Perception of patients’ unpredictability and beliefs on the causes and consequences of schizophrenia

Abstract.Background: The belief that mental disorders involve a high risk of unpredictable behaviours is a factor which influences negatively the social acceptance of the mentally ill. In this paper, we compare the beliefs about the causes and psychosocial consequences of schizophrenia expressed by 536 respondents who had the firm conviction that patients with schizophrenia are unpredictable and by 457 respondents who firmly believed that they are not.Methods: The survey was conducted in 30 Italian geographic areas, randomly selected taking into account their location and population density. The data were collected by the Questionnaire about Opinions on Mental Illness (QO).Results: Respondents who believed that patients with schizophrenia are unpredictable reported more frequently factors such as use of alcohol and drugs and frequenting bad company as being involved in the development of the disorder. In addition, this group showed more restrictive opinions about patients civil and affective rights. Low education was found to be significantly associated with perception of unpredictability in schizophrenia.Conclusions: These results suggest the need to: a) inform the general public on the main clinical characteristics of schizophrenia and on the risk of unpredictable behaviours in the acute phases of this mental disorder; b) carry out sensitisation campaigns against discrimination toward people with schizophrenia emphasising successful experiences of social integration.     

Early detection and treatment of schizophrenia: how early?

OBJECTIVE: Whereas early detection and therapy of schizophrenic psychoses until some time ago concentrated on frank schizophrenia, during the last years some centres have also started to treat patients even before a clear diagnosis could be established. This paper attempts to discuss if and when this is justified in the light of recent research. METHOD: Mini review of literature. RESULTS: The rationale for early detection and treatment of schizophrenia is based on several observations: diagnosis and treatment of schizophrenia are often seriously delayed. Consequences of the disease are severe already in the early undiagnosed phase of the disorder and early treatment seems to improve the course of the disease. It can therefore be stated quite safely that patients should be treated as early as possible. However, the question of how early has not been sufficiently answered up to now. CONCLUSION: We are at the moment in an ethical dilemma between either diagnosing and treating this disorder too late or too early. The only way and prerequisite for solving this dilemma is a more reliable identification of individuals at risk and the beginning disease process.     

Cannabis and cognitive dysfunction: parallels with endophenotypes of schizophrenia?

Currently, there is a lot of interest in cannabis use as a risk factor for the development of schizophrenia. Cognitive dysfunction associated with long-term or heavy cannabis use is similar in many respects to the cognitive endophenotypes that have been proposed as vulnerability markers of schizophrenia. In this overview, we examine the similarities between these in the context of the neurobiology underlying cognitive dysfunction, particularly implicating the endogenous cannabinoid system, which plays a significant role in attention, learning and memory, and in general, inhibitory regulatory mechanisms in the brain. Closer examination of the cognitive deficits associated with specific parameters of cannabis use and interactions with neurodevelopmental stages and neural substrates will better inform our understanding of the nature of the association between cannabis use and psychosis. The theoretical and clinical significance of further research in this field is in enhancing our understanding of underlying pathophysiology and improving the provision of treatments for substance use and mental illness.     

Apomorphine and the dopamine hypothesis of schizophrenia: a dilemma?

The dopamine (DA) hypothesis of schizophrenia implicates an enhancement of DA function in the pathophysiology of the disorder, at least in the genesis of positive symptoms. Accordingly, apomorphine, a directly acting DA receptor agonist, should display psychotomimetic properties. A review of the literature shows little or no evidence that apomorphine, in doses that stimulate postsynaptic DA receptors, induces psychosis in non-schizophrenic subjects or a relapse or exacerbation of psychotic symptoms in patients with schizophrenia. After a detailed review of the literature reporting psychotogenic effects of apomorphine in patients with Parkinson's disease, an interpretation of these data is difficult, in part because of several confounding factors, such as the concomitant use of drugs known to induce psychosis and the advanced state of the progressive neurological disorder. In the context of the DA hypothesis of schizophrenia, the limited ability of apomorphine to induce psychosis, in contrast to indirectly acting DA agonists that increase synaptic DA, may be explained by the relatively weak affinity of apomorphine for the D3 receptor compared with DA. Alternatively, enhancement of DA function, though necessary, may be insufficient by itself to induce psychosis.     

Comorbidity and pathophysiology of obsessive–compulsive disorder in schizophrenia: Is there evidence for a schizo-obsessive subtype of schizophrenia?

Epidemiologic and neurobiologic evidence suggests that patients with comorbid obsessive-compulsive disorder (OCD) and schizophrenia may represent a special category among patients with schizophrenia. Efforts to examine the neurobiology of this group have focused on neuroimaging studies and neuropsychologic testing. Convergent evidence suggests that there may be a specific pattern of neurobiologic dysfunction in this subgroup of patients accounting for symptom co-expression. This review indicates that future studies should distinguish among (1) apparent obsessive-compulsive symptoms (OCS) that occur only in the context of psychosis and that may overlap with psychotic phenomenology, representing a forme fruste of psychosis; (2) OCS occurring only in the prodromal phase of schizophrenia; (3) neuroleptic-induced OCS or OCD; and (4) OCS or frank OCD occurring concurrently with schizophrenia. We examine the evidence for a putative schizo-obsessive disorder and outline suggestions for identifying OCS in the presence of psychosis.     

Meta-analysis and the science of schizophrenia: variant evidence or evidence of variants?

Quantification (meta-analysis) of the neuroscience evidence on schizophrenia shows very modest average differences between patient and control distributions across a great variety of measures and literatures. The strongest findings involve cognitive and psychophysiological measures. Several possible explanations for this situation are reviewed including technical immaturity, methodological variability, dimensional and multiple illness models and the nature of cognitive measurement. An argument is developed that biological subtypes and endophenotypes within the broad diagnostic category of schizophrenia underpin the meta-analytic evidence. Considerations in the use of this evidence to identify illness variants are described and four candidate subtypes are proposed. Schizophrenia is a disease that will resist biological definition until its variants are isolated and extracted from the generic patient population.     

Quality of life in patients with schizophrenia—comparison of self-report and proxy assessments

Abstract.Background: While Quality Of Life (QOL) in subjects suffering from schizophrenia has been studied using a variety of generic or specific instruments, only very few studies have analyzed the agreement between patients and proxy ratings on patients QOL.Methods: We administered the World Health Organization Quality of Life assessment instrument (WHOQOL-100) to 292 patients and the Quality of Life for Proxies (QOL-P) to their proxies, respectively; the QOL-P is a 30-item instrument derived from the WHOQOL-100 and adapted for administration to a key informant.Results: Agreement between patients and proxies on the four main QOL areas was highest for the physical area (intraclass correlation coefficient, ICC = 0.41) and lowest for the psychological area (ICC = 0.29). In line with the results of other studies comparing patients and proxies ratings, proxies generally underestimated patients physical and psychological QOL. Moreover, the agreement between patients and proxies ratings was consistently higher across all QOL areas when the proxy was a relative compared to a non-relative proxy.Conclusions: The agreement between patients and proxies in QOL assessment is modest, but it is relatively higher when observable aspects of QOL are rated and when the proxy who makes the evaluation is a family member who has closer contacts with the patient. In order to obtain a comprehensive picture of patients QOL, it would be advisable to compare patients ratings with the assessments made by close informants.     

Is late‐onset schizophrenia a subtype of schizophrenia?

Vahia IV, Palmer BW, Depp C, Fellows I, Golshan S, Kraemer HC, Jeste DV. Is late‐onset schizophrenia a subtype of schizophrenia? Objective: To determine whether late‐onset schizophrenia (LOS, onset after age 40) should be considered a distinct subtype of schizophrenia. Method: Participants included 359 normal comparison subjects (NCs) and 854 schizophrenia out‐patients age >40 (110 LOS, 744 early‐onset schizophrenia or EOS). Assessments included standardized measures of psychopathology, neurocognition, and functioning. Results: Early‐onset schizophrenia and LOS groups differed from NCs on all measures of psychopathology and functioning, and most cognitive tests. Early‐onset schizophrenia and LOS groups had similar education, severity of depressive, negative, and deficit symptoms, crystallized knowledge, and auditory working memory, but LOS patients included more women and married individuals, had less severe positive symptoms and general psychopathology, and better processing speed, abstraction, verbal memory, and everyday functioning, and were on lower antipsychotic doses. Most EOS–LOS differences remained significant after adjusting for age, gender, severity of negative or deficit symptoms, and duration of illness. Conclusion: Late‐onset schizophrenia should be considered a subtype of schizophrenia.     

Lack of association between schizophrenia and the apolipoprotein E ε4 allele

The association between the 4 allele of the apolipoprotein E (APOE) gene and Alzheimer's disease (AD) has been reported. In order to examine if the 4 allele may play a role also in schizophrenia, another mental disorder, patients (n=87) and control subjects (n=57) were genotyped for APOE. No significant difference was found between the groups. The data indicate that the APOE gene is not of major importance for the genesis of schizophrenia.     

Early recognition and early treatment of schizophrenia: chance or dilemma?

The early recognition and treatment of schizophrenia in children and adolescents is one of the most important therapeutic goals because of the postulated relation between delayed initiation of treatment and an unfavourable developmental course. The duration of untreated psychosis (DUP) seems to be significantly prolonged in adolescents compared to adults due to both a protracted development of psychotic features and the failure of families and health workers to take seriously the initial signs of psychosis. The idea of primary prevention is criticized since the unspecificity of prodromal signs precludes any specific intervention to prevent schizophrenia. The tree hit model of pathogenesis is outlined and strategies of risk evaluation in early psychotic phases on the basis of the biopsychosocial model are promoted.     

A comparative study of caregivers’ perceptions of health-care needs and burden of patients with bipolar affective disorder and schizophrenia

Abstract

Background: Although many studies in schizophrenia have evaluated health-care needs, there is a lack of data on the needs of patients with bipolar affective disorder (BPAD), with only occasional studies evaluating them, and no study has evaluated the relationship of health-care needs of patients with caregiver's burden. Aim: To study the relationship of caregiver's burden and needs of patients as perceived by caregivers of patients with BPAD and schizophrenia. Method: Caregivers of patients with BPAD and schizophrenia were assessed using the Camberwell Assessment of Needs – Research version (CAN-R) and Supplementary Needs Assessment Scale (SNAS), the Family Burden Interview schedule (FBI) and the Involvement Evaluation Questionnaire (IEQ). Results: Mean total needs of patients on CAN-R were 7.54 (SD 3.59) and 7.58 (SD 4.24) for BPAD and schizophrenia respectively. Mean total needs for SNAS were 7.24 (SD 3.67) and 7.68 (SD 5.02) for BPAD and schizophrenia groups, respectively. Total objective and subjective burden as assessed on FBI was significantly more for the schizophrenia group. Caregivers of patients with BPAD perceived significantly less disruption of routine family activities and lower impact on the mental health of others. On IEQ, the mean score on the domain of supervision was significantly higher for the BPAD group. In the schizophrenia group, positive correlations were seen between the total number of unmet and total (met and unmet) needs and certain aspects of burden, but no such correlations emerged in the BPAD group. Conclusion: There is no correlation between number of needs and burden in the BPAD group; however, in the schizophrenia group the number of needs correlated with the perceived burden. Accordingly, orienting services to address needs of patients with schizophrenia can lead to reduction in burden among caregivers.     

The prevention of schizophrenia: what interventions are safe and effective?

Obstetric complications appear to increase the risk of developing schizophrenia, and post-World War II improvements in obstetric care may have contributed to a decline in the incidence of the illness in the developed world. Educating providers and consumers of psychiatric and obstetric services about the risk of obstetric complications in increasing the risk of schizophrenia could bring about a further small decrease in the incidence of the illness, safely and at low cost. On the other hand, attempts to prevent the occurrence of schizophrenia by treating people who manifest high-risk indicators prior to the development of the illness have a low probability of success and a high probability of unintended negative consequences. Early intervention with people who have developed the full schizophrenia syndrome is likely to have few negative effects and may yield benefits, although it is not yet clear that it will.     

Religion: a mediator of Anglo-American and Mexican attributional differences toward symptoms of schizophrenia?

This study examined the relationship of religiosity to attributions toward schizophrenia, within a cultural context. Previous research suggests that on self-report measures, Mexicans endorse holding greater moral-religious values than do their Anglo-American counterparts. Research also indicates that Mexicans, relative to Anglo-Americans, tend to hold fewer blameworthy attributions and are less likely to view patients with schizophrenia as responsible for the symptoms of the disorder. In an analog study of 88 Mexican and 88 Anglo-American college students asked to imagine that they have a brother with schizophrenia, this study assessed two competing hypotheses regarding the role of religion in shaping reactions to schizophrenia in a family member. For hypothesis 1, Baron and Kenny's mediational model (1986) was used to assess whether moral religious values may play a direct mediating role between ethnicity and controllability attributions for schizophrenia. In other words, based on observations of previous researchers, this set of analyses assessed whether ethnic differences in controllability attributions might be explained by a religious or spiritual tendency in Mexicans to view negative events, such as mental disability, as rooted in divine factors beyond the patient's personal control. In contrast, a second, competing, hypothesis was also assessed in this study: namely, that greater religiosity would be positively correlated with increasing perceptions of control over the symptoms of schizophrenia. This hypothesis stems from the premise of several investigators that religious individuals may be more likely to perceive another's adversity (such as having schizophrenia) as a punishment for prior wrongdoings or for failure to try to help oneself. Results indicate support for the latter hypothesis. Implications of the paradoxical finding, that Mexicans were both more religious and more external in their attributions, are discussed.     

Insight in schizophrenia–course and predictors during the acute treatment phase of patients suffering from a schizophrenia spectrum disorder

BackgroundTo analyse insight of illness during the course of inpatient treatment, and to identify influencing factors and predictors of insight.MethodsInsight into illness was examined in 399 patients using the item G12 of the Positive and Negative Syndrome Scale (“lack of insight and judgement”). Ratings of the PANSS, HAMD, UKU, GAF, SOFAS, SWN-K and Kemp's compliance scale were performed and examined regarding their potential association with insight. The item G12 was kept as an ordinal variable to compare insight between subgroups of patients.ResultsAlmost 70% of patients had deficits in their insight into illness at admission. A significant improvement of impairments of insight during the treatment (p < 0.0001) was observed. At admission more severe positive and negative symptoms, worse functioning and worse adherence were significantly associated with poorer insight. Less depressive symptoms (p = 0.0004), less suicidality (p = 0.0218), suffering from multiple illness-episodes (p < 0.0001) and worse adherence (p = 0.0012) at admission were identified to be significant predictors of poor insight at discharge.ConclusionThe revealed predictors might function as treatment targets in order to improve insight and with it outcome of schizophrenia.     

Transmission of NOTCH4 and GRIK2 in a population of Han Chinese with schizophrenia and affective disorder*★

BACKGROUND： Increasing evidence suggests overlapped genetic susceptibility across traditional classification systems that divided psychotic disorders into schizophrenia or affective disorder. OBJECTIVE： This study aimed to explore whether schizophrenia and affective disorder share genetic susceptibility in NOTCH4 and GRIK2 loci in a population of Han Chinese. DESIGN： Repetitive measurements. SETTING： The experiment was carried out at Shanghai Mental Health Center and Hongkou Mental Health Center of Shanghai between January 2001 and June 2004. PARTICIPANTS： Sixty-five mixed pedigrees （suffering from various diseases, in combination with schizophrenia and affective disorder）, composed of 45 completed trios and 20 single-parent families, were selected from Shanghai Mental Health Center and Hongkou Mental Health Center of Shanghai between January 2001 and June 2004. Probands received clinical diagnosis according to ICD-10; an independent clinician used identical criteria to review all diagnoses. All subjects were Han Chinese in origin and provided informed consent. There were 65 probands and 110 parents among the subjects. The probands comprised 30 males and 35 females： 33 with schizophrenia, 32 with affective disorder, mean age of （30.9 ± 9.8） years, mean age of onset （24.3 ± 8.8） years, mean duration （6.6 ± 7.0） years, and mean age of parents （58.8 ±10.9） years. METHODS： DNA samples from probands and their biological parents were extracted from peripheral blood according to standard methods. Four polymorphisms, -1725T/G and -25T/C in NOTCH4, rs6922753T/C and rs2227283G/A in GRIK2, were amplified and genotyped with PCR-RFLP techniques. MAIN OUTCOME MEASURES： Association between NOTCH4, GRIK2 polymorphism, and schizophrenia was analyzed by transmission disequilibrium test （TDT）. RESULTS： Sixty-five probands and 110 parents were included in the result analysis, with no dropouts. The results showed that the -25T/C polymorphism of NOTCH4 associated significantly with affecti     

Narcolepsy–cataplexy and schizophrenia in adolescents

BackgroundDespite advances in the understanding of narcolepsy, little information the on association between narcolepsy and psychosis is available, except for amphetamine-related psychotic reactions. Our case-control study aimed to compare clinical differences and analyze risk factors in children who developed narcolepsy with cataplexy (N–C), schizophrenia, and N–C followed by schizophrenia.MethodsThree age- and gender-matched groups of children with N–C schizophrenia (study group), N–C (control group 1), and schizophrenia only (control group 2) were investigated. Subjects filled out sleep questionnaires, sleep diaries, and quality of life scales, followed by polysomnography (PSG), multiple sleep latency tests (MSLT), routine blood tests, HLA typing, genetic analysis of genes of interest, and psychiatric evaluation. The risk factors for schizophrenia also were analyzed.ResultsThe study group was significantly overweight when measuring body mass index (BMI) (P = .016), at narcolepsy onset compared to control group 1, and the study group developed schizophrenia after a mean of 2.55 ± 1.8 years. Compared to control group 2, psychotic symptoms were significantly more severe in the study group, with a higher frequency of depressive symptoms and acute ward hospitalization in 8 out of 10 of the subjects. They also had poorer long-term response to treatment, despite multiple treatment trials targeting their florid psychotic symptoms. All subjects with narcolepsy were HLA DQ B1¹0602 positive. The study group had a significantly higher frequency of DQ B1¹-03:01/06:02 (70%) than the two other groups, without any significant difference in HLA-DR typing, tumor necrosis factor α (TNF-α) levels, hypocretin (orexin) receptor 1 gene, HCRTR1, and the hypocretin (orexin) receptor 2 gene, HCRTR2, or blood infectious titers.ConclusionBMI and weight at onset of narcolepsy as well as a higher frequency of DQ B1¹-03:01/06:02 antigens were the only significant differences in the N–C children with secondary schizophrenia; such an association is a therapeutic challenge with long-term persistence of severe psychotic symptoms.     

Metaphoric and non-metaphoric use of the term “schizophrenia” in Italian newspapers

Purpose  

This study examines how the term “schizophrenia” is used in Italian newspapers.     

Political change and course of schizophrenia in East Germany, 1984–1994

  Background: We tested the hypothesis that the political change occurring in East Germany after the fall of the Berlin Wall in November 1989 affected patients with long-term schizophrenia, resulting in more and longer hospitalisations. Methods: In two samples in East Germany (120 patients in East Berlin, 70 patients in Chemnitz) and in a control group from West Berlin (40 patients), hospitalisations for each month between November 1984 and October 1994 were assessed. Each sample included all schizophrenia patients who were in continuous treatment in the given community mental health centre throughout the full observation period. Results: Hospitalisation indices were not higher after November 1989 than before in any of the groups. Conclusions: There is no evidence that political change in East Germany negatively affected the course of long-term schizophrenia as assessed by hospitalisations. If consistent medical care is provided, characteristics of the political system may have less impact on the course of schizophrenia than is sometimes assumed. Accepted: 28 February 1999