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Reliability and Diagnostic Validity for Schizophrenia of the Japanese Version of the Bonn Scale for Assessment of Basic Symptoms (BSABS)

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Reliability and Diagnostic Validity for Schizophrenia of the Japanese Version of the Bonn Scale for Assessment of Basic Symptoms (BSABS) J Med Dent Sci 2010； 57： 83－94 Original Article Reliability and Diagnostic Validity for Schizophrenia of the Japanese Version of the Bonn Scale for Assessment of Basic Symptoms (BSABS) Kazunari Oshima1), Tsukasa Okimura2), Tomoaki Yukizane1), Katsuhiro Yasumi3), Astushi Iwawaki4), Toru Nishikawa1) and Seiichi Hanamura1)5) 1) Section of Psychiatry and Behavioral Science, Tokyo Medical and Dental University Graduate School 2) Inagidai Hospital, 3) Health Service Center,Tokyo Institute of Technology 4) Kanuma Hospital 5) Tokyo University of Social Welfare Schizophrenia is defined by operative diagnostic showed 0.711. Our findings suggest that, although criteria in DSM-IV with some typical symptoms as these clusters symptoms differ from DSM-Ⅳ hallucinations and duration of the disease. Huber criteria, they are related to fundamental process focused on the subjective experience of patients of schizophrenia. Use of some of these three and coined the term “basic symptoms” and created clusters with other neurophysiological markers BSABS. Our study investigated the reliability and could allow clinical evaluation of schizophrenia the diagnostic validity of the 5 clusters of BSABS from a new perspective. for DSM-IV-based diagnosis of schizophrenia with a cohort of 105 patients. Good inter-rater Key words: schizophrenia, reliability, diagnostic validity, reliability was obtained except for one item D.10. BSABS, DSM-IV As evaluated by Spearman’s rank correlation coefficients, among the 5 clusters excluding (1) Introduction Cluster 2, internal consistency was good. This suggests that, although each cluster is Schizophrenia is an illness causing dysfunction heterogeneous, cluster symptoms are the marked by repeated hallucinations and delusions, expression of physiological and biological disorganized speech, and catatonic behavior. disturbances of schizophrenia. Receiver Operating Historically, Kraepelin saw the importance of course of Characteristic Curve analysis was also used to illness in the classification of mental disorders, while show the ability of each cluster to discriminate Bleuler focused on loosening of association and schizophrenia. Results showed that the area disturbance of thought, and Schneider developed “first- representing the powers in discriminate rank symptoms” considered characteristic of schizophrenia of Cluster 4 “Adynamia”, which is schizophrenia 1). Based on this pathognomy, DSM-IV was considered related to the dynamic aspect of completed in 1994 as a set of operative diagnostic thinking,was highest, at 0.739. Cluster 1 criteria in the U.S. 2) In DSM-IV, schizophrenia is defined “Information processing disturbances” which has a by operative diagnostic criteria specifically derived predictive ability for schizophrenia showed 0.714 through statistical verification 2) :Criterion A: Two (or and Cluster 3 “Impaired tolerance to normal stress” more) of the following, each present for a significant portion of time during a 1-month period: (1) Delusions, (2) Hallucinations, (3) Disorganized speech, (4) Grossly Corresponding Author：Kazunari Oshima disorganized or catatonic behavior, and/or (5) Negative Yushima 1-5-45, Bunkyo-ku, Tokyo, 113-8519, Japan symptoms. Criterion B: Social/occupational dysfunction. Tel: 03-5803-5673 Fax: 03-5803-0245 E-mail: [email protected] Criterion C: Duration (Continuous signs of the Received September 30；Accepted November 13, 2009 disturbance persist for at least 6 months, including 84 K. Oshima et al. J Med Dent Sci periods of prodromal, active, or residual symptoms.) perception, and motor function, and covers several Schizophrenia is likewise defined by exclusion of other phases in the course of schizophrenia from subclinical mental illnesses and the direct physiological effects of signs in the prodrome, through progression to acute- a substance. 2) These DSM-IV criteria can be used to phase symptoms, to residual-phase symptoms. diagnose schizophrenia in a straightforward, operational In the dimensions of causalism-descriptivism and manner. objectivism-evaluativism, and in the context of patient- Despite national differences in traditional psychiatry, oriented psychiatry, BSABS could focus on a new these criteria have high diagnostic reliability, and the perspective on schizophrenia research. majority of current schizophrenia research worldwide Leading research using the BSABS includes the proceeds on the basis of the DSM-IV diagnostic criteria. following. In a follow-up study on development of Although DSM-IV has high reliability in diagnosis, symptoms, Klosterkötter12) followed the course of Criteria A symptoms do not account for all development from basic symptoms to first-rank schizophrenia symptoms, and the validity of DSM-IV- symptoms in 121 inpatients. Klosterkötter et al. then based diagnosis of schizophrenia has correspondingly examined the diagnostic validity of the BSABS 13) in become a topic of recent concern. 3) In the treatment of 1996. They applied a simplified version of the BSABS to schizophrenia, importance is laid on improvement of a group of 79 healthy individuals and a patient group of social function and increased interpersonal capability 243 individuals with disorders classified by WHO following acute-phase drug treatment, and there is a Classification of Diseases (ICD-10) categories as F0 - like focus on negative symptoms in the residual phase. Organic mental disorders; F1 - Mental and behavior Negative symptoms are defined only in terms of disorders due to psychoactive substance use; F2 - symptom complexes including affective flattening, Schizophrenia, schizotypal, and delusional disorders; alogia (poverty of speech), and avolition, and the Scale F3 - Mood (affective) disorders; F4 - Neurotic, stress- for the Assessment of Negative Symptoms (SANS) 4)5) is related, and somatoform disorders; and F6 - Disorders based on these clusters. In the residual phase, however, of adult personality and behavior. Through cluster a more detailed symptomatic scale relating to recovery analysis, they extracted 5 BSABS clusters and is needed. demonstrated that these clusters served as indicators In the U.S., where DSM-IV was created, a task force discriminating ICD-10 categories F0-F4 and F6. for DSM-Ｖ discussed certain dimensions of categorization of psychiatric disorders,6)7) namely: 1) causalism- Our research is original in the following two respects: descriptivism, 2) essentialism-nominalism, 3) First, it is the first to investigate the reliability and the objectivism-evaluativism, 4) internalism-externalism, 5) diagnostic validity of a simplified Japanese version of entities-agents, and 6) categories-continua. In this the BSABS by trial application among Japanese context, there is a focus on incorporating Patients’ patients. subjective experiences. 8) Second, it is also the first study using DSM-IV to In Germany, the center of descriptive phenomenology, investigate the validity of the BSABS in the diagnosis of beginning in the 1960s Huber noted the fact that many schizophrenia, although Klosterkötter used ICD-10 schizophrenia patients were aware of their own deficits diagnosis in his study of the diagnostic validity of and could also state what they were during most BSABS. phases of long-term progression. 9) He regarded this as evidence of fundamental disturbances akin to organic (2) Subjects and Methods factors and coined the term “basic symptoms.” 10) In 1982, Gross et al. provided a description and Instrument extensive listing of basic symptoms, after which the The BSABS was translated in its entirety, and a Bonn Scale for the Assessment of Basic Symptoms simplified Japanese version of the BSABS was created (BSABS) 11) was completed in 1987. from 53 items divided into 5 clusters extracted on the Klosterkötter, the successor of Huber, redefined basic basis of cluster analysis of cases with diagnosis ICD-10 symptoms as “self-perceivable” neuropsychological categories F0-F4 and F6 by Klosterkötter 13): Cluster 1 – deficits representing subtle, subclinical signs of illness. thought, language, perception, and motor disturbances The BSABS is a symptom assessment scale based on (Information processing disturbances). Cluster 2 – description of a variety of self-experienced symptoms Impaired bodily sensations (coenaesthesias), Cluster 3 – related to drive, stress-tolerance, emotion, thought, Impaired tolerance to normal stress, Cluster 4 – Reliability and Diagnostic Validity for Schizophrenia of BSABS 85 Adynamia (disorders of emotion and affect, disturbance schizophrenia. Of these 19 cases, 15 cases whom we of short-term memory and disturbance of immediate have followed did not develop schizophrenia. Among 4 recall, disturbance of thought process), and Cluster 5 – cases with schizophreniform disorder, 3 cases have still Increased emotional reactivity (Interpersonal irritation). the same diagnostic and one case stopped to come to The 5 clusters and 53 items are shown in Table Ⅰ. consultation. Among 4 cases with delusional disorder, any case did not develop schizophrenia. Among 2 Subjects cases with brief psychotic disorder, 1 case still have the same diagnostic and another case stopped to come The subjects included a total of 109 cases: A cohort to consultation. Among 9 cases with psychotic not of patients hospitalized in the Department of Psychiatry otherwise specified, 7 cases still have the same of the University Hospital of Medicine, Tokyo Medical diagnostic and 2 cases did not come to the and Dental University from 1998 to 2005 and consultation. diagnosed with schizophrenia
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