Prodromal phase and first episode psychosis in schizophrenia: early signs and diagnosis

Introduction

The detection of the initial prodrome of schizophrenia (SK) before the first episode psychosis remains a major concern in current psychiatric research.

Objectives

In this paper we aimed to analyse clinical and psychopathological aspects of prodromes leading to first-lifetime psychotic episodes and to highlight the high-risk features in order to establish preventive strategies and to provide early intervention in SK.

Methods

This is a retrospective observational descriptive study conducted in the ‘Prof. Dr. Alexandru Obregia’ Clinical Hospital of Psychiatry in Bucharest, Romania. We collected data from the medical records of 139 patients previously diagnosed with SK who were admitted to our clinic. For all included patients, diagnoses were recorded according to the DSM-IV TR and ICD-10 classification criteria. Data collected included patient demographics and clinical information. All analyses were conducted using SPSS package.

Results

Of the 139 patients included in this study, 130 patients (93,5%) presented prodromal symptoms. 73 of these patients (52,5%) presented with negative symptoms that were more common in our study in single male patients that had low academic performance and a family history of mental illness, findings consistent with the literature. A decline in social functioning decline was observed in 64 patients (46%) prior to their first admission. 87 patients (62,6%) had a prodromal phase which lasted more than one year.

Conclusions

These findings support the value of early psychopathology in predicting the diagnosis of SK, but clinical guidelines are needed for a more systematic evaluation of the SK prodrome.

Disclosure

No significant relationships.

A randomized controlled trial of allopurinol vs. placebo added on to antipsychotics in patients with schizophrenia or schizoaffective disorder

Adenosine agonists produce behavioral effects similar to dopamine antagonists, hence increasing adenosine levels might improve symptoms of schizophrenia. This hypothesis is supported by three single-site studies indicating that allopurinol, which increases adenosine levels, improved symptoms in patients with schizophrenia. We performed a multi-center, 8-week RCT of allopurinol vs. placebo added to anti-psychotic medications in 248 patients with schizophrenia or schizoaffective disorder. Both groups showed improvement in the PANSS (effect size 1.13) and in clinical and cognitive measures. No difference was observed between groups in primary (t=0.01, p=0.992) or secondary outcome measures. These findings do not support allopurinol as a treatment for schizophrenia.

[Right atrial thrombosis with acute abdominal onset]

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Nanostructured Biomaterials with Controlled Properties Synthesis and Characterization

Magnetic nanoparticles were obtained using an adjusted Massart method and were covered in a layer-by-layer technique with hydrogel-type biocompatible shells, from chitosan and hyaluronic acid. The synthesized nanocomposites were characterized using dynamic light scattering, transmission electron microscopy, and Fourier transformed infrared spectroscopy. Biocompatibility of magnetic nanostructures was determined by MTT (3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyltetrazolium bromide) cell proliferation assay, swelling tests, and degradation tests. In addition, interaction of hydrogel-magnetic nanoparticles with microorganisms was studied. The possibility of precise nanoparticles size control, as long as the availability of bio-compatible covering, makes them suitable for biomedical applications.

Clinical and cytological correlations in pericardial effusions with cardiac tamponade

We studied 27 patients diagnosed with pericardial effusion with cardiac tamponade on which pericardiocentesis was performed. The purpose of the study was to evaluate the benefits and limits of the cytological examination of the pericardial liquid in the etiological diagnosis and the treatment of patients with cardiac tamponade. The pericardial liquid taken was examined macroscopically, biochemically (content of proteins, glucose, cholesterol, and LDH), cytologically (MGG stained smears from pericardial liquid) and bacteriologically. The obtained results were compared to the clinical data, the laboratory and paraclinical tests, to differentiate the cause and therapeutically procedure. The cardiac tamponade remitted after pericardiocentesis in all patients. The pericardial liquid was exudate (Ligth criteria) in 82% of all patients. The cytological examination of the pericardial liquid showed malignant smear in 40.74% of the patients, smear of the TBC specific inflammation type in 7.40% patients, smear of non-specific inflammation type in 25.94% of patients, reactive type smear in 25.9% of patients.