Lipid profile in schizophrenia: case control study.

INTRODUCTION: Cardiovascular diseases are common co morbidities of schizophrenia and constitute the main factors of high mortality in this pathology. Cardiovascular damages are favored by some risk factors, of which one of the most important is dyslipidemia. In this context, a study of lipid profile in schizophrenia is interesting.  The aims of this study were to compare the lipid profile of patients with schizophrenia to healthy controls and to investigate the associations between lipid parameters and demographics, clinical and treatment characteristics of the patients. METHODS: We conducted a case-control study between April 2013 and March 2014 on 78 patients with schizophrenia and 68 healthy subjects who benefited from the dosage of four serum lipid parameters: total cholesterol (TC), triglycerides (TG), High-density lipoprotein Cholesterol (HDL-C) and Low-density lipoprotein cholesterol (LDL-C). For the socio-demographic and clinical assessments, we used an information sheet and the following psychometric scales: PANSS (Positive And Negative Syndrome Scale), CGI (Clinical Global Impressions), GAF (Global Assessment Functionning) and the Calgary scale for depression. RESULTS: The comparative study showed that serum concentrations of TC and LDL-C were significantly higher for patients compared to healthy controls respectively with (t=2,83 ; p=0,008) and             (t=9,35; p<0,001), the cholesterol ratio (TC / HDL-C) was also significantly higher for patients           (t=2,23; p=0,033). The patients had significantly higher prevalence of hypercholesterolemia              (OR = 2.96) and low density hyperlipoproteinemia (OR = 18.79). The analytical study in the population of patients showed that the age ≥35 year-old, male gender and alcohol consumption were associated with disturbances in lipid parameters. Cannabis consumption was associated with significantly lower concentrations in TG. Concerning clinical features, paranoid schizophrenia was associated with less dyslipidemia unlike the depressive dimension assessed by the Calgary scale. There was a negative correlation between plasmatic TG concentrations and doses of antipsychotics. CONCLUSION: The vast majority of the literature confirms that patients with schizophrenia are at greater risk of dyslipidemia. This high risk appears to be more important with the consumption of alcohol and tobacco. It seems also that age and masculine gender are dyslipidemia risk factors for schizophrenic patients. The paranoid type of schizophrenia and positive symptoms seem to be associated with less dyslipidemia while depressive symptoms worsen lipid parameters. It then follows that, clinical and regular monitoring of lipid profile, lifestyle recommendations (smoking cessation, exercise and balanced diet) and appropriate therapeutic choices could help reduce morbidity and mortality among patients with schizophrenia. A special focus should be accorded to patients with high negative and depression symptoms.

Persistent auditory hallucinations in out-patients with schizophrenia.

Objectives to estimate the prevalence of persistent auditory hallucinations (AHs) in a group of schizophrenic patients, to evaluate their dimensions and to identify their clinical associated factors. Method This was a cross-sectional study carried-on 144 out-patients followed for schizophrenia, according DSM-IV-TR criteria. The assessment was consisted by the collect of epidemiological, clinical and therapeutic data and the use of the Hoffman's auditory hallucinations rating scale (AHRS), and the positive and negative symptoms scale (PANSS). Results The prevalence of persistent AHs (AHRS score ≥ 5) was 40.3%. The mean total score of the AHRS was 10.7±7.8 for all patients and 19.4±7.7 for patients with persistent AHs. The AHs dimensions with higher sub-scores were the number, the influence and the reality of the voices. The PANSS items most related to the AHRS total score were P3 "hallucinatory activity", G1 "somatic concerns", G4 "tension" and the G5 "mannerisms and posture disorders". The clinical associated factors with persistent AHs after multivariate analysis were the absence of tobacco consumption, the hallucinatory onset of disorders, the notion of previous hospitalization and the continuous course. Conclusion Our results support the multidimensionality of AHs and confirm the existence of inter individual differences in the characteristics of these hallucinations. Persistent AHs were associated with poor prognosis, requiring more effective therapeutic strategies.

Prevalence and score of minor physical anomalies in patients with schizophrenia and their first degree relatives: a Tunisian study.

UNLABELLED: Minor physical anomalies (MPAs) have been consistently reported to be more frequent in schizophrenia subjects. Limited research has been conducted on these anomalies among biological relatives of patients with schizophrenia. The aims of this study were to investigate the MPAs in a Tunisian population: subjects with schizophrenia, their healthy siblings and control subjects. This study hypothesized that the mean MPAs score would be greater in patients than controls and that siblings would have intermediate scores. Furthermore, it was hypothesized that MPAs scores would be associated with negative and disorganised symptoms of schizophrenia. METHODS: We assessed 93 subjects with schizophrenia, 59 of their healthy siblings and 71 healthy controls, matched on gender and age. MPAs were assessed through use of a standardized scale derived from the Waldrop Scale [D. Gourion, G. Viot, C. Goldberger, M. Cartier, M.C. Bourdel, M.F. Poirier, J.P. Olié, H. Lôo, M.O. Krebs, 2001. French validation of a Minor Morphologic Anomalies Scale in schizophrenic patients and their parents. Encephale 27, 143-147]. The schizophrenia psychopathology was evaluated by the Positive and Negative Syndrome Scale (PANSS), Global Assessment of Functioning (GAF) and the Clinical Global Impression-Severity (CGI-S). RESULTS: Subjects with schizophrenia showed significantly higher MPAs score than siblings (4.6 ± 2.8 vs. 3.0 ± 2.1, p<0.0001) and controls groups: 1.9 ± 1.5 (p<0.0001). Siblings had significantly higher score than control subjects (p=0.02). MPAs were correlated negatively with age of onset of the disease, and age of first hospitalisation, and positively with number of hospitalisations. Positive correlations were found between MPAs and PANSS total score, PANSS negative sub-score and CGI-S score. COMMENTS: Results of this study showed that MPAs are more frequent in subjects with schizophrenia and their siblings compared to control subjects. Positive correlations were found between MPAs, age of onset, severity of illness, and negative symptoms of schizophrenia, suggesting that those anomalies are correlated to severe form of schizophrenia.

Neurological soft signs and schizotypal dimensions in unaffected siblings of patients with schizophrenia.

The objectives were to determine the neurological soft signs (NSS) scores in unaffected siblings of patients with schizophrenia compared with healthy controls and to examine their relationships with schizotypal dimensions. Participants comprised 31 unaffected siblings of patients with schizophrenia and 60 healthy controls matched according to age, gender and school level who were assessed by the Schizotypal Personality Questionnaire (SPQ) and the Krebs et al. NSS Scale. Higher NSS total scores and sub-scores were found in the unaffected siblings compared with the controls. The SPQ total score was significantly higher in unaffected siblings compared with control subjects. The NSS total score was positively correlated with the SPQ total score and the SPQ disorganization sub-score in unaffected siblings of patients with schizophrenia. Additionally, in unaffected siblings, motor coordination and integration abnormalities were positively correlated with the SPQ total score and the cognitive-perceptual sub-score. Motor integration abnormalities were also correlated with the SPQ disorganization sub-score. These results reveal that NSS, especially motor signs, are associated with some schizotypal dimensions in siblings of patients with schizophrenia, suggesting the value of using both assessments to study high risk populations.

Assessment of Affective temperaments in a Tunisian non-clinical population.

BACKGROUND: Temperament Evaluation of Memphis, Pisa, Paris and San Diego-Auto-questionnaire (TEMPS-A) is frequently used to assess affective temperaments in clinical and non clinical populations. AIMS: To assess the psychometric properties of the Tunisian TEMPS-A in a non-clinical population and to explore the gender and age effects on affective temperaments. METHODS: TEMPS-A is a self-administered questionnaire evaluating hyperthymic, depressive, cyclothymic, irritable and anxious temperaments. Its Tunisian version was administered to 840 employees of the University Hospital of Monastir. Among them, 547 completed the questionnaire (response rate=65%). RESULTS: The internal consistency and the test-retest reliability were good in general except for the depressive temperament. The factor analysis confirmed the five factors structure of the questionnaire with an overlap for the fifth dimension between depressive and anxious items corresponding to an anxio-depressive dimension. The study of correlations showed that the depressive, cyclothymic, irritable and anxious dimensions of TEMPS-A were strongly related to each other (P<0.001). Men had significantly higher scores than women in the hyperthymic temperament while women had significantly higher scores in the anxious, cyclothymic and depressive temperaments. For the age, the scores of the cyclothymic temperament decreased while the scores of the anxious temperament increased (P<0.05). CONCLUSION: The Tunisian version of the TEMPS-A has good psychometric properties with an overlap between depressive and anxious items. Moreover, the scores of affective temperaments differed by age and gender. Subsequent studies with larger samples should be realized to verify these results.

Abnormalities of auditory event-related potentials in students with high scores on the Schizotypal Personality Questionnaire.

Some auditory event-related potential (ERP) abnormalities characterize both patients with schizophrenia and subjects with schizotypal personality disorder. It was therefore hypothesized that subjects from the community with schizotypal traits might also present ERP abnormalities. In this study, we compared auditory ERP latencies and amplitudes in 13 subjects with high (H-SPQ) and 12 subjects with low (L-SPQ) scores on the Schizotypal Personality Questionnaire (SPQ), selected from 198 Tunisian students. Auditory ERPs were recorded at Fz, Cz, and Pz, with a standard oddball paradigm. Smaller P300 amplitudes and delayed P300 latencies were found in H-SPQ compared with L-SPQ participants. Confirming previous reports, our results suggest that reduced P300 amplitudes and delayed P300 latencies may be considered as vulnerability markers of the schizophrenia spectrum in nonclinical subjects from the community.

[Validation of the French version of the Raine schizotypal personality questionnaire in a population of Tunisian students]. / Validation de la version française du questionnaire de personnalite schizotypique de Raine en population estudiantine Tunisienne.

Schizotypal personality disorder is considered as a marquer of schizophrenia proneness. In opposition at other self report measures of schizotypal personality disorder, the "Schizotypal Personality Questionnaire" (SPQ) developed by Raine, assesses all nine features of this disorder. The aims of this study is to present the validation on the French version of the SPQ on Tunisian student sample. It consists on a transversal study directed from April to may 2000. The sample was compound of 198 healthy and voluntary students from the medical university of Monastir. The questionnaire has a high internal reliability (SPQ total: Cronbach's alpha = 0.91; SPQ nine subscales: Cronbach's alpha = 0.59 to 0.74). The ten percent high and low cutoffs for the top and the bottom ten percents of SPQ scores were respectively 42/74 and 10/74 for women, 42/74 and 7/74 for men and 42/74 et 9/74 for total sample. A principal component analysis revealed two main factors or dimensions of schizotypal personality disorder in our sample: positive dimension (made up of ideas of reference, magical thinking and unusual perceptual experiences) and a negative dimension (made up of no close friends, social anxiety and blunted affect). Our results were closely similar to these found by Raine and, other validation studies with SPQ. However some sociocultural aspects were found in our study.

[Adjustment disorders: a clinical study of a psychiatric hospital population in Tunisia]. / Troubles de l'adaptation: étude clinique d'une population hospitalière tunisienne.

The objectives of this study were to determine the frequency of adjustment disorders in psychiatric hospital and to establish the clinical and evolutional profiles of these disorders. A descriptive and retrospective study with approximately 115 patients hospitalized a first time in a psychiatric setting of the university hospital of Monastir in Tunisia for adjustment disorders according to the DSM-IV. The frequency of adjustment disorders in a psychiatric hospital was estimated at 11,8 %. The majority of patients were young (65,3 % between 16 and 20), female (60,9 %), of low professional and socio-economical status, and without any psychiatric history (59,1 %). The acute appearance of adjustment disorders caused by psychosocial stress factors which were usually various (60 %), recent (61,7 %) and with a high severity (69,6 %). The suicide attempts were frequent (53 %) representing the first reason for hospitalization. An evolution was favourable in 75,7 % of cases after a short hospitalization (about 8,2 days). Finally, the authors insist on the short hospitalization in order to provide evaluation, observation and treatment setting for these disorders.

Examining transcranial direct-current stimulation (tDCS) as a treatment for hallucinations in schizophrenia.

OBJECTIVE: Some 25%­30% of patients with schizophrenia have auditory verbal hallucinations that are refractory to antipsychotic drugs. Outcomes in studies of repetitive transcranial magnetic stimulation suggest the possibility that application of transcranial direct-current stimulation (tDCS) with inhibitory stimulation over the left temporo-parietal cortex and excitatory stimulation over the left dorsolateral prefrontal cortex could affect hallucinations and negative symptoms, respectively. The authors investigated the efficacy of tDCS in reducing the severity of auditory verbal hallucinations as well as negative symptoms. METHOD: Thirty patients with schizophrenia and medication-refractory auditory verbal hallucinations were randomly allocated to receive 20 minutes of active 2-mA tDCS or sham stimulation twice a day on 5 consecutive weekdays. The anode was placed over the left dorsolateral prefrontal cortex and the cathode over the left temporo-parietal cortex. RESULTS: Auditory verbal hallucinations were robustly reduced by tDCS relative to sham stimulation, with a mean diminution of 31% (SD=14; d=1.58, 95% CI=0.76­2.40). The beneficial effect on hallucinations lasted for up to 3 months. The authors also observed an amelioration with tDCS of other symptoms as measured by the Positive and Negative Syndrome Scale (d=0.98, 95% CI=0.22­1.73), especially for the negative and positive dimensions. No effect was observed on the dimensions of disorganization or grandiosity/excitement. CONCLUSIONS: Although this study is limited by the small sample size, the results show promise for treating refractory auditory verbal hallucinations and other selected manifestations of schizophrenia.

Association between cyclothymic temperament and clinical predictors of bipolarity in recurrent depressive patients.

BACKGROUND: Recent studies have suggested that clinicians may under diagnose bipolarity in a substantial proportion of depressive patients, and proposed that affective temperaments particularly cyclothymic temperament (CT), may predict bipolarity in these patients. The objectives of this study were to assess CT in patients with recurrent depressive disorder (RDD) and to explore its associations with clinical predictors of bipolarity. METHODS: 98 patients (43 men and 55 women, mean age=46.8±9.9years), followed for RDD according to DSM-IV-TR criteria, were recruited. CT was assessed using the Tunisian version of the TEMPS cyclothymic subscale with the threshold score of 10/21. RESULTS: The mean score of CT was 6.5±5.2. One-third of patients (33.7%) had a CT score ≥10. These patients with high CT scores had significantly early age at onset of first depressive episode and high number of previous depressive episodes, and had more psychotic and melancholic features and suicidal ideations and attempts during the last depressive episode compared to patients with low CT scores. The multiple regression analysis showed an association between CT scores and psychotic, melancholic and atypical features and suicide attempts during the last depressive episode. LIMITATIONS: This is a cross-sectional study with a relatively small number of patients. The Tunisian version of the CT subscale was not yet validated. CONCLUSIONS: CT was associated with some clinical predictive factors of bipolarity. These results suggest the relevance of the CT screening in RDD, considering the change of polarity risk and misdiagnosis of unipolar depression.