Clinical Schizophrenia and Related Psychoses最新文献

So far, demographic variables have not consistently been found to predict clinical response to antipsychotics. This study examines some differences in response to ziprasidone, which has been shown to be effective, with a better metabolic side effect profile, but was little used in New York State Hospitals. The aim was to study state hospital patients switched to ziprasidone. The results led to questions about different responses in different groups. Subjects from state hospitals who needed a change of antipsychotic participated in this open-label, 8-week trial of up to 240-mg ziprasidone. Analyses included comparisons of the very different results from two sites. Of the 36 study subjects, 12 terminated early. The 17 outpatients from Buffalo, who were older and on lower doses of antipsychotics pre-study, improved significantly. The 19 inpatients from the Bronx, overall younger and on higher pre-study doses, barely changed. Improvements in PANSS total score were significantly associated with older age, greater baseline severity, and lower doses of antipsychotics pre-study. The subjects improved on metabolic parameters. The results suggest that ziprasidone may be just as effective as previous antipsychotics taken by these severely mentally ill patients, and with fewer metabolic side effects. Note: The study described here includes a dosage of ziprasidone that has not been approved by the U.S. Food and Drug Administration (FDA). The FDA has approved daily doses of ziprasidone no greater than 100 mg PO bid.

We are presenting the case of a 37-year-old male with schizoaffective disorder who developed myocarditis within three weeks of starting on clozapine for his treatment-resistant psychosis. The patient also had a positive titer for Influenza A, which makes it a diagnostic dilemma regarding the cause of his myocarditis. It may be possible that the myocarditis was caused by the Influenza A virus or synergistically exacerbated the clozapine's propensity to cause it. Currently, there are no studies establishing the link between the two etiologies. As clozapine can be the only option for patients resistant to treatment of their psychiatric illness, and there being some evidence for successful rechallenge of clozapine, we consider that this patient could have benefited from a trial of a rechallenge; however, he was lost to follow-up.

Objectives: The Relapse Assessment for Schizophrenia Patients (RASP) was developed as a six-question self-report screener that measures indicators of Increased Anxiety and Social Isolation to assess patient stability and predict imminent relapse. This paper describes the development and psychometric characteristics of the RASP.

Methods: The RASP and Positive and Negative Syndrome Scale (PANSS) were administered to patients with schizophrenia (n=166) three separate times. Chart data were collected on a subsample of patients (n=81). Psychometric analyses of RASP included tests of reliability, construct validity, and concurrent validity of items. Factors from RASP were correlated with subscales from PANSS (sensitivity to change and criterion validity [agreement between RASP and evidence of relapse]).

Results: Test-retest reliability returned modest to strong agreement at the item level and strong agreement at the questionnaire level. RASP showed good item response curves and internal consistency for the total instrument and within each of the two subscales (Increased Anxiety and Social Isolation). RASP Total Score and subscales showed good concurrent validity when correlated with PANSS Total Score, Positive, Excitement, and Anxiety subscales. RASP correctly predicted relapse in 67% of cases, with good specificity and negative predictive power and acceptable positive predictive power and sensitivity.

Conclusions: The reliability and validity data presented support the use of RASP in settings where addition of a brief self-report assessment of relapse risk among patients with schizophrenia may be of benefit. Ease of use and scoring, and the ability to administer without clinical supervision allows for routine administration and assessment of relapse risk.

Introduction: Immune system genes, including cytokines, are associated with schizophrenia risk. Polymorphisms in cytokine genes may also impact on blood levels of cytokines, which are altered in patients with schizophrenia. We performed a meta-analysis of case-control studies of cytokine and chemokine genes in schizophrenia that have not been considered in previous quantitative reviews.

Methods: We identified articles by systematic searches of PubMed, PsycInfo, and ISI, and the reference lists of identified studies. For each cytokine or chemokine polymorphism, we performed an allele- and genotype-wise meta-analysis, using a random effects model.

Results: Twenty-one independent studies met the inclusion criteria, comprising polymorphisms for the IL1B, IL2, IL4, IL6, sIL6R, MCP1, and TGFB1 genes. For IL6, the A allele (OR=0.95, 95% CI 0.91-0.99) and AA genotype (OR=0.65, 95% CI 0.50-0.85) for the rs1800795 polymorphism, and for sIL6R, the A allele (OR=0.96 95%, CI 0.92-1.00) and AA genotype (OR=0.72, 95% CI 0.55-0.94) the rs8192284 polymorphism were associated with significantly decreased schizophrenia risk. In the genotype-wise analysis for IL1B, homozygosity for either allele (AA: OR=1.91, 95% CI 1.60-2.27; and GG: OR=0.40, 95% CI 0.33-0.49) of the rs1143627 polymorphism was also significantly associated with schizophrenia risk.

Conclusions: Associations between polymorphisms for the IL1B, IL6, and sIL6R genes and schizophrenia risk complement and extend previous findings regarding immune dysfunction in this disorder, including genome-wide association studies. Future studies of cytokine expression in schizophrenia should consider the effect of these polymorphisms. The finding of potential "protective" alleles may also be relevant for at-risk populations.

Background: Caregivers of schizophrenia play a major role in community-based care of patients. Recent studies have shed light on positive aspects of caregiving, in contrast to caregiving burden. There is limited research in this area in India.

Aims: To assess the "experience of caregiving" and "coping strategies" in caregivers of patients with schizophrenia, and to study associations, if any, between them.

Method: 102 caregivers of out- and in-patients with schizophrenia were assessed on the "Experience of Caregiving Inventory" (ECI) and "COPE Inventory" (COPE). Sociodemographic profiles of patients and caregivers, and clinical histories of patients were also collected.

Results: Maximum perceived negative experience of caregiving was "effects on family" while "stigma" was the lowest. Other domains had moderate scores. Among positive experiences, "good aspects of relationship" scored higher than "positive personal experiences." A wide range of adaptive and maladaptive coping strategies were used. Statistically significant positive correlations emerged between positive experiences of caregiving and adaptive coping strategies, and between negative experiences of caregiving and maladaptive coping strategies.

Conclusion: The association between experiences of caregiving and coping strategies suggests that caregiving experiences are influenced not only by the illness but also by the coping methods employed. Helping caregivers cope better might improve caregiving experience.

Introduction: Acute and transient psychotic disorder (ATPD) is a brief, self-limiting psychiatric disorder commonly seen in developing countries. This condition is associated with an elevated risk of suicide, but data on this association are lacking in developing countries.

Methodology: Consecutive outpatients with a diagnosis ATPD as per ICD-10 criteria (n=29) were recruited over a period of six months (February-July 2014) and retrospectively assessed for suicide-related ideations and attempts and their correlates both during and in between episodes of their illness.

Results: A total of 16 patients (55.17%) experienced suicide-related ideations, which occurred during a psychotic episode in 14 patients. Six patients (20.69%) made suicide attempts. A later age of onset was significantly associated with suicidality (p=0.04), as was a family history of depression or related ("spectrum") conditions (p<0.01). A relationship with higher educational status, reported in an earlier study, was not replicated in our sample.

Conclusions: Suicide-related ideation and suicide attempts are common in ATPD, and may be linked to a later onset and a genetic loading for depression-related conditions.

Introduction: The experience of psychosis or related treatment can be conceptualized as a traumatic event, which might lead to posttraumatic stress disorder (PTSD) or PTSD syndrome (which is defined as the presence of PTSD symptoms irrespective of the DSM-IV criterion A definition of a traumatic event as an actual or threatened harm). Few studies explored the subject so far.

Methods: This cross-sectional study included 52 clinically stabilized patients who were hospitalized for a first-psychotic episode during the two years preceding the study. Sociodemographic and clinical information were collected including past trauma history and drug and alcohol use. Patients were administered the Clinician-Administered PTSD Scale (CAPS), the Major Depression Inventory (MDI), the Positive and Negative Syndrome Scale (PANSS), the Global Assessment of Functioning scale (GAF), and the Brief COPE.

Results: A total of 22 patients (42.3%) met full PTSD criteria and 36 patients (69.2%) met PTSD syndrome criteria. Full PTSD as well as PTSD syndrome were both associated with physical restraint, higher scores on the MDI and its maladaptive coping scales. The most distressing symptoms were paranoid delusions, and the most distressing treatment experiences involved physical restraint and problems with other hospitalized patients.

Discussion/conclusions: Our data showed high rates of psychosis-related PTSD. To prevent PTSD, conditions of hospitalization should be optimized and the use of coercive treatments should be limited. Subjects with recent-onset psychosis should be screened for PTSD symptoms. Improving coping abilities with a well-fitted therapy would be useful in these patients.

The determinants of attitudes toward medication (ATM) are not well elucidated. In particular, literature remains equivocal regarding the influence of cognition, adverse events, and psychiatric symptomatology. This study evaluated relationships between those outcomes in schizophrenia and ATM. This is a retrospective analysis of data collected during the Texas Medication Algorithm Project (TMAP, n=307 with schizophrenia-related diagnoses), in outpatient clinics at baseline and every 3 months for ≥1 year (for cognition: 3rd and 9th month only). The Drug Attitude Inventory (DAI-30) measured ATM, and independent variables were: cognition (Trail Making Test [TMT], Verbal Fluency Test, Hopkins Verbal Learning Test), adverse events (Systematic Assessment for Treatment-Emergent Adverse Events, Barnes Akathisia Rating Scale), psychiatric symptomatology (Brief Psychiatric Rating Scale, Scale for Assessment of Negative Symptoms [SANS]), and medication adherence (Medication Compliance Scale). Analyses included binary logistic regression (cognition, psychiatric symptoms) and chi-square (adverse events, adherence) for baseline comparisons, and linear regression (cognition) or ANOVA (adverse events, adherence) for changes over time. Mean DAI-30 scores did not change over 12 months. Odds of positive ATM increased with higher TMT Part B scores (p=0.03) and lower SANS scores (p=0.02). Worsening of general psychopathology (p<0.001), positive symptoms (p<0.001), and negative symptoms (p=0.007) correlated with negative changes in DAI-30 scores. Relationships between cognition, negative symptoms, and ATM warrant further investigation. Studies evaluating therapies for cognitive deficits and negative symptoms should consider including ATM measures as endpoints. Patterns and inconsistencies in findings across studies raise questions about whether some factors thought to influence ATM have nonlinear relationships.