Schizophrenia Bulletin


Catatonic Schizophrenia: A Cohort Prospective Study
Schizophrenia Bulletin, 09/09/10
Kleinhaus K et al. – Patients with catatonic schizophrenia show a somewhat different profile of risk factors from those with other types of schizophrenia in this cohort and are more likely to attempt suicide. This lends some support to the hypothesis that catatonic schizophrenia may have a distinct etiology.




Prediction of a single psychotic episode: A 7.5-year, prospective study in first-episode psychosis
Schizophrenia Research, 12/09/10
Alvarez–Jimenez M et al. – Early treatment (within two months of onset of psychotic symptoms) and social support significantly reduce vulnerability to subsequent psychotic episodes. Future studies need to investigate the interplay between biological factors (i.e. sensitized dopaminergic system), environmental variables (i.e. exposure to trauma, stigma and discrimination), and psychological attributes (i.e. cognitive schemata) in order to elucidate the processes underlying the vulnerability to recurrent psychotic episodes.






Presynaptic Regulation of Dopamine Transmission in Schizophrenia
Schizophrenia Bulletin, 09/20/10
Lyon GJ et al. – Recent studies suggest that patients with schizophrenia, including those never exposed to antipsychotic drugs, maintain high presynaptic Dopamine Transmission accumulation in the striatum. New laboratory approaches are elucidating mechanisms that control the level of presynaptic DA stores, thus contributing to fundamental understanding of the basic pathophysiologic mechanism in schizophrenia.






Bupropion for Depression in Schizophrenia
Clinical Neuropharmacology, 10/04/10
Englisch S et al. – The authors report on a consecutive series of depressed patients with psychotic spectrum lifetime diagnoses who received bupropion extended release for a period of 6 weeks in addition to stable doses of antipsychotic agents. All patients experienced significant improvements of their major depressive episodes. Psychotic positive symptoms remained stably absent, whereas both negative symptoms and global psychopathology considerably improved. The treatment was generally well tolerated; however, subtle electroencephalographic deteriorations were observed. This case series suggests safe and effective antidepressive treatment with bupropion in patients with schizophrenic disorders, if stable antipsychotic medication and electroencephalographic–monitoring are provided.




Predictors of recovery from psychosis: Analyses of clinical and social factors associated with recovery among patients with first-episode psychosis after 5years
Schizophrenia Research, 12/01/10
Albert N et al. – These findings suggest that a stable social life with normal social functioning has a predictive value for good outcome. These measures might be influenced by negative symptoms, but in the multivariate analysis with negative symptoms included they have an independent effect.





Lurasidone for schizophrenia
Current Psychiatry, 01/07/11
Lincoln J et al. – Although the drug?s exact mechanism of action is not known, it is thought that lurasidone?s antipsychotic properties are related to its antagonism at serotonin 2A (5–HT2A) and dopamine D2 receptors. Lurasidone is absorbed in the gastrointestinal tract. It reaches maximum concentration (Cmax) in 1 to 3 hours. Cmax doubles when lurasidone is administered with food, but absorption is independent of the meal's fat content.4 After absorption, the drug is highly bound (99%) to serum proteins. The elimination half–life is 18 hours and steady–state concentration is reached within 7 days.1 Lurasidone is eliminated predominantly through cytochrome P450 (CYP) 3A4 metabolism in the liver.





Atypical antipsychotics for delirium: A reasonable alternative to haloperidol
Current Psychiatry, 01/07/11
Spiegel DR et al. – In addition to recommending identifying and addressing the underlying acute illness, American Psychiatric Association guidelines suggest prescribing psychotropic medications to treat delirium symptoms. Antipsychotics are considered first–line pharmacotherapy because they have been shown to lower hospital mortality rates8 and improve delirium symptoms even before underlying medical etiologies are treated. Haloperidol is the mainstay of delirium treatment.




Clozapine and blood dyscrasia
Psychiatric Bulletin, 01/07/11
Latif Z et al. – Clozapine is an effective antipsychotic medication but is associated with agranulocytosis, neutropenia and leucopenia. The reintroduction of clozapine improved management of treatment–resistant schizophrenia, yet resulted in a paradoxical situation whereby the risk of blood dyscrasias is rigorously managed but other adverse effects (e.g. seizures, cardiovascular complications) are less well monitored. Monitoring of weight, lipids, plasma glucose and other metabolic parameters is recommended.






Risperidone nonadherence and return of positive symptoms in the early course of schizophrenia
American Journal of Psychiatry, 01/12/11
Subotnik KL et al. ? This study examined the effect of medication nonadherence on the return of positive symptoms among recent-onset schizophrenia patients. Even brief periods of partial nonadherence lead to greater risk of relapse than what is commonly assumed. Patients in the early phase of schizophrenia should be cautioned about the possible consequences of partial or relatively brief periods of antipsychotic medication nonadherence. Methods
  • 3 sets of operational criteria for medication nonadherence with differing levels of severity compared for their ability to predict relapse
  • Explicit operational criteria provided with hope that they will be adopted by others
  • Psychotic symptoms were prospectively rated on frequent basis, and systematic criteria applied using computer scoring program to identify periods of psychotic symptom return
  • Specialized statistical survival analysis method, optimal for examining risk periods and outcomes that can recur during the follow-up assessment
  • Medication nonadherence robustly predicted return of psychotic symptoms during early phase of schizophrenia (HR=3.7?28.5, depending on severity of nonadherence)





Cognitive-Behavioral Therapy for Medication-Resistant Schizophrenia: A Review
FOCUS (The Journal of Lifelong Learning in Psychiatry), 01/14/11

Rathod S et al. – Research meta–analyses have found that cognitive–behavioral therapy (CBT) is beneficial for persistent symptoms of schizophrenia. This review describes and updates the evidence base for this statement.





Prefrontal cortical deficits and impaired cognition-emotion interactions in schizophrenia
American Journal of Psychiatry, 01/14/11
Ursu S et al. ? These results suggest that schizophrenia is characterized by a failure of prefrontal circuitry supporting the link between emotion and goal-directed behavior and that the failure of this mechanism may contribute to defi cits in processes related to emotion-cognition interaction. Methods
  • Slow event-related functional MRI paradigm
  • Examined brain activity of 23 schizophrenia patients and 24 healthy comparison subjects during trials in which they viewed affective picture and, after delay, reported their emotional experience while viewing it
  • Self-reports of emotional experience differed from those of healthy subjects when they rated their experience on dimensions inconsistent with stimulus valence but not when dimension was consistent with it
  • In the presence of emotional stimuli, brain activity in the patients was similar to that of the comparison subjects
  • During delay, patients showed decreased activation in network of brain structures, including dorsolateral prefrontal cortex and other prefrontal, limbic, and paralimbic areas
  • Delay-related response of dorsolateral prefrontal cortex to pleasant stimuli correlated negatively with an anhedonia measure





Neurocognition, insight into illness and subjective quality-of-life in schizophrenia: What is their relationship
Schizophrenia Research, 01/28/11
Kurtz MM et al. – These findings suggest that neurocognition and insight into illness have inverse relationships to Subjective quality–of–life (SQOL) and that elementary neurocognition does not influence SQOL through its link with illness insight.






Dose-dependent galactorrhea with quetiapine
Indian Journal of Psychiatry, 01/20/11
Sethi S et al. – Quetiapine is an atypical antipsychotic agent with minimal propensity to induce hyperprolactinemia in standard therapeutic dosages. Despite that quetiapine is considered to be a prolactin–sparing atypical antipsychotic, hyperprolactinemia with related side effects may rarely be encountered in susceptible individuals.






Treatment of Irritable Bowel Syndrome With Comorbid Anxiety Symptoms With Mirtazapine
Clinical Neuropharmacology, 01/28/11
Spiegel DR et al. – Presented here is a case report of a 66–year–old woman with a history of panic disorder and major depression and a 1–year history of Irritable Bowel Syndrome–mixed type, which she reported to be "worsened by panic attacks." On the basis that mirtazapine is a potent 5–HT3 receptor antagonist and has demonstrated pain relief from somatic symptoms, the authors treated their patient with mirtazapine, which seems to have decreased her diarrhea and constipation symptoms, and her psychopathological symptoms.


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