Spontaneous dyskinesia in first episode schizophrenia

In the west London prospective study of first episodeschizophrenia, the prevalence and nature of abnormal involuntarymovements were examined in 27 patients who had never receivedantipsychotic drugs and 36 who had been treated with such medication.Motor disturbance was assessed with rating scales designed to cover thefull range of spontaneous and drug induced movement disorder. Only oneperson in the drug naïve group showed evidence of parkinsonism, afinding which contrasts with recent reports suggesting that spontaneousextrapyramidal signs may not be uncommon in such patients. However,according to ratings on the modified Rogers scale, 11% of the drugnaïve group exhibited orofacial dyskinesia, 4% trunk and limbdyskinesia, 7% postural abnormalities, and 4% increased muscle tone.The respective figures in the closely matched medicated group were notsignificantly different except for increased muscle tone, which wassignificantly more common (25%). The proportion of drug naïvepatients fulfilling criteria for tardive dyskinesia on the abnormalinvoluntary movements scale ranged from 4% to 11% depending on thecriterion threshold score used. These findings are in accord with thenotion that abnormal involuntary movements, particularly orofacialdyskinesia, represent a neuromotor component of schizophrenia.

     

Disease-relevant autoantibodies in first episode schizophrenia

Journal of Neurology -     

Early prodromal symptoms and diagnoses before first psychotic episode in 219 inpatients with schizophrenia

The authors examined the diagnosis before the onset of schizophrenia and retrospectively evaluated the presence/absence of early prodromal symptoms (EPS) and their types (such as depressive symptoms, anxiety symptoms, and obsessive-compulsive [OC] symptoms) and the period from the onset of these symptoms to that of schizophrenia in 219 inpatients with schizophrenia diagnosed according to the DSM-IV(-TR). A diagnosis was made before the onset of schizophrenia in 53 patients (24.2%). The diagnoses were mood disorder in 39 patients, anxiety disorder in seven, obsessive-compulsive disorder (OCD) in three, adjustment disorder in two, and eating disorder in two. EPS were present in 65 (29.7%) of all patients, slightly more frequent in female patients (male:female = 1:1.41). In the group with EPS, depressive symptoms (61.5%) were most frequently observed, followed by anxiety symptoms (23.1%) and OC symptoms (9.2%). The age at onset for each type of symptom was significantly lower for OC symptoms (14.5 +/- 2.4 years) than for the other symptoms (approx. 20 years). The mean period from the onset of each symptom to that of schizophrenia was the shortest for depressive symptoms (2.7 +/- 3.1 years) and the longest (>4 years) for OC symptoms. These results as well as previous studies in Western countries showed that more non-specific and general symptoms are frequently present for some years before the onset of schizophrenia. With consideration of this point, efforts toward early detection of schizophrenia are important.     

Serotonergic function and suicidal behavior in schizophrenia

Recent studies suggest that altered serotonergic (5-HT) function, as assessed by lower prolactin (PRL) response to fenfluramine (FEN), a specific 5-HT releaser and uptake inhibitor, is associated with suicidal behavior in either depressed and personality disordered patients. The purpose of this study was to investigate, in schizophrenic patients, the relationship between suicidal behavior and PRL response to D-fenfluramine (D-FEN). A D-FEN test was performed in 18 healthy controls and 33 drug-free DSM-IV schizophrenic patients (12 with a history of suicide attempts, 21 without it). Schizophrenic patients with a history of suicide attempts showed a lower PRL response to D-FEN (Delta PRL) compared to schizophrenic patients without such history (P<0.04) and also compared to healthy controls (P<0.0003). Delta PRL did not differentiate schizophrenic patients without suicide attempts and controls. These findings could not be explained by PRL basal hormonal levels, age, sex, menstrual status, demographic or clinical characteristics. These results suggest that PRL response to D-FEN is a marker of suicidal tendencies also in schizophrenia, supporting the hypothesis that a dysfunction in serotonergic function is associated with suicidal behavior regardless of the psychiatric diagnosis.     

Suicides in males after the first episode of schizophrenia

The aim of this study was a retrospective analysis of available data on patients who committed suicide after the first episode of schizophrenia with focus on risk factors for suicide. Seven of 162 patients consecutively hospitalized at the Department of Psychiatry in Brno with first-episode schizophrenia and followed up for 10 years committed suicide by hanging (n = 4), shooting (n = 1), jumping from height (n = 1), and drowning (n = 1). All patients had more known risk factors and had visited a psychiatrist shortly before their suicide. However, according to the documentation, the patients were not asked about their intention to commit suicide and the potentially modifiable risk factors. Under the conditions of routine clinical practice, the prevention of suicide after the first psychotic episode should include early aggressive treatment and careful monitoring for suicidal behaviors in patients with known risk factors.     

One year outcome in first episode schizophrenia

The aim of this study was to identify the predictors of outcome at one year follow-up after the first psychotic episode of schizophrenia. Seventy-nine first-episode schizophrenia patients were assessed monthly with the Brief Psychiatric Rating Scale (BPRS), Scale for Assessment of Positive Symptoms (SAPS), and Scale for Assessment of Negative Symptoms (SANS) after discharge from their first hospitalization. Outcome measures were presence of relapse and rehospitalization, level of global functioning, employment status and severity of symptoms at one year. A total of 33% of the patients had a relapse, and 12.1% were rehospitalized during one year follow-up. Premorbid childhood functionality was worse in patients who had relapse, but there was no correlation between premorbid adjustment scores and BPRS, SANS and SAPS scores at one year. There was no difference in duration of untreated psychosis (DUP) between patients who had relapse and not; however, the patients who had double relapse, had longer DUP than those without relapse. The time period between discharge and rehospitalization was shorter in patients with longer DUP. Functionality in childhood and noncompliance to the treatment independently contributed to the relapse rate. Functionality in late adolescence independently contributed to the Global Assessment of Functioning (GAF) scale score at one year and the GAF score at discharge appeared as a predictor of employment. The results of the present study suggest that treatment compliance and early premorbid adjustment level seem to be important predictors of relapse rate in first episode schizophrenia.     

Spatio-temporal EEG waves in first episode schizophrenia

ObjectiveSchizophrenia is characterized by a deficit in context processing, with physiological correlates of hypofrontality and reduced amplitude P3b event-related potentials. We hypothesized an additional physiological correlate: differences in the spatio-temporal dynamics of cortical activity along the anterior–posterior axis of the scalp.MethodsThis study assessed latency topographies of spatio-temporal waves under task conditions that elicit the P3b. EEG was recorded during separate auditory and visual tasks. Event-related spatio-temporal waves were quantified from scalp EEG of subjects with first episode schizophrenia (FES) and matched controls.ResultsThe P3b-related task conditions elicited a peak in spatio-temporal waves in the delta band at a similar latency to the P3b event-related potential. Subjects with FES had fewer episodes of anterior to posterior waves in the 2–4 Hz band compared to controls. Within the FES group, a tendency for fewer episodes of anterior to posterior waves was associated with high Psychomotor Poverty symptom factor scores.ConclusionsSubjects with FES had altered global EEG dynamics along the anterior–posterior axis during task conditions involving context update.SignificanceThe directional nature of this finding and its association with Psychomotor Poverty suggest this result is related to findings of hypofrontality in schizophrenia.     

心理干预对首发精神分裂症患者的作用

目的:探讨心理干预对首发精神分裂症患者生活质量和社会功能的影响. 方法:120例首发精神分裂症患者随机分为观察组和对照组各60例.两组均给予阿立哌唑治疗,观察组在此基础上给予心理干预,观察8周,并随访6个月.采用阳性与阴性症状量表(PANSS)、世界卫生组织生活质量量表(WHOQOL-100)及社会功能缺陷筛选量表(SDSS)分别于入组时及随访结束时进行评估. 结果:入组时PANSS、WHOQOL-100及SDSS评分两组间比较差异均无统计学意义(P均>0.05);随访结束时,观察组PANSS总分、阴性症状、阳性症状和SDSS评分均显著低于对照组(P均<0.01);而WHOQOL-100中生活质量总评、独立性领域、社会关系领域评分均高于对照组(P<0.05或P<0.01). 结论:心理干预有助于缓解首发精神分裂症患者的精神症状,提高生活质量及社会功能.     

Correlates of cognitive deficits in first episode schizophrenia

OBJECTIVE: The presence of cognitive dysfunction in schizophrenia has been well documented, but questions remain about whether there are relationships between this dysfunction and clinical symptomatology. If present, such relationships should be most clearly observable in patients with first episode schizophrenia; that is, before the effects of chronic illness, institutionalization, or treatment might confound them. METHOD: 307 schizophrenia subjects in their first episode of illness were recruited to participate in a clinical trial comparing the long-term efficacy of haloperidol and risperidone. The psychopathology, cognitive functioning, early treatment history, and duration of untreated psychosis of these subjects were assessed prior to their assignment to randomized, double-blind treatment. Approximately two-thirds of the subjects were receiving antipsychotic treatment at the time of assessment; however, the duration of treatment was limited to 12 weeks or less. RESULTS: The severity of negative symptoms at the time of assessment was associated with deficits in memory, verbal fluency, psychomotor speed and executive function. Positive symptoms were not associated with cognitive deficits. Also, the duration of untreated illness (DUI) prior to assessment was not significantly associated with cognitive impairment. CONCLUSIONS: The results of this study of first episode schizophrenia patients suggest that a relationship exists between negative symptoms and cognitive dysfunction. However, that relationship accounts for only a minor portion of the variance (i.e., 10-15%) in the severity of cognitive dysfunction after controlling for a number of potentially confounding factors. This finding provides support for the theory that the neurobiological processes that give rise to symptomatology and cognitive dysfunction in schizophrenia are partially overlapping.     

首发精神分裂症住院病人疗效影响因素

目的 系统了解初发精神分裂症病人住院时疗效的影响因素。方法：采用前瞻性研究方法，应用简明精神病评定量表、阴阳必症状评定量表、艾森克个性问卷、社会支持评定量表、ＤＳＭ－Ⅲ轴Ⅴ病前社会适应功能水平评定、大体功能评定量表等工具，对符合ＣＣＭＤ－２诊断的１８４例连续就诊的住院精神分裂症病人进行评估。结果：初发精神分裂症病人出院时疗效的主要影响因素为：病前社会功能水平、客观家庭社会支持、思维贫乏、愉快感缺乏     

首发精神分裂症早期干预的康复效果

目的　探讨早期干预措施对首发精神分裂症患者的康复效果。方法　将 6 2例首发男性精神分裂症住院患者随机分为干预组 (30例 )和对照组 (32例 ) ,在利培酮治疗的同时 ,对干预组予以心理社会干预措施 ,观察时间为 8周 ,出院后随访 6个月。用阴性、阳性症状评定量表 (PANSS)、住院病人护士观察量表 (NOSIE 30 )和复发率进行评估。结果　入组时与随访最后时点评分差值的比较 ,干预组患者的PANSS总分 (4 6 37± 13 6 5 )、阳性症状分 (18 2 4± 5 83)、阴性症状分 (14 5 5± 5 4 0 )均优于对照组 (分别为 4 1 5 9± 14 6 3、15 30± 6 2 2、19 84± 7 36 ,P <0 0 5～P <0 0 1) ;干预组患者的积极因素分 (- 38 6 5± 9 79)、消极因素分 (31 0 2± 12 5 3)、总评估分 (- 6 6 30± 14 4 5 )皆显著优于对照组 (分别为 - 9 6 7± 11 2 3、3 18± 14 4 7、- 11 6 2± 2 3 75 ,P均 =0 0 0 0 ) ;干预组的复发率 (6 6 7% )低于对照组 (18 75 % ) ,但差异无显著性。结论　对首发精神分裂症患者早期干预措施 ,能较好改善患者的精神症状、提高社会功能、降低复发率 ,故有利于患者重返社会     

Perceptual organization in first episode schizophrenia and ultra-high-risk states

Deficits in perceptual organization have been consistently reported in schizophrenia, as has an association between these deficits, disorganized symptoms, and poorer premorbid functioning and prognosis, suggesting that they may be an index of illness severity or progression. It is unclear, however, whether the impairment is present at, or before the first psychotic episode. This study examined perceptual organization in young people considered to be at high-risk for schizophrenia, defined by the "close-in" strategy [Yung, A.R., McGorry, P.D., McFarlane, C.A., Jackson, H.J., Patton, G.C., Rakkar, 1996. Monitoring and care of young people at incipient risk of psychosis. Schizophrenia Bulletin, 22, 283-303]. The high-risk group (n=70) was compared to first-episode patients (n=54), and nonpatients (n=24) using a task with known sensitivity to perceptual organization deficits in schizophrenia, and whose scores have predicted long-term outcome and disorganized symptomatology in past studies [Knight, R.A., Silverstein, S.M., 1998. The role of cognitive psychology in guiding research on cognitive deficits in schizophrenia. In Lenzenweger, M., Dworkin, R.H., (Eds.), Origins and Development of Schizophrenia: Advances in Experimental Psychopathology. APA Press, Washington DC, pp. 247-295.; Silverstein, S.M., Knight, R.A., Schwarzkopf, S.B., West, L.L., Osborn, L.M. Kamin, D., 1996b. Stimulus configuration and context effects in perceptual organization in schizophrenia. Journal of Abnormal Psychology 105, 410-420.; Silverstein, S.M., Schenkel, L.S., Valone, C., Nuernberger, S., 1998a. Cognitive deficits and psychiatric rehabilitation outcomes in schizophrenia. Psychiatric Quarterly 69, 169-191.; Silverstein, S.M., Bakshi, S., Chapman, R.M., Nowlis, G., 1998b. Perceptual organization of configural and nonconfigural visual patterns in schizophrenia: effects of repeated exposure. Cognitive Neuropsychiatry 3, 209-223]. There were no differences between groups, and the first-episode group demonstrated non-significantly more sensitivity to stimulus organization than the other groups. When the high-risk group was broken down into its 3 subgroups (A--family history of psychotic illness and recent drop of 30+ points in the GAF scale; B--history of attenuated psychotic symptoms; C--brief limited intermittent psychotic symptoms), only group A demonstrated evidence of impairment, but this group differed significantly only from first- and young, later-episode schizophrenia patients, not from nonpatients. These findings are consistent with recent data on pre-attentive processes in schizophrenia which indicate that performance is not impaired and may even be enhanced, early in the illness, with dysfunctions beginning with increased chronicity.     

Early prediction of clinical response in first episode schizophrenia (FES) patients receiving olanzapine

Abstract

Background: At present, schizophrenia guidelines recommend waiting for 8?weeks before considering a patient as non-responder. This study aims to detect the optimal early response threshold that best predict the final outcome of olanzapine.

Methods: The study was conducted for 8-week, four points follow up (week 2,3,4, and 8) prospective observational study. A reduction of 20, 25, 30% in Positive and Negative Syndrome Scale (PANSS) score from the base line at week 2,3, and 4 respectively were considered as early response. A reduction of 50% at week 8 was considered as responders. Receiver Operating Characteristics (ROC) curves were performed to detect the optimal threshold.

Results: Mean total baseline PANSS score was 106.66(95% CI; 100.4, 112.9). Week 2 (AUC = 50.5%, p?>?0.964) and week 3 (AUC = 64.9, p?>?0.13) responses failed to predict the 8th week response. Week 4 response (AUC = 92%, p?<?0.001) can be taken for the prediction of 8th week response (specificity = 72%, sensitivity = 100%, Positive Predictive Value = 61.1%, Negative Predictive Value = 100% and Optimum Early Response (OER) = 29.4%). 25 patients (69%) achieved more than 50% reduction (responders) in PANSS score after 8?weeks of treatment.

Conclusions: Our study suggests that patients with early response at week 4 are likely to achieve positive response after 8?weeks. This may help in appropriate clinical decision making for early non-responders.

• Key Points

• The early response can forecast the outcome at the endpoint for the treatment of FES

• A reduction of baseline PANSS score by 30% or more after four weeks are likely to have remission after week 8 with olanzapine therapy.

     

Reduced anticardiolipin antibodies in first episode and chronic schizophrenia

The objective of this study was to measure anticardiolipin antibodies (aCL) in major psychiatric diseases. In Experiment 1, 96 subjects were evaluated: 20 first episode schizophrenia patients, [SCZ1] 20 chronic schizophrenia patients in acute exacerbation [SCZ2], l9 bipolar patients, 20 schizoeffective patients and 17 healthy age matched controls. In Experiment 2, 97 subjects were studied: 20 first episode schizophrenia patients [SCZ1], 60 chronic schizophrenia patients in acute exacerbation [SCZ2] and 17 healthy matched controls. Diagnosis was performed according to DSM-IV. Serum samples were tested for aCL in parallel by enzyme-linked immunosorbent assay in the presence of bovine serum. Five positive control samples with high levels of aCL were run in parallel. Background binding to wells uncoated with cardiolipin (CL) was also measured. In Experiment 1, aCL levels were similar in the control, bipolar and schizoeffective groups. In contrast, aCL levels in the SCZ1 and SCZ2 groups were significantly lower than in controls. In Experiment 2, Significantly lower levels of aCL antibodies were found in all schizophrenic patients versus controls. Interestingly, background levels in both experiments were higher in the schizophrenic groups than in controls. Serum aCL levels are lower in schizophrenic patients, and especially in first episode cases, than in controls. One possible explanation for the lower levels of aCL in schizophrenic patients is the consumption of these antibodies in the acute phase and exacerbation of the disease. The higher background levels in schizophrenic patients may indicate a high level of antibodies to some serum component in schizophrenic patients that is still unclear and needs further elucidation.     

Depressive symptoms in first episode schizophrenia spectrum disorder

Background

Depressive symptoms in ‘non-affective’ first episode schizophrenia spectrum disorders (FES) are common, but poorly understood, resulting in a range of conceptual and clinical management issues. This study had three aims: (i) to determine the prevalence of moderate to severe depressive symptoms (defined as a Clinical Global Impressions Scale-Bipolar Disorder (CGI-BP depression) score > 3) in a large representative sample of FES patients; (ii) to compare the clinical and functional characteristics of FES patients with and without these depressive symptoms at service entry; and (iii) to compare the characteristics of FES patients with and without persistent depressive symptoms.

Methods

Medical file audit methodology was employed to collect information on 405 patients with FES treated at the Early Psychosis Prevention and Intervention Centre (EPPIC), Melbourne, Australia.

Results

26.2% (n = 106) of the patients had moderate to severe depression at service entry. At service entry and at discharge, those with depressive symptoms had greater insight into their illness but did not differ from those without depressive symptoms in terms of severity of overall psychopathology. Substance use was significantly less common in those with depressive symptoms at service entry and at discharge. Of those who were depressed at baseline, 14.2% (n = 15) continued to have moderate to severe depressive symptoms at discharge.

Discussion

Depressive symptoms are common in patients with FES. Understanding the nature and characteristics of depression in FES has important clinical implications for both early intervention and treatment.     

Pharmacological long-term treatment strategies in first episode schizophrenia

In first-episode schizophrenia the advantage of new atypical neuroleptics compared to low-dose haloperidol as well as the indicated duration of neuroleptic maintenance treatment has still to be based on empirical evidence. Accordingly, a multi-center study on the optimization of acute and long-term treatment in first-episode schizophrenia is currently being carried out as part of the German Research Network on Schizophrenia. This paper reports on the design, methods and preliminary results of the two-year randomized double-blind study comparing risperidone and low-dose haloperidol within the framework of psychological interventions. In the second treatment year, relapse rates under continued neuroleptic treatment are compared with those under stepwise drug withdrawal substituting instead prodrome-based early intervention (intermittent treatment). As to the results, by November 2003 142 first episode patients (ICD-10 F20) have been included in the long-term study. One-year relapse rates were very low (3.8 %). On average, symptoms as well as drug side-effects decreased steadily under maintenance treatment. Although compliance on average was high, about 60% of the patients dropped out during the first study year. More pronounced psychopathology, (neurological) side-effects, lower compliance at study entry and absence of psychological treatment seemed to enhance the risk for drop-out. In conclusion, treatment in first episode schizophrenia is effective under both (further on blinded) neuroleptics; however these patients are at high risk for treatment drop-out. This emphasizes the need for a special support program.     

首发未用药精神分裂症患者攻击行为与血清C反应蛋白的相关性

目的 探讨首发未用药精神分裂症患者血清C反应蛋白（CRP）水平及临床症状对攻击行为的影响。方法 选取2020年1月至2022年11月在山东省精神卫生中心门诊就诊或者住院治疗的164例首发未用药精神分裂症患者为研究对象。采用修改版外显攻击行为量表（MOAS）评估患者的攻击行为，根据MOAS结果将患者分为攻击组（86例）和非攻击组（78例）。采用阳性与阴性症状量表（PANSS）评定患者的临床症状。采用二项Logistic分层回归分析首发未用药精神分裂症患者有攻击行为的影响因素。结果 攻击组患者的血清CRP水平[2.97(2.46,3.47)mg/L比1.73(1.36,2.10)mg/L]、PANSS总分[（89.27±9.82）分比（83.47±8.04）分]、阳性症状因子评分[33.90(33.01,34.79)分比30.13(29.28,30.98)分]、兴奋激越因子评分[14.12(13.43,14.80)分比7.01(6.41,7.61)分]、MOAS总分[12.85(11.90,13.80)分比2.28(1.36,3.20)分]、言语攻击维度评分[1.28(1.15,1.41)...     

Electrophysiological correlates of planning and monitoring in first episode schizophrenia

The aim of this study was to investigate the functional basis of frequently described cognitive deficits in schizophrenia patients by exploring the electrophysiological correlates of planning processes during performance of the Trail-Making Test-B (TMT-B). Via concurrent recording of behavioral test performance, exploratory eye movements and electrical brain activity functional components critical for task performance were extracted and characterized. Participants comprised 12 first episode patients and 12 matched healthy controls who were examined with concurrent infrared oculography and electroencephalography (EEG) while they carried out a computerized TMT-B. The performance process was segmented into planning and monitoring phases based on the interaction of eye and hand movements. Brain electrical activity was analyzed using low-resolution electromagnetic brain tomography (LORETA). During planning fixations compared to monitoring fixations, both groups showed enhanced current density in dorsolateral prefrontal cortex, cingulate gyrus and inferior parietal lobe. Concurrent with poorer performance, schizophrenia patients exhibited hypoactivity within prefrontal brain areas during planning. Thus, poorer performance in schizophrenia seems to be attributable to impaired planning behavior based on hypoactivity of prefrontal areas, involved in the temporal scheduling of deliberate actions as well as visuomotor integration.