Cross-sectional similarities and differences between schizophrenia, schizoaffective disorder and mania or mixed mania with mood-incongruent psychotic features

European Psychiatry - Tập 19 Số 1 - Trang 8-14 - 2004
Stefano Pini1, Valéria de Queiroz1, Liliana Dell’Osso1, Marianna Abelli1, C. Mastrocinque1, Marco Saettoni1, Mario Catena1, Giovanni Battista Cassano1
1Department of Psychiatry, Neurobiology, Pharmacology and Biotechnology, University of Pisa, via Roma 65, 56100 Pisa, Italy.

Tóm tắt

AbstractBackground. – The cross-sectional clinical differentiation of schizophrenia or schizoaffective disorder from mood-incongruent psychotic mania or mixed mania is difficult, since pathognomonic symptoms are lacking in these conditions.Aims of the study. – To compare a series of clinical variables related to mood and cognition in patient groups with DSM-III-R diagnosis of schizophrenia, schizoaffective disorder, mood-incongruent psychotic mania and mood-incongruent psychotic mixed mania.Methods. – One hundred and fifty-one consecutive patients were evaluated in the week prior to discharge by using the structured clinical interview for DSM-III-R-patient edition (SCID-P). Severity of psychopathology was assessed by the 18-item version of the brief psychiatric rating scale (BPRS) and negative symptoms by the scale for assessment of negative symptoms (SANS). Level of insight was assessed with the scale to assess unawareness of mental disorders (SUMD).Results. – There were no differences in rates of specific types of delusions and hallucinations between subjects with schizophrenia, schizoaffective disorder, psychotic mania and psychotic mixed mania. SANS factors scores were significantly higher in patients with schizophrenia than in the bipolar groups. Patients with mixed state scored significantly higher on depression and excitement compared to schizophrenia group and, to a lesser extent, to schizoaffective group. Subjects with schizophrenia showed highest scores on the SUMD indicating that they were much more compromised on the insight dimension than subjects with psychotic mania or mixed mania.Conclusion. – Negative rather than affective symptomatology may be a useful construct to differentiate between schizophrenia or schizoaffective disorders from mood-incongruent psychotic mania or mixed mania.

Từ khóa


Tài liệu tham khảo

Cassidy, 2001, Insight is greater in mixed than in pure manic episodes of bipolar I disorder, J Nerv Ment Dis, 189, 398, 10.1097/00005053-200106000-00008

Freeman, 1999, Clinical picture and etiologic models of mixed states, Psychiatr Clin North Am, 22, 535, 10.1016/S0193-953X(05)70094-0

Akiskal, 2000, Re-evaluating the prevalence of and diagnostic composition within the broad clinical spectrum of bipolar disorders, J Affect Discord, 59, S5, 10.1016/S0165-0327(00)00203-2

Azorin, 1990, Plasma 3-methoxy-4-hydroxyphenylglycol in manic patients: relationships with clinical variables, Acta Psychiatr Scand, 81, 14, 10.1111/j.1600-0447.1990.tb06442.x

10.1016/0006-3223(95)00310-D

1987, Diagnostic and statistical manual of mental disorders, rev

10.1016/S0165-0327(96)01405-X

10.1176/appi.ajp.158.1.122

10.1001/archpsyc.1978.01770310017001

10.1001/archpsyc.1973.04200040066011

Dell'Osso, 2000, Clinical characteristics of mania, mixed mania, and bipolar depression with psychotic features, Compr Psychiatry, 41, 242, 10.1053/comp.2000.7432

10.1002/anxi.3070010611

Akiskal, 1979, Psychotic forms of depression and mania, Psychiatr Clin North Am, 2, 419, 10.1016/S0193-953X(18)30987-0

10.1192/bjp.175.5.467

Bunney, 1972, The switch process in manic-depressive illness, Arch Gen Psychiatry, 27, 295, 10.1001/archpsyc.1972.01750270005001

Coryell, 1992, Rapidly cycling affective disorder. Demographics, diagnosis, family history, and course, Arch Gen Psychiatry, 49, 126, 10.1001/archpsyc.1992.01820020046006

Benabarre, 2001, Bipolar disorder, schizoaffective disorder and schizophrenia: epidemiologic, clinical and prognostic differences, Eur Psychiatry, 16, 167, 10.1016/S0924-9338(01)00559-4

Dayer, 2000, A theoretical reappraisal of mixed states: dysphoria as a third dimension, Bipolar Disord, 2, 316, 10.1034/j.1399-5618.2000.020404.x

10.1016/0006-3223(92)90061-4

10.1016/S0165-0327(99)00111-1

Andreasen, 1982, Negative symptoms predictive of schizophrenia: definition and reliability, Arch Gen Psychiatry, 39, 784, 10.1001/archpsyc.1982.04290070020005

Cassano, 1998, Occurrence and clinical correlates of psychiatric comorbidity in patients with psychotic disorders, J Clin Psychiatry, 59, 60, 10.4088/JCP.v59n0204

Endicott, 1976, The global assessment scale. A procedure for measuring overall severity of psychiatric disturbance, Arch Gen Psychiatry, 33, 766, 10.1001/archpsyc.1976.01770060086012

10.1001/archpsyc.1987.01800130015003

Dell'Osso, 1993, Psychotic and non psychotic bipolar mixed states: comparisons with manic and schizoaffective disorders, Eur Arch Psychiatry Clin Neurosci, 243, 75, 10.1007/BF02191568

Dell'Osso, 2002, Insight into illness in patients with mania, mixed mania, bipolar depression and major depression with psychotic features, Bipolar Disord, 4, 315, 10.1034/j.1399-5618.2002.01192.x

Mackinnon, 1997, Panic disorder with familial bipolar disorder, Biol Psychiatry, 42, 90, 10.1016/S0006-3223(96)00299-5

McElroy, 1992, Clinical and research implication of the diagnosis of dysphoric or mixed mania or hypomania, Am J Psychiatry, 149, 1633, 10.1176/ajp.149.12.1633

10.1097/00005053-199205000-00006

Galynker, 1996, Panic attacks with psychotic features, J Clin Psychiatry, 57, 402

Amador, 1993, Scale to assess unawareness of a mental disorder. Assessment of insight in psychosis, Am J Psychiatry, 150, 873

Akiskal, 1994, The temperamental borders of affective disorders, Acta Psychiatr Scand Suppl, 379, 32, 10.1111/j.1600-0447.1994.tb05815.x

1994, Diagnostic and statistical manual of mental disorders, 378

Spitzer, 1987, Instruction manual for the structured clinical interview for DSM-III-R (SCID 4/1787 revision)

[41] SPSS Version 10.0 for Windows. Chicago, IL: SPSS Inc; 1999.

Dilsaver, 1997, Suicidality, panic disorder and psychosis in bipolar depression, depressive-mania and pure-mania, Psychiatry Res, 14, 47, 10.1016/S0165-1781(97)00109-1

10.1007/s004060070015

Atre-Vaidya, 1997, Differences in prevalence of psychosensory features among schizophrenic, schizoaffective, and maniac patients, Compr Psychiatry, 38, 88, 10.1016/S0010-440X(97)90086-9

10.1016/S0920-9964(99)00215-7

Haberman, 1978, Analysis of qualitative data, 1

Amador, 1994, Awareness of illness in schizophrenia and schizoaffective and mood disorders, Arch Gen Psychiatry, 51, 826, 10.1001/archpsyc.1994.03950100074007

10.2466/pr0.1962.10.3.799

10.1017/S0033291700030300

Andreasen, 1983, The specificity of Bleulerian and Schneiderian symptoms: a critical reevaluation, Psychiatr Clin North Am, 6, 41, 10.1016/S0193-953X(18)30839-6

Thông tin
Thông tin xuất bản

European Psychiatry

Tập 19 Số 1

8-14

Thông tin tác giả