Scale For Assessment Of Positive Symptoms Research Articles

Residual experiential symptoms mediate the effect of expressive symptoms over the social functioning in remitted schizophrenia.

Impairment in social functioning had been consistently found in remitted schizophrenia; yet, predictors of social dysfunction had been hardly explored and intervention trials had rarely included remitted schizophrenia. 60 subjects with schizophrenia (diagnosed based on DSM5), currently in remission (SAPS and SANS global rating ≤2, for a minimum period of 12 weeks) and 46 age and gender-matched healthy controls were recruited after obtaining informed consent. The socio-demographic details, illness characteristics, depressive symptoms, positive and negative symptoms [using Scale for assessment of positive symptoms (SAPS), and scale for assessment of negative symptoms (SANS)] were assessed. The Theory of Mind (ToM) score was derived from the ToM tasks of a culturally validated tool, Social Cognition Rating Tools in Indian Setting. The social functioning was assessed using Groningen social disabilities schedule II (GSDSSII). The mean SAPS summary and SANS summary scores were 3.01 ± 2.99 and 4.32 ± 2.94, respectively. The social functioning was significantly impaired in remitted schizophrenia when compared to healthy controls. In the hierarchical regression, experiential dimension (β =1.941, t = 6.097, P < 0.001), followed by expressive dimension predicted social functioning (explained 70.5% of variance) after controlling for confounders. On mediation analysis, the effect of expressive dimension over the social functioning was significantly mediated by experiential dimension (E = 1.1821, Boot SE = 0.2895, C.I: 0.6934 to 1.7862). The experiential dimension mediates the effect of expressive dimension over the social dysfunction in remitted schizophrenia. Future studies should focus on targeting the experiential dimension and thereby social functioning.

Role of Age at Onset in the Clinical Presentation of Bipolar Disorder

Introduction: There is considerable evidence to suggest that the clinical expression of Bipolar Disorder (BD) differs according to Age at Onset (AAO) that has therefore been identified as a potential specifier of interest. Aim: To compare the clinical presentation of BD and also to compare the presence of family history of illness in three subgroups made on the basis of AAO. Materials and Methods: A cross-sectional hospital based observational study was carried out on 162 patients having a diagnosis of BD current episode manic. Three subgroups were made according to AAO viz., Early Onset Bipolar Disorder (EOBD; AAO ≤21 years; 67 patients), Intermediate Onset Bipolar Disorder (IOBD; AAO=22-34 years; 59 patients) and Late Onset Bipolar Disorder (LOBD; AAO ≥35 years; 36 patients). The subgroups were compared on clinical variables, items of the Young Mania Rating Scale (YMRS), Hamilton Depression Rating Scale (HAM-D) and Scale for Assessment of Positive Symptoms (SAPS) scales and family history of illness. Results: The EOBD subgroup had significantly more episodes per year (p-value &lt;0.001 and partial eta squared value=0.17) than IOBD and LOBD subgroups (mean episodes per year, respectively in EOBD, IOBD and LOBD were 1.8, 0.8 and 0.6). The prevalence of family history of mood disorder was also significantly higher in the EOBD (present in 35 out of 67; χ2 value=22.8 and p-value &lt;0.001) than both the other subgroups (present in 10 out of 59 in IOBD and 6 out of 36 in LOBD). Significant differences were found on different items of YMRS, HAM-D and SAPS scales among the subgroups EOBD subgroup had higher rating on irritability, motor activity energy, sexual interest, depressed mood, delusions, thought disorders, while LOBD subgroup had higher rating on elevated mood. Conclusion: EOBD subgroup can be considered as a specific phenotype of BD patients, which is more homogenous, severe and heritable form of illness.

Treatment Response on Positive Symptoms of Schizophrenia with Olanzapine and Risperidone

Introduction: Positive symptoms become perceptible in patients as schizophrenia progresses. If schizophrenia goes untreated catatonic motor behaviors are develops. Now a day’s catatonia which is a type of disturbed behavior is observed, with less frequency than in past years due to advances in treating schizophrenia. Treatment of schizophrenia by olanzapine and risperidone shows diverse outcomes.&#x0D; Objectives: To assess the response on positive symptoms of schizophrenia by olanzapine and risperidone.&#x0D; Materials and Methods: This study was conducted in Department of Pharmacology and Department of Psychiatry of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka during the period from September 2013 to January 2015. A total of 179 schizophrenia patients fulfilling the inclusion criteria were enrolled and of them 75 patients completed the study, where 40 were in olanzapine treated group and 35 were in risperidone treated group in a 12-weeks assessment where Scale for Assessment of Positive Symptoms (SAPS) was applied. After statistical analysis of scores between intergroup and intra group p&lt;0.05 was considered significant.&#x0D; Results: Treatment with both the olanzapine and risperidone were remarkably effective for progress of positive symptoms of schizophrenia patients but in olanzapine treated group the score was reduced more than that of risperidone treated group and the difference was significant (p&lt;0.05).&#x0D; Conclusion: Olanzapine has responded better on positive symptoms of schizophrenia patients than that of risperidone.&#x0D; Journal of Armed Forces Medical College Bangladesh Vol.15 (1) 2019: 58-60

AUDITORY BRAINSTEM RESPONSE ABNORMALITIES IN SCHIZOPHRENIC PATIENTS WITH AUDITORY HALLUCINATIONS

Background : although the exact pathogenesis of auditory hallucinations is not yet known, some suggested the impairment of perception and processing of auditory information as a possible explanation. So, the aim of this study is to evaluate auditory pathways of schizophrenic patients using auditory brainstem responses (ABR). Methods : schizophrenic patients with auditory hallucinations and age and sex matched healthy non-relative controls were recruited in this case-control study. Scale for assessment of positive symptoms (SAPS) was used for rating the severity of hallucinations. Then, ABR recorded from all participants and the latencies of waves I, II, III, IV, V and inter-peak latencies (IPL) of waves I-III, III-V were analyzed on both sides. Chi squire and independent t tests were applied for statistical analysis. P-value≤0.05 was considered significant. Results : 39 patients and 35 controls were included. Latencies of waves III and V and IPL of III-V were significantly prolonged on the left side. Disease duration had no influence on the results. Conclusion : there is a link between abnormal ABRs and auditory hallucinations in schizophrenic patients that indicates dysfunction and abnormal asymmetry of auditory pathways in these patients.

Pilot Validation Study of the Japanese Translation of the Brief Negative Symptoms Scale (BNSS).

PurposeThe brief negative symptoms scale (BNSS) is a concise instrument used to assess negative symptoms of subjects with schizophrenia covering five domains of negative symptoms and is suitable for use in clinical, experimental, and epidemiological settings. The original and translated version of BNSS has thus far been shown to have adequate psychometric properties. This study aimed to examine internal consistency, inter-rater and test-retest reliability, discriminant and convergent validity, and factor structure of the Japanese version of BNSS.Patients and methodsThe assessment was performed by 11 raters using interview videos of nine subjects. Reliability was calculated with Cronbach’s alpha for internal consistency and intra class correlation coefficient (ICC) for inter-rater reliability. Pearson’s correlation coefficients were calculated to estimate the test-retest reliability. In addition to BNSS, Scale for assessment of negative symptoms (SANS) and scale for assessment of positive symptoms (SAPS) was obtained to assess the convergent and discriminant validity. Factor structure was assessed using principle factor analysis.ResultsThe Japanese BNSS showed excellent internal consistency (Cronbach’s alpha=0.95), inter-rater reliability (intra class correlation coefficient=0.97), and test-retest reliability (r=0.94, p<0.001). The convergent validity shown by correlation with SANS total score (r=0.87, p<0.001) and discriminant validity shown by correlation with SAPS total score (r=0.17, p=−0.68) were also good. Principal factor analysis revealed a two-factor structure of BNSS, although the loading of each item differed from that in the literature.ConclusionOur pilot study demonstrated that Japanese BNSS had good psychometric properties which were achieved with relatively brief training. Further studies with more subjects and raters with various backgrounds recruited from multiple sites are warranted.

Determinants of Quality of Life in Spanish outpatients with schizophrenia spectrum disorders

Background and objectivesQuality of Life (QoL) studies of patients with psychosis living in the community and of its determinants can help to improve support offered to patients. This study evaluates QoL in Spanish outpatients with schizophrenia spectrum disorders and attempts to identify the QoL determinants. MethodsSixty-one patients with schizophrenia or schizoaffective disorders and stable disease, completed the generic WHOQOL-BREF, EUROQOL-5D-5L and the specific SQLS-R4 QoL scales and the SCIP (cognitive impairment), SAI-E (insight), and Calgary (depression) scales. SANS (Scales for Assessment of Negative Symptoms) and SAPS (Scales for Assessment of Positive Symptoms) and selected items from the QOLI-BV were also evaluated.Frequencies in the clinical, demographic and QoL variables were studied. Univariate and multivariate regression models were fitted to assess how clinical and demographic characteristics influence subjective QoL. Multivariate regression models were fitted with all explanatory variables found to be significant in univariate analysis. ResultsMean QoL scores were 58.8 in EUROQOL-health and 0.8 in EUROQOL-value, and ranged between 49.2 and 62.7 in WHOQOL-BREF and between 38.9 and 43.3 (QoL limitations) in SQLS-R4.Negative symptoms and depression were significantly related to the nine QoL areas studied. Age, gender, social activities, employment status, time since diagnosis, and insight were also related to QoL. The percentage of variance in the QoL areas explained in multivariate regression models ranged from 25 to 56%. ConclusionQoL was moderate in this sample of Spanish schizophrenia spectrum outpatients. Sociodemographic and clinical factors were found to be determinants of QoL. These patients could benefit from multidisciplinary treatment to improve their QoL.

Religiosity and religious delusions in schizophrenia - An observational study in a Hindu population.

Religion exerts a significant effect on the lives of many individuals including people with mental illness. As evidences keep accumulating, role of religion in mental illness is gaining importance. The study was designed to study the effects of religiosity on religious delusions, its presentation, acute course and outcome in schizophrenia. The study was a naturalistic observational study. Subjects with schizophrenia were grouped into those with religious (RG) and with non-religious delusions (NG). Their premorbid religiosity was assessed with Brief Multi-dimensional measurement of Religiosity/spirituality (BMMRS) and were rated on Scale for Assessment of Positive Symptoms (SAPS), Brown's Assessment of Belief Scale (BABS) and Positive and Negative Symptom Scale (PANSS) at baseline and 4 weeks. Scores on private religious practices, baseline scores of SAPS, BABS & PANSS and duration of untreated psychosis (DUP) were significantly higher for RG in comparison to NG. On component analysis, higher scores were seen on private praying, watching religious programs on TV, reading religious books and prayers at meals. But no significant correlation was found between the private religious practices and the baseline scores of (DUP), SAPS, BABS, PANSS and outcome measure. Also no significant difference was noted in measures of improvement between groups. Private religious practices are more prominent in patients of schizophrenia with religious delusions and this group of patient seems to present with a more severe illness, and a longer duration of untreated psychosis in comparison to those with non-religious delusions.

Clinical correlates of saccadic eye movement in antipsychotic-naïve schizophrenia

Some aspects of saccadic performance have been found to be abnormal in chronic schizophrenia. The majority of this research has, however, been performed on patients treated with long-term antipsychotic medication. Very few studies have examined saccadic performance in antipsychotic-naïve/free patients. There are also very few studies describing the relationship between saccadic performance and clinical symptoms, particularly in antipsychotic free patients. In this study, we compared pro and antisaccade performance in a large sample of antipsychotic-naïve/free schizophrenia patients (N = 45) with healthy controls (N = 57). Clinical symptoms were assessed using Scale for Assessment of Positive Symptoms (SAPS) and Negative Symptoms (SANS). In the antisaccade task, patients made significantly more errors, and their correct antisaccades had smaller amplitudes in comparison to healthy controls. Higher error rates were associated with increased severity of hallucinations. In the prosaccade task, patients had less accurate final eye positions, and made saccades with slower latency and reduced amplitude compared to the healthy controls. These observations in schizophrenia patients without the potential confounds of antipsychotic treatment suggest intrinsic link between saccadic deficits and schizophrenia pathogenesis. The relationship between antisaccade errors and hallucination severity supports the potential link between hallucinations and deficits in inhibitory control.

Augmentation of aripiprazole by flupenthixol decanoate in poorly responsive schizophrenia: a randomized clinical study

ABSTRACTOBJECTIVE: According to some studies, while first-generation antipsychotics were associated with slightly better outcomes and lower costs in comparison with second-generation antipsychotics, atypical antipsychotics have become the most commonly used class of antipsychotic drugs in clinical practice. The objective of this study was to examine whether there could be any positive outcome if flupenthixol decanoate was added, as an adjuvant, to aripiprazole in poorly responsive cases of schizophrenia.METHODS: Twenty-four male inpatients with diagnosis of schizophrenia, according to the DSM-5 diagnostic criteria, who had shown poor response to aripiprazole, were entered into an eight-week, parallel group, single-blind study for random assignment to either aripiprazole plus augmentative flupenthixol decanoate or current antipsychotic treatment in a 1:1 ratio. Primary outcome measures of the study were changes in the mean total scores of the Scale for Assessment of Positive Symptoms (SAPS) and the Scale f...

Adjunctive Depot Antipsychotic in Treatment-Resistant Schizophrenia

Objectives: Since according to some studies, atypical antipsychotics were connected with better results and lesser adverse effects in comparison with conventional ones, at the present time the later kind of medications are the preferred category of antipsychotics in clinical management of schizophrenia. But such a maneuver has not decreased hitherto the dilemma of treatment —resistance. The objective of the present assessment included evaluation of the effectiveness of adjunctive flupentixol decanoate in schizophrenic patient, who had responded inadequately to aripiprazole. Method: 24 male inpatients with diagnosis of schizophrenia, who had displayed poor response to aripiprazole, were entered into an eight-week, single-blind evaluation for random assignment to current antipsychotic treatment (aripiprazole) or aripiprazole plus adjunctive flupentixol decanoate. While the Scale for Assessment of Negative Symptoms (SANS) and the Scale for Assessment of Positive Symptoms (SAPS) were used as the primary outcome measures, the Clinical Global Impressions-Severity Scale (CGI-S), the Schedule for Assessment of Insight (SAI), and finally the Simpson-Angus Scale (SAS) were used as ancillary measures. Results: According to the results, while the mean total scores of CGI-S, SAI and SAPS in the augmented group dropped significantly in comparison with the aripiprazole group (p<0.007, p<0.03, p<0.001, respectively), with around 19.55% decrement of SAPS in the augmented group, the reduction in the mean total score of SANS was not significant in between -group analysis (P<0. 07). In addition, the mean total score of SAS was meaningfully improved in the target group (P< 0. 0000). The effect size (ES) analysis also revealed a great improvement with flupentixol augmentation regarding SAPS, SAI and CGI-S. Conclusion: While occurrence of extra-pyramidal adverse effects should not be overlooked by clinicians, addition of flupentixol decanoate to aripiprazole can be helpful for a number of poorly responsive schizophrenic patients. Keywords: Aripiprazole, extra-pyramidal, flupenthixol decanoate, poor response, treatment resistant, schizophrenia.

Olanzapine v Risperidone: A Contrast Between Atypical Antipsychotics Concerning Control of Schizophrenia

Objective: A number of studies have shown that olanzapine and risperidone are more clinically effective than other antipsychotics. Consequently, if a treatment-resistant schizophrenic patient has not received them so far in their treatment history, it would be a sensible choice to use these drugs in treatment before beginning a clozapine regimen. In the present investigation the efficacy and safety of these two atypical antipsychotics were compared with each other. Method: Sixty schizophrenic patients, allocated randomly into 2 matching groups to participate in a twelve-week, double-blind evaluation for random assignment to risperidone or olanzapine. The chief procedures used for assessment were Scale for Assessment of Negative Symptoms (SANS)' and 'Scale for Assessment of Positive Symptoms (SAPS)'. The Scale for Assessment of Negative Symptoms (SANS)' and 'Scale for Assessment of Positive Symptoms (SAPS)' were used as supplementary measures. Treatment efficacy was evaluated statistically by the use of the t statistic and repeated -measures analysis of variance (ANOVA). Clinical response was defined as a decrease of at least twenty percent in total scores of SANS and/or SAPS. Results: Both risperidone and olanzapine were significantly beneficial for alleviation of positive symptoms (p<0.001 & p<0.0001, respectively), but only olanzapine improved significantly the negative symptoms (p<0.001). In addition, SAI was boosted significantly by olanzapine (p<0.02). CGI-S had shown significant alterations by both of risperidone and olanzapine (p<0.05 and p<0.04, separately). Finally, risperidone triggered significant escalation of SAS in the related group (p<0.0001). Conclusion: In this evaluation, risperidone and olanzapine were equally useful in control of clinical symptoms of schizophrenia, but olanzapine demonstrated higher efficiency in comparison with risperidone. Keywords: Atypical antipsychotics, extrapyramidal side effects, negative symptoms, olanzapine, risperidone, schizophrenia.

A Comparison Between Quetiapine and Aripiprazole for Treatment of Schizophrenia: A Double Blind Contrast

Objective: Schizophrenia is usually characterized by abnormal social behavior, lack of insight, and positive and negative symptoms. While there is increasing evidence that atypical antipsychotics have advantages over conventional ones, few long-term studies have directly compared the atypical antipsychotics with each other. Therefore, in the present assessment, the efficacy and safety of aripiprazole had been compared with quetiapine. Method: 50 schizophrenic patients entered into two comparable groups for participation in a twelve-week, double-blind study, for random assignment to quetiapine or aripiprazole. The main outcome scales included the Scale for Assessment of Negative Symptoms (SANS) and the Scale for Assessment of Positive Symptoms (SAPS). Also, the Clinical Global Impressions-Severity Scale (CGI-S), the Simpson Angus Scale (SAS), and finally the schedule for Assessment of Insight (SAI) had been used as the auxiliary ones. Results: While both of aripiprazole and quetiapine demonstrated important efficacy in alleviation of positive symptoms (p<0. 04 & p<0. 01, respectively), their efficacy was not so with respect to negative cluster of symptoms (p<0. 07 & p<0.06, respectively). CGI-S and SAI, as well, revealed significant improvement with aripiprazole (p<0.05 & p<0.05, respectively) and quetiapine (p<0.05 & p<0. 04, respectively) at the end of the assessment. In contrast, in neither of groups any significant increase in SAS was detectible. Conclusion: Based on the outcomes of the current study, no significant difference was evident between aripiprazole and quetiapine regarding improvement of positive and negative symptoms of schizophrenia. Keywords: Aripiprazole, dopamine, quetiapine, schizophrenia, second generation antipsychotics, serotonin.

Serotonin 2A Receptor Inverse Agonist as a Treatment for Parkinson's Disease Psychosis: A Systematic Review and Meta-analysis of Serotonin 2A Receptor Negative Modulators.

There is uncertainty about the efficacy and tolerability of serotonin 2A (5-HT2A) receptor negative modulators for Parkinson's disease psychosis (PDP). This is the first meta-analysis of randomized placebo-controlled trials (RCTs) testing negative modulators of the 5-HT2A receptor as a treatment for PDP. The primary outcome was the Scale for Assessment of Positive Symptoms (SAPS)-hallucinations (H) and -delusions (D) scores (SAPS-H+D). Other outcome measures were SAPS-H, SAPS-D, the Unified Parkinson's Disease Rating Scale Part II and III (UPDRS-II+III), discontinuation rates, and individual adverse events. Four RCTs were identified that met inclusion criteria, all assessing the 5-HT2A inverse agonist pimavanserin (including 417 drug-treated and 263 placebo-treated PDP patients). Pimavanserin significantly decreased SAPS-H+D scores compared to placebo [weighted mean differences (WMD) = -2.26, 95% confidence interval (95% CI) = -3.86 to -0.67, p = 0.005, I2 = 30% , N = 4 studies, n = 502 patients]. Moreover, pimavanserin was superior to placebo for reducing SAPS-H (WMD = -2.15, 95% CI = -3.45 to -0.86, p = 0.001, I2 = 0% , N = 2, n = 237) and SAPS-D scores (WMD = -1.32, 95% CI = -2.32 to -0.32, p = 0.010, I2 = 0% , N = 2, n = 237). Pimavanserin was associated with less orthostatic hypotension than placebo (risk ratio = 0.33, 95% CI = 0.15-0.75, p = 0.008, I2 = 0% , number needed to harm = 17, p = 0.01, N = 3, n = 476). There were no significant differences in rates of all-cause discontinuation, adverse events, and death, UPDRS-II+III scores, and incidences of individual adverse events (other than orthostatic hypotension) between pimavanserin and placebo groups. Pooled RCT results suggest that pimavanserin is beneficial for the treatment of PDP and is well tolerated. We did not identify other negative modulators of the 5-HT2A receptor for the treatment of PDP.

Obsessive-Compulsive Disorder in Hospitalized Patients with Schizophrenia

Introduction:Comorbid obsessive-compulsive disorder (OCD) has been reported among patients with schizophrenia in other countries. But, the literature is not well-documented on this issue in Iran (Persia). The present study aimed to investigate the prevalence and severity of OCD and some of its related factors in a group of patients with schizophrenia in Iran.Methods:This is a cross-sectional study. A total of 150 hospitalized patients with schizophrenia were recruited at Razi Psychiatric Hospital in Tehran, Iran. Demographic and clinical checklists, as well as the Yale-Brown obsessive-compulsive scale (Y-BOCS), scale for assessment of negative symptoms (SANS), and scale for assessment of positive symptoms (SAPS) were administered to collect data. OCD was the dependent variable and independent variables included age, sex, severity of positive and negative symptoms, duration of schizophrenic disorder, the number of hospitalizations, and antipsychotic medications administered to them. Data were analyzed by analysis of variance (ANOVA), Chi-square, and T-test.Results:Overall, 31.3% of patients had OCD with an average severity of 12.81(SD=10.27). The prevalence of OCD was not affected by the number of psychiatric hospitalizations for schizophrenia or the duration of schizophrenic disorder. The severity of OCD significantly reduced as the duration of schizophrenia and the severity of negative symptoms increased.Conclusion:OCD was found among a considerable proportion of the study sample. OCD may be associated with exacerbating schizophrenic symptoms. Therefore, psychiatrists should consider the simultaneous treatment of OCD and schizophrenia. Further studies are suggested in this issue.

Amelioration of deficit syndrome of schizophrenia by norepinephrine reuptake inhibitor.

Negative symptoms are a significant barrier to successful functional outcome and recovery in individuals with schizophrenia and their management is not unproblematic. Reboxetine is a norepinephrine reuptake inhibitor (NRI). Previous studies regarding the useful effects of reboxetine on deficit symptoms of schizophrenia have resulted in inconsistent results. The present study therefore evaluated the effectiveness of reboxetine as an adjunctive treatment in a group of schizophrenic patients with prominent negative symptoms. A total of 50 male inpatients meeting diagnosis of schizophrenia entered into a 12-week parallel group, double-blind study for random assignment to reboxetine (n = 25 patients) or placebo (n = 25 patients). The inclusion criterion, in addition to the diagnosis of schizophrenia, was the existence of obvious negative symptoms for a duration of at least 2 years. The Scale for Assessment of Negative Symptoms (SANS) was used as the primary outcome measure. The Scale for Assessment of Positive Symptoms (SAPS), Simpson Angus Scale (SAS), Hamilton Rating Scale for Depression (HAM-D) and Mini-Mental Status Examination (MMSE) were used for comparison of the intervening parameters in this study. According to the findings, 76% of patients in the target group showed some positive response to reboxetine compared with 24% in the control group (p < 0.01). The mean total score of SANS in the reboxetine group decreased significantly from 79.94 ± 1.20 to 74.23 ± 4.07 (p < 0.0001) at the end of the study; such an improvement was not significant in the placebo group with a decrease from 80.42 ± 2.46 to 79.08 ± 5.83 (p < 0.29). Changes of SAPS were insignificant in both groups. Effect size analysis for changes of SANS at the end of assessment indicated a large improvement with reboxetine (Cohen's d = 2.91). Reboxetine, as an adjuvant to haloperidol, may have a helpful effect on the deficit syndrome of schizophrenia.

Reduced hippocampal volume and hypothalamus–pituitary–adrenal axis function in first episode psychosis: Evidence for sex differences

BackgroundHippocampal volume (HV) decline is an important marker of psychosis and has been associated with hypothalamus–pituitary–adrenal (HPA) axis dysregulation in various disorders. Given recent findings of sex differences in HPA axis function in psychosis, the current study investigated differences in HV in male and female first episode psychosis (FEP) patients and controls and the interaction of HV with the cortisol awakening response (CAR) and symptoms.MethodsFifty-eight patients with a diagnosis of FEP (39 men, 19 women) and 27 healthy community controls (15 men, 12 women) underwent structural magnetic resonance imaging (MRI) on a 1.5 T scanner. Hippocampal volume was determined using previously established segmentation protocols. Saliva samples for cortisol assessment were collected at 0, 30 and 60 min after awakening. Psychotic symptoms were assessed with the Scale for Assessment of Positive Symptoms (SAPS), the Scale for Assessment of Negative Symptoms (SANS) and the Global Assessment of Functioning (GAF) scale.ResultsMale patients had significantly smaller left and right HVs compared to male controls, which appeared to be secondary to global brain volume differences. However, even when controlling for overall brain size, male patients showed smaller HV compared to female patients. The CAR was significantly lower in male patients compared to male controls and female patients. Only in male patients, smaller left HV was significantly associated with a blunted CAR, and smaller HV bilaterally was related to positive psychotic symptoms and lower levels of functioning.ConclusionsWe propose that reduced hippocampal volume and an attenuated cortisol awakening response are related markers of increased stress vulnerability in male psychosis patients and that both contribute to the unfavorable clinical picture in men.

Clinical correlates of parametric digit-symbol substitution test in schizophrenia

Processing speed deficit, ascertained by digit-symbol substitution test (DSST), is considered as a fundamental impairment in schizophrenia. Clinical correlates of processing speed abnormalities, especially using the parametric version of DSST is yet to be evaluated comprehensively. In this study, we examined schizophrenia patients (N=66) and demographically matched healthy controls (N=72) using computer-administered parametric DSST (pDSST) with fixed (pDSSTF) as well as random (pDSSTR) conditions and analysed the relationship between pDSST performance and clinical symptoms. Psychopathology was assessed using Scale for Assessment of Positive Symptoms (SAPS)/Negative Symptoms (SANS) with good inter-rater reliability. In comparison with healthy controls, patients demonstrated significantly lesser number of correct responses (CN) in pDSSTF (t=8.0; p<0.001) and pDSSTR (t=7.8; p<0.001) as well as significantly prolonged reaction time in pDSSTF (t=7.1; p<0.001) and pDSSTR (t=7.0; p<0.001). The difference in CN between pDSSTF and pDSSTR [ΔCN] was significantly lesser in patients than healthy controls (t=2.61; p=0.01). The pDSST reaction time had significant positive correlation with negative syndrome scores as well as bizarre behaviour score. Significantly greater processing speed deficits in pDSST suggest potential relational memory/visual scanning abnormalities in schizophrenia. Furthermore, pDSST deficits demonstrated a significant association with the psychopathology, especially with the various negative symptoms and bizarre behaviour.

A Comparative Study between Olanzapine and Risperidone in the Management of Schizophrenia.

Introduction. Since a variety of comparisons between risperidone and olanzapine have resulted in diverse outcomes, so safety and efficacy of them were compared again in a new trial. Method. Sixty female schizophrenic patients entered into one of the assigned groups for random allocation to olanzapine or risperidone (n = 30 in each group) in a double-blind, 12-week clinical trial. Scale for Assessment of Positive Symptoms (SAPS) and Scale for Assessment of Negative Symptoms (SANS) were used as the primary outcome measures. Clinical Global Impressions-Severity Scale (CGI-S), Schedule for Assessment of Insight (SAI), and finally Simpson Angus Scale (SAS) as well were employed as secondary scales. Results. While both of olanzapine and risperidone were significantly effective for improvement of positive symptoms (P < 0.0001), as regards negative symptoms, it was so only by means of olanzapine (P < 0.0003). CGI-S and SAI, as well, were significantly improved in both of the groups. SAS increment was significant only in the risperidone group (P < 0.02). Conclusion. While both of olanzapine and risperidone were equally effective for improvement of positive symptoms and insight, olanzapine showed superior efficacy with respect to negative symptoms, along with lesser extrapyramidal side effects, in comparison with risperidone.

Randomized controlled trial of aripiprazole versus risperidone for the treatment of amphetamine-induced psychosis

Background: Lifetime prevalence of amphetamine-induced psychotic disorder is reported as being up to 23% for methamphetamine (MA) abusers. Approximately 25% of those with a baseline DSM-IV diagnosis of substance-induced psychosis are diagnosed with primary psychosis at one-year follow-up. Evidence on the treatment of amphetamine psychosis is very limited. Objectives: To investigate the efficacy of risperidone versus aripiprazole in treatment of amphetamine-induced psychotic symptoms. Methods: In a double-blind study, 45 participants were randomly allocated to either aripiprazole 15 mg or risperidone 4 mg daily over a six-week trial. Positive and negative symptoms of psychosis were assessed using the Scale for Assessment of Negative Symptoms (SANS) and the Scale for Assessment of Positive Symptoms (SAPS) at baseline and completion of the trial. Results: SANS and SAPS scores decreased significantly in both groups. Mean SAPS score reduction in risperidone and aripiprazole group was 16.20 and 10.80, respectively, after trial course (p < 0.001). Mean SANS score reduction in risperidone and aripiprazole group was 9.35 and 11.25, respectively (p = 0.08). Conclusions: Both aripiprazole and risperidone were effective for patients diagnosed with amphetamine-induced psychotic disorder. However, risperidone had the greater effect on positive psychotic symptoms while patients with negative symptoms may respond better to aripiprazole. There is a case for further studies evaluating the efficacy of atypical antipsychotics in this disorder.

A Longitudinal Study of Relation between Side-effects and Clinical Improvement in Schizophrenia: Is There a Neuro-metabolic Threshold for Second Generation Antipsychotics?

ObjectiveClassical studies demonstrated Neuroleptic Induced Extrapyramidal Side-effects (NIES; Neuroleptic threshold) to correlate with the efficacy of first generation antipsychotics. Second generation antipsychotics (SGAs), in addition to the extrapyramidal side effects, are also associated with metabolic side effects. This prospective study on antipsychotic-naïve schizophrenia patients, for the first-time, examined concurrently the relationship between clinical improvement and these side-effects NIES and Neuroleptic Induced Metabolic Side-effects.MethodsThirty six-antipsychotic-naïve schizophrenia (DSM-IV) patients were examined at baseline and after 5 weeks of treatment with antipsychotics. At baseline and follow-up, we recorded the body mass index (BMI) and assessed psychopathology using Scale for Assessment of Positive-symptoms (SAPS) and Scale for Assessment of Negative-symptoms (SANS), extrapyramidal symptoms using Simpson-Angus Extra Pyramidal Scale (SAEPS) and improvement using Clinical Global Impression Improvement (CGI).ResultsAfter treatment, patients showed significant reduction in SAPS (baseline, 27.97±14.47; follow-up, 14.63±13.25; p<0.001) and SANS total scores (baseline, 63.77±28.96; follow-up, 49.30±28.77; p=0.001) and a significant increase in BMI (baseline, 18.5±3.37; follow-up, 19.13±3.17; p<0.001). At follow-up CGI-Improvement score was (2.55±0.65) and SAEPS score was (0.8±1.32). CGI-Improvement score had a significant negative correlation with magnitude of increase in BMI (rs=-0.39; p=0.01) and SAEPS symptom score at follow-up (rs=-0.58; p<0.001). In addition, magnitude of increase in BMI showed positive correlation with the magnitude of reduction in SAPS total score (rs=0.33; p=0.04).ConclusionThe study findings suggest a possible relation between clinical improvement and antipsychotic-induced neuroleptic as well as metabolic side-effects in schizophrenia. Though the mechanism of this relation is yet to be elucidated, insulin signaling pathways and lipid homeostasis are potential mechanisms in addition to the established neurotransmitter hypothesis. Theoretically findings support the novel hypothetical construct of 'Neuro-Metabolic threshold' in the treatment of schizophrenia.