Clinical Correlators of Homelessness in Patients with Schizophrenia: Focused on Social Function / 신경정신의학

OBJECTIVES: The purpose of this study is to investigate the differences between homeless with schizophrenia and non-homeless with schizophrenia, and to identify the correlators of homelessness in schizophrenic patients. METHODS: Forty two schizophrenic inpatients were divided into the homeless group (n=19) and non-homeless group (n=23). Psychopathologic measures, neurocognitive tests, hinting task, and the Social and Occupational Function Assessment Scale (SOFAS) were administered in both groups. RESULTS: SOFAS showed high correlation with homelessness in schizophrenic inpatients. Duration of Untreated Psychosis, negative component of Positive and Negative Syndrome Scale, Continuous Performance Test (CPT) correct number, and hinting task were all mediated by SOFAS to explain homelessness in schizophrenic inpatients. In particular, CPT correct number showed direct correlation with homelessness without mediation by SOFAS. CONCLUSION: The results of this study suggest that cognitive rehabilitation and social skill training may be helpful in prevention of homelessness of schizophrenic patients. Social cognition and neurocognitive test including CPT may be useful for evaluating the risk of homelessness in schizophrenic patients.

Diagnosis of psychiatric disorders of the eldery

Korea is rapidly aging society and psychiatric disorders of the elderly increasing Korea is rapidly becoming an aging society and psychiatric disorders of the elderly are increasing significantly in importance. Interviewing the elderly requires special skills because of their physical weakness and cognitive impairments such as difficulty concentrating. There are various diagnostic tools for them, for more accurate diagnosis. Representative scales include the Mini-Mental Status Examination for dementia, the Geriatric Depression Scale for depression, and the Confusional Assessment Method for delirium. Differential diagnosis of psychiatric disorders from cerebral and physical disorders is important.

Schizophrenia in Late Life

This article has reviewed general characters of schizophrenia in late life. Specifically, it has reviewed epidemiology, course, and several results of biological researches and so on of schizophrenia in old age. Then, it has studied effect and safety of antipsychotics for schizophrenia in old age. Conclusively, considering understanding on the concept of schizophrenia and importance of the increasing olds in mental health, the magnitude of schizophrenia in old age will grow serious.

Volumetric Brain MRI Study in Patients with First Episode Schizophrenia / 신경정신의학

OBJECTIVES: To demonstrate the structural pathogenesis of schizophrenia, this study measures cerebral and cerebellar volumes of antipsychotics-navie and first episode schizophrenic patients. Also this study analyzes morphological character of patients with early schizophrenia. METHODS: Volume segmentation incorporating MRI scanning was performed on 25 patients with schizophrenia(mean age: 31.2+/-7.85yr, ranging: 14-18yr) and a control group of 29 healthy dindividuals(mean age: 29.03+/-7.02yr, ranging: 18-42yr). To carry out segmentation, the cerebrum and cerebellum were partitioned by gray matter, white matter and cerebrospinal fluid using a probabilistic histologic algorithm. These images of the segments were defined as the frontal, parietal, temporal and occipital lobes and cerebellum by using the semi-automated technique based on the atlas developed by Talairach. The area of dimension for each fraction was measured and its symmetry was compared. A statistical analysis was performed using the analysis of covariance by compensating the total brain volume with the level of covariance. RESULTS: The total brain volume of the schizophrenic patient group was significantly smaller than that of the control group(t=-1.986, d.f.=38.97, p=0.05). Female patients with schizophrenia showed a smaller right cerebellar volume than the female controls(F=4.20, d.f.=(1,51), p=0.046). Female with schizophrenia showed a larger left frontal white matter volume than their female controls and male with schizophrenia showed a smaller right frontal white matter volume than their male controls(F=6.89, d.f.=(1,51), p=0.012). Male patients with schizophrenia showed a larger right occipital white matter volume than the male controls. Females with schizophrenia showed a larger left occipital white matter volume than their female controls and male with schizophrenia showed a smaller left occipital white matter volume than their male controls(F=3.97, d.f.=(1,51), p=0.050). Female patients with schizophrenia showed a larger parietal white matter volume than the female controls(F=6.14, d.f.=(1,51), p=0.017). Female patients with schizophrenia also showed a smaller right and left cerebellar gray matter volume than the female controls(F=3.90, d.f.=(1,51), p=0.050). Female patients with schizophrenia also showed a smaller temporal gray matter volume than the female controls(F=4.74, d.f.=(1,51), p=0.034). CONCLUSION: These results demonstrate that the cerebellum and frontal lobe are involved in pathogenesis of schizophrenia, difference of white matter between schizophrenic patient and control is an important finding that suggest the importance of cortical dysconnection syndrome as pathophysiology on schizophrenia, and these findings suggest that pathogenesis of schizophrenia include many areas of brain.

Clinical Study of Clozapine Treatment and Predictors of Response in Schizophrenia / 대한정신약물학회지

OBJECTIVES: To search for the predictive clinical variables of the schizophrenic patients who responded to clozapine, the authors studied retrospectively the clinical variables of the schizophrenics who were treated with clozapine at least for 6 months at outpatient and inpatient department of Inha University Hospital. METHODS: Thee subjects were schizophrenic patients who satisfied DSM-IV diagnostic criteria and were treated with clozapine at least for 6 months at outpatient and inpatient department. 41 schizophrenic patients were used with clozapine, but 13 patients were excluded because of insufficient length and data, so 28 patients were analyzed finally. All ssubjects are divided into responder and non-responder by the CGI scores. Using SAS package program, all data were analyzed by Fisher's exact test, Mantel-Haenczel chi test and multiple regression test. RESULTS: Among the total 28 schizophrenic patients(male 18, female 10), 15 schizophrenics were responded with clozapine treatment. Age of onset, number of negative symptoms and clinical subtypes were significantly different from two groups and gender, mode of onset, number of hospitalizations, duration of hospitalization, family history of psychosis, maximal dose of clozapine and duration of clozapine treatment did not show significant difference between two groups. CONCLUSIONS: This study suggest that there is some schizophrenic patients who responded well with clozapine treatment. The characteristics of the responding group were older age of onset, a few negative symptoms and paranoid subtype.

An MRI Study of Cavum Septi Pellucidi in Schizophrenia and Mood Disorder / 신경정신의학

OBJECTIVES: This study was designed to verify neuro-developmental hypothesis of schizophrenia and mood disorder. METHOD: We performed Brain Magnetic Resonance Imaging study in 34 schizophrenic patients, 18 mood disorder patients and 22 controls and compared the incidence and the size of carum septi pellucidi (CSP). RESULTS: The incidences of CSP in schizophrenia, mood disorder and controls were 61%, 61%, and 41%, respectively. The incidences of large CSP, defined as largest diameter larger than 3mm in T1-weighted image, were 24% in schizophrenic patients, 11% in mood disorder patients, and 5% in controls. But they didn't show statistically significant differences. CONCLUSION: We could find the tendency that the incidence of CSP was high as following order; schizophrenia, mood disorder, controls. But it was not statistically significant difference. To verify neuro-developmental hypothesis, we need larger pool of patients and better study design.

Preliminary MRI Study of Cavum Septi Pellucidi in Schizophrenia / 신경정신의학

OBJECTIVES: To test the neurodevelopmental hypothesis of the schizophrenia, we compared MR brain scans of schizophrenic patients with headache patients. METHOD: We conducted 7mm-slice magnetic resonance imaging study to evaluate the prevalence of CSF in a sample of 28 headache patients and 23 schizophrenic patients. All subjects are right-handed person by Annett's questionaires. RESULTS: Any size CSF was fecund 13/23(56.5%)schizophrenics and 16/28(57.1%) of headache patients. But larger CSF was found 26.1% of schizophrenics and 10.7% of headache patients. No statistically significant difference in gender and clinical subtype. CONCLUSIONS: Higher incidence of CSF in schizophrenic patients supports the hypothesis that anomalous development of the brain is an important aspect of the schizophrenia.

Risperidone Treatment of Organic Delusional Disorder in Elderly Patient / 대한정신약물학회지

Conventional neuroleptic treatment of organic delusional disorder can induce many serious side effects including extrapyramidal symptoms, sedation and tardive dyskinesia, especially in elderly patients. Risperidone is an atypical neuroleptics that is lack of severe extrapyramidal symptoms. This 68-year-old male case demonstrated that elderly patients with organic delusional disorder could be treated with risperidone without serious side effects.