Transplantation of gut microbiota derived from patients with schizophrenia induces schizophrenia-like behaviors and dysregulated brain transcript response in mice.

Schizophrenia (SCZ), as a neurodevelopmental disorder and devastating disease, affects approximately 1% of the world population. Although numerous studies have attempted to elucidate the causes of SCZ occurrence, it is not clearly understood. Recently, the emerging roles of the gut microbiota in a range of brain disorders, including SCZ, have attracted much attention. While the molecular mechanism of gut microbiota in regulating the pathogenesis of SCZ is still lacking. Here, we first confirmed the difference of gut microbiome between SCZ patients and healthy controls, and then, we performed fecal microbiota transplantation (FMT) to clarify the roles of SCZ patients-derived microbiota in a specific pathogen free (SPF) mice model. 16 S rDNA sequencing confirmed that a significant difference of gut microbiome was present between two groups of FMT mice, which has a similar trend with the above human gut microbiome. Furthermore, we found that transplantation of fecal microbiota from SCZ patients into SPF mice was sufficient to induce schizophrenia-like (SCZ-like) symptoms, such as deficits in sociability and hyperactivity. Furthermore, the brains of mice colonized with SCZ microbiota displayed dysregulated transcript response and alternative splicing of SCZ-relevant genes. Moreover, 10 key genes were identified to be correlated with SCZ by an integrative transcriptome data analysis. Finally, 4 key genes were identified to be correlated with the 12 differential genera between two groups of FMT mice. Our results thus demonstrated that the gut microbiome might modify the transcriptomic profile in the brain, thereby modulating social behavior, and our present study can help better understand the link between gut microbiota and SCZ pathogenesis through the gut-brain axis.

Inflammation and comorbidities of chronic obstructive pulmonary disease: The cytokines put on a mask!

OBJECTIVE: Chronic obstructive pulmonary disease (COPD) is a well-known complex multicomponent disease characterized by systemic inflammation that frequently coexists with other conditions. We investigated the relationship between some inflammatory markers and complications in COPD patients to explore the possible roles of inflammation in these comorbidities. METHODS: This study used cross-sectional and case-control methods. We included 336 hospitalized COPD patients, 64 healthy controls, and 42 major depression patients and evaluated all participants using the Hamilton Rating Scale. C-reactive protein (CRP), red blood cell distribution width (RDW), neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), monocyte/lymphocyte ratio (MLR), interleukin-1ß (IL-1ß) and interleukin-6 (IL-6) were collected and measured in the study population. Statistical methods were used to analyze the association of inflammatory markers with COPD comorbidities. RESULTS: Cor pulmonale and psychological comorbidities (depression and anxiety) were more common in this study on COPD patients. We found that MLR (OR = 2.054, 95 % CI 1.129-3.735, p = 0.018) and RDW (OR = 1.367, 95 % CI 1.178-1.586, p = 0.000) were related to COPD patients complicated with cor pulmonale, while IL-6 (OR = 1.026, 95 % CI 1.001-1.053, p = 0.045) and RDW (OR = 1.280, 95 % CI 1.055-1.552, p = 0.012) were related to depression symptoms. CONCLUSION: MLR, RDW and IL-6 were closely related to cor pulmonale and depression in COPD patients. IL-1 ß and IL-6 are closely related to depression in humans.

A case of antipsychotic-induced psychomotor seizure.

A seizure is one of the most uncommon severe adverse side effects of antipsychotics. Clinical recognition rates for it are low, especially for psychomotor seizures. The authors present a case of psychomotor seizure caused by amisulpride to treat schizophrenia. A 60-year-old male patient in our hospital experienced a recent onset of repetitive, stereotyped involuntary and unconscious movements that began with amisulpride use. All of the symptoms disappeared following amisulpride withdrawal. His Naranjo Adverse Drug Reactions Probability Scale Score was 5 points. The case sheds light on the clinical risk of seizures related to antipsychotics.

Metformin in the Treatment of Amisulpride-Induced Hyperprolactinemia: A Clinical Trial.

Objective: To evaluate the efficacy and safety of metformin in the treatment of amisulpride-induced hyperprolactinemia. Methods: A total of 86 schizophrenic patients who developed hyperprolactinemia after taking amisulpride were screened and randomly assigned to the metformin group (42 patients) and placebo group (44 patients) and followed up for eight weeks. The patients' serum prolactin levels, blood glucose and lipids were measured at the baseline and the end of the intervention. The treatment emergent symptom scale (TESS) was also assessed. Results: After eight weeks of intervention, serum prolactin levels in the metformin group decreased from (1737.360 ± 626.918) mIU/L at baseline to (1618.625 ± 640.865) mIU/L, whereas serum prolactin levels in the placebo group increased from (2676.470 ± 1269.234) mIU/L at baseline to (2860.933 ± 1317.376) mIU/L. There was a significant difference in prolactin changes (Fcovariance = 9.982, P = 0.002) between the two groups. There was no significant difference in the incidence of adverse drug reactions (P > 0.05) between the two groups. Conclusion: Metformin is able to improve amisulpride-induced hyperprolactinemia with its safety.

Frequency of Self-reported Psychotic Symptoms among 2542 Outpatients at Their First Visit for Mental Health Services.

Objective: Psychotic symptoms are prevalent in both clinical settings and the general population. The distribution of psychotic symptoms across patients with different types of psychotic and non-psychotic mental disorders is helpful for understanding symptom specificity. This study aimed to explore the distribution differences of psychotic symptoms in an outpatient population in terms of frequency, age, gender, and psychotic and non-psychotic disorders.Methods: Outpatients were recruited consecutively at their first visit to the Shanghai Mental Health Center. Psychotic symptoms over the preceding year were self-reported through the PRIME Screen-Revised (PS-R) questionnaire. Seven categories of psychotic symptoms were grouped: perplexity and delusional mood (Item-1,5); first rank symptoms (Item-3,6,11); overvalued beliefs (Item-2,4); suspiciousness/persecutory ideas (Item-7), grandiose ideas (Item 8), perceptual abnormalities (Item-9,10), and disorganized communication (Item-12). Comparisons were made with respect to age group, sex, and diagnostic category.Results: Of 2542 outpatients, 1448(57.0%) were screened as positive, which was defined as having two or more symptoms with at least "somewhat agree" scores, ranging from 0 to 6. The threshold of one or more "yes" items was an endorsement to categorize the participant as positive for psychotic symptoms. The frequency of psychotic symptoms declined with age. Younger patients tended to report more psychotic symptoms than older patients(p < .001). Suspiciousness(p = .038) and disorganized communication (p = .004) were more common in females than males. Age, first rank symptoms, suspiciousness/persecutory ideas, grandiose ideas, and perceptual abnormalities were found to significantly differ between psychotic and non-psychotic disorders.Conclusions: Psychotic symptoms appear to be common in the clinical population and represent nonspecific indicators of psychopathology. The difference between psychotic and non-psychotic psychopathologies is more a function of the presence, frequency, and severity of psychotic symptoms.

Multiple Factor Analysis of Depression and/or Anxiety in Patients with Acute Exacerbation Chronic Obstructive Pulmonary Disease.

Objective: To reveal the risk factors, the symptom distribution characteristics, the clinical values of white blood cell counts (WBC counts), red blood cell distribution width (RDW), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and monocyte-to-lymphocyte ratio (MLR) in hospitalized patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) combined with depression and/or anxiety. Methods: The study included prospective cross-sectional and case-control studies, and was executed in the Affiliated Hospital of Zunyi Medical University, Guizhou, China. Previously diagnosed chronic obstructive pulmonary disease (COPD) patients who admitted to the hospital with AECOPD, patients with depression and/or anxiety, and healthy people were enrolled in the study. The Hamilton Rating Scales were used to assess all subjects, and the complete blood counts (CBC) were collected. Baseline data and clinical measurement data [spirometry, arterial blood gas analysis, and COPD evaluation test (the CAT scale)] from patients with AECOPD were collected. Results: Of the 307 patients with AECOPD included, 63.5% (N=195) had depressive and/or anxiety symptoms, and 36.5% (N=112) had no symptoms. Sex, respiratory failure, number of comorbidities, number of acute exacerbations in the previous year and the CAT score were closely related to AECOPD combined with depression and/or anxiety (p<0.05). The CAT scale score were the independent risk factor (OR=6.576, 95% CI 3.812-11.342) and significant predictor of AECOPD with depression and/or anxiety (AUC=0.790,95% CI 0.740-0.834); the patients with depression and/or anxiety were more severe and characteristic than the patients with AECOPD combined with depression and/or anxiety; RDW was associated with AECOPD with depression and/or anxiety (p=0.020, OR1.212,95% CI1.03-1.426), and had certain clinical diagnostic value (AUC=0.570,95% CI 0.531-0.626). Conclusion: Depression and anxiety should not be ignored in patients with AECOPD. The severity and quality of life of COPD were closely related to the occurrence of depression and/or anxiety symptoms. In most cases, perhaps depression and anxiety in AECOPD are only symptoms and not to the extents of the diseases. RDW had clinical diagnostic value in AECOPD combined with depression and/or anxiety. NLR, PLR, MLR, and RDW may become the novel indicators for evaluating the degree of inflammation of AECOPD and deserve further research.

How psychiatrists coordinate treatment for COVID-19: a retrospective study and experience from China.

BACKGROUND: Patients with COVID-19 are at high risk of developing mental health problems; however, the prevalence and management of mental disorders and how psychiatrists coordinate the treatment are unclear. AIMS: We aimed to investigate the mental health problems of patients infected with COVID-19 and to identify the role of psychiatrists in the clinical treatment team during the pandemic. We also share the experience of psychiatric consultations of patients with COVID-19 in Shanghai, China. METHODS: We analysed data from the psychiatric medical records of 329 patients with COVID-19 in the Shanghai Public Health Clinical Center from 20 January to 8 March 2020. We collected information including sociodemographic characteristics, whether patients received psychiatric consultation, mental health symptoms, psychiatric diagnoses, psychiatric treatments and severity level of COVID-19. RESULTS: Psychiatric consultations were received by 84 (25.5%) patients with COVID-19. The most common symptoms of mental health problems were sleep disorders (75%), anxiety (58.3%) and depressive symptoms (11.9%). The psychiatric consultation rate was highest in critically ill patients (69.2%), with affective symptoms or disturbed behaviour as their main mental health problems. Psychiatric diagnoses for patients who received consultation included acute stress reaction (39.3%), sleep disorders (33.3%), anxiety (15.5%), depression (7.1%) and delirium (4.8%). In terms of psychiatric treatments, 86.9% of patients who received psychiatric consultation were treated with psychotropic medications, including non-benzodiazepine sedative-hypnotic agents (54.8%), antidepressants (26.2%), benzodiazepines (22.6%) and antipsychotics (10.7%). Among the 76 patients who were discharged from the hospital, 79% had recovered from mental health problems and were not prescribed any psychotropic medications. The symptoms of the remaining 21% of patients had improved and they were prescribed medications to continue the treatment. CONCLUSIONS: This is the first study to report psychiatric consultations for patients with COVID-19. Our study indicated that a considerable proportion of patients with COVID-19, especially critically ill cases, experienced mental health problems. Given the remarkable effect of psychiatric treatments, we recommend that psychiatrists be timely and actively involved in the treatment of COVID-19.

Association of Folate Level in Blood with the Risk of Schizophrenia.

AIM AND OBJECTIVE: The aim of this study was to evaluate the association between folate level and the risk of schizophrenia and to identify possible biomarker for schizophrenia. MATERIALS AND METHODS: Data about folate were extracted from 16 high quality studies. The association of folate level in blood and schizophrenia was evaluated using standardized mean difference (SMD) and 95% confidence interval (CI). RESULTS: Totally 1183 (52.1%) cases and 1089 (47.9%) controls were included in the current metaanalysis. Folate level in schizophrenia patients was significantly lower than that in healthy controls (SMD= -0.65; 95% CI: [-0.86, -0.45]; P <0.00001). Subgroup analysis demonstrated that the decreased folate level was found in both Asian and European patients (SMD=-0.86, P<0.00001; SMD=-0.44, P<0.00001, respectively), while there were no significant differences in patients from other areas (P>0.05). Sensitivity analysis confirmed that these results were stable and reliable, no publication bias existed in our meta-analysis based on Egger's and Begg's tests (P=0.48 and 0.30, respectively). CONCLUSION: These results suggest that decreased folate may be a risk factor for schizophrenia. More epidemiological and biochemistry studies are required to describe how folate or folate supplementation play roles in the progress of schizophrenia.