Schizophrenia Research and Treatment

Schizophrenia as a Disorder of Communication

Margaret A. Niznikiewicz, Marek Kubicki, Christoph Mulert, and Ruth Condray — Sun, 12 May 2013 11:08:55 +0000

Sleep, Fatigue, and Functional Health in Psychotic Patients

Flavie Waters, Neepa Naik, and Daniel Rock — Tue, 30 Apr 2013 09:49:05 +0000

This study sought to examine the association between sleep, fatigue, and functional health in psychotic patients. Participants included 93 psychotic inpatients ( with schizophrenia) who completed the Chalder Fatigue Scale (ChFS), the Fatigue Symptom Inventory (FSI), the Pittsburgh Sleep Quality Index (PSQI), and the SF36 Health Survey. Patients were classified on the basis of their performance on sleep and fatigue measures: 60% reported significant levels of fatigue and 67% significant sleep disturbances. 28.4% reported both, suggesting that fatigue and sleep dysfunctions do not necessarily cooccur. A closer examination of patterns showed that fatigue was only related to qualitative aspects of sleep and not quantifiable aspects of sleep disturbances. The results also showed that functional health was the lowest in patients with high levels of fatigue, compared to patients with sleep problems only or patients with neither symptom. A regression analysis further showed that the size of the contribution of fatigue onto functional health was twice as much as that of sleep dysfunctions. In conclusion, the results show that (i) dissatisfaction with sleep—and not sleep itself—is related to fatigue symptoms and that (ii) fatigue is particularly detrimental to functional health, regardless of the presence of sleep dysfunctions.

Empirically Based Psychosocial Therapies for Schizophrenia: The Disconnection between Science and Practice

Glenn D. Shean — Tue, 23 Apr 2013 14:32:28 +0000

Empirically validated psychosocial therapies for individuals diagnosed with schizophrenia were described in the report of the Schizophrenia Patient Outcomes Research Team (PORT, 2009). The PORT team identified eight psychosocial treatments: assertive community treatment, supported employment, cognitive behavioral therapy, family-based services, token economy, skills training, psychosocial interventions for alcohol and substance use disorders, and psychosocial interventions for weight management. PORT listings of empirically validated psychosocial therapies provide a useful template for the design of effective recovery-oriented mental health care systems. Unfortunately, surveys indicate that PORT listings have not been implemented in clinical settings. Obstacles to the implementation of PORT psychosocial therapy listings and suggestions for changes needed to foster implementation are discussed. Limitations of PORT therapy listings that are based on therapy outcome efficacy studies are discussed, and cross-cultural and course and outcome studies of correlates of recovery are summarized.

Atypical Antipsychotics in the Treatment of Depressive and Psychotic Symptoms in Patients with Chronic Schizophrenia: A Naturalistic Study

Mon, 21 Jan 2013 10:40:21 +0000

Objectives. The aim of this naturalistic study was to investigate whether treatment with clozapine and other atypical antipsychotics for at least 2 years was associated with a reduction in psychotic and depressive symptoms and an improvement in chronic schizophrenia patients’ awareness of their illness. Methods. Twenty-three adult outpatients (15 men and 8 women) treated with clozapine and 23 patients (16 men and 7 women) treated with other atypical antipsychotics were included in the study. Psychotic symptoms were evaluated using the Positive and Negative Syndrome Scale (PANSS), depressive symptoms were assessed with the Calgary Depression Scale for Schizophrenia (CDSS), and insight was assessed with the Scale to Assess Unawareness of Mental Disorder (SUMD). Results. The sample as a whole had a significant reduction in positive, negative, and general symptoms, whereas the reduction in depression was significant only for patients with CDSS scores of 5 and higher at the baseline. At the follow-up, patients treated with other atypical antipsychotics reported a greater reduction in depression than patients treated with clozapine, but not when limiting the analyses to those with clinically relevant depression. Conclusions. Atypical antipsychotics may be effective in reducing psychotic and depressive symptoms and in improving insight in patients with chronic schizophrenia, with no differences in the profiles of efficacy between compounds.

Do People with Schizophrenia Lack Emotional Intelligence?

Sara Dawson, Lisa Kettler, Cassandra Burton, and Cherrie Galletly — Thu, 13 Dec 2012 09:08:53 +0000

Social cognition is a domain of cognitive function that includes the ability to understand and manage social interactions. Emotional intelligence (EI) has been identified as a component of social cognition and is defined as the ability to identify, use, understand, and manage emotions. Neurocognitive impairments are known to be associated with poorer social function in people with schizophrenia, but less is known about the relationships between EI, neurocognition, and social function. The current study assessed EI using the Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT) in 20 people with schizophrenia and 20 controls. The schizophrenia group had significantly lower scores on all measures of EI and demonstrated poorer neurocognition and social functioning than controls. The difference between schizophrenia and control groups was greatest for the Understanding Emotions Branch of the MSCEIT. The neurocognition score and total EI score accounted for 18.3% of the variance in social function in the control group and 9.1% of the variance in social function in the schizophrenia group. Our results suggest that a total EI score is not a useful predictor of overall social function and it may be more clinically useful to develop an individual profile of social cognitive abilities, including EI, to form a remediation program.

High Order Linguistic Features Such as Ambiguity Processing as Relevant Diagnostic Markers for Schizophrenia

Daniel Ketteler, Anastasia Theodoridou, Simon Ketteler, and Matthias Jäger — Tue, 11 Dec 2012 10:03:24 +0000

Due to the deficits of schizophrenic patients regarding the understanding of vague meanings (D. Ketteler and S. Ketteler (2010)) we develop a special test battery called HOLF (high order linguistic function test), which should be able to detect subtle linguistic performance deficits in schizophrenic patients. HOLF was presented to 40 schizophrenic patients and controls, focussing on linguistic features such as ambiguity, synonymy, hypero-/hyponymy, antinomy, and adages. Using the HOLF test battery we found that schizophrenic patients showed significant difficulties in discriminating ambiguities, hypero- and hyponymy, or synonymy compared to healthy controls. Antonyms and adages showed less significant results in comparing both groups. The more difficult a linguistic task was, the more confusion was measured in the schizophrenic group while healthy controls did not show significant problems in processing high order language tasks.

Health-Related Quality of Life and Overall Life Satisfaction in People with Serious Mental Illness

Amy L. Barnes, Meghan E. Murphy, Christopher A. Fowler, and Melisa V. Rempfer — Mon, 19 Nov 2012 13:01:37 +0000

Quality of life (QoL) in people with schizophrenia and other serious mental illnesses (SMI) is an important outcome goal, yet there is no consistent definition of the construct. We examined three aspects of QoL in persons with SMI: overall life satisfaction, physical health-related QoL (HRQoL), and mental HRQoL. This study had two primary aims: first, to examine whether there are differences in physical and mental HRQoL in persons with SMI, and, second, to investigate the cognitive, clinical, and functional correlates of the three QoL indicators. Participants were 48 persons with SMI who completed assessments of QoL, cognition, functional capacity, psychiatric symptomatology, and medical comorbidity. Results indicate that participants experience similar levels of physical and mental HRQoL, and these two constructs are not related to one another. Physical HRQoL is associated with less medical comorbidity, while mental HRQoL is associated with negative and depressive symptoms. Overall life satisfaction was associated with fewer psychiatric symptoms and less medical comorbidity. This study adds to the important literature defining distinct domains of QoL and supports the necessity of addressing both physical and mental health factors as they relate to recovery and well-being among persons with SMI.

Jumping to Conclusions Is Associated with Paranoia but Not General Suspiciousness: A Comparison of Two Versions of the Probabilistic Reasoning Paradigm

Steffen Moritz, Niels Van Quaquebeke, and Tania M. Lincoln — Thu, 18 Oct 2012 12:41:02 +0000

Theoretical models ascribe jumping to conclusions (JTCs) a prominent role in the pathogenesis of paranoia. While many earlier studies corroborated this account, some newer investigations have found no or only small associations of the JTC bias with paranoid symptoms. The present study examined whether these inconsistencies in part reflect methodological differences across studies. The study was built upon the psychometric high-risk paradigm. A total of 1899 subjects from the general population took part in an online survey and were administered the Paranoia Checklist as well as one of two different variants of the probabilistic reasoning task: one variant with a traditional instruction (a) and one novel variant that combines probability estimates with decision judgments (b). Factor analysis of the Paranoia Checklist yielded an unspecific suspiciousness factor and a psychotic paranoia factor. The latter was significantly associated with scores indicating hasty decision making. Subjects scoring two standard deviations above the mean of the Paranoia Checklist showed an abnormal data-gathering style relative to subjects with normal scores. Findings suggest that the so-called decision threshold parameter is more sensitive than the conventional JTC index. For future research the specific contents of paranoid beliefs deserve more consideration in the investigation of decision making in schizophrenia as JTC seems to be associated with core psychosis-prone features of paranoia only.

Elevated Serum Levels of Homocysteine as an Early Prognostic Factor of Psychiatric Disorders in Children and Adolescents

Tue, 02 Oct 2012 11:10:43 +0000

Background and Goal. The aim was to examine the serum levels of homocysteine (Hcy) and their associations with the methylenetetrahydrofolate reductase (MTHFR) gene C677T polymorphism in patients with schizophrenia and mood disorders as well as controls. Materials and Methods. There were 198 patients: 82 with schizophrenia spectrum disorders, 22 with mood disorders, and 94 controls. The level of Hcy was determined by an isocratic high-performance liquid chromatography system. MTHFR C677T polymorphism was analysed using the restriction fragment length polymorphism-polymerase chain reaction method. Results. The average level of Hcy was μmol/L for patients with schizophrenia, μmol/L for patients with affective disorders, versus μmol/L in a control. The highest level of Hcy has been observed in patients with episodic-recurrent course of schizophrenia (μmol/L), paranoid schizophrenia continuous (μmol/L), and in patients with affective disorders (μmol/L). An association between the MTHFR gene C677T polymorphism and Hcy level was found by linear regression analysis (, ). Conclusions. The data indicate a link between Hcy levels and schizophrenia and mood disorders. No associations between the level of Hcy in patients with schizophrenia and mood disorders and the MTHFR C677T polymorphism were found.

Long-Acting Injectable Antipsychotics in First-Episode Schizophrenia

Eduard Parellada, Dawn I. Velligan, Robin Emsley, and Werner Kissling — Tue, 21 Aug 2012 11:00:31 +0000

Long-Acting Injectable Antipsychotics for First-Episode Schizophrenia: The Pros and Cons

Borah Kim, Sang-Hyuk Lee, Yen Kuang Yang, Jong-Il Park, and Young-Chul Chung — Tue, 14 Aug 2012 16:57:00 +0000

Clinical and psychosocial deterioration associated with schizophrenia occurs within the first few years following the onset of the illness. Therefore, to improve the long-term prognosis, it is important to provide schizophrenia patients with intensive treatment following their first episode. Relapse is highly associated with partial medication adherence or nonadherence in patients with first-episode schizophrenia. Recent studies suggest that long-acting injectable (LAI) antipsychotics compared with oral antipsychotics are more effective for medication adherence and relapse prevention. Moreover, some clinical guidelines for the treatment of schizophrenia suggested that LAI antipsychotics should be considered when patients are nonadherent “at any stage.” Decreased compliance is a common cause of relapse during the initial stages of the disease. Therefore, LAI antipsychotics should be highly considered when treating patients with first-episode schizophrenia. In the present paper, clinical trial data and current guidelines on the use of LAI antipsychotics for first-episode schizophrenia are discussed as well as the pros and cons of this treatment option.

Examining the Factors Associated with Paid Employment of Clients Enrolled in First Episode of Psychosis Programs

Carolyn S. Dewa, Lucy Trojanowski, Chiachen Cheng, and Desmond Loong — Thu, 21 Jun 2012 14:50:27 +0000

Schizophrenia is one of the most debilitating mental disorders. For a significant portion of individuals who suffer from this disorder, onset occurs in young adulthood, arresting important social and educational development that is necessary for future successful labor force participation. The purpose of this paper is to contribute to the literature about clients enrolled in first episode psychosis programs and psychosocial outcomes by examining the factors associated with paid employment among young adults who have experienced their first psychotic episodes. In this paper, we consider the association of socioeconomic factors to employment. Our results suggest that in addition to treatment, socioeconomic factors such as receipt of public disability benefits and educational attainment are associated with employment status. These results can help to inform future directions for the enhancement of psychosocial programs in FEP models to promote paid employment.

From Semantics to Feelings: How Do Individuals with Schizophrenia Rate the Emotional Valence of Words?

Wed, 06 Jun 2012 11:31:05 +0000

Schizophrenia is characterized by both emotional and language abnormalities. However, in spite of reports of preserved evaluation of valence of affective stimuli, such as pictures, it is less clear how individuals with schizophrenia assess verbal material with emotional valence, for example, the overall unpleasantness/displeasure relative to pleasantness/attraction of a word. This study aimed to investigate how schizophrenic individuals rate the emotional valence of adjectives, when compared with a group of healthy controls. One hundred and eighty-four adjectives differing in valence were presented. These adjectives were previously categorized as “neutral,” “positive” (pleasant), or “negative” (unpleasant) by five judges not participating in the current experiment. Adjectives from the three categories were matched on word length, frequency, and familiarity. Sixteen individuals with schizophrenia diagnosis and seventeen healthy controls were asked to rate the valence of each word, by using a computerized version of the Self-Assessment Manikin (Bradley and Lang, 1994). Results demonstrated similar ratings of emotional valence of words, suggesting a similar representation of affective knowledge in schizophrenia, at least in terms of the valence dimension.

Schizophrenia as a Disorder of Social Communication

Cynthia Gayle Wible — Sun, 20 May 2012 15:33:25 +0000

Evidence is reviewed for the existence of a core system for moment-to-moment social communication that is based on the perception of dynamic gestures and other social perceptual processes in the temporal-parietal occipital junction (TPJ), including the posterior superior temporal sulcus (PSTS) and surrounding regions. Overactivation of these regions may produce the schizophrenic syndrome. The TPJ plays a key role in the perception and production of dynamic social, emotional, and attentional gestures for the self and others. These include dynamic gestures of the body, face, and eyes as well as audiovisual speech and prosody. Many negative symptoms are characterized by deficits in responding within these domains. Several properties of this system have been discovered through single neuron recording, brain stimulation, neuroimaging, and the study of neurological impairment. These properties map onto the schizophrenic syndrome. The representation of dynamic gestures is multimodal (auditory, visual, and tactile), matching the predominant hallucinatory categories in schizophrenia. Inherent in the perceptual signal of gesture representation is a computation of intention, agency, and anticipation or expectancy (for the self and others). The neurons are also tuned or biased to rapidly detect threat-related emotions. I review preliminary evidence that overactivation of this system can result in schizophrenia.

The PPAR𝜶 Agonist Fenofibrate Reduces Prepulse Inhibition Disruption in a Neurodevelopmental Model of Schizophrenia

Benjamin Rolland, Kevin Marche, Olivier Cottencin, and Régis Bordet — Tue, 15 May 2012 14:38:34 +0000

Oxidative stress has been implicated in neurodevelopmental theories of schizophrenia. Antioxidant Peroxysome Proliferator-Activated Receptors α (PPARα) agonist fenofibrate has neuroprotective properties and could reverse early preclinical infringements that could trigger the illness. We have evaluated the neuroprotective interest of fenofibrate in a neurodevelopmental rat model of schizophrenia. The oxidative lesion induced by Kainic Acid (KA) injection at postnatal day (PND) 7 has previously been reported to disrupt Prepulse Inhibition (PPI) at PND56 but not at PND35. In 4 groups of 15 male rats each, KN (KA-PND7 + normal postweaning food), KF (KA-PND7 + fenofibrate 0.2% food), ON (saline-PND7 + normal food), and OF (saline + fenofibrate food), PPI was recorded at PND35 and PND56. Three levels of prepulse were used: 73 dB, 76 dB, and 82 dB for a pulse at 120 dB. Four PPI scores were analyzed: PPI73, PPI76, PPI82, and mean PPI (PPIm). Two-way ANOVAs were used to evaluate the effects of both factors (KA + fenofibrate), and, in case of significant results, intergroup Student’s t-tests were performed. We notably found a significant difference (𝑃<0.05) in PPIm between groups KN and KF at PND56, which supposes that fenofibrate could be worthy of interest for early neuroprotection in schizophrenia.

Integrated Treatment to Achieve Functional Recovery for First-Episode Psychosis

Marcelo Valencia, Francisco Juarez, and Hector Ortega — Thu, 10 May 2012 08:07:36 +0000

This study describes an integrated treatment approach that was implemented to enhance functional recovery in first-episode psychotic patients. Patients were randomized to two treatment conditions: either to an integrated treatment approach: pharmacotherapy, psychosocial treatment, and psychoeducation (experimental group: 𝑁=39) or to medication alone (control group: 𝑁=34). Patients were evaluated at baseline and after one year of treatment. Functional recovery was assessed according to symptomatic and functional remission. At the end of treatment, experimental patients showed a 94.9% of symptomatic remission compared to 58.8% of the control group. Functional remission was 56.4% for the experimental group and 3.6% for the control group, while 56.4% of the experimental group met both symptomatic and functional remission criteria and were considered recovered compared to 2.9% of the control group.

Hospitalisation Utilisation and Costs in Schizophrenia Patients in Finland before and after Initiation of Risperidone Long-Acting Injection

Mon, 07 May 2012 16:25:34 +0000

Objectives. Quantify changes in hospital resource use in Finland following initiation of risperidone long-acting injection (RLAI). Materials and Methods. A retrospective multi-center chart review (naturalistic setting) was used to compare annual hospital bed-days and hospital episodes for 177 schizophrenia patients (mean age 47.1 years, 52% female, 72% hospitalized) before and after initiation of RLAI (between January 2004 and June 2005) using the within-patient “mirror-image” study design. The base case analytical approach allocated hospital episodes overlapping the start date entirely to the preinitiation period. In order to investigate the impact of inpatient care ongoing at baseline, the change in bed-days was also estimated using an alternative analytical approached related to economic modelling. Results. In the conventional analysis, the mean annual hospitalisation costs declined by €11,900 and the number of bed-days was reduced by 40%, corresponding to 0.19 fewer hospital episodes per year. The reductions in bed-days per patient-year were similar for patients switched to RLAI as inpatients and as outpatients. In the modelling-based analysis, an 8% reduction in bed-days per year was observed. Conclusion. Despite uncertainty in the choice of analytic approach for allocating inpatient episodes that overlapping this initiation, consistent reductions in resource use are associated with the initiation of RLAI in Finland.

Role of Long-Acting Injectable Second-Generation Antipsychotics in the Treatment of First-Episode Schizophrenia: A Clinical Perspective

Mon, 07 May 2012 10:36:41 +0000

Approximately 80% of patients with the first-episode schizophrenia reach symptomatic remission after antipsychotic therapy. However, within two years most of them relapse, mainly due to low levels of insight into the illness and nonadherence to their oral medication. Therefore, although the formal data available is limited, many experts recommend prescribing long-acting injectable second-generation antipsychotics (mostly risperidone or alternatively paliperidone) in the early stages of schizophrenia, particularly in patients who have benefited from the original oral molecule in the past and agree to receive long-term injectable treatment. Early application of long-acting injectable second-generation antipsychotics can significantly reduce the risk of relapse in the future and thus improve not only the social and working potential of patients with schizophrenia but also their quality of life.

Faulty Suppression of Irrelevant Material in Patients with Thought Disorder Linked to Attenuated Frontotemporal Activation

Thu, 19 Apr 2012 08:04:24 +0000

Formal thought disorder is a feature schizophrenia that manifests as disorganized, incoherent speech, and is associated with a poor clinical outcome. The neurocognitive basis of this symptom is unclear but it is thought to involve an impairment in semantic processing classically described as a loosening of meaningful associations. Using a paradigm derived from the n400 event-related, potential, we examined the extent to which regional activation during semantic processing is altered in schizophrenic patients with formal thought disorder. Ten healthy control and 18 schizophrenic participants (9 with and 9 without formal thought disorder) performed a semantic decision sentence task during an event-related functional magnetic resonance imaging experiment. We employed analysis of variance to estimate the main effects of semantic congruency and groups on activation and specific effects of formal thought disorder were addressed using post-hoc comparisons. We found that the frontotemporal network, normally engaged by a semantic decision task, was underactivated in schizophrenia, particularly in patients with FTD. This network is implicated in the inhibition of automatically primed stimuli and impairment of its function interferes with language processing and contributes to the production of incoherent speech.

Psychosis and Gender

Susana Ochoa, Judith Usall, Jesús Cobo, Javier Labad, and Jayashri Kulkarni — Wed, 18 Apr 2012 13:41:04 +0000

Gender Differences in Schizophrenia and First-Episode Psychosis: A Comprehensive Literature Review

Susana Ochoa, Judith Usall, Jesús Cobo, Xavier Labad, and Jayashri Kulkarni — Sun, 08 Apr 2012 13:37:17 +0000

Recent studies have begun to look at gender differences in schizophrenia and first-episode psychosis in an attempt to explain the heterogeneity of the illness. However, a number of uncertainties remain. This paper tries to summarize the most important findings in gender differences in schizophrenia and first-psychosis episodes. Several studies indicate that the incidence of schizophrenia is higher in men. Most of the studies found the age of onset to be earlier in men than in women. Findings on symptoms are less conclusive, with some authors suggesting that men suffer more negative symptoms while women have more affective symptoms. Premorbid functioning and social functioning seem to be better in females than males. However, cognitive functioning remains an issue, with lack of consensus on differences in neuropsychological profile between women and men. Substance abuse is more common in men than women with schizophrenia and first-episode psychosis. In terms of the disease course, women have better remission and lower relapse rates. Lastly, there is no evidence of specific gender differences in familial risk and obstetric complications. Overall, gender differences have been found in a number of variables, and further study in this area could help provide useful information with a view to improving our care of these patients.

Where Does Evidence from New Trials for Schizophrenia Fit with the Existing Evidence: A Case of the Emperor's New Clothes?

Mahesh Jayaram, Ranganath D. Rattehalli, and Clive E. Adams — Sun, 08 Apr 2012 08:39:11 +0000

Advent of “atypical” antipsychotics has spawned new trials in the recent years and the number of such trial reports has been increasing exponentially. As clinicians we have been led to believe that “atypicals” are better than “typicals” despite the odd dissenting voice in academic and clinical circles. This has been largely ignored until the publication of two landmark, independent, pragmatic trials, Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) and Cost Utility of the Latest Antipsychotic Drugs in Schizophrenia Study (CUtLASS), which proved that thoughtfully chosen “typical” antipsychotics were as good as the newer “atypicals.” We pooled “leaving the study early data” from Cochrane Reviews that existed before CATIE and CUtLASS and added data from CATIE and CUtLASS to the pool for a “before and after” comparison. Addition of CATIE and CUtLASS data only led to narrowing of the already existing confidence intervals, merely increasing precision, and decreasing the risk of Type II error. Perhaps surprisingly, CATIE and CUtLASS when pooled with the already existing data showed us that we had chosen to turn a blind eye to findings that already existed. This leads clinicians to question as to whether, in future, we need to feel less guilty about crying out early on that the emperor has no clothes on.

Cognitive Control and Discourse Comprehension in Schizophrenia

Megan A. Boudewyn, Cameron S. Carter, and Tamara Y. Swaab — Sun, 08 Apr 2012 08:27:22 +0000

Cognitive deficits across a wide range of domains have been consistently observed in schizophrenia and are linked to poor functional outcome (Green, 1996; Carter, 2006). Language abnormalities are among the most salient and include disorganized speech as well as deficits in comprehension. In this review, we aim to evaluate impairments of language processing in schizophrenia in relation to a domain-general control deficit. We first provide an overview of language comprehension in the healthy human brain, stressing the role of cognitive control processes, especially during discourse comprehension. We then discuss cognitive control deficits in schizophrenia, before turning to evidence suggesting that schizophrenia patients are particularly impaired at processing meaningful discourse as a result of deficits in control functions. We conclude that domain-general control mechanisms are impaired in schizophrenia and that during language comprehension this is most likely to result in difficulties during the processing of discourse-level context, which involves integrating and maintaining multiple levels of meaning. Finally, we predict that language comprehension in schizophrenia patients will be most impaired during discourse processing. We further suggest that discourse comprehension problems in schizophrenia might be mitigated when conflicting information is absent and strong relations amongst individual words are present in the discourse context.

Neurocognitive and Social Cognitive Approaches for Improving Functional Outcome in Early Psychosis: Theoretical Considerations and Current State of Evidence

Cali F. Bartholomeusz and Kelly Allott — Thu, 05 Apr 2012 10:32:28 +0000

Improving functional outcome, in addition to alleviating psychotic symptoms, is now a major treatment objective in schizophrenia research. Given the large body of evidence suggesting pharmacological treatments generally have minimal effects on indices of functioning, research has turned to psychosocial rehabilitation programs. Among these, neurocognitive and social cognitive interventions are at the forefront of this field and are argued to target core deficits inherent to the schizophrenia illness. However, to date, research trials have primarily focused on chronic schizophrenia populations, neglecting the early psychosis groups who are often as severely impaired in social and occupational functioning. This theoretical paper will outline the rationale for investigating adjunctive cognitive-based interventions in the early phases of psychotic illness, critically examine the current approach strategies used in these interventions, and assess the evidence supporting certain training programs for improving functional outcome in early psychosis. Potential pathways for future research will be discussed.

Gender Differences in Service Use in a Sample of People with Schizophrenia and Other Psychoses

Raquel Iniesta, Susana Ochoa, and Judith Usall — Tue, 03 Apr 2012 10:10:51 +0000

Objective. The main objective is to analyze the use of mental health services in a sample of people with schizophrenia and other psychoses according to gender. Method. The sample of this observational and retrospective study (𝑛=7483) consisted of all the persons who visited any mental health service of the Parc Sanitari Sant Joan de Déu from 2001 to 2007 with a diagnosis of schizophrenia and other psychoses. The main measures analyzed regarding gender were the frequency of patients for each diagnosis, their risk of being admitted into hospital, and the number and length of hospitalizations for the subsample of inpatient people during the study period. Results. Men are more frequent in the total sample (58.1%). For diagnosis of schizoaffective or delusional disorder, women have a higher frequency than men. Women with diagnosis of schizophrenia have a lower risk of being admitted to the hospital (RR=0.84, 95% CI (0.72, 0.97)). We found a higher risk of longer stays for men with schizophrenia of the disorganized type (RR=0.49, 95% CI (0.30, 0.81)), undifferentiated (RR=0.41, 95% CI (0.27, 0.61)), or delusional disorder (RR=0.65, 95% CI (0.49, 0.87)). Conclusion. Gender of patients is a relevant variable in mental health service use by patients with schizophrenia and other psychoses.

Treatment Adherence with Early Prescription of Long-Acting Injectable Antipsychotics in Recent-Onset Schizophrenia

Annie Viala, Françoise Cornic, and Marie-Noëlle Vacheron — Tue, 03 Apr 2012 10:09:06 +0000

Although response to treatment for the first episode of schizophrenia is generally favourable, nonadherence with the treatment is the first cause of relapse and rehospitalisation within the next few years. Long-acting injectable antipsychotics (LAIAs) combine the advantages of the newer antipsychotics and the long-acting formulation. The evaluation concerns 25 schizophrenic patients hospitalised for the first time, treated with risperidone long-acting injectable (RLAI) associated with reintegration methods, and followed up for at least 18 months. Clinical observation was completed using Clinical Global Impression (CGI) scale and Global Assessment of Functioning (GAF). Clinical improvement was coupled with a good reintegration rate, very few relapse, or rehospitalisation. Bimonthly injection combined with psychosocial methods improved interactive followup, and therefore patients’ compliance with the treatment. Treating with LAIA as early as possible, from the first episode if possible, can reduce relapse, number and duration of rehospitalisation, and cognitive symptoms and improve the quality of life and prognosis.

Evaluation of Factors Affecting Continuous Performance Test Identical Pairs Version Score of Schizophrenic Patients in a Japanese Clinical Sample

Mon, 02 Apr 2012 15:06:55 +0000

Aim. Cognitive impairment in schizophrenia strongly relates to social outcome and is a good candidate for endophenotypes. When we accurately measure drug efficacy or effects of genes or variants relevant to schizophrenia on cognitive impairment, clinical factors that can affect scores on cognitive tests, such as age and severity of symptoms, should be considered. To elucidate the effect of clinical factors, we conducted multiple regression analysis using scores of the Continuous Performance Test Identical Pairs Version (CPT-IP), which is often used to measure attention/vigilance in schizophrenia. Methods. We conducted the CPT-IP (4-4 digit) and examined clinical information (sex, age, education years, onset age, duration of illness, chlorpromazine-equivalent dose, and Positive and Negative Symptom Scale (PANSS) scores) in 126 schizophrenia patients in Japanese population. Multiple regression analysis was used to evaluate the effect of clinical factors. Results. Age, chlorpromazine-equivalent dose, and PANSS-negative symptom score were associated with mean d′ score in patients. These three clinical factors explained about 28% of the variance in mean d′ score. Conclusions. As conclusion, CPT-IP score in schizophrenia patients is influenced by age, chlorpromazine-equivalent dose and PANSS negative symptom score.

The Psychotomimetic Nature of Dreams: An Experimental Study

Oliver Mason and Dominic Wakerley — Mon, 26 Mar 2012 11:58:40 +0000

Several theories promote the similarities between dreaming and psychosis, but this has rarely been tested empirically. We assessed dreaming and waking reality using the Psychotomimetic States Inventory, a measure of psychotic-like experience originally designed for drug studies. Twenty participants completed the measure in each of two dream conditions and one waking condition. Dreams were assessed upon waking naturally and also using a movement-activated (actigraph) alarm during the night. Overall, participants reported more quasipsychotic characteristics during dreams (in both conditions) than when awake. This was most marked for paranoia and delusional thinking, but differences were also seen for perceptual abnormalities, mania, and anhedonia. The quality of dream experience seems particularly similar to psychosis in sometimes being highly self-referential and having a paranoid content. Subjective changes to cognition and affect are consistent with alterations in prefrontal cortical activity during REM sleep that mirror those of schizophrenia.

Stability of Facial Affective Expressions in Schizophrenia

H. Fatouros-Bergman, J. Spang, J. Merten, G. Preisler, and A. Werbart — Thu, 22 Mar 2012 15:09:23 +0000

Thirty-two videorecorded interviews were conducted by two interviewers with eight patients diagnosed with schizophrenia. Each patient was interviewed four times: three weekly interviews by the first interviewer and one additional interview by the second interviewer. 64 selected sequences where the patients were speaking about psychotic experiences were scored for facial affective behaviour with Emotion Facial Action Coding System (EMFACS). In accordance with previous research, the results show that patients diagnosed with schizophrenia express negative facial affectivity. Facial affective behaviour seems not to be dependent on temporality, since within-subjects ANOVA revealed no substantial changes in the amount of affects displayed across the weekly interview occasions. Whereas previous findings found contempt to be the most frequent affect in patients, in the present material disgust was as common, but depended on the interviewer. The results suggest that facial affectivity in these patients is primarily dominated by the negative emotions of disgust and, to a lesser extent, contempt and implies that this seems to be a fairly stable feature.

Sex Differences in Facial, Prosodic, and Social Context Emotional Recognition in Early-Onset Schizophrenia

Thu, 01 Mar 2012 10:55:09 +0000

The purpose of the present study was to determine sex differences in facial, prosodic, and social context emotional recognition in schizophrenia (SCH). Thirty-eight patients (SCH, 20 females) and 38 healthy controls (CON, 20 females) participated in the study. Clinical scales (BPRS and PANSS) and an Affective States Scale were applied, as well as tasks to evaluate facial, prosodic, and within a social context emotional recognition. SCH showed lower accuracy and longer response times than CON, but no significant sex differences were observed in either facial or prosody recognition. In social context emotions, however, females showed higher empathy than males with respect to happiness in both groups. SCH reported being more identified with sad films than CON and females more with fear than males. The results of this study confirm the deficits of emotional recognition in male and female patients with schizophrenia compared to healthy subjects. Sex differences were detected in relation to social context emotions and facial and prosodic recognition depending on age.