Sex differences in macular thickness of the retina in patients with psychosis spectrum disorders.

INTRODUCTION: Imaging of retinal structure in psychosis spectrum disorders (PSD) is a novel approach to studying effect of this illness class on CNS structure. Studies of optical coherence tomography (OCT) have revealed significant reductions in regarding: retinal nerve fiber layer (RNFL), macular thickness (MT), ganglion cell-inner plexiform layer (GC-IPL) and macular volume (MV). Sex differences in retinal structure in PSD have not been previously explored. METHODS: This cross-sectional pilot study included 81 participant of age matched patients and controls. There were no differences between genders regarding illness duration and antipsychotic daily dose in the patient group. SD-OCT assessed RNFL, GC-IPL, MT, MV, and optic nerve cup-to-disc (C/D) ratio. In order to assess the main effects of illness, sex, and illness × sex interaction on the retinal parameters, general linear model was performed. RESULTS: Patients demonstrated abnormalities on all OCT indices. Effects of sex were observed for central subfield MT and C/D ratio, which were lower in females. An illness × sex interaction effect was observed for the left MT, indicating greater thinning in female patients. CONCLUSION: Sex differences in OCT findings in PSD appear to be most prominent considering macular parameters. These preliminary data may have important implications for the valid interpretation of OCT findings as potential biomarkers for PSD.

Maintenance phase treatment of psychotic disorders in outpatients from Serbia - focus on long-term benzodiazepine use.

Introduction: Prescribing trends in maintenance therapy of patients with primary psychotic disorders (PSD) may vary worldwide. Present study aimed to investigate prescription patterns in a sample of outpatients with PSD from Serbia.Methods: In a sample of 73 PSD outpatients we analysed the rate of antipsychotic polypharmacy and psychotropic polypharmacy, concomitant continual benzodiazepine use, and associations between therapy, psychotic symptoms and quality of life.Results: Maintenance therapy (median daily dose 321 mg of chlorpromazine equivalents) predominantly consisted of monotherapy with second generation antipsychotics (45.2%), followed by antipsychotic polypharmacy based on first and second generation combination (25.0%). The median number of psychotropic drugs was 3. Benzodiazepines were continually prescribed to more than 60% of patients (mean daily dose 2.9 ± 2.0 mg lorazepam equivalents). Patients with benzodiazepine use had significantly more psychotropic medications and more antipsychotic polypharmacy, poorer quality of life and more severe psychopathology in comparison to another group.Conclusion: The present study demonstrated new information regarding the prescription patterns of psychotropic drugs in outpatients with PSD in Serbia, amplified with clinically relevant information. This study also revealed distinct prescription patterns concerning antipsychotic/benzodiazepine polypharmacy. Overall, such findings are likely to contribute to improving clinical practice and care for patients with PSD in general.KeypointsPresent exploratory research aimed to elucidate trends of antipsychotics polypharmacy and concomitant use of psychotropic medications including benzodiazepines in the maintenance treatment of outpatients with schizophrenia and other psychotic disorders, amplified with clinically relevant information (symptoms and quality of life).'Antipsychotic (AP) polypharmacy' was defined as concurrent use of more than one AP for at least 1 month; 'Psychotropic polypharmacy' was defined as the combination of AP and a different class of psychotropic drugs medication for at least one month.The median number of prescribed psychotropic drugs was 3 (mean 3.1 ± 1.1) and the average AP daily dose was moderate (median 321 mg of chlorpromazine equivalents). However, the rates of AP polypharmacy (45.2%) and benzodiazepine prescription on a continual basis (>60%) found in our sample could be considered relatively high.Outpatients with higher AP daily dose and higher BPRS symptom score were receiving more benzodiazepines.For improvement of the local, as well as general clinical practice and care for patients with psychotic disorders, and for education in psychiatry, such analyses need to be done on a regular basis and on larger samples.

Retinal structural abnormalities in young adults with psychosis spectrum disorders.

BACKGROUND: Structural retinal architecture in living organisms became measurable with the development of optical coherence tomography (OCT) scanners. Single-layer analysis with spectral-domain OCT, among other techniques, may provide further insight into pathological changes in complex brain disorders such as psychosis spectrum disorders (PSD). METHODS: This study investigated potential thinning of retinal layers (retinal nerve fiber layer - RNFL, macular volume, macular thickness, ganglion cell-inner plexiform layer- GC-IPL, optic cup volume and cup-to-disk ratio) using a spectral-domain OCT device in 33 non-acute PSD patients (illness duration 5.9 ± 3.9 years) and 35 healthy controls. RESULTS: In comparison to age and gender matched controls, patients had bilateral reductions in GC-IPL layer thickness and macular volume. Macular central subfield thinning was found in the right eye, while average macular thickness was lower in the left eye only. RNFL thinning was not observed in patients in comparison to controls, but we noticed that status of this layer could be affected by daily dose of antipsychotics and by illness duration. CONCLUSION: Taken together, our results reveal that retinal thinning is present in young adults with PSDs, but in comparison to the literature we found more prominent changes in both GC-IPL and macular volume/thickness, than in RNFL. Our findings may reflect synaptic loss and neuronal atrophy in non-acute young patients with psychosis.

Type D personality in patients with coronary artery disease.

BACKGROUND: During the past decade studies have shown that Type D personality is associated with increased risk of cardiac events, mortality and poor quality of life. Some authors suggested that depression and Type D personality have substantial phenomenological overlap. SUBJECTS AND METHODS: The sample consisted of non-consecutive case series of seventy nine patients with clinically stable and angiographically confirmed coronary artery disease (CAD), who had been admitted to the Clinic of Cardiology, University Clinical Centre, from May 2006 to September 2008. The patients were assessed by the Type-D scale (DS14), The Beck Depression Inventory (BDI), and provided demographic information. Risk factors for CAD were obtained from cardiologists. RESULTS: The findings of our study have shown that 34.2% patients with CAD could be classified as Type D personality. The univariate analysis has shown that the prevalence of Type D personality was significantly higher in individuals with unstable angina pectoris and myocardial infarction (MI) diagnoses (p=0.02). Furthermore, some components of metabolic syndrome were more prevalent in patients with Type D personality: hypercholesterolemia (p=0.00), hypertriglyceridemia (p=0.00) and hypertension (p=0.01). Additionally, the distribution of depression in patients with a Type D personality and a non-Type D personality were statistically significantly different (p=0.00). CONCLUSION: To our knowledge, this study is the first one to describe the prevalence and clinical characteristics of the Type D personality in patients with CAD in this region of Europe. We have found that the prevalence of Type D personality in patients with CAD is in concordance with the other studies. We also have found that Type D personality and depression are two distinctly different categories of psychological distress.

Metabolic issues in psychotic disorders with the focus on first-episode patients: a review.

Before the onset of the illness, future schizophrenia patients do not weigh more comparing to their peers. However, during the later course of the illness, obesity is twice as prevalent as in general public, afflicting the half of schizophrenia patient population. There is a list of potential factors that contribute to this, including lifestyle, dietary habits, unsatisfactory monitoring of physical health etc, but nowadays side effects of antipsychotic medication become the most prominent concern when weight gain and metabolic issues in psychosis are addressed. The fact is that second generation antipsychotics (SGA) are associated with weight gain and metabolic syndrome, but that might be the case with the first generation antipsychotics (FGA) too. Besides, obesity might be evident in patients before any exposure to medications, and all that bring lot of dilemmas into the field. This paper critically reviews available data on metabolic problems in patients with psychotic disorders, raging from genetic to molecular and environmental factors, and highlights the necessity of screening for the early signs of metabolic disturbances, as well as of multidisciplinary assessment of psychiatric and medical conditions from the first psychotic episode.

Bone remodeling, bone mass and weight gain in patients with stabilized schizophrenia in real-life conditions treated with long-acting injectable risperidone.

BACKGROUND: Prolactin-raising antipsychotics, risperidone (antidopaminergic activity), may be associated with low bone mass. On the other hand, risperidone may cause an increase in body weight thought to be favorable for bone. OBJECTIVES: (1) To determine bone remodeling parameters and bone mass in patients with schizophrenia on long-term treatment with long-acting injectable risperidone (LAIR) in naturalistic settings, and (2) to evaluate the change in body weight, metabolic profile and neuroendocrine status in these patients. DESIGN: This was a prospective, cross-sectional study. PATIENTS: Patients included 26 outpatients with controlled schizophrenia in real-life conditions (age 31.3 ± 1.3 years, BMI 28.1 ± 1.0) on long-term maintenance therapy with LAIR for a mean of 18.0 ± 1.6 months (range 6-36) with a mean dose of 38 ± 2 mg. 35 subjects matched for sex, age, BMI and education served as healthy controls. METHODS: Serum osteocalcin, C-terminal telopeptide of type I collagen (CTx), vitamin D, leptin, prolactin, sex steroids, and parathyroid hormone were assessed. Indices of insulin sensitivity and resistance were determined following an oral glucose tolerance test (OGTT). Bone mineral density (BMD) was measured by dual X-ray absorptiometry at the lumbar spine (LS) and femoral neck (FN). RESULTS: Mild to moderate hyperprolactinemia (1,000-2,000 mU/l) was associated with asymptomatic hypogonadism. Prolactin values >2,000 mU/l occurred in a few female patients. Hypogonadism leads to a slight increase (upper limit of normal) in bone resorption marker (CTx) in patients with schizophrenia (p = 0.023). As for bone mass, although lower at the spine than in healthy subjects, it did not reach statistical significance (p = 0.094), while at the FN, BMD was not different from healthy subjects. Body weight increased on average 8.7 ± 1.6 kg in more than 50% of patients. Leptin levels adjusted for BMI in females were significantly higher in patients than in healthy female subjects (p = 0.018), while in males there was no difference between the groups (p = 0.833). A high prevalence of low vitamin D levels and more current smokers were found in patients with schizophrenia. As for the metabolic profile during treatment with risperidone, the low Matsuda index of insulin sensitivity (p = 0.039) confirmed insulin resistance in these patients. CONCLUSION: A potential long-term consequence of asymptomatic hypogonadism due to risperidone-induced hyperprolactinemia might cause a slight rise in bone resorption marker (CTx). On the other hand, by increasing body weight, risperidone could have a protective effect on the bone and thus no change in bone mass was recorded when compared with healthy controls.

Prenatal stress during the 1999 bombing associated with lower birth weight-a study of 3,815 births from Belgrade.

During the 3-month bombing of Serbia (March 24-June 9, 1999), the entire population, including pregnant females as an especially vulnerable group, was exposed to a high degree of stress. This is the first study to explore the effects of prenatal stress during the 1999 bombing of Belgrade on the main obstetric characteristics of newborns. The design of the study was retrospective cross-sectional. The total number of birth records in the sample was 3,815, namely, 1,198 from the group exposed to prenatal stress and 1,251 and 1,366 from the respective control periods, years 1996 and 2003, when no stressful events affected the city. We found that exposed mothers gave birth to infants with statistically significantly lower birth weight (BW; mean difference = 86 g, 95% confidence interval = 67 to 104; F ((1, 3,349)) = 80.8, p < 0.001, eta (p) (2) = 0.024), when controlling for confounding effects of body length and head circumference. There was no specific relation between the trimester of stress exposure and BW in infants born in 1999. Neither increased frequency of preterm deliveries nor more complications of pregnancy and delivery were found in the given sample. Possible consequences of lower BW on psychosocial and somatic functioning should be evaluated through the lifetime.

Comparative analysis of soft neurological signs in positive and negative subtype of schizophrenia.

BACKGROUND: The objective of the study was to investigate neurological deficit in schizophrenia and to compare soft neurological signs in positive and negative subtypes of schizophrenia. SUBJECTS AND METHODS: 66 patients with schizophrenia were evaluated with the Positive and Negative Syndrome Scale to classify the subtype of schizophrenia: positive subtype (36 patients) and negative subtype (30 patients), all of which were entering into remission. To examine the neurological soft signs we compared scores on the Neurological Evaluation Scale (NES) for positive and negative subtype. RESULTS: The negative subtype of schizophrenia showed significantly higher neurological soft signs in comparison to the positive subtype, with reduced functioning in the sensory integration and motor coordination subscale as well as the other subscale. CONCLUSION: The main finding in this study indicates that patients with schizophrenia have neurological impairment, and that the negative subtype has significantly higher neurological impairment than the positive subtype. The results further support the significance of the soft neurological signs as a possible marker of different subtypes of schizophrenia.

Efficacy, tolerability and safety of tianeptine in special populations of depressive patients.

BACKGROUND: Tianeptine, a new generation antidepressant, possesses a unique mechanism of antidepressive action and has a specific pharmacokinetic profile. The aim of this study was to determine the efficacy, tolerability and safety of tianeptine in a "fragile" population of depressive patients: (1) a group of elderly patients and (2) a group with comorbid alcohol addiction. SUBJECTS AND METHODS: This was an open multicentric eight-week study of tianeptine efficacy, tolerability and safety including patients with mild to moderate depression (DSM-IV), age > or =55 years (group 1; n=45) or with comorbid alcohol addiction (group 2; n=32). Assessments was made with the following rating scales; MADRS, HAM-A and CGI for efficacy and DESS for tolerability. RESULTS: After eight-week tianeptine therapy, remission (MADRS < or =12) was established in 51.1% and 84.4% patients, respectively. On day 7, the therapy led to a significant decrease of MADRS. On endpoint, there were significant differences on HAM-A, CGI-I and CGI-S scores (p<0.01). No adverse effects with frequency > or = 10%, were registered. A lower tolerability of tianeptine was registered in a group of elderly (nausea 4.5%, leg fatigue 4.4%, irritability 2.2%, bursts of crying and sadness 2.2%), while only 3.1% depressive patients with comorbid alcohol addiction had dizziness. CONCLUSION: This is the first clinical study to evaluate tolerability, efficacy and safety of tianeptine in a special population of depressive patients in the region. The study showed that tianeptine had good efficacy in treatment of mild to moderate forms of depression in special populations of depressive patients (elderly population and patients with comorbid alcohol addiction). The drug was well tolerated.

Contemporary framework for alcohol craving.

OBJECTIVE: Fifty years ago, craving was defined as an "urgent and overpowering desire, or irresistible impulse", but subsequently, craving definitions have been modified by many authors and no unique definition of this phenomena, or a consensus in regards to its manifestation and significance exists. This review discusses the contemporary views of alcohol craving. Issues such as definition and different types, dynamics of craving, its mediators and moderators and clinical correlations are explored. SUBJECTS AND METHODS: We focused on the literature search (MEDLINE, PSYCHLIT, and EMBASE) and new findings in the addiction field, especially paying attention on the study of craving. FINDINGS: There is growing evidence to suggest that craving is associated with different aspects of addiction (i.e. withdrawal, relapse) and clinical characteristics such as depression and anxiety. These different phenomena contribute individual differences in intensity, frequency and types of craving. At present, there are several different models to better describe the complexity of craving. CONCLUSIONS: Craving is not an exact, precisely measurable value but it is rather an uncertain, descriptive phenomenon. Further research (biological, sociological and psychological) should be orientated primarily toward exploration of the relationship between environmental factors and personality variables and craving and its maintenance, with special attention to gender differences.

Treatment compliance of outpatients with schizophrenia: patient's attitudes, demographic, clinical and therapeutic variables.

AIM: To compare patient's attitudes, demographic, clinical characteristics, psychopathology, insight and type of antipsychotic therapy in compliant and non-compliant outpatients with schizophrenia; to explore correlations between patient's attitudes and related variables. METHODS: A sample of 44 outpatients of both genders (> 60 years), with a diagnosis of ICD-10 Schizophrenia (F20) was included into the study. All the patients were on maintenance treatment with different classes of antipsychotics (oral, depot or both), for at least 6 months from the latest hospitalisation. The exclusion criteria were determined. The BPRS and the PANSS were used to assess psychopathology and insight (G12 item). The self-report questionnaire MARS was used to assess patient's attitudes. RESULTS: Compliant patients (N=37) showed the following significant differences compared to non-compliant patients (N=7): higher the MARS (p<0.001), lower the PANSS (Positive sub score) (p<0.01) G12 scores (p<0.01) (the Student t test) and percentage of patients with previous non-compliance (p<0.05) (chi2 test). Considerable correlation between the MARS and the BPRS (p<0.001), the PANSS (Positive, General psychopathology) (p<0.001; p<0.01), G12 scores (p<0.05) (negative) and current compliance (p<0.001) was also found (The Spearman's correlation). CONCLUSIONS: Our results suggest that special attention should be paid to attitudes, severity of psychopathology, insight and history of non-compliance in compliance evaluation of outpatients with schizophrenia.

[Comorbidity of eating disorder and alcohol dependency].

INTRODUCTION: Epidemiological studies suggest that a high prevalence of alcohol addiction exists in female patients diagnosed with eating disorder in comparison to general population. For the purpose of explanation of the relationship of these disorders many conceptual models have been proposed. CASE REPORT: We presented a female patient displaying a comorbidity of eating disorder and alcohol dependency. We analyzed phenomenological similarities, personal characteristics and bio-psychological predisposition in order to ensure better understanding of the nature of the correlation of the two mentioned disorders. CONCLUSION: Even though, these days we find the synonym for eating disorders in the phrase "food addiction", it is impossible to categorize such a complex group of disorders to an addictive process. Moreover, we could assume that there exists a common psychobiological vulnerability which predisposes the development of one and/or the other disorder. To date knowledge has a significant implication for the development of new strategy in treating this comorbidity.