Validity of the Schizophrenia Diagnosis of the Psychiatric Assessment Schedule for Adults with Developmental Disability (PAS–ADD)

1996 ◽  
Vol 168 (3) ◽  
pp. 359-367 ◽  
Author(s):  
Steve Moss ◽  
Helen Prosser ◽  
David Goldberg
Keyword(s):  
Learning Disability ◽  
Negative Symptoms ◽  
Diagnostic Algorithm ◽  
Active Core ◽  
Key Informant ◽  
Symptom Frequency ◽  
Icd 10 ◽  
Third Person ◽  
Core Symptoms ◽  
First Rank Symptoms

BackgroundFirst rank symptoms are central to the diagnosis of schizophrenia, but their complexity makes it difficult to validly detect them in people with learning disability. This report investigates ability of PAS–ADD to detect schizophrenia, validated against expert clinical opinion.MethodThe sample consisted of 98 patients with learning disability, and a key informant for each sample member. Clinical opinions of the referring psychiatrists were sought using a symptom checklist. Reportage of remission, and the number of core schizophrenia symptoms identified, were used to estimate level of symptom activity at time of interview.ResultsThe proportion of schizophrenia cases detected by PAS–ADD increases with the number of active core symptoms identified by the referrer. Where two or more core symptoms were indicated, PAS–ADD detected 71 % cases. The most frequently fulfilled criterion was third-person auditory hallucinations. Six schizophrenia diagnoses disagreed with the clinician, four of which were referred as being hypomania. Overall symptom frequency detected by PAS–ADD was positively correlated with IQ.ConclusionsResults suggest there may be scope for modifying the ICD–10 diagnostic algorithm for use with learning disability, particularly in relation to the delusions and negative symptoms criteria.

The Epidemiology of Early Schizophrenia

1994 ◽  
Vol 164 (S23) ◽  
pp. 29-38 ◽  
Author(s):  
H. Häfner ◽  
K. Maurer ◽  
W. Löffler ◽  
B. Fätkenheuer ◽  
W. An Der Heiden ◽  
...  
Keyword(s):  
Negative Symptoms ◽  
Animal Experiments ◽  
Age Groups ◽  
Young Males ◽  
Retrospective Assessment ◽  
First Onset ◽  
Core Symptoms ◽  
First Rank Symptoms ◽  
Positive And Negative Symptoms ◽  
First Admission

For the investigation of the early course of schizophrenia starting from onset, the standardised Interview for the Retrospective Assessment of the Onset of Schizophrenia was developed and validated. In a representative sample of 267 first-admitted German schizophrenics of a broad diagnosis from a population of 1.5 million, the age at which different diagnostic and onset definitions were satisfied, the symptoms at the time of the interview, and the accumulation of positive and negative symptoms until first admission were assessed. Comparison between the two sexes and three age groups yielded hardly any differences in the accumulation of symptoms and their course until first admission, except for a slightly shorter period of negative symptoms in young males and a slightly longer one in older women – which contradicts prevailing opinion. At the time of the interview, no significant sex differences were found with respect to the core symptoms of schizophrenia (negative and first-rank symptoms), but clear and substantial differences emerged in disease behaviour. The significantly higher age at first onset in women is explained, on the basis of animal experiments and a clinical study, by the neuromodulatory effect of oestrogen on D2 receptors and by a higher vulnerability threshold in women.

scholarly journals First Rank Symptoms and Neurological Soft Signs in Schizophrenia

2014 ◽  
Vol 2014 ◽  
pp. 1-11
Author(s):  
Mahesh Hembram ◽  
Jayati Simlai ◽  
Suprakash Chaudhury ◽  
Parthasarathi Biswas
Keyword(s):  
Negative Symptoms ◽  
Clinical Symptoms ◽  
Assessment Instrument ◽  
Positive Symptom ◽  
Neurological Assessment ◽  
Neurological Soft Signs ◽  
Icd 10 ◽  
First Rank Symptoms ◽  
Written Informed Consent ◽  
Normal Controls

The aim of the study was to compare the neurological soft signs (NSS) in schizophrenia patients with and without first rank symptoms (FRS), their first degree relatives (FDR), and normal controls. The study was conducted on 60 schizophrenia patients diagnosed according to ICD 10 DCR and categorized into groups with and without FRS using Schedules for Clinical Assessment in Neuropsychiatry, 30 FDRs of the study sample, and 30 normal controls matched for age, education, and handedness. All the subjects gave written informed consent. Scale for the Assessment of Positive Symptoms and Scale for the Assessment of Negative Symptoms were applied to have a comprehensive assessment of the symptoms. NSS were assessed using Extended Standard Neurological Assessment Instrument. The correlations between NSS and clinical symptoms were relatively modest but significant. There was a weak relation between NSS and positive symptom severity. The FDR of schizophrenia patients had significantly lower NSS scores than schizophrenia patients, but only FDR of schizophrenia patients without FRS had significantly higher scores than normal controls. Our results indicate that NSS are more prominent in schizophrenia patients with negative symptoms and support the theory of NSS being a trait marker of schizophrenia particularly in those without FRS.

Is there a continuum of psychotic experiences in the general population?

2003 ◽  
Vol 12 (4) ◽  
pp. 242-252 ◽  
Author(s):  
Jim Van Os
Keyword(s):  
Negative Symptoms ◽  
Relevant Literature ◽  
World Health Organisation ◽  
World Health ◽  
Psychotic Symptoms ◽  
Diagnostic Systems ◽  
Traditional Concept ◽  
Funding Sources ◽  
Icd 10 ◽  
Core Symptoms

SummaryAims - Schizophrenia is a severe mental illness that affects 1% of the population. The diagnosis is made according to current diagnostic systems of DSM-1V (American Psychiatric Association, 1994) and ICD-10 (World Health Organisation, 1992), on the basis of characteristic ‘positive’ and ‘negative’ symptoms. The traditional model assumes a categorical view of the schizophrenia syndrome and its core symptoms, in which differences between psychotic symptoms and their normal counterparts are considered to be qualitative. An alternative, dimensional approach assumes that schizophrenia is not a discrete illness entity, but that psychotic symptoms differ in quantitative ways from normal experiences and behaviours. This paper reviews evidence for the continuity of psychotic symptoms with normal experiences, focusing on the symptoms of hallucinations and delusions. Methods - A qualitative review of the relevant literature. Results - The literature suggests that although current epidemiological approaches yield substantial evidence for a continuum view, it is rarely interpreted as such. Conclusions - The traditional concept ofschizophrenia as a homogeneous disease entity has become outdated and is in dire need of a more valid and clinically useful successor.Declaration of InterestsSupport has been received in the last two years from the Dutch Research Council, The Dutch Ministry of Health, Maastricht University, The Dutch Brain Society, ZON-MW, The Province of Limburg, The Council of Maastricht, Eli Lilly, Janssen-Cilag, Pfizer, Astra-Zeneca and Bristol Meyer Squibb. None of these funding sources represents a conflict of interest in relation to this article.

New dopaminergic and non-dopaminergic theories in schizophrenia and their therapeutic impact

1997 ◽  
Vol 9 (2) ◽  
pp. 64-67
Author(s):  
R.S. Kahn
Keyword(s):  
Cognitive Deficits ◽  
Negative Symptoms ◽  
Dopamine Neurons ◽  
Psychotic Symptoms ◽  
Positive Symptoms ◽  
The Core ◽  
Schizophrenic Patients ◽  
Core Symptoms ◽  
Influential Theory

The dopamine (DA) hypothesis of schizophrenia, postulating that schizophrenia is characterized by increased dopamine function, has been the most influential theory on the pathogenesis of schizophrenia. It has recently been revised based on the appreciation that the core symptoms of schizophrenia may not be the positive (psychotic) symptoms, but rather the negative symptoms and the cognitive deficits found in schizophrenic patients. This revision has prompted the hypothesis that schizophrenia is characterized by both decreased prefrontal dopamine activity (causing deficit symptoms) and increased dopamine activity in mesolimbic dopamine neurons (causing positive symptoms).Notwithstanding this revision of a role for dopamine in schizophrenia, it has become increasingly evident that dysfunction of other monoaminergic systems may be as important in contributing to the pathophysiology of schizophrenia. Specifically, the putative role of serotonin (5-hydroxytryptamine, 5-HT) in schizophrenia is gaining considerable attention. Several observations, such as the ability of the 5-HT antagonist, ritanserin, to alleviate schizophrenic symptoms and, when added to haloperidol (Haldol®), to decrease its extrapyramidal side-effects (EPS), have stimulated studies into a role of 5-HT in schizophrenia. The finding that clozapine (Leponex®), clinically superior to conventional neuroleptics, is a weak DA2 antagonist but a potent 5-HT1c and 5-HT2 antagonist has further stimulated 5-HT-related research in schizophrenia.

scholarly journals Music Therapy as Treatment of Negative Symptoms for Adult Patients Diagnosed with Schizophrenia—Study Protocol for a Randomized, Controlled and Blinded Study

Medicines ◽  
2019 ◽  
Vol 6 (2) ◽  
pp. 46
Author(s):  
Inge Pedersen ◽  
Lars Bonde ◽  
Niels Hannibal ◽  
Jimmy Nielsen ◽  
Jørgen Aagaard ◽  
...  
Keyword(s):  
Music Therapy ◽  
Psychosocial Functioning ◽  
Negative Symptoms ◽  
National Board ◽  
Randomized Controlled ◽  
System A ◽  
Cochrane Reviews ◽  
Danish Health ◽  
Icd 10 ◽  
General Functioning

Background: Three Cochrane reviews show that music therapy has a positive effect on schizophrenia concerning general functioning and positive/negative symptoms. This study aims to replicate these results in the Danish health system, a requirement for recommendation in guidelines from the Danish National Board of Health. Methods: The study is a randomized, controlled multi-site study, with a blinded design, aiming to include 90 participants who are 18–65 years in age, diagnosed according to ICD-10 with a schizophrenia diagnosis. The participants are randomized to one of two different music therapy activities for 25 weekly sessions. The study interventions are added to standard care. Outcome measures are rated at baseline, after 15 sessions and post therapy. A qualitative interview is performed as a one month follow up at the end of study. The primary intended outcome is a reduction in negative symptoms. The secondary intended outcome is progression in quality of life, alliance and psychosocial functioning. Results: As this study is still running, the results are not yet available. Conclusion: The study will investigate the direct effects of music therapy on negative symptoms as part of schizophrenia in a blinded, randomized trial. If proven effective, music therapy can be added to the small treatment armamentarium of effective therapies for negative symptoms in patients with schizophrenia.

scholarly journals Factor structure and familiality of first-rank symptoms in sibling pairs with schizophrenia and schizoaffective disorder

2000 ◽  
Vol 177 (1) ◽  
pp. 15-19 ◽  
Author(s):  
Josephine Loftus ◽  
Lynn E. Delisi ◽  
Timothy J. Crow
Keyword(s):  
Factor Structure ◽  
Principal Components ◽  
Genetic Predisposition ◽  
Schizoaffective Disorder ◽  
Sibling Pairs ◽  
Factor I ◽  
Third Person ◽  
Components Analysis ◽  
Major Factors ◽  
First Rank Symptoms

BackgroundSince their introduction as diagnostic criteria by Schneider in 1937, nuclear symptoms have played a key role in concepts of schizophrenia, but their relationship to each other and to genetic predisposition has been unclear.AimsTo ascertain the factor structure and familiality of nuclear symptoms.MethodsNuclear (Schneiderian) symptoms were extracted from case notes and interviews in a study of 103 sibling pairs with DSM–III–R schizophrenia or schizoaffective disorder.ResultsPrincipal components analysis demonstrated two major factors: one, accounting for about 50% of the variance, groups thought withdrawal, insertion and broadcasting, with delusions of control; and the second, accounting for <20% of the variance, groups together third-person voices, thought echo and running commentary. Factor I was significantly correlated within sibling pairs.ConclusionsThe correlation within sibling pairs suggests that, contrary to the conclusion of some previous studies, some nuclear symptoms do show a degree of familiality and therefore perhaps heritability.

scholarly journals Long-term affective disorder in people with mild learning disability

2001 ◽  
Vol 179 (6) ◽  
pp. 523-527 ◽  
Author(s):  
Marcus Richards ◽  
Barbara Maughan ◽  
Rebecca Hardy ◽  
Ian Hall ◽  
Andre Strydom ◽  
...  
Keyword(s):  
Learning Disability ◽  
Affective Disorder ◽  
Fourfold Increase ◽  
Frequency Scale ◽  
Medical Disorder ◽  
Increased Risk ◽  
Symptom Frequency ◽  
State Examination ◽  
Psychiatric Outcome

BackgroundIncreased risk of affective disorder in learning disability has been reported, although the extent to which this is due to adverse social and material circumstances is uncertain and there have been potential limitations in the measurement of affective disorder.AimsTo determine risk of affective disorder in those classified with mild learning disability in the British 1946 birth cohort and to investigate whether this risk was accounted for by disadvantage in childhood and adulthood.MethodLearning disability was defined as the equivalent of an IQ ≤ 69 at age 15 years. The Present State Examination at age 36 years and the Psychiatric Symptom Frequency Scale at age 43 years provided psychiatric outcome measures.ResultsLearning disability was associated with a fourfold increase in risk of affective disorder, not accounted for by social and material disadvantage or by medical disorder.ConclusionsLearning disability is strongly associated with risk of affective disorder, persisting well into midlife.

scholarly journals Clinical Features of Youth Depression with Attenuated Symptoms of the Schizophrenic Spectrum

Psychiatry ◽  
2021 ◽  
Vol 19 (1) ◽  
pp. 16-25
Author(s):  
M. A. Omelchenko
Keyword(s):  
Mental Health ◽  
Depressive Episode ◽  
Negative Symptoms ◽  
Mental Health Research ◽  
Research Centre ◽  
Psychotic Symptoms ◽  
Control Group ◽  
Youth Depression ◽  
Icd 10 ◽  
Type 3

Objective: establishment of clinical and psychometric features of youth depression with attenuated symptoms of the schizophrenic spectrum (ASSS) for early differential diagnosis and nosological assessment.Patients and methods: clinical and psychometric examination of young 219 inpatients (average age 19.6 ± 2.4 years), first admitted to the clinic “Mental Health Research Centre” from 2011 to 2020 with the first depressive episode with ASSS. Control group of inpatients (52 patients) with “classical” youth depressions without ASSS (average age 19.6 ± 2.4 years). Diagnosis  according ICD-10: F32.1, F32.2, F32.28, F32.8.Results: the psychopathological structure of youth depression with ASSS is characterized by the following types: (1) depression with attenuated psychotic symptoms (APS), which were divided into the subtype (1a) depression with APS and (1b) depression with brief limited intermittent psychotic symptoms (BLIPS); (2) depression with attenuated negative symptoms (ANS), comprising two subtypes (2a) with most emotional damage and (2b) with volitional impairment, and type (3) with attenuated symptoms of disorganization (ASD) in the structure of depressive episode. Clinical and reliable psychometric differences have been established between depressions with ASSS and «classical» youth depressions without ASSS. Conclusions: youth depression with ASSS is definitely different from “classical” youth depression without ASSS. Differences have been found in  the psychopathological structure of youth depression with ASSS, resulting in a typological differentiation.

scholarly journals En innføring i depresjonsvurdering med PHQ-9

2020 ◽  
Author(s):  
Tomas Formo Langkaas ◽  
Even Rognan ◽  
Sverre Urnes Johnson
Keyword(s):  
Clinical Practice ◽  
Diagnostic Algorithm ◽  
Test Results ◽  
Measurement Instruments ◽  
National Guidelines ◽  
General Introduction ◽  
Icd 10 ◽  
Dsm Iv ◽  
Cutoff Scores

Assessment of depression is a routine task in clinical practice in Norway. National guidelines (Helsedirektoratet, 2009) recommend the use of measurement instruments in assessment of depression. PHQ-9 is widely used in research and practice. The official PHQ-9 manual provides practical guidance on interpreting test results with the use of clinical cutoff scores and a diagnostic algorithm for DSM-IV. With background from clinical practice and research, we summarize and provide guidance on the practical use of PHQ-9 beyond what the official PHQ-9 manual offers, applied to a Norwegian context. We provide a general introduction to diagnostic assessment of depression and the limited role of measurement instruments in such assessments. We describe how the original diagnostic algorithm can be adapted to ICD-10 criteria, we describe how to apply clinical significance to use PHQ-9 as a feedback instrument to monitor treatment progress, and we describe how to interpret results with missing answers. Finally, we discuss the shortcomings of relying on measurement instruments in assessment of depression and conclude that PHQ-9 is better suited in ordinary practice than other instruments recommended in the national guidelines.

Prevalence of lung cancer in Colombia and a new diagnostic algorithm using health administrative databases: A real-world evidence study.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18764-e18764
Author(s):  
Giancarlo Buitrago ◽  
Javier Amaya-Nieto ◽  
Gabriel Fernando Torres
Keyword(s):  
Lung Cancer ◽  
Policy Design ◽  
Diagnostic Algorithm ◽  
Geographic Region ◽  
Administrative Databases ◽  
Prevalence Rates ◽  
Cross Sectional ◽  
Icd 10 ◽  
Estimate Prevalence ◽  
Official Sources

e18764 Background: Reliable, timely and detailed information of lung cancer mortality and costs from low- and middle-income countries is essential to policy design. We aimed to develop an electronic algorithm to identify lung cancer prevalent patient in Colombia using official databases and to estimate prevalence rates by age, sex, and geographic region. Methods: We performed a cross sectional study based on national claim databases in Colombia ( Base de datos de suficiencia de la Unidad de Pago por Capitación and Base de Datos Única de Afiliados) to identify lung cancer prevalent patients in 2017. Several algorithms based on the presence or absence of oncological procedures (Chemotherapy, radiotherapy and surgery), and a minimum number of months that each individual had lung cancer ICD-10 codes in the previous 3 years, were developed. After testing 16 algorithms, those with the closest prevalence rates to the ones reported by aggregated official sources (GLOBOCAN, National Cancer Institute and Cuenta de Alto Costo) were selected . We estimated prevalence rates by age, sex, and geographic region. Results: Two algorithm s were selected: i) it was defined as the presence of ICD-10 codes for 4 months or more (sensitive algorithm); and ii) adding the presence of at least one oncological procedure (specific algorithm). Estimated prevalence rates per 100,000 population were 15.3 and 9.7 for the sensitive and specific algorithms, respectively. These rates were higher in men (9.9), over 65 years old (37.1), who lived in Central and Bogota regions (14.7 and 10.9, respectively) (Table). Conclusions: Selected algorithms showed similar prevalence estimations to those reported by official sources and allowed us to estimate prevalence rates in specific aging, regional and gender groups for Colombia using national claims databases. These findings could be useful to identify clinical and economical outcomes related to lung cancer patients using national individual-level databases. [Table: see text]

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