The Hierarchical Taxonomy of Psychopathology (HiTOP): A dimensional alternative to traditional nosologies.

Journal of Abnormal Psychology, Journal Year: 2017, Volume and Issue: 126(4), P. 454 - 477

Published: March 23, 2017

The reliability and validity of traditional taxonomies are limited by arbitrary boundaries between psychopathology normality, often unclear disorders, frequent disorder co-occurrence, heterogeneity within diagnostic instability. These went beyond evidence available on the structure were shaped a variety other considerations, which may explain aforementioned shortcomings. Hierarchical Taxonomy Of Psychopathology (HiTOP) model has emerged as research effort to address these problems. It constructs psychopathological syndromes their components/subtypes based observed covariation symptoms, grouping related symptoms together thus reducing heterogeneity. also combines co-occurring into spectra, thereby mapping out comorbidity. Moreover, it characterizes phenomena dimensionally, addresses boundary problems Here, we review development HiTOP relevant evidence. new classification already covers most forms psychopathology. Dimensional measures have been developed assess many identified components, syndromes, spectra. Several domains this ready for clinical applications. promises improve practice addressing shortcomings nosologies. provides an effective way summarize convey information risk factors, etiology, pathophysiology, phenomenology, illness course, treatment response. This can greatly utility diagnosis mental disorders. remains work in progress. However, is developing rapidly poised advance health care significantly science matures. (PsycINFO Database Record

Language: Английский

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Treatment-Resistant Schizophrenia: Treatment Response and Resistance in Psychosis (TRRIP) Working Group Consensus Guidelines on Diagnosis and Terminology

American Journal of Psychiatry, Journal Year: 2016, Volume and Issue: 174(3), P. 216 - 229

Published: Dec. 6, 2016

Research and clinical translation in schizophrenia is limited by inconsistent definitions of treatment resistance response. To address this issue, the authors evaluated current approaches then developed consensus criteria guidelines.

Language: Английский

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Cortical Brain Abnormalities in 4474 Individuals With Schizophrenia and 5098 Control Subjects via the Enhancing Neuro Imaging Genetics Through Meta Analysis (ENIGMA) Consortium

Biological Psychiatry, Journal Year: 2018, Volume and Issue: 84(9), P. 644 - 654

Published: May 14, 2018

Language: Английский

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The Clinical Assessment Interview for Negative Symptoms (CAINS): Final Development and Validation

American Journal of Psychiatry, Journal Year: 2013, Volume and Issue: 170(2), P. 165 - 172

Published: Feb. 1, 2013

A major barrier to developing treatments for negative symptoms has been measurement concerns with existing assessment tools. Fulfilling the top recommendation of National Institute Mental Health's Consensus Development Conference on Negative Symptoms, Clinical Assessment Interview Symptoms (CAINS) was developed using an iterative, empirical approach, and includes items assessing motivation, pleasure, emotion expression. The authors employed multiple analytic techniques develop CAINS here provide final development validation results.The structure, interrater agreement, test-retest reliability, convergent discriminant validity were assessed in a large diverse sample 162 outpatients schizophrenia or schizoaffective disorder recruited from four sites.Three poor psychometric properties removed, resulting 13-item CAINS. factor structure replicated, demonstrating two modestly correlated scales: expression (four items) motivation/pleasure (nine items). scales demonstrated good internal consistency, stability, agreement. Strong by linkages other symptom measures, self-report sociality, coded facial expressions. Discriminant shown independence depression, medication side effects, cognition. Notably, related real-world vocational, independent living, social/familial functioning.The is empirically evaluated measure symptoms. Findings indicate that brief yet comprehensive employable across wide range research clinical contexts.

Language: Английский

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Treatments of Negative Symptoms in Schizophrenia: Meta-Analysis of 168 Randomized Placebo-Controlled Trials

Schizophrenia Bulletin, Journal Year: 2014, Volume and Issue: 41(4), P. 892 - 899

Published: Dec. 20, 2014

Abstract Objectives Existing treatments for schizophrenia can improve positive symptoms, but it is unclear if they have any impact on negative symptoms. This meta-analysis was conducted to assess the efficacy of available symptoms in schizophrenia. Methods All randomized-controlled trials interventions until December 2013 were retrieved; 168 unique and independent placebo-controlled used. Negative symptom scores at baseline follow-up, duration illness, doses medication, type interventions, sample demographics extracted. Heterogeneity addressed with I2 Q statistic. Standardized mean difference values Symptom Rating Scale used each study calculated as main outcome measure. Results 6503 patients treatment arm 5815 placebo included. No evidence publication biases found. Most reduced follow-up relative placebo: second-generation antipsychotics: −0.579 (−0.755 −0.404); antidepressants: −0.349 (−0.551 −0.146); combinations pharmacological agents: −0.518 (−0.757 −0.279); glutamatergic medications: −0.289 (−0.478 −0.1); psychological interventions: −0.396 (−0.563 −0.229). significant effect found first-generation −0.531 (−1.104 0.041) brain stimulation: −0.228 (−0.775 0.319). Effects most not clinically meaningful measured Clinical Global Impression Severity Scale. Conclusions Relevance Although some statistically effects evident, none reached threshold improvement.

Language: Английский

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Neural synchrony indexes disordered perception and cognition in schizophrenia

Proceedings of the National Academy of Sciences, Journal Year: 2004, Volume and Issue: 101(49), P. 17288 - 17293

Published: Nov. 16, 2004

Current views of schizophrenia suggest that it results from abnormalities in neural circuitry, but empirical evidence the millisecond range activity has been difficult to obtain. In pursuit relevant evidence, we previously demonstrated is associated with abnormal patterns stimulus-evoked phaselocking electroencephalogram γ band (30–100 Hz). These may reflect impairments assemblies, which have proposed use γ-band oscillations as a mechanism for synchronization. Here, report unique finding that, both healthy controls and patients, visual Gestalt stimuli elicit oscillation phase-locked reaction time hence processes leading conscious perception stimuli. However, frequency this lower schizophrenics than individuals. This suggests although synchronization must occur Gestalt, occurs at because reduced capability networks support high-frequency brain schizophrenics. Furthermore, degree phase locking correlated hallucinations, thought disorder, disorganization patients. data provide linking dysfunctional circuitry core symptoms schizophrenia.

Language: Английский

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D-serine added to antipsychotics for the treatment of schizophrenia

Biological Psychiatry, Journal Year: 1998, Volume and Issue: 44(11), P. 1081 - 1089

Published: Dec. 1, 1998

Language: Английский

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Clozapinev. first- and second-generation antipsychotics in treatment-refractory schizophrenia: systematic review and meta-analysis

The British Journal of Psychiatry, Journal Year: 2016, Volume and Issue: 209(5), P. 385 - 392

Published: July 8, 2016

Although clozapine is the 'gold standard' for treatment-refractory schizophrenia, meta-analyses of this condition are lacking.We conducted a systematic review and meta-analysis treatment people with schizophrenia.We searched Cochrane Schizophrenia Group's trial register, PubMed EMBASE hand-searched key papers randomised controlled trials schizophrenia.Twenty-one 25 comparisons were included. The number needed to treat was 9. Clozapine superior positive symptoms in both short long term. In term only total negative symptoms, higher response rates. Both funding source dosage affected results. Higher baseline psychosis scores predicted better outcomes meta-regression.Clozapine disorder but if there no by 6 months medications lower adverse reactions should be considered.

Language: Английский

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The current conceptualization of negative symptoms in schizophrenia

World Psychiatry, Journal Year: 2017, Volume and Issue: 16(1), P. 14 - 24

Published: Jan. 26, 2017

Negative symptoms have long been conceptualized as a core aspect of schizophrenia. They play key role in the functional outcome disorder, and their management represents significant unmet need. Improvements definition, characterization, assessment instruments experimental models are needed order to foster research aimed at developing effective interventions. A consensus has recently reached on following aspects: a) five constructs should be considered negative symptoms, i.e. blunted affect, alogia, anhedonia, asociality avolition; b) for each construct, due identifiable factors, such medication effects, psychotic or depression, distinguished from those regarded primary; c) cluster two one including affect alogia other consisting avolition asociality. In this paper, we report current definition; highlight differences among main instruments; illustrate quantitative measures, if available, relationship with evaluations based rating scales; describe correlates well models. We conclude that: symptom dimension improved, but even expert consensus-based diverge several aspects; use objective measures might contribute overcome uncertainties about reliability scales, these require further investigation validation; boundaries illness components, particular neurocognition social cognition, not defined; d) without reducing heterogeneity within dimension, attempts develop successful interventions likely lead great efforts paid back by small rewards.

Language: Английский

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Intensive case management for severe mental illness

Cochrane database of systematic reviews, Journal Year: 2010, Volume and Issue: unknown

Published: Sept. 28, 2010

Intensive Case Management (ICM) is a community based package of care, aiming to provide long term care for severely mentally ill people who do not require immediate admission. ICM evolved from two original models Assertive Community Treatment (ACT) and (CM), where emphasises the importance small caseload (less than 20) high intensity input.To assess effects (caseload <20) in comparison with non-Intensive > standard severe mental illness. To evaluate whether effect on hospitalisation depends its fidelity ACT model setting.For current update this review we searched Cochrane Schizophrenia Group Trials Register (February 2009), which compiled by systematic searches major databases, hand conference proceedings.All relevant randomised clinical trials focusing illness, aged 18 65 years treated community-care setting, Management, or were compared. Outcomes such as service use, adverse effects, global state, social functioning, behaviour, quality life, satisfaction costs sought.We extracted data independently. For binary outcomes calculated relative risk (RR) 95% confidence interval (CI), an intention-to-treat basis. continuous estimated mean difference (MD) between groups (CI). We employed random-effects analyses.We performed meta-regression analysis examine association intervention's rate hospital use setting trial was conducted treatment effect.We included 38 (7328 participants) review. The provided comparisons: 1. versus 2. non-ICM.1. Twenty-four length hospitalisation, results favoured (n=3595, 24 RCTs, MD -0.86 CI -1.37 -0.34). There level heterogeneity, but significance still remained when outlier studies excluded (n=3143, 20 -0.62 -1.00 -0.23). Nine found participants group less likely be lost psychiatric services (n=1633, 9 RR 0.43 0.30 0.61, I²=49%, p=0.05).One state scale did show Improvement those receiving ICM, GAF (n=818, 5 3.41 1.66 5.16). Results measured through various rating scales, however, equivocal, no compelling evidence that really any better improving state. No differences mortality occurred, either due 'all causes' (n=1456, 0.84 0.48 1.47) 'suicide' 0.68 0.31 1.51).Social functioning varied, terms contact legal system employment status, whereas significant improvement accommodation status found, incidence living independently, lower (n=1185, 4 0.65 0.49 0.88).Quality life groups, weak. CSQ scores showed greater participant (n=423, 2 3.23 2.31 4.14).2. non-ICM failed advantage reducing average (n=2220, 21 -0.08 -0.37 0.21). They find more advantageous follow-up (n=2195, 0.72 0.52 0.99), although substantial heterogeneity (I²=59%, p=0.01). Overall, compared broad mortality, costs.3. Fidelity Within i. adherent model, it at decreasing time ('organisation fidelity' variable coefficient -0.36 -0.66 -0.07); ii. higher baseline population, ('baseline use' -0.20 -0.32 -0.10). Combining both these variables within 'organisation longer significant, 'baseline result significantly influencing (regression -0.18 -0.29 -0.07, p=0.0027).ICM effective ameliorating many illnesses. Compared shown reduce increase retention care. It also globally improved ICM's remains unclear. value least illnesses are sub-group (about days/month past years) intervention should close model.It clear, what gain provides top formal approach.We think comparing justified, currently know undertaken.

Language: Английский

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