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The purpose of this study is to investigate if the MDA plasma concentrations are correlated to negative psychopathology in paranoid schizophrenic inpatients.
The sample was comprised by 38 patients who were admitted in the psychiatric ward of the University Hospital of the Canaries. Thirty eight patients were male and 9 were female with medium average age of 37.41±11.23. Exclusion criteria were psychoactive substance use, presence of acute or chronic organic pathology, treatment with immunosuppressive medication, pregnancy and mental retardation or severe cognitive impairment. There were performed two blood extractions following the circadian rhythm, at 12:00 and at 24:00 hours. One hour before night blood collection, each patient was placed in a reclined position in bed, with the eyes closed, in complete darkness and with eyes covered with a mask. Blood was centrifuged at 3.000 rpm for 10 minutes. Specific biological and psychopathological determinations were performed at admission and at discharge. Psychopathology was assessed with PANSS and by the same psychiatrist. Statistical analyses were carried out with the Social Statistical Package for the Social Sciences (SPSS). MDA was determined spectrophotometrically.
MDA level at night was 1.94±1.54 while MDA level at midday was 2.23±1.36.Mean PANSS negative score was 15.73±6.31.Serum MDA level correlated positively with PANSS negative scores, both at midday and night (midday r=0.39, p< 0.01, midnight r=0.41, p< 0.01).
The total negative subscale score correlated positively with day and night time levels of MDA, therefore we can conclude that MDA may be used as a marker of negative psychopathology.
We present the case of a schizophrenic patient with severe insomnia that had a partial response to high doses of benzodiazepines and sedating antipsychotics. Treatment with agomelatine allowed to suspend benzodiazepine treatment and restore quality of sleep.
Mr. Y is a 36 year old male patient diagnosed with simple schizophrenia that has complained of insomnia since the age of sixteen. During the last three years the treatment that the patient was following was stable and consisted of 100 mg of diazepam, 300 mg of levomepromazine and 120 mg of clotiapine every night. During the last year 60 mg of duloxetine were added to treat a moderate depression. His mood improved with the prescribed treatment, but eleven months later it worsened. In an attempt to simultaneously treat the mood and the sleep disorder, during a period of 4 days, a dosis of 12.5 mg of aglomelatin at dinner was introduced while the morning dose of duloxetine was reduced to 30mg. On the fifth day, agomelatine was increased to 25 mg at dinner while duloxetine was suspended. The antipsychotic treatment was kept stable while the patient was instructed to reduce 10 mg of diazepam every week until next appointment one month later. In the next appointment the patient had completely suspended diazepam one week before the appointment. The patient referred improved sleep quality and no rebound insomnia.
Agomelatine may be a valid treatment of insomnia in schizophrenia.
Stress and trauma have been reported as leading contributing factors in schizophrenia. And certainly child abuse (neglect, emotional, physical and sexual abuse among others) has a lasting negative impact, which is well established in literature.
To consider the presence of infant trauma and its relationship with psychopathology in paranoid schizophrenics.Methods. 37 patients (mean age 29±6.3; years from onset 9.20±4.7), meeting DSM IV paranoid schizophrenia criteria, undergoing treatment in a university hospital are studied. The PANSS is administered in order to rate psychopathology.
27 patients had infant trauma (55.8%). Main traumas are: sexual abuse (12.8%), child abuse (7.7%), both sexual and child abuse (5.18%), parental separation (7.7%), extra-rigid parents (2.6%), alcoholic parents (18.2%), child abuse and mother's death in childhood (2.6%). Infant trauma and psychopathology showed a significant relationship concerning Hostility (No 1.75±1.209, Yes 2.26±1.759), Unnatural Movements and Posture (No 1.55±0.945, Yes 1.16±0.545), Depression (No 1.25±0.550, Yes 1.74±1.284) and Preoccupation (No 2.75±1.410, Yes 3.26±1.996).
Infant trauma is common in paranoid schizophrenia and our findings give some evidence to a relationship with psychopathology, especially with dimensions as Hostility, Unnatural Movements and Posture, Depression and Preoccupation. Despite sample size, a high proportion (55.8%) of the patients presented infant trauma and future research is needed in order to open new avenues in this field, particularly studies concerning infant trauma and symptomatology specificity will be greatly appreciated as well as the plausible link to personality traits and personality disorders.
We study the fragmentation of a liquid drop that is hit by a laser pulse. The drop expands into a thin sheet that breaks by the radial expulsion of ligaments from its rim and the nucleation and growth of holes on the sheet. By combining experimental data from two liquid systems with vastly different time and length scales, we show how the early-time laser–matter interaction affects the late-time fragmentation. We identify two Rayleigh–Taylor instabilities of different origins as the prime cause of the fragmentation and derive scaling laws for the characteristic breakup time and wavenumber. The final web of ligaments results from a subtle interplay between these instabilities and deterministic modulations of the local sheet thickness, which originate from the drop deformation dynamics and spatial variations in the laser-beam profile.
The aim of this work was to identify factors associated with homelessness status in patients admitted to the psychiatric emergency ward of a French public teaching hospital over the 6-year study period (2001-2006).
The study was based on a retrospective review of the psychiatric emergency ward's administrative and medical computer databases. Each emergency care episode had accompanying data including demographic, financial, clinical, and management information.
During this 6-year study, the psychiatric service recorded 16,754 care episodes concerning 8,860 different patients, of which 591 were homeless (6.7%) and 8,269 were non-homeless (93.3%). The mean ± SD number of visits to the psychiatric emergency service was higher for homeless (4.9±12.3) than for non-homeless patients (1.7±2.4) (p< .001). A total of 331 homeless patients (56%) had more than one care episode, versus 2,180 (26%) for non-homeless patients. Factors associated with homelessness included male sex, single status, and the reception of social financial assistance. Schizophrenia (43.7%) and substance use disorders (31.0%) were the most frequent disorders in homeless patients. Aggressive behaviour and violence were reported equally in homeless and non-homeless patients. Homeless patients were hospitalized less often after having received care in the emergency ward.
Although there is near-universal access to free mental health care in France, our findings suggest that the quality and adequacy of subsequent care were not always guaranteed. Multidisciplinary and collaborative solutions are needed to improve the management of homeless patients.
Schizophrenia is a chronic disease. Several etiopathogenic aetiologies have been posed, among them the existence of cerebral inflammation. S100B is a calcium-binding protein, mainly produced and secreted by astrocytes, that mediates the interaction among glial cells and between glial cells and neurons. Serum S100B levels have been proposed as a peripheral marker of brain inflammation.
The aim of this research is to study if the serum level of the protein S100B has relationship with positive psychopathology.
31 paranoid schizophrenic inpatients (22 male and 9 female, 36.7±10.3 years) meeting DSM-IV criteria participated in the study. Blood was sampled by venipuncture at 12:00 and 24:00 hours. Blood extractions were carried out during the first 48 hours after hospital admission. Psychopathology was assessed by the Positive and Negative Syndrome Scale (PANSS). Serum S100B levels were measured by sandwich ELISA techniques.
Correlations between serum levels of S100B protein and PANSS positive scores are shown in the following table. The first figure corresponds to the Pearson's correlation coefficient, while the figure in brackets corresponds to its statistical significance.
Total Positive Score
Serum levels of S100B protein may be used as a biological marker of positive psychopathology in paranoid schizophrenia.Acknowledgement
Group-based trajectory modeling (GBTM) is a statistical method created to explore the heterogeneity of clinical groups based on their longitudinal outcomes by identifying distinct trajectories of change. This model can be applied to assess heterogeneity in responses to treatment. This pilot study explored the relevance of the GBTM associated with the dimensional evaluation of mood (MATHYS) to define trajectory of recovery in acute bipolar mood episodes on a short period of time during a naturalistic study.
The sample consisted in 118 bipolar patients and all patients were recruited during an acute phase: 56% had a major depressive episode, 26% a manic or hypomanic episode, and 18% a mixed state using the DSM-IV criteria. Patients were assessed four times with MATHYS during a three weeks follow-up period. It is an observational study and treatment was prescribed as usual. We applied the GBTM method and MATHYS total score to define trajectories of recovery.
This method allows identifying 4 trajectories of recovery. At Baseline, two of them started with a score of inhibition but with quite different evolutive profiles (stable inhibition versus improvement). The two others trajectories started with a score of activation (mild versus moderate) and showed a linear improvement of symptoms but with a more rapid recovery for the patients with the higher activation at baseline.
When considering the diagnosis of patients belonging in each trajectory, there model seems particular relevant to explore the high heterogeneity in response to treatment in bipolar patients during an acute depressive episode.
Interest in the premorbid personality of schizophrenic patients is well established in the psychiatric literature. The relationship between personality disorders and acute phase proteins (APP) in schizophrenia is not well known.
Investigating the relationship among acute phase proteins and personality disorders in schizophrenic patients in a sample of adult schizophrenic patients under psychiatric treatment in a general hospital health setting.
Material and Methods:
37 adult paranoid schizophrenics undergoing treatment in the University Hospital of the Canary Islands with DSM-IV diagnosis of paranoid schizophrenia are included. Years from onset 9.20 s.d. 6.29, age at onset 19.75 s.d. 4.73. The record of personality disorders as a secondary diagnosis in the medical chart was taking into account. A blood sample as routine standard analysis was carried out in each patient.
In 21 patients (56.7%) a personality disorder, mainly with paranoid and schizotypal traits, was registered. The percentage of each personality disorder is as follows, Schizotypal (16.2%), Paranoid (13.5%), Schizoid (2.7%), Paranoid and Schizotypal (24.3%). The results point to no significant correlation according to APP (C3, C4, alpha2-macroglobulin, alpha1-glicoprotein, ceruloplasmin) in the different diagnostic groups.
Discussion and conclusions:
In our study there is no evidence to support a significant correlation among APP and the different personality disorders in our sample of schizophrenics in spite of a positive correlation of APP and some psychopathology dimensions that has been communicated earlier elsewhere. In order to set some possible specificity of acute phase proteins and other clinical features in schizophrenia further research is required.
Antidepressants may induce manic or hypomanic episodes. The identification of predictors of antidepressant- induced mania (AIM) is essential to improve the management of bipolar disorder (BD). However, the rare studies on AIM are generally characterized by small sample sizes, varying definitions of AIM and heterogeneous groups of patients, thus leading to conflicting results.
To compare a population of AIM(+) to AIM(-) patients in order to identify specific clinical factors associated with AIM.
All 252 participants met the DSM-IV criteria for BD. Only patients who reported AIM in the 90 days after the beginning of an antidepressant (with or without a mood stabilizer) were diagnosed as AIM (+) and those without any lifetime history of AIM despite lifetime antidepressant prescription were considered AIM (-). Sociodemographic and clinical factors were collected using the DIGS, ALS, AIS BIS and WURS.
AIM(+) (N=74) and AIM(-) (N=178) patients did not differ significantly in terms of age, gender distribution, bipolar disorder duration and age of onset, ALS, BIS and WURS score. However, the rates of rapid cyclers, lifetime history of suicidal acts, alcohol use disorder and AIS score were significantly higher in the AIM(+)group. The type of polarity of onset was significantly different in both groups.
A history of rapid cycling, of suicidal acts and of alcohol use disorder could be considered as risk factors of AIM in BD. Patients with these factors could therefore be identified as a vulnerable subgroup prone to manic switch with antidepressant.
Two common approaches to identify subgroups of patients with bipolar disorder are clustering methodology (mixture analysis) based on the age of onset, and a birth cohort analysis. This study investigates if a birth cohort effect will influence the results of clustering on the age of onset, using a large, international database.
The database includes 4037 patients with a diagnosis of bipolar I disorder, previously collected at 36 collection sites in 23 countries. Generalized estimating equations (GEE) were used to adjust the data for country median age, and in some models, birth cohort. Model-based clustering (mixture analysis) was then performed on the age of onset data using the residuals. Clinical variables in subgroups were compared.
There was a strong birth cohort effect. Without adjusting for the birth cohort, three subgroups were found by clustering. After adjusting for the birth cohort or when considering only those born after 1959, two subgroups were found. With results of either two or three subgroups, the youngest subgroup was more likely to have a family history of mood disorders and a first episode with depressed polarity. However, without adjusting for birth cohort (three subgroups), family history and polarity of the first episode could not be distinguished between the middle and oldest subgroups.
These results using international data confirm prior findings using single country data, that there are subgroups of bipolar I disorder based on the age of onset, and that there is a birth cohort effect. Including the birth cohort adjustment altered the number and characteristics of subgroups detected when clustering by age of onset. Further investigation is needed to determine if combining both approaches will identify subgroups that are more useful for research.
Bipolar disorder (BD) is strongly associated with suicidal behaviors. Suicidal behavior is based on a stress/vulnerability model. Several factors have been identified, including clinical features (such as impulsivity) and cognitive deficits (such as impaired decision making or problem solving). Identifying specific factors in BD patients is needed to better prevent suicidal behaviors.
1) To identify clinical and cognitive characteristics associated with suicidal behaviors in euthymic BD patients.
2) To determine a correlation between neuropsychological variables and the number and characteristics of suicidal attempts.
214 euthymic BD patients from the national network of “Centres Experts Bipolaires” were included and divided into two groups based on the personal history of suicide attempts. Socio-demographic and clinical variables were collected and neuropsychological functions were assessed (attention, memory and executive functions).
We found an association between suicidal behavior and gender, employment status. Suicidal attempters had significantly more mixed episodes and hospitalizations. There was no difference between the two groups concerning neuropsychological measures. The number of suicide attempts and verbal fluency scores were negatively correlated.
The lack of significant differences in neuropsychological scores may be due to a common vulnerability between suicidal behaviors and BD. Further studies, especially prospective ones, are needed in order to characterize high risk BD patients in order to develop effective specific preventive strategies.
Recently, a renaissance of interest in ‘negative symptoms’ as emotional withdrawal or blunted affect, has occurred. Some investigators believe that these symptoms are important indicators of outcome, of response to treatment and of a distinct underlying pathologic process.
Research on the negative-symptom syndrome in schizophrenia has been handicapped until recently.
This research aims at studying whether acute phase proteins, precisely, Alpha1-glycoprotein, can be considered as a marker of negativesymptom in Schizophrenia.
29 chronic schizophrenics were assessed by the Positive and Negative Syndrome Scale (PANSS). A routine blood test including Alpha1-glycoprotein levels was carried out.
Alpha1-glycoprotein shows a positive correlation, according to Pearson correlation coefficient, with the Negative Scale at an almost significant level (p=.05), and at a significant level in the following items, Blunted affect (p=.03), Passive/apathetic Social Withdrawal (p=.01) of the Negative spectrum and Poor Attention (p=.02) of the General Psychopathology Scale.
There is a significant correlation with two Negative variables and an almost significant one, spite of the small sample, with the Negative Scale. Further studies with bigger samples are needed in order to consider alpha1-glycoprotein as a schizophrenia negative psychopathology marker.
Schizophrenia is a chronic disease characterized by disturbances of thought, perception, volition, affectivity and cognition. An imbalance of the oxidant-antioxidant system is one of the proposed etiological factors. There are controversies regarding the effect of antipsychotics on the oxidant-antioxidant balance.
The aim of this research is to study the serum levels of the total antioxidant capacity (TAC) in paranoid schizophrenia patients treated with typical and/or atypical antipsychotics.
The sample is comprised by 38 patients admitted to the psychiatric ward of the University Hospital of the Canary Islands. All patients met DSM-IV criteria for paranoid schizophrenia. Some patients were treated only with atypical antipsychotics (N=21) while others were treated with a combination of atypical and typical antipsychotics (N=17).
The next table shows the comparison of serum TAC levels at admission (TAC-A) and discharge (TAC-D) at 12:00 and 00:00 h.
Patients treated with a combination of typical and atypical antipsychotics present at discharge (12:00 hours) significantly higher levels of TAC than patients treated only with typical antipsychotics. The remaining comparisons did not elicit significant results.
The results point out the fact that a combination of typical and atypical antipsychotics is more helpful in reducing the deficits of the antioxidant system than treatments based only on typical antipsychotics.
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.
Relationships between total antioxidant capacity (TAC) and psychopathology in schizophrenia is controversial. Different methodological approaches may be a bias factor.
The aim of this research is to analyze the relationship between psychopathology as individual items and psychopathology as syndromes with the serum TAC concentration in schizophrenic patients.
20 DSM-IV paranoid schizophrenic outpatients were recruited from the psychiatric outpatient's clinic of the University Hospital of the Canary Islands. the severity of schizophrenia symptoms was measured with the Positive and Negative Syndrome Scale (PANSS). Blood samples were collected at 12:00 and 00:00 hours. Relationships between quantitative variables were assessed with the Pearson's correlation coefficient.
There was a significant correlation between the PANSS positive subscale and the nocturnal TAC levels (r=0.527, p< 0.02). the PANSS negative subscale was not correlated with TAC concentrations. Item by item scores of the positive and negative PANSS correlations with nocturnal and diurnal TAC levels revealed that only item 6 (suspicion) of the positive PANSS subscale was significantly correlated with the nocturnal TAC concentrations (r=0,491, p< 0.03). Only item 3 (poor contact) of the negative PANSS subscale was also significantly correlated with the nocturnal TAC concentrations (r=0,516, p< 0.02).
We strongly recommend analyzing not only global scores of psychopathology but individual items scores when researching on biological markers in schizophrenia.
This study was partly supported by a grant (PI: 08/115) of the Fundacion Canaria de Investigacion y Salud (FUNCIS).
None of the authors have conflict of interest to disclose.
The Total Antioxidant State (TAS), expressed as equivalent to the total antioxidant capacity of blood plasma. It is the cumulative ability to trap molecules, as H2O2 and free radicals such as RO, ROO, and O2.
Our aim is to describe the TAS levels in schizophrenic patients and to analyze if this marker has got a circadian rhythm. The only study in humans on this subject has carried out by Benot et al (1999) in healthy subjects, which has reported that there was a circadian rhythm of TAS, with a peak night at 01:00, which correlated directly with melatonin (MLT).
The sample was comprised by 43 paranoid schizophrenic inpatients.Blood samples were extracted by venipuncture at 12:00 and 24:00 hours. TAS levels were measured three times: at admission, discharge and three months after discharge. Clinical state was assessed by means of the Clinical Global Impression Scale (CGI). TAS serum levels were measured by ELISA techniques.
Our results show that there is statistical significance between 12:00 and 24:00 for the TAS at admission and three months control. This means that at both times, the income and control of the three months, the levels of midday TAS is significantly higher than the midnight TAS. However, these differences did not occur at discharge.Respect to CGI there are differences in clinical status, less high-control.
0,66 ± 0,1420,60 ± 0,158,p < 0,027.
0,64 ± 0,1530,63 ± 0,1350,740.
0,84 ± 0,100,0,76 ± 0,113p < 0,001.
4,37 ± 0,846,3,05 ± 0,754,3,37 ± 0,720.
3,70 ± 0,640,1,77 ± 0,895,2,23 ± 1,455.
Our results point to the fact that serum TAS may be considered as a possible marker of psychopathological descompensation worsening.
Terrestrial plant macrofossils from the sedimentary record of Lake Suigetsu, Japan, provide the only quasi-continuous direct atmospheric record of radiocarbon (14C) covering the last 50 ka cal BP (Bronk Ramsey et al. 2012). Since then, new high precision data have become available on U-Th dated speleothems from Hulu Cave China, covering the same time range (Cheng et al. 2018). In addition, an updated varve-based chronology has also been published for the 2006 core from Lake Suigetsu (SG06) based on extended microscopic analysis of the sediments and improved algorithms for interpolation (Schlolaut et al. 2018). Here we reanalyze the radiocarbon dataset from Suigetsu based on the new varve counting information and the constraints imposed by the speleothem data. This enables the new information on the calendar age scale of the Suigetsu dataset to be used in the construction of the consensus IntCal calibration curve. Comparison of the speleothem and plant macrofossil records provides insight into the mechanisms underlying the incorporation of carbon into different types of record and the relative strengths of different types of archive for calibration purposes.
Cognitive deficits have been reported during the early stages of bipolar disorder; however, the role of medication on such deficits remains unclear. The aim of this study was to compare the effects of lithium and quetiapine monotherapy on cognitive performance in people following first episode mania.
The design was a single-blind, randomised controlled trial on a cohort of 61 participants following first episode mania. Participants received either lithium or quetiapine monotherapy as maintenance treatment over a 12-month follow-up period. The groups were compared on performance outcomes using an extensive cognitive assessment battery conducted at baseline, month 3 and month 12 follow-up time-points.
There was a significant interaction between group and time in phonemic fluency at the 3-month and 12-month endpoints, reflecting greater improvements in performance in lithium-treated participants relative to quetiapine-treated participants. After controlling for multiple comparisons, there were no other significant interactions between group and time for other measures of cognition.
Although the effects of lithium and quetiapine treatment were similar for most cognitive domains, the findings imply that early initiation of lithium treatment may benefit the trajectory of cognition, specifically verbal fluency in young people with bipolar disorder. Given that cognition is a major symptomatic domain of bipolar disorder and has substantive effects on general functioning, the ability to influence the trajectory of cognitive change is of considerable clinical importance.
Depressive episodes experienced in unipolar (UD) and bipolar (BD) disorders are characterized by anhedonia and have been associated with abnormalities in reward processes related to reward valuation and error prediction. It remains however unclear whether these deficits are associated with familial vulnerability to mood disorders.
In a functional magnetic resonance imaging study, we evaluated differences in the expected value (EV) and reward prediction error (RPE) signals in ventral striatum (VS) and prefrontal cortex between three groups of monozygotic twins: affected twins in remission for either UD or BD (n = 53), their high-risk unaffected co-twins (n = 34), and low-risk twins with no family history of mood disorders (n = 25).
Compared to low-risk twins, affected twins showed lower EV signal bilaterally in the frontal poles and lower RPE signal bilaterally in the VS, left frontal pole and superior frontal gyrus. The high-risk group did not show a significant change in the EV or RPE signals in frontostriatal regions, yet both reward signals were consistently lower compared with low-risk twins in all regions where the affected twins showed significant reductions.
Our findings strengthen the notion that reduced valuation of expected rewards and reduced error-dependent reward learning may underpin core symptom of depression such as loss of interest in rewarding activities. The trend reduction in reward-related signals in unaffected co-twins warrants further investigation of this effect in larger samples and prospective follow-up to confirm possible association with increased familial vulnerability to mood disorders.