Characteristic of social perception and theory of mind in patients with early onset schizophrenia with high functioning and low functioning / 中国心理卫生杂志

Objective:To explore the characteristics of the social cognition in patients with high/low functioning early onset schizophrenia (HF-EOS).Methods:Eighty-four 13-18 years old patients with early onset schizophrenia and 45 gender-,age-,and level of education-matched healthy controls (HC) were selected.The diagnosis was made according to the criteria of the International Statistical Classification of Diseases and Related Health Prob lem,Tenth Revision (ICD-10) for schizophrenia.All patients were divided into HF-EOS group (total score ＞ 7,n =41) and LF-EOS group (total score ＜ 4,n =43)in the three aspects total score of social attainment,social compe tence and functional capacity.All patients were assessed with the Eye Basic Emotion Discrimination Task,Reading the Mind in the eyes,Yoni task and Faux Pas Recognition task.Results:Compared with healthy controls,LF-EOS patients performed poorer on Reading the Mind in the eyes task [(17 ± 4) vs.(9 ± 3.0),P ＜ 0.05],second-order cognitive condition of the Yoni task [(71 ± 18) vs.(83 ± 13),P ＜ 0.01] and Recognizing Faux pas [(8 ± 2) vs.(9 ± 2),P ＜0.05].HF-EOS and LF-EOS patients performed worse than the controls on second-order affective condition of the Yoni task [(80 ± 14),(75 ± 15) vs.(86.5 ± 10.0),P ＜ 0.01] and understanding paux pas [(17 ± 5),(14 ± 5) vs.(21 ± 6),P ＜ 0.01].Conclusion:It suggests that HF-EOS have preserved social perceptual abilities compared to LF-EOS patients.HF-EOS patients and LF-EOS patients both have impaired theory of mind compared to controls.

Effects of group psychotherapy on damage of theory of mind in patients with early-onset schizophrenia / 中国心理卫生杂志

Objective:To explore the effect of group psychotherapy on damage of theory of mind (TOM) in patients with early-onset schizophrenia.Methods:Totally 60 patients with early-onset schizophrenia were included and divided into the intervention group (n ＝ 30) and the health education group (n ＝ 30).The patients in the intervention group were offered 10 twice a week 2-hour sessions of group psychotherapy,and those in the control were offered group health education twice a week.All participants completed baseline measures and post-intervention measures with the Eye Emotion Recognition and Theory of mind Picture-sequencing Task (TOM-PST).Results:Totally 23 patients in the intervention group and 29 patients in the health education group finished the post-intervention measures.After 5-week intervention,subscores of sad and fear and total score of emotion recognition,total score of TOM-PST,understanding first order error belief,second order error belief,third order error belief,sense of reality,detecting fraud compared to baseline had statistically significant difference in intervention group.In health education group,subscores of joy emotion recognition,understanding first order error belief,third order error belief,total score of TOM-PST compared to baseline had statstically significant difference.The patients with group psychotherapy got higher scores of total score of TOM-PST and understanding second order error belief and third order error belief than the health education group after 5-week intervention (P ＜ 0.05).Conclusion:This study suggests the group psychotherapy could partially improve theory of mind with early-onset schizophrenia,and promote the recovery of social cognition.

Demographic Characteristics, Medication Profile and Treatment Outcome of Patients with Very Early-Onset Schizophrenia in One Hospital

OBJECTIVES: Very early-onset schizophrenia (VEOS) is a type of psychosis having a low frequency, insidious onset, and devastating clinical outcome. In this study, the demographic features, information on medication, clinical outcomes, and intellectual capability of patients diagnosed with VEOS in a hospital were analyzed to provide therapeutic strategies for this type of schizophrenia. METHODS: Using the electronic medical records of the National Center for Mental Health, 69 patients with VEOS were identified based on the DSM-5 criteria of schizophrenia. The data were summarized and analyzed according to the demographic characteristics, medications used, intellectual strength measured by the full intelligence quotient (FIQ) score, and current clinical status measured by the Clinical Global Impression-Severity (CGI-S) and various combinations of these parameters. RESULTS: The screened study group contained similar numbers of males and females. The younger the onset of psychosis, the lower the frequency. The study population included a significantly higher proportion of births in the winter season than that of the general population. The 3 most frequently used antipsychotic medications were risperidone and its derivatives, clozapine and olanzapine. Valproic acid and divalproex sodium were the most commonly added drugs for outcome augmentation. 53.5% of the study population had received benzodiazepines and/or hypnotics. The average FIQ of the study population was 69.4, which is quite low compared to previous Korean studies with similar populations. There was a weak negative correlation between FIQ and CGI-S, but it was not statistically significant. The average CGI-S score was 4.2, which meant that the patients were moderately ill. CONCLUSION: This study demonstrated that patients with VEOS showed more frequent intellectual deficits at baseline and poorer outcomes than the control group. Risperidone, clozapine, valproic acid and their combinations were the most preferred medications for the treatment of psychosis. Benzodiazepines were quite commonly added for various reasons.

Resting state fMRI study of amplitude of low-frequency fluctuation in early onset schizophrenia / 中国神经精神疾病杂志

Objective To investigate brain function alteration in early onset schizophrenia by amplitude of low-frequency fluctuation (ALFF) based on resting-state functional MRI (fMRI). Method Twenty patients with early on?set schizophrenia and 20 sex, age, education years matched healthy controls underwent resting-state functional MRI. The difference in ALFF was compared between patients and controls. Result Compared with control group, the ALFF values in patient group increased in the left frontal gyrus, precuneus, cingulate cortex, occipital lobe, parahippocampal gyrus and calcarine (P<0.05, AlphaSim revised), while decreased in the right superior temporal lobe and the posterior lobe of cerebellum (P<0.05, AlphaSim revised). Conclusion There are abnormal ALFF in multiple regions in early onset schizo?phrenia, suggesting that early onset schizophrenia may have altered in resting-state brain activity.

Intervenciones terapéuticas en psicosis esquizofrénica de niños y adolescentes / Therapeutic interventions in schizophrenic psychosis in children and adolescents

La prevalencia de Esquizofrenia es muy baja en la infancia y adolescencia temprana, aumentando en la adolescencia y adultez a un 1%. Se ha estimado que la prevalencia de psicosis de 0,9 en 10.000 a los 13 años y 17,6 en 10.000 a los 18 años. Los cuadros esquizofrénicos de inicio temprano y muy temprano son una variante severa del trastorno y se asocian a un mayor deterioro funcional, curso clínico más grave y peor evolución. Todo esto determina la necesidad de implementar tratamientos multimodales tempranos y eficaces, así como estrategias preventivas en los grupos de mayor riesgo. El tratamiento farmacológico cuenta con mayores evidencias de efectividad en este cuadro y otorga notables beneficios a los pacientes, sin embargo se requiere mayor investigación a largo plazo respecto a los efectos adversos secundarios, su impacto en individuos en desarrollo y la eficacia de estos agentes. Estos avances permitirán al clínico establecer un justo balance costo/beneficio de su uso en población infantojuvenil.

The prevalence of schizophrenia is very low during childhood and early adolescence, increasing later in adolescence and adulthood to 1%. It has been established that the prevalence of psychosis is 0.9/10000 at 13 years of age and 17.6/10000 at 18 years of age. Early and very early onset schizophrenia are a severe form of this disorder, and are associated to a larger disability, more severe form of the disease and worse prognosis. These factors determine the need of implementing treatments that are multimodal, early and effective, as well as preventive strategies in high risk groups. The pharmacological treatment of schizophrenia has evidence of effectiveness and gives patients important benefits, however, more long term research is needed regarding its side effects, its impact on the developing brain and its effectiveness. These facts would help the psychiatrist to establish the value, risks and benefits of the use of drugs in children and adolescents.

Study of faux pas recognition and belief understanding in early-onset schizophrenia / 中华行为医学与脑科学杂志

Objective To explore the cognitive function of the theory of mind(TOM) in early-onset schizophrenia from faux pas recognition and belief understanding dimensions.Methods 41 early-onset schizophrenias (EOS) and 40 normal adolescents were interviewed by the Chinese version of faux pas recognition task and theory of mind picture-sequencing task(ToM-PST),then early-onset schizophrenias cognitive features were analyzed.Results ①In faux pas recognition task,compared with healthy subjects,EOS showed significantly less total scores (16.11±6.34 vs 20.86±7.79,P＜0.05)and subscores of understanding faux pas questions (9.88±4.11 vs 13.27± 6.07,P＜0.05).In faux pas recognition scores(6.72±2.60vs 7.58±2.20) and control questions(9.83±0.44vs 9.97± 0.16) had no statistically significant difference (P＞0.05).②In ToM-PST task,early-onset schizophrenic patients also had significantly less total score(17.29±3.38 vs 21.48± 1.73,P＜0.01),subscores of understanding first order belief,first order error belief,second order belief,second order error belief,third order error belief,sense of reality,reciprocity,fraud,detecting fraud compared to normal controls had significant difference (all P＜ 0.05 or 0.01).③ The correlation between clinical course time and PANSS score and its subscores of the theory of mind picture-sequencing and faux pas task was non-significant(P＞0.05)except the subscores of understanding the first order belief (P＜0.01).Conclusion The theory of mind is apparent damage in early onset schizophrenia and non-significant correlation is found with psychiatric symptoms.

Study on neural biochemical metabolites of adolescent patients with first-episode schizophrenia / 中华实用儿科临床杂志

Objective To study the features of treatment on neurochemical metabolites in prefrontal lobe and thalamus by proton magnetic resonance spectroscopy (1H-MRS) in first-episode drug-naive patients with early-onset schizophrenia (EOS).Methods Forty-two EOS (study group) met with Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (DSM-Ⅳ) were recruited.Prefrontal lobe and thalamus were evaluated by multi-voxel 1H-MRS before and 4-week after treatment with a single atypical antipsychotic.The levels of N-acetylaspartate (NAA),creatine compounds (Cr) and choline-containing compounds (Cho) were measured.The patients also received Positive and Negative Syndrome Scale (PANSS).Forty normal controls (normal control group) underwent the same 1H-MRS detection.Results Before treatment,the NAA/Cr ratios in left prefrontal lobe,right prefrontal lobe and lefi thalamus in study group were lower than those in normal control group (1.45 ± 0.26 vs 1.60 ± 0.34,t =2.251,P =0.027;1.43 ±0.26 vs 1.60 ±0.35,t =2.505,P=0.014;1.48 ±0.27 vs 1.65 ±0.35,t =2.470,P =0.016).After 4-week treatment,the NAA/Cr ratios in both left prefrontal lobe and left thalamus of study group were significantly increased compared with those before treatment (1.58 ± 0.30 vs 1.45 ± 0.26,t =2.122,P =0.037;1.62 ± 0.32 vs 1.48 ± 0.27,t =2.167,P =0.033).After 4-week treatment in study group,the total score,positive symptom score,negative symptom score and general pathologic score of PANSS,and the total score of Clinical Global Impression (CGI) were significantly lower compared with those before treatment (59.1 ± 10.2 vs 82.0 ± 13.2,t =8.896,P=0.000;15.3 ±5.1 vs 22.9 ±7.1,t =5.634,P =0.000;16.4 ±5.2 vs 21.1 ±7.8,t =3.249,P =0.002;27.4 ±7.6 vs 38.1 ± 8.8,t =5.963,P =0.000;3.6 ± 0.4 vs 4.4 ± 0.5,t =8.097,P =0.000).There was no correlation between the changes of neurochemical metabolite levels such as NAA/Cr and Cho/Cr both in prefrontal lobe and left thalamus,and the clinical symptoms changes,such as total score and every score of PANSS,the total score of CGI in study group after treatment (all P ＞ 0.05).Conclusions The ratios of NAA/Cr are decreased not only in bilateral prefrontal lobe,but also in left thalamus,and the ratios may increase both in left prefrontal lobe and left thalamus after 4 weeks' treatment with atypical antipsychotics in EOS.The treatment outcomes of NAA/Cr do not agree with the improvement of the clinical symptoms.

A diffusion tensor imaging study of white matter in first episode neuroleptic-na?ve early-onset schizophrenia / 重庆医学

Objective To investigated cerebral structural connectivity and its relationship to neuroleptic-na?ve individuals with first episode early-onset schizophrenia using diffusion tensor imaging (DTI) which could demonstrate the white matter integrity . Methods We recruited subjects with first episode DSM-Ⅳearly-onset schizophrenia who had never been exposed to antipsychotic medication(n=19) and sex ,age-matched healthy volunteers (n= 19) .All subjects received DTI and structural magnetic resonance imaging scans .Voxel-based analysis was performed to investigate brain regions fractional anisotropy (FA) values .Results Statistics revealed that schizophrenia patients showed significant FA reduction in left inferior frontal gyrus ,left temporal gyrus ,left occipital lobe and right middle temporal gyrus as compared to healthy subjects .Conclusion Deficits of white matter integrity in widespread brain regions of the first episode neuroleptic-na?ve early-onset schizophrenia patients .The presence of white matter abnormalities in the early-onset patients is suggestive of being related to the etilology of schizophrenia .

Evaluación y tratamiento de la esquizofrenia en niños y adolescentes: una revisión actualizada / Assessment and treatment of schizophrenia in children and adolescents: a current review

Schizophrenia is a severe and chronic disorder affecting children, adolescents and adults. The international recommendations for the treatment of pediatric patients with this disorder point to a comprehensive management which includes early detection programs, pharmacological and psychosocial treatment. A review of current information regarding the efficacy and safety of antipsychotics in children and adolescents, as well as the effect of psychosocial interventions on the academic and social functioning of patients with early onset schizophrenia is presented. The pharmacological treatment's goal is to achieve optimal outcome with the lowest effective dose and the fewest side effects. It should be started with an antipsychotic that has been evaluated on its efficacy and safety in this age group. Risperidone, olanzapine and aripiprazole have been approved for the treatment of schizophrenia in adolescents, clozapine has shown greater efficacy for the treatment resistant condition. The side effects of these drugs must be monitored during treatment. The psychosocial treatment objectives are to provide information, to promote the patient's adaptation, to reduce comorbidity and to prevent relapses through psychoeducation, psychotherapy and rehabilitation programs. The psychoeducation programs include information about the characteristics and causes of the illness, the available treatment choices and the factors associated to recovery or relapse. Psychotherapy in schizophrenia has been examined in individual, group and family modalities, the cognitive behavioral therapy has demonstrated efficacy on cognition, social adjustment and quality of life. The rehabilitation programs include the training on social skills, cognitive remediation therapy and exercise programs, which would increase the wellbeing of patients and reduce metabolic alterations associated to the use of antipsychotics. In conclusion, the treatment of patients with early onset schizophrenia must be multimodal and directed to improve their long term outcome.

La esquizofrenia es un trastorno prevalente, crónico e incapacitante en niños, adolescentes y adultos. Las recomendaciones internacionales para su tratamiento en edad pediátrica incluyen programas de detección temprana y tratamiento farmacológico y psicosocial. El presente trabajo muestra una revisión actualizada de la eficacia y la seguridad de los antipsicóticos en niños y adolescentes, así como el efecto de las intervenciones psicosociales en el funcionamiento académico y social en pacientes con esquizofrenia de inicio temprano. La meta del tratamiento farmacológico es lograr un resultado óptimo a dosis mínimas efectivas del antipsicótico y tener el menor número de efectos secundarios. Deben de considerarse los antipsicóticos evaluados en estudios controlados en edad pediátrica. La risperidona, la olanzapina y el aripiprazol han sido aprobados por la FDA para el tratamiento de la esquizofrenia en adolescentes; la clozapina ha mostrado mayor eficacia en el tratamiento de la psicosis resistente, sus efectos adversos deben de ser monitorizados durante su uso. El tratamiento psicosocial brinda información al paciente y su familia, promueve la adaptación y disminuye la comorbilidad para prevenir recaídas, por medio de programas de psicoeducación, psicoterapia y rehabilitación. Los programas de psicoeducación incluyen la información acerca de la enfermedad y sus causas, los tratamientos disponibles y los factores asociados a las recaídas. La psicoterapia puede darse en el contexto individual, familiar o grupal, de acuerdo a las necesidades del paciente. La terapia cognitivo conductual ha mostrado eficacia en la adaptación social, cognitiva y en la calidad de vida. Los programas de rehabilitación incluyen entrenamiento en habilidades sociales, rehabilitación cognitiva y un programa de acondicionamiento físico para promover el bienestar general del paciente y evitar la aparición de los efectos secundarios sobre el metabolismo. En conclusión, la esquizofrenia en niños y adolescentes requiere de tratamiento multidisciplinario a fin de mejorar el pronóstico de los pacientes.

Brain functional connectivity of functional magnetic resonance imaging of patients with early-onset schizophrenia / 中南大学学报(医学版)

Objective To detect whether and where brain functional connectivity exists in the resting state of patients with early-onset schizophrenia by using functional magnetic resonance imaging (fMRI). Methods Nineteen early-onset schizophrenic patients were diagnosed with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) of American Psychiatric Association. The 19 early-onset schizophrenic patients and another 19 healthy volunteers underwent fMRI in resting state. Cingulate gyrus was selected as region of interest and the difference was analyzed in the cingulate gyrus functional connectivity pattern between the 19 patients with early-onset schizophrenia (EOS) and 19 matched controls using resting-state fMRI. A two-sample t test was performed on the individual in a voxel by voxel manner. Results Statistical map was set a combined threshold of P＜0.005 and the number of voxel>20. Functional connectivity in the resting state was abnormal in the patients,including decreased functional connectivity and increased functional connectivity. The abnormal area was distributed all over the brain. The brain area with decreased functional connectivity included bilateral posterior cerebellar lobes, superior frontal gyrus, middle frontal gyrus, gyrus rectus,hippocampus, cuneus gyrus,fusiform gyrus,middle occipital gyrus,inferior occipital gyrus, right inferior temporal gyrus,right middle temporal gyrus, and right angular gyrus. The brain area with increased functional connectivity included left middle temporal and left inferior temporal gyrus. Conclusion Abnormal cingulate gyrus functional connectivity of schizophrenia might exist in the resting state. Resting state fMRI is important for the research of schizophrenia.

Regional Cerebral Perfusion Abnormalities Assessed with Brain SPECT in Early-onset Schizophrenia: Statistical Parametric Mapping Analysis

OBJECTIVES: A voxel based investigation of cerebral blood flow was conducted to identify functional differences during resting state between children with early-onset schizophrenia and normal controls. METHODS: 19 children and adolescents with early-onset schizophrenia(8 boys and 11 girls, mean age 14.0+/-1.7 years old) and 17 comparison children(13 boys and 4 girls, mean age 11.0+/-1.9 years old) were examined by HMPAO-SPECT. The SPECT images were compared using statistical parametric mapping analyses, controlling for age and sex. RESULTS: Increased cerebral blood flow in left medial and inferior frontal gyrus, right superior and middle frontal gyrus, both inferior temporal gyrus, and right cerebellar tonsil was found in children and adolescents with early-onset schizophrenia compared to control subjects. In addition, decreased cerebral blood flow in right thalamus, left posterior cingulate gyrus, right anterior cingulate gyrus and relatively wide areas from left medical frontal gyrus to superior parietal lobule were found in children and adolescents with early-onset schizophrenia compared to control subjects. CONCLUSION: The results of the current study provide additional evidences for brain areas involving the onset of schizophrenia in early age.

Brain Imaging Studies in Child & Adolescent Psychiatry / 신경정신의학

Brain imaging techniques in child and adolescent psychiatry are developing at an astonishing speed. Neuroimaging techniques in the field of psychiatry have yielded many meaningful and significant scientific results. Until 1980's, its application in child and adolescent psychiatry has been somewhat limited by technical and ethical reasons. Recently, however, there are cascade of neuroimaging studies in the field of child and adolescent psychiatry owing to rapid progression of the technical aspect of imaging and confirmation of the safety of human young subjects. In this article, we summarize scientific results in neuroimaging of child and adolescent psychiatric field from early 1990's up until now. We described the advantages, disadvantages and application of diverse structural and functional imaging techniques and suggest future prospect on imaging techniques.

Brain MRI Findings for the Patient with the Late Onset Schizophrenia: Comparison among Patients with the Early Onset Schizophrenia, Progressive Schizophrenia, Senile Dementia and Controls

With increasing tendency of incidence and interest for the late onset schzophrenia, concerns about whether this disorder is etiologically or phenomenogically distinctive entity or not have increased also. To clarify the disease entity of the late onset schzophrenia and the role of structural brain changes in its etiology, authors tried to prove following hypothesis : Are there any evidences of structural brain changes in the late-onset schizophrenia? ; If present, are they not different from those of the early-onset schizophrenia or progressive schizophrenia? ; And are they not different from those of senile dementia? Subjects were 6 patients with the late-onset schizophrenia, 6 patients with the early-onset schizophrenia, 6 patients with progressive schizophrenia, 6 patients with Alzheimer's dementia, and 6 controls. We measured regions of interest of the magnetic resonance images by computer assisted planimetry using the AutoCad and digitizer. Our study results may suggest that the third ventricular enlargement and a reversal of normal difference between left and right temporal lobe and left-right difference in posterior lateral ventricle are common brain pathology for all type of schizophrenia including the late onset schzophrenia. And also suggest that brain structural changes of the late onset schizophrenia are related with neurodevelopmental abnormality rather than degenerative change.