Cohort Of Schizophrenic Patients Research Articles

Efficacy of Inhibitory Control in Antisaccade Task and the Polymorphisms of DRD2 Dopamine Receptor Gene in Schizophrenic Patients

The purpose of this pilot study was to investigate the association of five polymorphic loci of the DRD2 gene (rs1799732, rs1800497, rs6277, rs6275, and rs2242592) with antisaccade task performance in male cohorts of schizophrenic patients (n = 33) and healthy subjects (n = 30). The antisaccade error rate was analyzed as related to prefrontal inhibitory control. In patients, the increased percent of errors was associated with minor alleles of polymorphisms rs6277 (C), rs6275 (T), and rs2242592 (G), which are supposedly related to the risk of schizophrenia. At the same time, it was found that a decreased error rate in healthy subjects is associated with the C/C variant of rs6277; no association was observed between polymorphisms rs6275 and rs2242592 and task performance.

The incidence of metabolic syndrome and its reversal in a cohort of schizophrenic patients followed for one year

Cross-sectional studies showed a high prevalence of metabolic syndrome in patients with schizophrenia.This study aimed to identify the incidence of metabolic syndrome and its reversal in a non-preselected cohort of chronic psychotic patients in routine practice in one year follow-up and to find variables to describe development and reversal of metabolic syndrome. This cohort study was conducted as part of a disease management program and patients were included if they had two complete assessments in a one year follow-up. We conducted two logistic regressions to find variables to describe the development of metabolic syndrome and the reversal of metabolic syndrome. At the time of the first assessment 35% ( n = 92) of the 260 included patients had metabolic syndrome. Within one year 21 patients developed metabolic syndrome and 30 patients had it reversed. This was an incidence of 13% (21/168) and a reversal of 33% (30/92). Smoking, family history of cardiovascular diseases, and duration of disease >6 years was associated with a higher risk of developing metabolic syndrome as well as abdominal obesity and dyslipidemia. Patients with abdominal obesity had a smaller chance of reversing metabolic syndrome. Other variables included in the logistic regression such as receiving cardiovascular/antidiabetic drug treatment or duration of disease >6 years did not alter the risk of reversing the metabolic syndrome. Our study showed that the natural course of metabolic syndrome is dynamic. A considerable number of patients developed or reversed the metabolic syndrome in one year follow-up.

Étude Schizophrenia Outpatient Health Outcomes (SOHO) France : étude observationnelle à 36 mois d’une cohorte de patients schizophrènes ambulatoires traités par antipsychotiques

Background Studies describing long-term continuous care of outpatients with schizophrenia are relatively scarce. The prospective European Schizophrenia Outpatient Health Outcomes study (SOHO) provides data on a cohort of schizophrenic patients over a period of three years. Methods Prospective, long-term, observational study including outpatients who initiate therapy or change to a new antipsychotic. The study was designed to provide two patient groups of approximately equal size: treated either with olanzapine or a non-olanzapine antipsychotic. Sociodemographic, clinical and disease characteristics at baseline were described. Clinical severity of symptoms was assessed at each visit using the Clinical Global Impression scale (CGI). Treatment outcomes were analyzed as treatment discontinuation, remission and relapse rates. Results French results are presented in this report. Nine hundred and thirty-three patients (62% males) were recruited between March and December 2001. The mean age was 37.1 ± 11.5 years. The mean time since first consultation for schizophrenia was 8.0 ± 9.3 years. At study baseline, one quarter had paid employment, less than one third had a spouse or partner and more than half of them had an independent housing. Thirty percent of patients reported a previous suicide attempt. The mean CGI was 4.5 ± 1.0 at admission. Overall, medication discontinuation for any cause occurred for 42% of patients. A remission (defined by a CGI ≤ 3 maintained for 6 months, without hospitalization) was obtained in 63% of patients, 49% of patients relapsed (defined as hospitalization or CGI increase reaching 4 or more) during the three-year follow-up period. A suicide attempt occurred in 60 patients (cumulative proportion 7%). Conclusions The clinical findings of the French cohort of patients confirmed the high burden of the disease. Identification of risk factors for discontinuation of treatment should provide a better individualization of patient care and a better impact on the different domains of effectiveness.

Electroencephalographic Cerebral Dysrhythmic Abnormalities in the Trinity of Nonepileptic General Population, Neuropsychiatric, and Neurobehavioral Disorders

Electroencephalographic Cerebral Dysrhythmic Abnormalities in the Trinity of Nonepileptic General Population, Neuropsychiatric, and Neurobehavioral Disorders

Electroencephalographic Cerebral Dysrhythmic Abnormalities in the Trinity of Nonepileptic General Population, Neuropsychiatric, and Neurobehavioral Disorders

Subclinical electroencephalographic epileptiform discharges in neurobehavioral disorders are not uncommon. The clinical significance and behavioral, diagnostic, and therapeutic implications of this EEG cerebral dysrhythmia have not been fully examined. Currently the only connotation for distinctive epileptiform electroencephalographic patterns is epileptic seizures. Given the prevailing dogma of not treating EEGs, these potential aberrations are either disregarded as irrelevant or are misattributed to indicate epilepsy. This article reappraises the literature on paroxysmal EEG dysrhythmia in normative studies of the "healthy" nonepileptic general populations, neuropsychiatry, and in neurobehavioral disorders. These EEG aberrations may be reflective of underlying morpho-functional brain abnormalities that underpin various neurobehavioral disturbances.

Predictive factors of the number and the dose of anti‐psychotics in a cohort of schizophrenic patients

Anti-psychotic prescription in schizophrenia is characterised in Europe by frequent associations and high doses. Nevertheless, few longitudinal epidemiological studies have explored anti-psychotic prescriptions. (1) To describe the evolution of prescription patterns across time; (2) to determine risk factors for prescription of high doses of anti-psychotics and for anti-psychotic combinations. Three thousand four hundred seventy three subjects were included in 1993. Data collected in 1993 and subsequently in 1996 and 1999, provided information on demographics, clinical status and prescription. In 1996, the response rate was 68.5% and 56.7% in 1999. The number of anti-psychotics prescribed slightly decreased across time, while doses remained high for one-third of the patients. The factors predicting dose were: dose at previous evaluation, class of anti-psychotic and clinical severity. The factors predicting the number of anti-psychotics were: previous number and class of anti-psychotic and clinical severity. Higher dosage and combinations were related more to physicians' habits than to patient characteristics, as is frequently observed in chronic disease.

High-Frequency (600Hz) SEP Oscillations – Generators and Pathophysiological Aspects

Human median nerve somatosensory evoked potentials (SEP) contain a low-amplitude (<500 nV) high-frequency (˜600Hz) burst of repetitive wavelets (HFOs) which are superimposed onto the primary cortical response 'N20'. The following studies in human subjects are aimed to further clarify the cortical and subcortical structures involved in the generation of the HFOs and the (patho)physiological meaning of this somatosensory oscillatory activity. 1) 128-channel SEP recordings were obtained to right median nerve stimulation and ulnar nerve stimulation. Different source evaluation strategies provided converging evidence for a cortical HFO origin, with two different almost orthogonally oriented generators being active in parallel. The cortical HFO source constellation points to a „precortical“ source in terminals of thalamocortical fibers and a second intracortical HFO origin. Additionally, generation of the HFOs was localized in subcortical, near thalamic and subthalamic source sites. 2) We tested the hypothesis that HFOs might be more sensitive to temporal dispersion caused by demyelinating lesions in multiple sclerosis (MS) than the N20. HFOs in median nerve SEPs in 50 patients with definite MS and in 30 healthy controls were recorded. Three patterns of SEP alterations were found: (i) abolished HFOs with either normal (11% of stimulated limbs), or delayed N20 (16%); (ii) an attenuation of N20 amplitude with preserved HFOs (13%); and (iii) a mixture of both patterns (21%). The first pattern -normal N20 with abolished HFOs- indicates that the HFOs are a sensitive marker of slight demyelination. The second pattern is suggestive of a mainly axonal lesion type, while the third pattern points to a combined axonal/demyelinating process or a conduction block. Analysis of HFOs allows identification of slight demyelinating processes in MS patients in whom the N20 SEP component remains unaffected. 3) The behavior of HFOs in a cohort of schizophrenic patients in comparison to an age- and sex-matched group of controls was tested. HFOs in the group of patients showed a delayed latency. In the low frequency part of the SEPs an increase in amplitude was found. These results are interpreted as a lack of somatosensory inhibition in the somatosensory pathway, either on a thalamic or a cortical level. HFOs are an interesting tool to explore functionality and pathophysiology of the lemniscal system, especially of dysfunctions in thalamocortical impulse propagation.

Adjunctive use of reboxetine in schizophrenia

Background. – Schizophrenia is frequently complicated by depressive or negative symptoms that respond only moderately to treatment with antipsychotic drugs. Reboxetine is a novel antidepressant, which inhibits the reuptake of norepinephrine. We sought to study the efficacy and tolerability of the adjunctive use of reboxetine in a cohort of schizophrenic patients with prominent depressive or negative symptoms. Methods. – Sixteen schizophrenic inpatients were recruited for this study. All subjects received 4–8 mg of reboxetine/day while the antipsychotic medication (typical antipsychotics = 4; atypical antipsychotics = 12) was continued. All subjects underwent a standardized assessment including PANSS, CGI, HAMD, and CDSS before and after treatment with reboxetine (mean 26 ± 17 d). Results. – All subjects tolerated treatment with reboxetine. Adverse effects were mild and did not require discontinuation of reboxetine. All clinical scores (PANSS 93.1 vs. 63.1; CGI 5.4 vs. 4.1; HAMD 20.4 vs. 8.1; CDSS 12.5 vs. 4.6) improved significantly under adjunctive treatment with reboxetine (all P < 0.01). Conclusion. – The adjunctive use of reboxetine in schizophrenic patients was safe and well-tolerated. Our results suggest that the adjunctive use of reboxetine may be an effective treatment for depressive and negative symptoms in schizophrenia.

Granulocytopenia associated with neuroleptic therapy in a patient with benign familial leukopenia

Benign familial leukopenia (BFL) has been reported in several ethnic groups, including Ethiopians of Jewish origin. To date, there are no reported cases of patients with BFL developing granulocytopenia following administration of neuroleptics. We report a case of a young Ethiopian Jew suffering from schizophrenia, who exhibited premorbid benign reduced white blood cells (WBC) count and developed leukopenia and neutropenia following exposure to typical (zuclopentixol, perphenazine, haloperidol) antipsychotics and the atypical antipsychotic risperidone. The diagnosis of BFL was established and tissue typing of the patient was determined. To the best of our knowledge, this is the first report of leukopenia with neutropenia in an ethnically susceptible (due to BFL) schizophrenia patient following exposure to typical and atypical antipsychotics. HLA typing of this patient was distinct from that reported in patients susceptible to clozapine-induced agranulocytosis. Further extensive investigations including HLA typing in a larger cohort of schizophrenic patients is needed in order to define the association between HLA haplotypes and neuroleptic-induced hematological reactions and to identify the potentially vulnerable individuals.

Differences in frontal cortical activation by a working memory task after substitution of risperidone for typical antipsychotic drugs in patients with schizophrenia.

Antipsychotic drug treatment of schizophrenia may be complicated by side effects of widespread dopaminergic antagonism, including exacerbation of negative and cognitive symptoms due to frontal cortical hypodopaminergia. Atypical antipsychotics have been shown to enhance frontal dopaminergic activity in animal models. We predicted that substitution of risperidone for typical antipsychotic drugs in the treatment of schizophrenia would be associated with enhanced functional activation of frontal cortex. We measured cerebral blood oxygenation changes during periodic performance of a verbal working memory task, using functional MRI, on two occasions (baseline and 6 weeks later) in two cohorts of schizophrenic patients. One cohort (n = 10) was treated with typical antipsychotic drugs throughout the study. Risperidone was substituted for typical antipsychotics after baseline assessment in the second cohort (n = 10). A matched group of healthy volunteers (n = 10) was also studied on a single occasion. A network comprising bilateral dorsolateral prefrontal and lateral premotor cortex, the supplementary motor area, and posterior parietal cortex was activated by working memory task performance in both the patients and comparison subjects. A two-way analysis of covariance was used to estimate the effect of substituting risperidone for typical antipsychotics on power of functional response in the patient group. Substitution of risperidone increased functional activation in right prefrontal cortex, supplementary motor area, and posterior parietal cortex at both voxel and regional levels of analysis. This study provides direct evidence for significantly enhanced frontal function in schizophrenic patients after substitution of risperidone for typical antipsychotic drugs, and it indicates the potential value of functional MRI as a tool for longitudinal assessment of psychopharmacological effects on cerebral physiology.

CSF dopamine beta-hydroxylase in schizophrenia: associations with premorbid functioning and brain computerized tomography scan measures

The authors attempted to replicate previous findings of relationships of CSF dopamine beta-hydroxylase with premorbid functioning and computerized tomography (CT) scan measures in a new cohort of schizophrenic patients. Data on CSF dopamine beta-hydroxylase-like immunoreactivity and premorbid functioning, as well as CT scans, were obtained in 60 drug-free, male schizophrenic patients and two groups of normal comparison subjects. CSF dopamine beta-hydroxylase did not differ between the comparison subjects and schizophrenic patients. Lower CSF dopamine beta-hydroxylase was associated with better premorbid social functioning and with less prefrontal sulcal widening. Better premorbid school functioning and more years of education, however, were associated with higher CSF dopamine beta-hydroxylase. The association between low CSF dopamine beta-hydroxylase and premorbid functioning was confirmed for social functioning, while the opposite was observed for scholastic performance, suggesting that these are different dimensions. Dopamine beta-hydroxylase modulates the prognosis and potentially the course of schizophrenia without necessarily causing the disorder.

Mobility of schizophrenic patients, non-psychotic patients and the general population in a case register area

This preliminary study attempts to evaluate the effect of a community psychiatric service on residential mobility by comparing a cohort of schizophrenic patients over a 5-year period with that of non-psychotic and general population control groups in South Verona, a case register area in Northern Italy. No significant differences were found between the groups for different types of movement (within South Verona/outside catchment area of South Verona/outside City of Verona), except for movements within South Verona between the schizophrenic group and neurotic group. The former tended to move less than the latter. The sociodemographic factors associated with movements of the general population in Verona were being male and single, whereas place of birth was less important. The results showed that in the two patient groups as well as in the general population in South Verona, the percentages of those who moved outside the case-register area ranged between 1.5%-4.4% over a one-year period, and between 7.3%-13.8% over a five-year period, indicating a relatively consistent denominator for the Case Register.

The Evaluation of Mental Health Care Systems

While the demand for deinstitutionalization, strongly supported by the economic aspect of the issue, has resulted in a steep decline in the number of psychiatric beds in many Western countries, the evaluation of extramural psychiatric care has several difficulties, including that of proving effectiveness without experimental control of confounding influences. For a cohort of schizophrenic patients we investigated the impact of out-patient psychiatric treatment on length of stay in hospital and length of stay in the community. Out-patient care had a significant influence on readmission, but no effect on the length of in-patient treatment. While the average cost of community care was less than half that of traditional hospital care, in 6% of the patients this threshold value of continued in-patient care was exceeded. There also seems to be a non-monetary threshold, above which community care is no longer appropriate.

Schizophrenia: diagnostic criteria and outcome.

The files of a cohort of schizophrenic patients who were admitted to hospital for the first time in their lives in 1963, and who were representative of cases in a large unselected population, were examined , first by exclusion criteria, and then by the diagnostic criteria of Schneider's first-rank symptoms, Feighner et al's criteria, and the New Haven Schizophrenia Index (NHSI). Forty-three such cases were found who were schizophrenic on at least two sets of criteria, and who were followed up in 1977. Examination of the outcome showed no relationship with FRS presence or absence or number of first-rank symptoms, nor with the NHSI score, but did show a relationship to the Feighner et al criteria and an even stronger relationship to a simple score derived from these criteria.

Retention rates of schizophrenia: A comparison of shock therapy and psychopharmacological eras and of closed and open door policies

By means of comparison of the retention rates of cohorts of schizophrenic patients admitted to a regional mental hospital at different periods and using neurotic patients as controls, it was found, (1) the retention rates were maximal in schizophrenic patients in the shock treatment period and with a closed door policy, (2) retention rates were minimal during the period of psychopharmacotherapy and with the open door system (3) retention rates during the period of psychopharmacotherapy and closed door policy were distributed between both extremes just mentioned. (4) Corresponding to the marked decrease of bed utilisation during the open door system era down to the lowest administratively tolerated degree, a slight non-significant elevation of retention rates was observed. In females (5) an interesting but non-significant reversal of the trend found for males was observed in the first three months of stay. (6) The relation of the subsequent retention rates was similar to that of the male samples, though the only significant difference between cohorts was of greater retention during the closed door period of 1957 in comparison with 1964 during which both the open door system and the psychotropic drugs were in use. (7) The effect on the cohorts of the factors mentioned above, as well as their homogenity in respect to sex, age and clinical diagnosis, may be considered as adequately demonstrated. On the other hand, differences between the cohorts on other parameters that might have influenced the duration of the hospitalization were not analysed.