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Unlabelled: In order to provide clinicians, researchers, program evaluators and administrators with current information on the assessment of humanistic outcomes of services for schizophrenic patients, a literature review is performed in which references to quality of life (QOL) assessment were made in the context of schizophrenia. Measures are summarized according to purpose, content, psychometric properties. Fifteen QOL instruments are summarized and reflect considerable variability on the relevant criteria: 11 are developed for persons with severe and persistent mental illnesses and used among populations including a major part of schizophrenic patients; 3 are specific QOL measures for schizophrenic patients; 1 is a generic QOL instrument used among psychotic patients. Given that none of these QOL measures has been widely used or accepted as a standard, the choice of a measure must rest on the investigator's particular purpose and needs., Conclusion: There is a clear need for a QOL instrument that is specific for schizophrenia, given its high prevalence and chronic nature. The lack of information related to responsiveness of these scales stresses the problems of their inclusion in clinical trials. Scales that have been used in studies of schizophrenia were nearly all developed in the United States and the relevance of their content must be questioned. Rather than relying on the literature or experts to determine those needs that are important to patients with schizophrenia, the content of the instrument should be derived from qualitative interviews with patients who are at different stages of their illness. Moreover, the questionnaire should be self-administered.

The aim of this study was to investigate the concurrent validity of the French language version of the Calgary Depression Scale for Schizophrenics (CDSS). Ninety-five schizophrenic patients meeting the DSM-III-R criteria were enrolled in the study. The depressive symptoms were evaluated using the Calgary Depression Scale for Schizophrenics (CDSS), Hamilton Depression Rating Scale (HDRS), Montgomery and Asberg Rating Scale (MADRS), and Widlocher Psychomotor Retardation Scale (ERD). The psychotic symptoms were evaluated with the Positive and Negative Syndrome Scale (PANSS) and the extrapyramidal symptoms with the Extrapyramidal Syndrome Rating Scale (ESRS). The CDDS was significantly correlated with all the conventional depression-rating scales. We only found significant positive correlations between the CDSS and the PANSS-positive sub-scale. The CDSS total score was significantly correlated with some PANSS-positive items (delusions and hallucinatory behaviour). No significant correlation between the depression-rating scales and the PANSS-negative sub-scale was observed. For all the depression-rating scales, no correlation with the extrapyramidal symptom was evidenced. The results confirmed the validity of the CDSS in the evaluation of depression in schizophrenia. The relationship between depression and the positive symptoms of schizophrenia is discussed.

The Calgary Depression scale for schizophrenia (CDSS) is a 9 items scale, simple, quick and easy to use. It allows a quantitative approach of the subjective (or cognitive) dimension of the depression, and was developed by Addington et al. (1-5). In this work, we studied the psychometric properties of the CDSS in a population of 95 schizophrenic patients, and 41 non schizophrenic depressed patients. The CDSS was compared with commonly used hetero-questionnaires as the Hamilton Depression Scale (HDRS), the Montgomery-Asberg Depression Scale (MADRS), the Widlöcher depressive slowness scale (ERD), and auto-questionnaires as the Beck Depression Inventory (BDI), and the Beck Hopelessness scale (H). In the schizophrenic group, psychotic symptoms were evaluated with the Positive and Negative Symptoms Scale (PANSS), and the extrapyramidal symptoms with the Extrapyramidal symptoms scale (EPRS). In the two populations, the CDSS has similar psychometric properties. The principal component analyses accounts for a unifactorial structure in both groups. In schizophrenics the total score of the CDSS is strongly correlated with the total scores of the HDRS, the MADRS, the ERD, and the G6 item of the PANSS. In non schizophrenic depressed patients, the total score of the CDSS is highly correlated to the total scores of the HDRS, the MADRS and the BDI, with a weaker correlation with the ERD and the H total scores. In these patients, a cut-point strictly superior to 13 may be proposed as a severity criterion for depression in these patients. The internal consistency is satisfactory in both groups, with a Cronbach's alpha of 0.82 in schizophrenics and 0.59 in non schizophrenic depressed subjects. In schizophrenics, items C4 (guilty ideas of reference) and C7 (early awakening) are not necessary to the constitution of the scale. In depressed patients, the deletion of item C6 (morning depression) might increase the internal consistency. Inte-raters agreement is high, with weighted kappas all superior to 0.75 in schizophrenics and to 0.61 in depressed patients. Stability over time is good, and the 72 hours test-retest total score of the CDSS is independent from negative and extrapyramidal symptoms. On the other hand, the positive sub-score and the positive factor of the PANSS are correlated to the CDSS total score. The validation of the CDSS is still not complete: sensitivity to change and stability of the factorial structure remain to be explored. Nevertheless, the CDSS is an interesting tool for a quantitative approach of the subjective dimension of depression in both schizophrenic and non schizophrenic patients.

The aim of this study was to determine the psychometric properties (especially validity and reliability) of the French language version of the Calgary Depression Scale for Schizophrenia (CDSS) in schizophrenic patients. Ninety-five subjects who met DSM-IV criteria for schizophrenia were enrolled. The studies of the internal structural validity and of the reliability (internal consistency) showed that some items from the CDSS (early awakening and guilty ideas of reference) must be discussed in the constitution of this scale. The total score of the CDSS was significantly correlated with the MADRS total score, the HDRS total score, and the depression item (G6) on the PANSS, which suggests that the CDSS is a valid instrument for the assessment of depression in schizophrenia. The existence of a significant correlation between the CDSS total score and the PANSS positive sub-scale suggests a possible relationship between positive and depressive symptoms in schizophrenia.

Neuroleptics are the main biological treatment for psychotic patients. The brutal withdrawal of a neuroleptic treatment may induce an important aggravation of the psychotic symptoms. A few of those relapses may occur very early after the interruption of treatment; they are often associated with a modification of the symptoms and an unfavorable evolution in the course of the illness. Using those clinical observations a few authors have developed the concept of supersensitivity psychosis to explain those kinds of relapses and to formulate hypothesis about tolerance and resistance to neuroleptics. They focus on the possible correlation between supersensitivity psychosis and tardive dyskinesia. We report three cases of a dramatic aggravation of the psychotic symptomatology following the withdrawal of clozapine in three schizophrenic patients resistant to classical neuroleptic treatment. According to the clinical data and to the physiopathological hypothesis, the concept of supersensitivity psychosis can have implications in the therapeutic management of resistant schizophrenic patients.

High dosage buprenorphine is actually the principal treatment for substitution medication in France. Clinical trials have demonstrated the clinical efficacy of HD buprenorphine for narcotic addiction, but few data are published concerning the prognostic factors of treatment response in daily practice. A naturalistic study was performed in 1998. 200 generalist practitioners were recruited and 956 patients were included. Sociodemographic, medical and addiction history were collected. A quantitative socio-comportemental and medical indicator (SCMI) was performed. The psychometric properties of the SCMI were analyzed. Simple and multivariate analysis was performed. Patients with good social adjustment and past withdrawal are good responders to HD buprenorphine. Not treated psychiatric pathology was a prognostic factor associated with a relatively poor response to HD buprenorphine. A long duration of treatment (one year) and a clear therapeutic program were associated with good response.

Objective: The main objective of this study was to evaluate the psychometric properties of the French-language version of the Positive and Negative Syndrome Scale (PANSS)., Method: The validity and reliability of the PANSS were studied in a population of 342 patients diagnosed as schizophrenic according to DSM-III-R criteria., Results: The study of the internal consistency and principal-component analysis of the initial structure with three subscales (positive, negative and general psychopathology) led us to investigate other factorial structures. We isolated a 5-factor structure (negative, positive, hostility, disorganization and anxiety/depression) explaining 57.5% of the total variance. The internal consistency of the 5 factors isolated was good (0.87 for the negative factor, 0.82 for the positive factor, 0.78 for the hostility factor, 0.71 for the disorganization factor and 0.68 for the anxiety/depression factor, respectively). The validity study on the external criteria confirmed the relationship between the negative and anxiety/depression factors and the extrapyramidal symptoms., Conclusion: The stability of the PANSS factorial warrants discussion.

We conducted a study on 205 schizophrenic patients in order to explore the factorial structure of the Positive and Negative Syndrome Scale (PANSS). We first documented the validity and reliability of the five-dimensional structure of the PANSS, initially derived from the work of Kay and Sevy and completed by Lindenmayer et al. Some items (stereotyped thinking, mannerisms and posturing, poor attention, lack of judgement, disturbance of volition, and preoccupation) appeared to contribute little to the constitution of the dimensions initially described by Kay and Sevy. Those items were not taken into account in the forced five-dimensional factor analysis. We therefore investigated further the psychometric properties of the PANSS using only the retained items. The validity and reliability of this new five-dimensional structure are discussed.

The cost of schizophrenia has been a major point of interest abroad. In the United States, two authors evaluated the direct cost of the illness. According to Gunderson and Mosher (13), it reaches US $25,625 million. In the United Kingdom, the estimations are of 390 million pounds (7) and 1,178 million pounds (16). In Australia, a direct cost calculation based on incidence leads to US $24,621 million (1), which is 6 times as much as the cost of infarction. At last, the only French study (Rouillon et al., 1997) gives a result of FF 17,911 millions. The indirect cost estimations vary from 71% (29) to 83% (13) of the total cost. The difference between the 6 publications are suprizing (especially when they concern the same country) and are probably link to the difference of methodology. This point tempers largely the interest of these studies as a tool in order to hierarchise Public Health priorities. Moreover, the elaboration of structures equivalencies between the different countries is an ambitious enterprise and make difficult comparisons of the studies. Finally, the lack of transparency of some of them limits their credibility.

The Calgary Depression Scale for Schizophrenia (CDSS) is a nine-item structured interview scale developed by Addington et al. to assess depression in schizophrenics. This paper describes the testing of the reliability and validity of the French version of the CDSS in a population of 70 schizophrenic patients. The validity of the CDSS as a measure of depression was confirmed; a single factor accounted for 41% of the variance of the nine items. The total score on the CDSS was strongly correlated with those on the Montgomery-Asberg Depression Rating Scale (MADRS), the Hamilton Depression Rating Scale (HDRS) and also the G6 item (depression) of the Positive and Negative Syndrome Scale (PANSS). The correlation with the Psychomotor Retardation Scale (ERD) total score was much less significant and was better with the 'subjective' subscore. The internal consistency was good, with a Cronbach's alpha of 0.79. A high level of inter-rater reliability was observed (weighted kappa values were >0.75 in all cases). The CDSS has a lower stability over time than other depression scales. It is a simple, quick and reliable scale for assessing depression in schizophrenic populations.

Depression and mood disorders are frequently associated. They can be described as a part of schizophrenic symptomatology, observed as post-psychotic depression, be a part of a schizoaffective disorder or be a consequence of neuroleptic treatment. Suicide is the main risk of evolution in young schizophrenics and is often associated to depression. Despite methodological difficulties, a few studies demonstrate the efficacy of clozapine, one of the first atypical antipsychotic, in the treatment of depressive symptomatology in schizophrenics and schizoaffectives. This action remains controversial in the treatment of post-psychotic depression. This drug also contribute to reduce suicidality in a sample of chronic schizophrenics in an open study. This action has to be considered when we evaluate the risk-benefit of the prescription of clozapine.

The efficacy of conventional neuroleptics in the treatment of the negative symptoms of schizophrenia is highly controversial. Clozapine, the leading atypical neuroleptic, has been shown to be effective, in the majority of the controlled studies, on both the positive and negative symptoms of the disease. It appears to be active vis-à-vis both the primary and secondary negative symptoms. However, several weeks (at least 12) are required for the effect on primary negative symptoms to clearly emerge. The position of clozapine in the treatment of patients presenting with a state of deficiency remains more debatable.

Several cases of suicidal thinking or suicidal behavior during fluoxetine treatment are described in the literature. Akathisia or dysphoric extrapyramidal reactions may explain the emergence of suicidal ideation during fluoxetine treatment. Retrospective and controlled studies found no relationship between fluoxetine and the emergence of suicidal ideation. Some cases reports of akathisia or suicidal ideation with other selective serotonin reuptake inhibitors (SSRIs) suggest that same mechanisms (pharmacokinetic or pharmacodynamic interactions) are involved in extrapyramidal effects during treatment with SSRIs. The clinical use of SRIs is discussed.

Models of information processing, a part of cognitive psychology, have influenced theories of schizophrenia in the past few years. Study of attention disorders is an original approach of schizophrenics' cognitive disturbances. The authors have reviewed the literature of attention disorders in schizophrenia. Disorders of attention are analysed in different points of view. 'Subtype, syndromic (positive and negative forms) and symptomatic levels of analysis are documented. Subtype approach of attention disorders is not confirmed in the literature. Symptomatic approach of attention disorders in schizophrenia is actually well documented (especially for hallucination and delusion), but very heterogenous. Attention disorders are different in positive and negative syndromes of schizophrenia. Positive patients are more distractible and an early disorder of information processing is a part of cognitive disturbances of negative patients. Some neurobiological and information processing disturbances are discussed in reference of this syndromic approach.

Our study focuses on psychometrics properties of the french version of the Positive and Negative Syndrom Scale (PANSS). 85 schizophrenic subjects, in accordance with DSM III-R criteria were included in this study. Our results allow us to discuss the construct validity and the reliability of this scale. The traditional 3 dimensions of the PANSS (positive, negative and general psychopathology) are discuss. We show that expect positive scale and general psychopathology scale average several symptomatic dimensions. We propose a 5 dimensions solution (negative, hostility, positive, disorganization, anxiety), which represent 54% of the total inertie. The internal consistency of this solution is presented.

In schizophrenia, the hypothesis of frontal dysfunctions is sustained by various clinical, neuroradiological and neuropsychological observations. We have studied the degree of frontal cognitive impairment in 42 schizophrenic patients according to the DSM IV as compared to 19 normal subjects. Furthermore, the performances of the different tests were connected with the age, the duration of the disease, the severity of the illness (measured by the PANSS scale) and the incidence of the treatments. The neuropsychological tests used in this study were the D48, the Wisconsin card sorting test, the Stroop color and word test, the word fluency and a target detection test. The results obtained from this study agree with the occurrence of frontal cognitive impairments in schizophrenia. Such impairments are increased with the age and the duration of the disease.

A 42 years old man suffering from bipolar disorder I with rapid cycling, unresponsive to conventional therapy, was successfully treated with clozapine. The plasma clozapine levels were monitored. This case suggests that clozapine could be efficient in treating mania and preventing relapse in affective disorders. The plasma concentration of clozapine is discussed.

Weight gain is one of the more common side effects of psychotropic drugs (neuroleptics, antidepressants, lithium, benzodiazepines). This effect depends on the type of drug, doses and length of treatment. It appears gradually and seems linked to the patient's clinical history. Among neuroleptics, phenothiazines and benzamides have the most important effect on weight. Weight gain with lithium is well documented and it does not regress with time. There is actually a controversy about antidepressants direct effects on weight. Current information concerning benzodiazepines is insufficient. Weight gain is not an unavoidable side effect and etiopathogenic mechanisms are not well known. Many hypothesis are discussed (biochemical, pharmacological, psychological and environmental). Weight gain is a complex and multifactorial phenomena.

Objectives: we have realized an open study in a population of chronic schizophrenic inpatients treated with clozapine. The purpose of this study was to investigate the clinical response and the effect of extrapyramidal symptoms of this atypical antipsychotic., Methods: our sample is composed of 25 chronic hospitalized schizophrenics (18 males, 7 females; average age = 36.57, SD = 8.41) with an initial important symptomatology (average score on BPRS = 64.92, SD = 7.99). The weekly assessment was done using PANSS and EPRS during 9 weeks. After a 15-days period of treatment adjustment, each patient reached a daily dose of 400 mg. Then the dosage was adjusted according to the clinical condition of the patients (average = 429.41 mg per day)., Results: using the PANSS, we identified a statistically significant (p < 0.05) clinical improvement from the fourth week of treatment for global score, positive, negative and general psychopathology sub-score. For EPRS a dramatic improvement (p < 0.01) occurred from the second week. We found no correlation between the improvement of negative symptoms and the improvement of extrapyramidal symptoms. We individualized a sub-group of 7 good responders who showed an improvement of 20% or more on PANSS global score at the ninth week. This group showed a statistically significant (p < 0.01) more intense initial negative symptomatology compared to non-responders., Conclusion: the improvement of extrapyramidal symptoms precede the improvement of psychotic symptoms; this effect underlines the good neurological tolerance of clozapine. The clinical efficacy concerns both positive and negative symptoms. The efficacy on negative symptoms seems to be primary. In our sample, patients with intense negative symptomatology improve more than others.

The computerized medical file, used in routine work in an Adult Psychiatry University-Hospital Unit enabled us to select 113 cases among 1,000 consecutive hospitalizations, the diagnosis of which could possibly lead to schizophrenia. These cases which we named "paraschizophrenic states" are linked to DSM III-R criteria of borderline (27 cases), schizoid (40 cases) or schizotypical (15 cases) personalities, schizophreniform trouble and unspecified psychotic trouble (17 cases), brief reactional psychosis (14 cases). We selected 196 cases of schizophrenia in the same cohort of hospitalized patients. As it is now usually admitted, we marked out two subgroups in this second group: the positive schizophrenia which gather together the paranoid and undifferentiated patterns and the negative schizophrenia which correspond to disorganized, catatonic and residual models, according to DSM III-R criterion. We compared the "paraschizophrenic states'" group and its five subgroups (we indeed joined schizophreniform trouble and unspecified psychotic trouble under the name of "other psychotic trouble" by reason of their relative nosographic lacks of precision and of their too small sizes) with the schizophrenia's group and its two subgroups. Each group is matched for sex (1.51 men for 1 woman in the first group and 1.45 men for 1 woman in the second group). We evaluated statistics for markers usually studied in schizophrenia in each subgroup. These markers are of three classes: biographical: age during the study, age of troubles' onset, season of birth; socioeconomic: socioeconomic level of family and patient's student status; psychiatric: family (history affective trouble, psychotic trouble, alcoholism), treatment response and short- and middle-term prognosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Different drugs have been used as adjuvant to neuroleptics in chronic schizophrenia. Bromocriptine, carbamazepine and cyproheptadine have shown an efficacy added to neuroleptics in schizophrenia. In our study, 24 chronic schizophrenic inpatients considered to be resistant to neuroleptics were treated double blind with the associations haloperidol (40 mg a day)--carbamazepine (400 mg a day), haloperidol (40 mg a day)--bromocriptine (2.5 mg a day), haloperidol (40 mg a day)--cyproheptadine (24 mg a day) and haloperidol (40 mg a day)--placebo. The drugs were given successively, in a randomized succession using a latin square procedure, for four 5-weeks periods. A psychiatric assessment using the Brief Psychiatric Rating Scale (BPRS), the SANS (Scale for Assessment of Negative Symptoms) and the SAPS (Scale for Assessment of Positive Symptoms) occurred every two weeks. Extrapyramidal symptomatology and abnormal movements were assessed using the AIMS (Abnormal Involuntary Movement Scale) and the Simpson-Angus scale. Using an ANOVA, we cannot show any clinical efficacy of any of those three drugs as an adjuvant to haloperidol. The discrepancy between our results and the data of the literature can be linked to the high specificity of our sample (resistance to neuroleptics). We cannot show any specific efficacy of those drugs on positive and negative symptoms, using the sub-factors of the SAPS and SANS.

Both plasma MHPG level and red blood cell membrane transports (TM) of L-tyrosine (L-TYR) and L-tryptophan (L-TRY) were evaluated in 29 depressed patients and compared to 16 control subjects. On the basis of MHPG plasmatic levels, we were able to define two subgroups in the depressed population showing a biological homogeneity: in the first one, both MHPG level and TYR TM decreased, while in the second one neither of these indices were disturbed. These biological features were not related to the nosographic subgroups. Bipolar depressed subjects showed a decrease in both MHPG and TYR TM; unipolar depressed subjects exhibited a decrease in both MHPG and TYR TM associated to an increase in TRY TM, whereas no change was found in dysthymic disorders. The time course of MHPG and MT were desynchronized if followed during the antidepressant treatment. At day 7, MHPG level increased significantly, while clinical improvement showed a normalisation of MHPG and TYR TM.

The use of calcium channel blockers is usual in cardiology today, but seem to spread to others specialties, particularly in the field of neuropsychiatry. The authors report the major clinical studies in neurology (treatment of migraines, epilepsia, dizziness and ischemic stroke) where flunarizine and nimodipine seem to have an important role. In psychiatry, their introduction is more recent. However, some encouraging results have been noted in the treatment of panic disorder, Gilles de la Tourette disease and mania.