Early prodromal symptoms and diagnoses before first psychotic episode in 219 inpatients with schizophrenia

The authors examined the diagnosis before the onset of schizophrenia and retrospectively evaluated the presence/absence of early prodromal symptoms (EPS) and their types (such as depressive symptoms, anxiety symptoms, and obsessive-compulsive [OC] symptoms) and the period from the onset of these symptoms to that of schizophrenia in 219 inpatients with schizophrenia diagnosed according to the DSM-IV(-TR). A diagnosis was made before the onset of schizophrenia in 53 patients (24.2%). The diagnoses were mood disorder in 39 patients, anxiety disorder in seven, obsessive-compulsive disorder (OCD) in three, adjustment disorder in two, and eating disorder in two. EPS were present in 65 (29.7%) of all patients, slightly more frequent in female patients (male:female = 1:1.41). In the group with EPS, depressive symptoms (61.5%) were most frequently observed, followed by anxiety symptoms (23.1%) and OC symptoms (9.2%). The age at onset for each type of symptom was significantly lower for OC symptoms (14.5 +/- 2.4 years) than for the other symptoms (approx. 20 years). The mean period from the onset of each symptom to that of schizophrenia was the shortest for depressive symptoms (2.7 +/- 3.1 years) and the longest (>4 years) for OC symptoms. These results as well as previous studies in Western countries showed that more non-specific and general symptoms are frequently present for some years before the onset of schizophrenia. With consideration of this point, efforts toward early detection of schizophrenia are important.     

Depressive symptoms in first episode schizophrenia spectrum disorder

Background

Depressive symptoms in ‘non-affective’ first episode schizophrenia spectrum disorders (FES) are common, but poorly understood, resulting in a range of conceptual and clinical management issues. This study had three aims: (i) to determine the prevalence of moderate to severe depressive symptoms (defined as a Clinical Global Impressions Scale-Bipolar Disorder (CGI-BP depression) score > 3) in a large representative sample of FES patients; (ii) to compare the clinical and functional characteristics of FES patients with and without these depressive symptoms at service entry; and (iii) to compare the characteristics of FES patients with and without persistent depressive symptoms.

Methods

Medical file audit methodology was employed to collect information on 405 patients with FES treated at the Early Psychosis Prevention and Intervention Centre (EPPIC), Melbourne, Australia.

Results

26.2% (n = 106) of the patients had moderate to severe depression at service entry. At service entry and at discharge, those with depressive symptoms had greater insight into their illness but did not differ from those without depressive symptoms in terms of severity of overall psychopathology. Substance use was significantly less common in those with depressive symptoms at service entry and at discharge. Of those who were depressed at baseline, 14.2% (n = 15) continued to have moderate to severe depressive symptoms at discharge.

Discussion

Depressive symptoms are common in patients with FES. Understanding the nature and characteristics of depression in FES has important clinical implications for both early intervention and treatment.     

Perceptual organization in first episode schizophrenia and ultra-high-risk states

Deficits in perceptual organization have been consistently reported in schizophrenia, as has an association between these deficits, disorganized symptoms, and poorer premorbid functioning and prognosis, suggesting that they may be an index of illness severity or progression. It is unclear, however, whether the impairment is present at, or before the first psychotic episode. This study examined perceptual organization in young people considered to be at high-risk for schizophrenia, defined by the "close-in" strategy [Yung, A.R., McGorry, P.D., McFarlane, C.A., Jackson, H.J., Patton, G.C., Rakkar, 1996. Monitoring and care of young people at incipient risk of psychosis. Schizophrenia Bulletin, 22, 283-303]. The high-risk group (n=70) was compared to first-episode patients (n=54), and nonpatients (n=24) using a task with known sensitivity to perceptual organization deficits in schizophrenia, and whose scores have predicted long-term outcome and disorganized symptomatology in past studies [Knight, R.A., Silverstein, S.M., 1998. The role of cognitive psychology in guiding research on cognitive deficits in schizophrenia. In Lenzenweger, M., Dworkin, R.H., (Eds.), Origins and Development of Schizophrenia: Advances in Experimental Psychopathology. APA Press, Washington DC, pp. 247-295.; Silverstein, S.M., Knight, R.A., Schwarzkopf, S.B., West, L.L., Osborn, L.M. Kamin, D., 1996b. Stimulus configuration and context effects in perceptual organization in schizophrenia. Journal of Abnormal Psychology 105, 410-420.; Silverstein, S.M., Schenkel, L.S., Valone, C., Nuernberger, S., 1998a. Cognitive deficits and psychiatric rehabilitation outcomes in schizophrenia. Psychiatric Quarterly 69, 169-191.; Silverstein, S.M., Bakshi, S., Chapman, R.M., Nowlis, G., 1998b. Perceptual organization of configural and nonconfigural visual patterns in schizophrenia: effects of repeated exposure. Cognitive Neuropsychiatry 3, 209-223]. There were no differences between groups, and the first-episode group demonstrated non-significantly more sensitivity to stimulus organization than the other groups. When the high-risk group was broken down into its 3 subgroups (A--family history of psychotic illness and recent drop of 30+ points in the GAF scale; B--history of attenuated psychotic symptoms; C--brief limited intermittent psychotic symptoms), only group A demonstrated evidence of impairment, but this group differed significantly only from first- and young, later-episode schizophrenia patients, not from nonpatients. These findings are consistent with recent data on pre-attentive processes in schizophrenia which indicate that performance is not impaired and may even be enhanced, early in the illness, with dysfunctions beginning with increased chronicity.     

Dissociative symptoms in patients with schizophrenia: relationships with childhood trauma and psychotic symptoms

ObjectiveThis study sought to examine the stability of dissociative symptoms in patients with schizophrenia spectrum disorders as well as relationships between psychotic symptoms, childhood trauma, and dissociation.MethodOne hundred forty-five patients with schizophrenia spectrum disorders (72% schizophrenia, 67% men) were examined at admission to inpatient treatment and 3 weeks later using the Positive and Negative Syndrome Scale, the Childhood Trauma Questionnaire, and the Dissociative Experiences Scale.ResultsDissociative symptoms significantly decreased over time (mean, 19.2 vs 14.1; P < .001). The best predictor of dissociative symptoms at admission was the Positive and Negative Syndrome Scale positive subscale (F_{inc 3,64} = 3.66, P = .017), whereas childhood sexual abuse best predicted dissociation when patients were stabilized (F_{inc 10,80} = 2.00, P = .044).ConclusionDissociative symptoms in patients with schizophrenia spectrum disorders are related to childhood trauma. Dissociation seems to be state dependent in this diagnostic group. Moreover, diagnostic interviews, in addition to the Dissociative Experiences Scale, should be considered to avoid measurement artifacts.     

Cognitive performance in schizophrenia patients assessed before and following the first psychotic episode

BACKGROUND: The purpose of this historical prospective study was to follow the cognitive impairment in schizophrenia from the premorbid period until shortly after the onset of the first psychotic episode within the same subjects. METHODS: Forty-four first episode schizophrenia patients were enrolled in the study. Their cognitive performance was assessed as part of the Israeli Draft Board aptitude assessments at ages 16-17, when all were found to be in good mental health (first assessment) and again, following the manifestation of the first psychotic episode (second assessment). Forty-four healthy comparisons were also enrolled and tested twice, at the same ages as the patients. Both times, the assessments included four subtests assessing abstract reasoning (Raven Progressive Matrices-R), mental speed and concentration (Otis-R), verbal reasoning (Similarities-R), and mathematical abilities (Arithmetic-R). RESULTS: A within group analysis did not reveal statistically significant changes between the first and the second assessment among the schizophrenia patients on any measure. However, a between group comparison of changes showed that relative to the healthy comparisons, schizophrenia patients deteriorated on the RPM-R (p=0.021) and Otis-R (p<0.001), but not on the Similarities-R and Arithmetic-R. Schizophrenia patients performed worse than comparisons in all four subtests on the first and second assessments (all p<0.01). CONCLUSIONS: The results indicate that most of the cognitive impairment exhibited by first-episode schizophrenia patients precedes the first psychotic episode. A decline between ages 16 and 17 and the onset of psychosis is evident in some but not all cognitive functions.     

Self-rated schizotypal cognitions, psychotic symptoms and the onset of schizophrenia in young people at high risk of schizophrenia

OBJECTIVE: To examine the associations between the Rust Inventory of Schizotypal Cognitions (RISC) and psychotic symptoms measured by the Present State Examination (PSE) and to assess the predictive validity of the RISC for later onset of schizophrenia. METHOD: A total of 154 subjects at high risk for schizophrenia but who were currently well, 35 well controls and 28 first episode schizophrenic patients were assessed on specified PSE symptoms and completed the RISC. A subsample of the high risk group was subsequently monitored for onset of schizophrenia over 39 months. RESULTS: RISC scores at entry were significantly higher in subjects with psychotic symptoms on PSE. There were indications that high scorers on the RISC were likely to develop schizophrenia. However, less than half of those falling ill exhibited high RISC scores on entry. CONCLUSION: The RISC scale is highly associated with presence of psychotic symptoms on PSE and high scorers may be at increased risk of schizophrenia onset.     

华人精神分裂症吸烟患者首次发病前吸烟率的Meta分析

目的系统评价华人精神分裂症吸烟患者首次精神病发作前的吸烟率(病前吸烟率)。方法计算机检索中国知网、万方、维普中文期刊网、台湾电子期刊全文数据库、PubMed、EMbase和PsycINFO,查找华人精神分裂症吸烟患者病前吸烟率的原始文献,检索时间均从建库至2016年12月25日。由两位研究者按纳入与排除标准筛选文献、提取数据并评价纳入研究的方法学质量,采用R 3.1.1进行Meta分析。结果共17项研究(2 445例精神分裂症吸烟患者)纳入分析,所有研究均为低质量。华人精神分裂症患者的合并病前吸烟率为72.0%(95%CI:61.0%~86.8%,P0.01);亚组分析结果显示,近年发表(2012年-2016年)文献的病前吸烟率高于早年发表(2002年-2011年)文献(83.0%vs.61.0%,P=0.02),首发精神分裂症患者的病前吸烟率高于非首发患者(88.0%vs.67.0%,P=0.047)。结论大多数华人吸烟精神分裂症患者的吸烟行为发生在首次精神疾病发作之前。     

Brain structure, genetic liability, and psychotic symptoms in subjects at high risk of developing schizophrenia.

BACKGROUND: Structural magnetic resonance imaging (MRI) of the brain in patients with schizophrenia has consistently demonstrated several abnormalities. These are thought to be neurodevelopmental in origin, as they have also been described in first episode cases, although there may be a progressive component. It is not known at which point in development these abnormalities are evident, nor to what extent they are genetically or environmentally mediated. METHODS: One hundred forty-seven high-risk subjects (with at least two affected first or second degree relatives), 34 patients in their first episode, and 36 healthy control subjects received an MRI scan covering the whole brain. After inhomogeneity correction, regions of interest were traced by three group-blind raters with good inter-rater reliability. Regional brain volumes were related to measures of genetic liability to schizophrenia and to psychotic symptoms elicited at structured psychiatric interviews. RESULTS: High-risk subjects had statistically significantly reduced mean volumes of the left and right amygdalo-hippocampus and thalamus, as compared to healthy control subjects. They also had bilaterally larger amygdalo-hippocampi and bilaterally smaller lenticular nuclei than the schizophrenics. High-risk subjects with symptoms had smaller brains than those without. The volumes of the prefrontal lobes and the thalamus were the only consistent associates of genetic liability. CONCLUSIONS: Subjects at high risk of developing schizophrenia have abnormalities of brain structure similar to but not identical to those found in schizophrenia. Our results suggest that some structural abnormalities are genetic trait or vulnerability markers, others are environmentally mediated, and that the development of symptoms is associated with a third overlapping group of structural changes. Particular risk factors for schizophrenia may interact at discrete time points of neurodevelopment with different effects on specific brain regions and may represent relatively distinct disease processes.     

Persistent psychotic symptoms at discharge in patients with schizophrenia

A sample of patients with DSM-III schizophrenia was examined and rated using Andreasen's Schedule for the Assessment of Positive Symptoms (SAPS) and the Schedule for the Assessment of Negative Symptoms (SANS), soon after admission and in the week prior to discharge. A high proportion of the sample had persistent positive and negative symptoms at discharge. This finding is discussed in relation to the service demands placed on the hospital, changing government policies concerning hospital and community care, and the possible consequences of early discharge policies in the absence of adequate community services.     

Cognitive functioning and negative symptoms in first episode schizophrenia: Different patterns of correlates

Negative symptoms of schizophrenia have been related to disturbances of executive functions, memory, attention and motor functioning. The executive functions dimension comprises a variety of cognitive subprocesses, including speed of processing, flexibility and working memory. We independently analysed the relationship between different cognitive tasks and clinical symptoms (negative, positive and disorganized) in a sample of 126 first-episode patients with schizophrenia spectrum disorders. Negative symptoms were significantly associated with performance on executive-functions and motor coordination tasks. Within the executive functions domain only those tests that required speeded performance showed a significant association with the negative dimension. The widely described relationship between negative symptoms and executive impairments in schizophrenia appears to be mediated by likely dysfunctions in the speed of processing instead of by working memory impairment.     

Subjective quality of life in subjects at risk for a first episode of psychosis: a comparison with first episode schizophrenia patients and healthy controls

The concept of quality of life (QoL) is of growing relevance in schizophrenia research. However, there is to date no information on subjective QoL in subjects at risk for a first episode of psychosis in comparison to first episode schizophrenia patients (FE) or healthy controls (HC). Therefore 45 subjects in a putatively early initial prodromal state (EIPS), 40 FE and 45 HC were assessed on demographics, symptoms and subjective QoL as measured by the Modular System for Quality of Life. Results indicated that in most areas HC experienced the highest QoL scores followed in hierarchical order by EIPS and FE. EIPS and FE experienced significantly lower QoL than HC in 5 and 6 of 7 QoL domains. EIPS experienced the lowest ratings in affective QoL. Thus the data demonstrates that subjective QoL in subjects at risk for a first episode of psychosis is substantially reduced when compared with HC and suggests that subjective QoL is already compromised prior to the onset of first positive schizophrenia symptoms. These findings support the notion that subjects at risk for a first episode of psychosis constitute a clinical population for which further service and intervention research is indicated.     

Relationships between depression and psychotic symptoms of schizophrenia during an acute episode and stable period

The aim of the present study is to explore the relationship between depression and psychotic symptoms of schizophrenia over the course of illness. Sixty-eight patients meeting DSM-IV criteria for schizophrenia were enrolled, 27 in an acute episode, 41 when stable. Assessments were performed using the Calgary Depression Scale for Schizophrenia (CDSS) for depression and the Positive and Negative Syndrome Scale (PANSS) for psychotic symptoms. When considering patients in an acute episode (52% depressed), the CDSS score was correlated only with the PANSS positive sub-scale score. For patients in the stable period (38% depressed), the CDSS score was correlated with positive as well as negative and general psychopathology sub-scale scores. Hence, the relationship between depression and other symptoms of schizophrenia appear to differ during different stages of illness.     

精神分裂症高危人群的认知功能与焦虑、抑郁及精神病性症状

目的评估精神分裂症高危人群的认知功能与焦虑、抑郁及精神病性症状,为该人群的早期干预提供科学依据.方法收集来源于中国医科大学附属第一医院精神医学科和沈阳市精神卫生中心就诊的门诊和住院的精神分裂症患者健康子女109人作为精神分裂症遗传高危组,通过广告招募的与精神分裂症患者健康子女年龄、性别、受教育年限相匹配的健康人群,共109人作为健康对照组.两组分别完成威斯康星卡片测试(WCST)、认知成套测试(MCCB)、汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD-17)和简明精神症状量表(BPRS)测试.对两组被试者的一般人口学资料、认知状况及临床特征进行统计分析处理.结果(1)精神分裂症高危组在执行功能WCST卡片测试中的总正确数(Z=-4.54,P<0.01)、正确分类数(Z=-3.78,P<0.01)、总错误数(Z=-4.49,P<0.01)、持续错误数(Z=-3.91,P<0.01)及非持续错误数(Z=-3.38,P<0.01)与健康对照组比较,差异有统计学意义;(2)精神分裂症高危组在MCCB总分(t=11.58,P<0.01)、符号编码(t=11.25,P<0.01)、视觉空间记忆(t=4.59,P=0.04)、持续操作测验(t=6.18,P=0.02)显著低于健康对照组;(3)精神分裂症高危组在HAMA总分(t=2.54,P=0.01)、HAMD-17总分(t=3.03,P<0.01)和抑郁量表中的躯体性焦虑因子(t=2.70,P<0.01)、核心抑郁因子(t=3.04,P<0.01)评分显著高于健康对照组;(4)精神分裂症高危组在BPRS总分(t=3.14,P<0.01)、焦虑和抑郁因子分(t=2.90,P<0.01)亦显著高于健康对照组.结论精神分裂症高危人群不仅存在认知功能损害,而且焦虑、抑郁以及精神病性症状高于健康人群.     

Patients with an increased risk of developing a first psychotic episode: two cases

Patients with an 'at risk mental state' (ARMS) run an increased risk of developing a psychosis within the near future. Patients with an arms can be divided into three groups: those with genetic predisposition to schizophrenia and displaying decreased social functioning, those with attenuated psychotic symptoms and those with brief limited and intermittent psychotic symptoms (BLIPS). Patients with an arms are often suffering from comorbid anxiety and depressive symptoms. Our study focuses on two patients with an ARMS.     

Adoption, family relations and psychotic symptoms among Palauan adolescents who are genetically at risk for developing schizophrenia

Purpose

This paper focuses on the role of adoption and family relations as moderators of genetic risk for psychotic disorders.

Methods

Participants included 184 adolescents in the Republic of Palau identified to be at genetic risk for schizophrenia and other psychotic disorders. Palau is an island nation in Micronesia with a lifetime prevalence of 1.99% for schizophrenia and 2.67% for psychotic disorders more broadly defined [24]. In Palauan culture, kinship adoption is a common cultural practice; 47 of the 184 participants had been adopted at an early age. The current study was designed to test the hypothesis that adoption would function as a protective factor among Palauan youth at genetic risk for the development of psychotic symptoms. Participants were evaluated for psychotic and other psychiatric symptoms using KSADS-PL [16]. Concurrently, the Youth Self Report [1] was used to assess the perceived quality of family relationships.

Results

Results indicated that adopted adolescents were more likely to develop psychotic symptoms than non-adopted adolescents. However, perceived family relations moderated the association between adoption status and psychotic symptoms, such that adopted adolescents with poorer family relations reported disproportionately higher rates of psychotic symptoms. Family relations also moderated the association between level of genetic risk and psychotic symptoms, independently of adoption status.

Conclusion

Consistent with previous research, adolescents at high genetic risk who reported more positive family relations also reported fewer psychotic symptoms [4, 29].     

Neurological soft signs, clinical symptoms and treatment reactivity in patients suffering from first episode schizophrenia

OBJECTIVE : (a) To investigate the correlation between clinical symptoms and neurological soft signs in patients suffering from their first episode of schizophrenia and (b) to examine the relationship between soft signs and the reactivity of first episode treatment. METHODS: The trial included 92 male patients undergoing a first episode of schizophrenia. The clinical symptoms of the patients were rated on the positive and negative syndrome scale (PANSS). The PANSS scale was used to provide a measure for three syndromes: psychomotor poverty, disorganisation, and reality distortion. Neurological soft signs were assessed with the help of the neurological evaluation scale. RESULTS: The findings corroborated significant positive correlations between soft neurological signs on the one hand and negative symptoms and reduced treatment response on the other. CONCLUSION: Our study of the population of patients with first episode schizophrenia has corroborated the findings of those trials that found a correlation between neurological soft signs and the negative symptomatic dimension of schizophrenia. Another finding of the trial is that neurological soft signs were associated with poorer response to treatment of the first episode of schizophrenia.     

1 H-MR spectroscopy in ultra-high risk and first episode stages of schizophrenia

Using proton magnetic resonance spectroscopy biochemical characteristics in early stages of schizophrenia were examined. N-acetylaspartate, choline and creatine were measured in hippocampus, anterior cingulate gyrus (ACC) and medial prefrontal cortex (mPFC) of 24 first episode and 30 ultra-high risk patients. Careful LCModel analyses revealed no differences between the patient groups and 31 healthy controls, casting doubt upon the idea of metabolic changes in early stages of psychosis.     

首发、复发和双相抑郁患者精神症状的比较

目的:探讨首发、复发及双相抑郁患者精神症状的差异。方法:对首次抑郁发作患者(首发组,24例)、复发性抑郁症患者(复发组,57例)及双相抑郁患者(双相组,25例)进行汉密尔顿抑郁评定量表(HAMD)、汉密尔顿焦虑评定量表(HAMA)、杨氏躁狂评定量表(YMRS)以及阳性和阴性症状评定量表(PANSS)评定和比较。结果:HAMD、HAMA评分在3组间差异无统计学意义;YMRS评分3组间差异有统计学意义(F=5.2,P=0.007);双相组(6.6±9.0)显著高于首发组(2.8±3.4)和复发组(2.2±3.2)(q=3.86,q=4.40;P均<0.05)。双相组HAMD中的躯体焦虑因子分、体重因子分均显著低于复发组(P<0.05或P<0.01);双相组精神病理学症状评分如意志活动、愤怒、幻觉、易激惹、激越、思维联想加快、破坏或攻击行为、活动增加显著高于首发组及复发组(P<0.05或P<0.01)。结论:双相障碍患者抑郁发作时可出现与躁狂相关精神症状。