Trauma and Posttraumatic Stress Disorder (PTSD) in Patients with Schizophrenia or Schizoaffective Disorder

Trauma and posttraumatic stress disorder (PTSD) have high prevalence among individuals with severe mental illness, such as schizophrenia or schizoaffective disorder. This study examined whether trauma and PTSD are under-detected in this population, and whether the cognitive theory of PTSD is applicable to these individuals. Traumatic experiences, PTSD symptoms and negative posttraumatic cognitions were directly measured with questionnaires, and compared to information obtained via chart-review. Results showed clear evidence of under-report of trauma and under-diagnosis of PTSD in patients’ charts. Furthermore, negative posttraumatic cognitions were positively related to PTSD symptom severity, supporting the cognitive model of PTSD. These findings underscore the importance of assessing trauma history as well as PTSD in the routine evaluation of patients with schizophrenia or schizoaffective disorder in outpatient clinical settings. Furthermore, the finding of negative posttraumatic cognitions suggests that the cognitive model of PTSD may be applicable to patients with schizophrenia or schizoaffective disorder.     

齐拉西酮治疗精神分裂症临床观察

目的探讨齐拉西酮治疗精神分裂症的疗效和安全性。方法对60例临床诊断为精神分裂症患者治疗8周,采用阳性与阴性症状量表(PANSS)评定疗效,副反应量表(TESS)评价安全性。结果齐拉西酮对精神分裂症的有效率81.7%,痊愈率56.7%,不良反应轻,依从性好。结论齐拉西酮对精神分裂症的治疗安全有效,可作为精神分裂症治疗的首选药物。     

齐拉西酮与氯丙嗪治疗精神分裂症对照分析

目的探讨齐拉西酮与氯丙嗪对首发精神分裂症患者的临床疗效及安全性。方法80例精神分裂症患者随机分为2组，分别给予齐拉西酮与氯丙嗪，治疗8周，用阳性与阴性症状表（PANSS）和副作用量表（TESS）评定疗效和不良反应。结果齐拉西酮组疗效优于氯丙嗪组（P〈0．05），齐拉西酮组不良反应显著少于氯丙嗪（P〈0．05）。结论齐拉西酮是一种安全有效的抗精神病药。     

齐拉西酮与氯丙嗪治疗精神分裂症对照分析

目的探讨齐拉西酮与氯丙嗪对首发精神分裂症患者的临床疗效及安全性。方法80例精神分裂症患者随机分为2组,分别给予齐拉西酮与氯丙嗪,治疗8周,用阳性与阴性症状表(PANSS)和副作用量表(TESS)评定疗效和不良反应。结果齐拉西酮组疗效优于氯丙嗪组(P<0.05),齐拉西酮组不良反应显著少于氯丙嗪(P<0.05)。结论齐拉西酮是一种安全有效的抗精神病药。     

Ziprasidone Vs Olanzapine in Recent-Onset Schizophrenia and Schizoaffective Disorder: Results of an 8-Week Double-Blind Randomized Controlled Trial

Introduction: Head-to-head comparisons of antipsychotics have predominantly included patients with chronic conditions. The aim of the present study was to compare the efficacy and tolerability of ziprasidone and olanzapine in patients with recent-onset schizophrenia. Methods: The study was an 8-week, double-blind, parallel-group, randomized, controlled multicenter trial ({"type":"clinical-trial","attrs":{"text":"NCT00145444","term_id":"NCT00145444"}}NCT00145444). Seventy-six patients with schizophreniform disorder, schizophrenia or schizoaffective disorder (diagnosis < 5 y), and a maximum lifetime antipsychotic treatment <16 weeks participated in the study. Efficacy of ziprasidone (80–160 mg/d) and olanzapine 10–20 mg was measured using the Positive and Negative Syndrome Scale (PANSS), the Clinical Global Impression (CGI) Scale, the Calgary Depression Scale for Schizophrenia (CDSS), and the Heinrich Quality of Life Scale (HQLS); tolerability assessments included laboratory assessments, body weight, and electroencephalogram. Results: Olanzapine (n = 34) and ziprasidone (n = 39) showed equal efficacy as measured by the PANSS, CDSS, CGI, and HQLS. However, mean weight gain was significantly higher in the olanzapine group (6.8 vs 0.1 kg, P < .001). Ziprasidone was associated with decreasing levels of triglycerides, cholesterol, and transaminases, while these parameters increased in the olanzapine group (all P values < .05). There were no significant differences in fasting glucose and prolactin levels or in cardiac or sexual side effects. Patients on ziprasidone used biperiden for extrapyramidal side effects more frequently (P < .05). Discussion: The results of this study indicate that ziprasidone and olanzapine have comparable therapeutic efficacy but differ in their side effect profile. However, there is a risk of a type II error with this sample size. Clinically significant weight gain and laboratory abnormalities appear early after initiating treatment and are more prominent with olanzapine, while more patients on ziprasidone received anticholinergic drugs to treat extrapyramidal symptoms.     

齐拉西酮与阿立哌唑对血清催乳素及体重的影响

目的 探讨精神分裂症患者应用齐拉西酮与阿立哌唑治疗前后对血清催乳素（PRL）及体重的影响.方法 对60例未曾治疗或停药3个月的精神分裂症患者随机给予齐拉西酮与阿立哌唑规范治疗,于治疗前及治疗第8周末用化学发光法测查患者PRL水平并监测体重,进行对比分析.结果 服用齐拉西酮、阿立哌唑患者治疗前后血清催乳素及体重无明显变化（P＞0.05）;同组间比较,治疗前后血清催乳素及体重亦无显著差异（P＞0.05）,性别对血清催乳素无明显影响（P＞0.05）.结论 齐拉西酮与阿立哌唑对患者血清催乳素及体重无升高作用,是较安全的新型抗精神病药物.     

Efficacy and Tolerability of Switching to Ziprasidone in Italian Patients with Acute Exacerbation of Schizophrenia: An Open-Label Trial

The long-term maintenance of a stable condition is an important aim of schizophrenia therapy, which frequently requires the switch between 2 antipsychotic agents. This 8-week multicenter study, conducted in Italy, evaluates the switch from a previous antipsychotic to ziprasidone.Adult acute schizophrenic patients requiring a change in antipsychotic for lack of efficacy or tolerability issues took ziprasidone 20?-?80?mg/bid. Dosages could be adjusted during the study. The primary efficacy outcomes were the differences in positive and negative syndrome scale (PANSS) and clinical global impression severity (CGI-S) scores from baseline to study end. Other efficacy variables were clinical global impression improvement, global assessment of functioning, patient preference scale and drug attitude inventory.189 patients were evaluated; the mean (±SD) ziprasidone dose was 95.9±34.5?mg/day. PANSS and CGI-S scores significantly decreased throughout the study. All secondary outcomes significantly improved at the end of the study vs. baseline values. Ziprasidone was well tolerated; 13 patients reported a QTc prolongation (mild in 12 patients).Notwithstanding the limitations of any non-comparative study, these results suggest that ziprasidone may be an effective and well-tolerated option in acute schizophrenia patients who discontinued a previous antipsychotic agent.     

Long-Term Real-World Effectiveness of Pharmacotherapies for Schizoaffective Disorder

ObjectiveTo investigate the long-term real-world effectiveness of antipsychotics and other psychopharmacotherapies in the treatment of schizoaffective disorder (SCHAFF). MethodTwo nationwide cohorts of SCHAFF patients were identified from Finnish and Swedish registers. Within-individual design was used with stratified Cox regression. The main exposure was use of antipsychotics. Adjunctive pharmacotherapies included mood stabilizers, antidepressants, and benzodiazepines and benzodiazepine-related drugs. The main outcome was hospitalization due to psychosis. ResultsThe Finnish cohort included 7655 and the Swedish cohort 7525 patients. Median follow-up time was 11.2 years (IQR 5.6–11.5) in the Finnish and 7.6 years (IQR 3.8–10.3) in the Swedish cohort. Clozapine and long-acting injectable (LAI) antipsychotics were consistently associated with a decreased risk of psychosis hospitalization and treatment failure (psychiatric hospitalization, any change in medication, death) in both cohorts. Quetiapine was not associated with a decreased risk of psychosis hospitalization. Mood stabilizers used in combination with antipsychotics were associated with a decreased risk of psychosis hospitalization (Finnish cohort HR 0.76, 95% CI 0.71–0.81; Swedish cohort HR 0.84, 0.78–0.90) when compared with antipsychotic monotherapy. Combination of antidepressants and antipsychotics was associated with a decreased risk of psychosis hospitalization in the Swedish cohort (HR 0.90, 0.83–0.97) but not in the Finnish cohort (1.00, 0.94–1.07), and benzodiazepine use was associated with an increased risk (Finnish cohort HR 1.07, 1.01–1.14; Swedish cohort 1.21, 1.13–1.30). ConclusionsClozapine, LAIs, and combination therapy with mood stabilizers were associated with the best outcome and use of quetiapine and benzodiazepines with the worst outcome in the treatment of SCHAFF.     

Longitudinal Patterns of Health System Retention Among Veterans with Schizophrenia or Bipolar Disorder

Inconsistent service use for schizophrenia and bipolar disorder is associated with poorer outcomes of care. We analyzed VHA National Psychosis Registry data for 164,150 veterans with these disorders to identify characteristics associated with 5-year patterns of survival and with retention in VHA care. Most cohort members (63%) survived the period with no break in VHA healthcare lasting over 12 months. Inconsistent utilization was associated with younger age, no service-connected disability, and less physical comorbidity, regardless of diagnosis. The influence of gender and ethnicity on attrition varied by diagnosis and gap-duration. Variation in attrition by gender and ethnicity warrants additional attention.     

齐拉西酮与利培酮治疗首发精神分裂症疗效的对照研究

目的探讨齐拉西酮治疗精神分裂的疗效及安全性。方法将符合CCMD-3诊断标准的60例首发精神分裂症患者随机分为两组,分别给予齐拉西酮和利培酮治疗8周,采用PANSS、CGI、TESS、体格检查及实验室检查评定疗效和安全性。结果实验组和对照组的有效率分别为76.36%和75.68%,治愈率分别为53.43%和51.08%;两组患者PANSS量表总分治疗后2、4、6、8周与治疗前比较差异有显著性（P〈0.01）,两组之间比较无统计学差异（P〉0.05）。齐拉西酮不良反应显著少于利培酮（P〈0.05）。结论齐拉西酮对精神分裂症与利培酮同样有效,在改善阴性症状方面起效快,不良反应轻微,是一种安全有效的新型抗精神病药物。     

Reduced Fertility and Fecundity among Patients with Bipolar I Disorder and Schizophrenia in Egypt

Objective

To evaluate reproduction among patients with bipolar I disorder (BP1) or schizophrenia (SZ) in Egypt.

Methods

BP1 patients (n=113) were compared with community based, demographically balanced controls (n=124) and SZ patients (n=79, DSM-IV). All participants were evaluated using structured interviews and corroborative data were obtained from relatives. Standard indices of procreation were included in multivariate analyses that incorporated key demographic variables.

Results

Control individuals were significantly more likely to have children than BP1 or SZ patients (controls 46.8%, BP1 15.9%, SZ 17.7%), but the BP1-SZ differences were non-significant. The average number of children for BP1 patients (0.37±0.9) and SZ patients (0.38±0.9) was significantly lower than for controls (1.04±1.48) (BP1 vs controls, p<0.001; SZ vs controls, p<0.001). The frequency of marriages among BP1 patients was nominally higher than the SZ group, but was significantly lower than controls (BP1: 31.9% SZ: 27.8% control: 57.3%). Even among married individuals, BP1 (but not SZ) patients were childless more often than controls (p=0.001). The marital fertility, i.e., the average number of children among patients with conjugal relationships for controls (1.8±1.57) was significantly higher than BP1 patients (1.14±1.31, p=0.02), but not significantly different from SZ patients (1.36±1.32, p=0.2).

Conclusion

Selected reproductive measures are significantly and substantially reduced among Egyptian BP1 patients. The reproductive indices are similar among BP1 and SZ patients, suggesting a role for general illness related variables. Regardless of the cause/s, the impairment constitutes important, under-investigated disability.     

The Effect of Short-Term Electroconvulsive Treatment Plus Neuroleptics in Treatment-Resistant Schizophrenia and Schizoaffective Disorder

The effect of electroconvulsive therapy (ECT) plus loxapine in nine patients with treatment-refractory schizophrenia or schizoaffective disorder was studied in an open trial. Five of the nine patients (55.6%) improved significantly (>/=20%) in the Brief Psychiatric Rating Scale total scores by the end of the course of ECT. Improvement was greater in positive than in negative symptoms. A sixth patient improved 3-6 weeks after the completion of the acute course of ECT. Five patients who responded to ECT received maintenance ambulatory ECT; two patients remained improved for at least 6-9 months, whereas the other three relapsed within 4 months. Further study of the indications for and the effectiveness of ECT plus neuroleptic drugs in treatment-resistant schizophrenia is indicated.     

齐拉西酮治疗育龄期女性精神分裂症的临床研究

目的探讨齐拉西酮对育龄期女性精神分裂症的疗效及安全性。方法 56例育龄期女性精神分裂症患者随机分为研究组和对照组,各28例,研究组用齐拉西酮治疗,对照组用喹硫平治疗,共观察8周。采用阳性和阴性综合征量表（PANSS）及治疗中需处理的不良反应症状量表（TESS）评定疗效和不良反应。结果研究组和对照组的显效率分别为78.57%和75.00%,两组显效率比较无显著性差异（χ2=0.100,P﹥0.05）;治疗8周后研究组和对照组PANSS总分及各因子分与治疗前比较均显著下降（P〈0.01）,两组治疗第2、4、6、8周末的PANSS总分及各个因子分比较均无显著性差异（P＞0.05）;对照组头昏和头晕、体质量增加、月经改变发生率高于研究组（P〈0.05）。结论齐拉西酮不影响患者的体质量和月经,是治疗育龄期女性精神分裂症安全有效的药物。     

Neural Processing of Repeated Emotional Scenes in Schizophrenia,Schizoaffective Disorder,and Bipolar Disorder

Impaired emotional processing and cognitive functioning are common in schizophrenia, schizoaffective disorder, and bipolar disorders, causing significant socioemotional disability. While a large body of research demonstrates abnormal cognition/emotion interactions in these disorders, previous studies investigating abnormalities in the emotional scene response using event-related potentials (ERPs) have yielded mixed findings, and few studies compare findings across psychiatric diagnoses. The current study investigates the effects of emotion and repetition on ERPs in a large, well-characterized sample of participants with schizophrenia-bipolar syndromes. Two ERP components that are modulated by emotional content and scene repetition, the early posterior negativity (EPN) and late positive potential (LPP), were recorded in healthy controls and participants with schizophrenia, schizoaffective disorder, bipolar disorder with psychosis, and bipolar disorder without psychosis. Effects of emotion and repetition were compared across groups. Results displayed significant but small effects in schizophrenia and schizoaffective disorder, with diminished EPN amplitudes to neutral and novel scenes, reduced LPP amplitudes to emotional scenes, and attenuated effects of scene repetition. Despite significant findings, small effect sizes indicate that emotional scene processing is predominantly intact in these disorders. Multivariate analyses indicate that these mild ERP abnormalities are related to cognition, psychosocial functioning, and psychosis severity. This relationship suggests that impaired cognition, rather than diagnosis or mood disturbance, may underlie disrupted neural scene processing in schizophrenia-bipolar syndromes.     

Double-Blind Antiglucocorticoid Treatment in Schizophrenia and Schizoaffective Disorder: A Pilot Study

Summary: Background: Antiglucocorticoids, such as ketoconazole, have been investigated as antidepressant agents in major depression and other conditions. Despite evidence that a significant number of patients with schizophrenia and schizoaffective disorder are both hypercortisolemic and depressed, the antidepressant effects of antiglucocorticoids have never been assessed in these populations.

Methods: Fifteen symptomatic patients with diagnoses of schizophrenia or schizoaffective disorder, who were at least partially treatment-resistant, were treated with ketoconazole, up to 800 mg/day, (n = 8) or placebo (n = 7) for four weeks in a double-blind manner. The study medication was added to a pre-stabilized antipsychotic and/or antidepressant medication regimen.

Results: Ketoconazole treatment, compared to placebo, was associated with significant improvements in observer-rated depression, but not in subjectively rated depression, positive or negative psychotic symptom ratings, or cognitive performance scores.

Conclusions: These pilot data partially support the hypothesis that antiglucocorticoids reduce depressive symptoms in patients with schizophrenia and schizoaffective disorder, although objective and subjective ratings may not be similarly affected during a four-week course of treatment. Further studies with larger sample sizes, more extensive endocrine assessments and longer duration of drug administration seem warranted.     

齐哌西酮与氯丙嗪治疗女性精神分裂症患者的疗效比较

目的探讨齐哌西酮治疗女性精神分裂症患者的疗效及安全性。方法将女性精神分裂症患者随机分为齐哌西酮组和氯丙嗪组各50例,共治疗8周。分别采用阳性与阴性症状量表（PANSS）、不良反应量表（TESS）、生活质量量表（WHOQOL-100）评定疗效、不良反应和生活质量,同时检测体重、血糖及催乳素。结果齐哌西酮与氯丙嗪的总体疗效相当（P〉0．05）;氯丙嗪较齐哌西酮引起的锥体外系不良反应及抗胆碱能作用发生率高（P〈0．05）;而齐哌西酮对血清催乳素、血糖、体重影响则较小（P〈0．05）;齐哌西酮组WHOQOL-100各项均明显改善（P〈0．05）,氯丙嗪组则有改善,但无显著性差异（P〉0．05）;两组比较有显著性差异（P〈0．05）。结论齐哌西酮与氯丙嗪疗效相当,不良反应小,可明显改善患者生活质量。     

A Study of the Impact of Cannabis on Doses of Discharge Antipsychotic Medication in Individuals with Schizophrenia or Schizoaffective Disorder

Patients with schizophrenia or schizoaffective disorder have a high prevalence of comorbid cannabis use disorder (CUD). CUD has been associated with poorer outcomes in patients. We compared doses of antipsychotic medications at the time of discharge from hospital among inpatients with schizophrenia or schizoaffective disorder with or without concurrent cannabis use. We reviewed the medical records of patients (N = 8157) with schizophrenia or schizoaffective disorder discharged from the hospital between 2008 and 2012. The patients were divided into two groups; those with urine drug tests positive for cannabis and those negative for cannabis. Doses of antipsychotic medications were converted to chlorpromazine equivalents. Bivariate analyses were done with Student’s t test for continuous variables and χ ² test for categorical variables. Linear regression was carried out to adjust for potential confounders. Unadjusted analysis revealed that the cannabis positive group was discharged on lower doses of antipsychotic medication compared with the cannabis negative group (geometric mean chlorpromazine equivalent doses 431.22 ± 2.20 vs 485.18 ± 2.21; P < 0.001). However, the difference in geometric mean chlorpromazine equivalent doses between the two groups was no longer significant after adjusting for sex, age, race, and length of stay (geometric mean difference 0.99; 95 % CI 0.92–1.10). Though limited by lack of information on duration, amount and severity of cannabis use, as well as inability to control for other non-antipsychotic medications, our study suggests that cannabis use did not significantly impact on doses of antipsychotics required during the periods of acute exacerbation in patients with schizophrenia or schizoaffective disorder.     

心理干预对精神分裂症患者经期情绪障碍影响的研究

目的 了解精神分裂症患月经期的情绪障碍问题及心理干预时情绪障碍的影响，从而解决女性病人治疗中的疑难问题。方法 对我院126名住院的女性精神分裂症病人分别进行经期和非经期的焦虑自评量表SAS和抑郁自评量表SDS的测定，然后将126名病人随机分成干预组和对照组各63名，干预组进行2个月的心理干预，对照组不进行上述干预，其他治疗相同。第3个月再分别对两组病人进行经期和非经期的焦虑自评量表和抑郁自评量表的测定。结果 (1)精神分裂症病人经期SAS、SDS量表分均较非经期高，经统计学检验两差异显；(2)干预组经心理干预后无论经期还是非经期SAS、SDS量表分与对照组比较差异显；(3)干预组自身前后量表分比较差异显。结论 精神分裂症患月经期存在明显的焦虑、抑郁，易引起病情波动，针对女性病人内分泌变化进行心理干预有一定疗效。     

齐拉西酮治疗女性精神分裂症的对照研究

目的比较齐拉西酮与利培酮治疗女性精神分裂症的疗效和安全性。方法将60例女性精神分裂症随机分为二组,分别给予齐拉西酮和利培酮治疗8周。于治疗前及治疗第4、8周末采用阳性与阴性症状量表（PANSS）评定疗效,以治疗时出现的症状量表（TESS）评定不良反应。结果在治疗第8周末,两组PAN-SS评分较入组时均有显著降低（P〈0.01）;齐拉西酮组有效率为90.0%,显效率为66.7%;利培酮组有效率为93.3%,显效率为73.3%,两组无显著性差异（P〉0.05）。齐拉西酮组较利培酮组更少引起锥体外系反应、体重增加及月经改变（P〈0.05或P〈0.01）。结论齐拉西酮是一种安全有效的抗精神病药物,更适合于女性精神分裂症患者使用。