Drug maintenance treatment compliance and its correlation with the clinical picture and course of schizophrenia

The relationship between patients compliance with their drug therapy regime and important predictors of schizophrenia was studied on the basis of a 7-year observation (from the onset of illness) of 185 schizophrenic patients. Compliant patients (N= 57) were compared with noncompliant patients (N=37). The two groups were matched for age at onset, sex, social background and presence of precipitating factors. The compliant patients had better occupational and family adjustment, less intense behaviour disorders prior to the onset of schizophrenia, a shorter term of untreated first psychosis. These patients also had shorter periods of untreated relapses and longer remissions. They had more often insight of their disease whereas serious signs of defect were less frequent. They had later onset of disturbances of self-activity, vitality and identity. The results of this study suggest that with compliance with a neuroleptics drug treatment regime does not affect the number of admissions in the hospital but is related to longer remissions and less intense signs of deficiency.     

The clinical picture of non-regressive schizophrenia

Professor Gunnar Lundquist har tidigure varit överläkare vid Karolinska sjukhusets klinik för alkoholsjukdomar. Han rappor-terar här positiva erfarenheter av Desipramin.     

Guidelines for clinical treatment of early course schizophrenia

Several practice guidelines have been developed for the management of schizophrenia based on the current evidence base, but only a few have focused on the early course of this illness. In this article, we review the current literature on the approaches to management of early schizophrenia (ie, the prodromal, psychotic, and recovery phases of this illness). The efficacy of psychosocial and antipsychotic agents in the prodromal phase is an area of active research. Atypical antipsychotics are the mainstay of treatment for stabilization of the acute psychotic phase. Effective approaches in the recovery phase include combining medications with individual and family interventions, supported employment, assertive community treatment, cognitive remediation, and social skills training. Although evidence-based interventions have generated new optimism among those with the illness, more efforts are needed to increase access to care in community settings.     

The clinical picture and course in basilar impression

We have reviewed 29 cases of patients who suffered from basilar impression and had undergone hospital treatment since 1969. 12 of these patients were reexamined. The predominant symptoms were lesions of the long tracts while the ,,classical signs" such as headache and nystagmus occurred less frequently than expected. Only a quarter of our patients showed a marked deterioration during follow-up. The outcome for four patients who underwent operation is reported.     

Onset and clinical course of schizophrenia in Butajira-Ethiopia

Abstract. Background: There are reports on favourable course and outcome of schizophrenia in lowincome countries. The aim of the present study was to examine onset and clinical course of the illness in a community-based sample in rural Ethiopia based on crosssectional information. Method: A two-stage survey was carried out in Butajira-Ethiopia, a predominantly rural district. Altogether 68,378 individuals aged 15–49 years were CIDI-interviewed, of whom 2,159 were identified as cases according to the CIDI interview with regard to psychotic or affective disorders. Key informants identified another group of 719 individuals as being probable cases and a total of 2,285 individuals were SCAN-interviewed. The present paper reports on cases with schizophrenia. Results: There were 321 cases of schizophrenia giving an estimated lifetime prevalence of 4.7/1,000). Of the cases,83.2% (N = 267) were males. Mean age of first onset of psychotic symptoms for males was 23.8 (sd 8.6) compared to 21.0 (sd 7.8) for females (P = 0.037; 95 %CI 0.16–5.47). Over 80% had negative symptoms and over 67% reported continuous course of the illness. Less than 10% had a history of previous treatment with neuroleptic medication. About 7% were vagrants, 9 % had a history of assaultive behaviour,and 3.8% had attempted suicide. The male to female ratio was nearly 5:1. Conclusion: This large community-based study differs from most previous studies in terms of higher male to female ratio, earlier age of onset in females and the predominance of negative symptoms.     

The 12-year clinical course of schizophrenia

Summary A sample of 46 schizophrenic night-clinic patients (N patients), was matched with a sample of 46 hospital patients (H patients) for diagnosis, age, and sex. They were followed up from 1971/73 until 1983 on the basis of a personal interview and by review of all the case histories and other documents. Their average age at the time of the follow-up examination was 40 years. The average duration of the illness was 18 years in the night-clinic patients and 15 years in the hospital patients. Seven of the 46 N patients (1.4% per year) and two of the 46 H patients (0.4% per year) died during the 12 years. Of the surviving patients one-third had inconspicuous psychopathology. In one-fifth, psychopathology was only conspicuous to a psychiatrist. Only in one-quarter was it very conspicuous even to the layman. The N patients had already shown clearer signs of a chronic, insidious clinical course during the first four years of their illness than the H patients. Although substantially fewer were hospitalised at the time of the follow-up examination (17.6% cf 28.6% respectively), far more of them were receiving either outpatient or semiinpatient care. Unsatisfactory social integration was revealed, their strong tendency to self-isolation and their inadequate work rehabilitation: 71.8% of the N patients and 62% of the H patients were dependent on a disability pension, and only 15.4% of the N patients and 20% of the H patients were employed at work in keeping with their training and experience. Just under half of the patients were living alone. Some 30–40% of them had no contacts with friends or acquaintances. Predictors of a somewhat favourable clinical course included an acutely phasic course during the first few years of the illness, a low level of parental education, and a greater age at the time of the manifestation of the illness. In particular, patients whose illness ran an acute phasic course during the four years after onset had less lengthy hospitalisations in the second stage of the clinical course than patients exhibiting signs of chronicity in the early stage.     

The origin and course of schizophrenia: implications for clinical practice

The authors first review current evidence concerning abnormalities of brain structure and function in schizophrenia and interpret them within a "network" pathophysiological model of the disorder. This information is then placed within a contemporary neurodevelopmental framework that "roots" the illness in adverse events during early pregnancy, which result in a developmentally compromised nervous system. They then consider the controversy as to whether the subsequent expression of psychosis reflects an active morbid process and, in a more general sense, whether the disorder is characterized by subsequent progression and clinical deterioration. The authors argue that the developmental and progressive models should not be considered in an either-or manner, since this perspective is not logical and favors nihilistic approaches to intervention and treatment, but rather should be integrated within a lifetime trajectory model. Finally, implications for current psychiatric practice are considered.     

The change of quality of life and clinical picture in schizophrenia

The aim of the study was to determine how the quality of life changes during antipsychotic treatment in schizophrenia and whether there is any correlation between the change of quality of life and the change of clinical picture in 232 patients with the diagnosis of schizophrenia treated for 8 weeks with antipsychotic medication. The mental status improved significantly during treatment while patients' quality of life improved insignificantly. Severity of schizophrenic symptoms correlated negatively with patients' quality of life before treatment but not after treatment. Clinical improvement of schizophrenic symptomatology correlated negatively with the improvement of patients' quality of life. After treatment the quality of life was significantly worse in patients who had distinct depression before treatment, than in those without depression or with only slight depression before treatment.     

Past substance abuse and clinical course of schizophrenia.

To evaluate the effects of previous alcohol and drug use on the course and symptoms of schizophrenia, the authors compared 34 patients with schizophrenia who had histories of substance abuse with 17 patients with schizophrenia who were lifelong abstainers. Surprisingly, they did not find that individuals with past histories of abuse were more impaired or had more symptoms.     

The clinical course of depressive symptoms in schizophrenia

A sample of 31 schizophrenic patients free of anti-psychotic drugs was examined on admission to hospital. 14 (45%) exhibited depressed mood. The course of depressive symptoms and psychotic symptoms was followed weekly while the patients received increasing doses of haloperidol in a standardised regime. In 11 of the 14 patients there was a close correspondence between the course of depressive and psychotic symptoms, suggesting that in these cases, depression was an integral part of the schizophrenic illness. In the other three cases, clinical course of the various symptoms gave some support to the concepts of 'pharmacogenic' and 'post-psychotic depression', although it was not possible to choose between them.     

Disrupted in Schizophrenia 1 Interactome: evidence for the close connectivity of risk genes and a potential synaptic basis for schizophrenia

Disrupted in Schizophrenia 1 (DISC1) is a schizophrenia risk gene associated with cognitive deficits in both schizophrenics and the normal ageing population. In this study, we have generated a network of protein-protein interactions (PPIs) around DISC1. This has been achieved by utilising iterative yeast-two hybrid (Y2H) screens, combined with detailed pathway and functional analysis. This so-called 'DISC1 interactome' contains many novel PPIs and provides a molecular framework to explore the function of DISC1. The network implicates DISC1 in processes of cytoskeletal stability and organisation, intracellular transport and cell-cycle/division. In particular, DISC1 looks to have a PPI profile consistent with that of an essential synaptic protein, which fits well with the underlying molecular pathology observed at the synaptic level and the cognitive deficits seen behaviourally in schizophrenics. Utilising a similar approach with dysbindin (DTNBP1), a second schizophrenia risk gene, we show that dysbindin and DISC1 share common PPIs suggesting they may affect common biological processes and that the function of schizophrenia risk genes may converge.     

Psychopathology and clinical course of schizophrenia: a cross-cultural perspective

The authors critically review the existing literature on the outcome of schizophrenia in non-Western countries. Compared to studies conducted in Europe and North America, the majority of these non-Western longitudinal followup studies indicated significantly better outcome. Such cross-national variations in the outcome of schizophrenia have been substantiated by two large-scale multicentered studies sponsored by the World Health Organization. Along with this literature review, the authors also discuss potential methodological problems of these studies and examine in detail several key hypotheses concerning mediating factors that could differentially influence the fate of schizophrenic patients in divergent cultural settings. Finally, specific suggestions are made for future research directions.     

Neuropsychological impairments predict the clinical course in schizophrenia

To add to the open question whether cognitive impairments predict clinical outcome in schizophrenia, a sample of 125 first episode patients was assessed at the onset and over one year of controlled long-term treatment within a study of the German Research Network on Schizophrenia. No relapse according to predefined criteria occurred within the first year, but a total of 29 patients fulfilled post-hoc criteria of “clinical deterioration”. Impairments in cognitive functioning assessed by the Trail-Making Test B at the onset of long-term treatment differentiated between patients with vs. without later clinical deterioration and proved to be a significant predictor of the clinical course in a regression analysis outperforming initial clinical status as predictor. However, low sensitivity (72%) and specificity (51%) limit possibilities of a transfer to individual predictions. As a linear combination of neuropsychological and psychopathological variables obtained highest predictive validity, such a combination may improve the prediction of the course of schizophrenic disorders and may ultimately lead to a more efficient and comprehensive treatment planning.

     

Time course and clinical predictors of treatment response in schizophrenia

The severity of schizophrenic symptoms was examined in 50 male chronic patients while neuroleptic free for at least 3 weeks and during 6 weeks of treatment with haloperidol. The results suggested that 50% of the improvement associated with haloperidol administration occurred by the end of the first treatment week and that early improvement, at both 1 and 4 weeks of treatment, was predictable from drug-free symptom severity. There was a negative correlation between week 1 improvement and improvement during the next 3 weeks of treatment, suggesting that medication response is not linear. Finally, dose increases after 4 weeks of treatment with 20 mg of haloperidol did not lead to any clinical improvement. These results are discussed in terms of their implications for selecting chronic schizophrenic patients who will and will not benefit from medication treatment.