Agreement in psychiatric assessment.

In 103 schizophrenic patients we investigated the extent of practice needed in the use of the Brief Psychiatric Rating Scale (BPRS) to enable its reliability to be assessed. The agreement level of the 7 raters was analysed. Generally, the lowest mean agreement found was for the negative symptoms of the BPRS schizophrenia subscale. A high degree of agreement was attained both for the positive symptoms of the BPRS schizophrenia subscale and for the symptoms of the depression--and of the mania subscale. The degree of disagreement observed was due to both individual differences in assessment ability and the rating procedure. These results indicate that it is necessary to state the degree of agreement achieved in studies in which several raters are taking part.

The Brief Psychiatric Rating Scale. Dimension of schizophrenia--reliability and construct validity.

This study has focussed on a 10-item Brief Psychiatric Rating Scale (BPRS) subscale for the quantification of schizophrenic states. Seven psychiatrists interviewed jointly patients who all fulfilled the DSM-III criteria of schizophrenia, and in a subsequent pencil-and-paper procedure a judgment analysis was performed. The reliability analysis showed that less experienced BPRS raters made less consistent judgments implying the cautionary statement that the proper use of a scale for schizophrenia requires specialized training with the scale. The validity analysis showed that the BPRS items had an additive relationship implying that the sum of these items is a sufficient statistic for the measurement of severity of schizophrenic states. Finally, the results seem to indicate, that the underlying dimension defined by the 10-items BPRS subscale includes hierarchically the negative and positive symptoms of schizophrenia.

Epileptic aphasia and dysphoria interpreted as endogenous depression.

A case is reported of a 29-yr-old female with attacks of aphasia/dysphasia over a period of several months which lasted days to weeks accompanied by a dysphoric state. The patients was for long regarded as endogenous depressive with a hysterical speech disorder. However, the diagnosis of epilepsy was finally made based on generalized attacks, appropriate EEG changes, and the response to anti-epileptic therapy.

Sulpiride versus haloperidol, a clinical trial in schizophrenia. A preliminary report.

Sixteen out of 25 hebephrenic and paranoid schizophrenic patients completed a double-blind cross-over study with sulpiride and haloperidol. The patient sample was relatively chronic: Median age was 35 years (range 26-53 years), median duration of illness 10 years (4-35 years), and median duration of neuroleptic treatment 5 years (1-28 years). Each patient was treated with sulpiride/haloperidol in random order for 12 weeks with a drug-free period before each treatment phase. Mean total BPRS (Brief Psychiatric Rating Scale) score was reduced from 25 to 15 (P less than 0.05) during sulpiride (800-2800 mg/day, median 1600 mg/day), and from 28 to 15 (P less than 0.01) during haloperidol (6-18 mg/day, median 12). There were no significant differences between the groups with respect to total BPRS score, single items or symptom clusters. However, in a few, very "chronic", disturbed, and long-term treated patients, haloperidol appeared more beneficial than sulpiride. Autonomic side effects and parkinsonism tended to occur more frequently during haloperidol than during sulpiride, but no significant differences were found. It is concluded that sulpiride, a specific dopamine-2 receptor blocker, has antipsychotic effect, not significantly different from haloperidol, but may produce slightly less side effects.

Amniocentesis in prenatal diagnosis. A controlled series of 78 cases.

The outcome of 78 pregnancies, monitored by second trimester amniocentesis for prevention of genetic disease, and the outcome of an equal number of matched controls are reported. The controls were selected from the same obstetrical department, among the same population,and were matched for age, number of previous children, abortions and stillbirths. No significant difference was found in Apgar score, birth-weight and length, duration of pregnancy, placenta condition or malformation.