A placebo-controlled pilot study of the ampakine CX516 added to clozapine in schizophrenia.

CX516, a positive modulator of the glutamatergic alpha-amino-3-hydroxy-5-methylisoxazole-4-propionic acid receptor, improves performance in tasks requiring learning and memory in animals. CX516 was added to clozapine in 4-week, placebo-controlled, dose-finding (N = 6) and fixed-dose (N = 13) trials. CX516 was tolerated well and was associated with moderate to large, between-group effect sizes compared with placebo, representing improvement in measures of attention and memory. These preliminary results suggest that CX516 and other "ampakines" hold promise for the treatment of schizophrenia.

Development of a brief screening instrument: the HANDS.

BACKGROUND: The present study was designed to develop a briefer screening scale of approximately 10 items which maintained the validity of the Zung Self-Rating Depression Scale in a sample similar to that attending National Depression Screening Day (NDSD), as well as a more general audience. METHODS: We first administered 70 items from a variety of existing rating scales to 40 subjects who answered an ad for depressed subjects and 55 who answered an ad for non-depressed subjects, all of whose diagnoses were confirmed by the Structured Clinical Interview for DSM-IV (SCID). Based on the correlation between each item and the diagnostic criterion, we reduced the number of items to 17 which we then administered to another 45 subjects who answered an ad similar to that used for NDSD and also underwent a SCID interview. Based on these results, we arrived at the final 10-item Harvard Department of Psychiatry/NDSD scale (HANDS) with the assistance of the item-response theory. The items are scored for frequency of occurrence of each symptom over the past 2 weeks. Total scores range from 0 to 30. RESULTS: The 10-item scale (HANDS) has good internal consistency and validity: a cutpoint score of 9 or greater gave sensitivity of at least 95% in both studies. Although specificity was lower for all scales in the self-selected population, the HANDS performed at least as well as the 20-item Zung Scale, the 21-item Beck Depression Inventory-II and the 15-item Hopkins Symptom Depression Checklist. CONCLUSION: The 10-item HANDS performs as well as other widely used longer self-report scales and has the advantage of briefer administration time.

Development and initial validation of a brief mental health outcome measure.

Using a combination of classical test theory and Rasch item analysis, we developed a short scale designed to measure the effectiveness of mental health treatment across a wide range of mental health services and populations. Item development for the scale was guided by literature review and interviews with senior clinicians and with patients. Using 3 different samples consisting of inpatients, outpatients, and nonpatients, we reduced our initial item pool from 81 to 10 items. The 10-item scale had an alpha of .96 and showed strong correlations with commonly used measures of psychological well-being and distress. Our results suggest that the scale appears to measure a broad domain of psychological health. The scale appeared to lack ceiling and floor effects, and it discriminated between inpatients, outpatients, and nonpatients, suggesting the scale has excellent potential to be broadly responsive to a variety of treatment effects. In addition, the new scale proved to be sensitive to treatment changes in a sample of 20 psychiatric inpatients. Overall, the initial data suggest that we have developed a brief, sensitive outcome measure designed to have wide application across psychiatric and psychological treatments and populations.

Use of videophones and low-cost standard telephone lines to provide a social presence in telepsychiatry.

Research findings suggest that the value added by the video channel of currently available video conferencing technology is limited to the creation of a social presence of the other party. Almost all clinical information exchange takes place on the audio channel, while the interpersonal interactions (nods, blinks, facial expressions, and body language), which are so important in a face-to-face meeting, may not be adequately captured by the video. Several of our case studies are presented which suggest that, consistent with the social presence role for video, low-cost videophones may be effectively substituted for expensive ISDN-based systems in many mental health applications.

Applicability of telemedicine for assessing patients with schizophrenia: acceptance and reliability.

BACKGROUND: Telemedicine holds promise for providing expert psychiatric consultation to underserved populations, but has not been quantitatively studied in schizophrenia or any other major mental disorder. This study was conducted to assess the reliability and acceptance of video-conferencing equipment in the assessment of patients with schizophrenia. METHOD: We assessed reliability of the Brief Psychiatric Rating Scale (BPRS), Scale for the Assessment of Positive Symptoms (SAPS), and Scale for the Assessment of Negative Symptoms (SANS) under three conditions: (1) in person, (2) by videoconferencing at low (128 kilobits per second [kbs]) bandwidth, (3) by videoconferencing at high (384 kbs) bandwidth. All 45 patients met DSM-IV criteria for schizophrenia. All patients and the two interviewers rated various aspects of the study interviews against previous live psychiatric interviews. RESULTS: Total scores on both the BPRS and SAPS were assessed equally reliably by the three media. Total score on the SANS was less reliably assessed at the low bandwidth, as were several specific negative symptoms of schizophrenia that depend heavily on nonverbal cues. Video interviews were well accepted by patients in both groups, although patients in the high bandwidth group were more likely to prefer the video interview to a live interview. CONCLUSION: Global severity of schizophrenia and overall severity of positive symptoms were reliably assessed by videoconferencing technology. Higher bandwidth resulted in more reliable assessment of negative symptoms and was preferred over low bandwidth, although patients' and raters' acceptance of video was good in both conditions. Videoconsultation appears to be a reliable method of assessing schizophrenic patients in remote locations who have limited access to expert consultation.

Pilot studies of telemedicine for patients with obsessive-compulsive disorder.

OBJECTIVE: Remote video psychiatric assessment holds promise for providing expert consultation to underserved areas. The authors assessed the reliability of rating scales administered in person and over video to patients with obsessive-compulsive disorder. METHOD: Rating scales for obsessive-compulsive, depressive, and anxiety symptoms were administered in person (N = 16) and by means of narrow-bandwidth video transmission over one digital telephone line (N = 10). Interrater reliability was determined for each condition; for the video interviews one rater sat at the local site in front of the videoconsulting apparatus and asked the questions, and the patient and the second rater sat at the remote site. RESULTS: Reliability was excellent in both conditions, and there was no degradation in reliability when the assessment was conducted over video. CONCLUSIONS: Telemedicine resulted in near-perfect interrater agreement on rating scale scores. Its use for other disorders and for more in-depth assessments should be explored.

The role of the genetic counselor in a perinatal unit.

Perinatal units are becoming increasingly aware of the importance of a genetic counselor in a multidisciplinary team. As such, genetic counselors have the opportunity to contribute to the complex and labor-intensive care of high-risk patients in the perinatal setting. Their role is ever changing to fit this evolving and growing field which, although often difficult and challenging, can also be very rewarding.

Predicting cognitive recovery from closed head-injury in children and adolescents.

Longitudinal data from 84 head-injured children and adolescents, who were tested at three points in the first year postinjury, were analyzed to determine the best combination of demographic, injury-related, and behavioral factors predicting cognitive performance. Dependent variables were language, memory, visuomotor, and speeded performance factor scores obtained through confirmatory factor analyses of an extensive test battery. Multiple regression analyses indicated that injury severity and the existence of previous psychological, physical, or cognitive disorders were primary for predicting acute (1 month post-hospital discharge) performance for older subjects. For younger subjects, however, parental marital status was the most important correlate of acute cognitive performance. Those residing in homes with both parents fared better than children in one-parent families. At 6 months and 1 year postinjury, the older subjects who performed most poorly initially remained the most impaired. For younger children, acute cognitive standing was also an important predictor of later performance, but parental marital status remained a crucial influence on their longer-term recovery of cognitive skills.

A crossover study of lecithin treatment of tardive dyskinesia.

The authors enrolled 21 patients in a random-order, crossover, double-blind trial of phosphatidylcholine (lecithin) 20 g/day and placebo. Fourteen patients completed at least 6 weeks of the second 8-week trial and were used for efficacy analyses. Side effects were minimal. The lecithin treatment effect--about one half of an Abnormal Involuntary Movement Scale point--was seen as a statistical effect of treatment order, based on differences between patients who took the active compound before or after they took the placebo. Clinically, however, the lecithin effect was negligible.

An open trial of maprotiline for the treatment of cocaine abuse: a pilot study.

Eleven consecutive severe cocaine abusers were treated openly with maprotiline. Nine completed a 7-week trial, and eight maintained abstinence for at least 1 month as outpatients. Treatment compliance and response appeared better than for a similar group of subjects treated without antidepressants.