Quality of life and cognitive dysfunction in people with schizophrenia

The main purpose of the present study was to examine the relationship between quality of life (QOL) and cognitive dysfunction in schizophrenia. Subjects were 61 stabilized outpatients. Quality of life and cognitive function were assessed using the Quality of Life Scale (QLS) and the Brief Assessment of Cognition in Schizophrenia (BACS), respectively. Clinical symptoms were evaluated with the Positive and Negative Syndrome Scale (PANSS) and the Calgary Depression Scale for Schizophrenia (CDSS). The BACS composite score and the BACS Verbal memory score were positively correlated with the QLS total score and two subscales. The BACS Attention and speed of information processing score had positive correlation with the QLS total and all the subscales scores. The PANSS Positive and Negative syndrome scores also had significant correlations with the QLS total score and all of the subscales. In addition, the CDSS score was negatively correlated with the QLS total score and some of the subscales. Stepwise regression analysis showed that the BACS Attention and speed of information processing score was an independent predictor of the QLS total score but it was less associated with the QLS than the PANSS Negative syndrome score and the CDSS score. The results suggest that negative and depressive symptoms are important factors on patients' QOL and also support the view that cognitive performance provides a determinant of QOL in patients with schizophrenia.     

阿立哌唑与氯氮平治疗精神分裂症对照研究

目的：比较阿立哌唑与氯氮平治疗精神分裂症的临床疗效与安全性。方法：将精神分裂症患者100例随机分为阿立哌唑组与氯氮平组。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）、健康状况问卷（SF-36）评定疗效及不良反应。结果：两组治疗后PANSS评分均显著下降，两组问比较差异无显著性（P〉0．05）。不良反应发生率阿立哌唑组显著低于氯氮平组（P〈0．05）。结论：阿立哌唑治疗精神分裂症疗效与氯氮平相仿，不良反应少，是一种安全有效的抗精神病药。     

The five symptom dimensions and depression in schizophrenia

The aim of this study was to investigate the relationship between the five-factor model of psychopathology and depression in schizophrenia. Symptoms were rated using the Positive and Negative Syndrome Scale (PANSS) and the Montgomery and Asberg Depression Rating Scale (MADRS) in 105 chronic patients with schizophrenia. Principal-component analysis (PCA) produced a five-factor solution for the PANSS (psychomotor poverty, disorganisation, reality distortion, excitement, and depression), and a two-factor solution for the MADRS (psychological and behavioural depression). The PANSS depression factor was highly associated with the MADRS psychological depression factor but not with MADRS behavioural depression. By contrast, the PANSS excitement factor showed a strong positive correlation with the behavioural depression factor but not with psychological depression. These MADRS factors were not associated significantly with the core PANSS factors, including psychomotor poverty. It is suggested that depression exists as an independent domain, differentiated from negative symptoms, in the structure of schizophrenia symptomatology.     

阿立哌唑联用小剂量氯氮平治疗女性难治性精神分裂症对照研究

目的 探讨阿立哌唑联合小剂量氯氮平对女性难治性精神分裂症（TRS）的疗效和安全性。方法 将62例女性TRS患者随机分成研究组和对照组各31例,对照组采用阿立哌唑治疗,研究组采用阿立哌唑联用小剂量氯氮平治疗,观察26周。于治疗前及治疗后第8、12、26周末进行阳性和阴性综合征量表（PANSS）评定;治疗后第1、2、6、12、26周末用治疗中需处理的不良反应症状量表（TESS）评定不良反应。结果 治疗后第8、12、26周末两组PANSS总分均较治疗前下降（P〈0.01）,研究组PANSS总分低于对照组（P〈0.05）。两组间不良反应发生率比较差异无统计学意义（P〉0.05）。结论 阿立哌唑联合小剂量氯氮平治疗女性TRS更有效且安全。     

阿立哌唑与氯氮平治疗首发精神分裂症对照研究

目的比较阿立哌唑与氯氮平治疗首发精神分裂症的疗效及安全性。方法将63例首发精神分裂症患者随机分为阿立哌唑组(n=32)和氯氮平组(n=31)进行治疗,疗程8周。采用PANSS量表和TESS量表评定疗效和不良反应。结果两组疗效差异无显著性(P>0.05),阿立哌唑不良反应显著少于氯氮平(P<0.01)。结论阿立哌唑与氯氮平治疗首发精神分裂症均有效,前者不良反应少,安全性高。     

阿立哌唑与氯氮平治疗精神分裂症的疗效比较

目的探讨阿立哌唑治疗精神分裂症的疗效及安全性。方法按照CCMD-3诊断标准选择100例住院精神分裂症患者，并随机分为阿立哌唑组（47例）及氯氮平组（43例）分别进行治疗。疗程为8周。结果在治疗第8周末，两组的显效率分别为72．34％及69．77％（P〉0．05）；两组的PANSS总分的减分率分别为69．3％及67．8％（P〉0．05）；两组治疗前后的PANSS总分及各分量表分同组比较有显著性差异（P〈0．01），两组间比较除治疗末PANSS的阴性症状分阿立哌唑组较低，且有显著性差异（P〈0．01）外，其它均无显著性差异（P〉0．05）。其次，阿立哌唑组不良反应为焦虑、头痛、失眠、胃肠道反应等，未发现有明显的体重增加、锥体外系反应。结论阿立哌唑治疗精神分裂症的阳性及阴性症状有较好疗效，不良反应较微，安全性良好。     

Amisulpride augmentation of clozapine: an open non-randomized study in patients with schizophrenia partially responsive to clozapine

OBJECTIVE: Treatment options are very limited for individuals with schizophrenia resistant to clozapine. We tested the hypothesis that amisulpride augmentation would lead to an improvement in these patients. METHOD: This was an open non-randomized study. Thirty-three patients with sub-optimal response to clozapine were commenced on amisulpride in addition to clozapine. Clinical status was evaluated at baseline, 3 and 6 months using the Positive And Negative Syndrome Scale (PANSS), Scale for the Assessment of Negative Symptoms (SANS), Global Assessment Scale (GAS), Calgary Depression Scale, Calgary Anxiety Scale and various side effect rating scales. RESULTS: Twenty-eight subjects completed 6 months treatment on clozapine and amisulpride. There was a statistically significant improvement in the mean scores for PANSS, SANS and GAS at follow-up and no significant changes in side effect ratings. CONCLUSION: Co-administration of amisulpride, in a group of patients partially or non-responsive to clozapine, may lead to a substantial improvement in positive and negative symptoms, without worsening the side effect burden.     

Sexual functioning, psychopathology and quality of life in patients with schizophrenia

OBJECTIVE: The present study was to characterize relationships among sexual functioning, schizophrenia symptoms and quality of life measures. In addition, sexual functioning was compared among patients treated with different antipsychotic agents. METHODS: Outpatient subjects were assessed using the Positive and Negative Symptom Scale (PANSS), the Changes in Sexual Functioning Questionnaire (CSFQ) and the Hamilton Rating Scale for Depression (HAMD). Quality of life was assessed using two different instruments: observer-rated Heinrich's Quality of Life Scale (QLS) and self-rated The Behavior and Symptom Identification Scale (BASIS). RESULTS: One hundred twenty-four patients with schizophrenia or schizoaffective disorder were enrolled in the study. Eight-six patients (69%) completed at least part of the CSFQ assessment, which generated at least one valid subscale score. High rates of sexual impairment were found in both male and female patients (65%-94% across different subscales). For males, higher scores on the PANSS-positive subscale were associated with a lower frequency of sexual activity (p=0.04). For females, higher scores on the PANSS-positive subscale and PANSS-general psychopathology subscale were significantly associated with more difficulty in both sexual arousal and orgasm (p's<0.05). For both males and females, there were no significant relationships between any CSFQ subscale measures and the quality of life measures (p's>0.05). No significant differences were found among three antipsychotic treatment groups (clozapine, olanzapine or typical agents) on any CSFQ subscale measures or quality of life measures after controlling for PANSS total scores (p's>0.05). CONCLUSIONS: Effective treatment strategies still need to be developed to address sexual dysfunction and quality of life in patients with schizophrenia.     

Community dysfunction in schizophrenia: rate-limiting factors

The purpose of the present study was to investigate the impact of cognitive functioning, psychopathology, and severity of extrapyramidal side effects on community outcome in a group of Greek outpatients with schizophrenia. Participants were 40 outpatients with schizophrenia (25 men). Social adjustment was assessed with the Quality of Life Scale (QLS). Severity of symptoms of schizophrenia was measured with the Positive and Negative Syndrome Scale (PANNS), and extrapyramidal symptoms with the Extrapyramidal Symptom Rating Scale (ESRS). Finally, a battery of neuropsychological tests was administered in order to assess the following cognitive domains: executive functioning/set shifting, executive functioning/inhibition, fluency, verbal memory, visual memory, working memory, attention, visuospatial ability, and psychomotor speed/visual scanning. Total scores on the QLS were significantly correlated with negative symptoms, parkinsonism, and performance on the fluency tasks. Interpersonal relations subscale was significantly related with negative symptoms and fluency. No significant relationship was found between the Instrumental Role Functioning subscale and the PANSS, ESRS, or any cognitive domain. Scores on the Intrapsychic Foundation subscale were significantly correlated with negative symptoms and fluency. Finally, scores on the Common Objects and Activities subscale were significantly related with severity of negative symptoms, parkinsonism and visual memory. Our findings suggest that severity of negative symptoms, cognitive dysfunction, especially performance on fluency tasks and visual memory, as well as parkinsonism, are important determinants of functional outcome in schizophrenia.     

阿立哌唑与氯丙嗪治疗精神分裂症对照研究

目的比较阿立哌唑与氯丙嗪治疗精神分裂症的疗效及安全性。方法采用多中心、随机对照、开放性研究。阿立哌唑组31例,氯丙嗪组34例,两组均以PANSS量表[1]评估疗效,以TESS量表评估药物不良反应。结果PANSS阴性症状减分第8周末阿立哌唑组优于氯丙嗪组(P<0.05)。阿立哌唑组与氯丙嗪组的总体疗效相当(P>0.05)。TESS量表评估显示氯丙嗪引起锥体外系反应、体重增加和胆碱能系统等不良反应发生率较阿立哌唑高(P<0.05)。结论阿立哌唑对精神分裂症疗效与传统抗精神病药物氯丙嗪相当,但安全性高。     

Lamotrigine augmentation in patients with schizophrenia who show partial response to clozapine treatment

BackgroundSeveral placebo controlled studies investigating lamotrigine augmentation of clozapine in schizophrenia patients with partial response have shown varying results. The aim of this study was to further investigate the efficacy and safety of this augmentation strategy, and its effect on the glutamatergic system through utilizing mismatch negativity (MMN) component of auditory event related potentials.MethodsThe study was designed to evaluate the efficacy and safety of lamotrigine augmentation of clozapine in a 12-week, double-blind, placebo-controlled, prospective, randomized design. Thirty-four patients diagnosed according to DSM-IV schizophrenia criteria and with partial response to clozapine were included. Patients were randomized to 25 mg/day of lamotrigine or placebo, gradually increasing up to 200 mg/day on the 6th week. The change in psychopathology was assessed with Positive and Negative Syndrome (PANSS), Calgary Depression (CDS) and Clinical Global Impression-Severity (CGI-S) scales. A neuropsychological test battery was administered and MMN measurements were also obtained at baseline and endpoint. Safety evaluation included physical examination, UKU Side Effect Rating Scale (UKU) assessment and serum drug level measurements.ResultsNo significant differences were found between the two treatment groups in PANSS Positive and General Psychopathology, CDS, neurocognitive test and UKU scores, as well as MMN measurements. PANSS Total, Negative and CGI-S scores showed significant improvement compared to lamotrigine in the placebo group.ConclusionThis study did not show any benefit of augmentation of clozapine with lamotrigine in schizophrenia patients with partial response. The need for further investigation of other augmentation strategies of clozapine in partially responsive schizophrenia patients is evident.     

阿立哌唑与氯氮平对精神分裂症患者生活质量影响的对照研究

目的探讨阿立哌唑对精神分裂症患者生活质量的影响。方法对90例精神分裂症患者随机分为两组,分别给予阿立哌唑、氯氮平治疗6个月。用阳性症状与阴性症状量表（PANSS）评定精神症状,用世界卫生组织编制的生活质量量表（WHO QOL-100）评定生活质量,用TESS评定药物不良反应。结果治疗6个月后,两组对患者的生活质量均有改善。阿立哌唑组对WHO QOL-100各领域中,除精神支柱领域外,在生理、心理、独立性、社会关系和环境等领域的改善均明显优于氯氮平组;而氯氮平组仅明显改善心理领域。两组PANSS总分较疗前均有极显著性差异（P〈0．01）,两组间比较无显著性差异,但阿立哌唑对阴性症状的改善优于氯氮平。阿立哌唑比氯氮平的不良反应少且轻。结论阿立哌唑对精神分裂症患者生活质量的改善优于氯氮平,有利于患者重返社会。     

Deficits in sustained attention in schizophrenia but not in bipolar disorder

The aim of the present study was to investigate sustained attention in remitted patients with bipolar disorder and in patients with schizophrenia, as compared to each other and to healthy controls; a secondary aim was to investigate the correlations of different symptom dimensions with performance on sustained attention in the two patient groups. Participants were 29 (18 men) outpatients with schizophrenia (SZ), 19 (8 men) patients with bipolar disorder I (BP) in remission, and 30 (15 men) healthy controls (HC); all three groups were matched on age, sex ratio, and level of education. Symptom severity (positive symptoms, negative symptoms, and general psychopathology) of patients with SZ were assessed with the Greek version of the Positive and Negative Syndrome Scale (PANSS); residual affective symptoms of patients with BP were assessed with the Young Mania Rating Scale (YMRS) and the Montgomery-Asberg Depression Rating Scale (MADRS). Sustained attention was measured by means of the Penn Continuous Performance Test (PCPT). The three groups differed significantly on the PCPT scores. Patients with SZ performed more poorly than both the BP and HC groups, whereas patients with BP did not differ significantly from HC. Performance on the PCPT did not correlate significantly with scores on the YMRS and MADRS in patients with BP. Also, scores on the PCPT did not correlate significantly with scores on any of the three subscales of the PANSS. Outpatients with schizophrenia presented deficits in sustained attention, whereas patients with bipolar disorder I in remission did not manifest such impairment. These results imply that impaired sustained attention might be a more enduring deficit in schizophrenia than it appears to be in bipolar disorder.     

Efficacy and safety of aripiprazole and haloperidol versus placebo in patients with schizophrenia and schizoaffective disorder

BACKGROUND: Aripiprazole is an investigational agent for treating schizophrenia that has a novel pharmacologic profile. The present study investigated the efficacy, safety, and tolerability of aripiprazole and haloperidol compared with placebo. METHOD: A 4-week, double-blind, randomized study, conducted at 36 U.S. centers between July 1997 and June 1998, compared aripiprazole (15 mg/day, 30 mg/day) to placebo, with haloperidol (10 mg/day) as an active control. Fixed doses of each agent were administered from day 1 throughout the study. A total of 414 patients with a primary DSM-IV diagnosis of schizophrenia or schizoaffective disorder were randomized. Efficacy measures included the Positive and Negative Syndrome Scale (PANSS) total, PANSS positive, PANSS negative, PANSS-derived Brief Psychiatric Rating Scale (BPRS) core, Clinical Global Impressions (CGI)-Severity of Illness, and mean CGI-Improvement scores. Safety and tolerability evaluations included extrapyramidal symptoms (EPS), weight gain, serum prolactin level, and QTc interval. RESULTS: Both doses of aripiprazole and haloperidol, 10 mg, produced statistically significant (p < or = .05) improvements from baseline in PANSS total, PANSS positive, PANSS-derived BPRS core, and CGI-Severity scores and significantly lower CGI-Improvement scores at endpoint, compared with placebo. Aripiprazole, 15 mg, and haloperidol, 10 mg, significantly improved PANSS negative score compared with placebo. Both aripiprazole doses and haloperidol separated from placebo for PANSS total scores at week 2. Unlike haloperidol, aripiprazole was not associated with significant EPS or prolactin elevation at endpoint compared with placebo. There were no statistically significant differences in mean changes in body weight across the treatment groups versus placebo, and no patients receiving aripiprazole experienced clinically significant increases in QTc interval. CONCLUSION: Aripiprazole, effective against positive and negative symptoms, is a safe and well-tolerated potential treatment for schizophrenia and schizoaffective disorder.     

Association of symptomatology and cognitive deficits to functional capacity in schizophrenia

PURPOSE: This study aimed to evaluate the association of positive and negative symptoms, as well as of neurocognition to functional status in patients with schizophrenia. Participants were 309 veterans with DSM-IV-diagnosed schizophrenia or schizoaffective disorder who were enrolled in a 12-month double-blind clinical trial and randomized to receive either 5 to 20 mg/d of oral olanzapine or haloperidol. Patients were assessed at study entry and at 3, 6 and 12-months on the PANSS and measures of verbal memory, verbal fluency, fine motor coordination, visual sequencing/set shifting, and conceptual reasoning. Functional status was evaluated by the Heinrichs-Carpenter Quality of Life Scale (QLS) and by days of employment in the past 30. Hierarchical regression models examined the association of functional status with symptomatology and three neurocognitive factors (motor skills, memory and card sorting), controlling for demographics and visit number. A mixed effects model was used to adjust for repeated observations from the same subjects. RESULTS: The PANSS explained 16% additional variance in QLS total score after accounting for demographics and visit number (p<.001), while the neurocognitive factors explained only 4% additional variance beyond the effect of symptoms. When neurocognition was entered before symptoms, it explained an additional 8% of the variance on the QLS total score, while the PANSS explained an additional 12% over and above neurocognition. CONCLUSIONS: These findings suggest that symptoms may pose an equal or greater impediment to functional capacity independent of neurocognition, at least in younger non-institutionalized people with schizophrenia.     

Subjective and objective quality of life, levels of life skills, and their clinical determinants in outpatients with schizophrenia

The purpose of the present study is to investigate the relationships among subjective and objective quality of life (QOL), and levels of life skills, and their clinical determinants in outpatients with schizophrenia by using schizophrenia disease-specific QOL measures. Data collected from 64 outpatients were analyzed. Subjective QOL was measured with the Schizophrenia Quality of Life Scale (SQLS) and objective QOL with the Quality of Life Scale (QLS). Patients' family members completed the Life Skills Profile (LSP). Clinical symptoms were also assessed with several scales including the Brief Psychiatric Rating Scale (BPRS) and the Calgary Depression Scale for Schizophrenia (CDSS). Only the motivation/energy scale, but not the other scales of the SQLS, correlated with the QLS. The LSP rated by the family showed significant correlations with both the SQLS and the QLS. The CDSS score predicted each scale of the SQLS, and the BPRS negative symptoms score predicted the QLS. The LSP was predicted by the BPRS negative symptoms score and the CDSS score independently. These results indicate that the patient's QOL could be predicted by the life skills measured by a family member and suggest that active treatment for depressive and negative symptoms might be recommended to improve the patient's QOL and life skills.     

喹硫平与氯氮平对精神分裂症患者疗效及体重的影响

目的比较喹硫平与氯氮平对精神分裂症的疗效及对患者体重的影响。方法对80例精神分裂症患者随机分组治疗,喹硫平组40例平均剂量(701.3±150.5)mg/d,氯氮平组40例平均剂量为(375.4±101.6)mg/d。观察8周。两组于治疗前及治疗第2、4、8周末分别测定阳性与阴性症状量表(PANSS)、副反应量表(TESS)、体重和体重指数(BMI),并与健康人对照。结果喹硫平组各时点的PANSS总分及减分率与氯氮平组差异无显著性(P>0.05);氯氮平组不良反应较多(P<0.05);氯氮平组在治疗第4、8周末的体重及体重指数均显著高于喹硫平组和健康对照组(P<0.05)。喹硫平组和健康对照组的体重及体重指数各时点比较差异无显著性(P>0.05)。结论喹硫平治疗精神分裂症的疗效与氯氮平相当,但副作用较少,对患者体重无显著影响。     

阿立哌唑治疗难治性精神分裂症患者的疗效和安全性

目的:探讨阿立哌唑治疗门诊难治性精神分裂症患者的疗效和安全性。方法:204例入组患者符合中国精神障碍分类与诊断标准第3版精神分裂症的诊断标准,且符合难治性精神分裂症的标准。所有患者接受为期8周的阿立哌唑开放性治疗,在基线、治疗2、4和8周采用阳性与阴性症状量表(PANSS)评定疗效,采用治疗中出现的症状量表(TESS)评定不良反应。结果:阿立哌唑治疗4周开始起效,治疗8周,有效率为55.4%。治疗4和8周,患者PANSS总分减分率有统计学意义(t=2.44,P<0.05;t=3.61,P<0.01),PANSS阳性分减分率有统计学意义(t=3.53,P<0.05;t=3.89,P<0.01),PANSS阴性分减分率有统计学意义(t=3.19,P<0.05;t=4.02,P<0.01)。主要不良反应为焦虑、头晕头痛、失眠、恶心呕吐、嗜睡等。结论:阿立哌唑对于难治性精神分裂症患者的治疗具有一定的疗效,不良反应少,耐受性较好。     

Risperidone augmentation for schizophrenia partially responsive to clozapine: a double-blind, placebo-controlled trial

RATIONALE: Risperidone augmentation of clozapine in refractory schizophrenia has theoretical but only inconsistent support from clinical trials. OBJECTIVES: To examine if adding risperidone to stable yet symptomatic schizophrenia outpatients on optimized clozapine monotherapy improves psychopathology. METHODS: We conducted a double-blind placebo-controlled parallel-group trial of a fixed dose of 4 mg/day risperidone added for 6 weeks in 24 outpatients with schizophrenia. RESULTS: Subjects who received risperidone showed a non-significant decrease in PANSS total score. The PANSS disorganized thought subscale improved significantly (beta=-3.3079, p=0.047). CONCLUSIONS: Our trial does not support the routine addition of risperidone to clozapine in refractory schizophrenia patients. However, much larger trials are needed to conclusively settle the question of added efficacy from this combination.     

Beneficial effect of donepezil augmentation for the management of comorbid schizophrenia and dementia

Comorbid schizophrenia and dementia is a common clinical phenomenon; however, management of the coexisting illnesses remains incomplete. Donepezil, a cholinesterase inhibitor, may be beneficial for the management of symptoms of Alzheimer's disease, a disease in which cholinergic pathways in the cerebral cortex and basal forebrain are well known to be compromised. Furthermore, impaired cognition in elderly schizophrenic patients has been observed to be more than two thirds; however, there are no published controlled studies reporting the use of cholinesterase inhibitors in the management of schizophrenia in patients with associated dementia. In this study, six patients with chronic schizophrenia and comorbid dementia were administered donepezil, 5 mg, in single-blind fashion as augmentation to their standard antipsychotic medication for a 4-week period. Patients were evaluated with the Mini Mental State Examination (MMSE); Alzheimer's Disease Assessment Scale, Cognitive subscale; Positive and Negative Symptom Scale (PANSS); and the Clinical Global Impression (CGI) scales. A significant improvement was noted in MMSE scores (P < 0.01) and for CGI scores (P < 0.01). In addition, three patients demonstrated improvement on the PANSS. Donepezil appears to be an effective treatment for the management of symptoms of dementia accompanying patients with comorbid schizophrenia and dementia. Since cholinergic dysfunction may be present in some patients with schizophrenia, the authors' findings further demonstrate the possibility that this disorder may be managed with cholinergic medications as augmenting agents, at least in this specific subpopulation of patients with comorbid dementia. To confirm the findings of this preliminary trial, further investigation is mandated with a larger sample of subjects in the context of a double-blind medication trial.