Schizophrenia In Population Research Articles

Genome-wide association study of antipsychotic-induced sinus bradycardia in Chinese schizophrenia patients

Second-generation antipsychotics (SGAs) play a critical role in current treatment of schizophrenia (SCZ). It has been observed that sinus bradycardia, rare but in certain situations life threatening adverse drug reaction, can be induced by SGAs across different schizophrenia populations. However, the roles of genetic factors in this phenomenon have not been studied yet. In the present study, a genome-wide association study of single nucleotide polymorphisms (SNPs) was performed on Chinese Han SCZ patients to identify susceptibility loci that were associated with sinus bradycardia induced by SGAs. This study applied microarray to obtain genotype profiles of 88 Han Chinese SCZ patients. Our results found that there were no SNPs had genome-wide significant association with sinus bradycardia induced by SGAs. The top GWAS hit located in gene KIAA0247, which mainly regulated by the tumor suppressor P53 and thus plays a role in carcinogenesis based on resent research and it should not be a susceptibility locus to sinus bradycardia induced by SGAs. Using gene-set functional analysis, we tested that if top 500 SNPs mapped genes were relevant to sinus bradycardia. The result of gene prioritization analysis showed CTNNA3 was strongly correlated with sinus bradycardia, hinting it was a susceptibility gene of this ADR. Our study provides a preliminary study of genetic variants associated with sinus bradycardia induced by SGAs in Han Chinese SCZ patients. The discovery of a possible susceptibility gene shed light on further study of this adverse drug reaction in Han Chinese SCZ patients.

Psychiatric Nurses' Perceptions of Therapeutic Alliance With Individuals With Schizophrenia: A Survey Study.

Research on nurse-patient relationships with the schizophrenia population is sparse. The current study piloted a survey to explore therapeutic relationships. Fifty-one psychiatric nurses completed an online survey on therapeutic relationships with the schizophrenia population. Factor and chi-square analysis yielded preliminary findings. Fifteen of 16 survey items loaded onto four factors at ≥0.4. A significant association between level of education and professional certification and comfort working with patients with schizophrenia was found. Survey modifications and a larger sample size may generate useful information and clarify the relationship among education, certification, and comfort. [Journal of Psychosocial Nursing and Mental Health Services, 59(4), 21-29.].

Exploring the Relationship Between Movement Disorders and Physical Activity in Patients With Schizophrenia: An Actigraphy Study

Low physical activity (PA) and sedentary behavior (SB) are major contributors to mental health burden and increased somatic comorbidity and mortality in people with schizophrenia and related psychoses. Movement disorders are highly prevalent in schizophrenia populations and are related to impaired functioning and poor clinical outcome. However, the relationship between movement disorders and PA and SB has remained largely unexplored. Therefore, we aimed to examine the relationship between movement disorders (akathisia, dyskinesia, dystonia, and parkinsonism) and PA and SB in 216 patients with schizophrenia and related psychoses. Actigraphy, the St. Hans Rating Scale for extrapyramidal syndromes, and psychopathological ratings (PANSS-r) were applied. Data were analyzed using multiple linear regression, adjusting for sex, age, negative symptoms, and defined daily dose of prescribed antipsychotics. Parkinsonism was significantly associated with decreased PA (β = −0.21, P < .01) and increased SB (β = 0.26, P < .001). For dystonia, only the relationship with SB was significant (β = 0.15, P < .05). Akathisia was associated with more PA (β = 0.14, P < .05) and less SB (β = −0.15, P < .05). For dyskinesia, the relationships were non-significant. In a prediction model, akathisia, dystonia, parkinsonism and age significantly predicted PA (F(5,209) = 16.6, P < .001, R2Adjusted = 0.27) and SB (F(4,210) = 13.4, P < .001, R2Adjusted = 0.19). These findings suggest that movement disorders, in particular parkinsonism, are associated with reduced PA and increased SB in patients with psychotic disorders. Future studies should take movement disorders into account when examining PA and SB, to establish the clinical value of movement disorders in activating people with psychotic disorders to improve their mental and somatic health.

Digit ratio as an endophenotype in a schizophrenia population.

BackgroundSchizophrenia is a debilitating mental health condition affecting the lives of many South Africans. The origins of the heterogeneity in the presentation of the illness remain uncertain.AimThis cross-sectional study performed a retrospective data analysis to determine the usefulness of digit ratio as an endophenotype in a South African schizophrenia population.SettingA large genetic study in a South African schizophrenia population recruited patients from services in the Western and Eastern Cape.MethodsComplete clinical histories were captured for participants, including sets of images of the face and extremities. Software was utilised to measure the lengths of participants’ digits from said images and digit ratios (2D:4D) were calculated. Descriptive analyses were performed on the ratios and statistical differences in digit ratio means were calculated between groups characterised by sex, age of onset and the presence vs absence of positive symptoms. Linear modelling was utilised to assess for correlates between 2D:4D and positive and negative symptom severity using scores obtained from the Positive and Negative Syndrome Scale (PANSS) and Scale for the Assessment of Negative Symptoms (SANS).Results2D:4D in male participants did not significantly differ from female participants as in healthy populations. 2D:4D did not significantly correlate with the severity of positive or negative symptoms and 2D:4D means between groups did not significantly relate to age of onset.Conclusion2D:4D appears to be a possible endophenotype in schizophrenia in this population. 2D:4D, however, may not be as readily identifiable as certain minor physical anomalies and neurological soft signs significantly associated with schizophrenia in this population.

Genome-wide analyses of smoking behaviors in schizophrenia: Findings from the Psychiatric Genomics Consortium

While 17% of US adults use tobacco regularly, smoking rates among persons with schizophrenia are upwards of 60%. Research supports a shared etiological basis for smoking and schizophrenia, including findings from genome-wide association studies (GWAS). However, few studies have directly tested whether the same or distinct genetic variants also influence smoking behavior among schizophrenia cases. Using data from the Psychiatric Genomics Consortium (PGC) study of schizophrenia (35476 cases, 46839 controls), we estimated genetic correlations between these traits and tested whether polygenic risk scores (PRS) constructed from the results of smoking behaviors GWAS were associated with schizophrenia risk or smoking behaviors among schizophrenia cases. Results indicated significant genetic correlations of schizophrenia with smoking initiation (rg = 0.159; P = 5.05 × 10−10), cigarettes-smoked-per-day (rg = 0.094; P = 0.006), and age-of-onset of smoking (rg = 0.10; P = 0.009). Comparing smoking behaviors among schizophrenia cases to the general population, we observe positive genetic correlations for smoking initiation (rg = 0.624, P = 0.002) and cigarettes-smoked-per-day (rg = 0.689, P = 0.120). Similarly, TAG-based PRS for smoking initiation and cigarettes-smoked-per-day were significantly associated with smoking initiation (P = 3.49 × 10−5) and cigarettes-smoked-per-day (P = 0.007) among schizophrenia cases. We performed the first GWAS of smoking behavior among schizophrenia cases and identified a novel association with cigarettes-smoked-per-day upstream of the TMEM106B gene on chromosome 7p21.3 (rs148253479, P = 3.18 × 10−8, n = 3520). Results provide evidence of a partially shared genetic basis for schizophrenia and smoking behaviors. Additionally, genetic risk factors for smoking behaviors were largely shared across schizophrenia and non-schizophrenia populations. Future research should address mechanisms underlying these associations to aid both schizophrenia and smoking treatment and prevention efforts.

Genome sequencing broadens the range of contributing variants with clinical implications in schizophrenia

The range of genetic variation with potential clinical implications in schizophrenia, beyond rare copy number variants (CNVs), remains uncertain. We therefore analyzed genome sequencing data for 259 unrelated adults with schizophrenia from a well-characterized community-based cohort previously examined with chromosomal microarray for CNVs (none with 22q11.2 deletions). We analyzed these genomes for rare high-impact variants considered causal for neurodevelopmental disorders, including single-nucleotide variants (SNVs) and small insertions/deletions (indels), for potential clinical relevance based on findings for neurodevelopmental disorders. Also, we investigated a novel variant type, tandem repeat expansions (TREs), in 45 loci known to be associated with monogenic neurological diseases. We found several of these variants in this schizophrenia population suggesting that these variants have a wider clinical spectrum than previously thought. In addition to known pathogenic CNVs, we identified 11 (4.3%) individuals with clinically relevant SNVs/indels in genes converging on schizophrenia-relevant pathways. Clinical yield was significantly enriched in females and in those with broadly defined learning/intellectual disabilities. Genome analyses also identified variants with potential clinical implications, including TREs (one in DMPK; two in ATXN8OS) and ultra-rare loss-of-function SNVs in ZMYM2 (a novel candidate gene for schizophrenia). Of the 233 individuals with no pathogenic CNVs, we identified rare high-impact variants (i.e., clinically relevant or with potential clinical implications) for 14 individuals (6.0%); some had multiple rare high-impact variants. Mean schizophrenia polygenic risk score was similar between individuals with and without clinically relevant rare genetic variation; common variants were not sufficient for clinical application. These findings broaden the individual and global picture of clinically relevant genetic risk in schizophrenia, and suggest the potential translational value of genome sequencing as a single genetic technology for schizophrenia.

The Prevalence of Constipation and Its Risk Factors in Patients with Schizophrenia

Objective: Constipation is a common symptom in schizophrenia population. Patients treated with antipsychotic drugs are more likely to have constipation. In this study, we intended to identify possible associations and risk factors between schizophrenia patients and constipation. Methods: Patients with schizophrenia (n = 240) were recruited. In this cross-sectional study, we collected information of their socio-demographic and clinical details. Their psychotic symptoms were evaluated using clinical interview with positive and negative syndrome scale (PANSS). Results: In this study, the prevalence of constipation was 59.8%. Odds ratio (OR) (95% confidence interval [CI]) of PANSS average score, 1.018 (1.003–1.034), p < 0.05); OR (95% CI) of using second-generation antipsychotics (SGAs) solely, 3.475 (1.201–10.056), p < 0.05); and OR (95% CI) of using anticholinergic drugs, 1.853 (1.024–3.353), p < 0.05) were significantly associated with constipation. Conclusion: The prevalence of constipation is extremely high in this sample. In those patients who had severe psychotic symptoms, prescription of SGAs or anticholinergic agents, the focus should be on early detection, monitoring the constipation side effect, and early intervention.

A Novel Variant in Dopamine Receptor Type 2 Gene is Associated with Schizophrenia

Being the primary target of antipsychotic therapy, dopamine receptor type 2 (DRD2) remains a point of interest in schizophrenia pathology. Polymorphisms in DRD2 have been shown to alter patients' response to antipsychotics. DRD2 SNP rs6275 (C>T) have found to be associated with schizophrenia in different populations; however, data remains inconsistent. Keeping in view the genetic diversity the present study was aimed to explore association of rs6275 with schizophrenia in population from Pakistan. Using Diagnostic and statistical Manual 5 (DSM 5) criteria, 100 schizophrenia cases and 100 controls (individuals without any psychiatric illness) were enrolled in the study. Severity of illness was determined using PANSS score. Genotyping was done via Sanger sequencing. MEGA-X was used to align the sequences, Expasy translate tool was used to translate nucleotide sequences. Difference in genotype and allele frequencies between cases and controls was determined using χ2 test. No significant difference in genotype or allele frequencies of rs6275 (p >0.0.5) was found between cases and controls. Interestingly, a novel SNP (C>A, Pro297Thr) was spotted during electropherogram analysis at position chr11:113412805. Significant difference was found in genotype and allele frequency of this novel SNP among schizophrenia cases and controls (p=0.003). No association of rs6275 was observed with schizophrenia in Pakistani population. However, the study found significant association of a novel missense SNP of DRD2 at chr11:113412805 (C>T) with schizophrenia in Pakistani population. A large-scale multicenter study will be required to confirm the association of this novel SNP with schizophrenia.

Genetic polymorphisms of PIP5K2A and course of schizophrenia

BackgroundSchizophrenia is a severe highly heritable mental disorder. The clinical heterogeneity of schizophrenia is expressed in the difference in the leading symptoms and course of the disease. Identifying the genetic variants that affect clinical heterogeneity may ultimately reveal the genetic basis of the features of schizophrenia and suggest novel treatment targets. PIP5K2A (Phosphatidylinositol-4-Phosphate 5-Kinase Type II Alpha) has been investigated as a potential susceptibility gene for schizophrenia.MethodsIn this work, we studied the possible association between eleven polymorphic variants of PIP5K2A and the clinical features of schizophrenia in a population of 384 white Siberian patients with schizophrenia. Genotyping was carried out on QuantStudio 5 Real-Time PCR System with a TaqMan Validate SNP Genotyping Assay (Applied Biosystems, USA).ResultsPIP5K2A rs8341 (χ2 = 6.559, p = 0.038) and rs946961 (χ2 = 5.976, p = 0.049) showed significant association with course of schizophrenia (continuous or episodic). The rs8341*CT (OR = 1.63, 95% CI: 1.04–2.54) and rs946961*CC (OR = 5.17, 95% CI: 1.20–22.21) genotypes were associated with a continuous type of course, while the rs8341*TT genotype (OR = 0.53, 95% CI: 0.29–0.97) was associated with an episodic type of course of schizophrenia. Therefore rs8341*TT genotype presumably has protective effect against the more severe continuous course of schizophrenia compared to the episodic one.ConclusionsOur experimental data confirm that PIP5K2A is a genetic factor influencing the type of course of schizophrenia in Siberian population. Disturbances in the phosphatidylinositol pathways may be a possible reason for the transition to a more severe continuous course of schizophrenia.

The American Psychiatric Association Practice Guideline for the Treatment of Patients With Schizophrenia.

(Reprinted with permission from The American Journal of Psychiatry 2020; 177:868-872).

Diabetes in late-life schizophrenia: Prevalence, factors, and association with clinical symptoms

ObjectiveThe prevalence of diabetes mellitus has been found to be higher in patients with schizophrenia. Older patients are the fastest-growing segment of the schizophrenia population. However, few studies have explored diabetes in older patients with schizophrenia. Therefore, this study aimed to determine the prevalence and characteristics of factors associated with diabetes in Chinese patients with late-life schizophrenia (LLS), which has not been reported in previous studies. MethodsA total of 289 inpatients aged 60 or above who met the DSM-IV criteria for schizophrenia were recruited. The severity of psychopathology was assessed by the Positive and Negative Syndrome Scale (PANSS). Diabetes was diagnosed by fasting blood glucose tests, or oral glucose tolerance tests. ResultsThe overall prevalence of diabetes in LLS patients was 25.3%. The prevalence of diabetes in female patients was significantly higher than that in male patients (35% vs. 21.53%). Other factors associated with diabetes included higher BMI, greater waistline (only for males), higher levels of triglyceride, and more severe positive symptoms. ConclusionThese results indicate that the prevalence of diabetes in LLS patients is similar to that in the age-matched general population. Female gender, excess weight and abdominal obesity, dyslipidemia, and clinical symptoms can be potential risk factors of diabetes in the LLS patient group.

Perbandingan Skor Positive and Negative Syndrome Scale Antara Skizofrenia Awitan Remaja dan Awitan Dewasa

Pendahuluan: Skizofrenia awitan remaja meliputi sebagian kecil dari populasi pasien skizofrenia, namun memiliki derajat keparahan gejala yang lebih berat sehingga mempengaruhi kualitas hidup penderitanya. Salah satu instrumen yang dapat mengukur keparahan gejala skizofrenia adalah Positive and Negative Syndrome Scale (PANSS). Penelitian ini bertujuan untuk mengetahui karakteristik demografi dan membandingkan skor PANSS antara pasien skizofrenia awitan remaja dan awitan dewasa. Metode: Penelitian ini merupakan penelitian deskriptif dengan rancangan potong lintang yang dilakukan pada November 2019–Februari 2020. Penelitian ini menggunakan data sekunder dari rekam medik pasien skizofrenia yang dirawat di Rumah Sakit Umum Pendidikan Dr. Hasan Sadikin tahun 2018 dengan metode total sampling dan menggunakan uji statistik Mann-Whitney U test.Hasil: Karakteristik demografi pasien skizofrenia awitan remaja mayoritas adalah laki-laki, berpendidikan sekolah menengah, tidak bekerja, dan belum menikah. Tidak ditemukan perbedaan antara skizofrenia awitan remaja dan awitan dewasa pada skala positif, skala negatif, skala psikopatologi umum, dan total skor PANSS. Namun demikian, ditemukan skizofrenia awitan remaja lebih besar daripada awitan dewasa dalam skor “isi pikiran yang tidak biasa” dalam PANSS skala psikopatologi umum (p=0,01).Kesimpulan: Tidak ada perbedaan Skor PANSS antara skizofrenia awitan remaja dan awitan dewasa. Namun demikian, ditemukan “isi pikiran yang tidak biasa” pada skala psikopatologi umum lebih berat pada skizofrenia awitan remaja.

The American Psychiatric Association Practice Guideline for the Treatment of Patients With Schizophrenia

The American Psychiatric Association Practice Guideline for the Treatment of Patients With Schizophrenia

Association of HLA-A, -B, -C, -DRB1 and -DQB1 alleles at amino acid level in individuals with schizophrenia: A study from South India.

Schizophrenia, a chronic severe psychiatric illness of unknown aetiology, has been shown to be associated with HLA alleles but at varied degree in different population. The present study has focussed on analysing the frequency of HLA class I and class II alleles in persons with schizophrenia from South India. Ninety seven individuals with schizophrenia and 103 age- and gender-matched controls were typed for HLA- A, B, C, DRB1 and DQB1 loci by next-generation sequencing in Illumina MiniSeq using MIA FORA NGS FLEX HLA typing kit. The results showed that HLA-A*01:01:01, B*37:01:01 and C*01:02:01 were positively associated with schizophrenia while HLA-B*35:03:01 and DRB1*04:03:01 were negatively associated. Gender-specific associations revealed that DRB1*10:01:01 and DQB1*05:01:01 were positively associated while DQB1*03:02:01 was negatively associated with female subjects with schizophrenia. A*24:02:01~B*37:01:01~C*06:02:01~DRB1*10:01:01~DQB1*05:01:01 is the predominant haplotype in schizophrenia population when compared to healthy controls. Amino acid association in susceptible and protective alleles has shown that the presence of peptide in the peptide-binding groves of mature HLA-A protein (K, M, V, R and V at 44th, 67th, 150th, 156th and 158th position), HLA-B protein (D and S at 77th and 99th position) and HLA-C protein (M at 99th position) confer susceptibility to the disease, only in the absence of E (Glutamic acid) at 74th position in mature HLA-DRB1 protein. Interaction of amino acids in protective alleles namely B*35:01:01 and DRB1*04:03:01 has revealed that aspartic acid at 114th (D) position in mature HLA-B protein and glutamic acid (E) at 74th position of mature HLA-DRB1 protein have a combined effect in protecting against the disease. The study has revealed the HLA association with schizophrenia in south Indian population. The amino acid interaction with the disease needs to be confirmed in a larger population.

Schizophrenia and cancer.

The cancer mortality rate in persons with schizophrenia is higher than it is in the general population. The purpose of this review is to determine why, and to identify solutions. The recent literature points to three groups of reasons why mortality is high: patient reasons such as nonadherence to treatment, provider reasons such as diagnostic overshadowing, and health system reasons such as a relative lack of collaboration between medicine and psychiatry. Strategies for cancer prevention, early detection, and effective treatment are available but difficult to put into practice because of significant barriers to change, namely poverty, cognitive and volitional deficits, heightened stress, stigma, and side effects of antipsychotic medication. The literature makes recommendations about surmounting these barriers and also offers suggestions with respect to support and palliative care in advanced stages of cancer. Importantly, it offers examples of effective collaboration between mental health and cancer care specialists. The high mortality rate from cancer in the schizophrenia population is a matter of urgent concern. Although reasons are identifiable, solutions remain difficult to implement. As we work toward solutions, quality palliative care at the end of life is required for patients with severe mental illness. VIDEO ABSTRACT.

Cortical abnormalities and identification for first-episode schizophrenia via high-resolution magnetic resonance imaging

Evidence from neuroimaging has implicated abnormal cerebral cortical patterns in schizophrenia. Application of machine learning techniques is required for identifying structural signature reflecting neurobiological substrates of schizophrenia at the individual level. We aimed to develop a method to identify patients with schizophrenia from healthy individuals via the features of cerebral cortex using high-resolution magnetic resonance imaging (MRI). In this study, cortical features were measured, including volumetric (cortical thickness, surface area, and gray matter volume) and geometric (mean curvature, metric distortion, and sulcal depth) features. Patients with first-episode schizophrenia (n = 52, ranging 17–45 years old) and healthy controls (n = 66, ranging 18–46 years old) were included from the Department of Psychiatry at Xijing Hospital. Multivariate computation was used to examine the abnormalities of cortical features in schizophrenia. Features were selected by least absolute shrinkage and selection operator (LASSO) method. The diagnostic capacity of multi-dimensional neuroanatomical patterns-based classification was evaluated based on receiver operating characteristic (ROC) analysis. Mean curvature (left insula and left inferior frontal gyrus), cortical thickness (left fusiform gyrus), and metric distortion (left cuneus and right superior temporal gyrus) revealed both group differences and diagnostic capacity. Area under ROC curve was 0.88, and the sensitivity, specificity, and accuracy were 94 %, 82 %, and 88 %, respectively. Confirming these findings, similar results were observed in the independent validation (sensitivity of 91 %, specificity of 78 %, and accuracy of 85 %). There was a positive association between index score derived from the multi-dimensional patterns and the severity of symptoms (r = 0.33, P < .05) for patients. Our findings demonstrate a view of cortical differences with capacity to discriminate between patients with schizophrenia and healthy population. Structural neuroimaging-based measurements hold great promise of paving the road for their clinical utility in schizophrenia.

Schizophrenia phenomenology revisited: positive and negative symptoms are strongly related reflective manifestations of an underlying single trait indicating overall severity of schizophrenia.

To examine whether negative symptoms, psychosis, hostility, excitation, and mannerism (PHEM symptoms), formal thought disorders (FTD) and psychomotor retardation (PMR) are interrelated phenomena in major neurocognitive psychosis (MNP) or deficit schizophrenia and whether those domains belong to an underlying latent vector reflecting general psychopathology. In this study, we recruited 120 patients with MNP or deficit schizophrenia and 54 healthy subjects and measured the above-mentioned symptom domains. In MNP, there were significant associations between negative and PHEM symptoms, FTD and PMR. A single latent trait, which is essentially unidimensional, underlies these key domains of schizophrenia and MNP and additionally shows excellent internal consistency reliability, convergent validity, and predictive relevance. Confirmatory Tedrad Analysis indicates that this latent vector fits a reflective model. The lack of discriminant validity shows that positive (and PHEM or psychotic) and negative symptoms greatly overlap and probably measure the same latent construct. Soft independent modeling of class analogy (SIMCA) shows that MNP (diagnosis based on negative symptoms) is better modeled using PHEM symptoms, FTD, and PMR than negative symptoms. In stable phase MNP, which is a restricted sample of the schizophrenia population, negative and PHEM symptoms, FTD and PMR belong to one underlying latent vector reflecting overall severity of schizophrenia (OSOS). The bi-dimensional concept of "positive" and "negative" symptoms cannot be validated and, therefore, future research in stable phase schizophrenia should consider that the latent phenomenon OSOS as well as its reflective manifestations are the key factors of schizophrenia phenomenology.

M152. IS MEDICAL SERVICES UTILISATION A MODERATING FACTOR OF EARLY EXCESS MORTALITY IN PATIENTS WITH SCHIZOPHRENIA

BackgroundUnlike the general population, patients with schizophrenia have an excess of chronic physical morbidities such as diabetes, cardiovascular and respiratory disorders. In addition, they do no gain from primary and secondary medical services due to gaps in the accessibility and quality of those services. The result is a shorter life expectancy of about 20 years mostly due to preventable physical illnesses, of otherwise people with an exclusive brain disorder.In this study, we aimed to explore how does utilization of medical services moderate the association between physical morbidity and early mortality in schizophrenia patientsMethodsA retrospective cohort study derived from Clalit Health Services electronic database (the largest health provider in Israel, covers 53% of the national population). A three years follow-up (2012–2014) of 24,679 individuals with a diagnosis of schizophrenia (ICD 10 Code: F.20) and control general population (N=2,295,579), up to 75 years old age.ResultsSchizophrenia was associated with HR 3.52 (95% CI 3.35–3.72) for mortality, adjusted for age, sex and socioeconomic status. Patients’ mortality rate was 5.6% with about half dying from physical illnesses (cardiovascular, neoplasms, respiratory, and digestive disorders). Metabolic syndrome parameters were more prevalent in the schizophrenia population, with the exception of hypertension. While the adjusted Odd Ratio (OR) for primary physician (GP) contact was 0.42 for schizophrenia patients, the OR for hospitalization was 1.25 with more than double mean length of hospitalization. A higher number of contacts with GP or specialists was associated with lower mortality in patients with metabolic disturbancesDiscussionPatients with schizophrenia tend to die earlier, mostly from preventable physical illnesses also in Israel. Utilizing primary and secondary medical services was associated with better survival rates when having metabolic dysregulation. The main health policy implication of the study results is a call to establish a national system to detect and manage physical morbidity by increasing the accessibility of primary and secondary medical services for this high-risk population

S155. DIETARY PATTERNS AND OBESITY IN INDIVIDUALS WITH SCHIZOPHRENIA

BackgroundIt is well established that individuals with schizophrenia, compared to the general population, have reduced lifespan of up to 20–25 years. High mortality rates in schizophrenia is mainly attributed to physical illnesses which include cardiovascular diseases and diabetes. Obesity is a major risk factor for these diseases and is highly prevalent in the schizophrenia population. Although the mechanisms underlying weight gain in schizophrenia is unclear, it is generally accepted that the high obesity rate is a result of various factors which include metabolic effects of antipsychotic treatment, inadequate physical activity and unhealthy diets. This study aimed to (i) examine dietary practices of individuals with schizophrenia in comparison to the general population and (ii) to examine dietary practice correlates with Body Mass Index (BMI) classification of overweight/obese.MethodsA sample of 107 community-dwelling individuals with schizophrenia were enrolled in this cross-sectional study. Height and weight were taken, and BMI was calculated. A 24-hour food recall which allows derivation of nutritional information, and the Dietary Practices Questionnaire (DPQ) which examines dietary habits, were administered based on participants’ usual diet. Dietary information was compared against the general Singapore population based on the National Nutrition Survey 2010 and the National Health Survey 2010. Logistic regression was performed to study the relationship between dietary practice and BMI status; the model was adjusted for age, gender, antipsychotic medication and energy intake.ResultsNutritional information reported by participants showed that the total daily energy (1895.3kcal ± 684), macronutrient intake (protein: 68.6g ± 35, carbohydrate: 251.8g ± 104.8 and total fat: 67.5g ± 31.8) and dietary fibre intake (16.1g ± 9.0) was lower than both the recommended Singapore guidelines and intake of the general population. In terms of dietary habits, participants were often eating out and frequented fast food places as much as the general population, and do not usually skip breakfast. The proportion of participants who do not consume sweet desserts (32.7% vs 14.9%) and deep-fried food (21.5% vs 9.6%) were higher than the general population, however the proportion of individuals reporting no intake of sweetened drinks was higher in the latter (20.6% vs 54.6%). The proportion of overweight/obese participants (Male: 70%, Female: 66%) was about twice that of the general population (Male:46.6%, Female: 33.8%). Based on the dietary habits explored, participants who did not consume deep-fried food were less likely to be overweight/obese compared to those who do (OR: 0.3, 95% CI:0.09–0.82, p=0.02).DiscussionDespite potential inaccuracies due to recall or social desirability bias, the results seem to suggest that individuals with schizophrenia were below the recommended energy intake; their nutritional intake and dietary habits were either similar or lower/poorer than the recommended guidelines or the general population. Consumption of deep-fried food was the only dietary habit identified as a potential factor towards overweight/obesity. Despite this, the rate of overweight/obese individuals with schizophrenia were high. As overweight/obesity is the result of imbalance between energy intake and expenditure, future research should explore other lifestyle factors such as physical activity, in addition to dietary practices.

M122. DEPRESSION IN SCHIZOPHRENIA SPECTRUM DISORDERS: LONGITUDINAL COURSE AND THE RELATIONSHIP WITH OTHER CLINICAL PARAMETERS AND QUALITY OF LIFE

BackgroundThe relationship between schizophrenia and depression is complex. Longitudinal studies on the course of depression in first episode schizophrenia populations are scarce and there are conflicting results on the predictive value of some baseline measures.MethodsWe conducted an open label longitudinal cohort study which included 126 patients with first-episode schizophrenia spectrum disorders treated with long-acting antipsychotic medication over 24 months. Depression was assessed at three monthly intervals using the Calgary Depression Scale for Schizophrenia. Changes in depression over time were assessed using the linear mixed-effect models for continuous repeated measures. The relationship between depression and other clinical parameters was assessed with regression models.ResultsDepressive symptoms were most prominent at baseline and showed highly significant reductions in the first three months (p<0.0001). Majority of the patients with depression improved with antipsychotic medication alone and we found associations between depressive symptoms with insight and poorer quality of life, however only illness awareness (p=0.0035) was the only significant predictor on depression in our regression analysis. There were a few differences between patients who experienced depression during the acute phase of treatment and those in the post-acute phase.DiscussionOur findings suggest that depression in schizophrenia is common and generally responds well to treatment. The relationship between depression and insight has implications for further treatment considerations