bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of Family Burden Experienced by Caregivers to People with Intellectual Disability and Caregivers to People with Mental Disorders
Authors: Gutiérrez-Recacha P. , Martorell A. , Pereda A.
Published: March 2009

Background:

The term ‘family burden’ has been introduced to describe the adverse consequences of life with severely disturbed psychiatric patients. Literature has established a distinction between the intensity of worry and appraisals experienced by caregivers (subjective burden) and the real amount of resources (time, money, health, etc.) spent on the care (objective burden). the use has been extended to people with intellectual disability (ID).

Aims:

To compare the burden experienced by a group of caregivers to patients diagnosed with schizophrenia and a group of caregivers to people with ID.

Methodology:

179 adults with intellectual disability clients of the Carmen Pardo-Valcarce Foundation's sheltered workshop in Madrid (Spain) and 356 adults diagnosed of schizophrenia in the Gavá Mental Health Centre in Barcelona (Spain) were asked to participate in the present study along with their main caregivers. Burden experienced by caregivers was assessed with the ECFOS-II / SOFBI-II scale (Entrevista de Carga Familiar Objetiva y Subjetiva / Objective and Subjective Family Burden Interview). the tool hasan introductory section plus 8 modules which assess different domains of family burden.

Results:

Significant differences were found between both groups in all scales except two: Assistance in everyday activities and Effects perceived on the caregiver's health. Total scores also showed significant differences for both groups (p< 0.05).

Discussion:

Results indicate that, despite similar scores in some domains associated to subjective burden, caregivers to people with ID experience a lower level of objective burden than caregivers to patients diagnosed of schizophrenia.
an Economic Burden Comparison of Typical and Atypical Antipsychotic Therapies for Schizophrenia between General Hospital and Psychiatric Hospital
Authors: Han B. , Tang R. , Sun H. , Zhao S. , Xu M.
Published: March 2009

Aims:

To compare efficacy and medical costs of typital and atypical antipsychotics in treating schizophrenic patients.

Methods:

250 in patients in general hospital and psychiatric hospital were randomly allocated to one of the two groups, one treated with typital antipsychotics as chlorpromazine, haloperidol and so on with a mean daily dose of 500∼800 mg in chlorpromazine equivalents, and the other with atypical agents in cluding clozapine (mean daily dose of 400∼800mg ), risperidone of 6 mg, or olanzapine of 20 mg.

Results:

The total costs of the treatment were (3157±253) Yuan RMB for patients treated with typical agents in general hospital, and (3673±294) Yuan RMB for patients treated with typical agents in psychiatric hospital respectively. the costs for medicine were (774±903) Yuan RMB, (1061±903) Yuan RMB respectively. the costs in atypical group were(1120±390) Yuan RMB and (1637±325) Yuan RMB, and (108±157) Yuan RMB and (240±317) Yuan RMB respectively. the duration of patients treated with typical agents in hospital is longer than that with atypical agents.

Conclusions:

It indicates that atypical antipsychotics have similar efficacy to typical agents in treating schizophrenic patients with less costs.
Costs for Schizopsychotic Patients in Sweden
Authors: Helldin L. , Hjärthag F. , Lothgren M. , Hjortsberg C.
Published: March 2009

As part of the Clinical Long-term Investigation of Psychosis in Sweden (CLIPS), 200 patients diagnosed with schizophrenia, schizoaffective disorder or delusional disorder, are studied. the aim is to provide up-to-date costs for a defined patient population with schizopsychotic disorders in Sweden.

We identify the actual clinical management of illness and explain cost variability. Costs are combined with information on outcomes and severity of the disorder.

Total costs per patient-year amount to 62.320 Euro. Direct costs correspond to 41% and indirect costs to 59% of total costs. Inpatient and outpatient care corresponds to 7% each of total costs, while costs for special housing and assistance at home is estimated to 22% of total costs. Medication only corresponds to 3% of total costs.

We conclude that costs differ between patients depending on illness severity. Also a reallocation has taken place during the last 15 years between different cost items, from direct costs to indirect costs and from in-patient care at hospitals to out-patient care and assistance at home. the main cost driver is indirect costs due to decreased working ability and premature death. Special housing and home-assistance is the second largest cost item. In-patient care corresponds to 7% of total costs, which 15 years ago amounted to 50% of total costs. This reflects the change in care of schizopsychotic patients. Instead of treating patients at institutions, patients are now to a large extent living in their own housing but often receiving some kind of assistance at home provided by the local municipality.
Quality of Life and Gender Related Mechanisms of Social Adaptation in Patients with Schizophrenia
Authors: Berezantsev A. , Kachaeva M. , Mitrophanova O.
Published: March 2009

Aims:

To investigate the quality of life of schizophrenic patients, the influence of gender on their social adjustment and to compare male and female attitude to the quality of life.

Method:

Clinical and statistical, instruments for assessing Quality of Life (QOL). 200 patients (150 women and 50 men) were evaluated. We have compared clinical picture, socio-demographic factors, parameters of social adaptation and subjective attitude to the QOL in male and female schizophrenic patients.

Results:

The research has indicated sex related differences in the compared parameters. Male patients more frequently revealed personality disorders-like symptoms, they had poor social functioning and even social desadaptation, they were prone to aggression, substance abuse. Nevertherless they displayed subjective satisfaction with their QOL. Female patients more often revealed hypochondriacal symptoms but positive variant of social adaptation. at the same time women subjectively were not satisfied with their QOL.

The study has revealed that gender related mechanisms of social adaptation in women were presented by high compliance. Comparative analysis of males and females of the study exposed that gender related mechanisms of social adaptation with the inclusion of attitudes and behavioural patterns connected with regard of health and compliance are universal irrespective of clinical and social factors.

Conclusion:

There are considerable gender differences in the subjective perception of QOL among patients with schizophrenia. the study indicate better social adaptation of females based on specific gender mechanisms. Results will contribute to improve treatment and rehabilitation.
Expressed Emotion and Psychoeducational Intervention for Relatives of Patient with Sever Mental Disorder in Iran
Authors: Karamlou S. , Mazaheri A. , Mottaghipour Y.
Published: March 2009

Expressed emotion had been used as a construct in understanding the interaction between patients and their carers and families. A considerable amount of data from Western cultures suggests that high expressed emotion can lead to relapse in vulnerable individuals, even when they are on medication. studies on family intervention using EE as a target have shown the effects of psychoeducational family intervention for preventing relapses.

The purpose of this study was investigate the effectiveness of psychoeducational intervention in reducing expressed emotion and improve family environment in families of patient with sever mental disorder. Using an experimental design, with pretest and posttest with control group, families of 30 patient with Bipolar disorder (BPD), schizophrenia and Schizoaffective disorder divided in two conditions: 6 session family psychoeducation plus drug treatment (intervention), and drug treatment only (control). Expressed emotion were assessed using Family Questionnaire (FQ).

Results showed that family psychoeducation program would not diminish the emotional over involvement (EOI) but it had significant influence on reduction of critical comments (CC) in family members.

Furthermore, family intervention reduced CC but it had no significant changes in EOI. it can be show that various components of expressed emotion must be seen in the cultural context and embedded in the normative data of the population before the concept can be considered in association with the pathogenesis of relapse.
Correlation between Cognitive Functions, Axiety and Quality of Life in Schizophrenia
Authors: Krysta K. , Kozmin A. , Kafel J. , Cichon L. , Krupka-Matuszczyk I.
Published: March 2009

The purpose of the research was to find a relationship between selected cognitive functions and anxiety in relation to the quality of life in subjective assessment in schizophrenic patients. the study encompassed a group of patients hospitalized and continuing the treatment after the hospitalization in an outpatient setting. the battery of cognitive neuropsychological tests used to assess cognitive functions included: trail making test, and Stroop test. the intensity of anxiety as state and trait was assessed with the Spielberger State-Trait Anxiety Inventory (STAI).The patients were also requested to fill in the Life Quality Scale questionnaire and the questionnaire of the Frankfort Scale of mental and physical state. the results were analyzed statistically. In the examined group statistically significant relation was found between the results of measuring psychomotor speed, visual-spatial working memory, as well as intensity of anxiety as trait in a group of patients who have a negative opinion about the quality of their life. the correlation between negative opinion only about contacts with friends or eating meals was found in the group with anxiety as trait-was not found among the patients with psychomotor disruption. the above correlations between cognitive and executive tests results show how important are that interactions in the process of constructing a good rehabilitation program for patients with schizophrenia.
Violence and Psychosis; Treating the Untreatable (Novel Pharmacological Approaches) [P03-158]
Authors: Launer M.
Published: March 2009

Often the final pathway for psychosis is the forensic services. in many other cases the only options are prison or no care at all. Despite much research into the psychopharmacological approach many patients are either unresponsive or unable or unwilling to take medication. Many clinicians would support the early use of clozapine for these patients but despite the availability of clozapine in Europe for nearly 20 years the numbers who are treatment resistant are still highly significant. This affects patients, carers and indeed potential victims and staff who are increasingly vulnerable. the eclipse of the typical anti-psychotics and the fear of extra-pyramidal side effects has led to many patients being prescribed oral atypical agents which they do not actually take. the result of, in many cases years, of untreated or part treated psychosis is severe cognitive damage. This then contributes to difficulty in managing the patient and lack of engagement in the therapy process. the emergence of new depot preparations may be the answer but the degree of D2 blockade may still not be sufficient and the addition of 5HT blockade may be also useful. in the forensic settings there is much made of risk assessment but the most efficient predictor of future risk is a stable patient on an effective treatment regime. Several options are described including double depot, high dose olanzapine and clozapine enhancement.
Bupropion for Smoking Cessation in Schizophrenia
Authors: Lee H.-Y. , Kang R.-H. , Paik J.-W. , Ko Y.-H. , Lee M.-S.
Published: March 2009

Bupropion is a catecholamine reuptake inhibitor and also a potent noncompetitive ion channel site antagonist at the nicotinic acetylcholine receptor. Bupropion is indicated for use in combination with behavioral modification programs for smoking cessation. There have been a few studies about the effect of bupropion on smoking cessation in schizophrenia. Therefore, we aimed investigated the change of the symptomatology after smoking cessation with bupropion in the patients with schizophrenia.

There were fifty-six patients with smoking in the psychiatric ward of Hapcheon Korea Hospital. among them, thirty-nine inpatients meeting the DSM-IV criteria for schizophrenia were recruited. for 4 weeks, treatment team persuaded the patients to enter the program of smoking cessation. with the exception, if the patients did not agree the program, the patients were able to be transferred to another ward that smoking was permitted. All patients agreed to the program. Postive and Negative Symptom Scale (PANSS), Temperament and Character Inventory(TCI), State-Trait Anxiety Inventory(STAI), Fagerstrom Test for Nicotine Dependence(FTND) were evaluated at the beginning of the study and 12 weeks of Bupropion treatment.

At 12 weeks after successful smoking cessation with bupropion, FTND scores were significantly decreased after smoking cessation. the scores of STAI and PANSS were not significantly changed. the subcale of TCI, Novelty Seeking showed decreasing tendency after smoking cessation, although there was no statistical significance(p=0.054).

These results suggest that bupropion is an effective antidepressant on smoking cessation and does not aggravate the psychotic symptoms in schizophrenia. Further investigation with larger number of subjects is needed.
Endophenotypes and Diagnostic Categories: Event-related Potentials and the Schizophrenia-bipolar Dichotomy [P03-160]
Authors: Maltez J. , Dias D. , Silva H.
Published: March 2009

After decades of neuroscientific research and taxonomic endeavour in psychiatry the quest for biologic markers specific enough to accommodate nosologic categories has not succeeded. Yet, neurophysiology and neuroimaging have developed pwoerful tools to investigate brain function. an immense amount of data has been accumulated regarding normal and pathologic information processing, cognition, emotion and other domains. Some have been correlated with genes underpinning diseases and are candidate endophenotypes. These stand at an intermediate level between genes and phenotype. They encompass several kinds of dysfunctions or abnormalities in brain structure. Rather than matching to singular diagnostic categories, as we devise them today, the same endophenotype is usually shared by distinct pathologic entities. Assuming tha they reflect specif dysfunctions this raises critical questions regarding the DSM way of classifying mental disorders and to the understanding of the neurobiologic phenomena underlying them. It is the purpose of this presentation to discuss these questions and review some of the data, including our own, concerning event-related potentials endophenotypes of psychosis with special focus on the schizophrenia-bipolar dichotomy and present.
the Comparred Effect of Zyprasidone and Haloperidol at Hippocampal and Frontal Cortex at Rats
Authors: Marinescu D. , Mogoanta L. , Udristoiu T.
Published: March 2009

Background:

The alteration of hippocampal and prefrontal structures is linked with schizophrenia cognitive impairment and negative symptoms. the antipsychotics can induced apoptotic mechanisms correlated with the psychopharmacological mechanism of excesive blocking of the D2 receptors. Distress determined increase of the glucocorticoid aggression wich drive to the decrease of neuroprotective capacity at the brain level.

Methods:

We formed 5 study lots (5 adults rats) and a control lot. the substancies were administrated intraperitoneal, daily, saline solution equivalent to: ziprasidone (1.25mg/kg/day) and haloperidole (0.20mg/kg/day), dexametasone (0.20mg/kg/day):

N1 - Haloperidole; N2 - Dexametasone; N3 - Ziprasidone; N4 - Dexametasone and Haloperidole; N5 - Dexametasone and Ziprasidone; N6 -control lot.

We monitorised the cardiovascular function, respiration and EPS, without signaling any serious deadly adverse event. the rats were sacrificed during the 10th day and 21th day.

Results:

Frontal cortex and hippocamp were the most intensely affected even since the 10-th day to the N4 (haloperidole and dexametasone) lot with massive neuronal loss at the VI, V, and IV frontal cerebral layers.

The lots treated with ziprasidone presented significant lesser structural changes in frontal cortex and hippocamp, comparative to haloperidole. the lots treated with dexametasone and ziprasidone (N5) are lesser affected at the cerebral structure level.

Conclusions:

Haloperidole has a significant decrease in neuroprotection. Ziprasidone demonstrated an neuroprotective effect.
Association between Financial Strain, Social Network and Five-year Recovery from First Episode Psychosis
Authors: Mattsson M.
Published: March 2009

Despite much effort to positively affect long-term outcome in psychosis and schizophrenia many patients are still facing a poor outcome with persistent psychotic symptoms and decline in social functioning. the aim of this study was to examine the relationship between financial strain and social network and five-year outcome of first episode psychosis (FEP). FEP patients were divided into recovered (n = 52) and non-recovered (n = 19). Each personwas matched according to age and gender with fourpersons (n = 284) from a longitudinal populationbasedstudy. All persons had answered an extensivequestionnaire including social network, quantitative and qualitative, financial strain and mental health. Linear regression analysis showed that both financial strain and social network were associated, and had a unique contribution, to outcome. the results indicate that FEP patients might benefit from interventions that reduce financial strain thus facilitating daily life and cultural and social activities.
Prevalence of Metabolic Syndrome in Spanish Patients with Schizophrenia and Overweight
Authors: Azanza J.R. , Bernardo M. , Rojo L. , Rejas-Gutiérrez J. , Mesa F.
Published: March 2009

Aims:

The metabolic syndrome MS (visceral obesity, dyslipidaemia, hyperglycaemia, and hypertension), has become one of the major public-health challenges worldwide. Patients with schizophrenia are more likely to suffer from MS that the general population. We have analyzed the prevalence of MS in Spanish patients with schizophrenia and overweight.

Methods:

The CRESSOB study is a 12-month, prospective, naturalistic study including 110 community mental health clinics selected at random. Each site enrolled four consecutive patients with diagnosis of schizophrenia, according to DSM-IV TR criteria, and overweight (BMI > 25 Kg/m2). to assess the prevalence of MS we have analyzed the baseline results of the CRESSOB study. the National Cholesterol Educational Program (NCEP-ATPIII), the International Diabetes Federation (IDF) and the American Heart Association/National Heart, Lung, and Blood Institute (AHA/NHLBI) definitions were used to established the presence of MS.

Results:

A total of 391 patients were enrolled on the study (mean age 40.5 years, 63.8% men). 75.9% of the patients did not meet criteria for remission, using the selected PANSS items. Mean GAF score was 52.7 (SD 15.4). Using the different criteria, 59.0% of males and 58.3% of females fulfilled the NCEP-ATPIII criteria, 71.1% of males and 65.8% of females fulfilled the IDF criteria and 70.1% of males and 65.1% of females fulfilled the AHA/NHLBI criteria.

Conclusions:

The MS is highly prevalent in Spanish patients with schizophrenia and overweight. Given the metabolic syndrome is an important risk factor for cardiovascular disease, these patients should receive appropriate clinical monitoring for this syndrome.
Deinstitutionalization’s Impact on Chronic Psychiatric Patients’ Social Functioning: a Study using Hall and Baker’s Rehab Rating Scale
Authors: Giaglis G. , Michailidou B. , Aggelidis G.
Published: March 2009

Aims:

To assess the possible impact of deinstitutionalization on the social behaviour of chronic psychiatric patients.

Methods:

Hall and Baker's REHAB is a comprehensive behaviour rating scale designed to assess social functioning of people with a major psychiatric disorder. REHAB was completed for 58 chronic psychiatric patients (41 men - 17 women, mean age: 57.5±12.5 years) independently by a pair of raters one year before and another pair of raters one year after the patients’ relocation.

Results:

Among REHAB's five subscales that assess patients’ general behaviour, “community skills” and “social activity”, showed statistically significant improvement (p< 0.001 for both subscales), “self-care” and “overall impression” showed a mild but not significant change, while “speech disturbance” remained at almost identical levels. Gender was not associated but age correlated negatively with patients’ level of functioning (p=0.009). Regarding REHAB's section that assesses patients’ deviant behaviour, there was a significant decrease in the severity and/or frequency of patients’ self-talking (p=0.021) and a slight non-significant change in patients’ exhibiting physical violence, self-injurious or sexually offensive behaviour; nevertheless it is important to note that 40%-83% of the patients did not present with deviant behaviour to begin with. Gender did not influence results, but physical violence, self-injury and verbal aggression showed moderate negative correlation with age (r=-0.341 to -0.435).

Conclusions:

Even though deinstitutionalization does not improve every aspect or psychiatric patients’ social functioning, it reasonably enhances social and community skills and suppresses some of their deviant behaviours.
on the Differential Diagnosis of Obsessive-compulsive Symptoms in Schizophrenia: A Conceptual and Clinical Analysis
Authors: Michalopoulou P. , Oulis P. , Konstantakopoulos G. , Lykouras L.
Published: March 2009

Several shortcomings of the current psychodiagnostic manuals (DSM-IV, ICD-10) with respect to obsessive-compulsive disorder, such as the diagnostic parity of obsessions and compulsions and the deficient conceptualization of compulsions might artificially inflate the clinical prevalence of obsessive-compulsive (OC) symptoms in the course of schizophrenic disorders. Still, one cannot exclude on purely a priori grounds the possibility of a genuine coexistence of OC symptoms along with delusions in patients with schizophrenia. the aim of the present study was to provide a contrastive conceptual analysis of typical features of obsessions versus those of delusions and correlatively of compulsions versus delusionally-motivated repetitive behaviours, supplemented by four relevant vignettes as clinical tests of its adequacy. Although preliminary, the results of our conceptual and illustrative analyses suggest that General Psychopathology can afford the conceptual resources for the accurate differential diagnosis obsession/compulsions from delusions/delusionally-motivated repetitive behaviours. in turn, this would provide a more solid clinical ground for the investigation of the epidemiology and the pathophysiology of OC symptoms in schizophrenic disorders.
Prevalence of Alcohol use Disorders in Schizophrenia - A Systematic Review and Meta-analysis
Authors: Miettunen J. , Löhönen J. , Koponen H. , Isohanni M. , Koskinen J.
Published: March 2009

Objective:

Alcohol use disorders (AUDs) represent significant comorbidity in schizophrenia. Previous reviews have reported a wide range (12-55%) of dual diagnosis prevalence: however, there is no agreement on overall prevalence. Our aim is to present recent studies of AUD, estimate overall prevalence, and study characteristics affecting the prevalence of AUD.

Method:

We conducted a search using three electronic literature databases and a manual search on articles published in 1996-2007. Metaregression was used to study how prevalence is affected by different study characteristics.

Results:

Altogether 58 studies met our criteria. the median of current AUD prevalence was 10.1% (IQR=4.6-24.5, 19 studies) and median of lifetime AUD prevalence 22.2% (IQR= 12.1-32.0, 45 studies). in studies using DSM-III-R the median prevalence was higher than in studies using DSM-IV, ICD-9 or ICD-10 (32.3/18.1/10.3/5.9%).

Conclusions:

Our systematic literature search found a wide range of prevalence estimates of AUD in schizophrenia patients. Approximately every fifth schizophrenia patient had AUD diagnosis. When contrasted to studies published between 1990-95 our results show a descending trend in AUD prevalence: however, AUDs are still common in schizophrenia patients. the decrease may be explained by changes in diagnostic systems, although it is also possible that other addictive substances, such as cannabis, have replaced alcohol in some countries. other sample characteristics did not affect to the prevalence estimates.
Clinical and Evolutional Aspects of the Acute and Transient Psychosis
Authors: Lazarescu M.
Published: March 2009

In the Psychiatric Clinic in Timisoara, two groups of patients with acute and transient psychosis, were studied. One study was retro-prospective on a group of 35 cases which had their onset in 2001 and were studied in 2007. Another study was on 20 cases, which had their first episode in 2007 and are followed prospectively. We were interested in: genetics, the occurrences around the onset, the symptoms of the first episode, the clinical and social evolution after one year from the onset and in the first group also, after 5 years from the onset, for the cases that could be contacted. We have noticed a significant clinical and evolutional polymorphism.
the Long Term Evolution of Periodical Affective Disorders, with and without Psychotic Symptoms
Authors: Lazarescu M.
Published: March 2009

In the Psychiatric Clinic in Timisoara, we began a study of the long term evolution (over 10 years) on two comparative groups of patients with affective disorders, with and without incongruent psychotic symptoms. We compared one group of 20 bipolar patients with psychotic symptoms with another group of 20 bipolars without psychotic symptoms. the same was done with two groups of 20 patients with monopolar depression. We did not include the cases with more than one schizoaffective episode, which were studied separately. We came to the conclusion that affective disorders associated with incongruent psychosis, had an earlier onset, a worse prognosis and other genetic and temperamental characteristics, than the ones without psychotic symptoms. Also the cases with schizoaffective disorder (schizo-bipolar and schizo-depressive) we have studied had an earlier onset and a bad prognosis.
Quality of Life of Patients Suffering from Schizophrenia Treated with Clozapine and Risperidone
Authors: Milosavljevic M. , Lecic-Tosevski D. , Perunicic I.
Published: March 2009

Background:

Quality of life (QoL) is considered an important outcome in the treatment of schizophrenia and is linked with clinical and social recovery. Until recently treatments of schizophrenia have focused mainly on reducing positive symptoms, often leaving patients with numerous residual difficulties. It's been expected that atypical antipsychotics improve QoL equally as they improve clinical outcome of the patients with schizophrenia.

Objectives:

To compare clinical improvement and QoL of patients treated with risperidone and clozapine two months after the beginning of treatment.

Methods:

The sample included 40 patients (17 males and 23 females, mean age 33.1) with diagnosis of schizophrenia according to ICD-X. the patients were treated with either risperidone (n=20) or clozapine (n=20). the PANSS and CGI scales for clinical status were applied at the beginning of the treatment and two months later. the QoL was assessed by the WHOQOL-BREF.

Results:

Analysis of data has shown a significant difference for all four domains (physical, psychological, social relationships and environment) at WHOQOL-BREF scale for both medications after two months, but no difference between the two antipsychotics. the patients treated with clozapine had significantly higher scores on PANSS at the beginning of treatment. PANSS and CGI applied after two months have not shown differences between the medications.

Conclusion:

Both clozapine and risperidone had equal and statistically significant effect in reducing the symptoms of schizophrenia measured by PANSS and CGI in two months period, as well as in improving the quality of life. However no difference was found between the two medications.
Metabolic Syndrome in German Patients with Schizophrenia - Baseline-data from Treatment-naive Patients and Patients Previously Treated with Antipsychotics
Authors: Kraemer S. , Minarzyk A. , Beal C. , Hundemer H.P. , Forst T. , Kopf D.
Published: March 2009

Introduction:

Several studies have already reported increased prevalence of metabolic and cardiovascular risk factors in patients on antipsychotics. This observational aimed to assess the prevalence of metabolic syndrome (MetS) in differently treated patients with schizophrenia.

Methods:

Patients with schizophrenia (age >=18 years) from 162 psychiatric practices throughout Germany were enrolled if they were either treatment-naive and initiated on antipsychotic therapy, or had received previous antipsychotic treatment and were switched to a new medication. Baseline physical and laboratory parameters were evaluated to assess the prevalence of MetS (American Heart Association's definition). Clopper-Pearson 95%CIs were calculated. Patients were assigned to evaluation cohorts by previous treatment: olanzapine (Olz, N=62), risperidone (Risp, N=67), quetiapine (Quet, N=49), other atypical monotherapy (Atyp, N=103), typical therapy (Typ, N=90), atypical combination (Comb, N=109), treatment-naive (TN, N=162).

Results:

The sample included 642 patients, mean age 45.2 ±13.3 years, 325 (50.6%) women. Characteristics for the TN-cohort were: mean BMI 25.3 ±4.5, mean blood triglycerides 157.3 ±122.4 mg/DL, rates of concomitant diseases (28.4%), and prevalence of MetS (24.7%, CI18.3;32.1). in comparison, previously treated patients had a mean BMI: 27.0 ±4.9 (Quet) to 29.3 ±5.4 (Comb), mean triglycerides: 182.4 ±116.9mg/DL (Risp) to 232.3 ±164.3mg/DL (Comb), concomitant diseases: 29.9% (Risp) to 41.7% (Comb), MetS: 42.4% (Risp, CI30.3-55.2) to 57.0% (Comb, CI47.1-66.5).

Conclusion:

TN-patients (see above) had a significantly lower prevalence of MetS than the overall sample (42.8 CI 38.9;46.7). Comb-patients showed the highest prevalence of MetS. Typ-patients had a similar prevalence of MetS (43.3, CI32.9;54.2) than patients treated with atypical antipsychotics.
Antipsychotic Adherence Intervention for Veterans over 40 with Schizophrenia: Results of a Pilot Study
Authors: Mittal D. , Owen R. , Lacro J. , Landes R. , Edlund M. , Valenstein M. , Jeste D.
Published: March 2009

This pilot study tested the feasibility, acceptability, and effect-sizes of a multimodal, individual intervention designed to optimize antipsychotic medication use in patients ≥40 years of age with schizophrenia or schizoaffective disorder.

Methods:

We randomized 40 patients into two groups: usual care (UC) or a nine-session, manualized, antipsychotic adherence intervention (AAI). the AAI attempted to improve adherence by combining three psychosocial techniques:

a.

education,

b.

skills training, and

c.

alliance building.

Sessions employed a semi-structured format to facilitate open communication. the primary outcome was antipsychotic adherence at study end. We obtained qualitative data regarding patient preferences for the duration and modality for receiving the adherence intervention.

Results:

Compared to the UC group, a greater proportion of the AAI group was adherent post-intervention based on medication possession ratio, a commonly used measure of medication adherence (85% vs. 66.6%; OR=2.64), a difference that was statistically not significant. the entire AAI group reported that they intended to take medications, and 75% were satisfied with the intervention.

Conclusions:

The AAI was feasible and acceptable. Preliminary data on its effectiveness warrant a larger study. Qualitative data shows that patients prefer brief adherence interventions and accept telephone strategies.
Study of Pathological Personality as a Modulating Factor of Schizotypy
Authors: Moreno L. , Valero J. , Gaviria A.M. , Hernández A. , Gutiérrez-Zotes J.A. , Labad A.
Published: March 2009

Aims:

From a dimensional point of view, the schizotypal features would be continuously distributed in normal population and individuals with schizophrenia spectrum disorders. in the latter, differences have been found in personality traits between the diagnostic categories of the dimension, and also different schizotypy scores between them. in this study our main objective was to specify the domains and traits of pathological personality that can be considered risk factors for schizotypy.

Method:

SPQ and DAPP-BQ were administered to a sample of 91 subjects that were divided in four groups: psychotic patients with schizophrenia spectrum disorders, siblings of patients from this spectrum, patients with personality disorders, and healthy controls.

Results:

Patients with personality disorders presented the highest scores of schizotypy measured with SPQ, followed by psychotic patients, siblings, and finally the healthy controls. both groups of patients obtained higher pathological personality scores compared to siblings and controls. in the psychotic patients and their siblings emotional dysregulation, dissocial behavior and inhibition domains correlated with the SPQ factors, while in the personality disorder patients SPQ correlated only with inhibition. the trait social avoidance appears to be a predictive variable of psychometric schizotypy.

Conclusions:

Pathological personality underlying the schizotypy of psychotic patients of schizophrenia spectrum and their siblings is different from that of the personality disorder group. Social avoidance is a risk factor for schizotypy measured with SPQ.
Pharmacotherapy of Schizophrenia from Chlorpromazine Till Risperdal Consta
Authors: Najim H.
Published: March 2009

Schizophrenia is a severe and enduring mental illness which affects around 1% of any adult population. It affects both sexes equally. Schizophrenia is a lifelong condition with repeated relapses.

The discovery of the phenothiazines transformed treatment of schizophrenia from institutional bases to community bases.

Oral conventional antipsychotics provided more freedom for patients but created more problems with regards to side effects and compliance. These problems necessitated the development of the depot antipsychotics which guaranteed that patients take the drugs. Studies have demonstrated the superiority of injectable anti-psychotics.

The introduction of the atypical antipsychotics were another step forward in the battle against schizophrenia as they are less likely to produce extra-pyramidal side effects and this improves the outcome of the illness and compliance, again some patients refused to take the medication because of lack of insight and posed another challenge.

The introduction of long acting injectable risperidone (RLAI) was another step forward as it shown to improve compliance and clinical outcome, some patients prefer it to oral medication, many find regular contact with community psychiatric nurses beneficial. It also reduces the possibility of overdose.

RLAI over the past few years have improved clinical outcome of schizophrenia by improving cognitive performance and patient quality of life. Having said that RLAI has less favourable outcome in patients suffering from treatment resistant schizophrenia and for those patients clozapine remains the gold standard drug.
A Case of Obsessive Compulsive Schizophrenia: The Comorbidity and its Complexities
Authors: Jaafar N.R. Nik , Midin M. , Reddy J.P.
Published: March 2009

The comorbidity of obsessive compulsive disorder (OCD) and schizophrenia is an intriguing clinical phenomenon. Such presentation arguably deserves to be recognized as a distinct subgroup of schizophrenia with a possibly different set of challenges and treatment needs. This report describes a patient who had OCD before schizophrenic changes were observed. His continued struggle with his illness despite bouts of minor successes illustrates the complexities of this clinical entity. in managing this patient, we faced several clinical dilemmas including diagnostic ambiguity, issues with pharmacotherapy and difficulties in rehabilitating a patient from a family with high expressed emotion.
Diagnostic Stability of Psychotic Disorders: A Retrospective Study
Authors: Silveira C. , Norton A. , Martins A. , Domingues I. , Moreira R. , Timóteo S. , Silva A.
Published: March 2009

Background:

An essential condition to validate a diagnosis is its stability over time. Since there are no biological markers for psychiatric disorders, the diagnosis relies on clinical expertise, with several consequences in treatment planning, disease burden and disability, affecting outcome and public health.

Objectives:

The aims of this study were:

1.

the assessment of long term stability of the diagnosis of psychotic disorders,

2.

its implications in patient treatment, and

3.

the evaluation of eventual predictors of diagnosis stability.

Methods:

This was a retrospective study carried out in the Department of Psychiatry of a large University Hospital (Hospital S. João, Porto, Portugal). Patients enrolled were admitted in the inpatient unit from 2000 to 2003 (n=190, 12.41% of 1531 patients admitted), experienced a first psychotic episode, and fulfilled criteria for one of the following diagnosis: schizophrenia, schizoaffective disorder, bipolar disorder, drug induced psychosis, acute and transient psychotic disorders, schizophreniform disorder and psychosis NOS (ICD-10 classification). the diagnoses were extracted from clinical records, and reassessed five years after the initial diagnosis. the analysis focuses on diagnostic agreement over time; clinical and demographic variables were also collected and putative associations with diagnostic shift considered.

Results:

The study is now under statistic evaluation.
“Full Moon Fits”: Focal Temporal Epilepsy Presenting as First Episode Psychosis
Authors: Norton A. , Massano J. , Timóteo S. , Domingues I. , Pires I. , Silveira C.
Published: March 2009

Introduction:

Epilepsy rarely presents as psychosis; this is reportedly more common in temporal lobe epilepsy, particularly mesial temporal lobe sclerosis (MTLS). in first psychotic episodes, epilepsy is often a neglected diagnosis. Also, distinguishing ictal behavioral manifestations from postictal psychosis may be troublesome, hindering adequate management.

Case report:

26-year-old female without known psychiatric or neurological disorder, brought to the emergency department due to rapidly progressive behavioral disturbance, with Capgras and persecutory delusions, marked aggressiveness and disorientation. Hallucinations were absent. According to her mother, she experienced several “fits” during the previous 2 days, and she also invariably sustains these every month, around “the full moon days”. Blood and urine tests and a brain CT scan were normal. She was treated with risperidone and lorazepam, with symptom remission in two days. Further exploration revealed a two year history of undiagnosed partial complex and generalized seizures; MRI disclosed right MTLS. Interictal EEG and video-EEG were normal (with a negative psychogenic induction trial). the symptoms are successfully controlled with oxcarbazepine.

Discussion:

Although the EEG was not carried out acutely, this seems to be a case of postictal psychosis; this diagnosis is also supported by the clinical progression. the differential diagnoses include toxic psychosis and non-convulsive status epilepticus; a brief review of epilepsy-related psychosis will be conducted. A low suspicion threshold must be kept in these situations, and a meticulous multidisciplinary approach seems advisable.
Association Analysis of Heat Shock Protein 70 Gene Polymorphisms in Schizophrenia
Authors: Pae C.-U.
Published: March 2009

Objectives:

This study investigated the association between an enlarged set of SNPs at Heat shock proteins (HSPs) 70 gene and schizophrenia.

Methods:

Two hundred and ninety four patients with schizophrenia and 287 controls were enrolled in the study. Genotypings of 5 SNPs of HSP70 were performed using pyrosequencing method.

Results:

Significant association was detected at rs2075799 (allele A, Chi suare =8.03, d.f.=1 p=0.0046), but not at rs2227956 (p=0.28), rs1043618 (p=0.88), rs562047 (p=0.47) or rs539689 (p=0.32). in fact, the rs2075799*G/A genotype was more represented in patients with schizophrenia than in controls (Chi-sq=8.23, d.f.=1, p=0.0041). Haplotype based associations were also detected (global p value 0.000003); the T-A-C-C-G haplotype was more prevalent among the patients (odds ratio, OR 5.95). Sliding windows analysis revealed a major contribution from rs2227956 and rs2075799 (global-p value 0.0075), with T-A haplotype significantly associated with schizophrenia. There was no evidence of an association between the clinical variables and schizophrenia across the genotypes.

Conclusion:

Our results raise the possibility that HSP70 gene (i.e., haplotypes of rs2075799) might be implicated in the development of schizophrenia, although limited by rare haplotypic association with the disease. Hence further studies from different ethnics should be performed to confirm these results.
What’s Happened to Paraphrenia? The Modernity of Emil Kraepelin’s Thinking
Authors: Pelizza L. , Bonazzi F.
Published: March 2009

Paraphrenia is a psychotic disorder described by Kraepelin in 1913. He formulated this concept to define a group of patients who exhibited symptoms characteristic of dementia praecox (marked delusions with or without hallucinations), but with minimal disturbances of emotion and volition, and much less personality deterioration. after the publication of Mayer"s prognostic research in 1921 (which studied the outcomes of 78 paraphrenic patients reported by Kraepelin), the view to differentiate paraphrenia from schizophrenia was considered to be unfounded in Germany. Paraphrenia is now diagnosed relatively infrequently and is not listed in the current Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) or International Classification of Diseases (ICD-10). However, it appears that some psychiatrists recognize the illness but label it "atypical psychosis", "schizoaffective disorder," or "delusional disorder" for lack of a better diagnostic category.

Virtually no systematic research on paraphrenia has been conducted in the past 60 years. We describe a 30-year-old man affected by sistematic paraphrenia, according to the neo-Kraepelinian description of paraphrenia proposed by Ravindran et al. in 1999 (description compatible with the formats of DSM-IV and ICD-10). Using a questionnaire adapted from this description, our case of paraphrenia were distinguished from those of schizophrenia and delusional disorder. in conclusion, It is possible to define and recognize paraphrenia, because it is a viable diagnostic entity. as in the days of Kraepelin, the problems concerning paraphrenia cannot be neglected when considering the classification of psychotic disorders.
Metabolic Risk Factors in a Schizophrenic Community Sample (vallès Oriental, Catalonia, Spain)
Authors: Planas P. , Català R. , Madrid C. , Eduard S. , Lira S.
Published: March 2009

Introduction:

Life expectancy for individuals with schizophrenia is 20% lower than in general population. Medical illnesses, psychiatric comorbidities, less access to care, poverty and limited perception of illness are some of the most important factors associated with increased risk of morbidity. Cardiovascular death (CVD) is a major contributor to increased mortality in schizophrenia 2,3. Prevalence of obesity in patients with schizophrenia (40%-60%) is twice the rate of the general population (20%-30%). Obesity, high abdominal perimeter, serum lipid levels, and smoking are significant, Independent Risk Factors for CVD.

Metabolic syndrome is a cluster of metabolic disturbances, which is associated with an increased risk of CVD.

Objective:

To estimate the prevalence of CVRF in schizophrenic outpatients treated at Granollers' CSM.

Methods:

Cross-sectional descriptive study about 100 schizophrenic outpatients treated at CSM Granollers. Data on sociodemographics, physical examinations, blood test parameters, CVRF history and treatments are recorded. Each CVRF is established according to international criteria and/or pharmacological treatment.

Secondary objectives:

•

Prevalence of Metabolic Syndrome;

•

Antipsychotic drugs treatment.

Variables - Sociodemographic data and Schizophrenia diagnosis:

•

Physical examination;

•

Lab parameters;

•

Other CV risk factors (smoking, alcohol intake…).

Results and conlusions:

Estimated prevalences for most of the CVRF in schizophrenic outpatients are, in general, higher than those expected of the same age group in the general population. Data presented can support therapeutic decision-making and suggests a need of new prevention and monitoring strategies. New guidelines for monitoring and intervention will be needed for monitoring and intervention.
the Role of Cognition in Vocational Functioning of Schizophrenic Patients
Authors: Popescu C.A. , Miclutia I.V.
Published: March 2009

Background:

Unemployment is a factor that negatively affects the health of the entire population and is an important cause of exclusion, affecting persons with severe mental health problems. the rise of unemployment rates for these persons contrasts with the dropping of unemployment rate for the general population. Schizophrenia is associated with long-term unemployment. Cognitive dysfunction, rather than clinical symptoms, may be the most important factor in the ability to work for patients with this disorder.

Aims:

This study aims to evaluate the relationship between clinical symptoms, cognitive functioning and employment status in patients with schizophrenia.

Methods:

40 patients with schizophrenia were evaluated with PANSS, CANTAB (Cambridge Neuropsychological Test Automated Battery) and with an interview regarding work experience.

Results:

The results suggest that poor premorbid function, negative symptoms and cognitive dysfunction are significantly associated with unemployment in schizophrenia.

Conclusions:

The results of this study confirm the importance of cognitive functioning as a predictor of work function in patients with schizophrenia and the need of cognitive rehabilitation programs.