample of 103 consecutively admitted patients with schizophrenia and schizoaffective psychoses. A semistructured interview for schizophrenia was used. Subjects were diagnosed by Research Diagnostic Criteria (RDC) and classified as schizophrenic, depressive schizoaffective, and manic schizoaffective disorders. DSM-III-R criteria for schizophrenia were used to assign RDC schizophrenics to two groups: "true" schizophrenic (fulfilling both DSM-III-R and RDC criteria) and schizophreniform (fulfilling RDC but not DSM-III-R criteria). The Scale for the Assessment of Positive Symptoms (SAPS) and Scale for the Assessment of Negative Symptoms (SANS) were used. Our findings showed that both positive and negative symptoms were relevant to differential diagnosis between schizophrenia and other psychotic disorders. However, negative symptoms presented higher significant differences between diagnostic groups than positive symptoms. These results were obtained by global ratings and by scoring on individual symptoms of SAPS and SANS. Treatment with neuroleptic and biperidene drugs did not alter symptomatologic differences between groups that resulted from repeated analyses of covariance. Certain symptoms and clusters of symptoms were found to be of higher severity of higher severity in only one diagnostic group. They were as follows: pressure of speech for manic schizoaffective disorder; guilt for depressive schizoaffective; high scores on negative symptoms for depressive schizoaffective and schizophrenic disorders; inappropriate affect for schizophrenic disorder; and three "psychomotor retardation" symptoms of the affective flattening subscale of SANS (unchanging facial expression, decreased spontaneous movements, and paucity of expressive gestures) for depressive schizoaffective disorder.(ABSTRACT TRUNCATED AT 250 WORDS)

Abstract: To test underlying latent syndromes within schizophrenic syndromes assessed by the Positive and Negative Syndrome Scale (PANSS), a sample of 100 DSM-III-R schizophrenia patients was obtained through a semistructured interview for schizophrenia. Confirmatory factor analysis was used to evaluate the underlying symptomatological dimensions. The positive and negative construct was not confirmed by this study. The three- and four-dimension models obtained higher goodness of fit than the one- or two-dimension models. Models composed of three or four dimensions shared positive and negative syndromes, in addition to "disorder of relating" and/or "disorganization" dimensions. The disorder of relating dimension of PANSS was composed of emotional withdrawal and passive/apathetic social withdrawal. The disorganization dimension comprised two symptoms of PANSS (conceptual disorganization and poor attention) and an item not included in the PANSS: inappropriate affect. It is suggested that a schedule for the assessment of this item be added to the PANSS.

Abstract: The paper explores the reliability, concurrent validity and overlap of some positive/negative symptom rating scales and typological criteria in 100 schizophrenic patients. Rating scales include Andreasen's Scales for the Assessment of Positive and Negative Symptoms, Abrams and Taylor's Scale for Emotional Blunting, and Kay's Positive and Negative Syndrome Scale. Criteria for categorizing individual patients include Andreasen's and Kay's criteria for positive and negative types of schizophrenia as well as Carpenter's criteria for the deficit syndrome. The correlations among positive as well as among negative scales were high. The agreement among criteria tended to be lower. Both positive scales showed low internal consistency. Kay's negative scale had the greatest internal consistency, which suggests that it is measuring a homogeneous syndrome. All negative symptom scales and categorical syndromes identified a group of patients who were single and exhibited schizoid or schizotypal pre-morbid personality disorders, poor premorbid sexual/social adjustment, poor response to neuroleptics and poor prognosis.

Abstract: A principal component analysis of Wisconsin Card Sorting Test (WCST) scores has recently shown three factors. Only the Perseveration factor may measure the activity of the dorsolateral prefrontal cortex in schizophrenic patients. Liddle has hypothesized that a dysfunction in this area is specifically related to the negative syndrome and not to other schizophrenic syndromes (positive and disorganization). The factor analysis of the WCST was replicated with similar results in 38 schizophrenic or schizoaffective patients. In the total group, the correlation between the negative syndrome and the Perseveration factor did not reach significant levels. In the patients with a DSM-III-R diagnosis of schizophrenia (n = 30), the correlations did reach significant levels.

Abstract: OBJECTIVE: The purpose of this study was to test whether poor insight in patients with psychotic disorders is correlated with their performance on the Wisconsin Card Sorting Test. METHOD: The subjects included 52 psychotic patients (35 of whom had schizophrenia) given diagnoses according to DSM-III-R criteria. Their scores on the Wisconsin Card Sorting Test (number of categories and perseverative responses) were compared with those on three items measuring poor insight: lack of feeling ill, lack of insight, and uncooperativeness. RESULTS: None of the six correlations between scores on the two measures of the neuropsychological test and the three items measuring insight was significant. CONCLUSIONS: In spite of its limitations, this study suggests that poor insight may not be associated with poor performance on the Wisconsin Card Sorting Test.

Abstract: Recent factor-analytic studies have derived several trisyndromic models for schizophrenia, all based on the positive, negative, and disorganization syndromes. The goal of this study was to examine cognitive disorders in these three schizophrenic syndromes. The study group was composed of 40 schizophrenic patients consecutively admitted to the hospital due to a recrudescence of their symptomatology. They were selected on the basis of a semistructured interview, diagnosed with DSM-III-R criteria, and evaluated with scales for positive and negative symptoms. Their cognitive disorders were assessed with a battery of neuropsychological tests. The schizophrenic syndromes were weakly associated with cognitive performance through direct correlations and after correction for confounding variables. The disorganization and negative syndromes were more strongly associated with cognitive disturbances than was the positive syndrome, and both were associated with disturbances of visual-motor processes. Moreover, the disorganization syndrome was associated with disturbances in language and verbal memory and in time-controlled performance.

Abstract: OBJECTIVE: The aim of the study was to examine different models of the factor structure of negative symptoms in schizophrenia through the use of a confirmatory factor analysis procedure. METHOD: The cohort comprised 253 inpatients diagnosed with schizophrenia according to DSM-III-R criteria. Negative symptoms were evaluated with the Scale for the Assessment of Negative Symptoms (SANS). Seven alternative models of negative symptoms were compared by means of confirmatory factor analysis. RESULTS: The unidimensional model fit the data modestly. More complex multifactorial models fit the data better than simpler models. Both five-dimension models corresponding to the original SANS structure fit the data quite well; the model excluding inappropriate affect from the SANS was the best adjusted. CONCLUSIONS: Multidimensional models fit the data better than the unidimensional model. The data provide evidence for the factorial validity of the SANS and the characterization of the SANS subscales as true underlying dimensions of observable negative symptoms.

Abstract: A neuropsychological etiology has been suggested for lack of insight in schizophrenia patients, mainly based on frontal, right parietal, right hemisphere, or diffuse cerebral dysfunctions. The aim of this study ws to investigate the neuropsychological pathogeny of lack of insight in schizophrenia patients. We examined a sample of 40 DSM-III-R schizophrenia inpatients admitted because of a recrudescence of symptoms. Schizophrenic symptoms were evaluated through the Scale for the Assessment of Positive Symptoms and the Scale for the Assessment of Negative Symptoms. Neurologic explorations included an assessment of frontal neurologic signs, abnormal involuntary movements, and soft neurologic signs. Lack of insight was assessed through three items from the Manual for the Assessment and Documentation of Psychopathology (AMDP). A global index from these three items (lack of feeling ill, lack of insight, and uncooperativeness) was obtained. A neuropsychological battery composed of tests involving many functional areas of the brain was used. No correlation between bad performance and lack of insight was found on any test. On the contrary, lack of insight was associated with better performance on immediate verbal, immediate visual, and delayed visual memory tasks. Moreover, the three components of lack of insight were extracted as an independent factor when they were included together with the positive and negative symptoms, neurologic abnormalities (frontal and soft neurologic signs, and abnormal movements), and a global measure of cognitive performance. The results of the study do not support the neuropsychological hypothesis of lack of insight.(ABSTRACT TRUNCATED AT 250 WORDS)

Abstract: 1. The influence of clinical syndromes (determined by factor analysis) on treatment response was explored in a sample of schizophrenics treated by clinician choice. Patients were obtained from 115 consecutive admissions to an acute inpatient unit and were diagnosed by DSM-III-R criteria. Patients were thoroughly assessed during the first five days of hospitalization using SANS-SAPS, TLC and SEB. Factor analyses of these scales were carried out to explore the existence of syndromes made up of groups of symptoms. All patients were treated with neuroleptics and 70% with biperiden (to exclude akinesia). The response to treatment was measured by the CGI efficacy index. 2. Inappropriate affect, asociality, negative formal thought disturbances and bizarre behavior syndromes showed significant correlation with poor response to treatment. Affective flattening did not display consistent significant correlations with the response to treatment. Visual hallucinations (an infrequent syndrome) and manic thought disorder (a non-specific syndrome) showed significant correlations with better response to neuroleptics. 3. In a stepwise multiple regression model to predict treatment response, asociality and inappropriate affect were the most important predictors. In a discriminant analysis dividing patients between responders and non-responders, the syndromes predicting poor response were more important that those predicting good response.

Abstract: The current status of subjective experiences in schizophrenia is examined. Subjective experiences are very frequent disorders in schizophrenic patients, and their study has been largely neglected. Recently, a number of scales that evaluate subjective experiences have been published, and although the psychometric properties of most scales have not been sufficiently studied, they seem to have adequate interrater reliability, internal consistency, and convergent validity. A higher number of subjective experiences is associated with the female sex and is inversely correlated with the level of education and lack of insight into illness. Hypothetically, subjective experiences are ascribed to impairments of information processing; however, studies on the relationship between these symptoms and measures of information processing are scarce and contradictory. In the acute stage of the illness, subjective experiences are associated with positive symptoms, and at this stage they may reflect the process activity of schizophrenia. In the remission stage of the illness, subjective experiences are related to negative symptoms, and they constitute the subjective correlate of the psychological deficit. A theory of subjective experiences within the framework of the vulnerability/stress model of schizophrenia is proposed.

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Abstract: Various models of schizophrenia have postulated two syndromes (i.e., positive and negative), although other exploratory factor analyses have suggested a disorganization syndrome. We conducted a confirmatory factor analysis (CFA) on Schedule for the Assessment of Positive Symptoms (SAPS) and Schedule for the Assessment of Negative Symptoms (SANS) items and subscales to assess the latent structure of symptoms reflecting underlying pathological processes. The sample included 253 DSM-IIIR schizophrenic inpatients. Fourteen different models with one, two, three, or four syndromes were compared using CFA for "goodness of fit." The three-syndrome models displayed better fitness than any of the one- or two-syndrome models. All of the three-syndrome models shared the positive and negative dimensions; the third dimension in these three-syndrome models was either the disorganization or Strauss' relational dimensions. In the reported data, a four-syndrome model, including positive, disorganization, negative, and relational dimensions, showed excellent fitness. Despite its limitations, this study suggests the need to explore the validity of a four-syndrome model. The positive-negative model fits poorly with the data.

Abstract: We analyzed the psychometric properties of the Positive and Negative Syndrome Scale (PANSS) in a sample of 100 DSM-III-R schizophrenic patients. Our findings coincided with the results of Kay's group in the following points: (1) the PANSS scores were normally distributed; (2) the positive and negative scales showed good interrater reliability; (3) positive and negative syndromes are independent constructs; (4) the positive and negative scales held a high concurrent validity in relation to the Scale for the Assessment of Positive Symptoms and the Scale for the Assessment of Negative Symptoms; and (5) although positive and negative syndromes showed factorial validity, they were not sufficient to account for the whole of the schizophrenic symptoms. Unlike Kay's group, we found a modest internal consistency of the positive scale, indicating that it is composed of several independent components. The data suggest that the distinction between positive and negative symptoms is an oversimplification, and that schizophrenic symptoms can be better conceptualized as composed of, at least three dimensional syndromes: positive, disorganized, and negative.

Abstract: A study was conducted to survey the prescribing practices of neuroleptic doses in 100 consecutively hospitalized DSM-III-R schizophrenic patients. The relationship between doses and clinical and symptomatological variables was subsequently analyzed. Patients were evaluated through the Positive and Negative Syndrome Scale (PANSS). The peak mean dose in chlorpromazine equivalents was 1290 (range 250-7200). Haloperidol was the most commonly employed neuroleptic (67 patients). Neuroleptic doses were correlated with excitement, suspiciousness, hostility, uncooperativeness and poor impulse control. The neuroleptic doses administered in our hospital were similar to those found in other survey reports but higher than those recommended by the controlled dose-response studies. The correlation found between neuroleptic doses and symptoms of disruptive behavior suggests that we employed high-dose practices to treat the disruptive symptoms of schizophrenia. We concluded that it is useful to distinguish between the neuroleptic doses required to control the psychotic episode and those to treat the disruptive behavior.

Abstract: The SFII (Short-Form Impairment Index, Horton and cols, 1986) was used to assess cognitive impairment in patients with DSM-III-R diagnosis of schizophrenia and its relationship to the positive and negative schizophrenic symptoms was studied. Two samples of DSM-III-R schizophrenic patients were studied. The first sample was composed of 30 consecutively inpatients admitted by recrudescence of their symptoms. The second was composed of 19 patients that were attending to a Day Psychiatric Hospital by recrudescence of their symptoms or by socio-familiar dysfunctions. The SFII included three subtest: the "Trail Making" Form B, and cubes and digit symbol from the WAIS, that were converted to typical scores adjusted to age (Reitan, 1973). The positive and negative schizophrenic symptoms were assessed by the Andreasen scales (SAPS y SANS). No differences in epidemiological variables were found between both samples. Higher cognitive impairment (lower SFII) and higher negative symptoms were significantly correlated in both samples. This result suggests that the SFII could be a good marker of cognitive functioning in schizophrenic patients in postacute samples and also in mixed schizophrenic patients (acute and defectual population). The SFII presented some limitations in our young samples derived from their age-corrected values.

Abstract: The Scale for Assessment of Positive Symptoms was used to measure delusions and hallucinations in 115 DSM-III-R schizophrenics. Our factorial analysis of the hallucinations and delusions resulted in three factors with appropriate internal consistency and frequency: a Schneiderian delusional syndrome, an auditory hallucination syndrome, and a paranoid syndrome that tend to be present in schizophrenics with later onset. These results should be cautiously interpreted due to their cross-sectional nature and to the size of the sample which does not ensure the stability of the factors.

Abstract: BACKGROUND: Emotional blunting and negative symptoms were explored as interchangeable concepts in evaluating schizophrenic patients. METHOD: We evaluated 115 consecutively admitted patients who had DSM-III-R schizophrenia. We performed a principal component analysis of Abrams and Taylor's Scale for Emotional Blunting (SEB) and Andreasen's Scale for the Assessment of Negative Symptoms (SANS) and correlated the subscales derived by factor analyses with demographic and clinical variables. RESULTS: Both scales contained subscales corresponding to poverty of affect and speech and inappropriate affect. The SEB also included an indifference subscale, whereas the SANS included avolition-anhedonia, asociality, and blocking subscales. Poor premorbid functioning was most strongly associated with poverty of affect and speech. Inappropriate affect and anhedonia-avolition-asociality were moderately correlated with poor response to treatment. CONCLUSION: Negative symptoms and emotional blunting are similar concepts, but they are not interchangeable. Flatness and inappropriateness appear to be different affective dimensions with different clinical correlations. Inappropriate affect, inattention, and blocking should not be considered negative symptoms.

Abstract: The aim of this study was to examine whether specific forms of formal thought disorder distinguish schizophrenia from schizophreniform and schizoaffective psychoses. The sample was composed of 82 consecutively admitted patients with schizophrenic symptoms. Of these, 28 had a diagnosis of schizophrenia by RDC and DSM-IIIR criteria, 28 a diagnosis of schizophrenia by RDC but not DSM-IIIR (consequently they were labeled schizophreniform), and 26 a diagnosis of manic schizoaffective disorder by RDC criteria. They were assessed by a semi-structured interview for schizophrenia, by scales for positive and negative symptoms (SAPS and SANS) and by prognostic indicators. The assessment of thought disorder was carried out by using the Thought, Language and Communication scale (TLC). The schizophrenic patients showed higher global scores on formal thought disorder, and some of its subtypes were 'most specific' to schizophrenia (poverty of speech, poverty of content of speech, illogicality, tangentiality and perseveration). Schizophrenics had more loose associations than schizophreniforms. Manic schizoaffectives had higher scores on positive versus negative formal thought disorder than schizophreniforms. We suggested that the assessment of disordered thinking by the TLC may facilitate the differential diagnosis of psychotic disorders during the acute phase of the illness.

Abstract: The relationship between the self-perceived cognitive disorders (SPCD) assessed using the Frankfurt Complaint Questionnaire (FCQ) and 21 definitions of schizophrenia was studied in a sample of 118 consecutively admitted patients. The FCQ total score was significantly associated (p < 0.05) with the presence of Schneider's, Yusin's and Present State Examination criteria of schizophrenia. A significant association, in this case negative, was also found between the FCQ total score and the presence of the DSM-III-R criteria of schizophrenia. The results suggest that the SPCDs are more associated with Schneider-related criteria than with chronic or deficit models of schizophrenia. It was also found that the female sex as well as the presence of insight were significantly associated with a greater number of SPCDs.

Abstract: The Thought, Language and Communication Scale (TLC) was studied in a sample composed of 115 DSM-III-R schizophrenic patients admitted to an acute inpatient unit. A principal component analysis with varimax rotation was performed to explore the possibility of the existence of syndromes within the formal thought disturbances. Seven factors were found to have eigen values greater than 1 and five showed appropriate internal consistency. The first factor, or disorganization factor, was close to the Scale for the Assessment of Positive Symptoms (SAPS) formal thought disturbance subscale. The second, or negative factor (perseveration, poverty of speech and content), was moderately correlated with poor premorbid functioning and poor response to neuroleptic treatment. The third and fourth factors were, respectively, formed by stilted speech plus word approximations, and neologisms plus clanging. The fifth factor (distractibility and blocking), as well as the first two factors, were correlated to the Scale for the Assessment of Negative Symptoms (SANS) attention subscale.

Abstract: A study was carried out on a group of 95 schizophrenic patients (DSM-III-R criteria) under the age of 35, 23 of whom were cannabis abusers in the past year. The objective of the study was to evaluate the effect of cannabis on positive and negative schizophrenic symptoms, evaluated using Andreasen's Scales for the Assessment of Positive and Negative Symptoms (SAPS and SANS). There were no statistically significant differences between the groups on the SAPS; the group of cannabis abusers had higher scores except for the delusions subscale. On the SANS nonabusers scored higher, with a significant difference on the alogia subscale. The results suggest that the consumption of cannabis by schizophrenic patients could attenuate negative symptoms, which would support the self-medication hypothesis of cannabis abuse.

Abstract: In a sample of 71 Research Diagnostic Criteria (RDC) schizophrenic patients, the relationship among the basic symptoms measured by the Frankfurt Complaint Questionnaire and Andreasen and Olsen's types of schizophrenia was studied. The results do not support an overlap between negative and basic symptoms; rather, basic symptoms appear to be more frequent in patients with positive symptoms. Basic symptoms were consistently correlated to formal thought disturbances, but the values were only moderate (r = .3).

Abstract: A sample of 115 DSM-III-R schizophrenics was studied by means of the SANS and SAPS. A factor analysis from the nine subscales and two symptoms (inappropriate affect and poverty of content) and a review of the previous factor analyses suggest that schizophrenic symptoms cannot be appropriately classified into positive and negative syndromes. The low internal consistency of the SAPS suggests that the positive symptoms are not a homogeneous syndrome. Our results fit better with Liddle's model of three syndromes (negative, delusion-hallucination and disorganisation syndromes). It is argued that we are far from a valid classification of schizophrenic symptoms and the positive-negative dichotomy appears to be an oversimplification.

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Abstract: Using the 'polydiagnostic approach' method, the relationship between basic symptoms (BS) and Bleulerian and Schneiderian types of schizophrenia is studied. Eighty-six schizophrenic patients (RDC criteria) were studied using the Frankfurt Complaint Questionnaire for the evaluation of the BS. The patients were classified according to the type of symptoms predominant in Schneiderian (n = 32), Bleulerian (n = 12) and mixed (n = 42) schizophrenics. The patients with Schneiderian and mixed schizophrenia displayed more BS than those having Bleulerian schizophrenia. Significant differences (p less than or equal to 0.05) were found on the subscales of Perception (simple), Language, Memory, Motoric and Loss of automatism, in factors 1, 2 and 4, and in the total score. The results suggest that, from the perspective of the BS, Schneiderian schizophrenia is different from Bleulerian and that the BS may have the same production mechanisms as Schneider's FRS, the difference between them being in the different degree of phenomenological expression.

Abstract: The relationship between premorbid personality and schizophrenic symptoms assessed by the Scales for the Assessment of Positive and Negative Symptoms was explored in 115 DSM-III-R schizophrenics. The frequencies of normal, schizoid-schizotypal and other DSM-III-R personality disorders were 44%, 39% and 17%. Affective flattening and alogia were significantly more frequently present and severe in the schizoid-schizotypal group than in the rest of the patients. There were no differences in positive symptoms. It is suggested that, in some cases, negative symptoms are merely the persistence or exacerbation of schizoid traits present prior to the emergence of schizophrenic symptoms. These results should be cautiously interpreted because the premorbid personality was diagnosed in a retrospective way and the negative symptoms were assessed cross-sectionally.

Abstract: The authors have carried out a bibliography revision about the relation between Melatonin secretion in the pineal gland and mental disorders. In the introduction a revision is done of the aspects of the anatomical functions of Melatonin secretion regulation. After words they study from a chronological perspective' studies of literature with reference to mental disorders. Two stages in the evolution of knowledge about Melatonin. The first stage consists of pharmacologic studies and pharmacotherapeutic studies and pharmaco-endocrine studies. Beginning with the melatonin determinations in biological liquids during the 60's and 70's; and a second stage which began at the end of 70's up until the present date, namely Melatonin secretion endocrinal studies in mental disorders. Apart from this, the comparing of the other hormonal secretion endocrinal studies in mental disorders. Apart from this, the comparing of the other hormonal secretion rhythms such as corticoids with function tests in Hip- Hipof. axis using the Dexamethasone suppression Test (DST). The authors also compare their experimental results with previous bibliography publications. The importance of night levels of Melatonin secretions in some patients with major depressive disorders and with abnormal answers in the DST show a diminishing when compared with another depressive disorders and their normal controls. Lastly the possible pathophysiological implications of melatonin and the pineal gland in the affective disorders are discussed, such as the conceptual form and the use of future studies of chronobiological systems.

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