Scale For The Assessment Of Positive Symptoms Research Articles

52 Differences in Neuropsychological Test Performance and Symptom Data in Schizophrenia with Co-Occurring Cannabis Use

Objective:Long-term exposure to the psychoactive ingredient in cannabis, delta-9-tetrahydrocanabinol (THC), has been consistently raised as a notable risk factor for schizophrenia. Additionally, cannabis is frequently used as a coping mechanism for individuals diagnosed with schizophrenia. Cannabis use in schizophrenia has been associated with greater severity of psychotic symptoms, non-compliance with medication, and increased relapse rates. Neuropsychological changes have also been implicated in long-term cannabis use and the course of illness of schizophrenia. However, the impact of co-occurring cannabis use in individuals with schizophrenia on cognitive functioning is less thoroughly explored. The purpose of this meta-analysis was to examine whether neuropsychological test performance and symptoms in schizophrenia differ as a function of THC use status. A second aim of this study was to examine whether symptom severity moderates the relationship between THC use and cognitive test performance among people with schizophrenia.Participants and Methods:Peer-reviewed articles comparing schizophrenia with and without cannabis use disorder (SZ SUD+; SZ SUD-) were selected from three scholarly databases; Ovid, Google Scholar, and PubMed. The following search terms were applied to yield studies for inclusion: neuropsychology, cognition, cognitive, THC, cannabis, marijuana, and schizophrenia. 11 articles containing data on psychotic symptoms and neurocognition, with SZ SUD+ and SZ SUD- groups, were included in the final analyses. Six domains of neurocognition were identified across included articles (Processing Speed, Attention, Working Memory, Verbal Learning Memory, and Reasoning and Problem Solving). Positive and negative symptom data was derived from eligible studies consisting of the Positive and Negative Syndrome Scale (PANSS), the Scale for the Assessment of Positive Symptoms (SAPS), the Scale for the Assessment of Negative Symptoms (SANS), Self-Evaluation of Negative Symptoms (SNS), Brief Psychiatric Rating Scale (BPRS), and Structured Clinical Interview for DSM Disorders (SCID) scores. Meta analysis and meta-regression was conducted using R.Results:No statistically significant differences were observed between SZ SUD+ and SZ SUD-across the cognitive domains of Processing Speed, Attention, Working Memory, Verbal Learning Memory, and Reasoning and Problem Solving. Positive symptom severity was found to moderate the relationship between THC use and processing speed, but not negative symptoms. Positive and negative symptom severity did not significantly moderate the relationship between THC use and the other cognitive domains.Conclusions:Positive symptoms moderated the relationship between cannabis use and processing speed among people with schizophrenia. The reasons for this are unclear, and require further exploration. Additional investigation is warranted to better understand the impact of THC use on other tests of neuropsychological performance and symptoms in schizophrenia.

Is there a Relationship Between Caffeine Intake and Smoking and Positive and Negative Symptom Severity in Schizophrenia?

It has been reported that caffeine intake and smoking are more frequent in patients with schizophrenia than the general population. However, the cause of high caffeine and smoking and its correlation with positive and negative symptoms is unclear. Therefore, the aim of the present study is to evaluate the correlation between daily caffeine intake and smoking and the severity of positive and negative symptoms in patients with schizophrenia. This study included 177 participants, 89 of whom were healthy controls and 88 patients with schizophrenia. Scale for the Assessment of Positive Symptoms (SAPS) and Scale for the Assessment of Negative Symptoms (SANS) scales were applied to the patients with schizophrenia to measure the severity of positive and negative symptoms of the disease. The amounts of caffeine and tobacco consumption were significantly higher in the patients group than healthy controls (p=0.001 and p<0.001, respectively). There was no significant correlations between daily caffeine consumption and SAPS or SANS scores in patients with schizophrenia. There was a significant positive relationship between SAPS-delusions score and tobacco consumption. Our study is the first study in the literature that examines the relationship between caffeine and cigarette intake and SANS and SAPS scales in patients with schizophrenia. Although caffeine intake is higher in patients with schizophrenia than healthy controls, this study is valuable as it shows that it is not associated with symptom severity. In addition, although it is known that smoking is high in patients with schizophrenia, this study showed a positive relationship between SAPS-delusion scores and tobacco consumption.

Using support vector machine to explore the difference of function connection between deficit and non-deficit schizophrenia based on gray matter volume.

Schizophrenia can be divided into deficient schizophrenia (DS) and non-deficient schizophrenia (NDS) according to the presence of primary and persistent negative symptoms. So far, there are few studies that have explored the differences in functional connectivity (FC) between the different subtypes based on the region of interest (ROI) from GMV (Gray matter volume), especially since the characteristics of brain networks are still unknown. This study aimed to investigate the alterations of functional connectivity between DS and NDS based on the ROI obtained by machine learning algorithms and differential GMV. Then, the relationships between the alterations and the clinical symptoms were analyzed. In addition, the thalamic functional connection imbalance in the two groups was further explored. A total of 16 DS, 31 NDS, and 38 health controls (HC) underwent resting-state fMRI scans, patient group will further be evaluated by clinical scales including the Brief Psychiatric Rating Scale (BPRS), the Scale for the Assessment of Negative Symptoms (SANS), and the Scale for the Assessment of Positive Symptoms (SAPS). Based on GMV image data, a support vector machine (SVM) is used to classify DS and NDS. Brain regions with high weight in the classification were used as seed points in whole-brain FC analysis and thalamic FC imbalance analysis. Finally, partial correlation analysis explored the relationships between altered FC and clinical scale in the two subtypes. The relatively high classification accuracy is obtained based on the SVM. Compared to HC, the FC increased between the right inferior parietal lobule (IPL.R) bilateral thalamus, and lingual gyrus, and between the right inferior temporal gyrus (ITG.R) and the Salience Network (SN) in NDS. The FC between the right thalamus (THA.R) and Visual network (VN), between ITG.R and right superior occipital gyrus in the DS group was higher than that in HC. Furthermore, compared with NDS, the FC between the ITG.R and the left superior and middle frontal gyrus decreased in the DS group. The thalamic FC imbalance, which is characterized by frontotemporal-THA.R hypoconnectivity and sensory motor network (SMN)-THA.R hyperconnectivity was found in both subtypes. The FC value of THA.R and SMN was negatively correlated with the SANS score in the DS group but positively correlated with the SAPS score in the NDS group. Using an SVM classification method and based on an ROI from GMV, we highlighted the difference in functional connectivity between DS and NDS from the local to the brain network, which provides new information for exploring the neural physiopathology of the two subtypes of schizophrenic.

Using dimensionality-reduction techniques to understand the organization of psychotic symptoms in persistent psychotic illness and first episode psychosis

Psychotic disorders are highly heterogeneous. Understanding relationships between symptoms will be relevant to their underlying pathophysiology. We apply dimensionality-reduction methods across two unique samples to characterize the patterns of symptom organization. We analyzed publicly-available data from 153 participants diagnosed with schizophrenia or schizoaffective disorder (fBIRN Data Repository and the Consortium for Neuropsychiatric Phenomics), as well as 636 first-episode psychosis (FEP) participants from the Prevention and Early Intervention Program for Psychosis (PEPP-Montreal). In all participants, the Scale for the Assessment of Positive Symptoms (SAPS) and Scale for the Assessment of Negative Symptoms (SANS) were collected. Multidimensional scaling (MDS) combined with cluster analysis was applied to SAPS and SANS scores across these two groups of participants. MDS revealed relationships between items of SAPS and SANS. Our application of cluster analysis to these results identified: 1 cluster of disorganization symptoms, 2 clusters of hallucinations/delusions, and 2 SANS clusters (asocial and apathy, speech and affect). Those reality distortion items which were furthest from auditory hallucinations had very weak to no relationship with hallucination severity. Despite being at an earlier stage of illness, symptoms in FEP presentations were similarly organized. While hallucinations and delusions commonly co-occur, we found that their specific themes and content sometimes travel together and sometimes do not. This has important implications, not only for treatment, but also for research—particularly efforts to understand the neurocomputational and pathophysiological mechanism underlying delusions and hallucinations.

Validity and Reliability Study of Turkish Version of Clinical Assessment Interview for Negative Symptoms (CAINS).

This study aims to translate and investigate the validity and reliability of the Turkish version of the Clinical Assessment Interview for Negative Symptoms (CAINS), which has additional features compared to other scales in assessing negative symptoms in patients with schizophrenia. The Turkish version of CAINS was constructed upon an initial translation to Turkish, and an English back translation of the scale was later conducted. The patients diagnosed with schizophrenia (n=79) according to Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) diagnostic criteria were administered the Turkish version of CAINS, the Positive and Negative Syndrome Scale (PANSS), the Scale for the Assessment of Negative Symptoms (SANS), the Scale for the Assessment of Positive Symptoms (SAPS), the Calgary Depression Scale for Schizophrenia (CDSS), the Clinical Global Impression Scale (CGI), the Global Assessment of Functioning Scale (GAF) and the Simpson-Angus Extrapyramidal Side Effects Assessment Scale (SAS). In addition, two interviewers assessed the video recordings of 11 patients for reliability analysis. Inter-rater reliability was found to be high (intraclass correlation coefficient (ICC): 0.831). Exploratory and confirmatory factor analyses indicated that Cronbach's alpha was 0.956 for the full scale, and the two-dimensional structure explained the scale better. In convergent validity analyses, CAINS overall scores correlated significantly with the SANS total score (r=0,932) and PANSS negative score (r=0,902). In discriminant validity analyses, CAINS overall scores markedly correlated with the SAPS total (r=0,615), PANSS positive (r=0,497) and PANSS general psychopathology (r=0,737) scores. Additionally, when CGI and GAF scores were considered covariant, the significant correlation of CAINS total scores with the SANS total and PANSS negative scores continued; however, the correlation with PANSS positive score was prominently reduced, and the correlation with PANSS general psychopathology disappeared. The Turkish version of the CAINS appears to be a valid and reliable tool with strong psychometric properties in a sample consisting of patients with schizophrenia.

Evaluation of Changes in Peripheric Biomarkers Related to Blood Brain Barrier Damage in Patients with Schizophrenia and Their Correlation with Symptoms.

ObjectiveThe aim of the study was to evaluate the levels of peripheric biomarkers that have been associated with blood brain barrier (BBB) damage in healthy controls and two groups of patients with schizophrenia, those who received typical-atypical antipsychotics and those who received only atypical antipsychotics. Additionally, we sought relationships between these biomarkers and schizophrenia symptoms.MethodsThis study was conducted with the inclusion of 41 healthy volunteers and 75 patients with schizophrenia. The biomarkers measured to evaluate BBB injury were as follows spectrin breakdown product 145 (SBDP145), spectrin breakdown product 150 (SBDP150), ubiquitin carboxy terminal hydrolase L1 (UCHL1), ubiquitin ligase cullin-3 (cullin), occludin and claudin, which were measured via ELISA. Symptoms of patients with schizophrenia were evaluated with the Scale for the Assessment of Positive Symptoms (SAPS), Scale for the Assessment of Negative Symptoms, the Clinical Global Impression Scale (CGI), and the general assessment of functionality (GAF).ResultsCompared to controls, SBDP145 (p = 0.022) and cullin (p = 0.046) levels were significantly higher in patients with schizophrenia receiving atypical antipsychotic treatment. SBDP150 levels were lower in the combination treatment group compared to the control group (p = 0.022). Claudin (p = 0.804), occludin (p = 0.058) and UCHL1 (p = 0.715) levels were similar among groups. In recipients of combination treatment, SBDP145 levels were found to be positively correlated with SAPS-total (r = 0.440, p = 0.036) and SAPS-delusions (r = 0.494, p = 0.017) scores.ConclusionThe relationships demonstrated in this study indicate that more comprehensive research is needed to understand whether BBB defects contribute to clinical characteristics in patients with schizophrenia.

Increased NLRP3 inflammasome expression in peripheral blood mononuclear cells of patients with schizophrenia: a case-control study

Objective This study aimed to evaluate the gene expression of the P2X purinoceptor 7 (P2X7R)- nod-like receptor pyrin domain-containing protein 3 (NLRP3) signal pathway in peripheral blood mononuclear cells (PBMCs) between schizophrenia (SCZ) patients and healthy controls (HC) to reveal its relationship with clinical variables. Methods Thirty-two SCZ patients and 41 healthy controls were included in this study. The Scale for the Assessment of Positive Symptoms (SAPS) and the Scale for the Assessment of Negative Symptoms (SANS), The Global Assessment of Functioning (GAF) scale and the Functioning Assessment Short Test (FAST) scales were applied. P2X7R, NLRP3, IL-1β and IL-18 gene expression levels were evaluated by real-time polymerase chain reaction in PBMCs. Results NLRP3, P2RX7, IL-1β and IL-18 expression levels were significantly higher in PBMCs of SCZ patients than in HC subjects. Negative correlations were found between NLRP3 gene expression levels and GAF and FAST scales scores. There was a negative correlation between IL-18 expression levels and the GAF and FAST scales scores and a positive correlation with the SAPS scale scores. Conclusions Systemic inflammation is implicated in SCZ pathogenesis, according to our findings, which suggest that the NLRP3 pathway may be involved. The NLRP3 inflammasome may serve as a biomarker for SCZ, and its pharmacological regulation may be a promising treatment approach. Key points We hypothesised that the NLRP3 pathway may contribute to the etiopathogenesis of schizophrenia. NLRP3, IL-1β and IL-18 mRNA levels were higher in patients with schizophrenia compared to healthy controls. Negative correlations were found between NLRP3 gene expression levels and GAF and FAST scales scores. There was a negative correlation between IL-18 expression levels and the GAF and FAST scales scores. The SAPS scale scores and IL-18 expression levels had a positive correlation. Given all these findings, it can be stated that NLRP3 inflammasome may play a role in the pathogenesis and symptoms of schizophrenia.

Hierarchical Symptom Components in Early Psychosis.

Quantitative models of psychopathology can empirically guide subclassification of heterogeneous clinical presentations such as psychosis; they are particularly well-equipped to capture the nuanced symptomatology observed in first-episode psychosis. As well, components may be better aligned with biological variables. The current study sought to confirm and extend knowledge of the hierarchical structure of psychosis symptoms in first-episode psychosis. Based on past hierarchical work, we hypothesized that a 4 component level would be most closely associated with longitudinal disability. Participants with early-stage psychosis (N = 370) underwent clinical assessment with the scale for the assessment of positive symptoms (SAPS), scale for assessment of negative symptoms (SANS), and global assessment scale(GAS). A subset was assessed at 6 months (N = 221) and 1 year (N = 207). Hierarchical symptom components were extracted at 12 levels. The predictive utility of the components for global functioning was tested. As predicted, the 4-component model (reality distortion, thought disorder, inexpressivity, apathy/asociality) provided a superior prediction of functioning over other levels of the hierarchy. Baseline apathy/asociality longitudinally predicted functioning beyond the shared variance of the components at 6 months (b = -4.83, t(216) = -5.37, p < .001, R2adj = 0.12) and 1-year (b = -4.49, t(202) = -4.38, p < .001, R2adj = 0.09). The hierarchical structure of psychotic symptomatology and its external validity have been robustly established in independent, longitudinal first-episode psychosis samples. The established model incorporates multiple levels of granularity that can be flexibly applied based on the level that offers the greatest predictive utility for external validators.

A pilot choral intervention in individuals with schizophrenia-spectrum conditions; Singing away loneliness.

Social disconnection is associated with poor outcome and long-term disability in individuals with schizophrenia-spectrum conditions (SCZ) but social isolation is not typically a target for treatment. Singing together has long been shown to promote unique group cohesion and improve sense of well-being across the lifespan. Accordingly, we devised a novel choral intervention to examine the potential efficacy of this low-burden social intervention strategy designed to reduce loneliness in SCZ. Seventeen SCZ participated in a weekly, 1-hr choir group for 8 weeks. At pre- and post-intervention, we examined symptoms, loneliness, stress, and face recognition. Choral intervention led to significant reductions in scores for loneliness, the Brief Psychiatric Rating Scale (BPRS) and the Beck Depression Inventory-II (BDI-II). No significant changes were observed in scores for the Scale for the Assessment of Negative Symptoms (SANS), the Scale for the Assessment of Positive Symptoms (SAPS), face recognition, or the Perceived Stress Scale (PSS). Diminished loneliness was inversely correlated with the number of sessions attended. Participants judged the choir intervention to be acceptable and enjoyable. Reduced loneliness and symptom improvement after 8 weeks of intervention in SCZ suggest that choral intervention presents an enjoyable and low-burden opportunity to collaborate in a group setting for isolated individuals and thus may serve as a beneficial adjunct in a multi-arm intervention strategy for alleviating symptom distress and loneliness.

Eye movement characteristics in male patients with deficit and non-deficit schizophrenia and their relationships with psychiatric symptoms and cognitive function

BackgroundThe cognitive impairment pattern of deficit schizophrenia (DS) is centered on an impaired attention function. Previous studies have suggested that the exploratory eye movement (EEM) tests reflect attention deficits in patients with schizophrenia. However, no study has investigated the characteristics of eye movement in DS in the Chinese Han population. This study aimed to investigate the pattern of eye movement characteristics in DS patients and to examine whether eye movement characteristic is associated with serious negative symptoms and cognitive decline in this schizophrenia subtype.MethodsA total of 86 male patients [37 DS and 49 non-deficit schizophrenia (NDS)] and 80 healthy controls (HC) participated in this study. Clinical symptoms were assessed using the Scale for the Assessment of Positive Symptoms (SAPS) and Scale for the Assessment of Negative Symptoms (SANS). Cognitive function was assessed using the Mattis Dementia Rating Scale (MDRS-2). Eye movement data of subjects were collected using an eye movement tracking analyzer.ResultsThere were significant differences in the overall eye movement data and cognitive test scores among the three groups (all P < 0.001). Both DS and NDS schizophrenia subgroups showed more severe eye movement and cognitive impairment compared with the control group. The number of eye fixations (NEF), total of eye scanning length (TESL), and cognitive function in DS patients were significantly lower than those in NDS patients. The discriminant analysis (D score) was higher than that of the control group (P < 0.001). In the DS group, the inattention factor of SANS was negatively correlated with the attention factor (r = − 0.545, P = 0.001) and structure factor of cognitive (r = − 0.389, P = 0.023), the affective flattening factor of SANS was negatively correlated with TESL (r = − 0.353, P = 0.041) and initiation/retention factor of cognitive (r = − 0.376,P = 0.028). TESL was found to positively correlate with the MDRS-2 total score (r = 0.427, P = 0.012), attention factor (r = 0.354, P = 0.040), and memory factor (r = 0.349, P = 0.043) in the DS group, whereas the mean of eye scanning length (MESL) positively correlated with cognitive impairments in the NDS group. The negative symptoms showed no significant correlation with cognition in the NDS group.ConclusionsTotal of eye scanning length may be a characteristic eye movement symptom in DS patients, which is associated with serious negative symptoms and cognitive impairment in this schizophrenia subtype.

White Matter Correlates of Hostility and Aggression in the Visuospatial Function Network in Patients With Schizophrenia.

Background: Violent acts in patients with schizophrenia are often associated with their hostility and aggression levels. Poor visuospatial processing has been suggested as a possible risk factor of violence in schizophrenia. However, studies investigating the relationship between hostility, aggression, and the visuospatial function have been lacking. Here, we aimed to investigate brain dysconnectivity associated with hostility and aggression in schizophrenia, particularly focusing on the visuospatial function network.Methods: Eighty-eight participants with schizophrenia and 42 healthy controls were enrolled. The visuospatial function network regions of interest were analyzed using Tract-Based Spatial Statistics. The hostility item from the Positive and Negative Syndrome Scale (PANSS), aggressive, and agitated behavior item from the Scale for the Assessment of Positive Symptoms (SAPS), and the Rey Complex Figure Test (R-CFT) were measured.Results: Among the participants with schizophrenia, the SAPS aggressive and agitated behavior scores were significantly correlated with fractional anisotropies (FAs) of the white matter regions in the splenium of the corpus callosum (CC), left posterior thalamic radiations (PTR), and left posterior corona radiata (PCR). Exploratory correlational analysis revealed significant negative correlations between FAs of the splenium of the CC and R-CFT copy and immediate recall scores. In addition, three regions including CC, PTR, and PCR that significantly correlated with the aggression scores showed significant correlations with the total PANSS scores.Conclusion: Our main finding suggests that aggression of patients with schizophrenia may be associated with poor visuospatial ability and underlying white matter dysconnectivity. These may help enhance understanding aggression in patients with schizophrenia.

ПСИХОМЕТРИЧЕСКИЕ СВОЙСТВА И ДИАГНОСТИЧЕСКИЕ КРИТЕРИИ ШКАЛЫ ОЦЕНКИ ПОЗИТИВНЫХ СИМПТОМОВ SAPS У ПАЦИЕНТОВ С ШИЗОФРЕНИЕЙ

Objectives. To assess psychometric properties of Scale for the Assessment of Positive Symptoms (SAPS) and to develop criteria for assessing the severity of positive symptoms in the dynamics of therapy, to clinically verify SAPS metric criteria. Material and methods. The study involved 157 patients with the diagnosis of schizophrenia. Psychometric analysis of SAPS was carried out on the basis of the Rasch metric system with the development of criteria for assessing the severity of positive symptoms based on the index of minimum detectable changes for 95% probability (Minimum detectable change 95% - MDC95%). Clinical verification was conducted by statistical analysis of contingency tables of clinical and metric criteria using the Clinical Global Impression Scale (CGI). Results. All items of SAPS have reasonable level of construct validity. The scale is characterized by moderate reliability (r= 0.84) and high discrimination. Factor analysis has revealed heterogeneity of SAPS metric structure: items in the first group assess hallucinatory and delusional symptoms, items in the second group characterize behavioral disorders and formal thinking disorders. The heterogeneity of SAPS reflects dimensional structure of positive syndrome, which allows to consider total score on the scale as an indicator of this psychopathological construct severity. On the basis of metric approach, criteria for assessing the severity of positive symptoms in the dynamics of therapy have been developed. Statistically significant linear relationship has been found between the levels of SAPS and CGI scales: SAPS has shown higher discriminativeness in assessing severe levels and less marked discriminativeness in assessing low levels of positive symptoms compared to CGI. Conclusions. SAPS has acceptable psychometric characteristics. The developed diagnostic criteria are suitable for the use in clinical practice and research.

Efficacy results of pimavanserin from a multi-center, open-label extension study in Parkinson's disease psychosis patients

IntroductionPimavanserin, a selective 5-HT2A inverse agonist/antagonist, was approved for hallucinations and delusions associated with Parkinson's disease psychosis (PDP). We present durability of response with pimavanserin in patients with PDP for an additional 4 weeks of treatment. MethodsThis was an open-label extension (OLE) study in patients previously completing one of three double-blind, placebo-controlled (Core) studies. All patients received pimavanserin 34 mg once daily. Efficacy assessments included the Scale for the Assessment of Positive Symptoms (SAPS) PD and H + D scales, Clinical Global Impression (CGI) Improvement and Severity scales and Caregiver Burden Scale (CBS), through 4 weeks in the OLE. Safety assessments were conducted at each visit. ResultsOf 459 patients, 424 (92.4%) had a Week 4 efficacy assessment. At Week 4 (10 weeks total treatment), SAPS-PD mean (standard deviation) change from OLE baseline was −1.8 (5.5) and for SAPS-H + D was −2.1 (6.2) with pimavanserin 34 mg. Patients receiving placebo during the Core studies had greater improvements (SAPS-PD -2.9 [5.6]; SAPS-H + D −3.5 [6.3]) during the OLE. For participants treated with pimavanserin 8.5 or 17 mg during the Core studies, further improvement was observed during the OLE with pimavanserin 34 mg. The mean change from Core Study baseline for SAPS-PD score was similar among prior pimavanserin 34 mg and prior placebo-treated participants (−7.1 vs. −7.0). The CGI-I response rate (score of 1 or 2) at Week 4 was 51.4%. Adverse events were reported by 215 (46.8%) patients during the first 4 weeks of OLE. The most common AEs were fall (5.9%), hallucination (3.7%), urinary tract infection (2.8%), insomnia (2.4%), and peripheral edema (2.2%) ConclusionsPatients previously on pimavanserin 34 mg during three blinded core studies had durability of efficacy during the subsequent 4 week OLE SAPS-PD assessment. Patients previously on blinded placebo improved after 4 weeks of OL pimavanserin treatment. These results in over 400 patients from 14 countries support the efficacy of pimavanserin for treating PDP.

Role of age at onset in the clinical presentation of bipolar disorder in Indian population.

Objective:The objective of this study was to determine any association of age at onset (AAO) with clinical presentation of bipolar disorder (BD) and family history of illness.Materials and Methods:A hospital-based cross-sectional observational study was conducted including 162 patients having a diagnosis of BD current episode manic. Individuals were divided into three subgroups according to AAO, i.e., early-onset BD (EOBD) (AAO ≤21 years), intermediate-onset BD (AAO – 22–34 years), and late-onset BD (AAO ≥35 years). The subgroups were compared on clinical variables; items of the Young Mania Rating Scale (YMRS), Hamilton Depression Rating Scale (HAM-D), and Scale for the Assessment of Positive Symptoms (SAPS); and family history of illness.Results:The early-onset group had significantly more episodes per year than the other groups (P < 0.001). The prevalence of family history of mood disorder was also significantly higher in the early-onset group than the other subgroups. AAO was found to be significantly associated with different items of YMRS, HAM-D, and SAPS. The early-onset group had higher rating on irritability, motor activity–energy, sexual interest, depressed mood, delusions, and thought disorders, whereas the late-onset group had higher rating on elevated mood.Conclusion:EOBD can be considered as a specific phenotype of BD, which is more homogenous, severe, and inheritable form of illness.

High mobility group box-1 levels in schizophrenia: Potential biomarker of remission phase.

Background: Schizophrenia is a chronic mental disorder, characterized byacute exacerbation and remission phases. Immune system has a role in the pathophysiology of schizophrenia. High mobility group box-1 (HMGB-1) is a macrophage secreted protein activating immune cells to produce cytokines. The aim of this study was to evaluate HMGB-1 levels among patients with schizophrenia both in acute exacerbation and remission phases. Methods: Consecutive schizophrenia patients in acute exacerbation and remission phases were enrolled and compared with each other and with age-sex matched healthy subjects. Patients were assessed with the Scale for the Assessment of Positive Symptoms (SAPS), Scale for the Assessment of Negative Symptoms (SANS), Brief Psychiatric Rating Scale (BPRS), Clinical Global Impression Scale (CGI). Results: Mean HMGB-1 levels were not significantly different in acute exacerbation phase versus remission phase schizophrenia patients (2.139±0.564 g/L vs. 2.326± 0.471 g/L, p=0.335) and both were individually higher than the control group (1.791±0.444 g/L, p=0.05 for acute exacerbation vs control, p=0.002 for remission vs control). In remission phase schizophrenic patients, HMGB-1 levels were positively correlated with Scale For The Assessment of Positive Symptoms (r=0.447, p=0.015) and BPRS (r=0.397, p=0.033) scores and HMGB-1 levels were independently associated with BPRS. Conclusions: Serum HMGB-1 levels were shown to be increased in patients with schizophrenia patients irrespective of phase, there were no differences between patients in acute exacerbation and remission phase in terms of biomarker and HMGB-1 levels were related to symptom severity according to psychiatric scales among patients in remission phase of schizophrenia.

Social cognition correlation to white matter integrity alteration in mirror neurons of schizophrenic patients: DTI study

BackgroundIt is postulated that mirror neurons (MNs) abnormalities are associated with social skills. ObjectivesUsing DTI, altered structural connectivity and its association with social cognition in MNs-hub regions was investigated in schizophrenia in comparison to healthy. MethodsFifteen patients with schizophrenia in their first episode and 15 healthy controls were included in this study. They were subjected to the Structured Clinical Interview for DSM-IV Axis I Disorder (SCID-I), Scale for the Assessment of Negative Symptoms (SANS), with special consideration to “Anhedonia and Asociality” subscale, Scale for the Assessment of Positive Symptoms (SAPS) and a comprehensive cognitive assessment. DTI scans were acquired in patients and controls. FA and Trace of the regions of interest rich in mirror neurons were evaluated, i.e., anterior cingulate cortex (ACC), inferior parietal lobe (IPL) and premotor cortex (PMC). ResultsA significant difference in Trace of these 3 regions was observed in schizophrenia patients. There were no group differences in FA. There was a significant positive correlation between the Trace of the right IPL and right and left PMA, with the “Anhedonia & Associability” subscale. ConclusionsMirror neuron system in schizophrenia patients might be connected to negative symptoms, more specifically, to social deficits.

Serum galectin-3 levels are decreased in schizophrenia

Objective:To determine whether changes in serum galectin-3 (gal-3) concentrations in schizophrenia patients have etiopathogenetic importance. Since very little research has assessed the connection between galectins and schizophrenia, we wanted to examine alterations in the inflammatory marker gal-3 in schizophrenia and investigate possible correlations between clinical symptomatology and serum concentrations.Methods:Forty-eight schizophrenia patients and 44 healthy controls were included in this study. The Scale for the Assessment of Positive Symptoms (SAPS) and the Scale for the Assessment of Negative Symptoms (SANS) were administered to determine symptom severity. Venous blood samples were collected, and serum gal-3 levels were measured.Results:Mean serum gal-3 levels were significantly lower in schizophrenia patients, and there were no significant differences in age or sex with the control group. There was also a significant positive correlation between serum gal-3 concentrations and negative schizophrenia symptoms according to the SANS.Conclusion:The results indicate that gal-3 is decreased in schizophrenia patients, which could contribute to inflammation in the pathogenesis of schizophrenia.

M96. A NEW ASSESSMENT TOOL FOR FORMAL THOUGHT DISORDER IN SCHIZOPHRENIA: DOKUZ EYLUL THOUGHT DISORDER SCALE

BackgroundCurrent scales of formal thought disorder (FTD) in schizophrenia have been shown to hold considerable inadequacies: 1. The concept of FTD is usually limited to positive and negative symptoms of schizophrenia 2. There is no much consideration about pragmatic disturbances. 3. There are significant inconsistencies in measurements of posFTD and negFTD dimensions (eg, merely focusing on the positive dimension); 4. As to the comprehensive scales of posFTD and negFTD, administration or assessment is time-consuming for routine clinical use and they are not user friendly. Besides, some of the FTD scales include the utilization of materials such as pictures, figures, or extended structured interviews to be able to provide speech samples of the patient. Developing a new FTD assessment tool that can be practically applied in clinic might help clinicans in diagnosis, treatment and follow-up. The aim of our study was to develop a new scale for assessment of FTD and evaluate the reliability and validity of this scale. We named our new FTD scale as Dokuz Eylul Thought Disorder Scale (DETDS). The originality of this scale is based on the fact that it involves assessment of pragmatic comprehension as well as positive and negative FTD and it can be administered and scored practically in routine clinical examination.MethodsThis study included 130 patients with schizophrenia and 35 controls. For assessing the reliability of this new scale, internal consistency, test-retest and interrater reliability analyses were conducted. The validity of the scale was assessed with concurrent validity and factor analysis methods.ResultsIn the study, Cronbach’s was 0.86. The new scale has a good test-retest (r=0.83) and interrater (ICC=0.985) reliability. The posFTD subscale of the new scale showed high correlation with the posFTD subscale of the Scale for the Assessment of Positive Symptoms (SAPS) (r=0.95, p<0.001) and negFTD subscale of our scale showed high correlation with the alogia subscale of the Scale for the Assessment of Negative Symptoms (SANS) (r=0.95, p<0.001) and impoverishment of thought subscale of the Thought and Language Index (TLI) (r=0.66, p<0.001). The factor analysis revealed a 3-factor solution which explained 74.6% of the variance: 1. Positive Formal Thought Disorder, 2. Negative Formal Thought Disorder, 3. Pragmatic Comprehension Disorder.DiscussionOur findings showed that DETDS is a reliable and valid scale which can be used in assessing FTD in patients with schizophrenia in routine clinical use. Unlike most scales of FTD that are available in the literature, but similar to SANS, SAPS, and PANSS, it is practical to use because it is based on clinical interview. Another strength of DETDS is that it intensifies the posFTD and negFTD dimensions and scores them hierarchically in terms of severity. The fact that the new scale covers pragmatic comprehension disorders also presents an innovation to the literature.

S170. PROGRESSIVE SUBCORTICAL VOLUME LOSS IN TREATMENT-RESISTANT SCHIZOPHRENIA PATIENTS AFTER COMMENCING CLOZAPINE TREATMENT

BackgroundThe association of antipsychotic medication with abnormal brain morphometry in schizophrenia remains uncertain. Early studies investigating a switch from first generation antipsychotic to clozapine have steadily shown a decrease of caudate volume over time; however nowadays most patients are already on second generation antipsychotic medications prior to clozapine commencement and it remains unclear whether switching to clozapine in such circumstances would have any such effect on the basal ganglia. In this study we aimed to comprehensively investigate whether after 6 months of switching to clozapine, subcortical structures demonstrate any progressively neuroanatomical changes in patients with treatment-resistant schizophrenia compared to healthy controls, and whether any such changes are related to clinical variables including treatment response and amount of clozapine taken.MethodsMRI images were acquired for all participants at baseline and after 6 months at University Hospital Galway in a 1.5 T scanner. The longitudinal pipeline of Freesurfer v.5.3.0, based on an unbiased within-subject anatomical template, was employed to segment eight subcortical regions-of-interest: lateral ventricle, thalamus, caudate, putamen, globus pallidus, hippocampus, amygdala and nucleus accumbens. Subcortical volumes were bilaterally extracted following quality check of raw data and segmentation. Clinical assessments included the Positive and Negative Syndrome Scale (PANSS), The Scale for the Assessment of Positive Symptoms (SAPS), The Scale for the Assessment of Negative Symptoms (SANS) and Global Assessment Functioning Score (GAF). Two-way repeated ANCOVA was used to assess group differences in subcortical volumes over time and partial correlations to determine association with clinical variables. Change in volume was expressed using the following formula: (Follow Up -Baseline)/Baseline x 100.Results33 patients with treatment-resistant schizophrenia (TRS) and 31 healthy volunteers (HC) matched for sex and age were successfully recruited at both baseline prior to clozapine treatment and after 6 months. There was a significant effect of time on subcortical brain volumes between TRS and controls (F(7,143)= 52.54, p<0.001). Corrected post-hoc analyses demonstrated that patients had significant enlargement of lateral ventricles (F(1,59)= 48.89; p<0.001) and reduction of thalamus (F(1,59)= 34.85; p<0.001), caudate (F(1,59)= 59.35; p<0.001), putamen (F(1,59)= 87.20; p<0.001) and hippocampus (F(1,59)= 14.49; p<0.001) volumes. Thalamus and putamen volume reduction was associated with improvement in PANSS (r=0.42; p=0.021, r=0.39; p=0.033), SANS (r=0.36; p=0.049, r=0.40; p=0.027) and GAF (r=-0.39; p=0.038, r=-0.42; p=0.024). Reduced thalamic volume over time was associated with increased serum level at follow-up (r=-0.44; p=0.010). There was no significant overall effect of time on subcortical brain structures between patients responding to clozapine compared to patients non-responding to clozapine (F(7,20)=0.50; p=0.834).DiscussionThis study demonstrates that, despite the clinical and functional improvement of most patients with schizophrenia who are switched to clozapine, there is a counterintuitive progressive volume reduction in several subcortical structures over time. Furthermore, patients who have the greatest symptomatic improvement display the largest thalamo-putaminal reductions, indicating that volume reduction reflects an adaptive response associated with symptom improvement rather than a harmful or neurotoxic process in these patients.

M227. AN EXPLORATORY STUDY OF AUTOMATED LINGUISTIC ANALYSIS OF SOCIAL NARRATIVES IN SCHIZOPHRENIA

BackgroundSchizophrenia has been suggested to be a disorder of social communication, which depends on the way language is used to convey thoughts, beliefs, feelings, and intentions. Everyday language can also reveal personality, emotions, and social skills of the speaker. Extensive past research affirms the central importance of language and thought disorder as diagnostic features of schizophrenia, mostly focused on the neurocognitive aspects of language output collected during clinical interviews, and not on the social nature of language. In this study, we examined narratives written in response to viewing social scenes by individuals with schizophrenia (SZ) and matched controls (CO) using an automated computational linguistics and statistical-based text analysis tool that computes socially-relevant variables.Methods23 individuals with schizophrenia (SZ) and 23 demographically matched controls (CO) were shown paintings of social situations, and were asked to write reflections describing what they thought and felt about these scenes. Two pictures were presented consecutively. There was no time limit. Resulting narratives were analyzed with the Linguistic Inquiry and Word Count program (LIWC; Pennebaker et al, 2015). LIWC computes basic linguistic variables such as the % of self-referring and non-self-referring pronouns, social and emotion words, and cognitive items. LIWC also generates 4 complex variables: formal and logical thinking patterns (“analytic”); social status or confidence (“clout”); authenticity, and emotional tone. Clinical symptoms in SZ were assessed using the Scale for the Assessment of Positive Symptoms (SAPS) and the Scale for the Assessment of Negative Symptoms (SANS). For all participants, the UCLA Loneliness Scale, the National Adult Reading Test (NART), and the Edinburgh Handedness Inventory (EHI) were administered.ResultsThe two groups did not differ in NART or EHI. There was no group difference in the number of words produced. SZ produced greater number of pronouns than CO but this effect was driven by a higher % of self-referring pronouns in SZ than CO, with no group difference in non self-referring pronouns. For complex variables, CO scored significantly higher in authenticity than SZ but no group differences were observed in clout, analytics, or emotional tone. Loneliness was higher in SZ compared with CO. There were no other significant group differences. In SZ, pronoun use was correlated with positive symptoms (especially with ratings of hallucinations, bizarre behavior, delusions of mind-reading and thought broadcasting) and inversely correlated with negative symptoms (avolition, apathy and motor retardation). Social words were inversely correlated with SAPS Thought Disorder. Clout was inversely correlated with SANS Alogia and SAPS Thought Disorder. Authenticity was correlated with SANS Anhedonia and Asociality. In CO, loneliness was correlated with the % negative emotion words and NART was correlated with total number of emotion words.DiscussionWe used an automated linguistic analysis tool to extract information relevant to social communication from written narratives. We found group differences in the use of pronouns and authenticity. We also observed associations of clinical symptoms with certain social aspects of language use in schizophrenia. One advantage of automated text analysis tools is the minimization of implicit biases inherent in ratings of interviews. Limitations of this study include lack of direct social functioning measures and the sample size. Future work will incorporate linguistic text analysis within a social paradigm to directly examine the role of language use in social functioning.