Internet Addiction, Hikikomori Syndrome, and the Prodromal Phase of Psychosis

Computers, video games, and technological devices are part of young people's everyday lives. Hikikomori is a Japanese word describing a condition that mainly affects adolescents or young adults who live isolated from the world, cloistered within their parents' homes, locked in their bedrooms for days, months, or even years on end, and refusing to communicate even with their family. These patients use the Internet profusely, and only venture out to deal with their most imperative bodily needs. Although first described in Japan, cases have been described from around the world. This is the first published report from Canada. The disorder shares characteristics with prodromal psychosis, negative symptoms of schizophrenia, or Internet addiction, which are common differential or comorbid diagnoses. However, certain cases are not accompanied by a mental disorder. Psychotherapy is the treatment of choice although many cases are reluctant to present. The exact place of hikikomori in psychiatric nosology has yet to be determined. We searched Medline up to 12th May, 2015 supplemented by a hand search of the bibliographies of all retrieved articles. We used the following search terms: Hikikomori OR (prolonged AND social AND withdrawal). We found 97 potential papers. Of these 42 were in Japanese, and 1 in Korean. However, many of these were cited by subsequent English language papers that were included in the review. Following scrutiny of the titles and abstracts, 29 were judged to be relevant. Further research is needed to distinguish between primary and secondary hikikomori and establish whether this is a new diagnostic entity, or particular cultural or societal manifestations of established diagnoses.

Running for your life: A review of physical activity and cardiovascular disease risk reduction in individuals with schizophrenia

Individuals with schizophrenia have a greater risk for cardiometabolic risk factors (e.g. central obesity, insulin resistance, hypertension and dyslipidaemia), cardiovascular diseases and mortality. This risky profile may be explained by the adverse effects of antipsychotic medications and an unhealthy lifestyle (e.g. smoking, poor nutrition and low physical activity). In the general population, physical activity has been shown to be the optimal strategy to improve both cardiometabolic parameters and cardiorespiratory fitness levels. Accordingly, an emerging literature of non-pharmacological interventions (e.g. cognitive behavioural therapy, diet and physical activity) has been studied in individuals with schizophrenia. Therefore, the purpose of this review was 1) to conduct a critical literature review of non-pharmacological interventions that included some kind of physical activity (including supervised and unsupervised exercise training) and target cardiometabolic risk factors in individuals with schizophrenia. 2) To describe the contribution of physical activity alone by reviewing trials of supervised exercise training programmes only. A literature review via systematic keyword search for publications in Medline, PubMed, Embase and PsycINFO was performed. Many non-pharmacological interventions are efficient in reducing cardiovascular disease risk factors when combined with physical activity. Supervised physical activity has been successful in decreasing cardiovascular disease risk, and aerobic interval training appears to provide more benefits by specifically targeting cardiorespiratory fitness levels. In conclusion, physical activity is an effective strategy for addressing cardiovascular disease risk in individuals with schizophrenia. Long-term studies are needed to evaluate the feasibility and impact of exercise training programmes in individuals with schizophrenia.

Evidence from paranoid schizophrenia for more than one component of theory of mind

We previously reported finding that performance was impaired on four out of five theory of mind (ToM) tests in a group of 21 individuals diagnosed with paranoid schizophrenia (pScz), relative to a non-clinical group of 29 individuals (Scherzer et al., 2012). Only the Reading the Mind in the Eyes Test did not distinguish between groups. A principal components analysis revealed that the results on the ToM battery could be explained by one general ToM factor with the possibility of a latent second factor. As well, the tests were not equally sensitive to the pathology. There was also overmentalization in some ToM tests and under-mentalisation in others. These results led us to postulate that there is more than one component to ToM. We hypothesized that correlations between the different EF measures and ToM tests would differ sufficiently within and between groups to support this hypothesis. We considered the relationship between the performance on eight EF tests and five ToM tests in the same diagnosed and non-clinical individuals as in the first study. The ToM tests shared few EF correlates and each had its own best EF predictor. These findings support the hypothesis of multiple ToM components.

Impact of the resolution of brain parcels on connectome-wide association studies in fMRI

A recent trend in functional magnetic resonance imaging is to test for association of clinical disorders with every possible connection between selected brain parcels. We investigated the impact of the resolution of functional brain parcels, ranging from large-scale networks to local regions, on a mass univariate general linear model (GLM) of connectomes. For each resolution taken independently, the Benjamini-Hochberg procedure controlled the false-discovery rate (FDR) at nominal level on realistic simulations. However, the FDR for tests pooled across all resolutions could be inflated compared to the FDR within resolution. This inflation was severe in the presence of no or weak effects, but became negligible for strong effects. We thus developed an omnibus test to establish the overall presence of true discoveries across all resolutions. Although not a guarantee to control the FDR across resolutions, the omnibus test may be used for descriptive analysis of the impact of resolution on a GLM analysis, in complement to a primary analysis at a predefined single resolution. On three real datasets with significant omnibus test (schizophrenia, congenital blindness, motor practice), markedly higher rate of discovery were obtained at low resolutions, below 50, in line with simulations showing increase in sensitivity at such resolutions. This increase in discovery rate came at the cost of a lower ability to localize effects, as low resolution parcels merged many different brain regions together. However, with 30 or more parcels, the statistical effect maps were biologically plausible and very consistent across resolutions. These results show that resolution is a key parameter for GLM-connectome analysis with FDR control, and that a functional brain parcellation with 30 to 50 parcels may lead to an accurate summary of full connectome effects with good sensitivity in many situations.

Salience network and olanzapine in schizophrenia: implications for treatment in anorexia nervosa

The salience network (SN), a set of brain regions composed of the anterior fronto-insular cortex (aFI) and the anterior cingulate cortex (ACC), is usually involved in interoception, self-regulating, and action selection. Accumulating evidence indicates that dysfunctions in this network are associated with various pathophysiological deficits in both schizophrenia and eating disorders, stemming mainly from dysfunctional information processing of internal or external stimuli. In addition, the metabolic side effects of some antipsychotics (APs), as well as their pharmacological mechanisms of action, also suggest a link between the functional and neurophysiological changes in the brain in both schizophrenia and in eating disorders. Nevertheless, there is still a knowledge gap in explicitly and directly linking the metabolic side effects associated with AP treatment with the dysfunction in SN associated with processing of food-related information in schizophrenia. Here we provide neuroimaging evidence for such a link, by presenting data on a group of schizophrenia patients who followed 16 weeks of olanzapine treatment and undertook a passive viewing task while their brain activity was recorded. In response to food-related dynamic stimuli (video clips), we observed a decreased activity in SN (aFI and ACC) after the treatment, which also correlated with ghrelin plasma concentration and a measure of dietary restraint. Taken together with past findings regarding the role of SN in both schizophrenia and eating disorders, our results suggest that enhancing the reactivity in the SN has the potential to be a treatment strategy in people with anorexia nervosa.

CLINICAL TRIAL REGISTRATION NUMBER

NCT 00290121.

Who pioneered the use of antipsychotics in North America?

OBJECTIVE

Neuroleptics were introduced into North America 60 years ago. The credit for this advance is generally accorded to Heinz Lehmann. I sought to explore whether Lehmann really was the first North American psychiatrist to study the effects of chlorpromazine (CPZ) and to provide a more balanced view of its application in a clinical context.

METHOD

I searched for historical documents and published articles in several libraries and interviewed psychiatrists active from 1952-1970.

RESULTS

The first article in English was published in the July volume of the Archives of Neurology and Psychiatry in 1954 (n=71). Another article, written in French by Roland Saucier and published in a journal called Le Saguenay Médical, also described the effects of CPZ on a Canadian psychiatric population in August 1954 (n>200). However, the first prescription for CPZ was written by Roland Saucier, who brought the product back from Paris after a fellowship there. Ruth Kajander, in Ontario, was also one of the first prescribers of this drug, following her study of its use in anesthesia and a publication in the proceedings of a symposium.

CONCLUSION

The contents of the 2 naturalistic studies were compared. Lehmann's study started 1 month before that of Saucier. Lehmann was the first North American psychiatrist to publish an article on CPZ, but Roland Saucier nevertheless made an important contribution, being the first to prescribe this drug in North America and reporting results for a study with a sample size 3 times that of Lehmann's study.

Antipsychotic-induced changes in blood levels of leptin in schizophrenia: a meta-analysis

OBJECTIVES

Weight gain is a major side effect of antipsychotics (APs), which contributes to poor treatment adherence and significant morbidity. The mechanisms involved in AP-induced weight gain are incompletely understood. Recently, it has been proposed that changes in leptin, an cadipocyte-derived hormone exerting anorexigenic effects, may be involved in AP-induced weight gain. Thus far, studies on leptin changes during AP treatment have produced inconsistent results, prompting our group to perform a meta-analysis.

METHOD

A search of the literature was performed using PubMed and Embase. Studies were included only if reporting peripheral levels of leptin before and after AP treatment in schizophrenia. Effect size estimates were calculated with Hedges g and were aggregated using a random effects model as results were heterogeneous (P<0.10). Meta-regression analyses were performed using study length and changes in body mass index (BMI) as moderator variables.

RESULTS

Twenty-eight studies were retrieved, including 39 comparisons. A moderate and positive effect size was observed across studies. Olanzapine, clozapine, and quetiapine produced moderate leptin elevations, whereas haloperidol and risperidone were associated with small (nonsignificant) leptin changes. Across studies, BMI changes were significantly associated with increases in leptin levels. There was no effect of sex on AP-induced changes in leptin.

CONCLUSIONS

A physiological role of leptin in AP-induced weight gain is supported because the most significant leptin increases were observed with APs inducing the most weight gain and because of the observed association between leptin increases and BMI changes. The overall increase in leptin levels suggests that leptin acts as a negative feedback signal in the event of fat increase.

Impact of switching to long-acting injectable antipsychotics on health services use in the treatment of schizophrenia

OBJECTIVE

To better understand the treatment patterns, persistence and compliance, resource use, and associated costs, of long-acting injectable antipsychotics (LAI-AP), using the Régie de l'assurance maladie du Québec database.

METHOD

Patients with schizophrenia or schizoaffective disorder who were incident users of an LAI-AP prescribed between January 1, 2008, and March 31, 2012, were selected. Concomitant use of oral APs and treatment persistence and compliance with LAI-AP were analyzed. Patients were considered compliant if they had a medication possession ratio (MPR) of at least 0.80. Health care resource use (HCRU) and associated costs were analyzed during the year before and after LAI-AP initiation.

RESULTS

A total of 1992 patients met the inclusion criteria. The average persistence with LAI-AP was 217.2 days (SD 144.2). The mean MPR with LAI-AP during the postinitiation year was 0.58 (SD 0.35), with 37.5% of patients being compliant. In the preinitiation year, 29.0% of patients were compliant with previous oral AP. In the pre- and postinitiation periods, 1484 and 958 patients had at least 1 hospitalization, and hospitalized days were reduced by one-half (P<0.001). Cost of HCRU, including medication, was significantly decreased from $24,382 (SD $27,234) to $13,090 (SD $16,987), respectively, in the pre- and postinitiation years (P<0.001).

CONCLUSIONS

The initiation of an LAI-AP improved treatment compliance, compared with previous oral APs, resulted in significantly lower HCRU and costs. The primary drivers were the reduction in the occurrence and days of hospitalizations.

[RaeRae and Mahu: third polynesian gender]

Background On numerous islands of the Pacific, under various names, there are people considered to be neither men nor women but half-men/half-women. In French Polynesia, there is a sociological and anthropological condition called RaeRae or Mahu. A RaeRae is a man who behaves as and considers himself to be a woman. RaeRae and Mahu are good examples of culture-bound transsexuality or cross-dressing. Being Mahu has a cultural meaning, recognized in the history of Polynesian society, and cannot be considered as a medical or psychiatric condition. Being RaeRae extends the transformation to possible hormone therapy and surgery; the traditional social role (education, tourism) of Mahu is retained but in some cases is influenced by prostitution and at-risk homosexuality.Bibliographic sources and method We conducted a literature search using several medical, social, and anthropological bibliographic sources (MedLine, Google Scholar, PsycINFO, DUMAS). We used the terms RaeRae, Mahu, Polynesian androphilia, and Polynesian sexuality. We found 20 articles and theses. Some articles discuss a very similar condition in Samoa (fa'afafine). In addition, Mahu seems to be a derogatory term for a male homosexual or drag queen in the Hawaiian Islands.Results and contents RaeRae and Mahu is broadly defined as men with sweetness [OK?] or women who are prisoners of men's bodies. There is evidence of their presence and social functions in ancient times. The arrival of the missionaries and Christian morality resulted in the emergence of a new moral and sexual order. RaeRae and Mahu remain present and visible today. They are integrated into local professional and cultural life and are accepted, as long as their sexuality remains unspoken and invisible, which is more difficult for RaeRae. We describe the phenomenon and its context and the sociocultural hypotheses. We retain a reference connected to tacit knowledge of Polynesian sacrificial rites: Mahu did not undergo sacrifices the victims of which had to be men. A general discussion must be envisaged concerning the DSM-5, transgender identity and stigmatization. For instance, in Hawaii, people who identify as transgender continue to suffer high rates of violence, sexual assault and discrimination. The description contributes to an investigation of the limits of considering gender as binary; rather, it is a continuum not governed by the medicalization and psychologization of a cultural feature, which is also recognizable in other cultural areas including among the Amerindians. Studying RaeRae and Mahu in Polynesia means agreeing to confront the binary concept that structures and divides the world into two categories of gender and sex, male and female, just like grammatical gender in French. Examples from other cultures include the new half in Japan, muxe or muché among the Zapotecs of Tehuantepec, woubi in Côte d'Ivoire, femminielli in Italy, ladyboys or kathoeys in Thailand, natkadaw in Myanmar, hijra in India and Pakistan, khounta in Arab Islamic culture, and in Canada and the USA, agokwa among the Ojibwa, and ikoneta in the Illinois language. Mahu, or transgendered individuals and transvestites, were in fact viewed by the ancient Hawaiians as a normal element of the old social culture that preceded missionary days and American and French military missions. Mahu were not merely tolerated; they were regarded as a legitimate and contributory part of the ancient Polynesian community.

[History of the department of Psychiatry at the University of Montreal]

In its current form, the Département de psychiatrie at the Université de Montréal (UdeM) was created in 1964. The first person to have headed was Dr. Gerard Beaudoin… Between 1948 and 1964, several others psychiatrists were heading the Département without necessary bearing a particular title.The directors of the Département from 1951 to now were: Drs. Fernand Côté, Camille Laurin, Gerard Beaudoin, Yvon Gauthier, Arthur Amyot, Francis Borgeat, Hugues Cormier, Sylvain Palardy, Jean Hébert, and Emmanuel Stip.When the Département opened, it was the second institution in Montréal that was training psychiatrists. During the first year, there were 3 psychiatric residents, but within 20 years this number had increased to 63. From the early years, teaching psychiatry to residents, and subsequently to all UdeM medical students, has been a priority in the Département, and over the years many psychiatrists trained at UdeM have attained leadership positions elsewhere. The Département attained an early reputation for excellence in both clinical and basic research.The strengths the Département developed in its early years in clinical psychopharmacology, in basic research in neurotransmitters, sleep, cognition, forensic, and in community psychiatry have been augmented more recently with active programs in psychotherapy research, substance abuse research, psychoneuroendocrinology, developmental aspects of behavior, genetics, epigenetics as well as the study of the brain through a variety of brain scanning techniques.The history of the Département de psychiatrie de l'Université de Montréal is largely dependent on that of each of the institutions affiliated to the Université: the Pavillon Albert-Prévost de l'Hôpital du Sacré-Coeur de Montréal (HSCM), the Institut universitaire en santé mentale de Montréal (IUSMM) and the CHU Sainte-Justine. We must also remember that the discovery of the potentiating of lithium by antidepressants was made by Dr. Demontigny team at the Hôpital Louis-H. Lafontaine (now IUSMM). Significant advances related to the interaction between the psychoanalytic movement and community psychiatry were greatly influenced by the work at the Pavillon Albert-Prévost and the emergence of behavioral therapies (Dr. Yves Lamontagne) and cognitive studies conducted by the Hôpital Louis-H. Lafontaine. Great discoveries about sleep were performed at the Hôpital du Sacré-Coeur de Montréal by teams gathered around Jacques-Yves Montplaisir.We also recall that two ministers from the Quebec government with important political responsibilities were members or directors of the Département de psychiatrie. These are Drs. Camille Laurin and Denis Lazure.The Département aims to strengthen clinical and basic research by contributing new knowledge that will improve care for people with mental disorders. These efforts benefit both patients and the medical students and residents being trained to care for them. The Département remains committed to its program, to pre-doctoral education (ensuring that all medical students at the Université are trained to recognize, diagnose, and be familiar with treatment options for mental disorders), to post-doctoral education for future psychiatrists, and to the care of Quebec's patients.For over 50 years, the academic department has played a key role in attracting and recruiting excellent academic and clinical resources to staff the programs and services of our hospital partners.

La conscience des déficits neurocognitifs dans la schizophrénie : une méta-analyse

Contexte La schizophrénie est un trouble allant de pair avec un manque d’autocritique par rapport aux délires et aux hallucinations. En contrepartie, on en sait beaucoup moins en ce qui concerne la conscience des patients par rapport à leurs déficits cognitifs, qui sont des symptômes clés de ce trouble psychiatrique. Afin de faire la synthèse de l’état de la connaissance à ce sujet, nous avons effectué une méta-analyse de 22 études comprenant 1609 patients. Les analyses ont révélé que les patients rapportent davantage de plaintes subjectives que les sujets sains. La corrélation entre la cognition subjective et objective s’est avérée faible toutefois. Les études utilisant la Scale to Investigate Cognition in Schizophrenia ont produit des corrélations plus fortes que celles utilisant d’autres échelles de plaintes subjectives. La relation entre la cognition subjective et les symptômes dépressifs s’est avérée comparable à la relation entre la cognition subjective et la cognition objective. Enfin, une relation faible a été observée entre la cognition subjective et l’autocritique par rapport aux symptômes positifs. Les résultats de la présente méta-analyse montrent que les patients atteints de la schizophrénie se plaignent de déficits cognitifs, mais qu’ils n’ont pas une représentation claire de la nature de ceux-ci, ce qui confirme l’existence de déficits méta-cognitifs dans la schizophrénie.

Daily Task Performance and Information Processing among People with Schizophrenia and Healthy Controls: A Comparative Study

Introduction:

Many individuals with schizophrenia have information processing difficulties. This study investigated the use of information processing skills during the performance of a daily task by participants with schizophrenia and compared it to that of participants without a psychiatric diagnosis. Studies comparing similar groups found differences in the number and types of errors. However, there is limited knowledge about the related problematic information processing skills. This information could help to better pinpoint the needs of this group of clients.

Method:

Participants were paired based on age and gender. Information processing skills were assessed with the Perceive, Recall, Plan, and Perform system of task analysis. Generalized linear mixed models were used to compare both groups.

Results:

Individuals with schizophrenia made more accuracy errors and had more difficulties when attending and gathering information and when planning was required during the task. They were also more cognitively impaired than the comparison group.

Conclusion:

The large number of accuracy errors may result from specific skills deficits that impact on other processing skills or from a general vulnerability affecting most processing skills. In future studies, the influence of employment and of the social environment of housing on task performance should be investigated.

Clozapine and visuospatial processing in treatment-resistant schizophrenia

INTRODUCTION

Clozapine, the most widely used option in treatment-resistant schizophrenia, has been shown to be superior to other antipsychotic medications in improving cognitive function in patients. However, the results have not been consistent and the mechanisms underlying this effect have not been elucidated. Thus, the purpose of the present study was to evaluate verbal and nonverbal cognition (using visuospatial processing tests) in patients treated with clozapine (initially treatment resistant) and those treated with other second-generation antipsychotics, relative healthy control subjects. Furthermore, we examined neural correlates of visuospatial processing in the three groups.

METHODS

Twenty schizophrenia patients treated with clozapine (TR-C group), 23 patients stabilised with atypical antipsychotics other than clozapine (NTR group), and 21 healthy control participants completed a battery of verbal and visuospatial cognitive tests. In addition, participants underwent functional magnetic resonance imaging (fMRI) while performing one of the visuospatial tests (the mental rotation task). The fMRI data were analysed separately in each group using Statistical Parametric Mapping software (SPM5).

RESULTS

Overall, schizophrenia patients exhibited deficit on verbal and nonverbal processing relative to the healthy controls, but we observed some interesting differences between the two groups of patients. Specifically, the NTR group performed better than the TR-C group on the Block Design and the Raven's Progressive Matrices. With respect to brain function during mental rotation, the NTR group showed significant activations in regions of the temporal and occipital cortex, whereas the TR-C patients did not. The relative deactivations associated with the task were also more robust in NTR compared to the other group of patients, despite a similar performance.

CONCLUSION

Present results suggest better visuospatial processing in the NTR relative to the TR-C group. This difference could be attributed to the treatment resistance itself or a lack of beneficial effect of clozapine relative to other atypical antipsychotics in ameliorating nonverbal abilities. Future studies of the relationship between clozapine and cognition, as well as between treatment resistance and cognition, are warranted.

A microstructural study of sleep instability in drug-naive patients with schizophrenia and healthy controls: sleep spindles, rapid eye movements, and muscle atonia

This study aimed at characterizing the functional stability of sleep in schizophrenia by quantifying dissociated stages of sleep (DSS), and to explore their correlation with psychopathology. The sleep of 10 first-break, drug-naive young adults with schizophrenia and 10 controls was recorded. Four basic DSS patterns were scored: 1) the transitional EEG-mixed intermediate stage (EMIS); 2) Rapid-eye-movement (REM) sleep without rapid eye movement (RSWR); 3) REM sleep without atonia (RSWA); and 4) non-REM sleep with rapid eye movements. An intermediate sleep (IS) score was calculated by summing EMIS and RSWR scores, and the durations of intra-REM sleep periods IS (IRSPIS) and IS scored "at the expense" of REM sleep (ISERS) were determined. Patients were administered the Brief Psychiatric Rating Scale (BPRS) at the time of recording. Proportions of each DSS variables over total sleep time and proportions of IRSPIS and ISERS over REM sleep duration were compared between patients and controls. Correlation coefficients between DSS variables and BPRS total scores were calculated. The proportion of total DSS did not differ between patients and controls. Among DSS subtypes, RSWA was significantly increased in patients while other comparisons showed no significant differences. Significant positive correlations were found between BPRS scores and proportions of DSS, IS, RSWR, IRSPIS and ISERS over total sleep and REM sleep durations. These results demonstrate the functional instability of REM sleep in first-break, drug naive young adults with schizophrenia and unveil a pattern reminiscent of REM sleep behavior disorder. The significant correlation suggests that schizophrenia and REM sleep share common neuronal control mechanisms.

[Neurocognitive insight in schizophrenia: a meta-analysis]

Background Schizophrenia is well-known to be associated with a lack of insight into symptoms. Comparatively, little is known on insight into neurocognitive deficits in schizophrenia, despite the fact that these dysfunctions are undoubtedly core features of the disorder. Recently, growing interest has been paid to subjective cognition, and thus far, results have been heterogeneous. The objectives of current meta-analysis were to determine the magnitude of subjective complaints in schizophrenia; to examine the association between subjective cognitive complaints and objective cognition, as well psychiatric symptoms and insight into illness. The meta-analysis also sought to determine if results are influenced by the choice of the scale used to measure subjective cognition. Methods A search was performed with PubMed, PsycInfo and EMBASE, using the following key words: schizophrenia OR psychosis AND cognition OR memory OR attention OR "executive functions" AND insight OR "subjective cognition" OR awareness. Studies involving patients with schizophrenia-spectrum disorders and measuring subjective cognition with a validated self-report scale were included. Studies using scales measuring insight into thinking processes (e.g. Beck Cognitive Insight Scale) were excluded. Statistical analyses were performed with the Comprehensive Meta-Analysis-2 software. Cognitive scores were grouped into 6 cognitive domains (as recommended by the MATRICS group): attention, problems solving, speed of processing, verbal memory, visual memory and working memory. The difference in cognitive complaints between schizophrenia patients and healthy controls was examined using Cohen's d. The associations between subjective cognition and objective cognition, psychiatric symptoms and insight into illness were examined using Pearson's correlation coefficients. Results Twenty-two studies were retrieved, including a total of 1609 patients and 294 controls. Patients reported increased subjective cognitive complaints, compared to controls (moderate effect size). A weak association was observed between subjective and objective (global) cognition. The association was larger in studies using the Subjective Scale To Investigate Cognition in Schizophrenia (SSTICS), compared to studies using other scales. The largest association was observed between subjective complaints and problem solving. The association between subjective complaints and depressive symptoms was in the same range as the association between subjective complaints (measured with the SSTICS) and objective cognition. No association was found between subjective complaints and positive / negative symptoms. Finally, a weak association was found between subjective complaints and insight into illness. Discussion Taken together, these results suggest that schizophrenia patients report significant subjective cognitive complaints. However, patients have a poor understanding of these deficits, since subjective complaints are as strongly associated with depressive symptoms as they are associated with objective cognitive deficits. Schizophrenia patients may be more aware of their problem solving deficits. However, this observation is based on a limited number of studies and will need to be replicated in future studies. Our results also show that insight into neurocognitive deficits is largely independent from insight into illness. Finally, the results of the current meta-analysis may have methodological implications, since they suggest that the SSTICS produces stronger associations between subjective and objective cognition than other scales. In the future, greater attention will need to be paid to the domains of subjective complaints, as well as to subjective cognitive complaints in other psychiatric disorders.

Cannabis abuse is associated with better emotional memory in schizophrenia: a functional magnetic resonance imaging study

In schizophrenia cannabis abuse/dependence is associated with poor compliance and psychotic relapse. Despite this, the reasons for cannabis abuse remain elusive, but emotions may play a critical role in this comorbidity. Accordingly, we performed a functional magnetic resonance imaging study of emotional memory in schizophrenia patients with cannabis abuse (dual-diagnosis, DD). Participants comprised 14 DD patients, 14 non-abusing schizophrenia patients (SCZ), and 21 healthy controls (HC) who had to recognize positive and negative pictures while being scanned. Recognition of positive and negative emotions was prominently impaired in SCZ patients, relative to HC, while differences between DD and HC were smaller. For positive and negative stimuli, we observed significant activations in frontal, limbic, temporal and occipital regions in HC; in frontal, limbic and temporal regions in DD; and in temporal, parietal, limbic and occipital regions in the SCZ group. Our results suggest that emotional memory and prefrontal lobe functioning are preserved in DD relative to SCZ patients. These results are consistent with previous findings showing that cannabis abuse is associated with fewer negative symptoms and better cognitive functioning in schizophrenia. Longitudinal studies will need to determine whether the relative preservation of emotional memory is primary or secondary to cannabis abuse in schizophrenia.

Redevelopment of tertiary psychiatric services in British Columbia: a prospective study of clinical, social, and residential outcomes of former long-stay inpatients

OBJECTIVE

The objective of this study is to assess the clinical and social outcomes for a cohort of patients who were part of the redevelopment of psychiatric services in British Columbia.

METHOD

This study used a naturalistic, quasi-experimental design, to examine the outcomes of a cohort of 189 long-stay patients at Riverview Hospital (RVH), some of whom moved into Tertiary Psychiatric Residential Facilities (TPRFs), some into the community in less structured facilities, and some remained at RVH. Data was collected from clinical files at RVH and at each participating site, semi-structured interviews and self-report measures were completed with patients. In addition, semi-structured interviews were also conducted with staff members.

RESULTS

There was very minimal evidence of transinstitutionalization to prisons or homelessness; one participant resided in a correctional facility, one resided in a forensic facility, and one participant spent some time homeless. In addition, the majority of participants remained in residences that provided 24h care. Eighty percent of our population was diagnosed with a schizophrenia spectrum disorder. Psychiatric symptoms remained fairly stable; some embarrassing social behaviors increased; however, aggressive behaviors showed no increase; neuropsychological deficits did not deteriorate, there were even some improvements. Participants demonstrated increases in several independent living skills including: money management, food preparation and storage, job skills, and transportation skills. In addition, participants experienced a significant increase in their perceived quality of life.

CONCLUSIONS

This study builds on existing research demonstrating that well-planned and appropriately resourced hospital closures can lead to positive psycho-social outcomes for participants and can successfully avoid negative outcomes such as transinstitutionalization to the judiciary system and homelessness.

A randomized controlled trial with a Canadian electronic pill dispenser used to measure and improve medication adherence in patients with schizophrenia

Objective: Medication adherence is extremely important in preventing relapse and lowering symptoms in schizophrenic patients. However, estimates show that nearly half of these patients have poor adherence. The Brief Adherence Rating Scale (BARS) seems to be the most reliable tool assessing adherence in schizophrenia and shows that the antipsychotic adherence ratio (AAR) is about 49.5% in schizophrenia. The aim of the study was to test if an electronic pill dispenser named DoPill^® improved AAR of schizophrenic patients. Furthermore, we compared AAR obtained by the DoPill^® and the BARS, in order to verify whether the DoPill^® provides reliable assessment of medication adherence.

Methods: The DoPill^® is a smart pill dispenser that beeps and flashes at the appropriate time of the day. Each of its 28 compartments is covered by a plastic lamina that, when taken off, sends a signal to the pharmacist. Patients were randomized to the DoPill^® or treatment as usual groups for 6 weeks. The BARS was used as a reference measure.

Results: Forty-six percent of patients were deemed to be non-adherent with antipsychotic medication. The mean AAR was 67% after 6 weeks. DoPill^® recorded better AAR than some of those found in the literature and were lower than the BARS estimate we found.

Conclusion: These results suggest that DoPill^® is a valid tool that provides more reliable and objective data for the clinician about their patient’s adherence, than existing assessment tools like the BARS. Furthermore, the device may help patients successfully manage their medication regimen.