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Frauke Schultze-Lutter, Jean Addington, Stephan Ruhrmann, Joachim Klosterkötter

Schizophrenia Proneness Instrument, Adult version (SPI-A)


Giovanni Fioriti Editore s.r.l.
Psychiatry: directed by Alfonso Troisi
(pp. 97, prezzo 25 euro)






    The Schizophrenia Proneness Instrument, Adult version (SPI-A), assesses a wide range of subtle, self-experienced disturbances first described as basic symptoms. Primarily designed to support the prediction of first-episode psychosis, it also facilitates a broad range of clinical and research issues across the different states of the illness.
    The SPI-A provides important insight into subclinical complaints and deficits that often precede frank psychotic episodes and maintain during remission. Hence, it mainly targets psychiatrists and psychologists with a clinical and scientific interest in psychoses but it may be relevant for other professionals, students, patients and families involved in the care of those with psychosis. Patients themselves might be supported by the SPI-A in expressing their subjective experiences that often appear to be hard to describe spontaneously.
    The SPI-A has its origins in the basic symptom concept first described by Gerd Huber. Basic symptoms are subtle, subclinical self-experienced disturbances in drive, stress tolerance, affect, thinking, speech, perception and motor action, which are phenomenologically clearly distinct from psychotic symptoms. They can be present before the first psychotic episode, between and after psychotic episodes, even during psychotic episodes themselves. They were thought to be the most immediate psychopathological expression of the somatic disturbance underlying the development of psychosis ­ thus the term 'basic'.
    Basic symptoms are phenomenologically different from mental states known to the patient/subject from what s/he considers his/her 'normal' self and thus are clearly distinguishable from subtle disturbances described as traits in those at genetic high-risk. In addition, basic symptoms are phenomenologically clearly distinct from attenuated or frank psychotic symptoms ­ employed in the 'ultra-high risk' (UHR) criteria of an imminent risk of first-episode psychosis ­ as they are not necessarily observable by others as are odd thinking and speech, negative symptoms and formal thought disorders. They are regarded as having originating in the subject, unlike schizotypal perceptual disturbances and hallucinations, and do not primarily affect thought content as do magical thinking, ideas of reference, paranoid ideation and delusions.

    Frauke Schultze-Lutter, PhD, is the scientific-psychological head of the Early Recognition and Intervention Centre for mental crises (FETZ) at the Department of Psychiatry of the University of Cologne, Germany, Europe's first early detection service starting its work in 1997. Her interest in subjective experiences in psychoses dates back to her student's days in Göttingen where she graduated in clinical psychology with the diploma thesis on basic symptoms in persons with mental retardation, schizophrenia and both.

    Jean Addington, PhD, is a Professor in the Department of Psychiatry at the University of Toronto; Canada, and the Director of the PRIME Clinic, a research clinic for individuals at risk of psychosis, at the Centre for Addiction and Mental Health in Toronto, Canada. She is currently the President of the International Early Psychosis Association.

    Stephan Ruhrmann, MD, is the medical head of the FETZ and assistant medical director of the Department of Psychiatry of the University of Cologne. He had coordinated the pharmacological multi-centre early intervention trial within the German Research Network on Schizophrenia and the European Prediction of Psychosis Study (EPOS) and has special interest in the biological correlates of the prodromal phase.

    Joachim Klosterkötter, Professor, MD, is the medical director of the Department of Psychiatry and dean of the Medical Faculty of the University of Cologne. As a co-author of the Bonn Scale for the Assessment of Basic Symptoms (BSABS) and with his postdoctoral lecture qualification on transition sequences from basic to psychotic symptoms, he has a long standing interest in the early detection of psychoses and is the PI of several national and international mono- and multi-centre studies on this topic.

      Index
        INTRODUCTION
        Basic symptoms and criteria for predicting psychosis
        The Schizophrenia Proneness Instrument
        General assessment criteria

        MANUAL, EXAMPLES, QUESTIONS AND RATING CRITERIA

        Affective-dynamic disturbances (A, ADYN)
        A1 Impaired tolerance to certain stressors (A.8./B.1.)
        A1.1 ... unusual, unexpected or specific novel demands (A.8.1./B.1.2.)
        A1.2 ... certain social everyday situations (A.8.2./B.1.3.)
        A1.3 ... working under pressure of time or rapidly changing different demands (A.8.3./B.1.4.)
        A2 Change in mood and emotional responsiveness (A.6.1.)
        A2.1 Change in mood
        A2.2 Change in emotional responsiveness
        A3 Decrease in positive emotional responsiveness towards others (A.6.3.)

        Cognitive-attentional impediments (B, ATTENT)
        B1 Inability to divide attention (A.8.4.)
        B2 Feeling overly distracted by stimuli (C.2.8.)
        B3 Difficulties concentrating (C.1.5.)
        B4 Difficulties to hold things in mind for less than an hour (C.1.9.)
        B5 Slowed-down thinking (C.1.12.)
        B6 Lack of 'thought energy' or goal-directed thoughts (C.1.13.)

        Cognitive disturbances (C, COGNIT)
        C1 Increased indecisiveness with regard to insignificant choices between equal alternatives (A.5.)
        C2 Thought interference (C.1.1.)
        C3 Thought blockages (C.1.4.)
        C4 Disturbance of receptive speech (C.1.6.)
        C5 Disturbance of expressive speech (C.1.7.)
        C6 Disturbance of immediate recall (C.1.8.)

        Disturbances in experiencing the self and surroundings (D, SELF)
        D1 Decreased capacity to discriminate between different kinds of emotions (A.6.2.)
        D2 Increased emotional reactivity in response to routine social interactions that affect the patient or his/her significant others (B.2.2.)
        D3 Thought pressure (C.1.3.)
        D4 Unstable ideas of reference, 'subject-centrism' (C.1.17.)
        D5 Changed perception of the face or body of others (C.2.3.5.)

        Body perception disturbances (E, BODY)
        General comments
        E1 Unusual bodily sensations of numbness and stiffness (D.1.)
        E2 Unusual bodily sensations of pain in a distinct area (D.3.)
        E3 Migrating bodily sensations wandering through the body (D.4.)
        E4 Electric bodily sensations, feelings of being electrified (D.5.)
        E5 Bodily sensations of movement, pulling or pressure inside the body or on its surface (D.7.)
        E6 Sensations of the body or parts of it extending, diminishing, shrinking, enlarging, growing or constricting (D.9.)

        Perception disturbances (F, PERCEPT)
        General comments
        F1 Hypersensitivity to light or certain optic stimuli (C.2.2.1.)
        F2 Photopsia (C.2.2.2.)
        F3 Micropsia, macropsia (C.2.3.2.)
        F4 Hypersensitivity to sounds or noise (C.2.4.1.)
        F5 Changes in the perceived intensity or quality of acoustic stimuli (C.2.5.1.)
        F6 Somatopsychic bodily depersonalization (D.1.1.) 59

        Optional: Additional items with a positive predictive value of equal or greater 0.70 according to the prospective CER-study (O)
        O1 Thought perseveration (C.1.2.)
        O2 Decreased ability to discriminate between ideas and perception, fantasy and true memories (C.1.15.)
        O3 Disturbances of abstract thinking (C.1.16.)
        O4 Other visual perception disturbances
        O4.1 Near and tele-vision (C.2.3.1.)
        O4.2 Metamorphopsia (C.2.3.3.)
        O4.3 Changes in colour vision (C.2.3.4.)
        O4.4 Changed perception of the patient's own face (C.2.3.6.)
        O4.5 Pseudomovements of optic stimuli (C.2.3.7.)
        O4.6 Diplopsia, oblique vision (C.2.3.8.)
        O4.7 Disturbances of the estimation of distances or sizes (C.2.3.9.)
        O4.8 Disturbances of the perception of straight lines or contours (C.2.3.10.)
        O4.9 Maintenance of visual stimuli, 'visual echoes' (C.2.3.12.)
        O4.10 Partial seeing including tubular vision (C.2.1.3.)
        O5 Other acoustic perception disturbances
        O5.1 Acoasms (C.2.4.2.)
        O5.2 Maintenance of acoustic stimuli, 'acoustic echoes' (C.2.5.2.)
        O6 Disturbances of olfactoric, gustatoric or tactile perception (C.2.6.)
        O7 Captivation of attention by details of the visual field (C.2.9.)
        O8 Derealization (C.2.11.)
        O9 Motor interference exceeding simple lack of co-ordination (C.3.1.)
        O10 Motor blockages (C.3.2.)
        O11 Loss of automatic skills (C.3.3.)

        REFERENCES
        Appendix 1: Rating criteria in order of relevance


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