Tag: Schizophrenic

Is Schizophrenia Associated with Urbanisation?

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Research Paper Title

Association of Urbanicity with Schizophrenia and Related Mortality in China.

Background

Although higher prevalence of schizophrenia in Chinese urban areas was observed, studies focused on the association between schizophrenia and urbanicity were less in China. Using a national representative population-based data set, this study aimed to investigate the relationship between urbanicity and schizophrenia and its related mortality among adults aged 18 years old and above in China.

Methods

Data were obtained from the Second China National Sample Survey on Disability in 2006 and follow-up studies from 2007 to 2010 each year. The researchers restricted their analysis to 1,909,205 participants aged 18 years or older and the 2,071 schizophrenia patients with information of survival and all-caused mortality of the follow-up surveys from 2007 to 2010.Schizophrenia was ascertained according to the International Statistical Classification of Diseases, 10th Revision.

The degree of urbanicity and the region of residence were used to be the proxies of urbanicity. Of these, the degree of urbanicity measured by the ratio of nonagricultural population to total population and the region of residence measured by six categorical variables (first-tier cities, first-tier city suburbs, second-tier cities, second-tier city suburbs, other city areas, and rural areas).

Logistics regression models and restricted polynomial splines were used to examine the linear/nonlinear relationship between urbanicity and the risk of schizophrenia. Cox proportional hazards regression models were used to test the role of urbanicity on mortality risk of schizophrenia patients.

Results

10% increase in the degree of urbanicity was associated with increased risk of schizophrenia (OR = 1.44; 95% CI, 1.32 to 1.57). The nonlinear model further confirmed the association between the degree of urbanicity and the risk of schizophrenia. This association existed sex difference, as the level of urbanicity increased, schizophrenia risk of males grew faster than the risk of females. The hazard ratio (HR) of mortality in schizophrenia patients decreased with the elevated of urbanicity level, with a HR of 0.42 (95% CI, 0.21 to 0.84).

Conclusions

This research suggested that incremental changes in the degree of urbanicity linked to higher risk of schizophrenia, and as the degree of urbanicity elevated, the risk of schizophrenia increased more for men than for women. Additionally, we found that schizophrenia patients in higher degree of urbanicity areas had lower risk of mortality.

These findings contributed to the literature on schizophrenia in developing nations under a non-Western context and indicates that strategies to improve mental health conditions are needed in the progress of urbanicity.

Reference

Luo, Y., Pang, L., Guo, C., Zhang, L. & Zheng, X. (2020) Association of Urbanicity with Schizophrenia and Related Mortality in China. Canadian Journal of Psychiatry. doi: 10.1177/0706743720954059. Online 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].

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.