Effective Treatment For Schizophrenia Research Articles

IJCM_423A: Mental Health Literacy for Depression and Schizophrenia among Undergraduate students

Background: Mental Health Literacy (MHL) arose as a facet of Health Literacy after it was understood that the concept of health went beyond the physiological or the physical aspect. Despite improvements in various health indicators in the last couple of decades, India still significantly contributes to the global burden of disease and mental illnesses. Objective This study aimed to examine the level of Mental Health Literacy in terms of diagnosis, treatment, prognosis and help-seeking behavior for Depression and Schizophrenia among Indian Undergraduate students and to compare the levels of Mental Health Literacy among males and females Methodology: The study used a cross-sectional design with snowball sampling across various educational institutions the participants 324 in number were undergraduate students aged between 18 and 23. All consenting participants were recruited for the study and Google forms consisting of case vignettes and questions that followed them were distributed using snowball sampling. Results Participants were able to diagnose depression but were poor at diagnosing Schizophrenia. Psychological therapy was rated as the most effective treatment for depression and psychological and drug therapy were rated as the most effective treatments for Schizophrenia. Higher prognosis ratings were given to Depression as compared to Schizophrenia. Females were more optimistic about the prognosis of both disorders as compared to males. Conclusion: Overall, participants demonstrated better Mental Health Literacy for depression as compared to schizophrenia, possibly due to the availability of internet resources.

Response rate and factors associated with response in patients with schizophrenia undergoing bilateral electroconvulsive therapy

Schizophrenia is a severe mental illness and a common indication for electroconvulsive therapy (ECT). Research is lacking on the factors that influence response to acute ECT treatment in schizophrenia patients. This study examined the response rate and associated factors in patients with schizophrenia undergoing bilateral ECT. Demographic data, clinical characteristics, ECT data and treatment response were respectively reviewed in patients with schizophrenia undergoing bilateral ECT from January 2013 to June 2022. Forty-six patients were included. Nine responded after the first three sessions, 17 after six sessions, 20 after nine sessions, 25 after 12 sessions and 28 after the last ECT session, cumulatively. The mean of the baseline Brief Psychiatric Rating Scale psychotic symptom subscale score was significantly higher in responders (17.0) than non-responders (10.9) (P < 0.05). The mean of duration of electroencephalogram seizure was significantly longer in responders (53.9) than in non-responders (42.7). There was no association between demographic and ECT data and treatment response. Among 28 responders, 20 responded to ECT after nine sessions (faster responders) and eight responded later (slower responders). The number of failed antipsychotics prior to ECT was 2.8 for faster responders and 4.4 for slower responders (P = 0.02). Nominal logistic regression showed that the number of failed antipsychotics prior to ECT was associated with speed of response to ECT (P = 0.037, odds ratio = 1.77). ECT is an effective treatment for schizophrenia and may be influenced by the number of failed antipsychotics prior to ECT.

Lifestyle Coaching May Be an Effective Treatment for Schizophrenia.

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

Olanzapine/Samidorphan: A New Combination Treatment for Schizophrenia and Bipolar I Disorder Intended to Reduce Weight Gain.

Olanzapine is a second-generation antipsychotic with established efficacy in several psychiatric disease states, but its use is limited because of weight gain and metabolic side effects. Samidorphan is a novel opioid antagonist that binds to mu-opioid, kappa-opioid, and delta-opioid receptors and is hypothesized to reduce cravings for high-calorie foods thus attenuating antipsychotic-induced weight gain. The combination product olanzapine/samidorphan was approved by the US Food and Drug Administration in June 2021 for the treatment of schizophrenia and bipolar I disorder; this article reviews the pharmacological properties of oral olanzapine/samidorphan and its clinical efficacy and tolerability with a focus on mitigation of olanzapine-induced weight gain in these patient populations. In clinical trials, the combination of olanzapine/samidorphan was associated with significantly less weight gain and smaller increases in waist circumference as compared with olanzapine monotherapy. Olanzapine/samidorphan demonstrated similar efficacy as olanzapine monotherapy and was well tolerated. Weight gain and metabolic side effects associated with olanzapine monotherapy can result in tolerability issues and potentially medication nonadherence. Olanzapine/samidorphan is an effective treatment for schizophrenia and bipolar I disorder with less weight gain than olanzapine monotherapy.

Controlling astrocyte-mediated synaptic pruning signals for schizophrenia drug repurposing with deep graph networks.

Schizophrenia is a debilitating psychiatric disorder, leading to both physical and social morbidity. Worldwide 1% of the population is struggling with the disease, with 100,000 new cases annually only in the United States. Despite its importance, the goal of finding effective treatments for schizophrenia remains a challenging task, and previous work conducted expensive large-scale phenotypic screens. This work investigates the benefits of Machine Learning for graphs to optimize drug phenotypic screens and predict compounds that mitigate abnormal brain reduction induced by excessive glial phagocytic activity in schizophrenia subjects. Given a compound and its concentration as input, we propose a method that predicts a score associated with three possible compound effects, i.e., reduce, increase, or not influence phagocytosis. We leverage a high-throughput screening to prove experimentally that our method achieves good generalization capabilities. The screening involves 2218 compounds at five different concentrations. Then, we analyze the usability of our approach in a practical setting, i.e., prioritizing the selection of compounds in the SWEETLEAD library. We provide a list of 64 compounds from the library that have the most potential clinical utility for glial phagocytosis mitigation. Lastly, we propose a novel approach to computationally validate their utility as possible therapies for schizophrenia.

Can cognitive remediation therapy be delivered remotely? A review examining feasibility and acceptability of remote interventions

Cognitive remediation (CR) is an effective treatment for schizophrenia. However, issues such as motivational impairments, geographic limitations, and limited availability of specialized clinicians to deliver CR, can impede dissemination. Remote delivery of CR provides an opportunity to implement CR on a broader scale. While empirical support for the efficacy of in-person CR is robust, the evidence-base for virtual delivery of CR is limited. Thus, in this review we aimed to evaluate the feasibility and acceptability of remote CR interventions. Nine (n = 847) fully remote and one hybrid CR intervention were included in this review. Attrition rates for remote CR were generally high compared to control groups. Acceptability rates for remote CR interventions were high and responses from caregivers were positive. Further research using more methodologically rigorous designs is required to evaluate appropriate adaptations for remote treatment and determine which populations may benefit more from remote CR.

Olanzapine long-acting injection, discontinuation rates and reasons for discontinuation: 10 years' experience at a UK high-secure hospital.

Background:Olanzapine pamoate has been shown to be an effective second-generation long-acting injection. Its popularity has possibly been adversely affected by the rare incidence of post-injection syndrome (PIS) and the associated requirement to monitor for 3 h after each injection.Objective:This study aimed to collect and present data on the use of olanzapine long-acting injection (OLAI) over a 10-year period in a high-security forensic hospital in South East England.Design:This was a non-interventional retrospective study collecting information from anonymised electronic patient and prescription records. As per hospital Trust guidelines, patient consent to access of hospital records was presumed unless explicitly withdrawn.Method:All patients prescribed OLAI between the years 2009 and 2019 were identified. Data collected included date that OLAI was started, stopped, dose range, side effects and concomitant medication.Results:Of 88 patients who were started OLAI, 45 (51%) continued at month 24. At 60 months, 22 of 70 (31%) patients for whom data were available continued with OLAI. Over 60% of continuers were on higher than recommended doses. Of almost 5000 injections administered, there was 1 episode of PIS.Conclusion:OLAI is an effective treatment for schizophrenia and schizoaffective disorder, especially when used in patients have been able to tolerate the drug and were stabilised on it for 24 months. In over half the patients who continued OLAI, the doses were higher than that recommended by the manufacturer. The incidence of PIS in this study was very low in comparison with other studies.Registration code:2049

QEEG Biomarkers for ECT Treatment Response in Schizophrenia.

Background: Electroconvulsive therapy (ECT) is a clinically effective treatment for schizophrenia (SZD). However, studies have shown that only about 50 to 80% of patients show response to ECT. To identify the most suitable patients for ECT, developing biomarkers predicting ECT response remains an important goal. This study aimed to explore the quantitative electroencephalography (QEEG) biomarkers to predict ECT efficacy. Methods: Thirty patients who met DSM-5 criteria for SZD and had been assigned to ECT were recruited. 32-lead Resting-EEG recordings were collected one hour before the initial ECT treatment. Positive and negative symptoms scale (PANSS) was assessed at baseline and after the eighth ECT session. EEG data were analyzed using mutual information. Results: In the brain network density threshold range of 0.05 to 0.2, the assortativity of the right temporal, right parietal, and right occipital cortex in the response group was significantly higher than that in the non-response group (p < .05) in the beta band. In the theta band, the left frontal, parietal, right occipital cortex, and central area assortativity were higher in the response group than in the non-response group (p < .05). Conclusions: QEEG might be a useful approach to identify the candidate biomarker for ECT in clinical practice.

PREPARATION AND CHARACTERIZATION OF TRIFLUOPERAZINE LOADED TRANSDERMAL PATCHES FOR SUSTAINED RELEASE

Objective: The purpose of the present study was to formulate and evaluate the polymeric transdermal delivery system of antipsychotic drug Trifluoperazine (TFP) for sustained drug release. Methods: A transdermal patch loaded with (TFP) was formulated by solvent casting technique. Polyvinyl pyrrolidone (PVP) K-30 and ethyl cellulose (EC) was used as a polymeric matrix with different ratios. Di n-butyl phthalate was used as a plasticizer. The parameters such as thickness, folding endurance and weight variation of the prepared patches were studied. The interaction study by attenuated total reflectance-infrared (ATR-IR) spectroscopy, X-ray diffraction and thermal analysis by differential scanning calorimetry (DSC) were performed. In vitro drug release study was performed by modified paddle over-disc technique. Results: The infrared spectroscopic study confirmed the absence of any chemical interaction between TFP and selected polymers. All the prepared formulations showed folding endurance values ranging from 130-162 and a satisfactory drug loading of 90-95%. In in vitro drug release study, formulations PE-3 and PE-4 exhibited a sustained and stable cumulative release of 54 % and 48% respectively, at the end of 24 h. The DSC and XRD analysis proved the partial conversion of the drug from crystalline to amorphous form when integrated into the polymeric matrix. Conclusion: The prepared transdermal formulations using polymers PVP and ethyl cellulose demonstrated their ability to sustain the release of TFP. The developed formulation could be exploited for multiday therapy of TFP for the effective treatment of schizophrenia with a simplified dosing regimen and enhanced patient compliance.

Antipsychotic Potential and Safety Profile of TPGS-Based Mucoadhesive Aripiprazole Nanoemulsion: Development and Optimization for Nose-To-Brain Delivery.

Delivering therapeutics to the brain using conventional dosage forms is always a challenge, thus the present study was aimed to formulate mucoadhesive nanoemulsion (MNE) of aripiprazole (ARP) for intranasal delivery to transport the drug directly to the brain. Therefore, a TPGS based ARP-MNE was formulated and optimized using the Box-Behnken statistical design. The improved invitro release profile of the formulation was in agreement to enhanced exvivo permeation through sheep mucous membranes with a maximum rate of permeation co-efficient (62.87cmh-1×103) and flux (31.43μgcm-2.h-1). The pharmacokinetic profile following single-dose administration showed the maximum concentration of drug in the brain (Cmax) of 15.19±2.51μgmL-1 and Tmax of 1h in animals with ARP-MNE as compared to 10.57±1.88μgmL-1 and 1h, and 2.52±0.38μgmL-1 and 3h upon intranasal and intravenous administration of ARP-NE, respectively. Further, higher values of % drug targeting efficiency (96.9%) and % drug targeting potential (89.73%) of ARP-MNE through intranasal administration were investigated. The studies in Wistar rats showed no existence of extrapyramidal symptoms through the catalepsy test and forelimb retraction results. No exvivo ciliotoxicity on nasal mucosa reflects the safety of the components and delivery tool. Further, findings on locomotor activity and hind-limb retraction test in ARP-MNE treated animals established its antipsychotic efficacy. Thus, it can be inferred that the developed ARP-MNE could effectively be explored as brain delivery cargo in the effective treatment of schizophrenia without producing any toxic manifestation.

Psychopharmacology of schizophrenia

The revolution in psychopharmacology and biological psychiatry started by the introduction of chlorpromazine provided the first effective treatment for schizophrenia, as well as ideas and evidence about the pathophysiology of the illness. Brain imaging studies of receptor densities in young adults and children, or in patients with first-episode schizophrenia may be helpful in identifying early vulnerability factors.

Global research on cognitive behavioural therapy for schizophrenia from 2000 to 2019: a bibliometric analysis via CiteSpace

BackgroundCognitive behavioural therapy (CBT) is considered to be an effective treatment for schizophrenia. In recent years, researchers have published clinical research results on CBT for schizophrenia. However, there is currently...

Effectiveness of Psychoeducation Programme on Knowledge of Schizophrenia among Care Givers of the Patients with Schizophrenia, Admitted in Selected Hospital of SGR

Background: Schizophrenia is one of the commonly occurring disorders, often causing a high degree of disability to the patients, as well as being stressful to the caregivers. Many people are still unaware that there are effective treatments for schizophrenia. A combination of regular medication, family education and support reduce the relapse rate from 50% to 60%. Psychoeducation interventions provide information to patients and their families as well as provide the tools necessary to cope with the disorder. Aim: The study aimed to find the efficacy of psycho-education on knowledge regarding schizophrenia among care givers of patients by conducting pretest before intervention and posttest after intervention. Methods: Pre-experimental one group pre-test and posttest design was used for this study. The sample of 50 care givers were selected using purposive sampling technique consists of care givers of schizophrenia patients admitted in psychiatric ward. The study was conducted at the selected state govt. hospital IMHANS Srinagar J&amp;K India. Data was collected using structured knowledge questionnaire. The researcher first explained the aim of the evaluation and invited family members to take part. After consenting to participate in the study, family members were assessed in group of twenty five. Result: mean knowledge score at pre-test was 8.94+5.101 and 27.66+1.814 at post test. There was significant difference in knowledge scores of pre-test and post-test p&lt;0.001).There was no significant association between knowledge score and demographic variables. Conclusion: There was significant gain in knowledge score of care givers. The study concluded that psycho education was effective in increasing the knowledge of care givers of schizophrenia patients. Psycho education of the family members is the key to understand about the illness and provide better care to the patient.

Evolution of public beliefs about schizophrenia and attitudes towards those afflicted in Austria over two decades

PurposeIn the recent years, it was possible to observe two trends: First, there has been a trend to greater mental health literacy, in particular towards a biological model of schizophrenia. Secondly, an increase in public acceptance of professional help and psychiatric treatment has been observed in western countries. This indicates that the societal idea about mental illness and how it can be treated has changed. However, no changes or even changes to the worse occurred regarding the attitudes towards those suffering from the illness, particularly concerning schizophrenia. Thus, the question arises as to whether similar trends can also be found in Austria.MethodsWe use data from two representative population surveys in Austria, conducted 1998 (n = 1042) and 2018 (n = 1010) using face-to-face interviews, the same sampling procedure, interview mode, and interview schedule.ResultsThe data show that today Austrians tend to opt less frequently for genetic factors and chronic stress as causes of schizophrenia than 20 years ago. There were only slight changes regarding intended first help-seeking actions except for a stronger endorsement of lay help. The believe in an effective treatment of schizophrenia has increased significantly and there was a marked trend towards preference of medication over psychotherapy. Social acceptance of people with schizophrenia has increased, but also the ascription of violence.ConclusionIn summary, the evolution of attitudes and beliefs concerning schizophrenia in Austria shows a rather inconsistent pattern and differs to some extent from what has been observed in other western countries. This is important to know when planning awareness-raising or stigma-reducing initiatives.

Outcomes in patients with and without capacity in electroconvulsive therapy

Background: Electroconvulsive therapy (ECT) is an effective treatment for severe mental illness but access is limited for patients lacking consent capacity. We aimed to compare the symptomatic, cognitive, quality of life (QOL) and functional outcomes of patients with and without capacity receiving ECT for schizophrenia, depression or mania. Methods: Patients prescribed ECT in a single center had their clinical outcomes pre and post ECT compared with repeated measures ANOVAs. Differences in demographic, clinical characteristics and ECT treatment between the group lacking and having capacity were examined using independent t-tests for continuous variables and chi-squared tests for categorical variables. Results: 75.1% of 175 patients lacked capacity. The group lacking capacity had overall poorer cognitive and global functioning pre ECT but higher QOL. Objective psychiatric symptom ratings after ECT improved similarly between groups. Mood, cognition, QOL and function improved in both groups, with more improvement in mood and function in the group lacking capacity and a trend towards greater cognitive improvement (p = 0.051). Limitations: Subgroup analysis by diagnosis was not done due to smaller sample sizes in each group. Cognition was assessed with a general screening instrument not a full neuropsychological assessment. Conclusions: ECT is a safe and effective treatment for schizophrenia, bipolar mania and depression, and may provide similar or greater benefits in patients lacking capacity to consent, compared to those with capacity. These results support the provision of a framework for substitute decision making in the patients’ best interests for ECT in patients unable to provide their own consent.

Opposite clozapine and ziprasidone effects on the reactivity of plasma albumin SH-group are the consequence of their different binding properties dependent on protein fatty acids content

Antipsychotic drugs interfere with the antioxidant defense system provoking complex and often toxicological effects. Here we examined differences in plasma albumin reduced free thiol (SH) group content and its reactivity as a consequence of clozapine (CLZ) and ziprasidone (ZIP) binding. Chronic administration of CLZ reduced, whereas treatment with ZIP increased albumin-SH content in rats. Regardless of the ratio of stearic acid (SA) bound to protein, in vitro binding of ZIP to human serum albumin (HSA) increased both the SH group level and reactivity. In contrast, the effect of CLZ on HSA-SH reactivity was dependent on HSA to SA molar ratio. CLZ binding was accompanied by an increase in HSA-SH reactivity in samples with normal, but a reduction of its reactivity level with higher SA/HSA ratio, compared to drug-free samples. We demonstrate by steady-state fluorescence quenching studies that an increase in SA binding to HSA is associated with a significant reduction of binding constant for both antipsychotics. In addition, this is the first report of quantitative characterization of ZIP binding to HSA. Our findings suggest that albumin-SH content and reactivity is modulated by ZIP towards an increased antioxidant defense capacity in circulation, as opposed to CLZ, which can contribute to the safer, more effective treatment of schizophrenia.

The Dopamine Allosteric Agent, PAOPA, Demonstrates Therapeutic Potential in the Phencyclidine NMDA Pre-clinical Rat Model of Schizophrenia.

PAOPA, a potent analog of prolyl-leucyl-glycinamide, has shown therapeutic potential at the preclinical stage for dopaminergic related illnesses, including animal models of schizophrenia, Parkinson’s disease and haloperidol-induced extrapyramidal movement disorders. PAOPA’s unique allosteric mechanism and dopamine D2 receptor specificity provide a unique composition of properties for the development of potential therapeutics for neuropsychiatric illnesses. We sought to investigate PAOPA’s therapeutic prospects across the spectrum of schizophrenia-like symptoms represented in the established phencyclidine-induced rat model of schizophrenia, (5 mg/kg PCP twice daily for 7 days, followed by 7 days of drug withdrawal). PAOPA was assessed for its effect on brain metabolic activity and across a battery of behavioral tests including, hyperlocomotion, social withdrawal, sensorimotor gating, and novel object recognition. PAOPA showed therapeutic efficacy in behavioral paradigms representing the negative (social withdrawal) and cognitive-like (novel object recognition) symptoms of schizophrenia. Interestingly, some behavioral indices associated with the positive symptoms of schizophrenia that were ameliorated in PAOPA’s prior examination in the amphetamine-sensitized model of schizophrenia were not ameliorated in the PCP model; suggesting that the deficits induced by amphetamine and PCP—while phenotypically similar—are mechanistically different and that PAOPA’s effects are restricted to certain mechanisms and systems. These studies provide insight on the potential use of PAOPA for the safe and effective treatment of schizophrenia.

Electroconvulsive Therapy and Risk of Dementia-A Nationwide Cohort Study in Taiwan.

Background: Electroconvulsive therapy (ECT) is an effective treatment for schizophrenia, bipolar disorder, and major depressive disorder, and a temporary memory loss may occur after ECT. However, the association between ECT in patients with schizophrenia, bipolar disorder, and major depressive disorder, and the risk of dementia is yet to be examined.Objective: This study aimed to clarify as to whether ECT is associated with the risk of dementia after ECT in patients with schizophrenia, bipolar disorder, and major depressive disorder, using Taiwan's National Health Insurance Research Database (NHIRD).Methods: A total of 3,796 enrolled participants (schizophrenia, 46.68%; bipolar disorder, 11.77%; and major depressive disorder, 41.55%) with 994 patients who had received ECT and 2,982 controls matched for sex and age, between January 1, and December 31, 2000, were selected from the NHIRD. After adjusting for confounding factors, Fine and Gray's survival analysis was used to compare the risk of developing dementia during the 10 years of follow-up.Results: Of the study patients, 45 (4.53%) of them developed dementia when compared to 149 (5.0%) in the control group. Fine and Gray's survival analysis revealed that the study patients were not associated with an increased risk of dementia [hazard ratio (HR) = 0.612, 95% confidence interval (CI) = 0.438–1.854, P = 0.325]. After adjusting for sex, age, monthly income, urbanization level, geographic region, and comorbidities, the adjusted HR was 0.633 (95% CI = 0.448 – 1.895, P = 0.304).Conclusion: This study supports that ECT was not associated with the increased risk of dementia in patients with schizophrenia, bipolar disorder, and major depressive disorder, using the NHIRD.

Effect of age onset on schizophrenia-like phenotypes and underlying mechanisms in model mice

In humans, schizophrenia with onset in adolescence or adult has distinct features. To understand whether schizophrenia with either adolescence- or adult-onset have distinct phenotypes and cellular mechanisms in schizophrenia model mice, we altered Nrg1 signaling during either adolescence or adult mice via injection of anti-Nrg1 antibodies. We found that in either early-onset schizophrenia (EOS)- or late-onset schizophrenia (LOS)-like mice, certain behavior phenotypes are shared including hyperlocomotion, impaired working memory and impaired fear conditioning. Anxiety appears to be largely unaffected. In vitro electrophysiology in brain slices showed altered excitation/inhibition balance in EOS-like mice towards enhanced synaptic excitation, but intrinsic excitability of the fast-spiking GABAergic neurons was elevated in the LOS-like mice. Thus, although schizophrenia-like main phenotypes appear to be preserved in both age onset model mice, there are distinct differences in cellular mechanisms between them. We suggest that these differences are important for more precise diagnosis and more effective treatment of schizophrenia.

Metacognitive Training Online

Abstract. Psychological interventions such as cognitive-behavioral therapy and metacognitive training (MCT) have proven to be effective treatments for schizophrenia, but only a small number of patients actually gain access to them. Internet-based interventions are effective, but hardly explored for schizophrenia. This pilot study created an Online-MCT to investigate the feasibility, efficacy, and possible negative effects of the program. Fifteen patients participated in this uncontrolled study. During the 6-week intervention phase, two-thirds of participants completed the whole program. Only 6.1 % of all possible negative effects were strongly agreed to. Symptom severity did not change significantly, but 80 % of participants were (very) satisfied with the program, suggesting that internet-based interventions could help reduce the gap in psychological treatments of schizophrenia.