Validity and Reliability Study of Turkish Version of Clinical Assessment Interview for Negative Symptoms (CAINS).

Introduction: This study aims to translate and investigate the validity and reliability of the Turkish version of the Clinical Assessment Interview for Negative Symptoms (CAINS), which has additional features compared to other scales in assessing negative symptoms in patients with schizophrenia. Methods: The Turkish version of CAINS was constructed upon an initial translation to Turkish, and an English back translation of the scale was later conducted. The patients diagnosed with schizophrenia (n=79) according to Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) diagnostic criteria were administered the Turkish version of CAINS, the Positive and Negative Syndrome Scale (PANSS), the Scale for the Assessment of Negative Symptoms (SANS), the Scale for the Assessment of Positive Symptoms (SAPS), the Calgary Depression Scale for Schizophrenia (CDSS), the Clinical Global Impression Scale (CGI), the Global Assessment of Functioning Scale (GAF) and the Simpson-Angus Extrapyramidal Side Effects Assessment Scale (SAS). In addition, two interviewers assessed the video recordings of 11 patients for reliability analysis. Results: Inter-rater reliability was found to be high (intraclass correlation coefficient (ICC): 0.831). Exploratory and confirmatory factor analyses indicated that Cronbach's alpha was 0.956 for the full scale, and the two-dimensional structure explained the scale better. In convergent validity analyses, CAINS overall scores correlated significantly with the SANS total score (r=0,932) and PANSS negative score (r=0,902). In discriminant validity analyses, CAINS overall scores markedly correlated with the SAPS total (r=0,615), PANSS positive (r=0,497) and PANSS general psychopathology (r=0,737) scores. Additionally, when CGI and GAF scores were considered covariant, the significant correlation of CAINS total scores with the SANS total and PANSS negative scores continued; however, the correlation with PANSS positive score was prominently reduced, and the correlation with PANSS general psychopathology disappeared. Conclusion: The Turkish version of the CAINS appears to be a valid and reliable tool with strong psychometric properties in a sample consisting of patients with schizophrenia.

Symptoms of exhibitionism that regress with bupropion: A case report.

Exhibitionistic Disorder, one of the paraphilic disorders, is a disease with an unknown etiology and causes significant distress and loss of function in the patient's life. Serotonergic antidepressants are generally preferred in the treatment of this Disorder. However, in this case, we report a patient who did not respond to serotonergic antidepressants but bupropion, an antidepressant with dopaminergic and noradrenergic activity. Therefore, bupropion should be considered a medical treatment alternative in case serotonergic antidepressants do not work efficiently in the treatment of Exhibitionism.

Augmentation of Antipsychotic Treatment with Memantine in Patients with Schizophrenia: A Systematic Review and Meta-Analysis. / Sizofreni Hastalarinda Antipsikotik Tedavinin Memantin ile Güçlendirilmesi: Bir Sistematik Gözden Geçirme ve Metaanaliz.

OBJECTIVE: Many patients with schizophrenia respond partially to treatment with antipsychotic medications. A wide range of pharmaceutical agents are utilized as augmentation therapy in order to increase the efficacy of antipsychotic medication treatment. Memantine which is a noncompetitive N-methyl-D-aspartate (NMDA) receptor antagonist is one such agent among these. In this study, by conducting a systematic review and meta-analysis we aimed to assess the efficacy of memantine augmentation on psychopathology in patients with schizophrenia receiving antipsychotic medication. METHOD: We analyzed double-blind, randomized, placebo-controlled trials of memantine add-on treatment in schizophrenia patients receiving antipsychotic medications. The primary outcome measure was amelioration of negative symptoms and the secondary outcome measures were amelioration of positive, total and general psychopathology symptoms. Publication bias was evaluated by Funnel plot and Egger test. RESULTS: Eleven studies (n=570) were included. Although memantine add-on treatment was superior to placebo for ameliorating negative symptoms (SMD=0.596, 95% CI=0.075-1.118, p=0.025), there were no statistically significant differences in the amelioration of general psychopathology (SMD=0.034, 95% CI=0.419-0.488, p=0.883), positive (SMD=-0.041, 95% CI=0.217-0.135, p=0.650) and overall (SMD=0.315, 95% CI=0.256-0.887, p=0.280) symptoms. No publication bias was observed between studies according to Funnel plots and Egger test results. CONCLUSION: Memantine augmentation treatment seems to be beneficial for particularly treating negative symptoms in schizophrenia patients. Further studies with larger sample size and longer follow-up durations are needed.

[Augmentation strategies in patients with schizophrenia who show partial response to clozapine treatment]. / Klozapin tedavisine kismi yanit veren sizofreni hastalarinda tedaviyi güçlendirme: bir sistematik gözden geçirme.

A significant proportion of patients with schizophrenia receiving clozapine remain with partial response. In this group of patients findings regarding addition of various psychotropics to ongoing clozapine treatment for augmentation are controversial. In this review, literature regarding the efficacy and safety of adjunctive agents in clozapine resistant schizophrenic patients is examined. Augmentation agents added to clozapine in treatment resistant schizophrenic patients consist of antipsychotics, antidepressants, mood stabilizers, other agents (eg. omega 3 fatty acids and glutamatergic agents) and electroconvulsive therapy (ECT) in this review. The number of controlled studies evaluating augmentation of clozapine in schizophrenia patients are highest for risperidone and lamotrigine add on treatments. However, the results of recent meta-analyses studies do not support any benefit of either agent as adjunct to clozapine treatment. Some evidence regarding the success of clozapine augmentation with amisulpride, aripiprazole, mirtazapine, omega 3 fatty acids and ECT have been obtained which needs further clinical investigation. Current findings from relevant clinical studies point that theses studies have limitations of small sample size, variable definitions of clozapine resistance, heterogenity of outcome measures and methodological designs and that sufficient evidence does not yet exist regarding the success of various adjunctive treatments for clozapine resistant patients.

Lamotrigine augmentation in patients with schizophrenia who show partial response to clozapine treatment.

BACKGROUND: Several placebo controlled studies investigating lamotrigine augmentation of clozapine in schizophrenia patients with partial response have shown varying results. The aim of this study was to further investigate the efficacy and safety of this augmentation strategy, and its effect on the glutamatergic system through utilizing mismatch negativity (MMN) component of auditory event related potentials. METHODS: The study was designed to evaluate the efficacy and safety of lamotrigine augmentation of clozapine in a 12-week, double-blind, placebo-controlled, prospective, randomized design. Thirty-four patients diagnosed according to DSM-IV schizophrenia criteria and with partial response to clozapine were included. Patients were randomized to 25mg/day of lamotrigine or placebo, gradually increasing up to 200mg/day on the 6th week. The change in psychopathology was assessed with Positive and Negative Syndrome (PANSS), Calgary Depression (CDS) and Clinical Global Impression-Severity (CGI-S) scales. A neuropsychological test battery was administered and MMN measurements were also obtained at baseline and endpoint. Safety evaluation included physical examination, UKU Side Effect Rating Scale (UKU) assessment and serum drug level measurements. RESULTS: No significant differences were found between the two treatment groups in PANSS Positive and General Psychopathology, CDS, neurocognitive test and UKU scores, as well as MMN measurements. PANSS Total, Negative and CGI-S scores showed significant improvement compared to lamotrigine in the placebo group. CONCLUSION: This study did not show any benefit of augmentation of clozapine with lamotrigine in schizophrenia patients with partial response. The need for further investigation of other augmentation strategies of clozapine in partially responsive schizophrenia patients is evident.