Chronic Psychosis Research Articles

The burden of T. solium cysticercosis and selected neuropsychiatric disorders in Mocuba district, Zambézia province, Mozambique.

Taenia solium (neuro-)cysticercosis, a neglected tropical disease, can be associated with epileptic seizures and other neuropsychiatric (= neurological and psychiatric) disorders. This study aimed to evaluate the association of T. solium cysticercosis with selected neuropsychiatric disorders and/or symptoms (chronic headache, epileptic seizures/epilepsy and psychosis) in Mocuba district, Mozambique. Between March and May 2018, a cross-sectional study was conducted among 1,086 participants aged 2 years or above in Mocuba district, Zambézia province, central Mozambique, to assess the seroprevalence of human cysticercosis and risk factors for infection, as well as to explore its relation to selected neuropsychiatric disorders. Socio-demographic and clinical data were collected from each participant using a modified questionnaire designed by the Cysticercosis Working Group for Eastern and Southern Africa. Additionally, neuropsychiatric disorders, such as chronic headache, epileptic seizures/epilepsy and psychosis were assessed using four vignettes. T. solium antigen and cysticercosis IgG in serum were detected using both T. solium antigen B158/B60 enzyme linked immunosorbent assay (ELISA) and LDBIO Cysticercosis Western Blot, respectively. Overall, 112/1,086 participants (10.3%) were sero-positive for T. solium antigen or antibodies. Prevalence of antibodies (6.6%; n = 72) was higher than of antigens (4.9%; n = 54). In the questionnaires, 530 (49.5%) of participants reported chronic headache, 293 (27%) had generalized epileptic seizures, 188 (18%) focal seizures and 183 (18.3%) psychosis. We found a statistically significant association between seropositivity for T. solium and chronic headache (p = 0.013). Additionally, increasing age (p = 0.03) was associated with Ag-ELISA seropositivity. Our study revealed that in Mocuba, T. solium cysticercosis is prevalent and associated with self-reported chronic headache. Additionally, in the study setting, the seroprevalence of cysticercosis increased with age. However, it is not associated with other neuropsychiatric disorders such epileptic seizures/epilepsy and psychosis. Future studies are needed to confirm the high burden of neuropsychiatric disorders and their possible etiology, including neurocysticercosis, using additional serological, molecular biological and radiological diagnostic tools, as well as in-depth clinical examinations.

Continuing, reducing, switching, or stopping antipsychotics in individuals with schizophrenia-spectrum disorders who are clinically stable: a systematic review and network meta-analysis

Although antipsychotic maintenance treatment is widely recommended to prevent relapse in chronic psychoses, evidence-based guidelines do not provide clear indications on different maintenance treatment strategies, including continuing the antipsychotic at standard doses, reducing the dose, switching to another antipsychotic, or even stopping the antipsychotic. We aimed to compare the effectiveness of these maintenance treatment strategies, hypothesising the superiority of all strategies over stopping, and of continuing at standard doses over both switching and reducing the dose. We did a systematic review and network meta-analysis of randomized controlled trials (RCTs) that investigated antipsychotics for relapse prevention in adults with schizophrenia-spectrum disorders who were clinically stable, and which compared four treatment strategies: continuing the current antipsychotic at standard doses recommended for acute treatment; reducing the current antipsychotic dose; switching to a different antipsychotic; and stopping the antipsychotic and replacing it with placebo. We excluded RCTs with fewer than 25 individuals, a prerandomisation washout period greater than 4 weeks, a follow-up shorter than 6 weeks, and those recruiting treatment-resistant individuals. We searched MEDLINE, EMBASE, PsycINFO, CINAHL, CENTRAL, and online trial registers for published and unpublished RCTs from inception to Sept 1, 2021, combining terms describing all available antipsychotics, and terms describing continuation, maintenance, or long-term treatment for schizophrenia-spectrum disorders. Relative risks (RRs) and standardised mean differences were pooled using random-effects pairwise and network meta-analyses. We assessed risk of bias of each RCT with the Cochrane Risk-of-Bias 2 tool, and confidence of pooled estimates with CINeMA. The primary outcome was relapse prevention. The study protocol was registered in advance in the Open Science Forum registry. Of 3936 records identified, 119 records, reporting on 101 RCTs, were eligible, 98 of which (including 13 988 individuals) provided data that could be meta-analysed for at least one outcome. The mean proportion of female participants per study was 38% (range 0-100; median 39%, IQR 29-50), whereas for male participants it was 62% (range 0-100; median 61%, IQR 50-71), and the overall mean age was 38·8 years (range 23·2-63·9; median 39·3, IQR 35·0-43·9). Of the 98 RCTs meta-analysed, 89·8% were done in high-income and upper-middle-income countries. The ethnic group White or so-called Caucasian was the most represented (mean 56% participants per study), although this information was relatively scarce. All continuation strategies were significantly more effective in preventing relapse than stopping antipsychotic treatment, with a large risk reduction for continuing at standard doses (RR 0·37, 95% CI 0·32-0·43; number-needed-to-treat [NNT] 3·17, 95% CI 2·94-3·51) and antipsychotic switching (RR 0·44, 0·37-0·53; NNT 3·57, 3·17-4·25), and moderate risk reduction for dose reduction (RR 0·68, 0·51-0·90; NNT 6·25, 4·08-20·00). Continuing and switching antipsychotics did not differ significantly (RR 0·84, 0·69-1·02; with lower values favouring continuing), whereas reducing antipsychotic dose was outperformed by both continuing (RR 0·55, 0·42-0·71; NNT 4·44, 3·45-6·90) and switching (RR 0·65, 0·47-0·89; NNT 5·17, 3·77-18·18). Results were supported by moderate confidence of evidence and confirmed by secondary analyses and by several sensitivity and subgroup analyses, including removing studies with abrupt antipsychotic discontinuation or fast tapering (≤4 weeks). No tolerability differences emerged between treatment strategies. According to the Cochrane Risk-of-Bias tool, version 2, 16·8% of included RCTs had an overall high risk of bias for the primary outcome. We found moderate heterogeneity (τ2=0·13; I2=61%) and no overall incoherence for the primary analysis. Results were supported by moderate confidence of evidence and confirmed by secondary analyses. Contrary to our original hypothesis, we found that continuing antipsychotic treatment at standard doses or switching to a different antipsychotic are similarly effective treatment strategies, whereas reducing antipsychotic doses below standard doses is associated with higher risk of relapse than the other two maintenance treatment strategies and should therefore be limited to selected cases. Despite limitations, including moderate heterogeneity and moderate certainty of evidence, these results are of pragmatic relevance for clinicians, and should support the update of evidence-based guidelines. None.

Course of the Metabolic Syndrome (Mets) in a First Episode Psychosis Sample

IntroductionThere is evidence that metabolic syndrome (MetS) is common in chronic psychosis but also exists in the early stages.ObjectivesTo study the prevalence and course of MetS over a period of 2 year after a first episode psychosis. To determine whether there may be differences in its prevalence according to the type of antipsychotic used over two years.MethodsA sample of 300 patients participate in the PEPsNa Early Intervention Programme. SMet was determined at baseline and at 6, 12, 18 and 24 months. The type of antipsychotic used at each assessment moment is collected (none, aripiprazole, paliperidone, others). Adult Treatment Panel III (ATP III) criteria were used to define MetS.ResultsThe prevalence of MetS at baseline is 4.44% and increases to 7.96% at 6 months, 10.1% at 12 months, 8.62% at 18 months and 9.01% at 24 months. The prevalence of MetS increases at 6 (p<0.021) and 12 months (p<0.003) compared to baseline and then remains stable. Only at 6 months assessment there are significant differences (F-Ficher p<0.022) in the presence of MetS (15.8%) in the paliperidone group treatment (oral or LAI).ConclusionsMetabolic syndrome (MetS) exists from the early stages of psychosis and increases in the first 6-12 months and remains stable thereafter. The type of antipsychotic treatment only seems to have an influence at 6 months, with no differences at other follow-up times.DisclosureNo significant relationships.

Homeostasis Model Assessment of IR (HOMA-IR) and Metabolic Syndrome (MetS) in First Episode Psychosis

IntroductionMetabolic syndrome (MetS) is common in chronic psychosis but also exists in the early stages. HOMA-IR is an independent predictor of cardiovascular diseases and has already been described in first episode of psychosis.ObjectivesTo determine whether HOMA levels differ according to MetS at each time assessment over 2 years.MethodsMetS and HOMA levels are determined at baseline and at 6, 12, 18 and 24 months in a sample of 50 patients participating in the PEPsNa Early Intervention Programme during two years of follow-up. Adult Treatment Panel III (ATP III) criteria are used to define MetS. Insulin resistance measured with the Homeostatic Model Assessment (HOMA-IR) is computed with the formula fasting plasma glucose (mg/dL) times fasting insulin (mIU/mL) divided by 405. Mann-Whitney U Test are used to compare HOMA variable according to presence of metabolic syndrome.ResultsThe results showed that HOMA levels differed statistically significantly between patients who met MetS criteria and those who did not at 12 (p<0.046) and 24 (p<0.004) months of treatment.ConclusionsGiven the small sample size the results of our study indicate that there is a sustained relationship over time between HOMA levels and Metabolic Syndrome (MetS) and that the HOMA IR may be useful in identifying those patients with an increased metabolic and cardiovascular risk.DisclosureNo significant relationships.

Morphological Abnormalities in Schizophrenia: Systematic Review

Schizophrenia is a severe, frequent, heterogeneous, longlasting and disabling chronic mental illness with high social impact, belonging to the group of chronic psychoses. There are several clinical forms and several possible evolutionary modes. Its etiopathogenesis is multifactorial (hereditary, biological, environmental, etc.) but no single cause has been demonstrated up till now. Schizophrenia is a group of disabling heterogeneous disorders that are generally severe, the course of which is chronic and disabling, and the prognosis is poor. Many retrospective studies have attempted to trace the premorbid history of adult subjects who developed schizophrenia. Their results appear to be extremely disparate, due in particular to the heterogeneity of the means of investigation used. In addition, in recent years, many studies have focused on prodromal symptoms occurring during the year preceding the first psychotic episode in late adolescence or early adulthood. Minor physical cranio-cerebral (at the level of the ears, the palate, the cranial perimeter), temporomandibular, dental and palatal abnormalities, dermatoglyphic disturbances or even subtle neurological signs have been frequently found in schizophrenic patients, in particular oral anomalies, more precisely the measurements of the teeth, their vestibulo-lingual and mesio-distal diameters. The objective of our article is to study the morphological abnormalities that exist in the patient with schizophrenia, and to demonstrate whether there is a link between the presence of these physical abnormalities and the occurrence of schizophrenia. This issue has been vaguely mentioned in the literature, but in the Moroccan context, it is a pilot study.

Quality of Life in Patients with Chronic Psychotic Disorders: A Practical Model for Interventions in Romanian Mental Health Centers.

Background and Objectives: Current psychiatric care is increasingly focusing on patients’ quality of life (QoL). Research is still trying to determine the main factors which influence QoL. The present study aims to assess the QoL of patients with chronic psychotic-spectrum disorders, as well as its relation to symptomatology, functionality, adaptive behavior, and perceived level of recovery. Materials and Methods: The study included a sample of 78 patients with chronic psychosis. Symptomatology and illness severity were assessed with the Positive and Negative Syndrome Scale (PANSS) and the Clinical Global Impression Scale-Severity (CGI-S) scales, respectively. The Global Assessment of Functioning Scale (GAFS) and the Adaptive Behavior Assessment System II (ABAS-II)-Adult Form were used for the assessment of patients’ functionality, and the Quality-of-Life Inventory (QOLI) scale was applied for the evaluation of QoL. Results: According to the CGI-Severity scale, 20.5% of the patients were borderline mentally ill, and 24.4% were mildly ill. The highest number of patients (34.6%) were moderately ill, while 14.1% and 2.6% were markedly ill and severely ill, respectively. Among the moderately ill patients, more than half (63%) were patients with schizophrenia, 18.5% were patients with delusional disorder, and 18.5% were patients with schizoaffective disorder. Most of the patients (43.6%) presented moderate functioning deficiency, while 38.5% of the patients presented severe deficiency, according to the GAFS score. When assessed with the ABAS, we observed that almost half of the patients (44.9%) showed an average functioning across skill areas in the conceptual, social, and practical domains. A percent of 67.9% of the patients presented an average QoL, while 15.4% and 12.8% showed a very low and low QoL. QoL was not influenced by the patients’ symptomatology, gender, and education level. Having children, family support, better social and conceptual skills, and a higher perceived level of recovery was correlated with an increased QoL, hierarchical multiple regression R2 = 0.379, F(9, 68) = 2.616, and p = 0.012. Conclusions: Psychiatric interventions in psychosis should focus not only on symptoms’ control, but also on improving social and family support, as well as adaptive skills to increase the patients’ QoL.

Ethical considerations in the treatment of chronic psychosis in a periviable pregnancy

Background: Treatment of psychotic disorders in pregnancy is often ethically and clinically challenging, especially when psychotic symptoms impair decision-making capacity. There are several competing ethical obligations to consider: the ethical obligation to maternal autonomy, the maternal and fetal beneficence-based obligations to treat peripartum psychosis, and the fetal beneficence-based obligation to minimize teratogenic exposure. Objective: This article outlines an ethical framework for clinical decision-making for the management of chronic psychosis in pregnancy, with an emphasis on special considerations in the previable and periviable period. Case Presentation: A 31-year-old gravida 2, para 1 with intrauterine pregnancy at 12 weeks and 4 days gestation was brought to the emergency department by her husband seven months after delivering her first child, due to sudden onset of behavioral changes that included self-isolation, not eating, and not taking care of her child. Her past medical history included hypothyroidism and inflammatory bowel disease, but no prior psychiatric illness. After being admitted to the psychiatric hospital, she continued to have poor oral intake and weight loss despite initial inpatient treatment with antipsychotics, levothyroxine, and discontinuation of corticosteroids. Her pregnancy was also complicated by the diagnosis of multiple fetal anomalies at 20 weeks gestation, when the fetus was periviable. Conclusions: For previable or periviable pregnancies, the patient and/or surrogate should decide whether to pursue prenatal genetic screening and invasive diagnostic testing, as well as whether to continue or terminate the pregnancy. When the choice is made to continue the pregnancy, initiation of long-term psychiatric treatment (including medications with potential adverse fetal effects) should be based on shared decision-making between the physician and the patient and/or surrogate. Although some pharmacologic interventions may have potential adverse effects on the developing fetus, the use of psychotropic medications can be ethically justified, even if the patient herself does not have the capacity to consent and requires a surrogate, when the goal is to restore maternal autonomy and minimize the risks of maternal and fetal harm from untreated psychiatric illness.

Profil Peresepan Antipsikosis di Unit Rawat Jalan Rumah Sakit Mitra Keluarga Bekasi Timur Periode April – Mei 2021

One of the global burdens currently engulfing the world is the COVID-19 pandemic. But before COVID-19 was declared a pandemic by the WHO, the world was struggling with the global burden of mental disorders. WHO states that depression and anxiety are mental disorders with the highest frequency. Mental disorders are one of the health problems that often go unnoticed. To treat mental disorders, antipsychotic therapy is needed which can be obtained at various health facilities, one of which is the Mitra Keluarga Hospital, East Bekasi, which serves patients with mental disorders. Antipsychotics are useful in the therapy of acute and chronic psychosis, a mental disorder such as dreams and imaginary thoughts (hallucinations) and normalize abnormal behavior. The purpose of this study was to determine the profile of antipsychotic prescribing in the pharmacy outpatient unit at Mitra Keluarga Hospital, East Bekasi for the period April – May 2021. This study was conducted using a quantitative descriptive method by taking primary data from doctor's prescriptions containing antipsychotics. The results obtained can see the profile of the most widely used antipsychotic prescribing based on the active substance, drug class, drugs used concurrently with antipsychotic drugs and the most widely used antipsychotic drugs by gender. The final analysis results obtained can assist in the procurement of antipsychotic drugs in health facilities.

Characterizing speech heterogeneity in schizophrenia-spectrum disorders.

Schizophrenia-spectrum disorders (SSD) are highly heterogeneous in risk factors, symptom characteristics, and disease course outcome. Although speech anomalies have long been recognized as a core symptom of SSD, speech markers are an unexplored source of symptom heterogeneity that may be informative in recognizing relevant subtypes. This study investigated speech heterogeneity and its relation to clinical characteristics in a large sample of patients with SSD and healthy controls. Speech samples were obtained from 142 patients with SSD and 147 healthy controls by means of open-ended interviews. Speech was analyzed using standardized open-source acoustic speech software. Hierarchical clustering was conducted using acoustic speech markers. Symptom severity was rated with the Positive and Negative Syndrome Scale, and cognition was assessed with the Brief Assessment of Cognition for Schizophrenia. Three speech clusters could be distinguished in the patient group that differed regarding speech properties, independent of medication use. One cluster was characterized by mild speech disturbances, while two severely impaired clusters were recognized (fragmented speakers and prolonged pausers). Both clusters with severely impaired speech had more severe cognitive dysfunction than the mildly impaired speakers. Prolonged pausers specifically had difficulties with memory-related tasks. Prolonged pausing, as opposed to fragmented speaking, related to chronic active psychosis and refractory psychotic symptoms. Based on speech clustering, subtypes of patients emerged with distinct disease trajectories, symptomatology, and cognitive functioning. The identification of clinically relevant subgroups within SSD may help to characterize distinct profiles and benefit the tailoring of early intervention and improvement of long-term functional outcome. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Insula volumes in first-episode and chronic psychosis: A longitudinal MRI study

BackgroundAlterations in insular grey matter (GM) volume has been consistently reported for affective and non-affective psychoses both in chronic and first-episode patients, ultimately suggesting that the insula might represent a good region to study in order to assess the longitudinal course of psychotic disorders. Therefore, in this longitudinal Magnetic Resonance Imaging (MRI) study, we aimed at further investigating the key role of insular volumes in psychosis. Material and Methods68 First-Episode Psychosis (FEP) patients, 68 patients with Schizophrenia (SCZ), 47 Bipolar Disorder (BD) patients, and 94 Healthy Controls (HC) were enrolled and underwent a 1.5 T MRI evaluation. A subsample of 99 subjects (10 HC, 23 BD, 29 SCZ, 37 FEP) was rescanned after 2,53 ± 1,68 years. The insular cortex was manually traced and then divided into an anterior and posterior portion. Group and correlation analyses were then performed both at baseline and at follow-up. ResultsAt baseline, greater anterior and lower posterior insular GM volumes were observed in chronic patients. At follow-up, we found that FEP patients had a significant GM volume increase from baseline to follow-up, especially in the posterior insula whereas chronic patients showed a relative stability. Finally, significant negative correlations between illness severity and pharmacological treatment and insular GM volumes were observed in the whole group of psychotic patients. ConclusionsThe longitudinal assessment of both chronic and first-episode patients allowed us to detect a complex pattern of GM abnormalities in selective sub-portions of insular volumes, ultimately suggesting that this structure could represent a key biological marker of psychotic disorders.

The inhibitory effects of pimozide, an antipsychotic drug, on voltage-gated K+ channels in rabbit coronary arterial smooth muscle cells

Pimozide is an antipsychotic drug used to treat chronic psychosis, such as Tourette’s syndrome. Despite its widespread clinical use, pimozide can cause unexpected adverse effects, including arrhythmias. However, the adverse effects of pimozide on vascular K+ channels have not yet been determined. Therefore, we investigated the effects of pimozide on voltage-gated K+ (Kv) channels in rabbit coronary arterial smooth muscle cells. Pimozide concentration-dependently inhibited the Kv currents with an IC50 value of 1.78 ± 0.17 μM and a Hill coefficient of 0.90 ± 0.05. The inhibitory effect on the Kv current by pimozide was highly voltage-dependent in the voltage range of Kv channel activation, and additive inhibition of the Kv current by pimozide was observed in the full activation voltage range. The decay rate of inactivation was significantly accelerated by pimozide. Pimozide shifted the inactivation curve to a more negative potential. The recovery time constant from inactivation increased in the presence of pimozide. Furthermore, pimozide-induced inhibition of the Kv current was augmented by applying train pulses. Although pretreatment with the Kv2.1 subtype inhibitor guangxitoxin and the Kv7 subtype inhibitor linopirdine did not alter the degree of pimozide-induced inhibition of the Kv currents, pretreatment with the Kv1.5 channel inhibitor DPO-1 reduced the inhibitory effects of pimozide on Kv currents. Pimozide induced membrane depolarization. We conclude that pimozide inhibits Kv currents in voltage-, time-, and use (state)-dependent manners. Furthermore, the major Kv channel target of pimozide is the Kv1.5 channel.

A Comparison of Expressed Emotion in Caregivers of Patients with First-Episode Psychosis and Chronic Psychosis

Giriş: Bakım verenlerin duygu ifadesinin değerlendirilmesi ruhsal hastalığın sorumluluğunu alan aile bireyinin nasıl etkilenebileceğinin tespit edilmesi ve nüksün önlenebilmesi için önemlidir. Amaç: Araştırma, ilk atak ve kronik psikoz hastasına bakım verenlerin duygu ifadesi düzeylerini karşılaştırmak amacıyla tanımlayıcı kesitsel yapılmıştır. Yöntem: Araştırma, Kasım 2017-Kasım 2018 tarihleri arasında iki üniversite, bir eğitim araştırma ve bir ruh sağlığı hastalıkları hastanesinin psikiyatri polikliniklerinde yürütülmüştür. Araştırmanın örneklemini ilk psikoz atağı hastasına bakım veren 68, kronik psikoz hastasına bakım veren 70 kişi oluşturmuştur. Veri toplamada Duygu İfadesi Ölçeği (DİÖ) kullanılmıştır. Verilerin değerlendirilmesinde, sayı ve yüzde dağılımı, ki kare, fisher exact test ve bağımsız gruplarda t testi kullanılmıştır. Bulgular: İlk psikoz atağı hastasına bakım verenlerin duygu ifadesi puanlarının ortalaması ile kronik psikoz hastasına bakım verenlerin duygu ifadesi puanlarının ortalaması arasında anlamlı fark bulunmamıştır (t = 1.91, p = .058). Bakım verenlerin duygu ifadesi alt boyutlarından eleştirel yorumlar/düşmanlık (p = .104), duygusal aşırı meşguliyet (p = .240) boyutlarında anlamlı bir fark saptanmamıştır. Sonuç: Çalışmada, ilk psikoz atak ile kronik psikoz hastasına bakım verenlerin duygu ifadesi puanlarının hem toplam puan hem de eleştirel yorumlar/düşmanlık alt boyutları ve duygusal aşırı meşguliyet alt boyutları benzerdir. Bu sonuçlar ilk psikoz atak hastalarının bakım verenlerinin hastalığı deneyimleme süresinin kısa olmasına rağmen duygu ifadelerinin, kronik ruhsal hastalığı olan bireylerin bakım verenleri ile benzer olduğunu göstermektedir. İlk psikoz hastalarının bakım verenlerinin erken psikoz programları gibi müdahale programları ile güçlendirilmesi ve baş etme becerilerinin geliştirilmesi önemlidir. İlk psikoz atağı sürecinde başlatılacak aile müdahale programlarının hastalığın ilerleyen süreçlerinde yüksek duygu ifadesinin azalmasını sağlayabilir. Ayrıca ilk atak ve kronik psikoz hastalarının bakım verenlerin ruhsal hastalığı olan aile bireylerine tutum ve yaklaşımlarının derinlemesine inceleneceği kalitatif çalışmalar önerilmektedir.

Trifluoperazine Synergistically Potentiates Bortezomib-Induced Anti-Cancer Effect in Multiple Myeloma via Inhibiting P38 MAPK/NUPR1.

Multiple myeloma (MM) is a common hematological malignancy. Bortezomib (BTZ) is a traditional medicine for MM treatment, but there are limitations for current treatment methods. Trifluoperazine (TFP) is a clinical drug for acute and chronic psychosis therapy. Lately, researchers have found that TFP can suppress tumor growth in many cancers. We attempted to study the effects of BTZ and TFP on MM in vivo and in vitro. We concentrated on the individual and combined impact of BTZ and TFP on the proliferation and apoptosis of MM cells via Cell Counting kit-8 assay, EdU assay, western blot, and flow cytometry. We found that combination therapy has a strong synergistic impact on MM cells. Combination therapy could induce cell arrest during G2/M phase and induce apoptosis in MM cells. Meanwhile, BTZ combined with TFP could play a better role in the anti-MM effect in vivo through MM.1s xenograft tumor models. Furthermore, we explored the mechanism of TFP-induced apoptosis in MM, and we noticed that TFP might induce MM apoptosis by inhibiting p-P38 MAPK/NUPR1. In summary, our findings suggest that TFP could synergistically enhance the BTZ-induced anti-cancer effect in multiple myeloma, which might be a promising therapeutic strategy for MM treatment.

Inflammatory Subtypes in Antipsychotic-Naïve First-Episode Schizophrenia are Associated with Altered Brain Morphology and Topological Organization

BackgroundPeripheral inflammation is implicated in schizophrenia, however, not all individuals demonstrate inflammatory alterations. Recent studies identified inflammatory subtypes in chronic psychosis with high inflammation having worse cognitive performance and displaying neuroanatomical enlargement compared to low inflammation subtypes. It is unclear if inflammatory subtypes exist earlier in the disease course, thus, we aim to identify inflammatory subtypes in antipsychotic naïve First-Episode Schizophrenia (FES). Methods12 peripheral inflammatory markers, clinical, cognitive, and neuroanatomical measures were collected from a naturalistic study of antipsychotic-naïve FES patients. A combination of unsupervised principal component analysis and hierarchical clustering was used to categorize inflammatory subtypes from their cytokine data (17 FES High, 30 FES Low, and 33 healthy controls (HCs)). Linear regression analysis was used to assess subtype differences. Neuroanatomical correlations with clinical and cognitive measures were performed using partial Spearman correlations. Graph theoretical analyses were performed to assess global and local network properties across inflammatory subtypes. ResultsThe FES High group made up 36% of the FES group and demonstrated significantly greater levels of IL1β, IL6, IL8, and TNFα compared to FES Low, and higher levels of IL1β and IL8 compared to HCs. FES High had greater right parahippocampal, caudal anterior cingulate, and bank superior sulcus thicknesses compared to FES Low. Compared to HCs, FES Low showed smaller bilateral amygdala volumes and widespread cortical thickness. FES High and FES Low groups demonstrated less efficient topological organization compared to HCs. Individual cytokines and/or inflammatory signatures were positively associated with cognition and symptom measures. ConclusionsInflammatory subtypes are present in antipsychotic-naïve FES and are associated with inflammation-mediated cortical expansion. These findings support our previous findings in chronic psychosis and point towards a connection between inflammation and blood–brain barrier disruption. Thus, identifying inflammatory subtypes may provide a novel therapeutic avenue for biomarker-guided treatment involving anti-inflammatory medications.

DEMOGRAPHIC PROFILES OF PATIENTS ADMITTED IN PSYCHIATRIC WARD OF A TERTIARY CARE HOSPITAL

Objective: To determine the frequency of mental illnesses among patients admitted to a tertiary care hospital’spsychiatry unit.Study design: A Cross-sectional StudyDuration and place of study: The research was carried out between jan 2014– jan 2015Methods: Hospital records provided the admission charts for every patient admitted to the psychiatric ward for twoyears (2014–2015). Patient data was gathered from the records and then examined for clinical and sociodemographicinformation.Results: Over two years (2014–2015), 1727 patients were admitted to the hospital. 40% (n = 690) were men,and 60% (n = 1037) were women. The age group of 21 to 40 comprised most of the patients. According to ICDcategorization, the most common diagnoses were for mood disorders (63.8%), which were followed by anxiety disorders(7%) and acute and chronic psychosis (24.4%).Conclusion: Patients with acute mental problems that are difficult to treat make up the majority of the inpatientpattern.Keywords: Prevalence, Demographic characteristics, Psychiatric Disorders, Tertiary care hospital

P.0460 Insula longitudinal grey matter modification in first-episode and chronic psychosis: a MRI study

P.0460 Insula longitudinal grey matter modification in first-episode and chronic psychosis: a MRI study

Association between schizophrenia and periodontal disease in relation to cortisol levels: an ELISA-based descriptive analysis

BackgroundSchizophrenia is a chronic psychosis marked by multiple bioenvironmental and immunological dysregulation with its intricate role in etiopathogenesis of periodontal disease remaining unclear. Hence, the aim of this study is to determine the association between periodontal disease and schizophrenia in relation with cortisol levels.MethodsThe study is in descriptive design comprised of 40 subjects randomly selected (20 schizophrenic patients as Group A and 20 healthy volunteers as group B). All the study participants underwent complete periodontal examination including scoring of gingival index (GI), plaque index (PI), Probing depths (PD) and clinical attachment loss (CAL). Salivary cortisol levels are estimated using ELISA. Link between schizophrenia and periodontal disease is described in relation to cortisol levels with elimination of other shared risk factors, such as tobacco smoking and xerostomia.ResultsSignificant higher values of periodontal parameters are observed in Group A with schizophrenic patients (GI 2.467 ± 0.528; PI 2.402 ± 0.526; PD 2.854 ± 0.865; CAL 1.726 ± 3.096) than Group B with healthy subjects (GI 0.355 ± 0.561; PI 0.475 ± 0.678; PD 1.493 ± 0.744; CAL 0.108 ± 0.254). However, cortisol levels are lower in schizophrenic group (0.190 ± 0.059) than non-schizophrenic group (0.590 ± 0.228) ruling out the possible role of cortisol in periodontal disease severity associated with schizophrenic patients.ConclusionFindings of this study, provides ground evidence for consideration of schizophrenia as a risk factor for periodontitis and demands greater emphasis on management of schizophrenic patients in dental setting similar to other comorbid disorders such as diabetes mellitus and also incorporating periodontal care measures in the clinical guidelines for schizophrenia management.

Psychological Inflexibility in People with Chronic Psychosis: The Mediating Role of Self-Stigma and Social Functioning.

Psychosis is associated with self-stigmatization and loss of social functioning that increase the severity of the disorder. Psychological inflexibility (PI)—an individual’s tendency to suppress undesirable private events—plays a fundamental role in the emergence and worst prognosis of psychosis. The main objective of this study was to analyze whether self-stigma and social functioning mediate the association of PI with the severity of psychosis in adults with chronic schizophrenia. The study was carried out with a sample of 103 outpatients. The Acceptance and Action Questionnaire, the Internalized Stigma of Mental Illness Scale, and the Social Functioning Scale were used for clinical assessments. Data analyses were performed by using the PROCESS macro for SPSS. Results showed that the link between PI and the severity of psychosis is not direct, but is better explained by mediation of the self-stigma and social functioning of those assessed. PI also predicts worse social functioning without the need to take self-stigma into account. Moreover, self-stigma alone does not predict the severity of psychotic symptoms; this relationship has to be mediated by social functioning. These findings suggest that interventions designed to increase psychological flexibility, such as Acceptance and Commitment Therapy (ACT), may offer an alternative to attenuate the negative impact of self-stigma and to improve the social functioning.

Abstract 10022: Young Adults Hospitalized with Diabetes Remain at 25% Higher Risk of Acute Myocardial Infarction with Cannabis Use Disorder: A Nationwide Matched Analysis

Background: The impact of cannabis use on diabetes mellitus and associated cardiovascular events remains understudied. Rising trends in recreational cannabis use in the young prompted us to evaluate the risk and outcomes of acute myocardial infarction (AMI) in young diabetics with cannabis use disorder (CUD). Methods: We queried the National Inpatient Sample (2015 October-2017) to identify young adult admissions with diabetes. Demographically (age, sex, and race) matched (1:1) cohorts (CUD+ vs. CUD) were compared for comorbidities and risk of AMI and subsequent inpatient outcomes among young diabetics. Multivariable regression analysis was performed adjusting for confounders. Results: Of young adults admitted with diabetes (median 35 [29-40] years, 59.3% male, 42.3% white), demographically matched CUD+ (n=32170) and CUD- (n=32170) cohorts were obtained (Table 1). The CUD+ cohort often consisted of non-elective admissions (91.7% vs. 85.45%), Medicaid enrollees (51.6% vs. 38.7%), patients from lower household income quartile (47.9% vs. 43.1%) vs. CUD- cohort and had higher burden of smoking, alcohol abuse, chronic pulmonary disease, depression, psychosis and neurological disorders (p<0.001). On adjusted multivariable analysis, the risk of AMI was 25% higher (OR:1.25, 95%CI:1.02-1.51, p=0.03) in CUD+ cohort, however, there was no significant difference in the subsequent inpatient mortality. Male sex (aOR1.35), non-elective admission (aOR2.46), Medicaid/self-pay enrollment (aOR 2.0/3.8), AIDS (aOR6.24), coagulopathy (aOR1.85), peripheral vascular disease (aOR 1.82), hypertension (aOR 2.12), hyperlipidemia (aOR2.53), smoking (aOR1.78), and obesity (aOR1.36) were independent predictors of AMI. Conclusion: Young diabetics with CUD may have 25% higher risk of AMI hospitalizations. Male sex, cardiovascular comorbidities, tobacco smoking, AIDS and coagulopathy independently predicted higher risk of AMI among young diabetics with CUD.

Cortical and subcortical neuroanatomical signatures of schizotypy in 3004 individuals assessed in a worldwide ENIGMA study

Neuroanatomical abnormalities have been reported along a continuum from at-risk stages, including high schizotypy, to early and chronic psychosis. However, a comprehensive neuroanatomical mapping of schizotypy remains to be established. The authors conducted the first large-scale meta-analyses of cortical and subcortical morphometric patterns of schizotypy in healthy individuals, and compared these patterns with neuroanatomical abnormalities observed in major psychiatric disorders. The sample comprised 3004 unmedicated healthy individuals (12–68 years, 46.5% male) from 29 cohorts of the worldwide ENIGMA Schizotypy working group. Cortical and subcortical effect size maps with schizotypy scores were generated using standardized methods. Pattern similarities were assessed between the schizotypy-related cortical and subcortical maps and effect size maps from comparisons of schizophrenia (SZ), bipolar disorder (BD) and major depression (MDD) patients with controls. Thicker right medial orbitofrontal/ventromedial prefrontal cortex (mOFC/vmPFC) was associated with higher schizotypy scores (r = 0.067, pFDR = 0.02). The cortical thickness profile in schizotypy was positively correlated with cortical abnormalities in SZ (r = 0.285, pspin = 0.024), but not BD (r = 0.166, pspin = 0.205) or MDD (r = −0.274, pspin = 0.073). The schizotypy-related subcortical volume pattern was negatively correlated with subcortical abnormalities in SZ (rho = −0.690, pspin = 0.006), BD (rho = −0.672, pspin = 0.009), and MDD (rho = −0.692, pspin = 0.004). Comprehensive mapping of schizotypy-related brain morphometry in the general population revealed a significant relationship between higher schizotypy and thicker mOFC/vmPFC, in the absence of confounding effects due to antipsychotic medication or disease chronicity. The cortical pattern similarity between schizotypy and schizophrenia yields new insights into a dimensional neurobiological continuity across the extended psychosis phenotype.