Clinical Schizophrenia and Related Psychoses最新文献

Although the Positive and Negative Syndrome Scale (PANSS) is widely used in clinical research, factor analytic studies of the scale have been inconsistent and questions remain about the underlying factor structure of schizophrenia symptoms. The purpose of this study was to examine whether the factor structure of the PANSS differs in men and women with schizophrenia. Principal components analysis (PCA) with equamax rotation was used to examine the factor structure of the PANSS separately in 124 males and 74 females with schizophrenia-related psychoses. In males, a four-factor structure was identified: 1) Negative, 2) Cognitive, 3) Positive, and 4) Hostility. In females, a four-factor structure also emerged: 1) Negative, 2) Cognitive, 3) Positive, and 4) Depression. The most notable difference between the male and female PCAs was the presence of a depression factor in the females and a hostility factor in males. These results support sex differences in the factor structure of schizophrenia symptoms, which has important implications for clinical research.

Introduction: The Gyrification Index (GI) represents the degree of cortical folding and is of special interest in schizophrenia, since alterations in cortical folding indirectly reflect white matter development and axonal connectivity underneath. To the best of our knowledge, very few studies have investigated the effect of sex on GI in schizophrenia. Differences in the GI between patients with schizophrenia and healthy controls and the relation between sex, age symptoms and duration of illness with GI were investigated.

Methods: T1-images were acquired from schizophrenia patients (24 males [SZ-M] and 24 females [SZ-F]) and healthy volunteers (24 males [NC-M] and 24 females [NC-F]) matched for age, sex and handedness. GI analyses were performed using the fully automated CIVET pipeline.

Results: Significantly lower GI was found in patients relative to controls bilaterally in frontal, temporal, and parietal cortex. Sex differences were found: negative correlation was found between the duration of illness and the right parietal GI and right occipital GI in SZ-M, while SZ-F was found in the left frontal and bilateral temporal GI. Patients, regardless of sex, showed positive correlations between negative symptoms and GI in the right occipital. NC-F had greater GI values than SZ-F and both male groups.

Conclusions: Since GI reflects, in part, alterations in cerebral development and connectivity, the decrease in GI observed in patients is in agreement with the neurodevelopmental model of disconnectivity in schizophrenia; in addition, we emphasize the importance of sex differences in schizophrenia.

RBP-7000 (PERSERIS ^™ ) is a once-monthly subcutaneously administered formulation of risperidone that does not require oral supplementation when initiated. As with risperidone microspheres, RBP-7000 is required to be stored in a refrigerator. The injection kit, consisting of two syringes (one containing liquid polymer, the other containing risperidone powder), will need to come to room temperature prior to mixing their contents. RBP-7000 is administered in the abdomen using an 18 G 5/8-inch length needle. In an 8-week Phase 3 study in patients with acute schizophrenia, monthly RBP-7000 at doses of 90 mg (equivalent to oral risperidone 3 mg/day) and 120 mg (equivalent to oral risperidone 4 mg/day) were superior to placebo on changes in the PANSS total score. Overall tolerability was consistent with what is already known about risperidone/paliperidone, and the most common adverse reactions (≥5% and greater than twice placebo) were increased weight, sedation/somnolence, and musculoskeletal pain. Mean subject-reported injection site pain Visual Analog Scale scores (0=no pain to 100=unbearably painful) were similar for all treatment groups following both injections; with pain scores decreasing from a mean of 27 at 1 minute after the first dose to a range of 3 to 7 at 30 to 60 minutes postdose. RBP-7000 represents the first second-generation antipsychotic to be available as a subcutaneously administered long-acting injectable; having different choices of formulations can make the difference in finding the right intervention for the right patient.

Although a variety of metabolic, toxic, psychiatric, and neurologic conditions can produce catatonic syndromes, it is less widely recognized that this state may be caused by epilepsy. We present the case of a woman with catatonic behavior, which she could not recall. She also exhibited olfactory, auditory and visual hallucinations. An EEG demonstrated diffuse abnormal electrical activity, mainly on left temporal and frontal areas. Treatment with anticonvulsant drugs yielded excellent response.

Aims: Pregnenolone (PREG) and L-theanine (LT) have shown ameliorative effects on various schizophrenia symptoms. This is the first study to evaluate the efficacy and safety of augmentation of antipsychotic treatment among patients with chronic schizophrenia or schizoaffective disorder with PREG-LT.

Methods: Double-blind, placebo-controlled trial of PREG-LT or placebo augmentation was conducted for eight weeks with 40 chronic DSM-IV schizophrenia and schizoaffective disorder patients with suboptimal response to antipsychotics. Oral PREG (50 mg/day) with LT (400 mg/day) or placebo were added to a stable regimen of antipsychotic medication from March 2011 to October 2013. The participants were rated using the Scale for the Assessment of Negative Symptoms (SANS), the Hamilton Scale for Anxiety (HAM-A), and the Positive and Negative Syndrome Scale (PANSS) scales bi-weekly. The decrease of SANS and HAM-A scores were the co-primary outcomes. Secondary outcomes included assessments of general functioning and side effects.

Results: Negative symptoms such as blunted affect, alogia, and anhedonia (SANS) were found to be significantly improved with moderate effect sizes among patients who received PREG-LT, in comparison with the placebo group. Add-on PREG-LT also significantly associated with a reduction of anxiety scores such as anxious mood, tension, and cardiovascular symptoms (HAM-A), and elevation of general functioning (GAF). Positive symptoms, antipsychotic agents, concomitant drugs, and illness duration did not associate significantly with effect of PREG-LT augmentation. PREG-LT was well-tolerated.

Conclusions: Pregnenolone with L-theanine augmentation may offer a new therapeutic strategy for treatment of negative and anxiety symptoms in schizophrenia and schizoaffective disorder. Further studies are warranted.

Trial registration: clinicaltrials.gov Identifier: NCT01831986.