Clinical Course Of Schizophrenia Research Articles

Gender differences in clinical and biochemical parameters among patients hospitalized for schizophrenia: towards precision medicine.

The scientific literature shows some gender differences in the clinical course of schizophrenia. The aim of this study is to identify gender differences in clinical and biochemical parameters in subjects affected by schizophrenia. This would allow for the implementation of individualized treatment strategies. We examined a large set of clinical and biochemical parameters. Data were obtained from clinical charts and blood analyses from a sample of 555 schizophrenia patients consecutively admitted for exacerbation of symptoms to the inpatient clinic of Fondazione IRCCS Policlinico(Milan) or ASST Monza in Italy from 2008 to 2021. Univariate analyses, binary logistic regression, and a final logistic regression model were performed with gender as dependent variable. The final logistic regression models showed that male patients (compared to females) were more prone to lifetime substance use disorders (p = 0.010). However, they also had higher GAF (global functioning) mean scores (p < 0.001) at the time of hospitalization. Univariate analyses showed that male patients (with respect to females) had an earlier age at onset (p < 0.001), a more frequent family history of multiple psychiatric disorders (p = 0.045), were more often smokers (p < 0.001), had a more frequent comorbidity with at least one psychiatric disorder (p = 0.001), and less often suffered from hypothyroidism (p = 0.011). In addition, men had higher levels of albumin (p < 0.001) and bilirubin (t = 2.139, p = 0.033), but lower levels of total cholesterol (t = 3.755, p < 0.001). Our analyses indicate a less severe clinical profile in female patients. This is evident especially in the early years of the disorder, as suggested by less comorbidity with psychiatric disorders or later age at onset; this is consistent with the related literature. In contrast, female patients seem to be more vulnerable to metabolic alterations as demonstrated by more frequent hypercholesterolemia and thyroid dysfunction. Further studies are needed to confirm these results in the framework of precision medicine.

Sleep Problems, Suicidal Ideation, and Psychopathology in First-Episode Psychosis.

Insomnia occurs frequently in the clinical course of schizophrenia. A growing literature has found associations between insomnia, suicidal ideation and behavior, and psychopathology in schizophrenia. We explored associations between sleep problems, suicidal ideation, and psychopathology in a cohort of patients with first-episode psychosis. We performed a secondary analysis of data for n = 403 subjects with data from the Recovery After an Initial Schizophrenia Episode study using regression models. The prevalence of sleep problems and suicidal ideation at baseline was 57% and 15%, respectively. After controlling for potential confounders, in the study baseline sleep problems were associated with increased odds of suicidal ideation with evidence of a dose-dependent relationship (OR = 2.25, 95% CI 1.15-4.41, P = .018). Over 24 months, sleep problems at any time point were associated with an over 3-fold increased odds of concurrent suicidal ideation (OR = 3.21, 95% CI 1.45-7.14, P = .004). Subjects with persistent sleep problems were almost 14 times more likely to endorse suicidal ideation at least once over the study than those without sleep problems (OR = 13.8, 95% CI 6.5-53.4, P < .001). Sleep problems were also a predictor of higher Positive and Negative Syndrome Scale total (β = 0.13-0.22), positive (β = 0.14-0.25), and general (β = 0.16-0.27) subscale scores at baseline and multiple follow-up visits (P < .01 for each). Sleep problems are highly prevalent and associated with suicidal ideation and greater psychopathology in first-episode psychosis. Formal assessment and treatment of insomnia appear relevant to the clinical care of patients with psychosis as a predictor of suicidal ideation and symptom severity.

Exploring a Possible Interplay between Schizophrenia, Oxytocin, and Estrogens: A Narrative Review

Schizophrenia is characterized by symptoms of psychosis and sociocognitive deficits. Considering oxytocin's antipsychotic and prosocial properties, numerous clinical, and preclinical studies have explored the neuropeptide's therapeutic efficacy. Sex differences in the clinical course of schizophrenia, as well as in oxytocin-mediated behaviors, indicate the involvement of gonadal steroid hormones. The current narrative review aimed to explore empirical evidence on the interplay between schizophrenia psychopathology and oxytocin's therapeutic potential in consideration of female gonadal steroid interactions, with a focus on estrogens. The review was conducted using the PubMed and PsychINFO databases and conforms to the Scale for the Assessment of Narrative Review Articles (SANRA) guidelines. The results suggest a potential synergistic effect of the combined antipsychotic effect of oxytocin and neuroprotective effect of estrogen on schizophrenia. Consideration of typical menstrual cycle-related hormonal changes is warranted and further research is needed to confirm this assumption.

Longitudinal study of inflammation and relapse in schizophrenia

IntroductionThe clinical course of schizophrenia is often characterized by recurrent relapses. Blood inflammatory markers are altered in acute psychosis, and may be state markers for illness relapse in schizophrenia. Few studies have investigated longitudinal, intra-individual changes in inflammatory markers as a predictor of relapse. In the present study, we explored this association in a relapse prevention trial in patients with schizophrenia. MethodsWe analyzed blood inflammatory markers in 200 subjects, with a mean 11 samples per subject, during the 30 month Preventing Relapse in schizophrenia: Oral Antipsychotics Compared to Injectable: eValuating Efficacy (PROACTIVE) trial. Associations between longitudinal changes in inflammatory markers and relapse were analyzed using a within-subjects design. Results70 (35 %) of subjects relapsed during the study period. There were no significant differences in mean inflammatory marker levels based on relapse status (yes/no). Baseline levels of inflammatory markers did not predict incident relapse. Among subjects who relapsed, there was a significant decrease in mean blood IL-6 (n = 38, p = 0.019) and IFN-γ (n = 44, p = 0.012) levels from the visit before the relapse to the visit after relapse. ConclusionAlthough there was some evidence for inflammation as a potential state marker for acute psychosis, we did not find significant evidence for its utility as a relapse-predictive marker.

Lifestyle Coaching May Be an Effective Treatment for Schizophrenia.

This commentary critiques the Danish CHANGE trial, which evaluated 3 levels of outpatient intervention intensity, in a group of outpatients with obesity and schizophrenia. Neither adding care coordination with weekly nurse contacts alone nor combining this treatment with assertive community lifestyle coaching as compared to treatment as usual improved outcomes, which included cardiovascular disease risk calculation, cardiorespiratory fitness, weight, and self-reported behaviors such as smoking, physical activity, and diet. The CHANGE trial investigators appear strongly averse to recommending the development and implementation of lifestyle medicine programs as a major component when treating outpatients with severe mental disorders. The potential dismissal of lifestyle medicine as a component of treatment for severe mental disorders is problematic. Valuable lessons can be learned from more thoroughly analyzing secondary outcomes such as medical and psychiatric hospitalization rates and total health care cost. The CHANGE trial data analysis needs to be expanded beyond the focus on changes in weight and serum cholesterol. Insulin resistance and high refined carbohydrate intake may be major factors in determining both the medical and psychiatric clinical course of schizophrenia. Assertive community lifestyle coaching is a novel treatment modality. Evidence strongly suggests assertive community lifestyle coaching substantially decreases both psychiatric and medical hospitalization rates.

Magnetic Resonance Imaging throughout the Clinical Course of Schizophrenia: Neurobiological Underpinnings and Clinical Implications.

As a non-invasive detection method and an advanced imaging method, magnetic resonance imaging (MRI) has been widely used in the research of schizophrenia. Although a large number of neuroimaging studies have confirmed that MRI can display abnormal brain phenotypes in patients with schizophrenia, no valid uniform standard has been established for its clinical application. On the basis of previous evidence, we argue that MRI is an important tool throughout the whole clinical course of schizophrenia. The purpose of this commentary is to systematically describe the role of MRI in schizophrenia and to provide references for its clinical application.

Epigenetic clocks in relapse after a first episode of schizophrenia

The main objective of the present study was to investigate the association between several epigenetic clocks, covering different aspects of aging, with schizophrenia relapse evaluated over a 3-year follow-up period in a cohort of ninety-one first-episode schizophrenia patients. Genome-wide DNA methylation was profiled and four epigenetic clocks, including epigenetic clocks of chronological age, mortality and telomere length were calculated. Patients that relapsed during the follow-up showed epigenetic acceleration of the telomere length clock (p = 0.030). Shorter telomere length was associated with cognitive performance (working memory, r = 0.31 p = 0.015; verbal fluency, r = 0.28 p = 0.028), but no direct effect of cognitive function or symptom severity on relapse was detected. The results of the present study suggest that epigenetic age acceleration could be involved in the clinical course of schizophrenia and could be a useful marker of relapse when measured in remission stages.

Higher Depression Scores in Patients with Drug-Resistant Schizophrenia.

Schizophrenia is a mental illness with diverse clinical presentation, in which a significant proportion of patients show resistance to treatment. In patients with schizophrenia, symptoms from all psychotic and affective spectra are observed. On the one hand, affective symptoms determine the clinical course of schizophrenia and on the other hand, depressive symptoms are some of the most common ones in psychiatry in general. These data give us reason to explore the impact of depressive symptoms on the course of schizophrenia and its relationship with resistance to treatment. A study of 105 patients with schizophrenia was performed. Of these, 39 were male and 66 were female. The evaluation of the effectiveness of the treatment carried out at 12 weeks of therapy showed that 45 were resistant to schizophrenia and the remaining 60 were in clinical remission. The clinical evaluation of the patients was performed with the PANSS (Positive and Negative Syndrome Scale) and BPRS (Brief Psychiatric Rating Scale) scales. The assessment of depressive complaints was conducted with the Hamilton Depression Scale. Our study showed that in the analysis of depressive complaints with the Hamilton scale females got 12.55 points, and males got 11.44 points. We found a correlation of depressive complaints with the evaluation on the PANSS and BPRS scales, and in the analysis on the individual subscales we found a correlation on the subscale for positive and disorganized symptoms and no correlation on the scale for negative symptoms. We established a difference in the level of depression in patients with resistance in whom the level of depressive complaints was 13.82, while in those in clinical remission it was 10.87 points. The level of depressive symptoms in patients with resistant schizophrenia is higher than in clinical remission. Depressive symptoms correlate with positive and disorganized symptoms on the PANSS scale, but not with negative symptoms. Gender is not a determining factor in depressive complaints.

A 45-year follow-up study of adolescent schizophrenia. Part II: Age of disease onset, type of onset of the disorder and presence of developmental burden in the context of disease course and long-term social functioning of patients.

Research on predictors of adolescent schizophrenia, especially that based on long-term follow-up studies, is rare in the literature. In our analysis, we examine the relationships of the age of disease onset, type of onset of the disorder and the presence of developmental burden with clinical and social indicators of the disease course. A total of 69 patients hospitalized at an average age of 16 years (time point 0) due to schizophrenia (retrospectively re-diagnosed according to ICD-10 criteria) and re-examined 5 years later (time point 1 - personal examination of 41 individuals) were re-evaluated for clinical and social parameters 45 years after initial hospitalization (time point 2 - personal examination of 21 individuals). Besides personal examination, other methods of data collection were also used, including hospital queries. The hidden type of onset of schizophrenia revealed numerous and various correlations with both the symptomatic picture and the clinical course of schizophrenia, and with distant social functioning of the subjects, translating into a classical Bleuler symptomatic picture, weaker response to treatment, and worse functioning in personal and professional life. The presence of significant separations in childhood proved to be a factor conducive to insight and less intense psychopathology in the distant course of schizophrenia. The family burden of schizophrenia correlated with the catatonic picture in the future and with more hospitalizations and earlier death. The hidden type of onset of schizophrenia is the most important predictor of its later course.

A 45-year follow-up study of adolescent schizophrenia. Part I: Premorbid values of psychological and relational indicators in the context of illness course and long-term social functioning of patients.

Research on predictors of adolescent schizophrenia, especially those based on long-term follow-up studies, is rare in the literature. In our analysis, we examine the relationship between the premorbid functioning of the respondents and clinical and social indicators of the illness course. 69 patients at the average age of 16 years (time point 0), hospitalized due to schizophrenia (retrospectively re-diagnosed according to ICD-10 criteria) and re-examined 5 years later (time point 1 - personal examination of 41 individuals), were re-evaluated for clinical and social parameters 45 yearsafter their initial hospitalization (time point 2 -personal examination of 21 individuals). Premorbid indicators of mood, life drive, emotional expression, level of social withdrawal, intelligence, anxiety, development of sexual and aggressive drive, and family and extra-family relational life revealed numerous and various correlations with both the symptomatic picture and clinical course of schizophrenia as well as distant social functioning of the subjects. Variables of the greatest prognostic value were: the emotional attitude of "moving away from" people and the world, and rich relational life outside the family of origin. These variables revealed opposite correlations, especially with the severity of negative symptoms, the level of late insight and regression, the quality of professional life and GAF scores, with the correlations of rich relational lifeto be assessed as positive and the correlations of attitude of "moving away from" as negative. The harmonious development of drive as well as high intelligence also proved to be significant. The correlations of both of these variables have proved beneficial both in clinical and social terms. The so-called premorbid personality described by several indicators turns out to be an important prognostic factor in juvenile schizophrenia.

Oxidative Stress Biomarkers as a Predictor of Stage Illness and Clinical Course of Schizophrenia.

Pro/antioxidant imbalance has been reported in schizophrenia (SZ). However, the results of studies are inconsistent and usually do not include other factors that are highly affected by oxidative stress (OS).This cross-sectional study aimed to determine the serum levels of OS markers and their potential connection with schizophrenia. The total sample comprised 147: 98 individuals with SZ −47 first-episode (FS) and 49 chronic patients (CS)—and 49 healthy individuals (HC) as a control group. The examination included clinical variables and serum levels of antioxidants and oxidative damage products. The significant changes were observed in concentrations of all examined markers, without any specific direction of the pro/antioxidant balance shift between SZ and HC. In the regression model adjusted for cofounders, catalase: OR = 0.81 (95%CI: 0.74–0.88); glutathione peroxidase: OR = 1.06 (95%CI: 1.02–1.10); total antioxidant capacity: OR = 0.85 (95%CI: 0.75–0.98); oxidative stress index: OR = 1.25 (95%CI: 1.03–1.52); ferric reducing ability of plasma: OR = 0.79 (95%CI: 0.69–0.89); advanced glycation end products: OR = 1.03 (95%CI: 1.01–1.04); and advanced oxidation protein products (AOPP): OR = 1.05 (95%CI: 1.03–1.07) turned out to be significant predictors of schizophrenia. In the multiple stepwise regression model, pro/antioxidant status and their interaction with the duration of illness-related factors affected schizophrenia symptoms: positive symptoms (FRAPxKYN), negative (DITYR, FRAP, CAT), general (KYN), and over-all psychopathology (KYNxNFK). The results confirm differences in serum levels of oxidative biomarkers between SZ patients and healthy individuals. The pro/antioxidant status could be considered a predictor of schizophrenia and the factor affects patients' symptom severity.

Insomnia, Suicidal Ideation, and Suicide Attempts in the Clinical Antipsychotic Trials of Intervention Effectiveness.

Objective: Insomnia occurs frequently in the clinical course of schizophrenia. There is a robust association between insomnia and suicide in other psychiatric disorders. Several previous studies found associations between insomnia and suicidal ideation, suicide attempt, and psychopathology in schizophrenia. We explored these associations in a cross-sectional study of a large sample of patients with schizophrenia. Methods: In February 2020, we investigated relationships between current insomnia, suicidal ideation over the past 2 weeks, suicide attempt in the past 6 months (assessed by either the Calgary Depression Scale for Schizophrenia or self-report), and current psychopathology for subjects with baseline data from the Clinical Antipsychotic Trials of Intervention Effectiveness (DSM-IV schizophrenia trial conducted 2001-2004) using regression models. Results: After controlling for multiple potential confounding factors, terminal insomnia was associated with significant, 2.7-fold increased odds of current suicidal ideation (OR = 2.7, 95% CI = 2.0-3.6, P < .001). Initial/middle insomnia was associated with a significant, 5.5-fold increased odds of suicide attempt in the past 6 months (OR = 5.5, 95% CI = 1.4-21.1, P = .013). Terminal insomnia was also a significant indicator of higher Positive and Negative Syndrome Scale total (β = 0.12, P < .001), positive subscale (β = 0.11, P < .001), and general psychopathology subscale (β = 0.14, P < .001) scores. There were no other significant associations between insomnia, suicidal thinking or behavior, and psychopathology. Conclusions: Insomnia is associated with suicidal ideation, recent suicide attempt, and greater psychopathology in schizophrenia. Findings provide additional evidence that formal assessment of insomnia is relevant to the clinical care of patients with schizophrenia as an indicator of suicidal ideation and behavior, as well as symptom severity. Trial Registration: ClinicalTrials.gov identifier: NCT00014001.

Immunoinflammatory Profile in Patients with Episodic and Continuous Paranoid Schizophrenia.

Associations of disturbances in innate and adaptive immunity during the clinical course of schizophrenia have been found in a number of studies. Yet, the relationship of immune parameters and systemic inflammation in relation to the clinical course of the disease and its prognosis, remains poorly understood, which highlights an interesting topic for further research. The goal of this study was to research the immuno-inflammatory changes in patients with clinical continuous and episodic paranoid schizophrenia, to assess the pathogenetic significance of these changes. Thirty-six patients with paranoid schizophrenia, of which 20 had episodic symptoms and 16 had continuous symptoms, consented to participate in the study, together with 30 healthy volunteers. In the study we assessed the parameters of innate immune response (serum levels of key pro-inflammatory and anti-inflammatory cytokines, C-reactive protein) and the adaptive immune response, including humoral-mediated immunity (serum immunoglobulins IgA, IgM, IgG, circulating immune complexes), as well as the cell link of adaptive immunity (key lymphocyte subpopulations). Positive and negative symptoms were assessed with the positive and negative symptoms scale; frontal dysfunction was assessed by Frontal Assessment Battery (FAB). Both patient groups had higher than normal levels of C-reactive protein and IL-8. There was a significant elevation of circulating immune complexes among patients with continuous symptoms of schizophrenia, compared to patients with episodic symptoms and healthy controls. Levels of CD45+CD3+ lymphocytes (T-cells) differed between clinical groups, with higher values identified among patients with episodic symptoms and lower values among those with continuous symptoms. In addition, patients with episodic symptoms had significantly increased levels of CD45+CD3+CD4+CD25+CD127- regulatory T-cells. Finally, the level of CD45+CD3-CD19+ B-cells was significantly higher among patients with continuous symptoms vs. patients with episodic symptoms and the control groups. Markers of activation of humoral immunity were associated with the severity of frontal disorders in these patients. Comprehensive data on the serum level of cytokines and the parameters of adaptive immunity among individuals with continuous schizophrenia, by comparison with patients with episodic schizophrenia, are practically absent in the literature. We have shown that among those with continuous schizophrenia, there are signs of systemic inflammation and chronic activation of the adaptive humoral immune response, while among patients with episodic symptoms of the disease, there are signs of systemic inflammation and certain activation of cell-mediated immunity, without significant changes in the humoral link of adaptive immunity. More studies are needed, but the data obtained in this study are important for subsequent clinical studies of new treatment methods, based on various immunophenotypes of schizophrenia.

Validade e Confiabilidade da Versão Portuguesa da Brief Motor Scale em Pessoas com Esquizofrenia: Um Estudo Preliminar

Introdução: Os sinais neurológicos discretos (NNS) indicam uma disfunção cerebral não específica e têm sido documentados no curso clínico da esquizofrenia, sendo considerados como sintomas importantes para a monitorização da doença. A Brief Motor Scale (BMS) tem sido amplamente utilizada para avaliar os sinais neurológicos discretos em pessoas com esquizofrenia, mas a versão portuguesa continua indisponível. O objetivo deste estudo é a investigação da validade e confiabilidade da versão portuguesa Brief of Motor Scale (BMS_pt).&#x0D; Material e Métodos: As orientações internacionais para o processo de adaptação transcultural do instrumento foram consideradas. Participaram no estudo 43 adultos com esquizofrenia, entre os 23 e 63 anos (39,74±11,16), 38 homens e 5 mulheres.&#x0D; Resultados: Os índices de validade de conteúdo (&gt;0,75) da BMS_pt demonstraram um acordo moderado/forte entre os especialistas. A consistência interna foi confirmada, com alfa de Cronbach variando de 0,82 a 0,87. As correlações de Pearson variaram entre 0,93 e 0,99 (p&lt;0,01). A análise fatorial exploratória resultou num modelo de dois fatores que explicou 58,91% da variância total.&#x0D; Conclusão: Verificou‑se que todos os itens da BMS_pt são relevantes. A BMS_pt parece ser um instrumento válido e fiável para avaliar os sinais neurológicos motores discretos em pessoas com esquizofrenia, e com potencial para ser utilizado em serviços de reabilitação.

Insomnia, suicidal ideation, and psychopathology in Chinese patients with chronic schizophrenia

ObjectivesInsomnia occurs frequently in the clinical course of schizophrenia. A growing literature has found associations between insomnia, suicidal ideation, and psychopathology in patients with schizophrenia. We explored these associations in a cross-sectional study of a large sample of patients with chronic schizophrenia in China. We hypothesized that insomnia would be associated with an increased odds of current suicidal ideation and higher current psychopathology scores. MethodsWe recruited 328 inpatients with chronic schizophrenia, all of whom were prescribed psychotropics. We investigated relationships between current insomnia, suicidal ideation over the past two weeks, and current psychopathology for subjects using regression models. ResultsAfter controlling for multiple potential confounding factors, current insomnia was an indicator of a significant, 2.5-fold increased odds of suicidal ideation (OR = 2.56, 95% CI 1.10–5.95, p = 0.029). Insomnia was also a significant indicator of lifetime suicide attempt (OR = 1.07) as well as higher Positive and Negative Syndrome Scale total (β = 0.134, p = 0.017), positive (β = 0.154, p = 0.006) and general (β = 0.145, p = 0.010) subscale scores. ConclusionInsomnia is associated with suicidal ideation, lifetime suicide attempt, and higher psychopathology scores in inpatients with chronic schizophrenia. Formal assessment of insomnia appears relevant to the clinical care of patients with schizophrenia as an indicator of suicidal thinking and behavior, depression, and symptom severity.

Effects of aripiprazole long-acting injectable antipsychotic on hospitalization in recent-onset schizophrenia.

Recent-onset schizophrenia (ROS) represents a critical period that can greatly influence the clinical course of schizophrenia. The use of long-acting injectable antipsychotics (LAIs) in this period is increasingly being considered as a first-line treatment option. Aripiprazole LAI (ALAI) is the newest of all LAI's available on the market, with limited data on its effects on hospitalization rates after first episode of schizophrenia. It was our goal to evaluate whether ALAI has an effect on hospitalization rates, number of bed days and clinical improvement in patients with ROS. This mirror-image study included 138 inpatients suffering from schizophrenia. We collected sociodemographic data on all individuals, number of hospitalization days, hospitalization rates as well as Clinical Global Impression Scale-severity of illness (CGI-S) and Clinician-Rated Dimensions of Psychosis Symptom Severity (CRDPSS) scores at the initiation of ALAI and at the end of a 1 year follow up. Mean number of hospitalizations and hospitalization days in the year after starting ALAI significantly decreased compared to the year before (p = 0.005 and p < 0.001). Mean scores on both CGI and CRDPSS also significantly decreased after initiating ALAI (p < 0.001). Results suggest that ALAI is an important therapeutic option in patients with ROS. It leads to reduced usage of hospital services, potentially reducing the socio-economic healthcare burden.

Association between DRD2 and ANKK1 polymorphisms with the deficit syndrome in schizophrenia

BackgroundThe clinical course of schizophrenia varies among patients and is difficult to predict. Some patient populations present persistent negative symptoms, referred to as the deficit syndrome. Compared to relatives of non-deficit schizophrenia patients, family members of this patient population are at an increased risk of developing schizophrenia. Therefore, the aim of this study was to search for genetic underpinnings of the deficit syndrome in schizophrenia.MethodsThree SNPs, i.e., rs1799732 and rs6276 located within DRD2, and rs1800497 within ANKK1, were identified in the DNA samples of 198 schizophrenia probands, including 103 patients with deficit (DS) and 95 patients with non-deficit schizophrenia (NDS). Results: No significant differences concerning any of the analyzed polymorphisms were found between DS and NDS patients. However, significant links were observed between family history of schizophrenia and the deficit syndrome, G/G genotype and rs6276 G allele. In a separate analysis, we identified significant differences in frequencies of rs6276 G allele between DS and NDS patients with family history of schizophrenia. No significant associations were found between DRD2 and ANKK1 SNPs and the age of onset or schizophrenia symptom severity.ConclusionsThe results of our preliminary study fail to provide evidence of associations between DRD2 and ANKK1 polymorphisms with the deficit syndrome or schizophrenia symptom severity, but suggest potential links between rs6276 in DRD2 and the deficit syndrome in patients with hereditary susceptibility to schizophrenia. However, further studies are necessary to confirm this observation.

More Studies on Duration of Untreated Psychosis Needed

More Studies on Duration of Untreated Psychosis Needed

The clinical course of schizophrenia in women and men\u2014a nation-wide cohort study

Gender differences in schizophrenia have been reported in different aspect of the course of disease and may urge special clinical interventions for female patients. Current literature provides insufficient information to design guidelines for treating women with schizophrenia. We aim to quantify the clinical course of schizophrenia in men and women on premorbid hospitalizations and prescription drugs, age at diagnosis, pharmacological treatment, comorbidity, number of re-hospitalizations, and mortality. Our nationwide cohort study included all patients admitted for the first time to hospital during 2000–2014 for schizophrenia or schizo-affective disorder in Finland. Gender differences were compared with logistic regression, by calculating incidence rates, and mortality was assessed with Cox proportional hazard model. We included 7142 women and 9006 men with schizophrenia/schizo-affective disorder and found that both women (71%) and men (70%) had often been hospitalized for another psychiatric disorder in the 5 years before diagnosis. In women, the last psychiatric hospitalization before schizophrenia/schizo-affective diagnosis was often for mood disorders (62%, OR 2.56, 95% CI 2.28–2.87). Men were diagnosed earlier (mean 34.4 [SD12.6] vs. 38.2 [SD 13.8]) with peak incidence around 22, while incidence in women declining only slowly between age 18 and 65. During ten years follow-up, 69.5% of both genders needed at least one re-hospitalization, with slightly more hospitalizations in women. Women were less often prescribed clozapine or long-acting antipsychotics. Mortality was lower in women (HR = 0.54, 95% CI 0.50–0.60), with fewer suicide and cardiovascular deaths, but more cancer deaths. These results suggest a diagnostic delay for women, which might be shortened by screening women aged 20–65 participating in affective disorder programs. As number of hospitalizations is not lower for women, clinicians should take care not to undertreat women with schizophrenia.

In Patients with Schizophrenia, Does a Longer Initial Untreated Period Worsen Prognosis?

How much difference do early detection and prompt treatment make in the clinical course of schizophrenia? According to some theories, a longer duration