Increased NoGo-anteriorisation in first-episode schizophrenia patients during Continuous Performance Test

OBJECTIVE: NoGo-stimuli during a Continuous Performance Test (CPT) activate prefrontal brain structures such as the anterior cingulate gyrus and lead to an anteriorisation of the positive electrical field of the NoGo-P300 relative to the Go-P300, so-called NoGo-anteriorisation (NGA). NGA during CPT is regarded as a neurophysiological standard index for cognitive response control. While it is known that patients with chronic schizophrenia exhibit a significant reduction in NGA, it is unclear whether this also occurs in patients undergoing their first-episode. Thus, the aim of the present study was to determine NGA in a group of patients with first-episode schizophrenia by utilizing a CPT paradigm. METHODS: Eighteen patients with first-episode schizophrenia and 18 matched healthy subjects were investigated electrophysiologically during a cued CPT, and the parameters of the Go- and NoGo-P300 were determined using microstate analysis. Low resolution tomography analysis (LORETA) was used for source determination. RESULTS: Due to a more posterior Go- and a more anterior NoGo-centroid, NGA was greater in patients than in healthy controls. LORETA indicated the same sources for both groups after Go-stimuli, but a more anterior source in patients after NoGo-stimuli. In patients P300-amplitude responses to both Go- and NoGo-stimuli were decreased, and P300-latency to NoGo-stimuli was increased. After the Go-stimuli false reactions and reaction times were increased in patients. CONCLUSIONS: Attention was reduced in patients with first-episode schizophrenia, as indicated by more false reactions, prolongation of reaction time, P300-latencies and by a decrease in P300-amplitude. Significantly however, the NGA and prefrontal LORETA-sources indicate intact prefrontal brain structures in first-episode schizophrenia patients. Previously described changes in this indicator of prefrontal function may be related to a progressive decay in chronic schizophrenia. SIGNIFICANCE: The results support the idea of a possible new biological marker of first episode psychosis, which may be a useful parameter for the longitudinal measurement of changing prefrontal brain function in a single schizophrenia patient.     

Visual event-related potentials in first-episode psychotic patients and their relatives

We conducted a comprehensive examination of the sensory visual event-related potential (ERP) of psychiatric patients and their relatives using a methodology that improves upon those used previously by other investigators. One hundred thirty-five patients at the onset of their first psychotic episode, 146 first-degree relatives of these patients, and 113 normal controls were exposed to light flashes of four different intensities while their ERPs were recorded from three central scalp sites. For most analyses, various ERP amplitude measures did not discriminate the different psychiatric groups or their relatives either from one another or from the normal controls. These findings indicate that patients with schizophrenia, schizophreniform disorder, and affective disorder at the early stage of their illness do not display significant deficits in the processing and regulation of simple sensory visual stimulation.     

首发精神分裂症与生活事件和社会支持的关系

目的 了解生活事件和社会支持与首发精神分裂症的关系。方法 采用生活事件量表和社会支持量表作评定工具，对42例首发精神分裂症与42名正常人进行对比研究。结果 首发精神分裂症患者负性生活事件和正性生活事件及生活事件总值均显著高于对照组，首发精神分裂症患者的社会支持量表分明显低于对照组。结论 生活事件和社会支持不足与首发精神分裂症的发病密切相关。     

Bell s面瘫对患者的心理影响及其心理健康状况

目的探讨Bell's面瘫对首次发病患者形象、情绪、日常生活及社会活动的影响及发病早期患者的心理健康状况。方法采用自编面瘫对患者形象、情绪及社会活动影响的调查问卷及症状自评量表(SCL-90),对63例首次发病的Bell's面瘫患者进行调查。统计分析采用t检验及相关分析。结果Bell's面瘫对首次发病患者形象、情绪、日常生活及社会活动均有明显影响。Bell's面瘫患者SCL-90的躯体化、强迫、人际关系敏感、焦虑、抑郁、敌对、恐怖、精神病性因子分均高于全国成人常模,其SCL-90总分与自编面瘫影响问卷各条目得分均存在统计学相关关系。结论Bell's面瘫给首次发病患者带来不良心理影响,他们存在广泛的心身症状,这些不良影响与其心身症状有关。     

首发精神分裂症兴奋攻击行为与血清胆固醇水平研究

目的 研究精神分裂症患者兴奋攻击行为与血清胆固醇（CHO）水平的关系。方法 以阳性症状与阴性症状量裹（PANSS）中有关兴奋攻击行为条目评分，将60例精神分裂症患者分为研究组（有兴奋攻击行为组，30例）和对照组（无兴奋攻击组，30例），于入组时及治疗第2、4和6周末分别进行评估，同时抽取患者空腹静脉血样，测定血清胆固醇水平。结果 入组时研究组较对照组CHO水平显著低。治疗4用后，两组PANSS有关兴奋行为条目评分及CHO水平置异无显著性。结论 对于精神分裂症患者兴奋攻击行为，CHO水平有可能成为生物学指标之一。     

Neuroleptic malignant syndrome during low dosed neuroleptic medication in first-episode psychosis: a case report

 Neuroleptic malignant syndrome (NMS) is a rare but potentially fatal side-effect of antipsychotic drug therapy, especially of dopamine receptor antagonists. As a dose relationship has been postulated, low dose neuroleptization would be expected to help to avoid this side-effect. In contrast, we report on a 21-year-old female following low dose fluphenazine treatment with 2.5 mg/day. The patient recovered from NMS after 3 days of dantrolene administration. Eventually, remission from psychotic symptoms was achieved with clozapine. At 8-month follow-up, psychopathology remained stable and there were no more signs of NMS. Received: 8 July 1998 / Final version: 6 November 1998     

齐拉西酮与利培酮治疗首发精神分裂症的疗效和安全性

目的观察齐拉西酮与利培酮对首发精神分裂症患者的治疗效果和不良反应,以更好地为精神分裂症患者进行治疗。方法选择2010年8月-2012年8月广州市脑科医院收治的首发精神病患者64例为研究对象,随机分为两组。对照组给予利培酮治疗,实验组给予齐拉西酮治疗,对比观察两组疗效和不良反应。结果实验组患者经治疗,其PANSS优于对照组患者,组间比较差异有统计学意义(P<0.05);实验组不良反应发生率明显低于对照组(32例患者共发生14例),组间比较差异有统计学意义(P<0.05)。结论使用齐拉西酮对首发精神病患者进行治疗可取得更好的治疗效果,且患者不良反应少,值得临床推广应用。     

Correlates of insight with symptomatology and executive function in patients with first-episode schizophrenia-spectrum disorder: A longitudinal perspective

The present study aimed to examine the relationships of insight with symptomatology and executive function, both cross-sectionally and longitudinally in patients with first-episode schizophrenia-spectrum disorders. Ninety-two medication-naïve patients were recruited and 71 completed the assessments. Insight, symptoms and executive function were assessed at baseline, 6 months and 1 year. Insight was measured with the abridged version of Scale of Unawareness of Mental Disorder (SUMD). Symptoms were assessed using the Positive and Negative Syndrome Scale (PANSS). Executive function was measured with the Modified Wisconsin Card Sorting Test (MCST). The most significant improvement of insight and symptomatology was found over the first 6 months, whereas the perseverative errors of MCST were significantly improved between 6 and 12 months. Differential correlations of perseverative errors of the MCST and PANSS scores with SUMD were found at different time points. This suggests the involvement of different mechanisms in insight deficit at different stages of the illness. The baseline MCST perseverative errors were correlated significantly with the SUMD total score at 6 months and the change of SUMD scores over the first 6 months. Although the variance explained was small, it suggests better set-shifting capacity facilitates the improvement of insight at an early stage of the illness.     

Challenges to recovery following early psychosis: Nursing implications of recovery rate and timing

Early intervention in first episode psychosis is based on an indicated prevention approach that has early illness identification and timely recovery as primary goals. Nurses are instrumental in helping individuals and families achieve both aims. To better understand recovery following a first episode, a prospective cohort of 260 individuals participating in a three-year early intervention program was monitored for achievement of recovery outcomes. Two outcome measures were used to examine the recovery rate and timing of the cohort: (1) partial recovery was comprised of two criteria: (a) symptom control (psychosis and mania), and (b) daily functioning, and 2) comprehensive recovery was measured by three criteria: (a) symptom control; (b) daily functioning; and, (c) quality of life. Survival analysis, including the Kaplan-Meier statistic, and Cox hazard regression were used to examine the cohort's rate and timing for both measures. One hundred and seventy-four individuals attained partial recovery with half (51.1%) reaching the target within nine months. Comprehensive recovery was achieved by 59 individuals (22.7%), primarily in year two and three of treatment. Issues impacting quality of life delayed recovery for the majority of program participants. The gap between psychosis remission and satisfaction/fulfillment with one's everyday life is troubling, but could be improved with stronger nursing support and influence. Sharing the recovery experience with individuals and families that supports their life goals and the discovery of meaning, hope and purpose in the face of illness is the work of nurses. Suggestions for strengthening nursing's impact are considered.     

Expressed emotion and family burden in relatives of patients in first-episode psychosis

BACKGROUND

Evidence suggests that expressed emotion (EE) and family burden (FB) are phenomena that interact, but there is a lack of studies that analyze this association in patients in first-episode psychosis.