F. Catapano

Double dissociation of N1 and P3 abnormalities in deficit and nondeficit schizophrenia

It has been proposed that the presence of enduring, idiopathic negative symptoms define a group of patients with a disease (deficit schizophrenia, DS) that is separate from other forms of schizophrenia (nondeficit schizophrenia, NDS). Although several findings support this hypothesis, the possibility that DS represents the severe end of a single schizophrenia continuum cannot be excluded yet. We tested the hypothesis that DS and NDS differ relative to event-related potentials (ERPs). Amplitude, scalp topography and cortical sources of the ERP components were assessed in clinically stable DS and NDS outpatients and in matched healthy subjects (HCS). Twenty subjects per group were recruited. Among the subjects who completed the target detection task, there were no group difference in accuracy. For N1, only patients with DS, as compared with HCS, showed an amplitude reduction over the scalp central leads and a reduced current source density in cingulate and parahippocampal gyrus. For P3, only patients with NDS, as compared with HCS, showed a lateralized amplitude reduction over the left posterior regions and reduced current source density in left temporal and bilateral frontal, cingulate and parietal areas. The DS and NDS groups differed significantly from each other with regard to N1 amplitude and topography, as well as P3 amplitude and cortical sources. The N1 was affected in DS but not in NDS patients, whereas P3 was affected in NDS only. This double dissociation is consistent with the hypothesis that DS represents a separate disease entity within schizophrenia.

The role of relatives in pathways to care of patients with a first episode of psychosis

Aims: To explore the role of relatives in pathways to care of patients with a recent onset of psychosis. Methods: A total of 34 consecutive patients and their relatives from the Department of Psychiatry of the University of Naples SUN participated in the study. Pathways to care were retrospectively evaluated by administering the Pathways to Care Form and the Nottingham Onset Schedule (NOS) to patients, relatives and treating physicians. Relatives were addressed with the Family Involvement in Pathways to care Schedule (FIPS). Results: Duration of untreated illness (DUI) and duration of untreated psychosis (DUP) were 145.4 (±141.9) and 33.3 (±54.0) weeks, respectively. Help-seeking delay was 17.6 (±45.0) weeks. The first request for help was made by relatives in 76% of cases. Among health professionals, general practitioners were those most frequently contacted, followed by psychiatrists, neurologists or psychologists. Stigma and wrong attribution of psychotic symptoms were the main reasons for help-seeking delays. Conclusions: Relatives play a crucial role in pathways to care of patients with psychosis. DUI and DUP could be reduced by interventions aimed at increasing knowledge of early symptoms in the general population, and by the provision of psychiatric consultations in non-stigmatizing settings for young people with psychological distress.

Aripiprazole augmentation strategy in clomipramine-resistant depressive patients: an open preliminary study.

Recent evidence supports the use of second generation antipsychotics in drug resistant depression. The aim of the present open-label study was to evaluate the effect of aripiprazole as an add-on medication in drug-resistant depressed patients who had not responded to clomipramine. Thirty-five patients with major depressive disorder (MDD) were included in the study. All patients had not responded to a previous adequate treatment with an SSRI and had been receiving clomipramine (daily doses ranging from 100 to 300 mg) for 113.9 ± 18.9 days without getting significant clinical improvement. Aripiprazole was added at the fixed dose of 5mg/day and clinical status as well as clomipramine plasma levels were monitored before and after 4, 8, and 24 weeks of combined treatment. Hamilton depression rating scale scores significantly decreased over the follow-up period with 91.4% and 34.3% of patients getting a response or a remission, respectively, after 24 weeks of combined treatment. No worsening of clomipramine-related side effects nor new side effects were observed. The clinical improvement was accompanied by a progressive and significant increase in clomipramine plasma levels. With the limitation of an open-label design, these data suggest for the first time the putative efficacy and safety of aripiprazole in combination with a tricyclic medication in drug resistant depressed patients. The role of the observed pharmacokinetic interaction in the mechanism of aripiprazole antidepressant activity remains to be proved.

Brain natriuretic peptide as a biomarker of asymptomatic clozapine-related heart dysfunction: a criterion for a more cautious administration.

Clozapine-related pericarditis is a rare side effect of the drug. We reported the clinical cases of two women, aged 22 and 28 years, affected by schizophrenia with pericarditis symptoms related to clozapine treatment of 200 mg/day. Clozapine was discontinued in both patients, resulting in normalization of the ECG changes, and echocardiography confirmed the progressive disappearance of the pericardial effusion. Interestingly, while inflammatory indices and pro-brain natriuretic peptide (pro-BNP) plasma levels were high in both patients, only one of them showed tachycardia, subjective chest pain, shortness of breath and dyspnea, with a clinical symptomatology suggesting a cardiac involvement. BNP is a vasoactive peptide synthetized by the ventricular myocardium which splits in two fragments: BNP and the N-terminal (pro-BNP). Both are considered valuable biomarkers in clinical practice for the prediction of disease state and prognosis in patients with suspected heart failure. Pro-BNP acts as a key regulator in the homeostasis of water and salt excretion and in the maintenance of blood pressure, mainly by inhibiting the renin-angiotensin-aldosterone axis and blocking the sympathetic nervous activity. In our cases, pro-BNP plasma levels proved to be a profitable way to identify subjects with asymptomatic cardiac impairment who could benefit from a therapy preventing progression to heart failure.

Antipsychotic Treatment and Metabolic Syndrome: a Comparison Between Schizophrenic and Bipolar Patients

Only few studies have compared the effects of Typical and Atypical Antipsychotics on Metabolic Syndrome (MS) onset. The present study examined the impact of antipsychotic treatment on MS in schizophrenic and bipolar patients. Medical records of 535 patients who completed a 1-year treatment with haloperidol, olanzapine, risperidone, paliperidone, quetiapine, aripiprazole, clozapine were retrospectively reviewed, and metabolic outcomes were evaluated. MS was diagnosed according to ATP III criteria. The mean daily dose of each antispychotic was calculated in haloperidol equivalents (Eq). Schizophrenic patients were treated with a higher daily antipsychotic dose than bipolar ones (5.9 mg /die ± 4.2 mg/die vs 4.9 mg/die ± 4.0 mg/die, p

EPA-0283 – Olanzapine is faster than haloperidol in inducing metabolic syndrome in schizophrenics but not in bipolar patients

Metabolic profile of olanzapine as compared to haloperidol has been evaluated much less comprehensively in bipolar than in schizophrenic patients. Medical records of 343 patients who completed a 3-year treatment with haloperidol or olanzapine were retrospectively reviewed, and metabolic outcomes were evaluated. Twenty-three percent of patients fulfilled MetS criteria with a point prevalence of 25.3% in bipolar and 21.2% in schizophrenic group; 20.3% of schizophrenics treated with haloperidol and 22.4% of those treated with olanzapine developed MetS, which was detected, instead, in 17.1% of haloperidol-treated bipolar patients and 32.9% of those treated with olanzapine. Significant changes were detected overtime in fasting cholesterol, systolic BP, BW and BMI; some of these parameters at the 3-year follow-up presented more severe changes with olanzapine than haloperidol in both diagnostic groups. Overall, a significant number of subjects fulfilled MetS criteria in the first month of treatment, but only in schizophrenics olanzapine was faster than haloperidol in inducing such an effect. These data suggest that haloperidol and olanzapine increase the risk for MetS in both schizophrenic and bipolar patients with a higher prevalence for olanzapine only in bipolar patients. Morever, as compared to haloperidol, olanzapine has a faster dismetabolic action in schizophrenic but not in bipolar patients.

EPA-0282 – Clozapine treatment and other atypical and typical antipsychotics: incidence and course of blood dyscrasias during the first eighteen weeks of treatment

Blood dyscrasias induced by clozapine treatment and other Typical and Atypical Antipsychotics have received little attention. The aim of the present study was to shed more light on the incidence and course of clozapine-induced blood dyscrasias that occour during the first eighteen weeks of treatment compared to dyscrasias induced by other Typical and Atypical Antipsychotics. The study included 135 clozapine-treated patients (M 75 and F 60), 75 patients treated with other Atypical (M 35 and F 40), and 75 treated with Typical (M 39 and F 36). Persistent eosinophilia appeared in 36.8% of clozapine-treated patients, in 4%, (p

2643 – Metabolic syndrome and antipsychotic treatment: How about schizophrenia and bipolar disorder?

Many published studies underlined the relationship between Atypical Antipsychotic treatment and Metabolic Syndrome (MS) onset, but only few have compared the effects of Typical and Atypical Antipsychotics to this respect. The present study examined in schizophrenic and bipolar patients the impact of haloperidol (mean dose 3.37±2.28 mg and 2.51±1.48 mg, respectively) and olanzapine treatment (mean dose 12.42±6.53 mg and 9.97±5.36 mg, respectively) on glycemia, blood pressure, BMI, triglycerides and HDL cholesterol. A higher prevalence and a different time of appearance of Metabolic Syndrome was observed in Bipolar patients when treated with olanzapine. Moreover, weight increase was greater in bipolar patients treated with olanzapine (p

2644 – Transient and persistent blood dyscrasias induced by clozapine treatment

Blood dyscrasias, other than agranulocytosis, have received little attention in clozapine-treated patients. The aim of the present study was to shed more light on the incidence and course of clozapine-induced blood dyscrasias that occur during the first eighteen weeks of treatment with the antipsychotic. The study included 135 patients (M 75 and F 60), with a mean age of 33.1±10.4 years. The blood dyscrasias appeared in 88.1% of the total sample and were divided, on the basis of their duration, into transient and persistent. The analysis of data revealed that persistent dyscrasias had a higher incidence (56.2%) when compared to transient ones (11%). Persistent anemia was more common in female patients (F 52.5% vs M 11.2%), while male patients had a higher frequency of eosinophilia (M 26.2% vs F 21.2%), neutrophilia (M 18.7% vs F 15.0%) and leucocytosis (M 21.2% vs 8.7% F). The correlation between clinical response and blood dyscrasias revealed a statistically significant positive effect for male patients with eosinophilia (p

AS16-01 - Social deprivation and the early course of schizophrenia

Social deprivation has been consistently found as a risk factor for the incidence of psychosis. This study aimed at investigating the effect of social deprivation on short-term outcome of patients with a recent onset of schizophrenia ( A social deprivation score was calculated taking into account a low/very low socio-economic status, unemployment, low school education, and living alone. Psychiatric symptoms were assessed by BPRS. Compulsory and voluntary hospitalizations, engagement with mental health services, and suicidal attempts were also considered as outcome measures. The sample consists of 35 patients, who had a first episode of psychosis at 19.7 (±4.7) years. In the first two years of the illness, 28% of patients committed suicide attempts and 37% were hospitalized. Twenty-six per cent of the patients had high levels of social deprivation. Patients with higher levels of social deprivation had a more acute clinical onset and a worse short-term outcome, characterized by more severe positive symptoms, an higher number of voluntary and compulsory hospitalizations, and a reduced engagement with outpatient mental health facilities. No significant differences were found as regards suicidal attempts. These results highlight that social deprivation has a negative impact on short-term outcome of schizophrenia and on patients’ engagement with mental health services and on, and suggest the need of targeting interventions on the basis of patients’ clinical and social needs.