The assessment of light intensity preference in psychiatric patients: a questionnaire.

The assessment of abnormal light-related behaviour is important for methodological reasons, and has a prophylactic and heuristic value. Since no operationalization of these behaviour patterns has been published until now, we constructed a questionnaire to identify abnormal light intensity preference based on a systematic study and previous case reports. We administered the questionnaire to patients with schizophrenia (n = 46) or major depression (n = 55), and to healthy control subjects (n = 70). Photophilia was more frequently diagnosed in schizophrenia than in depression (P < 0.001). Photophobia was more frequently observed in depression than in schizophrenia; however, this difference was not statistically significant. None of the healthy subjects showed these phenomena. The kappa value was 0.66 for photophilia and 0.65 for photophobia. Patients with schizophrenia had a higher mean photophilia score than depressive patients (P < 0.001) and healthy subjects (P < 0.05). Depressed patients had higher photophobia scores than schizophrenics (P < 0.05) and healthy subjects (P < 0.001). The photophilia score was positively correlated and the photophobia score was negatively correlated with the light intensity preference (measured by means of a photometer) (P < 0.001). A significant positive correlation between the photophilia score and the percentage of time spent in bright and very bright areas was observed (P < 0.05). Scores were not related to age or gender. These results represent initial data in support of the validity and reliability of our questionnaire for distinguishing between patients with and without abnormal light-exposure behaviour patterns.

The deficit syndrome in first-admission patients with psychotic and non-psychotic disorders.

The authors study the frequency of primary enduring negative symptoms in first-admission patients with schizophrenic and non-schizophrenic disorders. Carpenter's criteria for distinguishing the primary, enduring negative symptoms from the more transient negative symptoms (secondary to different factors) were applied. Furthermore, they compare negative symptom complexes between first-admission patients and patients with recurrent hospitalizations (within 5 years after first admission). There was a trend for patients with recurrent admissions to show more frequently a deficit syndrome than first-admission patients. Nevertheless, this difference was not significant (chi(2) = 0.90). First-admission patients with deficit syndrome had significantly higher affective blunting (P < 0.05) and anhedonia (P < 0.001) than those with recurrent admissions. First-admission subjects with psychotic disorders had significantly higher frequency of deficit syndrome than those first-admission patients with non-psychotic disorders (P < 0.05). These results show that negative symptoms observed in first-admitted non-schizophrenic patients can also be enduring and primary. Thereby this work does not contribute to support the specificity of primary enduring negative symptoms for schizophrenia. Moreover, data suggest, that primary anhedonia and affective blunting can decrease within the first 5 years after discharge.

[Significance of primary negative symptoms in schizophrenic and other psychiatric patients]. / Uber die Bedeutung der primären Negativsymptomatik bei schizophrenen und anderen psychiatrischen Patienten.

We report on a short overview of our work which has examined different definitions of negative syndromes across a broad spectrum of diagnoses. Primary enduring negative symptoms were assessed with the Schedule for Deficit Syndrome (SDS) and with the Scale for Assessment of Negative Symptoms (SANS) in schizophrenic and non-schizophrenic patients. Results suggested that patients with psychotic disorders are in a high-risk group for deficit syndrome. A further study included (in the deficit group) only neuroleptic-free patients without current depression or psychosis. The frequency of primary enduring negative symptoms (PENS) showed no significant difference between schizophrenic and depressive patients. Study three compared primary negative symptoms between schizophrenic and nonschizophrenic patients. There were no significant differences between both groups with regard to the SANS scores. The last study compared primary with secondary negative symptom complexes by means of the SANS. No significant differences could be found. The results suggest that PENS are not specific for schizophrenia. Moreover, further efforts are indicated to grasp "core" deficiencies in psychoses with help of new operationalized instruments.

Primary enduring negative symptoms in schizophrenia and major depression.

Primary enduring negative symptoms (PENS) were studied in 26 patients with DSM-III-R schizophrenia and in 94 patients with unipolar major depressive episodes 5 years after the index episode. PENS were assessed with the Schedule for Deficit Syndrome (SDS). Negative symptoms were also assessed with the Scale for Assessment of Negative Symptoms (SANS) and subclassified into primary and secondary according to the SDS. The frequency of PENS did not differ significantly between schizophrenics and non-schizophrenic patients. Enduring negative symptoms (regardless of whether primary or not) were more frequently observed in schizophrenia (65% according to the SDS, and 88% according to the SANS) than in patients who had major depressive episodes (29% according to the SDS and 32% according to the SANS). By applying the SDS criteria for PENS, their frequency decreased in a manner which would probably affect the availability of patients samples for testing antinegative drugs. The results suggest that neither the negative symptomatology nor the primary enduring subtype ("deficit") is specific for schizophrenia. This finding might imply potential advantages of non-nosological, functional approaches for research into PENS.

The deficit syndrome in schizophrenic and nonschizophrenic patients: preliminary studies.

One hundred and eighty-seven patients suffering from DSM-III-R schizophrenia, schizoaffective, schizophreniform (psychotic group), unipolar, bipolar and other disorders were interviewed 5 years after discharge. Deficiencies were assessed by means of the Schedule for Deficit Syndrome (SDS) and the Scale for Assessment of Negative Symptoms (SANS). Binocular thresholds for discomfort to high luminances (TDHL) were assessed in 17 patients with a deficit syndrome. Results suggest that patients with psychotic disorders are in a high-risk group for deficit syndrome. Nevertheless, 9-28% and 9-30% of the 'nonpsychotic' group according to the SANS and the SDS, respectively, showed primary enduring negative symptoms. A positive correlation between the SANS total score and TDHL (r = 0.81) was found. These results suggest the nonspecificity of primary enduring negative syndromes. Furthermore preliminary data indicate a possible link between light sensitivity and the deficit syndrome, independently of diagnoses.

Negative symptoms and the course of positive symptoms in deficit schizophrenia.

Differences in the patterns of negative symptoms between two subgroups of inpatients with chronic schizophrenia and a deficit syndrome were examined: one subgroup presented episodic symptoms, while the other exhibited a continuous course of positive symptoms. Patients with a continuous course of positive symptoms showed significantly higher affective blunting and anhedonia according to the SANS, a lower BPRS activation score and a lower age of onset in males than episodic cases. These results suggest that in deficit schizophrenia different courses of positive symptoms are associated with different severity degrees and different patterns of negative symptoms.

Subtypes of negative symptoms: the primary subtype in schizophrenic and non-schizophrenic patients.

1. The specificity of negative symptoms remains an open question and requires further research. 2. Subtyping negative symptoms has been showed to be a very relevant point for the identification of primary negative symptoms and for their pharmacotherapy. Negative symptoms as a whole have been demonstrated in schizophrenic and non-schizophrenic patients, but these studies did not report about the primary and secondary subtypes. 3. The present study is the first one investigating primary negative symptoms in schizophrenic and non-schizophrenic patients. 84 consecutively admitted psychiatric patients have been studied 5 years after their discharge. 4. All negative symptoms (including the primary subtype) according to Carpenter (Kirkpatrick et al. 1989) and Andreasen (Andreasen 1981) could be identified in all diagnostic groups.

Increased concentrations of phosphatidylinositol (PI) and decreased esterification of arachidonic acid into phospholipids in platelets from patients with schizoaffective disorders or atypic phasic psychoses.

The concentration of various phospholipids (PLs) and sphingomyelin in platelets and the amount of [14C] arachidonic acid ([14C]-AA) esterified in phosphatidylinositol (PI), phosphatidylserine (PS), phosphatidylethanolamine (PE), and phosphatidylcholine (PC) were measured. The platelet-rich plasmas from unmedicated patients with psychiatric disorders and healthy controls were incubated for 30 min with 1 microM [14C]-AA. Platelets from patients with a schizoaffective disorder according to RDC criteria, a schizophreniform disorder (DSM III criteria) or an atypical phasic psychosis according to FC criteria contained twice as much PI and had significantly increased concentrations of PC as compared to controls (p less than 0.05, t-test). A highly significant (40-70%) reduced rate of esterification of [14C]-AA into PI/PS, PC and PE was found in platelets from patients with schizophreniform, schizoaffective and major depressive disorders but not in platelets from patients with chronic schizophrenia. The largest reduced esterification of [14C]-AA (about 70%) was found in PI/PS of platelets from patients with schizoaffective disorders (1.9 +/- 0.7 vs 6.3 +/- 1.7 mumol [14C]-AA/mol PI/PS; p less than 10(-4), t-test). The results indicate that changes in the metabolism of arachidonic acid and phosphatidylinositol and, to a lesser degree, of phosphatidylcholine in platelets are characteristic of patients with a likely favorable outcome of a psychotic episode.

Light exposure patterns in schizophrenia.

Spontaneous light exposure patterns were studied in 10 chronic schizophrenic patients. Half of our schizophrenic patients exposed themselves to bright light exceeding ordinary indoor illumination. There was a significant positive correlation between the percentage of exposure to bright light and the Brief Psychiatric Rating Scale subscore anergia and a significant negative correlation with depression.

Abnormal electroretinography in schizophrenic patients with a history of sun gazing.

Electroretinographic (ERG) measurements were performed in 9 schizophrenic patients and in 13 control subjects. The measurements of schizophrenic patients as a group did not differ from those of normals. However, 6 schizophrenic patients who had a past history of sun gazing showed a decrease in retinal responsiveness under conditions of light adaptation. These results suggest that a subgroup of schizophrenic patients, who show deviant light-related behavior, have abnormal ERG. We postulate that an abnormality in retinal dopaminergic neurons, which are known to reduce light responsiveness of horizontal and ganglion cells, is the underlying pathophysiology of this clinical finding.

Photophilic and photophobic behaviour in patients with schizophrenia and depression.

The authors interviewed 32 patients (25 with an RDC diagnosis of schizophrenia and seven with schizoaffective disorder) consecutively admitted to a psychiatric outpatient clinic. Ten patients had a history of photophilic behaviour with sun-gazing, while 20 patients showed no unusual behaviour related to light. Two patients who had depressive symptoms at the time of interview had a history of photophobic behaviour. Sixteen patients and 12 controls were tested for their threshold for discomfort of high intensity light; the thresholds were significantly higher in the patients with schizophrenia (especially in those with history of sun gazing). The implications of these findings for clinical practice and research are discussed.

Self-reports in chronic schizophrenic patients with primary negative symptoms: preliminary results.

The Frankfurt well-being scale (FBS), an instrument for evaluating the global inner state in schizophrenic patients, was used in a pilot study with 26 chronic schizophrenic inpatients simultaneously with the Munich version of the Andreasen scale (SANS). 11 of 26 patients were able to complete the FBS questions. These patients had weaker negative symptomatology (SANS total score) and the difference was highly significant (p less than 0.01) for the score "alogia". The major goal of the investigation was to contribute to the identification of those subgroups of schizophrenic patients who are not capable of filling in a self-report questionnaire. The results suggest that self-reports of actual mood in chronic schizophrenic patients are possible only in a subgroup of patients with no more than moderate primary negative symptoms, particularly those with a low alogia score. Further efforts to evaluate the subjective well-being of chronic patients differing in severity of negative symptoms complexes, could improve methods for evaluating the effect of psychotropic drugs.

[Process and phasic psychoses according to ICD-9 classification]. / Psicosis procesuales y fásicas según la clasificación ICD-9.

101 in-patients were diagnosed according to the ICD-9 and the Frankfurt (FC) classifications. The latter classification used the glossary of the AMDP system, and the Andreasen scale (SANS). 94% of the FC process psychoses were diagnosed as schizophrenia according to ICD-9 and 78% of the atypical phasic psychoses (FC) as schizoaffective schizophrenia (ICD-9). On the other hand, only 55% of the ICD-9 schozophrenias could be classified as a FC process psychosis. The results confirm the assumption that the ICD-9 classification is not helpful in distinguishing phasic from non-phasic psychoses. Advantages of a classification based on phasic or non-phasic course are mentioned. Finally it is emphasized that the operationalization of concepts (either classic or new), the polydiagnostic, and the use of international glossaries (like the AMDP system) are an unavoidable step for the development and extension of the psychiatric research in Latin America.

Phasic and process psychoses: a polydiagnostic comparison among the Frankfurt Classification System, DSM III, RDC, Feighner criteria and ICD-9.

The classification of endogenous psychoses is a controversial sector of psychiatry. Differences with regard to the evaluation of course and outcome contribute to this controversy. The course and outcome of a psychiatric illness are basic to the Frankfurt Classification System (FC) of endogenous psychoses. The main groups are process and phasic psychoses (typical and atypical). A third group, encompassing cases which could not be definitely classified at the time of examination, is entitled 'nonclassified endogenous psychoses'. This system was outlined according to the AMDP system and SANS using the cases of 100 patients admitted to the hospital (aged 18-86 years; 57 men, 43 women) and compared with four classifications (ICD-9, RDC, DSM III and Feighner). The listed definitions do not state whether or not a defective symptomatology is absolutely irreversible. Most of the atypic-phasic psychoses of the FC (50-78%) were schizoaffective psychoses according to the other classifications (Feighner, RDC, ICD-9) and most of the process psychoses (85-97%) were schizophrenias according to Feighner, ICD-9, RDC and DSM III. The major reason for the great correspondence (97%) between process psychoses (FC) and DSM III schizophrenias appears to be that 85% of the sample consisted of chronic and not subchronic schizophrenic disorders according to DSM III. On the other hand, about 45% of the ICD-9 and RDC schizophrenias (principally acute and subacute) were not diagnosed as process psychoses according to the FC. In the case of the typic-phasic psychoses, there was almost complete agreement with the other diagnostic systems. Most of the cases in which classification into the group 'process' or 'phasic psychosis' was unclear were diagnosed as schizophreniform disorders according to DSM III (70%) or into nearly equivalent groups according to RDC or ICD-9. Nonetheless, complete equivalency among these similar groups was not possible. In the context of some research aims (e.g. definitions of phenomenological or biological parameters), a classification system based on clearly-defined inclusion and exclusion criteria of such concepts as phasic and process psychoses (in shifts or insidious) is methodologically useful. The FC is suggested as a step in this direction.

Psicosis procesuales y fásicas según la clasificación ICD-9. / [Process and phasic psychoses according to ICD-9 classification]

101 in-patients were diagnosed according to the ICD-9 and the Frankfurt (FC) classifications. The latter classification used the glossary of the AMDP system, and the Andreasen scale (SANS). 94

of the FC process psychoses were diagnosed as schizophrenia according to ICD-9 and 78

of the atypical phasic psychoses (FC) as schizoaffective schizophrenia (ICD-9). On the other hand, only 55

of the ICD-9 schozophrenias could be classified as a FC process psychosis. The results confirm the assumption that the ICD-9 classification is not helpful in distinguishing phasic from non-phasic psychoses. Advantages of a classification based on phasic or non-phasic course are mentioned. Finally it is emphasized that the operationalization of concepts (either classic or new), the polydiagnostic, and the use of international glossaries (like the AMDP system) are an unavoidable step for the development and extension of the psychiatric research in Latin America.

[Photomaniac behavior and schizophrenia]. / Conducta fotomaníaca y esquizofrenia.

Two patients with a chronic residual schizophrenic disorder, according to DSM-III-R, showed a marked resistance to intensive light, manifested through a lack of intolerance and pain when looking at the Sun directly. Light suppresses melatonin secretion in humans, and the melatonin rhythm reflects the subject's light/darkness exposition. A photomaniac character of such a behavior (or phenomena that could favor it) recalls its opposite--the photophobic behavior as described in some cases of depression, and could cause a different profile of exposition to the light. Knowing about such phenomena--such though they lack every explanation for the time being--could be useful--from a methodology point of view, as well as heuristically valuable--during the study of photosensitive neuroendocrine processes in patients who evidence such phenomena.