Abstract
BackgroundThis study was to investigate the Heart Rate Variability(HRV) and emotional response to positive and negative audiovisual stimulation in patients with chronic schizophrenia and healthy control groupMethodsAmong 253 chronic schizophrenic patients admitted in 00 Hospital in 00 city by psychiatrist, 104 patients were informed about this research and consented. Those who met this study criteria were randomly selected. 35 healthy control consisted of peoples that did not have past and present history of mental and physical illness. Positive and negative affect and HRV were compared between chronic schizophrenia and healthy control groups, and positive and negative affect and HRV to positive and negative audiovisual stimulation were measured according to planed research process. Positive and negative audiovisual stimulation was defined by an art therapy professionalist and a psychiatrist as 10 positive and negative pictures. 3 positive and negative musics were shown to two groups for 4 minutes simultaneously. Positive and negative audiovisual stimulation were shown to two groups during 1-week intermission. HRV was measured with Ubpulse H3, an equipment for autonomic nervous system test made by Laxtha company and also analyzed by frequency domain analysis. Emotional Empathy Scale(EES) and Positive Affect and Negative Affect Schedule (PANAS) of two groups were measured at baseline and after positive and negative audiovisual stimulation. Global Assessment of Functioning Scale(GAF) and Positive and Negative Syndrome Scale(PANSS) of chronic schizophrenia group were measured by a psychiatrist.Results1) Positive affect of patients group were significantly lower than control group, negative affect of patients group were significantly higher than control group. Low Frequency(LF), High Frequency(HF), and Total Power(TP) of HRV in patients group were significantly lowered than control group at baseline.2) 7 subscales of emotional empathy scale were lowered in patients group compared to control group.3) Positive affect of patients group was significantly less increased compared to the control group after positive audiovisual stimulation, negative affect of patients group was significantly less decreased to the control group after positive audiovisual stimulation.4) Positive affect of patients group was increased after negative audiovisual stimulation, but positive affect of control group was significantly decreased compared to the patients group after negative audiovisual stimulation. There was no significant difference in negative affect between two groups after audiovisual stimulation.5) LF of patients group was significantly higher than control group after positive audiovisual stimulation, HF and TP of patients group were significantly lowered than control group after positive audiovisual stimulation.6) LF of patients group was significantly higher than control group after negative audiovisual stimulation, HF and PT of patients were significantly lowered than control group after negative audiovisaul stimulation.DiscussionPatients with schizophrenia showed lower positive affect, higher negative affect, and lowered HRV parameters compared to the control group. They also showed lower empathy ability and inappropriate and non-contexual response. Schizophrenic patients represented hypersensitive sympathetic nervous system activity and lowered parasympathetic nervous system activity to the audiovisual stimulation. These results suggested that schizophrenic patients would show higher negative affect, less adaptive autonomic nervous system and hypersensitive or sharp to audiovisual stimulation, and decreased relaxation ability after stimulation. Audiovisual stimulation in integrative arts therapy program for schizophrenia might have avoid overactive sympathetic stimulation and recommend activate parasympathetic stimulation. Integrative art therapy for schizophrenia must be sufficiently relaxed, empathetic, and promote positive affect during therapeutic process.
Highlights
Concrete thinking is one of the common clinical features of patients with schizophrenia, especially chronic and symptomatically severe patients
The concrete thinking scores had a significant influence on the change of the fixation time ratio in the patients with schizophrenia, confirming the possibility that the concrete thinking contributed to the difference of gaze information patterns between the two groups
If the price is higher than expected in the previous block, it is estimated that the negative emotion is triggered and schizophrenia patients could depend on concrete thinking rather than consolidating the information from the previous blocks and making a re-judgment
Summary
Negative symptoms (i.e., motivation deficits and diminished emotional expression) are prevalent in schizophrenia and consistently linked with functional impairment for affected individuals. While supporting the safety and potential efficacy of dopamine augmentation, these studies did not evaluate effects within specific symptom domains, negative symptoms. Statistical analyses included the intent-to-treat sample (i.e., participants who received at least one dose of study medication) and consisted of linear mixed models for change in SANS total score (our primary outcome), and change in other clinical and side effects measures as a result of treatment. Levodopa augmentation resulted in a significant improvement in negative symptoms, with a mean SANS reduction for study completers of 15.3 (SD 5.7). Discussion: Our findings suggest that levodopa augmentation of antipsychotics may be an effective and well-tolerated treatment for negative symptoms in schizophrenia. These findings, need replication in larger randomized controlled trials. CLINICAL FACTORS ASSOCIATED WITH CONTINUATION OF LONG-ACTING INJECTABLE ANTIPSYCHOTIC MEDICATION: RETROSPECTIVE CHART REVIEW
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