Faculty Bibliography

Phencyclidine induces a psychotomimetic state by blocking neurotransmission at N-methyl-D-aspartic acid (NMDA) receptors. In a double-blind, placebo-controlled fashion, 14 medicated patients with chronic schizophrenia were treated with glycine, a potentiator of NMDA-receptor-mediated neurotransmission. Significant improvement in negative symptoms occurred in the group given glycine but not in the group given placebo, suggesting that potentiation of NMDA-receptor-mediated neurotransmission may represent an effective treatment for neuroleptic-resistant negative symptoms in schizophrenia

Discusses efficacy data, on a micro level, and considers the side effects of reserpine (RE) in terms of the Brief Psychiatric Rating Scale (J.E. Overall and D.R. Gorham, 1962) and the Positive and Negative Syndrome Scale. RE was shown to have good antipsychotic efficacy for both positive and negative symptoms in several multicenter, placebo-controlled trials. Its action appears to be broad based, affecting thought disturbance, anergia, activation, paranoia, and depression. The incidence of extrapyramidal symptoms revealed no difference from placebo for 6 mg-8 mg of RE. Overall, RE was well tolerated. Major adverse effects were somnolence, fatigue, orthostatic dizziness, tachycardia, weight gain, sexual dysfunction, rhinitis, and nausea. A panel discussion of RE's efficacy and side effects follows the article.

Fifteen DSM-III-R diagnosed schizophrenics characterized by long-term neuroleptic nonresponse and significant negative symptoms were evaluated with the Positive and Negative Syndrome Scale, a well-operationalized measure of psychopathology, on a baseline neuroleptic and weekly thereafter across 26 weeks of clozapine treatment in order to explore clozapine's effect on other domains of schizophrenic psychopathology beyond its effect on positive symptoms. Mean differences from baseline indicated significant improvement on positive, negative, cognitive, excitement, and depression subscales after 12 weeks. Improvement observed after 12 weeks of clozapine treatment reliably predicted scores observed at week 26. There were no further significant improvements on any symptom profile, including positive and negative symptoms, in this long-term, nonresponder group between weeks 12 and 26. Overall, clozapine proved to affect a broad spectrum of discrete and nonoverlapping domains of psychopathology in this schizophrenic sample

A five-component model of schizophrenia has been presented by Kay and Sevy based upon an analysis of the Positive and Negative Syndrome Scale. Kay and Sevy found factorial validity for negative and positive syndromes, and they identified excitement, depressive, and cognitive components as well. They suggested that subtypes and syndromes can be mapped along dimensions presented in their model. The present study compares the five-component solution for a new sample of 146 subjects to a reanalysis of the Kay and Sevy data. Despite divergent demographic characteristics, the two samples produce similar dimensions. Correlations of component loadings and subject scores as well as confirmatory factor analysis are presented. Discussion focuses on points of agreement and important differences in the symptoms assigned to each component. How the dimensions relate to rationally derived models of positive and negative syndromes is reviewed, and implications for subtyping and other methods of examining the heterogeneity of schizophrenia are considered

OBJECTIVE: The purpose of this study was to test the reliability and validity of a new assessment instrument for positive and negative symptoms in severely disturbed children and adolescents (Kiddie-PANSS). METHOD: The Positive and Negative Syndrome Scale for adult schizophrenia was modified through successive field trials on the basis of developmental characteristics of children and adolescents. The scale was then given to 34 inpatients (19 children, mean age = 9.35 years, and 15 adolescents, mean age = 14.33 years) with DSM-III-R diagnoses of schizophrenia, psychosis not otherwise specified, schizoaffective, affective, conduct, personality, and developmental disorders determined independently by child psychiatrists. All patients with schizophrenia were placed in the schizophrenic group, and all others were placed in a general inpatient group. The Kiddie-PANSS ratings were given by three trained child psychiatrists after a 30-35-minute structured interview. The Achenbach Child Behavior Checklist, the Scale for the Assessment of Positive Symptoms, and the Scale for the Assessment of Negative Symptoms were also administered in order to determine criterion-related association. RESULTS: Intraclass correlation coefficients revealed that all subscales and total psychopathology were reliably assessed among raters. The Kiddie-PANSS and Scale for the Assessment of Positive Symptoms/Scale for the Assessment of Negative Symptoms correlated with one another, indicating criterion-related association. Differences on measures of positive, negative, and general psychopathology, as measured by the Kiddie-PANSS, between the patients with schizophrenia and the general inpatient group were highly significant. CONCLUSIONS: The Kiddie-PANSS shows good interrater reliability and criterion-related validity. In a cohort of inpatient children and adolescents the scale successfully differentiated schizophrenic patients from nonschizophrenic patients

Schizophrenic psychopathology is heterogeneous and multidimensional. Various strategies have been developed over the past several years to assess and measure more accurately discrete domains of psychopathology. One of the more fruitful strategies to investigate more homogenous domains of psychopathology has been the positive-negative syndrome approach. However, this approach is unable to address a number of important issues. Most schizophrenics present a mixed syndrome; the criteria for what constitutes a positive and negative syndrome are variable; distinguishing primary from secondary negative symptoms can be difficult. In order to address some of these problems, we propose the introduction of a five syndrome model based on a reanalysis of factor analytic procedures used on 240 schizophrenics assessed with the Positive and Negative Syndrome Scale (PANSS). We present data on a 5-factor solution which appears to best fit the psychopathological data and which is supported by three independent and comparable factor analyses; negative, positive, excitement, cognitive and depression/anxiety domains of psychopathology give patients their individual mark. Data on internal consistency of the five factors and on initial validation using demographic and clinical variables are presented

Reports the precipitation of dystonia by oral m-chlorophenylpiperazine (m-CPP), a nonspecific direct serotonergic agonist, in a 49-yr-old male schizophrenic patient undergoing an m-CPP double-blind challenge test.

Reviews recent advances in drug therapy of schizophrenia, as well as neurological side effects of such treatment. Dose-response relationships, serum drug levels, and management of neuroleptic malignant syndrome, a side effect of neuroleptic therapy, are addressed. Additional areas covered include maintenance treatment, methods for treating nonresponders, new antipsychotic drugs, and mechanisms of action of commonly used antischizophrenic drugs.