Differences between self-reported and clinician-rated evaluations of 1-year changes in auditory verbal hallucinations among schizophrenia patients.

Auditory verbal hallucinations (AVHs) constitute a frequent and distressing symptom of schizophrenia, associated with physical, emotional, and cognitive challenges. Despite their clinical importance, changes in the multiple dimensions of AVHs during treatment have rarely been examined, and subjective views thereof have received minimal attention. Here, we evaluated 87 patients with schizophrenia-related AVHs using the Hamilton Program for Schizophrenia Voices Questionnaire (HPSVQ; a self-report questionnaire) and the Psychotic Symptom Rating Scales-Auditory Hallucination Subscale (PSYRATS-AH; a clinician-rated scale) at baseline and after 6 months and 1 year of treatment. We explored dimensions that changed from the perspectives of both clinicians and patients and the relationships between these perceptions over the year. The test-retest reliabilities of the HPSVQ and PSYRATS-AH were generally fair. Improvements in AVHs were evident over the first 6 months; the PSYRATS-AH revealed a broader range of symptom improvement than did the HPSVQ. The "interference with life" dimension on the HPSVQ was not reduced, but the "disruption to life" score on the PSYRATS-AH was. At both baseline and 6 months, the physical characteristics of AVHs (frequency, duration, and loudness) were significantly correlated with both distress and life interference/disruption; all correlations except that for frequency were reduced at 1 year. The clinician-rated and self-reported personal perspectives on AVHs exhibited both differences and similarities; physical AVH components and subjective distressful experiences changed in different ways in those with chronic, persistent AVHs. The HPSVQ and PSYRATS-AH data were complementary, improving our understanding of the clinical implications of AVHs and subjective patient distress.

Comparison of clinician-rated and self-report insight in Korean patients with schizophrenia using VAGUS insight scale.

This study was aimed to explore self-report auditory verbal hallucinations to provide unique and valuable information in addition to clinician-rated assessment in patients with schizophrenia. The VAGUS (http://www.vagusonline.com) is a recently developed insight scale that includes both clinician-rated (CR) and self-report (SR) versions. Insight measures obtained by the two versions of the VAGUS from the clinicians and the patients, respectively, in forty-one patients diagnosed with schizophrenia by DSM-IV-TR criteria were compared. Correlation coefficients for inter-scale convergence and 3-D biplots for multivariate relationship were derived from the subscales of the VAGUS. For external validation, correlation analyses with abridged version of Scale to Assess Unawareness in Mental Disorder (SUMD-A) and PANSS G12 item were conducted. Total scores of VAGUS-CR and -SR were 5.2 ± 2.6 and 4.9 ± 2.2, respectively. There was a strong correlation between them along with moderate pairwise correlations among the subscales. The 3-D biplots demonstrated that most subscales were clustered as a single factor apart from self-report Symptom Attribution separated as an independent factor. The VAGUS-CR, not -SR correlated significantly with the SUMD-A and PANSS G12. The utility of the VAGUS in reaching more overall understanding of the elusive phenomenon of insight in patients with schizophrenia is discussed.

Assessment of risk factors related to suicide attempts in patients with bipolar disorder.

We compared the characteristics of patients with bipolar disorder with and without a history of suicide attempts to identify the risk factors of suicide in this disorder. Among 212 patients with bipolar disorder, 44 (21.2%) patients had histories of suicide attempts. Suicide attempters were younger and more likely to be diagnosed with bipolar II. The variables that differentiated those who did from those who did not attempt suicide included age at first contact, lifetime history of antidepressant use, major depressive episode, mixed episode, auditory hallucinations, rapid cycling, the number of previous mood episodes, age of first depressive episode, and age of first psychotic symptoms. Strong predictors of suicide attempts were younger age at onset, lifetime history of auditory hallucinations, and history of antidepressant use. Antecedent depressive episodes and psychotic symptoms predicted the first suicide attempt in patients with bipolar disorder. This study could help clinicians to understand the major risk factors of suicidal behavior in bipolar disorder.

The usefulness of a self-report questionnaire measuring auditory verbal hallucinations.

A self-report measure of psychotic symptoms has been considered to be unsuitable due to the possible denial of symptoms in the patients with schizophrenia. However, a self-report questionnaire would be an efficient tool for the evaluation of subjective aspects of auditory verbal hallucination (AVH), which requires further clarification. In this study, a total of 87 patients with schizophrenia took baseline evaluations for Hamilton Program for Schizophrenia Voices Questionnaire (HPSVQ), a self-report questionnaire for AVH, and Psychotic Symptom Rating Scales-Auditory Hallucination Subscale (PSYRATS-AH) and an item measuring hallucinations (P3) on Positive and Negative Syndrome Scale for Schizophrenia (PANSS), both interviewer-rated scales for AVH. At 1 week and at 6 months post-baseline, 39 and 68 patients repeated HPSVQ and PSYRATS-AH, respectively. Total scores on HPSVQ showed good agreement with those on PSYRATS-AH and PANSS, Item P3, and HPSVQ showed good test-retest reliability and internal consistency. In addition, the changes in total scores of HPSVQ during 6-month follow-up were also highly correlated to those of PSYRATS-AH. The findings of factor analysis and hierarchical cluster analysis suggested that the items addressing emotional characteristics of AVH constituted one factor and that the remaining items, primarily concerning the physical characteristics, combined to form another factor. Taken together, the HPSVQ, a self-report questionnaire measuring AVH, was characterized by good psychometric properties, which suggests the appropriateness of a self-report scale for examining the internal structure of AVH in patients with schizophrenia.

Changes in neurocognitive function in patients with schizophrenia after starting or switching to amisulpride in comparison with the normal controls.

We examined short- and long-term changes in neurocognitive functions in patients with schizophrenia who were either started or switched to amisulpride in comparison with the normal controls. Fifty-seven patients treated with amisulpride and 60 normal controls completed a comprehensive neurocognitive function test battery at the baseline, the 8-week, and the 1-year follow-up. We conducted and compared the results of both intention-to-treat (ITT) and per-protocol (PP) analyses to account for the follow-up loss. Three general results obtained were as follows: (1) the degree of the improvements in neurocognitive function was comparable to those of other second-generation antipsychotics in both ITT and PP analysis; (2) in light of the relative effect size, the composite effect size and the effect size in most measures in both ITT and PP analyses were smaller for the patient group than those of the control group, signifying that improvement in performance may be largely attributable to practice effects; and (3) nonetheless, there were evidences of both short- and long-term improvements in some cognitive tasks, such as in the Korean-Wechsler Adult Intelligence Scale vocabulary subtest and the Trail Making Test, that may not be accounted by practice effect. These results suggest the need to include a healthy control group to validate the medication effect of cognitive improvements in patients with schizophrenia and to consider practice effect in interpreting the results of repeated administration of neurocognitive function tests.

The model of the relationships among the predictors of quality of life in chronic stage of schizophrenia.

We attempted to formulate a model of quality of life (QoL) in chronic stage of schizophrenia with 72 patients by including key variables, i.e., psychopathology, insight, executive functioning, and side effects, proposed to be its significant predictors in previous studies. We applied the structural equation modelling (SEM) method to simultaneously test a number of possible hypotheses concerning the inter-relations among the predictors of QoL in schizophrenia patients by formulating possible models and examining their levels of fitness. Our most fit model (X(2)=2.106, df=4, P=0.716; CFI=1.000; TLI=1.213; RMSEA=0.000, LO=0.000, HI=0.132) showed that the severity of psychopathology not only directly causes poor QoL, but also by adversely affecting insight. On the other hand, executive function may not be affected significantly by psychopathology, but executive function still plays an important role in determining the QoL not only directly, but also indirectly by influencing self-evaluation of side-effects. Impaired insight and executive function caused by severe level of psychopathology contribute to an increased reporting of side-effects, resulting in cumulative dysfunction in daily life for patients with chronic schizophrenia. Our study illustrates that the complexity of the relationships among the predictors of QoL in chronic patients of schizophrenia should be considered when designing studies on QoL of this group.

The causal model of insight in schizophrenia based on the Positive and Negative Syndrome Scale factors and the structural equation modeling.

We used structural equation modeling to formulate a causal model of insight in schizophrenia patients that explains the inconsistent results of the studies on the relationship between insight and psychopathology. The Positive and Negative Syndrome Scale was used to assess 342 patients with acute stage schizophrenia and 5 factors were identified through factor analysis with which a causal model of insight was constructed. Our model, where positive, negative, and autistic preoccupation (cognitive) factors were the primary predictors of insight with the activation factor mediating between positive and autistic preoccupation factors and insight, was found to show a perfect fit by most goodness-of-fit indices and to be superior to other alternative models. Specifically, positive, negative, and autistic preoccupation factors each had some predictive power for insight and the activation factor played a partial mediating role for the positive factor and a moderating role for the autistic preoccupation factor.

Liverpool University Neuroleptic Side-Effect Rating Scale (LUNSERS) as a subjective measure of drug-induced parkinsonism and akathisia.

The Liverpool University Neuroleptic Side-Effect Rating Scale (LUNSERS) was examined for its usefulness as a subjective measure of drug-induced parkinsonism and akathisia. Eighty-three subjects were assessed using the LUNSERS, the Simpson-Angus Scale (SAS) and the Barnes Akathisia Rating Scale (BARS), before and after a 6-week treatment with olanzapine. Significant correlations were found between the changes in scores of parkinsonism items of LUNSERS and SAS. The changes in scores of akathisia item (restlessness), extrapyramidal side effects (EPS) subscale and psychic side-effects subscale of LUNSERS were significantly correlated with those of the BARS. 'Shakiness', one item of the EPS subscale of LUNSERS, correctly classified between parkinsonism and non-parkinsonism groups with 81.0% accuracy. A combination of four items included in EPS and psychic side-effect subscales of LUNSERS identified akathisia and non-akathisia groups with 76.2% accuracy. These results suggest that the EPS and psychic side-effect subscales of LUNSERS may be useful in screening for drug-induced parkinsonism and akathisia.