Psychotic Symptoms In Schizophrenia Research Articles

T124. CLINICAL DIFFERENCES BETWEEN URBAN AND RURAL SCHIZOPHRENIA

BackgroundSchizophrenia is a highly heritable disease; yet heritability rate could never exceed 80% in most studies. Genetic factors could never then, by their own, account for the whole risk for developing schizophrenia. Thus, environmental factors co-play a major role. Urbanity is now well established to be one of the most influential environmental factors for developing severe mental illnesses. A strong association between exposure to urban environment and the risk of developing schizophrenia, was demonstrated and several studies have shown that living in an urban environment increases the risk for developing schizophrenia.The aim of this study was to examine the clinic biological characteristics of patients with schizophrenia according to their rural or urban condition.MethodsThis study was based on 106 patients with a DSM 5 diagnosis of schizophrenia in period of remission. Sociodemographic and clinical characteristics were assessed. PANSS scale, Calgary depression scale, CGI scale were used to assess different features of the disease and biological variables (CBC, renal and liver markers, inflammatory markers: CRP and CRP hs) were evaluated. Two groups were formed according to the patient’s urban or rural birth and early living.ResultsThere were 71 urban and 35 rural patients. The mean age was 42,7 years in the urban group and 42,3 years in the rural group. Socio demographic characteristics were similar between the two groups. Patients with urban background had a higher score on the negative subscale (p=0,01) and the general psychopathology subscale (P=0,025) of the PANSS compared with rural patients. Otherwise, compared to patients with a rural birth and early living, urban patients showed more depressive symptoms on the Calgary depression scale (p=0,039). There were no significant differences between the two groups regarding the biological variables tested.DiscussionThe association between urban upbringing and risk for developing schizophrenia is well established. Nevertheless, relationship between epidemiological factors and different symptom dimensions is still poorly understood. Our study found a significant association between patients’ urban background and negative as well as disorganization and depressive symptoms. Most of published studies found a correlation between urban upbringing and positive psychotic symptoms in schizophrenia. To our knowledge, no similar result has ever been found before. Otherwise, there were several studies showing an association between disorganization and depressive symptoms with urban upbringing of the patients.

5. RETHINKING THE TAXONOMY, COURSE, AND OUTCOME OF PSYCHOSES: DIMENSIONAL, LATENT TRAJECTORY, AND TRANSDIAGNOSTIC APPROACHES

Overall : Evidence continues to accumulate on heterogeneity in phenomenology, course and outcome of non-affective and affective psychotic disorders. Both DSM and ICD classification systems have evolved to include a large number of categories of psychosis. However, doubt remains about this categorical approach because of high comorbidity, common etiological factors and the absence of zones of relative rarity between categorical diagnoses. Some authors have nevertheless argued that categorical representations of psychosis may still be of clinical utility if used in combination with dimensional indicators.It is now widely accepted that psychotic symptoms partition into several symptom dimensions that would support the heterogeneity of psychotic disorders. However, there is no consensus on the exact number of these dimensions, with previous factor-analytic work pointing towards models with two to twelve specific symptom dimensions. However, recently, there has been evidence for a transdiagnostic dimension underlying affective and non-affective psychotic symptoms in schizophrenia, schizoaffective and bipolar disorder that challenges their classification as distinct diagnostic constructs. There is also considerable heterogeneity in clinical course and outcome of psychotic disorders, but how to best map and model this over time remains to be established. Taken together, this presents significant challenges for the classification of psychotic disorders as separate diagnostic entities.This symposium brings together international researchers at the forefront of research into the phenomenology, course and outcome of psychotic disorders. Roman Kotov will present novel data on symptom dimensions and examines the course of these dimensions in an epidemiologic cohort of 628 first-admission inpatients with psychosis interviewed 6 times over two decades in the Suffolk County Mental Health Project. Craig Morgan will report new findings from the 10-year follow-up of the Aetiology and Ethnicity in Schizophrenia and Other Psychoses (AESOP-10) study, an epidemiological cohort of 552 patients with a first episode psychosis, using a data driven approach to identify latent trajectory classes to account for heterogeneity in patterns of change in psychotic symptoms over time and characterize these trajectories with the WHO classification, baseline demographic characteristics and diagnoses. Ulrich Reininghaus will present novel data from the Bipolar-Schizophrenia Network on Intermediate Phenotypes (B-SNIP) consortium to investigate whether there is a transdiagnostic dimension cutting across symptoms of schizophrenia, schizoaffective disorder and psychotic bipolar I disorder. Diego Quattrone will report recent findings from EU-GEI Functional Enviromics Study on genetic and socio-environmental factors associated with transdiagnostic and specific symptom dimensions of non-affective and affective psychosis. Robin Murray will discuss these findings in the context of new challenges in the field and directions for future research.

S26. HERITABILITY OF SOCIAL MISTRUST IN CHILD AND ADOLESCENT NON-CLINICAL SAMPLES: A HEALTHY TWINS STUDY

BackgroundParanoia, or excessive suspiciousness of others, has been one of the core psychotic symptoms of schizophrenia. Recent studies have extended the study of psychotic symptoms in clinical groups to psychotic-like experiences in the general population. Few studies have systematically examined the prevalence of paranoid thinking or its attenuated form, social mistrust, in young children in the community. The present study examined the Social Mistrust Scale (SMS) and utilized it to examine the structure, prevalence, and heritability of social mistrust in a large sample of Chinese children and adolescents.MethodsWe administered the SMS to 1047 pairs of healthy twins aged 8 to 14 years and conducted structural equation modelling (SEM) to assess the structure of the SMS. Heritability of social mistrust was estimated in a sub-sample of twins (n=959 pairs). Finally, we examined administered the SMS to 32 adolescents with childhood-onset schizophrenia and 34 healthy controls to examine the convergent validity between the SMS and the Positive and Negative Syndrome Scale (PANSS).ResultsThe SEM showed a three-factor structure for social mistrust (home, school, and general mistrust). Social mistrust was moderately heritable (39%, 95% CI [21%-59%]) with context-dependent sex differences. The SMS exhibited good discriminant validity in distinguishing adolescents with childhood-onset schizophrenia from healthy controls (AUC=0.80), and good convergent validity with the Positive and Negative Syndrome Scale (rs = 0.33–0.45).DiscussionTaken together, the present findings showed a stable latent structure of the SMS in a large-scale non-clinical sample of children and adolescents. We found a moderate heritability estimate for social mistrust (39%) in a large healthy-twin sample. In addition, significant gender differences were found, where home mistrust was heritable for males (58%) but not for females, and school mistrust was heritable for females (54%) but not for males. Finally, we also demonstrated that the SMS possesses good discriminate validity in identifying adolescents with childhood-onset schizophrenia from healthy controls and convergent validity with standardized clinical measures of schizophrenia symptoms.

Speech-on-speech masking and psychotic symptoms in schizophrenia

People with schizophrenia have impairments of target-speech recognition (TSR) in noisy environments with multiple people talking. This study investigated whether the TSR impairment in schizophrenia is associated with their impaired auditory working memory or certain psychotic symptoms. Thirty participants with schizophrenia (mean age = 35.2 ± 12.7 years) and 30 demographics-matched healthy controls (mean age = 32.9 ± 10.9 years) were tested for their TSR against a two-talker-speech masker. Auditory working memory and memory capacity were evaluated using the Paced Auditory Serial Addition Test (PASAT) and Digit Span Test. Psychotic symptoms were evaluated using the Positive and Negative Syndrome Scale (PANSS). The results showed that participants with schizophrenia had higher TSR threshold (i.e., poorer TSR performance) and poorer PASAT scores than their healthy controls. Moreover, positive correlations (with age, sex, educational years, ill-duration, and dosage of antipsychotics controlled as covariates) were revealed between the TSR threshold and the PANSS-positive syndrome (especially delusion), and between the TSR threshold and the PANSS-negative syndrome (especially lack of spontaneity in speech and passive-apathetic-social withdraw). However, neither the PASAT nor the forward digit span exhibited significant correlations with the TSR. This study provides evidence that the TSR impairment (i.e., augmented vulnerability to informational speech masking), which reflects disorganization of speech information processing (inability in either inhibiting unrelated speech signals or capturing the wanted speech signals), is specifically associated with the severity of delusion, poverty of speech, and hypobulia, suggesting the potential value of the TSR impairment used for predicting certain core symptoms of schizophrenia.

C-Reactive Protein Correlates with Negative Symptoms in Patients with Schizophrenia.

Peripheral and CNS-localized inflammatory processes are hypothesized to contribute to the complex pathophysiology of schizophrenia. Elevated levels of the acute phase reactant C-reactive protein (CRP) have been observed in schizophrenia, yet relatively few studies have investigated the association between this inflammatory biomarker and psychotic symptoms in schizophrenia. This study is a pilot cross-sectional analysis investigating the relation of plasma CRP levels and the positive and negative symptoms of schizophrenia (the primary aim), assessed by the Positive and Negative Syndrome Scale (PANSS). A secondary analysis was also performed evaluating the potential association of CRP with cognitive function using the NIH Toolbox Cognitive Test Battery. After adjusting for age, sex, race, and body mass index, a positive correlation was observed between CRP and PANSS negative symptoms (rho = 0.37, p = 0.05). There was no correlation between plasma CRP and any of the NIH Toolbox measures of cognitive function in the unadjusted or adjusted analyses. Though limited by a relatively small sample size and the unavailability of longitudinal data, the correlation between CRP and psychopathology in this sample of patients supports a role for inflammation in the pathophysiology of schizophrenia.

The Effects of Problem-Solving Skills Training on Self-control Behaviors and Psychotic Symptoms Among Community-Dwelling Patients With Schizophrenia

Purpose: Our aim was to evaluate the effects of problem-solving skills training (PSST) on self-control behaviors and the positive and negative psychotic symptoms of schizophrenia in community-dwelling patients.Method: This quasi-experimental study was conducted in 63 adult community-dwelling outpatients with schizophrenia in Taiwan. The control group (n=28) received routine life skills training alone, while the experimental group (n=35) received both routine life-skills and problem-solving training. The data were collected at four time points (at baseline, and at week 6, 12, and 16 [4 weeks after training ended]). This study measured outcome variables including problem-solving skills (using the Self-control Schedule [SCS]), and psychiatric syndromes (using the Positive and Negative Syndrome Scale [PANSS]).Results: Our generalized estimating equation (GEE) model showed a significant improvement in the self-control behavior score in the experimental group at week 12 and 4 weeks after training ended, compared with the control group. In addition, the negative symptoms score was significantly improved at week 12 and 4 weeks after training end, compared with baseline.Conclusion: These results demonstrated that PSST and routine living skills training have a positive impact on the negative symptoms of schizophrenia patients and could improve their problem-solving capacity and skills for dealing with daily life and health problems and could moderate negative psychotic symptom severity.

Prediction of Clinical Symptoms of Schizophrenia Based on Comt Methylation Marker

Introduction: The dopamine hypothesis of schizophrenia is based on the fact that hyperdopaminergic state is involved in causing psychosis and antipsychotic drugs block the dopamine receptor. COMT regulates the homeostatic levels of neurotransmitter dopamine in the synapses and plays a role in the neurocognitive function. The dysregulation of dopamine in the prefrontal cortex influences the cognitive function and the severity of the psychotic symptoms in schizophrenia. During epigenetic event, methylated COMT gene may cause reduction in its expression and contribute to the clinical presentation of schizophrenia. Therefore, the aim of this study was to assess the feasibility of using COMT DNA methylation for the prediction of specific psychotic presentation of schizophrenia. Materials and method: In this study, 138 schizophrenia patients were recruited from the Psychiatry Clinic, Hospital Tengku Ampuan Afzan, Kuantan Pahang. Genomic DNA from peripheral blood was subjected to the Methylight Taqman® analysis for quantitative measurement of the COMT DNA methylation. The psychopathological symptoms were assessed using the Positive and Negative Syndrome Scale (PANSS). Results: The regression analysis showed that the Positive and Excited subdomains of PANSS were significant predictors of COMT hypomethylation (β= -0.288, p= -0.031; β= - 0.288, p= -0.031). The Excited subdomain of PANSS was negatively correlated with COMT DNA methylation (r 2 = -0.380, p= 0.000) as well as the Depressed subdomain (r 2 = -0.288, p= 0.001). Conclusion: The relationship between DNA methylation of COMT with the positive, excited and depressed symptoms might indicate the epigenetic role of COMT gene in the manifestation of schizophrenia.

620. Cortical Networks Hyper- And Hypoconnectivity with Subcortical Nuclei is Specific and Links Distinctively with Cognitive and Psychotic Symptoms in Schizophrenia

620. Cortical Networks Hyper- And Hypoconnectivity with Subcortical Nuclei is Specific and Links Distinctively with Cognitive and Psychotic Symptoms in Schizophrenia

Early Development of Parvalbumin-, Somatostatin-, and Cholecystokinin-Expressing Neurons in Rat Brain following Prenatal Immune Activation and Maternal Iron Deficiency

Prenatal maternal infection and maternal iron deficiency during pregnancy are 2 early environmental insults associated with increased risk for schizophrenia in offspring. Substantial evidence suggests that abnormalities in inhibitory γ-aminobutyric acid (GABA) interneuron function, especially in the parvalbumin subtype of GABA interneuron, both developmentally and in adulthood, may contribute mechanistically to cognitive deficits and psychotic symptoms in schizophrenia. This study used a rat model to test whether prenatal immune activation with lipopolysaccharide (LPS; at gestation days, GD, 15 and 16) or maternal iron deficiency (from GD2 to postnatal day P7) or the combination of both insults alters major subtypes of GABAergic interneurons (parvalbumin, somatostatin, cholecystokinin) in brain regions relevant to schizophrenia (medial and dorsolateral prefrontal cortex [PFC], hippocampal CA1 and dentate gyrus, ventral subiculum) in offspring at P14 or P28. Prenatal LPS treatment significantly increased the density of parvalbumin-immunoreactive neurons at P14 in the medial PFC, dorsolateral PFC, and ventral subiculum of offspring born from iron-sufficient but not iron-deficient dams. Prenatal LPS also increased cholecystokinin neuron density in the medial PFC at P28, under both iron-sufficient and iron-deficient conditions. We observed a large increase in parvalbumin neuron density from P14 to P28 in the medial PFC and subiculum across all birth groups, that was not observed in other brain regions, and significant decreases in somatostatin neuron density from P14 to P28 in all brain regions examined across all birth groups, indicating differential developmental trajectories for parvalbumin and somatostatin neurons in various brain regions during this early postnatal period. Thus, it appears that the medial PFC and ventral subiculum, brain regions involved in circuitry modulating ventral tegmental dopamine and nucleus accumbens activities, may be regions vulnerable to effects of prenatal LPS on specific subpopulations of interneurons. It is known that the timing of maturation and expansion of parvalbumin neurons in early development provides threshold levels of inhibition that trigger critical periods for cortical plasticity, leading to long-term circuit consolidation. Thus, our finding of increased parvalbumin neuron density at early developmental times might suggest a mechanism by which an acute prenatal insult like LPS exposure could produce long-term changes in prefrontal cortical or subicular function.

Semi-mechanistic computer simulation of psychotic symptoms in schizophrenia with a model of a humanized cortico-striatal-thalamocortical loop

Despite new insights into the pathophysiology of schizophrenia and clinical trials with highly selective drugs, no new therapeutic breakthroughs have been identified. We present a semi-mechanistic Quantitative Systems Pharmacology (QSP) computer model of a biophysically realistic cortical-striatal-thalamo-cortical loop. The model incorporates the direct, indirect and hyperdirect pathway of the basal ganglia and CNS drug targets that modulate neuronal firing, based on preclinical data about their localization and coupling to voltage-gated ion channels. Schizophrenia pathology is introduced using quantitative human imaging data on striatal hyperdopaminergic activity and cortical dysfunction. We identified an entropy measure of neuronal firing in the thalamus, related to the bandwidth of information processing that correlates well with reported historical clinical changes on PANSS Total with antipsychotics after introduction of their pharmacology (42 drug-dose combinations, r2=0.62). This entropy measure is further validated by predicting the clinical outcome of 28 other novel stand-alone interventions, 14 of them with non-dopamine D2R pharmacology, in addition to 8 augmentation trials (correlation between actual and predicted clinical scores r2=0.61). The platform predicts that most combinations of antipsychotics have a lower efficacy over what can be achieved by either one; negative pharmacodynamical interactions are prominent for aripiprazole added to risperidone, haloperidol, quetiapine and paliperidone. The model also recapitulates the increased probability for psychotic breakdown in a supersensitive environment and the effect of ketamine in healthy volunteers.This QSP platform, combined with similar readouts for motor symptoms, negative symptoms and cognitive impairment has the potential to improve our understanding of drug effects in schizophrenia patients.

Pain-processing abnormalities in bipolar I disorder, bipolar II disorder, and schizophrenia: A novel trait marker for psychosis proneness and functional outcome?

Overlapping neural system dysfunctions, mainly involving the secondary somatosensory cortex (S2), the anterior cingulate cortex (ACC) and the anterior insular cortex (AIC), seem to be related to both pain-perception abnormalities and psychotic symptoms in schizophrenia (SCZ) and bipolar disorder (BD). Laser-evoked potentials (LEPs) were used to investigate pain-perception and central pain-processing abnormalities in SCZ, bipolar I disorder (BD-I), and bipolar II disorder (BD-II), and to evaluate their relationship with history of psychosis, and social-cognitive and functional impairments. Twenty patients with SCZ, 17 patients with BD-I, and 21 patients with BD-II who were all under similar pharmacological treatment underwent clinical, functional, and neuro-psychological assessment. LEPs were analyzed in patients and 19 healthy subjects (HS). LEPs elicit responses reflecting the activity of the S2 (N1 wave) and the ACC/AIC cortices (N2/P2 complex). A four-group ANOVA was conducted between patients and HS to compare pain-perceptive thresholds (PThs), N1, and N2/P2-LEP components. Compared to HS: (i) patients with SCZ showed pain-processing and pain-perception abnormalities, as revealed by significantly higher PTh (P<.01), and lower N1 (P<.01) and N2/P2 (P<.01) amplitudes, (ii) patients with BD-I showed only pain-processing abnormalities, as revealed by significantly lower N1 (P<.05) and N2 (P<.01) amplitudes; and patients with BD-II did not differ for any of the LEP variables investigated. N1 and N2 amplitudes negatively correlated to history of psychosis (P<.01), social-cognition (P<.05), and real-world functioning (P<.01) measures in the whole group of patients. To the best of our knowledge, this is the first study comparing central pain processing in patients with SCZ, BD-I, and BD-II. Our results suggest that pain-processing abnormalities may represent a novel locus of interest for research investigating trait markers of the psychosis spectrum.

High resolution examination of the role of sleep disturbance in predicting functioning and psychotic symptoms in schizophrenia: A novel experience sampling study.

Sleep disturbance is common in schizophrenia, but its role in predicting functioning and psychotic symptoms has yet to be rigorously examined. The purpose of this study was to conduct a prospective, high-resolution examination of the relationship between nightly sleep and next-day functioning and psychotic symptoms in people with a diagnosis of schizophrenia. Experience sampling methodology was integrated with actigraphy and sleep diaries across 7 days in 22 patients with a diagnosis of schizophrenia. Momentary assessments of mood, psychotic symptoms, and functioning were gathered at 5 points each day following pseudorandom schedules. Multilevel modeling was performed to evaluate the links between variables. Objective and subjective sleep disturbance predicted reduced next-day functioning, which remained significant after controlling for psychotic symptom severity. Increased sleep fragmentation and reduced subjective and objective sleep efficiency predicted greater next-day auditory hallucinations, whereas increased objective sleep fragmentation and reduced subjective sleep quality predicted greater paranoia and delusions of control. Negative affect on awakening mediated a proportion of these relationships (range: 17.9-57.3%). For the first time, we show that sleep disturbance is a predictor of next-day impaired functioning and psychotic symptom severity in people with a diagnosis of schizophrenia. Therefore, interventions targeting sleep may have the potential to directly and indirectly enhance functional and symptomatic recovery in those experiencing psychosis. (PsycINFO Database Record

Effect of a nurse-lead rehabilitation training on schizophrenia inpatients

Objective To evaluate the effect of a nurse-lead rehabilitation training on quality of life and psychotic symptoms of schizophrenia inpatients. Methods Totally 190 schizophrenia inpatients were divided into the intervention group (96 cases) and the control group (94 cases). In addition to rehabilitation activities which can be chosen freely, the schizophrenia in the intervention group received rehabilitation training including medication training, life skills training, social skill training and physical training, while the schizophrenia in the control group could only chose rehabilitation activities freely. The quality of life and the psychotic symptoms of the schizophrenia while enrolled and discharged were evaluated. Results No significant difference was found in the score of Schizophrenia Quality of Life Scale (SQLS) and Brief Psychiatric Rating Scale (BPRS) between the two groups (P >0.05 )while enrolled. The scores of SQLS, psychosocial and motivation/energy in the control group were 30.22 ± 17.21, 30.22 ± 17.21 and 18.28± 9.33, while 21.41±14.63,19.76± 18.85 and 15.95± 8.80 in the intervention group one month after intervention, the difference was significant (t=-2.14,-2.19,-1.99, P <0.05). The scores of BPRS and hostile suspiciousness in the control group were 26.39 ± 6.37 and 4.11± 1.87 , while 23.67± 6.37 and 3.44± 1.26 in the intervention group one month after intervention, the difference was significant (t=-2.33,-2.54, P <0.05). Conclusions The nurse-lead rehabilitation training can improve the quality of life and psychotic symptoms of schizophrenia inpatients. Key words: Quality of life; Nursing care; Schizophrenia

Pimavanserin: An Inverse Agonist Antipsychotic Drug.

Approximately all clinically useful antipsychotic drugs have known activity as dopamine receptor antagonists, but many of these drugs also are inverse agonists at the serotonin-2A (5HT2A) receptor. Pimavanserin is an inverse agonist at the 5HT2A receptor, with a lower binding affinity at the serotonin-2C receptor and sigma 1 receptor, but no significant binding to dopamine or other receptors. Because of its unique pharmacology, pimavanserin was approved for the treatment of psychosis associated with Parkinson's disease, and it has a low risk for exacerbating motor symptoms compared to standard antipsychotic medications. Whether pimavanserin can treat psychotic symptoms in schizophrenia, psychotic depression, psychotic mania, delirium, or drug-induced psychosis, is not known. Based on its inverse agonist effect at 5HT2A receptors, pimavanserin may have potential for treating symptoms associated with the use of hallucinogen drugs and for treating akathisia associated with antipsychotic medications. [Journal of Psychosocial Nursing and Mental Health Services, 54 (6), 21-24.].

Editorial: Endophenotypes for Schizophrenia and Mood Disorders: Implications from Genetic, Biochemical, Cognitive, Behavioral, and Neuroimaging Studies.

Editorial: Endophenotypes for Schizophrenia and Mood Disorders: Implications from Genetic, Biochemical, Cognitive, Behavioral, and Neuroimaging Studies.

Sex Steroids and Major Psychoses: Which Role for DHEA-S and Progesterone?

Objective: Endocrine pathways seem to play a role in the etiology of major psychoses. The identification of biomarkers associated with psychotic symptoms in schizophrenia (SKZ) and mood disorders would allow the identification of high-risk subjects for delusions and hallucinations. The aim of this study was to evaluate dehydroepiandrosterone sulfate (DHEA-S) and progesterone plasma levels in drug-free patients with major psychoses and their relation with the diagnosis and history of psychotic symptoms. Methods: Eighty-nine consecutive drug-free male inpatients with SKZ or mood disorders were recruited, and DHEA-S and progesterone plasma levels were measured. The groups, divided according to pathological/normal-range hormone levels, were compared in terms of clinical variables using χ² tests with Bonferroni's corrections or multivariate analyses of variance. The same analyses were performed for groups divided according to the presence/absence of lifetime psychotic symptoms. Binary logistic regression analysis was performed using hormone levels as independent variables and history of lifetime psychotic symptoms as a dependent one. Results: A higher number of patients with abnormal DHEA-S levels was found to have a family history of major depressive disorder (p < 0.05). Higher DHEA-S levels (F = 8.31; p = 0.005) were found in patients with a history of psychotic symptoms. In addition, binary logistic regression confirmed that DHEA-S levels were associated with a higher probability of lifetime psychotic symptoms (p = 0.037). Conclusions: Our results confirm previous data about the role of endocrine factors in the etiology of major psychoses. A high DHEA-S level might be a risk factor for psychotic symptoms. Studies with larger samples are needed to confirm these data.

An approach to comorbidity between obsessive-compulsive disorder and schizophrenia

IntroductionAn association has been observed between obsessive symptoms in Obsessive Compulsive Disorder (OCD) and psychotic symptoms in schizophrenia, being sometimes difficult to establish a clear limit between them. The term “schizo-obsessive disorder” was proposed to describe the resulting disorder of comorbidity of OCD and schizophrenia, although it has not been definitely settled.ObjectiveTo analyze the incidence of coexistence of OCD and schizophrenia symptoms and the way it modifies the treatment and prognosis of the illness.MethodReview of some articles published in Mental Health journals such as “Salud Mental” and “Actas Españolas de Psiquiatría”.ResultsSome studies about psychotic patients have determined 15% as the average of comorbidity of OCD and schizophrenia. The probability of having OCD is six times bigger if there is psychotic pathology associated.The fact that obsessive and psychotic symptoms get together in some patients shades the prognosis bringing more negative symptoms, more depressive humor, a larger cognitive impairment, more resistance to treatment and more relapses than we can observe in OCD and schizophrenia isolated.The pharmacological treatment usually consists in neuroleptic plus anti-obsessive drugs, together with cognitive-behavioral therapy. Sometimes, when there is a very bad evolution, it is required to consider psychosurgery as one necessary option, even though its use in this context is not much widespread.ConclusionsThe simultaneous presence of OCD and schizophrenia is more common than we could expect only by chance and makes the prognosis worse, being difficult to find a truly effective treatment.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Supplemental Material for High Resolution Examination of the Role of Sleep Disturbance in Predicting Functioning and Psychotic Symptoms in Schizophrenia: A Novel Experience Sampling Study

Supplemental Material for High Resolution Examination of the Role of Sleep Disturbance in Predicting Functioning and Psychotic Symptoms in Schizophrenia: A Novel Experience Sampling Study

Intrusive prospective imagery, posttraumatic intrusions and anxiety in schizophrenia

Trauma exposure and intrusive thoughts are commonly reported in both schizophrenia and posttraumatic stress disorder (PTSD). Information processing accounts suggest that intrusions occur in the two conditions as a result of insufficient state and/or trait contextual processing in long-term memory. Most research has focused on intrusions about past events, while growing evidence suggests that intrusions about prospective imagined events warrants further investigation. Prospective intrusive imagery has yet to be examined in psychotic disorders but could provide crucial information regarding the aetiology and maintenance of psychotic symptoms. The current study examines the role of prospective intrusive imagery, posttraumatic intrusions and anxiety in schizophrenia. Fifty-seven participants (30 patients and 27 healthy controls) completed measures of trauma, PTSD, anxiety, general non-affective use of imagery, and intrusive prospective imagery. Patients reported significantly more intrusive prospective imagery relative to control participants but, importantly, not greater use of general non-affective imagery. Intrusive prospective imagery was associated with posttraumatic intrusions and anxiety in schizophrenia. The findings are consistent with information processing models of intrusions and psychosis, and provide novel insights for theoretical accounts, clinical formulation and therapeutic targets for psychotic symptoms in schizophrenia.

Towards Using Microstate-Neurofeedback for the Treatment of Psychotic Symptoms in Schizophrenia. A Feasibility Study in Healthy Participants.

Spontaneous EEG signal can be parsed into sub-second periods of stable functional states (microstates) that assumingly correspond to brief large scale synchronization events. In schizophrenia, a specific class of microstate (class "D") has been found to be shorter than in healthy controls and to be correlated with positive symptoms. To explore potential new treatment options in schizophrenia, we tested in healthy controls if neurofeedback training to self-regulate microstate D presence is feasible and what learning patterns are observed. Twenty subjects underwent EEG-neurofeedback training to up-regulate microstate D presence. The protocol included 20 training sessions, consisting of baseline trials (resting state), regulation trials with auditory feedback contingent on microstate D presence, and a transfer trial. Response to neurofeedback was assessed with mixed effects modelling. All participants increased the percentage of time spent producing microstate D in at least one of the three conditions (p < 0.05). Significant between-subjects across-sessions results showed an increase of 0.42 % of time spent producing microstate D in baseline (reflecting a sustained change in the resting state), 1.93 % of increase during regulation and 1.83 % during transfer. Within-session analysis (performed in baseline and regulation trials only) showed a significant 1.65 % increase in baseline and 0.53 % increase in regulation. These values are in a range that is expected to have an impact upon psychotic experiences. Additionally, we found a negative correlation between alpha power and microstate D contribution during neurofeedback training. Given that microstate D has been related to attentional processes, this result provides further evidence that the training was to some degree specific for the attentional network. We conclude that microstate-neurofeedback training proved feasible in healthy subjects. The implementation of the same protocol in schizophrenia patients may promote skills useful to reduce positive symptoms by means of EEG-neurofeedback.