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Turner syndrome has various presentations such as short stature, webbed neck, amenorrhea, cubitus valgus, renal anomalies, cardiac defects, etc. Still, the concurrent psychiatric concerns with Turner syndrome are not well-established in the literature. Although most patients with Turner syndrome do not have any mental disorder, a significant proportion of patients with Turner mosaic develop schizophrenia and affective disorders. Very few sporadic cases have been reported in the literature that support the association of the Turner mosaic with schizophrenia and affective disorders worldwide. In this case report we will be discussing an 18-year-old who was identified as the 45X0 / 46Xi (Xq) Turner Mosaic by karyotyping. During her follow-up visits, she was diagnosed with a schizophreniform disorder. Individuals who have both these comorbid conditions are infrequent in this case. A multidisciplinary approach to management consisting of antipsychotics, supportive psychotherapy, and endocrine replacement therapy was initiated for our patient and she responded well on follow-up visits. Our case report adds a potential clue that emphasizes the association of Turner mosaic with the development of schizophrenia. It highlights the importance of early diagnosis of the syndrome and understanding its association with schizophreniform disorder, which should warrant the clinician's early psychotherapy specified toward the psychological as well as the emotional aspects which might play a major role in preventing severe psychiatric complications in these patients. A literature review on this topic is also presented.
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resumen Introducción: Se sabe que la falta de adherencia a los medicamentos psiquiátricos tiene consecuencias perjudiciales tanto para los pacientes como para la sociedad. Objetivo: Recopilar información sobre la incidencia de falta de adherencia, los factores y las causas que afectan a la adherencia al tratamiento psicofarmacológico de los pacientes con trastornos mentales graves y persistentes. Métodos: Revisión sistemática de artículos científicos en pacientes adultos (edad > 17 arios), publicados en los últimos 5 años (2015-2020) en bases de datos especializadas como Pub-Med, Scopus, Scielo y BioMed. Se incluyeron artículos de revistas indexadas con factor de impacto > 0,5 en inglés o español, originales, con diseño analítico, prospectivo, retrospectivo, transversal y aleatorizados. Una vez identificados los artículos, se procedió a su análisis, extrayendo la información necesaria para responder las preguntas de investigación. Resultados: Se incluyeron 15 artículos, el 40% (n = 6) publicados en 2020, el 20% (n = 3) realizados en China y el 53,3% (n = 8) de diseño observacional. Se incluyó una población total de 5.837 pacientes, varones el 50,6% (n = 2.955). Reportaron adherencia moderada 10 investigaciones (66,7%). La falta de adherencia varía desde el 7,7 al 60,6%. Los factores que afectan a la adherencia son propios del paciente (edad y sexo) o su red de apoyo familiar, relacionados con la enfermedad o el tratamiento. La principal causa de la falta de adherencia es la ausencia de insight. Conclusiones: La adherencia al tratamiento con psicofármacos es multifactorial. Se debería mejorar el acceso a los servicios de salud mental, poner énfasis en la formación del paciente y aportar mayor conocimiento de la enfermedad mental; la formación y la interacción con el psiquiatra podrían ser intervenciones beneficiosas.
abstract Introduction: It is known that non-adherence to psychiatric medications has harmful consequences for both patients and society. Objective: To collect information on the incidence of non-adherence, and the factors and causes affecting adherence to psychopharmacological treatment in patients with severe and persistent mental disorders. Methods: A systematic review of scientific articles on adult patients (>17 years) published in the last five years (2015-2020) on specialized databases such as PubMed, Scopus, Scielo and BioMed. Original articles from indexed journals with an impact factor>0.5, in English or Spanish, with an analytical, prospective, retrospective, cross-sectional and randomized design were included. Once the articles were identified, they were analyzed, extracting the information necessary to answer the research questions. Results: Fifteen articles were included. Of these, 40% (n = 6) were published in 2020, 20% (n = 3) were produced in China and 53.3% (n = 8) had an observational design. A total of 5,837 patients were included, of which 50.6% were men (n = 2,955), with moderate adherence (n = 10; 66.7%) reported in 10 investigations. Non-adherence varies from 7.7% to 60.6%. The factors that affect adherence are specific to the patient (age and sex), their family support network, and related to the disease or the treatment. The main cause of non-adherence is lack of insight. Conclusions: Adherence to treatment with psychotropic drugs is multifactorial. Access to mental health services should be improved, with an emphasis placed on patient education and providing greater knowledge of mental illness. Interventions to promote education and interaction with the psychiatrist could be beneficial.
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SUMMARY: Volume abnormalities in subcortical structures, including the hippocampus, amygdala, thalamus, caudate, putamen, and globus pallidus have been observed in schizophrenia (SZ) and bipolar disorder (BD), not all individuals with these disorders exhibit such changes. In addition, the specific patterns and severity of volume changes may vary between individuals and at different stages of the disease. The study aims to compare the volumes of these subcortical structures between healthy subjects and individuals diagnosed with SZ or BD. Volumetric measurements of lateral ventricle, globus palllidus, caudate, putamen, hippocampus, and amygdale were made by MRI in 52 healthy subjects (HS), 33 patients with SZ, and 46 patients with BD. Automatic segmentation methods were used to analyze the MR images with VolBrain and MRICloud. Hippocampus, amygdala and lateral ventricle increased in schizophrenia and bipolar disorder patients in comparison with control subjects using MRIcloud. Globus pallidus and caudate volume increased in patients with schizophrenia and bipolar disorder compared control subjects using Volbrain. We suggested that our results will contribute in schizophrenia and bipolar disorder patients that assessment of the sub-cortical progression, pathology, and anomalies of subcortical brain compositions. In patients with psychiatric disorders, VolBrain and MRICloud can detect subtle structural differences in the brain.
Se han observado anomalías de volumen en las estructuras subcorticales, incluidos el hipocampo, la amígdala, el tálamo, el núcleo caudado, el putamen y el globo pálido, en la esquizofrenia (SZ) y el trastorno bipolar (BD); no todos los individuos con estos trastornos presentan tales cambios. Además, los patrones específicos y la gravedad de los cambios de volumen pueden variar entre individuos y en diferentes etapas de la enfermedad. El estudio tuvo como objetivo comparar los volúmenes de estas estructuras subcorticales entre sujetos sanos e individuos diagnosticados con SZ o BD. Se realizaron mediciones volumétricas del ventrículo lateral, globo pálido, núcleo caudado, putamen, hipocampo y amígdala mediante resonancia magnética en 52 sujetos sanos (HS), 33 pacientes con SZ y 46 pacientes con BD. Se utilizaron métodos de segmentación automática para analizar las imágenes de resonancia magnética con VolBrain y MRICloud. El hipocampo, la amígdala y el ventrículo lateral aumentaron en pacientes con esquizofrenia y trastorno bipolar en comparación con sujetos de control que utilizaron MRIcloud. El globo pálido y el núcleo caudado aumentaron en pacientes con esquizofrenia y trastorno bipolar en comparación con los sujetos control que utilizaron Volbrain. Sugerimos que en pacientes con esquizofrenia y trastorno bipolar, nuestros resultados contribuirán a la evaluación de la progresión subcortical, la patología y las anomalías de las composiciones cerebrales subcorticales. En pacientes con trastornos psiquiátricos, VolBrain y MRICloud pueden detectar diferencias estructurales sutiles en el cerebro.
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Humans , Male , Female , Adult , Middle Aged , Schizophrenia/diagnostic imaging , Bipolar Disorder/diagnostic imaging , Magnetic Resonance Imaging/methods , Organ Size , Schizophrenia/pathology , Bipolar Disorder/pathology , Cross-Sectional Studies , Retrospective Studies , Cloud ComputingABSTRACT
Background: Schizophrenia is a chronic severe psychiatric illness affecting nearly 0.4 to 1.4% of people in India. Many newer anti-psychotic drugs are used now-a-days in schizophrenia. Poor adherence to the treatment given to patients of schizophrenia is observed very often. Although, the quality of life of schizophrenia patients is very much compromised; at the same time, quality of life of the caregiver is also compromised. Methods: A cross-sectional Observational study was conducted among patients already diagnosed with Schizophrenia and on treatment, after ethical approval. Data relevant to study variables was collected in a pre-designed case record form. Evaluation of drug utilization pattern was done by WHO core drug prescribing indicators. Medication adherence was assessed through modified Morisky scale. Quality of life of relative or caregiver was assessed through WHO-QOL BREF questionnaire scale. Results: Patients of 18 years and above were enrolled. Among them, average age was 35.8±5.5 years. In my study, female patients were 64.7% and male patients were 35.3%. Average number of drugs per prescription was 3.8. Drugs prescribed by generic name were around 86.2%. Around 56.9% of drugs were prescribed from national list of essential medicines. Atypical antipsychotics were prescribed in 32% of all prescriptions for Schizophrenia; Whereas Benzodiazepines were prescribed in 19% of all prescriptions. Average Medication adherence score using MMS scale was 3.7±2.2. Patients with high adherence to the medications prescribed were nearly 71% and patients with low adherence to the medications prescribed were 29%. Mean total WHOQOL-BREF score was 75.2±6.5 out of 120. Conclusions: Most prescribed class of drugs was atypical anti-psychotics. Pharmacotherapeutic adherence among patients with schizophrenia was relatively high. Quality of life of patients’ relative or caregiver was impaired to some extent, more impaired in physical health and social relationships domain.
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Resumen La mayoría de los estudios sugieren que los pacientes con esquizofrenia deficitaria presentan un deterioro funcional y neurocognitivo más grave en comparación con los pacientes con esquizofrenia no deficitaria. Sin embargo, existen pocos estudios al respecto en América Latina. Examinar las diferencias entre el funcionamiento y el deterioro neurocognitivo en pacientes con y sin esquizofrenia deficitaria; y analizar la validez de la estructura bifactorial de los síntomas negativos en una muestra de pacientes peruanos. Se reclutó a un total de 53 pacientes peruanos con esquizofrenia. Se utilizó la versión en español del Schedule for the Deficit Syndrome (SDS) para diagnosticar el síndrome deficitario, el Functioning Assessment Short Test (FAST) para evaluar el funcionamiento global, y el Screen for Cognitive Impairment in Psychiatry (SCIP) para evaluar el funcionamiento neurocognitivo. La prevalencia de esquizofrenia deficitaria fue del 62,3 %. Los pacientes con esquizofrenia deficitaria presentan un mayor deterioro en la memoria de trabajo (p = 0,003), fluidez verbal (p = 0,002), aprendizaje verbal retardado (p = 0,039) y velocidad de procesamiento (p = 0,004). En cuanto al funcionamiento global, los pacientes con esquizofrenia deficitaria muestran un rendimiento inferior en las dimensiones de autonomía (p = 0,002), laboral (p = 0,001), cognitiva (p = 0,010), finanzas (p = 0,015), relaciones interpersonales (p < 0,001) y tiempo de ocio (p < 0,001). Los pacientes con esquizofrenia deficitaria muestran un mayor deterioro en el funcionamiento global y cognitivo. La replicación de la estructura bidimensional de los síntomas negativos en una muestra peruana contribuye a la hipótesis de la universalidad del modelo de «déficit expresivo¼ y «apatía-abulia¼.
ABSTRACT Many studies suggest that patients with deficit schizophrenia exhibit a more severe functional and neurocognitive impairment than those with non-deficit schizophrenia. However, there are few studies on this topic in Latin America. To examine the differences in functioning and neurocognitive impairment between patients with and without deficit schizophrenia, and to analyze the validity of the bifactorial structure of negative symptoms in a sample of Peruvian patients. A total of 53 Peruvian patients with schizophrenia were recruited. The Spanish version of the Schedule for the Deficit Syndrome (SDS) was used to diagnose the syndrome under study. The Functioning Assessment Short Test (FAST) was employed to assess global functioning, and the Screen for Cognitive Impairment in Psychiatry (SCIP), to evaluate neurocognitive functioning. The prevalence of deficit schizophrenia was 62.3%. Patients with deficit schizophrenia exhibited greater impairment in working memory (p = 0.003), verbal fluency (p = 0.002), delayed verbal learning (p = 0.039), and processing speed (p = 0.004). Regarding global functioning, patients with deficit schizophrenia demonstrated poorer performance in the domains of autonomy (p = 0.002), occupational functioning (p = 0.001), cognitive functioning (p = 0.010), financial functioning (p = 0.015), interpersonal relationships (p < 0.001), and leisure time (p < 0.001). Patients with deficit schizophrenia display greater impairment in global and cognitive functioning. The replication of the bidimensional structure of negative symptoms in a Peruvian sample contributes to the hypothesis of the universality of the "expressive deficit" and "apathy-abulia" model.
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El Toxoplasma gondii es un parásito que se encuentra, aproximadamente, en el 30 % de la población humana. Durante los últimos años se ha evidenciado que la infección latente puede ser un factor de riesgo para el desarrollo de trastornos mentales; particularmente para la esquizofrenia, ansiedad, trastornos bipolares y trastornos de conducta. La asociación con los trastornos neuropsiquiátricos pueden explicarse por la influencia que tiene el parásito sobre la expresión de múltiples neurotransmisores; entre ellos la dopamina. Se realizó una búsqueda en las bases de datos PubMed y SciELO de 2015 a 2023, se seleccionaron artículos originales y de revisión de revistas científicas internacionales, en idiomas inglés y español con el objetivo de describir la relación entre la seroprevalencia de T. gondii y el desarrollo de trastornos mentales en población adulta. Existe relación entre los trastornos mentales en la población adulta con la infección por Toxoplasma gondii y este aumenta la posibilidad de desarrollar esquizofrenia y depresión en individuos sin historial previo, y que podría exacerbar cuadros psiquiátricos previos con dificultad en el tratamiento. Sin embargo, no todos los datos estadísticos establecen una relación directa, algunos estudios demuestran una asociación, ciertos datos son discordantes, lo que abre una puerta para futuras investigaciones.
Toxoplasma gondii is a parasite that is found in approximately 30 % of the human population. In recent years, it has been shown that latent infection can be a risk factor for the development of mental disorders; particularly schizophrenia, anxiety, bipolar disorders, and conduct disorders. The association with neuropsychiatric disorders can be explained by the influence of the parasite on the expression of multiple neurotransmitters; among them, dopamine has received the most attention. A narrative bibliographic review article was done with the search of original and review articles in international scientific journals, in English and Spanish listing the relationship between the seroprevalence of T. gondii and the development of mental disorders in the adult population. The relationship between mental disorders in the adult population with Toxoplasma gondii infection is present and increases the possibility of developing schizophrenia and depression in individuals with no previous history, including the ability to worsen previous psychiatric conditions, making it difficult for standard management. Not all statistical data establish a direct relationship, some studies show an association and certain data are discordant, which opens a door for future research.
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Adult , El SalvadorABSTRACT
Schizophrenia has various obstacles in cognition, thinking, emotion, behavior and other aspects; it belongs to the category of “madness” in traditional Chinese medicine (TCM). Once schizophrenia occurs, multiple factors are often intertwined, and a single therapy is difficult to be effective. At present, TCM compounds and active ingredients have significant effects in the clinical treatment of schizophrenia, which is an important direction for the development of new drugs for schizophrenia. This article summarizes the molecular mechanism of TCM compounds and active ingredients in the treatment of schizophrenia. It is found that Wendan decoction and Yudian decoction can inhibit the apoptosis of hippocampal cells by activating BDNF/TrKB/CREB signaling pathway; quercetin and icariin can promote neural development and regeneration by activating NMDA/ERK signaling pathway; Wendan decoction and icariin can maintain neural cell homeostasis by activating PI3K/AKT signaling pathway; Bushen zhuangyang capsule can enhance learning and memory abilities by activating CaMKⅡ signaling pathway; formulas such as Huatan huoxue tongzhi formula can enhance intercellular information transmission by inhibiting PKC signaling pathway; α-humulene and others can restore nerve cell function by inhibiting NRG1/ErbB4 signaling pathway. TCM compounds and active ingredients can improve schizophrenia by intervening in the above-mentioned signaling pathways.
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Objective To explore the correlation of serum glutamate(Glu)and gamma-aminobutyric acid(GABA)levels with clinical symptoms in chronic schizophrenia patients,and to assess their diagnostic value for cognitive impairment.Methods A total of 92 patients with chronic schizophrenia and another 80 healthy individuals in Wuhan Mental Health Center/Wuhan Hospital for Psychotherapy from January 2021 to July 2022 were enrolled as study group and control group,respectively.The patients in the study group were divid-ed into the cognitive impairment group(44 cases)and the cognitive normal group(48 cases)according to Montreal Cognitive Assessment Scale(MoCA).Clinical symptoms were assessed by using Positive and Nega-tive Syndrome Scale(PANSS).MoCA was used to evaluate the cognitive function.The levels of Glu and GA-BA in plasma were determined by high-performance liquid chromatography/electrospray tandem mass spec-trometry.The scores of PANSS and MoCA as well as serum levels of Glu and GABA were compared between two groups.Then the correlation of serum Glu and GABA levels with clinical symptoms and the diagnostic value for cognitive impairment in the patients in the study group were investigated.Results The Glu level in the study group was higher than that in the control group,and the GABA level was lower than that in the con-trol group(P<0.05).The serum Glu levels in both the cognitive impairment group and the cognitive normal group were higher than the normal range,and the Glu level in the cognitive impairment group was higher than that in the cognitive normal group(P<0.05).The serum GABA levels in both the cognitive impairment group and the cognitively normal group were lower than the normal range,and the GABA level in the cogni-tive impairment group was lower than that in the cognitive normal group(P<0.05).In the study group,ser-um Glu level was positively correlated with negative,positive,general psychopathological symptom scores,and overall score in PANSS(P<0.05),while GABA level was negatively correlated with negative,positive,gener-al psychopathological symptom scores,and overall score in PANSS(P<0.05).The sensitivity of the single and combined detection of serum Glu and GABA for the diagnosis of cognitive impairment in patients with chronic schizo-phrenia was 77.3%,72.7%and 93.2%,respectively,and the specificity was 72.9%,72.9%,and 75.0%,respec-tively,and the area under the curve was 0.778,0.769,and 0.868,respectively.Conclusion Serum Glu level in patients with chronic schizophrenia is higher than that in healthy individuals,while GABA level is lower than that in healthy individuals,and the above two indicators are correlated with PANSS score,which have high value in diagnosing cognitive impairment and could be used as effective biological indicators to help clinical doctors judge patients'cognitive function.
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Objective To investigate the expression of soluble transferrin receptor(sTfR)and fibroblast growth factor 22(FGF22)in serum of first-episode schizophrenia(FES)patients,analyze the relationship be-tween the two and the clinical symptoms of FES patients,and analyze their diagnostic value.Methods A total of 97 FES patients diagnosed in the hospital from March 2021 to February 2023 were regarded as the FES group,during the same period,96 healthy volunteers who came to this hospital for physical examination were regarded as the control group.Immunotransmission turbidimetry was applied to detect the level of sTfR,en-zyme linked immunosorbent assay(ELISA)was applied to detect the level of FGF22,Spearman method was applied to analyze the correlation between the levels of sTfR and FGF22 in the serum of FES patients and Pos-itive and Negative Syndrome Scale(PANSS)score and Wisconsin Card Sorting Test(WCST)results,and re-ceiver operating characteristic(ROC)curve was applied to analyze the clinical diagnostic value of levels of sTfR and FGF22 for FES.Results There were no obvious differences between the two groups in terms of gender,age,body mass index,years of education,history of alcohol consumption,and smoking history(P>0.05).Compared with the control group,the serum levels of sTfR and FGF22 in the FES group were obvious-ly lower(P<0.05).The area under the curve(AUC)of sTfR for diagnosing FES alone was 0.835,with the cut off value of 4.606 mg/L,the AUC of FGF22 for diagnosing FES alone was 0.772,with the cut off value of 208.333 μg/L,the AUC of the combination of the two(0.921)was obviously higher than that of sTfR alone(Z=2.613,P=0.009),and that of FGF22 alone(Z=5.140,P<0.001).The PANSS positive symptom score,negative symptom score,pathological symptom score,total score,WCST persistent errors,and incorrect responses in the high sTfR level group and high FGF22 group were lower than those in the low sTfR group and low FGF22 group(P<0.05),while the number of WCST completed classifications and WCST correct re-sponses were higher than those in the low sTfR group and low FGF22 group(P<0.05).The levels of sTfR and FGF22 in the FES group were negatively correlated with PANSS positive symptom score,negative symp-tom score,pathological symptom score,total score,WCST persistent errors,and WCST incorrect responses(P<0.05),and positively correlated with the number of WCST completed classifications and WCST correct responses(P<0.05).Conclusion The levels of sTfR and FGF22 in the serum of FES patients are obviously decreased.Combined detection of sTfR and FGF22 levels is of great significance for the clinical diagnosis of FES.
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Mitochondria are the main site of energy metabolism within cells,generating a substantial amount of ATP to supply energy to the human body.Research has shown that alterations in mitochondrial structure and function exist in individuals with schizophrenia,suggesting their potential impact on the onset of psychiatric disorders and clinical treatment efficacy.Therefore,understanding the research progress on the genetic mechanisms,pathological processes,image manifestations of schizophrenia and mitochondrial quality control,and summarizing the relevant evidence of mitochondrial-related targets as potential therapeutic targets for schizophrenia,can provide references for further research.
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Objective To investigate the correlation between the expression of purinergic ligand-gated ion channel 7 receptor(P2X7R)and connective tissue growth factor(CTGF)in serum and cognitive function and clinical symptoms in patients with schizophrenia.Methods A total of 160 patients with schizophrenia who were diagnosed and treated in Department of Mental Intensive Care of Wuhan Wudong Hospital from January 2021 to January 2023 were collected as the observation group,and 160 healthy volunteers who underwent physical examinations were collected as the control group for the study.According to the Positive and Negative Symptom Scale(PANSS),patients were evaluated for their clinical and psychiatric symptoms(positive and negative symptoms,general pathological symptoms,and additional symptoms).The patients were grouped into a high score group(PANSS total score≥70 points,n=72)and a low score group(PANSS total score<70 points,n=88).MATRICS consensus cognitive battery(MCCB)was applied to evaluate the cognitive abilities of patients;enzyme-linked immunosorbent assay(ELISA)was applied to detect serum P2X7R and CTGF levels.Spearman method was applied to analyze the correlation between serum P2X7R,CTGF levels and PANSS scores,and MCCB scores in patients with schizophrenia.Results Compared with the control group,the serum levels of P2X7R(610.71±107.83ng/L vs 384.78±80.62 ng/L)and CTGF(1.85±0.36μg/L vs 1.40±0.21μg/L)in the observation group were increased,with differences of statistical significance(t=21.226,13.658,all P<0.05).The scores of variety items of MCBB of patients with schizophrenia in the observation group were lower than those in the control group,with differences of statistical significance(t=14.845~24.862,all P<0.05),the positive symptom score(21.10±3.42score),negative symptom score(23.37±5.03 score),general pathological symptom score(39.48±8.11score),additional symptom score(8.26±1.22 score),and PANSS total score(92.21±12.50score)of schizophrenia patients in the high group were higher than those in the low group(13.65±3.04,15.62±3.91 score,30.14±6.15 score,5.20±0.94score,64.61±5.30score),with differences of statistical significance(t=14.576,10.964,8.280,17.915,18.764,all P<0.05).The serum levels of P2X7R and CTGF in patients with schizophrenia in the high group were higher than those in the low group,with differences of statistical significance(t=12.233,5.923,all P<0.05).The levels of serum P2X7R and CTGF in patients with schizophrenia were positively correlated with PANSS score(r=0.464~0.580,all P<0.05),and negatively correlated with MCCB score[r=-0.603~-0.439,all P<0.05].Conclusion The serum levels of P2X7R and CTGF in patients with schizophrenia are elevated,they are closely related to the clinical symptoms and cognitive function of patients.
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Objective:To investigate the therapeutic effect of aripiprazole or risperidone combined with clozapine in the treatment of treatment-refractory schizophrenia(TRS).Method:A retrospective analysis was conducted on the clinical data of 90 patients with TRS who received treatment at Tanggu Anding Hospital from May 2021 to May 2022.According to the drug treatment regimen,patients were divided into clozapine group,aripiprazole+clozapine group,and risperidone+clozapine group,with 30 cases in each group.The positive and negative symptom scale(PANSS)score,clinical efficacy,and total incidence of adverse reactions were compared before and after treatment among the three groups.Results:After treatment,the total scores and subscale scores of PANSS in the three groups decreased compared to before treatment(P<0.05).And after treatment,the total scores and subscale scores of PANSS in aripiprazole+clozapine group and risperidone+clozapine group were lower than those in clozapine group(P<0.05)and the scores in aripiprazole+clozapine group were lower than those in risperidone+clozapine group(P<0.05).After treatment,the total effective rates in aripiprazole+clozapine group and risperidone+ clozapine group were higher than those in clozapine group(P<0.05)and the total effective rate in aripiprazole+clozapine group was higher than that in risperidone+clozapine group(P<0.05).The total incidence of adverse reactions in the three groups was similar(P>0.05).Conclusion:The overall efficacy of aripiprazole combined with clozapine in the treatment of TRS is better than that of risperidone combined with clozapine or clozapine alone,and can be promoted as the preferred treatment plan.
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Objective To investigate the expression of histone deacetylase(HDAC)isoforms in the frontal lobe,hippo-campus and liver of offspring rats delivered by rats with maternal immune activation and their correlation with the efficiency of prepulse inhibition(PPI%).Methods Ten pregnant Sprague-Dawley rats were randomly divided into the model group(n=5)and control group(n=5).The rats in the model group were injected with 10 mg·kg-1 polyinosinic-polycytidylic acid(Poly I:C)via the caudal vein on the 9th day of pregnancy,while rats in the control group were given the same volume of sterile physiological saline.After 3 h,blood was collected from the caudal vein,and the levels of interleukin(IL)-1 β,IL-6 and tumor necrosis factor-α(TNF-α)in the plasma of pregnant rats were detected by enzyme-linked immunosorbent assay to evaluate the immune activation status.The pregnant rats in the two groups were fed until natural delivery,the offspring rats were weaned on the 21st day after birth,and the male offspring rats were fed continuously.A prepulse inhibition test was performed at puberty(the 40th day after birth)to evaluate the spatial recognition memory and sensory gating function of the offspring rats.The expression levels of the HDAC gene family in the hippocampus,frontal lobe and liver of offspring rats were detected by real-time fluorescence quantitative polymerase chain reaction.Results The plasma IL-6,IL-1 β and TNF-α levels in the model group were significantly higher than those in the control group(P<0.05).When the prepulse stimulation was 75 dB,the PPI%of the offspring rats at puberty in the model group was significantly lower than that in the control group(P<0.05).When the prepulse stimulation was 80 and 85 dB,there was no significant difference in PPI%between the model group and the control group(P>0.05).In the frontal lobe,the expression levels of HDAC3,HDAC4,HDAC8,HDAC9,HDAC10 and Sirt mRNA in the offspring rats in the model group were significantly lower than those in the control group(P<0.05),while the expression level of HDAC5 mRNA was significantly higher than that in the control group(P<0.05);there were no significant differences in the expression levels of HDAC1,HDAC2,HDAC6,HDAC7 and HDAC11 mRNA between the model group and the control group(P>0.05).In the hippocampus,the offspring rats in the model group had significantly lower expression levels of HDAC1,HDAC8 and HDAC10 mRNA and significantly higher expression levels of HDAC2 and HDAC5 mRNA than those in the control group(P<0.05);there were no significant differences in the expression levels of HDAC3,HDAC4,HDAC6,HDAC7,HDAC9,HDAC11 and Sirt mRNA between the model group and control group(P>0.05).In the liver tissue,the expression levels of HDAC6 and HDAC10 mRNA of the offspring rats in the model group were significantly lower than those in the control group(P<0.05);there were no significant differences in the expression levels of HDAC1,HDAC2,HDAC3,HDAC4,HDAC5,HDAC7,HDAC8,HDAC9,HDAC11 and Sirt mRNA between the model group and the control group(P>0.05).The expression level of HDAC2 mRNA in the hippocampus of offspring rats in the two groups was negatively correlated with PPI%at 75 dB(r=-0.965,P<0.05),the expression levels of HDAC10 and Sirt mRNA in frontal lobe tissues were positively correlated with PPI%at 75dB(r=0.946,0.925;P<0.05).Conclusion Pregnancy Poly I:C infection has significant effects on the expression of HDAC family proteins in offspring rats,and which is related to the impairment of early sensory gating,this may provide new ideas for the research in pathogenesis and drug treatment of schizophrenia.
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Objective To assess the safety of paliperidone palmitate(PP)injection versus other antipsychotic drugs long-acting injections(LAIs)in the treatment of schizophrenia.Methods PubMed,Web of Science,Embase,Cochrane Library,PsycINFO,CNKI,SinoMed,VIP and WanFang Data databases were searched to collect randomized controlled trials(RCTs)on PP injection versus other antipsychotic drugs LAIs in the treatment of schizophrenia from the inception to April 30,2023.Two reviewers independently screened literature,extracted data and assessed the risk of bias of included studies.Meta-analysis was then performed using RevMan 5.2 software.Results A total of 12 RCTs involving 4 368 patients were included.The results of Meta-analysis showed that there was no significant difference in clinical efficacy between PP injection treated group and risperidone LAIs treated group(P>0.05),no significant difference was found for positive and negative syndrome scale(PANSS)overall score changes between PP injection treated group and other antipsychotic drugs LAIs treated group(P>0.05).Compared with other antipsychotic LAIs treated groups,PP injection treated group had a significantly higher rate of total withdrawls(RR=1.14,95%CI 1.06 to 1.24,P<0.01)and the incidence of adverse reactions of abnormal injection site(RR=2.08,95%CI 1.03 to 4.22,P=0.04).Conclusion Current evidence indicates that PP injection didn't show significant difference in efficacy outcomes,while may increase the incidence of some adverse reactions when compared with other antipsychotic drugs LAIs for schizophrenic.However,due to the limitations of the quantity and quality of the included studies,the above conclusions still need to be validated by more high-quality studies.
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Objective:To explore and analyze the application of polysomnographic sleep monitor in patients with schizophrenia and the monitoring effect of that on sleep quality and sleep structure of them.Methods:A total of 90 patients with schizophrenia admitted to the First Affiliated Hospital of Xinjiang Medical University from March 2021 to May 2023 were selected as the observation group,and 80 healthy volunteers were selected as the health control group.All subjects were monitored by polysomnographic sleep monitor.Pittsburgh Sleep Quality Index(PSQI)score,sleep quality index of polysomnographic sleep monitor,the indicators of sleep structure and spindle wave index between two groups were compared.At the same time,Pearson correlation analysis was used to explore the correlation between PSQI score and sleep parameters.Results:PSQI score of the health control group was(5.36±0.65)scores,and that of the observation group was(14.24±3.58)scores,and the PSQI score of the observation group was significantly higher than that of the health control group,and the difference was statistically significant(t=23.115,P<0.05).Compared with the health control group,the observation group had shorter total sleep time,longer sleep latency,shorter rapid eye movement(REM)period and more awakening times,with statistical significances(t=15.136,40.355,36.620,24.226,P<0.05),respectively.There was no significant difference in REM latency between the observation group and the control group before treatment(P>0.05).Compared with the observation group before treatment,the observation group after treatment had longer total sleep time,shorter sleep latency,longer REM period and less awakening times,with statistical significances(t=3.145,12.021,8.668,9.101,P<0.05),respectively.Compared with health control group after treatment,the observation group after treatment had shorter total sleep time,longer sleep latency,shorter REM period and more awakening times,and the differences of them between two groups were statistically significant(t=9.704,14.781,15.899,9.901,P<0.05).Compared with the observation group before treatment,the N1%value was higher,the N2%value was higher and the N3%value was lower in the health control group before treatment,and the differences were statistically significant(t=10.163,9.483,10.065,P<0.05),respectively.There were no significant differences in REM%between the health control group and the observation group before and after treatment(P>0.05),respectively.Compared with the observation group before treatment,that after treatment had lower N1%value and N2%value,and higher N3%value(t=10.163,9.483,10.065,P<0.05),respectively.Compared with the health control group after treatment,the observation group after treatment had higher N1%value and N2%value,and lower N3%value,and the differences of them between two groups were statistically significant(t=7.628,4.210,7.153,P<0.05),respectively.Compared with the observation group before treatment,that after treatment had higher spindle wave density,amplitude and time.Compared with the health control group after treatment,the observation group after treatment had lower spindle wave density,amplitude and time,and the differences of them between two groups were significant(t=2.514,2.665,2.014,P<0.05),respectively.Pearson correlation analysis showed that PSQI score appeared significantly negative correlation with total sleep time,REM period,N3%value,spindle wave density and spindle amplitude,and appeared significantly positive correlation with sleep latency,awakening times,N1%value and N2%value,respectively,and the differences were statistically significant(r=-0.612,-0.269,-0.812,-0.778,-0.841,r=0.382,0.226,0.654,0.778,P<0.05).Conclusion:Abnormal sleep quality and structure,as well as abnormal sleep spindle wave activity,of patients with schizophrenia can be observed by using polysomnographic sleep monitor,which indicators is closely related to PSQI.
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BackgroundRehabilitation for schizophrenia typically relies on pharmacological interventions, yet their efficacy in improving social function and quality of life remains limited. In recent years, non-pharmacological approaches have shown promise in enhancing rehabilitation outcomes. However, research on the effectiveness of psychomotor therapy specifically for young and middle-aged schizophrenic inpatients is limited. ObjectiveTo explore the effects of psychomotor therapy on the rehabilitation of young and middle-aged schizophrenic inpatients, and to provide a reference for treatment strategies. MethodsA total of 104 young and middle-aged schizophrenic inpatients who met the International Classification of Diseases,tenth edition (ICD-10) diagnostic criteria and hospitalized in the Fourth People's Hospital of Wuhu from June 2021 to June 2022 were selected. Patients were randomly divided into two groups of 52 each using random number table method. Both groups received treatment with risperidone tablets (2~4 mg/d) , along with routine nursing care. Additionally, the research group received an extra 45~55 minutes of psychomotor therapy 2~3 times per week for 12 weeks. The control group received the same psychomotor therapy after the study. Positive and Negative Symptom Scale (PANSS), Scales of Social-skills for Psychiatric Inpatient (SSPI) and Insight and Treatment Attitude Questionnaire (ITAQ) were used to assess the patients before the intervention and at 4th, 8th and 12th week after the intervention. ResultsThe main effects of intervention at different time points for PANSS positive symptoms, negative symptoms and general psychopathology subscale scores, PANSS total score, SSPI score and ITAQ score were all statistically significant (F=33.989, 204.245, 82.817, 279.596, 26.144, 7.463, P<0.01). Furthermore, statistically significant between-group differences were observed in PANSS negative symptoms and general psychopathology subscale scores, PANSS total score, SSPI score and ITAQ score (F=30.053, 5.306, 33.417, 33.013, 18.608, P<0.05 or 0.01). Moreover, the interaction effect of time and group were statistically significant for PANSS positive symptoms, negative symptoms and general psychopathology subscale score, PANSS total score and SSPI score (F=3.472, 9.798, 3.843, 14.390, 20.661, P<0.05 or 0.01). After 12 weeks of intervention, the research group exhibited statistically significantly lower PANSS total score and subscale scores compared with baseline (P<0.01), while their SSPI total score was significantly higher than that of control group(P<0.01). Additionally, compared with the control group, the research group had statistically significantly lower PANSS total score and subscale scores , while their SSPI score was statistically significantly higher than those of control group(P<0.01). ConclusionPsychomotor therapy may contribute to the improvement of the psychiatric symptoms and social function in young and middle-aged inpatients with schizophrenia, enhancing their rehabilitation outcomes. [Funded by Health Commission Scientific Research Project of Wuhu (number, WHWJ2021y073)]
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This paper summarized professor JIA Hongxiao's experience in treating cognitive impairments in schizophrenia patients upon five spirits stored in corresponding viscera theory. By elucidating the cognitive psychological connotation of the five spirits stored in corresponding viscera theory, it is proposed that the cognitive impairment of schizophrenia should be differentiated and treated based on the symptom characteristics of different cognitive domain impairments in schizophrenia. The key pathogenesis of impairments to cognitive domains such as information processing speed, executive control ability and will is kidney deficiency, liver hyperactivity, and heart spirit restlessness, for which the treatment is to boost the kidney and calm the liver, nourish the heart and calm the mind, using Shizhen Anshen Formula (石珍安神方) modifications. The main pathogenesis of memory and attention cognitive impairment is spleen-kidney depletion and lung corporeal soul failing to descend, for which it is suggested to fortify the spleen and supplement kidney, boost lung and direct qi downward using Jianpi Bushen Formula (健脾补肾方) modifications.
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【Objective】 To elucidate the possible role of arginine and histidine in the pathogenesis of schizophrenia by exploring the serum levels of semi-essential amino acids (arginine and histidine) in patients with schizophrenia and their correlation with psychiatric symptoms. 【Methods】 We selected 72 inpatients with schizophrenia admitted to The First Affiliated Hospital of Xi’an Jiaotong University from March 2021 to October 2022 and 72 healthy volunteers enrolled in Yanta Community during the same period as the research subjects. Serum arginine and histidine levels were measured in patients with schizophrenia and healthy controls using serum liquid chromatography-mass spectrometry (LC-MS). We used the Positive and Negative Symptom Scale (PANSS) to evaluate the mental symptoms of patients with schizophrenia and analyzed the correlation of serum arginine and histidine levels with disease course, frequency of onset, and PANSS score. 【Results】 The levels of serum arginine (P<0.001) and histidine (P=0.011) in the schizophrenia group were significantly lower than those in the control group. The levels of serum arginine and histidine were significantly negatively correlated with the frequency of onset (rs=-0.410, rs=-0.262), total score of PANSS (rs=-0.298, rs=-0.256), positive factors (rs=-0.299, rs=-0.234) and cognitive impairment factors (rs=-0.251, rs=-0.296). In addition, serum arginine levels had significantly negative correlation with anxiety and depression factors (rs=-0.269, P<0.05). 【Conclusion】 The serum levels of arginine and histidine in patients with schizophrenia are significantly lower than those in healthy individuals, and are negatively correlated with overall mental symptoms, severity of positive symptoms and cognitive impairment. The severity of anxiety and depression symptoms is negatively correlated with arginine levels. The detection of serum arginine and histidine can provide reference for the diagnosis and assessment of the severity of schizophrenia in the future.
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Based on the theory of ti (character, 体) and yong (function, 用) in mental illness, ZHAO Yonghou's clinical experience in staged differentiation and treatment of schizophrenia is summarized. According to the theory, the core disease location of schizophrenia is in the brain, which is closely related to the organs, qi, and blood. It is proposed to interpret the pathogenesis of schizophrenia from the perspective of “zang-fu organs-qi and blood-brain and spirit”, that is, dysfunction of the zang-fu organs, disharmony of qi and blood, and malnourishment of the brain ti lead to dysfunction of the spirit ti and yong. In clinical practice, treatment of schizophrenia can be divided into four stages, for which the method of treating ti and yong simultaneously is suggested. In the prodromal stage, Liuwei Dihuang Decoction combined with Sini San (六味地黄汤合四逆散) with modifications is used to nourish the kidney and boost marrow, soothe the liver and rectify the spleen. For acute exacerbation with binding of phlegm and heat syndrome, Zhaoshi Yikuang Decoction (赵氏抑狂汤) with modifications is used to clear heat and dispel phlegm, awaken the brain and calm the mind. For phlegm-heat damaging yin pattern, Mengshi Guntan Pill combined with Zengye Decoction (礞石滚痰丸合增液汤) with modifications is used to clear heat and dispel phlegm, enrich yin and calm the mind. For the chronic treatment stage, Yudian Decoction (愈癫汤) with modifications is used to disperse phlegm and dissolve stasis, move qi and awaken the mind. For the rehabilitation and regulation stage, Shenan Pill (神安丸) with modifications is used to boost qi and nourish yin, and tranquilize the mind.
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BackgroundSchizophrenia is a common severe mental disorder with complex pathogenesis. There are few studies on the correlation between kynurenine metabolites in peripheral serum and urine in schizophrenia. ObjectiveTo investigate the concentration of tryptophan-kynurenine metabolites and interleukin-6 (IL-6) in serum and urine in patients with schizophrenia, and their correlation with clinical symptoms, so as to explore potential biological characteristics related to schizophrenia. MethodsA total of 38 patients with schizophrenia who met the criteria of the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), and were hospitalized or attended outpatient clinic at Hangzhou Seventh People's Hospital from December 2021 to December 2022 were included in the study. Additionally, 26 healthy individuals were concurrently recruited from the community of Hangzhou to serve as a control group. All participants were requested to complete the Positive and Negative Symptom Scale (PANSS). The levels of tryptophan (TRP), kynurenine (KYN), kynurenic acid (KYNA), quinolinic acid (QUIN), picolinic acid (PIC), xanthurenate and 5-hydroxytryptamine (5-HT) in both serum and urine were measured using ultra-high-performance liquid chromatography-triple quadrupole linear ion trap mass spectrometry. Serum and urine IL-6 were measured using enzyme-linked immunosorbent assay. Pearson correlation analysis was conducted to examine the correlation between serum and urinary KYN metabolites, as well as the correlation between metabolite levels and clinical symptoms in the patient group. ResultsPatients with schizophrenia had significantly higher level of IL-6 in serum (U=798.500, P<0.01) and lower level of PIC in urine (U=253.000, P=0.013) compared with the control group. Additionally, level of serum KYN was positively correlated with QUIN/KYNA ratio and QUIN/PIC ratio (r=0.562, 0.438, P<0.05) in patients with schizophrenia. 5-HT/KYN ratio in serum was positively correlated with PANSS total score and negative symptom subscale score (r=0.458, 0.455, P<0.01) in patients with schizophrenia. ConclusionSerum TRP-KYN pathway metabolite levels in patients with schizophrenia were associated with neurotoxic metabolite ratios in urine and the severity of negative symptoms. [Funded by Zhejiang Medical and Health Science and Technology Program Exploratory (number, 2022KY990)]