PANSS Scale Research Articles

Basic demographic outcomes: additional findings of a single-blind, randomised, controlled trial on metacognitive training for psychosis

ABSTRACT Background: Evidence of the effect of metacognitive and social cognitive impairment on the symptoms and functioning of patients diagnosed with schizophrenia led to the development of the Metacognitive Training. We hypothesise that improvement in these cognitive functions leads to less severe symptoms and to better adaptation to real-life social situations, which would be reflected in aspects of the patients’ demographic status. Method: We report the additional findings of a randomised, controlled, single-blind study with a six-month follow-up period. We provided 36 patients with training to improve their metacognition and social cognition. The control group received treatment as usual. Symptom severity, measured by the PANSS scale, and demographic data were assessed at baseline and six months after the training. Results: Compared to the control group, the intervention group showed less severe symptoms, and achieved more progress in demographic status. These steps may be statistically non-significant; yet, may represent crucial changes in some patients’ lives. Conclusions: Metacognitive Training is not only an appropriate method to decrease symptom severity, but the training of metacognitive and social cognitive functions can also contribute to a better adaptation to real-life.

The phenomenon of aggression in individuals with schizophrenia

Objective: to compare and identify differences in the psychopathological symptoms and domains of social cognition in groups of individuals suffering from schizophrenia with a high level of aggression with or without alcohol consumption.Materials and methods. In the period from 2014 to 2020, we performed a comparative, cross-section, one-stage, observational study with the formation of a sample by the method of directed selection at Gomel Regional Clinical Psychiatric Hospital. The following assessment methods were used: 1. Screening for alcohol use — ASSIST scale (Humeniuk R. et al. 2008), 2. Determination of the level of aggression — OAS scale (Yudofsky SC 1986), 3. Degree of severity of psychopathological symptoms — PANSS scale (S. Kay, L.Opler 1986), 4. Hostile attributive style of the AIHQ scale (Combs D. R. et al., 2007). 5. The research of emotional processing was performed using a computerized neuropsychological battery (PennCNP) to study the neuropsychological functioning of the Laboratory of Brain Problems of the University of Pennsylvania.Results and discussion: The group with a preclinical level of alcohol consumption revealed changes in emotional processing (″reduced facial memory″), a bias in the attributive style towards hostility, and changes in the psychopathological symptoms, such as an increase in ″emotional lability″ and ″decreased judgment and awareness of the disease″. In the group without alcohol consumption, an increase in ″false positive recognition of neutral emotions″ and an increase in the degree of manifestation of the symptom of ″delusion″ were revealed.Conclusion: Alcohol and aggression are in conjunction with the psychopathological symptom ″emotional lability″ (PANSS scale) and the domain of social cognition ″attributive style″ (″anger index″). In the group without alcohol consumption, aggression is related to the ″delusion″ symptom.

Evaluation of IGF-1 as a novel theranostic biomarker for schizophrenia

ObjectiveIn the current study, we aimed to investigate fasting plasma levels of glucose, insulin, growth hormone, IGF-1, and lipid profile in remission schizophrenia patients, treatment resistant schizophrenia patients and healthy controls and to determine whether IGF-1 levels can be used as a theranostic biomarker in schizophrenia. MethodsSixty-two patients under remission from schizophrenia, sixty-five treatment-resistant patients with schizophrenia and sixty-two healthy controls were included in the study. All patients were recruited and evaluated over 11 months. Symptoms at the time of evaluation were assessed twice using BPRS, PANSS, CGI, and GAF scales by an experienced psychiatrist in accordance with Andreaseen's remission criteria and TRIPS group resistance criteria. Blood samples were collected from all participants to determine fasting glucose, LDL, HDL, Triglyceride, Total Cholesterol, fasting, insulin, GH and IGF-1 levels. ResultsFasting blood glucose levels were found to be higher in patients with schizophrenia than in healthy controls. Moreover, LDL levels of the treatment sensitive group were higher than that of the treatment resistant group while they were not significantly different from the healthy controls. IGF-1 levels were lower in the treatment sensitive group than in both treatment resistant and healthy control groups. IGF-1, LDL and age of disease onset were found to be significantly associated with treatment resistance in a regression model. DiscussionIn the present study, remitted patients with schizophrenia could be distinguished from treatment-resistant patients and healthy controls with serum IGF-1, fasting glucose and LDL levels. In addition, we found that smoking and age of disease onset together with IGF-1 levels could significantly predict resistance to treatment.

Brain stimulation effects on serum BDNF, VEGF, and TNFα in treatment‐resistant psychiatric disorders

Resistance to pharmacological treatment poses a notable challenge for psychiatry. Such cases are usually treated with brain stimulation techniques, including repetitive transcranial magnetic stimulation (rTMS) and electroconvulsive therapy (ECT). Empirical evidence links treatment resistance to insufficient brain plasticity and chronic inflammation. Therefore, this study encompasses analysis of neurotrophic and inflammatory factors in psychiatric patients undergoing rTMS and ECT in order to refine the selection of patients and predict clinical outcomes. This study enrolled 25 drug-resistant depressive patients undergoing rTMS and 31 drug-resistant schizophrenia patients undergoing ECT. Clinical efficacy of brain stimulation therapies was gauged using MADRS and HAM-D scales in the depression group and PANSS scale in the schizophrenia group. Blood-derived BDNF, VEGF, and TNFα were analysed during the treatment course. For reference, 19 healthy control subjects were also enrolled. After statistical analysis, no significant differences were detected in BDNF, VEGF, and TNFα concentrations among healthy, depressive, and schizophrenic subject groups before the treatment. However, depressive patient treatment with rTMS has increased BDNF concentration, while schizophrenic patient treatment with ECT has lowered the concentration of TNFα. Our findings suggest that a lower initial TNFα concentration could be a marker for treatment success in depressed patients undergoing rTMS, whereas in schizophrenic patient group treated with ECT, a higher concentration of VEGF correlates to milder symptoms post-treatment, especially in the negative scale.

Atypical antipsychotics in the treatment of patients with a dual diagnosis of schizophrenia spectrum disorders and substance use disorders: the results of a randomized comparative study

The article presents the results of a randomized comparative study of Aripiprazole and Quetiapine in the treatment of patients with a dual diagnosis: schizophrenia and substance use disorders. During the study, 90 of the 266 male patients were screened. Among them, 54 individuals (60%) had a previously established diagnosis of mental disorder and 36 patients (40%) had no established psychiatric diagnosis. They were randomly randomized into three groups of 30 patients, each receiving an antipsychotic: Aripiprazole at a dose of up to 20 mg daily, Quetiapine at a dose of up to 600 mg daily, or Haloperidol at a dose of up to 30 mg daily. The efficacy of Aripiprazole and Quetiapine was evaluated using the following scales: PANSS, BPRS, VAS, and Substance Craving Scale (SCS). Drug safety was assessed by the development of adverse events, serious adverse events, or adverse reactions. Study results demonstrated the efficacy of atypical antipsychotics in the three groups. Analysis of independent variables showed significant differences between Aripiprazole and Haloperidol in PANSS and BPRS scores by Visit 4, in VAS scores by Visit 3, and in SCS scores by Visit 2. Intergroup analysis of independent variables showed significant differences between Quetiapine and Haloperidol in PANSS, VAS, and SCS scores by Visit 4. Intergroup analysis of independent variables showed significant differences between Aripiprazole and Quetiapine in the VAS and SCS scores. The correlation analysis allowed drawing conclusions about the close connection of the symptoms of schizophrenia and substance use disorders in patients with a dual diagnosis

Quality of life in patients with the first-episode psychosis

IntroductionThe use of a modern biopsychosocial model of care for patients with schizophrenia dictates the need for a dynamic assessment of the quality of life of patients at different stages of the disease to identify targets for treatment and rehabilitation measures. It is especially important to determine the available targets in the early stages of the disease in order to select effective complex therapy and improve the clinical and social prognosis.ObjectivesTo determine the socio-biological and clinical factors that have a significant impact on the quality of life of patients with first-episode psychosis.MethodsThe sample consisted of patients diagnosed with schizophrenia (n=58). The following research methods were used: 1) clinical-psychopathological; 2) quality of life assessment; 3) clinical-laboratory and functional research methods; 4) statistical. The QL-100 questionnaire was used as a tool for studying the quality of life. The PANSS scale was used to assess the severity of positive and negative syndromes.ResultsThe most significant adverse impact on the quality of life indicators are the absence of family, lack of work, low material wealth, active consumption of psychoactive substances, the predominance of negative symptoms and the presence of concomitant somatic disease in the acute phase.ConclusionsEarly identification of problematic aspects of the quality of life in patients with the first-episode psychosis allows us to conduct effective treatment and rehabilitation measures for these patients.

The factors associated with subjective cognitive complaints in schizophrenia

IntroductionSchizophrenia (SKZ) is a chronic, disabling and incapacitating psychiatric disorder. In addition to the traditional symptomes of schizophrenia, the suffering of this patients can be expressed through a set of cognitive complaintsObjectivesTo determe the factors associated with subjective cognitive complaints in schizophreniaMethodsWe conducted a cross-sectional descriptive and analytical study among a sample of of 72 patients followed in psychiatric outpatient of Hefi chaker university hospital in sfax. We used the SSTIC scale to determine subjectif complains ans the PANSS to evalue positif and negatif symptomesResultsThe mean age of our popularion was 46.83± 11.6 years. The patients had a low socio-economic level in 70.1%. They were unemployed in 46.9%, consumed alcohol in 23.6% and consumed tobacco in 58,6% of the cases. the total score on the PANSS scale was 46, distributed as follows: 9 for positive symptoms, 17 for negative symptoms and 22 for total psychopathological assessment. They had an average score of 25 on the total SSTICS score Factors significantly correlated with subjective cognitive complaints were: low socio-economic level (p=0.04), lack of occupation (p=0.001), alcoholism (p=0.001), smoking (p=0.01) and presence of negative symptoms (p=0.00).ConclusionsThis study demonstrates that socio-demographic characteristics and the predominance of negative signs may increase the subjectif cognitif complains in schizophrenia. The recognition of these associations by the psychiatrist can have an important implication in the therapeutic management.

Bayesian models to explain autistic traits in psychiatric population

IntroductionStudies on psychiatric patients have shown that the presence of autistic traits affects the effectiveness of the treatment, decreasing the likelihood of positive clinical outcomes.ObjectivesThe aim of the present study is to investigate which are the areas of overlap between psychiatric symptoms and the traits of the autism spectrum using a bayesian approach.MethodsA sample of 190 adult psychiatric patients, diagnosed with schizophrenia, bipolar disorder, major depression, and personality disorder participated in the study. The RAADS-R questionnaire was used to assess the presence of autistic traits. The severity of psychiatric symptoms was measured with the BPRS and PANSS scales, the perceived well-being and disability using the Whodas and Whoqol scales, the TOL and STROOP for the measurement of executive functions, the attentional matrices for visual-spatial attention, the Raven for general cognitive skills.ResultsNo difference emerged between the diagnoses regarding the presence of symptoms of the autism spectrum, which affects 64% of subjects. Logistic regression showed that the severity of symptoms measured as BPRS and PANSS predicted the probability of having autistic traits. Bayesian regression showed that specific autistic traits are indicative of executive functions deficits. Namely, motor impairment severity measured at RAADS is strongly predicted by rule violation with number of correct moves measured at TOL. The other executive functions seemed to be only moderately linked to autistic traits.ConclusionsThese results provide new information about the expression of comorbidity with autism in psychiatric patients.

Impairment of motivation in patients with schizophrenia and the development of a program for their psychosocial treatment

IntroductionReduced motivation in schizophrenia is expressed is as the reduction of activity and social functioning.ObjectivesAssessment of motivation in patients with schizophrenia and development to their psychosocial treatment.MethodsClinical, psychometric (URICA, PSP, PANSS), statistical. Included 100 patients diagnosed with schisophrenia F.20-29(ICD-10) with various levels of deficit.ResultsThe analysis showed the connection between the intensity of negative disorders of the patients with the level of their motivations: in the group of patients with severe deficiency (pseudoorganic), a decrease in the level of motivation was found: the score of the «Precontemplation» stage of the URICA scale (56.20 ± 9.29) was higher (P <0.001). Patients with moderate deficit (diminished schizoid) changes were distinguished by high motivation, high scores on the «Action» (49.34 ± 8.22, P <0.005) and «Maintenance» scale (52.43 ± 10.51, P <0.005). A negative correlation was established between the indicators of patient motivation and the PANSS scale: will disorders (r = -0.75, P <0.01), social withdrawal (r = -0.64, P <0.01), blunted affect (r = -0.62, P<0.005), etc. High positive correlation found between motivation rating and PSP scores in socially activity (r = 0,74, P <0,005) and social relationships (r = 0,65, P <0,01). We have developed a comprehensive program of psychosocial treatment, including compliance therapy, motivational, cognitive and social skills training, destigmatization actions and an assessment of its effectiveness.ConclusionsThe developed rehabilitation program showed high efficiency: increasing motivation, reducing self-stigmatization, developing communication skills, improving social functioning and cognitive sphere in patients with schizophrenia.

Do we really listen?

IntroductionThe improvement perceived by the patients is a subjective measure of the psychic state, while the clinical evaluation corresponds to an objective evaluation of the psychopathological improvement performed by a psychiatrist. It is therefore relevant to evaluate whether these parameters evolve in a common way after patients have undergone an intervention in Day Hospital focusing on first psychotic episodes.ObjectivesStudy the relationship between subjective improvement and clinical evaluation.MethodsThis is a prospective study, which includes consecutive patients admitted to the Day Hospital during 2018. Their objective clinical improvement was assessed by means of the PANSS and GAF scales at admission and discharge. Subjective clinical improvement was assessed using an anonymous Likert scale with a score between 1 and 7. Sociodemographic data and other satisfaction parameters were also collected. A statistical analysis was performed using Pearson’s correlation.ResultsA total of 73 patients were included. The perception of improvement on the part of the patients is very high presenting average values close to the maximum in almost all the evaluated items. The correlation between subjective improvement and PANSS variation presented a Pearson value 0.008; p = .957 and with the GAF variation presented a Pearson correlation of -0.066; p = .578 which indicates that there is no significant correlation between the variables.Diagnostic groupsFrequencyPercentageDrugs11,4Psychosis3750.7Affective2128.8Neurosis1013.7Personality34.1Total72ConclusionsClinical evaluation and subjective perception of improvement are independent parameters.

Early premorbid of children with ASD

IntroductionAccording to numerous studies, the origins of most endogenous mental diseases, in particular, autism, lie in early childhood. This concept is based on the classical theories of diathesis.ObjectivesThe purpose of this study was to clarify the phenomenology of mental disorders in children with an assessment of the prognostic significance of symptoms that preceded the development of the disease for future mental health.Methods The clinical material was collected during the survey of a child population. Selected for prospective observation was 40 children (1-3 years old) from the high-risk group for schizophrenia with functional disorders of the endogenous spectrum. All patients were examined by clinical methods and pathopsychological, neurophysiological. Psychometric scales PANSS, CARS were used. The results were mathematically evaluated using the Statistica 7 program.ResultsThe clinical picture of the mental state of young children, in children with autistic disorders in 1,5-3 years, was determined by a specific complex of disorders, which were reduced to a general deficit, especially in the emotional sphere, vegetative dysregulation, most often, the sleep-Wake rhythm. Motor skills, as a rule, did not lag significantly behind the age standards. The onset of actual autistic disorders was noted older than 1 year of life. Сhildren received medication and corrective therapy. The detailed clinical picture of violations developed gradually. Dynamics of psychopathological picture in (80,0%) children was regressive.ConclusionsThe study shows the importance of preventive measures in people related to ASD, sparing individual approach in education and therapy.

Research findings on Greek forensic patients found not guilty by reason of insanity. A juxtaposition of patients who committed a criminal offense during their first psychotic episode with those who did so later in the course of their illness

The aim of this study was to compare the baseline characteristics (demographic, psychiatric-psychopathological and legal) among Greek forensic patients found not guilty by reason of insanity. The first step of this approach being differentiating patients who committed a criminal offense during their first psychotic episode from the ones who did so later in the course of their illness. All patients were hospitalized in the Department of Forensic Psychiatry (DFP) of the Psychiatric Hospital of Thessaloniki (PHT) from January 2015 to January 2020 and were examined in order to be included in the study. The final research sample consisted of 78 patients (70 identifying themselves as males and 8 identifying themselves as females) aged 18 and older, 21 of whom committed a criminal offense during their first psychotic episode (FEP, N = 21) and 57 did so later on in the course of their illness (Course, N = 57). Data were collected from multiple sources and several psychometric tools were used (Mini International Neuropsychiatric Interview-M.I.N·I, Positive And Negative Syndrome Scale-PANSS, Addiction Severity Index-ASI, CAGE Questionnaire, Hostility and Direction of Hostility Questionnaire-HDHQ, Global Assessment of Functioning-GAF and Aggression Questionnaire). Comparing the two groups (FEP vs. Course) we found that patients in FEP were younger, had experienced stressful life events in the last 24 months, committed more serious violent crimes, and more frequently attempted suicide after the crime. Their victims were usually members of their family. The main psychometric disparities between the two groups were found in the “Hostility” score of the Aggression questionnaire, and the items “Criticism of Others” and “Paranoid Hostility” of the HDHQ questionnaire, where patients in FEP scored lower. Patients in FEP scored significantly higher in items P1 (delusions), P4 (excitement), P6 (suspiciousness/persecution) and P7 (hostility) of the PANSS scale. No statistically significant differences were found between the two groups regarding their evaluation with the CAGE, ASI or GAF questionnaires. When comparing the patients' present scores in PANSS scale, the patients in FEP had lower total scores in the Positive and the General Psychopathology subscales. Both groups showed significant improvement during hospitalization in all scales (PANSS & GAF), except for the Negative Subscale of the PANSS scale. Through logistic regression analysis, we found that patients in FEP were younger, more likely to have recently experienced stressful life events and more likely to have assaulted a member of their family. Patients with higher scores in the “Hostility” subscale of the Aggression questionnaire were found to remain at risk for committing a crime during the course of their illness. These findings underline the need to design and develop specialized mental health services in order to identify and treat patients involved in violent crime in a timely and effective manner addressing their multiple needs.

White Matter Microstructural Differences between Hallucinating and Non-Hallucinating Schizophrenia Spectrum Patients.

The relation between auditory verbal hallucinations (AVH) and white matter has been studied, but results are still inconsistent. This inconsistency may be related to having only a single time-point of AVH assessment in many studies, not capturing that AVH severity fluctuates over time. In the current study, AVH fluctuations were captured by utilizing a longitudinal design and using repeated (Positive and Negative Symptoms Scale) PANSS questionnaire interviews over a 12 month period. We used a Magnetic Resonance Diffusion Tensor Imaging (MR DTI) sequence and tract-based spatial statistics (TBSS) to explore white matter differences between two subtypes of schizophrenia patients; 44 hallucinating (AVH+) and 13 non-hallucinating (AVH-), compared to 13 AVH- matched controls and 44 AVH+ matched controls. Additionally, we tested for hemispheric fractional anisotropy (FA) asymmetry between the groups. Significant widespread FA-value reduction was found in the AVH+ group in comparison to the AVH- group. Although not significant, the extracted FA-values for the control group were in between the two patient groups, for all clusters. We also found a significant difference in FA-asymmetry between the AVH+ and AVH- groups in two clusters, with significantly higher leftward asymmetry in the AVH- group. The current findings suggest a possible qualitative difference in white matter integrity between AVH+ and AVH- patients. Strengths and limitations of the study are discussed.

Depressive symptoms in involuntary hospitalized patients in Cyprus: Socio-demographic and psychopathological characteristics.

Τhe severity and variation of depressive symptoms (DS), among psychotic individuals under involuntary hospitalization is unclear. We investigated the socio-demographic and clinical characteristics of psychotic adults with DS involuntarily hospitalized for compulsory treatment in Cyprus. We also evaluated the psychometric properties (internal consistency, known-group and discriminant validity) of the HDRS-17 and HAM-A for the assessment of depressive and anxiety symptoms, respectively. A descriptive correlational study with cross-sectional comparisons was applied. Data on demographics, cognitive functioning (MoCA scale), depressive (HDRS-17 scale), anxiety (HAM-A scale) and psychotic (PANSS scale) symptoms were collected (December 2016 -February 2018). Following informed consent, the sample included 406 patients. Among them, 21 males and 23 females reported DS (HDRS-17 total score ≥8). The latter were mainly Greek-Cypriots (61.4%), 45-65 years old (38.6%), single (77.3%), unemployed (72.7%), mainly admitted due to aggressiveness towards others (47.7%), most frequently diagnosed with a bipolar disorder (59.1%). The mean score (M) in the HDRS-17 was 30.72 (scale range: 8-50; Standard Deviation [SD]: 10.42). The highest mean score (M) per item was in the variables "Suicide behavior"'(M:3.09; SD:1.09) and "Depressive mood" (M=2.95; SD=1.07). The DS group (HDRS-17 score≥8) reported higher PANSS positive symptoms subscale score (t-test, p=0.003) and HAM-A total score (t-test, p=0.05) compared to the non-DS group (HDRS-17 score<8). In multivariable logistic regression analysis only female sex [OR (95%CI) = 3.28 (1.33.-8.04), p=0.01)] and a mood disorder diagnosis [OR95% CI: 15.22(4.13.-56.14), p<0.0001)] retained a statistically significant association with DS. Cronbach' s alpha was 0.827 for the HDRS, and 0.763 for the HAM-A. The present findings partially support the known-group validity of the HDRS-17 and the ΗΑΜ-Α, and the discriminant validity of the HDRS-17 in psychotic patients under involuntary hospitalization. Additionally, the most frequent diagnosis in the DS group was a bipolar disorder, and the most frequent admission cause was aggressiveness towards others; it is possible that the majority of the DS group participants were patients with a bipolar disorder in episodes with mixed features, presenting simultaneously depressive symptoms and aggressiveness. Further studies on relapse prevention regarding this clinical group are proposed, as well as studies on specificity and sensitivity of the HDRS-17 and HAM-A.

Cognitive biases are associated with clinical and functional variables in psychosis: A comparison across schizophrenia, early psychosis and healthy individuals

ObjectiveWe investigated the presence of cognitive biases in people with a recent-onset psychosis (ROP), schizophrenia and healthy adolescents and explored potential associations between these biases and psychopathology. MethodsThree groups were studied: schizophrenia (N = 63), ROP (N = 43) and healthy adolescents (N = 45). Cognitive biases were assessed with the Cognitive Biases Questionnaire for Psychosis (CBQ). Positive, negative and depressive symptoms were assessed with the PANSS and Calgary Depression Scale (ROP; schizophrenia) and with the CAPE-42 (healthy adolescents). Cannabis use was registered. The association between CBQ and psychopathology scales was tested with multiple linear regression analyses. ResultsPeople with schizophrenia reported more cognitive biases (46.1 ± 9.0) than ROP (40 ± 5.9), without statistically significant differences when compared to healthy adolescents (43.7 ± 7.3). Cognitive biases were significantly associated with positive symptoms in both healthy adolescents (Standardized β = 0.365, p = 0.018) and people with psychotic disorders (β = 0.258, p = 0.011). Cognitive biases were significantly associated with depressive symptoms in healthy adolescents (β = 0.359, p = 0.019) but in patients with psychotic disorders a significant interaction between schizophrenia diagnosis and CBQ was found (β = 1.804, p = 0.011), which suggests that the pattern differs between ROP and schizophrenia groups (positive association only found in the schizophrenia group). Concerning CBQ domains, jumping to conclusions was associated with positive and depressive symptoms in people with schizophrenia and with cannabis use in ROP individuals. Dichotomous thinking was associated with positive and depressive symptoms in all groups. ConclusionsCognitive biases contribute to the expression of positive and depressive symptoms in both people with psychotic disorders and healthy individuals.

What are the predictors of CGI- severity in chronic schizophrenia patients

Introduction. The CGI-S score is an essential tool used in the evaluation of the severity of schizophrenia symptoms. It provides an objective and standardized measure of symptom severity that can be used to monitor treatment response and guide clinical decision-making. The CGI-S score alone may not provide sufficient information regarding the underlying factors contributing to the patient’s clinical presentation. Additionally, exploring the correlation between CGI-S score and other variables, such as sociodemographic and medical history factors, treatment history and other scales (PANNS, GAF, LUNSERS, SWN) can help clinicians better understand the factors that contribute to symptom severity and identify strategies to optimize treatment outcomes for patients with schizophrenia. Method. This study was conducted between 01.10.2009 – 01.10.2012, at the Clinical Hospital of Psychiatry Al. Obregia, Bucharest, Romania, on 110 patients, each of whom received a CGI-severity score at 7-day intervals. Excluding the small number of patients with a CGI-S score of 6 (6 out of 110), the study results are presented for 104 patients, divided into three categories based on the CGI-Severity score, respectively CGI-S 3,4, and 5. Descriptive analysis was performed on the subjects, and the ANOVA Tukey analysis was utilized to determine any significant correlation between the CGI-S score and other factors that could impact it. Results. We included 104 patients in our study, of whom 18.3% (n=19), 51.9% (n=54), and 29.8% (n=31) had a CGI-Severity score of 3, 4, and 5 points, respectively. Among them, 59.6% were female (n=62) and 40.4% were male (n=42), with a mean age of 40.19 (SD 10.35). We could not identify a statistically significant association between the CGI-S score and sociodemographic or medical history factors. However, we observed a significant negative association between the CGI-S score and the GAF and PANSS scales, with a p&lt;0.006. We also found a significant association between CGI-S score and the level of medication procurement accessibility, with a p-value of 0.039 and a 95% CI (-1.65 to 0.04) between CGI-S scores of 3 and 4. Among other predictive factors for the CGI-S score, we identified the presence of adverse effects measured using the LUNSERS scale (in terms of extrapyramidal and psychic adverse effects) and a significant association between the CGI-S score and the Subjective Well-Being Under Neuroleptics scale (in terms of physical function, self-control, and social integration; SWN), with a p&lt;0.05. Conclusion. It is important to correlate the CGI-S scale in schizophrenia with other scales such as PANSS, GAF, SWN, LUNSERS, illness history, and the patient’s treatment history because this provides a more comprehensive understanding of the patient’s symptoms, level of functioning, and response to treatment. By using multiple scales and considering various aspects of the patient’s illness, clinicians can make more informed decisions about the most appropriate treatment approach and monitor the patient’s progress over time. This can ultimately lead to better outcomes for patients with schizophrenia.

Comparative study of olanzapine and risperidone in the control of positive and negative symptoms in the treatment of schizophrenia

Objective: To compare the efficacy of olanzapine and risperidone in the treatment of positive and negative symptoms of schizophrenia. Materials and Methods: The study was conducted in MGM medical college Navi Mumbai between October 2012 to September 2014. The study included 110 patients of schizophrenia. The positive and negative symptoms were assessed with the help of the PANSS (positive & negative symptom score) scale. Results: We observed that the mean percentage reduction in score in the positive scale of PANSS was 48.74% in the risperidone and 49.40% in the olanzapine group .The negative score reduced by 56.32% in the Risperidone group and by 61.59% in the olanzapine group on the PANSS. Conclusion: olanzapine was superior to risperidone in controlling the positive as well as negative symptoms of schizophrenia clinically but the results were not statistically significant. Keywords: Olanzaine, Risperidone, Schizophrenia.

Efficacy and safety of antipsychotics in adolescents with an acute psychotic episode in relation to the activity of CYP3A and CYP2D6 isoenzymes

Antipsychotics are a first-line treatment for psychotic disorders. The cytochrome P450 isoenzymes CYP3A4/5 and CYP2D6 metabolize most antipsychotics. The activity of these isoenzymes in children changes with maturation, so it is different from that in adults. Objective: to study the associations of CYP3A and CYP2D6 isoenzyme activity parameters with the efficacy and safety of antipsychotics in adolescents with an acute psychotic episode. Patients and methods. The investigation enrolled 53 adolescents with an acute psychotic episode who took antipsychotics. The observation period lasted 14 days. The CGAS, PANSS, UKU SERS, SAS, and BARS scales were used to evaluate the efficiency and safety of the therapy on day 14. The activity of CYP3A and CYP2D6 isoenzymes was measured by determining the metabolic ratios of the concentrations of endogenous substrates of the isoenzymes and their metabolites in a morning urine sample on days 1 and 14 of the study. The activity of CYP3A was assessed by the 6-beta hydroxycortisol/cortisol ratio; that of CYP2D6 was measured by the 6-hydroxy-1,2,3,4-tetrahydro-beta-carboline/pinoline ratio. The influence of carriage of polymorphic variants CYP2D6*4,*9,*10, CYP3A4*22, CYP3A5*3 on the activity of isoenzymes was excluded by removing their carriers from the analysis. Results and discussion. The investigators revealed an association of certain antipsychotic-induced undesirable symptoms with CYP3A and CYP2D6 activity parameters. On day 1, a lower CYP2D6 activity was initially observed in patients with tremor (0.54 [0.34; 1.34] vs 1.25 [0.91; 1.75]; p=0.023). Also, patients with any documented adverse reaction (ARs) to therapy had initially a decreased CYP3A activity (1.2 [0.85; 2.29] vs 2.55 [1.44; 4.83]; p=0.047) and an enhanced CYP3A activity during therapy (the activity difference between day 14 and day 1 was 0.28 [-0.28; 2.32] vs -1.3 [-3.47; 0.66]; p=0.042). Conclusion. The initially reduced activity of CYP2D6 and CYP3A isoenzymes is a significant predictor of antipsychotic-induced ARs in adolescents with an acute psychotic episode. The predictive role of CYP2D6 and CYP3A activity levels in the efficacy of antipsychotics has not been confirmed.

The metacognitive functioning of patients with paranoid schizophrenia through the prism of emotional intelligence: a connection with cognitive deficit, clinical manifestations, social functioning and quality of life

Metacognitive functioning is the basis of the individual’s ideas about his ability to build relationships with other people and manage own’s social behavior. Deterioration of metacognitive functioning in schizophrenia patients, presumably due to neurocognitive deficiency and other manifestations of the disease, probably contributes to disruptions of social functioning and quality of life. The aim of this study was to assess the metacognitive functioning (MF) of patients with paranoid schizophrenia, operationalized as a cognitive ability to understand their own and other people’s emotions, and to explore the connection between social functioning (SF) and quality of life (QOL), as well as to establish logical relationships between MF with clinical indicators and socio-demographic characteristics of patients. In a sample of 300 patients with paranoid schizophrenia (age from 18 to 50 years, disease duration of at least 5 years, a total PANSS score of less than 120), MF was assessed using the Lyusin emotional intelligence test (EmIn) and the subjective assessment of interpersonal relationships (SOMO) test. Cognitive deficit was verified using a standardized battery of a Brief Assessment of Cognition in Schizophrenia (BACS). The indicators obtained using the quality of life questionnaire for schizophrenia patients (QOL-SM) and the social functioning scale (PSP) were used to create an integrated indicator that comprehensively assesses SF and QOL of schizophrenia patients (Factor B). Reliable associations of this factor with indicators obtained using the Emin method (p&lt;0.05), SOMO (p&lt;0.001), the PSP scale, the QOL-SM questionnaire, the BACS and PANSS scales, and also with a number of clinical-dynamic and socio-demographic characteristics were established. Significant relationships between the parameters of MF, SF and QOL were obtained, and logical relationships between MF, neurocognitive deficiency and other clinical manifestations of schizophrenia were established.

Cognitive biases are associated with clinical and functional variables in psychosis: A comparison across schizophrenia, early psychosis and healthy individuals.

We investigated the presence of cognitive biases in people with a recent-onset psychosis (ROP), schizophrenia and healthy adolescents and explored potential associations between these biases and psychopathology. Three groups were studied: schizophrenia (N=63), ROP (N=43) and healthy adolescents (N=45). Cognitive biases were assessed with the Cognitive Biases Questionnaire for Psychosis (CBQ). Positive, negative and depressive symptoms were assessed with the PANSS and Calgary Depression Scale (ROP; schizophrenia) and with the CAPE-42 (healthy adolescents). Cannabis use was registered. The association between CBQ and psychopathology scales was tested with multiple linear regression analyses. People with schizophrenia reported more cognitive biases (46.1±9.0) than ROP (40±5.9), without statistically significant differences when compared to healthy adolescents (43.7±7.3). Cognitive biases were significantly associated with positive symptoms in both healthy adolescents (Standardized β=0.365, p=0.018) and people with psychotic disorders (β=0.258, p=0.011). Cognitive biases were significantly associated with depressive symptoms in healthy adolescents (β=0.359, p=0.019) but in patients with psychotic disorders a significant interaction between schizophrenia diagnosis and CBQ was found (β=1.804, p=0.011), which suggests that the pattern differs between ROP and schizophrenia groups (positive association only found in the schizophrenia group). Concerning CBQ domains, jumping to conclusions was associated with positive and depressive symptoms in people with schizophrenia and with cannabis use in ROP individuals. Dichotomous thinking was associated with positive and depressive symptoms in all groups. Cognitive biases contribute to the expression of positive and depressive symptoms in both people with psychotic disorders and healthy individuals.