Indian Journal of Psychological Medicine
  Home | About Us | Editorial Board | Search | Ahead of print | Current Issue | Archives | Instructions | Contact | Advertise | Submission | Login 
Users Online: 1049 
Wide layoutNarrow layoutFull screen layoutHome Print this page Email this page Small font sizeDefault font sizeIncrease font size


 
 Table of Contents    
ORIGINAL ARTICLE
Year : 2016  |  Volume : 38  |  Issue : 2  |  Page : 109-113  

Subjective symptoms in euthymic bipolar disorder and remitted schizophrenia patients: A comparative study


1 Department of Psychiatry, NRS Medical College, Kolkata, West Bengal, India
2 Department of Psychiatry, Central Institute of Psychiatry, Ranchi, Jharkhand, India
3 Department of Clinical Psychology, RINPAS, Kanke, Ranchi, India

Date of Web Publication16-Mar-2016

Correspondence Address:
Manish Kumar
14/1C, Genex Valley, Diamond Harbour Road, Joka, Kolkata - 700 104, West Bengal
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0253-7176.178771

Rights and Permissions
   Abstract 

Background: Subjective experience means subtle, not yet psychotic abnormalities of experience that might be present during remitted phase and also in prodromal phase of schizophrenia and might be accurately efficient in identifying individuals at risk of eminent psychosis (Parnas et al., 2003). Apart from schizophrenic patients, bipolar patients also experience certain subjective symptoms in their euthymic state. They often experience subtle cognitive impairment and functional disturbances during their euthymic states. These subjective experiences may be related to distorted cognitive functions in these patients. These experiences include a great variety of cognitive dysfunction complaints about attention, perception, memory, thinking, language, movement, and emotion. Objective: To measure the experience of subjective symptoms and compare them between euthymic bipolar and remitted schizophrenia patients. Materials and Methods: Thirty euthymic bipolar patients and 30 remitted schizophrenia patients as per International Classification of Diseases Tenth Revision were selected for the purpose of the study. At first, sociodemographic data were collected. And then, the patients were assessed using the scales; positive and negative syndrome scale, Young Mania Rating Scale, Hamilton Depression Rating Scale, Symptom Checklist-90-Revised, and Frankfurt Complaint Questionnaire-24. Results: Both the groups showed significant differences in terms of subjective symptoms. However, no significant correlation has been found between the objective psychopathology and subjective experience in the two groups. Conclusion: It can be suggested that the patients with schizophrenia show significantly higher subjective experience when compared with the patients of bipolar disorder.

Keywords: Euthymic bipolar disorder, remitted schizophrenia, subjective symptoms


How to cite this article:
Kumar M, Sinha VK, Mondal A. Subjective symptoms in euthymic bipolar disorder and remitted schizophrenia patients: A comparative study. Indian J Psychol Med 2016;38:109-13

How to cite this URL:
Kumar M, Sinha VK, Mondal A. Subjective symptoms in euthymic bipolar disorder and remitted schizophrenia patients: A comparative study. Indian J Psychol Med [serial online] 2016 [cited 2019 Sep 20];38:109-13. Available from: http://www.ijpm.info/text.asp?2016/38/2/109/178771


   Introduction Top


Subjective experience means subtle, not yet psychotic abnormalities of experience that might be present during remitted phase and also in prodromal phase of schizophrenia and might be accurately efficient in identifying individuals at risk of eminent psychosis. [1] Abnormal subjective experiences, other than delusions and hallucinations, are becoming accepted as having important implications for the comprehension and treatment of schizophrenic disorders. [2] These experiences include a great variety of cognitive dysfunction complaints about attention, perception, memory, thinking, language, movement, and emotion. Recently, there has been renewed interest in the study of subjective symptoms. Apart from schizophrenic patients, bipolar patients also experience certain subjective symptoms in their euthymic state. They often experience subtle cognitive impairment and functional disturbances during their euthymic states. These subjective experiences may be related to distorted cognitive functions in these patients.

Most studies of subjective experiences have been conducted in patients with schizophrenia. [3] It is generally accepted that cognitive dysfunction persists in the remitted schizophrenics. [1] In contrast, we do not have definite evidence of persistent cognitive dysfunction in euthymic patients with bipolar disorder. [4] More recently, however, the number of studies on the persistence of cognitive and perceptual distortion in bipolar patients has increased. [5] To date, little attention has been paid to subjective cognitive impairment in bipolar disorder. [6] To our knowledge, there are few studies to compare the subjective experience of patients with bipolar disorder with the patients with schizophrenia, and the results were inconsistent. [2] Joe et al.[6] compared the experience of subjective symptoms in normal control, euthymic bipolar patients, and remitted schizophrenia patients. The scores were significantly higher in the bipolar group than in the normal control group, and they were similar between the bipolar group and schizophrenia group. Depression, anxiety, phobic anxiety, and paranoid ideation subscale scores of the bipolar group were similar to those of the normal control group, and they were lower than those of the schizophrenia group. Most studies on the subjective experiences have been conducted in schizophrenia and to a lesser extent in affective disorders. However, studies comparing subjective experiences in schizophrenic and affective disorders have reached inconclusive results.

The aim of the present study was, therefore, to evaluate and compare the subjective experiences in schizophrenic and bipolar patients.


   Materials and Methods Top


Sample

Thirty euthymic bipolar patients (euthymia was defined by Young Mania Rating Scale [YMRS] score ≤12 and Hamilton Rating Scale for Depression [HRSD] cut-off values ≤7) and 30 remitted schizophrenic patients (positive and negative syndrome scale [PANSS] score <60 and the mean of any three sub scale of PANSS was not >3) diagnosed as per the International Classification of Diseases Tenth Revision (ICD-10) Diagnostic Criteria for Research were selected from the patients coming to outpatient department (OPD) or admitted in the Central Institute of Psychiatry, Ranchi, Jharkhand, India.

Tools

  1. A semi-structured pro forma for sociodemographic data.
  2. Symptom Checklist-90-Revised (SCL-90-R). [7]
  3. Frankfurt Complaint Questionnaire-24 (FCQ-24). [8]
  4. PANSS of schizophrenia. [9]
  5. YMRS. [10]
  6. HRSD. [11]


Procedure

Thirty euthymic bipolar patients and 30 remitted schizophrenia patients as per ICD-10 meeting the inclusion-exclusion criteria were selected for the purpose of the study. Written informed consent was taken after explaining the procedure to the patients in detail. Sociodemographic data were collected and then the patients were assessed using the abovementioned scales in OPD or in admitted patients. The collected data were then tabulated, analyzed, and assessed properly with appropriate use of statistics.

Statistical analysis

The statistical analysis was done with the help of Statistical Package for Social Sciences-13 (SPSS Inc., 233 South Wacker Drive, 11 th Floor, Chicago, IL, 60606-6412). Descriptive statistics (frequency, percentages, and mean), standard deviation (SD), Chi-square, and t-test were applied.


   Results and discussion Top


The two groups, euthymic bipolar and remitted schizophrenia, were compared on sociodemographic variables such as age, sex, education, occupational status, marital status, family type, economic status, and religion. However, no significant difference has been found between the two groups. On comparing the clinical variables between the two groups, the mean duration of illness was 9.30 ± 4.84 (SD) years in the bipolar group and 7.87 ± 4.59 (SD) years in the schizophrenia group with no significant difference between both the groups. Mean number of hospitalization was 1.00 ± 1.08 (SD) in the bipolar group and 0.57 ± 7.28 (SD) in the schizophrenia group with no significant difference between both the groups. Duration of remission was 26.36 ± 22.3 (SD) years in the bipolar group as compared to 20.80 ± 22.52 (SD) years in the schizophrenia group, but this also has not reached statistical significance. In regard to objective pathology of the two groups, mean YMRS score was 1.50 ± 1.69 (SD) and Hamilton Depression Rating Scale score was 2.57 ± 1.86 (SD) in the bipolar group. In the schizophrenia group, mean score on positive scale of PANSS was 8.20 ± 1.49, on negative scale it was 7.93 ± 1.08, and on general symptom scale it was 17.77 ± 3.22.

[Table 1] shows the comparison of FCQ-24 score between two groups where most of the phenomenological dimensions of FCQ-24 showed significant difference between the two groups except on memory (t = −1.304, P = 0.198) and anhedonia anxiety (t = −1.492, P = 0.141). Patient with schizophrenia, when compared with bipolar affective disorder, was found to show higher score in phenomenological areas of loss of control (t = −2.084, P = 0.042), simple perception (t = −3.568, P = 0.001), complex perception (t = −2.692, P = 0.009), language (t = −2.868, P = 0.006), thought (t = −5.298, P = 0.000), motility (t = −2.670, P = 0.010), and lack of automatism (t = −2.339, P = 0.023); further, schizophrenia group had shown a significantly higher FCQ-24 total score. In the comparison between bipolars and schizophrenics, problem in SP (simple perception) CP (complex perception), thought and language emerged among the phenomenological areas showing the widest differences. These data confirm those obtained by Ebel et al. [12] comparing schizophrenics with major affective patients, using the Bonn Scale for the Assessment of Basic Symptoms (BSABS), Arduini et al. [2] using Frankfurter Beschwerde-Fragebogen, and Parnas et al. [1] using BSABS. It indicates that in schizophrenics, qualitative alterations of the perception of single objects or of some details of objects were more frequent and lasting than in affective patients: A similar pattern was observed for abnormalities of complex perception. Data about qualitative alterations of perception refer mainly to the vulnerability pattern, which points to perceptive distortions, as being among the predisposing factors for schizophrenia, [13] and also emphasizes the necessity of addressing neuropsychological tests toward the areas of the central nervous system involved in these alterations. Thought and language disorders such as distinct concentration disorders, thought pressure, thought blocking, and thought interference seem to be more represented in schizophrenia patients than in bipolar patients. This emphasizes the importance of the alterations of the form of thought processes, as well as delusions, in the clinical characterization of major psychoses. [13]
Table 1: Comparison of 10 phenomenological subscale of FCQ-24 between the two groups

Click here to view


[Table 2] shows the relationship between FCQ scores and PANSS scores. It can be seen that there was no correlation of total FCQ scores with positive symptoms (P = 0.173), negative symptoms (P = 0.287), general symptoms (P = 0.316), and even with PANSS total scores (P = 0.173).
Table 2: Relationship between objective psychopathology (PANSS total, positive, negative, and general symptoms) and subjective symptoms (FCQ-24)

Click here to view


[Table 3] shows the relationship between FCQ, YMRS, and HRSD scores. It can be seen that FCQ total score did not correlate with YMRS score (P = 0.307). Total FCQ score also did not correlate with scores on HRSD (r = 0.196; P = 0.299).
Table 3: Relationship between objective psychopathology (YMRS and HRSD) and subjective symptoms (FCQ-24)

Click here to view


From the above two tables, it is found that all subjects in the bipolar group, in euthymic state and all subjects in the schizophrenia group, in remitted state and objective psychopathology as assessed by PANSS (positive symptoms, negative symptoms, and general symptoms scale), YMRS, and HRSD did not correlate to subjective symptoms measured by FCQ. These findings were conflicting among the results of previous studies which showed that subjective experiences were either related to negative symptoms [14] or display a relationship with positive ones. [15] On the contrary, this finding was in accordance with the finding of previous study by Joe et al. [6] who concluded that subjective symptoms measured by FCQ might not be secondary to psychosis or mood symptoms. This finding further supports that the subjective experience of bipolar and schizophrenia patients are distinct pathology from objective pathology. [6]

[Table 4] shows the comparison of SCL-90R score between two groups, where patients with schizophrenia when compared with bipolar affective disorder, were found to show higher score in the dimensions of obsessive compulsive (t = 2.732, P = 0.008), depression (t = 2.892, P = 0.005), anxiety (t = 3.142, P = 0.003), phobic anxiety (t = 2.444, P = 0.018), paranoid ideation (t = 3.560, P = 0.001), and psychoticism (t = 4.450, P = 0.000). It had not reached statistical significance in the dimensions of somatization (t = 0.00, P = 1.00), interpersonal sensitivity (t = 0.943, P = 0.350), and anger hostility (t = 1.838, P = 0.071). This finding was almost similar to the finding by Joe et al. [6] except that he had not found significant difference on obsessive compulsive and psychoticism. However, his finding on psychoticism had shown trend toward higher score in the schizophrenia group (P = 0.056).
Table 4: Comparison of subscale score of SCL-90R between the two groups

Click here to view



   Conclusion Top


It can be said that the schizophrenia group showed higher score on FCQ as compared to bipolar disorders mainly in the areas of perception, thought, language, and motility as well as total FCQ scores. When total score on SCL was compared between two groups, the schizophrenia group showed significantly higher score than the bipolar group demonstrating that the schizophrenia group was associated with increased level of qualitative anomalous of subjective experiences, especially in the domain of cognitive disturbances, perception, and motility. However, subjective symptoms did not correlate with objective psychopathology as measured by PANSS, YMRS, and HRSD supporting that the subjective experience of bipolar and schizophrenia patients are distinct pathology from objective pathology. These findings suggest that certain anomalies of subjective experience aggregate significantly in schizophrenia when compared with bipolar disorders.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Parnas J, Handest P, Saebye D, Jansson L. Anomalies of subjective experience in schizophrenia and psychotic bipolar illness. Acta Psychiatr Scand 2003;108:126-33.  Back to cited text no. 1
    
2.
Arduini L, Kalyvoka A, Stratta P, Gianfelice D, Rinaldi O, Rossi A. Subjective experiences in schizophrenia and bipolar disorders. Eur Arch Psychiatry Clin Neurosci 2002;252:24-7.  Back to cited text no. 2
    
3.
Gross G, Huber G, Klosterkötter J, Linz M. BSABS. Bonn Scale for the Assessment of Basic Symptoms. Berlin, Germany: Springer; 1987.  Back to cited text no. 3
    
4.
Ferrier IN, Thompson JM. Cognitive impairment in bipolar affective disorder: Implications for the bipolar diathesis. Br J Psychiatry 2002;180:293-5.  Back to cited text no. 4
    
5.
Cavanagh JT, Van Beck M, Muir W, Blackwood DH. Case-control study of neurocognitive function in euthymic patients with bipolar disorder: An association with mania. Br J Psychiatry 2002;180:320-6.  Back to cited text no. 5
    
6.
Joe S, Joo Y, Kim S. Experience of subjective symptoms in euthymic patients with bipolar disorder. J Korean Med Sci 2008;23:18-23.  Back to cited text no. 6
    
7.
Derogatis LR. Symptoms Check List 90-Revised; Administration Scoring and Procedure Manual. 3 rd ed. Minneapolis, MN: National Computer System, Inc.; 1994.  Back to cited text no. 7
    
8.
Loas G, Yon V, Brien D. Dimensional structure of the Frankfurt Complaint Questionnaire. Compr Psychiatry 2002;43:397-403.  Back to cited text no. 8
    
9.
Kay SR, Fiszbein A, Opler LA. The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull 1987;13:261-76.  Back to cited text no. 9
    
10.
Young RC, Biggs JT, Ziegler VE, Meyer DA. A rating scale for mania: Reliability, validity and sensitivity. Br J Psychiatry 1978;133:429-35.  Back to cited text no. 10
    
11.
Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiatry 1960;23:56-62.  Back to cited text no. 11
    
12.
Ebel H, Gross G, Klosterkötter J, Huber G. Basic symptoms in schizophrenic and affective psychoses. Psychopathology 1989;22:224-32.  Back to cited text no. 12
    
13.
Ricca V, Galassi F, La Malfa G, Mannucci E, Barciulli E, Cabras PL. Assessment of basic symptoms in schizophrenia, schizoaffective and bipolar disorders. Psychopathology 1997;30:53-8.  Back to cited text no. 13
    
14.
Stanghellini G, Quercioli L, Ricca V, Strik WK, Cabras P. Basic symptoms and negative symptoms in the light of language impairment. Compr Psychiatry 1991;32:141-6.  Back to cited text no. 14
    
15.
Peralta V, Cuesta MJ. A polydiagnostic approach to self perceived cognitive disorders in schizophrenia. Psychopathology 1992;25:232-8.  Back to cited text no. 15
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

Top
 
 
  Search
 
  
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
    Abstract
   Introduction
    Materials and Me...
    Results and disc...
   Conclusion
    References
    Article Tables

 Article Access Statistics
    Viewed1270    
    Printed6    
    Emailed0    
    PDF Downloaded65    
    Comments [Add]    

Recommend this journal