The Community Assessment Psychic Experience (CAPE): evaluation study of the Italian version

AbstractNegli ultimi anni il modello categoriale della psicosi e della schizofrenia in particolare, è stato riconsiderato a favore di una visione dimensionale. Questa assume che I sintomi psicotici differiscono in modo quantitativo dalle normali esperienze psichiche distribuendosi lungo un continuum che va dalla popolazione clinica affetta da schizofrenia ad individui con disturbo di personalità, fino alla popolazione generale che può mostrare esperienze simil psicotiche (Hanssen et al., 2003; Johns & Phil, 2005). Tale continuità fenomenologica è suggerita da studi che mostrano che le dimensioni del fenotipo della psicosi subclinica sono molto simili a quelle identificate nei disturbi clinici (Van Os et al. 2000; Van Os & Tamminga, 2007; Rossler et al., 2007). Sono state infatti riportate dimensioni positive e negative sia in ambito clinico che subclinico, mentre più incerta appare la presenza della dimensione disorganizzazione (Vollema & Hoijtink, 2000; van Os et al., 2002). Vari studi hanno riportato che i fenotipi clinico e non clinico condividono fattori di rischio, meccanismi psicologici ed i pattern epidemiologici (Sharpley & Peters,1999; Johns & van Os, 2001; van Os et al., 2001), fornendo un'ulteriore prova che l'espressione clinica e subclinica delle psicosi fanno parte dello stesso continuum

The effect of verbalization strategy on wisconsin card sorting test performance in schizophrenic patients receiving classical or atypical antipsychotics

BACKGROUND: A number of reports showed en encouraging remediation in some patients' executive deficits thanks to the use of 'information processing strategies'. Moreover the impact of antipsychotics on cognitive functions of the schizophrenics is an important issue, especially if an integrated psychosocial treatment is needed. The aim of this paper is to evaluate different executive performance and response to verbalization, a strategy of the Wisconsin Card Sorting Test (WCST) remediation, in subjects on classical vs atypical antipsychotic (AP) treatment. METHODS: Sixty-three schizophrenic subjects undertook the WCST under standard and modified (verbalization) administration. Subjects were stratified by the kind of WCST response (i.e. good, poor and remediable) and AP treatment (i.e. atypical vs. classical). RESULTS: Subjects on atypical APs showed a better performance than those on classical ones. More poor performers who did not remediate were seen in the sample with classical Aps while subjects who remediated the performance were seen in the subgroup with atypical APs only. An increase of perseverative and total errors was seen in poor performers subjects on classical APs. CONCLUSION: Subjects on atypicals showed a better cognitive pattern in terms of WCST performance. Since the naturalistic assignment of medication we cannot draw conclusions about its effect on cognitive performance and its interaction with cognitive remediation potential. However the data lead us to hypothesize that subjects with potential room for remediation did so with the atypical APs

Patterns of Structural MRI Abnormalities in Deficit and Nondeficit Schizophrenia

Negative symptoms of schizophrenia have generally been found in association with ventricular enlargement and prefrontal abnormalities. These relationships, however, have not been observed consistently, most probably because negative symptoms are heterogeneous and result from different pathophysiological mechanisms. The concept of deficit schizophrenia (DS) was introduced by Carpenter et al to identify a clinically homogeneous subgroup of patients characterized by the presence of primary and enduring negative symptoms. Findings of brain structural abnormalities reported by magnetic resonance imaging (MRI) studies focusing on DS have been mixed. The present study included 34 patients with DS, 32 with nondeficit schizophrenia (NDS), and 31 healthy comparison subjects, providing the largest set of MRI findings in DS published so far. The Schedule for the Deficit Syndrome was used to categorize patients as DS or NDS patients. The 2 patient groups were matched on age and gender and did not differ on clinical variables, except for higher scores on the negative dimension and more impaired interpersonal relationships in DS than in NDS subjects. Lateral ventricles were larger in NDS than in control subjects but were not enlarged in patients with DS. The cingulate gyri volume was smaller in NDS but not in DS patients as compared with healthy subjects. Both groups had smaller dorsolateral prefrontal cortex and temporal lobes than healthy subjects, but DS patients had significantly less right temporal lobe volume as compared with NDS patients. These findings do not support the hypothesis that DS is the extreme end of a severity continuum within schizophrenia