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White matter abnormalities play a prominent role in the pathogenesis of schizophrenia. Diffusion tensor imaging (DTI) studies showed a widespread decrease in fractional anisotropy (FA) in psychotic disorders.
To examine white and grey matter abnormalities in first episode psychosis (FEP).
We obtained T1-weighted and DTI magnetic resonance images (1.5 T) from 8 right-handed drug-naïve FEP patients and 8 healthy controls. The DTI data set was used to calculate FA maps; we carried-out optimized voxel-based morphometry (VBM) analysis of grey matter (GM) and FA maps using SPM2.
Patients were assessed with a neuropsychological battery comprising the Trail Making Test, the Stroop Colour Word Test, the Wisconsin Card Sorting Test and a test of Facial Affect recognition.
The voxelwise analysis showed decreased FA in the superior longitudinal and inferior fronto-occipital fasciculi, bilaterally, and in the left uncinate fasciculus. We observed reduced GM volume in the left frontal cortex (Brodmann areas [BA] 47, 13, 11, 10, and 9) and in right frontal (BA6), temporal (BA34) and occipital (BA 18, 19, and 30) cortex.
Neuropsychological assessment showed impaired executive function and deficit in facial affect recognition.
Our findings showed fronto-temporal disconnectivity in FEP and structural alterations in both cortical and subcortical regions.
Neuroanatomical findings are consistent with patients’ neuropsychological performance.
Further studies to establish a relationship between white and grey matter disarray on one hand and neuropsychological testing are needed.
The aim of the current study was to explore the changing interrelationships among clinical variables through the stages of schizophrenia in order to assemble a comprehensive and meaningful disease model.
Twenty-nine centers from 25 countries participated and included 2358 patients aged 37.21 ± 11.87 years with schizophrenia. Multiple linear regression analysis and visual inspection of plots were performed.
The results suggest that with progression stages, there are changing correlations among Positive and Negative Syndrome Scale factors at each stage and each factor correlates with all the others in that particular stage, in which this factor is dominant. This internal structure further supports the validity of an already proposed four stages model, with positive symptoms dominating the first stage, excitement/hostility the second, depression the third, and neurocognitive decline the last stage.
The current study investigated the mental organization and functioning in patients with schizophrenia in relation to different stages of illness progression. It revealed two distinct “cores” of schizophrenia, the “Positive” and the “Negative,” while neurocognitive decline escalates during the later stages. Future research should focus on the therapeutic implications of such a model. Stopping the progress of the illness could demand to stop the succession of stages. This could be achieved not only by both halting the triggering effect of positive and negative symptoms, but also by stopping the sensitization effect on the neural pathways responsible for the development of hostility, excitement, anxiety, and depression as well as the deleterious effect on neural networks responsible for neurocognition.
Neurological Soft Signs (NSS) are minor neurological signs indicating non-specific cerebral dysfunction. They are divided into four categories: sensory integration, motor coordination, sequencing motor complex acts and primitive reflexes.
We sought to determine whether NSS were specifically related to schizophrenia.
1) To compare NSS scores between patients with schizophrenia, bipolar disorder and controls.
2) to assess the relationship of NSS scores with psychopathological measures and treatment (olanzapine equivalents).
We assessed neurological functioning by the Neurological Evaluation Scale (NES) in 67 patients diagnosed with schizophrenia (SCZ), 69 diagnosed with bipolar disorder (BD) and 50 healthy controls. Psychopathological dimension were assessed through the Positive and Negative Syndrome Scale (PANSS). Furthermore, we studied the correlation between NSS scores and psychopathological measures.Independent samples Student's t-tests and Post Hoc Tests were used to compute group differences. The correlations between NSS, treatment and PANSS scores were calculated using Pearson correlation coefficients.
Total NES and subscale scores were significantly higher in patients than in controls. SCZ patients performed worse than BD patients (p < 0,001). PANSS total scores were significantly related to NES scores (r = 0.63; p < 0,001). Antipsychotic treatment showed a significant correlation with PANSS total scores (p < 0,05), while no correlations was found with NES scores.
These findings support the hypothesis that neurological deficits measured through NSS could be a common endophenotype in schizophrenia and bipolar disorder, related to symptoms and independent from pharmacological treatment.
Second-generation long-acting injectable antipsychotics (LAIs) constitute a valuable alternative for the treatment of schizophrenia and combine advantages of both long-acting injectable drugs and atypical antipsychotics. Realistic, naturalistic studies are necessary to evaluate the impact of LAIs on specific cluster of symptoms.
To collect clinical and functioning outcomes in outpatients with schizophrenia treated with LAIs during a follow-up period of 6 months.
To determine the impact on symptoms and functioning of second-generation LAIs.
It is a 6-month naturalistic, observational, prospective, non-interventional study of patients diagnosed with DSM-V schizophrenia disorder. Clinical data were assessed by the Positive and Negative Syndrome Scale (PANSS) and the Global Assessment of Functioning (GAF). For statistical analysis, we used the Wallwork's five-factor model of the PANSS.
A total of 50 schizophrenia patients (70% male; mean age: 36.2 ± 10.4) referred to the Depot Clinic at Sant’Andrea Hospital in Rome was included. Eight patients received treatment with risperidone LAI (RLAI), 20 with paliperidone-palmitate LAI (PLAI), 10 with olanzapine-pamoate LAI (OLAI) and 12 with aripiprazole LAI (ALAI). LAIs were overall associated with improved functioning and positive symptoms; OLAI, ALAI e PLAI correlated with improved negative symptoms, RLAI, OLAI e PLAI with improved disorganised/concrete symptoms, OLAI e PLAI with improved excited symptoms; ALAI improved depressive symptoms.
Over the 6-month period, LAIs were associated with improved functioning and illness severity in schizophrenia patients with different symptoms profile. Treatment with PLAI and OLAI showed the major clinical advantages, whereas only ALAI correlated with improved depressive symptoms.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
The 19-item ‘Scale Of Prodromal Symptoms’ (SOPS) and its semi-structured interview, the Structured Interview for Prodromal Symptoms (SIPS), have been developed to assess prodromes of psychosis. We assessed psychometric properties of the Italian version of the instrument.
We collected socio-demographic and clinical data of 128 people seeking first-time psychiatric help in a large Roman area, either as outpatients at community facilities or as inpatients in psychiatric wards of two general hospitals. Participants were administered the Italian version of the SOPS and the 24-item Brief Psychiatric Rating Scale (BPRS). Data were analysed through Pearson's correlation and factorial analysis.
The English and Italian SOPS versions showed similar psychometric properties and factorial structure. The best-fit model was trifactorial, explaining 90% of total variance, and roughly corresponding to the positive, negative, and general dimensions, with disorganisation spreading over the other dimensions. Compared with the BPRS, the Italian version of the SOPS showed construct validity and convergent validity.
The factor–structure of the Italian version of the SOPS is similar to those of the English and Spanish versions, in that the factors emerged are the same (positive, negative, and general symptoms). The scale could be used to assess at-risk people in early intervention services.