ARVCF single marker and haplotypic association with schizophrenia

We present a schizophrenia association study using an extensive linkage disequilibrium (LD) mapping approach in seven candidate genes with a well established link to dopamine, including receptors (DRD2, DRD3) and genes involved in its metabolism and transport (ACE, COMT, DAT, MAO-A, MAO-B). The sample included 242 subjects diagnosed with schizophrenia and related disorders and 373 hospital-based controls. 84 tag SNPs in candidate genes were genotyped. After extensive data cleaning 70 SNPs were analyzed for association of single markers and haplotypes. One block of four SNPs (rs165849, rs2518823, rs887199 and rs2239395) in the 3' downstream region of the COMT gene which included a non-dopaminergic candidate gene, the ARVCF (Armadillo like VeloCardio Facial) gene, was associated with the risk of schizophrenia. The genetic region including the ARVCF gene in the 22q11.21 chromosome is associated with schizophrenia in a Spanish series. Our results will assist in the interpretation of the controversy generated by genetic associations of COMT and schizophrenia, which could be the result of different LD patterns between COMT markers and the 3' region of the ARVCF gene.

Metabolic profile of antipsychotic-naive individuals with non-affective psychosis

BACKGROUND

Some studies suggest individuals with schizophrenia have an increased risk of diabetes prior to antipsychotic use. Small sample sizes and the potential for confounding by hypercortisolaemia have decreased confidence in those results.

AIMS

To examine diabetes-related factors in newly diagnosed, antipsychotic-naive people with non-affective psychosis.

METHOD

Participants with psychosis (the psychosis group; n = 50) and matched controls (the control group; n = 50) were given a 2 h oral glucose tolerance test. Fasting concentrations were also determined for adiponectin, interleukin-6 and C-reactive protein.

RESULTS

Compared with the control group, the psychosis group had significant increases in 2 h glucose and interleukin-6 concentrations, and in the prevalence of abnormal glucose tolerance (16% of psychosis group v. 0% of control group). Adiponectin and C-reactive protein concentrations did not differ significantly between the two groups. These findings could not be attributed to differences in cortisol concentrations, smoking, gender, neighbourhood of residence, body mass index, aerobic conditioning, ethnicity, socioeconomic status or age.

CONCLUSIONS

Individuals with non-affective psychosis appear to have an increased prevalence of abnormal glucose tolerance prior to antipsychotic treatment, as well as abnormalities in a related inflammatory molecule. These underlying problems may contribute to the metabolic side-effects of antipsychotic medications.

Association of A/G polymorphism in intron 13 of the monoamine oxidase B gene with schizophrenia in a Spanish population

BACKGROUND

Monoamine oxidase B (MAO-B) enzyme is involved in the oxidative metabolism of dopamine. We studied whether the A644G polymorphism in intron 13 of the MAO-B gene is a risk factor for schizophrenia.

METHODS

242 subjects diagnosed with schizophrenia and related disorders and 290 hospital-based controls participated in the study. Genomic DNA was isolated from whole blood and genotyped with the allele-specific oligonucleotide polymerase chain reaction method.

RESULTS

This polymorphism was studied by diagnosis subgroups and the G allele was identified as a risk factor for developing schizophrenia (p = 0.006). When we performed a sex-specific analysis, the G allele was only a risk factor for developing schizophrenia in women (p = 0.01). Although the frequency of the G allele is higher in male patients than in male controls, no statistically significant association with schizophrenia was found.

CONCLUSION

Our results support the involvement of the MAO-B gene in schizophrenia, particularly in women.

A continuous emotional task activates the left amygdala in healthy volunteers: (18)FDG PET study

Human amygdalar activation has been reported during facial emotion recognition (FER) studies, mostly using fast temporal resolution techniques (fMRI, H(2)(15)O PET or MEG). The (18)FDG PET technique has never been previously applied to FER studies. We decided to test whether amygdala response during FER tasks could be assessed with this technique. The study was conducted in 10 healthy right-handed volunteers who underwent two scans on different days in random order. Content of the tasks was either emotional (ET) or neutral (CT) and lasted for 17 (1/2) min. Three SPM2 analyses were completed. The first, an ET-CT contrast, showed left amygdalar activation. The second ruled out order effect as a confounder factor. Finally, the whole brain contrast showed activation of the emotional recognition-related areas. Time responses and errors indicated high rates of accuracy in both tasks. We discuss the results and the role of habituation phenomena and the possibility of applying this technique to samples of patients with psychiatric disorders. In conclusion, our study reveals left amygdalar activation assessed with FDG PET, as well as other major emotion recognition-related brain areas during FER tasks.

Cannabis use and age of diagnosis of schizophrenia

BACKGROUND AND OBJECTIVES

Observational studies have reported earlier onset of psychosis in schizophrenic patients with a history of cannabis use. Earlier age of onset of schizophrenia has been associated with a poorer outcome. We aimed to examine whether cannabis use determined an earlier onset of schizophrenia in a sample of first episode patients, in an area with one of Europe's highest rates of cannabis use.

METHODS

116 subjects with first episode psychosis and subsequent diagnosis of schizophrenia (after a 12-month follow-up) were included Age at first antipsychotic treatment (A1T) was used as proxy for age of psychosis onset, and acted as dependent variable for the statistical analysis. Cannabis use was evaluated retrospectively, and divided into three groups according to peak frequency (never, sporadic/frequent, daily).

RESULTS

46 (39.7%) subjects had never used cannabis, 23 (19.9%) had done so sporadically/frequently, and 47 (40.5%) daily. A1T differed between the three groups (mean, in years and [SD]: 27.0 [4.94]; 25.7 [4.44] and 24.5 [4.36]; p=0.033) and diminished as cannabis use increased (linear tendency; p=0.009). Post-hoc analysis showed that cannabis use (irrespective of frequency) was significantly associated with decrease in A1T (p=0.033), as shown by the first contrast [1 -1/2 -1/2]. Post-hoc contrast showed that cannabis users had a significantly lower age of onset of psychosis (mean decrease, in years: 1.93; CI (confidence interval) 95%: 0.17-3.70; p=0.033).

CONCLUSIONS

Cannabis use was significantly associated with a decrease in age of onset of schizophrenia. Age of onset of the disease correlated with frequency of cannabis use.

Telomere length and pulse pressure in newly diagnosed, antipsychotic-naive patients with nonaffective psychosis

INTRODUCTION

Recent studies suggest that in addition to factors such as treatment side effects, suicide, and poor health habits, people with schizophrenia may have an increased risk of diabetes prior to antipsychotic treatment. Diabetes is associated with an increased pulse pressure (PP) and a shortened telomere. We tested the hypothesis that prior to antipsychotic treatment, schizophrenia and related disorders are associated with a shortened telomere, as well as an increased PP.

METHODS

Telomere content (which is highly correlated with telomere length) and PP were measured in newly diagnosed, antipsychotic-naive patients with schizophrenia and related disorders on first clinical contact and in matched control subjects. Both groups were also administered an oral glucose tolerance test.

RESULTS

Compared with control subjects, the patients with psychosis had decreased telomere content and an increased PP. As previously reported, they also had increased glucose concentrations at 2 hours. These differences could not be attributed to differences in age, ethnicity, smoking, gender, body mass index, neighborhood of residence, socioeconomic status, aerobic conditioning, or an increased cortisol concentration in the psychotic subjects.

DISCUSSION

These results suggest that prior to antipsychotic use, nonaffective psychosis is associated with reduced telomere content and increased PP, indices that have been linked to an increased risk of diabetes and hypertension.

Insertion/deletion polymorphism of the angiotensin-converting enzyme gene is associated with schizophrenia in a Spanish population

A number of factors make the angiotensin-converting enzyme (ACE) a candidate gene for psychiatric disorders, including its action on neurotransmitters such as dopamine. An insertion/deletion (I/D) polymorphism in an ACE gene intron is associated with ACE levels. Here we examine whether the ACE I/D polymorphism is a risk factor for schizophrenia. Participants comprised 243 subjects diagnosed with schizophrenia and related disorders, and 291 hospital-based controls. The D allele of the ACE gene was identified as a protective factor, significantly reducing the risk of developing schizophrenia and related disorders (by 40%) and of developing schizophrenia (by 50%). This protection is explained by the additive genotype risk model, in which the protection increases with the number of D alleles. Our results indicate that the ACE D allele is involved in the development of schizophrenia.

Pharmacokinetics and time-course of D(2) receptor occupancy induced by atypical antipsychotics in stabilized schizophrenic patients

The (123)I-IBZM SPECT measured D(2) receptor occupancy (D(2)RO) in chronically dosed, stabilized schizophrenic patients and its relationship with antipsychotic (AP) pharmacokinetics (PK) over time is still unclear. The aims of this study were: 1) To define the relationship between striatal D(2) receptor occupancy (D( 2)RO) and plasma concentration (C(P)) in stabilized schizophrenic patients on clinically relevant doses using (123)I-IBZM SPECT; 2) To investigate the time course of AP-induced D(2)RO and corresponding C(P). Forty-six schizophrenic patients on their clinically required doses of risperidone, olanzapine, clozapine or quetiapine were included. D( 2)RO and C(P) were measured over time following a sparse-sampling experimental design, and individual PK and D(2)RO-time profiles were estimated using a population approach. Observed striatal D(2)RO and C(P) ranges were 28-75% and 9.4-60.5 ng/mL for risperidone, 22-84% and 8.6-89.5 ng/mL for olanzapine, 5-53% and 41.6-818.2 ng/mL for clozapine and 0-64% and 37.9-719.6 ng/mL for quetiapine. A PK-D(2)RO relationship was found for the four APs. D(2)RO pattern over time was stable for risperidone, olanzapine and clozapine but fluctuating for quetiapine. Stabilized schizophrenic patients show a wide range of both D(2)RO and C(P) at clinically effective doses of the four AP, suggesting that clinical response to these AP may be maintained with D(2)RO below 65%. D(2)RO patterns over time differ between AP. These results should be considered for accurate interpretation of D(2)RO measurements, proper design of studies and optimization of drug regimens for patients on AP treatment.

Glucose abnormalities in the siblings of people with schizophrenia

BACKGROUND

Some studies suggest that schizophrenia may be associated with an increased risk of diabetes, independently of antipsychotic medications and other confounding factors. Previous studies have also suggested that there is an increased prevalence of diabetes in the relatives of schizophrenia probands.

METHOD

First-degree siblings of schizophrenia probands (N=6) and control subjects (N=12) were administered a glucose tolerance test. Subjects were matched for gender, age, body mass index, neighborhood of residence, socio-economic status and smoking habits.

RESULTS

The siblings of schizophrenia probands had a significantly increased two-hour mean glucose concentration compared to the control subjects (respective means [SD] were 100.5 mg/dL [27.7] vs. 78.0 [12.3]; p<0.03). Baseline glucose concentrations did not differ.

CONCLUSIONS

Although confirmation with larger samples is needed, these results and other studies suggest that diabetes may share familial risk factors with schizophrenia.

Lower striatal dopamine transporter binding in neuroleptic-naive schizophrenic patients is not related to antipsychotic treatment but it suggests an illness trait

INTRODUCTION

Drug induced parkinsonism (DIP) is directly related to dopamine D2 receptor blockade. However, there are many references describing parkinsonian signs (PS) in naive-patients. In our previous study, we observed lower DAT binding in a group of first-episode schizophrenic patients after short-term treatment with risperidone, compared with age-matched healthy controls.

AIM

To clarify if DAT decrease could be an illness trait, excluding the effect of antipsychotics on DAT availability, and to determine whether DAT availability before treatment with antipsychotics may predict subsequent development of PS.

MATERIALS AND METHODS

A new series of 20 neuroleptic-naive schizophrenic patients and 15 healthy subjects was recruited. SPECT with [(123)I] FP-CIT (DaTSCAN(R)) was performed before starting antipsychotics and after 4 weeks of treatment. PS and psychopathological status were assessed by the Simpson-Angus (SAS), CGI and PANSS scales. Quantitative analyses of SPECTs were performed using ROIs placed in the caudate, putamen and occipital cortex.

RESULTS

Schizophrenic patients showed lower DAT binding compared with the healthy subjects at baseline (p<0.001) and after a 4-week-treatment period (p=0.001). Six out of eight schizophrenic patients of the DIP group were symptomatic for PS at baseline, in comparison to two out of 12 in the NoDIP group. Nonetheless, no differences were observed on DAT between DIP and NoDIP, neither at baseline (p=0.360) nor at endpoint (p=0.984). Finally, no differences between baseline-endpoint DAT binding were observed, neither in the DIP group (p=0.767) nor in the NoDIP group (p=0.093).

CONCLUSION

Our new series of first-episode naive-schizophrenic patients (1) points out DAT dysfunction as an illness trait due to the significantly lower DAT binding in schizophrenic patients in comparison to healthy subjects; (2) supports the results of other authors who describe PS in never-treated patients; (3) confirms that [(123)I] FP-CIT does not allow us to predict which patients will develop parkinsonism due to the lack of differences between DIP and NoDIP patients; and (4) confirms a null effect of antipsychotics on DAT due to the lack of differences in [(123)I] FP-CIT before and after a 4-week-treatment period.

Dopamine transporter (DAT) genotype (VNTR) and phenotype in extrapyramidal symptoms induced by antipsychotics

INTRODUCTION

Impaired dopamine transporter (DAT) function may be involved in antipsychotic (AP)-induced extrapyramidal symptoms (EPS). A polymorphism involving a variable number of tandem repeats (VNTR) has been described in the DAT gene (SLC6A3).

OBJECTIVE

We studied whether the SLC6A3 VNTR polymorphism is a risk or protection factor for AP-induced EPS. We also investigated the relationship between the polymorphism and DAT availability in the schizophrenic patient's brain.

METHODS

Sixty-one patients receiving AP therapy participated in the EPS study. Of these, thirty-two cases presented EPS (Simpson-Angus >3) and twenty-nine without EPS (Simpson-Angus < or =3). The DAT expression was studied in fifteen AP-naive patients by [(123)I] FP-CIT SPECT.

RESULTS

No significant differences were observed for the more common alleles ((*)9R and (*)10R) or for genotype frequencies between patients with EPS and those without EPS. The frequency of the (*)9R and (*)10R alleles was similar to that described in other European populations. There were no significant differences in striatal DAT binding among the three major VNTR genotype groups.

CONCLUSIONS

Our results suggest that the VNTR polymorphism did not influence AP-induced EPS and did not affect DAT gene expression or protein function.

Long-acting injectable risperidone in the treatment of schizophrenia in special patient populations

OBJECTIVE

Although atypical antipsychotic agents are effective in the treatment of schizophrenia, certain populations such as the elderly, young adults or those with a first episode of schizophrenia, and patients with schizoaffective disorder require special consideration when selecting pharmacotherapy. The introduction of a long-acting injectable atypical antipsychotic, long-acting risperidone, may be of benefit in these special groups. To determine the effectiveness of long-acting risperidone, the literature was reviewed to evaluate the efficacy and safety of long-acting risperidone in these populations. The impact of race was also considered.

EXPERIMENTAL DESIGN

Studies published between January 2002 and November 2005 were reviewed as identified from literature searches using MEDLINE and Embase. The primary research parameter was "longacting risperidone" and literature pertaining to these particular patient groups selected. Abstracts and posters on long-acting risperidone presented at key psychiatry congresses were also reviewed during this time period. PRINCIPLE OBSERVATIONS: Results demonstrated that long-acting risperidone is effective and well tolerated in elderly patients, young patients or those with a first episode of schizophrenia, patients with schizoaffective disorder, and patients of different ethnicity. All patient groups demonstrated improvements in mean total Positive and Negative Syndrome Scale scores and Clinical Global Impressions of Severity Scale scores. Long-acting risperidone also reduced relapse rates and had a favourable tolerability profile. As such, long-acting risperidone has the potential to improve compliance in these vulnerable patient groups.

CONCLUSIONS

Given the data presented here, further investigation of the effects of long-acting risperidone in these particular patient groups is warranted.

Disminución del transportador de dopamina estriatal en primeros episodios psicóticos de pacientes esquizofrénicos tratados con risperidona

Extrapyramidal symptoms and Parkinsonism (PS) are side effects commonly observed with antipsychotic treatment. However, about 24% of never-treated schizophrenic patients may suffer from PS, which contrast with that 1% observed from the general population. 123I-FP-CIT SPECT has probe useful to differentiate degenerative from non-degenerative PS, so it could be interesting using it for establishing the functional state of presynaptic dopamine neurons of these patients.

AIM

To determine the dopamine transporter binding (DAT) in a homogeneous group of first-episode schizophrenic patients.

METHODS

An open, transversal study. Thirty schizophrenic in-patients and 15 healthy subjects were recruited. Patients were treated with similar doses of risperidone and all subjects were scanned with 123I-FP-CIT. Extrapyramidal symptoms and psychopathological status was assessed by Simpson-Angus, CGI and PANSS. Semi-quantitative analyses of SPECT images were performed using ROIs placed in caudate nucleus, anterior, medium and posterior putamen and occipital cortex.

RESULTS

Whole striatum 123I-FP-CIT binding ratio was significantly lower in patients than healthy subjects (t = 2.56, p < 0.014). This was observed in whole putamen (t = 2.66, p < 0.011), anterior (t = 2.35, p < 0.023), medium (t = 2.38, p < 0.022) and posterior putamen (t = 2.09, p < 0.042). No differences were observed in caudate nucleus (t = 1.81, p = 0.076). Females obtained higher binding ratios than males (t = -3.13, p < 0.003). No correlation was observed between 123I-FP-CIT binding ratios and clinical scales.

CONCLUSION

In our series, first episode schizophrenic patients treated with risperidone have a decrease striatal DAT binding assessed with 123I-FP-CIT SPECT. This alteration could be related to their own schizophrenia disease or be secondary to the antipsychotic treatment.

Clinical experience and management considerations with long-acting risperidone

BACKGROUND

Risperidone is the first atypical anti-psychotic available in a long-acting injectable formulation.

OBJECTIVE

To provide an overview of the initial clinical experience gained with long-acting risperidone during clinical trials and in general treatment, including specific case studies, as well as providing practical advice on how to initiate treatment with this new drug.

METHODS

Studies published between January 2002 and June 2005 that evaluated the pharmacokinetics, efficacy and safety of long-acting risperidone for the treatment of schizophrenia were reviewed, as identified from literature searches using Medline and EMBASE. Although not peer-reviewed, abstracts and posters on long-acting risperidone presented at key psychiatry and schizophrenia congresses during this period were also reviewed where available in the public domain.

RESULTS

Clinical studies have consistently demonstrated that long-acting risperidone, available in dosage strengths of 25, 37.5 or 50 mg, given once every 2 weeks, is both effective and well tolerated in patients with schizophrenia. Furthermore, significant and sustained clinical improvement has been reported in patients switched to long-acting risperidone from other oral and long-acting antipsychotic agents. Several patients groups, including the young, the elderly and patients with schizoaffective disorder, have also been shown to derive significant benefit from long-acting risperidone.

CONCLUSION

A wide variety of patient groups may benefit from treatment with long-acting risperidone, including patients with suboptimal efficacy, particularly as a result of partial compliance, patients experiencing side-effects with another antipsychotic agent or those with a first episode of schizophrenia. Furthermore, long-acting risperidone, with its assured medication delivery, should improve patient compliance and assist patients in achieving remission, an important step towards functional recovery.

Patients in the early phases of schizophrenia and schizoaffective disorders effectively treated with risperidone long-acting injectable

The efficacy and safety of risperidone long-acting injectable (RLAI) was investigated in patients in the early phases of schizophrenia and schizoaffective disorders (< or = 3 years). Patients who required a treatment change received RLAI (2-weekly gluteal injections of 25, 37.5 or 50 mg, per clinical judgement), without an oral risperidone run-in phase.A total of 382 patients were included in this 6-month open-label study; 73% of patients completed the study. A total of 84% had schizophrenia with a median duration of 1.0 year since diagnosis. Previous medications were mainly atypical antipsychotics (70%) and depot neuroleptics (24%). The main reasons for treatment change were non-compliance (42%) and insufficient efficacy (31%) of previous medication. The total Positive and Negative Syndrome Scale (PANSS) and all its subscale scores improved significantly (p < or = 0.0001), with 40% of patients showing a 20% improvement on total PANSS. Global Assessment of Functioning, quality of life, patient satisfaction and movement disorders also improved significantly. Tolerability of RLAI was generally good and no unexpected adverse events were reported. The ensured delivery of medication with RLAI resulted in significant symptom improvement in this patient population. Direct initiation of RLAI is well accepted by patients. RLAI might represent a novel option for patients in the early phases of psychosis.

Efficacy and safety of direct transition to risperidone long-acting injectable in patients treated with various antipsychotic therapies

The maintained antipsychotic efficacy of risperidone long-acting injectable (RLAI) was investigated in patients with schizophrenia or other psychoses who were transitioned directly from their previous antipsychotic medication. Patients symptomatically stable, but considered to require a treatment change, received 25 mg of RLAI (increased to 37.5 or 50 mg, if necessary) every 2 weeks for 6 months. Assessments included Positive and Negative Syndrome Scale (PANSS), Clinical Global Impression-Severity (CGI-S), Global Assessment of Functioning (GAF), SF-36 Health-Related Quality of Life Questionnaire and Extrapyramidal Symptoms Rating Scale (ESRS). Of 1876 patients enrolled, 74% completed the 6-month study. The most frequent reasons for treatment change were non-compliance (38%), insufficient efficacy (33%) and side-effects (26%). There was a significant reduction from baseline to endpoint in mean total PANSS score and in the scores on all PANSS subscales and symptom factors (P<0.001). CGI-S improved significantly, as did mean GAF score, all factors on the SF-36 and patient satisfaction with treatment. Scores on ESRS showed significant, sustained improvements throughout the study period. Direct initiation of RLAI was effective and well tolerated. RLAI provides an advancement in the treatment options available for a wide range of patients requiring long-term antipsychotic therapy.

Striatal dopamine D2 receptor density in neuroleptic-naive and in neuroleptic-free schizophrenic patients: an 123I-IBZM-SPECT study

Most post-mortem autoradiographic studies have described striatal dopamine D(2) receptor up-regulation due to chronic neuroleptic exposure. The aim of our study was to compare in-vivo striatal D(2) receptor density in neuroleptic-naive and neuroleptic-free schizophrenic patients. We included 28 young (mean age: 28+/-8 years) acute psychotic patients meeting DSM-IV criteria for schizophrenia or schizophreniform disorder. Enrolled patients were either first-episode neuroleptic-naive (n=12) or neuroleptic-free (n=16) after a minimum washout period of 7 days. All neuroleptic-free subjects had previously received neuroleptic treatment for a median period of 3.5 years. Both groups were evaluated using standard clinical scales. In-vivo striatal D(2) receptor binding was assessed by basal ganglia/frontal cortex ratios using (123)I-IBZM SPECT. No statistically significant differences were found in age or clinical assessment between neuroleptic-naive and neuroleptic-free schizophrenic patients. No differences were found in the basal ganglia/frontal cortex ratios of neuroleptic-naive (1.78+/-0.11) and neuroleptic-free (1.81+/-0.15) patients. No striatal uptake laterality was observed in either group. No correlation was demonstrated between BG/FC ratios and duration of illness, period of neuroleptic exposure or time of drug washout. We conclude that our neuroleptic-naive and neuroleptic-free schizophrenic patients did not show differences in striatal D(2) receptor binding, suggesting that IBZM-SPECT fails to detect D(2) receptor up-regulation induced by chronic exposure to neuroleptic drugs.

Risperidone in the treatment of patients with delirium

BACKGROUND

The aim of this study was to evaluate the efficacy and safety of risperidone in the treatment of patients with delirium.

METHOD

We conducted a prospective, multicenter, observational 7-day study in 5 university general hospitals. Sixty-four patients (62.5% male [N = 40]; mean age: 67.3 +/- 11.4 years) hospitalized due to a medical condition who met criteria for delirium according to DSM-IV were enrolled in the study. Fifty-six patients received 7 days of treatment or less, while 8 patients continued treatment for more than 7 days. Effectiveness was assessed using the Trzepacz Delirium Rating Scale (DRS), the positive subscale of the PANSS (PANSS-P), the Mini-Mental State Examination (MMSE), and the Clinical Global Impressions scale (CGI). Safety assessment included the UKU Side Effect Rating Scale. Risperidone was administered at the time of diagnosis, and treatment was maintained according to clinical response. Response to treatment was defined as a reduction in DRS score to below 13 within the first 72 hours. Data were gathered from April to December 2000.

RESULTS

Risperidone (mean dose = 2.6 +/- 1.7 mg/day at day 3) was effective in 90.6% (58/64) of the patients and significantly improved all symptoms measured by the scales from baseline to day 7 (mean scores: DRS, 22.5 +/- 4.6 at baseline to 6.8 +/- 7.0 at day 7; PANSS-P, 21.5 +/- 8.8 to 10.1 +/- 7.3; MMSE, 13.1 +/- 10.9 to 26.4 +/- 8.9; and CGI, 4.5 +/- 0.9 to 1.9 +/- 1.2) (Friedman test, p <.001 in all cases). Two patients (3.1%) experienced adverse events, but none showed extrapyramidal symptoms.

CONCLUSIONS

Low-dose risperidone proved to be a safe and effective drug in the treatment of symptoms of delirium in medically hospitalized patients. These data provide the rationale for a prospective randomized controlled trial.

Lack of sex differences in striatal dopamine D2 receptor binding in drug-naive schizophrenic patients: an IBZM-SPECT study

Differences in antipsychotic treatment response, clinical course and outcome of schizophrenia could be related to gender-related cerebral differences in anatomy and function. The aim of the study was to assess sex differences in the striatal dopamine D2 receptor binding in 15 drug-naive schizophrenic patients (seven males, eight females) using (123)I-IBZM single photon emission computed tomography. Basal ganglia/frontal cortex (BG/FC) uptake ratios were obtained. No significant differences were found in global, left and right BG/FC ratios or laterality indices between males and females. No correlation was found between BG/FC ratios and age, duration of illness or scores on symptom rating scales. Our data indicate a lack of sex differences in striatal D2 receptor binding in drug-naive schizophrenic patients and do not support previous reports of left lateralized striatal asymmetry in male schizophrenic patients.

[Functional neuroimaging of auditory hallucinations in schizophrenia]

The neurobiological bases underlying the generation of auditory hallucinations, a distressing and paradigmatic symptom of schizophrenia, are still unknown in spite of in-depth phenomenological descriptions. This work aims to make a critical review of the latest published literature in recent years, focusing on functional neuroimaging studies (PET, SPECT, fMRI) of auditory hallucinations. Thus, the studies are classified according to whether they are sensory activation, trait and state. The two main hypotheses proposed to explain the phenomenon, external speech vs. subvocal or inner speech, are also explained. Finally, the latest unitary theory as well as the limitations the studies published are commented on. The need to continue investigating in this field, that is still underdeveloped, is posed in order to understand better the etiopathogenesis of auditory hallucinations in schizophrenia.

Double-blind olanzapine vs. haloperidol D2 dopamine receptor blockade in schizophrenic patients: a baseline-endpoint

The aim of this study was to compare in vivo striatal D2 dopamine receptor occupancy induced by olanzapine and haloperidol in schizophrenic patients using a baseline-endpoint [(123)I]IBZM single photon computed emission tomography (SPECT) design. The relationships of striatal D2 receptor occupancy with clinical efficacy and extrapyramidal symptoms (EPS) were also assessed. Twenty-seven inpatients with schizophrenia or schizophreniform disorder were included in a 4-week prospective, randomized, double-blind, parallel and comparative clinical trial. Thirteen patients were treated with haloperidol (10 mg/day) and 14 with olanzapine (10 mg/day). Ratings of clinical status and EPS were obtained weekly. The percentage of D2 receptor occupancy was estimated by using basal ganglia (striatum)/frontal cortex IBZM uptake ratios obtained from each patient before and after 4 weeks of maintained antipsychotic treatment. Olanzapine led to a mean striatal D2 receptor occupancy of 49% (range 28-69%), which was significantly lower than that induced by haloperidol (mean 64%, range 46-90%). The baseline-endpoint SPECT design used in this study revealed lower antipsychotic D2 occupancy percentage values than those reported in the literature, using other approaches. The degree of striatal D2 receptor occupancy correlated to the EPS, which predominantly appeared in patients on haloperidol. No relationship was found between the striatal D2 receptor occupancy and clinical improvement. Olanzapine induced a lower striatal D2 occupancy than haloperidol. This low striatal D2 occupancy, together with the lower incidence of EPS in olanzapine-treated patients, contributed to confirm the atypical behavior of this new antipsychotic drug. Nevertheless, conclusions based on SPECT-estimated percentages of antipsychotic D2 occupancy should be cautious, since the SPECT design could influence the results. In this regard, SPECT studies including baseline and endpoint examinations should be encouraged.

Psychopathology and wisconsin card sorting test performance in young unmedicated schizophrenic patients

The relationship between psychopathology and Wisconsin Card Sorting Test (WCST) performance was evaluated in 25 unmedicated young acute schizophrenic female patients (14 neuroleptic-naive and 11 neuroleptic-free) and 15 female controls. The schizophrenic patients (especially the neuroleptic-free) performed more poorly than controls in the WCST. In addition, WCST impairment correlated with both negative and positive symptoms. The results suggest that the neuropsychological dysfunction in schizophrenia is present at the onset of the illness, and is neither secondary to previous neuroleptic treatment nor to chronicity of the illness.

The resting and activation issue of hypofrontality: a single photon emission computed tomography study in neuroleptic-naive and neuroleptic-free schizophrenic female patients

BACKGROUND

Functional neuroimaging findings of "hypofrontality" in schizophrenic patients is still controversial, due to the heterogeneity of methods and patient samples. This study tries to prevent some of these concerns by studying neuroleptic-naive (NN) and neuroleptic-free (NF) young female patients both in resting conditions and during a frontal cognitive activation task.

METHODS

Regional cerebral blood flow (rCBF) was studied at rest and during the Wisconsin Card Sorting Test (WCST) in 25 young acute unmedicated schizophrenic female patients (14 NN and 11 NF) and 15 female controls, using single photon emission computed tomography.

RESULTS

The schizophrenic and control groups did not differ in rCBF during the baseline condition, but the schizophrenic group failed to activate the frontal lobe during the WCST condition. In addition, the left anterior temporal rCBF at rest correlated with the Scale for the Assessment of Positive Symptoms total score.

CONCLUSIONS

The results suggest that hypofrontality in young acute unmedicated schizophrenic patients is a result of an inability to activate frontal regions during cognition, rather than a baseline decrease in frontal activity. Furthermore, positive symptoms seem to be associated with left temporal cortex activity.

Role of the cingulate gyrus during the Wisconsin Card Sorting Test: a single photon emission computed tomography study in normal volunteers

The purpose of this study was to investigate the effect of the Wisconsin Card Sorting Test (WCST) on frontal regional cerebral blood flow (rCBF) in normal subjects, separating the cingulate gyrus from the prefrontal cortex. Two technetium-99m-hexamethyl-propylene-amine-oxime brain single photon emission computed tomography (SPECT) scans, at rest and during WCST performance, were performed in randomized order on 13 right-handed normal volunteers. A statistically significant rCBF increase was found in the left inferior cingulate and the left posterior frontal region, although rCBF ratios in the left and right prefrontal cortex, and in the right inferior cingulate, were slightly higher during WCST performance in nine of the 13 subjects studied. No differences in activation scores (activated-resting rCBF ratios) were found between subjects who had the resting SPECT first and subjects who had the resting condition second. These results suggest that the inferior cingulate cortex, a limbic region that has been implicated in attentional mechanisms, plays a significant role in WCST performance. Furthermore, the motor component of the WCST may account for the activation of the left posterior frontal region. In addition, no order effect was found in this study. These findings illustrate the advantage of independently evaluating the cingulate gyrus and the prefrontal cortex in SPECT studies of frontal cognitive function.

Regional cerebral blood flow pattern in normal young and aged volunteers: a 99mTc-HMPAO SPET study

The aim of this study was to investigate the normal pattern of regional cerebral blood flow (rCBF) distribution in normal young and aged volunteers using technetium-99m hexamethylpropylene amine oxime (99m-Tc-HMPAO) as a tracer. The region brain perfusion of young and aged subjects was compared, especially regarding rCBF differences due to age and gender, and interhemispheric rCBF asymmetries. Sixty-eight right-handed normal volunteers - 40 young (mean age 29. 5+/-6.3 years) and 28 aged (mean age 71.2+/-4.3 years) - were included in the study. rCBF was estimated on the basis of a semiquantitative approach by means of a left/right index and two region/reference ratios, using the cerebellum and the whole brain activity as references. A good correlation between these two region/reference ratios was found (P<0.005 in all cerebral regions). The highest rCBF ratios corresponded to the cerebellum, followed by the occipital lobe. The remaining cortical regions (temporal, parietal, frontal and basal ganglia) showed slightly lower values. The white matter showed rCBF ratios substantially lower than the grey matter. In neither young nor aged subjects were significant rCBF differences between the genders found in any of the two region/reference indices employed. Aged subjects showed significantly lower rCBF ratios than young subjects in the left frontal lobe and in the posterior region of the left temporal lobe. In both young and aged subjects, lower perfusion was found in the left hemisphere, except for the white matter region in both age groups and the frontal lobe in the young subjects. Aged subjects presented a slightly higher interhemispheric asymmetry in the frontal lobe. However, interhemispheric asymmetry was minimal (-1. 01% to 3.14%). Consequently, a symmetrical rCBF distribution can be assumed between homologous regions, independent of age.

Baseline, visual deprivation and visual stimulation 99TCm-HMPAO-related changes in visual cortex can be detected with a single-head SPET system

To determine the sensitivity of 99TCm-hexamethylpropylene amine oxime (99TCm-HMPAO) and a single-head SPET (single photon emission tomography) system in the detection of perfusion changes in the visual cortex due to different visual conditions, six normal healthy volunteers were studied under conditions of visual deprivation (blindfolded), visual stimulation (stroboscopic light) and baseline (dim light and eyes open). Visual cortex/whole-brain activity ratios, and the percentage of activity change between the different visual conditions were calculated after three-dimensional realignment of the images. The activity in the visual cortex was higher during visual stimulation than during the visual deprivation (P = 0.002, 17.6 +/- 8.6% increase) and baseline conditions (P = 0.009, 8.8 +/- 5.6% increase). Furthermore, the activity in the visual cortex was lower during the visual deprivation than in the baseline condition (P = 0.001, 8.1 +/- 2.9% decrease). 99TCm-HMPAO SPET, even with a single-head system, is capable of detecting changes in rCBF in the striate cortex, not only between conditions of visual stimulation and deprivation, but also between these two conditions and the baseline state.

Prefrontal dysfunction in young acute neuroleptic-naive schizophrenic patients: a resting and activation SPECT study

Regional cerebral blood flow (rCBF) was measured with single photon emission computed tomography (SPECT) in six neuroleptic-naive, young, acute schizophrenic patients and six normal control subjects. We evaluated rCBF changes in prefrontal areas at rest and during a prefrontal activation task, the Wisconsin Card Sorting Test (WCST). Schizophrenic patients had significantly higher prefrontal blood flow than did control subjects during the resting conditions. During activation, the control group showed significant increases in prefrontal blood flow, whereas the schizophrenic group did not. These results suggest that at rest there is no evidence of hypofrontality, whereas hyperfrontality seems to be the most frequent pattern in our selected sample of young acute neuroleptic-naive schizophrenic patients. Furthermore, schizophrenic patients seem to be unable to increase prefrontal blood flow under conditions that challenge the prefrontal cortex.

Prefrontal and temporal blood flow in schizophrenia: resting and activation technetium-99m-HMPAO SPECT patterns in young neuroleptic-naive patients with acute disease

This study assesses prefrontal and temporal regional cerebral blood flow (rCBF) changes in young, neuroleptic-naive schizophrenic patients with acute disease.

METHODS

A selected population of 10 young, never-treated schizophrenic women with acute disease was studied by two hexamethylpropyleneamine oxime (HMPAO) brain SPECT sessions, performed 48 hr apart, both at rest and during a prefrontal activation task using the Wisconsin Card Sort Test (WCST). All patients met Diagnostic and Statistical Manual of Mental Disorders, 3rd edition-revised criteria for schizophrenia or schizophreniform disorder, were neuroleptic-naive and had acute symptoms.

RESULTS

Under resting conditions, the schizophrenic group had significantly higher rCBF in the prefrontal regions, mainly in the left side and including the anterior cingulate, than did the controls. In addition, schizophrenic patients showed significant interhemispheric differences in prefrontal and posterior temporal index values at rest (left hyperfrontality and left hypotemporality). During WCST activation, the control group showed significant increases in prefrontal blood flow, whereas the schizophrenic group did not.

CONCLUSION

These results support a physiologic dysfunction of the prefrontal cortex in schizophrenia that is present at the onset of the illness prior to neuroleptic treatment. Furthermore, both left hyperfrontality and left hypotemporality may indicate a brain lateralization defect in schizophrenia.