Reduction In Positive And Negative Syndrome Scale Scores Research Articles

The cognitive improvement in patients with schizophrenia following low-intensity repetitive transcranial magnetic stimulation could last for 6 months: A randomized controlled trial

Cognitive impairments are a core symptom of schizophrenia. Although low-intensity repetitive transcranial magnetic stimulation (rTMS) also has cognitive improving effect like the commonly used high-intensity rTMS, it has not been applied in schizophrenia yet. To fill this gap, inpatients with schizophrenia were randomized to receive 20 sessions of daily adjunctive active low-intensity rTMS in 4 weeks, or sham treatment. At baseline, 4 weeks, and 6 months, the Positive and Negative Syndrome Scale (PANSS) was used to assess psychotic symptom severity, while the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and the Stroop Color and Word Test (SCWT) were used to assess cognitive functions. Compared to the sixty-nine patients receiving sham treatment, those fifty-nine patients receiving active rTMS performed better in all cognitive domains at post-treatment with small to large effect sizes. This superiority of active rTMS over sham treatment remained significant at 6-month follow-up, with small to large effect sizes, except for visuospatial function and delayed memory. The reduction in PANSS scores were not correlated with cognitive improvements. Our findings provide evidence for using low-intensity rTMS to ameliorate cognitive impairments in schizophrenia. More research are needed to determine the optimal intensity for each domain of cognitive functions.

The Relationship between Treatment Response in Patients with Acute Psychotic Episodes of Schizophrenia and the Activity of Their Platelet Enzymes

Background: imbalance in the energy processes, such as oxidative phosphorylation intensity, and antioxidant systems, and impaired glutamate metabolism in the brain are important biochemical pathogenetic links in the development of schizophrenia. Changes in the activity of a number of platelet enzymes involved in these biochemical pathways were found in patients with schizophrenia.Aim: to assess the relationship between the treatment effciency of acute psychotic episode in patients with paranoid schizophrenia and the activity levels of platelet enzymes involved in energy metabolism (cytochrome c-oxidase, COX), in the antioxidant glutathione system (glutathione reductase, GR), and glutamate metabolism (glutamate dehydrogenase, GDH).Patients and methods: we examined hospitalized adult patients with a diagnosis of paranoid schizophrenia, episodic course, exacerbation of the disease (F20.01), receiving antipsychotic therapy, and healthy volunteers as a control group for assessment of control ranges for enzymatic activities. Psychometric assessment was carried out using the Positive and Negative Syndrome Scale (PANSS). Treatment response was assessed as good with a reduction in PANSS scores of 20% or more. The evaluation was performed on the first days after hospitalization and immediately before discharge.Results: 113 subjects were recruited. 50 healthy volunteers formed the control group and 63 patients, including 60 men and 3 women made up the study group. All indicators were obtained in all control group members and in 42 patients. In the group with a good treatment response, the baseline COX, GDH and GR activities proved to be significantly more often met within the control range, and the GR activity in half of the patients increased after the treatment course. In the group with insuffcient response, half of the patients had an increase in GDH activity after treatment. Of all the biochemical indices, the parameter most associated with therapeutic response was GDH activity.Conclusion: GDH activity can be considered as a possible candidate for predicting the therapeutic response to antipsychotic therapy.

Oral versus long-acting injectable antipsychotic in first episode schizophrenia: A 12 weeks interventional study.

There is underutilization of long-acting injectable (LAI) antipsychotics for first-episode schizophrenia (FES) despite having convenient dosing and treatment retention. LAIs are predominantly used for patients with poor compliance, chronic course, and multiple relapses. Seventy-two treatment naïve patients with the first episode of Schizophrenia (DSM-5) were assessed for baseline severity of psychopathology using the positive and negative syndrome scale (PANSS) and quality of life (QOL) using the WHOQOL-BREF scale. Patients were randomized to receive either oral haloperidol or LAI haloperidol for a period of 12 weeks. Both the groups had a significant reduction in PANSS scores and improvement in QoL over 12 weeks period (P = 0.0001). The LAI group showed greater adherence and significantly better quality of life than the oral group (P = 0.023). The mean numbers of side effects were less in the LAI group at week 2 as compared to the oral group. LAI haloperidol is similar to oral haloperidol in patients with FES with respect to treatment response and offers benefits in form of a lesser number of side effects during early treatment, overall better adherence rates, and better QOL.

Shorter Chain Triglycerides Are Negatively Associated with Symptom Improvement in Schizophrenia.

Schizophrenia is a serious mental disorder requiring lifelong treatment. While medications are available that are effective in treating some patients, individual treatment responses can vary, with some patients exhibiting resistance to one or multiple drugs. Currently, little is known about the causes of the difference in treatment response observed among individuals with schizophrenia, and satisfactory markers of poor response are not available for clinical practice. Here, we studied the changes in the levels of 322 blood plasma lipids between two time points assessed in 92 individuals diagnosed with schizophrenia during their inpatient treatment and their association with the extent of symptom improvement. We found 20 triglyceride species increased in individuals with the least improvement in Positive and Negative Syndrome Scale (PANSS) scores, but not in those with the largest reduction in PANSS scores. These triglyceride species were distinct from the rest of the triglyceride species present in blood plasma. They contained a relatively low number of carbons in their fatty acid residues and were relatively low in abundance compared to the principal triglyceride species of blood plasma.

Finding Early Improvement Threshold to Predict Response After 8 Weeks of Treatment Using Risperidone in First-Episode Psychosis.

The study aims to assess whether the early response can predict the outcome at the endpoint for the treatment of first-episode psychosis with risperidone and identify the relationship between initial symptom reduction and late response. A prospective observational study with 4 points follow-up (weeks 2, 3, 4, and 8) was conducted in 48 adult first-episode psychosis patients. Symptoms were quantified by the Positive and Negative Syndrome Scale (PANSS) score. The initial recommended dose was 2 mg of risperidone once daily before sleep. The PANSS score on day 1 (before initiation of drug therapy) was considered as the baseline score. Treatment responses were considered as a reduction of more than 20%, 25%, 30% and 50% from the baseline score on first, second, third, and final follow-up, respectively. Receiver operating characteristic curves were generated for predicting response at the endpoint. Thirty-one (65%) patients achieved more than 50% reduction (responders) in PANSS score. The mean total PANSS score of the study population after 8 weeks of therapy was found to be 49.77 (95% confidence interval, 46.10-53.43). The mean percentage reduction in PANSS score after 8 weeks of therapy was found to be 52.92% (95% confidence interval, 48.83-57.01). Week 2 response can be taken as the early response (area under the curve = 81.9, P < 0.001). However, the more accurate prediction was possible with week 4 response (area under the curve = 88.7%, P < 0.001). Our study suggests that patients with an early response at week 2 are likely to achieve positive response after 8 weeks.

Longitudinal trajectory analysis of antipsychotic response in patients with schizophrenia: 6-week, randomised, open-label, multicentre clinical trial.

Understanding the patterns of treatment response is critical for the treatment of patients with schizophrenia; one way to achieve this is through using a longitudinal dynamic process study design. This study aims to explore the response trajectory of antipsychotics and compare the treatment responses of seven different antipsychotics over 6 weeks in patients with schizoprenia (trial registration: Chinese Clinical Trials Registry Identifier: ChiCTR-TRC-10000934). Data were collected from a multicentre, randomised open-label clinical trial. Patients were evaluated with the Positive and Negative Syndrome Scale (PANSS) at baseline and follow-up at weeks 2, 4 and 6. Trajectory groups were classified by the method of k-means cluster modelling for longitudinal data. Trajectory analyses were also employed for the seven antipsychotic groups. The early treatment response trajectories were classified into a high-trajectory group of better responders and a low-trajectory group of worse responders. The results of trajectory analysis showed differences compared with the classification method characterised by a 50% reduction in PANSS scores at week 6. A total of 349 patients were inconsistently grouped by the two methods, with a significant difference in the composition ratio of treatment response groups using these two methods (χ2 = 43.37, P < 0.001). There was no differential contribution of high- and low trajectories to different drugs (χ2 = 12.52, P = 0.051); olanzapine and risperidone, which had a larger proportion in the >50% reduction at week 6, performed better than aripiprazole, quetiapine, ziprasidone and perphenazine. The trajectory analysis of treatment response to schizophrenia revealed two distinct trajectories. Comparing the treatment responses to different antipsychotics through longitudinal analysis may offer a new perspective for evaluating antipsychotics.

Prognostic Utility of Multivariate Morphometry in Schizophrenia.

Background: Voxel-based morphometry studies have repeatedly highlighted the presence of distributed gray matter changes in schizophrenia, but to date, it is not clear if clinically useful prognostic information can be gleaned from structural imaging. The suspected association between gray matter volume (GMV) and duration of psychotic illness, antipsychotic exposure, and symptom severity also limits the prognostic utility of morphometry. We address the question of whether morphometric information from patients with drug-naive first-episode psychosis can predict the linear trajectory of symptoms following early antipsychotic intervention using a longitudinal design. Method: Sixty-two first-episode, drug-naive patients with schizophrenia underwent brain magnetic resonance imaging scans at baseline, treated with antipsychotics, and rescanned after 1-year follow-up. Positive and Negative Syndrome Scale (PANSS) was used to assess their clinical manifestations. A multivariate approach to detect covariance-based network-like spatial components [Source Based Morphometry (SBM)] was performed to analyze the GMV. Paired t tests were used to study changes in the loading coefficients of GMV in the spatial components between two time points. The reduction in PANSS scores between the baseline (T0) and 1-year follow-up (T1) expressed as a ratio of the baseline scores (reduction ratio) was computed for positive, negative, and disorganization symptoms. Separate multiple regression analyses were conducted to predict the longitudinal change in symptoms (treatment response) using the loading coefficients of spatial components that differed between T0 and T1 with age, gender, duration of illness, and antipsychotic dose as covariates. We also tested the putative “toxicity” effects of baseline symptom severity on the GMV at 1 year using multiple regression analysis. Results: Of the 30 spatial components of gray matter extracted using SBM, loading coefficients of anterior cingulate cortex (ACC), insula and inferior frontal gyrus (IFG), superior temporal gyrus (STG), middle temporal gyrus (MTG), precuenus, and dorsolateral prefrontal cortex (DLPFC) reduced with time in patients. Specifically, the lower volume of insula and IFG at baseline predicted a lack of improvement in positive and disorganization symptoms. None of the symptom severity scores (positive, negative, or disorganization) at baseline independently predicted the reduced GMV at 1 year. Conclusions: The baseline deficit in a covariance-based network-like spatial component comprising of insula and IFG is predictive of the clinical course of schizophrenia. We do not find any evidence to support the notion of symptoms per se being neurotoxic to gray matter tissue. If judiciously combined with other available predictors of clinical outcome, multivariate morphometric information can improve our ability to predict prognosis in schizophrenia.

The effectiveness and safety of amisulpride in Chinese patients with schizophrenia who switch from risperidone or olanzapine: a subgroup analysis of the ESCAPE study.

IntroductionSecond-generation antipsychotics show significant interpatient variability in treatment response and side-effect profiles, and the majority of patients with schizophrenia require multiple treatment changes. This subgroup analysis of the ESCAPE study evaluated the efficacy and safety of amisulpride in Chinese patients with schizophrenia who switched from risperidone or olanzapine.MethodsESCAPE was a prospective, open-label, multicenter, single-arm Phase IV study in which Chinese patients with an ICD-10 diagnosis of schizophrenia received amisulpride for 8 weeks. This analysis included 109 patients who switched to amisulpride from risperidone (n=68) or olanzapine (n=41) and 59 treatment-naïve patients for reference. The primary effectiveness outcome was a ≥50% decrease in Positive and Negative Syndrome Scale (PANSS) Total score from Baseline to Week 8. The study was registered at ClinicalTrials.gov (NCT01795183).ResultsOf the patients who switched from risperidone and olanzapine, 77.9% and 56.1% achieved ≥50% reduction in PANSS Total score from Baseline to Week 8 and 57.4% and 46.3% achieved ≥20% reduction in PANSS score from Baseline to Week 2, respectively; these end points were achieved by 66.1% and 61.0% of treatment-naïve patients, respectively. No unexpected adverse events (AEs) were reported. Of the most common AEs, extrapyramidal side effects occurred in 32.4% and 14.6%, blood prolactin increase in 32.4% and 39.0%, and ≥7% increase in body weight in 4.4% and 12% of patients switching from risperidone and olanzapine, respectively.ConclusionThe results of this subgroup analysis suggest that switching to amisulpride from risperidone and olanzapine is effective and generally well tolerated in Chinese patients with schizophrenia.

Socio-demographic correlates of treatment response among patients with schizophrenia in a tertiary hospital in South-East Nigeria.

Many patients with schizophrenia respond poorly to antipsychotic medication. Few studies have systematically examined the relationship of social and demographic characteristics of these patients to treatment response in our environment. To identify the social and demographic variables associated with treatment response in patients with schizophrenia. A total of 172 participants with a diagnosis of schizophrenia receiving antipsychotics took part in the study. Participants were consecutively recruited involving patients presenting for the first time, or relapsed patients who had stopped antipsychotics in the previous six months. Both in-patients and out-patients who met the inclusion criteria were studied. Socio-demographic interview schedule and the Positive and Negative Syndrome Scale (PANSS) were administered at the initial encounter and between 4 and 6 weeks, subsequently. Defining good treatment response as ≥ 20% reduction in PANSS score, 68% had a good response while 32% had poor response. Good response to treatment was associated with late age of onset of illness, satisfactory family relationship, acquisition of skilled occupation and being married. However, there was no association between treatment response and gender. Knowledge about these variables in relation to treatment response would improve mental health services as regards articulation of prognosis and psycho education.

Effectiveness of Electroconvulsive Therapy Augmentation on Clozapine-Resistant Schizophrenia.

ObjectiveThis retrospective case series study of the effectiveness of electroconvulsive therapy (ECT) augmentation on clozapine-resistant schizophrenia was conducted by EMR review.MethodsClozapine-resistance was defined as persistent psychotic symptoms despite at least 12 weeks of clozapine administration with blood levels over 350 ng/mL in order to rule out pseudo-resistance. Seven in-patients who were taking clozapine and treated with ECT were selected. We analyzed the psychopathology and subscales changed by ECT.ResultsThe average number of ECT sessions was 13.4 (±4.6). Total Positive and Negative Syndrome Scale (PANSS) score was significantly reduced by 17.9 (±12.8) points (p=0.0384) on average, which represented a reduction of 25.5% (±14.3). 71.4% (5/7) of patients were identified as clinical remission, with at least a 20% reduction in PANSS score. PANSS reduction was associated with number of ECT sessions, stimulus level in the final session, and blood clozapine levels before ECT. However, the negative subscale on the PANSS were not reduced by ECT in any patient. We did not observe any persistent adverse cognitive effects.ConclusionThis study supports that ECT augmentation on clozapine-resistant schizophrenia reveals clinically effective and safe. Further research should be done involving a larger number of patients to investigate the effectiveness of clozapine/ECT combination therapy.

Metabolic Disturbances, Side Effect Profile and Effectiveness of Clozapine in Adolescents.

Introduction:Data on effect of clozapine on metabolic syndrome in adolescent patients with psychosis are limited. This study aimed to evaluate the prevalence and incidence of metabolic syndrome in children and adolescents with psychotic disorders prior to clozapine and while receiving clozapine. Secondary aims were to study the effectiveness and side effect profile of clozapine.Materials and Methods:Thirteen child and adolescent patients were evaluated at baseline, 3 months, and a follow-up beyond 6 months. Assessments were made for metabolic profile, effectiveness by positive and negative syndrome scale (PANSS), and side effects.Results:Prior to starting of clozapine, the prevalence of metabolic syndrome was 23%. After 3 months on clozapine, 38.5% (5/13) patients fulfilled criteria of metabolic syndrome and further on follow-up beyond 6 months (with last observation carried forward) 46.2% (6/13) had developed metabolic syndrome. There was a significant reduction in PANSS scores at 3 months and follow-up more so in those who developed metabolic syndrome at 3 months. Among the other side effects, hypersalivation was the most common side effect (100%) followed by sedation (69%).Conclusion:Half the prevalence of metabolic syndrome in adolescents on clozapine can be attributed to other factors prior to starting of clozapine, and another half can be attributed to clozapine. Clozapine is effective in an adolescent population.

Population Pharmacokinetic-Pharmacodynamic Modeling of Haloperidol in Patients With Schizophrenia Using Positive and Negative Syndrome Rating Scale

The aim of this study was to develop a pharmacokinetic-pharmacodynamic (PKPD) model that quantifies the efficacy of haloperidol, accounting for the placebo effect, the variability in exposure-response, and the dropouts. Subsequently, the developed model was utilized to characterize an effective dosing strategy for using haloperidol as a comparator drug in future antipsychotic drug trials. The time course of plasma haloperidol concentrations from 122 subjects and the Positive and Negative Syndrome Scale (PANSS) scores from 473 subjects were used in this analysis. A nonlinear mixed-effects modeling approach was utilized to describe the time course of PK and PANSS scores. Bootstrapping and simulation-based methods were used for the model evaluation. A 2-compartment model adequately described the haloperidol PK profiles. The Weibull and Emax models were able to describe the time course of the placebo and the drug effects, respectively. An exponential model was used to account for dropouts. Joint modeling of the PKPD model with dropout model indicated that the probability of patients dropping out is associated with the observed high PANSS score. The model evaluation results confirmed that the precision and accuracy of parameter estimates are acceptable. Based on the PKPD analysis, the recommended oral dose of haloperidol to achieve a 30% reduction in PANSS score from baseline is 5.6 mg/d, and the corresponding steady-state effective plasma haloperidol exposure is 2.7 ng/mL. In conclusion, the developed model describes the time course of PANSS scores adequately, and a recommendation of haloperidol dose was derived for future antipsychotic drug trials.

Iloperidone for the Management of Adults with Schizophrenia

Background Iloperidone is a second-generation antipsychotic drug approved in May 2009 by the US Food and Drug Administration (FDA) for the acute treatment of schizophrenia in adults. It is a piperidinyl-benzisoxazole derivative with mixed serotonin (5HT2A) and D2 dopamine antagonist properties. Objective The purpose of this article was to review the pharmacology, pharmacokinetics, efficacy, safety, and role in treatment for iloperidone in schizophrenia. Methods Scientific and clinical data were collected through searches of PubMed, ClinicalTrials.gov, International Pharmaceutical Abstracts, and the FDA, using the search term iloperidone, and limited to English-language articles. Reference lists were reviewed for additional publications. Dates included the beginning of the database through 2010. No limits were placed on study design. Results In a 4-week Phase III trial, iloperidone 12 mg twice daily lowered the Positive and Negative Syndrome Scale (PANSS) total scores to a significantly greater extent than did placebo (−12 vs −7.1; P < 0.01). The ziprasidone active control also separated from placebo (−12.3 vs −7.1; P < 0.05). A pooled analysis of 3 Phase III trials compared iloperidone in divided doses to placebo. The primary outcome was reduction in PANSS scores. Study 1 included iloperidone 4, 8, or 12 mg/d, haloperidol as an active control, and placebo. The PANSS reduction in the 12 mg/d group was significantly greater at end point versus baseline when compared with placebo (−9.9 vs −4.6; P = 0.047). Study 2 included iloperidone 4 to 8 mg/d or 10 to 16 mg/d, risperidone 4 to 8 mg/d, or placebo. The primary efficacy measure was change from baseline to end point in the Brief Psychiatric Rating Scale (BPRS). Improvement from baseline on all iloperidone doses was significantly greater than with placebo (4–8 mg/d group: −6.2, P = 0.012; 10–16 mg/d group: −7.2, P = 0.001; placebo, −2.5). Study 3 included iloperidone 12 to 16 mg/d, risperidone 6 to 8 mg/d, and placebo. The results on the primary efficacy variable, reduction in the BPRS score, was not significant for the 12 to 16 mg/d group versus placebo (−7.1 vs −5.0; P = 0.09), but was significant for the 20 to 24 mg/d iloperidone group (−8.6 vs −5.0; P = 0.01) and for the risperidone group (−11.5 vs 5.0; P < 0.001). A 52-week maintenance trial included iloperidone versus haloperidol as an active control. The primary efficacy variable was time to relapse. Comparison of mean time to relapse of the 2 arms showed no significant difference. The most common adverse events (AEs) associated with iloperidone were dizziness (5.1%–23.2%), dry mouth (5.2%–10.4%), somnolence (4%–13%), and dyspepsia (4.8%–7.8%). AEs appeared dose related. Prescribing information recommends a starting dosage of 1 mg twice daily and then titrated over 7 days to reach a target dosage of 12 to 24 mg/d. The titration is necessary to reduce the risk of orthostatic hypotension-related dizziness. Conclusions Data support that when titrated slowly to a therapeutic dosage, iloperidone is generally well tolerated, has a favorable safety profile, and is an effective treatment option in patients with schizophrenia. Its place in therapy and performance in a typical patient population remain to be established. Slow initial titration and twice-daily dosing are potential disadvantages.

Tolerability and efficacy of paliperidone ER compared to olanzapine in the treatment of schizophrenia: A randomized, double-blind, multicentric trial

Background:Paliperidone is an active metabolite of risperidone and actss through a combination of central dopamine Type 2 (D2) and serotonin Type 2 (5HT2A) receptor antagonism.Aim:The present randomized, double-blind, multicentric trial was designed to determine the safety and efficacy of paliperidone extended release (ER) compared to olanzapine in the treatment of acute schizophrenia.Materials and Methods:A total of 214 patients with diagnosis of schizophrenia were randomized to paliperidone ER (n=109) and olanzapine (n=106) treatment groups. Totally 206 patients were evaluated for efficacy parameters using Positive and negative syndrome scale (PANSS) score and Clinical Global Impression-severity of illness (CGI-S) and Clinical Global Impression-improvement of illness (CGI-I) scales. Safety was assessed by treatment-emergent adverse events and movement disorders.Results:All patients showed significant reduction in PANSS scores at the end of treatment. However, the results were comparable and there was no significant difference at the end of the trial between paliperidone ER group and olanzapine group. Both the treatment groups showed decrease in the severity of illness and improvement in symptomatology. The most common adverse events reported in paliperidone ER versus olanzapine group were Extra Pyramidal Syndrome (EPS) (13.7% vs. 15.6%), headache (12.7% vs. 8.9%), increased appetite (8.8% vs. 10.0%) and drowsiness (4.9% vs. 303%). There was no clinically relevant difference in change from baseline to the end of the trial in abnormal involuntary movement scale (AIMS) and barnes akathisia rating scale (BARS) total scores between both the groups.Conclusion:Paliperidone ER is effective in controlling schizophrenic symptoms as well as exhibits comparable tolerability profile. Thus, paliperidone ER has the potential to be a useful new treatment option for patients with schizophrenia.

Comparison of Quetiapine and Risperidone in the Treatment of Schizophrenia

To compare the efficacy and tolerability of quetiapine and risperidone in the treatment of schizophrenia. In this 8-week, double-blind, multicenter, flexible-dose study, patients with schizophrenia (DSM-IV diagnosis) were randomly assigned to quetiapine (200-800 mg/day) or risperidone (2-8 mg/day). The primary hypothesis was that quetiapine was not inferior to risperidone. The primary efficacy measure was change from baseline in Positive and Negative Syndrome Scale (PANSS) total scores; secondary outcomes included response rate (> or = 40% reduction in PANSS scores), Clinical Global Impression-Change (CGI-C), and cognitive and social functioning. Tolerability assessments included treatment-emergent adverse events and changes in weight, glucose, and prolactin. Patients were recruited from June 2001 to September 2002. Patients (N = 673) were randomly assigned to quetiapine (N = 338, mean dose = 525 mg/day) or risperidone (N = 335, mean dose = 5.2 mg/day). The primary analysis demonstrated noninferiority between treatments (p < .05). Improvements with both treatments were comparable on PANSS total, negative, and general psychopathology subscales. Risperidone-treated patients had a significantly (p = .03) greater improvement in PANSS positive subscale score among all patients, but not among completers. Improvements in PANSS response rates, CGI-C, and cognitive function were similar between treatment groups. Changes in serum glucose and weight were minimal and comparable. The rate of extrapyramidal symptom (EPS)-related adverse events was significantly higher with risperidone (22%) than quetiapine (13%; p < .01). Somnolence was more common with quetiapine (26%) than risperidone (20%; p = .04). Prolactin levels increased with risperidone (+35.5 ng/mL), but decreased with quetiapine (-11.5 ng/mL; p < .001). Quetiapine and risperidone had broadly comparable clinical efficacy. Both agents improved cognitive and social functioning, and neither had a clinically significant effect on weight or glucose. Somnolence was more common with quetiapine; EPS and elevated prolactin rates were significantly higher with risperidone.

A 12-month prospective follow-up study of patients with schizophrenia-spectrum disorders and substance abuse: Changes in psychiatric symptoms and substance use

While it is widely known that patients with schizophrenia-spectrum psychoses and co-occurring substance use disorders are more difficult to manage, there is limited data on the course of their psychiatric symptoms when they remain in treatment over time. This prospective 12-month study evaluated changes in psychiatric symptoms and substance use to ascertain if the co-existence of substance use disorders influences ratings of psychiatric symptoms at follow-up. 147 outpatients in a continuing care program were assessed at intake and followed prospectively for 12 months. Psychiatric symptoms were measured at baseline and 12-month follow-up using the Positive and Negative Syndrome Scale (PANSS) and Hamilton Depression Rating Scale (HAM-D). Subjective psychological distress was rated with the Brief Symptom Inventory (BSI) and quality of life by the Satisfaction with Life Domains Scale (SDLS). Drug and alcohol use was measured with the Addiction Severity Index (ASI). 50.3% of patients were diagnosed with dual disorders (DD) (current and lifetime). The most common primary substances of abuse were alcohol (35.6%) and cannabis (35.1%). DD subjects had higher baseline PANSS positive scores but experienced a greater reduction at 12 months compared to single diagnosis (SD) patients. Severity of substance abuse as measured by ASI composite scores did not decrease significantly between baseline and 12 months. DD patients with schizophrenia and related psychoses treated for their psychiatric illness showed a reduction in PANSS scores over 12 months, even when their substance use remained largely unchanged. However, co-morbidity cases continued to show higher depression and anxiety ratings. Ongoing substance abuse appears to be related to levels of depression as 62.5% of DD-current versus 34.7% of SD patients had HAM-D scores in the depressed range at 12-month follow-up. Implications for treatment are discussed.