Changes in event-related potentials in patients with first-episode schizophrenia and their siblings.

BACKGROUND: This study aimed to explore the characteristics of event-related potentials induced by facial emotion recognition in patients with first-episode schizophrenia and in their siblings. METHODS: In this case-control study, 30 first-episode schizophrenia patients, 26 siblings, and 30 healthy controls were enrolled. They completed facial emotion recognition tasks from the Ekman Standard Faces Database as an induction for evoked potentials. Evoked potential data were obtained using a 64-channel electroencephalography system. Average evoked potential waveforms were computed from epochs for each stimulus type. The amplitudes and latency of the event-related potentials for P100 (positive potential 100 ms after stimulus onset), N170 (negative potential 170 ms after stimulus onset), and N250 (fronto-central peak) were investigated at O1, O2, P7, and P8 electrode locations. RESULTS: There were significant differences between the groups for P100 amplitude (F = 11.526, P < 0.001), electrode position (F = 450.592, P < 0.001), emotion (disgust vs. happiness vs. fear) (F = 1722.467, P < 0.001), and emotion intensity (low vs. moderate vs. high) (F = 1737.169, P < 0.001). Post hoc analysis showed significantly larger amplitudes in the schizophrenia group at the O1, O2, P7, and P8 electrode positions. There were no significant differences between the siblings of schizophrenia patients and the healthy controls. CONCLUSIONS: Patients with schizophrenia showed abnormalities in P100 amplitude, but similar results were not observed in their siblings. These results provide evidence of dysfunctional event-related potential patterns underlying facial emotion processing in patients with schizophrenia. P100 may be a characteristic index of schizophrenia.

The relationship between facial emotion recognition and executive functions in first-episode patients with schizophrenia and their siblings.

BACKGROUND: Although many studies have examined executive functions and facial emotion recognition in people with schizophrenia, few of them focused on the correlation between them. Furthermore, their relationship in the siblings of patients also remains unclear. The aim of the present study is to examine the correlation between executive functions and facial emotion recognition in patients with first-episode schizophrenia and their siblings. METHODS: Thirty patients with first-episode schizophrenia, their twenty-six siblings, and thirty healthy controls were enrolled. They completed facial emotion recognition tasks using the Ekman Standard Faces Database, and executive functioning was measured by Wisconsin Card Sorting Test (WCST). Hierarchical regression analysis was applied to assess the correlation between executive functions and facial emotion recognition. RESULTS: Our study found that in siblings, the accuracy in recognizing low degree 'disgust' emotion was negatively correlated with the total correct rate in WCST (r = -0.614, p = 0.023), but was positively correlated with the total error in WCST (r = 0.623, p = 0.020); the accuracy in recognizing 'neutral' emotion was positively correlated with the total error rate in WCST (r = 0.683, p = 0.014) while negatively correlated with the total correct rate in WCST (r = -0.677, p = 0.017). People with schizophrenia showed an impairment in facial emotion recognition when identifying moderate 'happy' facial emotion, the accuracy of which was significantly correlated with the number of completed categories of WCST (R(2) = 0.432, P < .05). There were no correlations between executive functions and facial emotion recognition in the healthy control group. CONCLUSIONS: Our study demonstrated that facial emotion recognition impairment correlated with executive function impairment in people with schizophrenia and their unaffected siblings but not in healthy controls.

Effect of time and duration of untreated psychosis on cognitive and social functioning in Chinese patients with first-episode schizophrenia: A 1-year study.

BACKGROUND: Duration of untreated psychosis (DUP) is believed to exert a deleterious effect on cognitive and social function. However, to date, results remain inconclusive. AIMS: To investigate the effect of time and DUP on cognitive and social functioning in first-episode schizophrenia (FES) subjects in Shanghai, China. METHODS: FES patients were subjected to a comprehensive neuropsychological battery, the Personal and Social Performance scale (PSP) and the Positive and Negative Symptoms Scale (PANSS) at baseline, 6 month and 1 year. DUP was defined as the time from onset of first psychotic symptoms to first contact made with psychiatric services. RESULTS: Though the rate of non-completers in our observational study was relatively high (40%), we did not find any significant differences between the completers and non-completers (P-values > 0.05). Significant impairments in verbal learning and memory and executive function were noted over the course of 1 year. Meanwhile, social function improved significantly over the course of 1 year. Although, DUP did not share any significant relationship with cognitive or social function the effect estimate (range: - 0.03 to 0.02) of an increase of 1 month in DUP was clinically non-negligible in this study. CONCLUSIONS: In Chinese FES patients, the longitudinal course of cognitive function tends to worsen in verbal learning and memory, executive function and motor speed, while that of social function tends to improve. DUP was not found to be associated with cognitive or social deterioration in Chinese FES.

Factors influencing quality of life in Chinese patients with persistent somatoform pain disorder.

This cross-sectional survey aimed to explore quality of life (QoL) and its correlated factors in Chinese patients with persistent somatoform pain disorder (PSPD) and their related correlation factors in Shanghai, China. A total of 60 patients were assessed with Short Form (36) health survey (SF-36) for QoL, medical outcomes study pain measurement (MOSPM) for pain symptoms, Hamilton depression scale - 17 items (HAMD) for depression and Hamilton anxiety scale (HAMA) for anxiety. Results were as follows: (1) Patients scored significantly lower on all SF-36 subscales' scores ( p < .01) apart from the mental health and vitality subscales; (2) With the exception of the general health subscale, SF-36 subscales' scores were negatively correlated with the total score of MOSPM, three factor scores of MOSPM, and total scores of HAMD and HAMA; (3) PSPD patients with severe depression had significantly lower scores (p < .01) on SF-36 subscales' scores (except for GH subscale) and component summary scores as compared to PSPD patients with none or moderate depression; and (4) Multiple linear stepwise regression revealed that SF-36's physical component summary (PCS) subscale correlated with patients' age and MOSPM total score while SF-36's mental component summary (MCS) subscale correlated with total scores of HAMD and MOSPM total score. In sum, PSPD patients had a lower QoL as compared to general population. Pain, depression, and anxiety were significantly correlated with QoL of PSPD patients while age, pain, and depression were important factors influencing PCS and MCS.

Applicability of the Chinese version of the 16-item Prodromal Questionnaire (CPQ-16) for identifying attenuated psychosis syndrome in a college population.

AIM: The aim of this study was to examine the reliability, validity, sensitivity and specificity of the Chinese version of the 16-item Prodromal Questionnaire (CPQ-16) for identifying attenuated psychosis syndrome (APS) in a college population. METHODS: The participants were recruited from a university. Five hundred seventy-nine students completed the CPQ-16 and the Symptom Checklist-90. One class (n = 79) was randomly selected to be retested with the CPQ-16 after 2 weeks. A randomly selected group of 49 individuals who tested positive and 50 individuals who tested negative were interviewed using the Structured Interview for Prodromal Syndromes (SIPS). RESULTS: The internal consistency reliability was good (Cronbach's α = 0.72). The test-retest reliability was 0.88. The total score on the CPQ-16 was moderately to highly correlated with the total score on the Symptom Checklist-90 and all of the subscales (r = 0.39-0.67, P < 0.001). A cut-off CPQ-16 score of 9 was used to differentiate between those with a APS diagnosis on the SIPS versus those with no SIPS diagnoses; this cut-off value yielded 85% sensitivity, 87% specificity, a positive predictive value of 63% and a positive likelihood ratio of 6.69. The area under the ROC curve (AUC) was significant for the CPQ-16 total score (AUC = 0.93, SE = 0.026, 95% CI = 0.87-0.98, P < 0.001). Based on the proposed cut-off score, the CPQ-16 yielded a positive rate of 5.0% (29/579). CONCLUSIONS: The CPQ-16, administered in a face-to-face interview, demonstrated high reliability and the ability to identify college students at risk for psychosis.

Identification and characterization of college students with attenuated psychosis syndrome in China.

Most studies on psychotic-like experiences in the non-clinical population were based on self-reported surveys, without any attempt to validate the clinical interview. The present study aimed to test whether the Attenuated Psychosis Syndrome (APS) could be detected in a college population by checking self-report results against an additional interview. A two-stage screening process was used in a sample of 579 college students (16-22 years old): a 16-item Chinese version of the Prodromal Questionnaire (CPQ-16) followed by the Structured Interview for Psychosis-Risk Syndromes (SIPS). Psychopathology symptoms were assessed using the Symptom Checklist-90 (SCL-90). There were 20 (3.5%) students who met the criteria for the APS according to SIPS. Compared with control students, the students with APS were more likely to be from divorced families and had more psychopathology based on the SCL-90. Certain factors on the SCL-90, including Obsessive-Compulsive (OBS), Interpersonal Sensitivity (INT), and Depression (DEP) were significantly correlated with positive psychosis risk symptoms on the SIPS, but only DEP had a strong correlation with the total score on the SIPS. These results demonstrate that the APS can be detected in a college sample and that psychosis risk symptoms are associated with co-occurring psychopathology.

A randomized, 4-week double-blind placebo control study on the efficacy of donepezil augmentation of lithium for treatment of acute mania.

INTRODUCTION: A significant number of mania patients fail to respond to current pharmacotherapy, thereby there is need for novel augmentation strategies. The results of some early studies showed the effectiveness of cholinomimetics in the treatment of mania. One open case series suggested the efficacy of donepezil in the treatment of bipolar disorder. Our aim was to explore whether an oral cholinesterase inhibitor, donepezil, administered during a 4-week treatment period, would benefit patients with acute mania. METHODS: We conducted a 4-week double-blind, placebo-controlled trial of donepezil as an adjunctive treatment to lithium in patients with acute mania. Eligible subjects were randomly assigned to receive donepezil or placebo in addition to lithium. Donepezil was started at 5 mg/day, and increased to 10 mg/day in the first week. Patients were rated with the Young Mania Rating Scale (YMRS) and Brief Psychiatric Rating Scale (BPRS) at baseline, day 1, week 1, week 2, and week 4. RESULTS: Out of the 30 patients who were enrolled, 15 were on donepezil and 15 were on placebo. All patients completed the 4-week trial. On the first day, there was a difference of 1.97 units on the psychomotor symptoms scale of the YMRS in the donepezil group as compared to the placebo group (t = 2.39, P = 0.02). There was a difference of 0.57 units (t = 2.09, P = 0.04) in the speech item and a difference of 0.29 units in the sexual interest item (t = 2.11, P = 0.04) in the donepezil group as compared to the placebo group. The total YMRS difference on the first day approached the conventional significance level (1.97 units, t = 1.84, P = 0.07). Over the course of 4 weeks, we failed to find that donepezil produced any significant difference in the YMRS (6.71 units difference, t = -1.44, P = 0.16) or the BPRS scale (1.29 units difference, t = -0.33, P = 0.75) as compared to placebo. Ten subjects (66.67%) in both groups met the criteria for clinical response (Fisher's exact P = 1.00). Five subjects (33.33%) in the donepezil group met the criteria for clinical remission while nine subjects (60.00%) in the placebo group met the remission criteria (Fisher's exact P = 0.27). CONCLUSION: Use of the oral anticholinergic donepezil had some benefit in the augmentation of lithium treatment on the first day, but did not provide any significant benefits in the long-term.