The Canadian Journal of Psychiatry

Al though the prin ci pal brain tar get that all an tipsy chotic drugs at tach to is the do pamine D₂ re cep tor, tra di tional or typi cal an tipsy chot ics, by at tach ing to it, in duce ex tra py r a mi dal signs and symp toms (EPS). They also, by bind ing to the D₂ re cep tor, ele vate se rum pro lac tin. Atypi cal a ntipsy chot ics given in dos ages within the clini cally ef fec tive range do not bring about these adverse clini cal ef fects. To un der stand how these drugs work, it is im por tant to ex am ine the atypical an tipsychot ics' mecha nism of ac tion and how it dif fers from that of the more typi cal drugs.

This re view analy zes the af fini ties, the oc cu pan cies, and the dis so cia tion time- course of vari ous an tipsy chot ics at do pa mine D₂ re cep tors and at se ro tonin (5-HT) re cep tors, both in the test tube and in live pa tients.

Of the 31 an tipsy chot ics ex am ined, the older tra di tional an tipsy chot ics such as tri fluperazine, pi mozide, chlor pro maz ine, fluphe nazine, ha loperi dol, and flupen thixol bind more tightly than dopamine it self to the do pa mine D₂ re cep tor, with dis so cia tion con stants that are lower than that for do pa mine. The newer, atypi cal an tipsy chot ics such as queti apine, re moxi pride, clo zapine, ol a nzap ine, sert in dole, zi pra si done, and amisul pride all bind more loosely than do pa mine to the do pamine D ₂ re cep tor and have dis so cia tion con stants higher than that for do pa mine. These tight and loose bind ing data agree with the rates of an tipsy chotic dis so cia tion from the human- cloned D₂ recep tor. For in stance, ra dio ac tive ha loperi dol, chlor pro maz ine, and ra clo pride all dis s o ci ate very slowly over a 30- minute time span, while ra dio ac tive queti apine, clo zap ine, re moxi pride, and amisul pride dis so ci ate rap idly, in less than 60 sec onds. These data also match clini cal brain-imaging find ings that show ha loperi dol re main ing con stantly bound to D2 in hu mans un der go ing 2 posi tron emis sion to mo gra phy (PET) scans 24 hours apart. Con versely, the oc cu pa tion of D₂ by clo zap ine or queti apine has mostly dis ap peared af ter 24 hours.

Atypi cals clini cally help pa tients by tran siently oc cu py ing D₂ re cep tors and then rap idly dis so ci at ing to al low nor mal do pa mine neu ro trans mis sion. This keeps pro lac tin lev els nor mal, spares cog ni tion, and ob vi ates EPS. One the ory of atypi cal ity is that the newer drugs block 5-HT_2A re ceptors at the same time as they block do pa mine re cep tors and that, some how, this serotonin- dopam i n e bal ance con fers atypi cal ity. This, how ever, is not borne out by the re sults. While 5-HT_2A re cep tors are read ily blocked at low dos ages of most atypi cal an tipsy chotic drugs (with the im por tant ex ceptions of re moxi pride and amisul pride, nei ther of which is avail able for use in Can ada) the do s ages at which this hap pens are be low those needed to al le vi ate psy cho sis. In fact, the an tipsy chotic thresh old oc cu pancy of D ₂ for an tipsy chotic ac tion re mains at about 65% for both typi cal and atypi cal an tipsychotic drugs, re gard less of whether 5-HT_2A re cep tors are blocked or not. At the same time, the a ntipsy chotic thresh old oc cu pancy of D₂ for elic it ing EPS re mains at about 80% for both typi cal and atypi cal an tipsy chot ics, re gard less of the oc cu pancy of 5-HT_2A re cep tors.

The “fast- off-D ₂” the ory, on the other hand, pre dicts which an tipsy chotic com pounds will or will not pro duce EPS and hy per pro lac ti ne mia and which com pounds pres ent a rela tiv ely low risk for tar dive dyski ne sia. This the ory also ex plains why L- dopa psy cho sis re sponds t o low atypi cal an tipsy chotic dos ages, and it sug gests vari ous in di vidu al ized treat ment strategies.

To out line the cog ni tive un der stand ing of symp toms of schizo phre nia, such as de lu sions, hal lu ci na tions, and emo tional with drawal, and to re view the cog ni tive ther apy ap proach to ame lio rat ing these symp toms.

We iden ti fied stud ies ex am in ing cog ni tive fac tors as so ci ated with symp toms of schizo phre nia by elec tronic search (us ing Med line and Psycinfo). This pa per in te grates e xperimental find ings and clini cal treat ment.

Re cent stud ies fo cus ing on the psy cho logi cal as pects of schizo phre nia dem onstrate the im por tance of com mon cog ni tive bi ases and dis tor tions that are func tion ally related to the main te nance of symp toms. Un der stand ing the dis or der in cog ni tive terms pro vides a frame work for psy cho thera peu tic in ter ven tion. Adapt ing cog ni tive strate gies suc cess fully used in cog ni tive ther apy of de pres sion and anxi ety pro vides an im por tant adjunct to stan dard treat ment of schizo phre nia.

Given that the out come of cur rent treat ment for schizo phre nia re mains poor, at ten tion to thera pist train ing in psy cho logi cal ap proaches is es sen tial.

As pres sure mounts to re duce the number of costly acute care beds, gov ernments and the lit era ture pro pose top- down ra tios. Is this rea son able and fair to the re spon s ible medi cal of fi cers who, as the key care pro vid ers, will need to ad mit pa tients and de velo p dis charge plans in a reduced- beds en vi ron ment?

Treat ing phy si cians of all acute care in pa tients on a given day (n = 212) and all new acute care ad mis sions over a 2- week pe riod (n = 125) com pleted an adapted ver sion of the Not ting ham Acute Beds Use Sur vey (NABUS) Ques tion naire.

On a given day, only 62 of 212 in pa tients were un suited for any al ter na tive to acute care hos pi tali za tion. A floor ra tio of 18 acute care beds per 100 000 in habi tants seems ade quate for the catch ment area in ques tion, pro vided that al ter na tives to hos pi tali z ation are fully and ef fi ciently avail able. Al ter na tives es sen tially in volve an ar ray of the follow ing: su per vised resi den tial set tings, day hos pi tals, and in ten sive home care (2 to 6 hours weekly). The ra tio of in ten sive home care work ers re quired would be 25 per 100 000 in habi tants.

Schizo phreni form dis or der (SFD) has an un clear di ag nos tic and prog nos tic status within the psy chotic spec trum.

We stud ied 36 in pa tients ad mit ted to our ward be tween 1983 and 1993 due to SFD. The pa tients were con tacted an av er age of 12 years af ter in dex hos pi tali za tion, and we noted the course of their ill ness, as well as their pres ent di ag no sis.

Of the sam ple, 84% had ad di tional, mostly psy chotic, epi sodes dur ing the follow-up, and 70% had di ag no ses in the schizo phrenic spec trum (that is, schizo phre nia and schizoaf fec tive dis or der). A sur vival analy sis re vealed that con fu sion and the pres ence of at least 2 good prog nos tic fac tors (GPF) at in dex hos pi tali za tion pre dicted bet ter out come.

SFD seems to be an early mani fes ta tion of schizo phre nia. Only a few of those sam pled did not ex pe ri ence ad di tional re lapses—a pes si mis tic find ing at 12-year follow- up. The find ings of this study ac cord with DSM- IV cri te ria and the lit era ture regard ing the long- term prog no sis of SFD and the im por tance of the GPF.

Syn thèse des dif fi cultés de tra duc tion des tests, de scrip tion des méth odes de tra duc tion et des procédu res de vali da tion des tests. Ap pli ca tion à un ques tion naire de personnalité.

Le ques tion naire de per son nal ité de Freiburg (FPI-R) a été traduit et les tech niques de vali da tion d'un test lui ont été ap pli quées: rétro tra duc tion, pré test et révi sion par un comité d'ex perts soig neuse ment choisi.

Au moyen de la re vue de la docu men ta tion, les dif fi cultés de la tra duc tion du FPI-R sont explici tées, en par ticu lier les diffé rents types d'équiva lence langue source/langue ci ble (séman tique, tech nique, idio ma tique, liée à l'expé ri ence et con cep t uelle). Les procédu res sta tis tiques de vali da tion ne sont abordées que dans leurs prin ci pes.

La méth ode cou rante al liant tra duc tion et rétro tra duc tion est in suffi sante et doit s'ac com pag ner au mini mum d'un pré test et d'une révi sion à chaque étape par un comité d'ex perts. La pré sence d'ex perts mono lingues sem ble in dis pen sa ble pour met tre à jour les moin dres détails de la langue ci ble, là où les bi lingues peu vent éch ouer.

We per formed a lit era ture search us ing Med line and Psycinfo da ta bases and Goo gle Inter net search en gine.

We iden ti fied 6 clini cal prac tice guide lines (CPGs). All stress the need for an tipsychotic ther apy and psy cho so cial in ter ven tions. Dif fer ences lie in types of an tipsy chot i cs recom mended, du ra tion of an tipsy chotic trial, man age ment of ex tra py ra mi dal symp toms, and types of psy cho so cial in ter ven tions. Ar eas poorly ad dressed by all guide lines in clude defi n ition of the sta ble phase of schizo phre nia, man age ment of ad verse ef fects with atypi cal agents, man age ment of clo zap ine non re spond ers, and man age ment of per son al ity is sues.

Pub lished CPGs are help ful in the man age ment of the sta ble phase of schizo phrenia, al though no sin gle CPG se ries ap pears to ad dress all treat ment needs faced by prac tising clinicians.

Our pri mary ob jec tive was to cre ate and vali date the So cial Cue Rec og ni tion Test-C (SCRT-C), a Ca na dian test com pa ra ble with the origi nal SCRT.

We ad min is tered the SCRT-C and the origi nal SCRT to 111 nor mal un der graduate stu dents.

In our sam ple, the re li abil ity and va lid ity of the SCRT-C were mod er ately high and simi lar to those found with Cor rigan's SCRT. The re sults also sug gest that the Eng lish and French ver sions of the Ca na dian SCRT are equiva lent.

The SCRT-C is an ap pro pri ate in stru ment for as sess ing so cial cue rec og n ition in emo tional con texts.