[Cardiovascular diseases burden attributed to low physical activity in China, 1990-2019]

Objective: To analyze the burden of cardiovascular disease (CVD) attributed to low physical activity (LPA) and its changing trends in China from 1990 to 2019. Methods: On the basis of the province results of the Study of Global Burden of Disease 2019 in China, we described the distribution of CVD death and disability-adjusted life year (DALY) attributed to LPA by sex, age and province. Joinpoint 4.9.1.0 was used to calculate the average annual percentage change. Results: In 2019, the number of CVD deaths and DALY attributed to LPA in people aged ≥25 years were 0.127 million and 1.863 million person-years in China, respectively, The age-standardized mortality rate (ASMR) and standardized DALY rate of CVD attributed to LPA were slightly higher in men than in women, and much higher in ischemic heart disease patients than in ischemic stroke patients. The ASMR (8.85/100 000) and the standardized DALY rate (112.34/100 000) of CVD attributed to LPA in China in 2019 showed no obvious change compared with 1990, while decreased in the last decade. The largest increases in the mortality rate and DALY rate were observed in people aged ≥75 years from 1990 to 2019 (26.89%, 15.61%), but the mortality rate and DALY rate in people aged 60-74 years showed a decreasing trend. The mortality rate and DALY rate in men aged 25- 44 years showed the largest increases (37.50%, 35.49%), while women aged ≥75 years had the largest increases (31.00%, 18.02%). In 2019, the highest ASMR and standardized DALY rate of CVD attributed to LPA were found in Jilin, Inner Mongolia and Hebei. The largest increases were found in Qinghai (182.41%, 154.70%), Gansu (181.29%, 152.77%), and Chongqing (132.01%, 102.79%) and the largest decreases were found in Beijing (59.11%, 62.09%), Macau (41.89%, 39.37%) and Guangdong (36.93%, 40.72%) from 1990 to 2019. Conclusion: The disease burden of CVD attributed to LPA in China was quite high and showed gender, age and area specific differences.

[24 hours urinary sodium and potassium excretion and association with blood pressure among people aged 18-75 years old in six Chinese provinces]

Objective: To analyze the level of sodium and potassium intake and their association with blood pressure among people aged 18 to 75 years old in six provinces. Methods: From October to December 2018, participants aged 18 to 75 years were selected from Hebei, Hunan, Sichuan, Jiangxi, Qinghai and Heilongjiang provinces by using cluster random sampling method. Demographic characteristics and lifestyle information were collected by using questionnaire survey. Physical measurement and 24-hour urine collection were also conducted. Results: A total of 2 636 subjects were finally included in the analysis. The average urine sodium, potassium and sodium-to-potassium molar ratio were(4 438.4±1 822.8)mg/d, (1 566.2±646.3)mg/d, and 5.2±2.2, respectively. According to World Health Organization standards, 94.5% and 98.7% of the respondents had excessive sodium intake and insufficient potassium intake. After adjusting for related factors, each 1 000 mg increase in sodium excretion was associated with increased systolic blood pressure (1.65 mmHg, 95%CI: 1.07, 2.22) and diastolic blood pressure (0.53 mmHg, 95%CI: 0.21, 0.84), and each 1 000 mg increase in potassium excretion was associated with decreased systolic blood pressure (3.02 mmHg, 95%CI:-4.25, -1.80) and diastolic blood pressure (1.27 mmHg, 95%CI:-2.05, -0.48). Conclusion: The sodium intake in Chinese population remains excessive and potassium intake is insufficient. Sodium and potassium could be associated with blood pressure and the intervention of reducing sodium and supplementing potassium should be conducted in the corresponding population.

[Feasibility evaluation of estimating the 24-hour urinary sodium excretion in Chinese population with three spot urine methods]

Objective: To evaluate the feasibility of three spot urine methods (Kawasaki, INTERSALT and Tanaka) for estimating the 24 h urinary sodium excretion in the Chinese population. Methods: In 2017, 1 499 participants aged 18 to 69 years old were selected from Yiwu City, Haining City, Taishun County, Yinzhou District of Ningbo City and Liandu District of Lishui City of Zhejiang Province by using the multistage random sampling method. Sociodemographic information of the subjects was collected with questionnaires and physical measurements were performed. 24 h urine was collected and urinary volume was recorded. The concentrations of urinary sodium, potassium and creatinine were also measured. Kawasaki, INTERSALT and Tanaka spot urine methods were applied to estimate the 24 h urinary sodium excretion and compared with actual values among 1 426 participants who passed urine integrity test. Results: The age of participants was (46.71±14.04) years old, including 700 males, accounting for 49.1%. The actual value of 24 h urinary sodium excretion was (167.10±74.70) mmol, but Kawasaki method overestimated it as (184.61±57.10) mmol, and INTERSALT and Tanaka methods underestimated it as(134.62±39.21) and (143.20±35.66) mmol. Estimated difference (95%CI) (mmol) from small to large was Kawasaki method [17.51 (13.54, 21.47)], Tanaka method [-23.90 (-27.60, -20.20)] and INTERSALT method [-32.48 (-36.29, -28.67)]. With the increase of 24 h sodium intake, all estimation methods changed from the overestimation to underestimation. In those with 24 h sodium intake <9.0 g, the estimated difference (95%CI) of the INTERSALT method was the smallest as 43.15 (37.73, 48.57) and 1.26 (-2.10, 4.63) mmol for <6.0 and 6.0-8.9 g groups, respectively. In those with 24 h sodium intake≥9.0 g, the Kawasaki method had the smallest estimated difference (95%CI) as -12.50 (-18.14, -6.86) and -53.73 (-61.25, -46.22) for 9.0-11.9 g and ≥ 12.0 g group, respectively. The consistency analysis of the Bland-Altman method showed that the Kawasaki method had the best consistency with actual measured value and it had the least number of points outside the range (69 points accounting for 4.84%). Conclusion: Among the three spot urine methods, the Kawasaki method has better applicability in predicting the excretion of 24 h urine sodium in the Chinese population.

Identification of Common Thalamocortical Dysconnectivity in Four Major Psychiatric Disorders

BACKGROUND

Recent genetic and imaging analyses of large datasets suggested that common biological substrates exist across psychiatric diagnoses. Functional connectivity (FC) abnormalities of thalamocortical circuits were consistently found in patients with schizophrenia but have been less studied in other major psychiatric disorders. This study aimed to examine thalamocortical FC in 4 major psychiatric disorders to identify the common connectivity abnormalities across major psychiatric disorders.

METHODS

This study recruited 100 patients with schizophrenia, 100 patients with bipolar I disorder, 88 patients with bipolar II disorder, 100 patients with major depressive disorder, and 160 healthy controls (HCs). Each participant underwent resting functional magnetic resonance imaging. The thalamus was used to derive FC maps, and group comparisons were made between each patient group and HCs using an independent-sample t test. Conjunction analysis was used to identify the common thalamocortical abnormalities among these 4 psychiatric disorders.

RESULTS

The 4 groups of patients shared a similar pattern of thalamocortical dysconnectivity characterized by a decrease in thalamocortical FC with the dorsal anterior cingulate, anterior prefrontal cortex and inferior parietal cortex. The groups also showed an increase in FC with the postcentral gyrus, precentral gyrus, superior temporal cortex, and lateral occipital areas. Further network analysis demonstrated that the frontoparietal regions showing hypoconnectivity belonged to the salience network.

CONCLUSION

Our findings provide FC evidence that supports the common network hypothesis by identifying common thalamocortical dysconnectivities across 4 major psychiatric disorders. The network analysis also supports the cardinal role of salience network abnormalities in major psychiatric disorders.

[Prevalence, control of hypertension and intake of sodium and potassium among residents aged 50-69 years old in Zhejiang Province in 2017]

Objective: To understand prevalence, control of hypertension and intake of sodium and potassium among residents aged 50-69 years old in Zhejiang Province. Methods: A multi-stage random cluster sampling method was used to select 3 032 residents aged 50-69 years old in Zhejiang Province. The demographic characteristics, prevalence and control of hypertension were collected through a questionnaire survey, and physical measurement was also performed. The stratified random sampling method was used to detect the level of sodium and potassium in the 24 h urine of 676 subjects. The total amount of 24 h urinary sodium ≥102.55 mmol and the ratio of 24 h urinary sodium and potassium content ≥2 were defined as excessive. Results: The prevalence of hypertension (95%CI) was 56.89% (54.39%-59.40%), and the awareness, treatment and control rate of hypertension were 58.25% (55.01%-61.49%), 45.37% (42.10%-48.65%) and 19.75% (17.01%-22.50%), respectively. 78.99% (n=534) of residents had excessive 24 h urinary sodium, and 95.41% (n=360) of residents had excessive ratio of 24 h urinary sodium and potassium. Conclusion: The prevalence of hypertension in residents aged 50-69 years old in Zhejiang Province was at a high level, and the control of hypertension was not satisfactory in 2017. Most of residents have excessive level of sodium intake and the level of sodium and potassium intake was not balanced.

Estimate dynamic changes of dysfunction and lifelong spent for psychiatric care needs in patients with schizophrenia

BACKGROUND

Disturbance of functionality is one of the core features of schizophrenia, and has deleterious effects on a patient's employment, increased healthcare costs, and a large societal burden. Thus, if a patient's disability status could be predicted, and interventions needed identified in advance, poor outcomes could be prevented. To achieve this aim, we developed a method by which to assess dynamic changes of dysfunction and estimate the lifetime duration of disability in patients with schizophrenia, as a proxy for assessing their specialized healthcare needs.

METHODS

The proposed method was developed based on a nationwide database and a cross-sectional survey. The primary analysis investigated the dynamic change in the proportion of patients with manifested disability over time, while the secondary analysis estimated the lifetime duration of disability, obtained as the proportion of patients with manifested disability multiplied by the survival probability throughout the life of patients.

RESULTS

The average lifetime duration of manifested disability of global functioning was estimated to be 20.9 years, which represents approximately 73% of the whole lifetime of patients. The duration of disability in socially-useful activities was estimated to be 15.6 years, while that in personal and social relationships was 17.5 years. The female patients had a longer duration of manifested disability (22.9 years) than the male patients (19.5 years).

CONCLUSIONS

The developed method of analysis indicated that the longest lifetime durations of manifest disability were observed in the areas of socially-useful activities and personal and social relationships, and the proportions of patients with these disabilities rapidly increased at 200 months after diagnosis.

Elevated tumor necrosis factor-alpha receptor subtype 1 and the association with abnormal brain function in treatment-resistant depression

BACKGROUND

Major depressive disorder (MDD) patients have shown elevated plasma levels of pro-inflammatory biomarkers compared to healthy controls. We hypothesized increased serum tumor necrosis factor-alpha receptor subtype 1 (TNF-α R1) is more associated with impaired brain function in patients with treatment-resistant depression (TRD) than those without TRD.

METHODS

34 MDD patients and 34 healthy subjects were recruited and we separated MDD patients to TRD group (n = 20) and non-TRD (n = 14) group. Pro-inflammatory cytokines were assessed by enzyme-linked immunosorbent assays. A standardized uptake values (SUV) of glucose metabolism measured by ¹⁸F-FDG positron-emission-tomography (PET) was applied to all subjects for subsequent region-of- interest analyses and whole-brain voxel-wise analyses. ¹⁸F-FDG-PET measures glucose uptake into astrocytes in response to glutamate release from neuronal cells, and was thus used as a proxy measure to quantify glutamatergic neurotransmission in the human brain.

RESULTS

Post-hoc analysis revealed that TRD group had higher serum concentrations of TNF-α R1 compared to healthy control or non-TRD group. In the MDD group, higher serum concentrations of TNF-α R1 significantly correlated with decreased SUV in anterior cingulate cortex (ACC) and bilateral caudate nucleus. The ROI analysis further supported the negative correlations of plasma TNF-α R1 and SUV in the ACC and caudate nucleus. Such correlation is more consistent in TRD group than in non-TRD and HC groups.

LIMITATION

Glutamate neurotransmission and the effect of chronic stress on glutamate release in the brain were not measured directly.

CONCLUSIONS

Increased TNF-α R1 was associated with impaired glutamatergic neurotransmission of caudate nucleus and ACC in MDD patients, particularly in the TRD.

Efficacy, tolerability, and safety of oral paliperidone extended release in the treatment of schizophrenia: a 24-week, open-label, prospective switch study in different settings in Taiwan

PURPOSE

Paliperidone extended release (ER) is an oral psychotropic treatment formulated to release paliperidone at a controlled, gradually ascending rate. We evaluated the efficacy and safety of switching to paliperidone ER in Taiwanese patients with schizophrenia who were unresponsive or intolerant to previous antipsychotic therapy.

PATIENTS AND METHODS

This was a 24-week, open-label, single-arm, multicenter, Phase IV trial. Based on consulting psychiatrists' judgment, patients were deemed eligible for the switch to paliperidone ER; the switch was achieved by cross-tapering, using a recommended starting dose of 6 mg. Eligibility considerations included lack of efficacy, tolerability, and/or adherence to previous oral antipsychotic medication.

RESULTS

Of the 297 enrolled patients, 178 (59.5%) completed the study. The main reasons for discontinuation included insufficient efficacy (8.7%), patient decision (8.4%), and adverse events (AEs; 6.4%). Improvements in the: Positive and Negative Syndrome Scale total score and Clinical Global Impression-Severity score were observed only in patients treated at medical centers and not in those treated at psychiatric hospitals. The most common AEs were insomnia, headache, constipation, and extrapyramidal syndrome. One or more serious AEs were reported in 11 (3.7%) patients; none resulted in death. No significant changes in body weight, plasma glucose, or lipid levels were observed.

CONCLUSION

Switching to paliperidone ER was effective and well tolerated for up to 24 weeks in patients with schizophrenia who were unresponsive or intolerant to previous antipsychotic therapy. The observed differences in treatment between psychiatric hospitals and medical centers with regard to dosage and titration of paliperidone ER warrant further investigation.

Self-Reported Graphic Personal and Social Performance Scale (SRG-PSP) for measuring functionality in patients with bipolar disorder

OBJECTIVES

The self-reported graphic version of the Personal and Social Performance Scale (SRG-PSP) is the first graphic, self-reported rating scale that assesses functioning, and its reliability and validity have been documented in patients with schizophrenia. This study investigated the validity of SRG-PSP in patients with bipolar disorder (BD).

METHODS

Patients with BD were recruited from psychiatric outpatient clinics, and assessed with the Young Mania Rating Scale (YMRS), the Montgomery-Åsberg Depression Rating Scale (MADRS), the Clinical Global Impression Scale (CGI)-Bipolar and CGI-Depression, the Positive and Negative Symptom Scale (PANSS), the Global assessment of function (GAF), and the PSP. All participants completed the self-rating questionnaires: the SRG-PSP, the 36-Item Short-Form Health Survey (SF-36), and the Sheehan disability Scale (SDS).

RESULTS

In total, 114 patients with BD were enrolled. The criterion-related validities between the SRG-PSP and the PSP were all significantly correlated with their counterparts. The global score of the SRG-PSP was significantly correlated with the scores of the YMRS, MADRS, PANSS, CGI-Depression, GAF, SF-36, and SDS. Three SRG-PSP domains (socially useful activities, personal and social relationships, and self-care) were negatively correlated with the scores of the MADRS, PANSS, CGI-depression, and SDS; and were positively correlated with the GAF, SF-36 scores. The disturbing and aggressive behavior domain was positively correlated with the scores of the YMRS, MADRS, PANSS, CGI-Bipolar, CGI-Depression, and SDS; and was negatively correlated with the GAF, SF-36 scores (all p<0.01).

CONCLUSION

The SRG-PSP is a validated self-reported scale for assessing functionality in patients with BD.

The development of a self-reported scale for measuring functionality in patients with schizophrenia--self-reported version of the graphic Personal and Social Performance (SRG-PSP) scale

BACKGROUND

The Personal and Social Performance (PSP) scale is used for the assessment of patient function by mental health professionals. This study aimed to evaluate the internal reliability and validity of a self-reported graphic version of the PSP (SRG-PSP) scale and its correlations with psychiatric symptoms, daily life ability and quality of life.

METHODS

The SRG-PSP scale was developed following the four PSP domains: socially useful activities, personal and social relationships, self-care, and disturbing and aggressive behavior. In total, 108 patients with schizophrenia were enrolled. All participants completed the SRG-PSP, the Activities of Daily Living Rating Scale II (ADLRS-II), and the World Health Organization Quality of Life-BREF (WHOQOL). They were also assessed using the PSP and the Positive and Negative Syndrome Scale (PANSS). Spearman's ρ was used to examine the correlations between SRG-PSP scores and other variables.

RESULTS

The results of the SRG-PSP were significantly correlated to those of their corresponding criteria on the PSP. The global score of the SRG-PSP and the scores of three domains, socially useful activities, personal and social relationships, and self-care, were positively correlated with most sub items of the ADLRS-II and WHOQOL, and were negatively correlated with the PANSS scores. The disturbing and aggressive behavior domain of the SRG-PSP was negatively correlated with most sub items of the ADLRS-II and WHOQOL (ρ=-0.19 to -0.36, all p<0.05) and positively correlated with the PANSS (ρ=0.24-0.30, all p<0.05), with the exception of negative symptoms (ρ=0.09, p=0.40).

CONCLUSION

The SRG-PSP is a valid self-reported scale for the assessment of functionality in patients with schizophrenia.

Impact of apolipoprotein A5 (APOA5) polymorphisms on serum triglyceride levels in schizophrenic patients under long-term atypical antipsychotic treatment

OBJECTIVES

Schizophrenic patients treated with clozapine or olanzapine often develop hypertriglyceridemia. The apolipoprotein A5 gene (APOA5), which affects VLDL production and lipolysis, has been implicated in the triglyceride (TG) metabolism. This study examined the association of common APOA5 genetic variants and TG levels in chronically institutionalized schizophrenic patients, on a stable dose of atypical antipsychotic (clozapine, olanzapine or risperidone.

METHODS

The TG levels in 466 schizophrenic patients treated with clozapine (n = 182), olanzapine (n = 89) or risperidone (n = 195) were measured. Patients were genotyped for the three APOA5 single nucleotide polymorphisms (SNPs) rs662799 (-1131T > C), rs651821 (3A > G) and rs2266788 (1891T > C).

RESULTS

A gene × drug interaction with TG levels was observed. In single-marker-based analysis, the minor alleles of the two polymorphisms (-1131C and -3G) were observed to be associated with increased TGs in patients treated with risperidone, but not with clozapine or olanzapine. Haplotype analysis further revealed that carriers of the haplotype constructed with the three minor alleles had higher TG levels than those who did not carry this haplotype in patients taking risperidone (CGC((+/+)) vs. = 125.4 ± 59.1 vs. 82.2 ± 65.8, P = 0.015; CGC((-/+ )) vs. CGC((-/-)) = 113.7 ± 80.4 vs. 82.2 ± 65.8, P = 0.012).

CONCLUSIONS

Our findings extend and add new information to the existing data regarding the association between APOA5 and TG regulation during long-term atypical antipsychotic treatment.

Intercorrelations between the Personal and Social Performance Scale, cognitive function, and activities of daily living

The aim of this study was to evaluate the intercorrelation between the Personal and Social Performance (PSP) score, cognitive function, and activities of daily living (ADLs). Twenty patients with chronic schizophrenia were recruited; the PSP and ADL scales and psychological assessments including the Wisconsin Card Sorting Test, the Wechsler Memory Scale-Revised (WMS-R), and the Continuous Performance Test (CPT) were administered. Positive correlations between the total PSP scale score and performance in the WMS-R, CPT, and ADL scores were identified. The PSP score was found to be of good reliability for cognitive function and ADL evaluation.

Treatment dilemma in comorbidity of schizophrenia and idiopathic Parkinson's disease

Extrapyramidal symptoms are frequently found in patients with schizophrenia. Most are attributed as drug-induced parkinsonism, but comorbidity of idiopathic Parkinson's disease is also possible. We report a 59-year-old male with a diagnosis of schizophrenia for 32 years. Progressive hand tremor was noted from age 53; and then masked face, bradykinesia, dysphagia, sialorrhea; and unsteady shuffling gait became markedly exacerbated, even after discontinuing all antipsychotics for 6 months. The diagnosis of idiopathic Parkinson's disease was confirmed by Tc99m TRODAT SPECT. The dilemma of psychopharmacological treatment to control both disorders was encountered. Based on the review of treatment for Parkinson's disease psychosis (PDP), the recommended treatments suggest the utilization of quetiapine, clozapine, or aripiprazole. However, monotherapy with each of the three atypical antipsychotics failed due to poor efficacy or worsening of parkinsonism symptoms. After a 2-month cautious titration, a combination of quetiapine 50 mg/day and clozapine 37.5 mg/day finally achieved satisfactory efficacy. This case report illustrates the dilemma of treating a patient with schizophrenia and comorbid idiopathic Parkinson's disease, which differed from PDP and required more clinical data for a proper treatment recommendation.

Association of weight gain and metabolic syndrome in patients taking clozapine: an 8-year cohort study

INTRODUCTION

Metabolic syndrome is an important side effect associated with clozapine. It has been hypothesized that weight gain contributes to the development of metabolic syndrome, but a direct diabetogenic effect has also been suggested. We conducted an 8-year cohort study to determine the association between weight gain and metabolic parameters among schizophrenic patients taking clozapine.

METHOD

This study is a retrospective cohort study combining a cross-sectional survey of metabolic syndrome and retrospective chart review. The subjects were hospitalized schizophrenic patients (DSM-IV) who began to receive clozapine at least 3 months before the survey (March to September 2005) and subsequently had monthly body weight monitoring. Anthropometric and biochemical measurements were performed to determine the presence of metabolic syndrome. The chart reviews were conducted to obtain gender, age at initiation of clozapine treatment, baseline body mass index (BMI), BMI changes after the initiation of clozapine treatment, treatment duration with clozapine, and concomitant psychotropic medications.

RESULTS

One hundred eighty-nine patients were maintained on clozapine for a mean ± SD treatment duration of 57.6 ± 27.3 months (range, 5-96). The prevalence of metabolic syndrome was 28.4%. The cohort regression models showed that baseline BMI (P < .01) and BMI change after clozapine treatment (P < .01) were significant factors for metabolic syndrome and 4 metabolic parameters except hyperglycemia, which was related to treatment duration (P < .05).

CONCLUSIONS

For patients treated with clozapine, metabolic syndrome and most metabolic parameters were related to weight gain; however, glucose dysregulation was associated with treatment duration independent of weight gain. The results confirm that monitoring body weight is important, but periodic monitoring of blood sugar may also be required for clozapine patients who do not have significant weight gain.

Association of adiponectin and metabolic syndrome among patients taking atypical antipsychotics for schizophrenia: a cohort study

INTRODUCTION

Adiponectin, an adipocyte-derived hormone controlling lipid and carbohydrate metabolism, has been suggested to be a biomarker for metabolic syndrome in the general population. This study investigated the association between adiponectin levels and metabolic syndrome in patients treated with atypical antipsychotics.

METHODS

Anthropometric and metabolic parameters and serum adiponectin levels were assessed in hospitalized patients with schizophrenia who had used the same atypical antipsychotic for at least 3 months. Retrospective reviews of the patients' medical records were conducted to obtain demographic data and pretreatment characteristics.

RESULTS

The study included 567 schizophrenia patients treated with clozapine (n=231), olanzapine (n=94) and risperidone (n=242), for an average of 45.8+/-27.8 months. The prevalence of metabolic syndrome among all subjects was 23.8%. The clozapine group had a higher prevalence of metabolic syndrome (28.7%) than did the olanzapine (24.2%) and risperidone groups (19.5%) (P=0.039), and the clozapine group had lower levels of adiponectin (8.46+/-6.02 mg/mL) than did the olanzapine (10.26+/-4. 9 mg/mL) and risperidone groups (10.69+/-7.43 mg/mL) (P=0.001). Adiponectin level was negatively correlated with body mass index (BMI) increase after initiation of antipsychotic treatment. Cross-sectional regression analysis showed that age (OR,=1.042, P=0.001), BMI (OR=1.404, P<0.0001), and adiponectin level (OR=0.862, P<0.0001) were significant factors in the presence of metabolic syndrome. Significant predictors of metabolic syndrome were age at initiation of antipsychotic treatment (OR=1.04, P=.007), BMI at initiation of antipsychotic treatment (OR=1.44, P<0.0001), BMI increase after initiation of antipsychotic treatment (OR=1.40, P<0.0001), and adiponectin level (OR=0.86, P<0.0001).

CONCLUSION

Lower levels of adiponectin and weight gain after taking antipsychotics are associated with higher risk of metabolic syndrome in patients taking atypical antipsychotics.

White matter abnormalities in schizophrenia patients with tardive dyskinesia: a diffusion tensor image study

OBJECTIVE

Tardive dyskinesia (TD) is a severe side effect of antipsychotics. While increasing evidence suggests that damaged brain microcircuitry of white matter (WM) is responsible for the clinical symptoms in schizophrenia, no reports of WM abnormality associated with TD were noted.

METHOD

Brain white matter abnormalities were investigated among 20 schizophrenia patients with TD (Schizophrenia with TD group), 20 age-, gender-, and handedness-matched schizophrenic patients without TD (Schizophrenia without TD group), and 20 matched healthy subjects with magnetic resonance imaging and diffusion tensor imaging analysis. Voxel-wise analysis was used to compare fractional anisotropy (FA) maps of the white matter following intersubject registration to Talairach space. Clinical ratings included the Positive and Negative Symptoms Scale (PANSS), Abnormal Involuntary Movement Scale (AIMS), and the Simpson-Angus Scale (SAS).

RESULTS

The study subjects were 75% female with average of 40.1+/-9. 8 years. The Schizophrenia with TD group had significantly higher PANSS total scores (p=0.024), PANSS negative score (p=0.001), SAS (p<0.001) and AIMS (p<0.001) scores; and demonstrated more widespread FA decreases than the Schizophrenia without TD group, especially over the inferior frontal gyrus, temporal sublobar extranuclear WM (around the basal ganglion), parietal precuneus gyrus WM (around somatosensory cortex), and medial frontal gyrus WM (around dorsolateral prefrontal cortex). The AIMS (p<0.01) and SAS (p<0.01) score positively correlated with decreased FA over these areas, and PANSS negative score positively correlated with FA decrease over medial frontal gyrus WM (p<0.01).

CONCLUSIONS

More widespread abnormality of white matter was noted among schizophrenia patients than those without, especially involved cortico-basal ganglion circuits with clinical symptom correlation of involuntary movements and negative symptoms. Further studies with larger sample size are required to validate the findings.

Adiponectin as a potential biomarker for the metabolic syndrome in Chinese patients taking clozapine for schizophrenia

OBJECTIVE

As the metabolic syndrome is an important side effect of some antipsychotics, use of a biomarker will enable clinicians to identify metabolic changes more effectively than anthropometry and biochemistry. Adiponectin, an adipocyte-derived hormone, serves as a central regulatory protein in many of the physiologic pathways controlling lipid and carbohydrate metabolism. The aim of this study is to determine the possible relationship between adiponectin and the metabolic syndrome among Chinese patients taking clozapine for schizophrenia.

METHOD

The study sample consisted of 188 hospitalized Chinese patients with schizophrenia (DSM-IV criteria) who had been receiving clozapine for at least 3 months. Cross-sectional anthropometric measurements, biochemical analysis, and serum adiponectin levels were assessed to determine the prevalence of metabolic syndrome. Retrospective chart reviews were conducted to obtain demographic data, age at which clozapine treatment was initiated, and weight change after the initiation of clozapine treatment. The study was conducted from March to September of 2005.

RESULTS

The prevalence of the metabolic syndrome was 28.4%. Adiponectin levels were negatively associated with weight change after the initiation of clozapine treatment, systolic blood pressure, diastolic blood pressure, body weight, body mass index (BMI), waist circumference, serum triglycerides, and insulin and were positively associated with high-density lipoprotein cholesterol. Multiple logistic regression analysis showed that age (OR = 1.083, p = .009), BMI (OR = 1.423, p < .001), and serum adiponectin (OR = 0.847, p = .01) each correlated significantly with the presence of the metabolic syndrome.

CONCLUSION

Independent of age and BMI, hypoadiponectinemia is a potential biomarker of the metabolic syndrome in patients taking clozapine for schizophrenia.

Equivalent switching dose from oral risperidone to risperidone long-acting injection: a 48-week randomized, prospective, single-blind pharmacokinetic study

OBJECTIVE

Previous studies showed clinical benefit of risperidone long-acting injection in the treatment of schizophrenia. However, the equivalent switching dose from oral risperidone to risperidone long-acting injection was still in debate. This study, conducted among hospitalized patients, included a long-enough study period and optimal control of drug compliance to test the equivalent switching dose.

METHOD

Fifty symptomatic, stable hospitalized patients with DSM-IV schizophrenia were randomly assigned to receive either daily oral risperidone or risperi-done long-acting injection every 2 weeks. Those originally receiving an oral risperidone dose of 4 mg/day or less received 25 mg of risperidone long-acting injection, those taking an oral dose of more than 4 mg/day but of 6 mg/day or less received 37.5 mg of risperidone long-acting injection, and those taking more than 6 mg/day received 50 mg of risperidone long-acting injection. Assessments of clinical efficacy, side effects, metabolic safety, drug tolerance, and serum concentration of risperi-done metabolites were performed repeatedly. The study was conducted from March 2004 to May 2005.

RESULT

Forty-five patients (90%) completed the study. There were no significant differences in Positive and Negative Syndrome Scale (PANSS) scores between the 2 groups, but the risperidone long-acting injection group showed reduced UKU Side Effect Rating Scale total scores (p = .048), Simpson-Angus Scale scores (p = .028), prolactin levels (p = .046), and serum concentrations of risperidone metabolites (p = .028). Among the risperidone long-acting injection group, patients who received either 25 mg q 2 weeks or 37.5 mg q 2 weeks of risperidone long-acting injection showed increased PANSS scores (p = .058), decreased serum metabolite concentrations (p = .028), and an increased tendency to relapse.

CONCLUSIONS

The results support good tolerability of risperidone long-acting injection, but it is suggested that the equivalent switching dose be adjusted as follows: those originally on an oral risperidone dose of 3 mg/day or less should receive 25 mg of risperidone long-acting injection, those taking an oral dose of more than 3 mg/day but of 5 mg/day or less should receive 37.5 mg, and those taking an oral dose of more than 5 mg/day should receive 50 mg of risperidone long-acting injection.

A Comparative Efficacy and Safety Study of Long-Acting Risperidone Injection and Risperidone Oral Tablets Among Hospitalized Patients: 12-Week Randomized, Single-Blind Study

OBJECTIVE

The superiority of risperidone long-acting injection (RLAI) over oral typical and atypical antipsychotics demonstrated in previous studies may be related to the improved drug compliance. The aim of the 12-week randomized, single-blind study was to test whether the superiority of RLAI remained among hospitalized patients that drug compliance could be optimally controlled.

METHODS

Fifty hospitalized stable schizophrenic patients, who had maintained on oral risperidone for more than 3 months, were randomized to the RLAI and oral risperidone group. Finally 49 patients (98 %) completed the study, and no dose change of oral risperidone, or RLAI was noted among all patients.

RESULTS

The RLAI group showed significantly increased positive score of Positive and Negative Syndrome Scale (PANSS) than the risperidone group (0.72 +/- 3.52 vs. -1.24 +/- 3.81, p = 0.022), but without significance difference for the PANSS total, negative and general psychopathology scores. The RLAI group also showed a significantly improved Udvalg for Kliniske Undersogelser (UKU) Scale (p = 0.037), social life domains of Short-Form Health Survey (SF-36) (p = 0.011), and reduced prolactin level (p = 0.001).

CONCLUSION

The results indicated that with optimal controlling of drug compliance among hospitalized patients, RLAI showed no benefit of efficacy over oral risperidone, but with advantages of improved side-effect profiles, social life ratings, and reduced prolactin levels.

Association of initial antipsychotic response to clozapine and long-term weight gain

OBJECTIVE

The aim of this study was to test whether the initial antipsychotic response to clozapine is related to subsequent weight change.

METHOD

This study was an 8-year retrospective chart review of 96 hospitalized patients with schizophrenia. Data on monthly weight change, initial clinical response, age, gender, clozapine dose, and concomitant use of mood stabilizers and other antipsychotics were analyzed.

RESULTS

Fifty-five (57.3%) of the patients received clozapine over the entire 8-year period; these subjects experienced an average weight gain of 11.7 kg (SD=1.6). Seventeen of these patients (30.9%) who had a significant initial clinical response (CGI improvement rating of 1 or 2 during the first 14 months) gained significantly more weight (13.8 kg [SD=8.4]) than did the 38 patients without a significant initial response (4.5 kg [SD=12.0]). Multiple linear regression analysis showed significant initial clinical response and lower baseline body mass index were associated with significantly more weight gain.

CONCLUSIONS

The results show that initial antipsychotic response to clozapine is associated with subsequent long-term weight gain as measured over 8 years.

The validity of an Internet-based Self-assessment Program for Depression

The Internet-based Self-assessment Program for Depression (ISPD) has been found to have good test-retest reliability for major depressive disorder (MDD). The purpose of this study was to further examine the validity of the ISPD for MDD. We found sensitivity and specificity of MDD by ISPD to be 81.8% and 72.7% respectively. Internet may play an important role for patients to self-assess their possibility of getting MDD.

Therapeutic effect of pirenzepine for clozapine-induced hypersalivation: a randomized, double-blind, placebo-controlled, cross-over study

The objective of this study was to investigate the efficacy of pirenzepine in the treatment of clozapine-induced hypersalivation. Pirenzepine is reported to counteract hypersalivation by its selective antagonistic activity on the M4-muscarinic receptor, which is stimulated by clozapine. Twenty patients with clozapine-induced hypersalivation underwent a random-order, double-blind, placebo-controlled, cross-over trial which lasted 8 weeks each for the pirenzepine and placebo investigations, with a 4-week washout period in between. The severity of hypersalivation was assessed using an objective measure: saliva production monitored through the diameter of wetted surface on tissue paper placed over the patient's pillow. Our study showed that pirenzepine had no significant therapeutic effect on hypersalivation compared with placebo, suggesting that hypersalivation induced by clozapine might have a neurobiological basis other than the M4-muscarinic receptor.

Emerging homosexual conduct during hospitalization among chronic schizophrenia patients

OBJECTIVE

The study investigated the emerging homosexual conduct during hospitalization among chronic schizophrenia patients.

METHOD

We interviewed 55 male and 58 female chronic schizophrenic patients to investigate their sexual history before and after admission. Those patients were under 45 years old, without significant deteriorated cognitive function, lived in a homogeneous gender chronic ward and did not demonstrate homosexual behaviour before admission.

RESULTS

Nineteen patients (16.8%) reported having homosexual conducts during hospitalization. Their characteristics were: 1) having sexual experience before admission; 2) with younger age at first sexual experience; and 3) female patients having more sexual partners before admission.

CONCLUSION

A significant proportion of patients need a sexual outlet during long-term hospitalization. Sexual education and counselling are greatly needed.

No evidence for association of alpha 1a adrenoceptor gene polymorphism and clozapine-induced urinary incontinence

Clozapine is an effective atypical antipsychotic that has high affinity for many neurotransmitter receptors. Among the adverse effects of clozapine, urinary incontinence is commonly found and is suggested to be caused by alpha-adrenergic blockade. We tested the hypothesis that clozapine-induced urinary incontinence is related to a genetic variant of the alpha(1a)-adrenoceptor. We also tested whether the alpha(1a)-receptor gene confers susceptibility to schizophrenic disorders. Our result indicated that the alpha(1a)-adrenoceptor gene polymorphism investigated plays no major role in the pathogenesis of schizophrenia or in clozapine-induced urinary incontinence. Considering the superior effects of clozapine and its potent adrenergic antagonistic effects, it is of interest to investigate the association between this polymorphism and the treatment response.

Apolipoprotein E genotype and schizophrenia

Schizophrenic disorders are complex genetic disorders and may involve multiple genes of small effect. The presence of apolipoprotein E (apoE) is associated with several neuropsychiatric disorders. Previous studies on apoE genotype distribution in schizophrenia have reported conflicting findings. We studied the genotype frequencies in a large group of schizophrenic patients. The genotype distribution was significantly different between the schizophrenic patients and the control subjects. Persons who were sigma3 carriers have an increased risk of schizophrenia. This result suggests that apoE isoforms may play a functional role in the pathogenesis of schizophrenic disorders. Some possible mechanisms regarding the effect of apoE on the development of schizophrenia are discussed.

No association between an intronic presenilin-1 gene polymorphism and schizophrenia in a Chinese population

We investigated the association between schizophrenic psychosis and an intronic polymorphism of the presenilin-1 (PS1) gene in a Chinese population. Schizophrenic and control groups had similar PS1 genotype distributions and allele frequencies, indicating that this polymorphism may not be involved in the development of schizophrenia.

Alpha-1-antichymotrypsin polymorphism in schizophrenia: frequency, age at onset and cognitive function

A common polymorphism in the alpha1-antichymotrypsin (ACT) gene is associated with Alzheimer's disease. ACT is also a trophic factor in the hippocampal neurons. In order to examine if the ACT gene plays a role in the pathogenesis of schizophrenic disorders, patients (n = 175) and control subjects (n = 114) were genotyped for ACT. We also investigated the relationship between genotypes and patients' cognitive function as evaluated by the Clinical Dementia Rating Scale and the Mini-Mental State Examination. The results demonstrated no association between schizophrenia and/or cognitive deficit in schizophrenia and ACT polymorphism. The data suggest that the ACT gene is not of major importance for the genesis of schizophrenia. Further studies measuring ACT expression as messenger RNA or serum ACT level may help to exclude the role of ACT in the pathogenesis of schizophrenia.

A retrospective study of clozapine and urinary incontinence in Chinese in-patients

OBJECTIVE

This study investigated the incidence of clozapine-associated urinary incontinence (UI) in schizophrenic patients, the percentage of these patients with persistent urinary incontinence (PUI), and the possible factors affecting the occurrence of UI.

METHOD

A total of 61 Chinese in-patients with schizophrenia (according to DSM-IV) treated with clozapine for more than 3 months were assessed retrospectively for the occurrence of UI. Patients who still had UI at the time of assessment were classified as having PUI. Patients whose UI had resolved at the time of assessment were classified as having self-limited urinary incontinence (SUI). We compared the characteristics of UI and non-UI cases and of PUI and SUI cases.

RESULTS

The results showed that urinary incontinence developed at some time in 27 of 61 patients (44.3%), and that it was persistent in 15 of 61 patients (25%). There were no statistically significant differences in age, sex, clozapine dose, duration of clozapine use, duration of index admission, duration of illness, age at onset of schizophrenia, or concurrent treatment with other psychiatric medications between the UI and non-UI groups and between the PUI and SUI groups.

CONCLUSION

Clozapine-associated urinary incontinence may be persistent in some patients, and it should be cautiously monitored in every patient taking clozapine.

Risk factors for substance use disorders among inpatients with major affective disorders in Taiwan Chinese

An assessment of potential risk factors for substance use disorders was performed in 49 patients with major affective disorders in a general hospital acute care unit in Taiwan. The major depression patients were noted to have a higher prevalence of substance use disorder than bipolar disorder patients (p = 0.011). Those patients with substance use disorders were noted to be significantly male-predominated (p = 0.043), to have a later onset age of affective disorder (p = 0.009), and to have more visits to the emergency room in the recent one year (p = 0.009). The sedatives-hypnotics-anxiolytics was the most frequently used forms of drug abuse. The major depression patients had a significantly higher sedative-hypnotics-anxiolytics use disorder rate than the bipolar disorder patients (p = 0.001). All patients with alcohol use disorder were noted to have other substance use disorders as well. Fifty six percent of those patients with substance use disorder were polysubstance users. Eighty three percent of the male patients with substance use disorder had poly-substance use disorder.

Substance use disorders among inpatients with bipolar disorder and major depressive disorder in a general hospital

The prevalence and type of substance abuse and dependence were determined for 49 patients with mood disorders on a general hospital psychiatric unit. A standardized diagnostic interview was conducted with a high value of inter-rater reliability. This study found that 18.4% of mood disorder inpatients met the diagnostic criteria for psychoactive substance use disorders by DSM-III-R. Sedatives-hypnotics-anxiolytics was the most common substance use disorder (10.2%), followed by alcohol (6.1%). Patients with major depression had a higher rate of comorbidity with substance use disorders than did the bipolar disorder patients (p = 0.011). The prevalence of sedatives-hypnotics-anxiolytics use disorder among major depression patients was 35.7%, which was higher than that among bipolar disorder patients (0%). Male patients had a significantly higher percentage of substance use disorders than did female patients (p = 0.054). Seventy-seven percent of the patients with a dual diagnosis of mood and substance use disorder were not diagnosed as having substance use disorders by psychiatrists in charge.

Risk factors for parasuicide among psychiatric inpatients

To improve suicide prevention during hospitalization, this study examined risk factors for parasuicide among psychiatric inpatients. A group of 58 psychiatric inpatients (19 with schizophrenia, 20 with depression, and 19 with other diagnoses) who displayed suicidal behavior during hospitalization were compared with two control groups of nonparasuicidal inpatients. For inpatients with schizophrenia, a history of parasuicide was a risk factor; for those with depression, it was suicidal behavior on admission; and for patients with other diagnoses, it was violence during hospitalization.

Suicide and parasuicide in psychiatric inpatients: ten years experience at a general hospital in Taiwan

We investigated 64 suicidal acts of 62 psychiatric inpatients over a 10-yr. period. The findings indicated the frequency of suicidal behavior of psychiatric inpatients was 0.91% of total admissions, two thirds of the patients who attempted suicide were diagnosed with schizophrenia or depression, and patients suffering from depression, substance abuse, and personality disorders had a higher parasuicide rate, among whom those diagnosed bipolar disorder with depressive episode had an extremely high parasuicide rate. Most of the incidents occurred in concealed places, and most of the patients used nonviolent methods. About half of the incidents occurred during the evening shift and depressed patients tended to attempt suicide during the night shift. Most suicidal attempts were unsuccessful and led to minor injury. There were two deaths.