Neuropsychological and functional correlates of clock-drawing test in elderly institutionalized patients with schizophrenia.

BACKGROUND: There has been a growing need for a cognitive assessment tool that can be used for older adults with schizophrenia in clinical settings. The clock-drawing test (CDT) is a brief cognitive test that covers a wide range of cognitive function. Although it is widely used to assess patients with dementia, limited data are available on its usefulness in older patients with schizophrenia. Thus, we investigated the psychometric properties of the CDT and their relationship with life functions to examine the test's usefulness for assessing cognitive function in older adults with schizophrenia. METHODS: Seventy-three older adults with chronic schizophrenia who had been hospitalized for over 1 year participated in the study. We adopted the executive clock-drawing task for administration and scoring of the CDT, which consists of free-drawn and copy conditions. The Mini-Mental State Examination and the Brief Assessment of Cognition in Schizophrenia were administered. Symptom severity and life functions were assessed with the Positive and Negative Syndrome Scale and the Life Skills Profile, respectively. RESULTS: Both free-drawn and copy scores significantly correlated with the Mini-Mental State Examination score and the Brief Assessment of Cognition in Schizophrenia composite score. These scores also significantly correlated with symptom severity and length of current hospitalization. Stepwise regression analysis showed that only the copy score, together with symptom severity, predicted the Life Skills Profile score. CONCLUSIONS: The CDT can assess cognitive function in older adults with schizophrenia. Moreover, CDT performance is associated with life functions independent from other clinical variables. These results suggest that the CDT is a useful cognitive assessment tool for this population.

Insight and quality of life in long-term hospitalized Japanese patients with chronic schizophrenia.

AIM: The aim of the study was to investigate the relationship between insight and quality of life (QOL) and the respective predictive factors in long-term hospitalized patients with chronic schizophrenia. METHODS: The present subjects were 47 Japanese patients with chronic schizophrenia who were hospitalized for >1 year (mean hospitalization period, 9.8 years). Assessments were made using the Scale of Unawareness of Mental Disorder (SUMD) and the EuroQoL-5 Dimensions (EQ-5D) scale. Sociodemographic details and illness-related variables were also evaluated, including use of the Positive and Negative Syndrome Scale. RESULTS: There was no association between SUMD and EQ-5D scores. Hallucinatory behavior was a predictor of good insight. Poor rapport was a predictor of bad insight. Poor attention was a predictor of bad QOL. CONCLUSION: The relationship between insight and QOL and the respective predictive factors might be different between acute and chronic stages. Further studies are needed to investigate how these changes occur.

Effect of institutional smoking prohibition on Japanese inpatients with chronic schizophrenia.

OBJECTIVE: A higher prevalence of smoking among schizophrenic patients has been well documented in Japan and other countries. Smoking reduction or cessation is desirable to reduce various physical complications in schizophrenic patients, but the effect of smoking reduction on psychiatric status and BMI remains ambiguous. The aim of this study was to determine the effect of an institutional smoking prohibition on smoking status, psychiatric status and BMI in Japanese inpatients with schizophrenia. METHOD: Smoking status, psychiatric status (Clinical Global Impression (CGI) scores: global severity score and global change score) and BMI were investigated in 256 chronic schizophrenic inpatients before and 3 months after prohibition of smoking in a Japanese psychiatric hospital building. RESULTS: Following prohibition, the smoking rate decreased from 36.3% to 22.2%. A weak positive correlation was found between decreased cigarette consumption and the CGI global change score (r=0.140, p=0.025), but the mean global change scores in the smoking groups were less than 6 (minimally worse). No significant increase in BMI was observed. CONCLUSION: Institutional smoking prohibition is effective in reducing the smoking rate, while having only a minor unfavorable effect on psychiatric status and BMI in chronic schizophrenic inpatients.

Relationship between patients' quality of life and coercion in psychiatric acute wards.

The influence of coercion on quality of life (QoL) was investigated in 202 patients in acute psychiatric wards. There was no correlation between either subjective or objective coercion and QoL. Global Assessment of Functioning scores on improvement and insight were correlated with QoL.

Body mass index among Japanese inpatients with schizophrenia.

BACKGROUND: Many studies have emphasized the high frequency of obesity in schizophrenic patients. However, the characteristics of the Body Mass Index (BMI) distribution in Japanese schizophrenic patients remain unknown, and the aim of this study was to clarify these characteristics in a Japanese schizophrenic inpatient population. METHODS: The subjects were 273 inpatients (males: 141, females: 132) with schizophrenia. The patient BMI distribution was compared with normal control data obtained from the 2003 Japanese National Health and Nutrition Survey. RESULTS: The mean patient BMI was 23.0 +/- 4.3, and the BMI showed a normal distribution. The proportion of patients who were obese, of normal weight and underweight was 30.8%, 53.1%, and 16.1%, respectively. No statistical evidence of a higher frequency of obesity was found in male patients, compared to normal controls, but a higher frequency of underweight patients and a lower frequency of normal-weight patients were apparent in most decades of age. In female schizophrenia patients, a higher prevalence of obesity occurred in patients aged 50-59 years old, compared to controls. A higher rate of underweight elderly patients and a lower rate of normal-weight patients aged 40 to more than 70 years old were also apparent. CONCLUSIONS: The results suggest that not only obesity but also weight problems related to an underweight condition occur more frequently in Japanese schizophrenic inpatients than in normal controls. The deviation of the BMI distribution in Japanese schizophrenic inpatients may have a relationship with higher mortality and sudden death in schizophrenia.