Hospitalized Schizophrenia Patients Research Articles

The impact of COVID-19 vaccination on psychiatric symptoms in schizophrenia patients: A retrospective study.

The objective was to investigate the impact of COVID-19 vaccination on anxiety, depression, stress perception, and psychiatric symptoms in patients with schizophrenia, and to explore severity of psychiatric symptoms is associated with vaccine hesitancy in individuals with schizophrenia. Mental health symptoms were evaluated in 273 hospitalized schizophrenia patients who received COVID-19 vaccination, and in 80 patients who refused vaccination, both before and after immunization. The study assessed the effects of vaccination on psychiatric symptoms and the potential association between vaccination behavior and psychological distress. Our findings suggest that COVID-19 vaccination is associated with a small worsening of schizophrenia symptoms in older inpatients. Moreover, vaccination behavior may increase anxiety, depression, and stress perception in hospitalized schizophrenia patients, which has implications for the mental health care team working in the context of the pandemic. The study highlights the importance of monitoring the mental health status of patients with schizophrenia during the COVID-19 pandemic, particularly in relation to vaccination behavior. Further research is needed to better understand the mechanisms underlying the observed effects of COVID-19 vaccination on psychiatric symptoms in patients with schizophrenia.

Built environment and schizophrenia re-hospitalization risk in China: A cohort study

BackgroundBuilt environment exposure, characterized by ubiquity and changeability, has the potential to be the prospective target of public health policy. However, little research has been conducted to explore its impact on schizophrenia. This study aimed to investigate the association between built environmentand and schizophrenia rehospitalization by simultaneously considering substantial built environmental exposures. MethodsWe recruited eligible schizophrenia patients from Hefei, Anhui Province, China between 2017 and 2019. The main outcome for this study was the time interval until the first recurrent hospital admission occurred within one year after discharge. For each included subject, we estimated the built environment exposures, including population density, walkability, land use mix, green and blue space, public transportation accessibility and road traffic indicator. Lasso (Least Absolute Shrinkage and Selection Operator) analysis was used to select the key variables. Multivariable Cox regression model was applied to obtain hazard ratio (HR) and its corresponding 95% confidence intervals (CI). Further, we also evaluated the joint effects of built environment characteristics on rehospitalization for schizophrenia by Quantile g-computation model. ResultsA total of 1564 hospitalized schizophrenia patients were enrolled, with 347 patients (22.2%) had a rehospitalization within one-year after discharge. Multivariable Cox regression analysis indicated that the re-hospitalization rate for schizophrenia would be higher in areas with a high population density (HR: 1.10, 95%CI: 1.04–1.16). Nonetheless, compared to the reference (Q1), participants who lived in a neighborhood with the highest walkability and NDVI (Normalized Difference Vegetation Index) (Q4) had a 76% and 47% lower risk of re-hospitalization within one year (HR:0.24, 95%CI: 0.13–0.45; and 0.53, 95%CI:0.32–0.85), respectively. Moreover, quantile-based g-computation analyses revealed that increased walkability and green space significantly eliminated the adverse effects of population density increases on schizophrenia patients, with a HR ratio of 0.61 (95%CI:0.48,0.79) per one quartile change at the same time. ConclusionOur study provides scientific evidence for the significant role of built environment in schizophrenia rehospitalization, suggesting that optimizing the built environment is required in designing and building a healthy city.

Psychiatric symptoms before and after COVID-19 vaccination: A cohort study of hospitalized schizophrenia patients.

This study aimed to examine the impact of COVID-19 vaccination on the psychiatric symptoms of hospitalized schizophrenia patients and to evaluate the association between the severity of psychiatric symptoms and the COVID-19 vaccination decision. We assessed the psychiatric symptoms of 330 hospitalized schizophrenia patients who accepted the vaccine and 114 patients who declined the vaccine option with PANSS before and after vaccination. We showed that the unwillingness to receive the vaccine is correlated with a higher level of psychiatric symptoms. COVID-19 vaccination is associated with slight deterioration of the schizophrenia symptoms of elderly hospitalized patients.

Medication Gaps and Antipsychotic Polypharmacy in Previously Hospitalized Schizophrenia Patients: An Electronic Cohort Study in Three Canadian Provinces

BackgroundReal world evidence about antipsychotics focuses on rehospitalization. Modeling the time course of pharmacotherapy would show patients' adherence to medications and physicians' adherence to medication guidelines. We aimed to calculate the cumulative time spent in second generation antipsychotics (SGAs), gaps, antipsychotic polypharmacy, and clozapine in discharged schizophrenia patients.MethodsHospitalization and pharmacy dispensing data from 2008–2018 in Manitoba, Saskatchewan, and British Columbia were linked and an electronic cohort (N = 2,997) was created (mean follow-up: 49 months, SD = 38). Cohort members were required to have a minimum of 6 weeks medicated with aripiprazole, olanzapine, paliperidone, quetiapine, risperidone, or ziprasidone.ResultsThe multistate model predicted that schizophrenia patients accumulated 44 months in SGA monotherapy, 4 months in polypharmacy, 11 months in medication gaps and 17 days in clozapine over a 5-year period. The majority of transitions were between SGA and medication gap. Accumulated time in medication gaps was seven times as much as in clozapine. Each 10% delay in SGA initiation post-discharge was associated with a 2, 1, and 6% higher risk for polypharmacy (95% CI: 1.01–1.02), gap (95% CI: 1.01–1.01), and clozapine (95% CI: 1.04–1.08), respectively.InterpretationSchizophrenia patients accumulated more time unmedicated and in polypharmacy compared to clozapine. Either treatment guidelines for schizophrenia are not followed, or real-world challenges hamper their implementation.

Adjunctive simvastatin treatment in schizophrenia patients; a double blind randomized and placebo controlled trial

Introduction: Statins such as simvastatin are recently introduced as agents that may have beneficial effects in schizophrenia regarding their prominent anti-inflammatory properties. Objectives: This study was designed to evaluate the effects of simvastatin on schizophrenia symptoms. Patients and Methods: In a double-blinded randomized clinical trial, 40 hospitalized schizophrenia patients (according to the DSM-IV-TR criteria) were studied for 6 weeks. One group of the patients (n=20) received simvastatin (with the dose of 40 mg/d) and the other group received (n=20) placebo. The patients were evaluated by the Positive and Negative Syndrome Scale (PANSS) for schizophrenia symptoms. Data were analyzed with mixed model repeated measure ANOVA, t test, and χ2 test or Fischer’s exact test by SPSS software. The significant cutoff was considered at P<0.05. Results: The mean age of the patients was 34.05±9.74 years and 50% of them were men. There was not a significant difference between the two groups regarding negative symptoms reduction. Conclusion: Our study demonstrated that adding simvastatin on atypical antipsychotic treatment had no significant beneficial effects on the negative and positive symptoms in patients with schizophrenia disorder. Trial Registration: The trial protocol was approved by the Iranian Registry of Clinical Trials (identifier: IRCT2017052034046N1; https://en.irct.ir/trial/26134, ethical code; ETH-457).

The effect of cognitive-behavioral group training of self-care skills on self-care in patients with schizophrenia

Background & Aim: Self-care is one of the challenges of the health care system in patients with schizophrenia. It has been less studied due to these patients have no insight into the symptoms. This study aimed to determine the effect of cognitive-behavioral group training on self-care skills in patients with schizophrenia.
 Methods & Materials: This single-blind randomized controlled clinical trial (blinding of data analysts) was performed on 50 hospitalized schizophrenia patients by convenience sampling method and random block allocation to the intervention (n=26) and control (n=24) groups in Ebn-Sina Psychiatric Hospital of Mashhad, Iran from late July 2020 to mid-January 2021. The intervention group received cognitive-behavioral group training of self-care skills based on Kashani Lotfabadi et al. (2020) protocol in 10 sessions (two sessions per week). The control group was placed on a waiting list. Data collection tools included the Self-Care Requisites Scale (SCRS-H) and the Positive and Negative Syndrome Scale (PANSS). The data were analyzed by SPSS 25 version, repeated measures of ANOVA test.
 Results: 60 % (n=30) of participants were female, and 40% (n=20) were male with a mean age of 32.98±8.35 years. The results of repeated measures of ANOVA indicated a significant difference between the intervention and control groups in terms of descending mean score of total self-care during the test stages (p=0.001).
 Conclusion: Cognitive-behavioral group training of self-care skills could promote self-care behaviors in patients with schizophrenia. Therefore, we suggest using this intervention to strengthen self-care skills in patients with schizophrenia.

Mental Symptoms and Stress of Hospitalized Schizophrenia Patients With 2019 Novel Coronavirus Disease: An Observation Study.

Background: The 2019 novel coronavirus disease (COVID-19) is an extremely rapidly spreading respiratory infection caused by SARS-CoV-2. Many schizophrenic patients were infected with COVID-19 in Wuhan City, Hubei Province. This study took hospitalized schizophrenia patients with COVID-19 as the research subjects and observed the changes in psychopathology and stress of patients with COVID-19 and the accompanying social isolation.Methods: To sort and isolate potential COVID-19-infected patients, an isolated ward was set up from January 30, 2020, to March 30, 2020. Schizophrenia patients with COVID-19 were referred to this ward, and long-term hospitalized cases were included in this study. The Positive and Negative Syndrome Scale and Perceived Stress Scale were used to evaluate the severity of mental symptoms and psychological stress in the early stage of the outbreak of COVID-19, after the diagnosis of COVID-19 and after recovery. At the time of diagnosis, we also extracted the patient's routine blood, biochemical and other indicators and asked the patient's perception of COVID-19.Results: 21 hospitalized schizophrenia patients with COVID-19 were recruited in this study. The changes in PANSS scores were not significant (p = 0.225 baseline vs. diagnosed, p = 0.399 cured vs. diagnosed). The CPSS scores increased significantly after diagnosis and transfer to the isolation ward (p < 0.001 baseline vs. diagnosed, p < 0.001 cured vs. diagnosed). The course of schizophrenia was a protective factor of stress levels to cases (t = −3.25, p = 0.006), and patients' perception of COVID-19 was a risk factor (t = 2.48, p = 0.038). The final multiple linear regression model was statistically significant (F = 8.16, p < 0.001).Conclusion: Hospitalized schizophrenia patients with COVID-19 had increased stress levels and negative symptoms but alleviated positive symptoms after medical isolated treatment. This reminds us that in the face of major epidemics, we must specifically alleviate the psychological burden at the peak of the epidemic and improve the prognosis of patients after the epidemic.

The Validity and Reliability of the Turkish Version of MacArthur Competence Assessment Tool for Treatment Decision: Correlates of Competence in Schizophrenia Patients.

Introduction:Informed consent is an indispensable condition of the clinical practice for the provision of health care. The main objective of this study is to translate the MacArthur competence assessment tool for treatment (MacCAT-T) into Turkish and evaluate the validity and reliability of the Turkish version in schizophrenia patients and healthy control subjects.Methods:In this cross-sectional study, 30 hospitalized schizophrenia patients and 25 healthy subjects were assessed with MacCAT-T, Mental Competence Evaluation Form for Assessment of Competency (MCEF), Positive and Negative Syndrome Scale, Beck Depression Inventory, Mini Mental State Examination, Wechsler Adult Intelligence Scale (WAIS) – Similarities subtest and the Schedule for Assessing the Three Components of Insight. Psychometric properties of MacCAT-T were examined by intra-class correlation coefficients and Cronbach’s alpha values.Results:Intra-class correlations ranged between 0.83 and 0.99 for four subscales of the tool. Cronbach alpha value of MacCAT-T was found 0.89. Severity of psychopathology and indices of insight were found to be negatively correlated with the subscales of the tool. WAIS-Similarities subtest scores were found to be positively correlated with understanding and reasoning subscales of MacCAT-T.Conclusion:The Turkish version of MacCAT-T is a valid and reliable instrument for Turkish patients. The severity of psychopathology, insight and executive functions were shown to be significantly related to the decision making capacity in patients with schizophrenia.

Influence of social isolation caused by coronavirus disease 2019 (COVID-19) on the psychological characteristics of hospitalized schizophrenia patients: a case-control study

Coronavirus disease 2019 (COVID-19) has been classified as a pandemic, and mental hospitals located in epidemic centers have been affected. Social isolation is an important and irreplaceable measure to control the spread of the epidemic. In this study, schizophrenic patients who were subjected to social isolation after close contact with COVID-19 patients were used as participants to explore the impact of social isolation on common inflammatory indicators and psychological characteristics. A total of 30 patients with schizophrenia were recruited from Wuhan Mental Health Center. In addition, 30 ordinary schizophrenic patients were matched with the isolation group and were recruited from another branch of Wuhan Mental Health Center as controls. We compared the differences in common inflammatory indicators and psychological characteristics between the isolated group and the control group, and longitudinal comparison of the differences in the above indicators before and after isolation among the isolation group. The Chinese Perceived Stress Scale (CPSS) score, Hamilton Depression Scale (HAMD) score and Hamilton Anxiety Scale (HAMA) score of the isolation group were significantly higher than those of the control group (p = 0.00, 0.00, 0.00, respectively). The C-reactive protein (CRP) level, CPSS score, HAMA score and Pittsburgh sleep quality index (PSQI) score of the isolation group were significantly higher after isolation (p = 0.01, 0.00, 0.00, 0.00, 0.00, respectively). Inpatients of schizophrenia suffered from social isolation due to COVID-19 have a severe psychological burden. Social isolation caused patients to develop a weak inflammatory state and led to worse anxiety and sleep quality.

Prevalence and associated factors of suicide among hospitalized schizophrenic patients

BACKGROUNDPrevious studies found several factors associated with suicide in schizophrenic patients, such as age, sex, education level, history of suicide attempts, psychotic symptoms, social factors, and substance abuse. However, there might be some additional factors that were not considered in previous studies but may be correlated with a greater likelihood of suicide attempts, such as medication and treatment.AIMTo investigate the prevalence of suicide attempts and identify the risk of suicidality in hospitalized schizophrenia patients.METHODSThis is a cross-sectional study of schizophrenic patients admitted to a psychiatric hospital who were 18 years of age or more. The outcomes and possible suicide risk factors in these patients were collated. The current suicide risk was evaluated using the mini-international neuropsychiatric interview module for suicidality and categorized as none (0 points), mild (1-8 points), moderate (9-16 points), or severe (17 or more points). This study used ordinal logistic regression to assess the association of potential risk factors with the current suicide risk in schizophrenic patients.RESULTSOf 228 hospitalized schizophrenia patients, 214 (93.9%) were included in this study. The majority (79.0%) of patients were males. Females appeared to have a slightly higher suicidality risk than males, with borderline significance. With regard to the current suicide risk assessed with the mini-international neuropsychiatric interview, 172 (80.4%) schizophrenic patients scored zero, 20 (9.4%) had a mild risk, 8 (3.7%) had a moderate risk, and 14 (6.5%) had a severe risk. The total prevalence of current suicide risk in these schizophrenic patients was 19.6%. Based on multivariable ordinal logistic regression analysis with backward elimination, it was found that younger age, a current major depressive episode, receiving fluoxetine or lithium carbonate in the previous month, or a relatively higher Charlson comorbidity index score were all significantly and independently associated with a higher level of suicide risk.CONCLUSIONThe prevalence rate of suicide attempts in schizophrenia is high. Considering risk factors in routine clinical assessments, environmental manipulations and adequate treatment might prevent or decrease suicide in these patients.

Prescription practices in the treatment of agitation in newly hospitalized Chinese schizophrenia patients: data from a non-interventional naturalistic study

BackgroundData on the pharmacological management of acute agitation in schizophrenia are scarce. The aim of this study is to investigate the prescription practices in the treatment of agitation in Chinese patients with schizophrenia.MethodsWe conducted a large, multicenter, observational study in 14 psychiatry hospitals in China. Newly hospitalized schizophrenia patients with the PANSS-EC total score ≥ 14 and a value ≥4 on at least one of its five items were included in the study. Their drug treatments of the first 2 weeks in hospital were recorded by the researchers.ResultsEight hundred and 53 patients enrolled in and 847 (99.30%) completed the study. All participants were prescribed antipsychotics, 40 (4.72%) were prescribed benzodiazepine in conjunction with antipsychotics and 81 were treated with modified electric convulsive therapy (MECT). Four hundred and 12 (48.64%) patients were prescribed only one antipsychotic, in the order of olanzapine (120 patients, 29.13%), followed by risperidone (101 patients, 24.51%) and clozapine (41 patients, 9.95%). About 435 (51.36%) participants received antipsychotic polypharmacy, mostly haloperidol + risperidone (23.45%), haloperidol+ olanzapine (17.01%), olanzapine+ ziprasidone (5.30%), haloperidol + clozapine (4.37%) and haloperidol + quetiapine (3.90%). Binary logistic regression analysis suggests that a high BARS score (OR 2.091, 95%CI 1.140–3.124), severe agitation (OR 1.846, 95%CL 1.266–2.693), unemployment or retirement (OR 1.614, 95%CL 1.189–2.190) and aggressiveness on baseline (OR 1.469, 95%CL 1.032–2.091) were related to an increased antipsychotic polypharmacy odds. Male sex (OR 0.592, 95%CL 0.436–0.803) and schizophrenia in older persons (age ≥ 55 years, OR 0.466, 95%CL 0.240–0.902) were less likely to be associated with antipsychotic polypharmacy.ConclusionThe present study demonstrates that monotherapy and polypharmacy display equally common patterns of antipsychotic usage in managing agitation associated with schizophrenia in China. The extent and behavioral activities of agitation and several other factors were associated with polypharmacy.

The Prevalence of Suicide Attempts and Independent Demographic and Clinical Correlates among Chronic Schizophrenia Patients in Agricultural Areas of China.

This study investigated the lifetime prevalence of suicide attempts (SA) and independent demographic and clinical correlates in stabilized schizophrenia inpatients. A cross-sectional study was conducted in three psychiatric hospitals in Anhui province, an agricultural province located in east China. Psychopathology and depressive symptoms were assessed using the Positive and Negative Syndrome Scale (PANSS) and Hamilton Depression Rating Scale (HAMD), respectively. A total of 315 stable schizophrenia inpatients were interviewed prior to discharge. The lifetime prevalence of SA was 22.2%. Multiple logistic regression analysis revealed that female gender (P < 0.001, OR = 3.4, 95%CI: 1.9-6.0), being married (P = 0.02, OR = 2.2, 95%CI: 1.1-4.4) and having more severe depressive symptoms (P = 0.014, OR = 1.2, 95%CI: 1.01-1.3) were independently and significantly associated with higher risk of SA. Lifetime SA is common among hospitalized schizophrenia patients living in agricultural areas of China. For suicide prevention, regular assessments, appropriate interventions and clinical management should be integrated into a community-based psychiatric service model for this population.

Long term effects of smoking cessation in hospitalized schizophrenia patients

BackgroundThe prevalence of smoking in patients with schizophrenia is higher than that in the general population and is an important medical issue. Short-term smoking cessation tends to worsen psychiatric symptoms in patients with schizophrenia but decreases sympathetic nervous system activity and improves plasma cholesterol levels in healthy people. Few studies have assessed the long-term effects of smoking cessation in patients with schizophrenia.MethodsSubjects were 70 Japanese patients with schizophrenia (38 smokers, 32 non-smokers). We compared the following clinical parameters between the two groups at baseline (before smoking cessation) and in each group separately between baseline and at three years after smoking cessation: autonomic nervous system activity, plasma cholesterol levels, body weight, drug therapy, and Global Assessment of Functioning scores. We also compared the mean changes in clinical parameters throughout this study between the groups at both time points. Autonomic nervous system activity was assessed by power spectral analysis of heart rate variability.ResultsParasympathetic nervous system activity and the doses of antiparkinsonian drugs in smokers were significantly higher than those in non-smokers at baseline. Smoking cessation was associated with significantly decreased sympathetic nervous system activity and decreased doses of antipsychotics and antiparkinsonian drugs at three years after smoking cessation. However, there was no significant difference in the mean change in clinical factors scores, except for Global Assessment of Functioning scores, between smokers and non-smokers at three years after smoking cessation.ConclusionsOur results suggest that smoking reduces both autonomic nervous system activity and the effectiveness of drug therapy with antipsychotics and antiparkinsonian drugs in patients with schizophrenia, but that both factors could be ameliorated over the long term by smoking cessation. Taken together with the findings of previous studies, smoking cessation in patients with schizophrenia has many long-term positive physiological effects.

Prevalence and risk factors of agitation in newly hospitalized schizophrenia patients in China: An observational survey

This multi-center observational study investigated the prevalence of agitation in newly hospitalized schizophrenia patients in China and its potential risk factors. It was performed in 2014 and covered 14 hospitals. Newly hospitalized patients with schizophrenia or suspected schizophrenia who met the diagnostic criteria of the International Statistical Classification of Diseases and Related Health Problems, 10th revision, were recruited. Agitation and related risk factors were evaluated by a questionnaire designed for the survey. General demographic data, disease characteristics, scores on schizophrenia rating scales and agitation rating scales (e.g., Positive and Negative Syndrome Scale-Excited Component [PANSS-EC] and Behavioral Activity Rating Scale [BARS]) were collected. Among the 1512 patients screened in the study, 1400 (92.59%) were eligible. According to the PANSS-EC and BARS, the prevalence of agitation was 60.92% (853 of 1400) and 59.00% (826 of 1400), respectively. The overall prevalence of agitation was 47.50% (665 of 1400). The most important risk factor of agitation was being aggressive at baseline (Modified Overt Aggression Scale score ≥4, odds ratio=6.54; 95% confidence interval=4.93–8.69). Other risk factors included a history of aggressive behavior, northern region of residence, involuntary hospitalization, disease severity, low level of education, living alone, being unemployed or retired.

Prevalence of overweight in schizophrenia patients in Asia: findings of the research on Asian psychotropic prescription patterns (REAP) study.

This study examined the proportion of overweight in schizophrenia inpatients in selected Asian countries and territories and its independent demographic and clinical correlates. Data on 1,534 hospitalized schizophrenia patients in 9 Asian countries and territories were collected by a review of medical files supplemented by a clinical interview during a 1-month period. Patients' sociodemographic and clinical characteristics, prescriptions of psychotropic drugs, and Body Mass Index (BMI) were recorded using a standardized protocol and data collection procedure. For analyzes, BMI ≥ 25 kg/m2 was defined as overweight. The proportion of overweight was 35.8% (549/1,534) in the entire sample, with 39.7% (224/564) in females and 33.5% (325/970) in males (p = 0.01) and with wide inter-country variations. Multiple logistic regression analysis revealed that after controlling for study sites, overweight was independently associated with more frequent use of mood stabilizers (p < 0.001, odds ration (OR) = 1.4, 95% confidence interval (CI) = 1.1-1.8) and longer length of illness (p < 0.001, OR = 1.6, 95% CI = 1.2-2.1) but was less likely found in male patients (p = 0.003, OR = 0.7, 95% CI = 0.5-0.8). The prevalence of overweight Asian schizophrenia patients is significantly lower than the reported figures among their Western counterparts. There is considerable variation in prevalence of overweight schizophrenia patients within Asian countries and territories.

Does Combined Antipsychotic Treatment Provide Better Control on Symptoms in Patients with Schizophrenia than the Monotherapy?

Objective: Combined antipsychotic treatment is frequently used in clinical practice either to improve the symptom control or to reduce the severity of side effects. The expected benefits by combining different antipsychotics include active cross-titration and co-utilization of different administration routes of the therapeutic agents. However, except the add-on therapies to clozapine, there is no objective evidence implying the superiority of combined therapy over monotherapy. Furthermore, there are a number of published case reports of significant side effects accompanying combined antipsychotic usage such as extrapyramidal and metabolic symptoms, seizures, and electrocardiographic abnormalities. It is also argued that switching into a new therapeutic agent might be more beneficial than augmenting the ongoing medication by polypharmacy. Here, we studied on a group of hospitalized schizophrenia patients in a training and research hospital in Turkey whether the Positive and Negative Symptom Scale (PANSS) scores differ between the patients under monotherapy and combined therapy. Methods: Hospital records belonging patients with schizophrenia who were followed up between the years of 2003 and 2013 were retrieved. Schizophrenia diagnoses were re-evaluated and confirmed according to the DSM-IV-TR criteria. All the patients who met the diagnostic criteria and having PANSS subscale scores (n=158) were included in the study. PANSS scores at the time of hospitalization are represented by adding “-before” suffixes, while the ones at the time of discharge by adding “-after”. Results: Our series composed of 158 schizophrenia patients (54 women and 104 men). When the medications were reviewed, we found that 66 patients (41.8%) were treated with a single drug and the atypical antipsychotics were the most commonly used group. Multiple drugs were combined on 92 patients (58.2%) and the most common combination was the “atypical + typical” antipsychotics. PANSS subscales and their comparisons among the groups of monotherapy and combined therapy revealed a slight statistical difference in PANSS negative scores at the time of hospitalization, although we found no significant changes in terms of PANSS scales, in general. Conclusion: In this study, we presented the overall frequency and patterns of our combined antipsychotic therapy in our daily routine work. We only used severity of symptoms in our study, and observed no differences between mono and combined therapy groups in terms of the PANSS evaluation. Further clinical studies with clinical, metabolic, and laboratory data as well as the long follow-ups are needed to uncover if combined therapy proves to be beneficial over monotherapy.

Use of electroconvulsive therapy for Asian patients with schizophrenia (2001-2009): Trends and correlates.

Little is known about electroconvulsive therapy (ECT) use in Asian inpatients with schizophrenia. This study examined trends of ECT use for schizophrenia patients in Asia between 2001 and 2009 and its independent demographic and clinical correlates. Data on 6761 hospitalized schizophrenia patients (2001 = 2399, 2004 = 2136, and 2009 = 2226) in nine Asian countries and territories were collected by either chart review or interviews during a 1-month period. Patients' sociodemographic and clinical characteristics, prescriptions of psychotropic drugs and ECT use were recorded using a standardized protocol and data-collection procedure. The frequency of ECT was 3.3% in the whole sample; rising from 1.8% in 2001 to 3.3% in 2004 and 4.9% in 2009 (P < 0.0001). However, this increased trend was driven solely by increased ECT use in China (P < 0.0001), and the inclusion of India in the 2009 survey. There were wide inter-country variations: 2001, 0% (Hong Kong, Korea) to 5.9% (China); 2004, 0% (Singapore) to 11.1% (China); 2009, 0% (Hong Kong) to 13.8% (India) and 15.2% (China). Multiple logistic regression analysis of the whole sample revealed that patients receiving ECT were less likely in the 35-64-year age group, had shorter length of current hospitalization and fewer negative symptoms, and were more likely to receive second-generation antipsychotic medications compared to those who were not treated with ECT (R(2) = 0.264, P < 0.001). ECT use for schizophrenia has increased over the past decade in China, being low/relatively stable in other Asian countries/regions. Reasons for substantial variations in ECT frequency in Asia require further study.

QTc prolongation in schizophrenia patients in Asia: clinical correlates and trends between 2004 and 2008/2009.

Little is known about the pattern of QT interval (QTc) prolongation in Asian patients with schizophrenia. This study examined trends of QTc prolongation in schizophrenia inpatients in six Asian countries and territories between 2004 and 2008/2009 and its independent demographic and clinical correlates. Data on 3482 hospitalized schizophrenia patients (2004 = 1826 and 2008/2009 = 1656) in six Asian countries and territories were collected by either chart review or interviews during a 1-month period. Patients' sociodemographic and clinical characteristics, prescriptions of psychotropic drugs, and QTc interval were recorded using a standardized protocol and data collection procedure. The frequency of QTc prolongation (>456 ms) was 2.4% in the whole sample, decreasing from 3.1% in 2004 to 1.6% in 2008/2009 (p = 0.004) with wide intercountry variations. However, this decreased trend was driven by decreased QTc prolongation detected in China and Hong Kong (both p-values < 0.05). Multiple logistic regression analysis of the whole sample revealed that patients having more likely to have an illness lasting longer than 5 years and received antipsychotics classified as list-1 drugs according to the Arizona Centre for Education and Research on Therapeutics. Compared with 2004, patients in 2008/2009 were less likely to have QTc prolongation. Thioridazine caused QTc prolongation most frequently (odds ratio (OR) 4.4; 95% confidence interval (CI) 1.2-15.2), followed by sulpiride (OR 2.4; 95% CI 1.3-4.5), clozapine (OR 2.4; 95% CI 1.4-4.2), and chlorpromazine (OR 1.9; 95% CI 1.07-3.5). Frequency of QTc prolongation was low in Asian patients with schizophrenia. QTc prolongation in schizophrenia decreased in China and Hong Kong between 2004 and 2008/2009 but increased in Taiwan over the same period, remaining low in the other countries.

The Effect of Multi-Disciplinary Psycho-Education for Hospitalized Schizophrenia Patients: The Key Factors for Re-Hospitalization

Object: We discovered the relationship between any experience and discharge, readmitted. Psycho-education effect schizophrenia patients to discharge. Cognitive function is most important factor about re-admission. Backgrounds: Today, in Japanese psychiatric hospital, more and more patients are taking an early discharge. This trend has caused a major concern in the psychiatric hospitals because more number patients are being re-hospitalized within a few months after their first discharge. Methods: We have conducted an experiment in which we offered multi-disciplinary psycho-education to 160 schizophrenia patients. The experiment was conducted in the time span of nearly three years (Dec. 2009-Jul. 2013), with all the patients’ agreement. The patients showed significant improvement in all of the following when compared with prior to the psycho-education: GAF, SAI-J, DAI-10, and objective SCORS-J. Comparing the 137 patients who were able to discharge with 23 patients who were not. And we comparing the 22 patients who re-admitted within one year and the 77 who were not. Results: Comparing discharge or not, there was no significant difference in the amount of CP. However, there was a great improvement in PANSS, BPRS, GAF, SAI-J, and both objective and subjective SCORS-J. Comparing re-admitted or not, PANSS, BPRS and most of other indicators showed any noticeable difference, objective SCORS-J showed a trend that non-readmitted patients had higher scores. Conclusions: This research suggests the potential of psycho-education’s function for schizophrenia patients as a preventive measure of re-hospitalization, and the significance of cognitive function as a critical factor.

Prevalence and clinical correlates of obsessive–compulsive disorder in schizophrenia

Obsessive compulsive symptoms frequently occur in a substantial proportion of patients with schizophrenia. The term schizoobsessive has been proposed to delineate this subgroup of schizophrenia patients who present with obsessive–compulsive symptoms/disorder. However, whether this co-occurrence is more than just co-morbidity and represents a distinct subgroup remains controversial. A striking variation is noted across studies examining prevalence of obsessive–compulsive symptoms/disorder in schizophrenia patients and their impact on clinical profile of schizophrenia. Hence, in this study, we examined the prevalence of obsessive–compulsive symptoms/disorder in a large sample of consecutively hospitalized schizophrenia patients and compared the clinical and functional characteristics of schizophrenia patients with and without obsessive–compulsive symptoms/disorder. We evaluated 200 consecutive subjects with the DSM-IV diagnosis of schizophrenia using the Structured Clinical Interview for DSM-IV Axis I disorders, Positive and Negative Syndrome Scale, Yale–Brown Obsessive–Compulsive Scale, Brown Assessment of Beliefs Scale, Clinical Global Impression-Severity scale, Global Assessment of Functioning Scale, Family Interview for Genetic Studies and World Health Organization Quality of Life scale. The prevalence of obsessive–compulsive symptoms in patients with schizophrenia was 24% (n=48); 37 of them had obsessive–compulsive disorder (OCD) and 11 had obsessive–compulsive symptoms not amounting to a clinical diagnosis of OCD (OCS). Schizophrenia patients with OCS/OCD had an earlier age at onset of schizophrenia symptoms, lower positive symptoms score, higher co-morbidity with Axis II disorders, higher occurrence of OCD in family and better quality of life. Findings of the study indicate a higher prevalence of OCS/OCD in schizophrenia. Schizophrenia patients with and without OCS/OCD have comparable clinical profile with few exceptions. High rates of OCD in first degree relatives suggest possible genetic contributions and differences in neurobiology. Finally, evidence to consider schizoobsessive as a distinct diagnostic entity is inconclusive and warrants further studies.