Gender, age at onset, and duration of being ill as predictors for the long-term course and outcome of schizophrenia: an international multicenter study.

BACKGROUND: The aim of the current study was to explore the effect of gender, age at onset, and duration on the long-term course of schizophrenia. METHODS: Twenty-nine centers from 25 countries representing all continents participated in the study that included 2358 patients aged 37.21 ± 11.87 years with a DSM-IV or DSM-5 diagnosis of schizophrenia; the Positive and Negative Syndrome Scale as well as relevant clinicodemographic data were gathered. Analysis of variance and analysis of covariance were used, and the methodology corrected for the presence of potentially confounding effects. RESULTS: There was a 3-year later age at onset for females (P < .001) and lower rates of negative symptoms (P < .01) and higher depression/anxiety measures (P < .05) at some stages. The age at onset manifested a distribution with a single peak for both genders with a tendency of patients with younger onset having slower advancement through illness stages (P = .001). No significant effects were found concerning duration of illness. DISCUSSION: Our results confirmed a later onset and a possibly more benign course and outcome in females. Age at onset manifested a single peak in both genders, and surprisingly, earlier onset was related to a slower progression of the illness. No effect of duration has been detected. These results are partially in accord with the literature, but they also differ as a consequence of the different starting point of our methodology (a novel staging model), which in our opinion precluded the impact of confounding effects. Future research should focus on the therapeutic policy and implications of these results in more representative samples.

Modeling psychological function in patients with schizophrenia with the PANSS: an international multi-center study.

BACKGROUND: The aim of the current study was to explore the changing interrelationships among clinical variables through the stages of schizophrenia in order to assemble a comprehensive and meaningful disease model. METHODS: Twenty-nine centers from 25 countries participated and included 2358 patients aged 37.21 ± 11.87 years with schizophrenia. Multiple linear regression analysis and visual inspection of plots were performed. RESULTS: The results suggest that with progression stages, there are changing correlations among Positive and Negative Syndrome Scale factors at each stage and each factor correlates with all the others in that particular stage, in which this factor is dominant. This internal structure further supports the validity of an already proposed four stages model, with positive symptoms dominating the first stage, excitement/hostility the second, depression the third, and neurocognitive decline the last stage. CONCLUSIONS: The current study investigated the mental organization and functioning in patients with schizophrenia in relation to different stages of illness progression. It revealed two distinct "cores" of schizophrenia, the "Positive" and the "Negative," while neurocognitive decline escalates during the later stages. Future research should focus on the therapeutic implications of such a model. Stopping the progress of the illness could demand to stop the succession of stages. This could be achieved not only by both halting the triggering effect of positive and negative symptoms, but also by stopping the sensitization effect on the neural pathways responsible for the development of hostility, excitement, anxiety, and depression as well as the deleterious effect on neural networks responsible for neurocognition.

Spatiotemporal gait characteristics of Huntington's disease during dual-task walking.

Purpose: Huntington's disease (HD) is an neurodegenerative genetic disorder with characteristic gait changes. HD also results in a range of cognitive impairments, such as difficulties to divide attention, or simultaneously monitoring two tasks.Aim: The impact of cognitive and/or motor tasks on HD gait has not been fully elucidated. The aim was to examine gait in HD patients while performing motor and/or cognitive dual-task walking.Methods: Gait was measured with and without performing concurrent cognitive and/or motor tasks. Sixteen HD patients and 24 healthy control (HC) subjects performed a self-paced basic walking task, a dual motor, a dual mental and a combined motor and mental task while walking.Results: Base walk gait parameters are significantly different between HD and HC groups. Same is true for motor, mental and combined tasks comparisons of HD and HC subjects. Gait velocity is also significantly reduced in HD compared to HC for all experimental conditions. Comparison of base walk and mental task performance showing differences in cycle time, stride length, double support time and CV of stride length, while base walk to motor task comparison is different only in stride length. No differences were found when motor and combined tasks were compared to mental task in HD patients.Conclusion: Gait pattern in HD patients while performing motor and/or cognitive dual tasks walking is remarkably preserved. Gait parameters are changed in order to reduce possible falls, and lack of differences of dual tasks gait parameters variability is attributed that patients minimizing risk of falling and preserving stability.

Staging of Schizophrenia With the Use of PANSS: An International Multi-Center Study.

INTRODUCTION: A specific clinically relevant staging model for schizophrenia has not yet been developed. The aim of the current study was to evaluate the factor structure of the PANSS and develop such a staging method. METHODS: Twenty-nine centers from 25 countries contributed 2358 patients aged 37.21 ± 11.87 years with schizophrenia. Analysis of covariance, Exploratory Factor Analysis, Discriminant Function Analysis, and inspection of resultant plots were performed. RESULTS: Exploratory Factor Analysis returned 5 factors explaining 59% of the variance (positive, negative, excitement/hostility, depression/anxiety, and neurocognition). The staging model included 4 main stages with substages that were predominantly characterized by a single domain of symptoms (stage 1: positive; stages 2a and 2b: excitement/hostility; stage 3a and 3b: depression/anxiety; stage 4a and 4b: neurocognition). There were no differences between sexes. The Discriminant Function Analysis developed an algorithm that correctly classified >85% of patients. DISCUSSION: This study elaborates a 5-factor solution and a clinical staging method for patients with schizophrenia. It is the largest study to address these issues among patients who are more likely to remain affiliated with mental health services for prolonged periods of time.

Health-related quality of life in adolescents with epilepsy in Montenegro.

OBJECTIVE: The objective of this study was to establish potential risk factors for poor health-related quality of life among adolescents with epilepsy in Montenegro. MATERIAL AND METHODS: A sample of 104 adolescents with epilepsy (age: 11-19years) at a tertiary referral center in Podgorica, Montenegro, completed the validated Serbian version of the QOLIE-AD-48 questionnaire. They were divided into two groups: a group with active epilepsy (60 adolescents) and a group with inactive epilepsy (44 adolescents). Demographic and clinical data were collected. RESULTS: Adolescents with active epilepsy had low quality of life and felt the negative impact of the disease. They also had more cognitive impairments, felt more stigmatized, and had considerably more distorted perception of their health than adolescents with inactive epilepsy (p<0.05). Females reported better social support than males (p<0.05). Older males had lower grades at school (p<0.05) than the younger ones. As expected, adolescents with the highest number of seizures in the past two years had the lowest quality of life (p<0.05). CONCLUSION: In our study, the quality of life in adolescents with epilepsy was determined by severity of the disease, age, and gender.

Attempted suicide in Podgorica, Montenegro: higher rates in females and unemployed males.

BACKGROUND: A change in suicide attempts is associated with comprehensive changes in mental and physical health and social environment. Attempted suicide and suicide are one of the biggest problems nowadays worldwide, not only in the field of mental health but also in the field of public health. The aim of the research was to determine the number of attempted suicides as well as the influence of clinical and demographic variables on the attempted suicide rate. METHODS: The data on the attempted suicide were analysed in the period 2012-2016 based on the data from the Emergency Ward of the Clinical Centre of Montenegro in Podgorica. The rate of attempted suicides as well as the unemployment rate was calculated. The statistical analysis included descriptive statistics of the raw data and relative numbers, Chi-squared test, Fisher's test and Spearman coefficient. RESULTS: The average age of males who attempted suicide was 38.35 ± 14.11, min 15 and max 88 years of age, and the age of women was 38.97 ± 16.81, min 16 and max 93 years of age. Women attempted suicide more frequently (p < 0.05). Female/male ratio during the investigation period slightly declined (1.93 in 2012 vs. 1.29 in 2016). The attempted suicide rates ranged from 103 per 100,000 residents in 2016 to 142 per 100,000 residents in 2015. Crude attempt rate was the highest in women in 2012 (102.42 per 100,000 residents) and for men in 2014 and 2015 (84.48 vs. 83.06 per 100,000 residents). Poisoning with psychotropic drugs was the dominant manner of attempt (93.2%), while the largest number of attempts was in the late spring and summer (May, June and July). Attempted suicide rate in man was associated with higher unemployment rate. CONCLUSIONS: Although women make the majority of attempted suicide cases, there has been a decline in the value of the rate for women and a rise for men. The attempted suicide rates in Podgorica belong to lower rates compared to the WHO European multicentre study on parasuicide. Poisoning with psychotropic drugs was the predominant manner, while the highest number of attempted suicides was in the late spring and summer (May, June and July). Unemployment influences men to attempt suicide much more frequently.

Public Awareness, Understanding and Attitudes Towards Epilepsy in Montenegro.

Stigma remains a distressing consequence of epilepsy worldwide. We assessed stigma markers among citizens of Montenegro. Randomly selected adults aged 18 to 65 were interviewed using a 10-item questionnaire, which had been used in similar settings. Descriptive statistics, χ2-test and Fisher exact test were used in order to identify factors associated with negative attitudes. After exclusions and refusals, the questionnaire was administered to 1000 people, 91% of whom had heard about epilepsy. Less than half knew someone with epilepsy and 31.5% had witnessed a seizure. One-fifth would object if their child played with a person who had epilepsy and three-quarters would object if their child married a person with epilepsy. Forty percent believed people with epilepsy should be employed in the same way as everybody else. Fewer than 8% of respondents thought epilepsy was a form of insanity. Over 80% favored brain disease as a cause of epilepsy and 95% chose convulsions to be a major feature of an epileptic attack. General awareness of epilepsy in Montenegro is similar to that in other countries. Understanding epilepsy is relatively good but the results suggest that there still are negative attitudes towards people with epilepsy.

CORRELATION OF C-REACTIVE PROTEIN AND COPD SEVERITY.

Chronic obstructive pulmonary disease (COPD) is a progressive pulmonary disease characterized by systemic inflammation. The aim of this study was to correlate the parameters of systemic inflammation, C-reactive protein (CPR) and total leukocyte count, with clinical indicators of the disease. Our study included 157 COPD patients, both outpatients and those hospitalized at the Knez Selo Department of Pulmonology of the Nis Clinical Centre during a six-month period, while in the phase of disease exacerbation. The symptoms of COPD in each patient were estimated by the COPD Assessment Test (CAT) and modified Medical Research Council (mMRC) dyspnea scale. The parameters of pulmonary function (FEV1 and FVC), acid-base status, body mass index, history of exacerbation and comorbidities were also evaluated. The level of CRP, but not leukocytes, showed significant correlation with the severity of clinical presentation according to GOLD classification. The higher the CRP concentration, the higher was the disease severity determined according to GOLD classification (p < 0.001). There was no statistically significant difference in CRP level and leukocyte count according to comorbidities (p = 0.29). The level of CRP was higher in patients with a high CAT score and mMRC scale (p < 0.001). The same trend was observed for leukocyte count when compared with CAT results, but not when correlated to mMRC scale. The level of CRP during COPD exacerbation can be an independent predictor of the disease severity and paraclinical findings.

Prevalence of epilepsy in Podgorica, Montenegro.

The purpose of this study was to assess for the first time the prevalence of epilepsy in the capital of Montenegro and to describe the clinical and epidemiological profile of the disorder. A door-to-door screening was performed on population of 6 randomly selected areas of Podgorica (capital of Montenegro) using validated screening questionnaire. In phase 1, the screening by questionnaire of 4007 individuals identified 307 suspected cases of epilepsy. Four of them dropped out of further investigation just before entering the phase 2. In phase 2, the remaining 303 suspected cases were first examined by general practioner and then by an epileptologist, on two follow-up visits. The confirmation of epilepsy was based on clinical examination. Electroencephalogram (EEG), computed tomography (CT) and/or magnetic resonance imaging (MRI) were also used. 29 persons were diagnosed with epilepsy. An overall prevalence of 7.2 cases per 1000 inhabitants was calculated (CI 95% 5.0­10.0). Majority of them had been previously diagnosed (86.20%), 27 had active epilepsy and over a half of them were on polymedication (65.51%). Referring to the 27 patients with active epilepsy, the predominant seizure type was partial (all types) in 14 (48.27%) and undetermined in 2 (6.89%). Cause of epilepsy was determined in 10 patients. EEG abnormalities were found in almost all patients (89.65%). CT anomaly was determined in 9 whereas only 1 patient had an abnormal MRI finding. The estimated prevalence of epilepsy indicated higher rates compared to neighboring counties and the rest of the Europe, but limitations of the study (high rejection rate and stigma) should be taken into consideration.

Psychiatric comorbidities among patients with epilepsy in Montenegro.

The aim of this study was to evaluate the prevalence of psychiatric comorbidities, depression and anxiety, among patients with epilepsy in the outpatient Clinic for Epilepsy, Clinical Centre of Montenegro. Patients aged 18 and above with a diagnosis of epilepsy for at least one year were consecutively enrolled during a six-month period. Patients anonymously filled out a questionnaire which included data on the gender, age, education, marital status and degree of seizure control. The Hamilton Depression Rating Scale (HAM-D) and Hamilton Anxiety Rating Scale (HAM-A) were used to evaluate the presence or absence of anxiety and depression. Total number of study patients was 70, including 52 patients with partial seizures and 18 patients with generalized tonic-clonic seizures. The mean patient age was 37 ± 7.92 years. The prevalence of depression in our sample was 32.8%, whereas the prevalence of anxiety was 21.4%. Patients with partial seizures were more depressed, while those with idiopathic generalized seizures were more anxious (p < 0.01). Depression was associated with a lower educational level, unemployment and poor seizure control (p < 0.05). The number of antiepileptic drugs showed a trend towards negative association with depression (p = 0.005). Anxiety was associated with the level of education and uncontrolled seizures (p < 0.01). Neither depression nor anxiety was associated with age, gender, marital status, age at onset and duration of epilepsy. Psychiatric disorders among patients with epilepsy are quite common but yet under-recognized. Therefore, appropriate recognition and efficient treatment of these disorders in patients with epilepsy might improve their quality of life and could consequently lead to better treatment success.