Biomedical subjects

D Addington

Publications and source records attributed to D Addington.

At least 55 records · Page 3Linked to original sources

PubMed1996

A psychometric comparison of the Calgary Depression Scale for Schizophrenia and the Hamilton Depression Rating Scale.

This study compared two measures of depression in a population with schizophrenia. Inpatients (n = 112) with schizophrenia, were assessed on the Hamilton (HDRS), and Calgary (CDSS) depression scales and the Positive and Negative Syndrome Scale (PANSS). Eighty-nine were reassessed 3 months later. A principal components factor analysis was applied to each depression scale. The relationship between measures of depression and positive and negative symptoms was explored using correlation, factor and regression analyses. There were no significant correlations between the total CDSS and positive or negative symptoms at either time. In contrast, the HDRS total score was correlated with both positive and negative syndromes at time 2. Moreover, a number of HDRS factors correlated significantly with the PANSS positive scale at both times and with the negative subscale score at time 2. Multiple regression analysis showed that the HDRS accounted for more of the variance in positive and negative symptoms scores than did the CDSS. The CDSS has fewer factors and less overlap with positive and negative symptoms than the HDRS. This suggests that it is a more specific measure of level of depression than the HDRS for individuals with schizophrenia.

Adult↗

PubMed1996

Clozapine: current status and role in the pharmacotherapy of schizophrenia.

OBJECTIVE: This study evaluates clozapine and its present role in the pharmacotherapy of schizophrenia. METHOD: Clozapine's current clinical status is reviewed, as is its position with respect to other treatment options. RESULTS: Clozapine represents the prototype of "atypical" neuroleptics, with evidence of clinical efficacy in both positive and negative symptoms, as well as a diminished risk of extrapyramidal side effects. It is the only neuroleptic to date that has established itself as having little, if any, risk of tardive dyskinesia. More recent research has focused on its potential for overall savings in health care costs, as well as possible benefits in the area of neuropsychological functioning. CONCLUSION: Evidence suggesting that the course of schizophrenia can be altered by effective treatment favours a systematic approach that optimizes treatment options. While clozapine does not represent a 1st-line agent because of its risk of agranulocytosis, it has an integral role to play in treatment-resistant schizophrenia or in individuals experiencing intolerable side effects with conventional neuroleptics.

Agranulocytosis↗

PubMed1996

Improving the management of patients with schizophrenia in primary care: assessing learning needs as a first step.

OBJECTIVE: To assess family physician learning needs related to the care of patients with schizophrenia. METHODS: Questionnaires were mailed to all family physicians and general practitioners practising in southern Alberta. Physicians were asked to indicate the number of patients with schizophrenia cared for, their interest in improving the care the provided, their preferred learning methods, and the content they wished to learn. RESULTS: A total of 539 surveys were returned for a return rate of 43.8%. Over half of the physicians (53.5%) indicated that they saw 1 to 2 patients with schizophrenia each month. Almost half (48.5%) indicated they were somewhat or very interested in increasing the care provided. Primary learning needs included increasing their knowledge of psychopharmacologic agents and monitoring and adjusting medications. Lectures and half-day workshops were the preferred learning methods. CONCLUSION: Our study was helpful in identifying the types of education that physicians wanted as well as the duration of the programming prior to the development of teaching interventions.

Alberta↗

PubMed1996

Gender and affect in schizophrenia.

OBJECTIVE: The objective of this study was to test the hypothesis that males with schizophrenia have more negative symptoms and females with schizophrenia have more depressive symptoms. Previous studies examining gender differences in negative and depressive symptoms in schizophrenia have been inconclusive, being limited by retrospective design and lack of suitable assessment instruments. METHOD: A consecutive series of 113 consenting inpatients meeting DSM-III-R criteria for schizophrenia (45 females, 68 males) were assessed using reliable measures of depression and negative symptoms. Negative symptoms were assessed by the Positive and Negative Syndrome Scale and depression by the Calgary Depression Scale for Schizophrenia. Ninety-two of the subjects were reassessed 3 months later. RESULTS: There were no differences in levels of negative or depressive symptoms between men and women. CONCLUSIONS: Within the limitations of the study, the results do not support the hypothesis of sex differences in negative and depressive symptoms in schizophrenia.

Adult↗

PubMed1995

The use of placebos in clinical trials for acute schizophrenia.

This review examines the scientific and ethical justification for the use of randomized concurrent placebo-controlled trials in the treatment of acute relapse in chronic schizophrenia. A literature search was conducted, and the national regulatory authority was consulted. Many placebo-controlled studies of acute or chronic schizophrenia are being published and it is the official position of both the Canadian and US regulatory authorities that such studies are required for both scientific and ethical reasons. The specific strengths and limitations of placebo-controlled studies are reviewed. Examples, drawn from Canadian studies, are presented to illustrate their benefits. It is concluded that the use of placebos in the particular situation of acute or chronic schizophrenia is ethically and scientifically justified. It forms an essential component of a comprehensive drug evaluation for new antipsychotic medications.

Acute Disease↗

PubMed1994

Specificity of the Calgary Depression Scale for schizophrenics.

This study sought to determine the specificity of the Calgary Depression Scale (CDS), a depression rating scale for schizophrenics. The specificity is the degree to which the scale assesses depression rather than negative or extrapyramidal symptoms. Subjects were 100 outpatients (OP) and 50 inpatients (IP) meeting DSM-III-R criteria for schizophrenia. Negative symptoms were assessed with the Positive and Negative Syndrome Scale (PANSS); extrapyramidal symptoms were assessed with the Simpson Angus Scale (SA) and depression with the CDS. Results were that the CDS showed no correlation with SA, but weak (0.33) statistically significant correlations with the PANSS negative symptom score in inpatients but not outpatients. Confirmatory factor analysis using Lisrel 6.0 showed that the model hypothesizing specificity of depression, negative symptoms and extrapyramidal symptoms, was significant, with a goodness of fit index of 0.89 and a root mean square residual of 0.07. It is concluded that the CDS achieves a useful degree of separation between measures of depression, negative and extrapyramidal symptoms in subjects with schizophrenia, when combined with the other measures used in this study.

Ambulatory Care↗

PubMed1993

Mentally retarded patients on general hospital psychiatric units.

Difficulties in the placement of two recurrently assaultive mentally retarded men who had been admitted to acute admission units for assessment led staff to hypothesize that mentally retarded patients were being inappropriately diverted into psychiatric services. To test this hypothesis, the charts of all mentally retarded patients admitted over two years were reviewed retrospectively. Contrary to expectations, there was no difference between the average length of stay of the mentally retarded patients and a comparison group of psychiatric patients. Furthermore, the mentally retarded patients presented with a full range of Axis I disorders, schizophrenia being the most common. It was concluded that, in general, the acute psychiatric services were being used appropriately for this group of mentally retarded patients.

Adult↗

PubMed1993

A Canadian multicenter placebo-controlled study of fixed doses of risperidone and haloperidol in the treatment of chronic schizophrenic patients.

In a double-blind study, 135 inpatients with a diagnosis of chronic schizophrenia were randomly assigned to 8 weeks of treatment with one of six parallel treatments: risperidone (a new central 5-hydroxytryptamine2 and dopamine D2 antagonist), 2, 6, 10, 16 mg/day; haloperidol, 20 mg/day; or placebo, after a single-blind placebo washout period. Doses were increased in fixed increments up to a fixed maintenance dose reached after 1 week. On the Clinical Global Impression-Severity of Illness and Improvement, all active medications were superior to placebo except for risperidone (2 mg) on the Clinical Global Impression-Improvement. On the total Positive and Negative Syndrome Scale (PANSS) score and positive subscale, superiority to placebo was observed for all treatment groups except for haloperidol and risperidone (2 mg), which tended to be superior to placebo on total PANSS and the positive subscale, respectively. On the PANSS negative subscale, only risperidone (6 mg/day) was significantly better than placebo. Risperidone (6 mg) was superior to haloperidol on the total PANSS, General Psychopathology, and Brief Psychiatric Rating Scale subscales. Although there was a linear increase in parkinsonism with increasing risperidone dosage, there were no statistically significant differences between risperidone (2, 6, and 16 mg/day) and placebo. At doses of 6 to 16 mg, risperidone displayed a marked antidyskinetic effect compared with placebo. This effect was more pronounced in patients with severe dyskinesia. By contrast, haloperidol produced significantly more parkinsonism than placebo and risperidone (2, 6 and 16 mg), with no effect on tardive dyskinesia. These data suggest that risperidone, at the optimal therapeutic dose of 6 mg/day, produced significant improvement in both positive and negative symptoms without an increase in drug-induced parkinsonian symptoms and with a significant beneficial effect on tardive dyskinesia.

Adult↗

PubMed1993

Assessing depression in schizophrenia: the Calgary Depression Scale.

Since existing depression scales were designed for assessment of depression in non-psychotic populations, such scales have items which do not distinguish depressed from non-depressed psychotic subjects. The authors describe a new scale, the Calgary Depression Scale, which was designed for the assessment of depression in schizophrenia. The scale was derived from two existing scales by factor analysis and reliability analysis. It has been further tested in two new samples. In the first it has been shown to be reliable, congruent with a self-report scale and valid. In the second sample it has been shown that there is no overlap with negative or extrapyramidal symptoms.

Adult↗

PubMed1993

Rating depression in schizophrenia. A comparison of a self-report and an observer report scale.

Prior research has indicated an inconsistent agreement between self-report and observer report of depression in schizophrenia. The purpose of this study was to assess the level of agreement between a self-report measure of depression and a structured interview. Both outpatients (N = 100) and inpatients (N = 50) with schizophrenia were assessed using the Beck Depression Inventory and a structured interview scale, the Calgary Depression Scale. Scores were convergent. However, a sizable proportion of inpatients had difficulty completing the self-report instrument. It is concluded that depressed affect can be assessed in schizophrenics by both self-report and structured interview, but the Beck Depression Inventory poses difficulties in use with inpatients.

Adult↗

PubMed1993

Premorbid functioning, cognitive functioning, symptoms and outcome in schizophrenia.

In this study we examined the relationship between premorbid functioning, outcome, cognitive functioning and positive and negative symptoms of schizophrenia. Cognitive functioning and symptoms were examined longitudinally in a sample of 39 subjects with schizophrenia (according to the DSM-III criteria). Subjects were assessed at admission to hospital and six months later during a period of relative remission. Premorbid functioning was significantly associated with negative symptoms but not with positive symptoms at both the acute phase and the remitted phase of the illness. Outcome was also associated with negative symptoms at admission and with both positive and negative symptoms at follow-up. Deficits on cognitive tests of verbal reasoning and concept formation were significantly associated with poor premorbid functioning and outcome.

Adolescent↗

PubMed1992

Reliability and validity of a depression rating scale for schizophrenics.

The Calgary Depression Scale (CDS) is a nine item structured interview scale, in which each item has a four point measure, each point anchored by descriptors. The scale has been specifically developed to assess depression in schizophrenics. This article describes the testing of the reliability and validity of the CDS. The scale is assessed and compared to three established measures, the Hamilton Depression Rating Scale (HDRS) the Beck Depression Inventory (BDI) and a depression measure derived from the Brief Psychiatric Rating Scale (BPRS). Confirmatory factor analysis demonstrated that the CDS is unidimensional, measuring the same construct in both in- and outpatients. The scale has high internal consistency, significant strong correlations with scores on the Hamilton, Beck and BPRS depression measures, and the presence of a major depressive episode. All items of the CDS significantly discriminate between the presence and absence of a major depressive episode. It is concluded that the CDS is a parsimonious reliable scale which is suitable for assessing depression across both the acute and residual stages of schizophrenia.

Adult↗

PubMed1992

Clozapine in the treatment of refractory schizophrenia: Canadian policies and clinical guidelines.

Clozapine is an atypical neuroleptic agent that has recently become available in Canada with potential clinical efficacy in the treatment of refractory schizophrenia, and in patients with schizophrenia neurologically intolerant to conventional neuroleptics. Although it causes few extra-pyramidal symptoms, the drug has a number of other adverse effects including a risk of agranulocytosis in one to two percent of all patients. Because of this, the use of the drug is permitted only if the white blood count is monitored weekly. The monitoring system, outlined in this article, requires a coordinated effort between clinical staff, pharmacy, laboratory and the Clozaril Support and Assistance Network. Clinical guidelines are proposed, detailing the indications and contraindications for treatment and the pharmacokinetics, dosing, adverse effects, and drug interactions with clozapine. In addition, the economics, government policies and implications for future research are considered. Although there are administrative and clinical difficulties associated with its use, clozapine represents an advance in therapeutic research. Patients and family members will be inquiring about the drug and may deserve a trial. This article aims to inform Canadian mental health professionals about the safe and beneficial use of clozapine.

Clozapine↗

PubMed1991

Cognitive functioning and positive and negative symptoms in schizophrenia.

The present study examined schizophrenics' performance on a variety of cognitive measures in order to explore the relationship between schizophrenic symptoms and cognitive performance. The Wechsler Adult Intelligence Scale and a battery of neuropsychological tests, developed at the Montreal Neurological Institute, were administered to 38 acutely ill, hospitalized schizophrenics. Patients were diagnosed using DSM III criteria. Negative symptoms were assessed with the SANS and positive symptoms with the SAPS. Both the cognitive tests and the symptom rating scales were re-administered to this sample at a 6 month follow-up period. Analyses revealed that, at both time periods cognitive deficits were more likely to be associated with high negative symptom ratings than with positive symptoms. Only certain tests showed significant improvement at the follow-up period. Furthermore, improved cognitive functioning was related to an improvement in positive, but not negative, symptoms.

Adolescent↗

PubMed1990

Depression dexamethasone nonsuppression and negative symptoms in schizophrenia.

This study compared three measures of depression in schizophrenia and their correlation with the Dexamethasone Suppression Test (DST). The degree of overlap of these three measures with negative symptoms was also examined. The Hamilton Depression Rating Scale (HDRS), the depressive syndrome score of the Present State Examination (PSE), and the Scale for the Assessment of Negative Symptoms (SANS) were administered to 50 acutely ill, hospitalized schizophrenics. Patients were diagnosed using DSM-III criteria for schizophrenia. DSM-III criteria were also used to assess the presence of a major depressive episode. Results were that DST nonsuppression was significantly associated with the presence of a major depressive episode, but not with depressive rating scale scores or with negative symptoms. It is concluded that the DST may be of value in differentiating a depressive syndrome from a negative symptom syndrome in schizophrenia.

Adult↗

PubMed1989

A comparison of voluntary with remanded schizophrenics.

In this study two groups of schizophrenic patients are compared on a number of clinical and demographic variables. The first group consists of 52 consecutive admissions to a forensic assessment unit of patients with a diagnosis of schizophrenia. The second is a consecutive series of schizophrenic patients admitted to two open admission units. Significant differences were found between the two groups. Specifically the forensic patients were more often male, single and antisocial as assessed by previous convictions and more often transient or living semi-independently in sheltered accommodation. They were less compliant with treatment. The two groups did not differ with respect to clinical features such as duration of illness and number of hospitalizations. It is concluded that individual patient characteristics may contribute to an outcome of legal involvement among schizophrenics. The implications of this for service delivery and future research on criminalization are discussed.

Adult↗

PubMed1989

Psychiatry training and research.

There is a growing concern that residents in psychiatric training programs may not be receiving an adequate exposure to the principles of research. This paper examines the need for such exposure and outlines a framework wherein the fundamentals of clinical research could be demonstrated to the resident physician.

Canada↗

PubMed1988

Homosexual panic: a review of its concept.

This paper traces the origin of the term "homosexual panic" when it was first described in 1920 to the Freudian bisexual theory of sexual development and the concepts of repressed and latent homosexuality, and questions the appropriateness of this term when used to diagnose as well as to describe different situations. Concerns are raised especially when dealing with conditions ranging from violent behaviour to outright psychotic episodes. Homosexual panic is also compared with pseudohomosexuality, and finally correlated with society's homophobic attitudes.

Adjustment Disorders↗