利培酮和氯氮平对首发精神分裂症患者血浆细胞因子的影响

目的 比较利培酮和氯氮平对首发精神分裂症患者血浆细胞因子影响的差异。方法 用酶联免疫吸附法(ELISA)测定利培酮和氯氮平两组各30例患者治疗6周前后的血浆白细胞介素-2(IL-2)、可溶性白细胞介素-2受体(sIL-2 R)、白细胞介素-6(IL-6)及可溶性白细胞介素-6受体(sIL-6R)的浓度,两组间进行比较,每组治疗前后各自进行比较。结果 两组间比较,血浆细胞因子水平无显著性差异(P>0.05);治疗前后各自进行比较,每组血浆IL-2及sIL-6R水平显著下降(P<0.05),IL-6水平显著升高(P<0.05),sIL-2R治疗前后无显著性差异(P>0.05)。结论 利培酮和氯氮平治疗均对首发精神分裂症患者的IL-2、IL-6及sIL-6R水平产生显著性影响,对sIL-2R水平影响不显著;利培酮和氯氮平对首发精神分裂症患者细胞因子水平的影响基本一致。     

Ⅰ、Ⅱ型精神分裂症患者血浆相关细胞因子的对照研究

目的：探讨首发Ⅰ型(以阳性症状为主)、Ⅱ型(以阴性症状为主)精神分裂症患者血浆白细胞介素6(IL-6)、可溶性白细胞介素6受体(sIL-6R)及白细胞介素13(IL-13)水平的变化。方法：精神分裂症患者30例，其中Ⅰ型组17例，Ⅱ型组10例，混合型3例；健康对照者28名。采用酶联免疫吸附法(ELSLA)对血浆IL-6、sIL-6R及IL-13水平进行检测。结果：精神分裂症患者血浆IL-6及sIL-6R水平均显著高于对照组，而血浆IL-13水平显著低于对照组；Ⅱ型组患者的IL-6及sIL-6R水平均比Ⅰ型组高，其中Ⅱ型组患者IL-6显著高于Ⅰ型组，Ⅱ型组患者血浆IL-13水平显著低于Ⅰ型组；未发现患者组及对照组血浆IL-6、sIL-6R及IL-13之间的相关性。结论：Ⅰ、Ⅱ型精神分裂症患者均存在IL-6、IL-13水平异常，血浆IL-6水平升高、IL-13水平降低可能是Ⅱ型精神分裂症患者的特征性免疫学指标之一。     

急性Guillain-Barre综合征患者血清sIL-2R和sIL-6R水平的测定

目的探讨可溶性白细胞介素2受体(sIL-2R)和可溶性白细胞介素6受体(sIL-6R)在急性Guillain-Barre综合征(GBS)发病中的作用.方法采用ELISA方法测定32例GBS患者和30名正常对照者血清sIL-2R及sIL-6R 水平. 结果 GBS患者血清sIL-2R和sIL-6R水平明显高于正常对照组(P<0.01,P<0.05),重型和极重型患者明显高于轻型及中型患者(P<0.01,P<0.05),且随着病情的好转,两种受体水平也逐渐下降,与治疗前比明显下降(均P<0.05).结论 sIL-2R和sIL-6R水平的高低可作为判断GBS病情变化的指标之一.     

氯氮平对精神分裂症患者血清白细胞介素6的影响

目的：探讨女性首发精神分裂症患者氯氮平治疗前后血清白细胞介素6(IL-6)变化及其与氯氮平血药浓度的关系。方法：采用酶联免疫吸附法测定20例精神分裂症患者治疗前及治疗第1、2、4周血清IL-6，同时用高效液相色谱法测定血清氯氮平浓度，以20名女性健康者血清IL-6作对照，用阳性与阴性症状量表(PANSS)评定治疗前与治疗第4周患者的精神症状。结果：患者组治疗前血清IL-6显著高于正常对照组，治疗第1、2、4周IL-6显著低于对照组；患者组治疗后各时点IL-6与氯氮平血清浓度无显著相关；氯氮平治疗4周后，PANSS减分率与IL-6减分率无显著相关。结论：女性首发精神分裂症患者IL-6水平与健康女性差异显著，氯氮平可显著降低女性精神分裂症患者IL-6水平，精神分裂症症状改善与IL-6变化无显著相关。     

抑郁症睡眠障碍与血清IL-2及sIL-2R水平的关系

目的探讨IL-2、sIL-2R与抑郁症睡眠障碍的关系.方法采用酶联免疫吸附法(ELSIA)检测35例抑郁症和30名健康对照的血浆IL-2、sIL-2R水平.结果抑郁症组IL-2水平低于对照组(P＜0.05),且IL-2水平与睡眠表浅呈正相关关系(P＜0.05);sIL-2R水平与对照组相比,无明显差异(P＞0.05).结论抑郁症患者的睡眠表浅可能与血浆IL-2水平降低有关.     

白介素—8和γ—干扰素在精神分裂症患者中表达水平的研究

目的 探讨白细胞介素—8和γ—干扰素表达水平与精神分裂症的关系.方法 对96例符合CCMD-3精神分裂症诊断标准的患者,用利培酮治疗.在治疗前后检测血清IL-8、INF-γ水平,在治疗前后评定PANSS和TESS量表,并采用酶联免疫试验(ELISA)检测血清IL-8和INF-γ含量.结果 首发精神分裂症血清IL-8明显高于正常组(P＜0.05),男女之间无差异;血清IL-8与病程、PANSS总分均呈正相关(r=0.627,0.592,P＜0.05),患者治疗前后血清INF-γ明显低于正常组,治疗前后变化无显著性差异(P＞0.05).结论 精神分裂症发生中IL-8产生增加并反映早期病情严重程度,患者INF-γ产生不足.     

血浆IL-6、sIL-6R及IL-13与首发精神分裂症临床特征的关系

目的　探讨首发精神分裂症患者血浆IL 6、sIL 6R、IL 13水平及其与精神分裂症临床特征之间的相关关系。方法　采用酶联免疫吸附法 (ELISA)测定 3 0例首发精神分裂症患者血浆IL 6、sIL 6R及IL 13水平 ,并用阳性和阴性症状评定量表 (PANSS)评定精神症状严重程度。结果　精神分裂症患者血浆IL 6及sIL 6R水平显著高于正常对照组 (P <0 0 5 ) ;而血浆IL 13水平显著低于正常对照组 (P <0 0 5 )。患者血浆sIL 6R水平与阳性症状分 (P分 )呈正相关 (r=0 3 79,P =0 0 2 0 ) ;血浆IL 13水平与阴性症状分 (N分 )呈负相关 (r=-0 60 2 ,P =0 0 0 0 ) ,IL 13与PANSS总分呈负相关 (r=-0 3 3 4,P =0 0 3 5 )。结论　精神分裂症患者可能存在免疫功能异常 ,sIL 6R可能作为反映精神分裂症阳性症状严重程度的免疫指标之一 ,IL 13可能作为反映精神分裂症阴性症状严重程度的免疫指标之一。     

首发精神分裂症患者临床疗效和血清炎性因子水平相关性

目的探讨首发精神分裂症患者临床疗效和血清炎性因子水平的关系。方法选取我院2017年12月～2018年12月收治的90例首发精神分裂症患者,所有患者接受奥氮平治疗,四周后采用阳性和阴性症状量表(PANSS)评估状态,检测转化生长因子-β1(TGF-β1)、白细胞介素-17(IL-17)、白细胞介素-6(IL-6)、白细胞介素-1β(IL-1β)、超敏C-反应蛋白(hs-CRP)。根据治疗前后的PANSS减分率,将患者分为一组和二组,一组的减分率低于50%,二组的减分率不低于50%。观察比较两组患者的TGF-β1、IL-6、IL-17、IL-1β、hs-CRP。结果所有患者治疗四周后,PNASS减分率低于50%的有47例,PNASS减分率不低于50%的有43例。两组患者治疗后的IL-6、IL-17、IL-1β比治疗前明显减少(P0.05),并且一组患者明显比二组患者更低;两组患者治疗后的hs-CRP比治疗前均明显增加(P0.05),两组组间比较无明显差异(P0.05)。结论奥氮平治疗首发精神分裂症患者后其血清IL-6、IL-17、IL-1β变化明显,可以一定程度上反映治疗效果。     

氯氮平所致精神分裂症患者白细胞减少与血浆中IL-2、IL-6水平变化

目的分析氯氮平所致精神分裂症患者白细胞减少与血浆中白细胞介素2(IL-2)、白细胞介素6(IL-6)水平变化的关系。方法对165例采用氯氮平治疗的首发精神分裂症患者进行全血细胞计数监测,按治疗过程中发生白细胞减少与否分为减少组(35例)和未减少组(130例);在两组患者服药前和减少组发生白细胞减少时、未减少组服药3个月后分别采样,采用酶联免疫吸附法分别测定两组患者两次样本血浆中的IL-2、IL-6的水平。结果用药前减少组的IL-2水平显著低于未减少组[(12.3±2.4)pg/mLvs(31.1±5.4)pg/mL,P<0.01],而两组的IL-6水平差异无统计学意义(P>0.05);用药后白细胞减少时减少组的IL-6水平显著低于用药后3个月未减少组[(20.6±3.7)pg/mLvs(40.8±10.3)pg/mL,P<0.05]。同组用药前后比较,减少组用药前后IL-2水平差异无统计学意义(P>0.05),而用药前IL-6水平显著高于用药后[(40.5±9.5)pg/mLvs(20.6±3.7)pg/mL,P<0.05]。未减少组用药前后IL-2、IL-6水平差异无统计学意义(P>0.05)。结论血浆IL-2、IL-6水平可能对预测氯氮平引起精神分裂症患者白细胞减少有一定价值。     

利培酮和氯氮平治疗儿童首发精神分裂症患者血清IL-10变化的研究

目的了解氯氮平和利培酮对儿童精神分裂症患者血清白细胞介素-10(IL-10)的影响,并探讨IL-10与精神病理之间的关系。方法115例儿童首发精神分裂症患者随机分为利培酮(59例)和氯氮平(56例)治疗组,采用酶联免疫吸附法检测两患者组治疗前后和正常对照组(50例)血清IL-10水平,对同一药物治疗前后、不同药物治疗组之间、患者组及对照组之间进行IL-10水平比较;同时采用阳性和阴性症状量表(PANSS)评估患者精神症状及其变化,分析IL-10与精神症状的相关性。结果①氯氮平和利培酮组患者治疗前及治疗后6个月末IL-10水平与对照组比较均无显著性差异(P>0.05),治疗后8周末IL-10水平均显著低于对照组(P<0.01);氯氮平组患者治疗后4周末IL-10水平显著低于对照组(P<0.05);②两治疗组患者治疗后4、8周及6月末IL-10水平均显著低于治疗前(P<0.05,P<0.01);③在治疗前及治疗后各时段,两治疗组之间IL-10水平比较均无显著差异(P>0.05);④氯氮平组患者,治疗后6月末IL-10水平与PANSS总分呈正相关(P<0.05),治疗后8周末IL-10变化率与阳性症状分减分率及总分减分率呈正相关(P<0.05);⑤氯氮平组患者治疗后8周末血清IL-10变化率与8周末的氯氮平日剂量呈正相关(P<0.05)。结论利培酮和氯氮平对儿童精神分裂症患者血清IL-10均有抑制作用,两种药物对患儿IL-10水平的影响基本一致;儿童首发精神分裂症患者血清IL-10水平与精神病理之间可能有一定关系。     

Homocysteine and cognition in first-episode psychosis patients

In the last years, there has been growing evidence linking elevated homocysteine levels with cognitive dysfunction in several neurological and neuropsychiatric diseases. The aim of the present study was to investigate the potential relationship between elevated homocysteine levels and cognitive deficits in first-episode psychosis patients. Plasma levels and cognitive performance of 139 patients and 99 healthy volunteers were compared. Patients were classified as elevated homocysteine (>90 percentile for controls) and normal and compared on 22 cognitive outcome measures grouped into cognitive domains known to be impaired in schizophrenia. Patients had a statistically significant increase in plasmatic homocysteine levels. In addition, they presented with significantly increased cognitive deficits. However, no relationship between homocysteine levels and cognitive impairment was detected. These results suggest the need for further studies to clarify the role of homocysteine in the etiology and prognosis of psychosis.     

'Social dysmetria' in first-episode psychosis patients

Waters F, Rock D, Dragovic M, Jablensky A. ‘Social dysmetria’ in first‐episode psychosis patients. Objective: The ‘embodied cognition’ hypothesis suggests a close relationship between internal self‐representations and the outward expression of social behaviours and emotions. Given self‐awareness disturbances in patients with first‐rank symptoms (FRS), we hypothesized that these patients would show abnormal social behaviours. In this study, we examined the social interactive skills of patients with first‐episode psychosis during an interview, together with changes in performance over time. Method: We analysed previously unreported data from 227 patients with first‐episode psychosis (90 with, and 137 without, FRS) who took part in the WHO multicentre study on the Determinants of Outcome of Severe Mental Disorders. They were assessed on the Psychological Impairment Rating Schedule (PIRS) and examined again after 2 years. Results: A principal component analysis on the Psychosocial Impairment Rating Schedule produced two factors (interactive skills; withdrawal from interactions). Patients with FRS showed greater impairments in the domain linked to ‘interactive skills’, which remained 2 years after the first experience of a psychotic illness. These findings were not explained by clinical characteristics, or presence of non‐FRS delusions. Conclusion: Self‐awareness deficits, as indexed by the FRS symptom cluster, are linked to deficits in social interactive behaviours. These abnormalities are indicative of ‘social dysmetria’ in this group, which involves difficulties conveying motor aspects of behaviours, volition and affect to facilitate mutual communication. These findings point to the utility of behavioural assessment scales in clinical and research settings.     

Neuropsychological impairment in first-episode and chronic schizophrenic patients

Patients with first-episode (FE) schizophrenia (n=40), with chronic schizophrenia (n=40) and healthy controls (n=40) matched for age, gender, education and parental socioeconomic status were administered a battery of standardized neuropsychological (NP) tests. Both patient groups showed generalized impairment relative to controls and the most pronounced deficits in visual-motor processing and attention (VSM). Compared with FE patients, chronic schizophrenics performed worse in VSM and abstraction/flexibility. Our findings suggest that NP deficits are fundamental manifestations of the illness, and that mainly frontally based dysfunctions are more prominent in chronic, kraepelinian patients.     

Neurocognitive performance in first-episode and chronic schizophrenic patients

Previous research on neuropsychological disturbances in first-episode and chronic schizophrenic patients has provided mixed results which can be partially attributed to methodological inconsistencies. For the present study, 70 schizophrenic patients (40 with chronic and 30 with first-episode schizophrenia) were compared to 30 healthy controls on a large battery of neuropsychological tests. Special attention was paid to potential confounds such as differences in psychopathology, age and educational level between the schizophrenic sub-samples. Healthy controls performed better than both first-episode and chronic patients in almost all cognitive domains (P < 0.01), while the patient samples did not differ in any of the tasks. Results were confirmed in a second series of analyses in which patient subgroups were equated for sociodemographic background variables. The present results confirm recent data collected in longitudinal studies, thus, lending further support for a neurodevelopmental model of schizophrenia. It is suggested that neuropsychological disturbances occur early in schizophrenia and do not worsen in the course beyond age-related decrement. Possible reasons why previous research has produced contradictory findings are discussed. Received: 26 July 2001 / Accepted: 4 December 2001     

Straight gyrus morphology in first-episode schizophrenia-spectrum patients

Previous studies on the straight gyrus have shown inconsistent results in first-episode schizophrenia. In the present study, straight gyrus morphometry in first-episode schizophrenia-spectrum patients was investigated by using a region-of-interest methodology. 141 schizophrenia-spectrum patients and 81 healthy subjects were studied. Magnetic resonance imaging brain scans (1.5 T) were obtained and images were analyzed by using BRAINS2. The main resulting measurements were straight gyrus gray matter volume and cortical surface area. Patients with schizophrenia-spectrum disorders did not significantly differ from controls in the straight gyrus morphometric variables evaluated (p > 0.115). There was neither significant group-by-side (p > 0.199) or group-by-gender interaction (p > 0.096). Clinical variables were not significantly related with straight gyrus morphology. Our results, based on a large and representative sample, do not confirm the presence of significant straight gyrus morphometric anomalies in schizophrenia-spectrum disorders, after controlling for potential confounding variables.     

Obsessive-compulsive disorder in patients with first-episode schizophrenia

OBJECTIVE: The aim of the present study was to determine the rate of obsessive-compulsive disorder (OCD) in patients with first-episode schizophrenia. METHOD: Fifty patients consecutively hospitalized with first-episode psychosis who met DSM-IV criteria for schizophrenia spectrum disorders were assessed for OCD. The instruments used were the Structured Clinical Interview for DSM-IV, Schedule for the Assessment of Positive Symptoms (SAPS), Schedule for the Assessment of Negative Symptoms (SANS), and Yale-Brown Obsessive Compulsive Scale. RESULTS: Seven (14%) of the 50 schizophrenic patients met DSM-IV criteria for OCD and scored significantly lower than schizophrenic patients without OCD on the formal thought disorder subscale of the SAPS and the flattened affect subscale of the SANS. CONCLUSIONS: OCD is relatively frequent in patients with first-episode schizophrenia and may have a "protective" effect on some schizophrenic symptoms, at least in the early stages of the disease.     

Neurocognitive functioning in patients with first-episode schizophrenia

To assess the course of neuropsychological (NP) impairment in schizophrenia, 71 patients with first episode (FE) schizophrenia and 71 healthy controls were given a comprehensive battery of NP tests at index assessment, after a 2-year and after a 5-year follow-up period. By means of the z-score standardization, summary scores for verbal intelligence (VBI), spatial organisation (SPT), verbal fluency (VBF), Verbal learning (VBL), semantic memory (SEM), visual memory (VIM), delay/retention rate (DEL), short-term memory (STM), visuomotor processing and attention (VSM) and abstraction/flexibility (ABS) were constructed. FE schizophrenia patients showed a worse performance compared to controls in all areas investigated, most pronounced in VSM, SEM and VBL. In the majority of cognitive domains, an improvement was found over the 5-year follow-up period without differences between the two groups. However, in VBF patients slightly deteriorated whilst controls improved and in memory functions patients improved less compared to controls. When controlling for relevant confounders, neither conventional nor atypical neuroleptics showed a deleterious influence on NP performance, except on VBF. Our data suggest that NP impairment is already present at the onset of the illness and remains stable over the early course of schizophrenia.     

Aggression in Asian patients with first-episode psychosis

AIMS: The aims of this study were to examine the prevalence and severity of aggression in patients with first-episode psychosis and to identify the association between aggression and sociodemographic and clinical factors. METHODS: Consecutive patients with first-episode psychosis admitted to the Early Psychosis Intervention Programme, Singapore, were assessed for a history of aggressive acts. Diagnosis was confirmed using the Structured Clinical Interview for DSM-IV and psychopathology was assessed using PANSS. RESULTS: Of the 146 patients, 63.0% had no history of aggressive acts, 13.7% demonstrated severe aggression (defined as weapon use, sexual assault or victim injury) and 23.3% had lesser aggression (all other acts of aggression). Patients with aggression had a significantly longer duration of untreated psychosis (DUP) than those with no history of aggression (p = .01). The mean total PANSS scores did not differ significantly among the three groups. However, the General Psychopathology scores and the scores for 'hostility', 'poor impulse control', 'lack of insight and judgement' and 'somatic concern' were all significantly elevated in patients with aggression (p < .05). CONCLUSION: The significant association between aggression and longer DUP once again reiterates the need for early detection and effective management of first-episode psychosis.     

Cortical excitability in neuroleptic-naive first-episode schizophrenic patients

Transcranial magnetic stimulation (TMS) provides an intriguing in vivo method to investigate motor cortex excitability in men. This offers new insights into the neurophysiological basis of neuropsychiatric diseases. Earlier TMS studies in patients with schizophrenia revealed inconsistent results, probably due to major confounding variables like state of medication and stage of illness. To control for these effects, we studied two TMS paradigms in 21 drug-naive first-episode schizophrenic patients and 21 age- and sex-matched healthy controls. The patient group demonstrated a significant lower resting motor threshold as compared with healthy controls, whereas TMS paradigms of intracortical inhibition and intracortical facilitation failed to show significant differences between patients and controls. This pattern of TMS parameters is similar to that obtained in healthy volunteers investigated under increasing doses of ketamine, a central acting drug known to produce psychosis-like effects. In agreement with recent results of functional imaging, our neurophysiological findings suggest that drug-induced and naturally occurring psychosis may share a common pathway, which may base on dysfunctional glutamatergic mechanisms.