Schizoaffective Disorder Patients Research Articles

Molecular and micro-architectural mapping of gray matter alterations in psychosis.

The psychosis spectrum encompasses a heterogeneous range of clinical conditions associated with abnormal brain development. Detecting patterns of atypical neuroanatomical maturation across psychiatric disorders requires an interpretable metric standardized by age-, sex- and site-effect. The molecular and micro-architectural attributes that account for these deviations in brain structure from typical neurodevelopment are still unknown. Here, we aggregate structural magnetic resonance imaging data from 38,696 healthy controls (HC) and 1256 psychosis-related conditions, including first-degree relatives of schizophrenia (SCZ) and schizoaffective disorder (SAD) patients (n = 160), individuals who had psychotic experiences (n = 157), patients who experienced a first episode of psychosis (FEP, n = 352), and individuals with chronic SCZ or SAD (n = 587). Using a normative modeling approach, we generated centile scores for cortical gray matter (GM) phenotypes, identifying deviations in regional volumes below the expected trajectory for all conditions, with a greater impact on the clinically diagnosed ones, FEP and chronic. Additionally, we mapped 46 neurobiological features from healthy individuals (including neurotransmitters, cell types, layer thickness, microstructure, cortical expansion, and metabolism) to these abnormal centiles using a multivariate approach. Results revealed that neurobiological features were highly co-localized with centile deviations, where metabolism (e.g., cerebral metabolic rate of oxygen (CMRGlu) and cerebral blood flow (CBF)) and neurotransmitter concentrations (e.g., serotonin (5-HT) and acetylcholine (α4β2) receptors) showed the most consistent spatial overlap with abnormal GM trajectories. Taken together these findings shed light on the vulnerability factors that may underlie atypical brain maturation during different stages of psychosis.

Difference in Laterality of the Dorsal Striatum in Schizoaffective Disorder.

Recent research has demonstrated that the dorsal striatum is directly associated with the integration of cognitive, sensory-motor, and motivational/emotional data. Disruptions in the corticostriatal circuit have been implicated in the pathophysiology of psychosis. The dorsal striatum was reported to show lateralized pathology in psychotic disorders. In this study, we aimed to analyze the laterality of the dorsal striatum with texture analysis of T2-weighted magnetic resonance imaging (MRI) images from schizoaffective disorder (SAD) patients. Twenty SAD patients, met the inclusion criteria and had available cranial MRI data were assigned as the patient group. Twenty healthy individuals were determined as the control group. Texture analysis values were obtained from striatum region of interests (ROI) generated from T2-weighted MRI images. Data are presented as mean and standard deviation. The suitability of the data for normal distribution was analyzed with the Kolmogorov-Smirnov test. Analysis of variance (ANOVA) test (Post Hoc TUKEY) was employed to compare the group data based on test findings. There was no significant difference between the groups in terms of gender and age. There were differences in the values of texture analysis parameters of both caudate and putamen nuclei in comparison to controls. We identified differences in the left dorsal striatum nuclei in SAD. The differences in the putamen were more and more pronounced than in the caudate. Texture analyses suggest that the left dorsal striatum nuclei may be different in SAD patients. Further studies are needed to determine the pathophysiology of SAD and how it may affect disease treatment.

The Corpus Callosum in Schizoaffective Disorder: A Shape Analysis Study

Objective: The corpus callosum is the largest white matter structure in the human brain that connects the cortical regions of both hemispheres. Diseases could lead to degenerative alterations in brain structures such as the corpus callosum (CC). Studies have associated CC abnormalities with Schizoaffective Disorder (SAD) symptoms. We predicted that there may be differences in the CC, an important structure connecting the two halves of the brain, in patients with SAD. The present study aims to analyze the CC of patients with statistical shape analysis (SSA) and compare the findings with healthy controls. Methods: Thirty-nine SAD patients and 39 healthy individuals (11 females and 28 males) of similar age that included subjects participated in the study. CC landmarks were marked on the mid-sagittal images of each participant. The mean ‘Procrustes’ point was determined, and shape deformations were analyzed with thin plate spline analysis. Results: Significant differences were observed between the shapes of CC in the two groups, and maximum CC deformation was observed in the posterior regions of SAD patients. There was no significant difference between the CC area of the SAD patients and the controls. Conclusion: In the present study, the maximum deformation was observed in the posterior region (isthmus and splenium) and the rostrum of the CC. The first CC region, the rostrum (+genu), connects prefrontal and premotor regions, which are associated with cognitive information (landmarks = 1, 7, 8, 9, 13, 15, and 12). The second area, the splenium, connects temporal and occipital cortical areas. These predominantly have auditory, peripheral, and central visual stimulation functions (landmarks = 5, 3, and 4). The current study could assist future studies on the etiology, diagnosis, and treatment of SAD.

Schizophrenia and schizoaffective disorder: Length of stay and associated factors.

Patients with schizophrenia and schizoaffective disorder often require longer admissions. To explore length of stay (LOS) and associated factors of patients with schizophrenia and schizoaffective disorder, admitted to a public sector specialised psychiatric hospital, over a 4-year period. The study was conducted at Tara Hospital in Johannesburg. A retrospective record review of 367 adult schizophrenia and schizoaffective disorder patients admitted between 01 January 2015 and 31 December 2018. Average LOS was calculated and the proportion of short-stay (< 30 days), medium-stay (31-90 days) and long-stay (> 90 days) admissions determined. Sociodemographic, clinical and admission outcome data were collected and analysed from a randomly selected subset of patients in each LOS category. Mean LOS was 128 days (median 87, interquartile range [IQR] 49-164, range 0-755 days). A significantly greater proportion had long-stay admissions (p < 0.001). Male gender (p = 0.018), being unmarried (p = 0.006), treatment resistant (p < 0.001) and on clozapine (p = 0.009) were factors found to have a significant association with long-stay admissions. Rates of unemployment (> 80%), comorbid substance use disorders (> 40%), medical illnesses (> 40%), antipsychotic polypharmacy (> 40%) and readmissions (> 80%) were high. Most (> 80%) were discharged. Long-stay admissions were frequently required for patients with schizophrenia and schizoaffective disorder admitted to Tara Hospital. This study highlights factors associated with long-stay admissions in patients with schizophrenia and schizoaffective disorder. More research is needed into whether increased access to community-based services, such as residential and daycare facilities, outpatient substance rehabilitation programmes and dual diagnosis clinics, could translate into shorter admissions, less frequent relapses and improved outcomes in this population.

Do Long‐Acting Injectable Antipsychotics Influence Serum Levels of Brain‐Derived Neurotrophic Factor in People With Schizophrenia and Schizoaffective Disorder?

Schizophrenia (SCZ) and schizoaffective disorder (SAD) are severe and complex psychiatric disorders whose liability threshold is modulated by the interplay of biological, mainly genetic, and environmental factors. Consistent evidence has pointed to the role of serum brain‐derived neurotrophic factor (BDNF) as a plausible illness biomarker in SCZ spectrum disorders. There is no consensus, however, on the temporal trajectory of this decline. Here, we present a secondary analysis of the Longitudinal Assessment of BDNF in Sardinian Psychotic patients (LABSP) study, focusing on the impact of antipsychotic therapy, particularly long‐acting injectable (LAI), on the longitudinal trajectory of serum BDNF levels and analyzing the effect of BDNF genetic variants. LABSP patients were assessed every 6 months for a series of measures, including the assessment of BDNF serum levels over 24 months. Blood samples for each patient were taken at the same time of the day (between 8:00 and 10:00 a.m.). BDNF serum levels were determined using the BDNF ELISA Kit. Four tag single nucleotide polymorphisms (SNPs) within the BDNF gene (rs1519480, rs11030104, rs6265 [Val66Met], and rs7934165) were selected using standard parameters and analyzed with polymerase chain reaction (PCR). Mixed‐effects linear regression models (MLRMs) were used to analyze longitudinal data. Twenty‐four patients out of 105 LABSP (22.9%) patients received therapy with LAI. Analysis with MLRM showed a significant effect of LAI treatment associated with increasing serum BDNF levels (Z = 2.2, p = 0.02). However, oral antipsychotics did not significantly impact the longitudinal trajectory of serum BDNF levels (Z = 0.15, p = 0.9). There was no moderating effect of variants within the BDNF gene on the identified association. We identified a significant longitudinal increase in serum BDNF in SCZ and SAD patients treated with LAI antipsychotic therapy. The significant impact of this preparation of antipsychotic treatment on serum BDNF, despite the limited sample size, points to a moderate to large magnitude of effect that should be investigated in future prospective studies.

Retinal Neurodegeneration as a Potential Biomarker of Accelerated Aging in Schizophrenia Spectrum Disorders.

Several biological markers are believed to reflect accelerated aging in schizophrenia spectrum disorders; however, retinal neural changes have not yet been explored as potential CNS biomarkers of accelerated aging in this population. The aim of this study was to determine whether retinal neural layer thinning is more strongly related to age in schizophrenia and schizoaffective disorder patients (SZ) than in a psychiatrically healthy control group (CON). Schizophrenia (n = 60) and CON participants (n = 69) underwent spectral domain optical coherence tomography (OCT) scans to examine the following variables in both eyes: retinal nerve fiber layer (RNFL) thickness, macula central subfield (CSF) thickness, macula volume, ganglion cell layer-inner plexiform layer (GCL-IPL) thickness, optic cup volume, and cup-to-disc ratio. Eleven participants in each group had diabetes or hypertension. Significant negative relationships between age and RNFL thickness, macula volume, and GCL-IPL thickness were observed in the SZ group, while no significant relationships were observed in the CON group. However, many of the findings in the SZ group lost significance when participants with diabetes/hypertension were removed from analyses. A notable exception to this was that the age × SZ interaction accounted for a unique proportion of variance in GCL-IPL thinning over and above the effect of diabetes/hypertension. The results suggest that retinal atrophy occurs at an increased rate in schizophrenia spectrum disorders, potentially reflecting accelerated aging inherent to these conditions, with considerable contributions from systemic medical diseases closely linked to this population.

Dysregulation of MicroRNAs Derived from Plasma Extracellular Vesicles in Schizoaffective Disorder.

The association between peripheral blood extracellular vesicles (EVs)-derived miRNAs (EVs-miRNAs) and neuropsychiatric diseases has been extensively studied. However, it remains largely unclear about the expression profile of EVs-miRNAs in schizoaffective disorder (SAD) patients. In our study, we isolated the EVs from plasma samples of patients and healthy controls, and then analyzed the expression profiles of EVs-miRNAs through small RNA sequencing. Our results identified 32 differentially expressed (DE) miRNAs (25 upregulated and 7 downregulated) in SAD patients. A module containing 42 miRNAs closely related to SAD was identified by weighted gene co-expression network analysis (WGCNA), among which has-miR-15b-5p, has-miR-301a-3p, has-miR-342-3p, has-miR-219b-5p, and has-miR-145-5p were identified as hub miRNAs. The enrichment analysis showed that the target genes of these 42 miRNAs were significantly enriched in multiple pathways related to neuropathology and located at synapses. A total of 6 DE miRNAs (has-miR-7-5p, has-miR-144-3p, has-miR-155-5p, has-miR-342-3p, has-miR-342-5p, and has-miR-487b-3p) associated with SAD were selected for qRT-PCR verification. The level of has-miR-342-3p in SAD patients was downregulated, and hsa-miR-155-5p was upregulated. Our findings support the hypothesis that dysregulation of EVs-miRNAs in plasma might be involved in the underlying neuropathology of SAD through several biological pathways and provide important preliminary evidence supporting the use of EVs-miRNAs as potential novel biomarkers in SAD.

Default mode network dynamic functional network connectivity predicts psychotic symptom severity.

Neuropsychiatric disorders affect millions of people worldwide every year. Recent studies showed that the symptomatic overlaps across neuropsychiatric disorders mislead schizophrenia and bipolar disorder diagnosis. Additionally, recent studies claimed that schizoaffective disorder as a condition overlapped with both schizophrenia and bipolar disorder. Since symptomatic overlap among these disorders causes misdiagnosis, a need for neuroimaging biomarkers differentiating these disorders for a more accurate diagnosis is crucial. This study investigates dynamics functional network connectivity (dFNC) in the default mode network (DMN) of schizophrenia, bipolar, and schizoaffective disorder patients and compares them with their relative and healthy control. Additionally, it explored whether DMN dFNC features can predict the symptom severity of these neuropsychiatric disorders. Here, we found that dFNC features can differentiate schizophrenia from bipolar disorder. At the same time, we did not see a significant difference between schizoaffective with other conditions. Additionally, we found dFNC features can predict symptom severity of these three conditions.

Investigating differences of medications in hospitalized schizophrenia and schizoaffective disorder patients: impact of substance use

ABSTRACT Background Substance use is a clinical comorbidity resulting in poor prognosis, non-adherence and increased admissions in schizophrenia and related disorders. This study investigated differences in treatment preferences in hospitalized schizophrenia and schizoaffective disorder patients with or without substance use. Method Retrospective recordings regarding patients hospitalized between July 2017 and July 2018 were obtained from a mental health hospital database. Results Younger people and males were prevalent in those reporting substance use. Total and involuntary hospitalization numbers were similar across groups. Admission to a psychiatry unit due to forensic issues was higher in substance users. Electroconvulsive therapy (ECT), long-acting injection antipsychotics (LAI APs) and clozapine use were more frequent in substance non-users. Total and involuntary hospitalization numbers predicted LAI AP use, while younger age, total hospitalization and illness duration predicted clozapine use. Substance use was predictive for clozapine use. Conclusions Substance use should be monitored in young, male cases with schizophrenia spectrum disorders. LAI AP, clozapine, and ECT use should be investigated more comprehensively in this group.

Neuropsychiatric Genetics of Psychosis in the Mexican Population: A Genome-Wide Association Study Protocol for Schizophrenia, Schizoaffective, and Bipolar Disorder Patients and Controls

No large-scale genome-wide association studies (GWASs) of psychosis have been conducted in Mexico or Latin America to date. Schizophrenia and bipolar disorder in particular have been found to be highly heritable and genetically influenced. However, understanding of the biological basis of psychosis in Latin American populations is limited as previous genomic studies have almost exclusively relied on participants of Northern European ancestry. With the goal of expanding knowledge on the genomic basis of psychotic disorders within the Mexican population, the National Institute of Psychiatry Ramón de la Fuente Muñiz (INPRFM), the Harvard T.H. Chan School of Public Health, and the Broad Institute’s Stanley Center for Psychiatric Research launched the Neuropsychiatric Genetics Research of Psychosis in Mexican Populations (NeuroMex) project to collect and analyze case-control psychosis samples from 5 states across Mexico. This article describes the planned sample collection and GWAS protocol for the NeuroMex study. The 4-year study will span from April 2018 to 2022 and aims to recruit 9,208 participants: 4,604 cases and 4,604 controls. Study sites across Mexico were selected to ensure collected samples capture the genomic diversity within the Mexican population. Blood samples and phenotypic data will be collected during the participant interview process and will contribute to the development of a local biobank in Mexico. DNA extraction will be done locally and genetic analysis will take place at the Broad Institute in Cambridge, MA. We will collect extensive phenotypic information using several clinical scales. All study materials including phenotypic instruments utilized are openly available in Spanish and English. The described study represents a long-term collaboration of a number of institutions from across Mexico and the Boston area, including clinical psychiatrists, clinical researchers, computational biologists, and managers at the 3 collaborating institutions. The development of relevant data management, quality assurance, and analysis plans are the primary considerations in this protocol article. Extensive management and analysis processes were developed for both the phenotypic and genetic data collected. Capacity building, partnerships, and training between and among the collaborating institutions are intrinsic components to this study and its long-term success.

Letter to the Editor: THE IMPACT OF THE COVID-19 PANDEMIC ON SCHIZOPHRENIA PATIENTS.

Letter to the Editor: THE IMPACT OF THE COVID-19 PANDEMIC ON SCHIZOPHRENIA PATIENTS.

M101. PREVELANCE USE OF TECHNOLOGICAL DEVICES AND INTERNET AMONG PATIENTS DIAGNOSED WITH SCHIZOPHRENIA AND SCHIZOAFFECTIVE DISORDER

BackgroundEffective use of technology makes human life much easier nowadays. This use has become widespread in health and has gained functionality in many areas. Using technology-based interventions, it is possible to minimize the loss of psychosocial functionality and cognitive disability in schizophrenia, in which social cognitive disability is one of the most basic symptom clusters. The aim of this study is to determine the prevalence of technological devices and internet usage in patients with schizophrenia and schizoaffective disorder, to determine the attitude of patients towards technological devices and internet usage and the relation between technology, internet usage with clinical variables such as psychosocial functioning, positive and negative symptoms.MethodsData were collected from the patients who applied to Dokuz Eylül University Medicine Faculty Schizophrenia Outpatient Clinic. Eighty-three schizophrenia patients and 13 schizoaffective disorder patients who meet the schizophrenia and schizoaffective disorder diagnostic criteria of DSM-5 were included in the study. The sociodemographic data registration form was completed. A questionnaire was developed for the purposes of the research to evaluate the use of technology. The level of psychosocial functioning was assessed using the Personal and Social Performance Scale (PSP), and the positive and negative symptom severity was evaluated using the Positive and Negative Syndrome Scale (PANSS).ResultsThe study found that 86% of patients owned mobile phone, 67% of patients used internet access, 67% of patients owned computer. 61% patients were using any kind of mobile application and 47% patients were using social media application. The most prevelant mobile applications among patients were facebook and whatsapp (48%). Younger patiens were using internet more than elders in a day (r=-0,395, p<0,001). Negative syptom scores were statistically lower among patients who were using mobile phones (M= 16,05, t=-2,50, p=0,014), internet connection in mobile phone (M=15,26, t=-2,93, p=0,004), using mobile application (M=15,47, t=-2,93, p=0,008), facebook (M=15,31, t=-2,32, p=0,022), whatsapp (M=14,77, t=-3,40, p=0,001), messenger (M=14,94, t=-2,33, p=0,022), messaging applications (M=14,96, t=-3,36, p=0,001), social media applications (M=15,04, t=-2,78, p=0,006) and who make video conversation (M=15,52, t=-2,21, p=0,029) than patients who were not using. PSP score of patients who were using mobile phone (M=50,62, t=2,34, p=0,021), internet access in mobile phone (M=57, t=3,07, p=0,003), mobile application (M=51,90, t=2,16, p=0,033), facebook (M=53,47, t=2,63, p=0,010), whatsapp (M=54,68, t=2,43, p=0,001), messenger (M=54,69, t=2,62, p=0,010), messaging applications (M=54,24, t=3,50, p=0,001), social media applications (M=54,29, t=3,10, p=0,003), and making video conversation (M=53,05, t=2,74, p=0,007) were statistically higher than the patients who were not using. There is also statistically significant relation between application usage and sub-items of PANSS.DiscussionThis study indicated that younger schizophrenia patients having less negative symptoms and increased psychosocial functionality was likely to use technological devices and mobile applications more. Patients may use applications more if they have been developed to facilitate their daily lives. Mobile applications and social media may affect the daily life activities of patients more intensively. In addition, using mobile applications may help patients to cope with their symptoms and improve psychosocial functioning.

S49. THE RELATION BETWEEN PROCESSING SPEED AND USAGE OF MOBILE APPLICATIONS IN PATIENTS WITH SCHIZOPHRENIA

BackgroundProcessing speed is one of the main areas of cognitive process which takes attention to do research on cognition in schizophrenia. Processing speed is also essential in learning, problem-solving and related to social cognitive functions. Technology use has become widespread in health and has gained functionality in many areas. By technology-based interventions, it might be possible to provide improvements in the psychosocial functioning of the patients with schizophrenia. The aim of this study is to look at the relationship between processing speed and technology use in schizophrenia patients.MethodsData were collected from the patients who applied to Dokuz Eylül University Medicine Faculty Schizophrenia Outpatient Clinic. Forty-one schizophrenia patients and 10 schizoaffective disorder patients who had been diagnosed as Schizophrenia or Schizoaffective Disorder according to DSM-5 diagnostic criteria were included in the study. A questionnaire to evaluate the use of technology of the patients was developed. The level of the psychosocial functioning was assessed using the Personal and Social Performance Scale (PSP), and the positive and negative symptom severity was evaluated using the Positive and Negative Syndrome Scale (PANSS). Stroop Colour and Word Test (SCWT) and Digit Symbol Coding Test (DSC) to rate processing speed have been applied.ResultsMore than half of patients had mobile phone (n=47, 92,2%), computer (n=33, 64,7%), internet connection at home (n=34, 66,7%), internet connection on mobile phone (n=34, 66,7%), mobile application (n=33, 64,7%), social media application (n=26, 51,0%). facebook (n=27, 52,9%), whatsapp (n=28, 54,9%), messaging application (n=31, 60,8%). There is a statistically significant difference as duration of shorter reaction in DSC scores between patients who use (u) internet access on mobile phone (u= 34,35, nu= 24,88, p=0,013), whatsapp (u=35,00, nu=26,57, p=0,025), and messaging application (u=34,52, nu=26,05, p=0,022) compared to patients who are nonusers (nu). Having internet connection on mobile phone (p=0,028) and using whatsapp (p=0,010) showed a statistically significant relationship with neutral stimulus reaction time on SCWT among users compared to nonusers. Also, congruent task is statistically related with using mobile application (p=0,038), whatsapp (p=0,042) and messaging application (p=0,050). The other significant finding is patients who use internet access on mobile phone (u= 94,67 seconds, nu= 120,94 s, p=0,017), messaging applications (u=92,33 s, nu= 120,50 s, p=0,015) and whatsapp (u= 88,85 s, nu=120,91 s, p=0,005) showed statistically significant shorter duration in incongruent task of SCWT compared to patients who are not users.DiscussionPatients who use the internet and messaging applications also had better scores in processing speed. “Being online” or having an opportunity to “be online” may improve processing speed skills or patients having good processing speed ability may easily use mobile phone applications. We found a significant reciprocal relationship between processing speed and using the internet, messaging application and social media applications.

Retinal structural alterations in chronic versus first episode schizophrenia spectrum disorders

Recent studies have found evidence of retinal thinning in schizophrenia spectrum disorder patients; however, it is not known whether retinal thinning is present at the first episode of psychosis or whether it is a result of the progression of the disease or related factors (e.g., emergence of medical comorbidities). We hypothesized that first episode patients (FEP) would not differ on any retinal variables when compared to age matched controls, while chronically ill patients would show evidence of retinal thinning compared to age matched controls. 15 first episode patients, 20 control subjects age-matched to the FEP group, 18 chronically ill patients, and 18 control subjects age-matched to the chronically ill group participated in Spectral Domain OCT scans. We collected data on retinal nerve fiber layer (RNFL) thickness, macula thickness and volume, and ganglion cell-inner plexiform layer (GCL-IPL) thickness as well as cup-to-disc ratio at the optic nerve head. No evidence of retinal structural change was found in the first episode group. In contrast, chronic schizophrenia and schizoaffective disorder patients were characterized by GCL-IPL thinning and overall macula thinning and volume reduction. No evidence of RNFL thinning was observed in the chronic group, however. These data suggest that retinal structure is unaffected very early in the course of schizophrenia spectrum disorders but that thinning is an aspect of illness progression, medical comorbidity, and/or long-term antipsychotic medication use in schizophrenia spectrum disorders. Among retinal indices, macula thickness and volume appear to be the most sensitive to the changes associated with illness chronicity.

Auditory brainstem response (ABR) profiling in schizoaffective disorder.

The aim of the study was to assess whether the auditory brainstem response (ABR) profiling test for schizophrenia (SZ) would recognise schizoaffective disorder (SZA) patients as SZ or not. Male and female SZA patients (n = 16) from the psychosis unit at Uppsala University Hospital were investigated. Coded sets of randomised ABR recordings intermingled with patients with SZ, adult attention-deficit hyperactivity disorder (ADHD) and healthy controls were analysed by an independent party blinded to clinical diagnoses. The ABR profiling test for SZ was positive in 5/16 patients (31%) and negative in 11/16 patients (69%) with SZA. A surprising finding was that 4/16 (25%) SZA patients were positive for the ABR profiling test for ADHD. With the ABR profiling test, a minority of patients with SZA tested positive for SZ. In contrast, a majority (85%) of patients with SZ in a previous study tested positive. These preliminary results leave us ignorant whether SZA should be regarded as a SZ-like disorder or a psychotic mood disorder and add to the questions regarding the validity of this diagnostic entity. However, the ABR profiling method is still in its infancy and its exploration in a range of psychiatric disorders is warranted.

Ambulatory Pharmacotherapy of Five Psychiatric Disorders in Bahrain: a Descriptive Study.

We examined the outpatient prescription pattern of psychotropic drugs used for the treatment of five major psychiatric diseases in Bahrain. Setting outpatient department of the main psychiatric hospital in Bahrain. Methods This was a retrospective, cross-sectional study in which we targeted randomly selected prescriptions (n = 992, 56.1% males, 43.9% females) from 1st of January until 31st of December, 2017. Main outcome measure the types of outpatient psychotropic drugs prescribed by the physicians. Results The pharmacotherapy of schizophrenia consisted of atypical anti-psychotics (92.8%), or typical anti-psychotics (17.8%). The anti-depressants used were: Selective-serotonin reuptake inhibiters (SSRIs) (41.6%), Serotonin-norepinephrine reuptake inhibiters (SNRIs) (34.5%), tricyclic anti-depressants (TCAs) (12.8%), and atypical anti-depressants (10.6%). Combination anti-depressants was employed in (12.4%) of cases. The pharmacotherapy for anxiety disorders was composed of benzodiazepines (59.5%), atypical anti-psychotics (45.2%), SSRIs (40.5%), SNRIs (28.6%), TCAs (14.3%), and anti-convulsants (16.7%) and atypical anti-psychotics (7.1). The medications prescribed for bipolar disorder were atypical anti-psychotics (78.6%), anti-convulsants (66.5%), benzodiazepines (27.7%), typical anti-psychotics (8.9%) and lithium (6.7%). Schizoaffective disorder patients received atypical anti-psychotics (97.3%), anti-convulsants (47.8%), benzodiazepines (27.4%), SNRIs (25.7%), SSRIs (15%), typical anti-psychotics (10.6%), atypical anti-depressants (10.6%) and TCAs (6.2%). A combination of antipsychotics and anti-depressants was employed in 33.6% and 4.7% of all subjects regardless of the diagnosis, respectively. Conclusions With a few exceptions, the pharmacotherapy of psychiatric diseases in Bahrain was in line with the latest recommendations. However, psychotropic polypharmacy was observed and calls for immediate attention.

Identifying commonality and specificity across psychosis sub-groups via classification based on features from dynamic connectivity analysis

It is difficult to distinguish schizophrenia (SZ), schizoaffective disorder (SAD), and bipolar disorder with psychosis (BPP) as their clinical diagnoses rely on symptoms that overlap. In this paper, we investigate if there is biological evidence to support the symptom-based clinical categories by looking across the three disorders using dynamic connectivity measures, and provide meaningful characteristics on which brain functional connectivity measures are commonly or uniquely impaired. Large-sample functional magnetic resonance image (fMRI) datasets from 623 subjects including 238 healthy controls (HCs), 113 SZ patients, 132 SAD patients, and 140 BPP patients were analyzed. First, we computed whole-brain dynamic functional connectivity (DFC) using a sliding-window technique, and then extracted the individual connectivity states by applying our previously proposed decomposition-based DFC analysis method. Next, with the features from the dominant connectivity state, we assessed the clinical categories by performing both four-group (SZ, SAD, BPP and healthy control groups) and pair-wise classification using a support vector machine within cross-validation. Furthermore, we comprehensively summarized the shared and unique connectivity alterations among the disorders. In terms of the classification performance, our method achieved 69% in the four-group classification and >80% in the between-group classifications for the mean overall accuracy; and yielded 66% in the four-group classification and >80% in the between-group classifications for the mean balanced accuracy. Through summarizing the features that were automatically selected in the classifications, we found that among the three symptom-related disorders, their disorder-common impairments primarily included the decreased connectivity strength between thalamus and cerebellum and the increased strength between postcentral gyrus and thalamus. The disorder-unique changes included more various brain regions, mainly in the temporal and frontal gyrus. Our work demonstrates that dynamic functional connectivity provides biological evidence that both common and unique impairments exist in psychosis sub-groups.

Genome-wide association study on antipsychotic-induced weight gain in Europeans and African-Americans

BackgroundAntipsychotic (AP) medications are the first line of treatment for schizophrenia. However, most conferr a risk of antipsychotic-induced weight gain (AIWG). The objective of this investigation was to conduct a genome-wide association study (GWAS) of AIWG, followed by comprehensive, post-GWAS approaches. MethodsWe investigated n = 201 schizophrenia or schizoaffective disorder patients of European and African American ancestry who were treated primarily with clozapine or olanzapine. We conducted a genome-wide association analysis for AIWG, defined primarily as a percentage of weight change from baseline. ResultsWhen examining Europeans (n = 147), we noticed an association between rs62097526 (β = 0.39, p = 3.59 × 10−6, CADD = 2.213) variant, located downstream of the CIDEA gene, which is considered a risk factor for AIWG. In the entire sample, we observed a significant association between rs1525085 (β = 0.411, p = 3.15 × 10−9) variant of the DGKB gene and AIWG. The association was nominally significant in Europeans (β = 0.271, p = 0.002) and African Americans (β = 0.579, p = 5.73 × 10−5) with the same risk allele. Our top genes (p < 5 × 10−5) were enriched in the GWAS catalog for the risk of obesity and interacted with the known risk factors for obesity (G6PD) and diabetes (IRS1). In addition, these genes are targeted by miRNAs related to schizophrenia (mir-34a) and obesity (mir-19b). However, our polygenic risk score analyses did not provide support for major genetic overlap between obesity and the risk of AIWG. ConclusionsIn summary, we propose that the CIDEA and DGKB genes are risk factors for AIWG in transethnic populations. Additionally, our evidence suggests that the G6PD and IRS1 gene-related pathways might be involved in AIWG.

Clinical-catamnestic and medical-social characteristics of periodic endogenous psychoses as a result of pathopersonological transformations (a comparative analysis)

Differential diagnosis of endogenous psychoses with episodic course is an extremely relevant issue of modern psychiatry due to the pathomorphosis of mental illnesses and subclinical persistence of clinical markers after the first episodes of the disease. Correct and timely diagnosis of these conditions determines the adequacy of therapeutic and socio-rehabilitation influences not only during disease exacerbations, but also in the period between bouts of psychosis in order to preserve the social adaptation of patients. The purpose of this study was to perform a comparative analysis of the clinical-catamnestic and medico-social characteristics of remission in patients with schizophrenia, schizoaffective disorder (SAD) and affective disorders (AD). Contingents and methods. A total of 221 patients were examined on the basis of the Regional Clinical Psychiatric Hospital ( Zaporizhzhіa ), 49 of whom were with AD (31 patients with a diagnosis of “bipolar affective disorder” and 18 with a diagnosis of “recurrent depressive disorder”), 76 patients were diagnosed with “schizoaffective disorder” and 96 patients were diagnosed with “paranoid schizophrenia, episodic course” having a pronounced affective component in the structure of psychotic episodes. An obligatory criterion for inclusion was the state of clinical remission with psychotic symptoms reduction. The main methods of the study were clinical-catamnestic and clinical-psychopathological as well as medical statistical analysis. Results. In patients with episodic course of endogenous psychosis, there is a persistent decline in the social adaptation level of varying degrees, the severity and manifestations of which differ depending on nosological form. Schizophrenia and SAD are characterized by a more pronounced negative impact on the level of labor adaptation than AR. This is confirmed by a large percentage of unemployed individuals (P < 0.01), a lower percentage of persons working in positions related to skilled and mental work (P < 0.01). SAD patients more often (P < 0.01) receive treatment courses in a hospital than patients with other periodic endogenous psychoses. Social factors are more likely (P < 0.01) cause repeated hospitalizations in SAD than in AD and episodic schizophrenia (26.7 %, 5.8 % and 12.5 %, respectively). Conclusions. A high level of rehospitalization for social reasons in SAD demonstrates persistent pathopersonological transformations and the lack of efficacy of therapeutic and rehabilitation measures used in SAD during a remission period. Persistent pathopersonological transformations, occurring in endogenous psychoses, require a comprehensive study and a system of congruent therapeutic and rehabilitation measures in order to prevent social disadaptation.

The continuing story of schizophrenia and schizoaffective disorder: One condition or two?

Although schizophrenia and schizoaffective disorder remain separable in diagnostic systems, the validity of the distinction is uncertain. This study asked whether schizophrenia and schizoaffective disorder are distinguishable on selected cognitive, social cognitive and structural social brain measures. Outpatients with a diagnosis of schizophrenia (n = 44) or schizoaffective disorder (n = 29) and non-psychiatric control participants (n = 62) were studied. Patients were assessed clinically (Positive and Negative Syndrome Scale) and all participants were administered a battery of cognitive (MATRICS Consensus Cognitive Battery; Wechsler Abbreviated Scale of Intelligence, Wide Range Achievement Reading) and social cognitive (Reading the Mind in the Eyes, Mayer-Salovey-Caruso Emotional Intelligence Test; MSCEIT) tasks. In addition, participants underwent structural magnetic resonance imaging (MRI) to yield cortical thickness data for 42 regions associated with the social brain network. Results showed no significant differences between patient groups on 17/18 cognitive/social cognitive and social brain cortical thickness measures. In contrast, schizophrenia and schizoaffective disorder patients differed from controls on 16/18 and 11/18 measures respectively. Schizoaffective disorder patients outperformed schizophrenia patients on an emotion regulation task (MSCEIT). Schizophrenia and schizoaffective disorder are largely indistinguishable on key cognitive, social cognitive and neural measures. The continuing separation of these syndromes in diagnostic systems and disease models requires is questionable and requires further attention.