Clinical Schizophrenia and Related Psychoses最新文献

Although antipsychotic medication has been the most widely used and efficacious treatment in ameliorating the symptoms of psychosis, there has been a growing realization that pharmacological treatment has limitations. A significant minority of individuals continue to show "treatment-resistant" symptoms and significant relapse risk, while others show symptom reduction without the corresponding improvement in social and role functioning. Psychotherapy, in combination with medication, can help with symptom reduction, as well as improve functioning and quality of life. In this paper, we focus on two modalities of psychotherapy which have been shown to improve symptomatology and functioning in individuals with psychosis: Cognitive Behavior Therapy for psychosis (CBTp) and Metacognitive Training (MCT). Both treatment approaches focus on increasing the individuals' understanding of the psychological mechanisms associated with delusions and hallucinations, and helping them develop strategies to improve reality testing and belief evaluation. We aim to provide an overview of both treatments, examining not only the theoretical mechanisms and efficacy of each approach, but also the common therapeutic components they share.

Most patients with schizophrenia will have subsequent relapses of the disorder, with continuous impairments in functioning. However, evidence is lacking on how symptoms influence functioning at different phases of the disease. This study aims to investigate the relationship between symptom dimensions and functioning at different phases: acute exacerbation, nonremission and remission.

Methods: Patients with schizophrenia were grouped into acutely ill (n=89), not remitted (n=89), and remitted (n=69). Three exploratory stepwise linear regression analyses were performed for each phase of schizophrenia, in which the five PANSS factors and demographic variables were entered as the independent variables and the total Global Assessment of Functioning Scale (GAF) score was entered as the dependent variable. An additional exploratory stepwise logistic regression analysis was performed to predict subsequent remission at discharge in the inpatient population.

Results: The Disorganized factor was the most significant predictor for acutely ill patients (p<0.001), while the Hostility factor was the most significant for not-remitted patients and the Negative factor was the most significant for remitted patients (p=0.001 and p<0.001, respectively). In the logistic regression, the Disorganized factor score presented a significant negative association with remission (p=0.007).

Conclusions: Higher disorganization symptoms showed the greatest impact in functioning at acute phase, and prevented patients from achieving remission, suggesting it may be a marker of symptom severity and worse outcome in schizophrenia.

Tardive dyskinesia (TD) remains a clinical concern for any patient who receives an antipsychotic. While the overall risk of developing TD is lower with newer antipsychotics compared to older agents, a significant number of patients who require long-term treatment will develop TD. Recently, valbenazine (brand name Ingrezza) became the first drug to be approved by the FDA specifically for the treatment of TD. In this New Drug Review, we summarize the basic pharmacology and clinical trial results for valbenazine. Valbenazine is a modified metabolite of the vesicular monoamine transporter 2 (VMAT-2) inhibitor tetrabenazine, which is approved for the treatment of the hyperkinetic movement disorder, Huntington's disease. In short-term clinical trials, valbenazine at a dose of 80 mg/day improved TD, with an effect size that is clinically significant (d=0.90). The effect size for the 40-mg/day dose was lower (d=0.52). Compared to tetrabenazine, valbenazine has better clinical characteristics (i.e., once-a-day dosing, better short-term side effect profile). However, only long-term experience in routine clinical populations can delineate valbenazine's full benefits, optimal dosing, and risks not identified during short-term registration trials.

Introduction: Despite the importance of medication adherence for the effective treatment of type II diabetes mellitus (T2DM), little research has examined adherence with diabetes medication treatment in schizophrenia. The purpose of this systematic review was to: 1) evaluate rates of adherence and determinants of adherence with medication for T2DM in individuals with schizophrenia; and, where possible, 2) examine the relationship between medication adherence and glycemic control.

Methods: Studies were included if they presented information on dosing regimens and adherence or compliance rates for T2DM and included samples where at least 50% of the participants were individuals with schizophrenia.

Results: Six studies were included in this review that predominantly examined men over the age of 50 years. Studies confirmed that many individuals with schizophrenia were not adhering to their diabetes medication as adherence rates ranged from 51-85%. Two studies that compared medication adherence in individuals with and without schizophrenia found those with the mental illness had higher rates of adherence. One study reported that blood glucose control levels were not statistically different between those who did and did not adhere to their medication, indicating more research is necessary in this area. Factors that improved adherence included disease and medical service and medication-related factors.

Conclusions: Interventions to increase diabetes medication adherence in schizophrenia need to address disease and medical service and medication-related factors. Further research needs to examine diabetes medication adherence in women, younger individuals, and those recently diagnosed with diabetes as these individuals have been underrepresented in the literature.

The 2017 International Congress on Schizophrenia Research, held in San Diego, California (March 24-28, 2017), attracted over 900 attendees from 34 countries. With the gracious assistance of Congress president James Meador-Woodruff, we bring you the following reports on the prospects for new drugs to treat schizophrenia.

Background: Bath salts have recently emerged as a popular designer drug of abuse causing significant hazardous effects on mental health and physical health, resulting in public health legislation making its usage illegal in the United States.

Objective: To educate mental health providers on the effects of the new designer drug bath salts, including its potential to cause psychosis and violence in patients.

Method: This is a case report on a 40-year-old male with no past psychiatric history who presented with new-onset psychosis and increased risk for violence after ingesting bath salts. In addition, a literature review was performed to summarize the documented effects of bath salts abuse and the current U.S. public health legislation on bath salts.

Results: The presented case illustrates a new-onset, substance-induced psychotic disorder related to bath salts usage. The literature review explains the sympathomimetic reaction and the potential for psychotic symptoms.

Discussion: To discuss the physical and psychological effects of bath salts, treatment options for bath salts abuse and U.S. legislation by Ohio state law to current U.S. federal law that bans production, sale, and possession of main substances found in bath salts.

Conclusion: It is important for mental health providers to be aware of bath salts, understand the physical and psychiatric effects of bath salts and be familiar with current legislative policy banning its usage. Lastly, bath salts abuse should be in the differential diagnosis where psychosis is new onset or clinically incongruent with known primary presentation of a psychotic disorder.