Differential effects of cannabis constituents on schizophrenia-related psychosis: a rationale for incorporating cannabidiol into a schizophrenia therapeutic regimen.

Schizophrenia is a serious mental health disorder that confers one of the highest mortality rates of all psychiatric illnesses. Although the disorder's psychotic symptoms are treatable with conventional antipsychotics, they remain incurable. Moreover, medication adherence is poor, and individuals with schizophrenia choose to self-medicate with illicit substances, including cannabis. It is well-established that the delta-9-tetrahydrocannabinol (delta-9-THC) component of cannabis elicits psychotomimetic effects at high doses; worsens schizophrenia-related psychosis; commonly develops into cannabis use disorder in individuals with schizophrenia; and increases the risk of earlier-onset schizophrenia symptoms in those harboring genetic susceptibility. However, individuals with schizophrenia commonly use cannabis and cannabis derivatives such as cannabidiol (CBD). These products seem to alleviate psychotic symptoms and relieve adverse side effects of antipsychotic medications. Therefore, one notion that has gained traction is the potential utility of cannabis-derived cannabidiol (CBD) as adjunct treatment to reduce schizophrenia-associated psychosis and other symptoms. Currently, preclinical and clinical data remain inconclusive. The present review distinguishes the mechanisms underlying schizophrenia-associated vs. cannabis-induced psychosis; reviews the evidence for delta-9-THC-mediated exacerbation vs. CBD-mediated amelioration of schizophrenia-associated psychosis; and describes potential approaches for incorporating CBD into schizophrenia therapeutic regimen in a safe and efficacious manner.

La catatonia. Diagnóstico y tratamiento a propósito de un caso / Catatonia. Diagnosis and treatment of a case report

El síndrome catatónico es un cuadro de etiología múltiple tanto médica como psiquiátrica, con una variada sintomatología que muchas veces escapa al ojo clínico, siendo por tanto un síndrome infradiagnosticado en la actualidad. Es necesario la realización de un abordaje multidisciplinar y global de estos pacientes, debido a la amplitud de factores predisponentes de tipo farmacológico, tóxico y orgánico y a la elevada morbimortalidad de este síndrome. Es por ello que presentamos un cuadro clínico de un síndrome catatónico inhibido en una paciente de 37 años con diagnóstico de esquizofrenia hebefrénica que presenta un cuadro de estupor, mutismo y negativismo.Es de vital importancia una formación en profundidad para los clínicos y la aplicación de escalas y criterios diagnósticos actualizados, para un diagnóstico, evolución y tratamiento de estos pacientes. La utilización de benzodiacepinas y la terapia electroconvulsiva de manera precoz son los tratamientos de primera línea, siempre asociados a medidas de soporte y prevención de complicaciones. (AU)

The catatonic syndrome present multiple etiologies, both medical and psychiatric, with a variety of symptoms that often escape the clinical eye; therefore, it is currently an underdiagnosed syndrome. A multidisciplinary and global approach is necessary in these patients, due to the wide range of pharmacological, toxic and organic predisposing factors and the high morbidity and mortality of this syndrome. That is why we show a clinical case of an inhibited catatonic syndrome in a 37-year-old patient diagnosed with hebephrenic schizophrenia who presents a clinical picture of stupor, mutism and negativism.In-depth training for clinicians and the application of up-to-date diagnostic scales and criteria are of vital importance for diagnosis, evolution and treatment of these patients. The use of benzodiazepines and early electroconvulsive therapy are the first-line treatments, always associated with support measures and prevention of complications. (AU)

Concurrent Obsessive-Compulsive Symptoms in Patients With Schizophrenia: A Retrospective Study From a Tertiary Care Centre in Sindh, Pakistan.

INTRODUCTION: The present study aimed to evaluate the proportion of concurrent symptoms of obsessive-compulsive symptoms (OCSs) among patients with schizophrenia. METHODS: A retrospective study was undertaken at the Department of Psychiatry, Jinnah Postgraduate Medical Center, Sindh, Pakistan between 1st March 2019 and 1st April 2020. All cases with diagnosed schizophrenia irrespective of gender, age, or ethnicity were eligible for the study. We excluded patients with acute psychosis due to isolated substance use disorder or any organic brain disease. The medical records for each patient were retrieved from the departmental database. Sociodemographic factors including age, gender, ethnicity, and presence of OCSs and other psychiatric comorbidities were recorded in a predefined pro forma. The presence of OCSs was noted by the attending psychiatrist during history taking as positive or negative. RESULTS: A total of 139 patients were included. A predominance of the male gender was noted. There were 63 (45.3%) patients with concurrent OCSs. Out of the total patients, 42 (66.67%) males and 21 (33.33%) females had OCSs. A total of 28 (44.44%) patients between 31 and 45 years of age had OCSs. Out of the 63 patients with OCSs, 36 (57.14%) had a history of substance abuse (p = 0.471). In the study, 17 (26.98%) Balochi and 19 (30.16%) Pashtuns had OCSs. However, the difference was statistically insignificant. CONCLUSION: In conclusion, OCSs were frequent in patients with schizophrenia, according to the current study. We discovered that males, individuals between the ages of 18 and 30 years, Balochis, Pashtuns, and those with a history of substance abuse were more likely to have OCSs. However, the difference was not statistically significant.

Rethinking Immunity and Cognition in Clinical High Risk for Psychosis.

It is well known that schizophrenia is associated with cognitive impairment, reduced cortical grey matter and increased circulating concentrations of inflammatory cytokines. However, the relationship between these findings is not clear. We outline the influential neuroinflammatory hypotheses that raised cytokines provoke a damaging immune response in microglia that results in reduced grey matter and associated cognitive performance. We investigated whether such an interaction might be detectable in the prodromal period as illness emerges from the Clinical High Risk for Psychosis (CHR-P). Meta-analyses suggest that compared with controls, impaired cognition and reduced grey matter are already present by the prodrome and that greater decrements are present in those who later develop symptoms. In contrast, the few cytokine studies report no abnormalities in CHR-P except that interleukin-6 (IL-6) levels were raised versus controls and to a greater extent in the future patients, in one study. We noted that cognitive impairment and less cortical grey matter are more severe in schizophrenia than in affective disorders, but that increased cytokine levels are similarly prevalent across disorders. We found no studies correlating cytokine levels with cognitive impairment in CHR-P but such correlations seem unlikely given the minimal relationship reported in a recent meta-analysis of the many cytokine-cognition studies in established illness. From this and other evidence, we conclude that neuroinflammation is not a core feature of schizophrenia nor a substrate for reduced grey matter volume or cognitive function. We draw attention instead to the emerging evidence that brain-resident immune cells and signalling molecules such as Tregs and IL-6, which are influenced by schizophrenia risk genes, regulate and are necessary for the development and function of neuron-glia interaction. We suggest that cognitive impairment in schizophrenia can be seen as a convergence of genetic and immune-neurodevelopmental dysregulation whereas raised cytokines are a consequence of impaired Tregs control of systemic inflammation.

The Delivery of Diagnosis by Child Psychiatrists: Process Characteristics and Correlates of Distress.

We describe the attitudes of child psychiatrists toward diagnosis delivery (DD) and explore potential stressful factors associated with the process. Eighty Israeli child psychiatrists completed a questionnaire on their perceptions of DD of schizophrenia, autism spectrum disorder (ASD), and attention deficit/hyperactivity disorder (ADHD). We also conducted semi-structured in-depth interviews with 12 child psychiatrists who were asked to share their personal experience with DD. The questionnaire responses revealed that child psychiatrists perceived schizophrenia and ADHD as the most and least severe disorders, respectively, and its treatment as being ineffective and effective, respectively. They expressed negative perceptions toward DD of schizophrenia and positive perceptions toward DD of ADHD. The results of linear regressions revealed that some factors predicted distress accompanying DD in all three diagnoses, such as lack of professional experience, negative perceptions of DD, and the effect of parents' attitudes of opposition to the diagnosis. The interviews revealed that DD was often described by psychiatrists as an emotional experience and that the psychiatrists' age, and whether the psychiatrists identified more with the child or the parent, affected their attitude toward DD. Lastly, the psychiatrists expressed feelings of loneliness in the procedure of DD and their wish to share and reflect on their experiences with others. These findings may contribute to a better understanding of the clinically important topic of DD in child psychiatry that has not been adequately addressed and help deal with psychiatrists' challenges in this task.

Neuronal and brain morphological changes in animal models of schizophrenia.

Schizophrenia, a severe and debilitating disorder with a high social burden, affects 1% of the adult world population. Available therapies are unable to treat all the symptoms, and result in strong side effects. For this reason, numerous animal models have been generated to elucidate the pathophysiology of this disorder. All these models present neuronal remodeling and abnormalities in spine stability. It is well known that the complexity in dendritic arborization determines the number of receptive synaptic contacts. Also the loss of dendritic spines and arbor stability are strongly associated with schizophrenia. This review evaluates changes in spine density and dendritic arborization in animal models of schizophrenia. By understanding these changes, pharmacological treatments can be designed to target specific neural systems to attenuate neuronal remodeling and associated behavioral deficits.

Early life stress and schizophrenia:a retrospective case-control study / 中华全科医师杂志

A total of 105 patients with first-episode schizophrenia (male =51,female =54) and 99 normal controls (male =51,female =48) were included into this retrospective case-control study.Childhood trauma questionnaire-28 item short form (CTQ-SF) was used to assess the experience of childhood abuse.The result of binary logistic regression showed that emotional abuse (β =0.630,P ＜ 0.05) and emotional neglect(β =0.270,P ＜ 0.05) were included into the final model of predicting schizophrenia.It indicates that patients with first-episode schizophrenia experienced more early life stress than controls.Particularly emotional abuse and emotional neglect may play important roles in the onset of schizophrenia.

Factores ambientales y genéticos asociados a la esquizofrenia paranoide en el área de salud 28 de septiembre / Environmental and genetic factors associated to paranoid schizophrenia in

La esquizofrenia es una enfermedad con una marcada expresividad variable, que sugiere la existencia de factores etiológicos y procesos fisiopatológicos heterogéneos y donde se considera cada vez más la hipótesis de la interacción gen-ambiente como su principal modo de transmisión. Objetivo: determinar los posibles factores ambientales y genéticos asociados con en el debut de la esquizofrenia. Método: se realizó un estudio analítico observacional de casos y controles en el área de salud 28 de Septiembre del municipio Santiago de Cuba, durante el cuatrimestre enero-abril de 2011, que incluyó 40 casos con diagnóstico de esquizofrenia paranoide seleccionados mediante muestreo aleatorio estratificado por sexo y a 80 controles sin este diagnóstico. Se aplicó la prueba de chi cuadrado, se calculó la oportunidad relativa (odds ratio) y el intervalo de confianza. Resultados: el estado civil soltero resultó significativo al debut y en tres cuartas partes de los casos se constató algún acontecimiento estresante al inicio de la misma. Hubo asociación de los antecedentes familiares de la afección en los casos; se registró un mayor número de familiares de primer grado afectados en ambos grupos, más significativo en el grupo de los casos, lo que explica la agregación familiar de la afección más frecuentemente en las personas que padecen la enfermedad. Conclusiones: existió asociación de los antecedentes familiares de la enfermedad en los pacientes con esquizofrenia paranoide; hubo mayor porcentaje de personas afectadas en familiares de primer grado en ambos grupos; se observó agregación familiar de la enfermedad; los antecedentes prenatales aumentaron el riesgo de la enfermedad y los patrones premórbidos desde la niñez resultaron altamente significativos...

Schizophrenia is an illnes that is marked by a variable expressiveness wihc suggests the existence of heterogeneus etiological factors and physiopathological processes. A hypothesis of gene-enviroment interaction is being considered as it main way of transmission. Objetive: to determine the possible enviroment and genetic factors associated with the illness onset. Methods: it carriedout an analytical-observational study of cases and controls on the area 28 de Septiembre of Santiago de Cuba during the four month period of january-april of 2011.It included 40 patients with a diagnosis of paranoic schizophrenia recorded on the Psychiatrist service selected randomly stratified by sex, as well as 80 controls without this diagnosis to determine the possible enviromental and genetic factors that could have influenced on the appearance of the disease. Chi square test was applied and the relative opportunity (odds ratio) by trist interval. Results: the civil status of single resulted significative at the appearing and three quarters of the cases studied presented a stressing went at the beginning of the disease. there was an asociation of the familiar antecedents of the affection in the cases. It was recorded a greater percentage affected persons in familiar of first degree in both groups difference that resulted to be more significative on the cases. It was also observed familiar addition of the affection more frequent on the cases than of the control. Conclusions: it was demonstrated that there is an association of the family antecedents of the illness in all the cases. There was more percent of affected people in first degree families in both groups. Family illness aggregation was observed. Prenatal antecedents increase the risk and pre-morbid patterns since childhood were hightly significant...

Effect of cognitive behaviour therapy on adjustment, intensity of symptoms and automatic thoughts in schizophrenia.

AIM: This study was undertaken with the objective of assessing the effect of Cognitive Behaviour therapy (CBT) on subjects suffering from schizophrenia or schizo affective disorder and to observe the sustainability of its effects over a longest period of time. A brief study was also undertaken about changes in career attitudes after psycho education about their wards' illness. METHOD: Fifty-one subjects participated in the study and completed the required numbers of sessions of CBT. Evaluation was carried out before and immediately after CBT. Twenty-four subjects were followed -up again after nine months to perceive sustainability of CBT effects. One family member for each subject was administered an attitude questionnaire before and after psycho education about schizophrenia. RESULTS: CBT sessions resulted in marked improvement in overall adjustment. Intensity of symptoms decreased from high to moderate or high to low intensity immediately after CBT. At follow-up nine months later, intensity of symptoms increased from low to moderate in most of the subjects in comparison to immediate post CBT evaluation but was still less than baseline There was marked decrease in negative thoughts and feelings immediately after CBT. During follow-up after nine months 60% subjects showed more improvement marked in negative thoughts than immediate post CBT while 40% showed less improvement than immediately after CBT. Neptive feelings increased after nine months in most of the subjects, but not to pre treatment levels. Family membets also expetienced more positive feelings about their sick wards after psycho education. CONCLUSION: Positive effects of CBT may not be sustained over a longer period of time and may need repeated sessions.