Positive And Negative Syndrome Scale General Psychopathology Research Articles

Association between forkhead-box P2 gene polymorphism and clinical symptoms in chronic schizophrenia in a Chinese population

The forkhead-box P2 (FOXP2) gene polymorphism has been reported to be involved in the susceptibility to schizophrenia; however, few studies have investigated the association between FOXP2 gene polymorphism and clinical symptoms in schizophrenia. This study investigated whether the FOXP2 gene was associated with the development and symptoms of schizophrenia in relatively genetically homogeneous Chinese population. The FOXP2 rs10447760 polymorphism was genotyped in 1069 schizophrenia inpatients and 410 healthy controls using a case-control design. The patients' psychopathology was assessed by the Positive and Negative Syndrome Scale (PANSS). We found no significant differences in the genotype and allele distributions between the patient and control groups. Interestingly, we found significant differences in PANSS total, positive symptom, and general psychopathology scores between genotypic subgroups in patients, with the higher score in patients with CC genotype than those with CT genotype (all p<0.05). After adjusting demographic and clinical variables, the difference still remained significant for the PANSS positive symptom score and general psychopathology (both p<0.05). Our findings suggest that the FOXP2 rs10447760 polymorphism may not contribute to the development of schizophrenia, but may contribute to the clinical symptoms of schizophrenia among Han Chinese.

The association of schizophrenia symptoms clusters with obsessive compulsive symptoms

IntroductionThirty percent of individuals with schizophrenia demonstrate obsessive compulsive symptoms (OCSs). There is conflicting data on the effects of antipsychotic medication on OCSs in schizophrenia. The delineation of the relationship of OCSs with positive, negative and general psychopathology symptoms has theoretical and treatment implications.ObjectivesTo investigate the relationship among OCSs with the symptoms clusters in schizophrenia.MethodsWe recruited 110 chronic schizophrenia patients and assessed OCSs (Yale-Brown Scale) and schizophrenia symptoms (Positive and Negative Syndrome Scale). In order to investigate the relationship of OCSs with clusters of schizophrenia symptoms, we conducted correlation analyses between YBOCS total scores or obsession or compulsion subscores with the PANSS symptoms scores (total, positive, negative and general psychopathology) and the cognitive scores derived from CANTAB. We re-conducted these correlations for the sub groups with clinically detectable OCSs (YBOCS &gt; 8) and clinically significant OCSs (YBOCS &gt; 14).ResultsThe only significant correlation was that of scores of OCSs with PANSS general psychopathology scores (rho = 0.190, P = 0.047). Obsessions and compulsions did not significantly correlate with positive or negative symptom clusters. No significant correlation between OCSs and schizophrenia symptoms were detected in the subgroups with clinically detectable or significant OCSs.ConclusionsOCSs appear to be a separate symptom cluster in the context of schizophrenia, suggesting that OCSs cannot be expected to be influenced by standard antipsychotic treatments.Disclosure of interestThe authors have not supplied their declaration of competing interest.

The regional project for the treatment of early psychosis implemented in the Reggio Emilia Mental Health Department: Preliminary data from a 2-year follow-up

IntroductionSeveral studies had shown the effectiveness of combined interventions in the treatment of young patients with a first episode of psychosis (FEP). More controversial are the evidence about the stability of the therapeutic outcomes in individuals ultra-high risk (UHR).AimsTo describe the regional project for the treatment of early psychosis implemented in the Reggio Emilia Mental Health Department (ReMHD) and also to report preliminary data from a 2-year follow-up.MethodsIn addition with the treatment as usual (TAU), treatment implemented within the regional project for early psychosis (PREP) in the ReMHD comprises the following:– pharmacotherapy according to international guidelines;– a phase-specific individualized Cognitive-Behavioural therapy;– a psycho-educational intervention addressed to family members;– a case management recovery-oriented.Action strategies are preceded by the administration of Reggio Emilia at Risk mental States Battery Checklist as a comprehensive assessment useful to define the severity and the quality of symptoms, the degree of functioning, the subjectivity of suffering, and the perceived quality of life.ResultsThe assessment carried out after 24 months of continuous treatment showed significant improvements in both the psychotic symptoms (positive, negative and general psychopathology PANSS subscales) that the daily functioning (SOFAS).ConclusionsAlthough our sample is still relatively small (n = 50) to draw definitive conclusions, it is emerging the good prognosis for UHR individuals and patients with FEP submitted on PREP treatment implemented in the ReMHD.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Biochemical, physiological and clinical effects of l-methylfolate in schizophrenia: a randomized controlled trial.

Folic acid supplementation confers modest benefit in schizophrenia, but its effectiveness is influenced by common genetic variants in the folate pathway that hinder conversion to its active form. We examined physiologic and clinical effects of L-methylfolate, the fully reduced and bioactive form of folate, in schizophrenia. In this randomized, double-blind trial, outpatients with schizophrenia (n=55) received L-methylfolate 15 mg or placebo for 12 weeks. Patients were maintained on stable doses of antipsychotic medications. The pre-defined primary outcome was change in plasma methylfolate at 12 weeks. Secondary outcomes included change in symptoms (PANSS, SANS, CDSS), cognition (MATRICS composite) and three complementary MRI measures (working memory-related activation, resting connectivity, cortical thickness). Primary, mixed model, intent-to-treat analyses covaried for six genetic variants in the folate pathway previously associated with symptom severity and/or response to folate supplementation. Analyses were repeated without covariates to evaluate dependence on genotype. Compared to placebo, L-methylfolate increased plasma methylfolate levels (d=1.00, p=.0009) and improved PANSS Total (d=.61, p=.03) as well as PANSS Negative and General Psychopathology subscales. While PANSS Total and General Psychopathology changes were influenced by genotype, significant PANSS Negative changes occurred regardless of genotype. No treatment differences were seen in other symptom rating scales or cognitive composite scores. Patients receiving L-methylfolate exhibited convergent changes in ventromedial prefrontal physiology, including increased task-induced deactivation, altered limbic connectivity, and increased cortical thickness. In conclusion, L-methylfolate supplementation was associated with salutary physiologic changes and selective symptomatic improvement in this study of schizophrenia patients, warranting larger clinical trials.

Scales for assessment of depression in schizophrenia: Factor analysis of calgary depression rating scale and hamilton depression rating scale

This study aimed to evaluate the factor structure of Calgary depression rating scale (CDSS) and Hamilton Depression Rating Scale (HDRS) among patients with schizophrenia in acute and remission phase of illness by using exploratory factor analysis. For this, 267 patients with schizophrenia were assessed on CDSS and HDRS. Exploratory factor analysis of CDSS yielded 2 factor models for the whole sample, patients in clinical remission and patients not in clinical remission phase of schizophrenia. Factor analysis of HDRS yielded 3 factor models; however, there was significant difference in the factor structure between those in clinical remission and those not in clinical remission phase of schizophrenia. CDSS total score did not correlate with PANSS positive and negative subscale scores. In contrast, HDRS total score correlated positively with PANSS positive subscale score, PANSS negative subscale score and PANSS general psychopathology subscale score. To conclude, present study suggests while CDSS items separate out into 2 factors, which are stable across different stages of illness, whereas HDRS factor structure appears to be less stable across different stages of illness. Correlation analysis suggests that rating on HDRS may be affected by positive and negative symptoms of schizophrenia, whereas CDSS do not correlate with positive and negative symptoms of schizophrenia.

The relationship between aggression and thyroid hormone and cortisol in schizophrenic patients

Objective To explore the relationship between aggressive behavior with thyroid hormone or cortisol and in schizophrenic patients. Methods According to the past violence history and modified overt aggression scale(MOAS)weighted total scores, 108 schizophrenic patients were divided into aggressive group(n=69) and non-aggressive group(n=39). Positive and Negative Syndrome Scale (PANSS) total scores, serum thyroid hormone levels and cortisol concentration were compared between the two groups before and after 2, 4 weeks treatment. And correlations of PANSS and sub-scales scores, thyroid hormone levels and cortisol concentration with MOAS weighted total scores and subscales scores were analyzed before these patients receiving treatment. Results Before treatment, total scores of PANSS, positive symptoms and general psychopathology scores in aggressive group((94.19±12.71), (23.77±4.94), (52.61±6.45))were higher than that in non-aggressive group ((83.26±11.21), (21.36±7.10), (45.49±6.84)) and these differences were significant(P 0.05). Free thyroxine(FT4) level of aggressive group ( (14.41±3.58)pmol/L) was higher than that of non-aggressive group ((12.95±2.66)pmol/L) before treatment and the difference was significant(P 0.05). After 2 or 4 weeks treatment, the differences between the two groups in TSH, FT3, FT4, TT3, TT4 levels were not significant(P>0.05). The differences between the two groups of cortisol concentration were not significant before and after 2, 4 weeks treatment(P>0.05). MOAS weighted total scores were positively correlated with PANSS total scores, negative symptoms scores, general psychopathology scores and level of FT4, and their r values were 0.471, 0.204, 0.531, 0.239(all P<0.05). Verbal aggression was positively correlated with PANSS total scores, positive symptoms scores and general psychopathology scores, and their r values were 0.213, 0.215, 0.292(P<0.05). Auto-aggression was positively correlated with PANSS total scores and general psychopathology scores, and their r values were 0.278, 0.382(P<0.05). Psychical aggression was positively correlated with PANSS total scores, negative symptoms scores, general psychopathology scores and level of FT4, and their r values were 0.361, 0.193, 0.338, 0.276(P<0.05). Conclusion The total scores of PANSS, positive symptoms, general psychopathology scores, level of FT4 and their variances can reflect severity of aggression and predict aggressive behavior in schizophrenic patients. Concentration of cortisol is not associated with aggressive behavior and can not be used as a predictor of aggressive behavior in schizophrenic patients. Key words: Schizophrenia; Aggression; Thyroid hormone; Cortisol

Decreased Functional Connectivity of Insular Cortex in Drug Naïve First Episode Schizophrenia: In Relation to Symptom Severity.

BackgroundThis study was to examine the insular cortical functional connectivity in drug naïve patients with first episode schizophrenia and to explore the relationship between the connectivity and the severity of clinical symptoms.MethodsThirty-seven drug naïve patients with schizophrenia and 25 healthy controls were enrolled in this study. A seed-based approach was used to analyze the resting-state functional imaging data. Insular cortical connectivity maps were bilaterally extracted for group comparison and validated by voxel-based morphometry (VBM) analysis. Clinical symptoms were measured using the Positive and Negative Syndrome Scale (PANSS).ResultsThere were significant reductions in the right insular cortical connectivity with the Heschl’s gyrus, anterior cingulate cortex (ACC), and caudate (p’s<0.001) in the patient group compared with the healthy control (HC) group. Reduced right insular cortical connectivity with the Heschl’s gyrus was further confirmed in the VBM analysis (FDR corrected p<0.05). Within the patient group, there was a significant positive relationship between the right insula-Heschl’s connectivity and PANSS general psychopathology scores (r = 0.384, p = 0.019).ConclusionReduced insula-Heschl’s functional connectivity is present in drug naïve patients with first episode schizophrenia, which might be related to the manifestation of clinical symptoms.

The Relationship of Insight with Psychopathology and Neuropsychological Functioning in Patients with Schizophrenia

The aim of this study was to investigate the relationship of the different dimensions of insight with clinical variables, symptom severity, and cognitive functions in patients with schizophrenia. In this cross-sectional descriptive study, 66 out patients that applied to the Karadeniz Technical University, Psychiatry Clinic and were diagnosed with schizophrenia according to DSM-IV were evaluated. The patients were evaluated with Structured Clinical Interview for DSM (SCID-I), the Positive and Negative Syndrome Scale (PANSS), the Calgary Depression Scale for Schizophrenia (CDSS), and the Schedule for Assessing the Three Components of Insight (SAI). Wisconsin Card Sorting Test, Verbal Fluency Test, Trail Making Test A and B and Rey Auditory Verbal Learning Test were applied to assess the cognitive function of each patient. The insight levels of the patients that were evaluated with SAI were found to be correlated with PANSS positive, negative, and general psychopathology symptom severity as well as Verbal Fluency Test and Trail Making Test A and B scores. In the multiple linear regression analysis, PANSS positive, Verbal Fluency Test and Trail Making Test A scores were determined the contributors of SAI total score. The relationship between insight and clinical symptoms may change depending on the course of the disease and severity of symptoms. These findings emphasize the importance of frontal executive function in the relationship between insight and cognitive functions.

Efficacy of Quetiapine Monotherapy in Posttraumatic Stress Disorder: A Randomized, Placebo-Controlled Trial.

This was a 12-week randomized, placebo-controlled trial to assess the efficacy of quetiapine monotherapy in the treatment of posttraumatic stress disorder (PTSD). Eighty patients were randomly assigned to treatment with either quetiapine or placebo. The primary outcome measure was the Clinician-Administered PTSD Scale (CAPS). Secondary efficacy measures included the CAPS subscales, the Davidson Trauma Scale, the Positive and Negative Syndrome Scale (PANSS), the Clinical Global Impressions (CGI) scales for severity of Illness and improvement, the Hamilton Depression Rating Scale (HAM-D), and the Hamilton Anxiety Rating Scale (HAM-A). Safety measurements included adverse events, vital signs, the Abnormal Involuntary Movement Scale, the Barnes Akathisia Scale, the Simpson-Angus Scale, and the Arizona Sexual Experiences Scale. After a 1-week placebo run-in, quetiapine was started at a daily dosage of 25 mg and increased to a maximum of 800 mg; the average was 258 mg (range, 50-800 mg). Reductions in CAPS total, re-experiencing, and hyperarousal scores were significantly greater for the quetiapine group than for the placebo group. Greater improvements were also observed for quetiapine in scores on the Davidson Trauma Scale, CGI severity and improvement ratings, PANSS positive symptom and general psychopathology subscales, HAM-A, and HAM-D than for placebo. Adverse events were generally mild and expected based on prior studies of quetiapine in this and other patient population. There were no differences in safety measures between groups. Quetiapine monotherapy was efficacious in the treatment of PTSD. These findings suggest quetiapine as a single agent is effective in treating military PTSD.

Symptom Profile of Substance-induced Psychosis Versus Primary Psychosis in a Sample of Egyptian Patients: A Preliminary Study

Introduction: There is an extensive literature on the link between psychosis and substance use. The nature of this association has been a matter of controversy for the last 2 decades, especially the possible cause effect relationship that may be involved in this association. The differential diagnosis of substance-induced psychotic disorder and primary psychotic disorder is particularly challenging during an acute admission when psychotic symptoms are the most severe and the identification of possible markers of these disorders could simplify their recognition and treatment. Objectives: The main objective of the current study was to compare the clinical picture between a sample of patients with substance-induced psychosis (SIP) and patients with primary psychosis, as regards the phenomenological aspects and to study the different correlates affecting their clinical picture. Materials and Methods: A comparative cross-sectional study including 22 patients with first-episode psychotic disorder recruited from the inpatient wards of the Institute of Psychiatry Ain-Shams University. All patients were interviewed between 1 week and 1 month of onset of symptoms using Structured Clinical Interview for DSM-IV (SCID-I) and Positive and Negative Syndrome Scale (PANSS). Patients were labeled into 2 groups according to diagnosis, group I: patients fulfilling criteria of brief psychotic episode. Group II: patients fulfilling criteria of substance-induced psychotic disorder. Results: No statistical difference between the 2 studied groups as regard PANSS score positive, negative, and general psychopathology, as well as the severity of symptoms. However, further analysis of the PANSS score components showed SIP group to have significantly higher P4 (excitement) score (P=0.02), G10 (disorientation) score (P=0.03), and G11 (poor attention) score (P=0.004). Conclusions: This study adds to a growing body of literature highlighting the differences between SIP and primary psychosis. It provides set of variables that distinguish the substance-induced and primary psychosis groups from one another, which should be an area for further studies.

The dopamine beta-hydroxylase gene polymorphism rs1611114 is associated with schizophrenia in the Chinese Zhuang but not Chinese Han population.

Schizophrenia (SCZ) is a devastating neurodevelopmental disorder. However, the mechanism underlying this highly heritable disorder remains unclear. The dopamine beta-hydroxylase (DBH) gene encodes a key metabolic enzyme of dopamine. Consequently, DBH is considered a candidate gene for SCZ. However, previous studies on its association with SCZ susceptibility have shown conflicting results. Here, we examined association between the rs1611114 polymorphism of DBH and SCZ susceptibility and related clinical symptoms. A total of 691 SCZ patients and 698 age- and gender-matched healthy controls were examined. mRNA expression levels of DBH were measured by quantitative real-time polymerase chain reaction, and the rs1611114 polymorphism was genotyped using the Sequenom MassARRAY platform. Also, the Positive and Negative Syndrome Scale (PANSS) was used to assess SCZ clinical symptoms. Our results show lower DBH mRNA expression levels in SCZ patients than healthy controls (Zhuang: p=0.000; Han: p=0.037). Interestingly, the rs1611114 polymorphism was significantly associated with SCZ susceptibility (overdominant model: p=0.010) in only the Chinese Zhuang population. Furthermore, the rs1611114 polymorphism was associated with PANSS total score (allele T/C: p=0.015) and general psychopathology score (allele T/C: p=0.027) in Chinese Zhuang SCZ patients. These results suggest that the DBH gene may play an important role in the occurrence of SCZ. Also, rs1611114 may be associated with SCZ susceptibility and related clinical symptoms in the Chinese Zhuang but not Han Chinese population. Further studies with larger samples of different ethnicities are needed to confirm the role of DBH in SCZ.

Altered serum levels of interleukin-3 in first-episode drug-naive and chronic medicated schizophrenia

Elevated serum levels of Interleukin-3 (IL-3), a major component of the cytokines, have been observed in chronic and medicated patients with schizophrenia, but this elevation may reflect either or both medication and illness chronicity effects. Thus, we compared serum IL-3 levels in first-episode drug-naive (FEDN) to chronic medicated patients with schizophrenia and examined the association of IL-3 with their psychopathological symptoms. Serum IL-3 levels were assessed in 55 FEDN patients, 52 chronic medicated patients and 43 healthy controls. Schizophrenia symptomatology was assessed with the Positive and Negative Syndrome Scale (PANSS). Serum IL-3 levels were measured by sandwich enzyme-linked immunosorbent assay (ELISA). We found significantly lower IL-3 levels in FEDN patients than both chronic patients and healthy controls (both p<0.001), while IL-3 levels in chronic patients were markedly higher than in healthy controls. No significant association was observed between IL-3 and any clinical psychopathology in FEDN patients; however, we found a significant correlation between serum IL-3 levels and the PANSS general psychopathology subscore in chronic medicated patients (p<0.05). Decreased IL-3 levels in FEDN patients suggest that suppressed immune function may be associated with developing schizophrenia, but as the disease progresses IL-3 levels increase perhaps related to medication treatment or other factors that occur during chronic illness.

Psychosocial functioning, quality of life and clinical correlates of comorbid alcohol and drug dependence syndromes in people with schizophrenia across Europe

Little is known about the correlates of comorbid drug and alcohol dependence in people with schizophrenia outside the USA. We tested hypotheses that dependence on alcohol/drugs would be associated with more severe symptoms, and poorer psychosocial functioning and quality of life. The EuroSC Cohort study (N=1204), based in France, Germany and the UK, used semi-structured clinical interviews for diagnoses, and standardized tools to assess correlates. We used mixed models to compare outcomes between past-year comorbid dependence on alcohol/drugs, controlling for covariates and modelling both subject and country-level effects. Participants dependent on alcohol or drugs had fewer negative symptoms on PANSS than their non-dependent counterparts. However, those dependent on alcohol scored higher on PANSS general psychopathology than those who were not, or dependent only on drugs. People with schizophrenia dependent on drugs had poorer quality of life, more extrapyramidal side effects, and scored worse on Global Assessment of Functioning (GAF) than those without dependence. People with alcohol dependence reported more reasons for non-compliance with medication, and poorer functioning on GAF, though not on Global Assessment of Relational Functioning. In people with schizophrenia, comorbid dependence on alcohol or drugs is associated with impaired clinical and psychosocial adjustment, and poorer quality of life.

Serum IL-18 level, clinical symptoms and IL-18-607A/C polymorphism among chronic patients with schizophrenia in a Chinese Han population

Literature suggests that alterations in the inflammatory and immune systems are involved in the pathogenesis of schizophrenia. Specifically, patients diagnosed with schizophrenia exhibit increased IL-18, a pleiotropic proinflammatory cytokine in type 1 T-helper (Th1) responses. The functional 607A/C promoter polymorphism of the IL-18 gene is also associated with the psychopathology of this disorder. However, no current study has explored its role in the clinical symptoms of schizophrenia as mediated through IL-18 levels. We recruited 772 inpatients with schizophrenia and 775 healthy controls in a Han Chinese population and genotyped the IL-18-607A/C polymorphism.Patient psychopathology was assessed using the Positive and Negative Syndrome Scale (PANSS). Serum IL-18 levels were measured in 80 patients and 93 healthy controls. Our results showed that there were no significant differences in the distribution of the allele and genotype frequencies between the patients and controls. Both increased IL-18 serum level and the IL-18-607A/C polymorphism were positively associated with the PANSS general psychopathology subscore and the PANSS total score. Moreover, interaction of increased IL-18 serum level and the IL-18-607A/C polymorphism influenced the clinical psychopathological symptoms, indicating that association of IL-18 level with the PANSS general psychopathology subscale or the total scores was present only among patients carrying the C allele. We demonstrate an association between the IL-18-607A/C variant and clinical psychopathological symptoms in schizophrenia. Findings suggest that the association between higher IL-18 levels and clinical symptoms in schizophrenia is dependent on the IL-18-607A/C polymorphism.

Soluble Fas ligand (sFasL) as a predictor of reduction of general psychopathology in schizophrenia after antipsychotic treatment

IntroductionDysregulation of the apoptotic process is associated with the etiopathogenesis of schizophrenia, which is observed at the brain and peripheral blood levels. A significant negative correlation between the duration of the disease and serum sFasL concentration was demonstrated by other authors. It was shown that an increased rate of apoptosis is more pronounced in neuroleptic-free patients with the first-episode of schizophrenia than in patients with chronic disease.AimSearch for a predictor of good response to antipsychotic treatment based on the analysis of the sFasL plasma level and its relationship with clinical symptoms.MethodsFifty-three patients with chronic schizophrenia and 46 healthy individuals were enrolled in the study. The concentration of sFasL was measured by ELISA. Clinical assessments (PANSS, SANS, SAPS) and blood analyses were conducted three times: during the active phase of disease (at admission), after 4 weeks of pharmacotherapy, and after reaching remission.ResultsIn the schizophrenia group, non-altered levels of sFasL (P = 0.1; U Mann-Whitney test), compared to the control, were detected at admission. The initial level of sFasL correlated negatively (r = −0.33; P = 0.04; Spearman's rank) with blood leukocyte count. Despite clinical improvement, no significant changes in the level of sFasL were observed. However, the sFasL level correlated negatively with the PANSS general psychopathology reduction after 4 weeks of pharmacotherapy (r = −0.7; P = 0.04) and after remission (r = −0.39; P = 0.026).ConclusionsThe results indicate a possible role of sFasL in apoptosis of blood leukocytes and suggest that the reduction of sFasL level can predict level of PANSS general psychopathology after antipsychotic treatment in schizophrenia.Disclosure of interestThe authors have not supplied their declaration of competing interest.

LAI versus oral antipsychotic maintenance treatment of schizophrenia: A case-control study on subjective experience of treatment

IntroductionLimited research has been devoted to the subjective impact of switching antipsychotic maintenance treatment (AMT) from oral to LAI formulation in schizophrenia.ObjectiveTo compare LAI AMT with oral AMT in terms of subjective experience of treatment, taking into account the effects on psychopathology.MethodsTwenty outpatients (7 males, mean age 40.55 ± 11.00 years) with remitted schizophrenia treated with either olanzapine or paliperidone and switching from oral to LAI AMT were recruited before the switch (LAI-AMT group). A group of 20 remitted schizophrenic subjects with oral AMT and matched for the main socio-demographic, clinical and treatment variables made up the controls (oral-AMT group). All participants were assessed by means of the PANSS and of the SWN-K at baseline (T0) and after 6 months (T1).ResultsBetween T0 and T1, general psychopathology of the PANSS and all but one of the SWN-K dimensions (except for “social integration”), showed significantly higher percent improvements in the LAI-AMT group compared to the oral-AMT group. After 6 months (T1), the LAI-AMT group showed significantly lower PANSS total and general psychopathology scores, as well as higher mean score of perceived “mental functioning” compared to the oral-AMT group. Item analysis of the general PANSS at T1 showed significant differences between the two groups in anxiety, tension, depression, guilt feelings, poor attention, and active social avoidance.ConclusionsOur data on switching from oral to LAI AMT in remitted schizophrenia suggest a better efficacy of the latter in terms of improvement of general psychopathology and subjective experience of treatment.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Prevalence and implications of Truman symptoms in subjects at ultra high risk for psychosis

Preliminary qualitative research has suggested that patients with early stages of psychosis and those at Ultra High Risk (UHR) may experience “Truman symptoms” (TS). This study is an exploratory investigation of TS in a sample of 26 UHR subjects and 14 matched controls (HC) recruited from three prodromal and early intervention clinics and its relation with clinical features, depersonalization and basic self-disturbances. The UHR were assessed with the Comprehensive Assessment of At-Risk Mental States (CAARMS), Social and Occupational Functioning Assessment Scale (SOFAS), the Positive and Negative Syndrome Scale (PANSS), the Cambridge Depersonalization Scale (CDS) and the Examination of Anomalous Self Experiences (EASE) checklist. In our sample, TS were specific (TS absent in HC) and highly prevalent (50%) in UHR subjects. We found a significant difference in EASE total scores across HC, UHR with TS and without TS but post-hoc analyses showed similar scores in the two latter groups. The presence of TS in our UHR sample was associated with significant higher PANSS general psychopathology but with non-significant difference in the CAARMS, CDS and SOFAS scores. This study of TS in UHR subjects suggested that they might be prevalent and specific of this population.

Extensive white matter abnormalities and clinical symptoms in drug-naive patients with first-episode schizophrenia: a voxel-based diffusion tensor imaging study.

Increasing evidence shows that disruption of connectivity has been implicated as a central abnormality in schizophrenia, and the alterations in white matter may be the core basis for this disconnection. Diffusion tensor imaging (DTI) has shown white matter abnormalities in first-episode schizophrenia. However, few studies have examined the correlation between clinical symptoms and white matter abnormalities in drug-naive patients with first-episode schizophrenia. The white matter fractional anisotropy (FA) values of the whole-brain were determined by using voxel-based DTI in 39 drug-naive patients with first-episode schizophrenia (diagnosed according to DSM-IV) and 30 healthy controls matched for age and gender. The psychopathology of schizophrenia was assessed with the Positive and Negative Syndrome Scale (PANSS). The study was conducted from April 2009 to March 2010. The patients showed widespread FA reduction in several brain regions, including corpus callosum, brainstem, internal capsule, cingulate, and cerebellum in patients with first-episode schizophrenia when compared to healthy controls (all P values < .01 after adjusting for gender, age, and education). The correlation analysis showed a significant negative correlation between the FA value in the left cerebellum and positive symptoms (r38 = -0.32, P < .05) and a significant positive correlation between the FA values in the corpus callosum and both the PANSS general psychopathology subscore (r38 = 0.39, P < .01) and the PANSS total score (r38 = 0.33, P < .05). Our results indicate that widespread disruption of white matter integrity occurs in an early stage of schizophrenic onset, suggesting an important role in pathogenesis and symptomatology of schizophrenia.

Short term effectiveness of haloperidol versus risperidone in first-episode schizophrenia

Aim: The supposed superiority of second-generation antipsychotic medication over first-generation antipsychotic medication has been challenged recently by several studies. This naturalistic retrospective study aims to compare outcomes between patients admitted for the first time with first-episode schizophrenia-spectrum disorders who were started on either haloperidol or risperidone. Would choice of antipsychotic affect length of admission and three-month outcome? Methods: Seventy-seven patients from the Early Psychosis Intervention Programme at the Institute of Mental Health were included in this study. Length of stay was obtained from hospital electronic records. Positive and Negative Syndrome Scale (PANSS) and Global Assessment of Functioning (GAF) scores at three months were used to assess severity of psychopathology and level of functioning respectively. A secondary analysis was also done to measure time to discontinuation for any reason. Results: There was a significant reduction in PANSS total, positive, negative and general psychopathology scores in both groups at three months, with the patients on risperidone showing a greater reduction in PANSS negative scores compared to the patients on haloperidol. However, there were no statistically significant differences between length of hospitalization and total PANSS score at three months between the two groups. Time to discontinuation was longer in the risperidone group compared to the haloperidol group. Conclusion: The findings of this study suggest that risperidone has a better effect on negative symptoms and is better tolerated, resulting in a longer time to discontinuation. Thus, starting a patient with first-episode schizophrenia-spectrum disorder on risperidone would result in a better short-term outcome as compared to starting the same patient on haloperidol.

Relationship Suicide, Cognitive Functions, and Depression in Patients with Schizophrenia.

The aim of this study was to compare schizophrenic patients with and without a suicide attempt history in terms of sociodemographic and clinical features and cognitive functions and to determine the predictive factors for suicide attempt history. In this study, we assessed and compared 70 patients with schizophrenia, 27 patients with a suicide attempt history, and 43 patients without a suicide attempt history. The cognitive functions of patients were assessed by the Stroop test, Wisconsin Card Sorting Test (WCST), and Rey Auditory Verbal Learning Test. In order to evaluate clinical symptoms, the Positive and Negative Syndrome Scale (PANSS) and Calgary Depression Scale for Schizophrenia (CDSS) were used. In this study, the number of hospitalizations, PANSS general psychopathology subscale score, CDSS total score, suicide item score, and WCST total number of responses (WCST1) were significantly higher among the patients with a suicide attempt history. The WCST1 and CDSS total scores were predicted using the suicide attempt history. Revealing the factors related to suicidal behavior in patients with schizophrenia contributes to the prevention of suicide. Studies with long-term follow-up and with a larger sample group are required for the investigation of relationship suicide, cognitive impairment, which is one of the core symptoms of schizophrenia, and depression.