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M J Cuesta

Publications and source records attributed to M J Cuesta.

At least 19 recordsLinked to original sources
PubMed2001

Motor features in psychotic disorders. I. Factor structure and clinical correlates.

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.

Adult↗
PubMed2001

Motor features in psychotic disorders. II. Development of diagnostic criteria for catatonia.

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.

Adult↗
PubMed2001

Effects of olanzapine and other antipsychotics on cognitive function in chronic schizophrenia: a longitudinal study.

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.

Adult↗
PubMed2000

The classification of first episode schizophrenia: a cluster-analytical approach.

OBJECTIVE: This paper examines, using data from the Cantabria First Episode Schizophrenia Study, the usefulness of subdividing, using a cluster analysis technique, this schizophrenia population into subgroups with similar symptoms profiles in terms of SANS and SAPS. METHOD: Diagnostic characteristics were determined using the Present State Examination (PSE-9) and the SANS/SAPS. Premorbid adjustment was assessed using a scale developed combining the Gittelman and Klein's Scales, and the Goldstein's scales. Social Adjustment was evaluated using the WHO-DAS. In addition clinical histories were used to assess the patients' clinical course. RESULTS: Our schizophrenic patients could be subtyped into four categories: negative, positive non-paranoid, simple and disorganized schizophrenia. There is an absence of significant association between the majority of the variables investigated and the four-cluster model. CONCLUSION: Even though our sample could be subtyped into different categories, the model does not show predictive power according to the 3-year follow-up data.

Acute Disease↗
PubMed2000

Differentiating primary from secondary negative symptoms in schizophrenia: a study of neuroleptic-naive patients before and after treatment.

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.

Adult↗
PubMed2000

Reappraising insight in psychosis. Multi-scale longitudinal study.

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.

Adult↗
PubMed1999

Negative parkinsonian, depressive and catatonic symptoms in schizophrenia: a conflict of paradigms revisited.

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.

Adult↗
PubMed1999

Dimensional structure of psychotic symptoms: an item-level analysis of SAPS and SANS symptoms in psychotic disorders.

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.

Adult↗
PubMed1999

Serum iron in catatonic and noncatatonic psychotic patients.

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.

Adult↗
PubMed1999

Thought disorder in schizophrenia. Testing models through confirmatory factor analysis.

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.

Adolescent↗
PubMed1999

Premorbid personality in psychoses.

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.

Adult↗
PubMed1999

Cantabria first-episode schizophrenia study: three-year follow-up.

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.

Adaptation, Psychological↗
PubMed1999

Diagnostic significance of Schneider's first-rank symptoms in schizophrenia. Comparative study between schizophrenic and non-schizophrenic psychotic disorders.

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.

Adult↗
PubMed1998

Illness duration and neuropsychological impairments in schizophrenia.

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.

Adolescent↗
PubMed1998

Factor structure and clinical validity of competing models of positive symptoms in schizophrenia.

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.

Adult↗
PubMed1998

Lack of insight in mood disorders.

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.

Adult↗