Male Schizophrenic Patients Research Articles

Glia dysfunction in schizophrenia: evidence of possible therapeutic effects of nervonic acid in a preclinical model.

Neuroinflammation may inhibit oligodendrocyte and astrocyte differentiation, which causes demyelination and synaptic degeneration. The myelin component nervonic acid (NA) may improve demyelinating and neurodegenerative diseases. This study firstly explored relationships between glial cell dysfunction and demyelination or synaptic degeneration in schizophrenia patients, and secondly determined nervonic acid therapeutic effects in a preclinical schizophrenia model of mice. Plasma samples were collected from 18 male healthy controls and 18 male schizophrenic patients (diagnosed by DSM-V) at aged 18-55. Mouse brain samples were collected from a maternal immune activation (MIA) model of schizophrenia via injecting 5mg/kg polyinosinic-polycytidylic acid. Male mouse offspring (age 2.5months, n = 12) were treated by clozapine (15mg/kg/day) or fed 0.5% NA for 6weeks. Cytokine and dopamine (DA) concentrations, and glial phenotypes and myelin markers were measured in both human plasma and mouse brain samples. In patient plasma, increased proinflammatory cytokines were associated with reactive microglia (Iba-1) up-regulation, while decreased anti-inflammatory cytokines were related to microglia (CD206) downregulation. Decreased astrocyte marker (p11) concentrations were accompanied by reduced concentrations of oligodendrocyte and synaptic markers. However, NA and DA contents were increased. Compared with control mice, SZ-like behaviors appeared in MIA male mice. Changes in microglia and astrocytes markers, and cytokine concentrations in the frontal cortex were consistent with those observed in patients' plasma. Hippocampal oligodendrocyte and synaptic marker expression were also decreased. DA content and DA/metabolite (DAPOC) were increased in MIA mouse brains. Most of these changes were normalized by both clozapine and NA. Even though some NA effects were more pronounced than clozapine, only clozapine restored cytokine function. The data suggest a possible therapeutic route for schizophrenia patients.

Relationship between stable smoking behavior and cognitive function in male schizophrenia patients

ObjectiveTo explore the relationship between stable smoking behavior and cognitive function in male schizophrenia patients. MethodsA simple random sampling method is applied to select 120 patients with schizophrenia admitted to a hospital from August 2020 to December 2022 as the subjects. They are divided into two groups based on whether they smoked or not. Their cognitive function is evaluated using the Stroop test (SWCT), continuous task test (CPT), and Chinese version of the Schizophrenic Cognitive Function Battery Test (MCCB). The Spearman correlation analysis is applied to verify the correlation between smoking behavior and SWCT, CPT, and MCCB in patients. Additionally, the Fagerstrom Nicotine Dependence Scale (FTND) is used to evaluate the nicotine dependence degree in smoking group patients. Pearson correlation analysis verifies the correlation between nicotine dependence and SWCT, CPT, MCCB in smoking group patients. ResultsAmong 120 patients include in this study, 3 have symptoms during the trial period, and 1 patient has an error in filling out the questionnaire, all of which are excluded. Finally, 116 valid documents are collected, with an effective recovery rate of 96.67%. According to the SWCT test results, the number of single word errors, single word time, double word errors, and double word time in the smoking group exceed the non-smoking group (P < 0.05). According to the CPT test results, the number of correct reactions in the smoking group is below the non-smoking group. The correct average reaction time, error rate of interference items, and error rate of ineffective items exceed the non-smoking group (P < 0.05). According to the MCCB test results, the scores of connectivity, visual spatial memory, and continuous operation test in the smoking group are below the non-smoking group (P < 0.05). The Spearman correlation analysis results show that stable smoking behavior in male schizophrenia patients is positively correlated with the number of single word errors, double word errors, double word time, correct mean reaction time, interference item error rate, and invalid item error rate (r = 0.216–0.524, P < 0.05). It is also positively correlated with the number of correct reactions, immediate memory, language function, delayed memory, MCCB connectivity, visual spatial memory, and continuous operation (r = −0.212-0.356, P < 0.05). The Pearson correlation analysis results show that the nicotine dependence degree in stable male schizophrenia patients is negatively correlated with monochromatic error count, immediate memory, visual span, attention, and MCCB scores (r = −0.321-0.930, P < 0.05). ConclusionSmoking in male schizophrenic patients may have impacts on their cognitive function. This impact worsens as the patient's nicotine dependence increases, especially on their memory function. Effective measures should be taken in clinical practice to correct patients' smoking behavior, reduce their nicotine dependence, and improve their cognitive function.

(128) Penile Replantation in Patient with Klingsor Syndrome; Case Report and Review of Literature

Abstract Introduction Penile amputation has multiple etiologies including self-mutilation, work-related accidents, circumcision, assault motivated by jealousy, rage and feelings of betrayal and animal attacks. By far self –mutilation due to underlying psychiatric disorders (Klingsor Syndrome) are the commonest cause. Re-implantation is the gold standard for management, however it may always not be possible to achieve because of significant local ischemia, tissue damage and prolonged duration post trauma. Objective We are reporting our experience with one case of Klingsor Syndrome and its stepwise management. Methods A 31 years old male Schizophrenic patient self-mutilated his penile shaft due to fixed illusion (get rid of devil in his penis). He also attempted to remove his entire scrotum. His father brought his son with the amputated penile part put in ice. Immediate application of wet saline towel to penile stump and putting of amputated penile part into cold iced saline. Anti-tetanic serum was given together with i.v. antibiotics. Urology team, Plastic microsurgery team together with Psychiatry treating consultant all were emergently called at once. Amputated penile shaft was prepared by the microsurgeon to identify the dorsal artery, vein and nerves and marked by micro-bulldogs. Urology team started by fixation of s.p. cath and preparing, cleaning penile stump. End-to end anastomosis of the urethra was done. Next, the corporal bodies, were reattached using interrupted sutures. Dorsal vein and artery were re-anastomosed microsurgically Results Few days post-operatively skin necrosis started inspite of positive needle brick to the glans indicating healthy underlying glans. Second stage debridement of necrotic skin with later skin grafting resulted in cosmetically and functionally excellent penis regarding erectile and voiding functions Conclusions Penile amputation is a rare surgical emergency mostly found in the literature as isolated case reports. Klingsor syndrome is well known etiology for this type of penile injury and warrants psychiatric control. A multidisciplinary approach involving a urologist, micro-vascular surgeons as well as a psychiatrist ensures good outcome. Microvascular re-implantation remains the treatment of choice with the highest probability of adequate cosmetic as well as functional outcomes Disclosure No.

Biopsychosocial Variables in Male Schizophrenic Patients: A Comprehensive Comparison with Healthy Controls.

this study aims to comprehensively compare neuropsychological, psychopathological, anthropometric, biochemical, pharmacological, and lifestyle variables between 27 male schizophrenic patients (SZ group) and 30 age- and sex-matched healthy male controls (HC group). participants underwent a battery of neuropsychological tests including the Trail Making Test (TMT), Stroop Color-Word Interference Test, and Verbal Fluency Test. Psychopathological symptoms in the SZ group were evaluated using the Positive and Negative Syndrome Scale (PANSS). Anthropometric measurements such as body weight, height, BMI, and waist circumference were taken. Biochemical markers measured included fasting glucose, total cholesterol, triglycerides, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, and fasting insulin. Lifestyle factors were assessed through a questionnaire for the study of views and eating habits of people aged 16 to 65. the HC group outperformed the SZ group in the TMT_A test and the Stroop test, but no significant differences were observed in the TMT_B test or in phonemic fluency tests. No correlation was found between age and PANSS scores within the SZ group. Anthropometrically, the SZ group had higher body weight, waist circumference, and BMI, with no difference in height. Biochemically, the HC group had higher HDL cholesterol levels but lower insulin and insulin resistance indices. Pharmacological assessment showed a more significant impact on body weight among SZ patients taking second-generation antipsychotics. Lifestyle factors such as diet and screen time were comparable between groups, but the SZ group reported longer sleep duration and lower leisure time activity. our study highlights distinct neuropsychological, pharmacological, anthropometric, and biochemical differences between male schizophrenic patients and healthy controls. The results underscore the complexity of schizophrenia and point toward the need for a multi-faceted approach to its management and understanding.

The Interplay of Oxytocin and Attachment in Schizophrenic Patients: An fMRI Study.

Attachment theory offers an important framework for understanding interpersonal interaction experiences. In the present study, we examined the neural correlates of attachment patterns and oxytocin in schizophrenic patients (SZP) compared to healthy controls (HC) using fMRI. We assumed that male SZP shows a higher proportion of insecure attachment and an altered level of oxytocin compared to HC. On a neural level, we hypothesized that SZP shows increased neural activation in memory and self-related brain regions during the activation of the attachment system compared to HC. We used an event-related design for the fMRI study based on stimuli that were derived from the Adult Attachment Projective Picture System to examine attachment representations and their neural and hormonal correlates in 20 male schizophrenic patients compared to 20 male healthy controls. A higher proportion of insecure attachment in schizophrenic patients compared to HC could be confirmed. In line with our hypothesis, Oxytocin (OXT) levels in SZP were significantly lower than in HC. We found increasing brain activations in SZP when confronted with personal relevant sentences before attachment relevant pictures in the precuneus, TPJ, insula, and frontal areas compared to HC. Moreover, we found positive correlations between OXT and bilateral dlPFC, precuneus, and left ACC in SZP only. Despite the small sample sizes, the patients' response might be considered as a mode of dysregulation when confronted with this kind of personalized attachment-related material. In the patient group, we found positive correlations between OXT and three brain areas (bilateral dlPFC, precuneus, left ACC) and may conclude that OXT might modulate within this neural network in SZP.

The Hypothalamic-Pituitary-Gonadal Axis in Men with Schizophrenia.

Schizophrenia is a severe mental disorder with a chronic, progressive course. The etiology of this condition is linked to the interactions of multiple genes and environmental factors. The earlier age of onset of schizophrenia, the higher frequency of negative symptoms in the clinical presentation, and the poorer response to antipsychotic treatment in men compared to women suggests the involvement of sex hormones in these processes. This article aims to draw attention to the possible relationship between testosterone and some clinical features in male schizophrenic patients and discuss the complex nature of these phenomena based on data from the literature. PubMed, Web of Science, and Google Scholar databases were searched to select the papers without limiting the time of the publications. Hormone levels in the body are regulated by many organs and systems, and take place through the neuroendocrine, hormonal, neural, and metabolic pathways. Sex hormones play an important role in the development and function of the organism. Besides their impact on secondary sex characteristics, they influence brain development and function, mood, and cognition. In men with schizophrenia, altered testosterone levels were noted. In many cases, evidence from available single studies gave contradictory results. However, it seems that the testosterone level in men affected by schizophrenia may differ depending on the phase of the disease, types of clinical symptoms, and administered therapy. The etiology of testosterone level disturbances may be very complex. Besides the impact of the illness (schizophrenia), stress, and antipsychotic drug-induced hyperprolactinemia, testosterone levels may be influenced by, i.a., obesity, substances of abuse (e.g., ethanol), or liver damage.

Association of Ishii test scores with pneumonia in stable schizophrenic subjects.

AimWe investigated the relationship between the sarcopenia-indicating Ishii test scores and pneumonia risk in stable schizophrenia patients.MethodsThis prospective investigation involves schizophrenic inpatients from two mental health centers in western China. Patient baseline information was gathered over 1 month from September 1 to 30 in 2020. All pneumonia-related patient information, including diagnosis and treatment, was acquired over 1 year between October 2020 and October 2021. Patients with schizophrenia were screened for sarcopenia utilizing a threshold value established by Ishii et al. Using regression analysis, the link between Ishii test scores and pneumonia risk in schizophrenia patients was investigated.ResultThis study recruited 232 males and 107 females with schizophrenia over the age of 50 and older. During a 1-year follow-up period, four patients (3 males and 1 female) acquired pneumonia within 1 week of relapse in schizophrenia; therefore, these patients were excluded from the study. Finally, data were collected for 335 patients. The pneumonia incidences were 29.3% in males and 14.2% in females. Our analysis confirmed that compared to the male schizophrenia patients with Ishii test scores < 105 (non-sarcopenia), those with Ishii test scores ≥ 105 (sarcopenia) exhibited an elevated pneumonia risk (OR = 2.739, 95%CI: 1.406–5.333). Following confounders adjustment, Ishii test scores ≥ 105 remained a risk factor for pneumonia (OR = 2.064, 95%CI: 1.029–4.143). Among females with schizophrenia, the Ishii test scores were not associated with pneumonia risk.ConclusionIn conclusion, our results demonstrated that the Ishii test scores ≥ 105 were strongly associated with pneumonia risk in stable schizophrenic male patients.

Estradiol and Progesterone as key modulators of central systems implicated in schizophrenia

IntroductionIt has been suggested that dysregulation of sex hormones is associated with schizophrenia. However, obesity and metabolic syndrome are very common between schizophrenic patients, and it can also dysregulate sex hormones so they could act as confounders.ObjectivesTo determine if estradiol and progesterone are abnormally elevated regardless of obesity or metabolic syndrome in men with SCZ.MethodsWe measured serum levels of progesterone and estradiol in 56 schizophrenic male patients at treatment with a depot antipsychotic. Subsequently, we studied the association or independence of our results with obesity or metabolic syndrome by a Chi Square Test.Results66.07% of our patients elevated progesterone levels, 19.64% of our patients elevated estradiol levels, and 16.07% of our patients elevated both, progesterone and estradiol, simultaneously. We found no relationship between increased estradiol and / or progesterone with obesity and / or metabolic syndrome.ConclusionsEstradiol and progesterone are abnormally elevated regardless of obesity and / or metabolic syndrome in male schizophrenic patients on depot treatment.DisclosureNo significant relationships.

Prevalence of tobacco dependence and associated factors among patients with schizophrenia attending their treatments at southwest Ethiopia; hospital-based cross-sectional study

Tobacco smoking is the most typically employed in patients with mental disorders; among them, patients with schizophrenia are the very best users. The rate of smoking among patients with schizophrenia is between two and three times greater than the general population in western countries. However, there is a scarcity of studies on the magnitude and associated factors of tobacco dependence among patients with schizophrenia in Ethiopia. Therefore, we assessed the prevalence of tobacco dependence and associated factors among patients with schizophrenia at Mettu Karl referral, Bedelle, and Agaro hospitals, Southwest, Ethiopia. Hospital-based the multistage stratified cross-sectional study design was conducted among 524 patients with schizophrenia who are on treatment. Fagerstrom Test for Nicotine Dependence (FTND) was used to screen the prevalence of tobacco dependence. Analysis of data was done using SPSS version 24. The prevalence of tobacco dependence among study participants was 22.3% (95% CI) (18.6, 26). Concerning the severity of tobacco dependence, 3.5%, 13.8%, and 5% of the respondents report moderate, high, and very high levels of tobacco dependence respectively. The proportions of tobacco dependence among male schizophrenic patients 88 (25.8%) were higher compared to their counterparts 27 (15.5%). After controlling the effects of cofounders in the final regression analysis, male gender (AOR 2.19, 95% CI = 1.25, 3.83), being on treatment for more than 5years (AOR 4.37, 95% CI = 2.11, 9.02), having a history of admission (AOR 4.01, 95% CI = 1.99, 8.11), and family history of mental illness (AOR 1.90, 95% CI = 1.04, 3.48) were shown to have a significant positive association with tobacco dependence. A study show a significant proportion of tobacco dependence among people living with schizophrenia. Factors like, being male gender, being on treatment for more than 5 years, having a history of admission, and family history of mental illness was found to have a significant positive association with tobacco dependence. Hence, there is a need for coordinated and comprehensive management clinically to manage tobacco dependence along with identified risk factors in patients with schizophrenia. Also the finding call for the clinicians, managers, ministry of health and other stakeholders on the substance use prevention strategies that target personal and environmental control.

The Difference in Negative Scale Score Measured with Positive and Negative Syndrome Scale in Schizophrenic Male Patient Treated with Risperidone in Addition to Vitamin E and Treated with Risperidone Alone at Prof. Dr. M. Ildrem Mental Hospital Medan

OBJECTIVES: The objectives of the study were to investigate the difference in negative scale score in schizophrenic male patients that received vitamin E-fortified risperidone and those receiving risperidone treatments alone. METHODS: This study was a pre- and post-test experimental design which compared two groups; a group of men with schizophrenia who were given risperidone treatment with added Vitamin E and another group of men with schizophrenia who were given only risperidone treatment. The study was conducted at the outpatient clinic of Prof.dr. M. Ildrem Mental Hospital Medan, North Sumatra within August to November 2019. The study has been approved by the Research Ethics Committee of the Faculty of Medicine, North Sumatera University. The instrument used to assess negative scale on the subjects is PANSS. RESULTS: We found that statistical analysis using corrected Mann–Whitney U-test obtained p &lt; 0.001 (p &lt; 0.05). CONCLUSIONS: There was a strongly significant difference in negative scale Positive and Negative Syndrome Scale (PANSS) scores on 4th and 8th weeks in the group which received risperidone treatment with additional Vitamin E compared to the other group that received risperidone alone.

Role of Tumor Necrosis Factor-Alpha in Schizophrenia and Cognitive Impairment

Background: Neuroinflammation and excitotoxicity play a key role as triggers and support for neurodegenerative processes, increase levels of TNF-α have been found in schizophrenic patients. Improved inflammatory processes have been demonstrated in acute and chronic schizophrenia. In schizophrenia is characterized by a collection of core symptoms that trigger individuals experiencing several cognitive disorders.&#x0D; Objective: To investigate the relationship of serum TNF-α levels to impaired cognitive function in schizophrenic patients in Medan, Indonesia.&#x0D; Method: This research is cross sectional analytical correlative study involving 40 male schizophrenic patients at Prof. Dr. M. Ildrem Mental Hospital through July to September 2019 that fulfilled our inclusion and exclusion criteria. Serum TNF-α levels were analyzed using Quantikine HS Human TNF-α Assay with a minimum detection limit of 0.1062 pg/ml while in the other hand, cognitive function test was carried out by using the Mini Mental State Examination.&#x0D; Results: Serum TNF-α levels with a mean of 25.1216 with a standard deviation of 1.7629. There is a positive correlation with moderate correlation (r = 0.4 - &lt;0.6) on cognitive function with the strength of correlation r = 0.434&#x0D; Conclusion: We found that there is a link between serum TNF-α level and cognitive function as assessed with the Mini-Mental State Examination (MMSE).

Effect Of Cognitive And Exercise Rehabilitation On Gait In Male Schizophrenic Patients Suffering From Depression Disorder

Objective ― The purpose of this study was to investigate the effect of cognitive and exercise rehabilitation training, and non-invasive brain stimulation on the gait of schizophrenic patients suffering from depression disorder. Methods ― Fifty-five male schizophrenic patients suffering from depression disorder aged 24 to 66 years were assigned to either a control group (n=10), cognitive rehabilitation group (n=10), exercise rehabilitation training group (n=13), transcranial direct current stimulation (tDCS) group (n=11) or multimodal intervention group (n=11). Gait was measured using a 10-meter gait speed test under normal, in dual-task cognitive-gait, and in dual task motor-gait conditions. Results ― Gait speed during the 10-meter walk test under normal conditions was significantly (P≤0.05) different from pre- to post-test in the exercise rehabilitation training, and cognitive rehabilitation multimodal intervention. Gait speed during the dual task motor-gait condition was significantly different from pre- to post-test in the exercise rehabilitation training, cognitive rehabilitation and, multimodal intervention groups (P≤0.05). Gait speed during the dual task cognitive-gait condition significantly changed from pre- to post-test following exercise rehabilitation training, cognitive rehabilitation, tDCS and the multimodal intervention group (P≤0.05). Conclusion ― This study’s findings demonstrate that exercise rehabilitation training, cognitive rehabilitation, and multimodal interventions could assist with preventing falls within Schizophrenic patients suffering from depression and thereby improve their functional independence.

Vitamin D Serum Level in Patients with Schizophrenia in West Java, Indonesia

Background: Vitamin D is an immune-regulator that influences the neuro-inflammation process in schizophrenia. The study aimed to explore the vitamin D serum level in schizophrenic patients at the outpatient clinic of the Provincial Mental Hospital, West Java, Indonesia. Methods: A quantitative descriptive study was conducted in November-December 2019 using secondary data of all-male schizophrenic patients at the Provincial Mental Hospital. Data collected were demographic characteristics, clinical characteristics, and vitamin D Level. Scoring was then performed using Positive and Negative Syndrome Scale (PANSS) and Montreal Cognitive Assessment (MoCA) to assess the positive and negative symptoms as well as the cognitive symptoms based on the serum vitamin D levels. Result: All male schizophrenic patients had a low serum vitamin D level (mean16.67±5.6ng/ml) with 64.52% of them had vitamin D deficiency (&lt;20 ng/ml). Interestingly, patients with vitamin D deficiency had a negative symptom (mean22.1±5.6ng/ml) whereas those with vitamin D insufficiency (20-29 ng/ml) had a positive symptom (mean 18.55±5.6ng/ml). Furthermore, patients with vitamin D deficiency had a lower impaired cognitive function value (mean 19.7±3.4ng/ml) compared to those with vitamin D insufficiency. Conclusions: A low vitamin D serum level in schizophrenic patients may play a role in the pathogenesis of this disorder. Further studies are needed to confirm this finding.

Daily Living Performance in Schizophrenic Patients in Correlation with Positive and Negative Symptoms

Background : Schizophrenia is a global mental health problem. Patients experience problems in their daily-living performance. Positive and negative symptoms have been part of characteristics of schizophrenia that are absent in normal individuals, which include a distinctive fundamental distortion of thoughts and perception (positive symptoms) and loss of normal function and behavior (negative symptoms). This study aimed to explore the correlation between positive and negative symptoms and daily-living performance in schizophrenia. Methods : A correlative analytical study with a cross-sectional approach was conducted using secondary data from the Outpatient Clinic of the Mental Hospital of West Java Province. Data on socio-demographic characteristics were collected and positive and negative symptoms as assessed by Positive and Negative Syndrome Scale or Subscales (PANSS) were correlated with the activities of daily living (ADLs) and instrumental activities of daily living (IADLs), which were further analyzed by Spearman’s correlation test. Results : In total, 31 male schizophrenic patients aged between 24-45 years old. There was no significant correlation between ADLs dependency levels and both positive and negative symptoms. However, there was a significant correlation between IADLs function and positive symptoms and not with negative symptoms. Conclusions : Even though no correlation was identified between ADLs dependency levels with positive and negative symptoms, the ADLs and IADLs assessments should be considered as important tools for schizophrenic patients for rehabilitation to improve daily-living functioning.

Daily Living Performance in Schizophrenic Patients in Correlation with Positive and Negative Symptoms

Background : Schizophrenia is a global mental health problem. Patients experience problems in their daily-living performance. Positive and negative symptoms have been part of characteristics of schizophrenia that are absent in normal individuals, which include a distinctive fundamental distortion of thoughts and perception (positive symptoms) and loss of normal function and behavior (negative symptoms). This study aimed to explore the correlation between positive and negative symptoms and daily-living performance in schizophrenia. Methods : A correlative analytical study with a cross-sectional approach was conducted using secondary data from the Outpatient Clinic of the Mental Hospital of West Java Province. Data on socio-demographic characteristics were collected and positive and negative symptoms as assessed by Positive and Negative Syndrome Scale or Subscales (PANSS) were correlated with the activities of daily living (ADLs) and instrumental activities of daily living (IADLs), which were further analyzed by Spearman’s correlation test. Results : In total, 31 male schizophrenic patients aged between 24-45 years old. There was no significant correlation between ADLs dependency levels and both positive and negative symptoms. However, there was a significant correlation between IADLs function and positive symptoms and not with negative symptoms. Conclusions : Even though no correlation was identified between ADLs dependency levels with positive and negative symptoms, the ADLs and IADLs assessments should be considered as important tools for schizophrenic patients for rehabilitation to improve daily-living functioning.

S216. CASE REPORT OF TREATMENT OF NEUROLEPTIC MALIGNANT SYNDROME IN CHILD ADOLESCENT

BackgroundNeuroleptic Malignant Syndrome is a rare clinical syndrome occurring due to idiosyncratic reaction after use of neuroleptics. We report a case of neuroleptic malignant syndrome in an adolescent patient with schizophrenia after treatment with antipsychotics.MethodsCase report.ResultsA 15-year-old male Schizophrenic patient was admitted to the psychiatric closed ward due to worsening of psychotic symptoms on July of 2017. Pineal cystoma and pituitary microadenoma were detected incidentally on MRI, and consultation with the department of pediatrics recommended close observation.After treatment with 6mg of risperidone in combination with 300 mg of quetiapine, psychotic symptoms improved enough to be discharged.Since March 25th of 2019, due to manifestation of paralytic ileus from worsening of underlying constipation, all the oral medications were stopped along with NPO for treatment; in addition, IM injection of haloperidol was only allowed for the symptom control. The day before the onset of neuroleptic malignant syndrome, IM injection of 15 mg of haloperidol and 10 mg of lorazepam resulted in vomiting, headache, fever of 39℃, systemic tremor and stiffness, confusion in consciousness, tachycardia and sweating. On April 1st of 2019, with suspicion of neuroleptic malignant syndrome, the patient was transferred to ICU at our institution. Blood work-up performed on day of admission at ICU indicated CPK 2836 IU/L and myoglobulin 337.2 ng/ml, and CPK, after peaking at 4493 IU/L, continuously decreased and was normalized by the 18th day at ICU. Diazepam (IV), dantrolene, domperidone, L-Dopa/benserazideand and cold blanket were applied because the patient continuously screamed due to fever, stiffness, tremor, and psychotic symptoms. Even though confusion improved after 3 days, nausea and vomiting persisted for 8 days. Tremor, stiffness, and fever were stabilized after 3 days. Tachycardia improved after 17 days. Recovery of hematologic abnormalities such as increased CPK and myoglobulin and leukocytosis were followed by stabilization of tremor, stiffness, and high fever on the 18th day.The patient was transferred out of ICU after 18 days, and symptoms were all stabilized after treatment with clozapine.DiscussionEvaluation of risk factors of NMS in patients requiring neuroleptics is most critical in order for prompt differentials and early intervention.Known risk factors are 1) male, 2) combination of more than two antipsychotic, 3) history of previous EPS symptoms or NMS, 4) psychiatric disorders such as severe agitation, mood disorder, or delirium, 5) recent initiation or increasing dose of antipsychotics, 6) IM injection of antipsychotics, 7) poor physical conditions like dehydration, infection, malnutrition, brain tumor, encephalitis, or AIDS, 8) use of zuclopenthixol acetat (clopixol acuphase), and 9) substance abuse.In this case, because the patient had 6 of the risk factors described above, which are biological vulnerabilities due to pineal cystoma and pituitary micro adenoma, dehydration and malnutrition caused by paralytic ileus, and sudden change in IM antipsychotics and dosage, it was critical to consider more carefully in medication injection and changes in dosage.Once diagnosed with NMS, immediate hydration and efforts to lower body temperature are critical to prevent complications like acute renal failure, and use of dantrolene, bromocriptine, and benzodiazepine is helpful in shortening the treatment period.In cases of NMS in patients who cannot terminate use of neuroleptics due to underlying mental disorders, ECT is an effective method to treat both NMS and mental disorders. Safety and efficacy of ECT have been already proven, and it is highly recommended when needed.

Blastocystis sp. Subtype 9: as the First Reported Subtype in Patients with Schizophrenia in Iran

Blastocystis sp. is more prevalent in mentally-retarded individuals, immunocompromised patients, and organ recipients. There are no inclusive studies in Iran evaluating the prevalence and molecular identification of Blastocystis sp. infection in schizophrenic patients. This study aimed to determine prevalence and subtype distribution of Blastocystis sp. in schizophrenic patients in Tehran province, Iran. This cross-sectional study was performed on 58 stool samples of schizophrenic male patients in Tehran province, Iran, using the sequence-tagged site (STS) and ST-specific primers. Overall, 58 stool samples were collected from hospitalized male patients with schizophrenia in Tehran province. After conventional PCR, positive samples were probed by ST-specific and STS primers. Following molecular evaluation, 32 samples (55.2%) were positive for Blastocystis sp. Which, 28 (87.5%) cases were ST3, 3 (9.4%) cases were found to be ST9, and one case (3.1%) was ST1.This study was the first report of the ST9 of Blastocystis in Iran. Blastocystis infection was more prevalent in asymptomatic patients (55.6%) compared with symptomatic patients (55%). There was a significant association between the duration of hospitalization and Blastocystis infection rate (0.002). The results of the present study represented a high prevalence and significance of Blastocystis sp. infection in schizophrenic patients. Patients with schizophrenia are unable to attend to their own care. Also, schizophrenic patients have a lack of perception that can result in poor hygiene, which needs more care, accuracy, prevention, and control.

The longitudinal course of schizophrenia: testosterone and progression of the negative symptoms

Background: The longitudinal course of schizophrenia shows a high level of heterogeneity with testosterone as a possible factor in the variety of clinical outcomes.Aim: Evaluation of the course of schizophrenia in male patients over an eight-year period and of the possible testosterone effects on changes in clinical features.Subjects and methods: The initial study population consisted of 120 male schizophrenic patients (aged 18–40) hospitalized in the University Psychiatric Hospital Vrapce in 2009. Patients were classified into nonaggressive (control, n = 60) and aggressive (n = 60) groups. In 2017, we reassessed 85 patients (67,5%) from the initial sample. Symptoms of schizophrenia were determined using the Positive and Negative Syndrome Scale (PANSS) and compared with the total serum testosterone level taken at the inclusion in the study. The distribution of values for individual variables was determined using the Smirnov–Kolmogorov test; for all further analyses, the appropriate non-parametric test was used.Results: The control group showed a statistically significant negative correlation between testosterone and negative PANSS. The initial PANSS scores, compared to those at the follow-up, showed a statistically significant reduction in positive and general symptoms in all groups, with the greatest reduction in the control group.Conclusion: We found a reduction in positive and general symptoms of schizophrenia among all patients and no changes in negative symptoms. Inverse correlation between testosterone and negative symptoms was found only in the control group, but there was no testosterone influence on the progression of any PANSS subscales.

The Comparison of Hospital Anxiety and Depression Scale-Anxiety Scores between Female Caregivers of People with Schizophrenia According to Gender Difference.

BACKGROUND:Caregiver plays an important role for a better outcome in people with schizophrenia, although it usually causes emotional distress for the caregiver. Anxiety is one of the emotional distress. Gender of schizophrenic patients is associated with the emotional distress of caregiver. The differences in HADS-A scores between female caregivers of people with schizophrenia according to gender in Indonesia remain unclear.AIM:To determine whether HADS-A scores are higher in a male group compare with the female group.METHODS:This study was an analytical study with a cross-sectional approach to determine the comparison of HADS-A score between 27 female caregivers of male schizophrenic patients (male group) and 27 female caregivers of female schizophrenic patients (female group) in Prof. Dr M. Ildrem Mental Hospital Medan, using a HADS rating scale.RESULTS:There is no difference between the male and female group in caregivers age, marital status, employment status, family income/month, education time, the relationship with people with schizophrenia, caring time, time spent / weeks, and the patients age, employment status, education time, PANSS score and number of relapses. The comparison between total HADS-A score between the male group and the female group is not significant with 9.52 ± 4.90 v 8.70 ± 4.49 (p = 0.53).CONCLUSION:HADS-A scores are not higher in caregivers of male with schizophrenia compared with caregivers of a female with schizophrenia.

Insights into the interplay of latent toxoplasmosis, testosterone, cortisol and oxidative stress in screened schizophrenic patients in Egypt

Background: Toxoplasma gondii is a wide-spread infection. Most cases are asymptomatic latent toxoplasmosis and its link with schizophrenia is of wide interest. Toxoplasmosis induces immunopathological and neuroendocrine alterations that induce activation of hypothalamic pituitary-adrenal axis resulting in higher glucocorticoid and testosterone levels. Oxidative stress also has a role since antioxidants as glutathione (GSH) were found to be reduced. Objective: To assess seroprevalence/serointensity of toxoplasmosis in schizophrenic patients in relation to the levels of testosterone, cortisol and GSH activity in order to evaluate these factors in the etiopathogenesis of schizophrenic patients harboring latent toxoplasmosis. Subjects and Methods: In this cross sectional case control study, 120 schizophrenic inpatients were compared with 120 individuals attending the outpatients’ clinics in the same age range, and after exclusion of schizophrenia. Schizophrenia was confirmed or excluded using positive and negative syndrome scale (PANSS). Levels of Toxoplasma IgG, free testosterone, cortisol and GSH were determined in both groups. Results: Statistical analysis revealed no differences between cases and controls as regard age, gender, contact with pets, and Toxoplasma IgG seroprevalence. Toxoplasma IgG seroprevalence was higher in males compared to females and in rural areas than in urban areas. In Toxoplasma-positive patients, testosterone was higher in both genders and glutathione was lower, while no significant difference was documented in relation to PANSS, treatment with electroconvulsive-therapy (ECT) or cortisol level. Schizophrenic patients showed higher Toxoplasma antibody titer, cortisol, free testosterone levels in both genders and lower GSH than control. Male schizophrenic patients particularly showed lower GSH level and higher Toxoplasma antibody titer. Free testosterone level was significantly higher in male patients who had received ECT. Conclusion: Latent toxoplasmosis may be involved in the etiology of schizophrenia. Screening and treatment of toxoplasmosis is advisable to prevent schizophrenia. Also, screening of schizophrenic patients for chronic toxoplasmosis and the fore mentioned parameters is recommended for prediction of complications and presents a promising approach for prevention and management.