1q21-q22 locus is associated with susceptibility to the reality-distortion syndrome of schizophrenia spectrum disorders.
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Alleles↗
Biomedical subjects
M J Cuesta
Publications and source records attributed to M J Cuesta.
[Psychopathology and classification of depressive disorders].
Depressive disorders are a heterogeneous group of conditions in terms of their etiology, symptom composition and outcome, which has resulted in difficulties in the definition of the axial depressive syndrome and its clinical forms. This gives rise to a number of problems regarding their definition and delimitation from other mental disorders and from normality. As a result, changing and to some extent overlapping definitions of depressive disorders have been proposed over time. A definition of axial depressive syndrome is proposed based on the differentiation between disturbances of mood and affect. The two main classificatory approaches (categorical and dimensional) are examined with regard to their appropriateness in classifying depressive disorders. Although the two approaches possess pros and cons, the dimensional approach has a number of characteristics that makes it more appropriate than the categorical approach for classifying mental disorders in general and depressive disorders in particular. A multidimensional model for classifying depressive disorders is proposed. The model includes etiological, symptomatological and course/outcome components, each of which is composed of a number of dimensions that have clinical and therapeutical relevance.
English Abstract↗
[Neurobiology of depression].
During decades, both aetiology and treatment in Depressive Disorders relied on neurotransmitters' physiopathology or on abnormalities in their receptors function. However, recently evidences from research on neurobiological grounds suggest that there are multiple and complex systems involved in the pathophysiology of Depressive Disorders. Several neurobiological structures, such as the neural, immune and endocrine systems seems to interact among themselves and to influence on clinical manifestations of illness. Moreover, dysregulations on lower levels, such as intracellular and genetic systems might cause anomalies in protein expression, and in consequence might modulate receptors' disfunction and disturbances at the intramolecular level of signal transmission. The above disturbances at different levels of complexity are finally integrated within the frame of most recent theoretical approaches to Depressive Disorders. Specifically, recent theories implicating neuronal plasticity and survival-death cell mechanisms are described. The aim of this review is to integrate recent evidence on pathophysiological mechanisms of Depressive Disorders. New lines of treatment based upon these 'new pathophysiology' of depression will be wellcome.
English Abstract↗
[Depressive disorder and depression within schizophrenia spectrum disorders: are they the same?].
Depressive states are a prevalent condition in mental disorders other than depressive disorders, which raises the question of whether or not depression in non-depressive disorders and depressive disorders has the same clinical and biological meaning. The aim of this study was to test the hypothesis that depression in schizophrenia spectrum disorders and depressive disorders does have the same characteristics regarding gender distribution and family history of mood disorders in first-degree relatives. The study sample was made up of 660 psychotic patients who were assessed for alternative definitions of depressive states. The pattern of gender distribution and family antecedents of mood disorders in those patients having depressive symptoms or syndromes was very similar to that reported in depressive disorders, and more specifically to depression in patients with schizophrenia spectrum disorders. These data support the hypothesis that depressions in schizophrenia spectrum disorders do have the same biological meaning as in depressive disorders.
English Abstract↗
Patterns of symptoms in neuroleptic-naive patients with schizophrenia and related psychotic disorders before and after treatment.
A three-factor structure of schizophrenic symptoms has received considerable support, but there are no data on the factor structure of symptoms in neuroleptic-naive patients and how symptoms evolve after the inception of antipsychotic treatment. Seventy neuroleptic-naive patients with schizophrenia or related psychotic disorders were assessed with the Scales for the Assessment of Positive and Negative Symptoms before and after neuroleptic treatment. Ten global ratings of symptoms were subjected to factor analysis at the two time points and the factor solutions compared. A three-factor structure composed of psychotic, disorganization, and negative dimensions was found at the two assessment points. The negative and disorganization factors were highly correlated at each assessment and across assessments. While the symptom composition of the factors at the neuroleptic-naive assessment fitted that described in most previous studies, the composition of the negative and disorganization factors after neuroleptic treatment was somewhat different in that attention and inappropriate affect loaded on the negative factor instead of the disorganization factor. It is concluded that caution is warranted when using the three-factor model of schizophrenic symptoms as it may not be stable at different phases of the illness.
Adult↗
Integrating psychopathological dimensions in functional psychoses: a hierarchical approach.
Previous factor analysis studies of psychotic symptomatology have demonstrated three psychopathological dimensions: positive, negative and disorganization. However, few studies have analyzed non-schizophrenic samples and most use a syndrome-level of analysis or only schizophrenic symptom scales. This study examined how many dimensions underlie psychosis, and whether within psychosis there is a hierarchical organization of dimensions.A total of 660 inpatients with an acute psychotic episode were studied. Psychopathology was measured through a wide psychopathological assessment using the Manual for the Assessment and Documentation of Psychopathology (AMDP-system). Principal component factor analysis was carried out on 64 psychopathological symptoms scoring 1 or higher in at least 10% of the sample. A 15-factor solution was obtained which failed to depict a psychosis model on clinical and methodological grounds. Further predetermined factor analyses ranging from 1 to 15 factors were carried out to examine alternative factor solutions. A 10-dimensional model was the best model on clinical, statistical and conceptual grounds. Moreover, the examination of the 1 to 10 dimensional models allowed us to infer a hierarchical model of psychopathological dimensions, which can be represented in the frame of a tree-structure. The model permitted transitions between psychiatric categories and psychopathological dimensions, and it was able to integrate previous factor solutions with different numbers of resulting dimensions.The findings have implications for the design of future studies and for the hierarchical conceptualization of psychopathological dimensions.
Adult↗
Are personality traits associated with cognitive disturbance in psychosis?
OBJECTIVE: Personality and cognition are often considered as disparate constructs, both in normal individuals and in those with a psychosis. The goal of the present study was to analyze the relationship between dimensions of personality and cognitive performance in individuals with psychosis. METHODS: Sixty-one consecutively admitted patients with an acute psychotic episode were recruited for this study. Personality was assessed through a semistructured interview with a close relative using the Personality Assessment Schedule. A wide neuropsychological battery was applied, including attentional, executive, memory tasks and global cognition. Assessments took place when symptomatology was in remission. RESULTS: Higher scores on a passive-dependent dimension were significantly associated with poorer memory performance. Similarly, higher levels for a schizoid dimension were significantly associated with poorer executive performance. The results remained significant after partialling out the effect of gender, psychopathological dimensions and drug status. CONCLUSION: It is hypothesized that personality traits and cognitive performance are interrelated domains in psychosis.
Adolescent↗
How many and which are the psychopathological dimensions in schizophrenia? Issues influencing their ascertainment.
During the last two decades, much effort has been made to precisely characterize the symptom dimensions of schizophrenia. A number of dimensional models have been proposed, the most popular of which has been a three-dimensional model consisting of psychotic, negative and disorganizational symptoms. This model, however, has been criticized as too simplistic, and more complex models have been proposed, although to date there has been no consensus as to the number and nature of dimensions necessary to account for the whole range of schizophrenic symptoms. In the present paper, the authors review the main methodological issues which have led to the current confusion about the number of dimensions underlying schizophrenic psychopathology. Among the main issues influencing the delimitation of dimensions are: statistical procedures for determining the number of factors, phase of the illness, level of analysis of symptoms (i.e., symptoms or groups of symptoms), and measurement instrument used. Studies analyzing either a broad range of symptoms or particular symptoms at a finer level have produced a rather complex picture of schizophrenic dimensions. There is evidence supporting the existence of eight major dimensions of psychopathology: psychosis, disorganization, negative, mania, depression, excitement, catatonia and lack of insight. The dimensional structure of symptoms becomes even more complex if one considers that these big dimensions can be further divided into more elementary components. A hierarchical approach for organizing the complex dimensional structure of schizophrenic symptoms is proposed.
Depression↗
Motor features in psychotic disorders. I. Factor structure and clinical correlates.
The dimensional structure of motor disorders remains largely unknown. This study aimed to ascertain the factor structure of motor signs and their clinical correlates in psychotic disorders. A sample of consecutive admissions of psychotic patients (n=187) was utilized to examine the factor structure of motor disorders as assessed by the Modified Rogers Scale (MRS). The relationship between motor dimensions and external variables was analyzed. A comparative examination of alternative factor solutions revealed that a six-factor structure, explaining 59% of the total variance, best fitted the 36 MRS items. This solution comprised the components of motor poverty, agitation, stereotypy/mannerisms, proskinetic, negativistic and dyskinetic. All the motor dimensions significantly improved over the psychotic episode. Motor dimensions differentially correlated with the syndromes of psychoses, with the association between motor poverty and the negative syndrome being particularly strong. Residual motor pathology, but not the acute one, was related to various clinical variables. Residual symptoms of motor poverty and stereotypy/mannerisms were associated with poor premorbid adjustment, more illness severity and a diagnosis of schizophrenia. It is concluded that the factor structure of motor disorders and its clinical correlates are rather more complex than generally acknowledged.
Adult↗
Motor features in psychotic disorders. II. Development of diagnostic criteria for catatonia.
Existing diagnostic criteria for catatonia have been based exclusively on theoretical assumptions. The present study aimed to develop empirical criteria for diagnosing catatonia. The same patient population (n=187) described in Part I (Peralta, V., Cuesta, M.J., Motor features in psychotic disorders. I. Factor structure and clinical correlates. Schizophr. Res., 00, 000-000) was used in this study. Fourteen catatonic signs with potential diagnostic value were cluster-analyzed to derive groups with and without a catatonic syndrome. Taking the cluster solution as the reference standard, the diagnostic value for individual signs was examined by means of multiple discriminant analysis, ROC analysis, and the parameters of sensibility, specificity, positive predictive power and negative predictive power. Cluster analysis divided the sample into a catatonic group (n=32) and a noncatatonic group (n=155). Discriminant analysis showed that 11 of the 14 potential diagnostic signs discriminated among groups: immobility/stupor, mutism, negativism, oppositionism, posturing, catalepsy, automatic obedience, echophenomena, rigidity, verbigeration and withdrawal. ROC analysis showed that any combination of three or more of these symptoms best fitted the cluster-derived catatonic syndrome. In conclusion, patients displaying three or more classical motor signs may be diagnosed with confidence as suffering from a catatonic syndrome.
Adult↗
Effects of olanzapine and other antipsychotics on cognitive function in chronic schizophrenia: a longitudinal study.
This study aimed to determine the effect of olanzapine and other antipsychotic drugs on cognitive functions after 6months of treatment. Baseline, 3month and 6month psychopathological and cognitive evaluations were made. Thirty-eight partially responsive outpatients with DSM-IV chronic schizophrenia diagnosis were included in the study. On the indication of their attending psychiatrists, 21 patients initiated treatment with olanzapine, and 17 remained on their previous treatment with other antipsychotic drugs. Cognitive assessments were blind to medication and psychopathological status. The olanzapine group presented a significantly greater improvement in negative symptomatology and verbal memory than the comparison group in repeated-measures of MANOVAs between baseline, 3month and 6month assessments. These differences remained statistically significant after covarying out gender, treatment with other atypical antipsychotics, biperidene doses and changes in positive and negative symptoms. In order to match previous differences between groups, cognitive baseline scores for each test were introduced as covariates, resulting in a significant improvement for the olanzapine group in negative symptomatology and the interference task of the Stroop test.We then re-analyzed the data, dividing the comparison group into two groups: risperidone-treated patients (n=9) and patients receiving conventional antipsychotic drugs (n=8). Post-hoc analyses between groups were carried out with baseline cognitive assessment as covariate. The olanzapine group improved significantly more than the risperidone group in negative symptomatology and in the interference task of Stroop test. The improvement in the number of categories of the Wisconsin Card Sorting Test was higher in risperidone patients than in those receiving olanzapine or conventional antipsychotic treatment. Conventional antipsychotic drugs did not present a significant improvement over atypical antipsychotic drugs in any cognitive function. In summary, in patients suffering from chronic schizophrenia, atypical antipsychotic agents were associated with slight differential improvements over time in attentional, verbal memory and executive functions compared with conventional neuroleptic drugs. No differential improvements were found in social functioning, verbal fluency, non-verbal domains of memory or visuo-motor abilities.
Adult↗
Classification issues in catatonia.
Kahlbaum described catatonia as a disorder in which mood syndromes were the primary features and the characteristic symptoms were the motor signs. In the present study, we examined the relationship between motor features and other syndromes of psychosis, the clinical validity of Kahlbaum's concept of catatonia, its relationship to schizophrenia and mood disorder, and its nosological position in relation to DSM-III-R, DSM-IV and Leonhard's classification of endogenous psychoses. Patients with Kahlbaum's catatonia differed from patients with schizophrenia or mood disorder in various demographic and clinical variables. Positive and negative motor syndromes, although interrelated, showed a different correlational pattern with other psychotic syndromes. Catatonia did not appear to fit into any particular nosological category, although this issue largely depends on whether schizophrenia and mood disorders are broadly or restrictively defined. When definitions are more restrictive as in Leonhard's system, catatonia seems to be better accommodated as a "third psychosis", i.e. described by the concept of cycloid psychosis.
Affective Disorders, Psychotic↗
Duration of illness and structure of symptoms in schizophrenia.
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Adult↗
The classification of first episode schizophrenia: a cluster-analytical approach.
OBJECTIVE: This paper examines, using data from the Cantabria First Episode Schizophrenia Study, the usefulness of subdividing, using a cluster analysis technique, this schizophrenia population into subgroups with similar symptoms profiles in terms of SANS and SAPS. METHOD: Diagnostic characteristics were determined using the Present State Examination (PSE-9) and the SANS/SAPS. Premorbid adjustment was assessed using a scale developed combining the Gittelman and Klein's Scales, and the Goldstein's scales. Social Adjustment was evaluated using the WHO-DAS. In addition clinical histories were used to assess the patients' clinical course. RESULTS: Our schizophrenic patients could be subtyped into four categories: negative, positive non-paranoid, simple and disorganized schizophrenia. There is an absence of significant association between the majority of the variables investigated and the four-cluster model. CONCLUSION: Even though our sample could be subtyped into different categories, the model does not show predictive power according to the 3-year follow-up data.
Acute Disease↗
Differentiating primary from secondary negative symptoms in schizophrenia: a study of neuroleptic-naive patients before and after treatment.
OBJECTIVE: The study examined the primary versus secondary character of negative symptoms in a group of first-episode, neuroleptic-naive psychotic patients before and after they started neuroleptic treatment. METHOD: Forty-seven inpatients with a first episode of schizophrenia or related psychotic disorders were examined for the presence of negative symptoms, psychosis, depression, and parkinsonism at admission to an inpatient psychiatric unit, before receiving neuroleptics, and at discharge an average 3.3 weeks later, after starting neuroleptic treatment. RESULTS: Although patients' mean scores on measures of positive, negative, and depressive symptoms decreased significantly over the treatment period, the mean rating of nonakinetic parkinsonism worsened. The mean rating of akinetic parkinsonism did not change significantly over the treatment period. Negative symptoms at admission were not predicted by positive or depressive symptoms at admission. Residual negative symptoms at discharge were mainly predicted by negative symptoms at admission (i.e., primary symptoms) and to a negligible degree by residual positive and depressive symptoms. Change in negative symptoms over the observation period was predicted to a marginal degree by change in depressive symptoms. CONCLUSIONS: Negative symptoms rated during a first psychotic episode before and after starting antipsychotic treatment are mainly primary in character and should be considered as a direct manifestation of the basic dysfunctions of schizophrenia.
Adult↗
Reappraising insight in psychosis. Multi-scale longitudinal study.
BACKGROUND: Many patients suffering from psychosis are unaware of their disorder and symptoms. AIMS: To investigate whether insight changes with time, and how it relates to patients' psychopathology, and to examine the correlations between insight scales in patients with psychoses. METHODS: Seventy-five consecutively admitted in-patients with schizophrenia, affective disorder with psychotic symptoms, or schizoaffective disorder were examined after remission of an acute episode and at follow-up (> 6 months). Three different scales were used to assess insight. RESULTS: To some extent, insight into past episodes improved over time in patients with psychosis, regardless of diagnosis. Few significant relationships between insight and psychopathology remained stable at follow-up. The higher the negative and disorganisation dimensions at baseline, the less did attitudes to treatment vary when tested at follow-up. No predictive value for variability of psychopathological dimensions was found for insight dimensions. The insight scales used were highly intercorrelated, suggesting that they measure the same construct. CONCLUSIONS: Insight and psychopathology seem to be semi-independent domains.
Adult↗
Negative parkinsonian, depressive and catatonic symptoms in schizophrenia: a conflict of paradigms revisited.
BACKGROUND: To study the interrelationship pattern of negative, depressive, parkinsonian and catatonic symptoms over an exacerbation phase of schizophrenia. METHOD: Forty-five inpatients with a DSM-IV diagnosis of schizophrenia or schizophreniform disorder were assessed at admission and discharge for negative, depressive, parkinsonian and catatonic symptoms. A subsample of patients unmedicated at admission (n=23) was specifically analyzed. RESULTS: Negative, parkinsonian and catatonic symptoms correlated significantly at both assessment points, as did their mean changes over the episode. At admission, depressive symptoms did not correlate with negative, parkinsonian or catatonic symptoms, but they did at discharge. Changes of depressive symptoms over the episode did not correlate with changes of the other groups of symptoms. In the patients who were unmedicated at admission, ratings of nonakinetic parkinsonism, unlike ratings of akinetic parkinsonism, worsened significantly after neuroleptic treatment. CONCLUSIONS: While negative, parkinsonian and catatonic symptoms are highly related features, depressive symptoms seem to be a relatively independent dimension of psychopathology in schizophrenia. Non-akinetic parkinsonian symptoms may be more useful than the akinetic symptoms in distinguishing primary from drug-induced negative symptoms.
Adult↗
Dimensional structure of psychotic symptoms: an item-level analysis of SAPS and SANS symptoms in psychotic disorders.
The factor structure of psychotic symptoms as assessed by means of the Scales for the Assessment of Positive and Negative Symptoms (SAPS and SANS) was examined in a sample of 660 psychotic inpatients. Analyses were conducted at item-level. Principal-component analysis (PCA) was used to extract factors, the OBLIMIN procedure to rotate factors, and the eigen value greater-than-one criterion to determine the number of factors. PCA resulted in 11 interpretable factors explaining 64% of the total variance: poverty of affect/speech, thought disorder/inappropriate affect, bizarre delusions, social dysfunction, other delusions, paranoid delusions, bizarre behavior, nonauditory hallucinations, auditory hallucinations, manic thought disorder, and attention. Many of the factors were significantly intercorrelated. A second-order PCA resulted in four second-order factors, the first three roughly corresponding to the well-known psychosis, disorganization and negative dimensions. It is concluded that the factor structure of psychotic symptoms is more complex than is generally acknowledged, and that the dimensions of psychosis, disorganization and negative represent second-order dimensions. The subscale composition of the SAPS and SANS was not supported.
Adult↗