Nonschizophrenic Patients Research Articles

Evaluation of Schneiderian First-rank Symptoms in Patients of Psychosis Attending a Tertiary Care Center from North India

Abstract Background: The Schneiderian first-rank symptoms (SFRS) have played an extremely important role in the diagnostic systems in psychiatry. However, all studies do not seem to support Schneider’s claim that FRS confer a clear indication of schizophrenia when no organic syndrome is present. Objectives: The objectives of this study were as follows: (1) to examine the presence of SFRS in untreated cases of psychosis, (2) to see the degree of improvement in SFRS with treatment over 12 weeks of short-term follow-up, (3) to see correlation of SFRS with sociodemographic and clinical parameters in our patients, and (4) to see the correlation of SFRS among diagnostic subgroups in our patients. Materials and Methods: Setting: Psychiatry department of a multi specialty tertiary care center in North India. Study Design: This was a short-term prospective study. After taking ethical clearance from the institutional ethics committee and written informed consent from all the patients, data sets were prepared for 60 patients of untreated psychosis. Data analysis was done using the SPSS version 20.0. Results: Voices discussing (83.33%) and voices commenting (80%) were the most commonly noted SFRS, and the mean number of SFRS in our sample was 3.34. Somatic passivity (f = 10.80, P = 0.0001) and thought insertion (f = 6.75 and P = 0.004) could significantly differentiate between schizophrenia and other diagnostic subgroups of untreated psychosis in our study. Conclusions: Only somatic passivity, delusional perception, and thought insertion were extremely specific in distinguishing the patients of schizophrenia from nonschizophrenic patients.

Dry Eye Disease in Patients With Schizophrenia: A Case-Control Study.

ObjectiveTo evaluate the clinical features and inflammatory cytokines of dry eye disease (DED) in patients with schizophrenia.MethodsThis is a case-control study. The modified self-rating depression scale (M-SDS) and the ocular surface disease index (OSDI) were used to evaluate the symptoms of depression and DED, respectively. Lipid layer thickness (LLT), partial blink rate (PBR), meibomian gland loss (MGL), tear break-up time (TBUT), corneal fluorescein staining, Schirmer I-test, and eyelid margin abnormalities were also measured. A multiplex ELISA Quantibody array was used to detect the inflammatory cytokines in the tears of all participants.ResultsForty schizophrenic patients and 20 control subjects were included. The mean age was 45.0 ± 9.5 years (range, 22–63 years) in schizophrenic patients and 45.4 ± 16.2 years (range, 23–76 years) in controls (P = 0.914). The ratio of male to female was 1.1 in schizophrenic patients and 1.0 in controls (P = 0.914). Ten women (52.6%) with schizophrenia and 2 (20%) in the control group (P = 0.096) were menopausal or post-menopausal. The OSDI [0.0 (0.0–4.2) vs. 7.3 (2.1–14.6)] and TBUT [4.5 (3.0–6.0) vs. 10.0 (3.5–11.0)] were significantly lower in patients with schizophrenia than in controls (P = 0.003 and P = 0.009, respectively). The rate of MGL [36.5 (17.5–47.5) vs. 8.5 (0.0–17.5)] increased in schizophrenic patients (P < 0.001). Among pro-inflammatory cytokines, the levels of interleukin (IL)-1α, IL-6, IL-11, IL-12A, IL-15, IL-17A, and granulocyte colony-stimulating factor (G-CSF) in tears were elevated in the schizophrenia group (all P < 0.01). Most of the chemokines examined were at increased levels in the tears of schizophrenics (all P < 0.05). The levels of matrix metalloproteinases-9 (MMP-9) and intercellular adhesion molecule-1 (ICAM-1) were also higher in the schizophrenic patients (all P < 0.001). The concentrations of IL-1Ra, tissue-inhibitor of metalloproteinase-1 (TIMP-1), and TIMP-2 in the schizophrenia group were decreased (all P < 0.001). In schizophrenic patients, the level of CCL2 in tears was positively correlated with OSDI (R = 0.34, P = 0.03). The increasing TIMP-1 and decreasing IL-5 were correlated with increasing LLT (R = 0.33, P = 0.035; R = −0.35, P = 0.027, respectively). The level of ICAM-1 was then positively correlated with partial blink rate (PBR) (R = 0.33, P = 0.035). There was a negative correlation between IL-8 and the Schirmer I-test (R = −0.41, P = 0.009).ConclusionsPatients with schizophrenia were more likely to experience asymptomatic DED, with mild symptoms and obvious signs. The inflammatory cytokines in the tears of schizophrenic patients differed greatly from that of non-schizophrenic patients.

Revisiting the “obsessional slowness” syndrome

IntroductionObsessional slowness (OS) is a rare condition of disabling slow motor performance, first described in 1974, by Rachman, who documented 10 cases of “primary obsessional slowness”. Rachman argued that, although his patients with OS had Obsessive Compulsive Disorder (OCD), their motor symptoms were not related to the presence of motor-slowness-triggering obsessions/compulsions (e.g. checking and mental rituals). Whether OS truly is a distinct and “primary” entity is still a controversial issue, however.ObjectivesTo present and discuss the phenomenology of OS.MethodsCase reports of OS published in the literature, including Rachman’s descriptions.ResultsThe literature on OS is extremely limited, with no published, large-scale descriptive studies or randomized controlled trials. Some authors doubt that OS is a “primary” condition, pointing out the clear overlap between OS and catatonia and emphasizing that the latter disorder also occurs in non-schizophrenic patients, for example, ones with OCD. Additionally, OCD and depression often co-occur. Thus, in severe cases, it may be challenging to disentangle the separate contribution of both disorders to psychomotor slowness. It is also crucial to exclude the possibility that a patience has juvenile parkinsonism or other causes of motor slowness before diagnosing him/her with OS, given that the diagnostic approaches and treatment strategies for OS and the aforementioned disorders differ.ConclusionsOS seems to be a rare but often disabling motor manifestation of OCD, rather than a primary disease entity. However, some cases sit on the edge of current diagnostic criteria. Future research should help define OS more precisely.DisclosureNo significant relationships.

Polymorphism of Dopamine D2-141C Ins/Del Receptor Gene in Paranoid Schizophrenia and Non Schizophrenia Patients of Batak Ethnicity in Sumatera Utara

Introduction: Schizophrenia is a chronic mental condition which is characterized by reality distortion as well as thought, speech and behavior disorders. Several factors that may cause schizophrenia include genetic abnormalities of dopamine receptors that contribute to disorders in function of the brain, several studies have found an association between schizophrenic and non schizophrenic patients in the dopamine receptor gene polymorphism D2 -141C Ins/Del. Aim: To investigate the relationship of DRD2 -141C Ins/Del gene polymorphism in schizophrenic and non-schizophrenic patients of Batak ethnicity in Sumatera Utara, Indonesia. Methods: This research was done as an unpaired analytical case-control study. The subjects of the study were DNA isolates obtained from 60 patients of paranoid schizophrenia and 54 non-schizophrenia of Batak ethnicity in Sumatera Utara, Indonesia. PCR examination was performed on the DNA isolates to examine D2 -141C Ins/Del dopamine receptor gene polymorphism. The data collected were then analyzed statistically. Result: In this study, three variants of DRD2 gene polymorphism (I/D: 304bp, 160bp, 144bp), (I/I: 160bp, 144bp), (D/D: 304bp) was identified. In both schizophrenic and non-schizophrenic patients, the highest I/D genotypes were identified (71.7%) and (63%) , and the least D/D genotypes were identified (6.7%) and (7.4%) with p = 0.726. Based on the allele distribution there was no difference of risk on allele D and allele I on the cause factor of schizophrenia (OR: 1.13; 95% CI: 0.66-1.92). According to Hardy-Weinberg Equilibrium law, both schizophrenic and non schizophrenic patients of Batak ethnicity in Sumatera Utara is in disequilibrium p = 0.0002 and p = 0.0057 with significance of p <0,05. Conclusion: There is no significant association between genotypic distribution and DRD2 -141C Ins/Del gene alleles in schizophrenic and non schizophrenic patients.

The evidence for a birth order factor in schizophrenia.

The evidence for a birth order factor in schizophrenia is reviewed, and a paradoxical situation is revealed. Previous conclusions pointing to an over-representation of early born from small families and late born from large are confused by the report of a large sample of psychiatric patients by Hare and Price. This showed that similar distortions in birth order distribution occur in the non-schizophrenic patients to a greater extent than in the schizophrenic patients. An attempt is made to resolve this paradox. The reported distortions are assumed to be a feature of the general population. It is then hypothesized that they are diminished in the schizophrenic sample by a secondary over representation of another intermediate birth position. Evidence is given for a specific over-representation of the last-but-one position in schizophrenic samples.

Perforated appendicitis in patients with schizophrenia: a retrospective cohort study

ObjectiveAltered pain sensitivity may affect the outcome of appendicitis in patients with schizophrenia. We aimed to compare the prevalence of perforation in appendicitis between patients with and without schizophrenia.DesignRetrospective cohort...

Screening of cardiovascular risk factors in patients with schizophrenia and patients treated with antipsychotic drugs: are we equally exhaustive as with the general population?

ABSTRACTMany studies have previously shown increased cardiovascular risk factors related to schizophrenia independently from the use of antipsychotic drugs. However, a poorer effort in clinical detection and management of cardiovascular risk in patients with severe mental illness could also explain these results. To test this hypothesis, we analyzed the differences in screening and incidence of cardiovascular risk factors between schizophrenia, non-schizophrenic patients on treatment with antipsychotic drugs (NS-TAD) and the general population.Data from adult subjects assessed by high-quality register general practitioners from 2006 to 2011 were extracted from the Catalonian SIDIAP database. The schizophrenia, NS-TAD, and control groups were compared in terms of measurements and incidence of diabetes, dyslipidemia, obesity, hypertension, and smoking.A total of 4911 patients in the schizophrenia group, 4157 in NS-TAD group, and 98644 in the control group were included. Schizophrenia patients were screened for dyslipidemia and diabetes more frequently than the control group, while for obesity or hypertension, they were screened equal to controls. Also, as compared to the control group, the NS-TAD group was more frequently screened for obesity with no differences in dyslipidemia and diabetes and less frequently for hypertension. Smoking was less frequently screened in both study groups. The incidence of all risk factors studied in both study groups was higher than or equal to the control group, except for hypertension, which had lower incidence.The lack of screening of risk factors does not appear decisive in the increased cardiovascular risk of patients diagnosed with schizophrenia seen in primary care. Studies evaluating the possible under diagnosis of the risk factors are required.Abbreviations: Schizophrenia (SZ); Treatment with antipsychotic drugs (TAD); Cardiovascular risk factor/s (CVRF); Without schizophrenia but on therapy with antipsychotic drugs (NS-TAD); Defined Daily Dose (DDD).

Female schizophrenia patients and risk of breast cancer: A population-based cohort study

ObjectiveBreast cancer is the most common type of cancer in women. This population-based cohort study aimed to examine the association between breast cancer in female schizophrenia patients and its association with the use of antipsychotics drugs. MethodsAll study subjects were selected from the Taiwan Insurance Claims Data (1998–2008). We compared the risk for breast cancer between female schizophrenia patients receiving antipsychotics (n=29,641) with female patients without any serious mental illnesses nor receiving antipsychotic drugs (n=59,282). We also compared between patients on 1) first-generation antipsychotics (FGAs) alone; 2) combination of first and second generation antipsychotics (SGAs); and 3) SGAs alone. We then stratified those on SGAs into two subgroups according to their prolactin-elevating properties: risperidone (RIS), paliperidone (PAL) or amisulpride (AMI) and all other SGAs. ResultsAfter adjusting for confounding factors, the risk of breast cancer in female schizophrenia patients was 1.94 higher than the non-schizophrenia cohort (aHR: 1.94, 95% CI: 1.43–2.63). Schizophrenia patients receiving a combination of FGAs and SGAs had a slightly higher risk of breast cancer than non-schizophrenic patients (aHR: 2.17, 95% CI: 1.56–3.01). Patients on RIS, PAL, and AMI had a 1.96-fold risk of breast cancer compared to the non-schizophrenic cohort (95% CI: 1.36–2.82). ConclusionsThis study raises awareness among both clinicians and patients about the importance of breast cancer screening and the promotion of healthy lifestyle choices. Due to the nature of our database, confounding factors – such as parity, obesity, hormone therapy, and smoking - could not be controlled for.

Comorbidity, stigma and emotional perception in psychiatric disorders

Schizophrenia is associated with significant comorbidity and mortality—patients seemingly suffer more often from type-2 diabetes mellitus, diabetogenic complications plus environmentally influenced conditions than non-schizophrenic patients. Schoepf et al. [1] in a 12-year follow-up study with 1,418 adult schizophrenic patients and 14,180 ageand gender-matched hospital controls compared whether comorbidities with somatic diseases in fact lead to higher mortality. They discovered many of them to be more prevalent plus associated with a worse outcome in the schizophrenia population, whereas these patients suffered less from hypertension, hyperlipidemia, angina and cataract than controls. In the end, except parkinsonism the hospital mortality due to comorbid physical diseases did not significantly differ from the control population. Parkinsonism, again, was significantly prevalent in deceased schizophrenic patients compared to those surviving the study period. Anyhow, the authors recommend to thoroughly monitor and manage the most prevalent comorbidities in schizophrenia. Since there is an overlap between affective and schizophrenia symptoms in a large group of patients, Wilson et al. [2] critically question the reliability and clinical utility of the diagnosis of schizoaffective disorder after finding statistically significant deviances between clinical and research diagnoses in 134 psychiatric inpatients: While the treating clinicians had diagnosed 48 of these patients with schizophrenia, 50 with schizoaffective disorder and 36 with psychotic bipolar disorder, trained research personal again using the Structured Clinical Interview of the DSM-IV-TR inclusive an explicit time threshold for criterion C diagnosed 64 patients with schizophrenia, 38 with schizoaffective disorder and 32 with psychotic bipolar disorder. The authors assume a tendency for less severe diagnoses on clinician side and advocate a more stringent criterion C for the diagnosis schizoaffective disorder to address an implicit bias in clinical practice, which in the end might affect the prevalence of the psychotic disorder diagnoses. Only few studies so far have broached the issue of disempowerment and stigma-related stress in patients with mental illness due to involuntary hospitalization. Rusch et al. [3] assessed shame and self-contempt, self-stigma, empowerment, quality of life and self-esteem in 186 seriously mentally ill persons. Self-stigma was significantly associated with higher stigma stress levels independent of psychiatric symptoms, diagnosis, age, gender or the number of involuntary hospitalizations during lifetime inducing a negative effect on quality of life and empowerment. Thus, emotional reactions and stigma as a stressor should be considered in interventions to reduce the negative effects of compulsory measures. In an fMRI study with 18 female patients with a diagnosis of borderline personality disorder and 18 healthy female controls, Scherpiet et al. [4] investigated whether not only the perception of emotional stimuli but also the mere anticipation of upcoming emotional pictures leads to emotional dysregulation associated with the disorder. Compared to controls, the patient sample showed deficient recruitment of various brain areas related to cognitiveemotional interaction already in the anticipation phase of both negative and ambiguously announced stimuli possibly adding to the emotional dysregulation and contributing to hypersensitivity toward emotional cues. Emotional perception is also subject of Schonenberg and Jusytes [5] A. Schmitt (&) P. Falkai Department of Psychiatry and Psychotherapy, LudwigMaximilians-University Munich, Nusbaumstr. 7, 80336 Munich, Germany e-mail: Andrea.Schmitt@med.uni-muenchen.de

A Comparison of New and Revised Rorschach Measures of Schizophrenic Functioning in a Serbian Clinical Sample

We empirically evaluated indexes derived from the Rorschach Comprehensive System (CS) and the Rorschach Performance Assessment System (R–PAS) that are used for the assessment of psychotic functioning in schizophrenia. We compared the Perceptual Thinking Index (PTI) and the Ego Impairment Index (EII–2) with their revised versions: Thought and Perception Composite (TP–Comp) and EII–3. We evaluated their predictive validity for differentiating schizophrenic from nonschizophrenic patients in a Serbian sample. The sample consisted of 211 (109 men and 102 women, 18–50 years old) inpatients in Serbia who were divided into 2 groups: schizophrenic (100) and nonschizophrenic (111). Test administration, coding, and form quality classification followed CS guidelines. Logistic regression analysis indicated that the new indexes TP–Comp and EII–3 have slightly better predictive power than their counterparts, PTI and EII–2, in identification of schizophrenia, and that TP–Comp performed better than other indexes, although all 4 indexes were successful in differentiating these groups. The results supported the use of TP–Comp in diagnosis of schizophrenia and generally provided evidence for the utility of the Rorschach in evaluating psychosis and for its use in a cross-national context.

Cancer Risk Among Future Schizophrenic Patients? A Biased Inference

The study by Ji et al1 is based on the excellent Swedish population-based registers. Unfortunately, there are methodological flaws in the analyses of these excellent data. The main criticism is the estimation of the “risk” of cancer in persons who develop schizophrenia in the future. In Ji et al, nonschizophrenic patients are those who die, emigrate from Sweden, or are alive and reside in Sweden without being diagnosed with schizophrenia within eg 20 years. Schizophrenic patients are those who survive, reside in Sweden, and are diagnosed with schizophrenia within the same time period. Persons with life- threatening cancers have poor survival and therefore a low chance of being attributed to the “future schizophrenic patient” group. Provided with the knowledge that the group of “future schizophrenia patients” cannot die from their cancer within the study period, it is not surprising that “future schizophrenic patients” have a decreased “risk” of cancer. To sum up, in their Table 2, they found that hypothetical persons who survive, do not emigrate from Sweden, and are registered with schizophrenia later during the study period have a decreased risk of any cancer compared with persons who are allowed to die and emigrate from Sweden during the study period (SIR=0.40) [before schizophrenia diagnosis], while persons who have developed schizophrenia have no decreased risk of any cancer (SIR=1.00) [after schizophrenia diagnosis]. No meaningful inferences can be drawn on the risk of cancer in a group of persons who are destined to survive long enough to be diagnosed with schizophrenia. A similar flaw was first described in the Stanford Heart Transplantation Program assigning patients to groups at time of transplantation instead of at time of enrolment for a new heart.2 In contrast, the inferences by Ji et al regarding the time period after being diagnosed with schizophrenia is appropriate. In this group of persons, the authors observed no overall increased risk of cancer in persons with schizophrenia. In other words, the result in Ji et al is negative, in the sense that there is no overall association between schizophrenia and cancer. Unfortunately, there are other flaws in the analyses of these excellent data that merits attention. The authors follow the total Swedish population from 1965 onwards until development of cancer, using information on first registered diagnoses with schizophrenia as a proxy for time of onset. This sort of analyses is based on the inherent assumption that for all persons followed they have information of the time of onset of both schizophrenia and cancer. For patients with both schizophrenia and cancer, the analyses, therefore, also assume knowledge of which disorder came first. Without this knowledge, it is not possible to provide meaningful inferences on the risk of cancer in patients with schizophrenia. The Swedish Hospital Discharge Register was first established in 1964 and from this year onwards, diagnoses from any contact to the Swedish psychiatric services were recorded. The first registered diagnoses can only be a meaningful proxy for time of onset if patients have the ability to be registered at time of onset. Due to the data collection procedure, a person born in eg 1920 cannot be registered with schizophrenia before 1964; inherent in their analyses of the data they are assuming that any diagnosis given after 1964 represents the patients’ first onset with schizophrenia,3 an obviously invalid assumption. As a consequence, it is not surprising that the authors demonstrated a higher age of onset with schizophrenia than reported in any previous study including true incident cases. The direction of the bias due to the reverse causality introduced cannot be evaluated. We recommend that the authors limit their analyses to a population for which they have information on time of first admission with both schizophrenia and cancer. A reasonable definition of such a population could be persons who were born in Sweden 1955–1995, and the analyses could then follow these persons forward in time. Also, within any observational study, one can divide persons into groups based on the persons’ past experience and provide meaningful inferences. However, when a researcher retrospectively divides persons into groups based on future experiences, any inferences will be meaningless. Unfortunately, this was the case in the study by Ji et al.

Hypothermia Associated With Antipsychotic Drug Use: A Clinical Case Series and Review of Current Literature

Hypothermia as an adverse reaction of antipsychotic drug use represents a potentially life-threatening complication. However, the mechanisms by which antipsychotic drugs alter thermoregulatory processes in the human body are far from being fully understood. Here we present a case series of 5 patients developing severe hypothermia after administration of olanzapine and benperidol. Controlled by a network of neural structures, body temperature is physiologically regulated in far more narrow boundaries than are other vital functions, and its homeostasis is critical for survival. The preoptic region in the ventral hypothalamus is assumed to act as a coordinating center that is endowed with thermosensory units that constantly compare actual body temperature with target values and initiate regulatory and compensatory mechanisms in case of mismatch. Hypothermia risk seems to increase in the first days after initiation of antipsychotic drug therapy or increases in the daily dose. Schizophrenic patients bear a higher risk than nonschizophrenic patients treated with antipsychotic drugs (such as patients with dementia or depression). Antipsychotic drugs with strong 5-HT2 antagonism seem to be more frequently associated with hypothermia. These cases demonstrate the clinical relevance of hypothermia as an adverse reaction to antipsychotic treatment and the importance of careful monitoring of body temperature.

Caregiving Experiences of Families Living with Patients with Schizophrenia: a Systematic Review.

Review question/objective The objective of the review is to determine the meaningfulness of caregiving experiences of families living with patients with schizophrenia. The specific review question is: - What are the experiences of caregivers who live with patients with schizophrenia? Inclusion criteria Types of participants The review will consider studies that include the family of person (18 years and older) with schizophrenia diagnosed for at least six months by any criteria based on the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders Third Edition Revised (DSM-III-R), the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM-IV), the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders Fourth Edition Text Revision (DSM-IV TR), the World Health Organization's International Statistical Classification of Diseases and Related Health Problems (ICD-10), or confirmed by their attending psychiatrists. Non-schizophrenic patients such as patients with psychosis, depression, bipolar, dementia, alcoholism, and substance-related disorders will be excluded. The family is defined as key persons who live or who are in close contact with the patient or who provide care or have taken on role as the main caregivers for a family member with schizophrenia. The caregivers should be at least 18 years old who can be parents, siblings, spouses, children, or other relatives. This review will consider studies in any culture. Studies that explore experiences of patients with schizophrenia will be excluded. Caregiving experiences are defined as any subjective data that families expressed or shared about their feelings and perceptions related to their caring or living with their schizophrenia member including caring tasks, feeling or attitudes or beliefs, needs, coping or help seeking behaviours or ways to solve problems. Types of intervention(s)/phenomena of interest The review will consider qualitative studies that explore caregiving experiences of families of patients with schizophrenia that related to their caring or living with their schizophrenia member including caring tasks, feeling or attitudes or beliefs, needs, coping or help seeking behaviours or ways to solve problems. This review will include studies conducted in either hospital or community settings. TRUNCATED TO 350 WORDS.

Increased Risks of Acute Organ Dysfunction and Mortality in Intensive Care Unit Patients With Schizophrenia

To investigate the risks of acute organ dysfunction and death in intensive care unit (ICU) patients with schizophrenia. Using a retrospective matched cohort design, we compared 203 schizophrenic patients to 2036 demographically matched (1:10) nonschizophrenic patients with first-time ICU admission between 2005 and 2007 using the claims data of a nationally representative cohort from the Taiwan National Health Insurance Research Database. Definitions of schizophrenia and associated diagnoses were based on the codes of the International Classification of Diseases, Ninth Revision, Clinical Modification. Analyses were performed using univariate and multivariate analyses. The median age of schizophrenic patients was 53 years; 61.1% were men. Schizophrenic patients were less likely to be hospitalized in a medical center and had fewer surgical conditions and principal cardiovascular diagnoses, but they had a higher prevalence of infection than nonschizophrenic patients. After controlling for the aforementioned baseline covariates, schizophrenic patients had a higher risk of acute organ dysfunction (adjusted odds ratio = 1.52, 95% confidence interval = 1.09-2.10). When individual organ systems were analyzed, they had a 47% higher risk of respiratory dysfunction, a 194% higher risk of renal dysfunction, and a 122% higher risk of neurological dysfunction than nonschizophrenic patients. Hospital mortality was also higher in schizophrenic patients than in nonschizophrenic patients (24.1% versus 14.4%, p < .001; adjusted odds ratio = 1.56, 95% confidence interval = 1.08-2.24). Among ICU patients, schizophrenic patients were sicker, having a higher risk of acute organ dysfunction and death.

The effects of hypertension and body mass index on diffusion tensor imaging in schizophrenia

Recently, the negative effects of hypertension and elevated body mass index on cognitive functioning in schizophrenia have been reported (Friedman et al., 2010). Data suggests that cognitive changes in hypertensive patients from the general population may be mediated, in part, by white matter damage. Therefore, we performed diffusion tensor imaging (DTI) in the same subjects studied by Friedman et al. (2010) to investigate the effects of hypertension and elevated body mass index on the fractional anisotropy (FA) of several major white matter tracts. Significant interactions between a diagnosis of schizophrenia and hypertension on FA in several white matter regions were detected. Hypertension was associated with lower FA in the schizophrenic group and higher FA in the same tracts in the non-schizophrenic subjects. These results suggest hypertension-induced compensatory mechanisms in the brains of non-schizophrenic patients with hypertension which may be impaired in persons with schizophrenia.

Practical value of the mental disorders predictive scale for screening schizophrenia

Objective To explore the assessment value of the Mental Disorders Predictive Scale(MDPS) for the screening of schizophrenia. Methods 200 schizophrenic patients,371 non-schizophrenic patients and 300 normal controls were tested and compared by MDPS. Taking 11 factor scores as the independents,the Fisher's dis-criminant functions were built by Bayes' stepwise discriminant analysis. Results The total score and all factor scores of schizophrenic group and non-schizophrenic group were significantly higher than those of the control group (P<0.05);some factor scores of schizophrenic group were significantly higher than those of the non-schizophrenic group. Family and past history, social support deficiency, personality disturbance, depression, neurosis and psy-chosis entered the discriminant functions according to the entry criteria of the models. The correctly classified rates of the original grouped cases by the discriminant models were 68. 0% for schizophrenic patients,75.5% for non-schizo-phrenic patients,92.1% for the normal controls, and the total coincidence was 79.2%. Conclusion MDPS is more ap-plicable for the screening of schizophrenia and has a good clinical value. Key words: Mental disorders predictive scale; Schizophrenia; Discriminant analysis

Acute care hospital mortality of schizophrenic patients

Although schizophrenic patients have higher mortality than the general nonschizophrenic population, few studies have investigated acute care hospital mortality of schizophrenic patients. To assess acute care hospital mortality of schizophrenic patients, we analyzed hospital mortality, the risk factors for hospital mortality, and the causes of death of schizophrenic patients admitted to an acute care hospital in Japan over an 18-year period. We identified 55 deaths among 1108 schizophrenic patients, for a mortality rate of 5.0%. The overall standardized mortality ratio was 1.29 (95% CI, 0.98-1.68) compared with nonschizophrenic hospitalized patients. Significant risk factors for mortality were malignant neoplasm, cardiovascular disease, and admission through the emergency department. The leading causes of death in acute care hospitalizations were suicide (14.5%), malignant lymphoma or leukemia (10.9%), stroke (9.0%), and sepsis (7.3%). There was a nearly significant trend toward increased mortality of schizophrenic patients receiving acute hospital care compared with that of nonschizophrenic patients. Because suicide was the most frequent cause of death, a focus on suicide prevention is needed in this population.

Tendência temporal da esquizofrenia: um estudo realizado no âmbito hospitalar

OBJETIVO: Verificar as variações quanto a sexo, idade, número e tempo de internação em pacientes com esquizofrenia. MÉTODOS: O estudo foi realizado no Hospital Doutor João Machado, referência estadual psiquiátrica, situado em Natal/RN - Brasil, no período de 1999 a 2005. O número de casos, o tempo de internação, a idade e o sexo foram coletados. Esses dados foram analisados pela estatística descritiva e Teste de Mann-Whitney com nível de significância de 5%. RESULTADOS: Durante esse tempo, 12.732 pessoas foram internadas. Os portadores de esquizofrenia corresponderam a 35,35% (4.501). A permanência no hospital foi de 44,33 ± 36,9 dias, diferente daquela observada nos não-portadores de esquizofrenia, 29,5 ± 61,6 dias (p &lt; 0,0001). A idade média foi de 38,7 ± 13,5 anos, sendo a maioria dos pacientes do sexo masculino (65,78%). Em 1999, de cada 100 internados, 39,8 eram portadores de esquizofrênia; em 2005 essa proporção reduziu-se para 30,1. A esquizofrenia paranóide foi a mais freqüente, ocorrendo em 1.829 (40%) dos pacientes durante o período. CONCLUSÕES: O estudo aponta uma tendência à redução no número de doentes internados com esquizofrenia, bem como uma diminuição no tempo de internação.

Associations between Chlamydophila infections, schizophrenia and risk of HLA-A10

Several microbes have been suspected as pathogenetic factors in schizophrenia. We have previously observed increased frequencies of chlamydial infections and of human lymphocyte antigen (HLA)-A10 in independent studies of schizophrenia. Our aim here was to analyze frequencies of three types of Chlamydiaceae in schizophrenic patients (n=72), random controls (n=225) and hospital-patient controls (n=36), together with HLA-A genotypes. Patients were diagnosed with schizophrenia according to Diagnostic and Statistical Manual of Mental Disorders-IV. Blood samples were collected at the beginning of hospitalization and analyzed with Chlamydiaceae species-specific polymerase chain reaction (PCR). Control panels consisted of randomly selected volunteers and hospitalized, non-schizophrenic patients. We found chlamydial infection in 40.3% of the schizophrenic patients compared to 6.7% in the controls. The association of schizophrenia with Chlamydiaceae infections was highly significant (P=1.39 x 10(-10), odds ratio (OR)=9.43), especially with Chlamydophila psittaci (P=2.81 x 10(-7), OR=24.39). Schizophrenic carriers of the HLA-A10 genotype were clearly most often infected with Chlamydophila, especially C. psittaci (P=8.03 x 10(-5), OR=50.00). Chlamydophila infections represent the highest risk factor yet found to be associated with schizophrenia. This risk is even further enhanced in carriers of the HLA-A10 genotype.

Successful treatment of polydipsia, water intoxication, and delusional jealousy in an alcohol dependent patient with clozapine

The beneficial effect of clozapine on polydipsia and water intoxication in patients with schizophrenia has been demonstrated many times. The authors report a successful clozapine treatment of polydipsia, intermittent water intoxication, and delusional jealousy of an alcoholic. This is a rare case of clozapine treatment of a non-schizophrenic patient affected by polydipsia.