Clinical Diagnosis Of Schizophrenia Research Articles

Association of obesity to reaction time and visual memory in schizophrenia

BackgroundBoth overweight and cognitive deficits are common among people with schizophrenia (SZ) and schizoaffective disorder. The results in earlier studies have been inconsistent on whether overweight is associated with cognitive deficits in psychotic disorders. AimsOur aim in this study was to detect possible associations between obesity and cognitive deficits among study participants with SZ and schizoaffective disorder. MethodsThe study sample included 5382 participants with a clinical diagnosis of SZ or schizoaffective disorder selected from the Finnish SUPER study. Obesity was measured both with body-mass index and waist circumference. The cognitive performance was evaluated with two tests from the Cambridge automated neuropsychological test battery: Reaction time was evaluated with the 5-choice serial reaction time task. Visual memory was evaluated with the paired associative learning test. The final analysis included a total sample of 4498 participants applicable for the analysis of the reaction time and 3967 participants for the analysis of the visual memory. ResultsObesity measured with body-mass index was associated with better performance in reaction time task among both female and male participants. Among male participants, overweight was associated with better performance in the visual memory test. The waist circumference was not associated with cognitive measures. ConclusionsThe results suggest that obesity in people with SZ or schizoaffective disorder might not be associated with cognitive deficits but instead with better cognitive performance. The results were opposite from earlier literature on the general population. More research is required to better understand whether the results might be partly caused by the differences in the etiology of obesity between the general population and people with SZ.

Internalized Stigma among Persons with Schizophrenia: A Study from Tertiary Care Center in the Northeastern Part of India

Abstract Background: Stigma relating to mental illness has mostly been studied in communities and families. Less research has been conducted in India to understand the current subjective experience of persons with mental illness in the tertiary care hospital setting in India. Aim and Objectives: This study aimed to assess the extent of internalized stigma among persons and to see the association between self-stigma, self-esteem, insight, and adherence. Methodology: The study used a cross-sectional design. The present study was conducted in the Outpatient Department of LGB Regional Institute of Mental Health, Tezpur, Assam. For the present study, 200 persons with schizophrenia were selected. Participants of this study were persons with a clinical diagnosis of schizophrenia according to the International Classification of Diseases-10 Diagnostic Criteria for Research. Sociodemographic and clinical data sheet, Brief Psychiatric Rating Scale, the Internalized Stigma of Mental Illness Scale, Morisky Adherence Scale, and Rosenberg Self-Esteem Scale were administered. The collected data were analyzed using descriptive and inferential statistics in Statistical Package for Social Science (SPSS) 21 version. Results: The findings show that 45% of the participants were having moderate internalized stigma and 21% of the participants were having severe internalized stigma. Self-Esteem Scale (B = −341, t = −2.940, P = 005), medication adherence (B = −701, t = −9.832, P = 000), and insight (B = −711, t = −6.496, P = 000) contributed significantly to the prediction of internalized stigma among persons with schizophrenia (F [3,63] =58.712, P = 000) accounting for 85.8% variance. Conclusion: The findings confirm that self-esteem, medication adherence, and insight contributed significantly to the prediction of internalized stigma among persons with schizophrenia.

Method for Classifying Schizophrenia Patients Based on Machine Learning.

Schizophrenia is a chronic and severe mental disorder that affects individuals in various ways, particularly in their ability to perceive, process, and respond to stimuli. This condition has a significant impact on a considerable number of individuals. Consequently, the study, analysis, and characterization of this pathology are of paramount importance. Electroencephalography (EEG) is frequently utilized in the diagnostic assessment of various brain disorders due to its non-intrusiveness, excellent resolution and ease of placement. However, the manual analysis of electroencephalogram (EEG) recordings can be a complex and time-consuming task for healthcare professionals. Therefore, the automated analysis of EEG recordings can help alleviate the burden on doctors and provide valuable insights to support clinical diagnosis. Many studies are working along these lines. In this research paper, the authors propose a machine learning (ML) method based on the eXtreme Gradient Boosting (XGB) algorithm for analyzing EEG signals. The study compares the performance of the proposed XGB-based approach with four other supervised ML systems. According to the results, the proposed XGB-based method demonstrates superior performance, with an AUC value of 0.94 and an accuracy value of 0.94, surpassing the other compared methods. The implemented system exhibits high accuracy and robustness in accurately classifying schizophrenia patients based on EEG recordings. This method holds the potential to be implemented as a valuable complementary tool for clinical use in hospitals, supporting clinicians in their clinical diagnosis of schizophrenia.

Brain functional connectivity based on phase lag index of electroencephalography for automated diagnosis of schizophrenia using residual neural networks.

The complexity of symptoms of schizophrenia (SZ) complicate traditional and effective diagnoses based on clinical signs. Moreover, clinical diagnosis of SZ is manual, time-consuming, and error-prone. Thus, there is a requirement to develop automated systems for timely and accurate diagnosis of SZ. This paper proposes an automated SZ diagnosis pipeline based on residual neural networks (ResNet). To exploit the superior image processing capabilities of the ResNet models, multi-channel electroencephalogram (EEG) signals were converted into functional connectivity representations (FCRs). The functional connectivity of multiple regions in the cerebral cortex is critical for a better understanding of the mechanisms of SZ. In creating the FCR input images, the phase lag index (PLI) was calculated based on 16-channel EEG signals from 45 SZ patients and 39 healthy control (HC) subjects to reduce and avoid the volume conduction effect. The experimental results showed that satisfactory classification performance (accuracy=96.02%, specificity=94.85%, sensitivity=97.03%, precision=95.70%, and F1-score=96.33%) was achieved by combining FCR inputs of beta oscillatory and the ResNet-50 model. The statistical analyses also confirmed that there is a significant difference between SZ patients and HC subjects (p<0.001, one-way ANOVA). More specifically, the average connectivity strengths between nodes in the parietal cortex and those in the central, occipital, and temporal regions were significantly reduced in SZ patients compared to HC subjects. Overall results demonstrated that this paper not only provided an automated diagnostic model whose classification performance is superior to most previous studies but also valuable biomarkers for clinical use.

The SIK1/CRTC2/CREB1 and TWIST1/PI3K/Akt/GSK3β signaling pathways mediated by microRNA-25-3p are altered in the schizophrenic rat brain.

Schizophrenia is a group of severe mental disorders. MiR-25-3p was shown to be involved in various neuropsychiatric diseases and can regulate SIK1 and TWIST1. The CRTC2/CREB1 and PI3K/Akt/GSK3β signaling pathways are downstream pathways of SIK1 and TWIST1, respectively. This study investigated whether miR-25-3p-mediated SIK1/CRTC2/CREB1 and TWIST1/PI3K/Akt/GSK3β signaling pathways are present in an animal model relevant to schizophrenia. A schizophrenic rat model was established by using sub-chronic MK-801 administration. An RNA-seq test was performed to examine the differentially expressed genes (DEGs) in the rat prefrontal cortex (PFC). The mRNA levels of miR-25-3p, SIK1, and TWIST in the PFC and caudate putamen (CPu) were assessed by qRT-PCR. Phosphorylation of the SIK1/CRTC2/CREB1 and TWIST1/PI3K/Akt/GSK3β pathways in the two brain regions was examined by Western blots. The RNA-seq data revealed down-regulated miR-25-3p expression and up-regulated SIK1 and TWIST1 mRNA expression induced by MK-801. Additionally, SIK1 and TWIST1 were shown to be possible downstream responders of miR-25-3p in previous studies. qRT-PCR confirmed the changes of miR-25-3p, SIK1, and TWIST1 induced by MK-801 in both brain regions, which, however, was reversed by risperidone. Furthermore, the phosphorylation of the SIK1/CRTC2/CREB1 pathway was repressed by MK-801, whereas the phosphorylation of the TWIST1/PI3K/Akt/GSK3β pathway was increased by MK-801 in either of the two brain regions. Moreover, the altered phosphorylation of these two signaling pathways induced by MK-801 can be restored by risperidone. In conclusion, this study suggests that altered SIK1/CRTC2/CREB1 and TWIST1/PI3K/Akt/GSK3β signaling pathways mediated by miR-25-3p is very likely to be associated with schizophrenia, revealing potential targets for the treatment and clinical diagnosis of schizophrenia.

The Gender-Specific Association of DRD2 Polymorphism with Metabolic Syndrome in Patients with Schizophrenia.

Background: Metabolic syndrome is widespread in patients with schizophrenia receiving long-term antipsychotic therapy. Dopamine D2 receptors play an important role in mediating both the therapeutic actions of antipsychotics and their side effects. The present study examined the association of two polymorphisms of the DRD2 gene with metabolic syndrome in patients with schizophrenia. Methods: We examined 517 patients from several regions of Siberia (Russia) with a clinical diagnosis of schizophrenia. Genotyping of two single nucleotide polymorphisms rs1799732 and rs4436578 of the dopamine D2 receptor gene (DRD2) was performed in a population of 471 patients. The results were analyzed using chi-square tests. Results: Functional polymorphism rs1799732 of the DRD2 gene is associated with drug-induced metabolic syndrome in women with schizophrenia. Conclusions: Our results show that the DRD2 gene may be involved in the pathogenesis of metabolic disorders in patients with schizophrenia. Further analysis of possible genetic markers will allow for personalized treatment with minimal side effects and optimal efficacy. This which seems relevant in light of the recent focus on improving the quality of life and ensuring a high level of social adaptation of patients with schizophrenia.

Electrophysiological measures from human iPSC-derived neurons are associated with schizophrenia clinical status and predict individual cognitive performance

Neurons derived from human induced pluripotent stem cells (hiPSCs) have been used to model basic cellular aspects of neuropsychiatric disorders, but the relationship between the emergent phenotypes and the clinical characteristics of donor individuals has been unclear. We analyzed RNA expression and indices of cellular function in hiPSC-derived neural progenitors and cortical neurons generated from 13 individuals with high polygenic risk scores (PRSs) for schizophrenia (SCZ) and a clinical diagnosis of SCZ, along with 15 neurotypical individuals with low PRS. We identified electrophysiological measures in the patient-derived neurons that implicated altered Na+ channel function, action potential interspike interval, and gamma-aminobutyric acid-ergic neurotransmission. Importantly, electrophysiological measures predicted cardinal clinical and cognitive features found in these SCZ patients. The identification of basic neuronal physiological properties related to core clinical characteristics of illness is a potentially critical step in generating leads for novel therapeutics.

Serum vitamin D level in patients with schizophrenia: A community-based study.

Serum vitamin D level in patients with schizophrenia: A community-based study.

Impact of urban birth and upbringing on expression of psychosis in a Chinese undergraduate population

BackgroundUrban birth and upbringing show consistent associations with psychotic illness but the key urban exposures remain unknown. Associations with psychotic-like experiences (PEs) are inconsistent. These could be confounded by common mental disorders associated with PEs. Furthermore, associations between PEs and urban exposures may not extrapolate to psychotic disorders such as schizophrenia.MethodsAnnual cross-sectional surveys among first year Chinese undergraduates 2014–2019 (n = 47,004). Self-reported, hierarchical categorisation of psychosis: from psychoticism, paranoid ideation, schizotypal symptoms, nuclear syndrome using SCL-90-R, to clinical diagnosis of schizophrenia. Depressive symptoms using PHQ 9. Dissociative symptoms and posttraumatic stress disorder (PTSD) measured using PCL-C. Etiological factors of family history and childhood disadvantage. We studied effects of urban birth, urban living and critical times of exposure in childhood on psychosis phenotypes.ResultsAssociations with urbanicity were found only after adjustments for depression. Urban birth was associated with paranoia (AOR 1.34, 1.18–1.53), schizotypal symptoms (AOR 1.59, 1.29–1.96), and schizophrenia (AOR 2.07, 1.10–3.87). The same phenotypes showed associations with urban residence > 10 years. Only schizophrenia showed an association with urban exposure birth-3 years (AOR 7.01, 1.90–25.86). Child maltreatment was associated with both psychosis and depression. Urbanicity measured across the total sample did not show any associations with demography, family history of psychosis, or child maltreatment. Sensitivity analysis additionally adjusting for dissociative symptoms and PTSD showed the same pattern of findings.ConclusionsUrban birth and urban living showed a hierarchical pattern of increasing associations from paranoid ideation to schizotypal disorder to schizophrenia, confirming that associations for psychotic experiences could be extrapolated to schizophrenia, but only after adjusting for confounding from depression, dissociative symptoms and PTSD. Several etiological factors were the same for psychosis and depression. Future studies of PEs should adjust for confounding from common mental disorders and dissociative symptoms. Effects of urbanicity on psychosis were not explained by demography, family history of mental disorder, or child maltreatment.

Comparative Characteristics of the Metabolic Syndrome Prevalence in Patients With Schizophrenia in Three Western Siberia Psychiatric Hospitals.

Objective: The purpose of this study was to compare the prevalence of MetS and the associated sociodemographic, clinical, and pharmacotherapeutic characteristics of patients with schizophrenia in three psychiatric hospitals in the West Siberian region.Methods: Patients with a clinical diagnosis of schizophrenia (ICD-10: F20) and an age between 18 and 60 years were included in the study after giving informed consent. Metabolic syndrome was diagnosed according to the International Diabetes Federation criteria. This research was carried out at three Western Siberian psychiatric hospitals in Kemerovo, Tomsk, and Omsk. The study population included respectively 94, 131, and 91 inpatients with schizophrenia. We carried out schizophrenia symptoms assessment by PANSS, antipsychotic therapy evaluation, anthropometry, and biochemical analysis. Statistical Analysis included the Shapiro–Wilk test, non-parametric Kruskal–Wallis H-test for independent samples, Mann–Whitney U-test for independent samples, the chi-square test, stepwise multiple regression analyses. The level of significance was p < 0.05.Results: The metabolic syndrome prevalence was higher among patients in Tomsk (36.6%), compared with Kemerovo (20.2%, p = 0.008) or Omsk (18.7%, p = 0.004), mainly due to the high prevalence of abdominal obesity, while men from Tomsk were more susceptible to this condition than men from other regions (p < 0.05). Patients from Omsk had the highest severity schizophrenia symptoms according to PANSS, and patients from Tomsk had the lowest severity of positive symptoms according to PANSS. Patients from Tomsk had the minimum duration of antipsychotic therapy compared with the patient from Kemerovo (p = 0.017) and from Omsk (p = 0.000019), but most patients from Tomsk received second-generation atypical antipsychotics, while patients from Omsk received mainly conventional antipsychotics (p = 0.0001). Multiple regression analysis showed that metabolic syndrome associated with schizophrenia duration and body mass index, although the association was not so strong (adjusted R2 = 0.2435, p < 0.0001).Discussion: The study illustrates that in different psychiatric hospitals within the same region, the prevalence of metabolic syndrome in patients with schizophrenia can vary significantly, which dictates the need to look for opportunities to minimize the risk of its occurrence, taking into account the experience of each hospital.

Genetic Polymorphisms of 5-HT Receptors and Antipsychotic-Induced Metabolic Dysfunction in Patients with Schizophrenia

Background: Antipsychotic-induced metabolic syndrome (MetS) is a multifactorial disease with a genetic predisposition. Serotonin and its receptors are involved in antipsychotic-drug-induced metabolic disorders. The present study investigated the association of nine polymorphisms in the four 5-hydroxytryptamine receptor (HTR) genes HTR1A, HTR2A, HTR3A, and HTR2C and the gene encoding for the serotonin transporter SLC6A4 with MetS in patients with schizophrenia. Methods: A set of nine single-nucleotide polymorphisms of genes of the serotonergic system was investigated in a population of 475 patients from several Siberian regions (Russia) with a clinical diagnosis of schizophrenia. Genotyping was performed and the results were analyzed using chi-square tests. Results: Polymorphic variant rs521018 (HTR2C) was associated with higher body mass index in patients receiving long-term antipsychotic therapy, but not with drug-induced metabolic syndrome. Rs1150226 (HTR3A) was also associated but did not meet Hardy–Weinberg equilibrium. Conclusions: Our results indicate that allelic variants of HTR2C genes may have consequences on metabolic parameters. MetS may have too complex a mechanistic background to be studied without dissecting the syndrome into its individual (causal) components.

How to assess emotional recognition in individuals with a diagnosis of schizophrenia and other psychotic disorders: a pilot study

Emotional recognition is a part of more general behaviour to promote adequate inter-relationship patterns and social functionality. Previous results on emotional recognition in individuals with a diagnosis of schizophrenia and other psychotic disorders suggest an impairment of this ability resulting in social inability. The purpose of the present pilot study was to investigate if the sensory modalities – visual and auditory- of stimuli interferes in the evaluation of emotional recognition and the relation between time of diagnosis and time of permanence in the rehabilitation centre and emotional recognition. The study involved a sample of thirty individuals, of both genders (70% men and 30% women), aged between 26 and 58 years old with a clinical diagnosis of schizophrenia or other psychotic disorders that attended two psychosocial rehabilitation centers of Oporto. They were presented with sets of visual (faces) and auditive (phrases) stimuli in order to evaluate their ability to recognize Ekman’s universal emotions. The results point to a better recognition of visual stimuli when compared auditive stimuli. In both sensory modality, joy and surprise are the emotions more correctly recognized with a significant statistical difference between modalities. For the emotion of sadness, the ability to better recognize sadness is through auditory stimuli. The time of diagnosis is positive and significantly associated with the recognition of the emotions of disgust and fear when using prosody. As to the impact of time of permanence in the institution and the ability to recognize emotions, the results suggest that a longer permanence is related to a more impaired ability for recognition. Evaluation and training of emotional recognition such be rethought.

Positive memory training for the treatment of depression in schizophrenia: A randomised controlled trial

BackgroundAround half of people diagnosed with schizophrenia suffer from co-morbid depression, yet there are no evidence-based psychological treatments to target this presentation. MethodParticipants were aged 18–65 years old, had a clinical diagnosis of schizophrenia or schizoaffective disorder and at least a mild level of depression. Participants were randomly assigned (1:1) to receive PoMeT or treatment as usual. PoMeT was delivered in up to 12 individual sessions within 3 months. We stratified randomisation by site and by severity of depression using randomised-permuted blocks. Assessments were carried out at baseline, 3-month, 6-month and 9-month by assessors who were blind to treatment allocation. The primary outcome was reduction in the symptoms of depression at 3-month, 6-month and 9-month as measured by the BDI-II. Analysis was by intention-to-treat with linear mixed-effects models. The trial was registered with the ISRCTN registry number 99485756. ResultsOne hundred participants were randomly assigned to either PoMeT (n = 49) or treatment as usual (n = 51). The reduction in BDI-II total score at 3 months was significantly greater for PoMeT than for treatment as usual (mean difference = 4.33, SE = 2.00, 95% CI 0.38 to 8.23; p = 0.03). DiscussionTo our knowledge this is, to date, the largest powered randomised controlled trial focused on the psychological treatment of depression in people diagnosed with schizophrenia. Results indicate that a brief targeted intervention can reduce the symptoms of depression in the group. The main limitation of the study is the lack of an active control group which may contribute to an inflated treatment effect.

T49. SOCIODEMOGRAPHIC AND LIFESTYLE FACTORS ASSOCIATED WITH GOOD PERFORMANCE IN PAIRED ASSOCIATES LEARNING TEST IN PATIENTS WITH SCHIZOPHRENIA

BackgroundSchizophrenia patients have been found to have long lasting, clinical state independent impairments in intellectual abilities as well as in specific cognitive domains of which visual learning and memory are central to our current study.The main aim of this study was to investigate the sociodemographic and lifestyle factors associated with good visual learning and memory in patients with schizophrenia in a sample of patients.MethodsThe basic population for this study consists of Finnish SUPER study on genetic mechanisms of psychotic disorders (SUPER), part of the Stanley Global Neuropsychiatric Genomics Initiative. The Northern Finland Birth Cohort 1966 (NFBC 1966) functioned as a reference group to define good cognitive performance.The Finnish SUPER study on genetic mechanisms of psychotic disorders is a part of the international Stanley Global Neuropsychiatric Genomics Initiative. The objective of the study is to understand the genetic and biological background of psychotic disorders.The participants of the present study were patients with clinical diagnosis of schizophrenia who were born between 1950–1979 (N=1,907). The reference group of members of the NFBC 1966 consisted 5,506 individuals aged 46–47 years.Paired Associates Learning (PAL) was used both in SUPER and NFBC 1966 studies. PAL test measures visual memory and new learning. We used the primary outcome variable of ‘total errors adjusted’ (TEA) which assesses learning over repeated attempts. Lower than the mean score of TEA of NFBC 1966 was used as cut-off for good performance in PAL test. SUPER participants with good performance in the PAL test were compared to other SUPER participants.Participants in SUPER study were interviewed and filled in a questionnaire about general mental wellbeing, subjective health and lifestyle factor. The association of following sociodemographic and lifestyle factors were investigated: education, age, marital status, self-rated memory, psychotropic medication use, alcohol consumption and cigarette smoking.ResultsOf the SUPER participants, 129 (6,9 %) performed at least on the level on which 50% of the participants of the NFBC 1966 performed. Of SUPER participant males 5,9 % and of the females 8,1 % performed on this level.Performing above the NFBC 1966 50% level in the PAL test was associated with higher educational level and higher use of alcohol in males, and with higher educational level and being married in females.DiscussionIn previous studies age, education, duration of illness, severity of symptoms have been found to count for some of the overall impairments found in schizophrenia. We found a subgroup of schizophrenia patients with good visual learning and memory and sociodemographic and lifestyle factors that were associated with good performance. In our study education and marital status in women and alcohol use in men was associated with better performance in PAL test.

Observational assessment of safety in seroquel (OASIS): a specialist cohort event monitoring (SCEM) study in England.

Background:This study was designed to monitor the short-term (up to 12 weeks) use and safety of quetiapine (Seroquel) extended release (XL) and quetiapine immediate release (IR) prescribed to patients with a clinical diagnosis of schizophrenia, and/or manic episodes associated with bipolar disorder by psychiatrists under normal conditions of use.Methods:A Specialist Cohort Event Monitoring (SCEM) study was conducted in England February 2010–April 2013. This observational cohort study recruited patients prescribed quetiapine XL within the secondary care setting by psychiatrists. A reference cohort of quetiapine IR users was also recruited. Baseline and 12 week observational data were collected from psychiatrists who abstracted information from medical records onto bespoke questionnaires. Data were collected on demographics, indication, past medical history, prescribing information and events of interest. Summary descriptive statistics were calculated.Results:The final cohort consisted of 869 eligible patients; 646 XL users and 223 IR users. The majority of XL and IR users were female (56.2% and 55.6%, respectively), with a median age of 40 (interquartile range [IQR]: 29, 49) and 39 (IQR: 28, 50) years, respectively. The most frequent indication for treatment was Manic episodes associated with Bipolar Affective disorder (53.4% XL and 49.8% IR). Median index dose was 200 mg/day (IQR: 100, 300) for XL users and 50 mg/day (IQR: 50, 100) for IR users, while median final maintenance dose was 400mg/day (IQR: 250, 600) and 300 mg/day (IQR: 100, 400), respectively. The most frequently reported event of interest in both cohorts was sedation (n = 151, 23.9% XL cohort and n = 49, 23.0% IR cohort).Conclusion:Utilisation of quetiapine XL appeared to be in line with prescribing guidelines in terms of dose, and commonly reported events of interest were in concordance with the known safety profile. Overall, this SCEM study provided important information on the safety and utilisation of quetiapine XL in the secondary care setting in England.

Decoding rumination: A machine learning approach to a transdiagnostic sample of outpatients with anxiety, mood and psychotic disorders

ObjectiveTo employ machine learning algorithms to examine patterns of rumination from RDoC perspective and to determine which variables predict high levels of maladaptive rumination across a transdiagnostic sample. MethodSample of 200 consecutive, consenting outpatient referrals with clinical diagnoses of schizophrenia, schizoaffective, bipolar, depression, anxiety disorders, obsessive compulsive and post-traumatic stress. Machine learning algorithms used a range of variables including sociodemographics, serum levels of immune markers (IL-6, IL-1β, IL-10, TNF-α and CCL11) and BDNF, psychiatric symptoms and disorders, history of suicide and hospitalizations, functionality, medication use and comorbidities. ResultsThe best model (with recursive feature elimination) included the following variables: socioeconomic status, illness severity, worry, generalized anxiety and depressive symptoms, and current diagnosis of panic disorder. Linear support vector machine learning differentiated individuals with high levels of rumination from those ones with low (AUC = 0.83, sensitivity = 75, specificity = 71). ConclusionsRumination is known to be associated with poor prognosis in mental health. This study suggests that rumination is a maladaptive coping style associated not only with worry, distress and illness severity, but also with socioeconomic status. Also, rumination demonstrated a specific association with panic disorder.

Changes in Body Fat and Related Biochemical Parameters Associated With Atypical Antipsychotic Drug Treatment in Schizophrenia Patients With or Without Metabolic Syndrome.

Background: Metabolic syndrome (MetS) is a common problem in schizophrenia patients and associated with increased mortality due to cardiovascular disease. Second-generation antipsychotics (SGAs) play an important role in facilitating MetS.Objective: The study aimed to assess weight changes and alterations of indicators of body fat composition and lipid-glucose metabolism induced by reinitiating atypical antipsychotics in patients with schizophrenia when with or without MetS.Methods: After giving informed consent, newly admitted patients with a clinical diagnosis of schizophrenia (ICD-10: F20) and an age between 18 and 55 years were included. MetS was diagnosed according to International Diabetes Federation (IDF) criteria. At entry and after 6 weeks of treatment, anthropometry and biochemical analysis were carried out. Total and visceral fats were measured with the use of non-invasive bioimpedance analysis and subcutaneous fat with calculation of total adipose tissue with the use of caliperometry. Based on biochemical assessments low density (LDL) and very low-density lipoproteins (VLDL), atherogenic index and Homeostatic Model Assessment of Insulin Resistance (IR-HOMA) were calculated. Statistical analysis was conducted using Wilcoxon signed-rank test, Mann-Whitney U-test, and chi-squared test. Differences were considered statistically significant at p < 0.05.Results: A total of 114 patients (59M/55F) with schizophrenia were examined; they were divided into two groups with (n = 43; 37.7%) and without (n = 71; 62.3%) MetS. After a 6-week SGA treatment, only the total fat fold, waist circumference, triglyceride level, and atherogenic index underwent statistically significant changes in patients with MetS. In those without MetS, statistically significant changes across all fat indicators were noted. Also, a significant increase in blood glucose and HOMA-IR parameters, triglyceride, and VLDL levels and atherogenic index was observed in this group.Discussion: The study illustrates the benefits of estimating both anthropometric and biochemical parameters shortly after (re)installing treatment of schizophrenia in order to minimize the risk of MetS development.

The distinguishing intrinsic brain circuitry in treatment-naïve first-episode schizophrenia: Ensemble learning classification

Schizophrenia is frequently characterized as a prototypical disorder of integration of brain function involving almost all intrinsic connectivity networks. However, a consistent conclusion regarding the most distinguishing brain circuitry in schizophrenia has not yet been reached. In this study, we used a novel network-based ensemble method to explore the most distinguishing brain circuitry in treatment-naive first-episode schizophrenia (n = 41) and healthy controls (n = 38) who underwent the task-free functional MRI scanning. Ensemble method showed commendable discrimination ability (84.7% for classification accuracy, 91.9% for sensitivity, 74.5% for specificity, all p < 0.05 for permuted test). The most distinguishing connections were located in the right paralimbic system and bilateral default mode network. Notably, distinguishing aberrations were significantly correlated with symptom severity (negative score: R2 = 0.58, P < 0.05, Bonferroni corrected; positive score: R2 = 0.74, P < 0.05, Bonferroni corrected) in schizophrenia patients. These most distinguishing aberrations present good potential for the underlying symptoms, and provide great insight into the mechanism of schizophrenia. Our results suggested that the ensemble method was a powerful tool to help with clinical diagnosis of schizophrenia and to explore the mechanism of schizophrenia.

Animal-assisted therapy for schizophrenia and related disorders: A systematic review

Animal-assisted therapy (AAT) is increasingly researched as a potential treatment for physical and mental illness, including schizophrenia. The aim of the current paper is to systematically review randomised controlled trials (RCTs) to assess the effectiveness of AAT for schizophrenia and related disorders. We searched PubMed, PsycINFO, CINAHL, EMBASE, The Cochrane Library, CAB Abstracts, and Web of Science for RCTs of AAT for schizophrenia and related disorders. Primary outcomes were mental state and behaviour, clinical global response, and quality of life and wellbeing. Studies were eligible if they were RCTs that had compared AAT, or other animal-assisted intervention, to any control group using any participants with a clinical diagnosis of schizophrenia (or related disorder), regardless of age, gender, setting, or severity and duration of illness. Seven studies were identified for the review. Meta-analysis was not possible due to heterogeneity of studies, including marked differences in outcome measures and interventions. Five out of seven studies included symptoms as an outcome measure, with one reporting improvements in negative symptoms and one study reporting improvements in positive and emotional symptoms. The remaining studies reported no significant effects of AAT. Three studies included quality of life as an outcome measure but did not find any significant effects. Two studies did, however, report improvements in various measures of self-view. The use of AAT for schizophrenia remains inconclusive and there is currently not enough evidence to draw any firm conclusions due to heterogeneity of studies, risk of bias, and small samples. Rigorous, large-scale RCTs are needed to assess the true impact of AAT on schizophrenia.

A pharmacogenetic study of patients with schizophrenia from West Siberia gets insight into dopaminergic mechanisms of antipsychotic-induced hyperprolactinemia

BackgroundHyperprolactinemia (HPRL) is a classical side effect of antipsychotic drugs primarily attributed to blockade of dopamine D2 receptors (DRD2s) on the membranes of lactotroph cells within the pituitary gland. Certain antipsychotic drugs, e.g. risperidone, are more likely to induce HPRL because of relative accumulation within the adenohypophysis. Nevertheless, due to competition for pituitary DRD2s by high dopamine levels may limit antipsychotic-induced HPRL. Moreover, the activity of prolactin-producing lactotrophs also depends on other hormones which are regulated by the extra-pituitary activity of dopamine receptors, dopamine transporters, enzymes of neurotransmitter metabolism and other factors. Polymorphic variants in the genes coding for these receptors and proteins can have functional significance and influence on the development of hyperprolactinemia.MethodsA set of 41 SNPs of genes for dopamine receptors DRD1, DRD2, DRD3, DRD4, the dopamine transporter SLC6A3 and dopamine catabolizing enzymes MAOA and MAOB was investigated in a population of 446 Caucasians (221 males/225 females) with a clinical diagnosis of schizophrenia (according to ICD-10: F20) with and without HPRL who were treated with classical and/or atypical antipsychotic drugs. Additive genetic model was tested and the analysis was carried out in the total group and in subgroup stratified by the use of risperidone/paliperidone.ResultsOne statistically significant association between polymorphic variant rs1799836 of MAOB gene and HPRL in men was found in the total group. Furthermore, the rs40184 and rs3863145 variants in SLC6A3 gene appeared to be associated with HPRL in the subgroup of patients using the risperidone/paliperidone, but not with HPRL induced by other antipsychotic drugs.ConclusionsOur results indicate that genetic variants of MAOB and SLC6A3 may have consequences on the modulation of prolactin secretion. A further search for genetic markers associated with the development of antipsychotic-related hyperprolactinemia in schizophrenic patients is needed.