ABSTRACT
BACKGROUND: This study has two main objectives: to describe the prevalence of undetected chronic obstructive pulmonary disease (COPD) in a clinical sample of smokers with severe mental illness (SMI), and to assess the value of the Tobacco Intensive Motivational Estimated Risk tool, which informs smokers of their respiratory risk and uses brief text messages to reinforce intervention. METHOD: A multicenter, randomized, open-label, and active-controlled clinical trial, with a 12-month follow-up. Outpatients with schizophrenia (SZ) and bipolar disorder were randomized either to the experimental group-studied by spirometry and informed of their calculated lung age and degree of obstruction (if any)-or to the active control group, who followed the 5 A's intervention. RESULTS: The study sample consisted of 160 patients (71.9% SZ), 78.1% of whom completed the 12-month follow-up. Of the patients who completed the spirometry test, 23.9% showed evidence of COPD (77.8% in moderate or severe stages). TIMER was associated with a significant reduction in tobacco use at week 12 and in the long term, 21.9% of patients reduced consumption and 14.6% at least halved it. At week 48, six patients (7.3%) allocated to the experimental group achieved the seven-day smoking abstinence confirmed by CO (primary outcome in terms of efficacy), compared to three (3.8%) in the control group. CONCLUSION: In this clinical pilot trial, one in four outpatients with an SMI who smoked had undiagnosed COPD. An intensive intervention tool favors the early detection of COPD and maintains its efficacy to quit smoking, compared with the standard 5 A's intervention.
Subject(s)
Mental Disorders , Pulmonary Disease, Chronic Obstructive , Smoking Cessation , Humans , Mental Disorders/diagnosis , Mental Disorders/epidemiology , Motivation , Pulmonary Disease, Chronic Obstructive/diagnosis , Pulmonary Disease, Chronic Obstructive/epidemiology , SmokingABSTRACT
PURPOSE: This study was performed to identify the predictive factors of functional capacity assessed by the Spanish University of California Performance Skills Assessment (Sp-UPSA) and real-world functioning assessed by the Spanish Personal and Social Performance scale (PSP) in outpatients with schizophrenia. METHODS: Naturalistic, 6-month follow-up, multicentre, validation study. Here, we report data on 139 patients with schizophrenia at their baseline visit. ASSESSMENT: Positive and Negative Syndrome Scale (PANSS), Clinical Global Impression-Severity (CGI-S), Sp-UPSA and PSP. STATISTICS: Pearson's correlation coefficient (r) was used to determine the relationships between variables, and multivariable stepwise linear regression analyses to identify predictive variables of Sp-UPSA and PSP total scores. RESULTS: Functional capacity: scores on the PSP and PANSS-GP entered first and second at P<0.0001 and accounted for 21% of variance (R(2)=0.208, model df=2, F=15.724, P<0.0001). Real-world functioning: scores on the CGI-S (B=-5.406), PANSS-N (B=-0.657) and Sp-UPSA (B=0.230) entered first, second and third, and accounted for 51% of variance (model df=3, F=37.741, P<0.0001). CONCLUSION: In patients with schizophrenia, functional capacity and real-world functioning are two related but different constructs. Each one predicts the other along with other factors; general psychopathology for functional capacity, and severity of the illness and negative symptoms for real-world functioning. These findings have important clinical implications: (1) both types of functioning should be assessed in patients with schizophrenia and (2) strategies for improving them should be different.
Subject(s)
Activities of Daily Living , Schizophrenia/diagnosis , Social Adjustment , Task Performance and Analysis , Adaptation, Psychological , Adult , Female , Humans , Male , Middle Aged , Psychometrics , Regression Analysis , Schizophrenic PsychologyABSTRACT
Schizophrenia is a heterogeneous clinical condition that may reflect a variety of biological processes. In particular, treatment-resistant (TR) schizophrenia may have a distinct neurobiological substrate. Within the context of clinical data, a simultaneous study with different imaging techniques could help to elucidate differences in cerebral substrates among schizophrenia patients with different responses to treatment. In the present work we used a set of biological data (basal and longitudinal volumetry, and P300 event-related potential measurements) to compare TR and treatment-responsive chronic schizophrenia patients with healthy controls. The TR patients showed higher baseline clinical scores, a more severe basal profile of brain alterations, as well as a different outcome as regards to volume deficits. These data support the notion that biological substrates vary among groups of different psychotic patients, even when they have the same diagnosis, and that those substrates may be related to the response to treatment.
Subject(s)
Antipsychotic Agents/therapeutic use , Event-Related Potentials, P300/drug effects , Event-Related Potentials, P300/physiology , Schizophrenia , Adult , Brain Mapping , Electroencephalography/methods , Female , Humans , Longitudinal Studies , Magnetic Resonance Imaging/methods , Male , Middle Aged , Psychiatric Status Rating Scales , Schizophrenia/drug therapy , Schizophrenia/pathology , Schizophrenia/physiopathology , Sensitivity and Specificity , Statistics, NonparametricABSTRACT
OBJECTIVES: A study of N-acetyl-aspartate (NAA) can provide data of interest about cortical alterations in psychotic illnesses. Although a decreased NAA level in the cerebral cortex is a replicated finding in chronic schizophrenia, the data are less consistent for bipolar disease. On the other hand, it is likely that NAA values in schizophrenia may differ in men and women. METHODS: We used proton magnetic resonance spectroscopy ((1)H MRS) to examine NAA levels in the prefrontal cortex in two groups of male patients, one with schizophrenia (n=11) and the other with bipolar disorder (n=13) of similar duration, and compared them to a sample of healthy control males (n=10). Additionally, we compared the degree of structural deviations from normal volumes of gray matter (GM) and cerebrospinal fluid (CSF) in the dorsolateral prefrontal cortex. RESULTS: Compared to controls, schizophrenia and bipolar patients presented decreased NAA to creatine ratios, while only the schizophrenia group showed an increase in CSF in the dorsolateral prefrontal region. There were no differences in choline to creatine ratios among the groups. CONCLUSIONS: These data suggest that the decrease in NAA in the prefrontal region may be similar in schizophrenia and bipolar disorder, at least in the chronic state. However, cortical CSF may be markedly increased in schizophrenia patients.
Subject(s)
Aspartic Acid/analogs & derivatives , Bipolar Disorder/physiopathology , Image Processing, Computer-Assisted , Magnetic Resonance Imaging , Magnetic Resonance Spectroscopy , Prefrontal Cortex/physiopathology , Schizophrenia/physiopathology , Adult , Aspartic Acid/metabolism , Bipolar Disorder/diagnosis , Bipolar Disorder/pathology , Cerebrospinal Fluid/physiology , Choline/metabolism , Chronic Disease , Creatine/metabolism , Fourier Analysis , Humans , Male , Nerve Fibers, Myelinated/pathology , Prefrontal Cortex/pathology , Reference Values , Schizophrenia/diagnosis , Schizophrenia/pathologyABSTRACT
Previous data show that the effects of clozapine on regional brain activity are different from those of other antipsychotic agents. It seemed of interest to study the brain activity patterns after treatment with clozapine, since this drug might correct basal deficits directly related to schizophrenia or instead induce changes that would in some way compensate distant abnormalities. In order to study the activity pattern resulting from clozapine treatment we have used FDG-PET and statistical parametric mapping (SPM) to explore the functional status of patients after chronic treatment with this drug, We compared their metabolic activity with normal controls and neuroleptic-naive (NN) patients, with the aim to identify if a reversion of pre-existing deficits or a induction of different changes was the result of clozapine administration. We compared metabolic patterns in 23 treatment-resistant (TR) patients after 6 months of treatment with clozapine, eighteen healthy subjects, and 17 NN schizophrenia patients. After treatment with clozapine, TR patients showed a clear hypofrontality and caudate hypometabolism in comparison with both the controls and NN patients, and also a lower thalamic activity than the healthy controls. In conclusion, our results support a preferential role for prefrontal regions and their subcortical connections in the mechanism of action of clozapine, resulting in a clearly hypofrontal state as compared to both controls and schizophrenia patients without previous treatment.
Subject(s)
Antipsychotic Agents/adverse effects , Clozapine/adverse effects , Frontal Lobe/drug effects , Frontal Lobe/metabolism , Positron-Emission Tomography , Schizophrenia/diagnostic imaging , Schizophrenia/drug therapy , Adult , Caudate Nucleus/drug effects , Caudate Nucleus/metabolism , Female , Fluorodeoxyglucose F18/pharmacokinetics , Follow-Up Studies , Humans , Magnetic Resonance Imaging , Male , Prefrontal Cortex/drug effects , Prefrontal Cortex/metabolism , Radiopharmaceuticals/pharmacokinetics , Thalamus/drug effects , Thalamus/metabolismABSTRACT
BACKGROUND: Decreased metabolic activity in the prefrontal cortex during cognitive activation is a recurrent finding and a likely functional marker of schizophrenia. AIMS: To investigate the occurrence of hypofrontality in patients with first-episode psychosis, with or without evolution to schizophrenia. METHOD: We used fluorodeoxyglucose positron emission tomography during the performance of an attention task and magnetic resonance imaging to study the dorsolateral prefrontal region in 13 men with a first episode of psychosis. Data from patients who progressed to schizophrenia were compared with those of patients who did not meet criteria for this diagnosis after 2 years. RESULTS: Patients who developed schizophrenia demonstrated a significant hypofrontality in the dorsolateral prefrontal cortex in comparison with the non-schizophrenia and control groups. CONCLUSIONS: Our results suggest that hypofrontality could be a marker of schizophrenia at the time of the first psychotic episode, in agreement with neurodevelopmental theories of schizophrenia.
Subject(s)
Prefrontal Cortex/metabolism , Psychotic Disorders/metabolism , Adult , Brain Mapping/methods , Disease Progression , Fluorodeoxyglucose F18 , Follow-Up Studies , Humans , Image Processing, Computer-Assisted/methods , Magnetic Resonance Imaging/methods , Male , Positron-Emission Tomography/methods , Prefrontal Cortex/diagnostic imaging , Psychiatric Status Rating Scales , Psychotic Disorders/diagnostic imaging , Radiopharmaceuticals , Schizophrenia/diagnostic imaging , Schizophrenia/metabolismABSTRACT
The existence of neurodegeneration is a debated issue in schizophrenia research. The P300 component of event-related electrical potentials (ERP) has been related to the different degree of damage to gray and white matter. This study explores the possible relationship between P300 amplitude and/or latency and the existence of degenerative processes in schizophrenia, by assessing its correlation with volume of sulcal CSF and duration of illness, as transversal indicators of neurodegeneration. Nineteen patients (14 males, 5 females) and 13 controls (6 males, 7 females) were studied with MRI and electrophysiological records (P300). The possible influence of sex and age at the time of the exploration was statistically controlled in both groups. The results show a significant negative correlation between P300 amplitude and prefrontal CSF volume in the patient group. A lower though still significant correlation was also found between P300 amplitude and duration of illness, whereas no correlation was found in the control group. These results support the hypothesis that P300 amplitude may be interpreted as a marker of neurodegeneration in schizophrenia.
Subject(s)
Event-Related Potentials, P300/physiology , Frontal Lobe/pathology , Frontal Lobe/physiopathology , Nerve Degeneration/pathology , Schizophrenia/physiopathology , Adolescent , Adult , Female , Humans , Magnetic Resonance Imaging , MaleABSTRACT
Las alucinaciones musicales son infrecuentes y se encuentran en la encrucijada de la práctica otológica, neurológica y psiquiátrica. No se dispone de suficiente información empírica como para conocer su función diagnóstica. Se presentan dos nuevos casos de alucinaciones musicales. El primero en el contexto de una psicosis de inicio tardío. En el segundo las alucinaciones aparecen de forma aguda en un paciente con una sordera bilateral antigua. Las alucinaciones musicales se han descrito en distintas situaciones clínicas: pérdida de la capacidad auditiva; lesiones cerebrales, procesos vasculares y encefalitis; consumo de sustancias psicoactivas y trastornos psiquiátricos. Dependiendo de la etiología la experiencia alucinatoria puede variar en la forma de comienzo, la familiaridad de lo escuchado, el tipo y el género musical, el origen de lo percibido, la localización, la presentación como único síntoma o acompañado de otra alteración de la sensopercepción u otra sintomatología psiquiátrica, la vivencia y el grado de insight. Las alucinaciones musicales son un fenómeno infrecuente y complejo. Clínicamente es posible que sean más frecuentes en la mujer y en la vejez. La etiología parece estar ligada a la sordera y otras enfermedades del oído, y a las lesiones cerebrales que afecten, predominantemente, al hemisferio no dominante. No parece probable que factores como la psicosis o los rasgos de personalidad influyan en el desarrollo de la mayoría de las alucinaciones musicales. En este trabajo, se presentan dos nuevos casos que vienen a confirmar la complejidad y riqueza de las alucinaciones musicales Alucinaciones musicales (AU)
