Chronic Schizophrenic Inpatients Research Articles

Cross-cultural adaptation and validation of the Arabic version of the BACS scale (the brief assessment of cognition in schizophrenia) among chronic schizophrenic inpatients

BackgroundAssessment of cognitive disorders in schizophrenia is becoming a part of clinical and research practice by using batteries that differ widely in their content. The Brief Assessment of Cognition in Schizophrenia (BACS) was developed to cover the main cognitive deficits of schizophrenia. The objective of this study was to assess concurrent validity of the Arabic version of the BACS with a standard neurocognitive battery of tests in Lebanese patients with schizophrenia and healthy controls.MethodsA sample of 120 stable inpatients diagnosed with schizophrenia and 60 healthy controls received the Arabic version of the BACS in a first session, and a standard battery in a second session.ResultsMean duration of completion for the BACS was 31.2 ± 5.4 min in patients with schizophrenia. All tests demonstrated significant differences between controls and patients (p < .01). Principal components analysis demonstrated that a one-factor solution best fits our dataset (64.8% of the variance). High Cronbach alpha was found (.85). The BACS composite scores were significantly correlated with the standard battery composite scores in patients (r = .73, p < .001) and healthy controls (r = .78, p < .001). Also, correlation analysis between the BACS sub-scores and the standard battery sub-scores showed significant results (p < .05).ConclusionResults showed that the Arabic version of the BACS demonstrated high ability to discriminate patients with schizophrenia from healthy controls and it is a useful tool for assessing cognition in patients with schizophrenia and could be used in clinical practice in Lebanon.

Integrated neurocognitive therapy in chronic schizophrenic inpatients: preliminary data and considerations.

The present paper aims at studying the efficacy of the Integrated Neurocognitive Therapy (INT), according to Roder's model, in a group of chronic schizophrenics in a long term residential condition. This kind of treatment is particularly interesting because, according to the most recent studies concerning schizophrenia as a neurodevelopmental disorder, allows to act on the neuro- and socio- cognitions areas, which are the most deteriorated ones. Moreover the INT program includes also computer aided activities (Cog PacK), which largely proved their efficacy on neurocognition. The study sample consists of 10 inpatients suffering of Schizophrenia (according to DSM-5), 5 Male and 5 Female, average age 52, disorder average length 24,9 years, with IQ not <80. The sample took part in the 18 months INT program and has been evaluated through the neurocognitive set RBANS and MCST (modified version of WCST for the survey of the executive functions: abstraction, categorization, set shifting at the beginning of the treatment (T0), after 12 months (T1), and at its end, after 18 months (T2). As regards neurocognition, starting from the preliminary result analysis, the only statistical significance refers to time factor concerning the immediate memory measured by RBANS at T2. We can also point out an improvement trend in T1 evaluations for the single cognitive functions and for the general cognitive profile. Concerning the executive functions (MCST), even without any statistical significance, a general improvement trend is present (completed categories, persisting and not persisting mistakes). The data presented, even in a numerically reduced sample, encourage however an optimistic perspective concerning the INT rehabilitation use in schizophrenic inpatients, substantially confirming the data already present in literature. We have to pay specific attention even in the evaluation of computerized programs, whose use can aid the general sociocognitive functioning. We hope that later and wider studies will support what we have herein preliminarly presented and discussed.

長期入院の慢性精神分裂病患者に対するSocial Skills Trainingの適用 : 般化・維持を促進する手続きの検討(原著)

長期入院の慢性精神分裂病患者に対するSocial Skills Trainingの適用 : 般化・維持を促進する手続きの検討(原著)

Clinical Symptoms, Social Cognition Correlated with Domains of Social Functioning in Chronic Schizophrenia

Background: Social and vocational dysfunctions of schizophrenic patients have generally been considered to result from their illness. Clinical symptoms and social cognition have a great impact on social functioning. The present study aimed to examine the relationship between clinical symptoms, social cognition and domains of social functioning in patients diagnosed with schizophrenia. Methods: Sixty schizophrenic patients were included in the study. All subjects participated in a semi-structured interview and a battery of assessments, including: a Positive and Negative Syndrome Scale (PANSS), a categories test, a Benton facial recognition test, and assessment exercises of picture completion, picture arrangement, object assembly and personal social performance. Results: Negative symptoms, duration of illness and picture arrangement were positively and negatively associated with socially useful activities respectively (r = .49, r = .25, r = -.32). Benton Facial Recognition Test (BFRT) and picture arrangement was negatively associated with personal and social relationship (r = -.60, r = -.20), while two domains of PANSS, including negative symptoms and general psychopathology were positively associated with personal and social relationship (r = .40, r =.25). Negative symptoms and picture arrangement were positively and negatively correlated with self-care respectively (r =.58, r = -.41). Only negative symptoms were positively correlated with disturbing, aggressive behavior (r = .48). Conclusions: Multiple regression analysis revealed that negative symptoms, picture arrangement, BFRT, duration of illness and general psychopathology were associated with socially useful activities, personal and social relationships, self-care, disturbing and aggressive behavior of social functioning. Chronic schizophrenic inpatients could receive treatments or interventions geared to improving their clinical symptoms and social functioning.

The Effects of Psychotropic Drugs on the Physical Capacity of the Chronic Schizophrenic Inpatients

The Effects of Psychotropic Drugs on the Physical Capacity of the Chronic Schizophrenic Inpatients

Cognitive Impairment and Perceived Stress in Schizophrenic Inpatients with Post-Traumatic Stress Disorder

The rate of lifetime traumas in the general population is high and a great deal of evidence suggests that persons with severe mental illness (SMI) show an even higher degree of vulnerability to trauma throughout their lives. Recent studies report between 13 and 29% of comorbid Post-Traumatic Stress Disorder (PTSD) in schizophrenic patients. Other studies showed that SMI patients with PTSD were in poorer health, had lower self-esteem, and had lower subjective quality of life and more cognitive deficits in comparison with those without PTSD. The aim of this work is to study a sample of chronic schizophrenic inpatients admitted after the L'Aquila earthquake, to assess if comorbid PTSD is associated with a higher rate of neurocognitive deficit and poorer quality of life in comparison with schizophrenic inpatients without PTSD. The sample of this study, recruited after the L'Aquila earthquake (between April 2009 and December 2009), consisted of 54 schizophrenic earthquake survivors admitted consecutively to the Psychiatric Inpatients Unit of L'Aquila San Salvatore Hospital. Each patient was assessed with the Positive and Negative Syndrome Scale (PANSS) and the General Health Questionnaire − 12 items (GHQ-12). The Impact of Event Scale-Revised (IES-R) was used to grade post-traumatic symptoms. PTSD diagnosis was made with the Structural Clinical Interview for DSM-IV (SCID-I). The cognitive assessment battery included WAIS-III Digit Span and Trail Making Test to assess working memory and executive functions, respectively. The severity of illness was measured with the Clinical Global Impression Scale (CGI). All the patients were on antipsychotic drugs at a mean daily chlorpromazine-equivalent dose of 236.38 mg (SD 183.5). 17% of the 54 schizophrenic inpatients (n 9) met the DSM-IV criteria for PTSD. PTSD subjects had significantly higher scores on the PANSS Positive Symptom subscale (P ≤ 0.015) and higher GHQ-12 mean score (30.50 vs 16.93). In the presence of post-traumatic symptoms a significant difference between the two groups (with and without PTSD) was found in hyper-arousal subscale scores, with a significant impairment of working memory in the PTSD sample. PTSD symptom measures positively correlated with the PANSS total and Positive score and GHQ-12 score &gt; 20 (“high stress level”). PTSD in schizophrenic patients is associated with a more severe cognitive deficit, higher levels of perceived stress and more positive symptoms. The investigation of PTSD in patients with schizophrenia might have important implications for their clinical management and for future research.

Deficit in Decision-Making in Chronic, Stable Schizophrenia: From a Reward and Punishment Perspective

ObjectiveWe compared patients with chronic schizophrenia and normal controls with respect to decision-making ability. Measures were implemented to control for the participants' intelligence levels as well as to ensure to use of a moderate sample size. The goal of this study was to confirm inconsistent results from previous studies which had stemmed from too small of a sample size, highly variable performance of normal controls, and not controlling for intelligence as a confounding factor.MethodsFifty-two chronic stable schizophrenic inpatients and 55 healthy controls participated in the study. We controlled for intelligence by including subjects with intelligence quotient's (IQ) between 80 and 120, examining any differences in decision-making performance between groups on the Iowa Gambling Task (IGT). We also addressed several issues relating to performance on the IGT, such as working memory and clinical symptoms.ResultsSchizophrenic patients were found to perform poorly on the IGT relative to normal controls (F1,105=17.73, p<0.001); however, more importantly, they also displayed the slow yet profitable shift from disadvantageous decks to advantageous decks over time. We also found that when compared with healthy controls, schizophrenic patients showed a poorer performance on the Wisconsin Card Sorting Test (WCST)(t=-5.48, p<0.001 for perseverative error) which was not related to their performance on the IGT.ConclusionBased on previous literature and the results of this study, impaired sensitivity to both reward and punishment might be a more plausible explanation for the poor performance on the IGT in the schizophrenic group. We speculated that this impairment seemed related more to the different responsiveness to the magnitude than to the frequency of punishment, and to the different interpretation of less informative verbal cues in the context of the reinforcing schedule.

Application study of self-care model in nursing of chronic schizophrenic inpatients

Objective To explore the serf-care project of chronic schizophrenic inpatients and its effect. Methods 80 chronic schizophrenic inpatients were divided into the experiment group and the control group according to the grouping method of minimization imbalance index. Then a double-blind comparison was conducted in the two groups. Both the two groups adopted the routine schizophrenic pharmacotherapy and the general nursing, and the experiment group additionally adopted the self-care on the before-mentioned basis. The observation lasted for 6 months. The ADL (Activity of Daily Living Scale) was used to evaluate the curative effect of patients in the two groups before and after the intervention. Results The score of ADL in the experiment group had a statistical meaning compared to that of control group (P < 0. 01). Conclusions On the basis of systematic hospitalization therapy, implementing the self-care among chronic schizophrenic inpatients can obviously improve their self-care ability and the rehabilitation effect, thereby helping the patients return to society early. Key words: Orem self-care model; Schizophrenosis; Self-care

Assessment of cognitive function with MMSE in chronic schizophrenic inpatients

A large number of chronic patients with serious mental disorder are hospitalized in the private sector, either because the public sector is not able to hospitalize them for long periods, or because a private clinic might be closer to the patient's habitat so that the relatives may have the possibility to visit them more often. In the frame of the Psychiatric Reform, the private sector has developed and adapted, in the direction of new data of benefits of Psychiatric care. However, the interaction of the chronicity of the disease with prolonged or life hospitalization has unknown effects on cognitive function. The aim of this project was to study if and how much the cognitive function of schizophrenic patients can be influenced by the long term of hospitalisation.

Absence of regional brain volume change in schizophrenia associated with short-term atypical antipsychotic treatment

The first aim of this pilot study was to determine if longitudinal change in caudate volume could be detected in chronic schizophrenic patients after 12 weeks of atypical antipsychotic treatment. A sub-aim of the first aim was to determine if similar results could be obtained from an operator-assisted segmentation tool for volumetric imaging (ITK-SNAP) and voxel-based morphometry (VBM) methods in the caudate. The second aim was to determine if frontal and temporal lobe grey matter, white matter, ventricular and sulcal cerebrospinal fluid volume change could be detected after 12 weeks of atypical antipsychotic treatment with VBM. Ten chronic schizophrenic inpatients, with illness duration averaging 10.6 years, underwent two MRI scans. The first scan was obtained after a mean of 39.4 days of antipsychotic withdrawal. The second MRI was obtained following twelve weeks of atypical antipsychotic treatment. Caudate volume change was first measured with ITK-SNAP. Then the location of grey matter volume change in the caudate was identified with VBM. Finally, the location of frontal and temporal lobe grey matter, white matter, ventricular and sulcal cerebrospinal fluid volume changes were identified with VBM. No longitudinal change in caudate volume or grey matter volume was observed after brief periods of atypical antipsychotic treatment. ITK-SNAP and VBM methods showed very similar results in the caudate. No statistically significant change was identified in the volume of frontal or temporal lobe grey matter, white matter, and lateral, third, or fourth ventricular cerebrospinal fluid. Although the results do not directly show that brief periods of atypical antipsychotic treatment are associated with basal ganglia and cortical volume change, there is much evidence to suggest that such an association exists.

Atypical antipsychotics and polydipsia: a cause or a treatment?

Primary polydipsia (PP) is a frequent complication that affects many chronic schizophrenic inpatients. Due to possible lethal consequences, for example, hyponatremia, coma and death, it's fundamental for the physician achieving early diagnosis and treating this condition. The first step is identifying polydipsia by clinical, biochemical and pharmacological means. Nowadays, the pathophysiology of PP remains unclear, and this limits the possibility of detecting an appropriate drug treatment. Typical antipsychotics have been associated to a worsening of polydipsic behavior, while more recently atypical antipsychotics have been reported as being useful. However results are still mixed and controversial. It appears that risperidone and olanzapine are not clearly effective; clozapine may improve symptoms, although it is difficult to manage from a therapeutic point of view; quetiapine has been poorly studied so far, nonetheless it has given interesting results. Through a case study analysis, this report presents a brief, yet selective, overview of the current state of psychopharmacology in the treatment of PP with atypical antipsychotics in schizophrenia.

Assessment of cognitive function with MMSE in chronic schizophrenic inpatients

Assessment of cognitive function with MMSE in chronic schizophrenic inpatients

Prevalence of diabetes mellitus in chronic schizophrenic inpatients in relation to long-term antipsychotic treatment

Background Many reports indicate that the incidence and prevalence of diabetes mellitus is increased in schizophrenic patients and related to antipsychotic treatment. In an exploratory cross-sectional study we assessed the prevalence of type 2 diabetes mellitus in 266 chronic schizophrenic and schizoaffective inpatients and investigated whether the duration of antipsychotic treatment was related to the development of diabetes mellitus. Method We measured the non-fasting plasma glucose level in 266 inpatients with DSM IV diagnosis of schizophrenia or schizoaffective disorder in 5 different long-stay wards in the Netherlands. Measured variables were: age, sex, ethnicity, BMI, current antipsychotic treatment, duration of illness and duration of antipsychotic treatment. Results The overall prevalence of type 2 diabetes mellitus was 9%, which is significantly higher than the prevalence of 4.9% in the general population (OR 1.89, CI 1.14–3.13; p < 0.014). The prevalence was increased in two age cohorts: 30–39 years (3.8% vs. 0.3%, OR = 13.29, CI = 2.17–81.36, p = < 0.005) and 40–49 years (9.3% vs. 1.5%, OR = 6.74, CI = 2.77–16.38, p = 0.000). No new cases of diabetes mellitus were detected during the course of the study. The increased prevalence was found to be related to overweight and obesity. The time of exposure to antipsychotic treatment was not significantly correlated with the prevalence of diabetes mellitus when adjusted for age ( F = 0.804, df = 1, p = 0.371, respectively, F = 0.194, df = 1, p = 0.660). Both typical and atypical antipsychotics contributed equally to the prevalence of diabetes mellitus. Conclusion No significant relation between long-term antipsychotic treatment and prevalence of diabetes mellitus was found. The high prevalence of diabetes mellitus in schizophrenic patients warrants screening of these patients already at young age for glucose disturbance.

Hormonal Profile Effects Following Dehydroepiandrosterone (DHEA) Administration to Schizophrenic Patients

Dehydroepiandrosterone (DHEA) is an important neurosteroid and has demonstrated efficacy in the improvement of mood and energy. The authors previously reported the efficacy of DHEA augmentation in the management of negative, depressive, and anxiety symptoms of schizophrenia. To characterize further the effects of DHEA administration and to describe any hormonal effects following DHEA augmentation of antipsychotic medication, several hormones were measured (TSH, prolactin, testosterone, insulin, and estradiol) in 27 chronic schizophrenic inpatients receiving DHEA or placebo augmentation for 6 weeks. No significant changes in hormonal blood measures were noted. At the study end point, an association was noted between DHEA-S and TSH levels (P < 0.05) as well as a change in DHEA-S and insulin levels (P < 0.001). A modest nonsignificant decrease in plasma testosterone was observed following DHEA treatment. In subjects receiving DHEA, change in testosterone levels was associated with improvement in anxiety (P < 0.05) and illness severity (P < 0.05). Findings in this preliminary study demonstrate minimal effects on hormonal profiles despite the theoretic possibility that DHEA may elevate various hormones (eg, testosterone) with potential long-term adverse effects. DHEA's clinical efficacy appears to be mediated by other mechanisms, including direct effects on membrane channel-coupled receptors.

Increased serum S100B in elderly, chronic schizophrenic patients: Negative correlation with deficit symptoms

In schizophrenia, elevations of serum and CSF S100B levels have been reported and related to state of the disease and negative symptoms. In elderly chronic schizophrenic inpatients with stable medication, S100B may be increased and correlated to psychopathology and neuropsychological deficits.We have measured serum levels of S100B in 41 elderly, chronic schizophrenic patients and 23 age- and gender-matched controls using an immunoluminometric assay. In patients, we assessed detailed psychopathology and neuropsychological performance and determined serum levels of haloperidol, clozapine and its two main metabolites desmethylclozapine and clozapine metabolite N-oxid by HPLC.S100B levels were increased in elderly chronic schizophrenic patients compared to healthy controls. In patients, levels were negatively correlated with deficit symptoms and positively with age. There were no significant differences of S100B between medication groups and no correlation with serum levels of antipsychotics or neuropsychological scores.Elevations of S100B in elderly chronic schizophrenic patients may be related to an active disease process lasting until old-age. Correlations point to the impact of S100B in neuroplasticity and ageing. Post-mortem studies should clarify the presence of altered S100B function in the brain and its relationship to neuroplastic or neurodegenerative processes.

Association of Muscarinic M1 Receptor Genetic Polymorphisms with Psychiatric Symptoms and Cognitive Function in Schizophrenic Patients

Objective: The cholinergic system is important in the search for the pathophysiology of schizophrenia due to its role in cognitive function, interaction with the dopamine system in brain regions relevant to schizophrenia, side effects of antipsychotic medication and potential antipsychotic effect of muscarinic receptor antagonists. This study investigated the association of type I muscarinic receptor (CHRM1) genetic polymorphisms with the clinical characteristics of chronic schizophrenic inpatients. Methods: We determined the genotype of CHRM1 genetic polymorphisms in 243 schizophrenic patients hospitalized in chronic care wards. Psychotic symptoms were assessed using the Brief Psychiatric Rating Scale (BPRS), and cognitive function was assessed using the Folstein Mini-Mental Status Examination (MMSE) test. Sixty of the 243 subjects also completed the Wisconsin Card Sorting Test (WCST). Results: There was a significant difference in the number of correct responses and the percentage of perseverative errors in the WCST in the CHRM1 C267A genotype group of schizophrenia patients. There was no significant association between age at onset, chlorpromazine equivalents, BPRS scores, MMSE or schizophrenia per se in patients with the CHRM1 C267A genotype. The full exon of the CHRM1 gene was screened out with single-strand conformation polymorphism, and 2 single nucleotide polymorphisms (C267A and C1353T) were identified in our patients and control subjects. These 2 single nucleotide polymorphisms were linked together without exception. Conclusion: This study demonstrated that in schizophrenic patients, the heterozygote group of CHRM1 C267A polymorphism (267C/A) had more correct responses and less perseverative errors on the WCST performance than the 267C/C homozygote group, implicating that this polymorphism may be related to prefrontal cortical function. Our results also suggested that the C267A polymorphism plays no major role in the susceptibility to and clinical manifestations of schizophrenia.

Diabetes Mellitus en 93 enfermos esquizofrénicos crónicos

Aims: In an exploratory research of the prevalence of hyperglycaemia or Diabetes Mellitus, type 2, among chronic schizophrenic patients in a chronic ward of a general psychiatric hospital, all patients with the diagnosis of schizophrenia or schizoaffective disorders were asked to cooperate in the study. Methods: Hyperglycaemia or DM, type 2, in the non-fasting patients was diagnosed in accordance with the NHG-guidelines (1999). 93 out of the 99 schizophrenic or schizoaffective patients actually participated in the research. Results: Hyperglycaemia was diagnosed in 11 of the 93 patients, of which only 1 was previously known. The prevalence of hyperglycaemia at the age of 20-49 years was significantly higher than in the general population (15,2% vs 5,7%, OR = 2.959. CI = 1.230-7.119, p < 0.05). The general prevalence of DM, type 2, was significantly raised in comparison to the general population (7,5% vs 1,9%, OR = 4.288, CI = 1.979-9.289, p < 0.001). In spite of a significantly raised prevalence of obesitas in the study population (20% vs 8%, OR = 2.953. CI = 1.698. p < 0.001). no relation with the raised prevalence of hyperglycaemia or DM, type 2, was found, neither was a relation found between diabetic disturbance and the prescribed antipsychotic medication. Conclusions: In an exploratory study of 93 chronic schizophrenic inpatients a significantly raised prevalence of hyperglycaemia and diabetes mellitus type 2 was found, which could not be explained by the raised prevalence of overweight. In contrast to case reports and some recent studies, no relation was found between diabetic disturbance and the prescribed antipsychotic medication. Whether this contrast results from differences in study population or other methodological differences, is a question for further research. This study has three major limitations. One is that the impact of inactivity, one well-known risk factor of diabetes mellitus type 2, was not assessed. The second limitation is the selection of the study population: only chronic, schizophrenic impatients were included in this study. The thrid limitation is the difficulty in assessing the effect of chronic, often decade-long antipsychotic regime of different antipsychotic medication in different dosages on glucose homeostasis. Further research are needed to help to elucidate these questions.

Smoking in Chronic Schizophrenic Inpatients in Taiwan

Objective: This study investigated the prevalence of smoking and its association with the clinical characteristics of Chinese inpatients with chronic schizophrenia. Method: Schizophrenic patients hospitalized in chronic wards were assessed using Brief Psychiatric Rating Scale (BPRS), Abnormal Involuntary Movements Scale (AIMS) and Folstein Mini-Mental Status Examination (MMSE) testing. Results: Of 257 patients, 105 smoked and 4 had ceased. Males exhibited a higher prevalence of smoking than females (p < 0.001). Smoking was not significantly associated with age at onset (AAO), chlorpromazine equivalents, MMSE, AIMS, BPRS positive symptom subscale, BPRS negative symptom subscale or total BPRS scores. Smokers had higher BPRS general subscales. Conclusion: Compared to the general population, smoking prevalence was slightly higher in schizophrenic males, double in schizophrenic females, but no difference in refractory schizophrenic clozapine users. Smoking did not affect patient AAO or daily antipsychotic dose. Patients with a higher BPRS general subscale may smoke to relieve affective symptoms.

Effects of risperidone on gonadal axis hormones in schizophrenia.

To investigate the effects of risperidone on the hypothalamo-pituitary-gonadal (HPG) axis of chronic schizophrenic male inpatients medicated regularly. Subjects included six inpatients who were diagnosed according to the Diagnostic and Statistical Manual, Fourth Edition, criteria for schizophrenia, and were termed treatment-refractory. Each patient gave informed consent for the research involved in this study. The neuroendocrine studies were done before and during risperidone administration. Patients took a mean dose of risperidone 9.5 mg/d for a mean period of 64.2 days. Psychotic symptoms were assessed using the Brief Psychiatric Rating Scale (BPRS). Prolactin (PRL) increased significantly during risperidone administration. However, luteinizing hormone, follicle-stimulating hormone, and testosterone did not show significant difference between blood concentrations before and during risperidone administration. Scores of the BPRS total, thought disturbance factor, and tension decreased significantly during risperidone administration. Throughout the study, none of the patients experienced clinically significant problems associated with elevated PRL concentrations including gynecomastia and/or sexual dysfunction. Addition of risperidone produced significant improvement of psychotic symptoms in treatment-resistant schizophrenic patients, and an increase in basal blood PRL concentrations, but not in basal blood HPG axis hormone concentrations. This preliminary result warrants further double-blind evaluation with a larger sample.

Propranolol as an effective agent for the treatment of agitation, aggression and violent behaviour in two inpatients with chronic schizophrenic inpatients

Propranolol as an effective agent for the treatment of agitation, aggression and violent behaviour in two inpatients with chronic schizophrenic inpatients