The Effectiveness of Cross-Tapering Switching to Ziprasidone in Patients with Schizophrenia or Schizoaffective Disorder

Objective

Switching antipsychotics is one useful therapeutic option when the treatment of schizophrenia encounters suboptimal efficacy and intolerability issues. This study aimed to investigate the efficacy and tolerability of cross-tapering switching to ziprasidone from other antipsychotics.

Methods

A total of 67 patients with schizophrenia or schizoaffective disorder were recruited in this 12-week, multicenter, non-comparative, open-label trial. Prior antipsychotics were allowed to be maintained for up to 4 weeks during the titration of ziprasidone. Efficacy was primarily measured using the 18-item Brief Psychotic Rating Scale (BPRS) at baseline, 4 weeks, 8 weeks, and 12 weeks. Efficacy was secondarily measured by the Clinical Global Impression-Severity (CGI-S) scale and the Global Assessment of Functioning (GAF) scale at each visit. Regarding the metabolic effects of switching to ziprasidone, weight, body mass index (BMI), waist-to-hip ratio (WHR), and lipid profile-including triglyceride (TG), high-density lipoprotein (HDL), low-density lipoprotein (LDL), and total cholesterol levels-were measured at each follow-up visit.

Results

The BPRS scores were significantly improved at 12 weeks after switching to ziprasidone (F=5.96, df=2.11, p=0.003), whereas the CGI-S and GAF scores were not significantly changed. BMIs, WHRs, and TG levels were significantly decreased, with no significant changes in other lipid profiles.

Conclusion

Cross-tapering switching to ziprasidone is effective for patients with schizophrenia spectrum disorders. Beyond the efficacy of the procedure, favorable metabolic profiles show that switching to ziprasidone may be helpful for maintenance therapy over an extended period.     

A Disrupted-in-Schizophrenia 1 Gene Variant is Associated with Clinical Symptomatology in Patients with First-Episode Psychosis

Objective

DISC1 gene is one of the main candidate genes for schizophrenia since it has been associated to the illness in several populations. Moreover, variations in several DISC1 polymorphisms, and in particular Ser704Cys SNP, have been associated in schizophrenic patients to structural and functional modifications in two brain areas (pre-frontal cortex and hippocampus) that play a central role in the genesis of psychotic symptoms. This study tested the association between Ser704Cys DISC1 polymorphism and the clinical onset of psychosis.

Methods

Two hundred and thirteen Caucasian drug-naive patients experiencing a first episode of non-affective psychosis were genotyped for rs821616 (Ser704Cys) SNP of the DISC1 gene. The clinical severity of the illness was assessed using SAPS and SANS scales. Other clinical and socio-demographic variables were recorded to rule out possible confounding effects.

Results

Patients homozygous for the Ser allele of the Ser704Cys DISC1 SNP had significantly (p<0.05) higher rates at the positive symptoms dimension (SAPS-SANS scales) and hallucinations item, compared to Cys carriers.

Conclusion

DISC1 gene variations may modulate the clinical severity of the psychosis at the onset of the disorder.     

The role of prenatal immune activation in the pathogenesis of autism and schizophrenia: A literature review

Autism spectrum disorder (ASD) and schizophrenia (SZ) are two neurodevelopmental disorders that, despite having distinct diagnostic criteria, share certain clinical and etiological features. The genetic origin of the two disorders is beyond doubt, with evidence for unique and overlapping genetic risk factors. However, lower estimates of heritability have recently been reported for both disorders, lending support to a significant contribution from non-genetic factors. Notably, there is increasing evidence that immune activation during prenatal life may act as a risk factor for ASD and SZ. In this review, evidence supporting the hypothesis that prenatal immune activation (PIA) influences the onset and progression of ASD and SZ is analyzed. Results show that the detrimental effects of PIA on neurodevelopment include morphological changes in various brain regions, with perhaps the most notable being the hippocampus and prefrontal cortex, as well as altered activity of neurotransmitter systems such as the serotonergic system and impairments in working memory and prepulse inhibition. An examination of the risk factor of PIA offers new insight into the pathophysiology of ASD and SZ, and in this way opens up new possibilities for the treatment of these two disorders.     

Comparing cognitive functioning in schizophrenia and autism using WAIS-III

The main goal of this study was to investigate differences and similarities in general cognitive functioning between adults with schizophrenia and autism, because this has not been systematically investigated. We used a cross-sectional design to compare adults with schizophrenia (n = 27), with autism (n = 114) and a healthy control group (n = 30). Schizophrenia diagnoses were based on the Structured Clinical Interview for the DSM-IV Axis I (SCID-I) and behavioral symptoms were assessed with the Positive and Negative Syndrome Scale (PANSS). Autism was diagnosed with a DSM-IV questionnaire for autism spectrum disorders and the Autistic Diagnostic Interview, revised version. The Wechsler Adult Intelligence Scale, third version (WAIS-III) was used to assess cognitive functions. All participants were between 18 and 65 years of age and had a minimum full scale intelligence of 80. Results showed that patients with schizophrenia scored significantly lower on processing speed than patients with autism and the healthy control group. Differences on other index scales were not found. In participants with schizophrenia a correlation was found between processing speed impairment and negative symptoms. Diagnosis could be predicted correctly with WAIS-III profile in 70.4% of the cases with schizophrenia compared to 56.7% of the healthy control group and 22.8% of the autism group.     

音乐节奏训练对慢性精神分裂症患者疗效和社会功能影响的研究

目的评价音乐节奏训练对精神分裂症患者临床症状的改善及对社会功能恢复的作用。方法将90例慢性精神分裂症患者随机分为研究组及对照组,研究组在原来药物治疗的基础上合并无错化学习模式的音乐节奏训练3个月。对照组在原来药物治疗的基础上合并普通工娱治疗3个月。在治疗前后用阳性和阴性综合征量表（PANSS）、个人和社会功能量表（PSP）评估患者临床症状和社会功能变化。结果研究组PANSS总分、阴性症状、一般精神病理、反应缺乏因子、激活因子及抑郁因子评分均较治疗前下降（P〈0.05）,对照组仅PANSS阴性症状评分较治疗前下降（P〈0.05）;治疗后研究组PANSS总分、阴性症状、反应缺乏因子评分低于对照组（P〈0.05）。研究组治疗后PSP总分较治疗前显著升高（P〈0.05）,治疗后研究组PSP总分高于对照组（P〈0.05）。结论音乐节奏训练对慢性精神分裂症阴性症状及社会功能的改善作用优于普通工娱治疗。     

农村精神分裂症患者精神卫生知晓率与病耻感相关分析

目的：了解重性精神疾病管理治疗项目救助的农村精神分裂症患者精神卫生知晓率与病耻感相关因素,为社区综合干预提供基础资料。方法随机抽取新乡县2011年重性精神疾病管理治疗项目救助的107例精神分裂症患者为调查对象。测查患者精神卫生知识知晓率、评估获得社会支持及病耻感状况,分析相关因素。结果对精神卫生知识知晓的有47例,占43.9%,与对照组相比较在价值否定和社交退缩方面差异具有显著性（P＜0.01）。结论影响精神分裂症患者病耻感存在多方面因素,应强化社区综合干预,提高精神卫生公众教育与知晓率。     

精神分裂症患者亲属心理健康状况调查

目的：探讨精神分裂症患者亲属心理健康状况,提高其心理健康水平,从而改善精神分裂症患者愈后。方法应用症状自评量表对100例精神分裂症患者亲属共187人进行测评,并与中国常模进行比较。结果症状自评量表总均分为158．41±49．56;阳性项目数为42．81±22．45。总均分,阳性项目及9个因子评分差异均有显著性（ P＜0．01）。结论精神分裂症患者亲属存在不同程度的心理健康问题,应及时给予健康宣教及心理干预。     

综合技能训练对精神分裂症患者住院依赖行为的效果评价

目的 :探讨综合技能训练对精神分裂症患者住院依赖行为的疗效。方法 :对 6 2例精神分裂症患者进行 12周的生活能力训练 ,社交基本技能训练 ,社会角色训练 ,症状及药物自我处置技能训练 ,并采用社会功能残疾评定量表 (DAS)、日常社会生活能力量表 (ADL)、生活满意度指数A量表(LSIA)、住院患者护士观察量表 (NOSIE)进行评定。结果 :1年后不但患者的精神症状得到了缓解 ,而且社会功能、日常生活能力、生活满意度得分均明显提高 ,(P <0 0 5 ,P <0 0 1)。结论 :综合技能训练可改善患者的住院依赖行为 ,提高其社会功能和社会适应能力     

阿立哌唑与氯氮平对精神分裂症患者生活质量的影响

目的研究阿立哌唑与氯氮平对精神分裂症患者生活质量的影响。方法将80例精神分裂症患者随机分为两组各40例,研究组口服阿立哌唑治疗,对照组口服氯氮平治疗,疗程12w。于治疗前及治疗第12w末采用潘氏量表评定临床疗效,生活质量综合评定问卷评定生活质量,副反应量表评定不良反应。结果治疗12w末两组总有效率相当,但研究组显效率显著高于对照组(P<0.05)。潘氏量表评分两组治疗12w末总分及各因子分均较治疗前有极显著性下降(P<0.01);研究组总分及阴性症状因子分较对照组下降显著(P<0.05或0.01)。生活质量综合评定问卷评分研究组除物质生活维度无显著变化外,其它各维度分均较治疗前有显著性提高(P<0.05),躯体健康、心理健康、社会功能维度分均显著高于对照组(P<0.05)。研究组不良反应发生率较对照组低,且程度较轻。结论阿立哌唑治疗精神分裂症疗效显著,改善患者的阴性症状及生活质量明显优于氯氮平,安全性高,依从性好,有利于患者重返社会。     

对恢复期精神分裂症病人实施护理干预的效果

目的观察护理干预对恢复期精神分裂症病人康复的疗效。方法将80例恢复期精神分裂症病人随机分为两组．在接受常规药物治疗的基础上，研究组给予认知行为护理干预，对照组按照常规干预，治疗12周。采用SCL-90、BPRS量表．分别对两组疗效进行评价。结果研究组干预前后SCL-90、BPRS量表评分变化与对照组比较，差异有显著性（t=4．702～18．364．P〈0．05）。结论认知行为护理干预对恢复期精神分裂症病人的精神康复有重要的作用。