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1.
JAMA Netw Open ; 3(2): e1921660, 2020 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-32083693

RESUMO

Importance: Little guidance exists to date on how to select antipsychotic medications for patients with first-episode schizophrenia. Objective: To develop a preliminary individualized treatment rule (ITR) for patients with first-episode schizophrenia. Design, Setting, and Participants: This prognostic study obtained data from Taiwan's National Health Insurance Research Database on patients with prescribed antipsychotic medications, ambulatory claims, or discharge diagnoses of a schizophrenic disorder between January 1, 2005, and December 31, 2011. An ITR was developed by applying a targeted minimum loss-based ensemble machine learning method to predict treatment success from baseline clinical and demographic data in a 70% training sample. The model was validated in the remaining 30% of the sample. The probability of treatment success was estimated for each medication for each patient under the model. The analysis was conducted between July 16, 2018, and July 15, 2019. Exposures: Fifteen different antipsychotic medications. Main Outcomes and Measures: Treatment success was defined as not switching medication and not being hospitalized for 12 months. Results: Among the 32 277 patients in the analysis, the mean (SD) age was 36.7 (14.3) years, and 15 752 (48.8%) were male. In the validation sample, the treatment success rate (SE) was 51.7% (1.0%) under the ITR and was 44.5% (0.5%) in the observed population (Z = 7.1; P < .001). The estimated treatment success if all patients were given a prescription for 1 medication was significantly lower for each of the 13 medications than under the ITR (Z = 4.2-16.8; all P < .001). Aripiprazole (3088 [31.9%]) and amisulpride (2920 [30.2%]) were the medications most often recommended by the ITR. Only 1054 patients (10.9%) received ITR-recommended medications. Observed treatment success, although lower than the success under the ITR, was nonetheless significantly higher than if medications had been randomized (44.5% [SE, 0.55%] vs 41.3% [SE, 0.4%]; Z = 6.9; P < .001), although only marginally higher than if medications had been randomized in their observed population proportions (44.5% [SE, 0.5%] vs 43.5% [SE, 0.4%]; Z = 2.2; P = .03]). Conclusions and Relevance: These results suggest that an ITR may be associatded with an increase in the treatment success rate among patients with first-episode schizophrenia, but experimental evaluation is needed to confirm this possibility. If confirmed, model refinement that investigates biomarkers, clinical observations, and patient reports as additional predictors in iterative pragmatic trials would be needed before clinical implementation.

2.
Artigo em Inglês | MEDLINE | ID: mdl-31954755

RESUMO

Several studies have suggested a higher oxidative stress in schizophrenia. However, the implications of oxidative stress on clinical symptoms remain unclear. This study aimed to investigate the platelet oxidative stress in different stages of schizophrenia (i.e., chronic stable and acute relapse) in order to clarify the clinical implications of oxidative stress and the treatment effects. We recruited 43 chronic stable patients with schizophrenia and 48 non-psychiatric controls. Platelets were collected for measuring the levels of nitric oxide (NO), lipid peroxidation (LPO), and glutathione (GSH) and the activity of GSH peroxidase (GPx) and superoxide dismutase (SOD). The levels and activity were compared between patients and controls and were examined for their relationship with clinical severity. Further, we evaluated the changes of levels and activity before and after treatment in an independent sample with acute relapse (N = 19). Patients with chronic stable schizophrenia had lower SOD activity compared to non-psychiatric controls. In chronic stable patients, NO level was positively correlated with positive and disorganized symptoms, while the GPx activity were negatively correlated with excitement. In patients with acute relapse, the levels and activity were not different before and after four weeks of antipsychotic treatment, but LPO level was negatively correlated with pretreatment disorganized symptoms. The change of LPO can also predict the change of disorganized symptoms and negative symptoms. Our findings suggest that platelet SOD was lower in chronic stable schizophrenia. Platelet LPO may be associated with less disorganized symptoms in acute relapse patients and better treatment response.

3.
Asia Pac Psychiatry ; 12(1): e12370, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31680479

RESUMO

INTRODUCTION: Stigma can be a barrier to early intervention of severe mental illnesses, especially schizophrenia, which further leads to poor outcomes. Mental health campaigns were designed to educate the general public about signs for early identification of psychosis, but the line between schizophrenia and attenuated psychosis was not well demarcated. We wonder if people would generalize their stigmas towards schizophrenia to subjects with subthreshold psychotic symptoms. METHODS: A cross-sectional survey was employed which used a structured questionnaire, comprised of four case vignettes describing attenuated psychosis syndrome (APS), schizophrenia, psychotic-like experiences (PLE), or depression, and was followed by two sets of questions using the 4-point Likert scale to measure discrimination and prejudices. Participants were chosen by convenience sampling of laypersons from different backgrounds. RESULTS: A total of 268 subjects completed this survey. A gradient of stigmas, highest toward schizophrenia, followed by APS/depression, and lowest toward PLE was apparent across gender, all age groups, and education levels. Participants who were younger and had higher education revealed a trend of lower prejudice and discrimination. People who have visited a psychiatric hospital showed higher discrimination toward schizophrenia, APS, and depression. People who have seen mentally ill persons in public places showed lower stigma toward PLE. DISCUSSION: Our respondents posed a differentiable attitude towards PLE, APS, and schizophrenia, while exhibiting no difference between APS and depression. Certain personal attributes were correlated with stigma levels. Further investigation about mental health literacy and attitudes towards subjects with psychotic symptoms in the general public is warranted.

4.
CNS Drugs ; 34(2): 117-126, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31741178

RESUMO

Continuing antipsychotic treatment in patients with schizophrenia under clinical remission remains controversial. Even though the mainstream opinion declares an outweighed balance against medication discontinuation, recent reviews and critiques suggest that some patients may remain symptom free and well functioning after stopping antipsychotics, but few predictors can identify who can try medication discontinuation, whilst no guidelines exist for reducing medication to reach the lowest effective dose safely. Analyzing the findings from studies employing different methodologies, adopting evidence from pharmacodynamic research, and observing dose reduction in stable patients, as well as taking inspiration from the metaphor of the Cantor set in natural philosophy, we introduce an alternative solution and propose a guided dose-reduction algorithm that follows a set of clear precautions and instructions. The algorithm recommends only a fraction (no more than 25%) of the dosage to be reduced at a time, with at least a 6-month stabilization period required before reducing another 25% of the dose. Patients are empowered to actively participate in decision making when they are ready for further dose tapering, or should they retreat to a previous dosage if warning signs of a relapse re-emerge. An intermittent or irregular dosing schedule can be used to adapt this algorithm to real-world practice. Our preliminary findings suggest that patients with remitted psychosis can do well along this path. We anticipate that this approach can help optimize the risk-benefit ratio and instill a hope in patients with schizophrenia that they can maintain in stable remission under a lower antipsychotic dose without an increased risk of relapse.

5.
J Formos Med Assoc ; 119(1 Pt 3): 439-448, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31558338

RESUMO

BACKGROUND: This study aimed to examine social-cognitive impairments in patients with schizophrenia using the Eyes test. In contrast to previous methods using the correct answers, we developed the Taiwanese version of the Eyes test and constructed the response network to explore impairments in the emotional aspects of theory of mind in patients with schizophrenia. METHODS: Eighteen patients with schizophrenia and 18 healthy controls were recruited to examine their performance of the Eyes test. To explore the internal structures of mental states, we used network analysis to construct the networks of choice patterns (i.e. participants' answers) by using two network indicators, including density (an index of structure diversity of a network) and centrality (an index of the choice patterns within a network). Moreover, we divided all the choices into negative, positive, and neutral item groups based on emotion polarity. RESULTS: The patient group was slower and less accurate than the control group. Moreover, there was a negative correlation between accuracy and blunted affect, and there were positive correlations between reaction time and emotional withdrawal and apathetic social withdrawal. As compared to healthy controls, patients with schizophrenia showed larger density in the network structure and higher centrality than controls. Also, patients showed poorer performance on negative words than healthy controls. CONCLUSION: Our results demonstrated more diversity to recognize negative emotions from patients' choice patterns as compared to those in the control group. These findings suggest that deficits on recognizing negative emotions might be associated with the dysfunctions of mental states in schizophrenia.

6.
Front Psychiatry ; 10: 223, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31037058

RESUMO

Background: Auditory event-related potentials (ERPs) have been utilized to study defective information processing of patients with schizophrenia. To delineate the pathophysiological processes from pre-psychotic state to first-episode psychosis, a study on subjects from ultra-high-risk (UHR) state to first-episode psychosis, ideally in an antipsychotic-free condition, can add important information to our understanding. Methods: Patients with UHR state or at their first-episode psychosis (FEP) who were drug-naive or only have been temporarily treated with antipsychotics were assessed by auditory ERPs measurement, including P50/N100 (sensory gating) and duration mismatch negativity (MMN; deviance detection). A group of age-matched healthy subjects served as their controls. Results: A total of 42 patients (23 UHR and 19 FEP) and 120 control subjects were recruited, including 21 pure drug-naive and 21 with very short exposure to antipsychotics. Collapsing FEP and UHR as a patient group, they exhibited significant sensory deficits manifested as larger P50 S2 amplitude, larger N100 ratio, and smaller N100 difference, and significantly less deviance detection response revealed by MMN. Such differences were less significant when treating FEP and UHR separately for comparisons. Comparisons of ERP results between drug-naive subjects and antipsychotic-short-exposure subjects revealed no significant difference in any P50/N100 and MMN parameter. Conclusion: Our study is one of the few studies focused on drug-naive or minimally treated patients at pre- or early-psychotic states. Our results exhibited impaired performance in sensory gating and deviance detection shown by certain parameters. A longitudinal study with larger sample sizes will be helpful to provide more evidence to elucidate the role of antipsychotics on an individual's neurophysiological performance at different stages of psychosis.

7.
Clin Neuropharmacol ; 42(3): 101-102, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31082834

RESUMO

OBJECTIVES: Pathological gambling can be potentiated by treatment with dopamine agonists. Aripiprazole, bearing a partial agonist activity at dopamine D2 and D3 receptors, has also been linked to such a behavioral aberration, usually on subjects predisposed with tendency of impulsive or addictive behaviors. METHODS: Review of patient's medical records and literature review. RESULTS: Two young patients' pathological gambling emerged simply due to exposure to aripiprazole, neither related to manic or psychotic symptoms nor with history of addictive or impulsive behaviors. Their pathological gambling disappeared soon after switching aripiprazole to other antipsychotics. One patient has tested such a relationship by reexposure to aripiprazole while his compulsion to gamble recurred. CONCLUSIONS: In addition to previously recognized risk factors, pathological gambling might occur in young patients whose history did not reveal an addictive tendency while they were sensitive to the pharmacological effect, as well as adverse effects, of psychotropic agents.


Assuntos
Antipsicóticos/efeitos adversos , Aripiprazol/efeitos adversos , Jogo de Azar/induzido quimicamente , Adulto , Antagonistas dos Receptores de Dopamina D2/efeitos adversos , Feminino , Jogo de Azar/psicologia , Humanos , Masculino
8.
J Hum Genet ; 64(7): 653-663, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30976040

RESUMO

Disrupted-in-schizophrenia 1 (DISC1) was reported to be associated with schizophrenia. In a previous study, we found significant association with schizophrenia patients with deficient sustained attention assessed by continuous performance test (CPT). This study aimed to identify risk polymorphisms in this specific neurocognitive subgroup and investigate the expression of different isoforms of DISC1. A total of 83 genetic variants were identified through direct sequencing in 50 controls and 100 schizophrenia patients. Fourteen variants were genotyped in 600 controls and 912 patients. Patients were subgrouped by familial loading (multiplex or simplex) and performance on CPT. The frequency of AA genotype of rs11122324 at the 3'-UTR of Es and Esv1 isoforms and of rs2793091 at intron 4 were significantly higher in multiplex schizophrenia patients than those in controls (corrected p < 0.05). In further subgrouping, the frequency of AA genotype of the two SNPs were significantly higher in multiplex schizophrenia patients with deficient sustained attention than those in controls (corrected p < 0.005). The mRNA expression levels of two extra-short isoforms (Es and Esv1) in the EBV-transformed lymphocytes of schizophrenia were significantly higher than those of controls. Luciferase reporter assays demonstrated that the A-allele of rs11122324 significantly upregulated DISC1 extra-short isoforms transcription compared with the G-allele. We found two SNPs (rs11122324 and rs2793091) of DISC1 may be specifically associated with multiplex schizophrenia patients with deficient sustained attention. The SNP rs11122324 may be a risk polymorphism, which may have functional influence on the transcription of Es and Esv1 through increasing their expression.


Assuntos
Proteínas do Tecido Nervoso/genética , Transtornos Neurocognitivos/genética , Esquizofrenia/genética , Alelos , Éxons , Feminino , Predisposição Genética para Doença , Humanos , Masculino , Proteínas do Tecido Nervoso/metabolismo , Transtornos Neurocognitivos/metabolismo , Polimorfismo de Nucleotídeo Único , Isoformas de Proteínas/genética , Isoformas de Proteínas/metabolismo , Isoformas de RNA/genética , Isoformas de RNA/metabolismo , Esquizofrenia/metabolismo , Taiwan
9.
Biol Psychiatry ; 86(1): 56-64, 2019 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-30926130

RESUMO

BACKGROUND: Whether paternal age effect on schizophrenia is a causation or just an association due to confounding by selection into late parenthood is still debated. We investigated the association between paternal age and early onset of schizophrenia in offspring, controlling for both paternal and maternal predisposition to schizophrenia as empirically estimated using polygenic risk score (PRS) derived from the Psychiatric Genomics Consortium. METHODS: Among 2923 sporadic schizophrenia cases selected from the Schizophrenia Trio Genomic Research in Taiwan project, 1649 had parents' genotyping data. The relationships of paternal schizophrenia PRS to paternal age at first birth (AFB) and of maternal schizophrenia PRS to maternal AFB were examined. A logistic regression model of patients' early onset of schizophrenia (≤18 years old) on paternal age was conducted. RESULTS: Advanced paternal age over 20 years exhibited a trend of an increasing proportion of early onset of schizophrenia (odds ratio per 10-year increase in paternal age = 1.28, p = .007) after adjusting for maternal age, sex, and age. Older paternal AFB also exhibited an increasing trend of paternal schizophrenia PRS. Additionally, a U-shaped relationship between maternal AFB and maternal schizophrenia PRS was observed. After adjusting for both paternal and maternal schizophrenia PRS, the association of paternal age with patients' early onset of schizophrenia remained (odds ratio = 1.29, p = .04). CONCLUSIONS: The association between paternal age and early onset of schizophrenia was not confounded by parental PRS for schizophrenia, which partially captures parental genetic vulnerability to schizophrenia. Our findings support an independent role of paternal age per se in increased risk of early onset of schizophrenia in offspring.

10.
Early Interv Psychiatry ; 13(3): 574-581, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-29271066

RESUMO

AIM: The purpose of this study is to develop a theoretical explanation of the prodromal schizophrenia process, or so-called psychosis risk syndrome, by describing patients' own experiences with symptoms, thoughts and feelings. METHODS: A total of 40 interviews were conducted in Taiwan. A Grounded Theory method was selected because of its demonstrated effectiveness in generating theory around dynamic and complex processes on which little is known, all of which is the case with psychosis risk syndrome. Constant comparison analysis, memo writing, member checking, and theoretical sampling were adopted. RESULTS: A core theoretical framework was developed in which the process of the psychosis risk syndrome is described as proceeding from manageable to uncontrollable. Four stages emerged from the analysis: (1) something is wrong, (2) boiling up, (3) breaking point, and (4) losing control. CONCLUSIONS: The framework resulting from this Grounded Theory research is innovative in presenting patterns and clinical staging that marks the progression from premorbid stage to full-blown psychosis. In addition to specifying the detailed process through in-depth interviews, this research makes two fundamental contributions by: (1) adding evidence to current science and (2) taking patients' experience into consideration to improve the validity of screening tools and design appropriate intervention programs for people with early warning signs of developing schizophrenia.


Assuntos
Teoria Fundamentada , Sintomas Prodrômicos , Transtornos Psicóticos/diagnóstico , Transtornos Psicóticos/psicologia , Adulto , Progressão da Doença , Feminino , Humanos , Masculino , Escalas de Graduação Psiquiátrica/estatística & dados numéricos , Psicometria/estatística & dados numéricos , Risco , Esquizofrenia/diagnóstico , Transtorno da Personalidade Esquizotípica/diagnóstico , Síndrome
11.
Early Interv Psychiatry ; 13(4): 895-901, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-29927087

RESUMO

AIM: Patient's long-term phenomenology after first-episode psychosis could be blurred due to early intervention. The contradictory messages regarding necessity of long-term antipsychotic treatment derived from different methodologies warrants careful reappraisal. METHODS: We approached a group of patients lost to follow-up in a previous study. Targeting these 44 missing patients, we sent 2 carefully worded letters to invite them for interviews to see if their life trajectories were different from those who stayed in a university-based hospital system. RESULTS: A total of 21 patients replied, but only 8 agreed to in-depth interviews. Of these, 2 warranted revision of their diagnoses as there had been no recurrence of psychotic symptoms and they had remained antipsychotic-free for several years despite displaying a dysthymic state; 1 fulfilled remission criteria on intermittent low-dose antipsychotics but kept a distance from any potential stressor; 1 achieved full remission with good functioning and discontinued medications for a year, but resumed taking antipsychotics after feeling an impending relapse; the other 4 showed common courses of chronic schizophrenia with repeated admission and/or rehabilitation programs in other service systems. CONCLUSIONS: The trajectories after first-episode psychosis should not be over-simplified by calculating the probability of relapse or the odds of achieving adequate functioning determined by medication adherence or not. Examining from a dynamic perspective employing a qualitative approach to take into account diagnostic stability, treatment preferences, psychosocial factors, individual coping strategies and personalized formulation of illness, we can gain more insight into the ambiguous information revealed by the recent literature.


Assuntos
Antipsicóticos/uso terapêutico , Transtornos Psicóticos/tratamento farmacológico , Esquizofrenia/diagnóstico , Adulto , Terapia Combinada , Feminino , Seguimentos , Humanos , Assistência de Longa Duração , Masculino , Adesão à Medicação , Readmissão do Paciente , Escalas de Graduação Psiquiátrica , Transtornos Psicóticos/diagnóstico , Transtornos Psicóticos/psicologia , Recidiva , Indução de Remissão , Esquizofrenia/tratamento farmacológico , Psicologia do Esquizofrênico
12.
Int Clin Psychopharmacol ; 33(2): 92-97, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29389697

RESUMO

To determine whether primary delusional jealousy can be treated effectively with antipsychotics or antidepressants, and whether any clinical variables are associated with response to pharmacotherapy, we carried out a retrospective case series observational study by reviewing clinical records of patients with an International Classification of Disease, 9th ed., diagnostic code of 297 (delusional disorders) who were treated at the Department of Psychiatry of a university affiliated hospital from January 2010 to December 2015. Only those records showing obvious delusional jealousy not secondary to other medical conditions, dementia, or schizophrenia were scrutinized thoroughly with respect to types of pharmacotherapy, treatment response, and other demographic and clinical variables likely to be associated with clinical outcomes. All except one of 32 patients, 16 men and 16 women, between 37 and 79 (60.9±10.6) years of age, were treated with low-dose antipsychotics. The general response was favorable as 19 (59.4%) were rated as good and 13 as inadequate responders (seven partial and six limited). Compared with antipsychotic monotherapy, concomitant therapy with antidepressants had a higher rate of good response, although statistically insignificant (75 vs. 53%, P=0.21). Younger age (P=0.01) and presentation at the index visit with their suspected unfaithful spouse were associated with a good response (P=0.036); comorbidity with delusions other than the jealous type was associated with a poor response (P=0.006). The overall outcome for delusional jealousy looks promising if the patients can accept pharmacotherapy in an outpatient setting.


Assuntos
Antidepressivos/administração & dosagem , Ciúme , Fumarato de Quetiapina , Esquizofrenia Paranoide , Sulpirida , Idoso , Antipsicóticos/administração & dosagem , Antipsicóticos/efeitos adversos , Delusões/classificação , Delusões/tratamento farmacológico , Relação Dose-Resposta a Droga , Monitoramento de Medicamentos/métodos , Quimioterapia Combinada/métodos , Feminino , Humanos , Classificação Internacional de Doenças , Masculino , Pessoa de Meia-Idade , Escalas de Graduação Psiquiátrica , Fumarato de Quetiapina/administração & dosagem , Fumarato de Quetiapina/efeitos adversos , Esquizofrenia Paranoide/diagnóstico , Esquizofrenia Paranoide/tratamento farmacológico , Esquizofrenia Paranoide/psicologia , Sulpirida/administração & dosagem , Sulpirida/farmacocinética , Taiwan , Resultado do Tratamento
13.
Hum Brain Mapp ; 39(5): 2007-2019, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29377322

RESUMO

Patients with schizophrenia do not usually achieve remission state even after adequate antipsychotics treatment. Previous studies found significant difference in white matter integrity between patients with good outcomes and those with poor outcomes, but difference is still unclear at individual tract level. This study aimed to use a systematic approach to identify the tracts that were associated with remission state in patients with schizophrenia. We evaluated 91 patients with schizophrenia (remitted, 50; nonremitted, 41) and 50 healthy controls through diffusion spectrum imaging. White matter tract integrity was assessed through an automatic tract-specific analysis method to determine the mean generalized fractional anisotropy (GFA) values of the 76 white matter tract bundles in each participant. Analysis of covariance among the 3 groups revealed 12 tracts that were significantly different in GFA values. Post-hoc analysis showed that compared with the healthy controls, the nonremission group had reduced integrity in all 12 tracts, whereas the remission group had reduced integrity in only 4 tracts. Comparison between the remission and nonremission groups revealed 4 tracts with significant difference (i.e., the right fornix, bilateral uncinate fasciculi, and callosal fibers connecting the temporal poles) even after adjusting age, sex, education year, illness duration, and medication dose. Furthermore, all the 4 tracts were correlated with negative symptoms scores of the positive and negative syndrome scale. In conclusion, our study identified the tracts that were associated with remission state of schizophrenia. These tracts might be a potential prognostic marker for the symptomatic remission in patients with schizophrenia.


Assuntos
Encéfalo/diagnóstico por imagem , Vias Neurais/diagnóstico por imagem , Esquizofrenia/diagnóstico por imagem , Substância Branca/diagnóstico por imagem , Adulto , Análise de Variância , Anisotropia , Antipsicóticos/uso terapêutico , Encéfalo/patologia , Imagem de Difusão por Ressonância Magnética , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Masculino , Escalas de Graduação Psiquiátrica , Estudos Retrospectivos , Esquizofrenia/tratamento farmacológico , Adulto Jovem
14.
Assessment ; 25(2): 183-192, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-27161505

RESUMO

Alphabetic working memory (WM) tests, such as the Wechsler Adult Intelligence Scale-III and IV Letter Number Sequencing, are not appropriate for nonalphabetic cultures. This study examined the psychometric properties of the Taiwan Odd-Even Number Sequencing Test (TOENST) and identified representative norms. The TOENST and other mental screening tasks were administered to 300 randomly selected healthy participants, 32 purposive sampling patients with schizophrenia, and 32 quota sampling controls. To investigate reliability and validity, a subset of the 300 healthy participants was randomly selected to receive a second TOENST ( n = 30) or conventional WM tests ( n = 42). The split-half reliability of the TOENST ranged from 0.69 to 0.95, and its test-retest reliability was 0.75. Criterion validity was demonstrated by significant correlations with conventional WM measures (all p < .05, except semantic verbal fluency), and construct validity was demonstrated by significant correlations with aging (main effect, F10,259 = 10.99, p < .001). Normative data were established, and performance was significantly associated with age and education. TOENST scores of patients with schizophrenia were significantly lower and correlated with frontal lobe tests, but not demographical or clinical characteristics. The TOENST has adequate psychometric properties and clinical utility and is as a viable alternative WM task for nonalphabetic cultures.


Assuntos
Memória de Curto Prazo , Testes Psicológicos/normas , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Idioma , Masculino , Pessoa de Meia-Idade , Psicometria , Reprodutibilidade dos Testes , Esquizofrenia , Taiwan , Escalas de Wechsler , Adulto Jovem
15.
Schizophr Res ; 190: 28-31, 2017 12.
Artigo em Inglês | MEDLINE | ID: mdl-28341002

RESUMO

Autoimmune encephalopathy caused by autoantibodies against neuronal cell-surface proteins in the brain is a newly discovered disease category associated with psychiatric disorders. Correct diagnosis of this condition relies on the detection of specific autoantibodies in the blood or cerebral spinal fluid in addition to the clinical presentations. The study aimed to understand the seroprevalence of selective anti-neuronal autoantibodies in our patients with schizophrenia. First, we screened for six anti-neuronal autoantibodies in an archived blood sample collected from patients with the first-episode schizophrenia. The six autoantibodies including antibodies against N-methyl-d-aspartate (NMDA) receptor, α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptors 1 and 2, γ-butyric acid receptor type B1 (GABARB1), leucine-rich glioma inactivated-1 (LGI1) protein, and contactin-associated protein-like 2 (CASPR2) protein. A total of 78 plasma samples (46 males and 32 females) were investigated; however, no positive case was identified. In this second study, we screened anti-NMDA receptor autoantibodies in a blood sample of 234 patients with chronic schizophrenia (133 females and 101 males) including 48 patients defined as treatment resistance. None of this sample was detected as positive. The negative findings in this study suggest that the seroprevalence of autoantibodies against neuronal surface proteins might be low in patients diagnosed with schizophrenia.


Assuntos
Autoanticorpos/sangue , Proteínas do Tecido Nervoso/imunologia , Esquizofrenia/epidemiologia , Esquizofrenia/imunologia , Doença Aguda , Adulto , Doença Crônica , Resistência a Medicamentos/imunologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Esquizofrenia/sangue , Estudos Soroepidemiológicos , Adulto Jovem
16.
Soc Psychiatry Psychiatr Epidemiol ; 52(2): 163-173, 2017 02.
Artigo em Inglês | MEDLINE | ID: mdl-28028581

RESUMO

PURPOSE: To examine the trend in annual first admission rates for psychotic disorders as a whole as well as individual psychotic disorders in Taiwan from 1998 to 2007, and influences of age, sex, and geographic region on the trend. METHOD: Using the inpatient claims records in the National Health Insurance Research Database, we estimated the yearly first admission rates for schizophrenia and other psychotic disorders, including voluntary (1998-2007) and involuntary (2004-2007) admissions. Both narrow and broad definitions of psychotic disorders were examined. RESULTS: While involuntary first admission rates were stable, a crescendo-decrescendo change in voluntary first admission rates for psychotic disorders was observed, peaking in 2001. The increase from 1998 to 2001 was closely associated with health insurance expansion. Before 2001, the voluntary first admission rates in males aged 15-24 were underestimated as military personnel records were not included in the database. From 2001 to 2007, voluntary first admissions for psychotic disorders decreased 38%; the decrease could not be accounted for by the mild diagnostic shifts away from schizophrenia to affective psychosis or substance-induced psychosis. During the entire observation period, first admission rates for schizophrenia decreased 48%, while affective psychosis increased 84%. Gender disparities in the first admission rates gradually diminished, but geographic disparities persisted. CONCLUSIONS: First admission rates for psychosis significantly reduced in Taiwan between 1998 and 2007, mainly driven by the reduced hospitalization risk for schizophrenia. Special attention should be paid to the increased hospitalization for other types of psychotic disorders (especially affective psychosis) and the unresolved geographic disparities.


Assuntos
Internação Compulsória de Doente Mental/estatística & dados numéricos , Programas Nacionais de Saúde/estatística & dados numéricos , Admissão do Paciente/estatística & dados numéricos , Transtornos Psicóticos/epidemiologia , Esquizofrenia/epidemiologia , Adolescente , Adulto , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos Psicóticos/terapia , Esquizofrenia/terapia , Fatores Sexuais , Taiwan/epidemiologia , Adulto Jovem
18.
BMJ Open ; 6(3): e010802, 2016 Mar 03.
Artigo em Inglês | MEDLINE | ID: mdl-26940114

RESUMO

OBJECTIVE: To examine the disparities in psychiatric service utilisation over a 10-year period for patients with first admission for psychosis in relation to urban-rural residence following the implementation of universal health coverage in Taiwan. DESIGN: Population-based retrospective cohort study. SETTING: Taiwan's National Health Insurance Research Database, which has a population coverage rate of over 99% and contains all medical claim records of a nationwide cohort of patients with at least one psychiatric admission between 1996 and 2007. PARTICIPANTS: 69,690 patients aged 15-59 years with first admission between 1998 and 2007 for any psychotic disorder. MAIN EXPOSURE MEASURE: Patients' urban-rural residence at first admissions. MAIN OUTCOME MEASURES: Absolute and relative inequality indexes of the following quality indicators after discharge from the first admission: all-cause psychiatric readmission at 2 and 4 years, dropout of psychiatric outpatient service at 30 days, and emergency department (ED) treat-and-release encounter at 30 days. RESULTS: Between 1998 and 2007, the 4-year readmission rate decreased from 65% to 58%, the 30-day dropout rate decreased from 18% to 15%, and the 30-day ED encounter rate increased from 8% to 10%. Risk of readmission has significantly decreased in rural and urban patients, but at a slower speed for the rural patients (p=0.026). The adjusted HR of readmission in rural versus urban patients has increased from 1.00 (95% CI 0.96 to 1.04) in 1998-2000 to 1.08 (95% CI 1.03 to 1.12) in 2005-2007, indicating a mild widening of the urban-rural gap. Urban-rural differences in 30-day dropout and ED encounter rates have been stationary over time. CONCLUSIONS: The universal health coverage in Taiwan did not narrow urban-rural inequity of psychiatric service utilisation in patients with psychosis. Therefore, other policy interventions on resource allocation, service delivery and quality of care are needed to improve the outcome of rural-dwelling patients with psychosis.


Assuntos
Assistência Ambulatorial/estatística & dados numéricos , Disparidades em Assistência à Saúde/estatística & dados numéricos , Serviços de Saúde Mental/estatística & dados numéricos , Admissão do Paciente/tendências , Transtornos Psicóticos/economia , Cobertura Universal do Seguro de Saúde/economia , Adolescente , Adulto , Bases de Dados Factuais , Feminino , Disparidades em Assistência à Saúde/tendências , Humanos , Estimativa de Kaplan-Meier , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Programas Nacionais de Saúde , Estudos Retrospectivos , População Rural , Taiwan , População Urbana , Adulto Jovem
19.
PLoS One ; 11(3): e0150435, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26986737

RESUMO

D-amino acid oxidase (DAO) has been reported to be associated with schizophrenia. This study aimed to search for genetic variants associated with this gene. The genomic regions of all exons, highly conserved regions of introns, and promoters of this gene were sequenced. Potentially meaningful single-nucleotide polymorphisms (SNPs) obtained from direct sequencing were selected for genotyping in 600 controls and 912 patients with schizophrenia and in a replicated sample consisting of 388 patients with schizophrenia. Genetic associations were examined using single-locus and haplotype association analyses. In single-locus analyses, the frequency of the C allele of a novel SNP rs55944529 located at intron 8 was found to be significantly higher in the original large patient sample (p = 0.016). This allele was associated with a higher level of DAO mRNA expression in the Epstein-Barr virus-transformed lymphocytes. The haplotype distribution of a haplotype block composed of rs11114083-rs2070586-rs2070587-rs55944529 across intron 1 and intron 8 was significantly different between the patients and controls and the haplotype frequencies of AAGC were significantly higher in patients, in both the original (corrected p < 0.0001) and replicated samples (corrected p = 0.0003). The CGTC haplotype was specifically associated with the subgroup with deficits in sustained attention and executive function and the AAGC haplotype was associated with the subgroup without such deficits. The DAO gene was a susceptibility gene for schizophrenia and the genomic region between intron 1 and intron 8 may harbor functional genetic variants, which may influence the mRNA expression of DAO and neurocognitive functions in schizophrenia.


Assuntos
D-Aminoácido Oxidase/genética , Polimorfismo de Nucleotídeo Único , Esquizofrenia/genética , Adolescente , Adulto , Feminino , Predisposição Genética para Doença , Haplótipos , Humanos , Masculino , Adulto Jovem
20.
Expert Opin Pharmacother ; 17(7): 921-36, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26831200

RESUMO

INTRODUCTION: In this review, the authors describe medications in phase III of clinical development for schizophrenia and schizoaffective disorder, and provide an opinion on how current treatment can be improved in the near future. AREAS COVERED: Recent (post 2013) phase III clinical trials of schizophrenia-targeted therapies were found in US and EU clinical trial registries. Two hundred fifty-three trials were identified, that included 16 investigational compounds. The antipsychotics brexpiprazole and cariprazine have been approved in the US, and although both are dopamine D2 receptor partial agonists, they differ markedly in their pharmacodynamic profiles. Encenicline and valbenazine are first-in-class candidates for treatment of cognitive impairment associated with schizophrenia (CIAS) and tardive dyskinesia, respectively. Eleven add-on compounds were previously approved for other therapeutic indications and are for the most part being studied at academic medical centers and smaller pharmaceutical companies for negative symptoms and CIAS or for specific populations (comorbidities, antipsychotic-induced obesity). EXPERT OPINION: Promising new agents are emerging for schizophrenia and schizoaffective disorder. In addition to better-tolerated antipsychotics that treat positive symptoms, we could see the arrival of the first effective drug for negative symptoms and CIAS, which would strongly facilitate the ultimate goal of recovery in persons with schizophrenia.


Assuntos
Antipsicóticos/uso terapêutico , Transtornos Psicóticos/tratamento farmacológico , Esquizofrenia/tratamento farmacológico , Ensaios Clínicos Fase III como Assunto , Transtornos Cognitivos/tratamento farmacológico , União Europeia , Humanos , Transtornos Psicóticos/psicologia , Sistema de Registros , Psicologia do Esquizofrênico , Estados Unidos
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