Age Of Onset In Schizophrenia Research Articles

Analysis of Time to Relapse among Schizophrenia Patients in St. Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia

Objective: To investigate the associated factors that affect time to relapse in patients with schizophrenia at St. Amanuel Mental Specialized Hospital, with recurrent events model.Material and Methods: A hospital-based retrospective review of the medical records of 332 patient with schizophrenia, covering a two-year period, were examined. Parametric frailty models were used to determine the correlation between discharge times and relapse, and to identify risk factors using R-software. Results: The distribution number of relapses was 162, and the median survival time of patients with schizophrenia was 665 days. The unobserved heterogeneity in patients and correlation between relapses, as estimated by the Weibull-gamma frailty model, was p-value≤0.001 and Kendall’s Tau (Γ)=0.498. This indicated that there was heterogeneity among participants and a correlation between relapses. The final model showed that the effect of psychiatric comorbidity (hazard ratio (HR)=6.522, p-value≤0.001), employment status (HR=5.334, p-value=0.001), history of suicide attempt (HR=2.167, p-value=0.003) and history of traditional treatment (HR=1.973262, p-value=0.021) had a significant effect on the hazard time to relapse. Onset Age of schizophrenia and drug adherence were not predictive. Subsequent relapses are likely dependent on both the first and previous relapses.Conclusion: Comorbidity, employment status, history of suicide attempt and history of traditional treatment are imperative risk factors influencing the hazard of time to relapse, which increases the risk of relapse.

Gender differences and clinical correlates in the age of the first hospitalization in patients with drug-naïve schizophrenia in China: a cross-sectional study.

Gender differences in the onset age of schizophrenia have been reported in many studies, but differences in the age of the first hospitalization and associated factors have not been explored. The present study investigated gender differences and clinical correlates in the age of the first hospitalization in drug-naïve schizophrenia (DNS). A total of 144 DNS patients and 67 health controls were included. Demographic information, duration of untreated psychosis (DUP), Positive and Negative Symptom Scale (PANSS) scores, the Brief Psychiatric Rating Scale (BPRS) scores, Global Assessment of Functioning (GAF) scores, and MATRICS Consensus Cognitive Battery (MCCB) scores were collected and analyzed. The age of the first hospitalization was significantly earlier in males than in females (P < 0.01). In addition, there were significant differences in the age of the first hospitalization in terms of marital status, occupation, family ranking, suicide attempt, and place of residence (all P < 0.05). After Bonferroni correction, only DUP had a positive correlation with the age of the first hospitalization (PBonferroni < 0.05/6 = 0.0083). Multivariate linear regression analysis showed that gender (β = 0.141, t = 2.434, P = 0.016), marital status (β = 0.219, t = 3.463, P = 0.001), family ranking (β = 0.300, t = 4.918, P < 0.001), suicide attempt (β = 0.348, t = 5.549, P < 0.001), and DUP (β = 0.190, t = 2.969, P < 0.004) positively predicted the age of the first hospitalization. The age of the first hospitalization in male DNS was earlier than in females. In addition, gender, marital status, suicide attempt, DUP, and family rank were independent risk factors for the age of the first hospitalization.

Are Executive Functions Deficits in Early-Onset Chronic Schizophrenia More Severe than in Adult-Onset Chronic Schizophrenia?

ObjectiveThe research on the age of schizophrenia onset and cognitive impairments leads to contradictory conclusions. It is still unknown whether neurocognitive deficits in early-onset schizophrenia (EOS) are more intense than adulthood-onset schizophrenia (AOS). The study aimed to examine specific aspects of the executive functions of chronic outpatients with different ages of schizophrenia onset.MethodTwo clinical groups (EOS and AOS) consisted of 60 chronic outpatients with schizophrenia recruited from the community-based support system. The executive functions were measured with the Wisconsin Card Sorting Test (WCST), Trail Making Test A&B (TMT A&B), verbal fluency task (VFT), and the N-back test. Obtained results were compared to control groups consisting of 40 healthy subjects, matched with age, sex, and years of education, respectively.ResultsThere were no differences in various aspects of executive dysfunctions between EOS and AOS outpatients. The outpatients in general, had lower scores than healthy controls regardless of their age of symptom onset. The most important finding suggests that some cognitive domains (visual working memory and processing speed) in presented schizophrenia patients were similar to those in healthy controls.Despite the demographic differences, both clinical groups present the same level of executive functioning. In addition, similar to the healthy participants, the outpatients had no problems in working memory and processing speed.ConclusionsThese observations suggest that EOS might not be associated with more severe cognitive deterioration. Moreover, the stabilization or improvement of their functioning might be linked with long-term psycho-social rehabilitation and modern pharmacotherapy.

General Cognition Shows Age-Dependent Patterns of Genetic Overlap With Schizophrenia Liability

Cognition shares substantial genetic overlap with schizophrenia, yet it remains unclear whether such genetic effects increase during developmental periods of elevated risk for schizophrenia, such as the peak age of onset. Should these genetic effects increase around this period, the genetic correlation between cognition and schizophrenia would be expected to differ for individuals who have not yet reached the peak age of onset for schizophrenia compared to those who have reached this age.

Management of Schizophrenia in Pregnancy: A Case Report

Skizofrenia merupakan kelainan mental berat yang ditandai dengan gangguan proses berfikir dalam, mempengaruhi bahasa, persepsi dan rasa terhadap diri. Pengalaman psikosis biasanya berupa seolah-olah mendengar suara-suara atau delusi. Onset usia tersering terkena skizofrenia adalah 25-35 tahun (usia reproduksi). Kami melaporkan sebuah laporan kasus seorang wanita hamil berusia 27 tahun dan mengidap skizofrenia paranoid. Wanita usia reproduktif dengan skizofrenia membutuhkan penanganan komprehensif selama usia reproduksi, termasuk kontrasepsi, asuhan pra-natal, antenatal, dan post-natal, serta menjadi orang tua yang aman dan efektif.

Toxoplasma gondii Infection and Clinical Characteristics of Patients With Schizophrenia: A Systematic Review and Meta-analysis

Abstract Schizophrenia is associated with an increased prevalence of IgG antibodies against Toxoplasma gondii (T. gondii seropositivity), whereby the infection seems to precede the disorder. However, it remains unclear whether a T. gondii infection affects clinical characteristics of schizophrenia. Therefore, a systematic review and meta-analysis was conducted following PRISMA guidelines examining the association between T. gondii seropositivity and severity of total, positive, or negative symptoms or age of onset in schizophrenia. PubMed, Embase, and PsycInfo were systematically searched up to June 23, 2019 (PROSPERO #CRD42018087766). Random-effects models were used for analysis. Furthermore, the influence of potential moderators was analyzed. Indications for publication bias were examined. From a total of 934 reports, 13 studies were included. No overall effect on severity of total, positive, or negative symptoms was found. However, in patients with a shorter duration of illness T. gondii seropositivity was associated with more severe positive symptoms (standardized mean difference [SMD] = 0.32; P &amp;lt; .001). Similar but smaller effects were seen for total symptoms, while it was absent for negative symptoms. Additionally, a significantly higher age of onset was found in those with T. gondii seropositivity (1.8 y, P = .015), although this last finding was probably influenced by publication bias and study quality. Taken together, these findings indicate that T. gondii infection has a modest effect on the severity of positive and total symptoms in schizophrenia among those in the early stages of the disorder. This supports the hypothesis that T. gondii infection is causally related to schizophrenia, although more research remains necessary.

Alterations of plasma cytokine biomarkers for identifying age at onset of schizophrenia with neurological soft signs

Several studies have been suggested that immunity plays a part in neurodevelopment and schizophrenia pathogenesis. Early age of onset in schizophrenia is associated with genetic factors which affect neurodevelopment. This study aims to identify immune abnormalities associated with neurodevelopmental impairments in early-onset schizophrenia (EOS) and adult-onset schizophrenia (AOS) patients. We determined the plasma levels of six cytokines (IL-1β, IL-4, IL-6, IL-10, IL-12 and TNF-α) in schizophrenia patients and healthy controls. Measurements included neurological soft signs (NSS) to distinguish and subgroup those with neurodevelopmental impairments. The study included 210 schizophrenia patients, which were divided into 84 EOS and 126 AOS patients, as well as 122 healthy controls. We observed significant differences in levels of IL-4, IL-6 and IL-10 between EOS and AOS patients. The results demonstrated the area under ROC curve (AUC) of the IL-4 in EOS and healthy controls was 0.81. Moreover, these results indicated that AUC of the IL-4 and the combination of IL-4, IL-6 and IL-12 in EOS with NSS and healthy controls were 0.91 and 0.95. These cytokines are altered in EOS and schizophrenia patients with neurodevelopmental impairments and demonstrated good classification abilities. These findings manifested that both pro- and anti-inflammatory cytokines are contributed to the clinical and pathophysiological features of schizophrenia. Future works are expected to explore potential genetic effectors and predictors as well as therapeutic directions in personalized medicine for early-onset schizophrenia.

Association between developmental milestones and age of schizophrenia onset: Results from the Northern Finland Birth Cohort 1966

We investigated relationships between early developmental milestones, schizophrenia incidence and variability in its age at onset. We hypothesized that the period of risk for schizophrenia would be longer for those with later development. The Northern Finland Birth Cohort 1966 was followed until 47 years of age, and those members diagnosed with schizophrenia or any other non-affective psychoses identified. Latent profile analysis was used to classify people into homogenous classes with respect to developmental milestones, and subsequently survival analysis explored relationship between classes and age of schizophrenia onset. Results suggest that 4-classes (early, regular, late, and extra late developers) can be identified, but due to few cases in one class (n = 93, <0.01% of 10,501), only 3 classes (early, regular, late) could be meaningfully compared. Schizophrenia incidence until 47 years of age differed systematically between classes: late developers had the highest cumulative incidence (2.39%); regular were intermediate (1.25%); and early developers had the lowest incidence (0.99%). However, age at onset and its variability was similar across classes, suggesting that our hypothesis of a wider ‘window’ for schizophrenia onset in late developers was not supported.

Стационарная помощь психически больным позднего возраста

Background: mental health саге reform and reduction of beds capacity in Russia caused shortage of beds in psychiatric hospitals. However it is known about higher need in inpatient psychiatric care among elderly patients. In this regard it became necessary to study how mentioned reform affects inpatient care for such patients. The goal of the research: to examine the use of a shrinking bed fund for psychiatric care in elderly mental health patients. Material and methods: the material for the study was data from the reports of Moscow psychiatric hospital #13 about treated patients older than 60 in 2016-2017. Apart from this clinic-epidemiological research of 20% sample of inpatients has been conducted. Results: it was stated that though bed fund has shrinked in 2017, numerical and age-sex composition of group of treated patients older than 60 did not differ from the analogical group of patients treated in 2016. It was demonstrated that this appeared to be possible due to reduction of length of stay in the hospital (for 10%in average) as well as reduction in patients' re-admissions (from 43.9% in 2016 to 35.4% in 2017). It also important to mention that in 1/3 cases hospitalization of elderly patients caused with social problems. The results of clinic-epidemiological study which confirmed clinical accuracy of reported data revealed that the proportion of elderly patients admitted due to affective disorders is dramatically small which does not corresponds known data about the grows of depression prevalence in old age. Apart from this there found a significant number of schizophrenia cases with notably late onset that again raises a question about specific age of onset for schizophrenia. Conclusion: the results of the study indicate the necessity for continued research (including economical) in order to optimize activity of the city psychiatric hospitals

Age of onset and quality of life among males and females with schizophrenia: A national study

BackgroundAge of onset is considered central to understanding the course of schizophrenia, yet little is known regarding its association with quality of life in general, and specifically among males and females. AimsTo examine the association between the age of schizophrenia onset and quality of life, in general, and among males and females, using data from a national sample and competing statistical models. MethodsParticipants with a diagnosis of schizophrenia (N = 1624) completed the Manchester Short Assessment of Quality of Life (MSA-QoL) and were rated on a parallel measure by their professional caregivers (N = 578). Multiple regression analysis models were computed for self-appraised quality of life, and mixed models with random intercepts were used for caregivers. Six competing models were tested for parsimony for each rating source. Three models without adjustment and three models adjusted for confounding variables. Sensitivity analyses were conducted for males and females separately. ResultsAge of onset was statistically significantly (P < .05) negatively associated with self-appraised and caregiver-appraised quality of life on aggregate and among females. Among males, a significant (P < .01) quadratic effect of onset age on self-appraised quality of life demonstrated a negative association up to onset age of 36.67 years, after which the association was positive. ConclusionsAn earlier age of onset is associated with a better quality of life in schizophrenia which is tentatively explained by social decline. Specific trends in psychiatric symptom severity may account for this association among females while social advantages may account for the particular results found among males.

F34. AUDITORY SENSORY GATING IN YOUNG ADOLESCENTS WITH EARLY-ONSET PSYCHOSIS: A COMPARISON WITH ADHD

BackgroundNumerous studies have demonstrated impaired sensory gating in schizophrenia and this phenomenon has been proposed as a candidate biomarker for the disorder. Sensory gating is typically assessed during an auditory paired-click test commonly referred to as a P50 suppression paradigm. When two identical stimuli are presented, healthy subjects show a decrease in their neural response to the second stimulus, reflected in a decreased P50 amplitude, whereas schizophrenia patients on average show a much smaller decrease. So far, sensory gating has primarily been investigated in adult patients with schizophrenia, but gating disturbances have also been demonstrated in other illnesses, e.g. in schizotypal personality disorder, albeit less marked. Although the typical age of onset for schizophrenia is late adolescence to early adulthood, a sizable group of patients presents with psychotic symptoms during childhood or early adolescence. Manifestation of psychotic symptoms before the age of 18 is commonly referred to as early-onset psychosis (EOP). Various studies have reported a more severe course of illness and a poorer outcome in EOP compared to the adult-onset form of the disorder. In parallel, we expect more pronounced sensory gating deficits in EOP.Impaired sensory gating may not be specific to psychosis, but rather a shared disturbance of neuropsychiatric disorders. Although symptoms of attention deficit hyperactivity disorder (ADHD) differ in many ways from those found in schizophrenia, there are common characteristics. Compared to schizophrenia, relatively few studies have investigated sensory gating in ADHD, and some report P50 gating deficits similar to those frequently found in patients with schizophrenia.MethodsWe investigated P50 suppression in a large cohort of adolescents (12–17 years old) consisting of patients with either EOP (N=56) or ADHD (N=28) as well as age and gender matched healthy controls (N=72). In our paradigm two identical sounds (clicks) were presented separated by a 500ms interval. The amount of suppression was expressed as the ratio between the P50 amplitude of a subject’s response to the first click and his/her amplitude in response to the second click.ResultsThe EOP patients scored significantly higher on PANSS (positive, negative, general, and total PANSS scores) compared to both ADHD patients and healthy controls. However, there were neither significant group differences in raw P50 amplitude, nor in the gating ratios between young adolescents with EOP, ADHD and healthy controls.DiscussionThis is the first study to investigate sensory gating in young adolescents with EOP. We found no P50 suppression deficits in these patients which, given the relatively large sample size in our study, cannot merely be ascribed to power issues. The results are in contrast with the majority of studies investigating sensory gating in schizophrenia and ADHD. However, the results are in agreement with earlier studies from our lab showing evidence of inconsistent P50 suppression deficits in two separate cohorts of adult, antipsychotic naïve, first-episode patients with schizophrenia. Based on our findings, P50 sensory gating cannot differentiate between young adolescents with EOP or ADHD, and deficient P50 suppression does not seem to be a valid biomarker for EOP.

F128. THE AGE OF ONSET OF SCHIZOPHRENIA SPECTRUM DISORDERS

BackgroundThis study characterizes the age of onset of schizophrenia spectrum disorders and summarizes findings regarding a range of clinical and social outcomes, cognition, brain structure, and mortality.MethodsThe review is based on series of systematic and nonsystematic literature searches. We included original articles and systematic reviews looking associations between age of onset and incidence, risk factors, suicides, brain structure and cognition.ResultsThe peak age of onset for schizophrenia spectrum disorders is between 20 to 29 years, in where the incidence estimate was among males 4.15 and among females 1.71 per 10,000 person-years. Male gender has been linked with earlier onset age, although among those with family history and cannabis use corresponding gender difference do not exist. Early onset schizophrenia has been linked e.g. with higher familial risk, poor premorbid social adjustment and cannabis use. In adult samples, earlier age of onset associated with worse outcome, regarding hospitalisations, negative symptoms, relapses, social and occupational functioning, and global outcome. Also in childhood and adolescence schizophrenia, earlier onset has been linked with more severe outcomes. Early age of onset has been linked also with larger cognitive deficits and brain alterations. In the few existing studies, later AOO has been linked with a higher suicide rate. In all, the current study found various differences between patients with different age of onset. However, the studies on age of onset are relative heterogeneous on methodology and have given varying results. More good quality studies are needed including patients without restriction due to the onset age.DiscussionAge of onset is an important characteristic of schizophrenia that could help when examining the origin, genetic mechanism and care of schizophrenia. Understanding factors that influence age of onset in schizophrenia may offer clues to prevent or delay the onset of this debilitating group of disorders.

Association between C-reactive protein and risk of schizophrenia: An updated meta-analysis.

C-reactive protein (CRP) has been indicated to be associated with the pathogenesis of schizophrenia (SZ) and other psychiatric disorders. The aim of this study is to investigate whether peripheral blood CRP levels are associated with the risk of SZ. We searched literature from databases of Pubmed, Embase and the Cochrane Library from inception to November 1, 2016 for studies that reported serum or plasma CRP levels in patients with SZ and non-SZ controls. At least two reviewers decided on eligibility and extracted data from included studies. Random effects meta-analyses were performed using standardized mean difference (SMD) as the effect estimate of the differences in CRP levels between subjects with SZ and healthy controls. We identified 18 studies representing 1963 patients with SZ and 3683 non-SZ controls. Compared with non-schizophrenics, blood CRP levels were moderately increased in people with SZ (SMD 0.53, 95% CI 0.30 to 0.76) irrespective of study region, sample size of included studies, patient mean age, age of SZ onset and patient body mass index. Publication bias was not detected through Egger's linear regression test (P = 0.292). We noticed that patients in Asia or Africa (n = 6, SMD 0.73, 95% CI 0.26 to 1.21) and whose age less than 30 years (n = 5, SMD 0.76, 95% CI 0.07 to 1.58) had substantially higher CRP levels. Our study provides evidence that higher CRP levels are associated with increased risk of SZ, especially for young adult patients less than 30 years. Further large-scale studies are strongly warranted to further confirm this association.

Very late-onset schizophrenia-like psychosis: Case report and current status of the issue

IntroductionSchizophrenia has traditionally been considered to strictly be an early-onset disorder. Current nosologies, including DSMV, are not restrictive with age of onset in schizophrenia and all patients that satisfy diagnostic criteria fall into the same category. Since 1998, International Late-Onset Schizophrenia Group consensus, patients after 60 are classified as very-late onset schizophrenia-like psychosis. Female overrepresentation, low prevalence of formal thought disorder, and a higher prevalence of visual hallucinations are associated with later age at onset. Atypical antipsychotics represent the election treatment because of the reduced likelihood of EPS and tardive dyskinesias, and should be started at very low doses, with slow increases.ObjectiveTo review the current knowledge about very late-onset schizophrenia through systematic review of the literature and the analysis of a case.MethodsCase Report. Review. Literature sources were obtained through electronic search in PubMed database of last fifteen years.ResultsWe present a case of a 86-year-old woman suffering from delusions and hallucinations, diagnosed with very late-onset schizophrenia-like psychosis, after differential diagnosis with other disorders. We analyze ethiology, epidemiology, clinical features and treatment in geriatric patients with schizophrenia.ConclusionsReluctance to diagnose schizophrenia in old people is still present today, probably in relation with the inconsistency in diagnostic systems and nomenclature, and consideration of medical conditions in the diagnosis. Identification of these patients is really important in order to start an appropriate treatment, which can lead to patient clinical stability.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Familiarity, gender and cannabis use determine age of onset in schizophrenia

There is evidence that certain risk factors for schizophrenia (e.g. copy number variations, obstetric complications) are associated with an earlier age of onset of psychosis. One possible explanation is that in such cases, early neurodevelopmental damage is associated with greater perturbance of critical neural systems and that this leads to the early presentation of psychosis. Less is known about the significance of age of onset for treatment response and outcome though patients presenting in childhood are reported to have a worse outcome than those who present later. We have conducted two large first episode psychosis studies in which we have examined those baseline characteristics which predict later treatment resistance, notably the AESOP and GAP studies. In each of these, early age of onset and also male gender were associated with treatment resistance. Interestingly in approximately three quarters of cases, treatment resistance was present at onset of psychosis and only in the remaining quarter did it develop over the course of the illness. One possibility is that there exists a type of schizophrenia which is associated with neurodevelopmental damage, early age of onset and lack of response to dopamine blockade; this is compatible with our previous finding that patients with treatment resistant schizophrenia do not show the increased synthesis of striatal dopamine which is usually found in actively psychotic individuals.Disclosure of interestThe author has not supplied his declaration of competing interest.

Current Concepts in the Diagnosis and Treatment of Schizophrenia in Later Life

Caring for patients with schizophrenia in later life is emerging as a major concern as well as a challenge for practicing psychiatrists. The clinical presentation and course of this disorder in older patients differ from that of younger patients with unresolved cognitive and social issues often being prominent. It is hard to establish a definite age of onset for schizophrenia in later life. However, based on research evidence, symptomatology, brain imaging studies, family history, and cognitive issues observed in older patients with schizophrenia, the International Late-Onset Schizophrenia Group proposed to retain the term schizophrenia for both early (before age 40) and late-onset, but further divided the late-onset schizophrenia into late-onset (onset after age 40) and very-late-onset (onset after age 60). The group also proposed that patients with onset of schizophrenia after age 60 should be called as very-late-onset-schizophrenia-like psychosis. This paper is an attempt to share current concepts relative to diagnosis and treatment options, based on bio-psycho-social model, for patients with schizophrenia in later life.

Accelerating Science-to-Practice for Early Psychosis.

It takes approximately 17 years for research findings to influence clinical practice, and even longer for a scientific discovery to have an impact on public health. Seventeen years also falls within the lower bound of the age of onset for schizophrenia, a devastating mental disorder characterized by recurrent psychotic episodes and accumulating disability. To improve outcomes for young adults with early psychosis, NIMH launched the Recovery After an Initial Schizophrenia Episode (RAISE) initiative in 2008. The goals were to develop a comprehensive, person-centered intervention for first-episode psychosis (FEP), test it in U.S. community treatment settings, and expedite dissemination, adoption, and implementation of promising findings. Rapid uptake of evidence-based interventions can occur when clinical research purposefully bridges gaps between service users’ needs, scientific curiosity, and policy makers’ concerns. The RAISE funding announcement took this into account and required investigators to establish partnerships with principal stakeholders—that is, service users, family members, clinicians, and health care administrators—at every stage of the research process. RAISE investigators studied implementation processes alongside outcomes and developed training and program materials to support the establishment of coordinated specialty care (CSC) programs in community clinics. The articles and columns in the special section suggest notable progress after only seven years— a decade earlier than the often cited 17 years—because they address implementation challenges and answer questions about feasibility, accountability, acceptability, effectiveness, and sustainability. Is it feasible to implement CSC programs in routine settings? Yes. The articles by Dixon and colleagues and byMueser and colleagues each describe team-based multicomponent programs for FEP. Across the two RAISE studies, 19 new CSC programs were established by training community mental health providers in stage-specific care for FEP. Can treatment fidelity be monitored in a practical way? Yes. The Best Practices column by Essock and colleagues describes an approach to CSC fidelity monitoring that uses information drawn from readily available data, such as routine service logs. Practical approaches to fidelity monitoring may be cost-effective and can provide an ongoing data source for quality improvement activities. Will young adults with FEP engage in treatment? Yes. Less than 10% of RAISE Connection participants dropped out over two years. Lucksted and colleagues highlight several features that promoted engagement: the individualized, flexible, and recovery-focused nature of treatment; the emphasis on shared decision making; and the availability of services such as supported employment and education. Are CSC programs effective? Yes. After one year of treatment, Srihari and colleagues found fewer hospitalizations and higher vocational engagement among CSC patients compared with those in usual care. Likewise, over two years, Dixon and colleagues noted significant improvements in symptoms, social functioning, and school and work activity among Connection Program participants. Are CSC programs sustainable? Perhaps. In the Research & Services Partnerships column, Essock and colleagues describe how state mental health authorities in New York and Maryland supported implementation, evaluation, and expansion of the Connection Program. Involvement in RAISE influenced each state’s decision to commit funds to extend early intervention services. The novel three-part financing model proposed by Frank and colleagues in the Economic Grand Rounds column offers another strategy for achieving sustainability: a payment system that rewards delivery of high-quality FEP care. These articles and columns convey hope that integrated and effective care for FEP is possible in the United States. As CSC programs multiply, we must anticipate new challenges that might reduce the public health impact of early intervention programs. Addington and colleagues’ brief report reminds us that many persons with FEP endure long periods of untreated psychosis, which augurs poorly for long-term recovery. Ouellet-Plamondon and colleagues in Canada alert us to potential disparities in access among minority groups and the need for different engagement strategies. Close partnerships between investigators and stakeholders will be critical for further progress. Through dynamic partnerships and ongoing collaboration, we should strive to make 17 years the age at which psychosis is prevented.

Factors associated with sexual dysfunction among schizophrenia men with nicotine dependency and non-smoking schizophrenia men

Cigarette-smoking in schizophrenia and its associations with sexual functioning have been relatively under-examined. The study purpose was to determine the factors associated with sexual dysfunction among schizophrenia men with nicotine dependency and those non-smokers. A retrospective study was conducted in a local hospital in Malaysia over a two-year period from 2011 to 2012. There were 54 schizophrenia men with nicotine dependency and 57 non-smokers. Sexual functioning was assessed using the Malay version of the International Index of Erectile Function-15. Logistic regression analysis was employed. All the 111 schizophrenia men had at least one sexual dysfunction domain. For the group with nicotine dependency, Positive and Negative Syndrome Scale (PANSS)-positive was positively associated with the ability to achieve orgasm and ejaculation. However, age of schizophrenia onset was negatively associated with the confidence to attain and keep an erection. For the non-smoker group, married status and durati...

Alterations of White Matter Integrity Related to the Season of Birth in Schizophrenia: A DTI Study

In schizophrenia there is a consistent epidemiological finding of a birth excess in winter and spring. Season of birth is thought to act as a proxy indicator for harmful environmental factors during foetal maturation. There is evidence that prenatal exposure to harmful environmental factors may trigger pathologic processes in the neurodevelopment, which subsequently increase the risk of schizophrenia. Since brain white matter alterations have repeatedly been found in schizophrenia, the objective of this study was to investigate whether white matter integrity was related to the season of birth in patients with schizophrenia. Thirty-four patients with schizophrenia and 33 healthy controls underwent diffusion tensor imaging. Differences in the fractional anisotropy maps of schizophrenia patients and healthy controls born in different seasons were analysed with tract-based spatial statistics. A significant main effect of season of birth and an interaction of group and season of birth showed that patients born in summer had significantly lower fractional anisotropy in widespread white matter regions than those born in the remainder of the year. Additionally, later age of schizophrenia onset was found in patients born in winter months. The current findings indicate a relationship of season of birth and white matter alterations in schizophrenia and consequently support the neurodevelopmental hypothesis of early pathological mechanisms in schizophrenia.

SOX10 rs139883 Polymorphism Is Associated with the Age of Onset in Schizophrenia

Schizophrenia is a common psychiatric disorder with high heritability. The age of onset is an important phenotype of schizophrenia and may be under considerable genetic control. Our previous study showed that a single nucleotide polymorphism (SNP) rs139887 in sex-determining region Y-box 10 (SOX10) gene was associated with the age of onset in schizophrenia. The aim of this study was to evaluate the effect of another SNP rs139883 in the exon 4 of SOX10 on schizophrenia using an early-onset samples in the Han Chinese population. A total of 309 schizophrenic patients with onset before age 18 and 390 healthy controls were recruited for association study. No significant differences of allele or genotype frequencies were identified between the schizophrenic patients and controls. However, the C allele was significantly associated with an earlier age of onset in total patients and male patients (Kaplan-Meier log rank test P = 0.026; Kaplan-Meier log rank test P = 0.047, respectively), but not in females. In conclusion, the SOX10 rs139883 polymorphism influenced the age of onset of schizophrenia in a gender-specific manner and this may represent a vital genetic clue for the etiology of schizophrenia.