Acute Episode Of Schizophrenia Research Articles

Clinical Effectiveness of Lurasidone Monotherapy in Patients with Acute Episodes of Schizophrenia and Associated Symptoms of Depression.

We endeavored to evaluate the efficacy of Lurasidone at doses of 40-160 mg per day on symptoms of schizophrenia associated with symptoms of depression in real clinical practice in a Russian patient population. One hundred sixty eight patients aged 18-65 years old, who at the time of the start of the observation were being treated in a hospital or day hospital due to an exacerbation of paranoid schizophrenia accompanied by symptoms of depression, were prescribed lurasidone. Treatment with lurasidone and other concomitant drugs, their prescription, withdrawal, selection, and dose modifications were determined based on the indications for the use of those drugs and the recommended doses in the instructions, clinical need, and patient interests, rather than by the goals of the study. During the observation period, the severity of depressive symptoms according to the Calgary Depression Scale (CDSS) and that of psychotic symptoms according to the Positive and Negative Syndrome Scale (PANSS) were assessed six times (before the start of treatment and then on the 4th, 7th, 14th, 28th, and 42nd days). A statistically significant reduction in the severity of the symptoms was observed with the use of lurasidone in doses ranging from 40 mg to 160 mg per day. The fastest and most significant (p <0.001) reductions in the total PANSS and CDSS scores were observed with lurasidone 120 mg. A somewhat lower efficacy of lurasidone was observed at a dose of 160 mg. The largest reductions in the total PANSS and CDSS scores with lurasidone 120 mg were associated with the highest survival rate and the longest median time from treatment initiation to discontinuation or follow-up. The most commonly reported side effects with lurasidone in this study (nausea, akathisia, tremor and drowsiness) were consistent with the known safety profile of the drug. Adverse events in most cases were assessed as mild, or occasionally moderate. A six-week prospective observational study of the real-world clinical effectiveness of lurasidone in doses ranging from 40 mg to 160 mg per day established statistically and clinically significant improvements in both psychotic and depressive symptoms in patients with acute exacerbation of schizophrenia and associated symptoms of depression.

P534. Initial Assessment of the Clinical Profile of the PDE10A Inhibitor MK-8189 in Patients With an Acute Episode of Schizophrenia

P534. Initial Assessment of the Clinical Profile of the PDE10A Inhibitor MK-8189 in Patients With an Acute Episode of Schizophrenia

A 10-year mirror-image study of effectiveness and cost of long-acting paliperidone palmitate injectable in patients with schizophrenia or schizoaffective disorder

Acute episodes of Schizophrenia and Schizoaffective Disorder often require hospitalizations and/or psychiatry emergency room (PER) visits, with significant economic burden. Long-acting injectables (LAI), such as the once-monthly Palmitate Paliperidone LAI (1MPP) are effective in suppressing symptoms and raise treatment adherence. This study is the first aimed at evaluating long-term efficacy of initiation of 1MPP. This was a mirror-image study with a total 10 year observational length. Sample was divided into five different groups according to time span of observation: 2,4,6,8, and 10 years. Number of participants per group was 162, 129, 95, 77 and 35, respectively. Main outcomes were number and length of hospitalizations and number of PER visit. Significant reductions in these outcomes after initiation of 1MPP were found in all groups. Subgroups consisting only of patients with full adherence were evaluated, and these had better outcomes. A cost evaluation was also performed, which demonstrated decreases every year, for all main outcomes. Sensitivity analysis in the 2-year group showed results in this time-frame are independent of gender, diagnosis, previous LAI or 1MPP initiation setting. Initiation of 1MPP reduces number and length of hospitalizations up to 5 years, decreasing associated costs. This study increases evidence supporting use of 1MPP in patients with Schizophrenia or Schizoaffective disorder.

Initial clinical profile of the PDE10A inhibitor MK-8189 in people with an acute episode of schizophrenia

Initial clinical profile of the PDE10A inhibitor MK-8189 in people with an acute episode of schizophrenia

Comparison of Formal Thought Disorder in the Acute Episode of Schizophrenia and Manic Episode of Bipolar Affective Disorder.

The aim of this study was to compare the formal thought disorder (FTD) in the acute episode of schizophrenia (SCHZ) and bipolar affective disorder (BPAD), and to determine the FTD dimensions associated with BPAD. The study included a total of 34 SCHZ patients not meeting the standardized remission criteria and 20 patients in BPAD manic episode. The patients completed the Positive and Negative Syndrome Scale (PANSS), the Clinical Global Impression Scale (CGI), the Young Mania Rating Scale (YMRS), the Hamilton Depression Rating Scale (HAM-D) and the Thought and Language Disorder Scale (TALD) in order to assess FTD. The association of FTD with the diagnoses was analyzed by a logistic regression model including the TALD factors and the SCHZ and BPAD groups. Statistically significant differences were not determined between the demographic features, the CGI scores and the TALD objective positive factor scores of the SCHZ and BPAD groups. The objective negative and subjective negative factors (p<0.001 for all) were higher in SCHZ group and the subjective positive factor were significantly higher in BPAD group (p=0.028). In the logistic regression model, the TALD subjective positive factor was associated with BPAD diagnosis, and the objective negative factor was associated with SCHZ diagnosis. In the BPAD group, the TALD total score correlated positively with the manic episode severity, and the scores on the subjective negative and subjective positive factors correlated negatively with disease duration. The study results show that FTD is common to the acute episodes of both SCHZ and BPAD and that assessment of the subjective positive FTD symptoms and objective negative FTD symptoms may be useful to differentiate the acute episode of SCHZ from the BPAD manic episode.

Social Intervention as an Adjuvant Therapy for Patients with Schizophrenia

Schizophrenia is one of the most debilitating psychiatric disorders due to its medical, social, professional and relational disability. With the lack of any progress made in the pharmaceutic treatment of this disorder in the last twenty years, developing adjuvant therapies to help patients live a normal professional and social life comes with great importance. Our study was conducted on 88 participants, which were recruited during an acute episode of schizophrenia at the Socola University Hospital, Iasi, Romania. These patients were randomly assigned to two experimental groups: one group received a social intervention consisting of one year of Behavioral Family Management (BFM), and the other group received the Supportive Family Management (SFM) intervention. The results of our study showed that the social intervention, whether it was behavioral or supportive, dramatically decreased the scores on the BPRS (Brief Psychiatric Rating Scale). At baseline our patients had mean score of 84.4 (SD=12.3). After 12 months of social intervention the mean scores for BPRS were 38.8 (SD=11.6) for the BFM group and 37.7 (SD=10.5) for the SFM group. The results of our study suggest that a more holistic approach in treating schizophrenia is needed. Working with the families of the patients in various forms of therapy might help not only with the decrease of schizophrenia’s symptoms, but also help patients to interact better with their families, colleagues and friends and therefore increase the quality of life of this at risk population.

Difference of olfactory deficit in patients with acute episode of schizophrenia and major depressive episode

AimOlfactory deficits are potential markers of early diagnosis, monitoring progress and predicting outcome in patients with schizophrenia and depression. We aimed to investigate differences in patterns and influencing factors of olfactory deficits between patients with acute episode of schizophrenia and major depressive episode (MDE). MethodsFifty-two patients with acute episode of schizophrenia, 75 patients with unipolar MDE and 199 healthy controls were included in this retrospective study. Following a structured interview, participants underwent olfactory tests (Sniffin' Sticks), assessment of psychiatric symptoms (Positive and Negative Syndrome Scale), depressive symptoms (Hamilton Depression Rating Scale), and cognitive function (color-word test and word generation test). ResultsBoth patients with schizophrenia and MDE exhibited significant olfactory deficits, and MDE patients have poorer olfactory sensitivity than schizophrenia. Patients with MDE had a higher proportion of olfactory deficits (45.3% and 28%, respectively) but a better self-awareness (21.3% and 9.6%, respectively) than patients with schizophrenia. In patients with schizophrenia, PANSS scores was positively associated with olfactory sensitivity but negatively associated with olfactory identification, and olfactory discrimination was associated with word generation. In patients with MDE, olfactory discrimination was associated with word generation and age, but not disease severity. First-episode schizophrenia group showed significantly lower threshold scores than recurrent schizophrenia group, and first-episode MDE group had significantly lower threshold scores and higher discrimination scores than the recurrent MDE group. ConclusionsPatterns and modulating factors of olfactory deficits in acute episode of schizophrenia and MDE are different, their differences should be considered when using olfactory deficits as marker in clinical practice.

Acute and Long-term Memantine Add-on Treatment to Risperidone Improves Cognitive Dysfunction in Patients with Acute and Chronic Schizophrenia

Patients with schizophrenia are mainly characterized by negative symptoms and cognitive dysfunction. In this proof-of-concept study we tested effects on cognition and negative symptoms of a 6- or 24-week memantine add-on treatment to risperidone in patients with acute or chronic schizophrenia. Patients with an acute episode of schizophrenia (n=11) and predominating positive symptoms were randomized to a 6-week add-on treatment with memantine (10 mg twice a day) versus placebo and patients with chronic schizophrenia (n=13) and negative symptoms were randomized to a 24-week add-on treatment with memantine (10 mg twice a day) versus placebo. All patients received antipsychotic medication with risperidone (2-8 mg/day). Psychopathological changes were assessed with the Positive and Negative Syndrome Scale (PANSS) at baseline and after 2, 4, 6, 12, and 24 weeks. Cognitive function was measured at baseline, after 6 weeks, and 24 weeks. Patients with acute schizophrenia who received add-on treatment with memantine showed a significantly higher performance in attention intensity (p=0.043), problem-solving (p=0.043), verbal learning (p=0.050), and flexibility (p=0.049). Patients with chronic schizophrenia showed a significantly higher immediate memory in the memantine group compared to the placebo group (p=0.033) and a significantly greater reduction of the PANSS sum score if compared to the placebo group. Our study gives further evidence that memantine add-on treatment to risperidone may have neuroprotective effects and improve cognitive function in patients with schizophrenia. ClinicalTrials.gov Number: NCT00148590 and NCT00148616.

Elevated brain-derived neurotrophic factor (BDNF) serum levels in an acute episode of schizophrenia in polish women: Correlation with clinical and metabolic parameters.

Brain-derived neurotrophic factor (BDNF) has been implicated in the pathogenesis of psychiatric disorders. Schizophrenia is associated with metabolic abnormalities and BDNF regulates energy homeostasis and glucose metabolism in peripheral tissues. The aim of this study was to examine serum levels of BDNF in schizophrenic women during 8 weeks of treatment and control group, and its correlation with clinical and metabolic parameters. The study was performed on a group of 96 women: 55 diagnosed with paranoid schizophrenia according to DSM-IV criteria, and 41 healthy controls. Positive and Negative Syndrome Scale (PANSS) was used to assess the severity of schizophrenia. BDNF serum levels and metabolic parameters: fasting serum glucose, total cholesterol, triglyceride (TG), high-density lipoprotein (HDL-C), low-density lipoprotein (LDL-C) were measured at baseline and week 8 of treatment. BDNF serum levels were significantly elevated in medicated patients with schizophrenia comparing to controls. After 8 weeks of antipsychotic treatment, BDNF levels did not significantly change. Increase in TG and TG/HDL-C ratio and a decrease in HDL-C was detected in medicated patients. Correlation between BDNF and lipid profile as well as symptoms severity was found. In our study we detected abnormalities in BDNF levels and lipid profile in medicated schizophrenic women in Polish population.

An open-treatment six-week study of the clinical effectiveness of Paliperidone Palmitate in schizophrenia: data from acute units in Spain (SHADOW study)

Objectives: To evaluate clinical evolution of patients with schizophrenia admitted in acute units because of a relapse and treated with once-monthly Paliperidone Palmitate (PP1M).Methods: This multicentre, open-label, prospective observational study followed patients with schizophrenia treated with PP1M in acute psychiatric units for up to 6 weeks.Results: Out of the 280 enrolled patients, 61 received PP1M as antipsychotic monotherapy, and 219 in combination with other antipsychotics. The average Clinical Global Impression–Schizophrenia (CGI-SCH) score decreased from 4.7 at baseline to 3.3 at final visit (p < .0001); the change was clinically and statistically significant both in patients treated with PP1M in monotherapy and in combination with other antipsychotics. Clear improvements in functioning and high patient satisfaction with the treatment were observed. Time from admission to PP1M therapy initiation correlated with the length of hospital stay (p < .0001); earlier start of PP1M treatment was associated with shorter hospital stay. Adverse events were reported in 7.1% of patients (all non-serious).Conclusions: PP1M was effective and well tolerated in treatment of acute episodes of schizophrenia both in monotherapy and in combination with other antipsychotics in clinical setting. Early start of PP1M therapy in acute schizophrenia episodes might help to shorten hospital stay.

Val66Met functional polymorphism and serum protein level of brain-derived neurotrophic factor (BDNF) in acute episode of schizophrenia and depression.

Brain-derived neurotrophic factor (BDNF) influences neuron differentiation during development as well as the synaptic plasticity and neuron survival in adulthood. BDNF has been implicated in the pathogenesis of schizophrenia and depression. Val66Met polymorphism and BDNF serum level are potential biomarkers in neuropsychiatric disorders. The aim of this study was to determine the effect of BDNF gene Val66Met functional polymorphism on serum BDNF concentration in patients with schizophrenia, during depression episode and in healthy control group. 183 participants were recruited (61 patients with depressive episode, 56 females with schizophrenia, 66 healthy controls) from Polish population. Serum BDNF levels were measured using ELISA method. Val66Met polymorphism was genotyped using PCR- RFLP method. Serum BDNF levels were not associated with Val66Met polymorphism in either of the groups. A significant increase of BDNF level in schizophrenia (p = 0.0005) and depression (p = 0.026) comparing to the control group has been observed. Our results suggest that the functional Val66Met BDNF polymorphism is not associated with BDNF serum levels, which is in line with previous findings. Replication studies on larger groups are needed.

Brain-derived neurotrophic factor serum and plasma levels in the treatment of acute schizophrenia with olanzapine or risperidone: 6-week prospective study

Antipsychotics have been the mainstay of the treatment of schizophrenia, and their potential role in neuroprotection could be related to brain-derived neurotrophic factor (BDNF). So far different effects on both serum and plasma levels of BDNF were reported related to the various antipsychotic treatments. Aim of this study was to investigate the influence of olanzapine or risperidone on both plasma and serum levels of BDNF in patients with acute schizophrenia. For 50 participants with acute episode of schizophrenia both plasma and serum BDNF, along with the Positive and Negative Syndrome Scale (PANSS) and the Clinical Global Impression scale, were assessed pretreatment and post treatment – after 6 weeks of either risperidone or olanzapine. Results show that a weak correlation between pretreatment plasma and serum levels of BNDF was found no longer significant after 6 weeks of treatment. Antipsychotics, olanzapine and risperidone showed no significant effect on post treatment plasma and serum levels of BDNF. Pretreatment plasma level of BDNF and PANSS positive subscale were positively correlated. Post treatment serum level of BDNF and Clinical Global Impression were negatively correlated. In conclusion, plasma and serum BDNF levels could be different markers to some extent with regard to clinical symptoms, response to therapy and outcome. The interrelation between serum and plasma BDNF should be established in further studies.

The SWITCH study: rationale and design of the trial.

Many patients do not respond to the first antipsychotic drug prescribed, but require multiple trials with different drugs before response is achieved. Current treatment guidelines vary substantially in their recommendations as to how long clinicians should wait before an antipsychotic treatment attempt should be considered as failed and the compound switched. It has, however, recently been shown that poor early response to an antipsychotic is associated with continuous poor later response in the course of the same treatment attempt. This finding suggests that patients who do experience poor early response might benefit from a switch in antipsychotic medication as early as 2weeks after treatment initiation. In the SWITCH trial, 350 patients suffering from an acute episode of schizophrenia are randomly assigned to double-blind treatment with either olanzapine or amisulpride. The primary endpoint is symptomatic remission at week 8. Patients not experiencing at least minor response after 2weeks are randomized again to either staying on the initially assigned drug or being switched to the alternative compound for another 6weeks. In case early switching proves superior to maintaining treatment, time wasted for unsuccessful treatment attempts could be minimized, patients' outcomes improved, duration of hospital stays reduced, and thus overall treatment expenses saved. The current report will present the methods of the trial, focusing on various specific features which could be adopted by future studies.

Are Urinay Tract Infections Associated with Acute Episodes of Schizophrenia?

Objectives To establish any association between urinary tract infections and acute episodes of schizophrenia Methods A Case control study conducted in University Psychiatry unit, National Hospital of Sri Lanka (NHSL), Colombo, Sri Lanka. Thirty four cases with acute episode of schizophrenia and 30 normal controls matched for age and gender were selected. Cases were patients who met the International Classification of Disease (ICD- 10) criteria to diagnose schizophrenia who attended the inward and outpatient care of the unit. Urine full report (UFR) and urine culture were performed in all cases and controls to detect and confirm urinary tract infections (UTI). Data was analyzed using SPSS software. Results Number of cases was 34 and controls were 30. Mean age of cases was 34.8 years while in controls it was 34.1 years. In cases 18 (52.9%) were males and in controls, 16 (53,3%) were males. Among patients who had acute episodes of schizophrenia 5 (14.7%) became positive for UFR and from controls 2 (6.6%) became positive. (Odds ratio=2.4). Urine culture was positive in 1 case and 1 control each. (Odds ratio=0.88). Conclusions Patients with acute schizophrenia are more likely to have positive urine full report than normal healthy controls. But they are not more likely to experience urinary tract infections than the normal healthy controls during their acute episode of schizophrenia.

Plainte mnésique isolée révélant un trouble du déficit de l’attention avec hyperactivité de l’adulte. À propos de six cas

L’électroconvulsivothérapie (ECT) est susceptible d’entraîner des altérations mnésiques, repérables à l’aide de tests neuropsychologiques « objectifs » et à l’origine de plaintes mnésiques « subjectives » rapportées par les sujets. Les études disponibles mettent en évidence des altérations mnésiques « objectives » à la suite d’un traitement par ECT variables selon les tests neuropsychologiques utilisés et la période d’évaluation par rapport aux séances ECT. Les méthodes d’évaluation des plaintes mnésiques « subjectives » et leurs résultats divergent également selon les études. L’objectif de cette revue de la littérature est de synthétiser les données disponibles concernant les altérations mnésiques « objectives » ainsi que les plaintes mnésiques « subjectives » rapportées à la suite d’un traitement par ECT et d’observer les relations entre ces deux types d’altérations mnésiques. Cette revue systématique de la littérature a permis de retenir 29 articles publiés de 1970 à 2012. Les seules altérations cognitives « objectives » persistantes à long terme après un traitement par ECT sont des altérations mnésiques rétrogrades autobiographiques. Les plaintes mnésiques concordent avec les altérations mnésiques objectives lorsqu’elles sont évaluées globalement, mais diffèrent lorsque les outils de mesure des plaintes subjectives utilisés demandent une évaluation plus spécifique.Electroconvulsive treatment (ECT) is an efficient treatment of depression, mania or acute episode of schizophrenia. However, ECT can lead to several side effects, particularly regarding cognitive functioning. Neuropsychological tests show that memory impairment is the most common cognitive disturbance. Memory impairments are also self-reported by 29 % to 55 % of patients treated with ECT. The subjective perception of memory impairment belongs to the field of metacognition (or, in this case, metamemory). Metacognition is indeed defined as monitoring and control of its own cognitive processes, and can be evaluated during or after cognitive task (on line or off line). The subjective perception of memory impairment after ECT treatment has been scarcely explored in the literature. The aims of this review of the literature are to describe the “objectives” characteristics of memory impairment, the “subjective” characteristics of memory complaints observed after treatment with ECT, and the relationships that exist between objective and subjective memory impairment.This review is based on a selection of articles identified using PubMed. Three exhaustive literature searches of Medline databases between years 1970 and 2012 were performed. The first search used the words “Electroconvulsive therapy” and “Anterograde Memory Loss” from the Medical Subject Headings or MESH (41 articles). The second search used the MESH words “Electroconvulsive therapy” and “Retrograde Amnesia” (103 articles). The third search used the MESH words “Electroconvulsive therapy” and the words “Subjective Memory” not listed in the MESH (29 articles). Titles and abstracts of literature review or meta-analysis in English and French were carefully screened. Regarding “objective” memory impairment, only studies comparing neuropsychological tests assessing memory conducted before and after treatment with curative ECT were selected. Regarding “subjective” memory impairment, only studies assessing memory complaints were selected. A selection of 29 relevant articles was carried out.The only “objective” long-term cognitive impairment observed after treatment with ECT is retrograde autobiographical memory impairment. Anterograde memory performances (learning, episodic and visuospatial memory) are disrupted in the short-term period following ECT, but no longer several months later. Three self-administered questionnaires assessing “subjective” memory complaints are available: Cognitive Failure Questionnaire or CFQ (assessing perceived learning, attention and memory functions), Squire Subjective Memory Questionnaire or SSMQ (evaluating perceived specific memory functions) and Global Self-Evaluation-Memory or GSE-My (evaluating perceived global memory impairment). After ECT treatment, improvement in the CFQ scores and SSMQ (less memory complaints) is observed. However, scores at GSE-My are significantly lower after treatment, suggesting that subjects rate their global memory functioning as impaired by ECT. “Subjective” memory complaints are correlated with “objective” memory impairment, when complaints are globally assessed using the GSE-My.The fact that there is no long-term cognitive impairment after treatment with ECT is an important information that must be shared within the healthcare team and the patients in order to improve adhesion to ECT. Few studies have investigated subjective complaints, and no study has evaluated metacognitive skills during the cognitive task. It might be of interest to explore subjective memory changes after ECT by using on line metacognitive skills evaluation.

Adherence therapy following an acute episode of schizophrenia: A multi-centre randomised controlled trial

Psychiatrische Pflege sieht sich im Hinblick auf die von ihr durchgeführten Interventionen einem wachsenden Begründungsdruck ausgesetzt. Im Sinne einer evidenzbasierten Behandlung gewinnen wissenschaftliche Hinweise auf die Wirksamkeit von Maßnahmen zunehmend an Bedeutung. Auch im Rahmen des SGB V und des Krankenpflegegesetzes wird eine wissenschaftliche Basierung von Interventionen gefordert.

Intervención educativa a familiares sobre contención física en enfermos neurológicos, neuroquirúrgicos y neuropsiquiátricos

Introducción: La contención física es el último recurso terapéutico para garantizar la seguridad del paciente. El enfermo de afecciones neurológicas suele presentar cuadros de agitación psicomotriz, deterioro neuronal, delírium causado por fármacos, anestesia o traumatismo quirúrgico, así como cuadros agudos de esquizofrenia, psicosis u otros padecimientos psiquiátricos. La seguridad del paciente corre riesgo debido a que puede retirarse las sondas, autoagredirse, caerse y otras situaciones, por lo que es necesario aplicar la contención física para su seguridad. La interacción con el familiar es de gran importancia si el familiar está adecuadamente informado, porque puede notificar al profesional de enfermería sobre los riesgos a que está expuesta la persona sujeta por causa de la contención física. Objetivo: Evaluar los conocimientos adquiridos sobre contención física por los familiares de enfermos neurológicos, neuroquirúrgicos y neuropsiquiátricos a través de la intervención educativa del profesional de enfermería. Metodología: Es un estudio cuantitativo, analítico, exploratorio, prospectivo y transversal; la muestra es a conveniencia y se utilizó un instrumento con 20 reactivos dicotómicos. Resultados: Se recolectaron 40 cuestionarios. La edad fluctúa entre 18 y 82 años; hubo mayor frecuencia del género femenino y mayor afluencia en el Servicio de Neurología; los enfermos recibían visita de sus hijos con más frecuencia y prevaleció la escolaridad de secundaria entre los visitantes; el 67.5% de las personas fueron informadas sobre la contención física, pero sólo 17.5% recibió informes de un profesional de enfermería. En el 50% de las personas se vigila que los enfermos no se jalen las sondas o catéteres y 47% eleva barandales al retirarse; en el 52.5% se solicitó ayuda al profesional de enfermería. Conclusiones: Es necesario implementar estrategias de intervención educativa de acuerdo a la escolaridad del derechohabiente, sin distinción de género que permita capacitar al familiar para garantizar la seguridad del enfermo y disminuir la frecuencia de eventos adversos.

Altérations cognitives et plaintes mnésiques lors d’un traitement par électroconvulsivothérapie : revue de la littérature

ObjectivesElectroconvulsive treatment (ECT) is an efficient treatment of depression, mania or acute episode of schizophrenia. However, ECT can lead to several side effects, particularly regarding cognitive functioning. Neuropsychological tests show that memory impairment is the most common cognitive disturbance. Memory impairments are also self-reported by 29 % to 55 % of patients treated with ECT. The subjective perception of memory impairment belongs to the field of metacognition (or, in this case, metamemory). Metacognition is indeed defined as monitoring and control of its own cognitive processes, and can be evaluated during or after cognitive task (on line or off line). The subjective perception of memory impairment after ECT treatment has been scarcely explored in the literature. The aims of this review of the literature are to describe the “objectives” characteristics of memory impairment, the “subjective” characteristics of memory complaints observed after treatment with ECT, and the relationships that exist between objective and subjective memory impairment. MethodsThis review is based on a selection of articles identified using PubMed. Three exhaustive literature searches of Medline databases between years 1970 and 2012 were performed. The first search used the words “Electroconvulsive therapy” and “Anterograde Memory Loss” from the Medical Subject Headings or MESH (41 articles). The second search used the MESH words “Electroconvulsive therapy” and “Retrograde Amnesia” (103 articles). The third search used the MESH words “Electroconvulsive therapy” and the words “Subjective Memory” not listed in the MESH (29 articles). Titles and abstracts of literature review or meta-analysis in English and French were carefully screened. Regarding “objective” memory impairment, only studies comparing neuropsychological tests assessing memory conducted before and after treatment with curative ECT were selected. Regarding “subjective” memory impairment, only studies assessing memory complaints were selected. A selection of 29 relevant articles was carried out. ResultsThe only “objective” long-term cognitive impairment observed after treatment with ECT is retrograde autobiographical memory impairment. Anterograde memory performances (learning, episodic and visuospatial memory) are disrupted in the short-term period following ECT, but no longer several months later. Three self-administered questionnaires assessing “subjective” memory complaints are available: Cognitive Failure Questionnaire or CFQ (assessing perceived learning, attention and memory functions), Squire Subjective Memory Questionnaire or SSMQ (evaluating perceived specific memory functions) and Global Self-Evaluation-Memory or GSE-My (evaluating perceived global memory impairment). After ECT treatment, improvement in the CFQ scores and SSMQ (less memory complaints) is observed. However, scores at GSE-My are significantly lower after treatment, suggesting that subjects rate their global memory functioning as impaired by ECT. “Subjective” memory complaints are correlated with “objective” memory impairment, when complaints are globally assessed using the GSE-My. ConclusionThe fact that there is no long-term cognitive impairment after treatment with ECT is an important information that must be shared within the healthcare team and the patients in order to improve adhesion to ECT. Few studies have investigated subjective complaints, and no study has evaluated metacognitive skills during the cognitive task. It might be of interest to explore subjective memory changes after ECT by using on line metacognitive skills evaluation.

A 3-Week, Open Label Study to Evaluate the Efficacy and Safety of Extended Release Quetiapine Fumarate in the Treatment of Agitation in Patients with Schizophrenia

Objective: To evaluate the efficacy of extended-release quetiapine fumarate (XR) monotherapy once daily, in the treatment of patients with acute episodes of schizophrenia and agitation.Method: Our study was a 3-week open-label study conducted in adult in- or outpatients with schizophrenia. Quetiapine XR was initiated at 300 mg on day 1,600 mg on day 2, and 400–800 mg (at the investigator's discretion) on day 3 and onwards. The primary endpoint was the change from baseline in the Positive and Negative Syndrome Scale Excited Component (PANSS- EC) score. Secondary endpoints included change from baseline in PANSS-Positive, PANSS-Negative, PANSS-General Psychopathological (PANSS-G) subscale scores, total PANSS score, PANSS aggression, hostility and depression cluster scores, CGI-Severity of illness (CGI-S) and the absolute CGI-Improvement (CGI-I) scales. Tolerability was assessed based on reported adverse events (AEs), the Simpson-Angus Scale (SAS) and Barnes Akathisia Rating Scale (BARS) scores, laboratory measurements and electrocardiograms (ECGs).Results: Of 40 patients enrolled, 35 completed the study. At day 21, statistically significant improvements versus baseline were seen for the primary and all secondary endpoints assessed. The incidence of AEs was low, and all were mild to moderate in severity. No extrapyramidal symptoms (EPS) as measured by the SAS and BARS were reported, indicating that the treatment was well tolerated. Hospitalization was required in one out-patient due to a relapse of psychosis, but was not considered to be treatment related.Conclusion: Once-daily quetiapine fumarate XR (400–800 mg/day) was effective in reducing agitation and a broad range of symptoms in acute schizophrenia. Treatment, including rapid dose escalation, was generally well tolerated in this study.

Adherence therapy following an acute episode of schizophrenia: A multi-centre randomised controlled trial

BackgroundNon-adherence with antipsychotic medication is common in patients with schizophrenia. AimsTo establish the efficacy of adherence therapy (AT) compared to treatment as usual (TAU) in improving medication compliance in patients following an acute episode of schizophrenia. MethodThe study was designed as a parallel group, single blind, randomised controlled trial. Fieldwork was conducted in four centres (3 in Germany and 1 in Switzerland) and involved a total of 161 patients. Patients received 8 sessions of AT in addition to treatment as usual. The main outcomes of this study were adherence and psychopathology at 12weeks post discharge follow up. ResultsIn total 80 patients received AT and 57 TAU. Intention-to-treat analysis included all randomised patients. Psychopathology, as determined using the PANSS-total, improved in the AT compared to TAU group by a mean of −6.16 points 12weeks after discharge from hospital (p<.05). AT had no significant effects on patients' adherence, treatment attitudes or functioning. No significant adverse events were reported. ConclusionAT improves psychopathology in patients recovering from an acute episode of schizophrenia.