Prevalence and background factors of depression in first admitted schizophrenic patients

OBJECTIVE: The aim of this study was to investigate the prevalence and background factors of depression in first admitted schizophrenic patients. METHOD: The study is an analysis of 998 consecutively admitted schizophrenic patients with their first hospitalization. Patient's characteristics were prospectively assessed using standardized instruments at the time of first admission and discharge. RESULTS: High prevalence rates of depressive symptoms were found. Depressed schizophrenic patients were more likely to have suicidal tendencies, were older, more frequently married, less frequently single and unemployed and had more family members with psychiatric disorders other than schizophrenia than the non-depressed patients. Positive, negative and extrapyramidal symptoms do not have a substantial influence on depression in these patients. CONCLUSION: The study suggests that depression represents a distinct psychopathological dimension of the acute illness in first admitted schizophrenic patients. In particular, in light of the suicidal tendencies, recognition and treatment of depression is an important clinical task.     

Homocysteine levels in newly admitted schizophrenic patients

We previously found a marked elevation of plasma homocysteine in young male schizophrenic patients in hospital. It seemed important to determine if this finding is already present in newly admitted schizophrenic patients. Serum homocysteine levels were studied in 184 consecutively admitted schizophrenic patients and 305 control subjects from an employee screening program. Homocysteine levels were markedly increased in this population of newly admitted schizophrenic patients, especially in young males. Newly admitted male schizophrenic patients have elevated homocysteine levels that cannot be explained on the basis of poor hospital nutrition. Smoking may raise homocysteine by 1-2 microM/L but this is not a large enough effect to explain our findings.     

The use of the Expressed Emotion Index as a predictor of outcome in first admitted schizophrenic patients in a French speaking area of Switzerland

A 5 year prospective study of 44 first admission schizophrenic patients was conducted in Geneva, in order to evaluate the prognostic value of Expressed Emotion (EE). The predictive power of the EE index was tested on 3 variables of outcome: relapse rates, social adaptation and hospital stays. The EE index and the outcome measures tended to be associated. After the third year, patients living with high EE relatives were significantly more maladjusted and relapsed more than those living with low EE relatives. At intake, the patients presenting more premorbid features lived in high EE households. Our results show that initial measure of EE in a first episode cohort is predictive of outcome over a five-year period. This may not be causal, as it cannot be excluded that poorer premorbid functioning alone may result in poorer outcome, and may also elicit high EE in the relative.     

The use of a psychiatric register in predicting the outcome "revolving door patient". A nation-wide cohort of first time admitted psychiatric patients

A nation-wide cohort of all first admitted patients to all Danish psychiatric institutions over a 1 year period and aged 15 years or more was followed for 10 years in the Danish psychiatric register. Revolving door patients were defined as patients with a minimum of four admissions and 1) no admission or discharge period lasting for more than 1/4 of the observation period or 2) at least four admissions over the first 1/4 of the observation period. The revolving door population comprised 1,397 patients with an incidence rate of 0.42 males and 0.32 females per 1,000. Forty-three point five percent belonged to the same diagnostic group at first and last diagnostic assessment ranging from 28.3% in "organic psychosis" to 57.6% in "neurosis". A multiple contingency analysis showed a number of variables at first admission significantly associated with the outcome "revolving door". Many were conditioned by others and the independent variables were "age group", "main diagnosis" and "sex". Patients aged 15-24 years constituted a high risk group among schizophrenics. The 15-24 age group was further at high risk among females with personality disorder or abuse and males with manic depressive and psychogenic psychosis. Living close to a psychiatric institution was in males associated with the outcome independently of age and diagnosis, in females it was restricted to personality disorder. Revolving door patients were significantly younger than others and more likely to suffer from schizophrenia or alcohol/substance abuse.     

A controlled dose comparison of haloperidol in newly admitted schizophrenic patients

Eighty newly admitted or readmitted men with DSM-III schizophrenia were assigned to receive 5, 10, or 20 mg/d of haloperidol for 4 weeks. Staff were not "blind" to dose. By Clinical Global Impression Scale ratings, the 20-mg dose appeared to be superior to both the 5- and 10-mg doses for the first 2 weeks of treatment but not thereafter. On the Brief Psychiatric Rating Scale Schizophrenia factor, the 20-mg dose was superior to the 5-mg dose throughout the trial and tended to be marginally superior to the 10-mg dose after the first 2 weeks of treatment. By the second week of treatment, however, the group receiving the 20-mg dose deteriorated significantly with regard to Brief Psychiatric Rating Scale ratings of Withdrawal-Retardation (blunted affect, motor retardation, and emotional withdrawal) as well as akinesia and akathisia ratings. Furthermore, 35% of patients given 20 mg/d of haloperidol insisted on leaving the hospital against medical advice vs only 4% of those given 5 or 10 mg/d of haloperidol. A 20-mg/d dose of haloperidol, therefore, may have substantial "psychotoxic" effects by the second week of treatment.     

Impact of duration of symptoms prior to first hospitalization on acute outcome in 998 schizophrenic patients

The hypothesis that a longer duration of symptoms prior to first hospitalization is associated with a poorer treatment response was prospectively investigated in 998 first-hospitalized schizophrenic patients. Results indicate that most indicators of outcome were worse when the duration of symptoms was long. This was also true when age, gender, as well as the acuteness of illness were controlled for in the analyses.     

首发精神分裂症病人的抑郁症状

目的探讨首发精神分裂症病人抑郁症状的发生率、特征及相关因素。方法于入院、治疗3、6、9、12月时用汉密尔顿抑郁量表(HAMD)、简明精神病评定量表(BPRS)、阴性症状量表中文版(SANS-CV)、临床总体印象量表(CGI)及功能总体评定量表(GAF)对164例首发精神分裂症患者进行评定。结果急性期首发精神分裂症病人轻度或以上程度抑郁症状的发生率为71%,但在缓解期降至12%。急性期突出的抑郁表现为认知障碍与迟缓(因子分各占HAMD总分的35%和29%)。抑郁症状随着精神病性症状的缓解而减轻,与性别、发病年龄、受教育时间、病程及前驱期长短无关。HAMD总分在急性期仅与BPRS的焦虑抑郁因子分有关,但在缓解期与阴阳性症状、临床总体印象以及总体功能均有密切的相关性;急性期以及治疗3个月时的抑郁症状与随后的阴阳性症状、总体功能的变化无关。结论首发精神分裂症急性期的抑郁症状可能是一个独立的症状群,抑郁程度不能作为预测首发精神分裂症病人预后的指标。     

Re-hospitalization of first-in-life admitted schizophrenic patients before and after rehabilitation legislation

BACKGROUND: In line with the worldwide trend of deinstitutionalization and development of community facilities, a rehabilitation legislation was passed in Israel in 2000. Its aim was to establish an infrastructure for the chronic mentally ill. The objective of the present study was to evaluate the impact of this legislation on the re-hospitalization of schizophrenic patients. METHOD: Re-hospitalization rates within 3 years of discharge were compared for two cohorts of first-in-life hospitalized schizophrenics, those discharged in 1990-1991 and those discharged in 2000-2001, after the passing of the law. Possible confounding variables were controlled for by logistic regression analyses. The same analysis was done for patients with affective disorders who are not generally beneficiaries of this legislation. RESULTS: In 2000-2001, the re-hospitalization rate was significantly lower than in 1990-1991 for schizophrenic patients with an in-patient stay longer than 6 months (chronic patients) but not for short-stay schizophrenics or for affective patients. CONCLUSION: The study suggests that the expanding of the rehabilitation facilities in the community by legislation leads to increase in the survival in the community of schizophrenic patients.     

Multivariate prediction of relatives' stress outcome one year after first hospitalization of schizophrenic and depressed patients

Objective The present study presents the 1–year follow–up findings of the Munich 5–year follow–up study on relatives of first hospitalized patients with schizophrenia or depression. The aim of the study was to determine which factors moderate the impact of the patient's illness on the stress experienced by his key relative in different dimensions. Method Of the relatives who had participated in the baseline assessment, 90% could be reassessed (n = 69) with respect to their objective and subjective burden, well–being, self–rated symptoms and subjective quality of life as well as different personal dispositions and resources. Results Data demonstrate a considerable level of burden in most of the relatives at 1–year follow–up. Compared to baseline, a significant reduction in objective and subjective burden as well as significant improvements in well–being, self–rated symptoms and subjective quality of life occured in two–thirds of the relatives, while well–being and self–rated symptoms remained worse when compared to norm values. Although stress reduction was significantly associated with patients' residual symptoms on the bivariate level, no main effects on relatives' stress outcome at 1–year follow–up could be observed under multivariate conditions. In multivariate linear regression models for each stress indicator, different combinations of predictors resulted, explaining up to 75% of the total variance of the stress indicators. The most relevant predictors were relatives'expressed emotion and neuroticism, their generalized negative stress response and life stressors, having significant direct and indirect effects on relatives' stress outcome. Stress reduction was mainly caused by an interaction of relatives' generalized positive stress response and patients' residual symptoms. Conclusion Findings support the transactional character of the stress process in caring for a patient with a severe mental disease. A multidimensional approach is necessary to identify the most important predictors of burden in order to improve family intervention strategies which aim to reduce burden.     

Adverse outcome of hip fractures in older schizophrenic patients

The psychiatric and ambulatory course of 21 older chronic schizophrenic patients who sustained hip fractures was studied prospectively, and their walking ability after the fractures was compared to that of 25 nonpsychiatric hip fracture patients. Although the schizophrenic patients were younger when the hip fractures occurred, their recuperation and ambulatory outcome were significantly worse. The psychiatric course was assessed with a standardized rating scale that was administered 6 months and 1 year after the fractures and compared to similar ratings done before the fractures. Significant mental deterioration was found at 6 months after the fractures, with no further changes later.     

Insight and the clinical outcome of schizophrenic patients

At the time of discharge from their index hospitalizations, 52 schizophrenic patients initially admitted for acute psychotic episodes were assessed on an Insight and Treatment Attitudes Questionnaire. When these patients were followed up 2 1/2 to 3 1/2 years later, adequate information on their clinical courses and outcomes was available in 46 cases. A global assessment of aftercare environment was made in each case, reflecting the degree to which individuals other than the patient were helpfully invested in maintaining the patient in treatment, whether these individuals were in the patient's living or treatment situations. Five factual outcome variables were also assessed: a) compliance with treatment 30 days after discharge; b) long-term compliance; c) whether or not patients were readmitted; d) readmissions per year; and e) percent of time spent in the hospital. As expected, aftercare environment was significantly related to outcome (p = .039). The overall relationship between insight and the outcome variables closely approached statistical significance (p = .053). Patients with more insight were significantly less likely to be readmitted over the course of follow-up. There was a trend for patients with more insight to be compliant with treatment 30 days after discharge. No significant interaction between aftercare environment and insight was found, suggesting that insight may influence outcome independently of aftercare environment.     

Lateral ventricular size and social network differentiation in young, nonchronic schizophrenic patients

The authors correlated lateral cerebral ventricular size with social network differentiation and social outcome in 15 young, nonchronic patients with schizophrenia and schizophreniform disorder. Patients with fewer social contexts, fewer types of relationships, and less independent residence had larger ventricles.     

Neuromorphological abnormalities in schizophrenic patients with good and poor outcome

OBJECTIVE: The present study was designed specifically to assess the relationship between brain morphology and outcome in schizophrenia. METHOD: Fifty-six schizophrenic patients and a matched group of 32 healthy subjects were studied with magnetic resonance (MR) imaging scans. Clinical assessment included the Krawiecka-Manchester Scale (K-MS) and the Outcome scale by Strauss and Carpenter. RESULTS: Along several neuromorphological measures the patients differed from controls only for right and left ventricular volumes. The 'poor outcome' patients had a left and right ventricular enlargement when compared to the 'good outcome' patients and healthy controls. A regression analysis showed that right ventricle volume, left temporal lobe volume and left hippocampal volume entered into the regression equation, accounting for a 27% of the outcome measure. CONCLUSION: The outcome does not seem to be predicted by one particular morphological site but involves different brain regions; however, the ventricular enlargement identifies a subgroup of patients with poor outcome.     

精神分裂症及其一级亲属性格特征的对比分析

本研究对缓解期精神分裂症患者６８例及其一级亲属和正常人各１１２人进行ＭＭＰＩ测查。结果提示：精神分裂症患者及其一级亲属Ｈｓ、Ｄ、Ｈｙ、Ｐｄ、Ｐａ、Ｐｔ、Ｓｃ等量表分高于正常人，其中Ｐｄ、Ｐａ、Ｓｃ增幅最大；而患者和一级亲属之间各量表分比较接近。精神分裂症患者和一级亲属具有明显的分裂性人格，两者的性格特征可能有着共同的遗传学基础。