Efficacy and Safety of Paliperidone Palmitate Treatment in Patients With Schizophrenia: A Real-World Multicenter, Retrospective, Mirror-Image Study.

PURPOSE: The aim of the study was to assess efficacy and safety of paliperidone palmitate (PP) in schizophrenic patients using real-life data. METHODS: This national, multicenter, retrospective, and mirror-image study was performed reviewing the medical records of patients in 18 centers. Adult schizophrenic patients receiving PP treatment (n = 205) were enrolled. Patients' data covering the last 12 months before the initial PP injection and the period until the end of study with at least 12 months after the initial PP injection were evaluated. Patients' characteristics, scale scores, and adverse events were recorded. RESULTS: Nonadherence to prior medication was the most frequent reason for switching to PP treatment. Comparing with the period before PP treatment, the rate of patients visiting the hospital for relapse (79.5% vs 28.9%, P < 0.001) and the median number of hospitalizations (2 vs 0, P < 0.001) were lower during PP treatment. During PP treatment, the Positive and Negative Syndrome Scale score decreased by 20% or more (response to treatment) in 75.7% of the patients. The frequency of adverse events did not differ between the period before and during PP treatment. Improvement in functionality was higher in those with disease duration of 5 years or less. CONCLUSIONS: Paliperidone palmitate is effective and safe in treatment of schizophrenic patients and in switching to PP treatment in patients with schizophrenia, which reduced the percentage of patients admitted to the hospital for relapse and the median number hospitalization, and has positive effects on functionality.

Brain regions associated with risk and resistance for bipolar I disorder: a voxel-based MRI study of patients with bipolar disorder and their healthy siblings.

OBJECTIVE: Bipolar I disorder is a highly heritable disorder but not all siblings manifest with the illness, even though they may share similar genetic and environmental risk factors. Thus, sibling studies may help to identify brain structural endophenotypes associated with risk and resistance for the disorder. METHODS: Structural magnetic resonance imaging (MRI) scans were acquired for 28 euthymic patients with bipolar disorder, their healthy siblings, and 30 unrelated healthy controls. Statistical Parametric Mapping 8 (SPM8) was used to identify group differences in regional gray matter volume by voxel-based morphometry (VBM). RESULTS: Using analysis of covariance, gray matter analysis of the groups revealed a group effect indicating that the left orbitofrontal cortex [Brodmann area (BA) 11] was smaller in patients with bipolar disorder than in unrelated healthy controls [F = 14.83, p < 0.05 (family-wise error); 7 mm(3) ]. Paired t-tests indicated that the orbitofrontal cortex of patients with bipolar disorder [t = 5.19, p < 0.05 (family-wise error); 37 mm(3) ] and their healthy siblings [t = 3.89, p < 0.001 (uncorrected); 63 mm(3) ] was smaller than in unrelated healthy controls, and that the left dorsolateral prefrontal cortex was larger in healthy siblings than in patients with bipolar disorder [t = 4.28, p < 0.001 (uncorrected); 323 mm(3) ] and unrelated healthy controls [t = 4.36, p < 0.001 (uncorrected); 245 mm(3) ]. Additional region-of-interest analyses also found volume deficits in the right cerebellum of patients with bipolar disorder [t = 3.92, p < 0.001 (uncorrected); 178 mm(3) ] and their healthy siblings [t = 4.23, p < 0.001 (uncorrected); 489 mm(3) ], and in the left precentral gyrus of patients with bipolar disorder [t = 3.61, p < 0.001 (uncorrected); 115 mm(3) ] compared to unrelated healthy controls. CONCLUSIONS: The results of this study suggest that a reduction in the volume of the orbitofrontal cortex, which plays a role in the automatic regulation of emotions and is a part of the medial prefrontal network, is associated with the heritability of bipolar disorder. Conversely, increased dorsolateral prefrontal cortex volume may be a neural marker of a resistance factor as it is part of a network of voluntary emotion regulation and balances the effects of the disrupted automatic emotion regulation system.

Gray matter changes in patients with deficit schizophrenia and non-deficit schizophrenia.

OBJECTIVES: Reduced gray matter volume is a frequently reported finding in brain imaging studies performed with schizophrenia patients. Some studies suggest a probable link between the negative symptoms of schizophrenia and gray matter loss; however, some of the negative symptoms observed in schizophrenia patients are not primarily linked to the core of schizophrenia. This study aimed to compare gray matter volumes in patients with primary negative symptoms (deficit schizophrenia [DS]), non-DS (NDS) patients, and healthy controls. MATERIALS AND METHODS: The study included 11 DS patients, 18 non-DS patients, and 17 healthy controls. Magnetic resonance imaging (MRI) was performed using a 1.5 Tesla MR unit. The Schedule for Deficit Syndrome (SDS) was used to determine which patients were DS and non-DS. MR images were compared using voxel-based morphometry (VBM) analysis. RESULTS: Contrary to expectations, no evidence to support less gray matter in DS patients than in NDS patients was observed. Furthermore, NDS patients had less gray matter volume in several brain regions (frontal and temporal cortices) than did the DS patients. All patients had perisylvian gray matter volume deficits, though the NDS patients had more widespread volume deficiencies. CONCLUSION: No evidence to support the hypothesis that DS patients have less gray matter volume than those of NDS patients was observed. On the contrary, DS patients had more gray matter volume in some regions; the differences observed in gray matter volume in these brain regions between the 2 patient groups may be responsible for the differences in their clinical manifestations.