Is cognitive enhancement therapy equally effective for patients with schizophrenia and schizoaffective disorder?

Patients with schizoaffective disorder (SZA) experience significant deficits in cognitive functioning similar to those seen in patients with schizophrenia (SZ), which are associated with poor functional outcomes. Cognitive remediation (CR) has shown promise in improving cognitive and functional outcomes in patients with SZ: however, no studies have compared these effects across diagnoses. We compared patients with SZ and SZA after cognitive enhancement therapy (CET) or enriched supportive therapy (EST). Both patient groups improved in multiple domains after CET, and diagnosis did not significantly moderate this relationship. Extending CR to all patients in which cognitive dysfunction is a core feature may be indicated.     

Looking forward: An impaired ability in patients with schizophrenia?

When two visual stimuli occur within 8 to 17ms of one another, subjects cannot tell they are asynchronous, yet recent results show they are not processed as simultaneous. Two spatially separate squares were presented at an interval ranging from 0 to 92ms and remained on the screen until subjects responded. Subjects pressed a right or left response key according to the judged simultaneity/asynchrony of the stimuli. We evaluated the Simon effect, i.e., the tendency to press the key on the same side as the stimulus. We found an effect even when the squares were displayed on opposite sides of the screen, with their onsets separated by less than 20ms. Controls were biased towards the last stimulus, whereas patients with schizophrenia were biased towards the first. We investigate here whether the results are related to spatial or temporal processing. Using the same paradigm, we explored the impact of spatial grouping by comparing connected vs. unconnected stimuli and manipulating the predictability of the second stimulus location. We tested different groups of mildly symptomatic patients and matched controls in two studies. Under 20ms, when stimuli were connected and the 2nd square location was predictable, patients tended to press the key to the side of the 1st square, whereas controls displayed the opposite tendency. The results suggest that controls put more emphasis on the last occurring event, but not patients with schizophrenia. This impairment is observed when spatial difficulties are removed, suggesting it is related to time rather than space.     

Combination warfarin-ASA therapy: which patients should receive it, which patients should not, and why?

Combination warfarin-ASA therapy is currently used in approximately 800,000 patients in North America as long-term treatment for the primary and secondary prevention of atherothrombotic and thromboembolic diseases. Despite a potentially complementary action of anticoagulant and antiplatelet drugs, the use of combination warfarin-ASA therapy is not based on compelling evidence of a net therapeutic benefit, with the exception of patients with a mechanical heart valve. On the other hand, there is more compelling and consistent evidence that combination warfarin-ASA therapy confers a 1.5- to 2.0-fold increased risk for serious bleeding compared with use of warfarin alone. In everyday practice, clinicians should combine the best available evidence with clinical judgment, considering that in most clinical scenarios, clinical practice guideline may not provide clear recommendations for patients who should, and should not, receive combination warfarin-ASA therapy. The objectives of this review are to describe which patients are receiving combined warfarin-aspirin therapy, to summarize the evidence for the therapeutic benefit and harm of combined warfarin-ASA therapy, and to suggest practical guidelines as to which patients should, and should not, receive such treatment.     

Does cognition predict community function only in schizophrenia?: a study of schizophrenia patients, bipolar affective disorder patients, and community control subjects

Cognitive deficits predict functioning in schizophrenia; however, little is known as to whether the association is present in other mental disorders. If specific cognitive deficits uniquely predict functional impairment in schizophrenia the association of select aspects of brain dysfunction with daily living would suggest an intervention target and perhaps a means by which to improve the functioning of schizophrenia patients. The relationship of cognition and functioning was investigated in schizophrenia (n=39), bipolar affective disorder (n=27), and nonpsychiatric control (n=38) participants to determine whether the associations varied across groups. We examined verbal memory, verbal learning, verbal fluency, vigilance, executive functioning, symptomatology, and generalized cognitive functioning for associations with social function. Correlational analyses revealed particular cognitive domains (e.g., verbal memory) to be associated with social functioning in schizophrenia, bipolar, and control subjects; however generalized cognitive function and symptomatology were also associated with social functioning in patients. Multiple regression analyses revealed that in schizophrenia poor verbal memory predicted worse social functioning even after the effects of generalized cognitive dysfunction were considered. Verbal memory indices failed to account for variance in social function in bipolar patients and control subjects after consideration of generalized cognitive function. Bipolar patients with worse planning and problem solving tended to have worse social functioning. Therefore, unlike schizophrenia patients who may fail to process verbally mediated material, bipolar patients' difficulty with logical approaches to problems in daily living may have the greatest impact on their community function.     

Cancer in patients with schizophrenia: What is the next step?

People with schizophrenia, who constitute approximately 0.3–1% of the general population, have a nearly 20% shorter life expectancy than the general population. The incidence of varied types of cancers in patients with schizophrenia is controversial. The majority of previous research has demonstrated that patients who have schizophrenia and cancer have early mortality compared to the general population with cancer. The causes of early mortality in patients with schizophrenia and cancer might be attributed to a lower cancer screening rate and lack of effective treatment, including: (i) patient factors, such as poor lifestyle, passive attitude toward treatment, or comorbidity; (ii) physician factors, such as physician bias, which may decrease the delivery of care for individuals with mental disorders; and (iii) hospital administration factors, such as stigma and discrimination. Additional studies on patients with schizophrenia and cancer are warranted and should include the following: a comprehensive review of previous studies; a focus on differentiating the specific types of cancer; and methods for improvement. To decrease the early mortality of patients with schizophrenia, the following measures are proposed: (i) enhance early detection and early treatment, such as increasing the cancer screening rate for patients with schizophrenia; (ii) provide effective, timely treatment and rehabilitation; (iii) improve patients’ psychiatric symptoms and cognitive impairment; (iv) promote healthy behavior in the general population and emphasize healthy lifestyles in vulnerable populations; and (v) remove the stigma of schizophrenia. To reduce disparities in physical health, public health strategies and welfare policies must continue to focus on this group of patients.     

Treating patients with schizophrenia deficit with erythropoietin?

This systematic review summarizes and critically appraises the literature on the effect of erythropoietin (EPO) in schizophrenia patients and the pathophysiological mechanisms that may explain the potential of its use in this disease. EPO is mainly known for its regulatory activity in the synthesis of erythrocytes and is frequently used in treatment of chronic anemia. This cytokine, however, has many other properties, some of which may improve the symptoms of psychiatric illness. The review follows the preferred reporting items for systematic reviews and meta-analysis (PRISMA) statement guidelines. Three databases (Medline, Web of Science, and Cochrane) were searched combining the search terms 'erythropoietin AND (psychotic disorders OR schizophrenia)'. Seventy-eight studies were included in qualitative synthesis, a meta-analytic approach being prohibited. The findings suggest that several EPO cerebral potential properties may be relevant for schizophrenia treatment, such as neurotransmission regulation, neuroprotection, modulation of inflammation, effects on blood-brain barrier permeability, effects on oxidative stress and neurogenesis. Several potentially detrimental side-effects of EPO therapy, such as increased risk of thrombosis, cancer, increased metabolic rate and mean arterial blood pressure leading to cerebral ischemia could severely limit or halt the use of EPO. Overall, because the available data are inconclusive, further efforts in this field are warranted.     

Attenuation of perceptual asymmetries in patients with early-onset schizophrenia: evidence in favour of reduced hemispheric differentiation in schizophrenia?

Lateral biases in visual perception have been demonstrated in normal individuals and in patients with unilateral brain lesions. It has been suggested that the absence of structural and functional asymmetries in schizophrenia could be due to a failure in lateralisation that may be most pronounced in those patients whose illness onset is at an early age. Here we examined lateral biases in patients with schizophrenia of an early onset (N = 21) and a late onset (N = 19), and their respective age-matched control groups, using the greyscales task, a sensitive measure of asymmetries in visual processing. The stimuli consisted of two rectangles, one above the other, shaded in opposite directions and matched overall for darkness. Participants judged which of the two rectangles looked darker overall. Previous studies using this task in healthy participants have reported a reliable bias, such that the rectangle with the darker end on the left is selected preferentially. Whereas the late-onset patients in this study exhibited a perceptual bias of similar direction and magnitude to that of controls, this was not the case for the early-onset patients, who exhibited significantly less bias than their control group. The reduced perceptual bias seen in the early-onset group, but not the late-onset group, suggests an attenuation of right hemisphere mechanisms dedicated to processing visuospatial information. The attenuated perceptual asymmetry in the early-onset group only may be consistent with the view that (i) an earlier illness onset reflects a greater loss of hemispheric differentiation and (ii) reduced functional asymmetries in the early-onset group are a manifestation of a failure to allocate functions to one or the other hemisphere.     

Estrogens and men with schizophrenia: is there a case for adjunctive therapy?

Adjunctive use of estrogen therapy has been shown to be effective in enhancing the treatment of schizophrenia in women. In men, consideration of estrogen therapy has been impacted by concerns of feminising side effects, however, clinical trials of the use of estrogen in treating prostate cancer, bone density loss and even aggression and psychosis in dementia or traumatic brain injury, show this to be a safe and effective therapy. The current 14-day randomised placebo-controlled trial in 53 men with schizophrenia was conducted to evaluate the efficacy of 2 mg oral estradiol valerate as an adjunct to atypical antipsychotic treatment. Results demonstrated for estradiol participants a more rapid reduction in general psychopathology that occurred in the context of greater increases in serum estrogen levels and reductions in FSH and testosterone levels. Approximately 28% of estradiol participants did not achieve an increase (at least a 50% from baseline) in serum estrogen suggesting that further research is needed to refine the type, dose and administration route for estrogen therapy in men. Findings do, however, suggest further exploration of a therapeutic role for adjunctive estradiol treatment in men with schizophrenia is warranted.     

Psychological therapy in schizophrenia: what is the evidence?

OBJECTIVE: The present contribution provides a critical outline of the current position of psychological therapies in schizophrenia. METHOD: Therefore, empirical research into the efficacy of psychological interventions in the treatment of schizophrenic disorders has been reviewed. RESULTS: Four cognitive-behavioural approaches have emerged as preeminently effective, or at least especially promising, as adjuncts to pharmacotherapy, i.e. the training of social skills, cognitive training programs for the remediation of neurocognitive deficits, psychoeducative, coping-orientated interventions with patients and their families, and cognitive-behavioural therapy of residual symptoms. These approaches are discussed with regard to their efficacy in reducing relapse rates, psychopathology as well as cognitive and social disability. CONCLUSION: Open questions and possibilities for the further development of these approaches are considered and prognostications are made concerning the future of psychotherapy research in schizophrenia, notably in the light of changing conditions in public health care systems.     

Measurement of insight in patients with bipolar disorder: are self-rated scales developed for patients with schizophrenia applicable?

Our aim was to study if the Birchwood Insight Scale has acceptable psychometric properties when used for patients with bipolar disorders. Patients with schizophrenia (n = 101), bipolar I (n = 57), and bipolar II disorder (n = 37) completed the self-report scale. The items form 3 subscales, awareness of illness, relabeling of symptoms, and need for treatment. The total scale had good internal consistency for patients with schizophrenia, fairly good for bipolar I, but poor for bipolar II disorder. On subscale level the internal consistency was mostly marginal to poor for all patient groups. The level of insight was similar in schizophrenia and bipolar I disorder. The psychometric properties for the insight scale were poorer in bipolar disorders than in schizophrenia, and the scale did not work for patients with bipolar II disorder. This suggests a cautious use of the scale across different diagnostic groups.     

Hormone replacement therapy in postmenopausal women with schizophrenia: positive effect on negative symptoms?

BACKGROUND: Some studies of premenopausal women suggest that the severity of psychopathology associated with schizophrenia may be related to levels of estrogen. METHODS: We examined psychopathology in community-dwelling postmenopausal women with schizophrenia who had received (n = 24) versus had never received (n = 28) hormone replacement therapy. RESULTS: Users of hormone replacement therapy and nonusers did not differ significantly with respect to age, ethnicity, education, age of onset, duration of schizophrenia, global cognitive functioning, or neuroleptic-induced movement disorders. The hormone replacement therapy users received lower average daily doses of antipsychotic medication; they had similar levels of positive symptoms but significantly less severe negative symptoms compared with hormone replacement therapy nonusers, independent of differences in antipsychotic dosage. CONCLUSIONS: Our results suggest that the use of hormone replacement therapy in conjunction with antipsychotic medication in postmenopausal women with schizophrenia may help reduce negative, but not positive, symptoms.     

Cerebral β amyloid deposition in patients with malignant neoplasms: its prevalence with aging and effects of radiation therapy on vascular amyloid

We examined immunohistochemically 123 autopsy brains from patients aged between 30 to 59, who died as a result of malignant neoplasms. Using antiserum to amyloid protein (A), we found that cerebral A deposits began in the subjects' fifth decade; its prevalence was 0%, 9.8% and 21.5% in the fourth, fifth and sixth decades, respectively. The major form of A deposition was diffuse-type plaques, although one third of the brains with A deposition showed amyloid angiopathy. Subpial A deposition is frequently associated with amyloid angiopathy. The prevalence of cerebral A deposits was about two times higher in the patients who had received brain radiation therapy (27.8%) compared to non-radiated patients (14.8%). Amyloid angiopathy was much more prominent (P<0.05) with radiation therapy (22.2%) than without (8.0%). We found that cerebral A deposition is dependent on aging, even in patients with malignant tumors and at beginning in their forties, and that brain radiation therapy is a possible risk factor of A deposition, especially in the form of amyloid angiopathy.     

Semantic hyperpriming in thought-disordered patients with schizophrenia: state or trait?--a longitudinal investigation

Enhanced semantic priming (SP) has been reported in individuals with schizophrenia who exhibit positive formal thought disorder (TD) and it has been linked to heightened automatic spreading activation in semantic networks of these patients. However, the state or trait nature of semantic hyperpriming in schizophrenia and its relation to clinical features (e.g., length of illness, symptom shifts) is not clear. To explore these issues, we administered a lexical decision task with semantically related, indirectly related or unrelated prime-target pairs to acutely ill inpatients with schizophrenia shortly after admission and again after 12-16 weeks, while most patients were already in (partial) remission (n=33). In addition, we examined 20 healthy control subjects twice (2 weeks apart). Relative to control subjects, TD patients with schizophrenia exhibited hyperpriming only in the acute psychotic state, but not during the follow-up examination, when TD and other positive symptoms had resolved. There were no associations between priming effects and length of illness or number of previous psychotic episodes. In conclusion, semantic hyperpriming in TD patients with schizophrenia appears to be clearly state-dependent and might be viewed as an episode marker of psychosis with TD.