Andrés Herrán

Quality of life in patients with schizophrenia in five European countries: the EPSILON study

Objective: To compare subjective quality of life (QOL) and objective QOL indicators in patients with schizophrenia from five European sites: Amsterdam, Copenhagen, London, Santander and Verona.

Determinants of smoking behaviour in outpatients with schizophrenia

The present study is an assessment of the rate and severity of tobacco consumption in outpatients with schizophrenia, and the determinants of smoking behaviour. Sixty-four patients, assessed by the Item Group Checklist section of the SCAN interview and fitting DSM-IV criteria, were evaluated with CGI and the PANSS scales. In addition, they completed STAI (Spielberger), EPQ (Eysenck), and TPQ (Cloninger) questionnaires. Tobacco dependence was assessed by the Fagerström test. One hundred and thirty-seven consecutive outpatients were psychiatric controls. Forty-one out of 64 patients with schizophrenia (64.1%) were current smokers, this rate being significantly higher than in other psychiatric patients and general population. The severity of cigarette consumption in smokers was greater (mean of 22.4 cigarettes/day) than in the general population, but it was not different from that of other psychiatric patients. For patients with schizophrenia, no one variable (except male sex) was different between smokers and non-smokers, but the number of cigarettes/day correlated with state anxiety, trait anxiety, and neuroticism. In the multivariate analysis, the only variable that remained significant was neuroticism. The relationship between clinical features and severity of smoking behaviour may be linked to non-specific variables such as neuroticism and anxiety, but not to psychotic symptoms.

Provision of services for people with schizophrenia in five European regions.

Background: An increasing diversity of public, voluntary sector and private providers offer services for the mentally ill in the ongoing process of psychiatric reform. Good service description is one important prerequisite for mental health service research. Aims 1) To describe service provision for the mentally ill in five European centres using the European Service Mapping Schedule (ESMS); and 2) to discuss the use of the instrument in describing service provision. Methods: All services providing care for people with severe mental illness in five European catchment areas (in Amsterdam, the Netherlands; Copenhagen, Denmark; London, UK; Santander, Spain; Verona, Italy) were identified through various sources. The identified services were classified, and service provision was quantified in accordance with the ESMS manual. Descriptive information was obtained. Results: We identified from 10 to 45 different services for catchment areas of between 50,000 (Copenhagen) and 560,000 (Santander) population run by three to 16 providers. They varied in aims, staffing and functioning. Hospital and non-hospital residential services, community-based services, and social support agencies were available in all sites. There was substantial variation across centres in the range, number and activities of services. Collecting comparable data sets on all service types, particularly for day and structured activity services and outpatient and community services required substantial effort. Conclusion: Operationalised description of mental health services across Europe is possible but requires further refinement.

Increased bone remodeling in first-episode major depressive disorder.

Objective Bone mineral density is decreased in patients with depressive disorder. This study evaluated biochemical bone remodeling markers in patients having their first depressive episode who had not taken psychotropic medications to evaluate possible pathogenic mechanisms implicated in the loss of bone mineral density in early states of this illness. Methods Serum osteocalcin, parathyroid hormone, bone alkaline phosphatase, telopeptide, collagen type I C-terminal propeptide, cross-laps, and 25-hydroxyvitamin D levels were measured in 19 depressive patients and 19 age-matched healthy women. In addition, serum cortisol and interleukin-6 were determined. Patients were assessed with the Schedules for Clinical Assessment in Neuropsychiatry interview and met criteria for a single depressive episode. Results Depressed patients had increased levels of osteocalcin (p = .003), an osteoblastic marker; telopeptide (p = .01), an osteoclastic marker; and cross-laps (p = .000), another osteoclastic marker. Parathyroid hormone was lower in patients (p = .02), whereas the rest of the markers were comparable between patients and healthy control subjects. Serum cortisol was higher in depressed patients than in control subjects (p = .003), but cortisolemia and interleukin-6 did not show any relationship with bone markers in patients. Clinical severity of the illness and weight loss due to depression in patients did not correlate with bone remodeling markers. Conclusions These data suggest that an increase in bone remodeling not due to vitamin D deficiency induces a release of calcium from bone and inhibition of parathyroid hormone secretion.

Personality traits in early phases of panic disorder: implications on the presence of agoraphobia, clinical severity and short‐term outcome

Objective:  To explore the relations between personality traits using the Big Five model and presence of agoraphobia, clinical severity and short‐term outcome in an unbiased clinical sample of never‐treated panic disorder patients.

Can personality traits help us explain disability in chronic schizophrenia

Abstract  Psychotic features have been considered the main determinant of psychosocial function in schizophrenia. However, other variables are likely to affect dysfunction in these patients. The authors’ hypothesis is that personality traits in outpatients with chronic schizophrenia differ from traits found in the healthy population and may be associated with disability in this disorder. A total of 62 patients with schizophrenia were evaluated with the Eysenck Personality Questionnaire (EPQ) and the Tridimensional Personality Questionnaire (TPQ). Psychotic features were measured with the help of the Positive and Negative Syndrome Scale (PANSS). Disability was assessed with the Disability Assessment Schedule (DAS). A total of 43 healthy subjects were used as controls for personality measurements. Normative data for the study population was also used to evaluate results in patients. Patients with schizophrenia had higher levels of neuroticism (median in percentile 65) and lower levels of extraversion (median in percentile 25) than the healthy population. Results of the TPQ showed higher harm avoidance and lower reward dependence levels compared to the healthy population. After multiple regression tests, negative symptoms were the strongest predictor of disability in patients with schizophrenia. Neuroticism contributed independently to the DAS overall behavior and global judgement subscales scores (more negative symptoms and higher neuroticism resulted in worse functioning), but not to the social role subscale. Outpatients with chronic schizophrenia showed high levels of neuroticism, harm avoidance, and introversion. Neuroticism significantly contributes to the long‐term deficits found in patients with schizophrenia.

Folate levels in psychiatric outpatients

This study examines folate in psychiatric outpatients. Fifty‐three outpatients with schizophrenia and 24 outpatients with depressive disorder assessed with the Schedules for Clinical Assessment in Neuropsychiatry interview are included. Patients with schizophrenia had lower serum folate levels than age‐ and sex‐matched controls, while red cell folate levels did not differ. Serum folate levels showed a negative correlation with the Clinical Global Impression, disorganized dimension, and total Positive and Negative Syndrome Scale score. Patients with depressive disorder had lower serum folate levels than healthy controls, but showed no differences in red cell folate levels. Only two patients with schizophrenia had red cell folate levels below the normal range.

Higher levels of serum copper in schizophrenic patients treated with depot neuroleptics

The findings of previous research on the status of trace elements in patients with schizophrenia have been controversial. We studied 62 outpatients with a DSM-IV diagnosis of schizophrenia, and compared them with sex- and age-matched healthy controls. Serum copper levels were significantly higher in schizophrenic patients (mean 117.4 microg/dl; S.D. 23.4) than in healthy controls (105.6+/-27.9). Those patients on treatment with depot neuroleptics had higher copper levels. Zinc levels did not differ between patients and healthy controls. Altered levels of trace elements in schizophrenic patients may be a consequence of antipsychotic treatment.

Manifesto for a European anxiety disorders research network

Despite the size, burden and costs of anxiety disorders, many patients remain unrecognised, and the effectiveness of evidence-based interventions in routine clinical practice can be disappointing. The European College of Neuropsychopharmacology (ECNP) has established the ECNP Network Initiative (ECNP-NI) to help meet the goal of extending current understanding of the causes of central nervous system disorders, thereby contributing to improvements in clinical outcomes and reducing the associated societal burden. The Anxiety Disorders Research Network (ADRN) has been adopted within the ECNP-NI: this consensus statement summarises its overall aims and objectives.

The acute phase response in panic disorder.

An acute-phase response (APR), manifested as an increase of acute-phase proteins has been shown in major depression. Panic disorder (PD) may share some aetiopathogenic mechanisms with depression, but APR has not been studied in this disorder. Forty-one panic patients in the first stages of their illness were compared with 32 healthy subjects of comparable sex, age, and body mass index. Clinical diagnosis was established with the mini international neuropsychiatric interview, and severity with the panic disorder severity scale and the CGI scale. Laboratory determinations included four acute phase proteins (APPs) [albumin, gammaglobulins, fibrinogen, C-reactive-protein (CRP)] and basal cortisol level. Patients were studied after 8-wk follow-up taking selective serotonin reuptake inhibitors (SSRIs) to assess the evolution of the APPs. Gammaglobulin levels were lower, and both cortisol and CRP levels were higher in PD patients than in controls. APP did not differ between patients with or without agoraphobia. At follow-up, patients who responded to SSRIs presented a decrease in albumin levels, and a trend towards a decrease in cortisol and CRP compared with levels at intake. The conclusions of this study are that there is an APR in patients suffering from PD, and this APR tends to diminish after a successful treatment with SSRIs.