Smoking in chronic schizophrenic inpatients in taiwan

OBJECTIVE: This study investigated the prevalence of smoking and its association with the clinical characteristics of Chinese inpatients with chronic schizophrenia. METHOD: Schizophrenic patients hospitalized in chronic wards were assessed using Brief Psychiatric Rating Scale (BPRS), Abnormal Involuntary Movements Scale (AIMS) and Folstein Mini-Mental Status Examination (MMSE) testing. RESULTS: Of 257 patients, 105 smoked and 4 had ceased. Males exhibited a higher prevalence of smoking than females (p < 0.001). Smoking was not significantly associated with age at onset (AAO), chlorpromazine equivalents, MMSE, AIMS, BPRS positive symptom subscale, BPRS negative symptom subscale or total BPRS scores. Smokers had higher BPRS general subscales. CONCLUSION: Compared to the general population, smoking prevalence was slightly higher in schizophrenic males, double in schizophrenic females, but no difference in refractory schizophrenic clozapine users. Smoking did not affect patient AAO or daily antipsychotic dose. Patients with a higher BPRS general subscale may smoke to relieve affective symptoms.     

精神分裂症患者发病年龄与临床特征的相关性研究

目的 探讨精神分裂症发病年龄与临床特征的关系。方法 对符合DSM-IV精神分裂症诊断标准的294例住院患者进行BPRS评估和BEAM检查，并收集其人口学资料和病史资料。结果 BPRS总分和迟滞因子分与发病年龄呈负相关，而BPRS总分、迟滞因子分和敌对猜疑因子分与未治疗期的长短呈正相关。发病年龄在性别和遗传因素中的差异无显著性，而在发病诱因、BEAM检查结果和诊断类型间的差别有统计学意义。结论 精神分裂症的临床特征与发病年龄明显相关，发病年龄越小病情越严重，阴性症状也越突出，提示在制定治疗康复方案方面，应有所区别。     

Distinguishing depression and negative symptoms in unmedicated patients with schizophrenia

Depression can occur in schizophrenia but can be difficult to distinguish from negative symptoms of the illness. To evaluate whether concurrent use of the Hamilton Rating Scale for Depression (HRSD) and the Brief Psychiatric Rating Scale (BPRS) could successfully separate depression and negative symptoms, we examined ratings on 69 unmedicated schizophrenic inpatients. A classical BPRS depression subscale score correlated highly (rho = 0.80) with the HRSD total score. The classical BPRS "negative symptom" subscale score was unrelated to both the BPRS and HRSD depression summary measures. Among individual HRSD items, negative symptoms correlated only with work/activities and retardation. The findings suggest that negative and depressive symptoms may be assessed independently.     

Measurement of depression and negative symptoms in schizophrenia.

The validity of the Hamilton Depression Scale (HAM-D) as a measure of depressive symptomatology in schizophrenic patients is questionable since it was not developed for this purpose, nor has it been validated in a schizophrenic population. Accordingly, 80 schizophrenic inpatients were administered the HAM-D, the 18-item Brief Psychiatric Rating Scale (BPRS), and the Scale for the Assessment of Negative Symptoms (SANS) at drug-free baseline and after 4 weeks of neuroleptic treatment. The findings revealed that the HAM-D total score was nonspecific, while individual HAM-D subfactors provided a better index of various symptom complexes. The HAM-D contained a depressive factor that correlated strongly with the BPRS depression factor and a negative symptom factor that correlated strongly with the SANS and the BPRS negative symptom factor. These findings suggest the need to utilize specific assessment techniques rather than global measures when assessing depression in schizophrenia.     

氟西汀治疗精神分裂症的辅助作用

目的：探讨氟西汀辅助治疗精神分裂症的疗效。方法：观察病例分为伴有抑郁症状及不伴有抑郁症状两组，原有抗精神病药不变，辅以氟西汀治疗，以简明精神病量表（BPRS）、阴性症状量表（SANS）、汉密尔顿抑郁量表（HAMD）评定疗效。观察期12周。结果：伴有抑郁症状组HAMD总分较治疗前有显著减少，新出现的副反应轻微。临床疗效总评量表（CGI）显示总有效率为41.7%。结论：氟西汀可改善精神分裂症伴发的抑郁、焦虑、紧张症状。     

Computed tomographic study of aged schizophrenic patients

Abstract  The width of interhemispheric fissure, lateral ventricles and third ventricle were measured using cranial computed tomography (CT; linear method) in 45 elderly inpatients with chronic schizophrenia and in 28 age-matched control subjects. Twenty-three patients were men and 22 were women. In addition, Mini-Mental State Examination, Brief Psychiatric Rating Scale (BPRS) and a subclass of BPRS were undertaken in all patients. There is a significant enlargement of the maximum width of the interhemispheric fissure (in both male and female) and a significant enlargement of ventricular system (more severe in men than in women) in aged schizophrenics, as seen with CT, compared with normal controls. These findings are consistent with previous studies of non-aged schizophrenic patients. Based upon the relation between psychiatric symptoms and CT findings, the most striking is a significant negative correlation between the third ventricle enlargement and the positive and depressive symptoms in all patients. This result suggests that the advanced third ventricle enlargement may decrease these symptoms in aged schizophrenics.     

Association of muscarinic m1 receptor genetic polymorphisms with psychiatric symptoms and cognitive function in schizophrenic patients

OBJECTIVE: The cholinergic system is important in the search for the pathophysiology of schizophrenia due to its role in cognitive function, interaction with the dopamine system in brain regions relevant to schizophrenia, side effects of antipsychotic medication and potential antipsychotic effect of muscarinic receptor antagonists. This study investigated the association of type I muscarinic receptor (CHRM1) genetic polymorphisms with the clinical characteristics of chronic schizophrenic inpatients. METHODS: We determined the genotype of CHRM1 genetic polymorphisms in 243 schizophrenic patients hospitalized in chronic care wards. Psychotic symptoms were assessed using the Brief Psychiatric Rating Scale (BPRS), and cognitive function was assessed using the Folstein Mini-Mental Status Examination (MMSE) test. Sixty of the 243 subjects also completed the Wisconsin Card Sorting Test (WCST). RESULTS: There was a significant difference in the number of correct responses and the percentage of perseverative errors in the WCST in the CHRM1 C267A genotype group of schizophrenia patients. There was no significant association between age at onset, chlorpromazine equivalents, BPRS scores, MMSE or schizophrenia per se in patients with the CHRM1 C267A genotype. The full exon of the CHRM1 gene was screened out with single-strand conformation polymorphism, and 2 single nucleotide polymorphisms (C267A and C1353T) were identified in our patients and control subjects. These 2 single nucleotide polymorphisms were linked together without exception. CONCLUSION: This study demonstrated that in schizophrenic patients, the heterozygote group of CHRM1 C267A polymorphism (267C/A) had more correct responses and less perseverative errors on the WCST performance than the 267C/C homozygote group, implicating that this polymorphism may be related to prefrontal cortical function. Our results also suggested that the C267A polymorphism plays no major role in the susceptibility to and clinical manifestations of schizophrenia.     

氯氮平撤药症状调查

目的：了解氯氮平的撤药症状。方法：对31例服用氯氮平治疗的精神分裂症患者停药1周，分别于停药前后予简明精神病评定量表(BPRS)、副反应量表(TESS)、汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)评定疗效及不良反应。结果：停药后BPRS、TESS、HAMD、HAMA总分均明显高于停药前，停药后有25例(80％)精神症状恶化。结论：氯氮平的撤药症状发生频率高，症状多样。     

Relationships between exploratory eye movement dysfunction and clinical symptoms in schizophrenia

Aim: Many psychophysiological tests have been widely researched in the search for a biological marker of schizophrenia. The exploratory eye movement (EEM) test involves the monitoring of eye movements while subjects freely view geometric figures. Suzuki et al. (2009) performed discriminant analysis between schizophrenia and non‐schizophrenia subjects using EEM test data; consequently, clinically diagnosed schizophrenia patients were identified as having schizophrenia with high probability (73.3%). The aim of the present study was to investigate the characteristics of schizophrenia patients who were identified as having schizophrenia on EEM discriminant analysis (SPDSE) or schizophrenia patients who were identified as not having schizophrenia on EEM discriminant analysis (SPDNSE). Methods: The data for the 251 schizophrenia subjects used in the previous discriminant‐analytic study were analyzed, and the demographic or symptomatic characteristics of SPDSE and SPDNSE were investigated. As for the symptomatic features, a factor analysis of the Brief Psychiatric Rating Scale (BPRS) rating from the schizophrenia subjects was carried out. Results: Five factors were found for schizophrenia symptoms: excitement/hostility; negative symptoms; depression/anxiety; positive symptoms; and disorganization. SPDSE had significantly higher factor scores for excitement/hostility, negative symptoms and disorganization than SPDNSE. Furthermore, the BPRS total score for the SPDSE was significantly higher than that for the SPDNSE. Conclusion: SPDSE may be a disease subtype of schizophrenia with severe symptoms related to excitement/hostility, negative symptoms and disorganization, and EEM parameters may detect this subtype. Therefore, the EEM test may be one of the contributors to the simplification of the heterogeneity of schizophrenia.     

健康状况调查问卷应用于精神分裂症患者中的信度和效度

目的 评价健康状况调查问卷(SF-36)在住院精神分裂症病人中的信度和效度。方法 通过面对面访谈方式调查90例住院精神分裂症患者,信度采用重测法、内部条目一致性分析(Cronbach’sα系数)。效度采用平行效度,用生活满意度指数A(LSIA)和简明精神病量表(BPRS)作为效标,与SF-36作相关分析。结果 整个测量的重测相关系数均大于0.469(P<0.01),内部一致性(Cronbach’s α系数)在0.73～0.96。平行效度:SF-36中的躯体功能、总体健康、生命活力、精神健康4个分量表与LSIA有较好相关性;总体健康、生命活力、社交功能、情感问题所致的角色受限、精神健康5个分量表与BPRS呈显著性负相关。 结论 SF-36是全面评价精神分裂症病人生命质量有效和可靠的量表之一。     

氯丙咪嗪与舒必利辅助治疗精神分裂症阴性症状的对照研究

目的： 比较氯丙咪嗪、舒必利辅助治疗精神分裂症阴性症状的效果。　方法： 使用氯丙咪嗪、舒必利分别作为氯氮平的辅助用药与单用氯氮平对８８ 例以阴性症状为主的精神分裂症病人进行对照研究; 以简明精神病评定量表、阴性症状量表和副反应量表进行评定。　结果： 合并氯丙咪嗪组、舒必利组及单用氯氮平组对阴性症状的治疗显效率分别为６９％ 、３１％ 、１３３３％ 。　结论： 氯氮平合并氯丙咪嗪治疗能有效地改善精神分裂症的阴性症状。     

长期住院精神分裂症患者伴发抑郁症状的影响因素分析

目的:探讨长期住院精神分裂症患者伴发抑郁症状及影响因素。方法:采用卡尔加里精神分裂症抑郁量表(CDSS-C)对长期住院(≥12个月)的200例精神分裂症患者进行抑郁症状的评估,以CDSS-C总分是否≥6分,将患者划分为伴抑郁组58例和非抑郁组142例,运用Logistic回归模型分析伴发抑郁症状的影响因素。结果:抑郁组在女性构成比、探视频率1次/月、抗精神病药单药治疗率、合并苯海索或苯二氮艹卓类药、有自杀意念构成比、阳性症状量表(SAPS)总分、阴性症状量表(SANS)总分和一般精神病理总分明显高于非抑郁组(P0.05或P0.001);主要探视人为I级亲属的构成比及平均住院周期显著低于非抑郁组(P0.05或P0.001)。Logistic回归分析显示主要探视人为I级亲属(OR=0.207,95%CI:0.072~0.591)、探视频率1次/月(OR=3.869,95%CI:1.332~11.239)、有自杀意念(OR=9.256,95%CI:3.191~26.854)是抑郁症状的影响因素(P0.01或P0.001)。结论:探视人(I级亲属)、探视频率及有自杀意念是长期住院精神分裂症患者伴发抑郁症状的主要影响因素。     

Depression in schizophrenia: comparison of first- and second-generation antipsychotic drugs

The aim of this study was to compare the effects of different antipsychotics on depressive symptoms in schizophrenic patients. The data were drawn from a retrospective, naturalistic, observational study in which 222 subjects diagnosed as being affected by schizophrenia during a re-exacerbation phase received 6 weeks of monotherapy with fluphenazine decanoate, haloperidol decanoate, haloperidol, clozapine, olanzapine, quetiapine, risperidone or l-sulpiride. The Brief Psychiatric Rating Scale (BPRS), Extrapyramidal Side Effects Rating Scale (EPSE) and Anticholinergic Rating Scale (ACS) were administered at baseline and six weeks after the beginning of the study; depressive symptoms were evaluated using the BPRS items "depressive mood" and "guilt feelings". All of the antipsychotic drugs led to improvements in the depressive dimension, but this was statistically significant only in the case of fluphenazine decanoate, haloperidol, olanzapine, risperidone and l-sulpiride. A clinical improvement in the depressive dimension significantly correlated with the severity of the psychotic picture and its amelioration. Female patients were significantly more likely to show an improvement in depressive symptoms. In conclusion, our findings suggest that atypical antipsychotics as a class do not seem to be more effective on the depressive dimension during the course of schizophrenia than typical ones, at least as far as the collected BPRS data are concerned. The only factor that seemed to influence the improvement in depressive symptoms during our study was gender, as females were significantly more likely to improve although there were no between-gender differences in the baseline severity of the clinical picture.     

首发精神分裂症病人的抑郁症状

目的探讨首发精神分裂症病人抑郁症状的发生率、特征及相关因素。方法于入院、治疗3、6、9、12月时用汉密尔顿抑郁量表(HAMD)、简明精神病评定量表(BPRS)、阴性症状量表中文版(SANS-CV)、临床总体印象量表(CGI)及功能总体评定量表(GAF)对164例首发精神分裂症患者进行评定。结果急性期首发精神分裂症病人轻度或以上程度抑郁症状的发生率为71%,但在缓解期降至12%。急性期突出的抑郁表现为认知障碍与迟缓(因子分各占HAMD总分的35%和29%)。抑郁症状随着精神病性症状的缓解而减轻,与性别、发病年龄、受教育时间、病程及前驱期长短无关。HAMD总分在急性期仅与BPRS的焦虑抑郁因子分有关,但在缓解期与阴阳性症状、临床总体印象以及总体功能均有密切的相关性;急性期以及治疗3个月时的抑郁症状与随后的阴阳性症状、总体功能的变化无关。结论首发精神分裂症急性期的抑郁症状可能是一个独立的症状群,抑郁程度不能作为预测首发精神分裂症病人预后的指标。     

Depression in Kraepelinian schizophrenia

In order to improve our understanding of depression in chronic schizophrenia, depressive symptoms were assessed in institutionalized, so called Kraepelinian, patients with schizophrenia (N = 43). The patients had been ill and dependent on others for at least 5 years. Depressive symptoms as measured by the Hamilton Depression (HAM-D) scale were less prevalent in this population compared to published data on non-Kraepelinian patients. Only 5% of our Kraepelinian patients had a HAM-D score >/= 16. There was also a low prevalence of core depressive symptoms (depressed mood, suicidal ideation, and guilt). The relationship of depression to other dimensions of schizophrenia was explored. Depression had a modest positive correlation (r = 0.44) with general psychopathology as measured by the Brief Psychiatric Rating Scale (BPRS), but not with positive symptoms as measured by BPRS positive subscale or negative symptoms as measured by the Scale for the Assessment of Negative Symptoms (SANS). Depression also showed a modest positive correlation (r =.48) using the Simpson-Angus Rating Scale (SAS) for extrapyramidal symptoms (EPS). These results indicate that in Kraepelinian schizophrenia, depression is not prevalent, even though patients are severely ill both in symptom and functioning domains. The results of our analysis support that Kraepelinian schizophrenia is a distinct subtype, and raise questions regarding the boundary between schizoaffective disorder and non-Kraepelinian schizophrenia. Finally, the low rate of depression observed revives the notion that preservation of core functional abilities is important for a depressive reaction to evolve in schizophrenia.     

Negative parkinsonian, depressive and catatonic symptoms in schizophrenia: a conflict of paradigms revisited

Background: To study the interrelationship pattern of negative, depressive, parkinsonian and catatonic symptoms over an exacerbation phase of schizophrenia. Method: Forty-five inpatients with a DSM-IV diagnosis of schizophrenia or schizophreniform disorder were assessed at admission and discharge for negative, depressive, parkinsonian and catatonic symptoms. A subsample of patients unmedicated at admission (n=23) was specifically analyzed. Results: Negative, parkinsonian and catatonic symptoms correlated significantly at both assessment points, as did their mean changes over the episode. At admission, depressive symptoms did not correlate with negative, parkinsonian or catatonic symptoms, but they did at discharge. Changes of depressive symptoms over the episode did not correlate with changes of the other groups of symptoms. In the patients who were unmedicated at admission, ratings of non-akinetic parkinsonism, unlike ratings of akinetic parkinsonism, worsened significantly after neuroleptic treatment. Conclusions: While negative, parkinsonian and catatonic symptoms are highly related features, depressive symptoms seem to be a relatively independent dimension of psychopathology in schizophrenia. Non-akinetic parkinsonian symptoms may be more useful than the akinetic symptoms in distinguishing primary from drug-induced negative symptoms.     

The impact of prolactin elevation with antipsychotic medications on subjective quality of life in patients with schizophrenia

In this cross-sectional study, the author tested the hypothesis that prolactin elevation with antipsychotic medications was associated with low subjective quality-of-life scores in patients with schizophrenia. The subjects were 42 male inpatients meeting Diagnostic and Statistical Manual of Mental Disorders, 4th edition, criteria for schizophrenia on typical antipsychotics. No correlations were found between prolactin or testosterone and the 3 subscales in the Japanese version of the Schizophrenia Quality of Life Scale. Multiple regression analyses showed total variance in the ratings of 3 subscales in the Japanese version of the Schizophrenia Quality of Life Scale as follows: Brief Psychiatric Rating Scale (BPRS) anxiety/depression factor, dosage of antipsychotics and BPRS hostile/suspiciousness factor in the psychosocial subscale (adjusted R2 = 0.394), BPRS anxiety/depression factor and dose of antipsychotics in the motivation/energy subscale (adjusted R2 = 0.475), and dose of antipsychotics and BPRS anergia factor in the symptoms/side effects subscale (adjusted R2 = 0.206). The results did not support the hypothesis.     

Clinical usefulness of cognitive evoked potentials to assess cognitive deficits in cerebrovascular diseases

Background: The aim of the present study is to evaluate the clinical applicability and usefulness of cognitive evoked potentials (CEP) to identify a cognitive deficit in patients with cerebrovascular diseases (CVD). Methods: The P3 latencies, amplitudes and latency to amplitude ratios (LAR) of CEP were measured in 25 healthy control subjects and 35 inpatients with CVD. The association of CEP with variables including age, sex, mini‐mental state examination (MMSE) score, CVD types, loci of hemiplegic limbs, duration, education, brief psychiatric rating scale (BPRS), instrumental activities of daily living (IADL) and daily living function assessment (DLFA) was also analyzed. Results: (i) The P3 latencies (447.87 ± 113.06 msec) and LAR (65.83 ± 43.25) were prolonged in CVD (P < 0.05), while the amplitudes (8.18 ± 2.51 µV ) were not changed; (ii) the P3 latencies (537.31 ± 101.14msec) and LAR (94.89 ± 46.44 in CVD with a MMSE score <24 were prolonged, and the amplitudes (6.45 ± 1.98 µV ) were reduced (P < 0.05, respectively); (iii) the BPRS, IADL and DLFA in CVD with a MMSE score <24 were different from MMSE ≥24 (P < 0.05); (iv) there was no difference in CEP between CVD caused by infaction and hemorrhage; (v) the P3 latencies were correlated positively with age, BPRS and IADL, while negatively with MMSE and DLFA. The amplitudes were correlated positively with MMSE and DLFA, while negatively with age, BPRS and IADL. The LAR were correlated positively with age, BPRS and IADL, while negatively with MMSE and DLFA; and (vi) on analyzing association of CEP with variables in CVD with MMSE <24, the P3 latencies were correlated positively with BPRS and DLFA, while negatively with MMSE and DLFA. The amplitudes were positively correlated with age. The LAR were positively correlated with IADL. Conclusions: The P3 latencies and LAR of CEP seemed to be useful clinical measures to assess cognitive disorders in CVD as well as in vascular dementia.     

Neurocognitive and symptom correlates of daily problem-solving skills in schizophrenia

Functional outcome for individuals with schizophrenia has been associated with cognitive impairment. Deficits in attention, memory, speed of information processing and problem-solving skills affect independent functioning, vocational performance, and interpersonal functioning. This study investigated the relationship between neurocognitive functioning, clinical symptoms and daily problem-solving skills in seriously and persistently ill persons. Thirty-eight inpatients and outpatients were administered a neurocognitive battery for attention, working memory, processing speed, perceptual organization, and executive functioning; and semi-structured clinical interviews using the BPRS and SANS. Estimates of daily problem-solving skills were obtained using the relevant factor subscale from the Independent Living Scales (ILS-PB). Daily problem-solving skills were significantly correlated with negative symptoms, processing speed, verbal memory, and working memory scores. A regression model using an enter method suggests that working memory and negative symptoms are significant predictors of daily problem-solving skills and account for 73.2% of the variance. Further analyses demonstrate that daily problem-solving skills and negative symptoms were significantly different for inpatients and outpatients and significantly correlated with community status. The findings suggest the ILS-PB has utility as a proxy measure for assessing real-world functioning in schizophrenia.     

慢性精神分裂症患者的抑郁症状研究

目的:了解慢性精神分裂症患者的抑郁症状及其相关的影响因素。方法:对180名住院慢性精神分裂症患者测试卡尔加里精神分裂症抑郁量表(CDSS)、阳性症状量表(SAPS)、阴性症状量表(SANS)、治疗中出现的症状量表(TESS)及自编的相关因素调查表。结果:慢性精神分裂症患者的抑郁症状发生率为40.6%;有无抑郁发生的两组比较,在总病程、住院次数、文化程度、家庭经济水平、社会支持、自知力恢复及药物种类、剂量、时间及不良反应、阳性阴性症状和合并躯体疾病等方面差异有显著性。Logistic回归分析显示,精神分裂症患者出现抑郁症状的相关影响因素依次为:阴性症状、合并躯体疾病、抗精神病药的种类、社会支持、自知力及药物不良反应。结论:慢性精神分裂症患者抑郁症状发生率高、影响因素多,需从多方面对精神分裂症患者的抑郁进行预防和治疗。