Physical capacity,respiratory quotient and energy expenditure during exercise in male patients with schizophrenia compared with healthy controls

BackgroundDespite massive research on weight gain and metabolic complications in schizophrenia there are few studies on energy expenditure and no current data on physical capacity.AimTo determine oxygen uptake capacity, respiratory quotient (RQ) and energy expenditure during a submaximal exercise test in patients with schizophrenia and healthy controls.MethodTen male patients and 10 controls were included. RQ and energy expenditure were investigated with indirect calorimetry during a cycle ergometer test. The submaximal work level was defined by heart rate and perceived exhaustion. Physical capacity was determined from predicted maximal oxygen uptake capacity (VO_2-max).ResultsThe patients exhibited significantly higher RQ on submaximal workloads and lower physical capacity. A significant lower calculated VO_2-max remained after correction for body weight and fat free mass (FFM). Energy expenditure did not differ on fixed workloads.ConclusionRQ was rapidly increasing in the patients during exercise indicating a faster transition to carbohydrate oxidation and anaerobic metabolism that also implies a performance closer to maximal oxygen uptake even at submaximal loads. This may restrict the capacity for everyday activity and exercise and thus contribute to the risk for weight gain. Physical capacity was consequently significantly lower in the patients.     

氯氮平对血浆神经肽Y及体质量的影响

目的:探讨氯氮平对精神分裂症患者血浆神经肽Y(NPY)及体质量的影响。方法:30例女性精神分裂症患者(氯氮平组),于氯氮平治疗前、治疗4周,分别测定体质量、血浆NPY水平,并与30例健康成年女性(对照组)比较。结果:氯氮平组治疗前血浆NPY(pg/ml)与对照组比较,差异无统计学意义(58.9±12.3,60.9±14.0,P>0.05);治疗后,氯氮平组体质量及血浆NPY均高于治疗前,差异有统计学意义(63.3±13.3,60.9±14.0;159.2±66.1,129.0±66.5,P<0.05)。治疗后、治疗前血浆NPY的差值,与治疗前后体质量的差值呈正相关(r=0.446,P=0.013)。结论:氯氮平引起体质量增加的同时,伴有血浆NPY增高,后者可能参与了氯氮平所致的体质量增加形成机制。     

Body composition in patients with schizophrenia: Comparison with healthy controls

ABSTRACT: BACKGROUND: Recently, a relationship between obesity and schizophrenia has been reported. Although fat mass and fat-free mass have been shown to be more predictive of health risk than body mass index, there are limited findings about body composition among patients suffering from schizophrenia. The aim of this study was to compare the body composition of schizophrenia patients with that of healthy subjects in Japan. METHODS: We recruited patients (n = 204), aged 41.3 +/- 13.8 (mean +/- SD) years old with a Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) diagnosis of schizophrenia who were admitted to psychiatric hospital using a cross-sectional design. Subjects' anthropometric measurements including weight, height, body mass index (BMI), and medications were also collected. Body fat, percentage (%) body fat, fat-free mass, muscle mass, and body water were measured using the bioelectrical impedance analysis (BIA) method. A comparative analysis was performed with schizophrenic subjects and 204 healthy control individuals. RESULTS: In a multiple regression model with age, body mass index, and dose in chlorpromazine equivalents, schizophrenia was significantly linked with more body fat, higher percentage body fat, lower fat-free mass, lower muscle mass, and lower body water among males. In females, schizophrenia had a significant association with lower percentage body fat, higher fat-free mass, higher muscle mass, and higher body water. CONCLUSIONS: Our data demonstrate gender differences with regard to changes in body composition in association with schizophrenia. These results indicate that intervention programs designed to fight obesity among schizophrenic patients should be individualized according to gender.     

Sex differences, season of birth and platelet 5-HT levels in schizophrenic patients

Summary. Similar occurrence of schizophrenia was observed in men and women independent of their season of birth. Platelet 5-HT concentration was determined in 116 healthy control subjects (61 male and 55 female) and 152 patients with schizophrenia (96 male and 56 female). Platelet 5-HT concentration was significantly higher in male than in female healthy persons and schizophrenic patients. Male and female healthy subjects born in different seasons had similar platelet 5-HT concentrations, whereas schizophrenic patients with different birth-seasons had significantly different platelet 5-HT concentrations. The highest platelet 5-HT levels were observed in both male and female schizophrenic patients born in winter when compared to matched healthy controls. Male schizophrenic patients born in winter had higher platelet 5-HT levels than schizophrenic men born in spring and summer. Female schizophrenic patients born in winter had higher platelet 5-HT than schizophrenic women born in all other seasons. These results indicated sex differences in platelet 5-HT levels in healthy persons and schizophrenic patients. The relationship between season of the birth and platelet 5-HT concentration observed only in schizophrenic patients added further support to the presumption that schizophrenia is connected with a disturbance in the central serotoninergic system. Received January 26, 1998; accepted September 18, 1998     

Gender differences in cognitive function of patients with chronic schizophrenia

Schizophrenic patients have cognitive impairments, but gender differences in these cognitive deficits have had limited study. This study assessed cognitive functioning in 471 subjects including 122 male and 78 female schizophrenic patients and 141 male and 130 female healthy controls. We found that immediate memory, language, delayed memory and total RBANS scores were significantly decreased in schizophrenia compared with healthy controls for both genders. Male patients had significant lower immediate memory, delayed memory and total RBANS scores than female patients, and healthy controls showed a similar gender difference. The RBANS showed modest correlations with PANSS scores, duration of illness and antipsychotic dose (chlorpromazine equivalents). Almost all RBANS scores in the schizophrenics and healthy controls showed significant positive correlations with education. Thus, patients of both sexes with schizophrenia experienced more deteriorated performance than healthy controls on cognitive domains of immediate memory, language and delayed memory. Furthermore, male schizophrenic patients had more serious cognitive deficits than female patients in immediate and delayed memory, but not in language, visuospatial and attention indices.     

Differences in resting energy expenditure and body composition between patients with schizophrenia and healthy controls

OBJECTIVE: A lowered energy metabolism in schizophrenia was reported already in the 1920s. However, these early investigations were case studies without control groups or statistical analysis. In this study the resting energy expenditure (REE) and relevant body composition variables were measured in patients with schizophrenia and healthy controls. METHOD: REE was determined in 30 patients and 17 controls. The difference between the measured and the expected level for each individual was calculated as DeltaREE. Body composition was assessed with bioelectrical impedance and calliper measurements. RESULTS: DeltaREE was significantly lower in the patients than in the controls. A decrease was also seen in the non-medicated patients. The patients showed significantly lower percentages of water in fat free-mass and intracellular water. CONCLUSION: The lowering of REE and body water fractions may suggest a homeostatic aberration in schizophrenia that may be of importance for the understanding of metabolic disturbances observed in the disease.     

Serum BDNF levels and weight gain in schizophrenic patients on long-term treatment with antipsychotics

Several lines of evidence suggest that central brain-derived neurotrophic factor (BDNF) modulates food intake, metabolism, and increases in body weight. Reports have also shown that serum BDNF is altered in schizophrenic patients treated with antipsychotics. This study aimed to determine if there was a relationship between BDNF and antipsychotic-induced weight gain in patients with chronic schizophrenia. Serum BDNF was measured in 124 schizophrenia patients chronically treated with clozapine (n = 57), risperidone (n = 23) or typical antipsychotics (n = 44) and 50 healthy control subjects. To further assess group differences in serum BDNF, additional analyses were performed in a subset of patients and controls individually matched for body mass index (BMI). BDNF levels were lower in patients with schizophrenia than normal controls. However, this difference was not present when controlling for current BMI. In the individually BMI-matched sample, no differences in serum BDNF levels were observed in schizophrenic patients compared to BMI-matched healthy controls. BDNF levels negatively correlated with BMI gain in female but not in male patients when gender was considered. Antipsychotic class exerted differential effects over BDNF levels and BMI gain. Our findings suggest that decreased BDNF levels may be associated with weight gain in female schizophrenic patients on long-term antipsychotic treatment.     

Can pill placebo augment cognitive-behavior therapy for panic disorder?

Background

There are limited findings about dietary patterns and food preferences among patients suffering from schizophrenia. The main objective of this study was therefore to compare the nutritional pattern of schizophrenia patients with that of matched healthy subjects.

Methods

The dietary pattern of 30 hospitalized 16–67 years old schizophrenic patients (11 female) was compared with that of 30 healthy age and sex matched individuals as control group. Subjects' anthropometric measurements including weight, height and body mass index (BMI), semi-quantitative food frequency (FFQ), medical and food history questionnaires were also collected and FFQs were then scored using Food Guide Pyramid to obtain the dietary scores. Percent body fat (%BF) was measured using bioelectrical impedance analysis (BIA) method.

Results

Female patients had more %BF and lower dietary pattern scores than that of their controls (32 ± 3.6 vs 27.7 ± 4.6 percent and 43.2 ± 11.9 vs 54.5 ± 10.7 points; respectively, p < 0.05 for both). They also consumed less milk and dairy products, fresh vegetables, fruits, chicken, and nuts compared with the female controls (p < 0.03). However, these patients used to eat more full-fat cream and carbonated drinks (p < 0.05). Male patients had lower BMI (22 ± 4.7 vs 25.6 ± 4.4; p < 0.05) than their counterpart controls but there was no significant difference between their %BFs. Moreover, they used to have more full-fat cream, hydrogenated fats, less red meat and nuts compared with the male controls (p < 0.05).

Conclusion

Schizophrenia patients have poor nutritional patterns. In particular, female patients have more percent body fat and lower dietary pattern scores compared with their healthy controls. All patients used to consume more fats and sweet drinks frequently. The findings of this study suggest that schizophrenia patients need specific medical nutrition therapies through limiting dietary fats and sugars intakes and weight control. Whether obesity is the consequence of disease, dietary preference or medications used remains to be cleared.     

Serum BDNF levels and weight gain in schizophrenic patients on long-term treatment with antipsychotics

Several lines of evidence suggest that central brain-derived neurotrophic factor (BDNF) modulates food intake, metabolism, and increases in body weight. Reports have also shown that serum BDNF is altered in schizophrenic patients treated with antipsychotics. This study aimed to determine if there was a relationship between BDNF and antipsychotic-induced weight gain in patients with chronic schizophrenia. Serum BDNF was measured in 124 schizophrenia patients chronically treated with clozapine (n = 57), risperidone (n = 23) or typical antipsychotics (n = 44) and 50 healthy control subjects. To further assess group differences in serum BDNF, additional analyses were performed in a subset of patients and controls individually matched for body mass index (BMI). BDNF levels were lower in patients with schizophrenia than normal controls. However, this difference was not present when controlling for current BMI. In the individually BMI-matched sample, no differences in serum BDNF levels were observed in schizophrenic patients compared to BMI-matched healthy controls. BDNF levels negatively correlated with BMI gain in female but not in male patients when gender was considered. Antipsychotic class exerted differential effects over BDNF levels and BMI gain. Our findings suggest that decreased BDNF levels may be associated with weight gain in female schizophrenic patients on long-term antipsychotic treatment.     

抗精神病药致血糖改变与体重体脂指标关系

目的：分析首次治疗的精神分裂症患者抗精神病药(APS)急性期治疗期间血糖改变及其与体重体脂指标间的关系方法：测定46例患者(男27例，女19例)APS单药治疗10周前后空腹血糖和餐后2h血糖；观察治疗前后体重指数(BMI)和腰臀比率(WHR)，并采用磁共振测定其中40例患者治疗前后腹部脂肪分布结果：患者治疗10周后餐后2h血糖明显增高，葡萄糖耐量低减(IGT)发生率增加。治疗前餐后2h血糖水平与体重体脂指标呈正相关；治疗10周后，餐后2h血糖水平与体重体脂指标无相关。结论：APS急性期治疗可致精神分裂症患者血糖异常；血糖水平改变与体重增加及体脂沉积有关。     

Sex differences in inferior parietal lobule volume in schizophrenia

OBJECTIVE: The inferior parietal lobule is a heteromodal association cortical region that has been implicated in the pathophysiology of schizophrenia. Inferior parietal lobule gray matter volumes have been shown to differ between healthy male and female subjects, with male subjects having larger left volumes. The authors sought to determine whether these volumetric sex differences also exist in patients with schizophrenia. METHOD: The authors used magnetic resonance imaging to measure inferior parietal lobule volumes of 15 pairs of male and female schizophrenic subjects who were individually matched to each other and to 15 pairs of healthy male and female subjects. RESULTS: Male schizophrenic patients exhibited a reversal of the normal left-greater-than-right male asymmetry in this region and had left inferior parietal lobule gray matter volumes that were significantly smaller than those of healthy male subjects. Female schizophrenic patients did not differ significantly from healthy female subjects in left or right inferior parietal lobule volume or in asymmetry. CONCLUSIONS: This study provides further evidence of brain morphology sex differences in schizophrenia that possibly contribute to the differential clinical disease expression in men and women.     

Exercise Reveals the Interrelation of Physical Fitness,Inflammatory Response,Psychopathology, and Autonomic Function in Patients With Schizophrenia

Maintaining and improving fitness are associated with a lower risk of premature death from cardiovascular disease. Patients with schizophrenia are known to exercise less and have poorer health behaviors than average. Physical fitness and physiological regulation during exercise tasks have not been investigated to date among patients with schizophrenia. We studied autonomic modulation in a stepwise exhaustion protocol in 23 patients with schizophrenia and in matched controls, using spirometry and lactate diagnostics. Parameters of physical capacity were determined at the aerobic, anaerobic, and vagal thresholds (VT), as well as for peak output. VT was correlated with psychopathology, as assessed by the Positive and Negative Syndrome Scale, with the inflammatory markers IL-1β, IL-6, and TNF-α and with peak output. The MANOVA for heart and breathing rates, as well as for vagal modulation and complexity behavior of heart rate, indicated a profound lack of vagal modulation at all intensity levels, even after the covariate carbon monoxide concentration was introduced as a measure of smoking behavior. Significantly decreased physical capacity was demonstrated at the aerobic, anaerobic, and VT in patients. After the exercise task, reduced vagal modulation in patients correlated negatively with positive symptoms and with levels of IL-6 and TNF-α. This study shows decreased physical capacity in patients with schizophrenia. Upcoming intervention studies need to take into account the autonomic imbalance, which might predispose patients to arrhythmias during exercise. Results of inflammatory parameters are suggestive of a reduced activity of the anti-inflammatory cholinergic pathway in patients, leading to a pro-inflammatory state.Key words: heart rate, physical exercise, respiration, schizophrenia, vagal threshold, cardiac death, inflammation, physical fitness     

Frontal dopamine D(2/3) receptor binding in drug-naive first-episode schizophrenic patients correlates with positive psychotic symptoms and gender.

BACKGROUND: The aim of the study was to examine extrastriatal dopamine D(2/3) receptor binding and psychopathology in schizophrenic patients, and to relate binding potential (BP) values to psychopathology. METHODS: Twenty-five drug-naive schizophrenic patients and 20 healthy controls were examined with single-photon emission computerized tomography (SPECT) using the D(2/3)-receptor ligand [123I]epidepride. RESULTS: In the hitherto largest study on extrastriatal D(2/3) receptors we detected a significant correlation between frontal D(2/3) BP values and positive schizophrenic symptoms in the larger group of male schizophrenic patients, higher frontal BP values in male (n = 17) compared to female (n = 8) patients, and - in accordance with this - significantly fewer positive schizophrenic symptoms in the female patients. No significant differences in BP values were observed between patients and controls; the patients, however, had significantly higher BP in the right compared to the left thalamus, whereas no significant hemispheric imbalances were observed in the healthy subjects. CONCLUSIONS: The present data are the first to confirm a significant correlation between frontal D(2/3) receptor BP values and positive symptoms in male schizophrenic patients. They are in agreement with the hypothesis that frontal D(2/3) receptor activity is significant for positive psychotic symptoms. Additionally, the data support a thalamic hemispheric imbalance in schizophrenia.     

Association of G72/G30 polymorphisms with early-onset and male schizophrenia

To explore the effect of G72/G30 polymorphisms on the clinical manifestations of schizophrenia, especially on the age at onset and sex of patients, we examined three single nucleotide polymorphisms in 216 schizophrenic patients and 321 healthy controls. Significant associations of schizophrenia with the A allele of rs947267 (P=0.012) and haplotype A-A-G (rs2391191-rs947267-rs778294) (P=0.008) were found in early-onset schizophrenic patients. So did the same allele (P=0.034) and haplotype (P=0.009) as mentioned above in male patients. These findings suggest that the G72/G30 gene may modulate the age at onset and there might be a potential interaction between this locus and sex in the pathogenesis of schizophrenia.     

精神疾病患者血清睾酮和雌二醇水平研究

目的：了解首发精神分裂症和情感性精神障碍患者血清睾酮和雌二醇的变化。方法：以放射免疫法对首次发病的５４例精神分裂症患者和３７例情感性精神障碍患者血清中睾酮和雌二醇进行测定,并与正常健康者作对照。结果：男性精神分裂症患者者血清雌 二醇浓度显著高于对照组男性,女性情感性精神障碍患者血清睾酮浓度显著高于对照组和精神分裂症组女性。治疗后女性患者血清雌二醇浓度显著下降,对睾酮浓度影响不大。结论：精神分裂症和     

Smaller cerebellar vermis but not hemisphere volumes in patients with chronic schizophrenia

OBJECTIVE: The authors previously reported that men with chronic schizophrenia had a smaller vermian subregion than did healthy men. In this study, they tested whether posterior superior vermis reduction would be seen in a larger group of schizophrenia patients, both male and female. METHOD: Brain volumetric analyses were performed with magnetic resonance imaging (MRI) in 59 male and female patients with chronic schizophrenia and 57 male and female healthy comparison subjects. RESULTS: The men as well as the women with schizophrenia had significantly smaller total vermis volume and smaller vermian subregions than did the healthy subjects. Total intracranial volume and cerebellar hemisphere volumes did not differ between schizophrenic and healthy subjects. CONCLUSIONS: The findings support the previous finding that in patients with chronic schizophrenia, there is a selective volume reduction of the cerebellar vermis within the cerebellum.     

The hormonal environment in utero as a potential aetiological agent for schizophrenia

There is consistent evidence in the literature that the foetal neurodevelopmental period is crucial for the genesis of schizophrenia later in adult life. There are also strong indications that the schizophrenic illness has sexually dimorphic features. A hypothesis consistent with both findings is that sexual hormones may act as aetiological agents for schizophrenia during the foetal period influencing the neurodevelopment in a differential way in males and females. The aim of this study is to verify this hypothesis exploiting the correlation between fingers’ length in adults and hormonal concentrations in utero, which has been demonstrated in previous studies. More specifically, the literature shows that the lengths of the second and fourth finger in adults are proportional to the foetal concentrations of respectively oestrogens and androgens. When the sample of patients suffering from schizophrenia analysed in this study was compared with healthy subjects, it was observed that the average length of the second digit in the female schizophrenic sample resulted significantly shorter than in the female controls. There was no significant difference when the male schizophrenic sample was compared with male controls. The result of the study is, therefore, compatible with the hypothesis that oestrogenic hormones protect female foetuses from damage during the neurodevelopment in utero and ultimately give more benign characteristics to the schizophrenic illness in women.     

抗精神病药物治疗急性期体脂分布特征及其与血脂代谢相关性研究

目的　探讨抗精神病药物治疗急性期体脂分布特征及其与血脂代谢的关系。方法　对 4 6例入选患者采用自身配对设计 ,给予单一抗精神病药物 (APS)治疗 10周 ,检测患者治疗前后体重、体重指数 (BMI)和血脂 ,并采用结构核磁共振测定其中 4 0例患者治疗前后体脂指标 ,包括腹部皮下脂肪 (SUB)和内脏脂肪 (IAF)。结果　APS治疗前后患者体重指标差异有显著性 (P <0 0 5～P <0 0 0 0 1) ,体脂指标差异有显著性 (PSUB<0 0 5、PIAF<0 0 0 1) ,男性体脂指标变化值明显高于女性 ;血脂指标治疗前后差异有显著性 (P <0 0 1～P <0 0 0 0 1) ;治疗后体重指数(BMI)与甘油三酯 (TG)呈正相关 (r=0 391;P =0 0 14 ) ;体脂指标中IAF与低密度脂蛋白 (LDL)呈正相关 (r =0 4 38;P =0 0 1)。结论　APS治疗急性期体脂分布具腹型肥胖特征 ,男性更明显 ,并伴有血脂增高     

Body mass index among Japanese inpatients with schizophrenia

BACKGROUND: Many studies have emphasized the high frequency of obesity in schizophrenic patients. However, the characteristics of the Body Mass Index (BMI) distribution in Japanese schizophrenic patients remain unknown, and the aim of this study was to clarify these characteristics in a Japanese schizophrenic inpatient population. METHODS: The subjects were 273 inpatients (males: 141, females: 132) with schizophrenia. The patient BMI distribution was compared with normal control data obtained from the 2003 Japanese National Health and Nutrition Survey. RESULTS: The mean patient BMI was 23.0 +/- 4.3, and the BMI showed a normal distribution. The proportion of patients who were obese, of normal weight and underweight was 30.8%, 53.1%, and 16.1%, respectively. No statistical evidence of a higher frequency of obesity was found in male patients, compared to normal controls, but a higher frequency of underweight patients and a lower frequency of normal-weight patients were apparent in most decades of age. In female schizophrenia patients, a higher prevalence of obesity occurred in patients aged 50-59 years old, compared to controls. A higher rate of underweight elderly patients and a lower rate of normal-weight patients aged 40 to more than 70 years old were also apparent. CONCLUSIONS: The results suggest that not only obesity but also weight problems related to an underweight condition occur more frequently in Japanese schizophrenic inpatients than in normal controls. The deviation of the BMI distribution in Japanese schizophrenic inpatients may have a relationship with higher mortality and sudden death in schizophrenia.     

A controlled magnetic resonance imaging study of corpus callosum thickness in schizophrenia

Two previous postmortem studies reported an increased thickness of the corpus callosum in schizophrenic patients compared to psychiatric controls. We report an in vivo study of the corpus callosum in schizophrenic patients (n = 38) and healthy controls (n = 41) using magnetic resonance (MR) brain imaging. A significant increase in mean callosal thickness was found in the middle and anterior, but not the posterior, parts of the callosal body. However, when the patients and controls were compared by gender and handedness, schizophrenic men were found not to differ from control men in callosal thickness, regardless of handedness, whereas schizophrenic women were found to have a highly significant increase in callosal middle and anterior thickness compared to control women. The data suggest that increased callosal thickness in schizophrenia is gender related, a factor that is not considered by postmortem studies. The implications of increased callosal dimensions in female schizophrenics are discussed.