首发精神分裂症神经心理测验和听感觉门控P50的相关性研究

目的：探讨首发精神分裂症神经心理测验和听感觉门控P50之间的关联性。方法：应用配对听觉条件（S1）、测试（岛）刺激范式。改良版威斯康星卡片分类测验（M-WCST）,韦氏记忆测验（W-MS）和工作记忆（WM）测验对37名精神分裂症首次发病患者（患者组）和31名健康正常者（对照组）进行检测。结果：①患者组P50抑制明显高于对照组（P〈0．01）。②M-WCST结果显示,患者组正确数和正确分类数低于对照组,错误数和持续错误数高于对照组（P〈0．01）;WMS结果显示,患者组远、近和瞬时记忆、记忆商数明显低于对照组（P〈0．01）;患者组WM低于对照组（P〈0．01）。③患者组P50抑制与神经心理测验指标之间经相关分析无相关性。结论：首发精神分裂症患者P50感觉门控功能、注意力、记忆力和高级执行功能缺陷。P50抑制与神经心理测验指标可能反映认知功能不同的中枢机制。     

阿立哌唑治疗女性精神分裂症的临床研究

目的：评价阿立哌唑治疗女性精神分裂症患者的疗效和副反应。方法：对70例女性精神分裂症患者随机分为阿立哌唑组和喹硫平组治疗8周,采用阳性症状与阴性症状量表（PANSS）、副反应量表（TESS）评定疗效和副反应。结果：阿立哌唑与喹硫平疗效相当,但其副反应轻,服用方便,依从性好。结论：阿立哌唑治疗女性精神分裂症患者疗效确切,值得推广使用。     

Combined neonatal stress and young-adult glucocorticoid stimulation in rats reduce BDNF expression in hippocampus: effects on learning and memory

Epidemiological studies suggest that multiple developmental disruptions are involved in the etiology of psychiatric illnesses including schizophrenia. In addition, altered expression of brain-derived neurotrophic factor (BDNF) has been implicated in these illnesses. In the present study, we examined the combined long-term effect of an early stress, in the form of maternal deprivation, and a later stress, simulated by chronic young-adult treatment with the stress hormone, corticosterone, on BDNF expression in the hippocampus of rats. To assess whether there were behavioral effects, which may correlate with the BDNF changes, learning and memory was tested in the Y-maze test for short term spatial memory, the Morris water maze for long-term spatial memory, and the T-maze test for working memory. Four groups of rats received either no stress, maternal deprivation, corticosterone treatment, or both. Dorsal hippocampus sections obtained from parallel groups were used for BDNF mRNA in situ hybridization. Rats which had undergone both maternal deprivation and corticosterone treatment displayed a unique and significant 25-35% reduction of BDNF expression in the dentate gyrus (DG), and similar trends in the CA1 and CA3 regions of the hippocampus. These "two-hit" animals exhibited a learning delay in the Morris water maze test, a marked deficit in the Y-maze, but little change in the T-maze test. However, some aspects of cognition were also altered in rats with either maternal deprivation or corticosterone treatment. This study demonstrates a persistent effect of two developmental disruptions on BDNF expression in the hippocampus, with parallel, but not completely correlative changes in learning and memory.     

An economic evaluation of aripiprazole vs olanzapine adapted to the Italian setting using outcomes of metabolic syndrome and risk for diabetes in patients with schizophrenia

Objective

To evaluate the cost-effectiveness of aripiprazole and olanzapine in patients with schizophrenia.

Methods

Data from a double-blind, randomized study demonstrating the efficacy of aripiprazole and olanzapine were used to observe new incidence of metabolic syndrome (26-week therapy) and to model the risk of developing diabetes over 5 years of therapy. Cumulative incidence of metabolic syndrome was compared using Kaplan–Meier estimates; diabetes risk was estimated using a validated, general population risk-prediction model. Economic assessment was conducted from the third-party payer perspective by evaluating pharmacotherapy costs of treating schizophrenia and medical costs associated with treating adverse metabolic effects in a hypothetical cohort of 1000 patients. Resource utilization and costs were derived from the underlying study and published data, using a 3% rate to discount costs and benefits.

Results

For the patients switched from olanzapine to aripiprazole, treatment with aripiprazole was a dominant cost-saving strategy. Use of aripiprazole avoided 184 events of metabolic syndrome over 26 weeks of treatment, contributing to a real-world (RW) cost savings of €2.53 per patient and a total savings of approximately €465.52 over a 5-year period. For the same cohort, the risk-prediction model indicated that 34 occurrences of diabetes could be avoided over 5 years, corresponding to a RW cost savings of €56.86 per patient and a total saving of approximately €1,933.24. These savings reflect avoided costs in treating adverse metabolic events and comparable costs in the acquisition of aripiprazole.

Conclusions

Maintenance aripiprazole therapy offers medical and economic benefits over olanzapine, reflected by reduced incidence of metabolic syndrome and diabetes and associated lower costs.     

Effects of risperidone and olanzapine on remnant-like lipoprotein particle cholesterol (RLP-C) in schizophrenic patients

Second generation antipsychotics are associated with the risk of metabolic disorders such as diabetes mellitus and hyperlipidemia. Remnant-like lipoprotein particles cholesterol (RLP-C) are a known risk factor for cardiovascular events. The present study was performed to determine possible differences in fasting blood RLP-C levels between schizophrenic patients treated with risperidone as compared to olanzapine. Patients on olanzapine had significantly higher RLP-C levels than those on risperidone (p < 0.01). In olanzapine-treated patients there was no abnormality in fasting blood glucose levels, but fasting insulin levels and homeostasis model assessment of insulin resistance (HOMA-IR) were elevated. RLP-C levels were significantly correlated with plasma triglyceride concentrations in both the olanzapine- (p < 0.01) and risperidone-treated patients (p < 0.01). The regression line slope was greater for the olanzapine group, suggesting a greater influence of olanzapine on RLP-C. There was a significant correlation between RLP-C and HOMA-IR in the risperidone group (p < 0.01) but not in the olanzapine group (p = 0.80). These results suggest that blood glucose monitoring may not be sufficient to detect metabolic disorder and that measurement of RLP-C might be helpful for the screening for metabolic disorders associated with olanzapine therapy.     

Selective impairment in visual perception of biological motion in obsessive-compulsive disorder

Obsessive-compulsive disorder (OCD) is associated with a variety of well-documented cognitive deficits such as deficits in memory and executive functioning, but little is known about basic perceptual concomitants of OCD. This study investigated global, configural processing in OCD using dynamic (moving) and static stimuli with minimal demands on cognitive function. Twenty OCD patients and 16 age- and education-matched healthy control subjects were tested on four perceptual tasks: two motion tasks involved detection and discrimination of human activity portrayed by point-light animations ("biological" motion). The other two tasks involved detection of coherent, translational motion defined by random-dot cinematograms and detection of static global shape defined by spatially distributed contours. OCD patients exhibited impaired performance on biological motion tasks; in contrast, their performance on tasks of coherent motion detection and global form perception were comparable to those of healthy controls. These results indicate that OCD patients have a specific deficit in perceiving biological motion signals, whereas their perception of non-biological coherent motion and static global shape is intact. Because efficient social interactions depend on accurate and rapid perception of subtle socially relevant cues, deficits in biological motion perception may compromise social functioning in people with OCD.     

Review of risperidone for the treatment of pediatric and adolescent bipolar disorder and schizophrenia

Risperidone is a commonly used medication for the treatment of bipolar disorder and schizophrenia in children and adolescents. It has been studied as a monotherapy treatment in early onset schizophrenia and as both monotherapy and combination therapy for pediatric bipolar disorder. Studies to date indicate that risperidone is an effective treatment for positive and negative symptoms of schizophrenia and mania symptoms of bipolar disorder. In young patient populations, side effects such as weight gain, extrapyramidal side effects, and prolactin elevation require consideration when evaluating the risk benefit ratio for individual patients. Here we review published studies of risperidone for the treatment of bipolar disorder and schizophrenia in children and adolescents to provide practitioners with an overview of published data on the efficacy and safety of risperidone in these patient populations.     

Exploring the burden of the primary family caregivers of schizophrenia patients in Taiwan

Aim: The purpose of the present study was to investigate the burden of the primary family caregivers of schizophrenia patients and the factors that affect caregiver burden. Methods: A total of 126 pairs of patients and their primary family caregivers were recruited from the day care and acute wards of two teaching general hospitals. Demographic information was collected. All patients went through an interview with a senior psychiatrist using the Brief Psychiatric Rating Scale (BPRS). The Caregiver Burden Inventory–Brief Version and the Chinese Health Questionnaire (CHQ) were used to assess the caregiver burden and the caregivers' health condition. One‐way analysis of variance and Pearson correlation were used to analyze the relationship between demographic factors and caregiver burden. Multiple regression was used to analyze predictors of burden of caregivers. Statistical significance in this study was defined as P ≤ 0.05. Results: The caregiver burden scores (25.9 ± 10.7; range, 3–61) indicated a moderate burden level. Among the five dimensions of burden, caregiver anxiety (2.13 ± 0.86) was the highest, followed by dependency of the patient (1.85 ± 1.02), feeling shame and guilt (1.56 ± 1.02), and family interference (1.43 ± 0.83). The burden level of stigmata (1.32 ± 1.24) was the lowest. The first three rankings of burden were ‘I worry about his/her safety when he/she is alone’ (2.26 ± 1.15), ‘I worry that she/he will become sick at any time’ (2.23 ± 1.10), and ‘I feel he/she depends on me very much’ (2.02 ± 1.29). Patient satisfaction with medical staff support (P = 0.00), CHQ scores of the caregivers (P = 0.00), and the BPRS scores of the patients (P = 0.01) were significantly associated with the caregiver burden scores. Conclusions: The physical and mental health condition of the primary family caregiver of schizophrenia patients was the most important factor determining the caregiver burden level. Comprehensive multidisciplinary care of chronic schizophrenia patients is needed, care that supports the needs and improves the psychiatric symptoms of the patients, helps to decrease the caregiver burden level, and facilitates family participation in treatment.     

Addition of antipsychotics to medication regimens during schizophrenic inpatient care

Aims:  The objective of the present study was to identify schizophrenia inpatients who had their original regimen augmented with additional antipsychotics during acute inpatient care, and to clarify the factors associated with these additions.
Methods:  The subjects were 204 schizophrenia inpatients at 34 acute care hospitals, of whom 42 (20.6%) had further antipsychotics added to their medication regimen during hospitalization.
Results:  Compared with patients who were not prescribed additional antipsychotics, the subjects were typically discharged with higher dosages of antipsychotics, principally low-potency medications. Patients who exhibited aggressive behavior, who had no physical illness, or whose psychiatrists preferred typical antipsychotics, were more likely to be prescribed additional new antipsychotics.
Conclusions:  Alternative approaches such as intensive care for aggressive patients and educational intervention with psychiatrists may prove useful in stabilizing patients without adding new antipsychotics unless absolutely necessary, and in simplifying medication regimens.