The Brief Negative Symptom Scale (BNSS): Independent validation in a large sample of Italian patients with schizophrenia

BACKGROUND: The Brief Negative Symptom Scale (BNSS) was developed to address the main limitations of the existing scales for the assessment of negative symptoms of schizophrenia. The initial validation of the scale by the group involved in its development demonstrated good convergent and discriminant validity, and a factor structure confirming the two domains of negative symptoms (reduced emotional/verbal expression and anhedonia/asociality/avolition). However, only relatively small samples of patients with schizophrenia were investigated. Further independent validation in large clinical samples might be instrumental to the broad diffusion of the scale in clinical research. METHODS: The present study aimed to examine the BNSS inter-rater reliability, convergent/discriminant validity and factor structure in a large Italian sample of outpatients with schizophrenia. RESULTS: Our results confirmed the excellent inter-rater reliability of the BNSS (the intraclass correlation coefficient ranged from 0.81 to 0.98 for individual items and was 0.98 for the total score). The convergent validity measures had r values from 0.62 to 0.77, while the divergent validity measures had r values from 0.20 to 0.28 in the main sample (n=912) and in a subsample without clinically significant levels of depression and extrapyramidal symptoms (n=496). The BNSS factor structure was supported in both groups. CONCLUSIONS: The study confirms that the BNSS is a promising measure for quantifying negative symptoms of schizophrenia in large multicenter clinical studies

Social cognition in people with schizophrenia: A cluster-analytic approach

Background The study aimed to subtype patients with schizophrenia on the basis of social cognition (SC), and to identify cut-offs that best discriminate among subtypes in 809 out-patients recruited in the context of the Italian Network for Research on Psychoses. Method A two-step cluster analysis of The Awareness of Social Inference Test (TASIT), the Facial Emotion Identification Test and Mayer-Salovey-Caruso Emotional Intelligence Test scores was performed. Classification and regression tree analysis was used to identify the cut-offs of variables that best discriminated among clusters. Results We identified three clusters, characterized by unimpaired (42%), impaired (50.4%) and very impaired (7.5%) SC. Three theory-of-mind domains were more important for the cluster definition as compared with emotion perception and emotional intelligence. Patients more able to understand simple sarcasm (14 for TASIT-SS) were very likely to belong to the unimpaired SC cluster. Compared with patients in the impaired SC cluster, those in the very impaired SC cluster performed significantly worse in lie scenes (TASIT-LI <10), but not in simple sarcasm. Moreover, functioning, neurocognition, disorganization and SC had a linear relationship across the three clusters, while positive symptoms were significantly lower in patients with unimpaired SC as compared with patients with impaired and very impaired SC. On the other hand, negative symptoms were highest in patients with impaired levels of SC. Conclusions If replicated, the identification of such subtypes in clinical practice may help in tailoring rehabilitation efforts to the person's strengths to gain more benefit to the person

A naturalistic study comparing two initial duloxetine dosing strategies in a clinical "real world" setting

To compare, in a "real world" setting. the efficacy and tolerability of two initial duloxetine starting doses: 30 mg once daily (q.d.) for I week, followed by escalation to, 60 mg q.d. versus 60 mg q.d. without titolation, evaluating expecially effects on sexual dysfunction. Methods. The sample is Constituted by outpatients meeting diagnostic criteria for mild-severe (HAMD(17) >= 24 and CGI-S >= 4) Major Depressive Episode as defined by DSM-IV-TR (Diagnostic and Statistic Manual for Mental Disorder. Fourth Edition-Text Revision). based oil the Structured Clinical Interview for DSM-IV-TR (Mini International Neuropsychiatric Interview, MINI),The study design planned all initial evaluation and 4 follow-up visits at each visit the following scales were administered: Hamilton Rating Scale for Depression (HAMD(17)) and Anxiety (HAMA), Clinical Global Impression Severity Scale (CGI-S) for severity evaluation and Arizona Sexual Experience Scale (ASEX) for Sexual disfunction evaluation. Results. Both of the groups showed 90% of response (>= 50% reduction in a patient's HAMD(17) total score from baseline) within 2 months of follow-up. 50%, of patients receiving a 30 mg q.d. starting dose achieved a HAMD(17) total score <= 7 versus 40% of 60 mg q.d. treating group. None showed relapses during the study After the first treatment month, the 60 mg q.d. receiving group showed a statistical significative amelioration of sexual function (Mann-Whitney test: p=0,02). Conclusions. Our naturalistic "real world" study results confirm previous duloxetine tolerability and efficacy findings suggesting a 60 mg q.d. after meal duloxetine somministration without titolation

Ameloblastoma maxilar superior : presentación de caso clínico

Fil: Moreno, P. Universidad de Buenos Aires. Facultad de Odontología. Carrera de Especialización en Cirugía y Traumatología Bucomaxilofacial; Argentina.Fil: Ruiz, D. Hospital General de Agudos “General Manuel Belgrano”; Argentina.Fil: Attaguile, A. Hospital General de Agudos “General Manuel Belgrano”; Argentina.Fil: Benitez, J. Universidad de Buenos Aires. Facultad de Odontología. Cátedra de Cirugía y Traumatología Bucomaxilofacial III; Argentina.Fil: Mozzoni, L. Universidad de Buenos Aires. Facultad de Odontología. Cátedra de Cirugía y Traumatología Bucomaxilofacial III; Argentina.Fil: Trigo, F. Universidad de Buenos Aires. Facultad de Odontología. Cátedra de Cirugía y Traumatología Bucomaxilofacial III; Argentina.Fil: Giannunzio, G. Universidad de Buenos Aires. Facultad de Odontología. Cátedra de Cirugía y Traumatología Bucomaxilofacial III; Argentina.El ameloblastoma es una entidad patológica benigna de origen odontogénico, de alta agresividad local, lo que ha sido un punto de controversia en la literatura científica. Se presenta un caso clínico, con ubicación en maxilar superior con diagnóstico de ameloblastoma solido multiquístico. Se evalúa el caso, su posibilidad de tratamiento, revisando las características clínicas y anatomopatológicas de la entidad, basándose en una búsqueda bibliográfica

The influence of illness-related variables, personal resources and context-related factors on real-life functioning of people with schizophrenia.

In people suffering from schizophrenia, major areas of everyday life are impaired, including independent living, productive activities and social relationships. Enhanced understanding of factors that hinder real-life functioning is vital for treatments to translate into more positive outcomes. The goal of the present study was to identify predictors of real-life functioning in people with schizophrenia, and to assess their relative contribution. Based on previous literature and clinical experience, several factors were selected and grouped into three categories: illness-related variables, personal resources and context-related factors. Some of these variables were never investigated before in relationship with real-life functioning. In 921 patients with schizophrenia living in the community, we found that variables relevant to the disease, personal resources and social context explain 53.8% of real-life functioning variance in a structural equation model. Neurocognition exhibited the strongest, though indirect, association with real-life functioning. Positive symptoms and disorganization, as well as avolition, proved to have significant direct and indirect effects, while depression had no significant association and poor emotional expression was only indirectly and weakly related to real-life functioning. Availability of a disability pension and access to social and family incentives also showed a significant direct association with functioning. Social cognition, functional capacity, resilience, internalized stigma and engagement with mental health services served as mediators. The observed complex associations among investigated predictors, mediators and real-life functioning strongly suggest that integrated and personalized programs should be provided as standard treatment to people with schizophrenia