Group Of Chronic Schizophrenics Research Articles

Negative correlation between PANSS negative subscale score and obesity in a chronic group of patients with schizophrenia, an observational study

Background. Schizophrenia, as a chronic mental disorder with lifelong evolution is associated with low functionality and a high degree of disability. Obesity is an overlapping risk factor that is present in almost half of the patients worldwide and is responsible for increasing the overall mortality by itself or by predisposing to extensive morbidity. Its pathophysiology describes many mechanisms, the central position being occupied by the appetite regulation throughout the lipids and glucose metabolism. It is important to analyze whether the trends of correlation pairs of obesity in schizophrenia in Romanian patients are similar to those described in literature and if they are depicted in smaller groups of patients. Methods. This study paper is an observational cross-sectional study taking into account 110 inpatients with schizophrenia. The study included 110 inpatients diagnosed with schizophrenia admitted in ”Prof. Dr. Alexandru Obregia” Psychiatry Hospital. They were divided into two groups by applying the criterium of BMI with a cut-off point set at 25 and were applied PANSS and GAFs altogether with a structured basic anamnestic interview. Results. The mean age of the patients was 39.15 years in the study group (SG) and 40.95 years in the control group (CG), the sex ratio was similar between the two groups. Regarding previous treatment, 59.3% normal weight patients were priorly medicated and 38.1% of those with BMI>25 received prior treatment. Both groups had a similar mean value of the positive and the general psychopathology subscales, the SG registered a slightly higher mean score on the negative subscale as well as on the total PANSS score. The mean value of Global Assessment of Functioning score was higher for the normal weight group. Discussion. Our findings point out that only PANSS negative subscale score has a negative statistical correlation (p=.005) with obesity in the chronic schizophrenic group we selected. No other statistically significant correlations between sex, age, place of living, education, employment and professional statuses, previous treatment, current antipsychotic medication and obesity were made possible due to reasons such as study design choice or the large number of obese patients related to the entire sample. Conclusion. There is an important number of schizophrenia patients that are overweight or obese. We found no major differences between the two groups on the topic of demographics or clinical variables, resulting in the conclusion that schizophrenia carries an important morbidity load, so that obesity can indiscriminately impact these patients.

Integrated neurocognitive therapy in chronic schizophrenic inpatients: preliminary data and considerations.

The present paper aims at studying the efficacy of the Integrated Neurocognitive Therapy (INT), according to Roder's model, in a group of chronic schizophrenics in a long term residential condition. This kind of treatment is particularly interesting because, according to the most recent studies concerning schizophrenia as a neurodevelopmental disorder, allows to act on the neuro- and socio- cognitions areas, which are the most deteriorated ones. Moreover the INT program includes also computer aided activities (Cog PacK), which largely proved their efficacy on neurocognition. The study sample consists of 10 inpatients suffering of Schizophrenia (according to DSM-5), 5 Male and 5 Female, average age 52, disorder average length 24,9 years, with IQ not <80. The sample took part in the 18 months INT program and has been evaluated through the neurocognitive set RBANS and MCST (modified version of WCST for the survey of the executive functions: abstraction, categorization, set shifting at the beginning of the treatment (T0), after 12 months (T1), and at its end, after 18 months (T2). As regards neurocognition, starting from the preliminary result analysis, the only statistical significance refers to time factor concerning the immediate memory measured by RBANS at T2. We can also point out an improvement trend in T1 evaluations for the single cognitive functions and for the general cognitive profile. Concerning the executive functions (MCST), even without any statistical significance, a general improvement trend is present (completed categories, persisting and not persisting mistakes). The data presented, even in a numerically reduced sample, encourage however an optimistic perspective concerning the INT rehabilitation use in schizophrenic inpatients, substantially confirming the data already present in literature. We have to pay specific attention even in the evaluation of computerized programs, whose use can aid the general sociocognitive functioning. We hope that later and wider studies will support what we have herein preliminarly presented and discussed.

Hippocampal volume reduction in male schizophrenic patients

Using magnetic resonance imaging of the brain, we examined volumetric measurements of total brain, hemispheres, lateral ventricles and the hippocampus/amygdala complex in male subjects (41 first-episode schizophrenics, 30 chronic schizophrenic patients and 32 healthy controls). We found significantly smaller total brain size in the chronic schizophrenic group, significantly larger lateral ventricles in both patient groups and hippocampal volume reduction bilaterally in first-episode patients (−13.2% left, −12.05% right) and chronic patients (−10.6% left, −10.5% right) compared to controls-irrespective of diagnostic subtype, family history for psychiatric diseases, psychopathology, duration of illness or age at onset.

Comprehension of irony in Schizophrenia

It has been proposed that the disordered communicative ability, as well as other signs and symptoms, observed in schizophrenia can be at least partly attributed to an impaired ability to make inferences about the mental state of others, or theory of mind (Frith, 1992). This ability is necessary for the successful understanding of utterances in which the intended and literal meanings differ (e.g. metaphor and irony), in which the listener must go beyond the literal decoding of the spoken words to perceive the speaker's intended meaning and sentiments (Sperber & Wilson, 1986). Comprehension of communicative intent in schizophrenia was investigated by comparing the performance of a group of chronic schizophrenics on a task assessing comprehension of irony with the performance of a psychiatric control group. As predicted, the schizophrenic group made more misinterpretations of ironic utterances as literal than the control group, who performed at ceiling levels. This difference could not be attributed to differences in current intellectual functioning between the schizophrenic and control groups. Within the schizophrenic group task performance

O-25-10 - Fenfluramine challenge test in schizophrenia

Radioimmunoassays of cortisol (F) and corticosterone (B) were carried out in 133 plasma specimens, obtained at 0800 or 1600 h on the day following administration of dexamethasone (1.0 mg), from 69 patients admitted to a psychiatric inpatient service, to test suggestions that assays of B might complement those of F in the dexamethasone suppression test (DST) in a psychiatric setting. The overall correlation between F and B was + 0.80. Concentrations of B averaged 5–8% those of F. We found close agreement (80–85%) between positive (F ≥ 4.5 μg/dl) and negative DST results for both steroids assayed by radioimmunoassay at a criterion of ≥1.5ng/ml for B, as well as a reasonable compromise between sensitivity and specificity of the B-DST at that criterion.Post-dexamethasone samples obtained at 1600 h showed somewhat closer agreement between the B-DST and the F-DST than at 0800 h. Inclusion of 0800 h samples added little to the rate of positive results with the F-DST but did add to those of the B-DST by about 10% or more, depending on the criterion selected for a positive B-DST. The rate of positive DSTs among 44 patients who had both steroids assayed at both times was approximately 61%, and the agreement between positive test results among these patients was 92%.In a mixed population of acutely ill, hospitalized patients with various DSM-III diagnoses, but excluding those with medical or pharmacologic contraindications to the DST, high rates of positive DST results were obtained in patients with major depressive disorders (47–58%), with little difference found among those with bipolar, non-bipolar or melancholic characteristics. High rates also were found among manic and other acutely psychotic patients, as well as others with neurotic or characterological diagnoses, but rarely in a small group of chronic schizophrenics. Thus, a positive DST as evaluated with B or F is evidently not specific for cases of major depression, but may be indicative of acute illness, possibly with affective features.The results support suggestions that a steroid suppression test based on corticosterone may be useful to aid in diagnosis of major psychiatric illnesses and might complement or substitute for the F-DST. It may be possible to avoid certain pharmacologic complications in the DST by use of a test based on suppression of B by F rather than by dexamethasone.

Laterality of visuo-spatial attention in acute and chronic schizophrenia, major depression and in healthy controls

Previous studies have suggested that schizophrenia is characterized by an asymmetry of visuo-spatial attention, in particular that acute unmedicated schizophrenics demonstrate relative inattention to right hemispace, whereas chronically medicated patients demonstrate the opposite pattern. In the present study, 30 unmedicated schizophrenic patients, 32 chronically medicated schizophrenic patients, 30 patients suffering from major depression and 60 healthy controls were assessed using two measures of hemispatial attentional neglect, namely letter and star cancellation. The results demonstrated that the chronic schizophrenic group made more total omissions for star cancellation (in both right and left hemispace), but that there was no difference between the groups in terms of omission asymmetry for either letter or star cancellation.

Eye movements in a group of chronic schizophrenics in remission

Eye movements in a group of chronic schizophrenics in remission

Plasma levels of interleukin-1β and interleukin-6 in schizophrenia, other psychoses, and affective disorders

Plasma levels of interleukin (IL)-1β and IL-6 were measured in 60 acutely hospitalized psychiatric patients and in 60 healthy controls by enzyme-linked immunosorbent assay (ELISA). Almost no IL-6 was detected in the plasma of the patients or controls. The mean level of IL-1β was found to be significantly higher in schizophrenic patients than in their corresponding controls ( P=0.03). The acute schizophrenics, but not the group of chronic schizophrenics, contributed to this increase. No correlation with age, duration of illness or overt psychopathology was found. The neuroleptic medication did not prove to have a significant effect on the plasma IL-1β levels. There was no difference between non-psychotic affective disorder patients (N = 17) and the controls.

Interferon responses in schizophrenia and major depressive disorders

The spontaneous and induced interferon (IFN) production in whole blood cultures was examined in 45 psychiatric inpatients and in 65 normal controls. Among inpatients there were 32 who were chronic schizophrenics (14 women, 18 men) and 13 who were severely depressed (11 women, 2 men). The analysis of the pooled results of assays in the heterogeneous population showed that leukocytes of the psychiatric patients produced significantly lower levels of IFN after stimulation with virus (NDV), lipopolysaccharide (LPS), and IFN spontaneously released without the inducers that control cells. In contrast, there was no difference between the psychiatric patients and controls in IFN response to phytohemagglutinin and phorbol myristate acetate (PHA + PMA). The results apparently confirmed observations made by Moises et al (1985) and Katila et al (1989). We have also tested our hypothesis that the statistics may mask the individual pattern of IFN response related to the specific psychiatric diagnosis, however. In fact, in the group of chronic schizophrenics we have found either high or low responders to all IFN inducers (NDV, PHA + PMA and LPS). Furthermore, the patients with high IFN response had dominant positive symptoms of schizophrenia (delusions, hallucinations, bizarre behavior and thought disorder). Whereas, in the patients with low IFN response the negative symptoms prevailed (asociality or withdrawal, flat affect, attention impairment, avolition or apathy). In plasma samples of schizophrenics, factors were detected that transferred a hypersensitivity to the IFN inducers to normal donor leukocytes. For instance, in leukocytes cultured in the presence of plasma from schizophrenics, there were 71% of high IFN responders after stimulation with NDV, versus 26% of high IFN responders in the presence of plasma from normal controls. We suggest that the factors may belong to the class of opioid peptides, which interact with the production of cytokines including IFNs.

Hypothalamic-pituitary-adrenal axis function in chronic schizophrenia: association with clinical features.

The function of the hypothalamic-pituitary-adrenal axis (HPA-axis) and its association with clinical features in chronic schizophrenia were investigated. Twenty of 33 chronic schizophrenics exhibited an abnormal diurnal variation of the saliva cortisol level. The patients with abnormal diurnal variation gave higher scores for some negative symptoms than those with normal diurnal variation. On the dexamethasone suppression test (DST) of saliva samples, 13 of 34 chronic schizophrenics were abnormal. The patients with DST nonsuppression were more frequently classified into disorganized type and exhibited low scores of anxiety compared with the patients with normal suppression. The 9 patients who showed abnormal diurnal variation and DST nonsuppression were more frequently classified into disorganized type and showed higher scores of negative symptoms than the 9 patients who did not show any abnormal cortisol data. These results suggest that there might be some disturbance in the function of the HPA-axis in a group of chronic schizophrenics and that these patients might have severe negative symptoms.

Perceived vulnerability, relapse risk and coping in schizophrenia. An explorative study.

Patients suffering from schizophrenia are faced with numerous adaptational demands as a consequence of their illness. Both directly perceived vulnerability and knowledge about precipitating factors deducted from the experience of recurrent relapses were assessed in a group of chronic schizophrenics. In addition, self-administered coping with symptoms and attempts to prevent relapses were explored. Most patients were aware of both aspects of vulnerability towards social-emotional and cognitive stressors and took various precautions to avoid relapse or to control symptoms. Results are discussed within the context of a theoretical model of coping with schizophrenia.

A comparison of CT findings in acute and chronic ward schizophrenics

Two groups of chronic schizophrenics, one from a short-stay hospital and the other from a chronic hospital setting, were matched on age and length of illness. Their CT (computed tomography) scans, obtained on the same equipment, were then compared with headache control subjects of similar age. Lateral ventricular size was significantly greater in the chronic ward schizophrenics than in either the acute ward patients or the controls. Over one-half the chronic ward samples had ventricles which exceeded the mean plus two standard deviations of the control group. There was also evidence of an increased frequency of reversed occipital asymmetry in the chronic ward schizophrenics. These findings suggest that previous discrepancies reported in the literature for CT studies of schizophrenics might be related to differences in the patient populations studied.

Third Ventricle Size and Dementia in Schizophrenia

Using an ultrasound technique, the widths of the third ventricle in a group of normal subjects was compared with groups of chronic schizophrenics and acutely ill schizophrenics. While the chronic patients showed a significantly wider ventricle (p less than 0.5) from the other two groups, only 14% of the chronic patients had a third ventricle greater than the accepted normal maximum of 8 mm. Neuropsychological tests confirmed organic brain impairment in both chronic and acutely ill patients but there was no significant difference between chronic patients with large ventricles and those with normal size ventricles. This suggests that third ventricle size is not part of the schizophrenic disease process and is not related to the dementia seen in the late stages of the illness.

Plasma corticosterone and cortisol following dexamethasone in psychiatric patients

Radioimmunoassays of cortisol (F) and corticosterone (B) were carried out in 133 plasma specimens, obtained at 0800 or 1600 h on the day following administration of dexamethasone (1.0 mg), from 69 patients admitted to a psychiatric inpatient service, to test suggestions that assays of B might complement those of F in the dexamethasone suppression test (DST) in a psychiatric setting. The overall correlation between F and B was + 0.80. Concentrations of B averaged 5–8% those of F. We found close agreement (80–85%) between positive (F ≥ 4.5 μg/ dl) and negative DST results for both steroids assayed by radioimmunoassay at a criterion of ≥1.5ng/ml for B, as well as a reasonable compromise between sensitivity and specificity of the B-DST at that criterion. Post-dexamethasone samples obtained at 1600 h showed somewhat closer agreement between the B-DST and the F-DST than at 0800 h. Inclusion of 0800 h samples added little to the rate of positive results with the F-DST but did add to those of the B-DST by about 10% or more, depending on the criterion selected for a positive B-DST. The rate of positive DSTs among 44 patients who had both steroids assayed at both times was approximately 61%, and the agreement between positive test results among these patients was 92%. In a mixed population of acutely ill, hospitalized patients with various DSM-III diagnoses, but excluding those with medical or pharmacologic contraindications to the DST, high rates of positive DST results were obtained in patients with major depressive disorders (47–58%), with little difference found among those with bipolar, non-bipolar or melancholic characteristics. High rates also were found among manic and other acutely psychotic patients, as well as others with neurotic or characterological diagnoses, but rarely in a small group of chronic schizophrenics. Thus, a positive DST as evaluated with B or F is evidently not specific for cases of major depression, but may be indicative of acute illness, possibly with affective features. The results support suggestions that a steroid suppression test based on corticosterone may be useful to aid in diagnosis of major psychiatric illnesses and might complement or substitute for the F-DST. It may be possible to avoid certain pharmacologic complications in the DST by use of a test based on suppression of B by F rather than by dexamethasone.

Multiple measures of hemispheric dysfunction in schizophrenia and depression.

Electrodermal, electroencephalographic and perceptual measures of lateral hemispheric function were obtained from groups of chronic schizophrenics, depressives and normals on 2 occasions, separated by 4 weeks. The measures of hemispheric function were derived from previous research. About half of the schizophrenics were medicated on both occasions; the other schizophrenics underwent drug 'washout' before the first session. Results revealed that the measures of laterality were not strongly intercorrelated. In the perceptual task, the schizophrenics and normals displayed different laterality effects. Unlike the normals, the schizophrenics' left hemisphere function appeared to be inferior to the right hemisphere function in the perceptual task. The laterality effects of the depressives and normals differed on two electrodermal measures: skin conductance level and skin conductance response amplitude. The depressives' electrodermal activity from the right hand was diminished as compared with the left hand; the normals did not show this effect. Medication decreased electrodermal activity in the schizophrenics, but had no significant effect on laterality. These results suggest that the various measures of laterality used singly in previous research in psychopathology may not all assess the same phenomenon.

Activity and Vestibular Function in Chronic Schizophrenia

This study was designed to assess vestibular function in persons with chronic schizophrenia and to determine whether a lifestyle characterized by little physical activity is related to existing dysfunction. Four groups of subjects were assembled. One group was composed of persons with the diagnosis of chronic schizophrenia. A second group was composed of spinal pain patients who were assumed to reflect chronically low levels of physical activity, but without suspected neurological involvement. The third group was composed of manic patients being treated with neuroleptic medications, as were the chronic schizophrenics. This group acted as a medication control group. The fourth group was a control group composed primarily of occupational and physical therapists in the community. Tests designed to assess vestibular function and tests designed to assess physical activity level were administered individually to each member of each group. It was hypothesized that if both the chronic schizophrenic group and the spinal pain group manifested low scores on vestibular instruments as well as low scores on the activity instrument when compared to control subjects, then prolonged levels of physical inactivity and not a primary neurological dysfunction could possibly be associated with vestibularly based sensory integrative dysfunctions in these populations. This was not found. However, low levels of physical activity were experimentally confirmed in both the chronic schizophrenic and the spinal pain group. Additionally, similar patterns of vestibular response were found in the chronic schizophrenic and the manic groups suggesting the possible interference of neuroleptic medications when vestibular functions are considered.

Lymphocyte monoamine oxidase activity and chronic schizophrenia

Lymphocyte monoamine oxidase (MAO) activity was assayed in 62 chronic schizophrenic patients, 113 normal volunteers, and 23 first-degree relatives of schizophrenic patients. Mean lymphocyte MAO activity was significantly lower ( p < 0.001) in the chronic schizophrenic group than in controls; first-degree relatives had a mean lymphocyte MAO activity midway between the schizophrenics and normals. No relationship was found between lymphocyte MAO activity and sex or age of subjects. When subjects were subgrouped by race, blacks had significantly lower MAO activity than whites ( p < 0.001).

Platelet monoamine oxidase: Studies on the rate of heat inactivation in normal and in paranoid and nonparanoid chronic schizophrenic groups

The heat inactivation curves for platelet monoamine oxidase (MAO) in chronic schizophrenic and normal subjects were virtually identical. There were also no differences found when schizophrenic patients were subgrouped into paranoid and nonparanoid types. However, the MAO from one of the normal subjects showed a substantially greater thermolability than that of any other control or schizophrenic subject.

Treatment of tardive dyskinesia

Neuroleptic drugs cause many forms of extra-pyramidal syndromes. One of these, tardive dyskinesia,1 occurs only after the patient has been taking the drug for some time (‘tardive’ refers to the late onset). The movements are involuntary and repetitive usually involving the face and tongue, but they may also affect the limbs and trunk. Tongue protrusion, licking and smacking of the lips, sucking and chewing movements, grimacing, grunting, blinking and furrowing of the forehead have all been described and attributed to long-continued medication with neuroleptic drugs of the phenothiazine, butyrophenone and thioxanthene groups. The patient can inhibit the movements, but anxiety makes them worse. Many of these symptoms were noticed in schizophrenic patients before neuroleptic drugs were introduced2 and they can occur in otherwise normal untreated elderly people. Nevertheless it is generally accepted that in most cases tardive dyskinesia is an unwanted effect of neuroleptic medication. Despite suggestions to the contrary, the abnormal movements are not necessarily associated with high dosage of neuroleptic drugs or with pre-existing brain damage.3 4 Tardive dyskinesia has been reported in 3–6% of a mixed population of psychiatric patients5 and over half of a group of chronic schizophrenics on long-term treatment.4 The more careful the neurological examination, the greater the apparent incidence.

Symbolism and imagery in a group of chronic schizophrenics.

(1978). Symbolism and Imagery in a Group of Chronic Schizophrenics. International Journal of Group Psychotherapy: Vol. 28, No. 1, pp. 73-80.