Sample Of Schizophrenia Patients Research Articles

Psychometric properties of the Spanish version of the Health of Nation Outcome Scales for schizophrenia patients.

INTRODUCTION: The HoNOS scale was designed for the assessment of psychosocial impairment in various domains. While it is widely used in psychiatric settings, it has not been validated in Spanish for use in patients with schizophrenia. To examine the psychometric properties of the Spanish version of the HoNOS scale in a sample of schizophrenia patients. A total of 194 individuals aged 18 to 65 with schizophrenia spectrum diagnoses were evaluated using the HoNOS. Illness severity and level of functioning were also assessed. The HoNOS showed moderate internal consistency, good inter-observer reliability and good test-retest reliability. Factor analysis revealed an internal structure consisting of four factors, with item distribution differing from the theoretical dimensions proposed for the original scale. The Spanish version of the HoNOS scale is a reliable and valid instrument for assessing psychosocial impairment in individuals diagnosed with schizophrenia spectrum disorders. However, further research is needed to determine its internal structure more accurately. The HoNOS scale provides researchers and clinicians with a valid measure of impairment in twelve different domains, which can facilitate and guide the treatment of schizophrenia patients.

Development and validation of a scale of self-alienation-related attributes for the early diagnosis of schizophrenia

BackgroundThe onset of schizophrenia is often preceded by a prodromal phase. However, it is difficult to predict the future transition to schizophrenia from the prodromal symptoms. Based on the diagnostic significance of Schneider's first rank symptoms (FRS), especially those representing “ego disorders (Ichstörungen)”, we developed a scale of self-alienation-related attributes (Self-A) to assess the psychological characteristics associated with ego disorders for the early diagnosis of schizophrenia. MethodsIn total, 153 schizophrenia (Sz) patients, 83 at-risk mental state (ARMS) subjects, and 154 healthy control (HC) subjects participated in this study. The Self-A scale was constructed by items from the Minnesota Multiphasic Personality Inventory (MMPI) based on the differences between schizophrenia patients with and without FRS representing ego-disorders designated as “self-alienation symptoms”. The Self-A scale was tested for its reliability and validity in a different sample of schizophrenia patients, and was then applied to different cohorts including first-episode schizophrenia (FES) patients, ARMS individuals, and HC subjects. ResultsThe Self-A consisting of 27 items exhibited good internal consistency reliability. The validity was well demonstrated by the high correlation of the Self-A scores with the self-alienation symptom scores. The ARMS and FES groups had higher Self-A scores than the HC group. The Self-A score in the ARMS individuals who later developed schizophrenia was higher than that in the ARMS subjects who did not, and was comparable with that in the FES group. ConclusionsThis study suggests that the newly developed Self-A scale assessing the self-alienation-related attributes can improve the early diagnosis of schizophrenia.

Motor cognition in schizophrenia: Control of automatic imitation and mapping of action context are reduced

The ability to imitate is considered impaired in schizophrenia patients. This assumption, however, is based on heterogeneous studies mostly targeting voluntary imitation, e.g., pantomime. Studies on automatic imitation, however, and on underlying mechanisms of top-down inhibition of automatic imitation and contextual modulation in schizophrenia are highly limited. We employed two sensorimotor paradigms to examine imitation-inhibition and action context mapping in 37 schizophrenia patients and 36 matched controls. In the first experiment, participants performed finger lifts while observing a hand executing compatible or incompatible finger lifts from the third-person perspective. The compatibility or incompatibility of these finger lifts affected participants' reaction times (RTs). The comparison of between-condition RT differences shows a larger movement compatibility effect in schizophrenia than in controls. The second experiment involved finger lifts while watching a still hand, from the first-person perspective, with constrained fingers that either corresponded or did not correspond to the participants' response fingers. Here, schizophrenia patients showed a diminished RT slowing in corresponding constraint trials. While the former results provide evidence for an impaired control of imitation in patients with schizophrenia, the latter results indicate a reduced encoding of action context. In conclusion, this study provides the first evidence for deficits of top-down control of imitation and motor context processing in the same sample of schizophrenia patients.

Neuroanatomical Features That Predict Response to Electroconvulsive Therapy Combined With Antipsychotics in Schizophrenia: A Magnetic Resonance Imaging Study Using Radiomics Strategy.

ObjectiveNeuroimaging-based brain signatures may be informative in identifying patients with psychosis who will respond to antipsychotics. However, signatures that inform the electroconvulsive therapy (ECT) health care professional about the response likelihood remain unclear in psychosis with radiomics strategy. This study investigated whether brain structure-based signature in the prediction of ECT response in a sample of schizophrenia patients using radiomics approach.MethodsThis high-resolution structural magnetic resonance imaging study included 57 patients at baseline. After ECT combined with antipsychotics, 28 and 29 patients were classified as responders and non-responders. Features of gray matter were extracted and compared. The logistic regression model/support vector machine (LRM/SVM) analysis was used to explore the predictive performance.ResultsThe regularized multivariate LRM accurately discriminated responders from non-responders, with an accuracy of 90.91%. The structural features were further confirmed in the validating data set, resulting in an accuracy of 87.59%. The accuracy of the SVM in the training set was 90.91%, and the accuracy in the validation set was 91.78%.ConclusionOur results support the possible use of structural brain feature-based radiomics as a potential tool for predicting ECT response in patients with schizophrenia undergoing antipsychotics, paving the way for utilization of markers in psychosis.

Laterality patterns in relation to schizophrenia patients' age at onset

ABSTRACT Based on numerous findings of an abnormal laterality in schizophrenia disorder, we hypothesized that handedness and lateral preferences may affect the age at onset in schizophrenia patients. Two samples of schizophrenia patients, the first a sample of 34 right-handers and 42 left-handers and a replication set of 84 right-handers, were examined with regard to age at onset considering handedness and the four Luria’s signs (arm folding, hand clasping, familial sinistrality and eye dominance) as well as gender. The association between these parameters and age at onset was investigated by means of multiple regression analysis. Our analyses revealed that right-handers with right arm folding and left-handers with left arm folding showed an early age at onset, while in the late age at onset the opposite preferences prevailed. Apart from arm folding, signs of ambilaterality, i.e., left eye dominance in right-handers and familial sinistrality in left-handers were additional predictors for an early age at onset. Remarkably, all observations found in the first right-handed sample were confirmed in the right-handed replication set. We conclude that among the many different factors specific lateral preferences should also be considered in assessing patients who are at risk of psychosis.

Polygenic analysis suggests the involvement of calcium signaling in executive function in schizophrenia patients

Cognitive deficits are increasingly recognized as a core dimension rather than a consequence of schizophrenia (SCZ). The previous evidence supports the hypothesis of shared genetic factors between SCZ and cognitive ability. The objective of this study was to test whether and to what extent the variation of disease-relevant neurocognitive function in a sample of SCZ patients from the previous clinical interventional studies can be explained by SCZ polygenic risk scores (PRSs) or by hypothesis-driven and biomedical PRSs. The previous studies have described associations of the SNAP25 gene with cognition in SCZ. Likewise, the enrichment of several calcium signaling-related gene sets has been reported by genome-wide association studies (GWAS) in SCZ. Hypothesis-driven PRSs were calculated on the basis of the SNAP-25 interactome and also for genes regulated by phorbol myristate acetate (PMA), an activator of the signal transduction of protein kinase C (PKC) enzymes. In a cohort of 127 SCZ patients who had completed a comprehensive neurocognitive test battery as part of the previous antipsychotic intervention studies, we investigated the association between neurocognitive dimensions and PRSs. The PRS for SCZ and SNAP-25-associated genes could not explain the variance of neurocognition in this cohort. At a p value threshold of 0.05, the PRS for PMA was able to explain 2% of the variance in executive function (p = 0.05, uncorrected). The correlation between the PRS for PMA-regulated genes and cognition can give hints for further patient-derived cellular assays. In conclusion, incorporating biological information into PRSs and other en masse genetic analyses may help to close the gap between genetic vulnerability and the biological processes underlying neuropsychiatric diseases such as SCZ.

Reverse translated and gold standard continuous performance tests predict global cognitive performance in schizophrenia

Attentional dysfunction contributes to functional impairments in schizophrenia (SZ). Sustained attention is typically assessed via continuous performance tasks (CPTs), though many CPTs have limited cross-species translational validity and place demands on additional cognitive domains. A reverse-translated 5-Choice Continuous Performance Task (5C-CPT) for human testing—originally developed for use in rodents—was designed to minimize demands on perceptual, visual learning, processing speed, or working memory functions. To-date, no studies have validated the 5C-CPT against gold standard attentional measures nor evaluated how 5C-CPT scores relate to cognition in SZ. Here we examined the relationship between the 5C-CPT and the CPT-Identical Pairs (CPT-IP), an established and psychometrically robust measure of vigilance from the MATRICS Consensus Cognitive Battery (MCCB) in a sample of SZ patients (n = 35). Relationships to global and individual subdomains of cognition were also assessed. 5C-CPT and CPT-IP measures of performance (d-prime) were strongly correlated (r = 0.60). In a regression model, the 5C-CPT and CPT-IP collectively accounted for 54% of the total variance in MCCB total scores, and 27.6% of overall cognitive variance was shared between the 5C-CPT and CPT-IP. These results indicate that the reverse translated 5C-CPT and the gold standard CPT-IP index a common attentional construct that also significantly overlaps with variance in general cognitive performance. The use of simple, cross-species validated behavioral indices of attentional/cognitive functioning such as the 5C-CPT could accelerate the development of novel generalized pro-cognitive therapeutics for SZ and related neuropsychiatric disorders.

T10. HERITABILITY OF AMYGDALA ACTIVITY AND ITS GENOME WIDE ASSOCIATION WITH THE SCHIZOPHRENIA RISK LOCUS OF MIR137

BackgroundIt is well known that heritability plays a prominent role in risk for schizophrenia, and that this brain disorder is crucially characterized by emotional symptoms. Less known is how heritability shapes brain activity during emotion processing and whether this brain phenotype is also associated with genetic variation increasing risk for schizophrenia. Here, we implemented a multi-step, data-driven approach in order to assess the relevance of the link between heritability, genetic variation, and schizophrenia for brain activity during emotion processing.MethodsWe investigated three samples of healthy individuals and one sample of schizophrenia (SCZ) patients: i) 28 healthy twin pairs (16 monozygotic and 12 dizygotic twin pairs); ii) 289 unrelated healthy participants (genome-wide association study - GWAS -discovery sample); iii) 90 unrelated healthy participants (replication sample); iv) 40 SCZ patients. During fMRI, participants approached or avoided threatening angry faces (explicit emotion processing). Intra-class correlations (ICC) between twin pairs and ACE models (A: additive genetics; C: common environment; E: unique environment) were used to identify regions of interest (ROIs) with heritable functional activity. Then, we extracted BOLD signal from these ROIs and conducted a GWAS on 565,137 single nucleotide polymorphisms (SNPs) (selected with the following criteria: minor allele frequency>0.15, Hardy–Weinberg equilibrium<0.001, linkage disequilibrium pruning r2>0.9) using robust linear models of allelic dosage corrected for multiple comparisons (Gao et al. 2008 Genetic Epidemiology). Finally, we assessed the effect of surviving SNPs in the replication sample of healthy individuals as well as in the sample of SCZ patients.ResultsIn healthy twins, we identified bilateral amygdala as the brain region with the highest heritability during explicit emotion processing as evaluated with our task (ICC=.79; h2=0.54; p<.001). The subsequent GWAS in healthy non-twins indicated that bilateral amygdala activity during the task was associated with a polymorphism close to miR-137 (rs1198575) (p=1.5 × 10–7), with the C allele corresponding to lower activity than the t allele. A similar effect was found in the replication sample (p=.01) and in patients with SCZ (p=.03).DiscussionOur data-driven approach revealed that amygdala activity as evaluated with our task is heritable. Furthermore, our results indicate that a polymorphism in miR-137 has genome wide association with amygdala response during emotion processing which is also replicated in two independent samples of healthy subjects and of patients with schizophrenia. Previous findings indicated that this polymorphism has genome-wide association with schizophrenia (Ripke et al. 2014). Other results reveal that miR-137 is a key regulatory neuronal factor linked to SCZ and involved in emotion processing (Cosgrove et al., 2017). Our findings are consistent with these previous findings and further highlight a crucial role for miR-137 in emotion processing and SCZ (Anticevic et al., 2012 Schizophr Bull).

Latent Toxoplasma gondii infection is associated with decreased serum triglyceride to high-density lipoprotein cholesterol ratio in male patients with schizophrenia

BackgroundPrevious studies suggested a complex association between Toxoplasma gondii (TG) infection and host lipid metabolism. Both TG infection and metabolic disturbances are very common in patients with schizophrenia, but this relationship is not clear. MethodsIn this cross-sectional study, we evaluated the association between TG seropositivity, serum lipid levels, body mass index (BMI) and metabolic syndrome (MetS) in 210 male inpatients with schizophrenia. ResultsIn our sample of schizophrenia patients, with the mean age of 43.90 ± 12.70 years, the rate of TG seropositivity was 52.38% and the prevalence of MetS was 17%. Patients with the TG antibodies had lower serum triglyceride levels and body weight compared to TG seronegative patients, despite having more frequently received antipsychotics (clozapine, olanzapine risperidone and quetiapine), which are well known to induce weight gain and metabolic abnormalities. However, the only significant change in metabolic parameters, observed in TG seropositive patients with schizophrenia, was decreased serum triglyceride to high-density lipoprotein cholesterol (HDL-C) ratio. No associations were observed between TG seropositivity and serum total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C) and glucose levels, waist circumference, BMI and the rate of MetS. ConclusionThis is the first report of the association between TG infection and decreased serum triglyceride to HDL-C ratio in a sample of carefully selected men with chronic schizophrenia.

Meta-analysis on the association between genetic polymorphisms and prepulse inhibition of the acoustic startle response

Sensorimotor gating measured by prepulse inhibition (PPI) of the acoustic startle response (ASR) has been proposed as one of the most promising electrophysiological endophenotypes of schizophrenia. During the past decade, a number of publications have reported significant associations between genetic polymorphisms and PPI in samples of schizophrenia patients and healthy volunteers. However, an overall evaluation of the robustness of these results has not been published so far. Therefore, we performed the first meta-analysis of published and unpublished associations between gene polymorphisms and PPI of ASR. Unpublished associations between genetic polymorphisms and PPI were derived from three independent samples. In total, 120 single observations from 16 independent samples with 2660 study participants and 43 polymorphisms were included. After correction for multiple testing based on false discovery rate and considering the number of analyzed polymorphisms, significant associations were shown for four variants, even though none of these associations survived a genome-wide correction (P<5∗10−8). These results imply that PPI might be modulated by four genotypes – COMT rs4680 (primarily in males), GRIK3 rs1027599, TCF4 rs9960767, and PRODH rs385440 – indicating a role of these gene variations in the development of early information processing deficits in schizophrenia. However, the overall impact of single genes on PPI is still rather small suggesting that PPI is – like the disease phenotype – highly polygenic. Future genome-wide analyses studies with large sample sizes will enhance our understanding on the genetic architecture of PPI.

Metabolic health in patients with schizophrenia – CVD risk in a Norwegian outpatient population

The mortality of schizophrenia patients is approximately twice that of the general population and there is a 20% reduction in life expectancy in this patient group. Cardiovascular disease (CVD) is responsible for as much as 50% of the excess mortality associated with schizophrenia. One important source of the high CVD prevalence is the cluster of metabolic characteristics defining the metabolic syndrome (MetS: 3 or more of the following features: abdominal obesity, high blood pressure, elevated levels of triglycerides and fasting glucose and low levels of high-density lipoproteins). Patients with schizophrenia seem to be undertreated for these vascular risk factors relative to the general population. More knowledge is needed concerning broadened risk factors of cardiovascular disease in a representative sample of schizophrenia patients. We conducted preliminary cross sectional analyses in a sample of 64 consecutive outpatients with schizophrenia with a mean age of 37 years consisting of 59% men, who were enrolled in a treatment study. All used antipsychotics, and 71% were smokers. We found that (percentage of patients under treatment for the respective somatic condition in parenthesis) 82% were overweight, 49% had hypertonia (17%), 24% hyperglycemia (3%), 48% hypertriglyceridemia and 13% hyperlipidemia (10% triglycerid or cholesterol lowering medication). Forty percent had metabolic syndrome compared to 11% in the normal population (Norway, age corrected). Additionally, estimates of insulin resistance will be conducted. We found that the prevalence of MetS components was high in outpatient schizophrenia. A substantial discrepancy was found between metabolic ill health and medication treatment of such conditions.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Social anxiety disorder co-morbid with schizophrenia: a cross-sectional study from India

Introduction: The co-morbidity of various psychiatric disorders with schizophrenia (SZ) is increasingly being recognized, with anxiety disorders (ADs) being no exception. Among the various ADs, the co morbidity of social anxiety disorder (SAD) and SZ is not well studied. We hypothesized that the prevalence of SAD in SZ is high. Objective: We aimed to study the prevalence of SAD in patients with SZ, and to determine the associated socio-demographic and clinical correlates. Materials and methods: This was an outpatient study on consecutively sampled 64 International Diagnostic Criteria (ICD-10) diagnosed treatment-naive SZ patients, who were rated on the Positive and Negative Syndrome Scale (PANSS), the Social Interaction Anxiety Scale (SIAS), the WHO-5 Well-Being Index (WHO-5) and the Global Assessment of Functioning Scale (GAF). Results: The prevalence of SAD in or sample of SZ patients was 26.56%. Compared to the SZ without SAD group, the SZ with SAD group had a lower quality of life (QoL) and GAF scores, but, no significant difference in the PANSS ratings. Conclusions: The SAD is highly co morbid with SZ, and appears to be independent of psychosis, and is associated with lower QoL and psychosocial functioning. Future follow-up studies should evaluate whether this SAD co-morbidity has any impact on the treatment outcome of SZ.

The effects of a genome-wide supported variant in the CACNA1C gene on cortical morphology in schizophrenia patients and healthy subjects.

Schizophrenia is a highly heritable disorder with multiple susceptibility genes. Previously, we identified CACNA1C rs2007044 as a new risk locus for schizophrenia, with the minor allele G as risk allele. This association was recently validated by a powerful genome-wide association study. However, the underlying neural mechanisms remain unclear. Therefore, we tested whether the risk allele has an influence on cortical surface area and thickness in a sample of schizophrenia patients and healthy controls. We found significant genotype by diagnosis interactions on cortical surface area, but not thickness, in the right dorsolateral prefrontal cortex and the left superior parietal cortex, both of which are key components of the central executive network. Moreover, the surface areas of both regions were inversely correlated with PANSS negative scores in AA homogeneous patients but not in G-carriers. This is the first study to describe the influence of the new genome-wide supported schizophrenia risk variant on cortical morphology. Our data revealed a significant genetic effect of cortical surface area in pivotal brain regions, which have been implicated in the pathophysiology of schizophrenia, possibly via their involvement in cognitive functions. These results yield new insights into the potential neural mechanisms linking CACNA1C to the risk of schizophrenia.

Clinical and functioning outcomes of second-generation long-acting antipsychotics in a sample of schizophrenia patients during a follow-up period of 6 months

IntroductionSecond-generation long-acting injectable antipsychotics (LAIs) constitute a valuable alternative for the treatment of schizophrenia and combine advantages of both long-acting injectable drugs and atypical antipsychotics. Realistic, naturalistic studies are necessary to evaluate the impact of LAIs on specific cluster of symptoms.ObjectivesTo collect clinical and functioning outcomes in outpatients with schizophrenia treated with LAIs during a follow-up period of 6 months.AimsTo determine the impact on symptoms and functioning of second-generation LAIs.MethodsIt is a 6-month naturalistic, observational, prospective, non-interventional study of patients diagnosed with DSM-V schizophrenia disorder. Clinical data were assessed by the Positive and Negative Syndrome Scale (PANSS) and the Global Assessment of Functioning (GAF). For statistical analysis, we used the Wallwork's five-factor model of the PANSS.ResultsA total of 50 schizophrenia patients (70% male; mean age: 36.2 ± 10.4) referred to the Depot Clinic at Sant’Andrea Hospital in Rome was included. Eight patients received treatment with risperidone LAI (RLAI), 20 with paliperidone-palmitate LAI (PLAI), 10 with olanzapine-pamoate LAI (OLAI) and 12 with aripiprazole LAI (ALAI). LAIs were overall associated with improved functioning and positive symptoms; OLAI, ALAI e PLAI correlated with improved negative symptoms, RLAI, OLAI e PLAI with improved disorganised/concrete symptoms, OLAI e PLAI with improved excited symptoms; ALAI improved depressive symptoms.ConclusionOver the 6-month period, LAIs were associated with improved functioning and illness severity in schizophrenia patients with different symptoms profile. Treatment with PLAI and OLAI showed the major clinical advantages, whereas only ALAI correlated with improved depressive symptoms.Disclosure of interestThe authors have not supplied their declaration of competing interest.

A Meta-Analysis of Mismatch Negativity in Schizophrenia: From Clinical Risk to Disease Specificity and Progression

BackgroundThe observation that mismatch negativity (MMN) is consistently impaired in schizophrenia has generated considerable interest in the use of this biomarker as an index of disease risk and progression. Despite such enthusiasm, a number of issues remain unresolved regarding the nature of MMN impairment. The present study expands upon an earlier meta-analysis of MMN impairment in schizophrenia by examining impairment across a range of clinical presentations, as well as across experimental parameters. MethodsOne hundred one samples of schizophrenia patients were included in the present study, including first-episode (n = 13), chronic (n = 13), and mixed-stage (n = 75) samples. Additionally, MMN was examined in three related conditions: bipolar disorder (n = 9), unaffected first-degree relatives (n = 8), and clinical high risk (n = 16). ResultsWe found that MMN impairment 1) likely reflects a vulnerability to disease progression in clinical high-risk populations rather than a genetic risk for the condition; 2) is largely unrelated to duration of illness after the first few years of illness, indicating that impairment is not progressive throughout the life span; 3) is present in bipolar disorder, albeit to a lesser degree than in schizophrenia; and 4) is not modulated by experimental parameters such as magnitude of change between standard and deviant tones or frequency of deviant tones but may be modulated by attentional demands. ConclusionsSuch findings lay the foundation for a better understanding of the nature of MMN impairment in schizophrenia, as well as its potential as a clinically useful biomarker.

Auditory mismatch negativity and repetition suppression deficits in schizophrenia explained by irregular computation of prediction error.

BackgroundThe predictive coding model is rapidly gaining attention in schizophrenia research. It posits the neuronal computation of residual variance (‘prediction error’) between sensory information and top-down expectation through multiple hierarchical levels. Event-related potentials (ERP) reflect cortical processing stages that are increasingly interpreted in the light of the predictive coding hypothesis. Both mismatch negativity (MMN) and repetition suppression (RS) measures are considered a prediction error correlates based on error detection and error minimization, respectively.MethodsTwenty-five schizophrenia patients and 25 healthy controls completed auditory tasks designed to elicit MMN and RS responses that were investigated using repeated measures models and strong spatio-temporal a priori hypothesis based on previous research. Separate correlations were performed for controls and schizophrenia patients, using age and clinical variables as covariates.ResultsMMN and RS deficits were largely replicated in our sample of schizophrenia patients. Moreover, MMN and RS measures were strongly correlated in healthy controls, while no correlation was found in schizophrenia patients. Single-trial analyses indicated significantly lower signal-to-noise ratio during prediction error computation in schizophrenia.ConclusionsThis study provides evidence that auditory ERP components relevant for schizophrenia research can be reconciled in the light of the predictive coding framework. The lack of any correlation between the investigated measures in schizophrenia patients suggests a disruption of predictive coding mechanisms in general. More specifically, these results suggest that schizophrenia is associated with an irregular computation of residual variance between sensory input and top-down models, i.e. prediction error.

Markers of low activity of tissue plasminogen activator/plasmin are prevalent in schizophrenia patients

IntroductionClot buster tissue plasminogen activator (tPA) and its end-product plasmin play a well-defined role in neurochemistry. They mediate a number of events that culminate in tolerance against excitotoxicity, hippocampal neurogenesis, synaptic remodeling, neuronal plasticity, cognitive and emotional processing. Abnormalities in these processes have been implicated in schizophrenia pathogenesis. MethodsLaboratory markers of low activity of tPA/plasmin were analyzed in 70 schizophrenia adults (DSM-IV), and 98 age-matched controls, consecutively selected at university hospitals. ResultsAll but two patients had positive markers (1–6, mean 2.1). Twenty-nine patients and 11 controls had hyperinsulinemia (44% vs. 11%) and 20 patients and 11 controls had hypertriglyceridemia (29% vs. 11%). Both insulin and triglycerides stimulate production of plasminogen activator inhibitor (PAI)-1, a major tPA inhibitor. Nineteen patients and six controls had hyperhomocysteinemia (27% vs. 6%), a condition that impairs tPA catalytic activity. Fifteen patients (22%) but no controls had free-protein S deficiency, a condition that reduces PAI-1 inhibition. Twenty-one patients (30%) but no controls had 1–3 antiphospholipid antibodies in medium or/high levels. Such antibodies are able to inhibit tPA/plasmin activity. Both PAI-1 polymorphism 4G/5G and heterozygous prothrombin G20210A were more prevalent in patients (60% vs. 48% and 2% vs. 1%, respectively), but difference lacked significance. PAI-1 polymorphism was synergistic with hyperinsulinemia. Protein C deficiency was not detected in patients or controls. ConclusionWe have found a high prevalence of markers of low tPA/plasmin activity in a sample of schizophrenia patients. Our findings should be validated in large studies, preferably in medication-naïve patients.

The Lille Apathy Rating Scale (LARS): Exploring its psychometric properties in schizophrenia

BackgroundApathy in schizophrenia patients is linked to marked functional impairments and can be defined as a quantitative reduction of voluntary, goal-directed behaviors. If there are now convincing arguments to consider apathy as a multidimensional psychopathological state (cognitive, emotional, and behavioral), there is a lack of validated and standardized instruments for detecting apathy and assessing its multidimensional aspects in schizophrenia. The Lille Apathy Rating Scale (LARS) is a semi-structured interview, yielding a global score and composite subscores for the different domains of apathy and has been validated in several different contexts but not in schizophrenia patients. ObjectiveThe aim of this study is to examine the psychometric properties of the LARS and identify the distinct components of apathy in a sample of schizophrenia patients. MethodsOne hundred-and-twelve schizophrenia patients were included and they completed the LARS, The Calgary Depression Scale in Schizophrenia, the Positive and the Negative Syndrome Scale and the Scale for the Assessment of Negative Symptoms. The patient group was compared to 51 healthy control subjects. ResultsPrincipal component analysis showed that the LARS proved a single construct which forms the root of an oblique factor structure reflecting four dimensions: novelty and social life, behavioral involvement, emotional involvement, and judgment skills. The main psychometric properties of the LARS were satisfactory. ConclusionsOur findings show that the LARS has satisfactory psychometric properties when used in a different setting than the original version. The LARS is a promising instrument to examine apathy in schizophrenia through a multidimensional framework.

Does treatment of schizophrenia with antipsychotic medications eliminate or reduce psychosis? A 20-year multi-follow-up study.

This research assesses whether multi-year treatment with antipsychotic medications reduces or eliminates psychosis in schizophrenia. It provides 20 years of longitudinal data on the frequency and severity of psychotic activity in samples of schizophrenia patients (SZ) treated versus those not treated with antipsychotic medications. A total of 139 early young schizophrenia and mood-disordered patients were assessed at index hospitalization and then reassessed six times over 20 years for psychosis and other major variables. At each follow-up assessment over the 20 years, a surprisingly high percentage of SZ treated with antipsychotics longitudinally had psychotic activity. More than 70% of SZ continuously prescribed antipsychotics experienced psychotic activity at four or more of six follow-up assessments over 20 years. Longitudinally, SZ not prescribed antipsychotics showed significantly less psychotic activity than those prescribed antipsychotics (p < 0.05). The 20-year data indicate that, longitudinally, after the first few years, antipsychotic medications do not eliminate or reduce the frequency of psychosis in schizophrenia, or reduce the severity of post-acute psychosis, although it is difficult to reach unambiguous conclusions about the efficacy of treatment in purely naturalistic or observational research. Longitudinally, on the basis of their psychotic activity and the disruption of functioning, the condition of the majority of SZ prescribed antipsychotics for multiple years would raise questions as to how many of them are truly in remission.

EPA-0781 – Psychopathology and pattern of tobacco use in patients with schizophrenia.

Introduction The self-medication hypothesis proposes that schizophrenia patients may smoke as an attempt to reduce their cognitive deficits, their symptoms or the antipsychotic side-effects. Aim to identify the relationship between the smoking topography and psychopathology among outpatients with DSM-IV schizophrenia. Method The sample included 26 smoking outpatients with DSM-IV schizophrenia from a Mental Health Center sited in the North of Spain [65.5% males; mean age (SD) = 44.66 (7.83)]. Instruments: (1) Psychopathology: Positive and Negative Syndrome Scales (PANSS); Clinical Global Impression of Severity (CGI-S); n° antipsychotic. (2) Pattern of tobacco use: n° cigarettes/day; Fargerstrom test for nicotine physical dependence; Glover-Nilsson test for nicotine psychological dependence; Expired carbon monoxide (CO ppm). Results prevalence was 59.3% for non-heavy smokers [ Conclusion In this sample of schizophrenia patients, there is no relation between the severity of psychopathology and the dependence of nicotine. However, the sample of this study is small.