Clinical characteristics and risk factors for Kraepelinian subtype of schizophrenia: replication of previous findings and relation to summer birth

The aims of the study were: (1) to replicate findings that patients with Kraepelinian schizophrenia constitute a distinct subgroup and (2) to examine the relationship between season of birth and the Kraepelinian subtype. Thirty-one Kraepelinian patients, defined on the basis of a longitudinal criterion--at least 5 years of continuous and complete dependence on others to maintain the basic necessities of life, including food, clothing and shelter--were compared with 279 non-Kraepelinian schizophrenic patients. All patients met ICD-10 criteria for schizophrenia and were evaluated with the Positive and Negative Syndrome Scale. Kraepelinian schizophrenic patients had more negative symptoms and were more disorganized than non-Kraepelinian patients. Positive and anxious-depressive symptoms did not differ between the two groups. Among Kraepelinian patients, there was an excess number of births in the month of July. These findings are consistent with previous reports that Kraepelinian patients could have a disease with an etiopathophysiology separate from that of other schizophrenic patients.     

Characteristics of very poor outcome schizophrenia

The authors compared 21 "Kraepelinian" schizophrenic patients who had been ill and dependent on others for the past 5 years with 76 chronic schizophrenic patients in remission or with exacerbations requiring hospitalization. The Kraepelinian patients met the criteria for schizophrenia by more diagnostic systems than the exacerbated patients, were less responsive to haloperidol, had more severe negative symptoms, and had similarly severe positive symptoms. They had cerebral ventricles that were more asymmetrical and a greater family history of schizophrenia spectrum disorders than the other chronic patients. These data suggest that patients with 5 years of illness and complete dependency on others may represent a subgroup of schizophrenia.     

Depression in Kraepelinian schizophrenia

In order to improve our understanding of depression in chronic schizophrenia, depressive symptoms were assessed in institutionalized, so called Kraepelinian, patients with schizophrenia (N = 43). The patients had been ill and dependent on others for at least 5 years. Depressive symptoms as measured by the Hamilton Depression (HAM-D) scale were less prevalent in this population compared to published data on non-Kraepelinian patients. Only 5% of our Kraepelinian patients had a HAM-D score >/= 16. There was also a low prevalence of core depressive symptoms (depressed mood, suicidal ideation, and guilt). The relationship of depression to other dimensions of schizophrenia was explored. Depression had a modest positive correlation (r = 0.44) with general psychopathology as measured by the Brief Psychiatric Rating Scale (BPRS), but not with positive symptoms as measured by BPRS positive subscale or negative symptoms as measured by the Scale for the Assessment of Negative Symptoms (SANS). Depression also showed a modest positive correlation (r =.48) using the Simpson-Angus Rating Scale (SAS) for extrapyramidal symptoms (EPS). These results indicate that in Kraepelinian schizophrenia, depression is not prevalent, even though patients are severely ill both in symptom and functioning domains. The results of our analysis support that Kraepelinian schizophrenia is a distinct subtype, and raise questions regarding the boundary between schizoaffective disorder and non-Kraepelinian schizophrenia. Finally, the low rate of depression observed revives the notion that preservation of core functional abilities is important for a depressive reaction to evolve in schizophrenia.     

Correlates of lateral ventricular size in chronic schizophrenia, I: Behavioral and treatment response measures

The ventricle-brain ratio (VBR) of 28 drug-free male schizophrenic inpatients was significantly higher than that of 21 matched normal control subjects and was not related to severity of positive or negative symptoms. Response to haloperidol in an open 6-week trial using a fixed-dose schedule was not predicted by severity of positive or negative symptoms or by VBR. The nine severely deteriorated patients with chronic "Kraepelinian" schizophrenia had left lateral ventricles 28% larger than their right, whereas the control subjects and other schizophrenic patients did not show ventricular asymmetry.     

Symptomatic overlap of cocaine intoxication and acute schizophrenia at emergency presentation.

Cocaine intoxication and acute abstinence alter brain dopaminergic functioning, resulting in behavioral changes closely mimicking the positive and negative symptoms of schizophrenia. In emergency room settings, recent cocaine abuse can be mistaken for schizophrenia and may cause inappropriate diagnosis and in some instances medical mismanagement. Schizophrenia patients presenting with recent cocaine abuse may also present with significant diagnostic and treatment dilemmas. This study attempts to distinguish between cocaine and schizophrenic psychosis by examining patients who present with both recent cocaine abuse and acute schizophrenia (CA+SZ), cocaine intoxication without schizophrenic illness (CA), and acute schizophrenia with no comorbid substance abuse (SZ) within the first 24 hours after arrival at the Bellevue psychiatric emergency service. Clinical assessment included the Brief Psychiatric Rating Scale, the Schedule for the Assessment of Positive Symptoms, and the Schedule for the Assessment of Negative Symptoms. Both cocaine abusing groups were required to have positive urine toxicology screens for inclusion in the study. Multivariate analysis of variance showed the CA+SZ patients present with a clinical profile that overlaps with CA patients on mood and negative symptom dimensions and overlaps with SZ patients on most positive symptoms. CA+SZ patients differed from both groups, however, by presenting with significantly more hallucinatory experiences than cocaine abusing or schizophrenia patient counterparts. Despite considerable overlap, each group of patients presented with a discernible cross-sectional symptom pattern.     

Negative symptoms in depressed and schizophrenic patients: how do they differ?

BACKGROUND: The present study evaluated differences in negative symptoms between schizophrenic and depressive patients and investigated whether a consideration of the nature of negative symptoms (enduring vs. nonenduring) can help to improve their specificity for schizophrenia. METHOD: Patients enrolled in the study were consecutively hospitalized with an acute exacerbation of schizophrenia (N = 33) or major depressive disorder (N = 43) (DSM-IV). Negative and depressive symptoms were assessed with the Scale for the Assessment of Negative Symptoms (SANS) and the Montgomery-Asberg Depression Rating Scale, respectively. Duration of negative symptoms was assessed through a semistructured interview with the patients and their closest relatives. On the basis of the assessed duration of symptoms, negative symptoms were categorized as enduring or nonenduring. RESULTS: Analyses revealed high SANS ratings for both diagnostic groups. Negative symptoms in depressive patients (p =.01), but not in schizophrenic patients, were significantly associated with the presence or the emergence of depressive symptoms. The prevalence of enduring negative symptoms was significantly higher in schizophrenic patients than in depressive patients (p <.01). A consideration of enduring negative symptoms significantly increased the discriminative power of negative symptoms for schizophrenia (p =.02). CONCLUSION: The present findings suggest that negative symptoms in most depressive patients are just an epiphenomenon of depressive symptoms and can be distinguished from schizophrenic negative symptoms.     

Obsessive-compulsive symptoms in schizophrenia: prevalance and clinical correlates

Obsessive-compulsive symptoms (OCS) have been observed in a substantial proportion of schizophrenic patients. In this study, the rate of occurrence of OCS and obsessive-compulsive disorder (OCD) in schizophrenic patients, and also the interrelationship between OCS and schizophrenic symptoms and depressive symptoms were assessed. A total of 100 subjects with a diagnosis of schizophrenia from the 4th edition of the Diagnostic and Statistical Manual (DSM-IV) were evaluated by the structured and clinical interview for axis-1 DSM-IV disorders-patient edition (SCID-P), the Positive and Negative Syndrome Scale (PANSS), Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), and the Calgary Depression Rating Scale for Schizophrenia. The prevalance of OCS in individuals meeting criteria for schizophrenia was 64%. A total of 30 of these patients (Y-BOCS total score > or =7) also met the DSM-IV criteria for OCD. The total score on Y-BOCS was significantly correlated with total score on PANSS, Positive-PANSS score, General-PANSS score and total score on Calgary Depression Rating Scale for Schizophrenia. OCS and OCD relatively frequent in schizophrenic patients and OCS are significantly correlated with the severity of psychosis, positive symptoms, and depressive symptoms in schizophrenic patients. These findings provide further evidence for the importance of OCS in schizophrenia.     

首发未服药精神分裂症患者血清S100B蛋白浓度变化

目的 探讨血清S100B蛋白浓度与首发未服用抗精神病药的精神分裂症患者精神病理症状间的关系.方法 采用酶联免疫(ELISA)方法 检测64例首发未服用抗精神病药精神分裂症患者和66名正常对照的血清S100B蛋白浓度,比较2组间的差异;采用阳性和阴性症状量表(PANSS)评定精神病理症状,分析血清S100B蛋白浓度与PANSS评分、患者年龄、发病年龄、病程间的关系.结果 ①患者组血清S100B浓度明显高于对照组,筹异有统计学意义[(0.27±0.13)μg/L vs(0.11±0.04)μg/L,t=10.89,P＜0.001];②患者组中偏执型、瓦解型、未分化型、残留型4个亚组间血清S100B浓度的差异有统计学意义(F=4.63,P=0.006),残留型组明显高于偏执型组(P=0.001)、瓦解型组(P=0.012);且各亚型组均明显高于对照组(P＜0.001).③患者组血清S100B浓度与年龄、总病程、PANSS总分及其阴性症状因子分相关(r为0.36、0.46、0.42、-0.38,P均小于0.005).结论 首发未服药的精神分裂症患者血清S100B浓度升高,并与某些病理症状尤其是阴性症状关联,在一定程度上可反映疾病严重程度.     

Mortality in Kraepelinian schizophrenic patients: a prospective study with a median follow-up of 8.4 years

Kraepelinian schizophrenia is a subtype of schizophrenia defined by its very poor outcome.Several studies have demonstrated the validity of this distinction, but the expected excess mortality has not been investigated.The aim of the present study was to test the hypothesis that Kraepelinian schizophrenic subjects have a higher mortality rate, notably due to natural causes, than non-Kraepelinian schizophrenic subjects. The results of a prospective study with a median follow-up of 8.4 years are reported. Three hundred ten schizophrenic subjects meeting the International Classification of Diseases, 10th Revision, criteria for schizophrenia were classified on admission as Kraepelinian schizophrenia (n = 31) and non-Kraepelinian schizophrenia (n = 279); 31 deaths (16 from unnatural causes, 13 from natural causes, and 2 from undetermined causes) were observed during follow-up. Univariate and multivariate Cox regression analyses were performed using schizophrenia subtype (Kraepelinian vs non-Kraepelinian), age, and duration of illness as predictors. Schizophrenia subtype was a significant predictor of mortality in univariate analysis only for death from natural causes, and a trend was observed after adjusting for age and duration of illness. A log-rank test was used to compare mortality rates between Kraepelinian and non-Kraepelinian schizophrenic subjects and showed a significantly higher mortality rate from natural causes in Kraepelinian schizophrenia (16.7%) than in non-Kraepelinian schizophrenia (4.1%).     

齐拉西酮合并艾司西酞普兰治疗以阴性症状为主的精神分裂症对照研究

目的 探讨齐拉西酮合并艾司西酞普兰治疗以阴性症状为主的精神分裂症的疗效和安全性。方法 将86例以阴性症状为主的精神分裂症患者随机分为研究组（齐拉西酮合并艾司西酞普兰治疗）和对照组（单用齐拉西酮治疗）,各43例。于治疗前及治疗后第2、4、8、12周末采用阳性和阴性综合征量表（PANSS）和阴性症状量表（SANS）评定两组的疗效,治疗中需处理的不良反应症状量表（TESS）评定两组的不良反应。结果 治疗后第2周末起研究组PANSS总分及阴性症状因子分较治疗前下降（P〈0.05）,研究组治疗后第2周末起PANSS总分及阴性症状因子分低于对照组（P〈0.05）。治疗后第4周末研究组SANS总分、情感平淡、注意障碍因子分低于对照组（P〈0.05）。两组不良反应发生率比较无显著性差异（P〉0.05）。结论 齐拉西酮合并艾司西酞普兰治疗以阴性症状为主的精神分裂症起效快、疗效好,且未增加不良反应。     

Neurological soft signs in schizophrenic patients with obsessive-compulsive disorder

The purpose of this study was to examine neurological soft signs (NSS) in schizophrenic patients with obsessive-compulsive disorder (OCD). Neurological soft signs were assessed in 15 schizophrenic patients with OCD (OCD-schizophrenia), 38 schizophrenia patients without OCD (non-OCD-schizophrenia), and 24 healthy controls (HC) by means of the Neurological Evaluation Scale (NES). The OCD-schizophrenia group had significantly higher scores on total and subscales of 'sensory integration' and 'others' of NES than the HC group. Subscale scores of 'sequencing of motor acts' in-non-OCD-schizophrenia patients were significantly higher compared to OCD-schizophrenia patients. Total NES scores of both groups were significantly correlated with Scale for the Assessment of Negative Symptoms (SANS) scores. Only the subscale of 'sequencing of motor acts' was significantly correlated with SANS within the OCD-schizophrenia group. These results suggest that NSS do not significantly differ between schizophrenia patients with and without OCD, contrary to expectations. The NES scores in OCD-schizophrenic patients do not appear to be related to a more severe form of schizophrenia. Neurological signs and negative symptoms in schizophrenia patients with and without OCD may be considered as neurodevelopmental predisposing factors. Further research is required in schizophrenia patients with OCD to investigate the relationships between NSS and several neuroimaging or neuropsychological findings, constituting a subgroup within the schizophrenia spectrum.     

Obsessive-compulsive disorder in hospitalized patients with chronic schizophrenia

Obsessive-compulsive (OC) symptoms have been observed in a substantial proportion of schizophrenic patients. In this study, we assessed the rate of occurrence of OC symptoms and the interrelationship between OC and schizophrenic symptoms in 68 hospitalized chronic schizophrenic patients. The patients were interviewed with the Structured Clinical Interview for Axis-I DSM-IV Disorders - Patient Edition (SCID-P) and the appropriate rating scales including the Scale for the Assessment of Positive Symptoms, the Scale for the Assessment of Negative Symptoms, the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), the Barnes Akathisia Scale, the Abnormal Involuntary Movement Scale, and the Social Behaviour Schedule (SBS). Sixteen patients (23.5%) met the DSM-IV criteria for OCD. A comparison of schizophrenic patients with and without OCD showed that the schizo-obsessive patients were significantly (1.7-fold) more impaired in basic social functioning, as reflected by the SBS score. No significant between-group differences for any of the other clinical variables were found. There was no significant correlation between OC and schizophrenic symptoms within the schizo-obsessive subgroup. The mean Y-BOCS score for the patients with both schizophrenia and OCD was within the typical range (22.8+/-1.7) observed in OCD without psychosis. The findings provide further evidence for the importance of the OC dimension in schizophrenia and may have important implications for the application of effective treatment approaches in this difficult-to-treat subgroup of schizophrenic patients.     

有遗传史的精神分裂症患者某些特征研究

目的:探讨首发精神分裂症患者的微小躯体异常(MPAs)与阴性症状及语词记忆缺陷的关系。方法:对36例有家族史和50例无家族史的首发精神分裂症患者进行躯体异常量表(W S)、阳性和阴性症状量表(PANSS)评定,并在恢复期进行选择性提醒测验。结果:有家族史组MPAs评分异常的比例显著高于无家族史组(P<0.05);有家族史组PANSS总分、阴性因子分显著高于无家族史组,其中阴性症状子项目中情感迟钝、抽象思维困难、交流缺乏自发性和流畅性3项评分显著高于无家族史组;有家族史组语词记忆10次通过率低;回忆总数、保持数、长时再现数及恒定长时再现数均低于无家族史组。结论:有家族史的精神分裂症患者MPAs异常比例高,阴性症状较多,语词记忆能力也明显较差,反映遗传可产生多方面影响。     

精神分裂症患者攻击行为与临床症状、记忆及智力的相关性

目的探讨精神分裂症患者攻击行为与临床症状、记忆及智力的相关性,分析临床症状、记忆及智力能否作为精神分裂症患者攻击行为的预测因子。方法以2014年5月-2016年5月在中山市第三人民医院早期干预科住院的符合《国际疾病分类(第10版)》(ICD-10)精神分裂症诊断标准的患者为研究对象,所有患者均处于急性发作期。依据既往暴力史和修订版外显攻击行为量表(MOAS)加权总分为5分区分攻击组和非攻击组,其中攻击组69例,非攻击组39例。采用阳性和阴性症状量表(PANSS)评估临床症状,采用韦氏记忆量表修订版(WMS-R)、韦氏成人智力量表中国修订版(WAIS-RC)评估记忆和智力,并对MOAS与PANSS、WMS-R和WAIS-RC评分进行相关分析。结果攻击组MOAS加权总分、言语攻击、对财产的攻击和体力攻击的评分均高于非攻击组,差异均有统计学意义(P0.05或0.01)。攻击组PANSS总评分和阳性症状评分均高于非攻击组,差异均有统计学意义(P0.05或0.01)。两组WMS-R和WAIS-RC评分比较差异均无统计学意义(P均0.05)。MOAS加权总分、体力攻击评分与PANSS总评分、阳性症状评分和一般精神病理评分呈正相关(r=0.203~0.535,P0.05或0.01),体力攻击评分与心智评分呈负相关(r=-0.343,P0.05)。结论与非攻击组相比,攻击组的攻击行为体现在言语攻击、对财产的攻击与体力攻击方面。PANSS总评分与阳性症状可能与精神分裂症患者的攻击行为相关。记忆和智力与精神分裂症患者的攻击行为不相关,不能作为攻击行为的预测因子。     

以阴、阳性症状为主的精神分裂症患者威斯康星卡片分类测验的比较研究

目的探讨精神分裂症患者认知功能障碍的特点。方法对２３例以阴性症状为主的精神分裂症、３０例以阳性症状为主的精神分裂症和２８名正常人进行了威斯康星卡片分类测验（ＷＣＳＴ）。结果显示以阴性症状为主的精神分裂症患者的总测验次数、持续错误数和非持续错误数明显高于以阳性症状为主的精神分裂症患者和正常人，差异有显著性（Ｐ＜０．０５）。同时发现，ＷＣＳＴ的以上测验指标在两组患者之间差异亦有显著性（Ｐ＜０．０５）。相关分析显示，以阴性症状为主的精神分裂症患者的Ａｎｄｒｅａｓｅｎ阴性症状量表总分与简明精神病评定量表的迟滞因子分和持续错误数呈显著正相关（ｒ分别为０．４３７２和０．４５５１）。结论提示精神分裂症患者存在执行功能障碍，其中阴性症状可能与额叶功能缺陷有关。     

Is alexithymia related to negative symptoms of schizophrenia? A preliminary longitudinal study

BACKGROUND: Alexithymic features are close to anhedonia, blunted affect, and alogia that are also characteristics of the negative symptoms of schizophrenia. This study aimed to evaluate whether alexithymia is associated with negative symptoms and is related to the change of schizophrenic symptoms over time. SAMPLING AND METHODS: A consecutive sample of 29 schizophrenic outpatients was evaluated at baseline and at 3, 6, and 12 months during appropriate treatment. They completed the Positive and Negative Syndrome Scale, the Montgomery and Asberg Depression Rating Scale, the Global Assessment of Functioning Scale, and the 20-item Toronto Alexithymia Scale at any time points. RESULTS: The psychiatric scale scores showed significant symptom improvement over time but were unrelated to the alexithymia score that was instead stable over time. Hierarchical regression showed that the 20-item Toronto Alexithymia Scale at baseline was the sole predictor of alexithymia at 12 months, after controlling for psychopathology and psychological functioning. CONCLUSIONS: Alexithymia was unrelated to negative symptoms, suggesting it is an independent and separate construct from schizophrenia. As expected, the negative symptoms were associated instead with illness-related aspects of depression and psychosocial functioning. Caution should be expressed in generalization mainly because this study is limited by the small sample size.     

Substance abuse and suicidality in schizophrenia: a common risk factor linked to impulsivity

Lifetime substance abuse comorbidity is frequent in schizophrenic patients, but the clinical correlates remain unclear. We have explored the chronological relations between substance abuse and course of schizophrenia, and compared several clinical characteristics and personality dimensions in 50 schizophrenic patients with or without lifetime substance abuse or dependence. Abuse occurred mainly after the first prodromal symptoms and just before the first psychotic episode. Substance-abusing patients were not different from non-substance-abusing patients on the Chapman Physical Anhedonia Scale, PANSS total score, negative subscore or depression item, CGI, treatment response and demographic variables. In contrast, substance-abusing patients had higher scores on the Barratt Impulsivity Scale (total, cognitive and non-planning scores) and had attempted suicide more often. In patients with schizophrenia, as in the general population, substance abuse or dependence appears associated with higher impulsivity and suicidality. High impulsivity could facilitate substance abuse as a maladaptive behavior in response to prodromal symptoms, precipitating the onset of a characterized psychosis.     

Depressive symptoms in schizophrenia.

OBJECTIVE: The authors assessed the presence and severity of depressive symptoms, as well as their associations with other clinical measures, in a group of mid- to late-life patients with schizophrenia who were not in a major depressive episode or diagnosed with schizoaffective disorder. METHOD: Sixty outpatients with schizophrenia between the ages of 45 and 79 years and 60 normal comparison subjects without major neuropsychiatric disorders, proportionally matched for age and gender, were studied. Depressive symptoms were rated primarily with the Hamilton Depression Rating Scale. Standardized instruments were also used to measure global psychopathology, positive and negative symptoms, abnormalities of movement, and global cognitive status. RESULTS: Depressive symptoms were more frequent and more severe in schizophrenic patients than in normal comparison subjects; 20% of the women with schizophrenia had a Hamilton depression scale score of 17 or more. Severity of depressive symptoms correlated with that of positive symptoms but not with age, gender, negative symptoms, extrapyramidal symptoms, or neuroleptic dose. CONCLUSIONS: Depressive symptoms are common in older patients with schizophrenia. They may be an independent, core component of the disorder or, alternatively, may be a by-product of severe psychotic symptoms.     

Reexamination of the characteristics of the deficit schizophrenia patients

The aim of this study was to reexamine and compare the characteristics of the deficit and nondeficit schizophrenic patients. This cross-sectional study consisted of 62 in- and out-patients, 18–65 years of age, diagnosed with schizophrenia according to DSM-IV. The sociodemographic variables, premorbid adjustment, clinical course and general functioning level in the past five years were evaluated by utilizing the appropriate sections of Comprehensive Assessment of Symptoms and History (CASH). In addition, GAF, the Schedule for the Deficit Syndrome (SDS), Positive and Negative Syndrome Scale (PANSS), Montgomery Äsberg Depression Scale (MADRS), the Neurological Evaluation Scale (NES) and the Simpson Angus Extrapyramidal Side Effects (EPS) Rating Scale, Trail A and B, Verbal Fluency, Stroop, Block Design and Finger Tapper tests were administered. Using the SDS, 19 patients (30.6 %) were categorized as deficit; 43 (69.4 %) were categorized as nondeficit. The deficit patients were worse on the Functioning During Past Five Years score of CASH. The PANSS and MADRS mean scores were not significantly different between the two groups, except a higher level of negative symptoms observed in the deficit group. NES scores were also significantly higher in the deficit group. However, sociodemographic and other clinical variables, neurocognitive measures and EPS symptoms did not show any significant difference between the two groups. Our findings suggest that the deficit schizophrenia is a distinct subgroup comprised of patients who have more negative symptoms, neurological impairment and poor functioning which may have a common underlying pathology.     

Heart rate dynamics and their relationship to psychotic symptom severity in clozapine-treated schizophrenic subjects

The analysis of heart rate variability (HRV) has proven to be useful in evaluating the neuroautonomic dysfunctions associated with various clinical conditions. The purpose of this study was to investigate the linear and non-linear dynamic measures of HRV, and to evaluate their relationship with the psychotic symptom severity, in clozapine-treated schizophrenic subjects. Fifty schizophrenic patients treated with clozapine as monotherapy and 50 normal control subjects were evaluated for HRV analysis. The HRV measurements were obtained from a 30-min resting electrocardiogram (ECG). The severity of psychotic symptoms was assessed using the Positive and Negative Syndrome Scale (PANSS). In the patient group, the complexity and symbolic dynamics measures as well as the time and frequency domain measures of HRV were significantly lower than in the control group (P<0.01). The intermediate-term fractal scaling component value was significantly higher in the patient group (P<0.01). The PANSS total score and the positive symptom subscale score had significant negative correlations with the sample entropy (SampEn) value (P<0.01). In conclusion, schizophrenic patients treated with clozapine had markedly different heart rate dynamics compared to normal control subjects. The severity of psychotic symptoms was associated with the SampEn value, suggesting that the non-linear complexity measure might be useful in assessing the neuroautonomic dysfunction in schizophrenia.