Individual and common coping in families with parents suffering from schizophrenia

Using a triangulation design the individual and family coping strategies in families with parents suffering from schizophrenia are ascertained and contrasted utilising qualitative and quantitative data. For children (n = 25) three coping strategies are identified: "Aggressive coping", "controlling coping", and "moderate coping" i. e. inconspicuous coping. Parents seem to model coping for their children. Qualitative analysis of data for 35 families revealed five patterns of shared familial coping-processes. A clear picture emerges showing that the children's contribution to family functioning consists essentially of taking on responsibility and family tasks. The results emphasize the need for family-oriented interventions.     

Old patients suffering from long-standing schizophrenia: clinical aspects

Although some patients suffering from schizophrenia experience an age-related amelioration, a great number of people who are entering old age suffer from long-standing schizophrenia. These patients show specific psychiatric and somatic problems that must be taken into account. Firstly, some display high levels of all schizophrenic symptoms, while others experience changes in the symptom profile with aging, i.e. a reduction in positive symptoms and an increase in negative ones. Secondly, the occurrence of significant depressive symptoms among elderly patients with schizophrenia is well recognized. Thirdly, in recent years, studies have begun to shed more light on the trajectories of cognitive impairment of these patients in old age. Lastly, aged persons with schizophrenia often have side effects due to long-term antipsychotic medications and medical co-morbidity, more untreated somatic disorders (diabetes, cardiovascular diseases) and higher mortality rates. These may be the result of both lifestyle factors and lack of adequate medical care. Levels of adaptive functioning and quality of life are closely associated with clinical and social factors. Thus, we must consider all these different aspects in order to effectively manage the therapeutic and service needs of these patients.     

Electroconvulsive therapy for the treatment of clozapine nonresponders suffering from schizophrenia

Objective This open label study describes the efficacy of electroconvulsive therapy (ECT) as adjunctive treatment in clozapine nonresponders suffering from schizophrenia. Method The results of clozapine and ECT treatment in 11 clozapine nonresponders suffering from schizophrenia are reported in terms of remission and relapse. Results Eight patients had a remission with this combination treatment. After remission of symptoms five patients had a relapse. Three of the five patients who relapsed had a second successful ECT course and remained well with maintenance ECT and clozapine. No evidence for adverse effects was found. Conclusion Adjunctive ECT can be efficacious in clozapine nonresponders suffering from schizophrenia.     

外周血异型淋巴细胞与精神分裂症

目的研究中国的精神分裂症病人外周血异型淋巴细胞的比例、相互间的关系以及与药物治疗的关系.方法收集92例样本,分3组精神分裂症组52例,年龄(41.1±9.66)岁,该组又分为治疗和非治疗组;其他精神病组(非精神分裂症)26例,年龄(49.0±12.84)岁,正常对照组14例,年龄(29.9±3.21)岁.应用May Guunwal-Giemsa染色法,研究外周血细胞的形态学,计数异型淋巴细胞的百分比,进行统计学处理.结果P细胞在精神分裂症组比其他精神病组和健康对照组明显增高(P＜0.01),而应激淋巴细胞在精神分裂症组比其他精神病组和健康对照组明显减低(P＜0.05);性别之间无差异.抗精神病药物治疗组P细胞比未治疗组显著降低(P＜0.05);抗精神病药物对应激淋巴细胞的比例没有影响.Spearman相关分析发现,精神分裂症中P细胞和应激淋巴细胞间存在明显的负相关(r=-0.649)(P＜0.01).结论精神分裂症病人外周血中始终存在高比例的P细胞及低比例的应激淋巴细胞,P细胞并非由抗精神病药物引起.P细胞有可能作为一个生物学的标记,有助于精神分裂症病因的研究.     

Art therapy with patients suffering from anorexia nervosa

Current literature on anorexic patients includes very little about their drawings. This article investigates the visual correlates of drawings done by anorexic patients with key psychodynamic variables of self-image, self-esteem, and control. Implications for treatment are discussed.     

No gender differences in social outcome in patients suffering from schizophrenia

Differences between female and male patients with schizophrenia in psychopathology and course of illness have frequently been reported. However, the influence of sex on symptomatic and social remission is still an open issue. In the present study, differences between males and females in both clinical and social remission rates and in scores on several scales assessing social functioning were evaluated in 295 stabilized patients with schizophrenia, schizoaffective or delusional disorder. Female patients, as compared with males, showed a later onset of the illness, less negative symptoms and less frequent alcohol abuse. No significant difference was found between females and males in the rate of symptomatic and functional remission. No significant effect of sex was observed on any index of social functioning.     

Dietary fatty acid and antioxidant intake in community-dwelling patients suffering from schizophrenia

INTRODUCTION: Brain phospholipids are uniquely rich in polyunsaturated fatty acids (PUFAs). Most PUFAs such as alpha-linolenic acid 18:3(n-3), eicosapentaenoic acid 20:5(n-3), and docosahexaenoic acid 22:6(n-3) are essential and must be provided through the diet. PUFAs are also very sensitive to oxidative stress. Decreased essential fatty acid content has been observed in cell membranes of various tissue types of schizophrenia patients, including neural cell membranes. A number of mechanisms may account for these deficits, such as inadequate dietary supply or increased oxidation. It is known that patients with schizophrenia make poor dietary choices. However, whether their dietary fatty acid or antioxidant intake is insufficient and contributes to the observed deficiencies has not been assessed. METHODS: After obtaining informed consent, a 24-h diet recall was administered to elicit nutritional information in 146 outpatients with schizophrenia. Intake of fatty acids and antioxidants including vitamins A, C, and E was compared to U.S. population standards according to the National Health and Nutrition Examination Survey Cycle III (NHANES III) results. RESULTS: Saturated and polyunsaturated fatty acid (PUFA) intake was significantly higher in schizophrenia patients than in controls (p相似文献   

Acute psychosis leads to increased QT variability in patients suffering from schizophrenia

Patients with schizophrenia have been reported to experience sudden cardiac death 3 times more likely than individuals from the general population. One important factor related to an increased risk of cardiac arrhythmias and sudden death is the prolongation of the QTc interval. This study examined whether acute psychosis might influence the beat-to-beat variability of the QT interval, which reflects effectively cardiac repolarization lability. High resolution electrocardiographic recordings were performed in 25 unmedicated patients suffering from acute schizophrenia and matched controls. From these, parameters of beat-to-beat heart rate and QT variability measures such as approximate entropy and QT variability index (QTvi) were calculated. Measures were correlated with the scale for the assessment of positive symptoms (SAPS) and negative symptoms (SANS). QTvi was significantly higher in patients with schizophrenia compared to controls. While QTvi correlated with the degree of delusions and hallucinations, no correlation with electrolyte concentrations was found. Approximate entropy of heart rate was decreased indicating reduced complexity and decreased vagal tone. In conclusion, increased QT variability in patients with schizophrenia indicates abnormal cardiac repolarization lability, which can result in serious cardiac arrhythmias. The correlation of positive symptoms with QT variability might indicate high sympathetic cardiac activity in these patients, which might be associated with increased cardiovascular mortality.     

Response and remission of subjective well-being in patients suffering from schizophrenia spectrum disorders

Background

Purpose of this study was to assess subjective well-being in schizophrenia inpatients and to find variables predictive for response and remission of subjective well-being.

Method

The subjective well-being under neuroleptic treatment scale (SWN-K) was used in 232 schizophrenia patients within a naturalistic multicenter trial. Early response was defined as a SWN-K total score improvement of 20% and by at least 10 points within the first 2 treatment weeks, response as an improvement in SWN-K total score of at least 20% and by at least 10 points from admission to discharge and remission in subjective well-being as a total score of more or equal to 80 points at discharge. Logistic regression and CART analyses were used to determine valid predictors of subjective well-being outcome.

Results

Twenty-nine percent of the patients were detected to be SWN-K early responders, 40% fulfilled criteria for response in subjective well-being and 66% fulfilled criteria for remission concerning subjective well-being. Among the investigated predictors, SWN-K early improvement and the educational status were significantly associated with SWN-K response. The SWN-K total score at baseline showed a significant negative predictive value for response. Baseline SWN-K total score, PANSS global subscore, and side effects as well as the educational status were found to be significantly predictive for remission.

Conclusions

Depressive symptoms should be radically treated and side effects closely monitored to improve the patient's subjective well-being. The important influence of subjective well-being on overall treatment outcome could be underlined.     

Linear and non-linear measures indicate gastric dysmotility in patients suffering from acute schizophrenia

Cardiac autonomic dysfunction has been reported in patients suffering from schizophrenia. The aim of the present study was to evaluate gastric electrical activity in unmedicated patients suffering from acute schizophrenia in relation to their symptoms.Electrogastrography was performed before and after test meal ingestion in 26 patients suffering from schizophrenia and 26 matched controls. The non-linear measure approximate entropy (ApEn) was calculated for the first time from the obtained signal in addition to standardized measures. Results were correlated with the scales for the assessment of positive symptoms and negative symptoms. In addition, autonomic and abdominal symptoms were assessed by the autonomic symptom score.We found a significantly increased amount of tachygastria and arrhythmia within the signal of the activity of the gastric pacemaker before and after test meal digestion in patients compared to controls, indicating increased sympathetic modulation within the enteric nervous system. A significant difference was observed for slow wave, which represents the dominant frequency of gastric pacemaker activity, indicating gastric dysmotility in our patients. The elevated ApEn measure points to increased complexity and dysregulation. In addition, we have observed a correlation between delusions and tachygastria.Sympathetic function seems to be altered in the enteric nervous system of patients suffering from schizophrenia. Future studies need to explore the influence of the disease on different branches of the autonomic nervous system and clinical consequences of enteric dysfunction. Our findings point to a possible systemic autonomic imbalance that needs to be studied in respect to the neurobiology of schizophrenia.     

Financial burden on spouses of patients suffering from schizophrenia, depression or anxiety disorder

The aim of this study was to compare financial burden of spouses, whose relative suffers from schizophrenia, depression or anxiety disorder. 151 spouses filled in the questionnaire about illness related expenses and financial loss. Additionally they estimate their subjective burden according to these experienced costs. Direct cash expenditures on behalf of the patients' illness were reported by 66 % spouses. In the sampling the amount of spent money did not differ statistically, however spouses of patients with anxiety disorder emphasised experiencing financial strain and described more often subjective economic disadvantages. Although most spouses of patients with psychiatric disorders experience illness related financial disadvantages, these costs were usually not considered as serious problem or as burdensome. Based on a subjective hierarchy of burdens financial problems can be regarded as less important for spouses of patients with mental illness. Thus, not only the material, but also the immaterial costs of care giving spouses should be taken into consideration when planning health policy decisions.     

住院精神分裂症患者家属自测健康状况调查研究

目的探讨住院精神分裂症患者家属的自测健康状况,为改善患者的家庭支持系统提供依据。方法采用分层随机取样法,抽取2012年9月-12月在广东省河源市源城区精神卫生防治所住院的精神分裂症患者的家属(家属组)和一般人群(对照组)各100例,进行自测健康评定量表(SRHMS)调查,并采用简易应对方式量表(SCSQ)调查家属组的应对方式特点。结果家属组SRHMS的健康总体自测维度得分和社会健康子量表得分均低于对照组[(28.39±8.95)分vs.(32.51±3.65)分,(75.47±25.52)分vs.(88.66±11.94)分],差异有统计学意义(t=3.015、3.311,P0.01);家属组的积极应对方式和消极应对方式得分与常模比较差异有统计学意义(t=2.056、4.494,P0.05或0.01);家属组SRHMS各维度与积极因子正相关(r=0.728~0.299,P0.05或0.01);除维度1、5、8、9及社会健康子量表分、健康量表总分外,其余各维度与消极因子负相关(r=-0.416~-0.304,P0.05或0.01)。结论精神分裂症患者家属的健康水平偏低,可能与消极应对方式有关。     

Psychoeducation for patients with schizophrenia and their families

In this review, the current evidence for the efficacy of psychoeducation, a nonpharmacological treatment strategy in the treatment of patients with schizophrenia and their families, is assessed by summarizing meta-analyses/reviews and important single studies published after the recent meta-analyses. It was found that psychoeducation for patients with schizophrenia and their families can reduce the relapse rates of these patients; long-term family interventions (i.e., with durations of more than 3 months) are particularly helpful. However, there are still unsolved questions in this area. Therefore, future research needs are a further focus of this review; for example, on the questions of how to adapt programs for stable outpatients and their families, and the minimum effective dose of psychoeducation. Finally, new approaches in the area of psychoeducation, such as including quality-of-life issues, offering psychoeducation formats for combined diagnoses, family and patient peer-to-peer programs, and focusing on gender aspects are discussed.     

Cognitive deficits in the families of patients with schizophrenia

PURPOSE OF REVIEW: Studies of first-degree relatives of patients with schizophrenia over the past 25 years have reported a number of cognitive deficits, primarily in the domains of memory and executive function. Nevertheless, due to a number of methodological issues, such as including different types of relatives and not controlling for possible psychopathology, it is not yet clear that these findings can fully support a conclusion of heritability of cognitive dysfunction associated with a schizophrenia genotype. RECENT FINDINGS: Several recent meta-analyses have shown that the most consistent deficit shown by relatives is impaired performance on 'maintenance plus' frontal-lobe tasks requiring increased effort and higher central executive processing. Studies of multiplex families (multiple diagnoses in one family) also report that family members tend to have more difficulty on executive function tasks. Another interesting trend is research on subgroups of patients and relatives displaying distinct cognitive syndromes, particularly a subgroup with a generalized cognitive deficit. SUMMARY: As methodological designs improve, this field of study holds promise not only for understanding the neurobiological mechanisms of schizophrenia and the associated cognitive deficits, but also for possibly describing endophenotypes that may lead to identifying at-risk patients and relatives.     

The efficacy of Cavain in patients suffering from anxiety

The therapeutical efficacy of Cavain should be proved in the treatment of patients suffering from abnormal anxiety, psychosomatic complaints and psychoreactive disorder. Thus two randomized groups of patients (26 each) were treated in double-blind technique with either 2 x 200 mg daily Cavain or placebo for a period of 28 days. Prior to the beginning of the investigations and within 14 days intervals the Hamilton Anxiety Scale (HAMA) and the Adjective Check List (Janke and Debus) were applied. The global therapeutical improvement and compatibility were documented after 14 and 28 days. A significant superiority of Cavain in comparison to placebo could be found. Cavain acted anxiolytically and promotive on the subjective vitality-related performance. Therapeutical conclusions are discussed.