Skip to main content

Discussion

Discussion

It was found that clinical trials in schizophrenia are likely to utilize the PANSS for psychopathology as well as the set of AIMS, BARS and SAS for EPS assessment. Overall frequency in the assessment scales for schizophrenia in an effort to evaluate multiple domains within the illness appeared to be similar across years, except for more recent attention on cognition, functioning and subjective perspectives. The PANSS together with the set of AIMS, BARS and SAS may be regarded as ‘the standard’ in clinical trials for schizophrenia. This ‘standard’ set of assessment scales is expected to take about 60 minutes (30–40/5–10/10/10 minutes for the PANSS/AIMS/BARS/SAS, respectively).2 Such a time requirement obviously represents an obstacle for real-world practice.

 

Studies have utilized different scales for their different interests and we can not be entirely certain about which scales are adequate in a specific study. It is important to acknowledge that all assessment scales do have some pertinence across multiple illness domains. Furthermore, contrary to the naming, the QLS for example was designed to assess deficit symptoms and can well be regarded as a functional outcome measure in schizophrenia. On the other hand, an interpretation of clinical relevance on improvements in a part of the scales, or in subscales within the scale, remains somewhat complex although such a data presentation is sometimes found to focus on statistically significant differences.

 

Limitations of this paper include a limited number of years and studies investigated and an arbitrary classification of outcomes into domains. Outcome measures may be in part guided by the nature of the study (e.g., pharmacologic versus psychosocial) or the setting (e.g., real-world versus research). The year of publication (or tradition) of each rating scale is also an important factor since rating scales would require some time to become familiarized with (and years that accompany the citations serve to have a sense of the ‘age’ of the scales). Challenges with the existing rating scales are discussed below.

Comments

Popular posts from this blog

ADVOKATE: A Tool for Assessment of Eyewitness Evidence

ADVOCATE: A Tool for Assessment of Eyewitness Evidence It is a tool designed to assess the eyewitness evidence that how much it is reliable. It requires the user to respond to several statements/questions. Forensic psychologist, police or investigative officer can do it. The mnemonic ADVOKATE stands for: A = amount of time under observation (event and act) D = distance from suspect V = visibility (night-day, lighting) O = obstruction to the view of the witness K = known or seen before when and where (suspect) A = any special reason for remembering the subject T = time-lapse (how long has it been since witness saw suspect) E = error or material discrepancy between the description given first or any subsequent accounts by a witness.  Working with suspects (college.police.uk)

Diagnostic test for catatonia, the lorazepam challenge test

Benzodiazepines are the mainstay of the treatment of catatonia and are also helpful as a diagnostic probe. A positive Lorazepam Challenge Test validates the diagnosis of catatonia. After we examine the patient for signs of catatonia, 1 or 2 mg of lorazepam is administered intravenously. After 5 minutes, the patient is re-examined. If there has been no change, a second dose is given, and the patient is again reassessed (46, 78). A positive response is a marked reduction (e.g., at least 50%) of catatonic signs and symptoms, as measured with a standardized rating scale. Favorable responses usually occur within 10 min (46). If lorazepam is given intramuscularly or per os, the interval for the second dose should be longer: 15′ and 30′, respectively. Many clinicians will share the experience that a “lorazepam test” not only confirms the diagnosis of catatonia but that it also makes the underlying psychopathology apparent “by permitting mute patients to speak” (79). Analogous to the lorazepa

Classification of Depression According to the ICD-10

A first depressive episode, duration at least15 days →depressive episode (F32)  A first depressive episode, severe and rapid onset, duration less than 15 days →still depressive episode (F32) A depressive episode can be mild (2 core symptoms, 2 other symptoms from the list) (32.0) moderate (2 core symptoms, 3 or preferably 4 other symptoms) (32.1) Severe (3 core symptoms, 4 other symptoms) without psychotic symptoms (32.2) (no delusion, hallucination or stupor) Severe with psychotic symptoms (above plus either delusions, hallucinations or stupor) (F32.3) Delusions can be mood-congruent or incongruent (neutral delusions e.g. delusions of reference are considered mood incongruent. None of them count towards schizoaffective disorder unless one of the first-rank)  A mild and moderate depressive episode can be  with somatic syndrome (four or more somatic symptoms, or three very severe somatic symptoms) without somatic syndrome (three or less somatic symptoms, not severe)  A severe depressi