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2018 Volume 30 Issue 3
In this issue
In this issue Dengtang Liu
Systematic review and meta-analysis
Research Progress in Biological Studies of Schizophrenia in China in 2017 Dengtang LIU, Haixin CEN, Kaida JIANG, Yifeng XU
Summary: Schizophrenia is a severe mental disorder and its etiology and pathological mechanism are unknown. This article mainly introduces the progress of biological studies of schizophrenia in China in 2017, including neuroimaging, genetics, and immunology studies. It also introduces the research progress of high risk psychotic syndrome and physiotherapy.
Key words: schizophrenia; biological psychiatry, China
Original research article
An Association Study on the Cognitive Function and the Cerebral Grey Matter Volume of Patients with First-Episode Schizophrenia Xinyue ZHANG, Jingjing YAO, Yiding LV, Xiaoxin ZHAO, Yuan LI, Yuxiu SUI, Zhiping DAI
Background: The impairment of cognitive function is one of the core symptoms in schizophrenia, and the degree of recovery is closely related to whether patients are able to rejoin society successfully.
Objective: This study was to clarify the correlation between cognitive function and cerebral grey matter volume in schizophrenia.
Methods: The neuro-cognitive functions of thirty-seven patients with first-episode schizophrenia (the patient group) and thirty healthy controls (the control group) was evaluated with the Clock Drawing Test, Trail Marking Test, Digit Span Test, Auditory Verbal Learning Test, Wisconsin Card Sorting Test, Verbal Fluency Test, Semantic Similarity Test and Stroop Color-Word Test. The facial emotion cognitive task was employed to assess the facial emotion cognitive functions of thirty-two patients with first-episode schizophrenia (the
patient group) and 29 healthy controls (the control group). The psychotic symptoms of patients with first episode schizophrenia were evaluated using the Positive and Negative Syndrome Scale (PANSS). The brain imaging data of the patient group and control group were collected using the magnetic resonance imagine (MRI).
Results: The difference between the patient group and the control group in the results of Clock Drawing Test, Trail Marking Test, Digit Span Test, Auditory Verbal Learning Test, Wisconsin Card Sorting Test, Verbal Fluency Test, Semantic Similarity Test and Stroop Color-Word Test’s reaction time were significant. These two groups' Slopes in the facial emotion cognitive task were also significantly different from each other. According to the comparison of cerebral grey matter volume between the patient group and the control group, it was found that the grey matter volume of the patient group increased in the left superior frontal gyrus, and decreased
in the left occipital gyrus, lingual gyrus and upper cerebellum. Based on the analyses of neuro-cognitive data and brain imaging data of the patient group, the scores of the number of correct responses in Stroop Color-Word Test’s Card C were negatively correlated with grey matter volumes of the left upper frontal gyrus, right upper frontal gyrus and middle frontal gyrus. The analyses on the facial emotion cognitive task and brain imaging data of the patient group showed that the slope data were positively correlated with grey matter volumes of the right superior temporal gyrus, middle temporal gyrus, left middle temporal gyrus, inferior temporal gyrus and fusiform gyrus.
Conclusion: There are general impairments in the neuro-cognitive functions and facial emotion cognitive functions of patients with first-episode schizophrenia, and the results suggest that brain areas with abnormal grey matter volumes are likely to be the brain structure and functional basis of the cognitive impairments.
Key words: first-episode schizophrenia; neuro-cognition; facial emotion cognition; grey matter volume
A Comparison Study of Working Memory Deficits between Patients with Methamphetamine-Associated Psychosis and Patients with Schizophrenia Hong GAN, Zhenhua SONG, Peiwei XU, Hang SU, Yingying PAN, Min ZHAO, Dengtang LIU
Background: Both patients with methamphetamine-associated psychosis (MAP) and patients with schizophrenia suffer from obvious cognitive deficits in working memory, and this affects the functional prognosis of patients.
Aim: This study is to investigate the difference of working memory deficits between patients with MAP and patients with schizophrenia, especially the difference of central executive system function, and the relevance of working memory deficits and clinical characteristics.
Methods: Twenty-eight male patients with MAP and twenty-eight patients with schizophrenia were recruited. The working memory of subjects was evaluated with the n-back task edited and adapted from English language materials. The positive syndrome scale of PANSS and CGI were employed to assess psychotic symptoms and the severity of patients.
Results: According to the results of repeated measure variance analysis, it was found that both the between group variable (group) and within-group variable (n) had significant main effects, and the interaction between the between-group variable and the within-group variable was also significant. After Z-transformation, mean (sd) working memory scores of patients with MAP and schizophrenia were 0.91 (0.77) and -0.91 (2.11) respectively, and the difference between these two groups were statistically significant (F=19.253, p
The relevance between working memory deficits and clinical characteristics was low in both the patients with MAP and patients with schizophrenia.
Conclusion: Patients with MAP were better at regulating, updating, executing and controlling active information than patients with schizophrenia.
Key words: methamphetamine-associated psychosis; schizophrenia; working memory; n-back task
Comparison of Olanzapine versus Other Second-Generation Antipsychotics in the Improvement of Insight and Medication Discontinuation Rate in Schizophrenia Hongbo HE, Yanling ZHOU, Mingzhe YANG, Xiongxiong LI, Yu-Tao XIANG, Jiandong LUO
Background: In the last decade, olanzapine became widely used in mental health service worldwide even after being criticized for its metabolic side effects. Patients with schizophrenia on olanzapine were usually found to stay on their medications longer than the other second-generation antipsychotics (SGAs) except clozapine. The reason for this is unknown.
Objective: This prospective study compared the influences of olanzapine and other SGAs except clozapine on improving insight and medication discontinuation rate in schizophrenia.
Methods: A total of 148 patients with schizophrenia medically indicated for initiation of treatment with olanzapine or other SGAs were evaluated for symptoms, insight, attitudes toward medication, side effects, body weight and fasting lipid and glucose parameters at admission and before discharge, and follow-up calls one-year after discharge documented whether they were regularly taking prescribed psychotropic medication or not.
Results: After an average of 72.8 days of inpatient treatment, the olanzapine and other SGAs group exhibited similar levels of symptom improvement with an average reduction of 28.7 in the Positive and Negative Syndrome Scale (PANSS) total score. The Olanzapine group exhibited better improvement in insight assessed using the G12 item of PANSS and Insight and Treatment Attitudes Questionnaire (ITAQ), more metabolic side effects indexed with total cholesterol, triglycerides levels and weight gain, and a lower medication
discontinuation rate than the other SGAs group.
Conclusion: Although general symptom improvement was similar, olanzapine significantly improved insight and presented less medication discontinuation compared to other SGAs, which might partially explain why patients on olanzapine stayed longer on their medications.
Key words: insight, medication discontinuation rate, olanzapine, second-generation antipsychotics, schizophrenia
The Effect of Repetitive Transcranial Magnetic Stimulation on the Reinstatement of Methamphetamine-Induced Conditioned Place Preference in Rats Xueqing WU, Yunyue JU, Dongliang JIAO, Min ZHAO
Background: The abuse of methamphetamine (METH) has become a public health problem worldwide. This type of new drug can not only lead to addiction but can also cause cognitive impairment. Currently, there is no effective treatment. Repetitive transcranial magnetic stimulation (rTMS) is a painless and noninvasive green physiotherapy which can be used in the clinical treatment of neuropsychiatric disorders such as depression, anxiety, schizophrenia, and Parkinson’s disease. However, whether it can be used to
treat methamphetamine addiction is unclear.
Objective: To explore the effect of rTMS on the relapse behavior of methamphetamine addiction.
Methods: METH-induced rats conditioned place preference (CPP) model and rTMS technique were used in this study. Rats were given high frequency(10Hz) rTMS treatment for one day (experiment 1) or three days (experiment 2) after the extinction of CPP behavior. The reinstatement test was performed 24 hours after rTMS treatment and the effects of acute and chronic rTMS on the reinstatement of METH-induced CPP in rats were explored.
Results: Acute rTMS treatment (1 day) had a trend of an inhibitory effect on the relapse behavior of METH-induced CPP, but it was not statistically significant compared with the sham stimulation group (t=1.48, p=0.431). However, chronic rTMS treatment (3 days) had a significant inhibitory effect on the reinstatement of METH-induced CPP compared with the sham stimulation group (t=3.33, p=0.004).
Conclusion: Chronic rTMS treatment inhibited the relapse behavior of METH-induced CPP in rats.
Key words: methamphetamine; repetitive transcranial magnetic stimulation; conditioned place preference; reinstatement.
Forum
Research Status and Strategies for Cognitive Function in Schizophrenia Ke MA, Chuan SHI
Case report
Hypokalemia Caused by Quetiapine and Risperidone Treatment in Schizophrenia: A Case Report Qiongwei YANG, Xiaoyun GUO, Dengtang LIU
Summary: Hypokalemia can cause abnormalities in multiple systems. Long term use of antipsychotic medications can lead to electrolyte imbalance, including hypokalemia. We report a 49-year-old female patient with schizophrenia who developed hypokalemia after oral quetiapine and risperidone treatments. Her blood potassium became normal after she switched to another antipsychotic drug (amisulpride). In addition, we discuss the potential mechanism of antipsychotic drugs leading to hypokalemia and clinical
cautions.
Key words: Hypokalemia, somatic, quetiapine, risperidone, antipsychotic drugs, schizophrenia
Biostatistics in psychiatry
Assessing the Accuracy of Diagnostic Tests Fangyu LI, Hua HE
Summary: Gold standard tests are usually used for diagnosis of a disease, but the gold standard tests may not be always available or cannot be administrated due to many reasons such as cost, availability, ethical issues etc. In such cases, some instruments or screening tools can be used to diagnose the disease. However, before the screening tools can be applied, it is crucial to evaluate the accuracy of these screening tools compared to the gold standard tests. In this assay, we will discuss how to assess the accuracy of a diagnostic test through an example using R program.
Key words: AUC; gold standard test; ROC analysis; ROC curve; sensitivity; specificity
Correspondence
Posterior Fossa Arachnoid Cyst Presenting as Negative Symptoms of Psychosis Soumitra DAS