吸烟对男性住院精神分裂症患者认知功能的影响

目的：探讨吸烟对男性住院精神分裂症患者认知功能的影响。方法采用横断面研究,用精神分裂症认知功能成套测验共识版（M CCB ）对149例吸烟与75例非吸烟男性住院精神分裂症患者进行认知功能评估,同时用PANSS评估两组患者的临床症状。比较两组患者认知功能和临床症状的差异,并分析吸烟与认知功能的相关性。结果吸烟组和非吸烟组患者临床症状的差异无统计学意义。吸烟组M CCB中数字序列[（14．52±5．51）分比（17．39±5．54）分]、言语记忆[（17．11±5．56）分比（19．69±6．05）分]、视觉记忆[（13．41±8．10）分比（16．96±8．06）分]3个分测验得分均低于非吸烟组,差异具有统计学意义（P＜0．05）。吸烟组中,吸烟时间、吸烟量、吸烟指数与认知功能均无相关性（P＞0．05）。结论吸烟可能损害男性精神分裂症患者的认知功能,尤其是记忆力。     

Phospholipid patterns of erythrocytes in schizophrenia: relationships to symptomatology

The phospholipid composition of red blood cells (RBC) from 32 haloperidol-treated schizophrenic patients, classified according to the positive and negative syndrome scale (PANSS) as showing either predominantly positive or predominantly negative symptoms, was determined and compared with that of normal controls. While the levels of phosphatidylcholine and phosphatidylserine were similar in all three groups, sphingomyelin (SM) and phosphatidylethanolamine (PE) were, respectively, increased and decreased in RBCs of schizophrenic patients. In both patient groups, the SM/PE ratios correlated directly with the PANSS negative symptom scale scores and inversely with the positive symptom scale scores. However, the inverse changes in the contents of SM and PE were much more expressed in the negative group. It is suggested that a main source of that difference is a higher activity of the polyunsaturated acid-selective phospholipase A(2) in the negative syndrome patients than in the positive syndrome and control groups.     

长期住院男性精神分裂症患者认知功能调查

目的：探讨长期住院男性精神分裂症患者的认知功能。方法：采用数字划消测验、空间广度测验评定57例男性长期住院精神分裂症患者（患者组）和57名正常对照者（正常对照组）的认知功能。结果：患者组在数字划消测验的完成时间、漏划个数以及空间广度测验的总分、顺行得分、逆行得分上明显差于正常对照组（t=8．21,t=3．47,t=4．72,t=2．36,t=5．88;P〈0．05或P〈0．001）。相关分析显示,患者的病程、服药时间与数字划消测验的完成时间呈显著正相关（r=0．41,P〈0．01;r=0．30,P〈0．05）。结论：长期住院男性精神分裂症患者的认知功能明显受损,且与患者的病程和服药时间相关。     

Cigarette smoking in Chinese male inpatients with schizophrenia: a cross-sectional analysis

Given the high rates of cigarette smoking in schizophrenia in many published studies from around the world, we studied the relationship between smoking status and clinical characteristics in male Chinese schizophrenic inpatients. Two hundred seventy-nine schizophrenic inpatients were assessed using clinical data forms to ascertain historical, demographic and treatment variables and collateral information was also collected from case records and interviews with patients and family members. Current smokers (N=112) were compared with non-smokers (N=167) on clinical variables by independent sample t-tests and chi(2) tests, with adjustment for confounding variables using ANCOVA and binary logistic regression analysis. Compared to non-smokers, current smokers were significantly more likely to be divorced, have lower educational attainment, a more episodic course, have a greater number of previous psychotic relapses and more likely to be treated with clozapine. There was no correlation, however, between smoking consumption and schizophrenic psychopathology. Accordingly, cigarette smoking may be associated with certain clinical features in schizophrenic patients, and should be carefully screened for when making treatment and rehabilitation plans.     

长期住院的男性精神分裂症患者认知功能与社会功能研究

目的:探讨长期住院的男性精神分裂症患者认知功能和社会功能的相关性。方法:采用数字划消测验、言语流畅性测验、连线测验(TMT)-A及-B、动物命名测验、Stroop色-词测验、韦氏智力测验中国版木块图及空间广度测验检测48例病情稳定的男性精神分裂症患者(患者组)及24名健康对照者(对照组)的认知功能;采用住院精神病患者社会功能评定量表(SSPI)评估患者的社会功能;分析患者认知功能和社会功能的关系。结果:患者组各项认知功能测验成绩与对照组差异有统计学意义(P均0.01);相关分析显示数字划消、TMT-A及-B得分与社会功能各因子负相关(r=-0.331~-0.582;P均0.05),其他各项认知功能测验与社会功能各因子正相关(r=0.134~0.633;P均0.05)。结论:长期住院的男性精神分裂症患者存在广泛的认知功能损害,并与社会功能损害程度一致。     

Higher fasting serum insulin levels are associated with a better psychopathology profile in acutely ill non-diabetic inpatients with schizophrenia

OBJECTIVE: Recent studies have suggested a beneficial role of insulin on brain function and psychological well-being. This study was undertaken to examine whether fasting serum insulin levels are associated with the psychopathology profile in a cross-sectional sample of acutely ill non-diabetic inpatients with schizophrenia. METHODS: Subjects were recruited from a county hospital. Each subject underwent a psychopathology assessment with the Positive and Negative Syndrome Scale (PANSS). A fasting blood sample was taken to measure serum insulin, plasma glucose and lipids. RESULTS: Twenty-six subjects (7 females, 19 males) were included in the study. Pearson correlation analysis showed significant inverse relationships between serum insulin level and PANSS-Total, Positive Symptom subscale, and General Psychopathology subscale scores (r=-0.41, p=0.037; r=-0.49, p=0.010; r=-0.45, p=0.023, respectively). However, there was no significant relationship between serum insulin level and PANSS-Negative Symptom subscale score (r=-0.13, p=0.53). Partial correlation analysis showed that the inverse relationships between serum insulin levels and PANSS-Total, Positive Symptom subscale, and General Psychopathology subscale scores became even stronger after controlling for potential confounding variables including age, gender, race, family history of mental illness, age of illness onset and body-mass index (BMI). CONCLUSIONS: Higher fasting serum insulin levels are associated with a better psychopathology profile in acutely ill non-diabetic inpatients with schizophrenia. It is speculated that insulin might improve clinical symptoms of schizophrenia by interacting with dopamine and other neurotransmitter systems.     

Diurnal cortisol patterns of young male patients with schizophrenia

Aims: It has been suggested that schizophrenic patients are more vulnerable to stress than healthy persons, and that stressors can trigger a psychotic episode or worsen symptoms. The biological system often studied in relation to stress is the hypothalamic–pituitary–adrenal (HPA) axis, which controls the release of cortisol. We investigated whether the diurnal basal activity of the HPA axis differed between young male patients with schizophrenia and healthy controls. Methods: Twenty‐seven male patients (mean age 22 ± 5 years) and 38 healthy male control subjects (mean age 22 ± 3 years) were included in the present study. Saliva was sampled at five time points during the day: directly after awakening, 30 min thereafter, and at 12.00 hours, 16.00 hours and 22.00 hours. Results: The cortisol concentration decreased significantly more during the day in the patient group thanin the control group. Patients also showed a significantly decreased area under the curve with respect to the increase, again indicating that the cortisol concentrations decreased more during the day in patients than in controls. Both the morning increase and the area under the curve with respect to the increase were significantly negatively correlated with negative symptom severity. Conclusions: Patients with schizophrenia showed a different daytime sensitivity of the HPA axis. Our findings further suggest that an increase in negative symptom severity is related to a decreased HPA axis sensitivity.     

Cerebellar deficits in schizophrenia are associated with executive dysfunction

Cerebellar abnormalities have been documented in schizophrenia in postmortem, functional and volumetric neuroimaging studies. This study aims to establish the relationship between structural changes in the cerebellum and executive dysfunction in patients with schizophrenia using voxel-based morphometry. We compared 28 outpatients with 28 healthy controls. A widely used executive battery and the voxel-based morphometry approach were used to investigate possible structural cerebellum changes on magnetic resonance imaging. Working memory dysfunctions in schizophrenia correlated with grey matter in both cerebellar hemispheres and vermis. Mental flexibility dysfunctions also correlated with reductions in white matter volume in bilateral cerebellum. This evidence supports the contribution of cerebellar grey and white matter deficits to executive dysfunctions observed in schizophrenia.     

Negative symptoms are associated with modularity and thalamic connectivity in schizophrenia

Negative symptoms, including avolition, anhedonia, asociality, blunted affect and alogia are associated with poor long-term outcome and functioning. However, treatment options for negative symptoms are limited and neurobiological mechanisms underlying negative symptoms in schizophrenia are still poorly understood. Diffusion-weighted magnetic resonance imaging scans were acquired from 64 patients diagnosed with schizophrenia and 35 controls. Global and regional network properties and rich club organization were investigated using graph analytical methods. We found that the schizophrenia group had higher modularity, clustering coefficient and characteristic path length, and lower rich connections compared to controls, suggesting highly connected nodes within modules but less integrated with nodes in other modules in schizophrenia. We also found a lower nodal degree in the left thalamus and left putamen in schizophrenia relative to the control group. Importantly, higher modularity was associated with greater negative symptoms but not with cognitive deficits in patients diagnosed with schizophrenia suggesting an alteration in modularity might be specific to overall negative symptoms. The nodal degree of the left thalamus was associated with both negative and cognitive symptoms. Our findings are important for improving our understanding of abnormal white-matter network topology underlying negative symptoms in schizophrenia.

     

Late component ERPs are associated with three syndromes in schizophrenia

Previous studies have revealed various abnormalities in late-component ERP amplitude and latency in schizophrenia, considered as a diagnostic category. The aim of this study was to investigate the within-sample associations between late-component ERPs and three primary syndromes of schizophrenia Reality Distortion, Psychomotor Poverty and Disorganisation. Subjects included 40 schizophrenics and 40 age and sex matched nonpsychiatric controls. Auditory ERPs (N100, N200, P200, P300) were elicited using an auditory oddball paradigm. Between-group analyses of target data showed reduced N100, N200 and P300 amplitude, increased P200 amplitude and delayed N200 latency in schizophrenics compared to controls. For non-target data, schizophrenics showed similarly reduced N100 amplitude and delayed N200 latency. Within-group analyses of target data showed that the three syndromes (determined by principal component analysis of PANSS ratings) were differentiated by ERP latency, but not amplitude (Disorganisation delayed left hemisphere P200 and P300 latency; Reality Distortion earlier global, midline and left hemisphere N200 latency; Psychomotor Poverty delayed posterior N100 latency). Notably, only Disorganisation showed a divergent pattern of associations with non-target ERP data: reduced P200 amplitude and delayed N100 latency.     

Falls among geropsychiatry inpatients are associated with prn medications for agitation

A retrospective chart review study was conducted to determine risk factors associated with falls. All patients on a 23-bed geropsychiatry service who fell during the course of one calendar year (17 patients, 30 falls) were compared to a control group of 30 non-fallers from the same service and time period. The group of patients who fell during hospitalization was characterized by more frequent history of falls (18% vs 0%, p < 0.05) and ambulatory impairment (76% vs 47%, p < 0.05) and longer length of hospital stay (81 days vs 46 days, p < 0.02). There was no difference in number of medical diagnoses or standing medications between the fallers and non-fallers, but the fallers were more frequently administered benzodiazepines (0.088 doses/day vs 0.034 doses/day, p < 0.03) and neuroleptics (0.039 doses/day vs 0.014 doses/day, p <0.06) on a PRN basis for agitation. We conclude that falls among geropsychiatry inpatients are associated with the administration of PRN benzodiazepines and neuroleptics to control agitation.     

Association of psychopathic traits and symptomatology with violence in patients with schizophrenia

The main aim of the current study is to investigate the association of psychopathic traits and symptomatology with violence in male patients with schizophrenia. The Psychopathy Checklist-Revised (PCL-R) and the Brief Psychiatric Rating Scale (BPRS) were administered to 35 hospitalized male patients diagnosed with schizophrenia. Based on their history of violence, the sample was divided into violent (N = 19) and nonviolent (N = 16) groups. Data were analyzed using parametric, nonparametric and regression analyses. The mean psychopathy and hostility (component of the BPRS) scores were significantly higher for the violent group. Only three patients (16%), all from the violent group, met the diagnostic cutoff for psychopathy (a PCL-R score > or = 30). Regression analyses suggest that both the hostility component of the BPRS and the behavioral component of the PCL-R (Factor 2) are significant predictors of violent behavior in male patients with schizophrenia. However, when the psychopathy scores are high, the probability for violence is already considerable and the level of hostility has only a slight effect. These findings suggest that improvement in illness condition may not reduce the likelihood for violence in male patients with a high psychopathic profile.     

Recurrent falls are associated with increased length of stay in elderly psychiatric inpatients

OBJECTIVES: To identify factors which may contribute to prolonged length of stay in an elderly psychiatric inpatient setting. DESIGN: Retrospective case note study. METHODS: A list of all patients over the age of 65 discharged from a private psychiatric hospital over a three-year period excluding those with a length of stay of over 365 days was obtained (n = 1147). A random sample of 150 patients was selected from the study population. A case note study was then performed looking at a number of variables which have been postulated to affect length of stay. The resulting data was analysed using multivariate statistics. RESULTS: There was no statistically significant association found between baseline factors (including age, gender, cognitive impairment, marital status, order of admission and preadmission living arrangement) and length of stay. Having recurrent falls whilst an inpatient was associated with prolonged hospital stay (p = 0.0006). CONCLUSION: Experiencing recurrent falls whilst an inpatient is associated with prolonged length of stay. Recurrent falls in the elderly may be associated with both physical illness and the use of psychotropic medications. A prospective study examining factors contributing to falls would be important in decreasing fall risk and reducing length of stay.