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D Huys,
C Bartsch,
P Poppe,
D Lenartz,
W Huff,
J Prütting,
L Timmermann, J Klosterkötter,
M Maarouf,
T Rommel,
A Hartmann,
V Sturm,
J Kuhn
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ABSTRACT: Neurodegenerative movement disorders, such as Huntington's disease (HD), have become a promising field for Deep Brain Stimulation (DBS). This study aims to contribute to the establishment of a well-grounded database including both expected and unexpected effects of pallidal DBS in HD, and to discuss the ethical and legal restrictions of DBS in cognitively limited patients. Evaluation of the outcome data indicates that pallidal DBS exerted an independent effect on motor symptoms but probably also on the patient's cognitive and affective state. The cognitive decline, however, that characterizes the late stage of neurodegenerative disorders implicates ethical and legal problems given the patients' inability to give informed consent to DBS.
Fortschritte der Neurologie · Psychiatrie 04/2013; 81(4):202-205. · 0.74 Impact Factor
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R K R Salokangas,
P Dingemans,
M Heinimaa,
T Svirskis,
S Luutonen,
J Hietala,
S Ruhrmann,
G Juckel,
H Graf von Reventlow,
D Linszen,
M Birchwood,
P Patterson,
F Schultze-Lutter, J Klosterkötter
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ABSTRACT: OBJECTIVE: Schizotypal features indicate proneness to psychosis in the general population. It is also possible that they increase transition to psychosis (TTP) among clinical high-risk patients (CHR). Our aim was to investigate whether schizotypal features predict TTP in CHR patients. METHODS: In the EPOS (European Prediction of Psychosis Study) project, 245 young help-seeking CHR patients were prospectively followed for 18 months and their TTP was identified. At baseline, subjects were assessed with the Schizotypal Personality Questionnaire (SPQ). Associations between SPQ items and its subscales with the TTP were analysed in Cox regression analysis. RESULTS: The SPQ subscales and items describing ideas of reference and lack of close interpersonal relationships were found to correlate significantly with TTP. The co-occurrence of these features doubled the risk of TTP. CONCLUSIONS: Presence of ideas of reference and lack of close interpersonal relations increase the risk of full-blown psychosis among CHR patients. This co-occurrence makes the risk of psychosis very high.
European Psychiatry 02/2013; · 2.77 Impact Factor
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J Kuhn,
M Möller,
J F Treppmann,
C Bartsch,
D Lenartz,
T O J Gruendler,
M Maarouf,
A Brosig,
U B Barnikol, J Klosterkötter,
V Sturm
Molecular psychiatry 01/2013; · 15.05 Impact Factor
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Der Nervenarzt 11/2012; 83(11):1477-8. · 0.68 Impact Factor
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R Schennach,
M Riesbeck,
A Mayr,
F Seemüller,
W Maier,
S Klingberg,
I Heuser, J Klosterkötter,
M Gastpar,
A Schmitt,
H Sauer,
F Schneider,
M Jäger,
W Wölwer,
W Gaebel,
H-J Möller,
M Riedel
[show abstract]
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ABSTRACT: Schennach R, Riesbeck M, Mayr A, Seemüller F, Maier W, Klingberg S, Heuser I, Klosterkötter J, Gastpar M, Schmitt A, Sauer H, Schneider F, Jäger M, Wölwer W, Gaebel W, Möller H-J, Riedel M. Should early improvement be re-defined to better predict the maintenance of response in first-episode schizophrenia patients? Objective: To evaluate the predictive validity of early response in first-episode schizophrenia within a 1-year follow-up trial and to compare the resulting cutoff to the currently proposed early response definition (20% improvement by week 2). Method: Receiver operator characteristic (ROC) analyses were used to identify the predictive validity of the psychopathological improvement of treatment from week 1 to week 8, regarding the maintenance of response until week 52 as well as to define the most reasonable cutoff in 132 first-episode patients. The Youden Index (maximum of sensitivity and specificity) was used to compare the newly developed and the commonly used early response definition. Results: Starting with week 6, a reasonable validity to predict the maintenance of response was found (area under the curve = 0.721) with the best fitting cutoff being a 51.6% PANSS total score improvement. Using this cutoff 74 patients (56%) were correctly identified to become responder and maintain response during follow-up (sensitivity: 0.747). The Youden Index was higher applying the newly developed early response cutoff featuring higher specificity compared to the commonly used early response definition. Conclusion: Regarding long-term treatment, it seems more appropriate to base predictions of the patient's maintenance of response not before 6 weeks of treatment.
Acta Psychiatrica Scandinavica 09/2012; · 4.22 Impact Factor
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D H Nieman,
E Velthorst,
H E Becker,
L de Haan,
P M Dingemans,
D H Linszen,
M Birchwood,
P Patterson,
R K R Salokangas,
M Heinimaa,
A Heinz,
G Juckel,
H G von Reventlow,
A Morrison,
F Schultze-Lutter, J Klosterkötter,
S Ruhrmann
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ABSTRACT: Nieman DH, Velthorst E, Becker HE, de Haan L, Dingemans PM, Linszen DH, Birchwood M, Patterson P, Salokangas RKR, Heinimaa M, Heinz A, Juckel G, von Reventlow HG, Morrison A, Schultze-Lutter F, Klosterkötter J, Ruhrmann S, on behalf of the EPOS group. The Strauss and Carpenter Prognostic Scale in subjects clinically at high risk of psychosis. Objective: To investigate the predictive value of the Strauss and Carpenter Prognostic Scale (SCPS) for transition to a first psychotic episode in subjects clinically at high risk (CHR) of psychosis. Method: Two hundred and forty-four CHR subjects participating in the European Prediction of Psychosis Study were assessed with the SCPS, an instrument that has been shown to predict outcome in patients with schizophrenia reliably. Results: At 18-month follow-up, 37 participants had made the transition to psychosis. The SCPS total score was predictive of a first psychotic episode (P < 0.0001). SCPS items that remained as independent predictors in the Cox proportional hazard model were as follows: most usual quality of useful work in the past year (P = 0.006), quality of social relations (P = 0.006), presence of thought disorder, delusions or hallucinations in the past year (P = 0.001) and reported severity of subjective distress in past month (P = 0.003). Conclusion: The SCPS could make a valuable contribution to a more accurate prediction of psychosis in CHR subjects as a second-step tool. SCPS items assessing quality of useful work and social relations, positive symptoms and subjective distress have predictive value for transition. Further research should focus on investigating whether targeted early interventions directed at the predictive domains may improve outcomes.
Acta Psychiatrica Scandinavica 07/2012; · 4.22 Impact Factor
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ABSTRACT: HintergrundIn Deutschland wurden in den vergangenen Jahren in mehreren Städten Programme und Maßnahmen initiiert, mittels derer das Stigma
psychischer Erkrankungen und insbesondere der Schizophrenie bekämpft werden soll. Erkenntnisse über die Wirksamkeit dieser
Maßnahmen liegen für Einzelinterventionen in bestimmten Zielgruppen vor, jedoch bislang noch nicht bezogen auf die Allgemeinbevölkerung.
Material und MethodenIn den Jahren 2001 und 2004 wurden in 6 Städten Deutschlands, in denen zum Teil Antistigma-Initiativen tätig sind, repräsentative
Telefonbefragungen im Messwiederholungsdesign an der gleichen Kohorte durchgeführt (n=7225/4622). Erhoben wurden die soziale
Distanz gegenüber schizophren Erkrankten und die Bekanntheit von Antistigma-Initiativen.
ErgebnisseIm Erhebungszeitraum reduzierte sich die soziale Distanz insgesamt. Signifikante, wenn auch kleine Effekte zeigten sich insbesondere
bei Befragten, die Antistigma-Initiativen kannten und in Städten, in denen Antistigma-Maßnahmen durchgeführt werden.
SchlussfolgerungErstmals konnte gezeigt werden, dass Antistigma-Programme und -Initiativen auf Bevölkerungsebene nachweisbare Effekte erzielen.
BackgroundIn several German cities various programmes and initiatives have been conducted during recent years aimed at reducing the
stigma attached to mental illness, especially schizophrenia. So far only single interventions in specific target groups have
been evaluated but not their effectiveness in the general population.
MethodsTwo representative telephone surveys with repeated measurements were conducted in six German cities (n 7,225/4,622). Social
distance towards people with schizophrenia and knowledge of antistigma projects were assessed.
ResultsBetween 2001 and 2004 the social distance toward persons with schizophrenia decreased in the general population. Persons familiar
with antistigma projects or who lived in cities with such projects showed lower social distance.
ConclusionsFor the first time evidence has been found that antistigma interventions are successful in reducing the stigma attached to
schizophrenia in the general population.
Der Nervenarzt 05/2012; 78(7):787-795. · 0.68 Impact Factor
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R Schennach,
S Meyer,
F Seemüller,
M Jäger,
M Schmauss,
G Laux,
H Pfeiffer,
D Naber,
L G Schmidt,
W Gaebel, J Klosterkötter,
I Heuser,
W Maier,
M R Lemke,
E Rüther,
S Klingberg,
M Gastpar,
H-J Möller,
M Riedel
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ABSTRACT: BACKGROUND: To analyse insight of illness during the course of inpatient treatment, and to identify influencing factors and predictors of insight. METHODS: Insight into illness was examined in 399 patients using the item G12 of the Positive and Negative Syndrome Scale ("lack of insight and judgement"). Ratings of the PANSS, HAMD, UKU, GAF, SOFAS, SWN-K and Kemp's compliance scale were performed and examined regarding their potential association with insight. The item G12 was kept as an ordinal variable to compare insight between subgroups of patients. RESULTS: Almost 70% of patients had deficits in their insight into illness at admission. A significant improvement of impairments of insight during the treatment (p<0.0001) was observed. At admission more severe positive and negative symptoms, worse functioning and worse adherence were significantly associated with poorer insight. Less depressive symptoms (p=0.0004), less suicidality (p=0.0218), suffering from multiple illness-episodes (p<0.0001) and worse adherence (p=0.0012) at admission were identified to be significant predictors of poor insight at discharge. CONCLUSION: The revealed predictors might function as treatment targets in order to improve insight and with it outcome of schizophrenia.
European Psychiatry 04/2012; · 2.77 Impact Factor
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ABSTRACT: Im Rahmen dimensionaler Diagnostik von Persönlichkeitsstörungen (PS) werden sowohl kontinuierliche Übergänge von normalen
zu pathologischen Persönlichkeitsmerkmalen (Kontinuitätshypothese) als auch eine universelle Gültigkeit basaler Persönlichkeitsdimensionen
(Universalitätshypothese) angenommen. In der vorliegenden Studie wurde die Validität der von Leonhard konzipierten akzentuierten
Wesenszüge (WZ) als vermittelndes Konstrukt zwischen normalen Persönlichkeitsmerkmalen (Big-Five-Faktoren) und PS anhand einer
gesunden (n=166) und einer klinischen Stichprobe (n=78) untersucht. Neun empirisch und theoretisch abgeleitete Kontinua über die 3 Konstruktebenen hinweg (Big Five, WZ, PS)
wurden mit Hilfe von Fragebogendaten geprüft. Obwohl sich die beiden Stichproben hoch signifikant in fast allen untersuchten
Variablen unterschieden, zeigte sich eine weitgehende Ähnlichkeit hinsichtlich der (In)validität einzelner Kontinua als auch
der komplexen Ähnlichkeitsstruktur aller untersuchten Variablen in ihren wechselseitigen Abhängigkeiten, die mit Hilfe multidimensionaler
Skalierung analysiert wurden. Das Konzept der WZ kann in 6 von 9 getesteten Kontinua als sinnvolle Ergänzung für ein universell
gültiges dimensionales Modell der Persönlichkeit(sstörungen) angesehen werden.
A dimensional diagnostic system for personality disorders (PD) postulates continuous transition from normal to disordered
personalities (continuity hypothesis) and universal validity of basic personality dimensions (universal hypothesis). The present
study investigates the validity of Leonhard's concept of attenuated personalities that define a conceptual link between normal
personality dimensions and PD. Nine possible continuous transitions between three conceptual levels (Big Five personality
factors, nine attenuated personality traits, nine PD) were tested by questionnaire data obtained from a mentally healthy (n=166) and a clinical sample (n=78). Both samples differed significantly in nearly all variables. However, they showed substantial similarity concerning
the (in)validity of single continua and the complex structure of all variables as analyzed by multidimensional scaling. The
concept of attenuated personalities could be validated for six out of nine tested continua and can be recommended for application
in dimensional models of personality and personality disorders.
Der Nervenarzt 04/2012; 73(3):247-254. · 0.68 Impact Factor
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I Spellmann,
M Riedel,
R Schennach,
F Seemüller,
M Obermeier,
R Musil,
M Jäger,
M Schmauß,
G Laux,
H Pfeiffer, [......],
L G Schmidt,
W Gaebel, J Klosterkötter,
I Heuser,
W Maier,
M R Lemke,
E Rüther,
S Klingberg,
M Gastpar,
H J Möller
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ABSTRACT: On the background of the growing evidence that the patient's functioning significantly influences the course and outcome of schizophrenia aims of this analysis were to examine what proportion of patients achieve functional outcome criteria after one year and to identify clinical and sociodemographic predictive factors for functional remission. Patients with the diagnosis of schizophrenia who are treated as inpatients at the beginning of the study were examined within a naturalistic follow-up trial. The present study reports on the time frame from admission to discharge of an inpatient treatment period and the 1-year follow-up assessment. The Global Assessment of Functioning (GAF) Scale and Social and Occupational Functioning Assessment Scale (SOFAS) were evaluated with respect to functional outcome, whereas Positive and Negative Syndrome Scale (PANSS) scores were rated as psychopathological outcome measures. Functional remission thresholds were defined according to a GAF score of ≥61 points and a SOFAS score ≥61 points. Symptomatic remission criteria were applied according to the remission criteria of the Schizophrenia Working Group. The Strauss-Carpenter Prognostic Scale (SCPS), the Phillips Premorbid Adjustment Scale, medical history, sociodemographic and psychopathologic parameters were evaluated in order to find valuable predictors for functional remission. One year after discharge from inpatient treatment 211 out of 474 patients were available for analysis according to both functional remission considered rating-scales (GAF and SOFAS). Forty-seven percent of patients fulfilled criteria for functional remission (GAF and SOFAS) at discharge and 51% of patients at the one-year follow-up visit. With regard to symptomatic remission criteria corresponding remitter rates were 61% of patients at discharge and 54% at the one-year follow-up visit. Forty-two percent of patients fulfilled both remission criteria at discharge and 37% at the one-year follow-up visit. A significant association was found between functional and symptomatic remission at discharge and at the one-year follow-up visit (p<0.001). The strongest predictors for functional remission at the one-year follow-up visit were: a higher SCPS total score at admission, a lower number of previous hospitalizations, a status of employment, lower scores in all PANSS subscales at discharge, a better premorbid social adjustment, the occurrence of a first psychotic episode, a younger age, a lower PANSS negative subscore at admission, a status of being an early responder, a shorter duration of inpatient-treatment, a higher age of onset and female gender.
Psychiatry Research 03/2012; · 2.52 Impact Factor
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ABSTRACT: Cannabidiol is a component of marijuana that does not activate cannabinoid receptors, but moderately inhibits the degradation of the endocannabinoid anandamide. We previously reported that an elevation of anandamide levels in cerebrospinal fluid inversely correlated to psychotic symptoms. Furthermore, enhanced anandamide signaling let to a lower transition rate from initial prodromal states into frank psychosis as well as postponed transition. In our translational approach, we performed a double-blind, randomized clinical trial of cannabidiol vs amisulpride, a potent antipsychotic, in acute schizophrenia to evaluate the clinical relevance of our initial findings. Either treatment was safe and led to significant clinical improvement, but cannabidiol displayed a markedly superior side-effect profile. Moreover, cannabidiol treatment was accompanied by a significant increase in serum anandamide levels, which was significantly associated with clinical improvement. The results suggest that inhibition of anandamide deactivation may contribute to the antipsychotic effects of cannabidiol potentially representing a completely new mechanism in the treatment of schizophrenia.
Translational psychiatry. 02/2012; 2:e94.
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A Bechdolf,
A Ratheesh,
S J Wood,
T Tecic,
P Conus,
B Nelson,
S M Cotton,
A M Chanen,
G P Amminger,
S Ruhrmann,
F Schultze-Lutter, J Klosterkötter,
P Fusar Poli,
A R Yung,
M Berk,
P D McGorry
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ABSTRACT: Bipolar affective disorder (BD) is a severe, recurrent and disabling disorder with devastating consequences for individuals, families and society. Although these hazards and costs provide a compelling rationale for development of early detection and early intervention strategies in BD, the development of at-risk criteria for first episode mania is still in an early stage of development. In this paper we review the literature with respect to the clinical, neuroantomical and neuropsychological data, which support this goal. We also describe our recently developed bipolar at-risk criteria (BAR). This criteria comprises the peak age range of the first onset of bipolar disorder, genetic risk, presenting with sub-threshold mania, cyclothymic features or depressive symptoms. An initial pilot evaluation of the BAR criteria in 22 subjects indicated conversion rates to proxies of first-episode mania of 23% within 265 days on average, and high specificity and sensitivity of the criteria. If prospective studies confirm the validity of the BAR criteria, then the criteria would have the potential to open up new avenues of research for indicated prevention in BD and might therefore offer opportunities to ameliorate the severity of, or even prevent BD.
Current pharmaceutical design 01/2012; 18(4):358-75. · 4.41 Impact Factor
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ABSTRACT: Deep brain stimulation (DBS) has successfully advanced our treatment options for putative therapy-resistant neuropsychiatric diseases. Building on this strong foundation, more and more mental disorders in the stadium of therapy-resistance are considered as possible indications for DBS. Especially, schizophrenia with its associated severe and difficult to treat symptoms is gaining attention. This attention demands critical questions regarding the assumed mechanisms of DBS and its possible influence on the supposed pathophysiology of schizophrenia. Here, we synoptically compare current approaches and theories of DBS and discuss the feasibility of DBS in schizophrenia as well as the transferability from other psychiatric disorders successfully treated with DBS. For this we consider recent advances in animal models of schizophrenic symptoms, results regarding the influence of DBS on dopaminergic transmission as well as data concerning neural oscillation and synchronisation. In conclusion, the use of DBS for some symptoms of schizophrenia seems to be a promising approach, but the lack of a comprehensive theory of the mechanisms of DBS as well as its impact on schizophrenia might hinder the use of DBS for schizophrenia at this point in time.
Fortschritte der Neurologie · Psychiatrie 11/2011; 79(11):632-41. · 0.74 Impact Factor
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J Korkeila,
R K R Salokangas,
M Heinimaaa,
T Svirskis,
T Laine,
S Ruhrmann,
H von Reventlow,
G Juckel,
D Linszen,
M Birchwood, J Klosterkötter
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ABSTRACT: BACKGROUND: Subjects with psychoses have significantly increased rates of physical illnesses, but the nature of the relationship remains largely unknown. MATERIAL AND METHODS: The present study is part of the European Prediction of Psychosis Study (EPOS). Data were collected from 245 help-seeking individuals from six European centers (age 16-35) who met criteria for ultra-high risk of psychosis criteria. This paper seeks to investigate self-reported physical ill health and its associations with psychiatric symptoms and disorders, risk factors, and onset of psychosis during 48 months of follow-up. RESULTS: In multivariate analysis, lifetime panic disorder (OR=2.43, 95%CI: 1.03-5.73), known complications during pregnancy and delivery (OR=2.81, 95%CI: 1.10-7.15), female gender (OR=2.88, 95%CI: 1.16-7.17), family history of psychosis (OR=3.08, 95%CI: 1.18-8.07), and having a relationship (OR=3.44, 95%CI: 1.33-8.94) were significantly associated with self-reported physician-diagnosed illness. In the Cox proportional hazard model we found no significant differences between those who had undergone a transition to psychosis and those who had not. CONCLUSIONS: The physical health of patients defined to be at ultra-high risk of psychosis seems to be commonly impaired and associated with female gender, marital status, complications during pregnancy and birth, lifetime panic disorder, and genetic risk of psychosis.
European Psychiatry 09/2011; · 2.77 Impact Factor
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S Dragt,
D H Nieman,
F Schultze-Lutter,
F van der Meer,
H Becker,
L de Haan,
P M Dingemans,
M Birchwood,
P Patterson,
R K R Salokangas,
M Heinimaa,
A Heinz,
G Juckel,
H Graf von Reventlow,
P French,
H Stevens,
S Ruhrmann, J Klosterkötter,
D H Linszen
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ABSTRACT: Numerous studies have found a robust association between cannabis use and the onset of psychosis. Nevertheless, the relationship between cannabis use and the onset of early (or, in retrospect, prodromal) symptoms of psychosis remains unclear. The study focused on investigating the relationship between cannabis use and early and high-risk symptoms in subjects at clinical high risk for psychosis.
Prospective multicenter, naturalistic field study with an 18-month follow-up period in 245 help-seeking individuals clinically at high risk. The Composite International Diagnostic Interview was used to assess their cannabis use. Age at onset of high risk or certain early symptoms was assessed retrospectively with the Interview for the Retrospective Assessment of the Onset of Schizophrenia.
Younger age at onset of cannabis use or a cannabis use disorder was significantly related to younger age at onset of six symptoms (0.33 < r(s) < 0.83, 0.004 < P < 0.001). Onset of cannabis use preceded symptoms in most participants.
Our results provide support that cannabis use plays an important role in the development of psychosis in vulnerable individuals. Cannabis use in early adolescence should be discouraged.
Acta Psychiatrica Scandinavica 08/2011; 125(1):45-53. · 4.22 Impact Factor
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R K R Salokangas,
P Patterson,
M Heinimaa,
T Svirskis,
T From,
L Vaskelainen, J Klosterkötter,
S Ruhrmann,
H G von Reventlow,
G Juckel,
D Linszen,
P Dingemans,
M Birchwood
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ABSTRACT: Our previous study (Salokangas et al., 2009) suggested that the subjective experience of negative attitude of others (NAO) towards oneself is an early indicator of psychotic development. The aim of this prospective follow-up study was to test this hypothesis.
A total of 55 young psychiatric outpatients assessed as being at current risk of psychosis (CROP) were followed for up to 60 months and rates of transition to psychosis (TTP) identified. CROP was assessed employing the Bonn Scale for assessment of basic symptoms (Schultze-Lutter and Klosterkötter, 2002) and the Structured Interview for prodromal symptoms (Miller et al., 2002). TTP was defined by a psychotic episode lasting for more than one week. Associations between NAO at baseline and TTP were analyzed by a Cox regression survival analysis.
Eight (14.5%) TTP were identified: four (57.1%) within seven NAO patients and four (8.7%) within forty-six non-NAO patients. In the multivariate Cox regression analysis, NAO at baseline significantly (P=0.007) predicted TTP.
The prospective follow-up results support our hypothesis that subjective experience of NAO is an early indicator of psychotic in development.
European Psychiatry 02/2011; 27(4):264-6. · 2.77 Impact Factor
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ABSTRACT: Gamma-hydroxybutyric acid (GHB, "liquid ecstasy") and its legal prodrugs gamma-butyrolactone and 1,4-butanediol are gaining importance as recreational drugs in Germany. Because of the wide availability of GHB and its prodrugs physicians are increasingly being confronted with cases of intoxication. The effect of GHB intoxication is comparable with those of alcohol and/or benzodiazepines. Likewise, symptoms of withdrawal may occur. In this review, we summarise current data regarding the history, pharmacodynamics and pharmacokinetics of the drug as well as the relevant symptoms of intoxication or withdrawal as they pertain to neurology and psychiatry.
Fortschritte der Neurologie · Psychiatrie 01/2011; 79(1):21-5. · 0.74 Impact Factor
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ABSTRACT: Dysfunctional basal ganglia loops are thought to underlie the clinical picture of Tourette syndrome (TS). By altering dopaminergic activity in the affected neural structures, bilateral deep brain stimulation is assumed to have a modulatory effect on dopamine transmission resulting in an amelioration of tics. While the majority of published case reports deals with the application of bilateral stimulation, the present study aims at informing about the high effectiveness of unilateral stimulation of pallidal and nigral thalamic territories in TS. Potential implications and gains of the unilateral approach are discussed.
Translational psychiatry. 01/2011; 1:e52.
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R Schennach-Wolff,
M Obermeier,
F Seemüller,
M Jäger,
T Messer,
G Laux,
H Pfeiffer,
D Naber,
L G Schmidt,
W Gaebel, J Klosterkötter,
I Heuser,
W Maier,
M R Lemke,
E Rüther,
S Klingberg,
M Gastpar,
H-J Möller,
M Riedel
[show abstract]
[hide abstract]
ABSTRACT: To examine depressive symptoms, their course during treatment, and influence on outcome.
Weekly Calgary Depression Scale for Schizophrenia ratings were performed in 249 inpatients with schizophrenia. Early response was defined as a 20% reduction in the total score of the Positive and Negative Syndrome Scale for Schizophrenia from admission to week 2, response as a 50% reduction in the total score of the Positive and Negative Syndrome Scale for Schizophrenia (PANSS) from admission to discharge and remission according to the consensus criteria.
Thirty six per cent of the patients were depressed at admission, with 23% of them still being depressed at discharge. Depressed patients scored significantly higher on the PANSS negative and general psychopathology subscore, featured more impairments in subjective well-being (P < 0.0001) and functioning (P < 0.0001). They suffered from more suicidality (P = 0.0021), and had greater insight into their illness (P = 0.0105). No significant differences were found regarding early response, response, and remission.
Patients with depressive symptoms should be monitored closely, given the burden of negative symptoms, their impairments in well-being and functioning and the threat of suicidality.
Acta Psychiatrica Scandinavica 10/2010; 123(3):228-38. · 4.22 Impact Factor
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R Schennach-Wolff,
H-J Möller,
M Jäger,
F Seemüller,
M Obermeier,
T Messer,
G Laux,
H Pfeiffer,
D Naber,
L G Schmidt,
W Gaebel, J Klosterkötter,
I Heuser,
W Maier,
M R Lemke,
E Rüther,
S Klingberg,
M Gastpar,
M Riedel
[show abstract]
[hide abstract]
ABSTRACT: The aim of this paper is to apply the proposed consensus remission criteria to an acutely ill inpatient sample at admission and evaluate their adaptability in this patient population and pharmaceutical trials.
The Remission in Schizophrenia Working Group's consensus criteria were applied to 272 acutely ill schizophrenia patients. Patients were examined using the PANSS, HAMD, UKU and SWN-K total scales at admission as well as the GAF, SOFAS and the Strauss-Carpenter Prognostic Scale. Sociodemographic and clinical baseline variables were assessed using a standardized documentation system.
33 patients (12%) fulfilled the symptom severity component of the proposed remission criteria already at baseline. Almost no significant differences were found when comparing patients with achieved and failed symptom severity component that would explain the hospitalization of the patients with achieved criteria despite their apparently mild psychopathological symptoms. The only explainable difference was that patients with an achieved symptom severity component had received significantly more antipsychotics and had suffered from significantly more life events before admission.
The present results raise the question whether the symptom severity threshold is adequate to identify patients in remission when applied in clinical trials.
Pharmacopsychiatry 10/2010; 43(7):245-51. · 2.07 Impact Factor
