Schizophrenic Patients In Remission Research Articles

Analysis of Factors Influencing Telemedicine-Based Psychiatric Extended Care and Care of Psychiatric Patients.

The aim of this paper is to understand the current situation of the care burden of patients with mental illness in remission and the factors affecting it in order to provide a scientific basis for targeted interventions. This paper reviews the concept of telemedicine, the application of telemedicine in home hospice care, and the remaining problems and improvement strategies of telemedicine in home hospice care, with the aim of providing a reference for the application of telemedicine in home hospice care in China. The Zarit Burden Scale, Family Care Scale, and Social Functioning Scale were used to conduct one-to-one interviews with 201 schizophrenic patients in remission and their primary caregivers in Hubei Province. Among them, 66, 72, and 25 cases (32.8%, 35.9%, and 12.4%) had mild, moderate, and severe burdens, respectively. Caregivers' family care and patients' social functioning were generally poor. The results of multiple linear regression analysis showed that caregiver age, caregiver education, caregiver family care, patient medical costs, and patient social functioning were factors influencing the burden of care for patients with schizophrenia in remission (P < 0.05). The government, mental health centers, and families should understand the level of caregiving burden of patients with schizophrenia in remission and the factors influencing it and provide targeted measures to reduce the caregiving burden.

Interaction of symptoms and cognitive dysfunction in remitted schizophrenic patients with and without residua – important sign of heterogeneity for design of cognitive enhancer studies

IntroductionIt is well-known fact that cognitive dysfunction (CD) determines the quality of remission in patients with schizophrenia. However many attempts to demonstrate the link between symptoms and CD failed. The reason for this fact is unclear.ObjectivesHeterogeneity on basis of the important sign jeopardizes the signal detection.AimsAssessment of interaction between clinical symptoms and CD in schizophrenic patients in remission with and without residual psychotic symptoms (RPS).MethodsAdult schizophrenic patients in remission with and without RPS (DSM 295.30) on stable treatment not less than 6 months were assessed with PANSS, CGI, BACS. The indices of the testing were compared between groups. The correlation analysis was performed. The correlation was considered significant if R &gt; 0.60.ResultsTen females and 34 males were divided into two groups according to presence (27 patients) or absence (17 patients) of RPS (PANSS items P1 and P3 &gt; 2 but &lt; 5). The severity of symptoms and CD were equal in both groups, excluding P6 (P = 0.0005), P20 (P = 0.007), P23 (P = 0.0004), and positive subscale PANSS (P = 0.00001). In the group without RPS, we found that CGI score, scores of 10 items of PANSS, scores of PANSS subscales, excluding negative subscale, and total PANSS score highly negatively correlated with total BACS score (average R = –0.70 ± 10). In the group of patients with RPS, no correlations were found.ConclusionsPatients with RPS has clinical significant dissociation of psychic and cognitive functioning that should be considered in planning, and assessing of results of cognitive enhancers studies.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Treatment of schizophrenia using tablet and smartphone based applications (Polish Study)

Relapses, deterioration of cognitive functioning, negative symptoms, neuroleptic resistance are the examples of many consequences of noncompliance in schizophrenia. In order to improve the compliance, schizophrenic patients treated in an outpatient department in a traditional way have been given an additional possibility of contacting their doctors with the use of a special application on a portable electronic device. Other functions of this application are possibilities of PANSS, Calgary and CGI measurements and cognitive trainings for the patients. This type of a remote contact with patients can be an effective tool in the work in an outpatient setting. The compliance was assessed using a telepsychiatric system, sending reminders: 1 hour before the planned dose to remind them that drug intake is approaching, and at the moment of intake to check if they took the drug. In general the compliance in the group of schizophrenic patients in remission is very low, however the telemedicine system improves the compliance in this group of patients, in which the compliance is the worst.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Irony comprehension and context processing in schizophrenia during remission – A functional MRI study

Schizophrenic patients have Theory of Mind (ToM) deficits even during remission, but it is yet unknown whether this could be influenced. We examined the neural correlates of irony understanding in schizophrenic patients, as an indicator of ToM capacity, and evaluated how linguistic help inserted into the context phase could affect irony comprehension. Schizophrenic patients in remission and healthy controls were subjected to event-related functional MRI scanning while performing irony, ‘irony with linguistic help’, and control tasks. Patients understood irony significantly worse than healthy controls. The patients showed stronger brain activity in the parietal and frontal areas in the early phase of irony task, however the healthy controls exhibited higher activation in frontal, temporal and parietal regions in the latter phase of the irony task. Interestingly the linguistic help not only improved the patients’ ToM performance, but it also evoked similar activation pattern to healthy controls.

Personality Traits of Schizophrenic Patients in Remission and Their First-Degree Relatives: A Dopaminergic and Glutamatergic Gene Polymorphism Study

Objective: The dopaminergic and glutamatergic systems are of major interest in the etiology of schizophrenia and supposed endophenotypes such as personality traits. In the present study, we investigated the association between the catechol-O-methyltransferase (COMT) gene P2 promoter rs2075507, Val/ Met (rs4680), the dopamine transporter gene (DAT1) VNTR and the glutamate transporter gene (SLC1A2) promoter -181A/C polymorphisms, and personality traits as well as symptomatic features in schizophrenia.Methods: There were 112 healthy subjects, 51 schizophrenic patients in remission for at least six months and 45 first-degree relatives of the patients enrolled in the study. The samples were genotyped for the COMT P2 promoter rs2075507, Val/Met, DAT1 VNTR and SLC1A2 promoter -181A/C polymorphisms and assessed with the Temperament and Character Inventory (TCI). Schizophrenia patients were also evaluated using the Operational Criteria Checklist for Psychotic Illness (OPCRIT) for each of the five factor-derived scales (negative symptoms, delusions, hallucinations, mania, and depression) and The Positive and Negative Symptom Scale.Results: Our findings demonstrate that schizophrenic patients, even after remission, had a different personality pattern from controls, showing higher scores in harm avoidance and self-transcendence and lower scores in novelty seeking, persistence, self-directedness and cooperativeness. First-degree relatives of patients also had profiles distinguishable from those of the patients only by intermediate levels of harm-avoidance and higher levels of cooperativeness. In the association of genotypes and personality, COMT Val/Met polymorphism was not associated with personality in patients or in healthy subjects. Another functional polymorphism in the COMT gene the P2 promoter rs2075507 G allele was associated with significantly higher novelty seeking scores in patients than was the A allele. DAT1 VNTR long alleles (10 or 11 repeats) were demonstrated to show a non-significant trend to association with higher self-transcendence scores than in those with the short alleles (3, 7, 8 or 9 repeats) in control samples and patients. In SLC1A2 promoter -181A/C polymorphism, the C allele was significantly associated with higher self-transcendence scores than in those with the A allele in healthy subjects. We did not find any associations between the psychotic symptom dimensions of patients and DAT1 VNTR, SLC1A2 promoter -181A/C and COMT Val/Met polymorphism; however, COMT P2 promoter rs2075507 polymorphism showed an association with the delusion and mania factor scores.Conclusions: Schizophrenia may be associated with different personality patterns from controls and some personality dimensions may be associated with the appearance of psychotic symptoms. The same genes may be responsible for the development of the disease, with personality patterns seen in at least one group of patients.

Cognitive Impairment in Bipolar Disorder and Schizophrenia: A Systematic Review

Aims: Previous comparisons of cognitive decline among patients with bipolar disorder (BD) and schizophrenia (SZ) have found somehow quite similar profiles of deficits, but results have varied between studies. Therefore an extensive and thoughtful systematic review of the matter is warranted.Methods: Studies were found through systematic search (PubMed) following PRISMA guidelines. To be included, studies must have assessed the following cognitive functions: executive functions, memory, IQ, attention-concentration, and perceptuomotor function. In order to make comparison between the two entities, studies should include BD patients with operationally defined euthymia, schizophrenic patients in remission, and third group of healthy control patients. Comparisons were made after controlling for years of schooling and residual affective symptoms.Results: We found that overall both SZ and BD patients present deficits on all neurocognitive measures compared to healthy controls. In particular, SZ patients show more severe and pervasive cognitive deficits while BD patients present a milder and more confined impairment. In addition, evidence from the literature suggests that SZ and BD patients share a similar cognitive impairment profile with different degrees of deficits. Therefore, the difference between the two groups seems to be more quantitative (degree of deficit) rather than qualitative (profile), supporting a dimensional approach to the two clinical entities. Limitations of the present review includes the impossibility to control for effects of medication, varying time required for assessment across studies, illness diagnosis reliability, and course severity.Conclusion: Patients with BD might exhibit a cognitive impairment that could be similar to SZ in terms of their profile, although patients with SZ may have more severe and widespread impairments.

Comprehension of metaphor and irony in schizophrenia during remission: The role of theory of mind and IQ

The study reported herein explored the comprehension of metaphor and irony in schizophrenia during remission, and examined the role of IQ and a theory of mind. Performance of 29 Schizophrenic patients in remission and 22 healthy controls was compared on metaphor and irony comprehension tasks and first- and second-order theory of mind tasks. Participants' IQs were measured using the Wechsler Adult Intelligence Scale-Revised, and the symptoms of individuals with schizophrenia were assessed using the Positive and Negative Syndrome Scale. The results showed that patients with schizophrenia were impaired in their comprehension of metaphor and irony as compared with healthy controls. A theory of mind deficit was found in patients with remitted schizophrenia. The comprehension of metaphor was significantly correlated with second-order false belief understanding and the comprehension of irony was not significantly related to theory of mind. IQ and verbal IQ did not explain the deficit of metaphor and irony comprehension. These findings were not explained by Happé's [Happé, F.G.E., 1993. Communication competence and theory of mind in autism: a test of relevance theory. Cognition 48, 101–119] theory and the shared semantic understanding requirement was discussed.

The effect of Ondansetron on memory in schizophrenic patients

It has been well established that patients with schizophrenia have impaired cognitive function on neuropsychological tasks related to memory. Previous studies also suggest serotonin's central role in memory. This double-blind crossover study aimed to explore the effect of Ondansetron, a selective serotonin 3 receptor (5-HT 3) antagonist, on a variety of memory tasks in schizophrenic patients. Clozapine-treated schizophrenic patients in remission ( N = 21) were randomly treated with Ondansetron or placebo and then evaluated at three consecutive points. These evaluations included clinical measures (including Positive and Negative Syndrome Scale for Schizophrenia, Clinical Global Impression and Extrapyramidal Symptoms Rating Scale) and neuropsychological measures (including Digit Span, Paired Association, Rey–Osterich Complex Figure Test, Digit Symbol and the Rivermead Behavioral Memory Tests). Ondansetron, when compared with placebo, did not affect the above clinical measures and most of the neuropsychological tests. Short-term administration of Ondansetron, however, was associated with significantly improved visuo-spatial memory as measured by the Rey–Osterich Complex Figure Test. These preliminary results suggest Ondansetron's possible role in enhancement of memory function in schizophrenia.

Deficits of spatial working memory in chronic schizophrenia

This study tests the hypothesis that deficits of spatial working memory are an inherent trait in schizophrenic patients, regardless of their clinical status. The participants were 22 chronic schizophrenic patients, 11 schizophrenic patients in remission, and 22 normal adults. All participants were asked to track the outlines of a square presented on a computer screen in a clockwise direction while moving their eyes at their preferred rate and then to reproduce the square on a blank computer screen (Task A). Thereafter, the computer only displayed the four corners of the same square. The corners were displayed sequentially in a clockwise direction, one at a time at equal intervals. They were asked first to track the four corners of the square and then to reproduce the square on a blank computer screen (Task B). Chronic schizophrenic patients reproduced tasks A and B with significantly greater distortions than normal controls. The extent of their distortions was significantly greater during the reproduction of Task A than Task B. By contrast, schizophrenic patients in remission reproduced both Tasks A and B with the same accuracy as normal controls. On the basis of these findings it is concluded that the chronic schizophrenic patients have a significant deficit of spatial working memory, but that this deficit can be ameliorated by cognitive interventions and is therefore not an immutable trait in schizophrenia.

The hypothalamic–pituitary–thyroid axis in patients with schizophrenia

Serum concentrations of thyroxine (T 4), triiodothyronine (T 3), reverse triiodothyronine (rT 3) and thyrotropine (TSH) were measured in 31 acutely ill in-patients with schizophrenia before and after four weeks of treatment with the phenothiazine derivative perazine. The serum levels of all the above hormones were also determined in 19 schizophrenic patients in remission who were receiving no medication, 20 schizophrenic patients in remission taking neuroleptic drugs, and 24 patients with residual-type schizophrenia. The serum levels of T 4 of acutely ill schizophrenic patients were elevated, while those of T 3, rT 3 and TSH were normal. Their T 4 levels showed a positive correlation with the severity of illness and the degree of clinical response to neuroleptic treatment. There was a significant fall in serum concentrations of T 4 and rT 3 during four weeks of drug treatment and the decrease was significantly correlated to clinical response. No abnormalities in the serum concentrations of any of the hormones measured were found in schizophrenic patients in remission or in residual-type schizophrenia. In conclusion, our results indicate that the elevated serum levels of T 4 may be specific for acutely ill schizophrenic patients and that neuroleptic medication may affect thyroid hormone metabolism, this interaction being involved in the mechanism of action of these drugs.

Serum and cerebrospinal levels of calcium and magnesium in acute versus remitted schizophrenic patients.

Serum and cerebrospinal fluid levels of calcium and magnesium were measured in acute schizophrenics versus schizophrenic patients in remission. The acute schizophrenics demonstrated statistically significant lower levels of cerebrospinal fluid magnesium. The mechanism that underlies this difference is not clear.

Reduced emotional response of schizophrenic patients in remission during social interaction

Inappropriate emotional response during social interaction is a prominent feature of schizophrenia during the acute stage of illness. This study evaluates the course of reduced facial activity in schizophrenic patients in remission and compares it with healthy controls. The experimental conditions included watching two films, one inducing happy and the other sad emotional states. Each is followed by an interview eliciting happy and sad feelings. The facial actions were recorded (1) by a computer-based analysis of recordings of the skin movement and (2) by electromyography of the corrugator and zygomaticus muscles. Twenty schizophrenic patients in remission and 20 normal controls participated in the study. In contrast to previously studied acute patients, there was no overall reduction of facial expression in the upper face of schizophrenic patients in remission. Patients showed fewer movements (automatic analysis) of the lower face during the happy interview and more movements during the sad interview compared with controls. Furthermore, schizophrenic patients showed reduced zygomaticus activity (EMG) during both the happy film and the interview, suggesting a reduced ability of schizophrenic patients to express happy facial expressions, such as smiling, in the lower face. This may indicate a reduced variability in emotional response in schizophrenia.

Smaller auditory P300 amplitude in schizophrenics in remission.

The P300 event-related potential (ERP) was recorded using the auditory oddball paradigm in 12 (6 male) schizophrenic (DSM-IIIR) patients in rigorously defined clinical remission. The ERP was also recorded in 10 (5 male) age-, sex- and education-matched control subjects. ERP latencies and amplitude were measured at Cz and Pz recording sites. Mean latencies of the P300 in schizophrenic patients in remission at Cz [343.6 +/- 31 (SD) ms] and Pz (346.15 +/- 30 ms) did not differ from those of normals (Cz: 332.8 +/- 23 ms, Pz: 323 +/- 38 ms). The P300 ERP amplitude was significantly (p < 0.05) smaller in schizophrenics in remission at both Cz (9.2 +/- 4.4 microV) and Pz (8.8 +/- 4.4 microV) than in normals (Cz: 13.3 +/- 2.90 microV; Pz: 12.71 +/- 4.18 microV). The significance of the smaller auditory P300 amplitude in schizophrenia is discussed.

The perception of emotion by schizophrenic patients.

Studies which have examined the perception of emotion by schizophrenic patients have produced conflicting results, an outcome which may, in part, be due to difficulties in presenting a realistic portrayal of emotion. This study exposed 32 schizophrenic patients in remission and ten controls to five videotaped scenes of emotional situations played by actors. The schizophrenic patients were divided into three groups, namely those living with high-EE relatives, those living with low-EE relatives and those living alone, in order to test the hypothesis that patients in a high-EE environment are less able to identify emotionally charged situations. Measures of electrodermal activity and self-ratings of tension were recorded concomitantly. The schizophrenic patients in all groups were as adept at identifying emotions as were the controls. There was no difference between the groups in electrodermal activity and subjective tension for all video scenes, except for the one which portrayed the only pleasant interaction; the high-EE group was significantly more aroused on both measures, which were independent of each other.

Serum interleukin-6 in schizophrenic patients

We examined serum interleukin-6 (IL-6) in 90 schizophrenic patients in remission and 90 normal controls using enzyme-linked immuno-sorbent assay (ELISA). We found a significant difference in variation between the schizophrenic and the control groups (F = 10.9, P < .002). The difference in distribution was also statistically significant by Kolmogorov-Smirnov (chi-square = 45.0, P < .001). Eight patients had aberrantly high serum levels of interleukin-6. Since the higher levels of IL-6 are characteristically found in several autoimmune disorders, our finding suggests a link between schizophrenia and immune response, which could be either autoimmune or a process induced by reactivation of viruses.

Small Intestine Permeability in Schizophrenia

Gastrointestinal permeability was assessed by means of absorption of 51Cr-labelled EDTA in 24 patients with schizophrenia (12 in relapse and 12 in remission). The results were compared with those for patients with coeliac disease and those for normal controls. Significant differences between the schizophrenic patients and the normal controls were not established. The results for the schizophrenic patients in remission were no different from those for the patients in relapse, and there was no evidence from the study of an effect on gastrointestinal permeability of either anticholinergic or antidepressant medication. It is concluded that schizophrenia is, at least in the majority of cases, unrelated to coeliac disease.

Small Intestine Permeability in Schizophrenia

Gastrointestinal permeability was assessed by means of absorption of 51Cr-labelled EDTA in 24 patients with schizophrenia (12 in relapse and 12 in remission). The results were compared with those for patients with coeliac disease and those for normal controls. Significant differences between the schizophrenic patients and the normal controls were not established. The results for the schizophrenic patients in remission were no different from those for the patients in relapse, and there was no evidence from the study of an effect on gastrointestinal permeability of either anticholinergic or antidepressant medication. It is concluded that schizophrenia is, at least in the majority of cases, unrelated to coeliac disease.

Group sociotherapy: a psychoeducative model for schizophrenic patients and their families.

The clinical and research community have identified critical issues in educating schizophrenic patients and their families about schizophrenia. A review of the literature, a comprehensive alternative model, and descriptive modules inherent in an effective group sociotherapy program are offered for schizophrenic patients in remission and for their families. The model provides advantages for monitoring patients on an outpatient basis and has applicability to mental health clinic, day hospital, and day treatment center programs.

Characteristics of very poor outcome schizophrenia.

The authors compared 21 "Kraepelinian" schizophrenic patients who had been ill and dependent on others for the past 5 years with 76 chronic schizophrenic patients in remission or with exacerbations requiring hospitalization. The Kraepelinian patients met the criteria for schizophrenia by more diagnostic systems than the exacerbated patients, were less responsive to haloperidol, had more severe negative symptoms, and had similarly severe positive symptoms. They had cerebral ventricles that were more asymmetrical and a greater family history of schizophrenia spectrum disorders than the other chronic patients. These data suggest that patients with 5 years of illness and complete dependency on others may represent a subgroup of schizophrenia.

Development and Evaluation of Social Skills Training for Schizophrenic Patients in Remission

Investigated were measures of self-esteem, self-perceived attitudinal dimensions and locus of control to assess the effects of group social skills training for schizophrenic psychiatric inpatients. A pretest, posttest control group design was employed utilizing forty subjects currently in treatment. It was hypothesized that short-term cognitively structured group therapy would realize significant improvement in self-esteem, internal locus of control and assertive attitude change. Significant mean differences between the treatment group's level of self-esteem, perceived assertive behavior and internal locus of control as a result of treatment were realized. Discussion of training methodology, issues and import for clinical applications and research are discussed.