Tag: Schizophrenia

Treating Schizophrenic with Comorbid Alopecia Universalis (AU) with add-on High Definition Transcranial Direct Current Stimulation (HD-tDCS

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Research Paper Title

Successful application of add-on high-definition transcranial direct current stimulation in a schizophrenic patient with comorbid alopecia universalis.

Background

High-definition transcranial direct current stimulation (HD-tDCS), an advanced version of tDCS, is found to show alleviation of auditory verbal hallucinations (AVHs) as an add-on treatment modality in schizophrenia.

There is a scarcity of data evaluating the utility and tolerability of the same.

Local skin-related side effects are the most common adversities reported with HD-tDCS.

Density of hair follicles is hypothesised to be influencing the sensory adversities related to electrical stimulation and insulation, and loss of hair as seen with alopecia might pose a technical challenge.

In this case report, the researchers describe the utility and tolerability of HD-tDCS in a patient diagnosed with schizophrenia with persistent AVH with comorbid alopecia universalis (AU).

Reference

Parlikar, R., Selvaraj, S., Shiva, L., Sreeraj, V.S., Venkatasubramanian, G. & Chandra, P.S. (2019) Successful application of add-on high-definition transcranial direct current stimulation in a schizophrenic patient with comorbid alopecia universalis.

Electroconvulsive Therapy (ECT) in Treatment-Resistant Schizophrenia & Coexisting Myasthenia Gravis (MG)

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Research Paper Title

Successful administration of electroconvulsive therapy in a patient with treatment-resistant schizophrenia and coexisting myasthenia gravis.

Background

Electroconvulsive therapy (ECT) is an efficacious treatment for resistant schizophrenia.

However, the presence of comorbid myasthenia gravis (MG) poses considerable challenge and concerns for administering anesthesia during ECT.

To the best of the researchers knowledge, till this date, there is only a solitary case reporting the use of ECT in schizophrenia with coexisting MG.

Hence, in this case report, they describe successful administration of modified ECT under anaesthesia in a patient with treatment-resistant schizophrenia with MG.

Reference

Sreeraj, V.S., Venkataramaiah, S., Sunka, A., Kamath, S. & Rao, N.P. (2019) Successful administration of electroconvulsive therapy in a patient with treatment-resistant schizophrenia and coexisting myasthenia gravis. Indian Journal of Psychiatry. 61(6), pp.653-654. Available from World Wide Web: http://www.indianjpsychiatry.org/text.asp?2019/61/6/653/270349. [Accessed: 16 February, 2020].

Analysis of Voluntary vs Involuntary Admissions

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Research Paper Title

Voluntary admissions for patients with schizophrenia: A systematic review and meta-analysis.

Background

Voluntary admission rates of schizophrenia vary widely across studies.

In order to make the topic be informed by evidence, it is important to have accurate estimates.

This meta-analysis examined the worldwide prevalence of voluntary admissions for patients with schizophrenia.

Methods

PubMed, EMBASE, PsycINFO, the Cochrane Library, Web of Science and Medline databases were systematically searched, from their commencement date until 19th November 2018.

Meta-analysis of included studies was performed using the random-effects model.

Results

Thirty-five studies with 134,100 schizophrenia patients were included.

The overall voluntary admission rate of schizophrenia was 61.9 % (95 %CI: 52.3 %-70.7 %), while the involuntary rate was 43.0 % (95 %CI: 34.8 %-51.7 %).

Subgroup analyses revealed that patients in Europe had significantly higher voluntary admission rates, while their North American counterparts were more likely admitted involuntarily.

Papers published prior to 2008 reported higher involuntary admission rates.

Meta-regression analyses showed that higher male percentage and higher study quality were significantly associated with higher voluntary admission rate.

Conclusions

Although the worldwide prevalence of voluntary admissions was higher than that of involuntary admissions, the latter was common for schizophrenia.

With the continuing liberalisation of mental health laws broadening community-based psychiatric services, the rate of voluntary psychiatric admissions is expected to further increase over time.

Reference

Yang, Y., Li, W., Lok, K.I., Zhang, Q., Hong, L., Ungvari, G.S., Bressington, D.T., Cheung, T. & Xiang, Y.T. (2019) Voluntary admissions for patients with schizophrenia: A systematic review and meta-analysis. Asian Journal of Psychiatry. 48:101902. doi: 10.1016/j.ajp.2019.101902. [Epub ahead of print].

Analysing Voluntary Admission Rates for Patients with Schizophrenia

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Research Paper Title

Voluntary admissions for patients with schizophrenia: A systematic review and meta-analysis.

Background

Voluntary admission rates of schizophrenia vary widely across studies. In order to make the topic be informed by evidence, it is important to have accurate estimates. This meta-analysis examined the worldwide prevalence of voluntary admissions for patients with schizophrenia.

Methods

PubMed, EMBASE, PsycINFO, the Cochrane Library, Web of Science and Medline databases were systematically searched, from their commencement date until 19th November 2018. Meta-analysis of included studies was performed using the random-effects model.

Results

Thirty-five studies with 134,100 schizophrenia patients were included. The overall voluntary admission rate of schizophrenia was 61.9 % (95 %CI: 52.3 %-70.7 %), while the involuntary rate was 43.0 % (95 %CI: 34.8 %-51.7 %).

Subgroup analyses revealed that patients in Europe had significantly higher voluntary admission rates, while their North American counterparts were more likely admitted involuntarily.

Papers published prior to 2008 reported higher involuntary admission rates. Meta-regression analyses showed that higher male percentage and higher study quality were significantly associated with higher voluntary admission rate.

Conclusions

Although the worldwide prevalence of voluntary admissions was higher than that of involuntary admissions, the latter was common for schizophrenia.

With the continuing liberalisation of mental health laws broadening community-based psychiatric services, the rate of voluntary psychiatric admissions is expected to further increase over time.

Reference

Yang, Y., Li, W., Lok, K.I., Zhang, Q., Hong, L., Ungvari, G.S., Bressington, D.T., Cheung, T. & Xiang, Y.T. (2019) Voluntary admissions for patients with schizophrenia: A systematic review and meta-analysis. Asian Journal of Psychiatry. 48:101902. doi: 10.1016/j.ajp.2019.101902. [Epub ahead of print].

Is Protein Intake Associated with Cognitive Functioning in Individuals with Psychiatric Disorders?

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Research Paper Title

Protein intake is associated with cognitive functioning in individuals with psychiatric disorders.

Background

Schizophrenia and bipolar disorder are associated with reduced cognitive functioning which contributes to problems in day-to-day functioning and social outcomes.

A paucity of research exists relating dietary factors to cognitive functioning in serious mental illnesses, and results are inconsistent.

The study aims to describe the nutritional intake of persons with schizophrenia and those with a recent episode of acute mania and to determine relationships between the intake of protein and other nutrients on cognitive functioning in the psychiatric sample.

Methods

Persons with schizophrenia and those with acute mania were assessed using a 24-h dietary recall tool to determine their intakes of protein and other nutrients.

They were also assessed with a test battery measuring different domains of cognitive functioning. Results indicate that lower amounts of dietary protein intake were associated with reduced cognitive functioning independent of demographic and clinical factors.

Results

The association was particularly evident in measures of immediate memory and language.

There were not associations between cognitive functioning and other nutritional variables, including total energy, gluten, casein, saturated fat, or sugar intakes.

Conclusions

The impact of dietary interventions, including protein intake, on improving cognitive functioning in individuals with psychiatric disorders warrants further investigation.

Reference

Dickerson, F., Gennusa, J.V. 3rd, Stallings, C., Origoni, A., Katsafanas, E., Sweeney, K., Campbell, W.W. & Yolken, R. (2019) Protein intake is associated with cognitive functioning in individuals with psychiatric disorders. Psychiatry Research. doi: 10.1016/j.psychres.2019.112700. [Epub ahead of print].

Utility of Add-on Mirtazapine to Clozapine-Responsive Early-Onset Schizophrenia

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Research Paper Title

Add-on mirtazapine to clozapine-responsive early-onset schizophrenia.

Abstract

Early-onset schizophrenia is notorious for poor prognostication and treatment-refractoriness.

Clozapine remains a viable option, albeit off-label, but is clearly underutilised in this population.

Use is typically fraught with panoply of drastic side effects.

Here, the authors report on an adolescent case with schizophrenia that responded ultimately to clozapine.

Add-on mirtazapine was advantageous spanning negative and cognitive symptom domains whilst addressing clozapine-related sialorrhea and urinary incontinence.

This might open new venues for such complicated clinical scenarios.

Reference

Moodliar, S., Naguy, A. & Elsori, D.H. (2019) Add-on mirtazapine to clozapine-responsive early-onset schizophrenia. Psychiatry Research. https://doi.org/10.1016/j.psychres.2019.112701.

Schizophrenia & the Dopamine Transporter

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Research Paper Title

Altered levels of dopamine transporter in the frontal pole and dorsal striatum in schizophrenia.

Background

The dopamine hypothesis proposes that there is a hypodopaminergic state in the prefrontal cortex and a hyperdopaminergic state in the striatum of patients with schizophrenia.

Evidence suggests the hyperdopaminergic state in the striatum is due to synaptic dopamine elevation, particularly in the dorsal striatum.

However, the molecular mechanisms causing disrupted dopaminergic function in schizophrenia remains unclear.

The researchers postulated that the dopamine transporter (DAT), which regulates intra-synaptic dopamine concentrations by transporting dopamine from the synaptic cleft into the pre-synaptic neuron, could be involved in dopaminergic dysfunction in schizophrenia.

Methods

Therefore, they measured levels of DAT in the cortex and striatum from patients with schizophrenia and controls using postmortem human brain tissue. Levels of desmethylimipramine-insensitive mazindol-sensitive [3H]mazindol binding to DAT were measured using in situ radioligand binding and autoradiography in gray matter from Brodmann’s area (BA) 10, BA 17, the dorsal striatum, and nucleus accumbens from 15 patients with schizophrenia and 15 controls.

Results

Levels of desmethylimipramine-insensitive mazindol-sensitive [3H]mazindol binding were significantly higher in BA 10 from patients with schizophrenia (p = 0.004) and significantly lower in the dorsal striatum (dorsal putamen p = 0.005; dorsal caudate p = 0.007) from those with the disorder.

There were no differences in levels of desmethylimipramine-insensitive [3H]mazindol binding in BA 17 or nucleus accumbens.

Conclusions

These data raise the possibility that high levels of DAT in BA 10 could be contributing to lower synaptic cortical dopamine, whereas lower levels of DAT could be contributing to a hyperdopaminergic state in the dorsal striatum.

Reference

Sekiguchi, H., Pavey, G. & Dean, B. (2019) Altered levels of dopamine transporter in the frontal pole and dorsal striatum in schizophrenia. NPJ Schizophrenia. 5(1), pp.20. doi: 10.1038/s41537-019-0087-7.

Is Varenicline a Useful Target Compound for Improving Cognitive Impairment in Schizophrenia?

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Research Paper Title

Varenicline for cognitive impairment in people with schizophrenia: systematic review and meta-analysis.

Background

People with schizophrenia frequently have cognitive dysfunction, which does not respond to pharmacological interventions. Varenicline has been identified as a potential treatment option for nicotinic receptor dysfunction with a potential to treat cognitive impairment in schizophrenia.

Methods

The researchers conducted a systematic review of Pubmed, Embase, Psycinfo, CINAHL and the Cochrane Schizophrenia Trial Registry for randomised controlled trials of varenicline in people with schizophrenia for cognitive dysfunction.

They excluded trials among people with dementia. They then undertook a meta-analysis with the primary outcome of difference in change of cognitive measures between varenicline and placebo as well as secondary outcomes of difference in rates of adverse events.

They also conducted a sensitivity analysis on smoking status and study duration.

Results

The researchers included four papers in the meta-analysis (n = 339).

Varenicline was not superior to placebo for:

  • Overall cognition (SMD = -0.022, 95% CI -0.154-0.110; Z = -0.333; p = 0.739);
  • Attention (SMD = -0.047, 95% CI -0.199-0.104; Z = -0.613; p = 0.540);
  • Executive function (SMD = -0.060, 95% CI -0.469-0.348; Z =- 0.290; p = 0.772); or
  • Processing speed (SMD = 0.038, 95% CI -0.232-0.308; Z = 0.279; p = 0.780).

There was no difference in psychotic symptoms, but varenicline was associated with higher rates of nausea.

Sensitivity analyses for smoking status and study duration did not alter the results.

Conclusions

Within the present literature, varenicline does not appear to be a useful target compound for improving cognitive impairment in schizophrenia.

Based on these results, a trial would need over 2,500 participants to be powered to show statistically significant findings.

Reference

Tanzer, T., Shah, S., Benson, C., De Monte, V., Gore-Jones, V., Rossell, S.L., Dark, F., Kisely, S., Siskind, D. & Melo, C.D. (2019) Varenicline for cognitive impairment in people with schizophrenia: systematic review and meta-analysis. Psychopharmacology. doi: 10.1007/s00213-019-05396-9. [Epub ahead of print].

Cognitive Subgroups of Schizophrenia: Are There Brain Morphological & Functional Features?

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Research Paper Title

Brain morphological and functional features in cognitive subgroups of schizophrenia.

Background

Previous studies have reported different brain morphologies in different cognitive subgroups of patients with schizophrenia. The researchers aimed to examine the brain structures and functional connectivity in these cognitive subgroups of schizophrenia.

Methods

The researchers compared brain structures among healthy controls and cognitively deteriorated and preserved subgroups of patients with schizophrenia according to the decline in intelligence quotient.

Connectivity analyses between subcortical regions and other brain areas were performed using resting-state functional magnetic resonance imaging among the groups.

Results

Whole brain and total cortical gray matter, right fusiform gyrus, left pars orbitalis gyrus, right pars triangularis, left superior temporal gyrus and left insula volumes and bilateral cortical thickness were decreased in the deteriorated group compared to the control and preserved groups.

Both schizophrenia subgroups had increased left lateral ventricle, right putamen and left pallidum and decreased bilateral hippocampus, left precentral gyrus, right rostral middle frontal gyrus and bilateral superior frontal gyrus volumes compared with controls.

Hyperconnectivity between the thalamus and a broad range of brain regions was observed in the deteriorated group compared to connectivity in the control group, and this hyperconnectivity was less evident in the preserved group.

The researchers also found hyperconnectivity between the accumbens and the superior and middle frontal gyri in the preserved group compared with connectivity in the deteriorated group.

Conclusions

These findings provide evidence of prominent structural and functional brain abnormalities in deteriorated patients with schizophrenia, suggesting that cognitive subgroups in schizophrenia might be useful biotypes to elucidate brain pathophysiology for new diagnostic and treatment strategies.

Reference

Yasuda, Y., Okada, N., Nemoto, K., Fukunaga, M., Yamamori, H., Ohi, K., Koshiyama, D., Kudo, N., Shiino, T., Morita, S., Morita, K., Azechi, H., Fujimoto, M., Miura, K., Watanabe, Y., Kasai, K. & Hashimoto, R. (2019) Brain morphological and functional features in cognitive subgroups of schizophrenia. Psychiatry and Clinical Neurosciences. doi: 10.1111/pcn.12963. [Epub ahead of print].

Reduction of Plasma Procoagulant Activity in Patients with Schizophrenia during Pharmacotherapy

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Research Paper Title

[Reduction of plasma procoagulant activity in patients with schizophrenia during pharmacotherapy: thrombodynamic parameters of coagulation before and after treatment].

Background

To detect plasma procoagulant activity in patients with schizophrenia at admission to the hospital in a state of exacerbation before (point 1) and after (point 2) pharmacotherapy and evaluate plasma and platelet hemostasis abnormalities.

Methods

The study included 80 women, aged from 16 to 57 years, median age 28 years, with schizophrenia with continuous, paroxysmal-progressive or paroxysmal course (F20.00, F20.01, F20.02 according to ICD-10).

In 42 of 80 patients, depressive disorders in the structure of schizophrenia were observed. The thrombodynamic test (TD) was performed on T-2 Trombodynamis device according to the manufacturer’s instructions (Hemacore LLC, Moscow, Russia).

Blood for the TD test was taken in admission to the hospital (point 1) and on discharge (point 2). All patients received standard pharmacotherapy according to their condition.

Results

For the first time, it was established that in the whole group of patients (n=46) thrombodynamic indicators of the rate of growth of the clot: initial velocity (Vin), stationary velocity (Vst) and adjusted for spontaneous clots velocity (V) and the amount of clot for 30 minutes test TD (ClotSize, CS) were significantly higher compared to normal values.

The mean time of occurrence of spontaneous thrombosis (Tsp) was significantly less than 30 min (p<0.0001), indicating rapid, spontaneous thrombosis. Other parameters of TD did not differ significantly from the norm.

As a result of treatment, the initial growth rate of the clot from the activator (Vi) decreased from 58,5 μm/min to 54,5 μm/min; V speed from 37,4 μm/min to 33,5 μm/min; CS clot size from 1249 μm to 1219 μm; clot density – from 24 874 units up to 23 658 units. All these changes are significant.

Such dynamics of plasma haemostasis clearly indicates a significant decrease in the coagulation activity of the blood plasma of patients as a result of treatment.

An increase in the time of appearance of spontaneous clots after treatment (from 23.5 minutes to 30.5 minutes) indicates a decrease in the procoagulant activity of platelet microparticles after treatment, i.e. the reduction of platelet activation as a result of treatment.

Conclusions

The study has shown for the first time that treatment of patients with antidepressants and antipsychotics reduces the generation of spontaneous clots. The treatment of patients with schizophrenia is accompanied by a decrease in the activity of plasma and platelet haemostasis. This is of great practical importance, since hypercoagulation of spontaneous clots in schizophrenic patients aggravates their chronic inflammatory disorders and affects their resistance to treatment.

Reference

Brusov, O.S., Karpova, N.S., Faktor, M.I., Sizov, S.V. & Oleichik, I.V. (2019) [Reduction of plasma procoagulant activity in patients with schizophrenia during pharmacotherapy: thrombodynamic parameters of coagulation before and after treatment]. In Russian. Zhurnal Nevrologii i Psikhiatrii Imeni S.S. Korsakova. 119(10):51-55. doi: 10.17116/jnevro201911910151.