The Association between Lifestyle Choices and Schizophrenia Symptoms.

Due to poor eating habits, insufficient physical activity, and nicotine use, schizophrenia patients are at increased risk of lifestyle diseases. Factors contributing to unhealthy behaviors include lower socioeconomic status and level of education as well as social isolation. Schizophrenia manifestations such as amotivation, apathy, and cognitive deficits can further hinder development of proper health habits. The aim of this study was to assess the possible association between lifestyle-related choices and schizophrenia symptoms severity. This observational study enrolled 106 patients with schizophrenia (42 Males/64 Females), 18-69 years (mean: 41.89 ± 9.7 years). Mean duration of schizophrenia was 14.61 ± 9.7 years. Multiple significant correlations were found between patients' lifestyle and their biochemical laboratory parameters (lipid profile and fasting glucose). Most importantly, a significant link emerged between presented habits and schizophrenia symptom severity. There were also significant gender differences in the intake of sweets and sweet beverages. Quite unexpectedly, a behavioral shift towards more healthy lifestyle choices was observed after completion of questionnaires on lifestyle and health habits. There are clear benefits to systematic provision of educational interventions concerning physical activity and proper eating habits to schizophrenia patients. These simple preventive measures could significantly improve both mental and physical health outcomes in schizophrenia patient populations.

Metabolic Dysregulation and Psychosocial Stress in Patients with Schizophrenia Spectrum Disorders: A Case-Control Study.

Patients with schizophrenia spectrum disorders have a reduced life expectancy, which is largely the consequence of a high co-occurrence of cardiovascular diseases. To date, several intrinsic and environmental factors underlying this phenomenon have been found. However, the association with psychosocial stress has not been extensively addressed. In this study, we tested the relationship between a history of adverse childhood experiences (ACEs), lifetime stressors, perceived stress and metabolic parameters in patients with schizophrenia spectrum disorders and in healthy controls. The participants included 85 inpatients with schizophrenia spectrum disorders and 56 healthy controls. Serum levels of glucose, insulin, low- and high-density lipoproteins (LDL and HDL), triglycerides, total cholesterol and high-sensitivity C-reactive protein (hsCRP) were determined. After adjustment for potential confounding factors, patients had significantly higher levels of glucose (F = 4.856, p = 0.030), triglycerides (F = 4.720, p = 0.032) and hsCRP (F = 7.499, p = 0.007) as well as significantly lower levels of HDL (F = 5.300, p = 0.023) compared to healthy controls. There were also significant effects of interactions between diagnosis and a history of ACEs on the levels of insulin (F = 4.497, p = 0.036) and homeostatic model assessment of insulin resistance (HOMA-IR) (F = 3.987, p = 0.048). More specifically, the levels of insulin and HOMA-IR were significantly higher in the subgroup of patients with schizophrenia spectrum disorders and a positive history of ACEs compared to other subgroups of participants. No significant associations between lifetime stressors and perceived stress with metabolic parameters were found. Our findings indicate that a history of ACEs might be associated with insulin resistance in patients with schizophrenia spectrum disorders. Therapeutic strategies targeting early-life stress should be considered with early interventions that aim to manage cardiometabolic comorbidity in patients with schizophrenia spectrum disorders.

Stress coping strategies and their clinical correlates in patients with psychosis at various stages of illness: A case-control study.

AIMS: There is evidence that individuals with psychosis adopt inefficient coping styles. Moreover, it has been hypothesized that inefficient coping styles might serve as trait-dependent characteristics of psychosis. Therefore, we aimed to explore coping styles and their clinical correlates at various stages of psychosis. METHODS: We recruited 37 individuals at familial high risk of psychosis (FHR-P), 42 individuals with first-episode psychosis (FEP), 28 acutely relapsed schizophrenia (SCZ-AR) subjects and 40 healthy controls. Coping strategies were assessed using the Coping Inventory for Stressful Situations. RESULTS: Individuals with FEP were less likely to use task-focused coping, while SCZ-AR subjects preferred using distraction when compared to controls. Both groups of participants did not differ significantly in terms of using specific coping styles. No significant differences in the use of various coping strategies between FHR-P individuals and controls were found. Higher odds of using emotion-focused coping and distraction were associated with more severe depressive symptoms in individuals with psychosis. Moreover, higher frequency of using distraction was associated with worse functioning in individuals with psychosis. However, this association appeared to be insignificant after adjustment for multiple testing. CONCLUSIONS: Coping styles are similar in FEP and SCZ-AR subjects. However, decreased use of task-focused coping is more specific for FEP individuals while a preference of distraction might be more typical for SCZ-AR individuals. The use of various coping styles is similar in FHR-P individuals and controls. Preference of distraction and emotion-focused coping might be related to more severe depressive symptoms and poor functioning in individuals with psychosis.

Allostatic load index and its clinical correlates at various stages of psychosis.

Accumulating evidence indicates systemic biological dysregulations in patients with psychosis that have been conceptualized as the "allostatic load" (AL) index. We aimed to investigate the AL index in 37 subjects at familial high risk of psychosis (FHRP), 42 first-episode psychosis (FEP) patients, 25 acutely relapsed schizophrenia (SCZ-AR) patients and 42 healthy controls (HCs), taking into account psychopathology and cognitive impairment. The AL index was calculated based on 15 biomarkers (cardiovascular markers, anthropometric measures, inflammatory markers, glucose homeostasis parameters, lipids and steroids). Cognition was assessed using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). The AL index was significantly higher in patients with psychosis and FHR-P individuals compared to HCs. Patients with FEP and FHR-P individuals had similar AL index. Moreover, the AL index was significantly higher in SCZ-AR patients compared to other groups of participants. Higher AL index was associated with more severe general psychopathology and depressive symptoms, lower scores of attention (total score, digit span and digit coding tasks) and semantic fluency, as well as worse general functioning in patients with psychosis. There was a significant negative correlation between the AL index and the scores of attention (total score and digit coding task) in FHR-P individuals. No significant correlations between the AL index and cognition were found in HCs. Our results indicate that biological dysregulations, captured by the AL index, appear already in FHR-P individuals and progress with psychotic exacerbations. Elevated AL index might contribute to cognitive impairments in FHR-P individuals and patients with psychosis.

Evaluation of hyperhomocysteinemia prevalence and its influence on the selected cognitive functions in patients with schizophrenia.

There is evidence that hyperhomocysteinemia may be associated with the development of schizophrenia and cognitive impairment. Therefore, the aim of this study was to analyze the relationship between cognitive functions and normal homocysteine concentrations vs. hyperhomocysteinemia in schizophrenia patients before and after supplementation with vitamins B6, B12 and folate. An 8-week prospective, non-randomized study enrolled 122 adult patients with schizophrenia (67F/55M, mean age 43.54 ±â€¯11.94 years). Homocysteine concentrations were measured in all individuals and afterwards hyperhomocysteinemia patients (n = 42) were divided into two subgroups: treated with oral vitamins supplementation (B6 - 25 mg/d, B12 - 20 µg/d, folate - 2,5 mg/d) (n = 22) and without supplementation (n = 20). The assessment of schizophrenia symptoms severity in study group was performed using the Positive and Negative Syndrome Scale (PANSS). Cognitive functions were evaluated using the Stroop test and the Trail Making Test (TMT). We observed a higher prevalence of hyperhomocysteinemia in schizophrenia patients (34.4%) in comparison to the general population. Individuals with schizophrenia and coexisting hyperhomocysteinemia had worse performance on the Stroop and the TMT tests as well as higher PANSS scores. In these patients, supplementation with vitamins effectively decreased the homocysteine concentrations to the normal values, however there was no statistically significant improvement in the PANSS and cognitive test scores, except a significant decrease in the number of the Stroop test errors. We conclude that significant results obtained in this study show that there is a relationship between homocysteine blood concentration and schizophrenia severity. Moreover, homocysteine concentration lowering might be beneficial in schizophrenia patients with hyperhomocysteinemia in terms of cognitive functions improvement.

Pharmacy switch of antipsychotic medications: patient's perspective.

BACKGROUND AND AIM: Several studies have raised concerns over consequences of brand-to-generic and generic-to-generic pharmacy-generated medication substitutions in psychiatric and non-psychiatric patients. The purpose of this retrospective study was to assess behavioral and emotional responses of patients with schizophrenia to antipsychotic medication substitution performed by pharmacies. METHODS: A group of Polish ambulatory patients with schizophrenia (n = 196) chronically treated with antipsychotic medications were asked whether antipsychotic medication substitution had been proposed by a pharmacist in the last 12 months. Ninety-nine patients answering positively were administered more questions addressing the patient's emotional and behavioral response to the pharmacy proposal. RESULTS: The most important findings of the present study can be summarized as follows: (1) approximately half of the patients were confronted with a pharmacy proposal to switch their antipsychotic medications in the last 12 months, (2) one quarter of these patients did not accept the pharmacy switch, (3) a substantial proportion of patients (>40 %) did not receive any explanation from a pharmacist offering medication substitution, (4) pharmacy-generated substitution proposals were mainly associated with negative patient attitudes and negative emotional responses, (5) substitution proposals provoked an unscheduled psychiatric visit in approx. 10 % of patients, (6) despite the negative attitudes reported by patients, the pharmacy switch rarely led to treatment discontinuation, but did provoke a change in drug dosing in 7 % of patients accepting the switch. CONCLUSIONS: A pharmacy proposal to switch their antipsychotic medications is a relatively common experience of Polish ambulatory patients with schizophrenia. Pharmacy-generated substitution proposals are mainly associated with negative patient attitudes, but rarely lead to antipsychotic treatment discontinuation in this group of patients.

[HIV-associated neurocognitive disorders]. / Zaburzenia neuropoznawcze w przebiegu zakazenia wirusem HIV.

HIV infection is an important medical and social problem. In Poland, similarly to other countries, patients with HIV infections are mostly young people. Apart from typical immunologic pathologies, the HIV infection leads to some neurocognitive, motoric and behavioral disorders. The aim of this paper is to present the up-to-date knowledge of HIV-associated neurocognitive disorders (HAND).

[Depression in children and adolescents -symptoms, etiology, therapy]. / Depresja u dzieci i mlodziezy-obraz kliniczny, etiologia, terapia.

Early onset depression, regarding its high prevalence and debilitating effects on development, is considered to be one of the major mental illness in children and adolescents. Most commonly is recurrent and continues in adulthood. Factors determining vulnerability to depression can be grouped into following categories: genetics, familial environment, personal characteristics and severe stress. Main risk factors include: being a female, family history of depression, subclinical symptoms, negative cognitive style, negative life events. Common symptoms of depression can be different in children and teens than they are in adults. Often occur with atypical features. The diagnosis might be problematic as it often relays on the observation of children's dysfunctions. Therefore treatment of major depression in children and adolescents is considered difficult. It is important to estimate all the features that underlie the symptoms, their persistence, and then implement proper therapy.