Depression and Suicide Risk in Patients with Schizophrenia during the Treatment by Second Generation Antipsychotic Agents: A Mini-Review

Yasuhiro Kaneda 대한정신약물학회 2007 CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE Vol.5 No.1

This mini-review focuses on the depression and suicide risk in patients with schizophrenia during the treatment by second generation antipsychotic drugs. Regarding depressive symptoms and depressive illness in schizophrenia, several studies have found a relationship between negative or positive symptoms and depressive symptoms. Also,“revealed depression”,“akinetic depression”, or“pharmacogenic depression” is reported to explain the presence of depression in schizophrenia. There are several good reasons to consider that second generation antipsychotic drugs may prove to have at least somewhat superior effects on depression in schizophrenia than first generation antipsychotic drugs: their relatively weak blockade at D2 receptors, minimal serum prolactin elevations, and minimal extrapyramidal symptoms. Regarding suicide in schizophrenia, depression is one of the important factors for suicide. Second generation antipsychotic drugs particularly clozapine are thought to be effective for suicide in schizophrenia, via several proposed mechanisms including an antidepressant effect. Over all, second generation antipsychotic drugs are considered to be effective for both depression and suicide in schizophrenia. However, since patients would have strong psychological reactions to their symptom improvement, which would make a maladaptive or adaptive response, it should be noted that changes in awareness associated with treatment be carefully monitored regardless of medications we choose. This mini-review focuses on the depression and suicide risk in patients with schizophrenia during the treatment by second generation antipsychotic drugs. Regarding depressive symptoms and depressive illness in schizophrenia, several studies have found a relationship between negative or positive symptoms and depressive symptoms. Also,“revealed depression”,“akinetic depression”, or“pharmacogenic depression” is reported to explain the presence of depression in schizophrenia. There are several good reasons to consider that second generation antipsychotic drugs may prove to have at least somewhat superior effects on depression in schizophrenia than first generation antipsychotic drugs: their relatively weak blockade at D2 receptors, minimal serum prolactin elevations, and minimal extrapyramidal symptoms. Regarding suicide in schizophrenia, depression is one of the important factors for suicide. Second generation antipsychotic drugs particularly clozapine are thought to be effective for suicide in schizophrenia, via several proposed mechanisms including an antidepressant effect. Over all, second generation antipsychotic drugs are considered to be effective for both depression and suicide in schizophrenia. However, since patients would have strong psychological reactions to their symptom improvement, which would make a maladaptive or adaptive response, it should be noted that changes in awareness associated with treatment be carefully monitored regardless of medications we choose.

Prevalence of High Blood Pressure and its Relationship with Body Weight Factors among Inpatients with Schizophrenia in Taiwan

Yu-Li Lan,Tzy-Ling Chen 한국간호과학회 2012 Asian Nursing Research Vol.6 No.1

Purpose: The objective of this study was to document the prevalence of high blood pressure (BP) and to explore its relationship with weight among inpatients with schizophrenia. Additionally, other possible risk factors impacting BP levels in relation to patients’ demographic characteristics and use of atypical antipsychotic drugs and medications to reduce blood pressure were analyzed. Methods: Using medical records, demographic data, and results of physical examination, this crosssectional study investigated the prevalence of hypertension and high BP and its association with body weight among 1,030 inpatients with schizophrenia in a large psychiatric facility in Taiwan. Results: The prevalence of high BP and hypertension were found to be higher among inpatients with schizophrenia in Taiwan in comparison with those of the general population in line with the latest evidence. Hypertensionwas significantly associated with body mass index; meanwhile, other risk factors,including age, gender, length of hospital stay, time since initial schizophrenia diagnosis, medications used to reduce blood pressure, and atypical antipsychotics, were identified. However, body mass index was the most effective predictor of blood pressure in the study. Conclusion: The findings of this research shed light on the importance of developing effective weight and blood pressure monitoring and management programs for inpatients with schizophrenia. There is also a need for clinical nurses to employ multiple behavioral intervention strategies to minimize risks of high BP in patients with schizophrenia. We recommend that clinical nurses carefully monitor and control BP among inpatients with schizophrenia. Purpose: The objective of this study was to document the prevalence of high blood pressure (BP) and to explore its relationship with weight among inpatients with schizophrenia. Additionally, other possible risk factors impacting BP levels in relation to patients’ demographic characteristics and use of atypical antipsychotic drugs and medications to reduce blood pressure were analyzed. Methods: Using medical records, demographic data, and results of physical examination, this crosssectional study investigated the prevalence of hypertension and high BP and its association with body weight among 1,030 inpatients with schizophrenia in a large psychiatric facility in Taiwan. Results: The prevalence of high BP and hypertension were found to be higher among inpatients with schizophrenia in Taiwan in comparison with those of the general population in line with the latest evidence. Hypertensionwas significantly associated with body mass index; meanwhile, other risk factors,including age, gender, length of hospital stay, time since initial schizophrenia diagnosis, medications used to reduce blood pressure, and atypical antipsychotics, were identified. However, body mass index was the most effective predictor of blood pressure in the study. Conclusion: The findings of this research shed light on the importance of developing effective weight and blood pressure monitoring and management programs for inpatients with schizophrenia. There is also a need for clinical nurses to employ multiple behavioral intervention strategies to minimize risks of high BP in patients with schizophrenia. We recommend that clinical nurses carefully monitor and control BP among inpatients with schizophrenia.

Regional Homogeneity Brain Alterations in Schizophrenia: An Activation Likelihood Estimation Meta-Analysis

Xiaolei Qiu,Wenwen Xu,Rongrong Zhang,Wei Yan,Wenying Ma,Shiping Xie,Min Zhou 대한신경정신의학회 2021 PSYCHIATRY INVESTIGATION Vol.18 No.8

Objective Resting state functional magnetic resonance imaging (rsfMRI) provides a lot of evidence for local abnormal brain activity in schizophrenia, but the results are not consistent. Our aim is to find out the consistent abnormal brain regions of the patients with schizophrenia by using regional homogeneity (ReHo), and indirectly understand the degree of brain damage of the patients with drug-naive first episode schizophrenia (Dn-FES) and chronic schizophrenia. Methods We performed the experiment by activation likelihood estimation (ALE) software to analysis the differences between people with schizophrenia group (all schizophrenia group and chronic schizophrenia group) and healthy controls. Results Thirteen functional imaging studies were included in quantitative meta-analysis. All schizophrenia group showed decreased ReHo in bilateral precentral gyrus (PreCG) and left middle occipital gyrus (MOG), and increased ReHo in bilateral superior frontal gyrus (SFG) and right insula. Chronic schizophrenia group showed decreased ReHo in bilateral MOG, right fusiform gyrus, left PreCG, left cerebellum, right precuneus, left medial frontal gyrus and left anterior cingulate cortex (ACC). No significant increased brain areas were found in patients with chronic schizophrenia. Conclusion Our findings suggest that patients with chronic schizophrenia have more extensive brain damage than FES, which may contribute to our understanding of the progressive pathophysiology of schizophrenia.

한국인 조현병 환자에서 흡연과 사회인구학적, 임상적 특성과의 관계

조다함,나경세,김용식,윤진상,안용민,이종일,한진희,김종우,류성곤,민경준,박기창,김철응 대한신경정신의학회 2012 신경정신의학 Vol.51 No.5

Objectives In patients with schizophrenia, the prevalence of smoking is significantly higher than that of the general population. This study aimed to evaluate the relationships between cigarette smoking and socio-demographic and clinical characteristics in patients with schizophrenia in South Korea. Methods Post analysis of 2008-2009 three multi-center studies on the paliperidone extended-release switching was performed. A total of 509 patients with a diagnosis of schizophrenia were recruited and interviewed regarding socio-demographic variables, smoking characteristics. Krawiecka Scale, Clinical Global Impression-Schizophrenia-Severity, Clinical Global Impression-Schizophrenia-Improvement, and Personal and Social Performance Scale were used to evaluate psychological disturbance. Safety assessments included adverse events, evaluation of extrapyramidal symptoms using the Drug Induced Extra Pyramidal Symptoms Scale, and laboratory tests.Results The results revealed that the prevalence of smoking in Korean patients with schizophrenia is significantly higher than that of the general population. Male, patients with occupation,and paranoid type showed higher rate of smoking and smokers with schizophrenia had higher rates of overweight, thick waist, high blood pressure than non-smokers with schizophrenia. The results revealed that smokers with schizophrenia had higher rating scales of negative and cognitive symptoms. Conclusion From this study, we reported significant relationships between cigarette smoking and socio-demographic and clinical characteristics in patients with schizophrenia in South Korea. More studies will be needed to evaluate the association between cigarette consumption and schizophrenia, effect of smoking according to the antipsychotics, mechanism of nicotine on schizophrenia. 본 연구는 한국 조현병 환자들을 대상으로 흡연과 임상적,인구사회학적 특성의 연관성을 알아보고자 하였다. 그 결과흡연을 하는 조현병 환자들에서 직업을 가진 경우가 많았고,편집성 아형인 경우가 많았으며, 혈압도 높은 것으로 조사되었다. 또한 인지장애증상과 음성 증상도 비흡연자보다 덜 나타나는 것도 알 수 있었다. 하지만 약물처방패턴과 BMI, 양성증상과 우울증상, 사회적 기능 및 약물 부작용 등은 유의한 차이가 없었다. 조현병에서의 흡연율은 나라 및 문화권에 따라 차이가 있고, 특히 국내에서의 기존 연구가 많지 않은 상황이라는 점에서 특히 본 연구는 의의가 있다. 이 연구 결과를 바탕으로 하여, 향후에는 흡연량과 조현병 증상 및 약물 부작용의 관련성을 더 상세히 알아볼 수 있는 전향적 연구가 필요하다. 또한 조사시점에서 복용 중인 항정신병약물 별로 흡연이 어떠한 영향을 끼치는지, 니코틴이 조현병에 작용하는 기전이 무엇인지에 대해 더 알아보는 연구도 필요하겠다.

불안장애의 경계 : 강박장애와 정신분열병

임준석,김찬형 大韓神經精神醫學會 2008 신경정신의학 Vol.47 No.6

Although obsessive-compulsive disorder (OCD) is recognized as a major psychiatric illness, few studies have investigated obsessive-compulsive symptoms in patients with schizophrenia. Recent increases in dual diagnosis due to changes to the DSM-IV diagnostic criteria, findings of obsessive-compulsive symptoms (OCS) after administration of atypical antipsychotics, in-creased reports of co-occurrence of schizophrenia and OCD have increased the interest in OCS in schizophrenia. The incidence of OCS patients with schizophrenia is reported to be 3-59% ; however, the rate of progression to schizophrenia from OCD is not higher than in the general population. Level of insight, which differentiates obsessions from delusions, can be confounded by the specifier 'with poor insight' in OCD. OCD with schizotypal personality disorder or poor insight differs from pure OCD in that it responds poorly to treatment, has a poor prognosis, leads to deficits in cognitive functioning similar to those observed in schizophrenia, and responds well to low-dose antipsychotics. In the past, it was believed that OCS could prevent or delay the deteriorative course of schizophrenia. However, recent studies have shown that co-occurrence of OCD and schizophrenia in-creases the severity of symptoms, delays the treatment response, and reduces socio-occupational functions. Schizophrenia and OCD share the same pathophysiology in that both diseases have defects in the fronto-basal functional circuitry of the brain. The use of serotonin and dopamine has been addressed in schizophrenia due to the use of atypical antipsychotics in patients with schizophrenia. The finding of drug-induced OCS suggested that the two diseases share a similar pathogenesis involving neurotransmitters. Further studies are needed to make an exact diagnosis between the two diseases and to determine the com-mon pathophysiology between OCD and schizophrenia.

Association between Intracellular Infectious Agents and Schizophrenia

Mi-Hee Park,Young-Joon Kwon,Hee-Yeun Jeong,이화영,황보영,Hee-Jung Yoon,심세훈 대한정신약물학회 2012 CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE Vol.10 No.2

Objective: A number of studies have reported association between Toxoplasma gondii (T. gondii ) and Chlamydia infection and the risk of schizophrenia. The aim of the present study was to compare the prevalence of T. gondii and Chlamydia infection between the schizophrenia and normal control subjects and to compare the clinical features between seropositive and seronegative schizophrenia patients. Methods: The rate of serum reactivity to T. gondii, Chlamydia trachomatis (C. trachomatis ), Chlamydia pneumonia in 96 schizophrenia and 50 control subjects was investigated using enzyme-linked immunosorbent assay and indirect fluorescent antibody technique. The clinical symptoms of the schizophrenia patients were scored with Positive and Negative Syndrome Scale and a comparative analysis was carried out. Results: A significant positive association between immunoglobulin G (IgG) antibodies to T. gondii and C. trachomatis in schizophrenia was found, and the odds ratio of schizophrenia associated with IgG antibody was found to be 3.22 and 2.86, respectively. The Toxoplasma-seropositive schizophrenia patient had higher score on the negative subscale N1 and N7 and general psychopathology subscale G13, while C. trachomatis-seropositive schizophrenia patient had higher score on the general psychopathology subscale G10. Conclusion: The results from the present study suggest significant association between T. gondii, C. trachomatis infection and schizophrenia. In future, further studies are needed to elucidate the correlation between the two types of infection and schizophrenia.

Viral Infections as Etiological Factors of Schizophrenia

JungJin Kim 대한신경정신의학회 2007 PSYCHIATRY INVESTIGATION Vol.4 No.2

Schizophrenia is a major psychiatric disorder with different clinical subtypes. However, the etiological factors and pathogenetic mechanisms involved in the development of schizophrenia remain obscure. The discrepancies among the findings of previous genetic studies of schizophrenia that have taken place over several decades may have resulted from the failure of these studies to account for environmental risk factors. Epidemiological studies have indicated viral infection as one of the environmental risk factors of schizophrenia. Prenatal and perinatal infections may affect the immune reaction or neuronal development and result in schizophrenia in genetically susceptible individuals. Viral infections during development may be a source of the differences in the subgroups of patients with schizophrenia. Several putative viral infectious agents have been suggested as potential risk factors for schizophrenia. Although there are some constraints on the investigation of infectious agents in patients with schizophrenia, viral infection as an etiologic factor involved in the development of schizophrenia should be a primary focus of future studies.

조현병 뇌질병설에 대한 비판적 검토

한기하,정우진 한국동서철학회 2022 동서철학연구 Vol.- No.105

This paper reviews the validity and meaning of the schizophrenia brain disease hypothesis. The brain disease hypothesis is an etiological interpretation that structural and functional mutations in the brain are the only cause of schizophrenia. This interpretation is incompatible with the view that environmental factors are one of the causes of schizophrenia, and conflicts with the psychogenic interpretation. The popular belief that pharmacological achievements support the hypothesis of schizophrenia is not valid. This is because antipsychotic drugs also affect non-psychiatric patients, and the effects of drugs are compatible with psychogenic diseases. Efforts to reinforce the brain disease hypothesis by finding neural correlates of schizophrenia have also been unsuccessful. This is because schizophrenia is a constitutive category of several symptoms, and phenomena such as ventricular expansion have only a statistical correlation with the schizophrenia symptoms, and it is not possible to find a neural correlator for the individual symptoms constituting schizophrenia. A follow-up study on the high-risk group for schizophrenia was intended to meet the antecedent, that is, causal conditions of structural functional mutation, but it did not prove antecedent. Therefore, the hypothesis of brain disease in the sense that the brain is the only cause does not hold. The hypothesis of brain disease should be understood as meaning that structural and functional mutations in the brain together with the mind constitute the cause of schizophrenia, or that physical structural functional mutations in the brain occur accompanying symptoms of schizophrenia. 이 논문은 조현병 뇌질병설의 타당성과 의미를 검토한다. 뇌질병설은 뇌의 구조기능적 변이가 조현병의 유일한 원인이라는 병인론적 해석이다. 이 해석은 환경요소가 조현병 유발 원인 중 하나라는 견해와 양립하지 못하고, 마음이 원인이라는 심인성 해석과 상충한다. 약물학의 성취가 조현병 뇌질병설을 지지한다는 통속적 믿음은 타당하지 않다. 항정신병 약물은 정상인에게도 영향을 미치고, 약물의 효과는 심인성 질병관과 양립가능하기 때문이다. 조현병의 신경상관자를 찾음으로써 뇌질병설을 강화하고자 하는 노력도 성공적이지 못하다. 조현병은 여러 증상을 묶어 놓은 구성범주인데다, 뇌실 확장과 같은 현상들은 조현병 증상과 통계적 상관성만을 가지고 있고, 조현병을 구성하는 개별 증상에 대한 신경 상관자를 찾을 수도 없기 때문이다. 조현병 고위험군에 관한 추적조사 연구는 구조기능적 변이의 선행 즉, 인과조건을 충족하기 위한 것이지만, 선행성을 입증하지 못한다. 따라서 뇌가 유일한 원인이라는 의미의 뇌질병설은 성립하지 않는다. 뇌질병설은 뇌의 구조기능적 변이가 마음과 함께 조현병의 원인을 구성한다는 의미, 혹은 뇌의 물리구조기능적 변이가 조현병 증상에 수반하여 발생한다는 의미로 이해되어야 한다.

중년기 이후에 발병한 정신분열증에 대한 고찰

홍현상,채영래,백인호 大韓神經精神醫學會 1991 신경정신의학 Vol.30 No.6

It has been thought that the onset of schizophrenia is limited to youth. However, many European investigators have reported the occurrence of schizophrenia in later life. They have noted that the symptoms found in late-onset schizophrenia are not different from those noted in patients with early-onset schizophrenia. With the advent of the DSM-III-R(1987), there has been a renewal of interest in schizophrenia that arise for the first time in late life. This study was designed to examine some characteristic findings on demographics, clinical features, and treatment response in late-onset schizophrenia. The subjects consisted of 36 patients with late-onset(after 40) schizophrena and 72 patients with early-onset schizophrenia(before 40) by DSM-III-R who were admitted to the Department of Neuropshcyiatry of Kangnam St. Mary's Hospital, Catholic University Medical College from March 1982 to July 1990 The results were as follows : 1) The male to female ratio of the late-onset schizohprenic patients was 1 : 5. 2) The patients with late-onset schizophrenia were more likely to have grandiose delusions and auditory hallucinations than those of early-onset schizophrenia. 3) There was no significant difference in frequenty of clinical symptoms such as loosening of association, inappropriate affect, catatonia and response to neuroleptic treatment among each group. In light of these results, it seems likely that late-onset schizophrenia is somewhat different from, or might be a subtype of, more typical schizophrenia.

Positive Association of TEAD1 With Schizophrenia in a Northeast Chinese Han Population

Yang Sun,Lin Wen,Yi-Yang Luo,Wen-Juan Hu,Hui-Wen Ren,Ye Lv,Cong Zhang,Ping Gao,Li-Na Xuan,Guan-Yu Wang,Cheng-Jie Li,Zhi-Xin Xiang,Zhi-Lin Luan 대한신경정신의학회 2023 PSYCHIATRY INVESTIGATION Vol.20 No.12

Objective Schizophrenia is a complex and devastating psychiatric disorder with a strong genetic background. However, much uncertainty still exists about the role of genetic susceptibility in the pathophysiology of schizophrenia. TEA domain transcription factor 1 (TEAD1) is a transcription factor associated with neurodevelopment and has modulating effects on various nervous system diseases. In the current study, we performed a case–control association study in a Northeast Chinese Han population to explore the characteristics of pathogenic <i>TEAD1</i> polymorphisms and potential association with schizophrenia.Methods We recruited a total of 721 schizophrenia patients and 1,195 healthy controls in this study. The 9 single nucleotide polymorphisms (SNPs) in the gene region of <i>TEAD1</i> were selected and genotyped.Results The genetic association analyses showed that five SNPs (rs12289262, rs6485989, rs4415740, rs7113256, and rs1866709) were significantly different between schizophrenia patients and healthy controls in allele or/and genotype frequencies. After Bonferroni correction, the association of three SNPs (rs4415740, rs7113256, and rs1866709) with schizophrenia were still evident. Haplotype analysis revealed that two strong linkage disequilibrium blocks (rs6485989-rs4415740-rs7113256 and rs16911710-rs12364619-rs1866709) were globally associated with schizophrenia. Four haplotypes (C-C-C and T-T-T, rs6485989-rs4415740-rs7113256; G-T-A and G-T-G, rs16911710-rs12364619-rs1866709) were significantly different between schizophrenia patients and healthy controls.Conclusion The current findings indicated that the human <i>TEAD1</i> gene has a genetic association with schizophrenia in the Chinese Han population and may act as a susceptibility gene for schizophrenia.