schizophrenia

摘要： BACKGROUND In contrast to many Western countries,China has maintained its large psychiatric hospitals.The prevalence and clinical characteristics of coronavirus disease 2019(COVID-19)in inpatients with schizophrenia(SCZ)are unclear.AIM To assess the prevalence of COVID-19 among inpatients with SCZ and compare the infected to uninfected SCZ patients in a Wuhan psychiatric hospital.METHODS We retrospectively collected demographic characteristics and clinical profiles of all SCZ patients with COVID-19 at Wuhan’s Youfu Hospital.RESULTS Among the 504 SCZ patients,84 had COVID-19,and we randomly sampled 174 who were uninfected as a comparison group.The overall prevalence of COVID-19 in SCZ patients was 16.7%.Among the 84 SCZ patients with confirmed COVID-19,the median age was 54 years and 76.2%were male.The most common symptom was fever(82%),and less common symptoms were cough(31%),poor appetite(20%),and fatigue(16%).Compared with SCZ patients without COVID-19,those with COVID-19 were older(P=0.006)and significantly lighter(P=0.002),and had more comorbid physical diseases(P=0.001).Surprisingly,those infected were less likely to be smokers(<0.001)or to be treated with dozapine(P=0.03).Further logistic regression showed that smoking[odds ratio(OR)=5.61],clozapine treated(OR=2.95),and male(OR=3.48)patients with relatively fewer comorbid physical diseases(OR=0.098)were at a lower risk for COVID-19.SCZ patients with COVID-19 presented primarily with fever,but only one-third had a cough,which might otherwise be the most common mode of transmission between individuals.CONCLUSION Two unexpected protective factors for COVID-19 among SCZ inpatients are smoking and dozapine treatment.

摘要： Schizophrenia and bipolar disorder are disabling psychiatric disorders with a worldwide prevalence of approximately 1%.Both disorders present chronic and deteriorating prognoses that impose a large burden,not only on patients but also on society and health systems.These mental illnesses share several clinical and neurobiological traits;of these traits,oligodendroglial dysfunction and alterations to white matter(WM)tracts could underlie the disconnection between brain regions related to their symptomatic domains.WM is mainly composed of heavily myelinated axons and glial cells.Myelin internodes are discrete axon-wrapping membrane sheaths formed by oligodendrocyte processes.Myelin ensheathment allows fast and efficient conduction of nerve impulses through the nodes of Ranvier,improving the overall function of neuronal circuits.Rapid and precisely synchronized nerve impulse conduction through fibers that connect distant brain structures is crucial for higher-level functions,such as cognition,memory,mood,and language.Several cellular and subcellular anomalies related to myelin and oligodendrocytes have been found in postmortem samples from patients with schizophrenia or bipolar disorder,and neuroimaging techniques have revealed consistent alterations at the macroscale connectomic level in both disorders.In this work,evidence regarding these multilevel alterations in oligodendrocytes and myelinated tracts is discussed,and the involvement of proteins in key functions of the oligodendroglial lineage,such as oligodendrogenesis and myelination,is highlighted.The molecular components of the axo-myelin unit could be important targets for novel therapeutic approaches to schizophrenia and bipolar disorder.

摘要： Schizophrenia(SCZ)is a severe mental illness that affects several brain domains with relation to cognition and behaviour.SCZ symptoms are typically classified into three categories,namely,positive,negative,and cognitive.The etiology of SCZ is thought to be multifactorial and poorly understood.Accumulating evidence has indicated abnormal synaptic plasticity and cognitive impairments in SCZ.Synaptic plasticity is thought to be induced at appropriate synapses during memory formation and has a critical role in the cognitive symptoms of SCZ.Many factors,including synaptic structure changes,aberrant expression of plasticityrelated genes,and abnormal synaptic transmission,may influence synaptic plasticity and play vital roles in SCZ.In this article,we briefly summarize the morphology of the synapse,the neurobiology of synaptic plasticity,and the role of synaptic plasticity,and review potential mechanisms underlying abnormal synaptic plasticity in SCZ.These abnormalities involve dendritic spines,postsynaptic density,and long-term potentiation-like plasticity.We also focus on cognitive dysfunction,which reflects impaired connectivity in SCZ.Additionally,the potential targets for the treatment of SCZ are discussed in this article.Therefore,understanding abnormal synaptic plasticity and impaired cognition in SCZ has an essential role in drug therapy.

摘要： Schizophrenia(SCZ)is a devastating and complicated mental disorder accompanied by variable positive and negative symptoms and cognitive deficits.Although many genetic risk factors have been identified,SCZ is also considered as a neurodevelopmental disorder.Elucidation of the pathogenesis and the development of treatment is challenging because complex interactions occur between these genetic risk factors and environment in essential neurodevelopmental processes.Adult neural stem cells share a lot of similarities with embryonic neural stem cells and provide a promising model for studying neuronal development in adulthood.These adult neural stem cells also play an important role in cognitive functions including temporal and spatial memory encoding and context discrimination,which have been shown to be closely linked with many psychiatric disorders,such as SCZ.Here in this review,we focus on the SCZ risk genes and the key components in related signaling pathways in adult hippocampal neural stem cells and summarize their roles in adult neurogenesis and animal behaviors.We hope that this would be helpful for the understanding of the contribution of dysregulated adult neural stem cells in the pathogenesis of SCZ and for the identification of potential therapeutic targets,which could facilitate the development of novel medication and treatment.

摘要： BACKGROUND Insulin resistance(IR)and impaired energy expenditure(IEE)are irreparable metabolic comorbidities in schizophrenia.Although mechanism(s)underlying IR and IEE remains unclear,leptin and fatty acid signaling,which has profound influence on insulin secretion/sensitivity,glucose metabolism and energy expenditure,could be disrupted.However,no association of plasma leptin with erythrocyte membrane fatty acids,body mass index(BMI),and psychotic symptoms in the same cohort of untreated patients with first-episode psychosis(FEP)or medicated patients with chronic schizophrenia(CSZ)is presented before.These studies are crucial for deciphering the role of leptin and fatty acids in the development of IR and IEE in schizophrenia.AIM To determine the association between plasma leptin,erythrocyte membrane fatty acids,particularly,saturated fatty acids(SFAs),BMI and psychotic symptoms in patients with FEP and CSZ.METHODS In this study,twenty-two drug naive patients with FEP,twenty-one CSZ patients treated with atypical antipsychotic drugs,and fourteen healthy control(CNT)subjects were analyzed.Plasma leptin was measured using sandwich mode enzyme-linked immunosorbent assay.Erythrocyte membrane SFAs were measured using ultrathin capillary gas chromatography.BMI was calculated by using the formula:weight(kg)/height(m^(2)).Psychiatric symptoms were evaluated at baseline using brief psychiatric rating scale(BPRS),and positive and negative syndrome scale(PANSS).The total BPRS scores,positive and negative symptom scores(PANSS-PSS and PANSS-NSS,respectively)were recorded.Pearson correlation coefficient(r)analyses were performed to find the nature and strength of association between plasma leptin,PANSS scores,BMI and SFAs,particularly,palmitic acid(PA).RESULTS In patients with FEP,plasma leptin not BMI was significantly lower(P=0.034),whereas,erythrocyte membrane SFAs were significantly higher(P<0.005)compared to the CNT subjects.Further,plasma leptin showed negative correlation with erythrocyte membrane SFAs-PA(r=-0.4972,P=0.001),PANSS-PSS(r=-0.4034,P=0.028),and PANSS-NSS(r=-0.3487,P=0.048).However,erythrocyte membrane SFAs-PA showed positive correlation with PANSS-PSS(r=0.5844,P=0.0034)and PANSS-NSS(r=0.5380,P=0.008).In CSZ patients,plasma leptin,BMI,and erythrocyte membrane SFAs,all were significantly higher(P<0.05)compared to the CNT subjects.Plasma leptin showed positive correlation with BMI(r=0.312,P=0.032)but not with PANSS scores or erythrocyte membrane SFAs-PA.However,erythrocyte membrane SFAs-PA showed positive correlation with PANSS-NSS only(r=0.4729,P=0.031).Similar changes in the plasma leptin and erythrocyte membrane SFAs have also been reported in individuals at ultrahigh risk of developing psychosis;therefore,the above findings suggest that leptin-fatty acid biosynthesis could be disrupted before the onset of psychosis in schizophrenia.CONCLUSION Disrupted leptin-fatty acid biosynthesis/signaling could be an early manifestation of metabolic comorbidities in schizophrenia.Large-scale studies are warranted to validate the above findings.

摘要： Psychotic syndromes are divided into affective and non-affective forms.Even among the non-affective forms,substantial differences exist.The aim of this relatively brief review is to synthesize what is known about the differences between two non-affective psychoses,schizophrenia and delusional disorder(DD),with respect to clinical,epidemiological,sociodemographic,and treatment response characteristics.A PubMed literature search revealed the following:in schizophrenia,hallucinations,negative symptoms and cognitive symptoms are prominent.They are rare in DD.Compared to schizophrenia patients,individuals with DD maintain relatively good function,and their delusions are believable;many are beliefs that are widely held in the general population.Treatments are generally similar in these two forms of psychosis,with the exception that antidepressants are used more frequently in DD and,for acute treatment,effective antipsychotic doses are lower in DD than in schizophrenia.It is with the hope that the contrasts between these two conditions will aid in the provision of safe and effective treatment for both that this review has been conducted.

摘要： BACKGROUND Antipsychotic drugs remain the mainstay of schizophrenia treatment;however,their effectiveness has been questioned,and it is not possible to predict the response to a specific antipsychotic drug in an individual patient.Thus,it is important to compare the effectiveness of the various antipsychotics and search for possible response predictors.AIM To investigate the effectiveness of antipsychotic drugs,we examined response trajectories and predictors for belonging to different trajectory groups.METHODS The Bergen-Stavanger-Innsbruck-Trondheim(BeSt InTro)trial compared the effectiveness of three atypical antipsychotics-amisulpride,aripiprazole,and olanzapine-in a prospective,semirandomized,rater-blind,head-to-head design.Adult participants with a schizophrenia spectrum disorder diagnosis,according to international classification of diseases,Tenth Revision(ICD-10)F20–29,were included.Participants were followed for a period of 12 mo,with assessments at baseline;after one,three and six weeks;and after three,six,nine and 12 mo.A latent class mixed model was fitted to our data.The three-trajectory model based on the Positive and Negative Syndrome Scale(PANSS)total score reduction was found to have adequate fit,and the study drugs,as well as various demographic and clinical parameters,were tested as predictors for belonging to the different trajectory groups.RESULTS Overall,144 participants were included,and 41%completed the 12-mo study period.The largest trajectory group,consisting of 74%of participants,showed a PANSS total score reduction of 59%from baseline to 12 mo(Good response group).A trajectory group comprising 13%of participants had their PANSS total score reduced by 82.5%at 12 mo(Strong response group),while the last response trajectory group comprising 13%of the participants had a PANSS total score reduction of 13.6%(Slight response group).The largest part of the total reduction for the Good and Strong response groups occurred at six weeks of treatment,amounting to 45%and 48%reductions from baseline,respectively.The use of amisulpride predicted belonging to the Strong response group,while unemployment,depression,and negative psychotic symptoms at baseline increased the chance of belonging to the Slight response group,indicating a poor response to antipsychotic drug treatment.CONCLUSION Most of the participants(87%)had a good outcome after one year.Amisulpride users,more often than aripiprazole and olanzapine users,belonged to the response trajectory group with a strong response.

摘要： Adjunctive melatonin use in schizophrenia, as supported by a modicum ofevidence, has multiple transcending chronobiotic actions, including fixingconcurrent sleep problems to bona fide augmentative antipsychotic actions,mitigating the risk of tardive dyskinesias, curbing the drastic metabolic syndromeand ultimately providing neuroprotective actions. Its use is rather an art thanscience!

摘要： The Association of Schizophrenia, psychosis, and Marijuana is decades old. Swedish Conscripts cohort study [1] was one of the earlier studies which reported dose-dependent associations between Marijuana use and schizophrenia. This landmark study was substantiated in other countries through research and systematic reviews [2], which further strengthened the dose-dependent association between Marijuana and Psychosis. The dose defined in these studies [1] was based on the frequency of use that is more times used means more risk of developing schizophrenia and or related psychosis. The concept of using highly concentrated marijuana is relatively new, especially in the light of episodes lasting longer than anticipated with treatment resistance. There is not much data on how it will change the course of psychosis and affect the current diagnostic criteria for Substance-induced psychosis, Schizophreniform Psychosis, and schizophrenia. Based on these challenges, we report a case of Dabs or concentrated Tetra Hydro Cannabinoid (THC)-induced prolonged psychosis with tachycardia and treatment resistance on two separate occasions. Both inpatient admissions were triggered using concentrated Tetra Hydro Cannabinoid (THC).

摘要： BACKGROUND Antipsychotics are associated with abnormalities in glucose metabolism in patients with schizophrenia. Liraglutide, a GLP-1 receptor agonist, is Food and Drug Administration approved for the treatment of type 2 diabetes mellitus. However, ways to maintain the long-term stability of psychotic symptoms and balance the disadvantages of obesity, diabetes, and other metabolic disorders caused by antipsychotic medications remain unclear. In this study, we present a case of weight gain and hyperglycemia in a schizophrenia patient who received antipsychotic polypharmacy for 6 years.CASE SUMMARY A 27-year-old man with olanzapine and sodium valproate-treated disorganized schizophrenia was admitted to a diabetes outpatient clinic. He was diagnosed with type 2 diabetes(fasting blood glucose, 20 mmol/L) and obesity(body mass index, 38.58 kg/m). The patient had been treated with glargine(40 IU/d) and metformin(1.5 g/d) and showed a poor response for 2 mo. Two years of liraglutide treatment resulted in stable blood glucose levels and weight loss in addition to a maintained stable mental status for a long time. The biological activities of GLP-1 significantly improved glucose levels and body weight in the schizophrenia patient treated with antipsychotic medications.CONCLUSION Liraglutide administration can be considered an effective alternative treatment for abnormalities in glucose metabolism in schizophrenia patients receiving antipsychotics.