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Aim: Explore the possible association between clinical factors and genetic variants of the dopamine pathways and negative symptoms. Materials & methods: Negative symptoms were assessed in 206 patients with schizophrenia using the Arabic version of the self-evaluation of negative symptoms scale and the Positive and Negative Syndrome Scale. Genotyping for COMT , DRD2 , MTHFR and OPRM1 genes was performed. Results: Multivariable analysis showed that higher self-evaluation of negative symptoms scale scores were significantly associated with higher age, higher chlorpromazine-equivalent daily dose for typical antipsychotics and in married patients. Higher negative Positive and Negative Syndrome Scale scores were significantly associated with women and having the CT genotype for MTHFR c.677C>T (β = 4.25; p = 0.008) compared with CC patients. Conclusion: Understanding both clinical/genetic factors could help improve the treatment of patients.

Background: The self-evaluation of negative symptoms scale (SNS) is a new easy-to-use self-administered questionnaire allowing clinicians to understand the clinical and genetic factors affecting the negative symptoms in patients with schizophrenia. There was a need to translate and validate this scale in Arabic so that Arab-speaking patients benefit from it. Therefore, the aim of our study was to validate the Arabic version of the SNS in a sample of Lebanese patients with schizophrenia., Methods: The Arabic SNS was used to quantify the disability associated with negative symptoms in patients with schizophrenia (n = 206). Six weeks after completing the SNS, the participants were interviewed again to assess test-retest reproducibility. The validity was confirmed by factor analyses using the principal component analysis technique with a varimax rotation. The Positive and Negative Syndrome Scale (PANSS) was also assessed., Results: None of the items of the SNS scale were removed; all items converged over a solution of five factors that had an eigenvalue > 1, explaining a total of 66.01% of the variance (Cronbach's alpha = 0.879; test part). The mean total SNS score was 17.33 ± 8.43 for the "test", and 16.35 ± 7.50 for the "retest". The correlation coefficients between the SNS total score and the PANSS scale and subscales were as follows: total PANSS (r = 0.044; p = 0.530), positive PANSS score (r = - 0.106; p = 0.131), negative PANSS score (r = 0.204; p = 0.003), and general psychopathological PANSS score (r = 0.03; p = 0.530)., Conclusion: This study is the first to validate the Arabic version of the SNS in patients with schizophrenia. Using this scale would help improve treatment by correctly assessing negative symptoms, thus optimizing treatment options.

Objectives: Negative symptoms can be present at any stage of schizophrenia but their evaluation remains challenging. Self-evaluations may be particularly useful in screening negative symptoms quickly and effectively. The purpose of this study was to determine the sensitivity, the specificity, and the threshold beyond which the negative symptoms are considered pathological in a comparative study between patients with schizophrenia and healthy subjects using the Self-assessment of Negative Symptoms (SNS)., Methods: One hundred and nine patients with schizophrenia and schizoaffective disorders (DSM-5) and 99 healthy controls were included and evaluated with the SNS. AUROC analyses were performed to assess the discriminant performance of the SNS scale for screening negative symptoms in the whole sample of patients but also in 2 patient sub-samples without high scores of depression or negative symptoms., Results: The SNS (AUROC = 0.942 ± 0.046; p < 0.001) appears to be an appropriate screening tool for distinguishing between SZ and HC with a threshold value of 7, and the sensitivity and specificity were 92.7% (95CI = [86.1-96.8]) and 85.9% (95CI = [77.4-92.1]) respectively. A threshold at 7 was also observed in the samples without patients with high level of depressive or negative symptoms., Conclusion: These results indicate that SNS might be a valuable tool for screening negative symptoms in clinical practice regardless the level of depressive and negative symptoms. Further studies using SNS in subjects at high risk for psychosis or with a first psychotic episode would be useful in the detection of negative symptoms., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Introduction: Schizophrenia is a disorder affecting 1% of the population and is associated with severe functional impairment. Negative symptoms are responsible for the majority of this impairment, and many patients with schizophrenia have negative symptoms. However, their evaluation is still a challenge. Thus, standardized assessments are needed to facilitate identification of these symptoms. Many tools have been developed, but most are based on observer ratings. Self-evaluation can provide an additional outcome measure and allow patients to be more engaged in their treatment. The Self-evaluation of Negative Symptoms (SNS) has been developed recently. This is a remarkably understandable instrument for patients with schizophrenia as it allows them to readily complete it without assistance, providing information with respect to their own perception of negative symptoms. The SNS is a self-assessment that permits patients to evaluate themselves in 5 dimensions of negative symptoms. This validation study for the SNS revealed good psychometric properties alongside satisfactory acceptance by patients., Aim: This study was to confirm the validation of the French version of the self-evaluation of negative symptoms (SNS)., Methods: Patients with schizophrenia or schizoaffective disorder according to the DSM-IV-R, with a stable regimen of anti-psychotic drugs for the last two months, aged more than 18 years old were eligible for the study. Symptoms were rated using the SNS, the Scale for the Assessment of Negative Symptoms (SANS), the Calgary Depression Scale for Schizophrenics (CDSS), the Brief Psychiatric Rating Scale (BPRS) and the Clinical Global Impression and Parkinsonism. Patients were asked to fulfill the SNS twice, 6 weeks apart., Results: Sixty patients were evaluated. Cronbach's coefficient (α=0.8) showed good internal consistency. The SNS significantly correlated with the SANS (r=0.6), the negative sub-score of the BPRS (r=0.6) and the Clinician Global Impression on the severity of negative symptoms (r=0.7). SNS scores did not correlate with level of insight (r=0.08) or Brief Psychiatric Rating Scale positive sub-scores (r=0.2). SNS scores correlated with CDSS scores. However, we did not find correlation between the first item of the CDSS which evaluates depression and the "diminished emotional range" sub-score of SNS. The test-retest of SNS revealed no changes of scores at two evaluations 6 weeks apart., Conclusion: The acceptance by patients of the SNS was excellent. The French version of the SNS demonstrated a good internal consistency, good convergent validity and good discriminant validity. The study demonstrates the ability of patients with schizophrenia to accurately report their own experiences. Self-assessments of negative symptoms should be more widely employed in clinical practice because they may allow patients with schizophrenia to develop appropriate coping strategies., (Copyright © 2017 L’Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.)

Schizophrenia is a severe chronic mental disorder that mainly manifests by positive symptoms, negative symptoms, disorganized behavior and thought and cognitive impairments. Taken together, these symptoms have substantial impact on quality of life, well-being and functional outcome. Patients with schizophrenia have dramatically higher levels of cardiovascular and metabolic morbidity than the general population due to poor physical fitness and to sedentary lifestyle. They have a reduced life expectancy, and an excess mortality being two or three times more than that in the general population. Moreover, despite major therapeutic advances in the overall management of these patients, some symptomatic dimensions, and more specifically the negative and cognitive ones, remain to be resistant to the usual pharmacological approaches. Moreover, antipsychotics can also reinforce the global cardiovascular risk due to side effects and low neurometabolic tolerance. The benefits of physical activity on health are now well described in the general population and in many medical diseases. More recently, physical activity has also found its place as an adjuvant therapy in severe mental illnesses, particularly in schizophrenia. In the literature physical activity programs, in addition to pharmacological treatments, appear to be feasible in patients and improve both physical and mental health as well as functional outcome. Clinical benefits of physical activity would be underpinned by biological and cerebral mechanisms, which remain unclear. In this review, we propose to present a state of the art and to present an update of the interests of physical activity in the management of patients with schizophrenia. We emphasize the clinical benefits of physical activity regarding the different symptomatic dimensions and its impact specifically on cognitive deficits. Finally, we describe the various underlying pathophysiological mechanisms in particular in the neurobiological, cerebral and physiological fields. We then discuss the barriers, facilitators and motivating factors towards physical activity to enhance health promotion initiatives, to optimize resource allocation when delivering physical activity programs in clinical practice, and to maximize physical activity participation. Physical activity appears to be an original and novel adjunctive therapeutic approach in the management of patients with schizophrenia and would both reduce schizophrenic symptoms and act like pro-cognitive therapy, improve quality of life and long-term functioning in daily life and reduce cardiovascular comorbidities. However, efforts are still needed to increase the motivating factors and adherence towards physical activity participation for people with schizophrenia., (Copyright © 2018 L’Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.)

Current conceptualizations of schizophrenia have been introduced over centuries and continue to progress in recent decades. Symptoms have been divided into several domains, contrasting negative and positive symptoms which are different in their nature, onset, progression and response to treatment. An account of the different historical changes of the concept – essentially nosographic – has led to models attempting to integrate findings for each dimension of the disorder. This paper reviews the history of negative symptoms in diagnosis and how different approaches have been utilised to consider negative symptoms in the concept of schizophrenia. The paper also bridges various international classifications which have evolved and modified the role of negative symptoms in their diagnostic criteria for schizophrenia, which highlights the challenge of defining this disease.

Reliable and valid assessment of negative symptoms is crucial to further develop etiological models and improve treatments. Our understanding of the concept of negative symptoms has undergone significant advances since the introduction of quantitative assessments of negative symptoms in the 1980s. These include the conceptualization of cognitive dysfunction as separate from negative symptoms and the distinction of two main negative symptom factors (avolition and diminished expression). In this review we provide an overview of existing negative symptom scales, focusing on both observer-rated and self-rated measurement of negative symptoms. We also distinguish between measures that assess negative symptoms as part of a broader assessment of schizophrenia symptoms, those specifically developed for negative symptoms and those that assess specific domains of negative symptoms within and beyond the context of psychotic disorders. We critically discuss strengths and limitations of these measures in the light of some existing challenges, i.e. observed and subjective symptom experiences, the challenge of distinguishing between primary and secondary negative symptoms, and the overlap between negative symptoms and related factors (e.g. personality traits and premorbid functioning). This review is aimed to inform the ongoing development of negative symptom scales., (Copyright © 2016 Elsevier B.V. All rights reserved.)

Introduction: Negative symptoms are a fundamental dimension of schizophrenia despite their limited role in the international diagnostic classification. Although a consensual definition seems to be attempted regarding the main negative dimensions (anhedonia, alogia, social withdrawal, blunted affect, avolition), several standardized assessment scales have been created., Objectives: The objective of this study was to identify a set of unidimensional instruments which allows an assessment of negative symptoms in schizophrenia and also to identify their general characteristics and the items included., Methods: Inclusion criteria were: (a) the unidimensional assessment scales of negative symptoms of schizophrenia; (b) instruments in English (with French versions if possible); (c) all assessment instruments, the oldest and the most recent. The investigation ended in February 2013., Results: Twelve unidimensional instruments were identified with only one of them based on a self-administered survey (MAP-SR). The number of items included is from 6 (SDS) to 25 (SANS). The fastest instrument is the HEN (5-10min) and the longest is the SANS (30min). The MASS needs an evaluation by another person (family or care-giver). Most instruments need to be handled and take place during a semi-structured or structured psychiatric interview. The SANS allows an assessment of the most important number of negative domains (11 domains). On the other side, we have the MAP-SR (3 domains). The most frequently evaluated domains are emotional blunting, alogia, social withdrawal, anhedonia and avolition. On the other side, we have mood and thought disorders. Only SDS allows to distinguish the primary and secondary negative symptoms., Discussion: The oldest instruments (SANS, NSA-16, SDS) are more complicated to handle and to use. The SANS is the most complete instrument but there are more recent instruments which are easier to use and handle (BNSS, CAINS). Using a self-evaluation survey, MAP-SR is judicious as this type of evaluation is reliable. However, in this case, the assessment covers only a limited part of the negative symptoms., Conclusion: Despite some progress in the definition, assessment and treatment of negative symptoms and despite new scales further instruments which are easy to use in clinical practice and integrating the patient's self-report are needed., (Copyright © 2016 L’Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.)

Schizophrenia is a mental disorder characterized by language disorders. Studies reveal that both a functional dysconnectivity and a disturbance in the integrity of white matter fibers are implicated in the language process in patients with schizophrenia. Here, we investigate the relationship between functional connectivity within a language-comprehension network and anatomical connectivity using fiber tracking in schizophrenia. We hypothesized that patients would present an impaired functional connectivity in the language network due to anatomical dysconnectivity. Participants comprised 20 patients with DSM-IV schizophrenia and 20 healthy controls who were studied with functional magnetic resonance imaging and diffusion tensor imaging. The temporal correlation coefficient and diffusion values between the left frontal and temporal clusters, belonging to the language network, were individually extracted, in order to study the relationships of anatomo-functional connectivity. In patients, functional connectivity was positively correlated with fractional anisotropy, but was negatively correlated with radial diffusivity and/or mean diffusivity, in the left arcuate fasciculus and part of the inferior occipitofrontal fasciculus, determined as the fronto-temporal tracts. Our findings indicate a close relationship between functional and anatomical dysconnectivity in patients with schizophrenia. The disturbance in the integrity of the left fronto-temporal tracts might be one origin of the functional dysconnectivity in the language-comprehension network in schizophrenia., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

Unlabelled: Studies and meta-analyses investigating the influence of substance use disorder (SUD) (substance abuse or dependence) on psychopathology and neurocognitive function in schizophrenia patients have revealed controversial results. Most studies did only have small samples and did not focus exclusively on first-episode schizophrenia patients., Method: In a post-hoc analysis of the European First Episode Schizophrenia Trial (EUFEST) psychopathology and cognitive performances of patients with (FE-SUD, N=119, consisting of N=88 patients with persisting SUD at baseline and N=31 patients with previous SUD) and without SUD (FE-non-SUD, N=204) were compared at baseline and 6 months follow-up. Neurocognitive assessment included the Rey Auditory Verbal Learning Test (RAVLT); Trail Making Tests A and B (TMT), Purdue Pegboard and Digit-Symbol Coding., Results: In total 31.1% of patients reported SUD, and 22.2% of patients used cannabis. There were no significant differences between patients with and without SUD concerning PANSS scores, extrapyramidal motor symptoms or neurocognitive measures except better performance in psychomotor speed (TMT-A, p=0.033, Cohen's d=0.26) in patients with SUD at 6 months follow-up. Interestingly, SUD patients with ongoing substance use at follow-up showed elevated positive symptoms (PANSS positive score, p=0.008, Cohen's d=0.84) compared to those who abstained. PANSS scores at baseline were increased in patients with an onset of SUD before the age of 16 years. In addition we found a correlation between longer duration of cannabis use and higher cognitive performance as well as reduced symptom improvement and more extrapyramidal motor symptoms in patients with higher frequency of cannabis consumption., Conclusions: FE-SUD and FE-non-SUD show similar psychopathology and neuropsychological performances at baseline and during the first 6 months of antipsychotic treatment., (Copyright © 2013 Elsevier B.V. All rights reserved.)

Background: Up to now, studies have not demonstrated significant efficacy of antipsychotics on cognitive impairments in patients with psychotic disorders. These cognitive deficits are of particular interest since they traditionally start early before the diagnosis of psychosis. They are observed during premorbid and prodromal stages, and during the first episode of psychosis. Moreover, cognitive impairments may be detected without any psychotic symptoms (such as positive symptoms) suggesting their development independently of the psychotic symptoms. Cognitive disturbances consist of impairments of episodic and working memories, intellectual functioning, executive functions (planning, inhibition, and cognitive flexibility), selective and sustained attentions and social cognition (emotion, recognition, theory of mind). The altered cognitive functions observed in schizophrenia are the same as in earlier stages but at a lower level of severity., Literature Findings: Data suggest that cognitive deficits can be considered as vulnerability markers of psychosis since they have been described in healthy relatives of psychotic patients with high genetic risk. Cognitive deficits might also be considered as predictive of the occurrence of the disease after the first episode of psychosis. Indeed, retrospective studies suggest cognitive impairments in patients with schizophrenia during premorbid and prodromal phases but not in bipolar patients. Cognitive assessment might be of particular interest in people at risk for psychosis, in order to differentiate diagnostic outcomes. Cognitive functioning impairs until the diagnosis of first episode psychosis, even though cognitive profiles are quite heterogeneous in these patients. Once the diagnosis of schizophrenia is considered, cognitive deficits may be stable, although the literature is still controversial. Several factors such as symptoms and gender can contribute in diversifying the cognitive profiles. Moreover, age of onset might worsen the prognosis because of a disruption of the cognitive development and the disturbance of scholarship in young individuals., Discussion: Considering these results, the treatment of cognitive deficits should be initiated as soon as possible, e.g. in people at risk for psychosis in order to reinforce the normal cognitive development, prevent cognitive decline and to preserve the educational, professional and social status. Since antipsychotic medications do not impact on cognitive functioning, alternative therapeutics should be developed such as cognitive remediation. Several studies and meta-analyses have shown that cognitive remediation programs are particularly efficient in patients with schizophrenia or bipolar disorders. Contrary to antipsychotics, these techniques should be used in patients with a first psychotic episode, but also in individuals with subpsychotic symptoms, subthreshold to the diagnosis of schizophrenia., (Copyright © 2013. Published by Elsevier Masson SAS.)

A prerequisite to longitudinal fMRI studies in schizophrenia is the knowledge on fMRI signal reliability in schizophrenia patients. We assessed the reproducibility of activations elicited by two fMRI sessions, which were 21 months apart, of a story listening paradigm in 10 schizophrenia patients and 10 healthy subjects. In both groups, we observed a high degree of spatial overlap of activation maps as well as a good reproducibility of signal variations assessed on a voxel-wise basis in temporal areas underlying early stages of language processing. Task performance, assessed through a comprehension questionnaire, had no impact on the activation reproducibility., (Copyright © 2011 Elsevier B.V. All rights reserved.)

We evaluated hemispheric lateralization of language production in non-right-handed (NRH) patients with schizophrenia compared with matched right-handed (RH) patients, NRH control, and RH control subjects. First, the ability to generate verbs during overt training trials was checked in 78 subjects. They were then evaluated with functional magnetic resonance imaging (fMRI) while performing a covert verb generation task. No significant interactions between illness and handedness and no illness effect were observed in functional asymmetry. There was significantly less leftward asymmetry of the inferior frontal, precentral, and supramarginal gyri as well as the intra-parietal sulcus in non-right-handers compared to right-handers taking into account the task performances. Our findings suggested that decreased lateralization for language production was more closely related to handedness than to schizophrenia., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

Background: Longitudinal functional magnetic resonance imaging (fMRI) studies in patients with schizophrenia allow exploration of the course of the illness and brain activity after therapy. A crucial question, however, is whether fMRI findings are reliable, because they can be affected by performance deficits in patients with schizophrenia. Our aim was to evaluate the reproducibility of fMRI activations in highly integrated language areas in patients with schizophrenia, taking into account task performance., Methods: Ten patients with schizophrenia and 10 matched healthy controls were scanned twice, 21 months apart, while performing a story comprehension task. The reproducibility of the activations in each participant was evaluated globally by the percentage of spatial overlap between the 2 sessions and locally by a voxel-wise computation of the between-session relative standard deviation. We performed between-group comparisons both with and without the inclusion of comprehension scores (measuring task performance) as a covariate., Results: On average, patients with schizophrenia had significantly lower comprehension scores than controls (4.5/12 v. 7.8/12, p = 0.002). The mean spatial overlap between fMRI sessions was 30.6% in the patient group and 47.0% in the control group (p = 0.017). Locally, the lower reproducibility in patients was most prominent in the left posterior middle temporal gyrus, inferior frontal gyrus and medial prefrontal cortex (p < 0.001 uncorrected for multiple comparisons). Comprehension scores were positively correlated with both reproducibility measures in patients (overlap: r = 0.82, p = 0.004; relative standard deviation: several significant clusters at p < 0.001). When we included the comprehension scores as a covariate, most of the local between-group differences in reproducibility were removed, and the difference in overlap was not significant., Limitations: Owing to the small sample size, we could not investigate the impact of clinical subtypes and different types of medications on reproducibility., Conclusion: Our findings suggest that the greater variability in activation in patients with schizophrenia compared with controls concerns high-level areas and is mainly attributable to deficient task performance. Consequently, cognitive performance must be carefully controlled when longitudinal fMRI studies are undertaken.

Background: Profile and correlates of cognitive deficits in first episode (FE) schizophrenia patients are still debated. The present study is aimed to clarify in a large sample of FE patients the extent of impairment in key cognitive domains and its relationships with demographic and clinical variables., Method: The European First Episode Schizophrenia Trial collected demographic, clinical and neurocognitive baseline data in 498 FE patients with minimal or no prior exposure to antipsychotics. Two-hundred-twenty healthy subjects (HS) were also evaluated. Neurocognitive assessment included the Rey Auditory Verbal Learning Test; Trail Making A and B, Purdue Pegboard and Digit-Symbol Coding., Results: Patients performed worse than HS on all tests (effect sizes from -0.88 to -1.73). Correlations with psychopathological dimensions were weak and involved reality distortion and disorganization. The duration of untreated psychosis (DUP) was not associated with cognitive impairment. Subjects living alone had a better neurocognitive performance, while the occupation status did not reveal any association with cognition., Conclusions: A moderate/severe impairment of processing speed, motor dexterity, verbal memory and cognitive flexibility was found in the largest sample of FE patients analyzed so far. The impairment was largely independent from psychopathology and not associated with DUP.

Objective: We and others have observed that patients with schizophrenia commonly presented a reduced left recruitment in language semantic brain regions. However, most studies include patients with leftward and rightward lateralizations for language. We investigated whether a cohort comprised purely of patients with typical lateralization (leftward) presented a reduced left recruitment in semantic regions during a language comprehension task. The goal was to reduce the inter-subject variability and thus improve the resolution for studying functional abnormalities in the language network., Methods: Twenty-three patients with schizophrenia (DSM-IV) were matched with healthy subjects in age, sex, level of education and handedness. All patients exhibited leftward lateralization for language. Functional MRI was performed as subjects listened to a story comprising characters and social interactions. Functional MRI signal variations were analyzed individually and compared among groups., Results: Although no differences were observed in the recruitment of the semantic language network, patients with schizophrenia presented significantly lower signal variations compared to controls in the medial part of the left superior frontal gyrus (MF1) (x=-6, y=58, z=20; Z(score)=5.6; p<0.001 uncorrected). This region corresponded to the Theory of Mind (ToM) network. Only 5 of the 23 patients (21.7%) and 21 of the 23 (91.3%) control subjects demonstrated a positive signal variation in this area., Conclusions: A left functional deficit was observed in a core region of the ToM network in patients with schizophrenia and typical lateralizations for language. This functional defect could represent a neural basis for impaired social interaction and communication in patients with schizophrenia.

Previous studies analyzing semantic priming in schizophrenic patients have reported conflicting results. In the present study, we explored semantic priming in a sample of schizophrenic patients with mild thought disorders. We wondered if distinct cognitive processes, such as facilitation and/or inhibition, underlie semantic hyperpriming and are variously impaired in schizophrenic patients. Using a lexical decision task, we evaluated semantic priming in 15 schizophrenic patients (DSM-IV) with mild thought disorders and 15 healthy controls matched for sex, age, and education level. The task was designed to divide semantic priming into two additive components, namely facilitation effect and inhibition effect. One-sample t-tests were performed to investigate differences in semantic priming, facilitation, and inhibition within each group. ANOVAs were performed to compare the effects of semantic priming, facilitation, and inhibition between groups. Patients displayed greater semantic priming than controls (i.e., hyperpriming), but this was not due to increased facilitation in processing semantically related pairs. On the contrary, hyperpriming was the result of prolonged response time to process semantically unrelated pairs, corresponding to a requirement to inhibit unrelated information. We demonstrated semantic hyperpriming in stabilized schizophrenic patients with mild severity of symptoms. Thus, semantic hyperpriming may be an intrinsic feature of schizophrenia that is not related to the clinical state of patients. Semantic hyperpriming was due to an inhibition effect involved in processing semantically unrelated information not to increased facilitatory effect for related pairs.

Introduction: This article is a review of studies using the semantic priming paradigm to assess the functioning of semantic memory in schizophrenic patients., Context: Semantic priming describes the phenomenon of increasing the speed with which a string of letters (the target) is recognized as a word (lexical decision task) by presenting to the subject a semantically related word (the prime) prior to the appearance of the target word. This semantic priming is linked to both automatic and controlled processes depending on experimental conditions (stimulus onset asynchrony (SOA), percentage of related words and explicit memory instructions). Automatic process observed with short SOA, low related word percentage and instructions asking only to process the target, could be linked to the "automatic spreading activation" through the semantic network. Controlled processes involve "semantic matching" (the number of related and unrelated pairs influences the subjects decision) and "expectancy" (the prime leads the subject to generate an expectancy set of potential target to the prime). These processes can be observed whatever the SOA for the former and with long SOA for the later, but both with only high related word percentage and explicit memory instructions., Literature Findings: Studies evaluating semantic priming effects in schizophrenia show conflicting results: schizophrenic patients can present hyperpriming (semantic priming effect is larger in patients than in controls), hypopriming (semantic priming effect is lower in patients than in controls) or equal semantic priming effects compared to control subjects., Discussion: These results could be associated to a global impairment of controlled processes in schizophrenia, essentially to a dysfunction of semantic matching process. On the other hand, efficiency of semantic automatic spreading activation process is controversial. These discrepancies could be linked to the different experimental conditions used (duration of SOA, proportion of related pairs and instructions), which influence on the degree of involvement of controlled processes and therefore prevent to really assess its functioning. In addition, manipulations of the relation between prime and target (semantic distance, type of semantic relation and strength of semantic relation) seem to influence reaction times. However, the relation between prime and target (mediated priming) frequently used could not be the most relevant relation to understand the way of spreading of activation in semantic network in patients with schizophrenia. Finally, patients with formal thought disorders present particularly high priming effects relative to controls., Conclusion: These abnormal semantic priming effects could reflect a dysfunction of automatic spreading activation process and consequently an exaggerated diffusion of activation in the semantic network. In the future, the inclusion of different groups schizophrenic subjects could allow us to determine whether semantic memory disorders are pathognomonic or specific of a particular group of patients with schizophrenia.

We assessed the subjective quality of life (QOL) of 30 deficit schizophrenic patients compared to 112 nondeficit schizophrenic patients. The deficit patients did not differ in term of QOL, total score of positive symptoms, general psychopathology from the nondeficit patients. This result suggested an absence of impact of primary negative symptoms on the subjective QOL in schizophrenic patients.

Frontal cognitive inabilities have been amply described in schizophrenic patients with negative symptoms, but findings are controversial. These discrepancies could be due to the fact that negative symptoms are heterogeneous, composed of primary and secondary negative symptoms. The hypothesis tested was that executive/attentional dysfunctions would be significantly more impaired in patients with primary than in patients with secondary negative symptoms independently of IQ, the severity of negative or positive symptoms, treatments and side effects. Fifty-six DSM-IV schizophrenic patients characterized either by primary or secondary negative symptoms and 56 controls matched on age, sex and level of education were assessed with executive/attentional cognitive tests. The categories score of the Modified Card Sorting Test (MCST) and the Verbal Fluency Test, which reflect solving and organizing skills, were significantly more impaired in the primary negative subtype than in the secondary negative subtype. In contrast, scores on the MCST (perseveration), the Trail Making Test and the Stroop Color Word Test, which test the ability to inhibit an automatic response, did not differ between the two subtypes. In conclusion, this study supports the view that primary and secondary negative symptoms could be associated with different levels of executive/attentional dysfunctions.

Background: In some reports, summer birth has been associated with deficit schizophrenia. Deficit schizophrenia and nondeficit schizophrenia also differ in several other ways., Objective: To conduct a combined analysis of the published and unpublished data sets from the northern hemisphere that relate deficit and nondeficit schizophrenia to month of birth., Data Sources: Studies of season of birth in which it was possible to make a deficit/nondeficit categorization., Study Selection: Published studies with samples of convenience and all known population-based studies with the deficit/nondeficit categorization were included. The studies came from 6 countries., Data Extraction: Three published studies of samples of convenience, 2 population-based prevalence studies, and 5 population-based studies that approximated incident samples were included. Month of birth was compared for deficit and nondeficit schizophrenia, using meta-analytic fixed-effects models., Data Synthesis: A group x month goodness-of-fit chi2 showed a significant difference between deficit and nondeficit subjects in season of birth (P < .001) in the studies that approximated incidence. This difference was largely due to an increase in deficit schizophrenia births in June and July (odds ratio, 1.9; 95% confidence interval, 1.3-2.9). Similar results were found in the prevalence studies. A similar pattern was found in 2 of the 3 samples of convenience, but when combined, these 3 samples did not show a significant deficit/nondeficit difference., Conclusions: Deficit schizophrenia has a season of birth pattern that differs from that of nondeficit schizophrenia. This analysis supports the notion of a separate disease within schizophrenia.

The purpose of this study was to investigate the neurofunctional substrate of verbal learning and memory impairments in schizophrenic patients. In this pilot study, our aim was to compare the memory disturbance of schizophrenic patients to the subcortico-frontal memory profile of Parkinson's disease (PD) patients. The California Verbal Learning Test, a verbal episodic memory test, was administered to 60 subjects, 20 patients with schizophrenia, 20 patients with PD and 20 healthy control subjects. All subjects were aged between 50 and 70 years and all patients were in a stable phase. Like the Parkinson patients, the schizophrenic patients showed a major deficit of retrieval characterized by deficit of recalls but contrarily to PD patients, schizophrenic patients' encoding scores were altered. These impairments in episodic memory could suggest a dysfunction of the subcortico-frontal circuits in schizophrenic patients. However, they demonstrated an additional encoding deficit associated with probable frontal in situ alteration.

The aim of this study was to determine whether executive/attentional cognitive performances could be considered as markers of vulnerability to schizophrenia. The Stroop Color Word and fluency tests were significantly impaired in schizophrenic patients and their parents compared to controls matched on age and sex while performances on Nelson's Modified Card Sorting Test and the Trail Making Test did not differ. The impairments on the Stroop and fluency could be considered as endophenotypic markers of schizophrenia.

Objective: Proton magnetic resonance spectroscopy (1H-MRS) was used to study medial prefrontal metabolic impairments in schizophrenic patients with the deficit syndrome., Method: The subjects were 22 schizophrenic patients categorized as deficit (N=5) or nondeficit (N=17) and 21 healthy subjects. (1)H-MRS was performed for the right and the left medial prefrontal cortex., Results: The patients with the deficit syndrome had significantly lower ratios of N-acetylaspartate to creatine plus phosphocreatine than did the healthy subjects or nondeficit patients., Conclusions: As N-acetylaspartate levels could reflect neuronal density and/or viability, this finding suggests a neuronal loss in the medial prefrontal cortex of deficit patients.

Background: Discrepancies in the biochemical research on negative symptoms in schizophrenia may be ascribed to the lack of differentiation into primary and secondary negative symptoms. We have used Carpenter's criteria to define the deficit syndrome of schizophrenia as the presence of enduring and primary negative symptoms and measured catecholaminergic parameters in deficit as compared with nondeficit schizophrenics., Methods: We have investigated plasma homovanillic acid (pHVA) and 3-methoxy-4-hydroxyphenylglycol (pMHPG) concentrations in 34 DSM-III-R neuroleptic-treated schizophrenic patients who were classified into deficit (n = 14) and nondeficit (n = 20) forms of schizophrenia. All these patients were in a stable clinical and therapeutic status for the preceding 12 months., Results: The 14 deficit schizophrenic patients had lower plasma levels of pHVA and higher plasma concentrations of pMHPG from 9 AM to 12 AM as compared with the 20 nondeficit schizophrenic patients. The two groups did not differ on any demographic, therapeutic, or clinical variable considered., Conclusions: Our data are consistent with the postulated distinct pathophysiological basis for the deficit syndrome of schizophrenia and suggest that opposite alterations in the pHVA or pMHPG levels may reflect specific changes in noradrenergic and dopaminergic functions in these deficit patients.

Beside the syndromic dichotomy (negative-positive), other symptomatic dimensions have been described in schizophrenia. A question of interest is, therefore, to know which symptom structures can be individualized to characterize schizophrenia. Using confirmatory factor analysis in 135 patients, a two-factor model (negative-positive), a three-factor model (negative-positive-disorganization) and a four-factor model (negative-positive-disorganization-relational) were primarily identified with SANS (Scale for the Assessment of Negative Symptoms) and SAPS (Scale for the Assessment of Positive Symptoms). In contrast, no models could be identified with PANSS (Positive and Negative Syndrome Scale). The results confirm the relevance of other syndrome dimensions, beside the negative and positive ones and suggest that SANS-SAPS was more useful than PANSS in identifying an adequate dimensional factor structure of schizophrenic symptoms.

Coined by Sifneos in 1972, alexithymia refers to a relative narrowing in emotional functioning, an inability to find appropriate words to describe their emotions and, a poverty of fantasy life. Although initially described in the context of psychosomatic illness, alexithymic characteristics may be observed in patients with a wide range of medical and psychiatric disorders: Parkinson disease, depression, anxiety, substance abuse and eating disorders. Flattening of affect and poverty of speech, major negative symptoms, referred to chronic schizophrenia: there is a lack of outward display of emotion. Accordingly, some disturbances of alexithymia's scores would be expected in schizophrenic patients. The purpose of this study was to estimate and compare the prevalence of alexithymia in deficit and non-deficit schizophrenia. The term "deficit symptoms" may be used as Carpenter, to refer specifically to those negative symptoms that are not considered secondary. The influence of patients' symptoms has also been studied on alexithymia scores: negative and positive symptoms of schizophrenia, depression, anxiety, anhedonia and effects of neuroleptics. Twenty-five patients, meeting DSM III-R criteria for schizophrenia have been studied. All of them treated by neuroleptics, were in a stable clinical status for at least one month. The patients have been categorized into deficit (n = 12) and non-deficit (n = 13) subgroups by one trained psychiatrist (SD), using the Schedule for the Deficit Syndrome. The subjects have been assessed by the same rater (IN), blind to deficit status, using six rating scales: Beth Israel Questionnaire (BIQ) and Toronto Alexithymia Scale (TAS) for alexithymia, Positive and Negative Syndrome Scale (PANSS), Montgomery and Asberg Depression Rating Scale (MADRS), revised Physical Anhedonia Scale (PAS), and finally, Extrapyramidal Symptom Rating Scale (ESRS). Using TAS, alexithymic characteristics were more prevalent in the deficit subgroup as compared to non-deficit subgroup (83% versus 30.76%; p < 0.01). Significant correlations were observed in the non-deficit subgroup between: TAS and anxiety (r = 0.743; p < 0.01), TAS and depression (r = 0.568; p < 0.05), BIQ and blunted affect (r = 0.636; p < 0.02), BIQ and poverty of speech (r = 0.629; p < 0.02). These correlations were not significant in the deficit group of patients. Alexithymia in schizophrenic patients seems to be a trait characteristic in deficit patients, and a state related to many symptoms, such as flattening of affect, poverty of speech, depression and anxiety in nondeficit patients.

Coined by Sifneos in 1972, alexithymia refers to a relative narrowing in emotional functioning, an inability to find appropriate words to describe their emotions, and a poverty of fantasy life. Although initially described in the context of psychosomatic illness, alexithymic characteristics may be observed in patients with a wide range of medical and psychiatric disorders: Parkinson disease, depression, anxiety, substance abuse and eating disorders. Flattening of affect and poverty of speech, major negative symptoms, referred to chronic schizophrenia: there is a lack of outward display of emotions. Accordingly, some disturbances of alexithymia's scores would be expected in schizophrenic patients. The aims of this study were: first to establish some correlations between alexithymia and some symptoms of schizophrenia, and second to estimate the intensity of alexithymia in negative versus positive and undifferentiated schizophrenic patients. Twenty-nine patients, meeting DSM III-R criteria for schizophrenia have been studied. All of them treated by neuroleptics, were in a stable clinical status for at least one month. The patients were assessed by one trained psychiatrist (IN) using six rating scales: Beth Israel Questionnaire (BIQ) for alexithymia, Positive and Negative Syndrome Scale (PANSS), Depressive Retardation Rating Scale (DRRS), Montgomery and Asberg Depression Rating Scale (MADRS), revised Physical Anhedonia Scale (PAS), and finally, Extrapyramidal Symptom Rating Scale (ESRS). In the total sample, the mean score of BIQ was 4.79 +/- 1.68 (mean +/- SD). Significant correlations were found between alexithymia and blunted affect (r = 0.376; p < 0.05), poverty of speech (r = 0.471; p < 0.01), anxiety (r = 0.370; p < 0.05), total score of DRRS (r = 0.370; p < 0.05), and motor subscore of DRRS (r = 0.429; p < 0.05). The patients with negative symptoms of schizophrenia had significantly higher total scores in alexithymia (p < 0.05), blunted affect (p < 0.0001), poverty of speech (p < 0.0001), anxiety (p < 0.05), total score of DRRS (p = 0.01) and his motor subscore (p < 0.0001) as compared to positive and undifferentiated subtypes. In our study, alexithymia seems to be correlated with negative and depressive symptoms in negative forms of schizophrenia, regardless of medication status.

Heterogeneity in schizophrenia is an old concept, already evoked by Kraepelin and Bleuler. During the XXth century, this conception has led to a multiplication of diagnostic systems, which allow to define similar groups of patients from a country to another. However, these systems cannot select homogeneous groups of patients, since they include "polythetic" diagnostic criteria. Moreover, comparison of groups selected by different diagnostic systems shows that they are very heterogeneous too. It is why a polydiagnostic approach could be a relevant strategy: this consists of using many diagnostic systems at the same time in order not to select an arbitrary subgroup of schizophrenic patients over another. Therefore, several ways are possible to isolate the most homogeneous groups of patients from the heterogeneous population obtained with the polydiagnostic approach, depending on the aim of the research. A first possibility is a dimensional approach, in individualizing syndromic dimensions from psychopathological scales using principal component analyses. This approach might be useful to test the efficiency of an antipsychotic on a syndromic dimension. A second possibility is to identify groups of patients characterized by the largest homogeneity inside each group and the largest differences between groups. One way to perform it is the cluster analysis. Authors present a study using such a method: 5 different subgroups are identified in 138 schizophrenic patients. This approach is useful to study a subgroup of patients in comparison with a control group. A third possibility is represented by Carpenter et al. approach (7) with the definition of the deficit syndrome; a very homogeneous group of patients defined by standardized criteria can be individualized and characterized by physiopathologic anomalies.

The heterogeneity of schizophrenia has led to a multitude of diagnostic criteria systems. Thus, the best strategy for schizophrenia research might be the use of several diagnostic systems simultaneously. This polydiagnostic approach can be associated with isolating subtypes of symptoms or patients. In this way, the authors present several approaches such as, first, dimensional approaches, second, cluster analyses, and third the selection of a very homogeneous subtype with standardized criteria. One homogeneous subtype can be represented by deficit schizophrenia according to Carpenter as defined by the Schedule of Deficit Syndrome.

The debate concerning the stable or instable aspect of schizophrenic symptomatology has lead the authors to study this phenomenon by taking into account, at the time of inclusion of a schizophrenic patient, such parameters as: the phase of the illness (acute, post-acute or stable) or the course (chronicity) as well as the relationship between the negative symptomatology variation and other symptomatic dimension variation (depression, akinesia, etc.), in follow-up studies. The results of these studies are clearly in favour of taking into consideration all or part of these parameters, to evaluate at best the stability of positive and negative schizophrenic symptoms.

Monoamine oxidases (MAO) A and B, which are encoded by two distinct genes located on the human X chromosome, are both involved in the oxidative metabolism of dopamine. Decreased levels of platelet MAO-B activity has been reported in patients with schizophrenia and genetic variation in MAO activity had been proposed as a significant factor in the etiology of this disease. We carried out an association study using two intragenic polymorphisms within the MAO-A and MAO-B genes in 110 schizophrenic patients and 87 control subjects. For each polymorphic marker, no significant difference in allelic frequencies was observed between patients and controls. Nevertheless, a trend toward an association between allele 1 of the MAO-B gene and paranoid schizophrenia was found. Our results do not support the hypothesis that inherited variants of MAO genes might play a major role in a genetic predisposition to schizophrenia. Since several previous reports found a low MAO-B platelet activity in patients with paranoid schizophrenia, the identification of polymorphisms related to enzyme activity would be useful.

Whereas the instability of positive symptoms over time is well recognized, the instability of negative symptoms is still debated. This controversy could be due to the fact that different negative symptoms have been studied in different phases of schizophrenia. We, therefore, hypothesized that some negative symptoms would improve whereas others would remain perfectly stable during the remission of the acute phase of illness. We further hypothesized that the changes in these negative symptoms would be linked to changes in other domains such as extrapyramidal, depressive and positive symptomatology. A broadly defined sample of schizophrenic patients was evaluated at admission and discharge of the hospital with the Scale for the Assessment of Negative Symptoms (SANS) and the Scale for the Assessment of Positive Symptoms (SAPS), the Montgomery and Asberg Depression Rating Scale (MADRS) and the Extrapyramidal Symptoms Rating Scale (ESRS). Doses of antipsychotic medications were converted into chlorpromazine-equivalents. Fifty-seven patients (mean age 40.3 years old) were included in the sample and followed-up during their hospitalization. All the sub-scores of the SANS-SAPS decreased significantly but 4 items of the SANS belonging to the affective flattening subscale (unchanging facial expression, decreased spontaneous movements, paucity of expressive gestures and lack of vocal inflections) and one item belonging to the alogia subscale (poverty of speech) did not vary significantly, showing the necessity of taking into account the individual items of the SANS rather than the subscale scores to evaluate the course of negative symptoms. Changes in all the SANS subscores except the alogia subscore were associated with variations in scores of other scales. The change in attentional subscores was positively correlated to the change in the positive formal thought disorder subscores, probably because both belong to the same syndrome. The change in affective flattening subscores was associated with changes in depressive and akinetic scores and 28% of the variance of the change in the affective flattening subscores was explained by the change in the MADRS scores. Changes in avolition-apathy and anhedonia subscores were also associated with changes in MADRS scores but not with the change in akinesia scores.

Despite the effectiveness of antipsychotic drugs in schizophrenia, many patients continue to have persistent positive symptoms like hallucinations. It has provided new interest for coping strategies used by hallucinated patients. Therefore the aim of the study was to explore the existence of such strategies in 50 schizophrenic patients defined by the presence of hallucinations. A specific questionnaire about coping strategies and a scale for the assessment of positive and negative symptoms were used. Our results showed that each patient developed at least one strategy, even rudimentary. Moreover, whenever the type of hallucinations, they developed specific coping strategies, most of the time logically used: they used them as much as they were efficace. So coping strategies should be taken into account for the clinical management of hallucinated patients. Learning of these strategies through behavioural and cognitive therapy could help patients suffering from resistant hallucinations.

Whereas Chapman's social and physical scales are the most used instruments for the assessment of anhedonia in schizophrenia, no French translation has been still validated by the authors. Therefore, the aim of this study was first to translate into French the both scales, and after back translation, to obtain the agreement of the original authors. Second, the aim was to establish values and to establish the cut-off beyond of which French subjects could be considered as anhedonic. One hundred and twenty-three subjects were included: 72 control subjects without mental disorders and 51 stable schizophrenic patients defined by the DSM III-R, ICD 9, ICD 10, RDC or Feighner criteria. According to the literature, schizophrenic patients had higher scores for both scales than control subjects (p < 0.001; Student t test). The social anhedonia scores are different due to cultural variations. The distribution of physical anhedonia scores in control subjects or in schizophrenic patients differed from normal distributions (respectively, p < 0.05; p < 0.0001; Shapiro-Wilks test). The distribution of social anhedonia scores differed from normal distributions (p < 0.01) only in schizophrenic patients but not in control subjects. By maximising the Younden indice [Sensitivity + Specificity -1], the cut-off of the physical anhedonia score was 18 (Younden indice = 0.45), and the cut-off of the social anhedonia score was 12 (Younden indice = 0.24). In using this cut-off, the French physical anhedonia scale had a good positive predictive value (evaluated by logistic regression) for schizophrenia. Therefore, a patient with a physical anhedonia score beyond 18 have a probability of 64% to be schizophrenic. In contrast, the social anhedonia scale was less discriminant for schizophrenia. Indeed, patient with a social anhedonia score beyond 12 have a probability of 52% to be schizophrenic. This French version of Chapman's anhedonia scales could be considered as an useful instrument to assess anhedonia, in particular physical anhedonia, in schizophrenic patients.

Taking into account the wellknown frequency of depressive and extrapyramidal symptoms in schizophrenia and the rare studies about their evolution, several questions can be raised: How do these different symptoms move? Are there specific characters of each of them? First, stability of negative symptoms evaluated by the Scale for the Assessment of Negative Symptoms (SANS) was studied among 57 schizophrenic patients at admission and at discharge. The course of negative symptoms was compared to that of depressive MADRS (Montgomery et Asberg Depression Rating Scale) and akinetic symptoms (Extrapyramidal Symptom Rating Scale). All the subscores of the SANS decreased significantly but 4 items belonging to the affective flattening subscale and one item belonging to the alogia subscale did not vary significantly, showing the necessity of taking into account the individual items of the SANS rather than the subscale scores to evaluate the course of negative symptoms. Changes in all the SANS subscores except the alogia and anhedonia subscores were associated with variations in scores of other scales. Correlations between the changes of negative symptoms and the changes of depressive symptoms showed the necessity to do more specific scales, for example, scales for depression in schizophrenia. Langlois-Théry et al. (1994) evaluated among 53 schizophrenic patients stabilized with neuroleptic treatment, depressive symptomatology with Echelle de Ralentissement Dépressif (ERD, Widlöcher, 1983) and MADRS, negative symptomatology (Positive and Negative Syndrome Scale) and akinesia (ESRS), to determinate whether ERD composed of 3 subscores (motor, ideic and subjective) could be able to evaluate the depressive symptomatology, independently of the measures of negative and akinetic symptomatology.(ABSTRACT TRUNCATED AT 250 WORDS)

Since the Bleuler's early writings, studies in schizophrenia have often shown a frequent occurrence of depression in the context of schizophrenia and also its implications for the morbidity and mortality of schizophrenic patients. The wide variability in the prevalence of depression (between 7 to 70% in post-psychotic period) is due in part to the difficulty in clearly separating depressive symptoms from akinesia induced by neuroleptic or negative symptoms and to the lack of a valid assessment of depressive symptoms in schizophrenic patients. Under these conditions, a better understanding of depressive symptomatology in schizophrenia seems to be necessary to go further in this area of research with clinical and therapeutical purposes. The "Echelle de Ralentissement Dépressif" (ERD, Widlöcher, 1983) was studied in a sample of 53 schizophrenic patients to determinate whether ERD composed of three subscores (motor, ideic and subjective) could be able to evaluate the subjective depressive symptomatology and whether its measure would be independent of negative symptoms or akinesia. Pearson's correlations and correlations with variables partialled out were used to compare ERD to Montgomery and Asberg Depression Rating Scale (MADRS, 1979) and to establish their relationship with Positive And Negative Syndrome Scale (PANSS< Kay, 1987) and an Extrapyramidal Symptom Rating Scale (ESRS, Chouinard & Ross-Chouinard, 1980). Fifty three in or outpatients (35 males and 18 females, mean age +/- standard deviation = 38.26 +/- 9.82) were evaluated in a stable condition (i.e., when the psychotic symptomatology and the neuroleptic treatment have been stabilized since 4 weeks). According to DESM III-R criteria, 49 patients met the diagnosis of schizophrenia (2 schizoaffective disorders and 2 schizophreniform disorders).(ABSTRACT TRUNCATED AT 250 WORDS)

Plasma homovanillic acid (pHVA) was measured over a 13 hr-period in 16 DMS-III-R schizophrenic patients, all treated with neuroleptic drugs and in a stable clinical and therapeutic status for the preceeding 12 months. Patients were categorized into deficit (n = 9) and nondeficit (n = 7) forms of schizophrenia according to the Schedule for the Deficit Syndrome (SDS) criteria. As compared to the nondeficit group, deficit patients display significantly lower mean pHVA concentrations from 9 AM to 12 AM and a lack of diurnal variations. None of the demographic, clinical, and therapeutic variables can explain these biological differences. These data suggest a specific biochemical basis for the deficit syndrome of schizophrenia as defined by the SDS criteria, that is, primary, enduring, negative symptoms.

The negative symptoms of schizophrenia have generated a great interest leading some authors (Crow, Andreasen, Kay) to delineate schizophrenic subtypes based on their presence or absence. Carpenter et al. have recently proposed another subtype, the deficit syndrome, based on Kraepelin's clinical description. This differs from other proposed negative subtypes and refers to the presence or absence of prominent, enduring and primary negative symptoms. Primary negative symptoms have to be due to psychophrenia itself, in other words, independent of factors such as depression, anxiety, akinesia... Kirkpatrick et al. have proposed the Schedule for the Deficit Syndrome (SDS) to reliably identify this deficit syndrome. Some studies using this instrument have supported the validity of the deficit syndrome concept. Particularly, deficit patients have clinical, neuropsychological, neurological, eye-tracking and brain imaging impairments compared to nondeficit patients. We realized a french translation of SDS and used it to study a biological index (plasma homovanillic acid, pHVA) among deficit and nondeficit schizophrenic patients. Our data suggest a specific biochemical basis for the deficit syndrome, ie, significant lower mean pHVA levels with a lack of diurnal variation for deficit patients. The french version of SDS was validated by Kirkpatrick after english back translation. We present here our psychometric data regarding reliability (assessed by weighted and unweighted kappa coefficients) and cohesiveness of the construct (assessed by rank-order correlations of each negative symptoms with the other five, using Spearman's rho). These data are quite significant and in agreement with the SDS authors.

With a polydiagnostic approach of schizophrenia in mind, the authors present, in french language, a computer-diagnostic instrument, essential for any research at the present time. This includes a 183-item checklist constructed from 14 diagnostic systems for schizophrenia and from Chronic Hallucinatory Psychosis (CHP), a typically french diagnostic entity, not recognized by English-speaking countries which do not individualize it from schizophrenia. This study tested the reliability in interviewing the patients simultaneously by 2 examiners with the checklist. The interrater agreement was excellent (Kappa from 0.75 to 1) for schizophrenic diagnoses under the systems CATEGO, DSM III-R, Feighner, ICD9, Langfeldt, Pull, Schneider and Taylor-Abrams. It was good (Kappa from 0.40 to 0.75) for the 6 other schizophrenic systems, Bleuler (k = 0.52; p > 0.01), Carpenter with a cut-off at 6 (k = 0.52; p < 0.05), ICD10 (k = 0.70; p < 0.01), New-Haven (k = 0.58), RDC (k = 0.59; p < 0.01), Vienne (k = 0.68; p < 0.01), and the Chronic Hallucinatory Psychosis (Pull) (k = 0.71; p < 0.01). The validity of the computer program was tested by the concordance (Cohen's Kappa) between the diagnoses established by a medical examiner and by computer, both obtained from the same collected data (the checklist). The tests show that the concordances were excellent for the 15 diagnoses for schizophrenia and CHP (Kappa form 0.75 to 1) and always above those obtained by the tests of interreliability.

The aim of this study was to investigate the relationship between depressive and positive symptoms, two positive symptom using scales (PANSS and SAPS) in samples defined by three schizophrenic diagnostic systems (DSMIII-R, ICD9 and Langfeldt) at difference phases of the illness and in taking into account the negative and extrapyramidal symptoms and the doses of neuroleptics. With both scales, correlations between depressive and positive symptoms were significantly negative in two diagnostic subgroups (DSMIII-R and Langfeldt) in the acute phase. These correlations were also significant when negative symptoms, subjective extrapyramidal signs and the doses of neuroleptics were partialled out. Only the extrapyramidal physician's score was intercorrelated with positive and negative symptoms. Among the positive symptoms, 'conceptual disorganization' (or 'positive formal thought disorder') and 'suspiciousness/persecution' were especially correlated negatively with depression. At the post-acute phase or at the residual phase, no significant correlation between depressive and positive symptoms was found in any diagnostic subgroup. These results show the necessity of taking into account the phase of illness and the diagnostic criteria in order to study depression in schizophrenia.

In the first part, the authors re-examined the concept of "hypothymie" described by J. Delay in 1946. "Hypothymie" is characterized by a mood disorder and particularly by an absence of mood and it is a fundamental syndrome of hebephrenia. From this syndrome "hypothymie", others signs will appear such as schizophrenic symptoms (characterized by attention disorder and formal thought disorder), paranoid symptoms or catatonic ones. Several authors, like J. Delay, had emphasized the importance of the mood disorder (an absence) in this pathology. It is the case of Kretschmer, Dide and Guiraud (who evoked the "athymhormie"), Bleuler, Kraepelin and also Stransky, Griesinger and at the beginning of the XIXth century, Haslam in England and Pinel in France. In the present time, "hypothymie" is related to some current concepts, especially the deficit forms of schizophrenia described by Carpenter and the schizophrenia type II defined by Crow. In the second part, the relationships between paranoid symptoms, depression and "hypothymie" were studied. The authors stressed the fact that there is an overlap between depressive and paranoid symptoms at the acute phase. They gave an illustration including 51 patients in an acute phase and in a stabilized one. In the acute phase, there was a negative correlation between positive symptoms and depressive symptoms in particular between conceptual disorganization, suspiciousness/persecution, positive formal thought disorder and depression (r = -0.65, p < 0.01; r = -0.57, p < 0.01; r = -0.66, p < 0.01 respectively). These correlations disappeared at discharge of the hospital and did not exist in the stabilized group.(ABSTRACT TRUNCATED AT 250 WORDS)

The discrepancies of studies on symptomatology and treatment of schizophrenia could be related to the selection of different patients diagnosed by one diagnostic system, different from a study to another. Therefore, we tested whether 14 diagnostic systems could include 51 patients differently as regard to the intensity of positive, negative or depressive symptomatology and to the phase of illness. The distribution of the patients in different sets of diagnosis has been carried out by a computer program and the symptomatology has been evaluated with PANSS and MADRS. Some diagnostic criteria like DSMIII-R, Langfeldt, Taylor, ICD 9 include negative and depressive patients preferentially. Others systems like Berner, Catego, ICD 9, New-Haven, Schneider, include more patients with acute than residual symptoms. These results show the importance of the choice of one or more diagnostic criteria depending on the aim of the study.