摘要:

The aim of this study was to explore the extent and the specific features of drop‐out for patients having a first contact with an university psychiatric outpatient clinic in Italy over the course of 1 year and to determine which variables were associated with early termination of treatment. Of the 158 patients selected for this study, there was an overall 3‐month drop‐out rate following the first visit of 63 %. Of the 59 patients who had returned once after the initial contact, 28 interrupted subsequently the treatment, although the therapist's plan included further visits. The overall drop‐out rate at 3 months was thus 82%. The only 2 variables associated with drop‐out rates were the patients’ perception of the severity of their disorder and the psychiatric history: continuing patients were more frequently in agreement with the clinician's judgment as compared with those who dropped out and were more likely to have already been in psychiatri

ISSN:0001-690X    

DOI:10.1111/j.1600-0447.1995.tb09534.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

ISSN:0001-690X    

DOI:10.1111/j.1600-0447.1995.tb05936.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

At the end of the last century, Hughlings‐Jackson suggested that positive and negative syndromes should be kept apart in psychotic disorders. When the concepts of dementia praecox and schizophrenia were introduced by Kraepelin and Bleuler, emphasis was laid on the negative symptoms, regarded as fundamental. After the introduction of the “first rank symptoms” by Schneider emphasis switched to the positive symptoms in schizophrenia and these symptoms were included in most diagnostic criteria. In the 1980s Andreasen and Crow suggested a dichotomy into positive and negative syndromes in schizophrenia. Kay and co‐workers introduced a Positive And Negative Syndrome Scale (PANSS) for schizophrenia. In the original studies satisfactory construct validity and inter‐rater reliability were demonstrated. However, in studies outside the USA a high construct validity was found for the negative scales but not for the positive and general psychopathology scales. Furthermore, the inter‐rater reliability of the negative scale was a problem. After introduction of the Structured Clinical Interview for the PANSS (SCI‐PANSS) the inter‐rater reliability increased for all three scales.In an early study Kay and Sevy found seven factors in a principal component analysis of the PANSS and suggested a four factor pyramidical model. Later principal component analyses by Lepine, Peralta et al. and Kawasaki et al. suggested that the four factor model was an oversimplification and Lindstrijm and von Knorring suggested a five factor pyramidical model. A similar model was later suggested by Bell et al. after a reanalysis of the original series of Kay and Sevy.In short‐ and long‐term studies of the new balanced serotonin SHT2‐dopamine D, antagonist, risperidone, it has been demonstrated that all five factors, the positive, the negative, the excited, the anxious/depressive and the cognitive, are sensitive to changes induced by means of psychopharmacological drugs. Thus the five factor model of schizophrenia seems to be an interesting tool when new, selective, psychopharmacological drugs are to be evaluated and when differences in clinical profiles are sought be

ISSN:0001-690X    

DOI:10.1111/j.1600-0447.1995.tb05937.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Prescribing patterns of antidepressant drugs were studied, over a period of 30 months, in a random sample of 8743 residents of the area of Rome, Italy. Data from the regional outpatient drug monitoring system were used. The proportion of subjects receiving, during the study period, at least one prescription of antidepressant drugs, was 5.4%; the female‐to‐male ratio was 2.1. Consumption prevalence increased with age. The single most prescribed drug was fluoxetine followed by amitriptyline and ademetionine. For a surprisingly high proportion of subjects, the observed length of treatment was shorter than expected on the basis of current knowledge in clinical pharmacology. Inappropriate diagnostic and therapeutic procedures are likely explanati

ISSN:0001-690X    

DOI:10.1111/j.1600-0447.1995.tb09535.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Depression is a common mental disorder; effective methods for treating it are also available. Its recognition and diagnosis are prerequisite to effective treatment. A majority of depressed patients are generally managed in the primary care setting; only a half of the cases, however, are identified at their first visit. Screening instruments to improve recognition of depression have therefore been developed. The Depression Scale (DEPS), consisting of 10 items, was developed and tested in primary care patients aged 18 to 64 years. Clinical assessments were made on the basis of Present State Examination interviews with 436 patients. The DEPS proved to be satisfactory. Increasing age and poor education had an adverse effect on the screening process, however. The sensitivity of the DEPS for clinical depression was 74% and the specificity for non‐depression 85%. The sensitivity for severe depression was 84% and the specificity for symptom‐free patients 93%. The DEPS seems to improve the recognition of depression in primary care and may also be suitable for screening depression in the general population and for identifying high‐risk g

ISSN:0001-690X    

DOI:10.1111/j.1600-0447.1995.tb09536.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Many conflicts in the literature about negative symptoms arise because different authors use different definitions of negative symptoms. If narrow definitions are used, it appears that drugs have little effect against negative symptoms, although those who use broader definitions tend to conclude that negative symptoms do respond to drugs. Another complication is that negative symptoms may be secondary to other causes, such as psychotic symptoms, the side effects of drugs, depression and understimulation as a result of hospitalisation.Attempting to measure drug effects on negative symptoms can be complicated by such factors as different co‐medication in the test and control groups and different pharmacological profiles of test and standard drugs, in particular in terms of extrapyramidal side effects or antidepressant effects.Several approaches to dissecting the direct effect of drugs from their indirect effects on negative symptoms have included analyses of covariance, regression analyses and path analyses. Applying path analysis to the data from the North American clinical trial of risperidone suggests that a significant component of the advantageous effect of risperidone on negative symptoms, compared with haloperidol, is due to a direct effect that cannot be accounted for by the effect of risperidone on positive symptoms and its superior side‐effect profile.Although it is possible to analyse studies retrospectively in this way, the best approach is probably to design future clinical trials so that the effects of drugs on negative symptoms are more easily determined than has been the case in the p

ISSN:0001-690X    

DOI:10.1111/j.1600-0447.1995.tb05938.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Negative symptoms in schizophrenia comprise a psychopathologic and pathophysiologic syndrome which is absent from normal mental function. Renewed interest in negative symptoms has led to the development of better measuring instruments, among which is the Positive And Negative Syndrome Scale (PANSS), which provides a way of measuring and reporting positive and negative symptoms in a balanced and convenient form.A number of strategies are being investigated for treating negative symptoms. Dopamine agonists such as levodopa, amphetamines and bromocriptine have been shown to produce improvements in negative symptoms, although good, well‐controlled clinical trials arc lacking. Partial dopamine agonists, such as MAR 327, are also currently under investigation and results arc expected soon.Tricyclic, selective serotonin reuptake inhibitors and monoamine oxidase antidepressants appear to be able to modify negative symptoms in schizophrenia, although, once again, carefully designed trials are nccdcd. Modification of GABAergic transmission has shown little promise, but the use of glycine to augment transmission at N‐methyl‐D‐aspartate (NMDA) synapses suggests that the strategy may be beneficial. These results also imply that altered glutamate receptor function may be partly responsible for negative symptoms.One strategy that has been shown to have a beneficial effect against negative symptoms is combined serotonin/dopamine antagonism. Clozapine was found to have this profile after its introduction, and the recently introduced antipsychotic, risperidone was developed intentionally to be a combined 5‐HT2/D2antagonist. Both risperidone and clozapine have been shown to be effective against negative symptoms.One problem associated with the assessment of drug effects on negative symptoms, however, is that drugs can act on both primary and secondary negative symptoms. However, apost hocanalysis of covariance of the North American risperidone clinical trial data suggested that the drug was effective against primary negative

ISSN:0001-690X    

DOI:10.1111/j.1600-0447.1995.tb05939.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

An important contemporary conceptualization of anxiety has suggested that heightened early separation anxiety is specifically associated with the risk of adult panic disorder, with hereditary factors underlying that cluster of anxiety disorders. Yet there is a dearth of studies examining whether early separation anxiety is inherited. The present twin study, based on a retrospective approach, revealed a substantial genetic contribution to separation anxiety in females but not in males, with unique environmental influences being important in both gender groups. Although speculative, an evolutionary explanation is offered to account for the apparent gender difference in the inheritance of early separation anxiety. It is hypothesized that, in some women, phylogenetic vestiges of separation anxiety may conflict with their need to compete in an individualistic manner in the modern workplace. Whether such an attachment‐autonomy conflict accounts for the increased rate of panic disorder and agoraphobia in women is worthy of further stud

ISSN:0001-690X    

DOI:10.1111/j.1600-0447.1995.tb09537.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Mood disorders in schizophrenia are common and are associated with a poor outcome, an increased risk of relapse and a high rate of suicide. Consequently, treatment strategies need to take mood disorders into account.In depressed and actively psychotic schizophrenic and schizoaffective patients, treatment with neuroleptic plus antidepressant may be less effective than neuroleptic alone. However, patients with post‐psychotic depression on maintenance neuroleptics respond well to tricyclic antidepressants. Mood disorders can be caused by neuroleptics and if so will often improve if the dose is reduced or if the drug is changed. Anticholinergics may also help. In schizoaffective disorder, lithium is usually beneficial, especially for patients with classical affective disorder. Carbamazepine may be more effective in patients with schizoaffective and schizophreniform disorders. At doses comparable with those effective in schizophrenia, clozapine may be as good or better than conventional neuroleptics in schizophrenic patients with psychotic mood disorder or schizoaffective disorder. In patients with high BPRS anxiety/depression scores, risperidone (8 mg/day) was more effective than haloperidol (10 mg/day). Risperidone at a mean dose of 8.6 mg/day was also more effective than haloperidol (mean dose 9.2 mg/day) or levomepromazine (methotrimeprazine — mean dose 125 mg/day) on the Psychotic Anxiety Scale.Mood‐related symptoms are therefore amenable to treatment. Risperidone and clozapine appear to be good candidates for the long‐term treatment of mood disorders in schizophrenia, although long‐term, double‐blind, controlled studies are needed to c

ISSN:0001-690X    

DOI:10.1111/j.1600-0447.1995.tb05940.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Conventional neuroleptics are widely accepted as being effective against the positive symptoms of schizophrenia, but do not benefit all patients. Furthermore, they are relatively ineffective against negative symptoms and cognitive disorders, and most have unpleasant side effcct profiles. New strategies for treating schizophrenia include the development of dopamine antagonists with high selectivity for different subtypes of dopamine receptors, dopamine partial agonists, antagonists at different serotonin (5–hydroxytryptamine; 5–HT) receptor subtypes, drugs with mixed pharmacological profiles and drugs which modify transmission via amino acids or peptides in the brain.The prospect is that some of these strategies will lead to the introduction of new drugs and that some of these will become the standards against which future drugs will be compared. The search for new drugs and their use in clinical practice will also lead to developments in our knowledge and understanding of schizophre

ISSN:0001-690X    

DOI:10.1111/j.1600-0447.1995.tb05941.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY