Negative Syndrome Scale For Schizophrenia Research Articles

Corollary Discharge Dysfunction as a Possible Substrate of Anomalous Self-experiences in Schizophrenia

Abstract Background and Hypothesis Corollary discharge mechanism suppresses the conscious auditory sensory perception of self-generated speech and attenuates electrophysiological markers such as the auditory N1 Event-Related Potential (ERP) during Electroencephalographic (EEG) recordings. This phenomenon contributes to self-identification and seems to be altered in people with schizophrenia. Therefore, its alteration could be related to the anomalous self-experiences (ASEs) frequently found in these patients. Study Design To analyze corollary discharge dysfunction as a possible substrate of ASEs, we recorded EEG ERP from 43 participants with schizophrenia and 43 healthy controls and scored ASEs with the ‘Inventory of Psychotic-Like Anomalous Self-Experiences’ (IPASE). Positive and negative symptoms were also scored with the ‘Positive and Negative Syndrome Scale for Schizophrenia’ (PANSS) and with the ‘Brief Negative Symptom Scale’ (BNSS) respectively. The N1 components were elicited by two task conditions: (1) concurrent listening to self-pronounced vowels (talk condition) and (2) subsequent non-concurrent listening to the same previously self-uttered vowels (listen condition). Study Results The amplitude of the N1 component elicited by the talk condition was lower compared to the listen condition in people with schizophrenia and healthy controls. However, the difference in N1 amplitude between both conditions was significantly higher in controls than in schizophrenia patients. The values of these differences in patients correlated significantly and negatively with the IPASE, PANSS, and BNSS scores. Conclusions These results corroborate previous data relating auditory N1 ERP amplitude with altered corollary discharge mechanisms in schizophrenia and support corollary discharge dysfunction as a possible underpinning of ASEs in this illness.

The Insight of Patients and Their Parents Differ in the Early Phase of Psychosis

The aim of this cross-sectional study was to investigate whether the insight of patients and their parents differ in the early phase of psychosis. Target population were the patients hospitalized with the diagnosis of the psychotic spectrum (F20- F29; ICD- 10th; disease duration ≤ 5 years), both sexes, with average age M = 25.4 (SD = 3.56, C = 25, min = 18, max = 32) and their parents. Insight into illness in patients was assessed using the Scale to assess Unawareness of mental Disorder (SUMD) abbreviated version. Parents’ insight into illness was assessed with a modified version of the SUMD with question rephrased to probe parents’ understanding of patients’ illness. The expression, structure and severity of psychotic symptoms was assessed by The Positive and Negative Syndrome Scale of Schizophrenia (PANSS- Five factor models) and Clinical global impression scale (CGI- s). The results indicated a statistically significant (Z = 2.99; p < 0.01) higher mean value on General Awareness of patients (M = 6.1, SD = 3.26) compared to parents (M = 5.0, SD = 2.99. A significant difference was obtained by the sex of parents too (z = -2.07, p < 0.05): fathers had better insight (M = 2.0, SD = 1.15) than mothers (M = 1.5, SD = 0.89). The results call for necessity to develop innovative and comprehensive program for early family interventions.

Psychological/Personal recovery and its correlates in patients with first episode psychosis.

Recovery in psychosis is a multidimensional construct. The numbers of studies specially focusing on the recovery aspects in patients with first episode psychosis (FEP) are limited, with no study from India. Further, no study has looked specifically into the variables that affect recovery process in patients with FEP and little is known about factors which influence recovery in patients with FEP. To evaluate psychological recovery and its correlates in patients with FEP, currently in clinical remission. One hundred three patients of FEP in clinical remission were assessed on Recovery Assessment Scale (RAS), Positive and Negative Syndrome Scale for Schizophrenia, Calgary Depression Rating Scale for Schizophrenia, Negative Symptom Assessment 16, Rosenberg Self-esteem Scale, Social and Occupational Functioning Assessment Scale, the Alcohol, Smoking and Substance Involvement Screening Test, Beck Cognitive Insight Scale, Internalized Stigma of Mental Illness Scale, the Everyday discrimination Scale, Subjective Scale to Investigate Cognition in Schizophrenia and social cognitive deficits in theory of mind was evaluated on the Social Cognition Rating Tools in Indian Setting-Theory of Mind. The needs of the participants were assessed on the Camberwell Assessment of Needs - Research version and Supplemental Assessment of Needs. Coping, social support, medication adherence were also assessed by standardized scales. The mean weighted score was highest for goal and success orientation subscale followed by seeking and relying on social support, personal confidence and hope, overcome the illness and awareness and control over the illness as assessed by 41 items of the RAS. The main factors identified to affect psychological recovery in patients with FEP were duration of untreated psychosis, greater psychopathology, lower self-esteem, total unmet need, feeling of discrimination and stigmatization. The present study suggests that treatment of FEP should be started at the earliest and issues such as residual psychopathology, lower self-esteem, total unmet need, feeling of discrimination and stigma during the remission phase should be addressed by psychosocial interventions to promote psychological recovery in patients with first episode psychosis.

Obstetric complications and clinical presentation in first episode of psychosis.

Psychotic disorders exhibit a complex etiology that combines genetic and environment factors. Among the latter, obstetric complications (OCs) have been widely studied as risk factors, but it is not yet well understood how obstetric complications relate to the heterogeneous presentations of psychotic disorders. We assessed the clinical phenotypes of individuals with a first episode of psychosis (FEP) in relation to the presence of OCs. 277 patients with a FEP were assessed for OCs using the Lewis-Murray scale, with data stratified into three subscales depending on the timing and the characteristics of the obstetric event, namely: complications of pregnancy, abnormal fetal growth and development and difficulties in delivery. We also considered other two groups: any complications during the pregnancy period and all obstetric complications taken altogether. Patients were clinically evaluated with the Positive and Negative Syndrome Scale for schizophrenia. Total OCs and difficulties in delivery were related with more severe psychopathology, and this remained significant after co-varying for age, sex, traumatic experiences, antipsychotic dosage, and cannabis use. Our results highlight the relevance of OCs for the clinical presentation of psychosis. Describing the timing of the OCs is essential in understanding the heterogeneity of the clinical presentation.

Pathways to the first contact with mental health services among patients with schizophrenia: A cross-sectional observational study.

Schizophrenia is a mental illness with a profound impact on patient and their caregivers. There is increasing evidence that delay in the commencement of treatment following the onset of illness may be related to the pathways; patients navigate before accessing mental health services. The aim of this study is to assess the pathways of care to the first contact with mental health services among patients with schizophrenia. A total of 150 diagnosed schizophrenia patients aged 12-60 years were recruited as per inclusion and exclusion criteria. The sociodemographic details were gathered using semistructured sociodemographic data sheets; semistructured pathways to care questionnaire and positive and negative syndrome scale for schizophrenia were administered. The most common first pathway to care was faith healers. The education of the head of family, socioeconomic status, rural background, and occupational status of patients have a significant impact on the first pathway of psychiatric care. The findings suggest that while planning mental health services, emphasis should be made on collaboration between psychiatric and nonpsychiatric services. The pathways patient choose depend on a number of factors like their socio-cultural background, belief about the supernatural causation of psychiatric illness, stigma associated with psychiatric illness, lack of knowledge about the mental illness, and influence of close family relatives on the choice of treatment.

Alpha-Interferon Induced Psychosis: A Single Case Study

Ms. X, 33 years old, was referred with the complaints of suspiciousness against family members and doctors, suspiciousness towards medical treatment and food items, poor medicine compliance, social withdrawal, irritability, anger outbursts and body aches. It was aimed to find out the efficacy of Cognitive Behavior Therapy in the treatment of symptoms of Schizophreniform. Single case ABA research design was used. The assessment of the patient was done through clinical interview, Mental State Examination (MSE) and Visual Analogue Scale Ratings of presenting complaints, and by Positive and Negative Syndrome Scale for Schizophrenia (PANSS). She was diagnosed with 295.40 (F20.81) Schizophreniform. The results of the study showed that there was a significant decrease in the severity of symptoms which showed that CBT is an effective mode of treatment for dealing the symptoms of Schizophreniform.

Symptom dimensions stability over time in recent onset psychosis: A prospective study

BackgroundThe factorial structure of schizophrenia symptoms has been much debated but little is known on its degree of unicity, specificity as well as its dynamic over time. Symptom differentiation is a phenomenon according to which patients' symptoms could differentiate from one another during illness to form more independent, distinct dimensions. On the contrary, symptom dedifferentiation is an increase in the correlations between those symptoms over time. The goal of this study was to investigate symptom differentiation or dedifferentiation over time in recent onset psychosis using the Positive and Negative Syndrome Scale. MethodsA confirmatory factor analysis model based on the consensus five-factor model of the Positive and Negative Syndrome Scale for schizophrenia was estimated on seven different time points over a three-year period. A general factor capturing common variance between every symptom was also included. Explained common variance was computed for the general factor and each specific factor. ResultsThree hundred and sixty-two recent onset psychosis patients were assessed. Results showed no evidence for either symptom differentiation or dedifferentiation over time. Specific symptoms accounted for >70 % of the variance suggesting a high degree of specificity of the symptomatology. ConclusionsOverall, this study adds support for a highly multidimensional approach to clinical symptom assessment with an explicit focus on depression. The premise behind the staging approach being inherently one-dimensional, implications for further research is discussed.

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BACKGROUND:Schizophrenia is a serious mental illness with profound impact on patient and their care givers. There is increasing evidence that delay in commencement of treatment following the onset of illness, may be related to the pathways patients navigate before accessing mental health services.AIM:To assess the pathways of care to the first contact with mental health services among patients with schizophreniaMATERIAL AND METHOD:150 diagnosed schizophrenia patients aged 12-60yrs were recruited as per inclusion and exclusion criteria. The socio demographic details were gathered using semi-structured socio-demographic data sheet, semi-structured pathways to care questionnaire and positive and negative syndrome scale for schizophrenia (PANSS) were administered.RESULT:The four major pathways to care in study were faith healers (62.67%), quacks(15.33%(, general physician (14.67%) and psychiatrist (7.33%). Statistically significant association between pathways to care and socio- economic status and occupation. However, no statistically significant association between age, sex, religion and marital status were found.CONCLUSION:The most common pathway to care were faith healers. Education of head of family, socio-economic status rural background and occupational status of patient have a significant impact on first pathway of psychiatric care. The findings suggest that while planning mental health services, emphasis should be made on collaboration between psychiatric and non psychiatric services.

The Effectiveness of the Repetitive Transcranial Magnetic Stimulation (rTMS)with high frequency (20 Hz) on Auditory Hallucinations, Inner Speech and Working Memory in Schizophrenic Patients

Background: The purpose of the present study was to investigate the effectiveness of high frequency transcranial magnetic stimulation (rTMS) treatment (20 Hz) on auditory hallucinations, inner speech and working memory in schizophrenic patients. Materials and Methods: This study was a pretest-posttest experimental design with control group. The statistical population of this study consisted of all schizophrenic patients referring to the outpatient department of Imam Hossein hospital in 2019, 12 of whom were selected by available sampling based on inclusion and exclusion criteria then were assigned randomly into two groups of 6 each. High frequency transcranial magnetic stimulation (r TMS) treatment (20 Hz) was used for experimental group but the control group received no intervention during the study. The instruments were the positive and negative syndrome scale in schizophrenia, the inner speech questionnaire, and the Daneman and Carpenter working memory questionnaire before and after the intervention. The data were analyzed by descriptive statistics, and one-way covariance analysis (ANCOVA) and multivariate covariance analysis (MANCOVA) were used to analyze the data. Results: The results showed that there were significant differences between experimental and control group (p<0.005). The rate of auditory hallucinations and inner speech significantly decreased in comparison with pretest and control group, but the rate of active memory increased. Conclusion: Repetitive transcranial magnetic stimulation (r TMS) treatment (20 Hz) significantly reduced auditory hallucinations, inner speech and improved active memory.

Effects of Adherence to Pharmacological Treatment on the Recovery of Patients with Schizophrenia.

The aim of this study was to evaluate the effects of adherence to antipsychotic treatment on the recovery of patients with schizophrenia in northern Chile. One hundred and fifty-one patients diagnosed with schizophrenia completed the Drug Attitude Inventory (DAI-10), Positive and Negative Syndrome Scale for Schizophrenia (PANSS), Recovery Assessment Scale (RAS-24), sociodemographic information, and clinical and treatment characteristics of patients with schizophrenia. Multivariate analysis with multiple linear regression was then performed to identify variables that were potentially associated with the recovery assessment (variable criterion). A significant association was found between adherence to antipsychotic medication and the Willing to Ask for Help dimension of Recovery (β = 0.239, p = 0.005). Association of clinical and socio-demographic variables with recovery were identified: negative symptoms with Personal Confidence and Hope (β = −0.341, p = 0.001) and Goal and Success Orientation (β = −0.266, p = 0.014); cognitive symptoms with Willing to Ask for Help (β = −0.305, p = 0.018) and no domination by symptoms (β = −0.351, p = 0.005); marital status with reliance on others (β = −0.181, p = 0.045); age with Personal Confidence and Hope (β = −0.217, p = 0.021), Goal and Success Orientation (β = −0.296, p = 0.003), and no domination by symptoms (β = 0.214, p = 0.025). Adherence has a positive relationship with personal recovery in this sample of Chilean patients with schizophrenia.

Clinical features and psychiatric comorbidities in military veterans with schizophrenia with or without suicidality

Suicide is currently among the leading causes of death among individuals with schizophrenia. Reducing mortality from suicide remains a major clinical challenge in the care of veterans with schizophrenia. There is a need to increase our understanding of what elevates suicide risk in veterans with schizophrenia as a first step towards the future development of suicide prevention interventions. This study compared demographic and clinical features of military veterans with schizophrenia with vs. without suicidality to determine specific risk factors for suicidality. The sample consisted of two groups of veterans with schizophrenia: suicide ideators and/or attempters (SIA) and individuals without a history of suicidal ideation or attempts (no-SIA). Participants were interviewed using the Structured Clinical Interview for DSM-5 Axis I disorders (SCID-I), Positive and Negative Syndrome Scale for Schizophrenia (PANSS), Hamilton Depression Rating Scale (HDRS), and Schizotypal Personality Questionnaire (SPQ). In bivariate analyses, the PANSS-Positive Symptom scores, PANSS-General Psychopathology scores, HDRS total score, HDRS-Paranoid symptoms item score, and SPQ total scores were higher among SIA compared with no-SIA patients. In this unique clinical sample of veterans with schizophrenia, SIA patients were more likely to have mood disorders, post-traumatic stress disorder (PTSD), and/or alcohol use disorder in comparison to the no-SIA group. Logistic regression analysis indicated that the HDRS total score and presence/absence of comorbid mood disorder drive the difference between the groups. These results indicate that suicide risk assessment in veterans with schizophrenia should include identifying individuals with comorbid mood disorders/symptoms, PTSD, alcohol use disorder, marked positive symptoms, and schizotypal features.

How painting facilitated dance movement psychotherapy interventions for a visual artist suffering from schizophrenia – Taming tigers and butterflies –

ABSTRACT Twelve individual dance movement psychotherapy sessions were provided during a 3 month period to a professional visual artist suffering from schizophrenia, and drawing was incorporated. Therapist’s records were kept and paintings of patient and therapist were created after every session. Positive and Negative Syndrome Scale for Schizophrenia (PANSS), the Strategic Approach to Coping Scale (SACS) and Laban Movement Analysis (LMA) were completed at baseline and at the end of the study. Sessions ‘fed’ one another through the paintings, connecting the body experience to art and, through art, to her reality. This connection enabled her to express feelings and relate them to her needs towards better coping and resilience. At the end of the study, PANSS score remained low, SACS indicated that the patient’s attitude towards external factors became less extreme and LMA revealed reduced maladaptive movement behaviour and improved quality of movement reaching an almost normal level.

Protocol for a pharmacogenomic study on individualised antipsychotic drug treatment for patients with schizophrenia.

Schizophrenia is a severe and complex psychiatric disorder that needs treatment based on extensive experience. Antipsychotic drugs have already become the cornerstone of the treatment for schizophrenia; however, the therapeutic effect is of significant variability among patients, and only around a third of patients with schizophrenia show good efficacy. Meanwhile, drug-induced metabolic syndrome and other side-effects significantly affect treatment adherence and prognosis. Therefore, strategies for drug selection are desperately needed. In this study, we will perform pharmacogenomics research and set up an individualised preferred treatment prediction model. We aim to create a standard clinical cohort, with multidimensional index assessment of antipsychotic treatment for patients with schizophrenia. This trial is designed as a randomised clinical trial comparing treatment with different kinds of antipsychotics. A total sample of 2000 patients with schizophrenia will be recruited from in-patient units from five clinical research centres. Using a computer-generated program, the participants will be randomly assigned to four treatment groups: aripiprazole, olanzapine, quetiapine and risperidone. The primary outcomes will be measured as changes in the Positive and Negative Syndrome Scale of schizophrenia, which reflects the efficacy. Secondary outcomes include the measure of side-effects, such as metabolic syndromes. The efficacy evaluation and side-effects assessment will be performed at baseline, 2 weeks, 6 weeks and 3 months. This trial will assess the efficacy and side effects of antipsychotics and create a standard clinical cohort with a multi-dimensional index assessment of antipsychotic treatment for schizophrenia patients. This study aims to set up an individualized preferred treatment prediction model through the genetic analysis of patients using different kinds of antipsychotics.

The effects of high-frequency repetitive transcranial magnetic stimulation on auditory hallucinations and working memory among patients with schizophrenia

Background and aims: Schizophrenia is one of the most complicated psychiatric disorders. Some afflicted patients show resistance to routine treatments. Repetitive transcranial magnetic stimulation (rTMS) is a noninvasive brain stimulation technique with the potential to reduce symptoms among patients with schizophrenia. The aim of this study was to evaluate the effects of high-frequency rTMS on auditory hallucinations and working memory among patients with schizophrenia. Methods: This experimental study was conducted using a pretest-posttest controlled design. The statistical population of the study consisted of all patients with schizophrenia and auditory hallucinations who referred to the outpatient psychiatric emergency department of Imam Hossein hospital, Tehran, Iran, in 2019. In total, twelve eligible patients were recruited through convenience sampling and randomly allocated to a control and an intervention group. Participants in the intervention group individually received rTMS in ten sessions, while their counterparts in the control group received no intervention during the study. Data were collected using the diagnostic interview, the screening questionnaire for rTMS, the Positive and Negative Syndrome Scale for schizophrenia, the Varieties of Inner Speech Questionnaire, and the Working Memory Measure. Data analysis was performed using univariate and multivariate analyses of covariance. Results: The posttest mean score of auditory hallucination in the intervention group was significantly less than the control group, while the posttest mean score of working memory in the intervention group was significantly greater than the control group (P<0.05). Conclusion: This study suggests the effectiveness of rTMS in significantly reducing auditory hallucinations and improving working memory among patients with schizophrenia.

Adjuvant High-Definition Transcranial Direct Current Stimulation for Negative Symptoms in Schizophrenia: A Pilot Study.

In schizophrenia, negative symptoms account for a substantial amount of the comorbidity resulting in poor performance in social interaction, interpersonal relationships, economic functioning, and recreational activities. Research has implicated hypofrontality in the pathogenesis of negative symptoms of schizophrenia. Conventional transcranial direct current stimulation (tDCS) to the dorsolateral prefrontal cortex has attracted significant interest as an add-on treatment for negative symptoms in schizophrenia. High-definition tDCS (HD-tDCS), an optimized form of tDCS, has the potential for more focalized neuromodulation. Hence, we aimed to evaluate the efficacy of HD-tDCS over the left dorsolateral prefrontal cortex in the improvement of negative symptoms in schizophrenia. Fourteen patients with schizophrenia with predominantly negative symptoms were enrolled for this pilot, randomized, sham-controlled, double-blind trial. Each participant received 10 sessions of HD-tDCS at 2 mA for 20 minutes twice daily over 5 days. Negative symptoms were assessed with the Scale for Assessment of Negative Symptoms and Positive and Negative Syndrome Scale for Schizophrenia. The Calgary Depression Scale for Schizophrenia was used to rule out depressive symptoms. Assessments were carried out at baseline and at 2 weeks. The improvement in negative symptoms in the active group was statistically significant at P value of 0.05 as compared with the sham group. These results suggest that HD-tDCS may lead to improvement in negative symptoms of schizophrenia. Its use as an adjunct to pharmacological treatment of negative symptoms may be worth considering.

Peripheral immune markers and antipsychotic non-response in psychosis

BackgroundPeripheral immune markers have previously been linked to a poor response to antipsychotic medication and more severe negative symptoms at the onset of psychosis. The present study investigated the association of blood cytokines and complement markers with the presence of antipsychotic non-response and symptom severity in patients with psychosis. MethodsThis cross-sectional study recruited 94 patients with schizophrenia and other psychoses, of whom 47 were defined as antipsychotic responders and 47 as antipsychotic non-responders. In all subjects we measured plasma levels of cytokines (IL-1β, IL-2, IL-4, IL-6, IL-8, IL-10, IL-12p70, IL-13, TNF-α, and IFN-γ), complement markers (C1-inhibitor, C3, C4, C3a, C3b, Bb, factor D, C5a, terminal complement complex) and high sensitivity C-reactive protein (hsCRP). Symptom severity was recorded using the Positive and Negative Syndrome scale for Schizophrenia (PANSS). Binary logistic regression tested each immune marker as predictor of response status while covarying for relevant socio-demographic variables. Correlation analyses tested the association between immune markers and the severity of symptoms. ResultsInterleukin (IL)-8 significantly predicted antipsychotic non-response (OR=24.70, 95% CI, 1.35–453.23, p = 0.03). Other immune markers were not associated with antipsychotic response. IL-6, IL-8, IL-10 and TNF-α significantly positively correlated with negative psychotic symptoms. ConclusionsHigher levels of IL-8 are associated with a poor response to antipsychotic treatment. Increased cytokines levels are specifically associated with more severe negative symptoms in patients with schizophrenia and other psychoses.

Salivary cortisol response to psychosocial stress in patients with first-episode psychosis

AimTo analyze the difference in the salivary cortisol response to psychosocial stress between the patients with the first episode of psychosis (FEP) and the control group.MethodsWe performed a cross-sectional analysis of the baseline measurements of a prospective cohort study conducted from 2015 to 2018 at two Croatian psychiatric hospitals. The study consecutively enrolled 53 patients diagnosed with FEP and 63 healthy controls. The primary outcome was the difference in the changes of salivary cortisol concentration during the stress test. The secondary outcome was the difference in the baseline levels of salivary cortisol between patients with FEP and controls. The tertiary outcome were the correlations of salivary cortisol levels with the results of the Positive and Negative Syndrome Scale for Schizophrenia, Rosenberg Self-Esteem Scale, and the International Personality Item Pool.ResultsPatients with FEP had significantly higher baseline salivary cortisol than controls, but their salivary cortisol increased significantly less during the stress test.ConclusionPatients with FEP respond differently to stressful stimuli than controls, as shown by the increased baseline salivary cortisol and blunted cortisol response, possibly indicating a greater vulnerability to psychosocial stress.

Type 17 Immune Response Facilitates Progression of Inflammation and Correlates with Cognition in Stable Schizophrenia.

Dysregulation of the type 17 immune pathway has already been considered in schizophrenia and we previously measured decreased sera values of interleukin (IL)-17 in early stages. We further explored the possible correlation of IL-17 systemic levels with proinflammatory cytokines and cognitive scores and additionally analyzed the percentage of IL-17 producing lymphocytes in peripheral blood of patients with stable schizophrenia. We included 27 patients diagnosed with schizophrenia (F20), after a three-month stable depot antipsychotic therapy (risperidone or paliperidone) and 18 healthy control subjects. Positive and Negative Syndrome Scale of Schizophrenia and the Montreal-Cognitive Assessment (MoCA) were conducted. Sera concentrations of IL-17, IL-6, tumor necrosis factor alpha (TNF-α) and soluble ST2 receptor (sST2) were measured. Flow cytometry and Natural Killer (NK) and T cell analyses were done in 10 patients and 10 healthy controls. Moderate positive correlation was established between IL-17 and TNF-α (r = 0.640; p = 0.001), IL-17 and IL-6 (r = 0.514; p = 0.006), IL-17 and sST2 (r = 0.394; p = 0.042). Furthermore, a positive correlation between the serum levels of IL-17 and MoCA scores was observed, especially with visuospatial and executive functioning, as well as language functioning and delayed recall (p < 0.05). Significantly higher percentage of IL-17 producing CD56+ NK cells was measured in peripheral blood of patients with schizophrenia in remission vs. healthy individuals (p = 0.001). The percentage of CD4+ T cells and CD4+ T cells that produce IL-17 was significantly increased in patients (p = 0.001). This study revealed the involvement of innate type 17 immune response in the progression of inflammation and this could be related to cognitive functioning in stable schizophrenia.

Effectiveness of clozapine on quality of life and functioning in patients with treatment-resistant schizophrenia

Background Although it is well known that treatment with clozapine is associated with improvement in core symptoms of schizophrenia, little information is available about its impact on other outcome variables. Accordingly, this study aimed to evaluate the short term (3 months) effectiveness of clozapine in patients with treatment-resistant schizophrenia (TRS) in terms of quality of life, disability, and level of functioning. Methods This naturalistic follow-up study evaluated 52 participants at the baseline and three months (±1 week) after initiation of clozapine (prospective assessment) on Positive and Negative Syndrome Scale for schizophrenia, Calgary Depression Scale for Schizophrenia, Yale-Brown Obsessive-Compulsive Scale Checklist and Scale, Clinical Global Impression (CGI) scale, Beck Cognitive Insight Scale (BCIS), Scale to Assess Unawareness of Mental Disorders (SUMD), Social Occupational Functioning Scale – SOFS, Functioning Assessment Short Test (FAST), Indian Disability Evaluation and Assessment Scale (IDEAS), World Health Organisation Quality Of Life–BREF (WHOQOL-BREF) and Self-report Quality of Life Measure for people with schizophrenia. Results Treatment with clozapine led to significant improvement in the quality of life, functioning, and disability; reduction in psychopathology (positive, negative, general psychology, depression), the severity of illness, compulsive behavior, and improvement in insight including cognitive insight. Conclusions Treatment with clozapine leads to improvement in core symptoms of schizophrenia and is also associated with significant improvement in the quality of life, functioning, and disability.

Increased matrix metalloproteinases in cerebrospinal fluids of patients with major depressive disorder and schizophrenia.

BackgroundChronic inflammation of the brain has a pivotal role in the pathophysiology of major depressive disorder (MDD) and schizophrenia (SCZ). Matrix metalloproteinases (MMPs) are extracellular proteases involved in pro-inflammatory processes and interact with interleukin-6, which is increased in the cerebrospinal fluid (CSF) of patients with MDD and SCZ. However, MMPs in the CSF in patients with MDD and SCZ remain unclear. Therefore, we compared MMPs in the CSF of patients with MDD and SCZ with those of healthy controls (HC).MethodsJapanese patients were diagnosed with DSM-IV-TR and clinical symptoms were assessed with the Hamilton Rating Scale for Depression for MDD and the Positive and Negative Syndrome Scale for SCZ. CSF was obtained from MDD (n = 90) and SCZ (n = 86) and from age- and sex-matched HC (n = 106). The levels of MMPs in CSF were measured with multiplex bead-based immunoassay.ResultsThe levels of MMP-2 in CSF were higher in both MDD and SCZ than HC and were positively correlated with clinical symptomatic scores in MDD, but not in SCZ. Regardless of diagnosis, the levels of MMP-2, -7, and -10 were positively correlated with each other, and the levels of MMP-7 and -10 were higher in MDD, but not in SCZ, compared with HC.ConclusionIncreased CSF levels of MMP-2 in MDD and SCZ may be associated with brain inflammation. State-dependent alteration of MMP-2 and activation of cascades involving MMP-2, -7, and -10 appeared to have a role in the pathophysiology of MDD.