1Neuro Endocrinol. Lett. 2006 Aug 27: 433-7
TitleDexamethasone suppression test in first-episode schizophrenia.
AbstractHigher rates of dexamethasone test (DST) nonsuppression in schizophrenia have been attributed to depressive symptoms, suicidality and negative symptoms. No study concerning first-episode schizophrenia has yet been published.
In patients hospitalised for the first time with first-episode schizophrenia the DST has been performed before, at the end of the acute treatment and after one year. At the same time the clinical evaluation with PANSS was performed. A cortisol value >5 microgram/dl in either of the postdexamethasone samples indicated nonsuppression of cortisol.
A total of 56 males were included. 18% of PTS were DST nonsuppressors at medication-free baseline, 5% and 16% after acute treatment and after one year respectively. After 1 year 42/56 of patients fulfilled the criteria of remission. The rate of nonsuppression was 21.4%, 5% and 16.4% in remitters and 7%, 7% and 14.3% in nonremitters. Significant differences in the whole group were found between postdexamethasone cortisolemia at discharge on the one hand and on admission and at the one-year follow-up on the other. Significant correlations were observed between postdexamethasone cortisolemia and negative symptoms at the end of acute treatment.
In first-episode schizophrenia the short-term treatment led to a decrease in cortisolemia and rates of nonsuppression and an increase at a one-year follow-up.
Rates of DST nonsuppression in schizophrenia including first-episode schizophrenia are influenced by the stage of illness and medication status. The impairment of feedback regulation of cortisol secretion may be related to different biopathogenetic mechanisms depending on the phase of the illness.
SCZ Keywordsschizophrenia, schizophrenic
2Clin Pract Epidemiol Ment Health 2007 -1 3: 30
TitleFrequency and severity of aggressive incidents in acute psychiatric wards in Switzerland.
AbstractAggression and violence and negative consequences thereof are a major concern in acute psychiatric inpatient care globally. Variations in study designs, settings, populations, and data collection methods render comparisons of the incidence of aggressive behaviour in high risk settings difficult.
To describe the frequency and severity of aggressive incidents in acute psychiatric wards in the German speaking part of Switzerland.
We conducted a prospective multicentre study on 24 acute admission wards in 12 psychiatric hospitals in the German speaking part of Switzerland. Aggressive incidents were recorded by the revised Staff Observation Aggression Scale (SOAS-R) and we checked the data collection for underreporting. Our sample comprised 2344 treatment episodes of 2017 patients and a total of 41'560 treatment days.
A total of 760 aggressive incidents were registered. We found incidence rates per 100 treatment days between 0.60 (95% CI 0.10-1.78) for physical attacks and 1.83 (1.70-1.97) for all aggressive incidents (including purely verbal aggression). The mean severity was 8.80 +/- 4.88 points on the 22-point SOAS-R-severity measure; 46% of the purely verbally aggression was classified as severe (>/= 9 PTS.). 53% of the aggressive incidents were followed by a coercive measure, mostly seclusion or seclusion accompanied by medication. In 13% of the patients, one ore more incidents were registered, and 6.9% of the patients were involved in one ore more physical attack. Involuntary admission (OR 2.2; 1.6-2.9), longer length of stay (OR 2.7; 2.0-3.8), and a diagnosis of schizophrenia (ICH-10 F2) (OR 2.1; 1.5-2.9) was associated with a higher risk for aggressive incidents, but no such association was found for age and gender. 38% of the incidents were registered within the first 7 days after admission.
Aggressive incidents in acute admission wards are a frequent and serious problem. Due to the study design we consider the incidence rates as robust and representative for acute wards in German speaking Switzerland, and thus useful as reference for comparative and interventional research. Implications for clinical practice include the recommendation to extend the systematic risk assessment beyond the first days after admission. The study confirms the necessity to differentiate between types of aggressive behaviour when reporting and comparing incidence-data.
SCZ Keywordsschizophrenia, schizophrenic
3J Bodyw Mov Ther 2013 Apr 17: 169-76
TitleThe physiotherapists' experience of Basic Body Awareness Therapy in patients with schizophrenia and schizophrenia spectrum disorders.
AbstractScandinavian physiotherapists (PT) treat patients with schizophrenia and schizophrenia spectrum disorder, mainly because of the latter's bodily difficulties. One commonly used method is Basic Body Awareness Therapy (BBAT), targeting the difficulties with sensory motor dysfunction and disembodiment. The aim of the study is to describe the physiotherapist's experiences of using BBAT for patients with schizophrenia.
In a qualitative study, eight physiotherapists, who use BBAT when treating patients with schizophrenia were interviewed. The interview transcriptions were analysed according to content analysis.
Three stage related themes were created: "encountering" "discovery towards embodiment", and "inner space towards outer world". In "encountering" the PTS described important aspects at the beginning of treatment. "Discovery towards embodiment" revealed how the PTS conceived that the patients' attention is directed toward their own body and their bodily experiences. The theme, "inner space towards outer world" reflects the PTS experience of the changes achieved and how patients turn their attention to the outside world as a more competent self.
SCZ Keywordsschizophrenia, schizophrenic
4Psychiatry Res 2014 Dec 220: 175-80
TitleEffectiveness and clinical predictors of response to combined ECT and antipsychotic therapy in patients with treatment-resistant schizophrenia and dominant negative symptoms.
AbstractThe effectiveness and predictors of response to electroconvulsive therapy (ECT) combined with antipsychotics (AP) in treatment-resistant schizophrenia patients with the dominance of negative symptoms (TRS-NS) have not been studied systematically so far. 29 patients aged 21-55 years diagnosed with TRS-NS underwent ECT combined with antipsychotics (ECT+AP). Prior to the ECT, the symptom profile and severity were evaluated using Positive and Negative Syndrome Scale (PANSS). Demographic and medical data was collected; ECT parameters and pharmacotherapy results were evaluated. After the combined ECT+AP therapy a significant decrease in symptom severity was found. A response to treatment was achieved by 60% of patients. The greatest reductions were obtained in general and positive PANSS subscale (median change: 11 and 7 PTS.) and the smallest, but still significant, ones in negative symptoms subscale (median: 3.5 PTS.). Patients who responded to ECT+AP demonstrated a significantly shorter duration of the current episode in comparison with patients who did not experience at least a 25% reduction in symptom severity (median: 4 vs. 8 months). A combination of ECT and antipsychotic therapy can provide a useful treatment option for patients with TRS-NS. The only significant predictor of response to treatment was a shorter duration of the current episode.
SCZ Keywordsschizophrenia, schizophrenic
5J Pharm Health Care Sci 2015 -1 1: 15
TitleHyperglycemic adverse events following antipsychotic drug administration in spontaneous adverse event reports.
AbstractAntipsychotics are potent dopamine antagonists used to treat schizophrenia and bipolar disorder. The aim of this study was to evaluate the relationship between antipsychotic drugs and adverse hyperglycemic events using the FDA Adverse Event Reporting System (FAERS) database. In particular, we focused on adverse hyperglycemic events associated with atypical antipsychotic use, which are major concerns.
We analyzed reports of adverse hyperglycemic events associated with 26 antipsychotic drugs in the FAERS database from January 2004 to March 2013. The Standardized Medical Dictionary for Regulatory Activities Queries (SMQ) preferred terms (PTS) was used to identify adverse hyperglycemic events. The number of adverse hyperglycemic reports for the top eight antipsychotic drugs, quetiapine, olanzapine, risperidone, aripiprazole, haloperidol, clozapine, prochlorperazine, and chlorpromazine was 12,471 (28.9%), 8,423 (37.9%), 5,968 (27.0%), 4,045 (23.7%), 3,445 (31.5%), 2,614 (14.3%), 1,800 (19.8%), and 1,003 (35.7%), respectively. The reporting ratio increased with co-administration of multiple antipsychotic drugs. For example, adverse hyperglycemic events represented 21.6% of reports for quetiapine monotherapy, 39.9% for two-drug polypharmacy, and 66.3% for three-drug polypharmacy.
Antipsychotic drug polypharmacy may influence signal strength, and may be associated with hyperglycemia. After considering the causality restraints of the current analysis, further robust epidemiological studies are recommended.
SCZ Keywordsschizophrenia, schizophrenic