Positive And Negative Syndrome Scale For Schizophrenia Research Articles

Adjunctive agents to antipsychotics in schizophrenia: a systematic umbrella review and recommendations for amino acids, hormonal therapies and anti-inflammatory drugs

QuestionThis umbrella review and guidelines aimed to provide evidence to support the rational choice of selected adjunctive therapies for schizophrenia.Study selection and analysisFollowing the Preferred Reporting Items for Systematic Reviews...

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.

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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.

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.

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.

The Positive and Negative Syndrome Scale for Schizophrenia Autism Severity Scale (PAUSS) in young people with autism and schizophrenia

Schizophrenia spectrum disorders (SSD) share symptoms with autism spectrum disorders (ASD). Autistic phenotypic profiles in SSD may be associated with a poor prognosis. We aimed to assess the evidences for reliability and convergent validity of the Positive and Negative Syndrome Scale for Schizophrenia (PANSS) Autism Severity Scale (PAUSS) in a sample of young people with ASD and SSD, and to use the PAUSS to explore correlates of "autistic profiles" in the SSD sample. ASD (n=33, age=13-27 years) and SSD subjects (n=26, age=16-35 years) underwent PANSS, Autism Diagnostic Observation Schedule-Generic (ADOS-G), Autism Diagnostic Interview-Revised (ADI-R), and Social Responsiveness Scale (SRS) assessments. We derived PAUSS total/domain scores from the PANSS and applied these back-to-back with ADOS calibrated severity scores (CSS), ADI-R current behavior algorithm (CBA) scores, and SRS scores. Our results show evidence for an acceptable PAUSS score reliability and convergent validity both in the ASD and SSD samples. PAUSS total and socio-communication scores significantly correlated with ADOS Overall/Social Affect CSS, both in ASD and in SSD. SSD with higher PAUSS scores ("autistic-SSD") showed Overall/Social Affect CSS scores positioned in between ASD and "non-autistic SSD". The PAUSS total score was significantly associated with global functioning in SSD (adjusted R2=0.311). There seems to be evidence for the reliability and validity of PAUSS scores for quantifying autism symptom severity transdiagnostically and to identify "autistic phenotypes" in adolescents/young adults with SSD.

The Positive and Negative Syndrome Scale for Schizophrenia Autism Severity Scale (PAUSS) in young people with autism and schizophrenia

IntroductionSchizophrenia spectrum disorders (SSD) share symptoms with autism spectrum disorders (ASD). Autistic phenotypic profiles in SSD may be associated with a poor prognosis. We aimed to assess the evidences for reliability and convergent validity of the Positive and Negative Syndrome Scale for Schizophrenia (PANSS) Autism Severity Scale (PAUSS) in a sample of young people with ASD and SSD, and to use the PAUSS to explore correlates of “autistic profiles” in the SSD sample. Materials and methodsASD (n=33, age=13–27 years) and SSD subjects (n=26, age=16–35 years) underwent PANSS, Autism Diagnostic Observation Schedule-Generic (ADOS-G), Autism Diagnostic Interview-Revised (ADI-R), and Social Responsiveness Scale (SRS) assessments. We derived PAUSS total/domain scores from the PANSS and applied these back-to-back with ADOS calibrated severity scores (CSS), ADI-R current behavior algorithm (CBA) scores, and SRS scores. ResultsOur results show evidence for an acceptable PAUSS score reliability and convergent validity both in the ASD and SSD samples. PAUSS total and socio-communication scores significantly correlated with ADOS Overall/Social Affect CSS, both in ASD and in SSD. SSD with higher PAUSS scores (“autistic-SSD”) showed Overall/Social Affect CSS scores positioned in between ASD and “non-autistic SSD”. The PAUSS total score was significantly associated with global functioning in SSD (adjusted R2=0.311). ConclusionsThere seems to be evidence for the reliability and validity of PAUSS scores for quantifying autism symptom severity transdiagnostically and to identify “autistic phenotypes” in adolescents/young adults with SSD.

T117. PROMINENT AND PERSISTENT AUTISTIC TRAITS ARE ASSOCIATED WITH EARLY NON-REMISSION IN FIRST-EPISODE SCHIZOPHRENIA

BackgroundAutistic phenotypic profiles in patients with schizophrenia are reportedly associated with poor outcomes, including higher odds of antipsychotic treatment failure. The Positive and Negative Syndrome Scale for Schizophrenia (PANSS) Autism Severity Scale (PAUSS) has been validated as a tool to identify “autistic profiles” in adolescents and adults with schizophrenia. We used the PAUSS (total score and subscores) to quantify autistic symptom load at different time points in a sample of patients with first episode schizophrenia (FES). We sought to investigate whether showing “prominent and persistent” autistic symptom load was associated with not achieving clinical remission at week 4 after the FES.MethodsWe analysed a subsample of FES patients from the OPTiMiSE study that was treated with amisulpride in an open-label design and had completed 4 weeks of follow-up. The selected subsample was composed of 55 individuals (27.3% female, mean age 25.6 (6.2) years) at “high-risk of non-remission” at week 2; i.e. patients with schizophrenia (not schizophreniform nor schizoaffective disorder) that showed prominent and persistent baseline-to-2-week negative symptoms (PNS, using Galderisi et al 2013 definition) and that had not achieved clinical remission at week 2 (using Andreasen criteria).ResultsIn the selected subsample, the PAUSS showed acceptable internal consistency at baseline, 2-week, and 4-week visit (all Cronbach’s alpha>0.7). Those with prominent (over the third tertile) and persistent (over the 4-week follow-up) PAUSS total scores, i.e. “autistic FES patients” had, relative to non-autistic FES patients, higher rates of comorbid social phobia (18.2% vs 0%, p= .041), higher PANSS positive, negative and total scores at week 2 and 4 (all p<.01), and a higher proportion of “non-remitters” at week 4 (91.7% vs 51.2%, p=.018). No other differences in demographic or clinical variables were found between both FES groups. Stepwise logistic regression analyses, controlling for potential confounders, revealed that showing a prominent and persistent “autistic phenotype” was associated with not achieving clinical remission at week 4 (B=2.148, OR=8.57, 95% CI= 1.01–73.5, p<0.05).DiscussionThe delineation of “autistic profiles” with the PAUSS in the early stages of schizophrenia might enable early detection of subjects at higher risk of short-term antipsychotic treatment failure. It may also enable to explore the neurobiological underpinnings of particular phenotypic groups within schizophrenia, which might in turn help advance in the understanding of the pathophysiology and aetiology of psychosis.

Effect of Cognitive Behavioural Therapy on the Psychotic Symptoms of People with Schizophrenia-Associated Psychopathology in South-West Nigeria

Schizophrenia is a severe mental illness that is resistant to pharmacological therapy. This study aimed at assessing the effect of Cognitive Behavioural Therapy on the psychotic symptoms of people with schizophrenia-associated psychopathology in South-West Zone of Nigeria. Quasi-experimental research design was utilized in the study. 60 persons diagnosed with schizophrenia were purposively assigned into intervention and control groups. Two research questions and four null hypotheses guided the study. Positive and Negative Syndrome Scale for schizophrenia (PANSS) instrument was used to collect data before and after CBT intervention. Data collected were summarized using frequency and percentages to describe the participants’ demographic characteristics. The research questions were answered using mean score and standard deviation, while Mann-Whitney test was adopted in testing the null hypotheses at 0.05 level of significance. Mann-Whitney Test analysis of the post-intervention scores of psychotic symptoms between the intervention group and control group in the positive domain revealed a significant difference between the intervention group and control group with z- score 2.60, p-value 0.009. Reduced psychotic symptoms were found among the participants who received CBT than those who did not receive CBT. In conclusion, CBT intervention with pharmacological management was effective in reducing psychotic symptoms. CBT should be integrated into routine care given to the schizophrenic clients in nursing intervention.

The Mediating Effect of Depression and Disability in the Relationship Between Schizophreniaand Self-Esteem.

Depressive symptoms, in addition to positive and negative symptoms, are commonly observed in the course of schizophrenia. These symptoms may cause disability and reduced self-esteem. Disability and lower self-esteem may disrupt the quality of life and lead to social isolation. Demonstrating the relationships among these concepts and correcting possible disturbances may help to augment treatment compliance and improve the prognosis. In this study, the Calgary Depression Scale for Schizophrenia (CDSS), the Positive and Negative Syndrome Scale for Schizophrenia (PANSS), the World Health Organization Disability Assessment Schedule 2.0 (WHODAS), and the Rosenberg Self Esteem Scale (RSES) were applied along with a sociodemographic data form to 146 patients with schizophrenia. Path analyses were used to demonstrate the direct effect of schizophrenia severity on self-esteem and its indirect effect through disability and depression, the mediating effect of depression in the relationship between schizophrenia severity and disability, and the mediator effect of disability in the bidirectional relationship between self-esteem and depression. Statistically significant results were obtained. In multivariate regression analysis, significant effects on disability were demonstrated for PANSS General Psychopathology subscale, CDSS, and RSES. These data suggest that attention should be focused on concepts such as depression, disability, and self-esteem in schizophrenia patients.

Study of various factors affecting compliance in schizophrenia: A single center experience in India

Aim of the studySchizophrenia is a major psychiatric disorder, imparting a major burden in health care sector. Many treatments are available now a days to treat schizophrenia, although, its burden is not decreasing. The main reason behind this is noncompliance to treatment.This study aims to find out the non compliance prevalence and to study influence of sociodemographic factors, treatment related variables, illness related variables and various subjective reasonings in patients with schizophrenia.Subject or material and methodsOver the period of 1 year, 80 patients with schizophrenia who gave written informed consent were enrolled in the study and their sociodemographic, treatment related and illness related variables were noted. PANSS(positive and negative syndrome scale for Schizophrenia) was used to indicate the severity of illness. ROMI(Rating of Medication Influences Scale in Schizophrenia) was used to assess subjective reasons. Chi square test was used to find out statistical significance.Results37.5% patients were non compliant in our study. Education, the illness severity, the type of regimen and dosages of medication have a significant influence on treatment compliance. The subjective reason “no perceived benefit” is significantly associated with treatment noncompliance.DiscussionA wide literature is available across the globe on compliance in schizophrenia. This study aids in the available resources and throws a light on the regional factor.ConclusionsSchizophrenia, being a major disease imparting burden in psychiatry health care system, needs an attention in the area of compliance to treatment. This type of research should be done on regional basis to find out and address the factors that influence treatment compliance.

PRELIMINARY STUDY ON THE EFFECT OF REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION ON NEGATIVE SYMPTOMS IN PATIENTS WITH SCHIZOPHRENIA

Back Ground: Negative symptoms of schizophrenia have been demonstrated to be the most relevant predictor of increased future socio-occupational dysfunction and poorer quality of life which is linked to impaired functioning of the prefrontal cortex, mainly reduced activation of the dorsolateral prefrontal cortex. Repetitive Trans-cranial Magnetic Stimulation (rTMS) is a relatively safe and non-invasive tool to modulate neuronal activity. High-frequency rTMS might have role in improvement of negative symptoms of schizophrenia. Aim of work: The Aim of this study to explore the effects of highfrequency rTMS stimulation to the DLPFC on negative symptoms observed in schizophrenia patients. Patients and Methods: 40 patients with schizophrenia who accept and there guardians to participate in the study and sign the written informed consent were assessed by Positive and Negative Syndrome Scale for Schizophrenia (PANSS), before the rTMS sessions and after the sessions. Meanwhile the operator allocated the subjects to active or sham group then the subjects of the study received active or Sham rTMS . The rTMS was delivered for 3 sessions /week during six weeks, each session lasts for 13 minutes. Results: There was a statistical significance between active and sham group as regard PANSS Negative subdomain scale, used before and after the rTMS sessions (P value= 0.001 ) Also there was a statistical significant difference among active group before and after the rTMS stimulation( P value<0.001). Conclusion: This study suggests that high frequency rTMS applied to DLPFC may be of benefit in alleviating negative symptoms in schizophrenic patients. A larger sample size is needed to confirm our findings.

Correction: Comparing Schizophrenia Patients With a Predicted High/Low Risk of Nonresponse Receiving Treatment with Ziprasidone and Haloperidol: A Randomized-Controlled Study.

Introduction The aim of this double-blind randomized study was to evaluate the response to antipsychotic treatment in schizophrenia patients with predicted high/low risk of nonresponse identified by applying a set of well-established scales and predictors of outcome and to compare efficacy between ziprasidone and haloperidol. Methods One hundred twelve schizophrenia patients (ziprasidone: n=54; haloperidol: n=58) were rated weekly on the Positive and Negative Syndrome Scale for Schizophrenia (PANSS), the Global Assessment of Functioning Scale (GAF), the Social and Occupational Functioning Scale (SOFAS), the Simpson-Angus Scale (SAS), and Hillside Akathisia Scale (HAS). Results Ninety-two patients (82%) were predicted to have a high risk of nonresponse. No significant difference regarding PANSS improvement in this subsample was found comparing ziprasidone and haloperidol (p=0.563). Also, for the total patient sample, no significant difference was found regarding the course of the PANSS total score, GAF (p=0.921), and SOFAS (p=0.658) between ziprasidone and haloperidol. Haloperidol resulted in higher scores on the SAS (p=0.001) and HAS (p=0.011). Discussion An alarmingly high number of patients were at high risk of nonresponse to antipsychotic treatment.

Cortico-thalamic dysconnection in early-stage schizophrenia: a functional connectivity magnetic resonance imaging study.

Studies have indicated thalamus-related network dysfunction in schizophrenia and psychotic disorders. However, whether thalamus-related functional connectivity (FC) contributes to the psychopathology and cognitive deficits of early-stage schizophrenia requires further investigation. A total of 34 patients with early-stage schizophrenia (illness duration = 1.62 ± 1.16 years; age = 26.00 ± 6.34years) and 34 age- and sex-matched healthy controls were enrolled in our study and underwent comprehensive assessments of the clinical symptoms of schizophrenia, working memory tasks, and resting-state FC magnetic resonance imaging. The patients with early-stage schizophrenia had increased FC of the thalamus with the bilateral postcentral and temporal gyri, inferior occipital cortex, and temporal pole and decreased FC of the thalamus with the vestibulocerebellum and frontal pole compared with the controls. Furthermore, increased FC between the thalamus and temporal pole was positively correlated with positive scores of the Positive and Negative Syndrome Scale for Schizophrenia (PANSS) and negatively correlated with performance on working memory tasks in early-stage schizophrenia. Increased FC of the thalamus with the inferior occipital cortex was positively associated with negative PANSS scores and negatively correlated with Personal and Social Performance Scale scores in early-stage schizophrenia. Our results supported the vital role of thalamus-related network dysfunction in the psychopathology and cognitive deficits of early-stage schizophrenia.

Effects of haloperidol on the delta-9-tetrahydrocannabinol response in humans: a responder analysis.

Δ-9-Tetrahydrocannabinol (Δ-9-THC) produces psychotomimetic effects in humans. However, the role of dopamine signaling in producing such effects is unclear. We hypothesized that dopaminergic antagonism would reduce the psychotomimetic effect of Δ-9-THC. The objective of this study was to evaluate whether pre-treatment with haloperidol would alter the psychotomimetic and perceptual-altering effects of Δ-9-THC, measured by the Positive and Negative Syndrome Scale for Schizophrenia (PANSS) and the Clinician-Administered Dissociative Symptom Scale (CADSS) in humans. In a two-test-day double-blind study, 28 healthy individuals were administered with active (0.057mg/kg) or placebo oral haloperidol, followed 90 and 215min later by intravenous administration of active (0.0286mg/kg) Δ-9-THC and placebo, respectively. This secondary analysis was conducted because of the observation in other studies and in our data that a significant proportion of individuals may not have an adequate response to THC (floor effect), thus limiting the ability to test an interaction. Therefore, this analysis was performed including only responders to THC (n= 10), defined as individuals who had an increase of at least one point on the PANSS positive scale, consistent with prior human laboratory studies. In the 10 responders, Δ-9-THC-induced increases in PANSS positive scores were significantly lower in the haloperidol condition (1.1+0.35) compared with the placebo condition (2.9+0.92). This responder analysis showed that haloperidol did reduce the psychotomimetic effect of Δ-9-THC, supporting the hypothesis that dopaminergic signaling may participate in the psychosis-like effects of cannabinoids.

Comparing Schizophrenia Patients With a Predicted High/Low Risk of Nonresponse Receiving Treatment with Ziprasidone and Haloperidol: A Randomized-Controlled Study.

The aim of this double-blind randomized study was to evaluate the response to antipsychotic treatment in schizophrenia patients with predicted high/low risk of nonresponse identified by applying a set of well-established scales and predictors of outcome and to compare efficacy between ziprasidone and haloperidol. One hundred twelve schizophrenia patients (ziprasidone: n=54; haloperidol: n=58) were rated weekly on the Positive and Negative Syndrome Scale for Schizophrenia (PANSS), the Global Assessment of Functioning Scale (GAF), the Social and Occupational Functioning Scale (SOFAS), the Simpson-Angus Scale (SAS), and Hillside Akathisia Scale (HAS). Ninety-two patients (82%) were predicted to have a high risk of nonresponse. No significant difference regarding PANSS improvement in this subsample was found comparing ziprasidone and haloperidol (p=0.563). Also, for the total patient sample, no significant difference was found regarding the course of the PANSS total score, GAF (p=0.921), and SOFAS (p=0.658) between ziprasidone and haloperidol. Haloperidol resulted in higher scores on the SAS (p=0.001) and HAS (p=0.011). An alarmingly high number of patients were at high risk of nonresponse to antipsychotic treatment.

Trajectories of depressive symptoms in the acute phase of psychosis: Implications for treatment

Depression is common in schizophrenia and associated with negative outcomes. Previous studies have identified heterogeneity in treatment response in schizophrenia. We aimed to investigate different trajectories of depression in patients suffering from psychosis and predictors of change in depressive symptoms during antipsychotic treatment. Two hundred and twenty-six patients >18 years acutely admitted due to psychosis were consecutively included and the follow-up was 27 weeks. The Calgary Depression Scale for Schizophrenia (CDSS) sum score was the primary outcome. Latent growth curve (LGCM) and Growth Mixture Models (GMM) were conducted. Predictors were the Positive sum score of the Positive and Negative Syndrome Scale for Schizophrenia (PANSS), Schizophrenia spectrum/non-spectrum psychoses, gender and being antipsychotic naive at inclusion. We found support for three depression-trajectories, including a high- (14.7%), a low depression-level (69.6%) class and a third depressed class quickly decreasing to a low level (15.7%). Change in CDSS was associated with change in PANSS positive score in all time intervals (4 weeks: b = 0.18, p < 0.001, 3 months: 0.21, p < 0.023, 6 months: 0.43, p < 0.001) and with a diagnosis within schizophrenia spectrum but not with antipsychotic naivety or gender. The schizophrenia-spectrum patients had less depressive symptoms at inclusion (−2.63, p < 0.001). In conclusion, an early responding and a treatment refractory group were identified. The treatment-refractory patients are candidates for enhanced anti-depressive treatment, for which current evidence is limited. The post-psychotic depression group was characterized by depressive symptoms in the acute phase as well. We could not identify differentiating characteristics of the depression trajectories.

Chronic low-grade peripheral inflammation is associated with ultra resistant schizophrenia. Results from the FACE-SZ cohort.

A high rate of patients with schizophrenia (SZ) does not sufficiently respond to antipsychotic medication, which is associated with relapses and poor outcomes. Chronic peripheral inflammation has been repeatedly associated with schizophrenia risk and particularly to poor responders to treatment as usual with cognitive impairment in SZ subjects. The objective of present study was to confirm if ultra resistance to treatment in schizophrenia (UTRS) was associated to chronic peripheral inflammation in a non-selected sample of community-dwelling outpatients with schizophrenia. Participants were consecutively included in the network of the FondaMental Expert Centers for Schizophrenia and received a thorough clinical assessment, including recording of current treatment. Current psychotic symptomatology was evaluated by the Positive and Negative Syndrome scale for Schizophrenia (PANSS). UTRS was defined by current clozapine treatment + PANSS total score ≥ 70. Functioning was evaluated by the Global Assessment of Functioning scale. High sensitivity CRP (hs-CRP) was measured for each participant as a proxy to define peripheral low-grade inflammation. 609 stabilized community-dwelling SZ subjects (mean age = 32.5 years, 73.6% male gender) have been included. 60 (9.9%) patients were classified in the UTRS group. In multivariate analyses, UTRS has been associated independently with chronic peripheral inflammation (OR = 2.6 [1.2-5.7], p = 0.01), illness duration (0R = 1.1 [1.0-1.2], p = 0.02) and impaired functioning (OR = 0.9 [0.9-0.9], p = 0.0002) after adjustment for age, sex, current daily tobacco smoking, metabolic syndrome and antidepressant consumption. Peripheral low-grade inflammation is associated with UTRS. Future studies should explore if anti-inflammatory strategies are effective in UTRS with chronic low-grade peripheral inflammation.