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PubMed2001

A structured interview guide increases Brief Psychiatric Rating Scale reliability in raters with low clinical experience.

OBJECTIVE: To assess the beneficial impact of a structured interview on the reliability of BPRS ratings in raters with low clinical experience. METHOD: Each patient was rated once a week in two separate interviews, conducted on the same day. The first interview was conducted by a rater with low clinical experience (recruited from a group of five residents in psychiatry and one clinical psychologist in training). All second interviews were conducted by the same highly experienced psychiatrist. RESULTS: The number of items with full agreement between observers increased with the use of SIG. The value of intraclass correlation coefficients for individual items and the total score also increased, approaching reported studies with experienced raters. CONCLUSION: These results suggest that the use of SIG reduces variability of information gathering in reliability testing of BPRS with less experienced raters.

Humans↗
PubMed1994

Religiosity and Psychosocial Adjustment Among 100 Homng Refugees.

PURPOSE OF THE PAPER. The purpose of this paper is to study the relationship between religiosity and psychosocial adjustment in a group of Asian refugees from Laos. SUMMARY OF METHODS UTILIZED. Subjects consisted of 100 adult Hmong refugees from Laos who had relocated one decade earlier to Minnesota. At the time of the interview, about 80% remained in Minnesota; the remainder were interviewed in their respective communities. Five measures of religiosity were operationalized: Religious Belief (animism versus monotheism); recent Religious Practice (present/absent in previous monthrpar;; Religious Conversion lpar;present/absent in the U.S.rpar;; having a Home Altar (present/absent today); and having a shamanistic Trance Ritual (present/absent in the last five years). These five indices of religiosity were then compared against four general areas of psychosocial adaptation as follows: demographic characteristics lpar;5 itemsrpar;; sociocultural indices of adaptation lpar;5 items, including 2 scales) health care seeking over the previous five years (6 items); and psychiatric signs and symptoms (4 psychiatric scales). SUMMARY OF METHODS UTILIZED. Methods of data collection were as follows: (1) questionnaire-based interviewing by Hmong research assistants to provide data on religion affiliation, belief and practice; demographic information; psychosocial function; cultural affiliations and behaviors; and health care seeking; (2rpar; a psychiatric interview by the senior author followed by completion of two psychosocial scales (Axis 4 Psychosocial Stressors and Axis 5 Psychosocial Function using DSM-III criteriarpar; and several psychiatric rating scales lpar;Hamilton Anxiety Scale, Hamilton Depression Scale, Brief Psychiatric Rating Scale, and Global Assessment Scalerpar;. PRINCIPAL FINDINGS. Religious Pracitice in the last month was highly associated with several measures of psychosocial adaptation. Conversely, any Trance Ritual in the last five years was associated with increased anxiety and health care seeking. Religious Belief (animism versus monotheism) and having a Home Altar were associated with the other cultural factors, but not with psychosocial, heatlh and mental health measures. CONCLUSIONS. Aspects of religiosity among Hmong refugees were related to psychosocial adaptation in diverse ways, with some factors associated with better adaptation, some factors associated with maladaptation, and some factors related to other cultural dimensions but not psychosocial adaptation. KEY WORDS. Hmong; psychosocial adjustment.

Journal Article↗
PubMed1993

m-Chlorophenylpiperazine effects in neuroleptic-free schizophrenic patients. Evidence implicating serotonergic systems in the positive symptoms of schizophrenia.

OBJECTIVE: This study evaluated whether alterations in serotonin function in schizophrenic patients could be demonstrated by comparing the reactivity to a serotonin partial agonist, m-chlorophenylpiperazine (MCPP) in patients and healthy subjects. This study also assessed whether stimulation of serotonin receptors influenced the symptoms of schizophrenia. DESIGN: Double-blind randomized comparison of MCPP (0.1 mg/kg, intravenously, administered over 20 minutes) and placebo effects in patients and healthy subjects. SETTING: Department of Veterans Affairs Medical Center, West Haven, Conn. PATIENTS AND HEALTHY SUBJECTS: Fifteen healthy subjects recruited by public advertisement and 12 schizophrenic inpatients who had been neuroleptic free for at least 2 weeks prior to entry into the study. MAIN OUTCOME MEASURES: The principal outcome variable was the positive symptoms of schizophrenia operationally defined as the sum of scores on the four key items for schizophrenia on the Brief Psychiatric Rating Scale and the Brief Psychiatric Rating Scale thought disorder factor. Anxiety was assessed with a clinician-rated visual analog scale and plasma hormone levels were measured. RESULTS: m-Chlorophenylpiperazine significantly increased the positive symptoms of schizophrenia in patients but not healthy subjects. Patients and healthy subjects exhibited anxiety increases of comparable magnitude following MCPP. However, patients had higher baseline levels of anxiety and exhibited more prolonged anxiogenic responses to MCPP. Anxiety elevations did not correlate with increases in the four key symptoms in patients. Patients exhibited lower baseline prolactin levels compared with healthy subjects, but the two groups did not differ in their prolactin, growth hormone, and cortisol responses to MCPP. CONCLUSIONS: Schizophrenics, the only psychotic patient group studied to date, are the first patient group to exhibit propsychotic responses to MCPP. These data provide further evidence that serotonin systems modulate positive symptoms in some schizophrenic patients.

Antipsychotic Agents↗
PubMed2005

Pallidal stimulation in dystonia: effects on cognition, mood, and quality of life.

Bilateral deep brain stimulation (DBS) of the globus pallidus internus (GPi) alleviates symptoms in patients with dystonia but its effects on cognition, neuropsychiatric status, and quality of life have not been examined. This is a case series report of 15 consecutive patients with different forms of dystonia who underwent bilateral implantation of DBS electrodes in the GPi. The patients were evaluated preoperatively and after 3-12 months of DBS with tests of cognition (Mattis Dementia Rating Scale, Stroop Test, Trail Making Test, Phonemic and Category Word Fluency, Digit Span, Rey Auditory Verbal Learning Test, Tonic and Phasic Alertness), neuropsychiatric status (Beck Depression and Anxiety Inventories, Montgomery Asberg Depression Rating Scale, Snaith-Hamilton Pleasure Scale, Brief Psychiatric Rating Scale), quality of life, and motor functions. GPi DBS significantly improved dystonic symptoms, functional abilities, and quality of life allowing for a significant reduction of antidystonic medications. No deterioration was observed in cognitive scores and neuropsychiatric measures. The present case series report thus provides preliminary evidence for the safety of GPi DBS regarding cognitive and neuropsychiatric functions in patients with dystonia.

Adolescent↗
PubMed2005

Open-label study of atypical neuroleptic quetiapine for treatment of borderline personality disorder: impulsivity as main target.

BACKGROUND: Recent studies indicate that atypical neuroleptics may be safe and useful in treating many symptoms of borderline personality disorder (BPD), including impulsivity, which can constitute the core dimension of this pathology. This study aimed to evaluate the efficacy and safety of quetiapine in patients with well-defined BPD. It was hypothesized that quetiapine would reduce impulsivity (primary hypothesis) and also affective and micropsychotic symptoms, resulting in improved social and global functioning (secondary hypothesis). METHOD: Twenty-three outpatients with BPD according to DSM-IV criteria and the revised Diagnostic Interview for Borderlines completed a 12-week open-label study with quetiapine. The study was conducted from May 2001 to May 2003. The clinical efficacy was assessed using the following: Hamilton Rating Scales for Depression and Anxiety, Hopelessness Scale, Brief Psychiatric Rating Scale, Barratt Impulsivity Scale, Buss-Durkee Hostility Inventory, Temperament and Character Inventory, Social Adjustment Scale, and Global Assessment of Functioning. RESULTS: The mean daily dose of quetiapine (251 +/- 50 mg; range, 175-400 mg) was well tolerated. Impulsivity was significantly improved by quetiapine (p = .0015), as were most of our outcome measures: hostility, depression, anxiety, character dimensions, and social and global functioning (p < .05). In the small subgroup of patients with psychotic symptoms at baseline, there was a significant reduction in these symptoms (N = 8, p = .018). CONCLUSION: In a sample of patients with severe BPD without or with only few psychotic symptoms, a low dose of quetiapine was associated with a strong positive clinical impact, including improvement of impulsivity.

Adolescent↗
PubMed2003

Reduced cortical folding in schizophrenia: an MRI morphometric study.

OBJECTIVE: Although well documented, regional brain structural abnormalities in schizophrenia are nonspecific, and morphometric parameters show significant overlapping between patients and healthy comparison subjects. An increasing number of studies have focused on supraregional models involving abnormalities of the neuronal circuitry between cortical regions in schizophrenia. The aim of the present study was to investigate cortical folding as an index of the neuronal wiring in different subtypes of schizophrenia. METHOD: Magnetic resonance imaging measures of gyrification index in intervals of 3.6 mm along the total cerebral cortex were compared in 40 patients with DSM-IV schizophrenia and 20 healthy subjects. Psychopathology was assessed with the Positive and Negative Syndrome Scale, Brief Psychiatric Rating Scale, and the Negative Symptom Rating Scale. RESULTS: The schizophrenia patients showed significantly reduced bilateral cortical folding relative to healthy comparison subjects. Such reductions were more pronounced in those with the disorganized subtype and showed an inverse correlation with negative symptoms and a positive correlation with positive symptoms. The paranoid subtype showed reduced cortical folding that was restricted to the left hemisphere. CONCLUSIONS: These results from a larger patient group confirm a previous report of reduced cortical folding in schizophrenia patients. They also suggest a distinct pattern of abnormality between schizophrenia subtypes regarding the process of cerebral lateralization and are in agreement with the neurodevelopmental hypothesis of schizophrenia.

Adult↗
PubMed2006

A practical clinical trial comparing haloperidol, risperidone, and olanzapine for the acute treatment of first-episode nonaffective psychosis.

OBJECTIVE: Randomized controlled drug trials have demonstrated that antipsychotic medication is effective to rapidly improve psychotic symptomatology in first-episode psychosis. However, these results may not be generalizable to routine clinical practice. We evaluated the effectiveness, tolerability, and safety of olanza-pine, risperidone, and haloperidol in individuals with first-episode nonaffective psychosis who are representative of clinical practice and who are treated in routine clinical settings. METHOD: 172 patients participated in a practical clinical trial and were randomly assigned to haloperidol (N = 56), risperidone (N = 61), and olanzapine (N = 55). The mean modal daily doses were 5.4 mg/day for halo-peridol, 4 mg/day for risperidone, and 15.3 mg/day for olanzapine; 98.3% of subjects were drug naive at baseline. Data from clinical measures of treatment response and tolerability and safety data from the 6-week acute phase of a large epidemiologic and longitudinal (February 2001 to February 2005) intervention program of first-episode psychosis (schizophrenia spectrum disorders, DSM-IV criteria) are reported. RESULTS: All 3 treatments showed similar effectiveness in reducing the severity of general, negative, and positive symptomatology after 6 weeks of treatment, as reported by mean change in total Clinical Global Impressions-Severity of Illness scale, Brief Psychiatric Rating Scale (BPRS), Scale for the Assessment of Positive Symptoms, and Scale for the Assessment of Negative Symptoms scores between baseline and 6 weeks. The proportion of study subjects responding, defined as 40% or greater BPRS total score improvement from baseline, was 57.1% (N = 32 of 56) haloperidol, 52.5% (N = 32 of 61) risperidone, and 63.6% (N = 35 of 55) olanzapine, with no statistical differences among groups. The frequency of extrapyramidal symptoms (chi(2) = 24.519; p < .001) and concomitant anticholinergic medication use (chi(2) = 57.842; p < .0001) was greater with haloperidol than olanzapine or risperidone. Olanzapine-treated patients had significantly more weight gain compared with the haloperidol and risperidone groups (p < .001). CONCLUSION: Relatively low doses of haloperidol, risperidone, and olanzapine are equally effective for the acute treatment of first-episode nonaffective psychosis under usual conditions of real clinical practice.

Acute Disease↗
PubMed1990

Welfare status and psychosocial adjustment among 100 Hmong refugees.

Although the mental health of recently employed persons has been well studied, the mental health of welfare recipients is not well understood. Among our increasing refugee population, many receive welfare benefits at some point. The Hmong are among those who are highly represented among welfare recipients in several areas of the United States. Do psychiatrists have anything to contribute toward the resolution of high welfare rates? This question is especially relevant in refugee populations who are at increased risk for several psychiatric disorders, including depression, paranoia, and adjustment disorders. This study was undertaken among 100 Hmong refugees who had been in the United States for 8 years. Indices of mental health included two rating scales (the Zung Depression Scale and the SCL-90), five-axis DSM-III diagnoses, Hamilton Anxiety and Depression Scales, Global Assessment Scale, Brief Psychiatric Rating Scale, Inpatient Multidimensional Scale, and Mini-Mental State Exam. These indices were compared with current welfare status and the duration of time on welfare. Other comparisons with welfare included demographic characteristics, material possessions, acculturation characteristics, health and social problems, and nonoccupation avocations. Results indicate that welfare recipients show lower acculturation and elevated psychiatric symptom levels. Suggestions for ameliorating this situation are extrapolated from studies in the literature on chronically unemployed persons.

Acculturation↗
PubMed2002

An open-label trial of divalproex in children and adolescents with bipolar disorder.

OBJECTIVE: This study evaluated the safety and effectiveness of divalproex sodium (Depakote ) in the treatment of youths with bipolar disorder. METHOD: Forty bipolar disorder patients aged 7 to 19 years, with a manic, hypomanic, or mixed episode, enrolled in an open-label study of divalproex (2-8 weeks), followed by a double-blind, placebo-controlled period (8 weeks). RESULTS: Twenty-two subjects (61%) showed > or =50% improvement in Mania Rating Scale (MRS) scores during the open-label period. Significant ( <.001) improvements from baseline were seen for mean scores of all efficacy measures, including the MRS, Manic Syndrome Scale, Behavior and Ideation Scale, Brief Psychiatric Rating Scale, Clinical Global Impressions Severity scale, and Hamilton Rating Scale for Depression. Of the 23 subjects who discontinued the study during the open-label period, 6 (15%) discontinued for ineffectiveness, 6 (15%) for intolerance, 6 (15%) for noncompliance, and 6 (15%) for other reasons. Adverse events were generally mild or moderate in severity, with the most common being headache, nausea, vomiting, diarrhea, and somnolence. Laboratory data results were unremarkable. Too few subjects participated in the double-blind period for statistical analysis. CONCLUSION: This study provides preliminary support for the safety and effectiveness of divalproex in the treatment of bipolar disorder in youths.

Adolescent↗
PubMed1991

Glycosaminoglycan polysulfate in the treatment of old age dementias.

1. In a multicenter, placebo-controlled, double-blind clinical trial in 155 elderly patients with cognitive decline, glycosaminoglycan polysulfate was found to be a therapeutically effective agent in the treatment of old age dementias. 2. Treatment with glycosaminoglycan polysulfate in the daily dosage of 600 LRU, administered on the basis of a divided dosage schedule for 12 weeks, was significantly superior to an inactive placebo on several outcome measures including the Wechsler Memory Scale-Russell Revision (Easy Paired Associates Learning and Immediate Visual Reproduction), Mini Mental State Examination, the Sandoz Clinical Assessment Geriatric (Cognitive Dysfunction and Depression), Hachinski Dementia Scale, Brief Psychiatric Rating Scale (Confusion and Depressive Withdrawal) and Global Improvement Scale of the Clinical Global Impression. 3. Adverse effects with glycosaminoglycan polysulfate were few and mild. The drug was equally well tolerated and equally effective in the two major dementias of old age, i.e., primary degenerative and multi-infarct. The number of abnormal laboratory test readings remained essentially unchanged from pre-treatment to post-treatment.

Activities of Daily Living↗
PubMed2001

Predictors of short-term deterioration and compliance in psychiatric emergency patients: a prospective study of 457 patients referred to the emergency room of a general hospital.

The aim of this study was to identify predictors of (1) short-term outcome and (2) short-term compliance with treatment (for non-hospitalized patients) in psychiatric emergency patients. Subjects comprised 457 patients referred to the emergency ward of a French general hospital and requiring examination by a psychiatrist. Clinical and therapeutic assessments were carried out at baseline, using DSM-IV diagnoses and overall psychopathological scoring scales [Brief Psychiatric Rating Scale (BPRS) and Symptom Checklist-90 Revised]. Clinical outcome and compliance were assessed 3 weeks after entry. For each of the two issues assessed, stepwise logistic regression analysis was performed following univariate comparisons. The three best predictors of deterioration at 3 weeks were lack of compliance to treatment, presence of a previous psychiatric history, and a low BPRS hebephrenic factor score. The best predictors of compliance in non-hospitalized patients were a previous psychiatric history, marital status, a low BPRS hostility factor score, and older age. The main predictor of deterioration was non-compliance. Thus, we emphasize the importance of improving compliance, especially among young patients with no previous psychiatric history.

Adult↗