Inter-rater reliability of the Greek version of CAARMS among two groups of mental health professionals.

There is increasing interest within the Greek psychiatric community in the early detection and prevention of psychotic disorders. To support this, there is a need for a valid and reliable tool to identify young people that may be at risk of developing a psychotic disorder. Our team has previously translated the Comprehensive Assessment of At-Risk Mental States (CAARMS). The validity of the CAARMS was ensured by the procedure of translation and the aim of the current study was to estimate the interrater reliability of the CAARMS Greek translation among residents in psychiatry and specialized mental health professionals. 43 mental health workers (27 residents in psychiatry and 16 specialized mental health professionals (i.e. 11 psychiatrists and 5 psychologist) participated in two seminars that covered theoretical information about the ultra high risk concept and training in the CAARMS. During the seminars, 10 vignettes with psychiatric history cases were presented, including healthy, ultra high risk and first episode psychosis. The mean correlated percentage of agreement with the correct answers regarding diagnosis of the presented history cases among all our subjects was 81.42, among specialized mental health professionals 77.88, and among residents 84.46. Intraclass correlation co-efficients were 0.994 for specialized mental health professionals and 0.997 for residents. The translated Greek version of CAARMS presents a satisfying interrater reliability when used by both residents and specialized mental health professionals. Residents declare even higher intraclass correlation co-efficients and mean correlated percentage of agreement than specialized mental health professionals, which indicate that residents are capable of using the CAARMS in early intervention units.

[Attempted suicide during the financial crisis in Athens].

Suicidal behavior is considered as the result of complex cognitive and emotional processes and it is a timeless, global and multifactorial phenomenon. Periods of financial crises in the past, such as the Great Depression in the USA in 1929 and the economic crises of Asia, Russia and Argentina in the late 1990s, have been associated with impairment of mental health of the economically affected. Unemployment, job insecurity, debts, poverty and social exclusion seems to lead to higher incidence of anxiety and depressive symptoms and increased suicidality. Alcohol and substance use and the reduction of the state budget for health services reinforce the negative effects of the economic recession on mental health. The financial crisis which currently affects many European countries began in 2008 and its impact on the mental health of European citizens is in progress. Greece is probably the most affected country by the European financial crisis. The aim of this study is to investigate the potential impact of the crisis' consequences on the attempted suicide rates in the Athens population and the differentiation of suicide attempters on social, demographic and clinical-psychopathological parameters during the crisis. A retrospective study was conducted. The semi-structured records of 165 attempters who were hospitalized in the Internal Medicine Clinics of the "Sotiria" General Hospital in Athens, after attempted suicide in the years 2007 and 2011, before and during the financial crisis respectively, were studied. Among suicide attempters 95(57.6%) were suffering from mental disorders. Most often diagnoses were these of mood disorders (n=60, 63.2%). Demographic data, current psychiatric disorder, previous suicide attempt and severity of psychopathology at the time of suicide attempt were recorded for each patient. Furthermore, the severity of each suicide attempt was estimated. Suicide attempts were 70 in 2007, before the financial crisis (mean age 36.9 years, 71% women) and 95 in 2011, during the financial crisis (mean age 41.0 years, women 65%). There is an increase of suicide attempts by 35.71%. There were no statistically significant differences between the two periods regarding the gender and age of attempters. There was a statistically significant increase of unemployed (p=0.004), as well as of married/widowed/divorced (p=0.02) suicide attempters during the crisis. There was not statistically significant difference in the severity of suicide attempts before and during the economic crisis or the severity of psychopathology of the attempters. The financial crisis is probably associated with upward trend in attempted suicide of the Athens population. Most affected are those who are unemployed, married, widowed, divorced. Suicide prevention programs are essential for the accurate and timely identification and the immediate and effective management of this special high risk group of attempters during the financial crisis.

Suicide in Greece: 2001-2011.

Since 2008 several European countries have fallen into a financial crisis. This crisis has mainly affected the Greek population. The lower of income and the increase of unemployment as consequences of crisis lead to negative effects on people's mental health. Usually, in periods of economic crisis there is an increase of suicidality of population. The aim of this study is to examine the changes of suicide rates in Greece during the last decade (2001-2011) with particular consideration in the recent period of economic crisis (2008-2011). Data regarding the greek general population and the crude data on suicides were obtained from the Hellenic Statistical Authority (ELSTAT). We assessed the specific suicide rate, i.e. the number of suicide cases per 100.000 inhabitants (SSR) using population data on the 2001 and 2011 census. Yearly and mean total, age and sex-SSR were calculated in five years age groups. There were no suicide cases among children under the age of fifteen. We compared total and male, female SSR during the period before the crisis (2001-2007) and during the crisis (2008-2011). During the decade 2001-2011 a total number of 4133 suicide cases were recorded. There were 3423 (82.8%) male suicides and 710 (17.2%) female suicides. During the decade 2001-2011 total SSR increased by 38.4%. In males increased by 33.1% and in females by 69.6%. In the period before the crisis (2001-2007) total SSR decreased by 3.9%. In males decreased by 8.4% but in females increased by 22.3%. During the period of crisis (2008-2011) total SSR increased by 27.2%. In males increased by 26.9% and in females by 28.5%. There was a statistically significant increase in total SSR during the crisis regarding subjects 50-54 years old (t=3.43, p=0.007) and in total SSR of males (t=2.31, p=0.047) as well as of the males age groups 50-54 (t=3.56, p=0.006), 45-49 (t=2.87, p=0.02), 30-34 (t=2.96, p=0.02). There were no statistically significant differences both in total SSR and in SSR of all age groups of females during the crisis. The most often used method of suicide all the year of this study was by hanging. In absolute count the total suicide cases for the year 2011 in Greece were 477 (SSR=4.22) and the male suicides 393 (SSR=7.02) which are the highest number of suicides observed in Greece during the last decades. Findings suggest an increase in suicide mortality in Greece during the financial crisis. Reorientation of the goals of the national mental health system as well as targeted interventions should be applied in high risk individuals, i.e. unemployed, poor, suffering from mental or/and physical illnesses, in order to prevent or to mitigate the impact of the financial crisis in the greek population.

A study of acculturation in psychotic and non-psychotic immigrants living in Athens.

BACKGROUND: Acculturation is the phenomenon that results when a group with one culture comes into continuous contact with a host culture. AIMS: To investigate the correlation between acculturation and psychotic symptomatology in a group of immigrants suffering from psychosis and to explore differences in demographic factors related with the acculturation process between individuals with and without psychosis. METHODS: Sixty-five patients and 317 non-psychotic immigrants were interviewed using the Immigrant Acculturation Scale (IAS) and a structured questionnaire for demographic data. The Positive and Negative Syndrome Scale (PANSS), the Calgary Depression Scale for Schizophrenia (CDSS) and the Global Assessment of Functioning (GAF) were also administered to all immigrants suffering from psychosis. RESULTS: Total IAS scores, as well as IAS everyday life scores, were positively correlated with GAF scores. IAS everyday life score in the patient group related with religion, marital status, gender and years in Greece, while in the non-psychosis group it was related with gender and years in Greece. IAS wishful orientation/nostos (the strong desire for one's homeland) related with religion in both groups. The IAS identity in the psychosis group did not show any significant relation with any of the variables, while in the non-patient group, it was related with marital status, gender and years in Greece. Age, duration of residence in Greece and higher adoption of Greek ethnic identity were the variables that differentiated the two groups of immigrants. CONCLUSION: Acculturation in immigrants suffering from psychosis could be seen as a process that does not correlate strongly with the severity of the symptomatology but is probably influenced by different set of factors.

Alexithymia, depression and serum lipids in suicide attempters.

Over the last decade several studies have discussed the association between serum cholesterol, depressive disorders and suicide. A specific psychological variable related to affect is alexithymia. Alexithymia has been linked to depression and suicidal behaviour. Concerning lipid levels there are several studies that suggest changes in serum lipid composition maybe related to depression and suicidal behaviour. In this study we examined the possible relationship between alexithymia, depression and serum lipids in suicide attempters. We studied 50 non-violent suicide attempters (drug overdosers) with a mean age of 35.0 (±12.2) years. Alexithymia was measured using the Shalling-Sifneos Personality Scale Revised (SSPS-R) and depression using the Montgomery-Asberg Depression Rating Scale (MADRS). Serum lipids concentrations were determined by enzymatic method within 24h of hospital admission. For the statistical evaluation Spearman's rank correlation coefficients were used. The mean serum lipid levels were: total serum cholesterol (TC) 175.2 (±29.6) mg/dL, highdensity lipoprotein cholesterol (H-DLC) 47.08 (±13.1) mg/dL, low density lipoprotein cholesterol (L-DLC) 109.5 (±23.5) mg/dL and the mean serum triglycerides (TR) level was 89.4 (±39.1) mg/dL. The mean scores on the questionnaires were: SSPS-R 10.3 (±3.7), MADRS 33.5 (±5.9). There were significant correlations between: (a) SSPS-R score and MADRS score (r=0.439, p<0.001), (b) SSPS-R score and TR level (r=0.323, p<0.05). There were no significant correlations between MADRS score and any of the lipid fractions measured. To our knowledge, only few studies have examined the association between alexithymia and clinical-psychopathological parameters in suicide attempters. There are no previous studies comparing serum lipid profile with alexithymia in suicide attempters. This is the first study to compare at the same time serum lipids, alexithymia and depression in suicide attempters. The results suggest that although there was a strong relationship between alexithymia and depression in suicide attempters only alexithymia was correlated to Serum triglyceride levels.

Glandular cystitis and lithium intoxication in a patient with bipolar disorder.

A 42-year-old woman, with a 12-year history of bipolar disorder was referred to our department due to tremor, sedation, dysarthria, polyuria and polydipsia. She had been on lithium monotherapy during the last 3 years. On admission, her cognitive status was intact, and neither depression nor euphoria was reported. Lithium plasma levels were 1.6 mEq/L, whereas creatinine and urea levels were 2.8 IU/L and 110 IU/L, respectively. The patient did not take other medications or misused lithium. Lithium was immediately discontinued. Ultrasound scans of the urinary tract were suggestive of bilateral hydronephrosis secondary to bladder contraction and cystoscopy-guided bladder biopsy revealed glandular cystitis a benign tumour into the bladder's wall, which impeded the bladder's contraction leading to hydronephrosis and subsequent toxic lithium plasma levels. The patient was switched to valproate and was referred for surgical excision of the lesion. One year later, she was in good physical and mental health under treatment with valproate (1000 mg/day). This is the first case report of glandular cystitis leading to lithium intoxication by impairing renal function. Acute renal failure leading to lithium intoxication would be possible. However, a thorough imaging, endoscopical and histological study revealed glandular cystitis as the cause of renal impairment. Although physicians are alert about lithium's toxicity and a monitoring of renal function is routinely prescribed, little focus has been made on the integrity of the urinary tract. We suggest that urinary tract imaging should be part of the routine work-up in patients presenting with symptoms and signs of lithium intoxication, since concomitant urinary tract lesions might occasionally be the cause of renal impairment leading to reduced lithium excretion.

Fatigue in female patients with major depression: the effect of comorbid anxiety disorders.

Several studies have investigated fatigue in the general population, in primary care facilities as well as in patients with fatigue-related physical diseases, but only marginally in patients with Major Depressive Disorder (MDD). Therefore, the investigation of correlates of depression-related fatigue is highly warranted and expected to facilitate the implementation of effective fatigue-specific treatment strategies. Depressed patients often suffer from comorbid anxiety disorders (CADs) or subthreshold anxiety symptoms. This study aimed to investigate the independent correlation of the severity of fatigue in female patients with MDD with the presence, number and type of CADs. We studied 70 consecutive female MDD patients (48.6% inpatients), aged 23-65 years (mean 48.2±10.6 years), currently in a Major Depressive Episode [17-item Hamilton Depression Rating Scale (HDRS) score≥17] and free of other fatigue-associated conditions. Diagnostic assessments were made with the short structured DSM-IV-based MINI version 5.0.0. Reported fatigue was assessed with the 14-item Chalder Fatigue Questionnaire (FQ). Correlations between the FQ score and age, inpatient status, HDRS score, presence and number of CADs were calculated. Then, stepwise multiple regression analyses were performed, with the FQ score as the dependent variable,so as to isolate independent predictors of the severity of fatigue. 92.9% of patients had clinically significant fatigue. 62.9% were suffering from at least one CAD (38.6% met criteria for one CAD,21.4% for two and 2.9% for three). 51.4% were diagnosed with generalized anxiety disorder (GAD),25.7% with panic disorder and/or agoraphobia (PD/AP), 17.1% with social anxiety disorder and 7.1%with obsessive-compulsive disorder. The FQ score was significantly correlated with the HDRS score(r=0.406, p<0.001), the presence of any CAD(s) (rho=0.4, p=0.001), the number of CADs (rho=0.393,p=0.001), the presence of GAD (rho=0.421, p<0.001) and the presence of PD/AP (rho=0.252, p=0.035).In multiple regression analyses, the presence and number of CADs and the presence of comorbid GAD turned out as significant independent predictors of the FQ score along with the HDRS score.The severity of fatigue in female MDD patients is independently correlated with the presence and number of CADs and, in specific, comorbid GAD. Our findings imply that: (1) this effect might in part account for greater impairment/disability and adverse prognosis for MDD with CADs; (2) high levels of fatigue, putatively clustering with anxiety symptoms, may be a marker of severity and anxiety disorders comorbidity for MDD and may define an "anxious-fatigued" subtype/phenotype in this population; (3) medications and psychotherapies for the management of severe depression-related fatigue should also target CADs.

Seasonality, suicidality and melatonin.

Seasonality of suicidal behavior has been investigated regarding both neurobiological and climatic factors, as well as psychopathological and social aspects. Most of the studies detectedpeaks in late spring and troughs in the winter. Several lines of evidence evaluated the role of extended periods of light associated with probability of suicides whereas others summarize the alterations of melatonin excretion and its seasonal variation along with seasonaldistribution of psychiatric disorders. The purpose of this paper is to provide an overview of studies attempted to reach an explanatory model of underlying pathophysiology of melatonin in thepathogenesis of seasonal variation in suicidality. There is argument on the interconnection between suicide rates and weather factors. However, an inverse pattern of melatonin levels and the seasonalpeak in suicides was observed. These findings suggest that sunlight exposure along with a wide spectrum of other factors may explain the aetiopathogenesis of suicidal behavior.

Attitudes on euthanasia and physician-assisted suicide among medical students in Athens.

Attitudes towards assisted death activities among medical students, the future health gatekeepers, are scarce and controversial. The aims of this study were to explore attitudes on euthanasia and physician-assisted suicide among final year medical students in Athens, to investigate potential differences in attitudes between male and female medical students and to review worldwide attitudes of medical students regarding assisted death activities. A 20- item questionnaire was used. The total number of participants was 251 (mean age 24.7±1.8 years). 52.0% and 69.7% of the respondents were for the acceptance of euthanasia and physician-assisted suicide, respectively. Women's attitudes were more often influenced by religious convictions as well as by the fact that there is a risk that physician-assisted suicide might be misused with certain disadvantaged groups. On the other hand, men more often believed that a request for physician-assisted suicide from a terminally ill patient is prima-facie evidence of a mental disorder, usually depression. Concerning attitudes towards euthanasia among medical students in various countries there are contradictory results. In USA, the Netherlands, Hungary and Switzerland most of the students supported euthanasia and physician-assisted suicide. However, in many other countries such as Norway, Sweden, Yugoslavia, Italy, Germany, Sudan, Malaysia and Puerto Rico most students expressed negative positions regarding euthanasia and physician assisted suicide.

Fatigue and somatic anxiety in patients with major depression.

The objective this study aimed to investigate the independent contribution of somatic anxiety to the severity of depression-related fatigue. Seventy-six patients (85.5% female), aged 23-65 years (mean 48.7±10.6), diagnosed with major depressive disorder and currently in a major depressive episode (ΜΙΝΙ 5.0.0.) with a 17-item Hamilton Depression Rating Scale (HDRS) score ≥17, were studied. Forty-nine patients (64.5%) were concurrently suf fering from anxiety disorder(s). Patients with physical diseases or other fatigue-related conditions were excluded. Reported fatigue was measured with the 14-item Fatigue Questionnaire (FQ). Based on HDRS item 11 (somatic anxiety) scores, patients were divided into those with somatic anxiety (HDRS-11≥2) and those without (HDRS-11≤1). Pearson's (r) and Spearman's (rho) correlations between FQ score, age, gender, inpatient status, HDRS score and somatic anxiety status were calculated. A multiple regression analysis was then performed, with FQ as the dependent variable. Fifty-seven patients (75%) were rated as suffering from somatic anxiety (HDRS-11≥2). Patients with somatic anxiety had significantly higher HDRS and FQ scores. The FQ score significantly correlated with the HDRS score (r=0.36, p=0.001) and somatic anxiety status (rho=0.35, p=0.002). The FQ score was independently predicted by HDRS score and somatic anxiety status, with standardised beta coefficients of 0.259 (p=0.028) and 0.255 (p=0.031), respectively. R2 was 0.185. Both the severity of depression and the presence of somatic anxiety independently correlate with the severity of reported fatigue in patients with major depression. This finding has potential implications for the management of depression-related fatigue.

Clinical symptoms and social functioning among immigrant and greek patients with schizophrenia: A comparative study.

Migration is considered an important risk factor for schizophrenia. However, studies on the differences in psychotic symptomatology between immigrants and native patients revealed mixed results. This study compared clinical symptoms and social functioning between immigrant and native patients with schizophrenia in Greece in order to examine the influence of social factors on the disorder's manifestation and severity. A structured questionnaire including demographic and clinical information was administered to two groups of patients with schizophrenia; the first one was comprised of 65 immigrant patients (38 men and 27 women) and the second included 58 greek patients (35 men and 23 women). Patients' psychopathology was evaluated by the Positive and Negative Syndrome Scale (PANSS), the Calgary Depression Scale for Schizophrenia (CDSS) and the Global Assessment of Functioning Scale (GAF). The x2 test and the ANOVA were used for the comparisons of categorical and continuous variables respectively between the two groups of patients. Analysis of eigenvalues and multivariate analysis (MANOVA) were also used. Age and duration of illness were significant greater in the greek group of patients. Lack of insight was the only reason of hospitalization of immigrant patients. The immigrant group of patients had significantly lower scores in the negative syndrome subscale, the general psychopathology subscale and the total PANSS scale while they had significantly higher scores in the GAF scale. No between patients' groups difference was found on CDSS scores. Analysis of eigenvalues and MANOVA revealed that the national group (immigrants vs native) and the reason of admission were the only general variables with significant influence on patients' psychopathological features and functioning. Consistently with previous studies that have shown better prognosis in immigrant compared to the native patients with schizophrenia, immigrant patients in our study had milder negative and total psychotic symptomatology and were less impaired in terms of global functioning than the greek group. Being an immigrant appears to be an important factor related to these differences between our study groups. A possible explanation of our findings could be that immigrant patients with schizophrenia attending to greek mental health services have been 'filtered'because of a 'salmon bias' type phenomenon; the severe ill usually return to their country of birth due to the lack of financial and social support for immigrant patients in Greece. An alternative hypothesis is that the families and the local communities of immigrant patients with schizophrenia, being tied enough, provide support to their ill members that results in better outcome, especially with respect to negative syndrome and social functioning.

Drug-induced tardive motor syndromes.

Drug-induced tardive motor syndromes (TMS) is a group of disorders, characterized by involuntary movements of the tongue, face, lips, trunk and extremities, occurring after long-term exposure to a variety of pharmacological agents, mostly neuroleptics. The diagnosis of TMS requires exposure to dopamine receptor blocking agents for a period at least of 3 months, although for people over 60 years old the necessary exposure period is limited to 1 month. The exact pathophysiology still remains obscure. The aim of this article is to review the phenomenology, epidemiology and treatment options of the TMS, as clinically distinct movement disorders. TMS include tardive dyskinesia, which is the most common movement disorder, tardive dystonia, tardive akathisia, tardive Tourettism, tardive tremor and tardive myoclonus as well as some specific syndromes less often presented such as Pisa, Meige and Rabbit syndromes. Prevention remains the cornerstone in good clinical practice. Preventive approach requires thorough diagnostic process with frequent reviews in order to determine the necessity of use and dosing of neuroleptic treatment. Clinical vigilance for early detection of signs of TMS as well as recording of early extrapyramidal side-effects in the patient's history is needed, as these may predict the occurrence of TMS. In case of occurrence of TMS, gradual discontinuation of the offending agent is required. Therapeutic interventions include the administration of the following agents: atypical antipsychotics (mainly clozapine), benzodiazepines, vitamin E, reserpine, tetrabenazine, anticholinergics, botulinum toxin A. The early management of TMS is crucial for the patients' better clinical outcome and improved quality of life.

Switching to amisulpride monotherapy for treatment-resistant schizophrenia.

The objective of this study was to assess switching to amisulpride (AMS) in treatment-resistant schizophrenia. Seven male subjects were switched to AMS and followed for 8 weeks. PANSS scores improved from 123 to 66 over this period. We conclude that AMS is of interest in the treatment of refractory schizophrenia.

Impaired P600 in neuroleptic naive patients with first-episode schizophrenia.

Deficits of working memory (WM) are recognized as an important pathological feature in schizophrenia. Since the P600 component of event related potentials has been hypothesized that represents aspects of second-pass parsing processes of information processing, and is related to WM, the present study focuses on P600 elicited during a WM test in drug-naive first-episode schizophrenics (FES) compared to healthy controls. We examined 16 drug-naive first-episode schizophrenic patients and 23 healthy controls matched for age and sex. Compared with controls schizophrenic patients showed reduced P600 amplitude on left temporoparietal region and increased P600 amplitude on left occipital region. With regard to the latency, the patients exhibited significantly prolongation on right temporoparietal region. The obtained pattern of differences classified correctly 89.20% of patients. Memory performance of patients was also significantly impaired relative to controls. Our results suggest that second-pass parsing process of information processing, as indexed by P600, elicited during a WM test, is impaired in FES. Moreover, these findings lend support to the view that the auditory WM in schizophrenia involves or affects a circuitry including temporoparietal and occipital brain areas.

Prevalence and characteristics of patients with pseudoakathisia.

Pseudoakathisia (PsA) is characterised by the typical motor features of akathisia but there is a lack of subjective awareness. A total of 153 in-patients on neuroleptic medication hospitalized in two representative wards of the Psychiatric Hospital of Attica in Athens were rated on the census date using the Rating Scale for Drug-Induced Akathisia [Barnes, Br. J. Psychiatry, 154 (1989) 672-676], the Rating Scale for Extrapyramidal Side-Effects [Simpson and Angus, Acta Psychiatr. Scand. 212 (Suppl.) (1970) 11-19] and the Abnormal Involuntary Movements Scale [US Department of Health, Education and Welfare, ECDEU Assessment Manual (1976) pp. 534-537]. Eight subjects of the total in-patient population were found to have PsA of chronic type (point prevalence 5.23%). The point-prevalence of PsA among schizophrenic patients was 4.76%. In addition to the diagnosis of chronic pseudoakathisia, five patients (62.5%) had a concurrent diagnosis of chronic parkinsonism. Among patients with PsA, significant correlations were found between parkinsonism score and current daily dose of neuroleptics or high potency neuroleptics. There is evidence of a relationship between chronic pseudoakathisia, chronic parkinsonism and daily dose of neuroleptic.

Comparison of four scales measuring depression in schizophrenic inpatients.

Several scales have been used to diagnose and evaluate depression in schizophrenia. However, the association between different depression scales and between depression scales and negative symptoms has not been studied adequately. Sixty-four consecutively admitted schizophrenic patients to Eginition Hospital, Department of Psychiatry, Athens, were assessed on the following scales: the Calgary Depression Scale for Schizophrenia (CDSS), the Hamilton Depression Rating Scale (HDRS), the Expanded Brief Psychiatric Rating Scale-Depression subscale (EBPRS-D), the Positive and Negative Syndrome Scale-Depression subscale (PANSS-D) and the Negative Symptoms subscale (PANSS-N). The depression scales were found to be highly intercorrelated with the exception of the comparison between the EBPRS-D and the PANSS-D. Out of the four depression scales studied, only CDSS and EBPRS-D can discriminate between depression and a PANSS-Negative Symptoms subscale score or negative item scores.

The Greek version of the calgary depression scale for schizophrenia.

The aim of this study was to evaluate the reliability and validity, as well as the specificity, of the Greek version of the Calgary Depression Scale for Schizophrenia (CDSS). Schizophrenic inpatients consecutively admitted at the Eginition Hospital, University of Athens, were included in the study. Patients were assessed on admission using the CDSS, the Hamilton Depression Rating Scale (HDRS), the Positive and Negative Syndrome Scale (PANSS), the Rating Scale for Extrapyramidal Side Effects (RSESE), the Rating Scale for Drug-Induced Akathisia (RSDIA) and the Abnormal Involuntary Movement Scale (AIMS). The CDSS was found to have a high inter-rater reliability, as well as test-retest reliability or split-half reliability. The internal consistency of the CDSS was good (a=0.87). There were positive correlations between the CDSS and the HDRS, or the depression cluster of the PANSS. The mean score on the CDSS showed no significant correlations with that of the PANSS negative subscale (r=0.123); a negative but not significant correlation with that of the PANSS positive subscale (r=-0.036); a weak correlation with that of the PANSS general psychopathology subscale (r=0.218); and no significant correlations with that of the RSESE (r=0.197), the RSDIA (r=0.160) or the AIMS (r=0.031). Our results give further support to the reliability, the validity, and the specificity of the CDSS.