Confirmatory factor analysis in neurophysiological and neuropsychological dimensions of schizophrenia

This study applied confirmatory factor analysis (CFA) to examine the construct of smooth pursuit eye movements (SPEM) and the Wisconsin Card Sorting Test (WCST) in schizophrenia. Participants were assigned to two groups: Group 1 included 27 probands chosen from families with schizophrenia in first-degree relatives, and Group 2 included 54 schizophrenics who had no families with schizophrenia spectrum disorders. There were no differences in the eye tracking pursuit and the WCST between the sporadic and familial schizophrenics. Gender impacted the catch-up saccades (CUS) and anticipatory saccades (AS) indices of the SPEM, and the conceptual level responses (CLR) index of the WCST. Education impacted the CLR and perseverative errors of the WCST. Although there were no correlation between the SPEM and the WCST, but the two instruments showed good content validity, which might be useful in the subtyping of schizophrenia.     

氯氮平、利培酮及奥氮平对首发精神分裂症患者血清脂类的影响

目的探讨氯氮平、利培酮及奥氮平对首发精神分裂症患者血脂的影响。方法选择在我院治疗的首发精神分裂症患者90例,并分为3个月,每组各30例,分别单一用氯氮平、利培酮及奥氮平治疗。于治疗前、治疗第4周末和第8周末检测甘油三酯、胆固醇及脂蛋白。结果氯氮平、奥氮平组治疗第4周末、8周末甘油三酯值与治疗前有显著差异。氯氮平与奥氮平组治疗第8周末甘油三酯有显著差异。氯氮平组治疗第8周末低密度、高密度脂蛋白与治疗前有显著差异。奥氮平组治疗第8周末低密度脂蛋白与治疗前有显著差异。利培酮组治疗前后无显著差异。结论氯氮平对精神分裂症血脂影响最大,其次是奥氮平,最小是利培酮。对服用氯氮平和奥氮平的患者应定期监测血脂。     

奥氮平治疗精神分裂症疗效与血清同型半胱氨酸的关系

目的:探讨奥氮平治疗精神分裂症疗效与血清同型半胱胺酸的关系.方法:应用荧光偏振免疫法检测精神分裂症患者的血清同型半胱氨酸水平,根据检测结果选取34例高同型半胱胺酸血症(HHcy)患者为观察组,另外选取34例非高同型半胱胺酸血症患者为对照组,均给予奥氮平系统治疗,疗程12周.采用阳性和阴性症状量表(PANSS)、临床总体...     

齐拉西酮联合奥氮平对早期精神分裂症患者的效果

目的 探讨早期精神分裂症患者采用齐拉西酮联合奥氮平治疗的价值.方法 纳入120例早期精神分裂症患者(2019年8月～2021年6月),按治疗方案分为2组,以奥氮平治疗者60例纳入对照组,采用齐拉西酮+奥氮平治疗者60例纳入观察组,统计两组临床疗效、副反应量表(TESS)评分、阴性症状量表评分(SANS)、阳性症状量...     

奥氮平联合氯氮平治疗难治性精神分裂症患者的疗效观察

目的：观察奥氮平联合氯氮平治疗难治性精神分裂症的疗效和不良反应。方法：50例难治性精神分裂症患者随机分为合用药组和单用药组各25例。合用药组给予奥氮平合并小剂量氯氮平治疗,单用药组仅给予奥氮平治疗。疗程12周。采用阳性与阴性症状量表（PANSS）及治疗中出现的症状量表（TESS）于治疗前及治疗4、8、12周分别评定疗效和不良反应。结果：治疗后两组PANSS总分、阳性症状及阴性症状分均较治疗前明显降低（P〈0.05或P〈0.01）,以合用药组显著低于单用药组（P〈0.05）。两组不良反应比较差异无统计学意义（P〉0.05）。结论：奥氮平联合氯氮平治疗难治性精神分裂症疗效好,不良反应少且依从性好。     

Japanese and North American Alzheimer's Disease Neuroimaging Initiative studies: Harmonization for international trials

Introduction

We conducted Japanese Alzheimer's Disease Neuroimaging Initiative (J-ADNI) and compared the basic characteristics and progression profiles with those of ADNI in North America.

The effects of clozapine, risperidone, and olanzapine on cognitive function in schizophrenia.

Cognitive function is markedly impaired in most patients with schizophrenia. Antecedents of this impairment are evident in childhood. The cognitive disability is nearly fully developed at the first episode of psychosis in most patients. The contribution of cognitive impairment to outcome in schizophrenia, especially work function, has been established. Preliminary results indicate that cognitive function, along with disorganization symptoms, discriminate schizophrenia patients who are able to work full-time from those who are not. Typical neuroleptic drugs lack the ability to improve the various domains of cognitive function impaired in schizophrenia. Atypical antipsychotic drugs pharmacologically related to clozapine-quetiapine, olanzapine, risperidone, sertindole, and ziprasidone--share the ability to produce fewer extrapyramidal symptoms than typical neuroleptic drugs and more potent antagonism of serotonin2a relative to dopamine2 receptors. However, they have a number of different clinical effects. We have identified all the studies of clozapine, olanzapine, and risperidone that provide data on their effects on cognition in schizophrenia. Data for each drug are reviewed separately in order to identify differences among them in their effects on cognition. Twelve studies that report cognitive effects of clozapine are reviewed. These studies provide (1) strong evidence that clozapine improves attention and verbal fluency and (2) moderate evidence that clozapine improves some types of executive function. However, results of the effects of clozapine on working memory and secondary verbal and spatial memory were inconclusive. Risperidone has relatively consistent positive effects on working memory, executive functioning, and attention, whereas improvement in verbal learning and memory was inconsistent. Preliminary evidence presented here suggests that olanzapine improves verbal learning and memory, verbal fluency, and executive function, but not attention, working memory, or visual learning and memory. Thus, atypical antipsychotic drugs as a group appear to be superior to typical neuroleptics with regard to cognitive function. However, available data suggest that these drugs produce significant differences in specific cognitive functions. These differences may be valuable adjunctive guides for their use in clinical practice if cognitive improvements reach clinical significance. The effects of the atypical antipsychotic drugs on cholinergic and 5-HT2a-mediated neurotransmission as the possible basis for their ability to improve cognition are discussed. It is suggested that the development of drugs for schizophrenia should focus on improving the key cognitive deficits in schizophrenia: executive function, verbal fluency, working memory, verbal and visual learning and memory, and attention.     

奥氮平与利培酮对慢性精神分裂症认知功能的疗效

目的探讨奥氮平与利培酮在治疗慢性精神分裂症的认知功能的临床效果。方法选择本院2010—2012年收治的精神分裂患者98例,按随机数字法分为2组,分别给予奥氮平及利培酮治疗,分别在入组、治疗12周及6个月进行PAN-SS量表评定以及认知功能的测定。结果 A组42例和B组44例完成了6个月的治疗,所有患者从基线到6个月精神症状均显著改善,6个月时认知功能显著提高。结论奥氮平和利培酮均能显著改善慢性精神分裂患者的认知功能。     

奥氮平与齐拉西酮对精神分裂症患者生活质量影响的对照研究

目的:比较奥氮平与齐拉西酮对精神分裂症患者生活质量的影响.方法:将68例精神分裂症患者随机分为2组,各34例,分别采用奥氮平和齐拉西酮治疗8周,分别于治疗前及治疗2、4、6、8周采用阳性和阴性症状量表(PANSS)评定疗效,用治疗中出现的症状量表(TESS)评定不良反应,用生活质量综合评定问卷( GQOLI-74)于治...     

A comparison of the effects of clozapine and olanzapine on the EEG in patients with schizophrenia

Clozapine is known to induce epileptic seizures and changes in EEG-patterns, including slowing and the appearance of epileptiform activity. Olanzapine, a new antipsychotic drug, shares many pharmacological and clinical properties with clozapine. However, in patients treated with olanzapine, no case of seizure induction has been reported so far, and the EEG has not been studied systematically. We examined the EEGs of patients with schizophrenia treated with either olanzapine (N = 9) or clozapine (N = 9) prior to medication and 3 to 7 weeks afterwards. Clozapine induced significant EEG slowing present in 78% of the patients, and definite epileptiform activity appeared in 33%. Olanzapine also induced significant EEG slowing, but less frequently (in 44% of the patients) and less pronounced than clozapine. Olanzapine had no significant effect an epileptiform activity, but in one patient, an isolated sharp/slow-wave complex was observed. These preliminary data suggest that olanzapine induces EEG slowing to a lower extent than clozapine. Olanzapine's possible effect an the seizure threshold deserves further attention.     

奥氮平与齐拉西酮对精神分裂症患者生活质量影响的对照研究

目的比较奥氮平与齐拉西酮对精神分裂症患者的社会功能和生活质量的影响。方法将64例精神分裂症患者随机分为两组,口服奥氮平组及口服齐拉西酮组,于治疗前及出院后3、6、12个月末采用PAN-SS、TESS、WHOQOL-100及SDSS评定。结果 3、6、12个月末随访,两组PANSS总分及各因子分均较治疗前显著下降(P<0.01);同期两组之间总分及各因子分比较无显著性差异(P>0.05)。两组WHOQOL-100躯体功能、心理功能、独立性、社会关系、生活质量总评因子分均较治疗前显著提高(P<0.01),同期两组之间总分及各因子分比较无显著性差异(P>0.05)。两组SDSS的婚姻职能、社会性退缩、家庭外的社会活动、家庭内活动过少、家庭职能、个人生活自理、对外界的兴趣和关心7个因子分均显著低于治疗前(P<0.01),同期两组之间各因子分比较无显著性差异(P>0.05)。奥氮平组不良反应发生率为44.1%(15/34),齐拉西酮组不良反应发生率为46.7%(14/30),两组间比较差异无显著性(P>0.05)。结论奥氮平和齐拉西酮均能提高精神分裂症患者的生活质量。     

The Declaration of Helsinki and clinical trials: a focus on placebo-controlled trials in schizophrenia

OBJECTIVE: The authors' goal was to consider ethical approaches to placebo-controlled clinical trials in the light of the evolving Declaration of Helsinki, with special attention to applications to research on schizophrenia. METHOD: They review the Helsinki position on placebos, including the 2002 Clarification, exploring the potential negative effects of banning placebos in studies involving conditions for which at least partially effective treatments exist. The Clarification is examined as an approach to this issue that, in contrast to earlier formulations, better acknowledges the complexity of clinical research and the need for protocol-specific determinations. Placebo controls in schizophrenia studies are used to illustrate issues relevant to all clinical research on therapeutic interventions. RESULTS: The Helsinki Clarification provides a basis for operationalizing criteria for review of placebo use in clinical trials. Six criteria are proposed for judging the ethical acceptability of placebo controls, including the likelihood that the intervention being tested will have clinically significant advantages over existing treatments, the presence of compelling reasons for placebo use, subject selection that minimizes the possibility of serious adverse consequences, and a risk-versus-benefit analysis that favors the advantages from placebo use over the risks to subjects. CONCLUSIONS: The Helsinki Clarification constitutes an important advance in international approaches to placebo use, requiring protocol-by-protocol judgments on complex issues of clinical research ethics. When operationalized, it provides review boards with a useful methodology for reaching determinations on the appropriateness of placebo controls in particular studies.     

The genetics of symptom dimensions of schizophrenia: review and meta-analysis

BACKGROUND: The use of symptom dimensions of schizophrenia as quantitative phenotypes has been proposed as a mean to reduce the heterogeneity of schizophrenia and facilitate genetic research. However, the genetic background of symptom dimensions is not clear. AIM: We aim to investigate whether the symptom dimensions "reality distortion", "psychomotor poverty" and "disorganization" are heritable phenotypes. METHOD: We performed a Medline search including all papers from 1980 to August 2007. In addition to reviewing the articles, we performed meta-analyses on these studies where possible. RESULTS: We identified 18 relevant papers. Only the studies on affected sibling pairs were suitable for meta-analysis. Data from twin and affected sibling studies are consistent with a genetic contribution to the disorganization dimension. However these studies did not unequivocally support a large genetic contribution to neither the reality distortion symptom dimension nor to the psychomotor poverty symptom dimension. In contrast several molecular genetic studies did report associations of genes with psychomotor poverty. CONCLUSIONS: These data suggest that only the disorganization symptom dimension may provide an useful alternative phenotype for genetic research. More research is required to make any definitive conclusions.     

Functional lateralization of the sensorimotor cortex in patients with schizophrenia: effects of treatment with olanzapine.

BACKGROUND: Earlier cross-sectional studies with functional magnetic resonance imaging (fMRI) in treated patients with schizophrenia have reported abnormalities of cortical motor processing, including reduced lateralization of primary sensory motor cortex. The objective of the present longitudinal study was to evaluate whether such cortical abnormalities represent state or trait phenomena of the disorder. METHODS: Seventeen acutely ill, previously untreated patients were studied after 4 weeks and after 8 weeks of olanzapine therapy. Seventeen matched healthy subjects served as control subjects. All subjects underwent two fMRI scans 4 weeks apart during a visually paced motor task using a simple periodic block design. Functional magnetic resonance imaging data were analyzed in Statistical Parametric Mapping (SPM99). Region of interest analyses were used to determine a laterality quotient (an index of lateralization) of motor cortical regions. RESULTS: The fMRI data indicated that patients had reduced activation of the primary sensory motor cortex at 4 weeks but not at 8 weeks; however, the laterality quotient in the primary sensory motor cortex was reduced in patients at both time points. CONCLUSIONS: These results suggest that some cortical abnormalities during motor processing represent state phenomena, whereas reduced functional lateralization of the primary sensory motor cortex represents an enduring trait of schizophrenia.     

Comparative effects of risperidone and olanzapine on cognition in elderly patients with schizophrenia or schizoaffective disorder

OBJECTIVE: To examine the effects of risperidone and olanzapine on cognitive functioning in elderly patients with schizophrenia or schizoaffective disorder. METHOD: One hundred seventy-six elderly inpatients and outpatients with schizophrenia or schizoaffective disorder were enrolled in this multicenter, double-blind trial. After their antipsychotic medications were tapered for 1 week, patients were randomly assigned to receive either risperidone 1 to 3 mg/day or olanzapine 5 to 20 mg/day for 8 weeks. Performance on the Continuous Performance Test (CPT), Serial Verbal Learning Test (SVLT), TMT (Trail Making Test) Parts A and B, Wisconsin Card Sorting Test (WCST), and Verbal Fluency Examinations (VFE) was assessed at baseline and at end point. RESULTS: Patients in the risperidone group had improved scores on at least one test of attention, memory, executive function, and verbal fluency, and those in the olanzapine group had improved scores on at least one test of attention and memory function. Scores on the TMT Part B, WCST total errors (executive function domain), and the VFE improved significantly from baseline in the risperidone group but not in the olanzapine group. No significant differences in change scores between the two groups were found. Higher baseline scores on each test predicted more improvement at endpoint. CONCLUSIONS: Low doses of risperidone and olanzapine improve cognitive function in elderly patients with schizophrenia or schizoaffective disorder. Consistent with research in younger populations, these improvements occur in aspects of cognitive functioning related to functional outcome.     

奥氮平对精神分裂症患者血清神经递质白介素及微量元素的影响

目的探讨奥氮平对精神分裂症患者血清神经递质、白介素及微量元素的影响程度。方法选取于本院进行治疗的64例精神分裂症患者为研究对象,以随机分配方式分为对照组(氯氮平治疗组)32例和观察组(奥氮平治疗组)32例,比较2组治疗前与治疗后2周及8周的血清神经递质、白介素及微量元素水平。结果治疗后2周及8周时观察组血清NO、IL-2、Zn及Mg均高于对照组,而其他血清神经递质、白介素及微量元素水平则均低于对照组,2组治疗后血清指标比较差异有统计学意义(P0.05)。结论奥氮平对精神分裂症患者血清神经递质、白介素及微量元素的影响明显大于氯氮平,具有良好的改善作用。     

氨磺必利与奥氮平治疗老年期精神分裂症的临床疗效及对糖脂代谢影响的比较

目的 比较氨磺必利与奥氮平对老年期精神分裂症患者血糖和血脂代谢的影响。方法 60例老年期精神分裂症患者采用随机数字表法分为氨磺必利组（30例）和奥氮平组（30例）,分别给予氨磺必利片和奥氯平片口服,检测入纽时和治疗2,4,8周后两组空腹血糖（FBS）,总胆固醇（TC）,高密度脂蛋白（HDL）,低密度脂蛋白（LDL）,甘油三酯（TG）及体质量指数（BMI）,并评定入组时和治疗2,4,8周后两组的PANSS评分,治疗不良反应量表（TESS）评定不良反应。结果 氨磺必利组有效率82．8％,奥氮平组为86．2％,两组比较差异无统计学意义（U=0．118,P〉0．05）。两组患者治疗8周末PANSS总分及各量表评分差异无统计学意义（P〉0．05）。奥氮平组MBI,FBS,LDL,TC,TG随时间升高趋势明显,经重复测量方差分析,差异有统计学意义（P〈0．05）,而氨磺必利组内各时点各项指标变化不明显,差异无统计学意义（P〉0．05）。两组治疗8周末TESS评分氨磺必利组为（2．49±1．32）分,奥氮平组（2．95±1．56）分,两组比较差异有统计学意义（t=2．190,P=0．033）,氨磺必利组不良反应发生率低。结论 氨磺必利对老年期精神分裂症的疗效与奥氮平相当,但对患者血糖、血脂的影响明显小于奥氮平。     

阿立哌唑联合奥氮平治疗住院男性精神分裂症患者的效果及对代谢综合征的影响

背景 精神分裂症及抗精神病药物使用均可能导致患者发生代谢综合征（MS）,增加心血管疾病的发生风险,不利于疾病预后。有效预防或降低精神分裂症患者伴发MS的风险至关重要。目的 探讨阿立哌唑联合奥氮平治疗男性精神分裂症的效果及其对患者MS的影响,以期为男性精神分裂症患者抗精神病药物的选择提供参考。方法 连续选取2023年2月—6月在梅州市第三人民医院住院治疗的、符合《国际疾病分类（第10版）》（ICD-10）精神分裂症诊断标准的80例男性患者。采用随机数表法分为研究组（阿立哌唑联合奥氮平口服）与对照组（奥氮平单药口服）各40例,两组均连续用药6周。治疗前,两组均接受阳性和阴性症状量表（PANSS）评定和MS相关指标［空腹血糖（FPG）、糖化血红蛋白（HbA1c）、体质量指数（BMI）、腰臀比（WHR）及血脂水平］、血清S100钙结合蛋白B（S100B）以及超敏C反应蛋白（hs-CRP）水平检测,于治疗第2、4、6周末再次行PANSS评定,于治疗第2周和第6周末进行临床疗效总评量表（CGI）评定,治疗第6周末再次进行MS相关指标、S100B以及hs-CRP水平检测及副反应量表（TESS）评定。结果 两组PANSS评分的组别效应、时间效应及组别与时间的交互效应均有统计学意义（F=18.092、634.780、2.917,P<0.05或0.01）。两组CGI评分的组别效应和时间效应均有统计学意义（F=20.492、99.190,P均<0.01）。治疗第6周末,研究组HbA1c和甘油三酯（TG）水平均低于对照组（t=-3.495、-3.293,P均<0.05）。治疗第6周末,研究组hs-CRP水平低于对照组（t=-3.916,P<0.05）。研究组TESS评分低于对照组（t=-4.684,P<0.01）。结论 与奥氮平单药治疗相比,阿立哌唑联合奥氮平可能更有助于改善男性精神分裂症患者的精神病性症状,且对MS相关指标的影响更小。