Prescribing pattern of antipsychotics for patients with schizophrenia using the total daily dose online tool.

This study aimed to investigate the prescribing pattern of antipsychotic medications for schizophrenia using the British National Formulary total daily dose (TDD) online tool. We analysed data from the electronic medical records at King Khalid University Hospital (KKUH) of 272 patients diagnosed with schizophrenia who were prescribed both typical and atypical antipsychotic medications. The results showed that aripiprazole was the most commonly prescribed antipsychotic drug, followed by haloperidol then risperidone. The TDD online tool was used to calculate the TDD of each prescribed antipsychotic medication. Most patients were prescribed doses within the recommended range for each medication, although some were prescribed doses above or below the recommended range. Moreover, a high recommended TDD was associated with the combined use of antipsychotics rather than monotherapy. Additionally, high TDD levels were associated with the following antipsychotics: haloperidol, olanzapine, paliperidone, and quetiapine. Our findings highlight the importance of using evidence-based tools such as the TDD online tool to guide prescribing practices and ensure optimal dosing of antipsychotic medications for patients with schizophrenia.

Butyl Methacrylate-Co-Ethylene Glycol Dimethacrylate Monolith for Online in-Tube SPME-UHPLC-MS/MS to Determine Chlopromazine, Clozapine, Quetiapine, Olanzapine, and Their Metabolites in Plasma Samples.

This manuscript describes a sensitive, selective, and online in-tube solid-phase microextraction coupled with an ultrahigh performance liquid chromatography-tandem mass spectrometry (in-tube SPME-UHPLC-MS/MS) method to determine chlopromazine, clozapine, quetiapine, olanzapine, and their metabolites in plasma samples from schizophrenic patients. Organic poly(butyl methacrylate-co-ethylene glycol dimethacrylate) monolith was synthesized on the internal surface of a fused silica capillary (covalent bonds) for in-tube SPME. Analyte extraction and analysis was conducted by connecting the monolithic capillary to an UHPLC-MS/MS system. The monolith was characterized by scanning electron microscopy (SEM) and Fourier transform infrared spectrometry (FTIR). The developed method presented adequate linearity for all the target antipsychotics: R² was higher than 0.9975, lack-of-fit ranged from 0.115 to 0.955, precision had variation coefficients lower than 14.2%, and accuracy had relative standard error values ranging from -13.5% to 14.6%, with the exception of the lower limit of quantification (LLOQ). The LLOQ values in plasma samples were 10 ng mL-1 for all analytes. The developed method was successfully applied to determine antipsychotics and their metabolites in plasma samples from schizophrenic patients.

[The Effects of a Biosensing Game on the Physical Health-Related Fitness of Chronic Schizophrenic Patients].

BACKGROUND: Being overweight is a common problem among chronic schizophrenic patients. However, these patients lack related exercise interventions that are both effective and convenient. PURPOSE: To explore the effects of a biosensing game intervention on the health-related fitness of chronic schizophrenic patients. METHODS: Two rehabilitation wards at a psychiatric hospital in New Taipei City were selected as the study sites. Simple random sampling was used to recruit participants. Participants in the experimental group received a 12-week biosensing game intervention, while participants in the control group received routine nursing care only. The study instruments included a demographic data sheet and anthropometric measurements. In addition, health-related fitness variables including cardiovascular endurance, muscular endurance, flexibility, and body composition (e.g., body mass index (BMI), waist-hip ratio, and body fat) were used as outcome indicators. RESULTS: A total of 35 patients participated in the experimental group and 35 patients participated in the control group. The results showed that the mean differences between the pre-test and post-test values for body weight (t=6.07, p<.01), BMI (t=5.79, p<.01), and waist-hip ratio (t=2.87, p<.05) differed significantly, with the experimental group performing better than the control group on all three indicators. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: The results indicate that this 12-week intervention holds the potential to help chronic schizophrenic patients improve their health-related fitness, especially in terms of body weight, BMI, and waist-hip ratio. This study may be used as a reference for the promotion of health-related fitness programs in psychiatric institutes in the future.

Empathy deficit in male patients with schizophrenia and its relationships with impulsivity and premeditated violence.

Objective: To explore the pattern of empathy characteristics in male patients with schizophrenia (SCH) and to examine whether empathy deficit is associated with impulsivity and premeditated violence. Methods: One hundred and fourteen male SCH patients were enrolled in this study. The demographic data of all patients were collected and the subjects were divided into two groups, namely, the violent group, including 60 cases, and the non-violent group, comprising 54 cases, according to the Modified Overt Aggression Scale (MOAS). The Chinese version of the Interpersonal Reactivity Index-C (IRI-C) was used to evaluate empathy and the Impulsive/Predicted Aggression Scales (IPAS) was employed to assess the characteristics of aggression. Results: Among the 60 patients in the violent group, 44 patients had impulsive aggression (IA) and 16 patients had premeditated aggression (PM) according to the IPAS scale. In the violent group, the scores of the four subfactors of the IRI-C, i.e., perspective taking (PT), fantasy (FS), personal distress (PD), and empathy concern (EC), were significantly lower than in the non-violent group. Stepwise logistic regression showed that PM was independent influencing factor for violent behaviors in SCH patients. Correlation analysis revealed that EC of affective empathy was positively correlated with PM but not with IA. Conclusion: SCH patients with violent behavior had more extensive empathy deficits compared with non-violent SCH patients. EC, IA and PM are independent risk factors of violence in SCH patients. Empathy concern is an important index to predict PM in male patients with SCH.

Toxoplasmosis Is More Frequent in Schizophrenia Patients Than in the General Population in Mexico and Is Not Associated with More Severe Course of Schizophrenia Measured with the Brief Psychiatric Rating Scale.

Toxoplasmosis is a disease, which was discovered in 1908, caused by the intracellular parasite Toxoplasma gondii. T. gondii infects neuronal, glial, and muscle cells, and chronic infections are characterized by the presence of cysts, in the brain and muscle cells, formed by bradyzoites. T. gondii is capable of synthesizing L-DOPA, a precursor of dopamine. Dopamine is a neurotransmitter that is key in the etiology of neuropsychological disorders such as schizophrenia. Previous studies have shown high levels of IgG Toxoplasma antibodies in schizophrenia patients. Many published studies show that the prevalence of toxoplasmosis is higher in schizophrenia patients. In this study, we aimed to identify the prevalence of Toxoplasma infection in patients with schizophrenia and the relationships between, sociodemographic factors and the Brief Psychiatric Rating Scale. A total of 27 schizophrenic patients were included and IgG anti-T. gondii was determined in serum samples by ELISA. The Brief Psychiatric Rating Scale, sociodemographic factors were associated with seropositivity. We found that the prevalence of Toxoplasma antibodies was 51.7%. In the Brief Psychiatric Rating Scale, statistical significant association (p = 0.024) was found in Item 13 which is related to motor retardation, however, the association turned non-significant after of correction for multiple tests or after of analyzed with a logistic regression p = 0.059, odds ratio (OR) = 2.316 with a 95% confidence interval [0.970 to 5.532]. Other association was not found between toxoplasmosis and others factors. The prevalence of toxoplasmosis on our population under study was significantly higher than that reported by general population or other group of Mexican schizophrenia patients.

Optimizing and Individualizing the Pharmacological Treatment of First-Episode Schizophrenic Patients: Study Protocol for a Multicenter Clinical Trial.

Introduction: Affecting ~1% of the world population, schizophrenia is known as one of the costliest and most burdensome diseases worldwide. Antipsychotic medications are the main treatment for schizophrenia to control psychotic symptoms and efficiently prevent new crises. However, due to poor compliance, 74% of patients with schizophrenia discontinue medication within 1.5 years, which severely affects recovery and prognosis. Through research on intra and interindividual variability based on a psychopathology-neuropsychology-neuroimage-genetics-physiology-biochemistry model, our main objective is to investigate an optimized and individualized antipsychotic-treatment regimen and precision treatment for first-episode schizophrenic patients. Methods and Analysis: The study is performed in 20 representative hospitals in China. Three subprojects are included. In subproject 1, 1,800 first-episode patients with schizophrenia are randomized into six different antipsychotic monotherapy groups (olanzapine, risperidone, aripiprazole, ziprasidone, amisulpride, and haloperidol) for an 8-week treatment. By identifying a set of potential biomarkers associated with antipsychotic treatment response, we intend to build a prediction model, which includes neuroimaging, epigenetics, environmental stress, neurocognition, eye movement, electrophysiology, and neurological biochemistry indexes. In subproject 2, apart from verifying the prediction model established in subproject 1 based on an independent cohort of 1,800 first-episode patients with schizophrenia, we recruit patients from a verification cohort who did not get an effective response after an 8-week antipsychotic treatment into a randomized double-blind controlled trial with minocycline (200 mg per day) and sulforaphane (3 tables per day) to explore add-on treatment for patients with schizophrenia. Two hundred forty participants are anticipated to be enrolled for each group. In subproject 3, we tend to carry out one trial to construct an intervention strategy for metabolic syndrome induced by antipsychotic treatment and another one to build a prevention strategy for patients at a high risk of metabolic syndrome, which combines metformin and lifestyle intervention. Two hundred participants are anticipated to be enrolled for each group. Ethics and Dissemination: The study protocol has been approved by the Medical Ethics committee of the Second Xiangya Hospital of Central South University (No. 2017027). Results will be disseminated in peer-reviewed journals and at international conferences. Trial Registration: This trial has been registered on Clinicalrials.gov (NCT03451734). The protocol version is V.1.0 (April 23, 2017).

A novel approach to cardiovascular disturbances in patients with schizophrenia spectrum disorders treated with long-acting injectable medication.

PURPOSE: This research article assesses the cardiovascular impact of long-term injectable antipsychotic therapy on patients diagnosed with schizophrenia spectrum disorders. In our study, we attempted to quantify the potential causes of cardiovascular damage, assess cardiovascular parameters, and correlate them with the time elapsed from the onset of the psychosis until the initiation of injectable antipsychotic therapy, as well as the duration of long-acting therapy, and finally, to compare two of the most utilized long-acting injectable (LAI) medications (olanzapine vs risperidone). PATIENTS AND METHODS: This cross-sectional study recruited 64 patients of 2 outpatient clinics undergoing treatment with LAI antipsychotics for schizophrenic spectrum disorder. The study reports outpatients' clinical data, laboratory blood sample findings, routine echocardiography, as well as speckle tracking echocardiography. RESULTS: Among patients with longer durations of pre-long-acting antipsychotic treatment, body mass indices, mitral velocity wave values (E and A waves), and the global longitudinal strain (GLS) measurements significantly correlated with patients' myocardial contractility. The study also found that GLS was significantly lower in the group in which pre-LAI duration was prolonged, and was not influenced by the duration of LAI treatment. Furthermore, patients receiving olanzapine showed significantly improved myocardial contractility as measured by the aforementioned parameters, in comparison with patients treated with risperidone. CONCLUSION: The results of our study indicate that patients suffering from schizophrenia and who are left untreated or poorly treated for a longer period of time may develop myocardial impairment. The changes may be both secondary to a high prevalence of cardiovascular risk factors and may also be generated by the disease per se. The group who received olanzapine demonstrated improved results for a longer period of time without proper medication.

Relationship between Caregiver Burden and Expressed Emotion in Families of Schizophrenic Patients.

BACKGROUND: Schizophrenia is a clinical syndrome that is variable, but highly disturbing; its psychopathology involves cognition, emotion, perception, and other aspects of behaviour. Schizophrenic patients who are hospitalised, who return to a family environment characterised by high levels of criticism, excessive emotional involvement, or hostility (referred to as high expressed emotion) are more likely to experience the recurrence than schizophrenic patients returning to families characterised by low expressed emotion. AIM: We aimed to investigate the level of care load in the families of schizophrenic patients. METHODS: This research is an analytic study with a cross-sectional approach. The research site is in the outpatient installation of BLUD Mental Health Hospital of North Sumatra Province using consecutive non-probability sampling. The samples are family members who carry schizophrenic patients go to an outpatient installation at the BLUD Mental Health Hospital of North Sumatra Province that meets the inclusion and exclusion criteria. RESULTS: The burden of care for the families of the most schizophrenic patients was mid load as many as 36 people, namely 36%, the light burden of 34 people, 34%, no burden of 18 people, 18%, and the heavy burden of 12 people, 12%. There is a significant relationship between the burden of treatment with expressed emotion, which is 0.004 (p < 0.05). CONCLUSION: In this study, we showed a significant relationship between the burden of treatment with expressed emotion (p = 0.004). This study is by the study conducted by Darwin in 2013, and Carra in 2012, which showed that there was a significant relationship between the burden of treatment with expressed emotion in the families of schizophrenic patients. Other studies also show that the burden of care has an impact on emotional, physical health, social life, and financial status as a result of caring for sick people.

The Comparison of Olanzapine and Risperidone Treatment in Male Schizophrenic Patients using Positive and Negative Syndromes Scale (PANSS).

INTRODUCTION: The most common method to compare olanzapine and risperidone is by calculating the score of positive and negative syndromes scale (PANSS). However, there were some conflicting results mentioned from previous studies. AIM: This study aimed to compare the treatment of olanzapine and risperidone using PANSS, limited to only male patients receiving inpatient treatment to obtain more significant results. METHODS: The subjects of this study were male schizophrenic patients in the acute phase of treatment (N = 68) who were hospitalised at the Mental Hospital Prof. Dr M. Ildrem, Indonesia. These participants were divided into two groups and treated with different atypical antipsychotics (olanzapine, 20 mg/day [n = 34]; risperidone, 6 mg/day [n = 34]). The scores of PANSS from both groups were collected from pre-test and post-test after 6 -week treatment. RESULTS: The improvement of the schizophrenia symptoms measured by PANSS after 6 weeks showed significant differences in the scores of PANSS between the male patient groups treated with olanzapine and risperidone (p-value < 0.001). CONCLUSION: The group of olanzapine shows a higher improvement of the scores of PANSS than that the group of risperidone.

Effectiveness of gratitude disposition promotion program on depression and quality of life of chronic schizophrenic patients.

CONTEXT: Gratitude intervention is expectedly an effective intervention to reduce depression and improve the quality of life in schizophrenic patients, but there is a lack of literature on it. AIMS: We attempted to develop and test the effectiveness of the gratitude disposition promotion program for chronic schizophrenic patients in Korea. SETTINGS AND DESIGN: Nonequivalent control group pre- and post-test design was used in two mental health centers located at Gyeonggi-do in South Korea. MATERIALS AND METHODS: This paper was a quasi-experimental study and the participants who took part in the gratitude disposition promotion program were 17 of experimental group and 15 of control group. Gratitude disposition (the short gratitude, resentment, and appreciation test), depression (Beck Depression Inventory), and quality of life (developed by Kook) of chronic schizophrenic patients were measured before and after an intervention, as compared to the control. STATISTICAL ANALYSIS: Chi-square test, Fisher's exact test, and t-test were performed for prehomogeneity testing for variables related to the general characteristics. Testing for the effectiveness of gratitude disposition promotion program and hypothesis testing for its effect on depression and quality of life were by ANCOVA and t-test, as verified to significance level of P < 0.05. RESULTS: The participants who received the gratitude disposition promotion program showed significant improvements in gratitude disposition (F = 18.740, P < 0.0001) and in quality of life (F = 9.800, P = 0.004), but no significant difference in depression (F = 3.870, P = 0.059). CONCLUSIONS: The gratitude disposition promotion program was an effective clinical intervention program for enhancing gratitude disposition and quality of life of chronic schizophrenic patients in community.

Negative Correlation between Serum S100B and Leptin Levels in Schizophrenic Patients During Treatment with Clozapine and Risperidone: Preliminary Evidence.

Recently, extensive efforts have been made to understand the rate of energy expenditure and the weight gain associated with atypical antipsychotic treatment, including identification of markers of obesity risk. In recent years, leptin, an adipocyte hormone, has gained significant interest in psychiatric disorders. S100B has been considered as a surrogate marker for astrocyte-specific damage in neurologic disorders. Also, S100B has been detected in adipose with concentration as high as nervous tissue as a second release source. In this study we evaluated the relationship between S100B and leptin in schizophrenic patients under treatment with clozapine and risperidone.This study included 19 patients meeting the DSM-IV-TR criteria for schizophrenia, having body mass index (BMI) of 16- 25 kg/m(2) and suffering schizophrenia for more than 3 years and from this study. Twenty five healthy controls were group matched for age and gender whose BMI was 16-25 kg/m(2). Serum S100B and leptin levels and positive and negative symptom scale (PANSS) were assessed at admission and after six weeks. During the study, S100B showed a strong and negative correlation with leptin (r = -0.5, P = 0.01). Also, there were negative correlation between serum S100B level and PANSS negative subscale after 6 weeks of treatment (r = -0.048, P = 0.8). Positive correlation between leptin level and PANSS suggested a potential role for leptin which can mediate the link between antipsychotic induced weight gain and therapeutic response in schizophrenia.

Effectiveness of Vitamin D Supplement Therapy in Chronic Stable Schizophrenic Male Patients: A Randomized Controlled Trial.

In this study, the aim was to determine whether adding vitamin D to the standard therapeutic regimen of schizophrenic male patients with inadequate vitamin D status could improve some aspects of the symptom burden or not. This study was an open parallel label randomized clinical trial. Eighty patients with chronic stable schizophrenia with residual symptoms and Vitamin D deficiency were recruited randomly and then received either 600000 IU Vitamin D injection once along with their antipsychotic regimen or with their antipsychotic regimen only. Serum vitamin D was measured twice: first at the baseline and again on the fourth month. Positive and Negative Syndrome Scale (PANSS) was assessed at the baseline and on the fourth month. During the study, the vitamin D serum changes in vitamin group and control group were 22.1 ± 19.9(95%CI = 15.9-28.8) and 0.2 ± 1.7(95%CI = 0.2-0.8) (ng/mL) (p<0.001) respectively. The changes of PANSS positive subscale score (P) were -0.1±0.7 (95%CI =-0.3-0.1) and 0.00 ± 0.8 (95%CI = -0.2-0.2) in vitamin D and control group respectively (p=0.5). The changes of PANSS negative subscale score (N) were -0.1 ± 0.7 (95%CI = -0.3-0.05) and -0.1 ± 0.5 (95%CI = -0.2-0.04) in vitamin D and control group respectively (p = 0.7) and there was a negative but not significant correlation between serum vitamin D level changes and PANSS negative subscale score (r = -0.04, p = 0.7). We did not find a relationship between serum vitamin D level changes and the improvement of negative and positive symptoms in schizophrenic patients and more randomized clinical trials are required to confirm our findings.

Visual field loss in schizophrenia: evaluation of magnocellular pathway dysfunction in schizophrenic patients and their parents.

PURPOSE: We sought to evaluate the visual pathway deficits in schizophrenic patients, compared with their parents and healthy controls, using Matrix frequency doubling technology (FDT) perimetry. Matrix FDT is an ophthalmic test used to detect visual field loss. METHOD: A total of 13 patients, 13 parents, and 12 healthy controls were enrolled in the study. Participants were subjected to Matrix FDT perimetry in a single test session. We analyzed the mean deviation for each eye and used a generalized estimated equation to evaluate differences among the groups and correct the dependency between the eyes. RESULTS: The global mean deviation (presented as the mean of both eyes) was significantly lower in the schizophrenic patients than in their parents or controls. Analysis of the general sensitivity of the fibers crossing the optic chiasm showed a difference between the groups (P = 0.006), indicating that the sensitivity of the fibers crossing the optic chiasm was lower than those which did not cross. But when we analyzed the specific groups, the difference between the fibers was not considerable. Comparison of the right and left hemispheres showed that general sensitivity was lower for the left hemisphere, but when we analyzed specific groups, the difference was not significant (P = 0.29). CONCLUSION: These findings are suggestive of a lower global sensitivity in schizophrenic patients and their parents compared with controls. This difference may be an endophenotype of schizophrenia. The present study adds to a growing body of research on early-stage visual processing deficits in schizophrenia.

Faux Pas Test in schizophrenic patients / Teste de Faux Pas em pacientes com esquizofrenia

ABSTRACT Objective The aim of this study is to validate the adult version of “Faux Pas Recognition Test” created by Stone and colleagues (1998) as a reliable instrument assess and discriminate social cognition among schizophrenia patients and healthy controls. Methods This is a cross-sectional study with a total of 196 participants (mean age = 26.45; CI (95%) [25.10; 27.83]) 51% male. From those, 44 (22.4%) patients with schizophrenia and 152 (77.6%) healthy controls. The participants answered a short version of the Faux Pas Recognition Test, composed by 10 stories. Results Significant differences were found between both groups regarding their scores on Faux Pas Recognition Test (p = 0.003). Patients with schizophrenia had lower score, compared to healthy controls. Story 14 was the best to distinguish both groups, and Story 16, the worst. Among the questions of Faux Pas stories, the one related to intuition presented the most significant difference between the groups (p = 0.001), followed by the one related to understanding (p = 0.003). Conclusion The Brazilian version of the Faux Pas Recognition Test is a valid test to assess social cognition in schizophrenia and can be an important instrument to be used on the clinical practice.

RESUMO Objetivo O objetivo deste estudo é validar a versão brasileira da versão adulta do Teste de Reconhecimento de Faux pas criado por Stone e colaboradores (1998) como um instrumento confiável para avaliar e discriminar a cognição social entre pessoas com esquizofrenia e controles saudáveis. Métodos Trata-se de um estudo transversal com um total de 196 participantes (idade média = 26,45; IC (95%) [25,10; 27,83]), sendo 51% homens; destes, 44 (22,4%) eram pessoas com esquizofrenia e 152 (77,6%), controles saudáveis. Os participantes responderam a uma versão reduzida do Teste de Reconhecimento de Faux Pas, contendo 10 histórias. Resultados Foram encontradas diferenças significativas entre grupos no Teste de Reconhecimento de Faux Pas (p = 0,003). Pessoas com esquizofrenia obtiveram menor pontuação comparadas com o grupo controle. A história 14 foi a mais eficiente para distinguir os grupos, ao passo que a história 16 foi a pior. Quanto às questões das histórias Faux Pas, aquela referente à intuição foi a que apresentou maior diferença entre grupos (p = 0,001) seguida por compreensão (p = 0,003). Conclusão A versão brasileira do Teste de Reconhecimento de Faux Pas é um instrumento válido para avaliar a cognição social em esquizofrenia e pode ser um instrumento importante a ser usado na prática clínica.

Schizophrenic patients have a preference for symmetrical rectangles: A comparison with preferences of university students.

Objective. We examined figure preferences of 26 schizophrenic patients and a control group of 53 controls (university students). Methods. Figures utilized included a square and six different rectangles of equal area (26 cm(2)). The schizophrenic patients and normal university students were asked to draw either a horizontal or a vertical line to divide each rectangle at the most aesthetically pleasing location. Results. Both the schizophrenic patients and the normal university students tended to divide the rectangles into symmetric parts. This finding suggests that both groups prefer symmetry, in accordance with the Gestalt of Pragnanz, which states that symmetrical figures represent regularity and simplicity, and that people tend to prefer "good figures". Compared with normal university students, however, schizophrenic patients preferred extremely symmetrical figures to asymmetrical figures. Conclusion. We suggest that schizophrenic patients' extreme preference for symmetry reflects their generally static stances and poor flexibility, as well as a defect in their ability to synthesize a whole object from its parts.