Association of Wider Social Environment with Relapse in Schizophrenia: Registry Based Six-Year Follow-Up Study.

INTRODUCTON: The impact of social environment on the frequency and prevalence of schizophrenia is well known. However, in schizophrenia and other psychotic disorders, there are few studies which investigate the effect of social environment on disease prognosis and relapse. The aim of this study was to investigate the effect of neighborhood social capital level and address change on relapse in schizophrenia and similar psychotic disorders. METHODS: The research sample consisted of 147 patients (schizophrenia, 76.1%; n=112), who were being followed up at regular intervals of at most six months at the Psychotic Disorders Unit outpatient clinic. Patients were followed-up for relapse indicators between January 1, 2009 and December 31, 2013. During the follow-up, relapse criteria including hospitalization, increased need for help, self-harm, suicidal thoughts, violent behavior, suicide attempts, antipsychotic dose increase and electroconvulsive therapy were used. At least one of these criteria was accepted as a relapse for that period. Neighborhood social capital levels were obtained from a general public survey conducted in Izmir city center in 2008 and the voting rates in the neighborhood during the follow-up period. In addition, during the follow-up period, any change in the address of the patient was recorded. RESULTS: While there was no correlation between the neighborhood social environment and relapse, a significant relationship was found between relapse and address changes. The probability of relapse was 1.3 times higher in patients with change of address (95%CI: 1.0-1.6; p<0.05), and decreased likelihood of relapse was found as the duration of residence in the same neighborhood shortened (ß: (-0.05) 95%CI: [(-0.10)-(-0.003)]; p<0.05). CONCLUSION: In schizophrenia, relapse appears to be related with the narrow social environment (family, home address) in which the person lives, not with the wider social environment (social capital of the neighborhood). The need for adaptation to a new social environment that arises with a change of address, albeit narrowly, can lead to an increase in symptoms of schizophrenia as a psychosocial stressor.

Cognitive dysfunctions in patients with obsessive-compulsive disorder compared to the patients with schizophrenia patients: relation to overvalued ideas.

OBJECTIVE: The clinical overlaps between schizophrenia and obsessive-compulsive disorder (OCD) seem to be related to thought disorders involving obsessions, overvalued ideas, and delusions. Overvalued ideas are beliefs falling in between obsessions and delusions and are stronger than obsessions but weaker than delusions. The goal of the present study was to compare patients with OCD to those with schizophrenia in terms of cognitive functions and to relate cognition and overvalued ideas in OCD. METHODS: Twenty three patients with OCD (free of depression), 24 patients with schizophrenia, and 22 healthy subjects matched to patients in age, gender, education, and hand dominance were included in the study. All subjects were administered neurocognitive tests assessing verbal learning-memory, executive functions, verbal fluency, attention and verbal working memory. RESULTS: Patients with schizophrenia showed worse performance on cognitive tests than the OCD and control groups. The severity of overvalued ideas was significantly correlated to cognitive functions in the OCD group. There were no significant differences in cognitive functions between schizophrenia group and the OCD patients who had higher scores on the Overvalued Ideas Scale (OVIS). CONCLUSION: Overvalued ideas in OCD may be related to cognitive dysfunctions in OCD and this subtype of OCD may have similar characteristics to schizophrenia in terms of cognition.

A double-blind study of combination of clozapine with risperidone in patients with schizophrenia: effects on cognition.

BACKGROUND: Atypical antipsychotic drugs produce improvement in some domains of cognition as well as psychopathology in patients with schizophrenia. However, the effect of combinations of atypical antipsychotic drugs on cognitive function is unknown. The aim of this study was to compare the effect of risperidone or placebo on cognitive function in patients with schizophrenia who were previously treated with clozapine monotherapy. METHOD: This prospective, randomized, double-blind, placebo-controlled, 6-week study included 30 patients with DSM-IV schizophrenia. Patients whose psychopathology was no more than partially responsive to clozapine treatment were randomly assigned to receive adjunctive treatment with risperidone (N = 16) up to 6 mg/day or placebo (N = 14). Cognitive test scores for verbal learning and memory, verbal fluency, attention, executive function, verbal working memory, and motor function were the primary outcome measures. Secondary outcome measures included assessment of psychopathology, extrapyramidal side effects, and global functioning. Data were collected between November 2001 and July 2003. RESULTS: Significant improvement was found in both treatment groups in a variety of cognitive measures, but there was significantly greater improvement in the placebo-augmented group on measures of initial learning acquisition and attention. The improvement in cognition was not correlated with improvement in psychopathology. There were significant correlations between improvement in verbal working memory, verbal learning and memory, and attention and quality of life and global functioning in the placebo-augmented but not the risperidone-augmented group. CONCLUSION: Adjunctive treatment with risperidone for 6 weeks in patients with schizophrenia who had received chronic treatment with clozapine does not significantly improve cognitive function.