ABSTRACT
BACKGROUND: Although self-disorders are common in schizophrenia, little attention is paid to them in clinical practice. AIM: To provide an overview of the knowledge regarding self-disorders in schizophrenia in the context of diagnosis and treatment. METHOD: A description of the literature on the history, background, diagnosis and treatment of self-disorders in schizophrenia. RESULTS: From a phenomenological perspective, disturbances in the minimal self frequently occur in schizophrenia. Two self-disorders are described: decreased self-affection (reduced sense of ownership of experiences, reduced sense of authorship of actions) and hyperreflexivity (normally self-evident experiences receive disproportionate attention). Self-disorders are common in schizophrenia, but also in other psychiatric classifications. Partly due to the emphasis on reliability of DSM-5 classifications, there is limited interest in the self-disorders. Treatment focused on physical and social activity can probably enhance the basic sense of self. In addition, hyperreflexivity may be reduced by interventions aimed at acceptance, while targeting so-called erroneous cognitions may possibly worsen hyperreflexivity. CONCLUSION: Self-disorders in schizophrenia are common and insufficient attention is paid to self-disorders in research and clinical practice. More knowledge about self-disorders might lead to new insights into therapeutic options in schizophrenia.
Subject(s)
Cognition Disorders , Schizophrenia , Humans , Reproducibility of Results , Schizophrenia/diagnosis , Schizophrenia/therapy , Schizophrenic Psychology , Self ConceptABSTRACT
BACKGROUND: Clinical staging has been developed to capture the large heterogeneity in schizophrenia spectrum disorders. Including cognitive performance in the staging model may improve its clinical validity. Moreover, cognitive functioning could predict transition across stages. However, current evidence of the association between cognition and clinical staging is inconsistent. Therefore, we aim to assess whether cognitive parameters are associated with clinical stages in a large sample of patients with schizophrenia spectrum disorders and to identify cognitive markers at baseline that are associated with stage-transition at three and six-year follow-up. METHODS: We applied the staging model of Fusar-Poli et al. (2017) in 927 patients with non-affective psychotic disorders, assessed at baseline, and after three and six-year follow-up. Cognitive performance was assessed with a standard test battery. Generalized linear mixed models were used to analyze associations of cognitive performance with staging and stage-transition at follow-up. RESULTS: Findings showed that higher stages of illness were significantly associated with lower processing speed (F = 3.688, p = 0.025) and deficits in working memory (F = 6.365, p = 0.002) across assessments. No associations between cognitive parameters at baseline and stage-transition at three- and six-year follow-up were found. CONCLUSION: We conclude that processing speed and working memory were modestly associated with higher stages of illness in schizophrenia spectrum disorders, thereby slightly improving its clinical validity. However, associations were small and we found no evidence for predictive validity.
ABSTRACT
BACKGROUND: There are concerns about the declining efficacy of antidepressants and antipsychotics in clinical trials. A potential cause may be found in poor training practices to achieve sufficient inter-rater reliability (IRR). However, it is unknown whether IRR and training procedures are currently reported. AIM: To determine the proportion of publications concerning double-blind randomized controlled trials (RCTs) investigating antipsychotics or antidepressants that report IRR and training procedures. METHOD: We extracted all double-blind RCTs from five large meta-analyses concerning antidepressants and antipsychotics. Further, we conducted a Medline-search for double-blind RCTs investigating antidepressants from January 2016 - January 2020, and antipsychotics from January 2000 - January 2019. RESULTS: In 179 double-blind RCTs with antidepressants, only 4.5% reported an IRR coefficient whereas 27.9% reported on training procedures. Further, in 207 double-blind RCTs with antipsychotics, 11.2% reported an IRR coefficient and 34.8% reported training procedures. CONCLUSION: There is a substantial lack of reporting IRR and training procedures in RCTs with antidepressants and antipsychotics. Considering the implications of insufficient IRR, it is necessary to conduct and report training procedures and IRR. Reporting IRR and training procedures should be made mandatory by editorial boards of scientific journals.
Subject(s)
Antidepressive Agents , Antipsychotic Agents , Antidepressive Agents/therapeutic use , Antipsychotic Agents/therapeutic use , Humans , Reproducibility of ResultsABSTRACT
OBJECTIVE: The Clinician-Rated Dimensions of Psychosis Symptom Severity (CRDPSS) was presented in the DSM-5 as a new scale to assess the dimensional aspects of psychosis in daily clinical practice. However, agreement in CRDPSS-ratings among raters in clinical practice remains unknown. We examined the inter-rater reliability (IRR) and convergent validity of the CRDPSS. METHOD: Consecutively recruited outpatients with recent onset schizophrenia spectrum disorders were included between January 2015 and July 2018. We collected multiple CRDPSS measurements of 335 participants, of whom 179 PANSS measurements were available. IRR was determined by comparing the CRDPSS-ratings of psychiatrists with a vis-à-vis contact and CRDPSS observations based on a detailed clinical presentation. IRR was expressed in Krippendorff's alpha and we estimated convergent validity by studying associations with PANSS factors by Spearman's rank correlation coefficient. RESULTS: Inter-rater reliability scores measured in Krippendorff's alpha were low (0.35-0.64) for all items of the CRDPSS, except the item delusions (0.74). A three-factor model was found: 'deficit/motor symptoms', 'positive symptoms' and 'mood symptoms'. Positive associations between CRDPSS factors with PANSS factors were found. CONCLUSION: This study demonstrated that the IRR of the CRDPSS between raters in clinical practice was insufficient. We did find some supporting evidence for convergent validity of the CRDPSS, but these results should be interpreted carefully due to low IRR. Consequently, general implementation in clinical practice should be done with caution and we recommend assessors to be trained.
