Diagnostic Criteria For Schizophrenia Research Articles

Schizophrenia plus - comorbidity of schizophrenia and personality disorders. Clinician's reflections.

The diagnostic criteria for schizophrenia and the diagnostic criteria for personality disorders refer to the same dimensions of mental functioning, except for the presence of typical psychotic symptoms in schizophrenia (hallucinations, delusions and catatonic behaviours). Since schizophrenia is a psychosis with a predominantly chronic course, with exacerbations and steady course periods, a simultaneous diagnosis of personality disorders, which are also "permanent" in nature, and a significant part of which affect the same areas of mental functioning, in the same patient is at least controversial. Although therapeutic interventions in patients with schizophrenia are mainly based on pharmacotherapy, psychotherapy and work with the patient's family are also important. Since pharmacotherapy is virtually ineffective for personality disorders, psychotherapy is the main form of management. This however does not constitute a justification for a simultaneous use of these two diagnoses in the same patient.

Comparative serum proteomic analysis of a selected protein panel in individuals with schizophrenia and bipolar disorder and the impact of genetic risk burden on serum proteomic profiles

The diagnostic criteria for schizophrenia (SCZ) and bipolar disorder (BD) are based on clinical assessments of symptoms. In this pilot study, we applied high-throughput antibody-based protein profiling to serum samples of healthy controls and individuals with SCZ and BD with the aim of identifying differentially expressed proteins in these disorders. Moreover, we explored the influence of polygenic burden for SCZ and BD on the serum levels of these proteins. Serum samples from 113 individuals with SCZ and 125 with BD from the PsyCourse Study and from 44 healthy controls were analyzed by using a set of 155 antibodies in an antibody-based assay targeting a selected panel of 95 proteins. For the cases, genotyping and imputation were conducted for DNA samples and SCZ and BD polygenic risk scores (PRS) were calculated. Univariate linear and logistic models were used for association analyses. The comparison between SCZ and BD revealed two serum proteins that were significantly elevated in BD after multiple testing adjustment: “complement C9” and “Interleukin 1 Receptor Accessory Protein”. Moreover, the first principal component of variance in the proteomics dataset differed significantly between SCZ and BD. After multiple testing correction, SCZ-PRS, BD-PRS, and SCZ-vs-BD–PRS were not significantly associated with the levels of the individual proteins or the values of the proteome principal components indicating no detectable genetic effects. Overall, our findings contribute to the evidence suggesting that the analysis of circulating proteins could lead to the identification of distinctive biomarkers for SCZ and BD. Our investigation warrants replication in large-scale studies to confirm these findings.

Correlation of Blood Biochemical Markers with Tardive Dyskinesia in Schizophrenic Patients.

Objective Oxidative stress factors and proinflammatory cytokines had been found to be involved in the pathogenesis of patients with tardive dyskinesia (TD). This study assumes that blood biochemical markers would have a link with TD in schizophrenia patients. To explore the correlation between blood biochemical markers and tardive dyskinesia in patients with schizophrenia (SCH). Methods From January 2010 to August 2021, the inpatients who met the diagnostic criteria of schizophrenia in the Chinese Classification and Diagnosis Criteria of Mental Disorders (DSM-4) and the American Diagnostic and Statistical Manual of Mental Disorders (DSM-4) were followed up in the psychiatric outpatient department of Jinxia Street Community Health Service Center, Longhu District, Shantou City. The diagnostic criteria of Abnormal Involuntary Movement Scale (AIMS) used in the TD study of Schooler and Kane were used to screen the patients. Patients were divided into the schizophrenia (SCH group) and the schizophrenia with TD groups (TD group). Oxidative stress factors including Superoxide Dismutase1 (SOD1), Glutathione Peroxidase1 (GPX1), Malondialdehyde1 (MDA1), Catalase Activity1 (CAT1), and brain-derived neurotrophic factor 1 (BDNF1) and some inflammatory cytokines including interleukin-2 (IL-2), interleukin-6 (IL-6), interleukin-8 (IL-8), serum tumor necrosis factor (TNF-α), prolactin, estrogen, and cortisol were measured in 121 schizophrenic patients with tardive dyskinesia and 118 schizophrenic patients. The correlation analysis was conducted on the data. Results Age and female were immutable risk factors for the development of TD, and there were significant differences in blood biochemical indices GPX1, MDA1, CAT1, and TNF-α in schizophrenic patients with and without TD. Conclusion This study supports that oxidative stress and immune disorders are associated with TD patients. Blood biochemical markers GPX1, MDA1, CAT1, and TNF-α may play an important role in the pathogenesis of schizophrenia combined with TD patients, and they may be useful in the diagnosis of schizophrenia with tardive dyskinesia.

Case Analysis of Sprint Interval Training for Adolescents With Severe Mental Illness

Case Analysis of Sprint Interval Training for Adolescents With Severe Mental Illness

Long-term outcome of postpartum psychosis: a prospective clinical cohort study in 106 women

ObjectiveWe aimed to investigate the outcome of postpartum psychosis over a four-year follow-up, and to identify potential clinical markers of mood/psychotic episodes outside of the postpartum period.MethodsOne hundred and six women with a diagnosis of first-onset mania or psychosis during the postpartum period were included in this prospective longitudinal study. Women were categorized into either (1) recurrence of non-postpartum mood/psychotic episodes or (2) mania/psychosis limited to the postpartum period. We summarize the longitudinal course of the illness per group. We used a logistic regression model to identify clinical predictors of recurrence of mood/psychotic episodes outside of the postpartum period.ResultsOver two thirds of the women included in this study did not have major psychiatric episodes outside of the postpartum period during follow-up. The overall recurrence rate of mood/psychotic episodes outside the postpartum period was ~ 32%. Of these women, most transitioned to a bipolar disorder diagnosis. None of the women fulfilled diagnostic criteria for schizophrenia or schizophreniform disorder. No clinical markers significantly predicted recurrence outside of the postpartum period.ConclusionsFor the majority of women with first-onset postpartum psychosis, the risk of illness was limited to the period after childbirth. For the remaining women, postpartum psychosis was part of a mood/psychotic disorder with severe non-postpartum recurrence, mainly in the bipolar spectrum. No clinical predictors for risk of severe episodes outside the postpartum period emerged. Our findings add to previous evidence suggesting a fundamental link between postpartum psychosis and bipolar disorder, which may represent two distinct diagnoses within the same spectrum.

Prevalence and Treatment of Tobacco Use among Patients Being Treated for Mental Disorders

Background: People with mental disorders use tobacco as a strategy for coping with various symptoms and the side effects of prescribed medications. In addition to being harmful to their health, tobacco use also interferes with their treatment process. Objective: To examine tobacco use among patients being treated for mental disorders in a public health system in a Brazilian the city. Methods: were interviewed 362 patients being treated by the specialized services for mental health. The participants included persons who met the diagnostic criteria for schizophrenia, schizotypal, and delusional disorders, mood (affective) disorders, or neurotic, stress-related, and somatoform disorders. Results: The median age of participants was 46.4 years, of which 73.5% were women and 42.5% were unmarried, 37.8% smokers. Among the smokers, 82% claimed they wanted to quit smoking, and 49% made daily visits to the health center. 79.6% of the participants had tried to quit smoking previously, and of these, 84.3% had tried to do so on their own. Conclusion: Tobacco use is an important factor to be considered in developing treatment plans for people with mental disorders. It is necessary to develop strategies to help people quit smoking and train health professionals to incorporate these strategies into the treatment process.

Acting on delusions in patients suffering from schizophrenia

Aim of the studyBackground: Schizophrenia patients are more prone to violent crimes because of associated risk factors- delusions, hallucinations, and substance misuse. The phenomenology of delusions associated with action provides a new way of understanding delusions and identifying key targets for risk management intervention secondary to medications. Aims: To assess the prevalence of delusional action in patients suffering from Schizophrenia and to identify the phenomenological characteristics of those delusions which are associated with action.Subject or material and methodsA cross-sectional study was conducted on a sample of 77 patients and their informant using DSM- 5 diagnostic criteria for Schizophrenia and Maudsley Assessment of Delusion Schedule was applied.ResultsFifty one (66.2%) acted on their delusions. Delusion of persecution was commonest being present in 58.4%. Actions on delusions consisted of protecting themselves (32.5%), losing temper (25.9%), hitting self/others (12.9%), moving/leaving house (15.6%), trying to stop it (27.2%). Informants reported that the patients felt unsafe, frightened or scared at home, suspicious of others, violent to someone, showed unusual behaviour.DiscussionActing on delusion occurs in significant proportion of patients. A higher proportion of the patients who reported feeling angry acted on their delusions and the difference was statistically significant. There was a higher rate of acting on delusions in those cases where the informant reported that the patient was frightened and had violent behaviour towards others. Both these differences were statistically significant.ConclusionsContent of behavior can help understand the treating physician the probable precipitating factor, the psychopathology of the patient’s illness.

Schizophrenia and motherhood.

The primary aim of this study was to analyze the impact of schizophrenic disorders on pregnancy outcomes. The secondary aim was to briefly analyze the potential role of antipsychotic treatment on influencing pregnancy outcomes in expectant mothers with schizophrenia. We searched the MEDLINE, PsycINFO, and Science.gov databases for articles published in English from January 1980 to January 2019. We used the following search terms: 'schizophrenia', 'motherhood', 'pregnancy/foetal/neonatal outcomes', and 'birth defects'. The reference lists of retrieved articles were also consulted to find additional pertinent studies missed in the electronic search and/or those published before 1980. Data were extracted from articles that provided primary data on the impact of maternal schizophrenia spectrum disorders on obstetrical and perinatal outcomes. After excluding duplicates, 35 articles were identified. Systematic reviews were searched on the same databases to briefly assess the effects of antipsychotics on pregnancy outcomes. The reviewed studies showed several limitations. They were published during a time range from the early 1970s to 2019. During this period, there were significant changes in the diagnostic criteria for schizophrenia. Moreover, such studies showed no homogeneity in the investigation of potential confounders. Most importantly, no research has differentiated the effects of maternal illness on pregnancy, fetal, and neonatal outcomes from those associated with antipsychotic treatments. Thus, it is not surprising that such studies show conflicting results. Despite such limitations, in managing pregnant women with schizophrenia clinicians should consider an integrated approach that includes: antipsychotic treatment, psychological treatment, optimal dietary approaches for prevention of excessive weight gain and gestational diabetes, meticulous gynecologic and obstetric surveillance, and social and occupational support.

Klasifikacija psihotičnih poremećaja - aktuelnosti

Two decades after the World Health Organization released the Tenth Revision of the International Classification of Diseases (ICD-10) and the American Psychiatric Association published the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), mental health professionals were presented with the newest revisions of the aforementioned classification systems (ICD-11 and DSM-5). The present review summarizes the major changes of ICD-11 and DSM-5 regarding the categorization and diagnostic criteria for psychosis spectrum disorders, emphasizing the most important similarities and differences between the two classification systems. The main changes brought by the newest ICD and DSM revisions are elimination of the clinical subtypes of schizophrenia, modifications in the diagnostic criteria for schizophrenia and schizoaffective disorder, and reconceptualization of catatonia. Moreover, the newest ICD and DSM revisions highlight the importance of the dimensional assessment of key psychopathology domains, whereby the significance of evaluation of (impaired) cognitive functioning has been formally recognized for the first time among these domains. The DSM-5's inclusion of attenuated psychosis syndrome under chapter Conditions for further study (appendix), reflects partial acknowledgment of the concept of early detection and early intervention in psychotic disorders, aimed to promote further research in this area. ICD-11 and DSM-5 did not bring fundamental changes concerning classification of psychotic disorders, in comparison to their previous versions - ICD-10 and DSM-IV. A major source of criticism in the latest revisions of the classification systems was that they had not been based on the up-to-date scientific data and neurobiological foundation of psychiatric disorders. Search for valid biomarkers for psychotic disorders is still a research priority in this area, and their integration into DSM and ICD. This remains a challenging task for future revisions of the classification systems.

S104. THE RELIABILITY AND VALIDITY OF THE CORE SCHIZOPHRENIA SYMPTOMS SCALE OF THE STANDARD FOR CLINICIANS’ INTERVIEW IN PSYCHIATRY

BackgroundCore schizophrenia symptoms (CSS) include delusions, hallucinations and disorganization and have been included in the diagnostic criteria of schizophrenia since Kraeplin (Kendler 2016). More than 40 subtypes of delusions, hallucinations and disorganization have been described as symptoms and signs of schizophrenia. There is a need to derive a short list of the core symptoms and signs of schizophrenia that are reliable, valid and useful for clinicians in clinical settings and clinical research.MethodsThe Standard for Clinicians’ Interview in Psychiatry (SCIP) is a new diagnostic interview designed to be used by clinicians (psychiatrists and experienced mental health professionals) in clinical settings and clinical research. The SCIP is a valid and reliable tool and was tested in an international multisite study in three countries (USA, Canada and Egypt) between 2000 and 2012 (Aboraya, El-Missiry et al. 2014, Aboraya 2015, Aboraya 2016, Aboraya, Nasrallah et al. 2016). A total of 700 patients were interviewed at William R. Sharpe Jr. Hospital in Weston, West Virginia (670 patients) and Chestnut Ridge Center in Morgantown, West Virginia (30 patients). Mean patient age was 34, 59% male, 95% White and 34% had less than 12 years of education. The SCIP includes 38 items covering subtypes of delusions, hallucinations and disorganization. The 38 items were shortened by removing items with low prevalence, low sensitivity or low item-rest correlation (< 0.4). The reliability and validity of the remaining items was recalculated with repetitive iterations. The final model was developed with input from experts. The result is the Core Schizophrenia Symptoms (CSS) Scale which has 18 items: 6 items measuring hallucinations, 8 items measuring delusions and 4 items measuring disorganization. The items were scored with binary and Likert-type scales ranging from 0 to 3. The reliability of the CSS scale was measured using the kappa coefficient for inter-rater reliability of the CSS individual items and Cronbach’s alpha for internal consistency of the CSS dimension. The validity of the CSS scale was assessed using Receiver Operating Characteristic (ROC) curves to determine the best clinical cut-off point for the CSS scale that maximizes sensitivity and specificity of the scale against the SCIP diagnosis of schizophrenia (the reference standard).ResultsTable (1) shows stable kappa values and standard error of 15 CSS items. Nine items have good reliability (kappa > 0.7), three items have fair reliability (kappa values range from 0.5 to 0.7) and three items have poor reliability (kappa < 0.5). Table (2) shows the internal consistency of the CSS dimension using Cronbach’s alpha and one-sided 95% confidence interval. The Cronbach’s alpha is 0.8317, indicating excellent internal consistency. Table (3) shows the sensitivity and specificity of the Core Schizophrenia Symptoms (CSS) scale. At a cut-off of one or more positive items, sensitivity is 95.06% and specificity is 88.94%; at a cut-off of two or more positive items, sensitivity is 90.12% and specificity is 89.39%.DiscussionThe Core Schizophrenia Symptoms (CSS) Scale is reliable at the level of individual items and at the dimensional level. In addition, the CSS scale is a valid scale that differentiates between schizophrenia and non-schizophrenia cases in a clinical population.

Association Between Schizophrenia and DNA Demethylase Activity in Human Peripheral Blood Mononuclear Cells.

DNA demethylase is a crucial enzyme in the epigenetic modification and regulation mechanisms of gene transcription. Based on previous assertions that the pathophysiology of schizophrenia is associated with epigenetics, we aimed to explore whether DNA demethylase activity might be related to schizophrenia in northeast China. We recruited 25 patients with first-episode schizophrenia and 29 normal controls from a northeast Chinese Han population. The diagnostic criteria of schizophrenia were determined according to diseases and related health problems, the tenth revision (ICD-10), and criteria of mental disorders, the third revised edition (CCMD3). DNA demethylase activity in human peripheral blood mononuclear cells (PBMCs) was measured using a DNA demethylase activity colorimetric assay ultra kit. Using Student's t-test, activation of DNA demethylase and its activity were higher in schizophrenia patients compared to healthy individuals (p < 0.001). Furthermore, the level of DNA demethylase activity in male and female subjects with schizophrenia significantly increased (all p < 0.05). Our data showed that DNA demethylase might play a role in the pathophysiology of schizophrenia, and individuals with higher DNA demethylase activity were susceptible to schizophrenia in a northeast Chinese Han population. To the best of our knowledge, this is the first time directly measured human blood samples to examine the association between first-episode schizophrenia patients and DNA demethylase activity, which will provide new insight to explore the effect on the mechanism of schizophrenia.

Pica – Mind over matter: a case report

The geneses, treatment and outcome of pica remains the subject of much debate. Data regarding pica in adults and in schizophrenia is limited. We present the case of a forty-year old male who presented with subacute intestinal obstruction. Having met the diagnostic criteria for schizophrenia, he subsequently developed symptoms which enabled a diagnosis of pica. Initially the pica symptoms were as a response to the command hallucinations, but later persisted in the absence of hallucinations. Pica can be potentially life-threatening, depending on the substance ingested and the complications that follow, as was the case in this patient. Risperidone, olanzapine or electro convulsive therapy did not have any impact on his symptoms of pica. Clozapine was commenced and a dramatic response was observed, with the pica symptoms completely resolving within 10 days – thus revealing a new facet to the already versatile therapeutic effects of clozapine.

Risperidone improves interpersonal perception and executive function in patients with schizophrenia.

ObjectiveTo investigate whether risperidone improves social cognitive impairments and executive dysfunction in people with schizophrenia.MethodsFifty-six patients who met the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, diagnostic criteria for schizophrenia were allocated to a risperidone treatment group (RTG, n=28) and a typical antipsychotic treatment group (TATG, n=28). Twenty-eight healthy volunteers were recruited as the normal control group (NCG). The Positive and Negative Syndrome Scale, Interpersonal Perception Task-15 (IPT-15), and Wisconsin Card Sorting Test (WCST) were rated at baseline and after 4 and 12 weeks of treatment with risperidone or typical antipsychotics.ResultsRisperidone and typical antipsychotics decreased Positive and Negative Syndrome Scale scores for total psychopathology and positive and negative symptoms. At baseline, in the IPT-15, total scores and five factor scores, as well as the number of categories completed and the percentage of conceptual level responses, were significantly lower in the RTG and TATG than in the NCG, whereas total response errors, perseverative errors, and failure to maintain set were significantly higher in the patient groups than in the NCG. Repeated measures analysis of variance revealed a significant main effect of time period (baseline, 4 weeks, and 12 weeks) for IPT-15 scores and WCST performances, and significant interactions for time period × group (RTG and TATG). Multivariate analysis of variance showed no significant differences between the RTG and TATG on IPT-15 scores at 4 weeks, but there were significant differences between these two groups at 12 weeks. Significant differences were also found between the RTG and TATG on WCST performances at 4 and 12 weeks.ConclusionIndividuals with schizophrenia have impairments in social cognitive and executive function, which might be improved by risperidone.

Family-Based Whole-Exome Sequencing for Identifying Novel Variants in Consanguineous Families with Schizophrenia

Background: Schizophrenia (SCZ) is a complex neuropsychiatric disorder characterized by pronounced genetic heterogeneity. Much of the genetic architecture of the disorder has not yet been clearly elucidated. Objectives: In the present experimental genetic analysis study, we used the whole-exome sequencing (WES) approach to identify the SCZ-related genetic variants in consanguineous multi-affected families. Patients and Methods: The current study was conducted between 2013 and 2015. The patients were recruited from two mental hospitals, including Razi hospital (Tehran, Iran) and Mirza Koochak Khan hospital (Rasht, Iran). All patients were diagnosed based on the DSM-IV-TR diagnostic criteria for SCZ. DNA samples from one proband for each of the three consanguineous Iranian families with twelve affected patients were subjected to WES. Then, a multi-step analysis strategy was employed to identify the genetic variants that may have potentially contributed to SCZ. Results: After variant filtering, WES data revealed two previously known pathogenic mutations (rs450046 in PRODH and rs1800497 in ANKK1 genes) and five novel variants in five genes (NOS1, ANKK1, ARVCF, GRID1, and ANK3), all of which were predicted to be causing damage by SIFT, Polyphen-2, and MutationTaster tools. Two of these novel variants (c.562C > T in ANKK1 and c.7649G > T in ANK3) showed complete segregation in the families, which makes them good candidates for further case-control studies. Conclusions: By applying WES, both novel and known SCZ pathogenic variants with complete or incomplete segregation in the families with multiple cases of schizophrenic patients were identified.

Extraordinary system of delusions and the social functioning - a case study

Abstract Schizophrenic psychoses are a heterogeneous group of diseases that affect about 1% of the world’s population. The first symptoms of the disease usually manifest between ages 20 and 30. The diagnostic criteria for schizophrenia and its subtypes are characterized in detail in ICD-10. Diagnosis is based primarily on the presence of productive symptoms such as delusions or hallucinations occurring for at least one month which cannot be explained in another way. Schizophrenia is a disease which largely affects social functioning of patients, such as occupational performance, family life, interpersonal relationships or housing situation. Apart from the sociological aspect, social lives of schizophrenia sufferers are significantly impoverished due to cognitive impairment associated with improper functioning of NMDA receptors. The study describes a case of a patient suffering from paranoid schizophrenia which sheds light on the social functioning of this group of patients.

Hospital admissions and direct costs: A comparative study between paliperidone palmitate and oral antipsychotics

IntroductionThe total costs of schizophrenia increased to 2576 million Euros in 2013 in Spain, or 2.7% of the annual cost of health services. The hospitalizations, along with other intermediate resources, such as Day Hospital, etc., significantly contribute to the increase of economic burden. In Spain, the average hospital stay of schizophrenic patients is 18.24 days, totalling to an average cost of 6,753 Euros/patient (370.23 Euros/patient/day).Material and methodsThe sample selected included patients from both sexes, aged between 18 and 65 years old, with diagnostic criteria of schizophrenia (according to DSM-IV and ICD-10), admitted in the Mental Health Hospital Unit (MHHU), Úbeda between 2012 and 2013, with registered visits of at least 2 outpatient visits or 1 hospitalization related to the schizophrenia diagnosis (n = 48).ResultsAfter the start of treatment with the injectable antipsychotic drug of prolonged duration, the number of patients that required hospitalization for any psychiatric motive went from 24 patients (49.7%) to 11 patients (22.4%; P &lt; 0.001). The patients who started treatment with PAP during hospitalization had an average stay of 15.7 days, as compared to 18.24 days of average hospital stay due to schizophrenia in Spain. The direct costs of hospitalization stays due to psychiatric reasons decreased from 162,071.88 Euros to 74,282.95 Euros (P &lt; 0.001).ConclusionsThis observational study shows us that the treatment with PAP reduced the average length of the hospital stay, and resulted in a decreased percentage of re-admissions as compared to oral treatments for schizophrenia. These data led to savings of more than 50% of the direct costs of hospitalization.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Relationship between Suicidality and Low Self-esteem in Patients with Schizophrenia.

ObjectiveLow self-esteem is associated with suicide risk in the general psychiatric population. The aim of this study was to examine associations between suicidality and self-esteem in patients with schizophrenia.MethodsSubjects meeting the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) diagnostic criteria for schizophrenia were enrolled. Sociodemographic and clinical variables, including previous suicide attempt history, were assessed. Psychopathology, self-esteem, and self-perceived stigma were also measured using the Positive and Negative Syndrome Scale, the Rosenberg Self-Esteem Scale (SES), the Beck Depression Inventory (BDI), the Beck Hopelessness Scale, and the Korean version of the Internalized Stigma of Mental Illness scale (K-ISMI).ResultsOf the total of 87 participants, 20 (23.0%) had attempted suicide. Patients with a history of suicide attempts had significantly higher scores on the BDI (p=0.036) and K-ISMI (p=0.009), and significantly lower scores on the SES (p=0.001). Analysis of covariance revealed that the SES scores were significantly lower in patients with a history of previous suicide attempts than in those with no history, after controlling for K-ISMI and BDI scores (p=0.039).ConclusionLow self-esteem appears to represent a psychological dimension that is closely related to suicide risk. Therefore, clinical attention should be paid to the evaluation and enhancement of low self-esteem in schizophrenia patients with suicidality. A longitudinal prospective study is required to ascertain whether low self-esteem leads suicide attempts.

Triiodothyronine accelerates and enhances the antipsychotic effect of risperidone in acute schizophrenia

In acute psychotic schizophrenia patients we investigated if the combination of triiodothyronine (T3) plus risperidone was more effective when compared to risperidone monotherapy. Thirty-two in-patients meeting the DSM-IV-TR diagnostic criteria for schizophrenia and without thyroid disease received risperidone (flexibly adjusted dose for tolerability) and were randomized to additionally receive either T3 (25 μg daily; risperidone plus T3 group) or placebo (risperidone plus placebo group). Treatment lasted until meeting the response to treatment criteria defined as score of ≤3 on the Clinical Global Impression Severity and Improvement scales. Acute psychotic episode symptom severity was evaluated using the Brief Psychiatric Rating Scale (BPRS) at treatment initiation and at the final study assessment. Fourteen patients were randomized to receive risperidone plus T3 and eighteen to receive risperidone plus placebo. The time until treatment response was shorter in the risperidone plus T3 group relative to the risperidone plus placebo group (25.5 ± 4.4 days vs 32.2 ± 8.2 days, respectively; p = 0.001). Moreover, there was a greater reduction of BPRS-total score (p = 0.01) in the risperidone plus T3 group relative to the risperidone plus placebo group. Treatment with T3 was associated with shorter time to treatment response (β = −0.440, p = 0.022) and with greater improvement in BPRS score (β = 0.240, p = 0.053), independent of patients' gender, age, baseline BPRS score and mean risperidone dose. The study confirms that addition of T3 to risperidone was associated with accelerated and enhanced treatment response in acutely psychotic schizophrenic patients.

Tobacco smoking in persons with schizophrenia followed up at a teaching hospital in Sri Lanka

Background Studies in Western populations indicate that the prevalence of smoking in patients with schizophrenia ranges from 70-90%. Data from low and middle income countries is sparse. Aims To determine the prevalence of smoking in patients with schizophrenia, and to identify probable associations. Methodology The study was conducted at the psychiatry outpatient clinics of Colombo North Teaching Hospital, Ragama. Consecutive outpatients who met ICD-10 diagnostic criteria for schizophrenia were invited to answer an interviewer administered, pre-tested questionnaire on socio-demographic status, smoking habits, disease and treatment related characteristics. The Fagerstrom’s Test for Nicotine Dependence was used to grade the level of nicotine addiction. Results Of the 400 patients with schizophrenia, 171 (42.8%) were smokers. Of them 150 (87.7%) were dependent on nicotine. In terms of Fagerstrom’s Test, high dependence was seen in 3.3% ( n =5) while 39.2% ( n =59) and 57.3% ( n =86) reported moderate and low dependence respectively. All the smokers were male. For a majority of the patients the age of initiation of smoking was between 16-25 years, correlating with the onset of schizophrenia. Interestingly, most of the smokers (63.2%) were keen to quit smoking. Participants who smoked were significantly more likely to misuse other substances ( p =0.001) and to suffer from physical illnesses ( p =0.0001), compared to non-smokers. Smokers were also significantly more likely to be on intramuscular depot antipsychotics ( p =0.032), whereas non-smokers in contrast, were more likely to be on atypical antipsychotics ( p =0.0001). Conclusion A dual diagnosis of schizophrenia and nicotine dependence could be made in nearly half of our study population with schizophrenia. Although these rates are lower than in western populations, it is an issue that needs to be addressed in the treatment. DOI: http://dx.doi.org/10.4038/sljpsyc.v5i2.7816 Sri Lanka Journal of Psychiatry Vol 5(2):19-23

Comparative study of brain function tests between patients with schizophrenia and normal controls

Objective To investigate differences in brain function tests between patients with schizophrenia and normal controls.Methods 80 patients who met diagnostic criteria for schizophrenia of International Classification of Diseases (10th edition) received brain function tests,for the same period 52 cases of normal control also received brain function tests.Test results were compared to analyze differences in brain neurotransmitters.Results There were statistically significant differences in GABA and Glu neurotransmitters power between schizophrenia group and normal control group (t =-1.991,P =0.049; t =-2.228,P =0.028).There was statistically significant difference in glutamate neurotransmitter relative power between two groups (t =-2.115,P =0.036).There was statistically significant difference in neurotransmitters total power between two groups (t =-2.631,P =0.010).Conclusion Glutamate neurotransmitter power,relative neurotransmitters power and total neurotransmitters power in schizophrenia group were higher than those in normal control group,which suggested abnormal brain neurotransmitters function in patients with schizophrenia. Key words: Schizophrenia; Normal control group; Brain function tests