Psychiatric Rating Scale Scores Research Articles

Evaluation of the efficacy of the continuation electroconvulsive therapy in treatment-resistant schizophrenia

Background : Electroconvulsive therapy (ECT) has been reported being a safe and effective treatment in schizophrenia. However, there are a limited number of studies assessing continuation ECT utilization in patients with schizophrenia giving partial response to pharmacological treatment. Objective : The aim of this study is to evaluate the effectiveness of continuation ECT in preventing relapse in patients with treatment-resistant schizophrenia. Methods : In this retrospective analysis, schizophrenia patients (n = 73) were defined in three groups such as patients who received only AP treatment (only AP), patients who received acute ECT only during hospitalization (aECT+AP), patients who received acute ECT and continuation ECT (a-cECT+AP). Three groups were compared according to positive and negative syndrome scale (PANSS) and Brief Psychiatric Rating Scale (BPRS) scores. Results : As per comparison of only AP group, aECT+AP group and a+cECT+AP groups in terms of after discharge PANSS and after discharge BPRS scores for 1st month, 3rd month and 6th month; 3rd and 6th month’s PANSS scores of a+cECT+AP group were statistically significantly lower than other two groups. Discussion : Although this study suffers the limitations of retrospective medical chart analysis, results suggest that, in patients with a diagnosis of schizophrenia who have responded to an acute course of ECT, continuation ECT in combination with antipsychotics is more effective than antipsychotics alone in preventing relapse.

Carbamazepine for schizophrenia.

Many people with schizophrenia do not achieve a satisfactory treatment response with just antipsychotic drug treatment and various adjunct medications are used to promote additional response. The antiepileptic carbamazepine is one such drug. To examine whether carbamazepine or oxcarbazepine alone is an effective treatment for schizophrenia and schizoaffective psychoses and whether carbamazepine or oxcarbazepine augmentation of neuroleptic medication is an effective treatment for the same illnesses. For the original version we searched The Cochrane Schizophrenia Group's Register of Trials (December 2001), The Cochrane Library (Issue 3, 2001), MEDLINE (1966-2001), EMBASE (1980-2001), Biological Abstracts (1980-2001), PsycLIT (1886-2001) and PSYNDEX (1974-2001). For the most recent update we searched the Cochrane Schizophrenia Group's Register of Trials in July 2012. We also inspected references of all identified studies for further trials and contacted relevant pharmaceutical companies and authors for additional data. We included all randomised controlled trials (RCTs) comparing carbamazepine or compounds of the carbamazepine family with placebo or no intervention, whether as sole treatment or as an adjunct to antipsychotic medication for the treatment of schizophrenia and/or schizoaffective psychoses. We extracted data independently. For homogenous dichotomous data we calculated fixed-effect, risk ratio (RR), with 95% confidence intervals (CIs) on an intention-to-treat basis. For continuous data, we calculated mean differences (MD). We assessed the risk of bias for included studies and created a 'Summary of findings' table using GRADE. The updated search did not reveal any further studies that met our inclusion criteria. The number of included studies therefore remains at 10 with the number of participants randomised still 283.One study comparing carbamazepine with placebo as the sole treatment for schizophrenia was abandoned early due to high relapse rate with 26 out of 31 participants relapsing by three months. No effect of carbamazepine was evident with no difference in relapse between the two groups (1 RCT n = 31, RR 1.07 CI 0.78 to 1.45). Another study compared carbamazepine with antipsychotics as the sole treatment for schizophrenia. No differences in terms of mental state were found when comparing 50% reduction in Brief Psychiatric Rating Scale (BPRS) scores (1 RCT n = 38, RR 1.23 CI 0.78 to 1.92). A favourable effect for carbamazepine was found when more people who received the antipsychotic (perphenazine) had parkinsonism (1 RCT n = 38, RR 0.03 CI 0.00 to 0.043). Eight studies compared adjunctive carbamazepine versus adjunctive placebo, we were able use GRADE for quality of evidence for these results. Adding carbamazepine to antipsychotic treatment was as acceptable as adding placebo with no difference between the numbers leaving the study early from each group (8 RCTs n = 182, RR 0.47 CI 0.16 to 1.35, very low quality evidence). Carbamazepine augmentation was superior compared with antipsychotics alone in terms of overall global improvement, but participant numbers were low (2 RCTs n = 38, RR 0.57 CI 0.37 to 0.88). There were no differences for the mental state outcome of 50% reduction in BPRS scores (6 RCTs n = 147, RR 0.86 CI 0.67 to 1.12, low quality evidence). Less people in the carbamazepine augmentation group had movement disorders than those taking haloperidol alone (1 RCT n = 20, RR 0.38 CI 0.14 to 1.02). No data were available for the effects of carbamazepine on subgroups of people with schizophrenia and aggressive behaviour, negative symptoms or EEG abnormalities or with schizoaffective disorder. Based on currently available randomised trial-derived evidence, carbamazepine cannot be recommended for routine clinical use for treatment or augmentation of antipsychotic treatment of schizophrenia. At present large, simple well-designed and reported trials are justified - especially if focusing on people with violent episodes and people with schizoaffective disorders or those with both schizophrenia and EEG abnormalities.

Psychiatric disorders in idiopathic-isolated focal dystonia

Idiopathic-isolated focal dystonia (IIFD) is a movement disorder characterised by involuntary, sustained muscle contractions, leading to abnormal postures. Psychopathology is frequent in patients with IIFD, and while traditionally this was thought to be a secondary phenomenon, there is emerging evidence for shared neurobiological mechanisms. We conducted a single-centre cross-sectional study of 103 consecutive patients with IIFD and two comparison groups: 78 consecutive patients with hemifacial spasm (HFS) and 93 healthy control subjects. Assessments with regard to psychiatric disturbances were performed using self-report questionnaires, including the self-report version of the Yale-Brown Obsessive Compulsive Scale (Y-BOCS-SR), the Beck Anxiety Inventory (BAI), and the Beck Depression Inventory (BDI). Compared to healthy control subjects and patients with HFS, the IIFD group had higher OCS, anxiety, and depression scores as measured by the Y-BOCS-SR, BAI, and BDI, respectively. The Y-BOCS-SR, BAI, and BDI were highly correlated across all the subjects. Logistic regression analysis showed that the main driver of high obsessive-compulsive symptom scores, irrespective of neurological diagnosis, was the BDI, whereas it was BAI (and not BDI), that drives the association between the psychiatric rating scale scores and the neurological diagnosis. Our findings suggest that while clinically significant obsessive-compulsive symptoms are over-represented in IIFD patients relative to controls, the BAI may have better discriminatory power to distinguish between the psychiatric symptoms in IIFD patients.

Addiction to lizard: A rare case report.

Sir, Drug use and abuse is as old as mankind itself. Human beings have always had a desire to eat or drink substances that make them feel relaxed, stimulated, or euphoric. As time went by, “home remedies” were discovered and used to alleviate aches, pains and other ailments. Most of these were naturally occurring substances. No refinement had occurred and isolation of specific compounds (drugs) had not taken place. The use of various insects as substances of abuse is interesting and has not been reported in detail in medical literature. The Indian spiny tailed lizard (Uromastyx hardwickii) is found patchily distributed in the Thar desert, Kutch and surrounding arid zones in India and Pakistan. Since ancient times, these are hunted by the locals in the belief that the oil extracted from the fat of the lizard's body is an aphrodisiac and is used as an embrocation and as a cure for impotence.[1] We would like to illustrate a case report on lizard being used as a substance of abuse in a cannabis addict. A 25-year-old male prisoner, with a 15-year history of cannabis abuse, shifted his drug of abuse to lizards due to non-availability of cannabis in prison. He would burn lizards and take the charred remains and fill them in a bidi and inhale deeply. He claimed “instant high” on this substance equating it as pleasurable as cannabis. He was introduced to this practice of smoking lizard powder by other jail inmates who were drug addicts and due to non-availability of drugs, started abusing lizard powder. On his release from prison, he started using cannabis again and also continued the use of lizard powder by mixing it with cannabis (sulfa) and smoked it in a bidi. After a month of smoking this combination, he presented with an acute psychotic episode with grossly disorganized behavior and was admitted for the same. He was diagnosed with cannabis induced psychosis. His initial Brief Psychiatric Rating Scale score (BPRS) was 59 and he was treated with tablet risperidone 6 mg/day and benzodiazepines for sedation. His condition improved in a week, BPRS score was 30; but he continued to be apathetic, anergic and slothful. His attention and concentration were also impaired. There was also history of apathy, anergia and amotivation for the past few years. Past history and family history of any psychiatric disorder was negative. The diagnosis of comorbid amotivational syndrome was considered and patient was started on tablet dothiepin 75 mg/day. His symptoms improved and he was followed-up for 1 year during which he did not abuse any substance and his mental condition was normal. During adverse conditions due to non-availability of drugs or other substances of abuse, the man has found alternatives in the form of lizard powder, snake and scorpion venom and wasp sting.[2345] The psychoactive properties of lizard, which cause addiction are not known. Thus, future research should be directed at finding the root cause of this addiction and long term affects of such addictions.

A Case Report on Myxedema Madness: Curable Psychosis

Myxedema madness is a very rare but established entity. A psychotic patient having hypothyroid features should always be evaluated regarding same. A 30-year-old female without known significant past medical history had, for the past one and half year, continuous persecutory and referential delusions; second and third person auditory hallucinations, facial puffiness and Brief Psychiatric Rating Scale (BPRS) score of 41 on admission. Her thyroid profile was: Thyroid stimulating hormone - 63.71 mIU/L, Free tri iodo threonine (FT3) - 2.1 pg/ml, free tetra iodo thyronine (FT4) - 0.6 ng/ml with normal ultrasound-thyroid. Patient was started on thyroxin 100 μg with a low dose risperidone 2 mg. Risperidone was withdrawn over a week and the patient was discharged on thyroxin alone with BPRS score of 8 and absence of delusions and hallucinations.

Vascular Endothelial Growth Factor and Brain-Derived Neurotrophic Factor in Quetiapine Treated First-Episode Psychosis

Objective. It has been suggested that atypical antipsychotics confer their effects via brain-derived neurotrophic factor (BDNF). We investigated the effect of quetiapine on serum levels of BDNF and vascular endothelial growth factor (VEGF) in drug-naive first-episode psychosis subjects. Methods. Fifteen patients drawn from a larger study received quetiapine treatment for twelve weeks. Baseline levels of serum BDNF and VEGF were compared to age- and sex-matched healthy controls and to levels following treatment. Linear regression analyses were performed to determine the relationship of BDNF and VEGF levels with outcome measures at baseline and week 12. Results. The mean serum BDNF level was significantly higher at week 12 compared to baseline and correlated with reductions in Brief Psychiatric Rating Scale (BPRS) and general psychopathology scores. Changes in serum VEGF levels also correlated significantly with a reduction in BPRS scores, a significant improvement in PANNS positive symptoms scores, and displayed a positive relationship with changes in BDNF levels. Conclusions. Our findings suggest that BDNF and VEGF are potential biomarkers for gauging improvement of psychotic symptoms. This suggests a novel neurotrophic-based mechanism of the drug effects of quetiapine on psychosis. This is the first report of VEGF perturbation in psychosis.

Do patients with paranoid and disorganized schizophrenia respond differently to antipsychotic drugs?

The aim of this study was to compare the differential response to amisulpride in patients with paranoid versus disorganized schizophrenia. We reanalyzed the original data from five different randomized drug trials comparing Brief Psychiatric Rating Scale (BPRS) scores in a database containing 427 paranoid and 296 disorganized patients with schizophrenia. Both the disorganized and the paranoid group showed a substantial improvement of the BPRS total score within the first 4 weeks. In the paranoid group, mean (±SD) BPRS reduction was 16.9 (±14.6) (t = 24.06, df = 426, P < 0.001) and in the disorganized group 17.0 (±15.9) (t = 18.49, df = 295, P < 0.001). An analysis of covariance (ancova) controlling for BPRS at baseline and the influence of different trial protocols showed significant differences between diagnostic groups (F = 13.47, df = 1, P < 0.001), Cohen's D 0.31 (CI = 0.16-0.46). Paranoid patients improved by 4.8 BPRS points more than disorganized patients (adjusted means 18.90 (CI = 17.33-20.37) for the paranoid and 14.1 (CI = 12.04 - 16.11) for the disorganized group. We conclude that amisulpride is effective in disorganized as well as in paranoid schizophrenia, but that symptom reduction in the disorganized subtype is less pronounced.

Blonanserin, a Novel Antipsychotic, Is Suitable for Treating Schizophrenia Associated With Hyperprolactinemia

Recently, atypical antipsychotic agents have primarily been used in pharmacological treatment of schizophrenia because of the fewer associated adverse effects. Blonanserin is a novel atypical antipsychotic recently introduced to treat patients with schizophrenia in Japan and South Korea. In this study, we examined the efficacy of switching antipsychotic medications to blonanserin monotherapy in patients with chronic schizophrenia with associated hyperprolactinemia. Ten schizophrenic patients (5 males and 5 females) with hyperprolactinemia were recruited. Clinical data before (baseline) and 12 weeks after (end point) switching to blonanserin monotherapy were assessed using the Brief Psychiatric Rating Scale score, Drug-Induced Extrapyramidal Symptoms Scale, and serum prolactin levels. The mean (SD) blonanserin dosage was 14.8 (3.8) mg/d. After switching to blonanserin, there were significant improvements in the Brief Psychiatric Rating Scale in the patients from both sexes. Moreover, serum prolactin levels in the female patients significantly decreased to within reference range. There were no additional adverse effects observed with the blonanserin treatment. Switching to blonanserin can reverse medication-induced prolactin elevations found in female patients- and blonanserin is a suitable antipsychotic for schizophrenic patients.

Efficacy of repetitive transcranial magnetic stimulation versus electroconvulsive therapy in the treatment of medication resistant major depressive disorder: a systematic review protocol

Review question/ objective The aim of this review is to compare the efficacy of repetitive transcranial-magnetic stimulation (rTMS) with electroconvulsive therapy (ECT) in the treatment of medication resistant major depressive disorder. Inclusion Criteria Types of participants This review will consider all randomized controlled trials that attempt to compare the efficacy of rTMS versus ECT in the treatment of medication resistant major depressive disorder; given for patients of any age and gender with a diagnosis of major depression disorder, with or without psychotic features according to either the DSM–IV (American Psychiatric Association, 1994) or ICD–10 (World Health Organization, 1993) diagnostic criteria. All patients included in this study have to have been judged as clinically appropriate for a course of ECT or rTMS based on the chronicity and severity of depression, presence of multiple medication trials and/or lack of adequate response or intolerance to pharmacotherapy. Types of intervention(s) This particular review will include all randomized controlled trial studies that compared the efficacy of rTMS with ECT therapy in the treatment of medication resistant major depressive disorder, given for patients of any age and gender. Types of outcomes The primary outcome measure of this review will be the score on the Hamilton Depression Rating Scale (HAM-D) and the proportion of patients with remissions (Hamilton score, < 8) after treatment with rTMS or ECT. Secondary outcomes will include mood self-ratings on the Beck Depression Inventory-II and Visual Analogue Mood Scales, Brief Psychiatric Rating Scale (BPRS) score, Young Mania Rating Scale (YMS), Clinical Global Impression scale (CGI) and both self-reported and observer-rated cognitive changes.

Single- and Multiple-Dose Pharmacokinetic, Safety, and Tolerability Profiles of Olanzapine Long-Acting Injection: An Open-Label, Multicenter, Nonrandomized Study in Patients With Schizophrenia

BackgroundThis was the first study, to our knowledge, in patients with schizophrenia in which olanzapine long-acting injection (LAI) was used to attempt delivery of depot formulation in multiple therapeutic doses. ObjectiveThis study assessed the safety profile, tolerability, and pharmacokinetic (PK) properties of olanzapine after single and multiple administrations of olanzapine LAI and evaluated maintenance of symptom control. MethodsThis was an open-label, multicenter, nonrandomized study of olanzapine LAI in patients with schizophrenia stabilized with oral olanzapine. Key inclusion criteria included well-tolerated and efficacious treatment with daily olanzapine. Patients were required to be receiving a stable oral dose for 4 weeks before study entry with no requirement for as-needed additional antipsychotic medication within 2 weeks before entry. Exclusion criteria included serious unstable illnesses, unresolved seizures, pregnancy or breastfeeding, hypothyroidism, hyperthyroidism, narrow-angle glaucoma, or serious suicidal risk. Initially, 34 patients received olanzapine LAI as a single injection of 50 to 450 mg, and as the study progressed, 247 patients received consecutive injections of 100 to 405 mg olanzapine LAI administered every 2, 3, or 4 weeks for 3 to 6 months. Spontaneously reported adverse events were recorded at each visit. Analyses of efficacy and safety profile parameters were performed on an intent-to-treat basis. All hypotheses were tested at a 2-sided significance level of P < 0.05. ResultsStudy participants had a mean age of 39 years and were primarily white men. The PK properties suggested prolonged release providing sustained olanzapine plasma concentrations and supporting a dosing interval ≤4 weeks. Olanzapine LAI doses of 150 or 300 mg every 2 weeks and 210 or 405 mg every 4 weeks provide mean steady-state olanzapine concentrations similar to those after oral administration of 5 to 20 mg/d. The mean baseline Brief Psychiatric Rating Scale score of 17.27 decreased by 2.68 points, and the mean baseline Clinical Global Impression–Severity score of 3.39 decreased by 0.23 points, indicating that patients’ psychiatric health was maintained or slightly improved. Significant mean weight gain (P < 0.001) and treatment-emergent changes in nonfasting glucose were observed. Incidence of weight gain ≥7% of baseline was observed in 17.8% of patients. The common adverse events were injection site pain, anxiety, sedation, insomnia, somnolence, and headache, and the safety profile for olanzapine LAI was comparable to that of oral olanzapine, except for injection site–related adverse events. ConclusionThe safety profile and PK data from this study support continued clinical development of olanzapine LAI in controlled efficacy studies at doses ≤300 mg every 2 weeks or 405 mg every 4 weeks. Clinical trial registry ID: 4535 http://www.lillytrials.com/results/ZyprexaLAI.pdf.

Predictors of insight in first-episode schizophrenia: A 5-year cohort study from India

There is a dearth of data on the predictors of insight in schizophrenia. This study attempted to assess the predictors of insight in a cohort of first-episode schizophrenia followed up over 5 years. Patients diagnosed to have Diagnostic and statistical manual of mental disorders (4th ed.; DSM-IV) schizophrenia (n = 131) were assessed prospectively for insight, psychopathology and explanatory models of illness over a 5-year period using standard instruments. Multiple linear regression and generalized estimating equations (GEE) were employed to assess predictors of insight. We could follow up 95 (72.5%) patients, 5 years after recruitment. A total of 65 of these patients interviewed at 60 months (68.4%) achieved remission. Cross-sectional evaluations suggest a relationship between insight, psychosis rating and explanatory models of illness with good insight and medical models associated with good outcome. However, baseline and early illness data do not predict insight scores at 5 years. Serial longitudinal assessment of insight is negatively associated with Brief Psychiatric Rating Scale (BPRS) scores and positively associated with the number of nonmedical explanatory models of illness held by patients. These findings argue that insight and explanatory models of illness are secondary to psychopathology, course and outcome. They are dependent on the trajectory of the person's illness, are not independent of the condition and call for multifaceted understanding of the issues.

Clinical subtypes of severe bipolar mixed states

ObjectiveThe aim of the present study was to identify different clinical subtypes in severe, treatment resistant bipolar mixed state (MS). MethodThe sample comprised 202 Bipolar I patients currently in MS referred for an Electro-convulsive Therapy (ECT) trial and evaluated in the first week of hospitalization and one week after the ECT course. Principal component factor analysis (PCA) followed by Varimax rotation was performed on 21 non-overlapping items selected from Hamilton rating-scale for depression (HAMD) and from Young mania rating-scale (YMRS) at baseline evaluation. Cluster subtypes derived from the factor scores were compared in clinical variables and final HAMD, YMRS, Brief Psychiatric Rating Scale (BPRS) and Clinical Global Impression (CGI) scores. ResultsThe principal-component analysis extracted 6 interpretable factors explaining 55.9% of the total variance. Cluster analysis identified four groups, including respectively 63 (31.2%) subjects with Agitated-Irritable Mixed-Depression, 59 (29.2%) with Psychotic Mixed-Mania, 17 (8.5%) with Anxious-Irritable-Psychotic Mixed-Mania, and 63 (31.2%) with Retarded-Psychotic Mixed-Depression. The four clusters were statistically distinct and did not show significant overlap in the main symptomatological presentation. Cluster subtypes reported differences in number of past mood episodes, duration of the current episode, suicide attempts, lifetime comorbidity with panic and eating disorders, baseline and final rating-scale scores and rate of remission after ECT trial. ConclusionsOur study indicates that, at least in severe treatment resistant MS, multiple depressive and manic subtypes can be observed with substantial differences in terms of clinical presentation, course, associated comorbidities and treatment response.

Aripiprazole Versus Haloperidol in Combination With Clozapine for Treatment-Resistant Schizophrenia

Long-term studies for patients with resistant schizophrenia are necessary to assess the effectiveness of combination strategies on persisting positive symptoms. This multicenter, naturalistic, randomized, superiority study (ClinicalTrials.gov identifier: NCT00395915) aimed to compare clinical efficacy and tolerability of haloperidol versus aripiprazole as combination treatment with clozapine in patients with resistant schizophrenia. One hundred six patients were followed up for 12 months. After 12 months, the proportion of patients who discontinued treatment was not significantly different between aripiprazole and haloperidol (37% vs 28%, respectively; P = 0.431). The change in the Brief Psychiatric Rating Scale score was similar in the aripiprazole and haloperidol groups (-7.0 vs -7.9, respectively; P = 0.389), whereas the tolerability total score decreased significantly more in the aripiprazole group (-7.2 vs -2.3; P = 0.008). While the effectiveness of clozapine augmentation with a second antipsychotic agent is not clearly demonstrated yet, results from this study suggest that augmentation with aripiprazole offers no substantial benefit over haloperidol in efficacy. Aripiprazole was perceived more tolerable than haloperidol, but it is uncertain how this finding may translate into the real world of clinical practice.

The relationship between schizoaffective, schizophrenic and mood disorders in patients admitted at Mathari Psychiatric Hospital, Nairobi, Kenya

The prevalence of schizoaffective disorder (SAD) and the relationship between schizophrenia (SCZ), SAD and mood disorders (MD) in non-Western countries is unknown. To determine the prevalence of SAD and the relationship between SCZ, SAD and MD in relation to socio-demographic, clinical and therapeutic variables in 691 patients admitted at Mathari Psychiatric Hospital, Kenya. A cross-sectional comparative study using both clinician and SCID-1 for DSM-IV diagnoses. Approximately twenty three percent (n=160) met DSM-IV criteria for SAD using SCID-1. There were significant differences between SCZ, SAD and MD regarding: affective and core symptoms of schizophrenia (with the exception of core symptoms of schizophrenia between SCZ and SAD); presence of past trauma; a past suicide attempt; and comorbidity with alcohol and drug abuse disorders. SAD and MD patients took significantly more mood stabilizers than SCZ patients. There were no significant differences between the three groups regarding socio-demographic variables, brief psychiatric rating scale scores, cognitive performance, anxiety and depressive symptoms, presence of obsessions, and usage of both antipsychotics and antidepressants. There is no distinct demarcation between the three disorders. This lends support to recent evidence suggesting that SAD might constitute a heterogeneous group composed of both SCZ and MD patients or a middle point of a continuum between SCZ and MD.

Socio-demographic and clinical correlates of subjective quality of life among Nigerian outpatients with schizophrenia

This study aimed to measure the subjective quality of life (QOL) of Nigerian outpatients with schizophrenia and to examine its socio-demographic as well as clinical determinants. A total of 313 outpatients with schizophrenia participated in the study. Data were collected on socio-demographics, outpatient clinic attendance, perceived social support, perceived satisfaction with hospital care, medication adherence, illness severity and QOL. Multiple linear regression analysis was used to determine the amount of variance in the QOL domain scores explained by socio-demographic and clinical variables. Employment status, perceived social support, satisfaction with outpatient care, antipsychotic medication dose, Brief Psychiatric Rating Scale (BPRS) scores and medication adherence had significant relationships with all the QOL domains. Average monthly allowance and outpatient clinic default were significantly associated with all QOL domains except social relationship. Socio-demographic and clinical factors explained only a modest part (29.4%) of the variance in the QOL scores. It is likely that unmeasured ‘internalised’ determinants contribute in a much larger sense to the variation in subjective QOL.

Intérêt de l’électroconvulsivothérapie de maintenance dans les troubles de l’humeur

Maintenance electroconvulsive therapy (M-ECT) is a treatment indicated for the treatment and prevention of recurrent depression in patients who either do not respond or do not tolerate psychotropic medication. We evaluated, retrospectively, clinical response to a 6-month minimum course of M-ECT in 25 patients with a diagnosis of bipolar disorder or schizoaffective disorder according to DSM IV-TR criterion. Our study demonstrated a significant improvement of Global Assessment of functioning (GAF) scores after a six month minimum course of M-ECT (34.8 ± 12.6 vs 65.6 ± 10.8; P<0.05) as well as Brief Psychiatric Rating Scale scores (BPRS): 79.3 ± 12.4 vs 43.4 ± 10.2; P<0.05). We observed a slight increase of Mini Mental State Examination (MMSE) scores after M-ECT; nonetheless, it was not statistically significant (24.2 ± 2.4 vs 26.2 ± 2.4; P=0.2). Regarding the mean duration of hospitalizations, we showed a statistically significant decrease in the median number of days of hospitalization (72 [59-93.50] days before M-ECT vs 43 [25-76] days since the first M-ECT; P=0.017). Maintenance ECT allowed a significant improvement in psychiatric symptoms and global functioning of the patients included in this study, as well as a decrease in the number of days of hospitalization. However, our pattern is limited because of its small size; so, further prospective studies in this field, including larger population is highly recommended.

Clozapine-Induced Restless Legs Syndrome Treated With Aripiprazole

Clozapine-Induced Restless Legs Syndrome Treated With Aripiprazole

Association between a COMT polymorphism and clinical response to risperidone treatment

A total of 130 Chinese schizophrenic patients (45 male, 85 female) were enrolled in the study. Clinical efficacy was determined using Brief Psychiatric Rating Scale (BPRS) scores. We genotyped 10 single-nucleotide polymorphisms (SNPs) of the catechol-O-methyl transferase gene (COMT) in our patients and re-examined them for association with changes in BPRS scores after 8 weeks of risperidone monotherapy. COMT is one of the genes that confer susceptibility to schizophrenia, both because of its role in neurotransmitter metabolism and because of its location in the high-risk schizophrenia-related region 22q11. Recent studies also found that COMT functional polymorphisms influenced individual response to antipsychotic medication. Our aim in this study was to explore the influence of COMT polymorphisms on pharmacological response to risperidone in the Chinese population. Statistical analysis revealed a significant association between an upstream COMT SNP, rs9606186, and scores reduction of BPRS in all patients and in the male subgroup but not in the female subgroup (allele analysis: P=0.055 for all, P=0.012 for male patients; genotype analysis: P=0.046 for all, P=0.020 for male patients, uncorrected, odds ratio=3.95). The COMT gene polymorphism, SNP rs9606186, is associated with risperidone therapy efficiency in the Chinese population. This association exhibited a sexually dimorphic difference, which may shed light on the genetics of COMT and its enzymatic sex-dependent mechanism.

Optimizing the Early Prediction Model for Symptomatic Remission With Short-Term Treatment for Schizophrenia

Remission seems achievable for a portion of schizophrenic patients. This study aimed to identify the early predictors for remission and to establish an optimal prediction model. One hundred thirty-five acutely ill schizophrenic inpatients received 150-mg/d zotepine treatment for 4 weeks. Psychopathologic severity was assessed weekly using the Brief Psychiatric Rating Scale (BPRS). Symptomatic remission was defined according to the consensus criteria proposed by Andreasen et al. Backward stepwise logistic regression model was used to obtain the early predictors. The receiver operating characteristic curve was used to determine the cutoff point of predictors. The study was conducted from June 2004 to April 2005. Twenty-one (21.0%) of 100 completers remitted after 4 weeks of treatment. The most influential predictors for ultimate remission were percentage of BPRS score reduction at week 2 and BPRS remission-items score at week 2. Brief Psychiatric Rating Scale score reduction at week 2 of 35% and BPRS remission-items score of 18 at week 2 seemed to be the optimal cutoff points. They provided a sensitivity of 62% and 84% and a specificity of 86% and 65%. Patients with less than a 35% BPRS score reduction and a BPRS remission-items score larger than 18 during the first 2 weeks of treatment were unlikely to reach a final remission. Whether the finding can be extrapolated to other validated assessment scales and other antipsychotics require further studies.

Retrospective Study of Japanese Patients with Schizophrenia Treated with Aripiprazole

Aim. The purpose of this retrospective study was to evaluate changes in clinical indicators which influence the quality of life (QOL) of patients with schizophrenia treated by antipsychotic therapy before and after switching to aripiprazole. Methods. A retrospective chart review of 27 patients diagnosed with schizophrenia and who were switched from one antipsychotic to aripiprazole was performed. Clinical indicators about the daily dosage of antipsychotics and antiparkinsonian drugs, psychiatric condition, and glucose/lipid metabolism, clinical evaluation by nursing observation were used to measure the responsiveness of subjects to aripiprazole. Results. Of the 27 subjects, 14 responded to the switch to aripiprazole with significant improvement of the Brief Psychiatric Rating Scale (BPRS) score (P = 0.04), significant decrease in dosage of antipsychotics in 71% of patients (P = 0.03), and tendency toward reduction in dosage of antiparkinsonian drugs (P = 0.07) and body mass index (BMI) (P = 0.06). However, 8 of 27 subjects had a significant increase in lipid levels after switching to aripiprazole (P = 0.01). Conclusion. QOL for subjects who responded to the switch to aripiprazole improved as indicated by lower doses of antipsychotic and antiparkinson medications, improvement in BPRS score, and a decrease in BMI. Results indicate little influence on patient's QOL.