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The relationship between subjective quality of life (QOL), clinical measures, and service utilization was measured in out-patients with schizophrenia. A total of 72 subjects completed the Quality of Life Interview and were also assessed by means of the Positive and Negative Syndrome Scale, a battery of neuropsychological tests, and two measures of social functioning. Use of psychiatric services over a 2-year period was ascertained from comprehensive records. Global subjective QOL was lower than patients' satisfaction with specific life domains. There were few significant correlations between satisfaction with, and objective measures of, specific life areas. In a multiple regression, patients' global subjective QOL was inversely related to their scores on the PANSS depression factor, and to the number of psychiatrist out-patient visits.
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PMID:Subjective quality of life in out-patients with schizophrenia: clinical and utilization correlates. 971 38

Various theories have been proposed to account for poor insight in schizophrenia. This study examined the relationships between insight, mood, schizophrenic symptoms and cognitive functioning. The relationship between longitudinal changes in insight and changes in symptoms and mood was also investigated. One-hundred patients with DSM-III-R schizophrenia, recently recovered from a relapse of their illness, were rated on the Insight and Treatment Attitudes Questionnaire (ITAQ), the Positive and Negative Syndrome Scale (PANSS), the Montgomery Asberg Depression Rating Scale (MADRS), the Rivermead Behavioural Memory Test and tests of current and premorbid IQ. A random sample of 53 were then given an educational package (video and booklets) designed to improve their insight. Follow-up ratings on the ITAQ, PANSS and MADRS were subsequently obtained. At baseline, better insight was significantly correlated with lower mood and fewer positive symptoms. It was not related to cognitive functioning. Improvement in insight at follow up was related to worsening of mood, but not to change in positive symptoms. The results are consistent with the concept that poor insight, at least in part, results from the psychotic disease process itself. In addition, they suggest that poor insight may protect against depression in the early stages of recovery from schizophrenia.
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PMID:Correlates of insight and insight change in schizophrenia. 1009 70

While many would debate the very reality of Post Abortion Syndrome, the author of this article has experienced Post Abortion Syndrome first hand. Excerpted from a speech she gave before a Florida meeting of the National Organization of Episcopalians for Life (NOEL), the article outlines the various stages and symptoms of Post Abortion Syndrome: denial, repression, guilt, anxiety, depression. She then describes the process for healing and recovery, and presents a model for a Post Abortion support group which is patterned after Alcoholics Anonymous.
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PMID:Post abortion syndrome. 1029 80

The effectiveness of adding moclobemide to antipsychotic treatment in schizophrenic patients with prominent negative symptoms was examined. Eleven chronic schizophrenic patients had their regular antipsychotic treatment augmented by the addition of moclobemide 450 mg/day for 8 weeks. A significant improvement was seen on the Positive and Negative Syndrome Scale (PANSS) negative factor and for the Scale for the Assessment of Negative Symptoms (SANS) scores, PANSS total score, PANSS general factor score and Hamilton Depression Scale scores. Positive symptoms were not altered. Moclobemide augmentation may ameliorate negative, depressive and general symptoms in schizophrenia.
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PMID:The effect of augmentation with moclobemide on symptoms of schizophrenia. 1043 75

We evaluated psychiatric symptoms and neurocognitive functioning among 25 institutionalized and 25 outpatient DSM-IV-diagnosed schizophrenia patients, as well as 25 middle-aged and elderly normal comparison subjects. All subjects were assessed with the Positive and Negative Syndrome Scale, Hamilton Rating Scale for Depression, modified Simpson-Angus Extrapyramidal Symptom Scale, the Abnormal Involuntary Movement Scale, and the Mattis Dementia Rating Scale (DRS). The two patient groups had similar levels of depressive symptoms, but the institutionalized patients had more severe positive and negative symptoms and were on higher doses of neuroleptic medication. The institutionalized patients had significantly more cognitive impairment on the DRS than outpatients and normal comparison subjects, particularly on the subscales of initiation/perseveration, conceptualization, and memory. Results are discussed in terms of the possible neuropathology associated with cognitive impairment in chronic schizophrenia.
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PMID:Cognitive deficits and psychopathology in institutionalized versus community-dwelling elderly schizophrenia patients. 1044 49

A combination of nefazodone with a conventional neuroleptic would lead to a serotonin (5-HT)2 and D2 receptor blockade resembling that of an atypical neuroleptic, with an additional increase of 5-HT (and noradrenaline) turnover. This may be of benefit in some cases of schizophrenia. In this study, eight patients with schizophrenia with predominantly negative and/or depressive symptoms underwent an open prospective 26-week trial with nefazodone, added to conventional neuroleptics. The total Positive and Negative Syndrome Scale (PANSS) and the Montgomery-Asberg Depression Rating Scale (MADRS) scores (the last observations carried forward, LOCF) significantly (P < 0.05) decreased in these eight patients by a mean of 31% and 63%, respectively, mainly within the first 6 weeks. Positive symptoms, observed in three patients and panic attacks in two patients disappeared entirely. The doses of neuroleptics, stable during the first 6 weeks of the trial, subsequently were able to be decreased by 28%. Extrapyramidal symptoms noticeably improved during the phase of stable neuroleptic dose regimen. Of the three patients who discontinued the trial prematurely (after 14 weeks or more), only one evidenced a nefazodone-related adverse event. Adjunctive nefazodone may be a useful treatment option in this patient population, but additional studies are recommended.
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PMID:Adjunctive nefazodone in neuroleptic-treated schizophrenic patients with predominantly negative symptoms: an open prospective pilot study. 1046 16

The abrupt appearance of clozapine discontinuation symptoms represents a particularly unique situation that has not been characterized in a double-blind, placebo-controlled trial. A randomized, double-blind comparison of placebo (N = 53) and olanzapine 10 mg (N = 53) for 3 to 5 days following the abrupt discontinuation of clozapine (< 300 mg/day) was carried out. Subjects were assessed with the Positive and Negative Syndrome Scale (PANSS), the Clinical Global Impression Scale of Severity, the Montgomery-Asberg Depression Rating Scale (MADRS), and the Mini-Mental State Evaluation. Subsequently both groups received open-label olanzapine (10-25 mg/day) for an additional 9 weeks. Statistically significantly more placebo-treated (24.5%) than olanzapine-treated (7.5%) patients experienced clozapine discontinuation symptoms (p = 0.017). Core symptoms included delusions, hallucinations, hostility, and paranoid reaction and translated into a significantly higher worsening from baseline on the PANSS total, PANSS General Psychopathology subscale, and MADRS among subjects randomly assigned to receive placebo. After open-label treatment with olanzapine for 9 weeks, both groups were clinically stable, suggesting that the discontinuation symptoms were transient. However, subjects who had been randomly assigned to the 3- to 5-day placebo discontinuation segment achieved somewhat less global clinical improvement. Although a pharmacologic interpretation is speculative, evidence of a clozapine discontinuation syndrome was apparent. In most cases, the direct substitution of a pharmacologically similar agent (olanzapine) prevented the syndrome. Clozapine discontinuation or noncompliance should be considered in the differential assessment of an acutely emergent psychosis. The possibility that subjects who experience a clozapine discontinuation syndrome may take longer or are less likely to clinically restabilize warrants further investigation.
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PMID:Controlled, double-blind investigation of the clozapine discontinuation symptoms with conversion to either olanzapine or placebo. The Collaborative Crossover Study Group. 1050 85

The Positive and Negative Syndrome Scale (PANSS) was originally designed as a rating system that provides balanced representation of positive and negative symptom features. Evidence from recent factor-analytic studies suggests that a five-dimensional solution appears to best fit the psychopathological data as assessed with the PANSS. To investigate the dimensional structure, we administered the PANSS to 253 inpatients with schizophrenia. In accordance with former studies, principal components analyses yielded five orthogonal dimensions: hostile excitement; negative, cognitive, and positive syndrome; and depression. When compared with questionnaires measuring subjective nonpsychotic experiences of schizophrenia, paranoid mood, and depression, the correlation pattern verifies the PANSS components. In addition, we investigated a subsample of 70 male patients with a Continuous Performance Test (CPT), a Span of Apprehension Task, and a Modality Shift Effect (MSE) paradigm; the CPT was significantly associated with the cognitive syndrome, and the MSE correlated with the negative syndrome.
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PMID:Psychopathological syndromes of schizophrenia: evaluation of the dimensional structure of the positive and negative syndrome scale. 1075 79

The aim of this study was to investigate the concurrent validity of the French language version of the Calgary Depression Scale for Schizophrenics (CDSS). Ninety-five schizophrenic patients meeting the DSM-III-R criteria were enrolled in the study. The depressive symptoms were evaluated using the Calgary Depression Scale for Schizophrenics (CDSS), Hamilton Depression Rating Scale (HDRS), Montgomery and Asberg Rating Scale (MADRS), and Widlocher Psychomotor Retardation Scale (ERD). The psychotic symptoms were evaluated with the Positive and Negative Syndrome Scale (PANSS) and the extrapyramidal symptoms with the Extrapyramidal Syndrome Rating Scale (ESRS). The CDDS was significantly correlated with all the conventional depression-rating scales. We only found significant positive correlations between the CDSS and the PANSS-positive sub-scale. The CDSS total score was significantly correlated with some PANSS-positive items (delusions and hallucinatory behaviour). No significant correlation between the depression-rating scales and the PANSS-negative sub-scale was observed. For all the depression-rating scales, no correlation with the extrapyramidal symptom was evidenced. The results confirmed the validity of the CDSS in the evaluation of depression in schizophrenia. The relationship between depression and the positive symptoms of schizophrenia is discussed.
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PMID:Study of the concurrent validity of the Calgary Depression Scale for Schizophrenics (CDSS). 1078

The main objective of the study was to verify the stability of the five-factor (negative. positive, excitation, depression and cognitive) structure of the Positive and Negative Syndrome Scale (PANSS). The psychometric properties (validity and reliability) of the forced five-factor structure of the PANSS were explored in two different populations of schizophrenic patients: one in relapse and the other in the chronic phase of the disease. Three hundred and forty-two schizophrenic patients according to DSM-III-R criteria were involved. One hundred and eighteen (34.5%) patients were in relapse, and 224 (65.5%) were in the chronic phase. The forced five-factor principal-component analysis explained 64.3% of the total variance in the relapse patients and 62.1% in the chronic patients. The order of the factors was reversed for the depression and excitation factors in chronic patients compared with patients in relapse. The internal consistency of this five-factor structure was good (Cronbach's alpha >0.70) in the relapse and chronic patients, except for the cognitive factor. In conclusion. five dimensions (negative, positive, excitation, depression and cognition) are necessary to account for the various clinical aspects of schizophrenia described by PANSS in relapse and chronic schizophrenic patients.
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PMID:Stability of the five-factor structure of the Positive and Negative Syndrome Scale (PANSS). 1078 81


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