Iginia Mancinelli

Emotion recognition impairment is present early and is stable throughout the course of schizophrenia

Individuals with schizophrenia experience problems in the perception of emotion throughout the course of the disorder. Few studies have addressed the progression of the deficit over time. The present investigation explores face emotion recognition (FER) performance throughout the course of schizophrenia. The aim of the study was to test the hypotheses that: 1) FER impairment was present in ultra high-risk (putatively prodromal) individuals, and that 2) impairment was stable across the course of the illness. Forty-three individuals with a putative prodromal syndrome, 50 patients with first episode of schizophrenia, 44 patients with multi-episode schizophrenia and 86 unaffected healthy control subjects were assessed to examine emotion recognition ability. ANCOVA analysis adjusted for possible confounder factors and subsequent planned contrasts with healthy controls was undertaken. The results revealed deficits in recognition of sadness and disgust in prodromal individuals, and of all negative emotions in both first-episode and multi-episode patients. Furthermore, there were no significant differences between clinical groups. Within the framework of the neurodevelopmental model of schizophrenia, our results suggest the presence of emotional recognition impairment before the onset of full-blown psychosis. Moreover, the deficit remains stable over the course of illness, fitting the pattern of a vulnerability indicator in contrast to an indicator of chronicity or severity.

Where Schizophrenic Patients Commit Suicide: A Review of Suicide among Inpatients and Former Inpatients

Objective: To review the literature on suicide of inpatients with schizophrenia, to identify suicide risk factors as well as typical patterns of behavior and to suggest a rationale and strategies for future interventions. Method: A computerized MedLine, Excerpta Medica and PsycLit search supplemented by an examination of cross-references and reviews. Results: Up to half the suicides among patients with schizophrenia occur during inpatient admission. Inpatient suicides were found among those of a young age group who were predominantly single, childless and socially isolated. The vast majority experienced an illness characterized by long duration and prolonged psychiatric hospitalizations or multiple admissions and discharges. Up to 50% of the suicides occurred in the first few weeks and months following discharge from the hospital. The paranoid subtype of schizophrenia, where positive symptoms prevail and negative symptoms are few, is associated with a suicide risk that is three times greater than that associated with nonparanoid subtypes and eight times greater than the risk associated with the deficit subtype. Conclusions: Treatment of suicide is a major problem among inpatients with schizophrenia. Evidence suggests that suicide is generally carried-out by patients who have been recently discharged or by those who manage to get away from the hospital. Strategies aimed at preventing this phenomenon have been introduced to the medical personnel, but suicide in these patients does not seem to have been reduced. We emphasize the need to establish guidelines for the prevention of suicide in hospitalized patients with schizophrenia.

Suicide in Italian Prisons in 1996 and 1997: A Descriptive Epidemiological Study

This study analyses the suicides in Italian prisons in 1996 and 1997, formulates hypotheses regarding possible risk factors for such suicides, and suggests possible preventive measures. The data come from the anonymous records on prison suicides provided by the Italian Prison Administration Department. Data were collected and elaborated according to statistical-epidemiological criteria using the World Health Organization Epi 6 programme. In 1996, there were 45 suicides in Italian prisons among a prison population of 48,528 (93/100,000 inmates/year). In 1997, there were 55 suicides among 49,306 inmates (112/100,000 inmates/year). Some of the suicide risk factors found were: mental disorders, drug addiction, previous incarceration, and the lack of objective assessment of the suicide risk. On the basis of possible risk factors identified in this study and the results of the reported international studies, the authors suggest guidelines for the prevention of prison suicides integrated on three levels: environmental, diagnostic, and therapeutic.

Anatomical substrates of cognitive and clinical dimensions in first episode schizophrenia

To explore gray (GM) and white matter (WM) abnormalities and the relationships with neuropsychopathology in first‐episode schizophrenia (FES).

White matter microstructure in ultra-high risk and first episode schizophrenia: A prospective study

There is increasing evidence of white matter (WM) pathology in schizophrenia, but its role at the very early stage of the disorder remains unclear. In an exploration of WM microstructure in ultra-high risk (UHR) subjects and first episode schizophrenia (FES), 34 FES, 27 UHR and 26 healthy control (HC) subjects underwent a magnetic resonance imaging (MRI) tract based spatial statistics (TBSS) investigation. Whole brain fractional anisotropy (FA), mean diffusivity (MD), radial (RD) and axial diffusivity (AD) values were extracted. UHR subjects who later developed psychosis showed lower FA compared with HC in the corpus callosum (CC), the left superior and inferior longitudinal fasciculus, the left inferior fronto-occipital fasciculs (IFO), and the forceps; RD was significantly higher in the CC, the forceps, the anterior thalamic radiation bilaterally, and the cingulum bundle. FES, compared to HC, showed a significant FA reduction of the CC, the superior and inferior longitudinal fasciculi bilaterally, the IFO bilaterally, the corona radiate bilaterally, and the forceps; while RD was found to be significantly increased in the left superior longitudinal fasciculus. UHR who later developed psychosis had WM abnormalities affecting brain pathways that are crucial for intra- and inter-hemispheric connections.

Letter to the editor-making sense of nurses' role in the prevention of suicide in schizophrenia

We read with great interest the review on suicide and schizophrenia by Pinikahana, Happell, and Keks (2003). The authors focused their review on articles written in English and published between 1990 and 1999. Their research highlighted some major risk factors for suicide in patients with schizophrenia and provided accurate analysis of variables involved in the suicidality of schizophrenic patients. We would like to add some considerations about the implications for mental health nursing in the caring of schizophrenic patients at risk of suicide. Indeed, mental health nurses have a crucial role in the prevention of suicide among these patients. Nurses not only need to know risk factors for suicide in schizophrenia, but above all they must take into account the peculiar relationship that suicidal schizophrenic patients establish with staff. Both in outpatient and inpatient care, the role of mental health nurses has been widely recognized. In outpatient care, patients in treatment with clozapine, which was approved by the U.S. Food and Drug Administration for the treatment of suicidal behavior in patients with schizophrenia or schizoaffective disorder, need regular monitoring of white blood cells. These weekly blood counts have been said to provide an opportunity to break social isolation. The interaction with doctors and nurses may provide a warmth and empathic environment where patients feel protected and safe from rejection. These individuals desperately need to socialize and be accepted. Nurses should aim at acquiring skills that foster such an empathic environment, which reduces suicidality in patients with schizophrenia (Meltzer & Okayli, 1995). In inpatient care, things get complicated as the relationship between patients and staff is much more profound. Patients may interact with the same members of the staff for months, often years when multiple

Hemochromatosis-induced bipolar disorder: A case report

OBJECTIVE A patient presenting with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, bipolar disorder was found to be affected by high iron hemochromatosis. This prompted us to explore the relation between bipolar disorder and iron overload. METHOD We report the case and review the peer-reviewed literature focusing on mood symptoms in patients with hemochromatosis or iron overload. Animal studies of brain effects of iron overload are summarized. High iron hemochromatosis was confirmed by genetic testing, and treatment was instituted to address iron overload. RESULTS Patients bipolar symptoms completely subsided after phlebotomic reduction of iron overload. CONCLUSION Clinicians should explore the possibility of iron overload and seek genetic confirmation of hemochromatosis in resistant bipolar disorder to avoid unnecessary medication.

Suicide Attempters in the Emergency Department Before Hospitalization in a Psychiatric Ward

PURPOSE The study aims to compare the current suicidal risk of mood disorder patients who had just attempted suicide, as compared with those who had not attempted suicide, admitted to an emergency department (ED), and then hospitalized in a psychiatric unit. METHOD One hundred sixty-one mood disorder patients admitted to the ED were studied. A total of 22.4% of the participants were admitted for a suicide attempt. Patients were assessed for psychopathology and diagnosis. FINDINGS Suicide attempters were nearly 12 times more likely to report ongoing suicidal ideation during the psychiatric evaluation in the ED than nonattempters. Men and women did not differ for current and previous suicide attempts or for ongoing suicidal ideation. PRACTICAL IMPLICATIONS It is important to conduct a suicide risk assessment when individuals are admitted to an ED.

Preventing Suicide in Young Schizophrenics Who Are Substance “Abusers”

We read with great interest the article by Bolognini and colleagues (Bolognini et al., 2003), which analyzed suicide attempts among adolescents. The authors pointed to the ‘‘abuse’’ and misuse of various substances by adolescents and outlined the importance of such behavior among risk factors for suicide attempts. Also, they proposed principles for early and better assessment of suicide risk among this population. We here point to the need to act in the same way for the prevention of attempted suicide (which constitutes an important risk factor for suicide) in young schizophrenics who are substance ‘‘abusers.’’

Re: Schizophrenia, suicide, and blood count during treatment with clozapine.

An in-depth analysis of follow-up studies has estimated that 10% to 13% of individuals with schizophrenia die by suicide, making it the first cause of death for this group (2). Most authors suggest that the following characteristics indicate individuals with schizophrenia who are more likely to commit suicide: young age, male sex, white ethnicity, good premorbid function, never-married status, postpsychotic depression, and a history of substance abuse and suicide attempts. Hopelessness, awareness of illness, and hospitalization are also very important risk factors. In recent years, atypical antipsychotic drugs have changed the therapeutic approach to schizophrenia. These new drugs—as is the case with clozapine—can also affect the suicide rate among these individuals (3). One of the most important risk factors for suicide among patients with schizophrenia is the social isolation they experience. Together with hopelessness, it induces several feelings that may lead to suicide. It should not be underestimated that meeting with medical staff may play a central role in reducing this social isolation (4). The fact that these patients have to follow a specific pattern of tests (as is the case with periodic blood counts), which leads to interaction with people who may provide warmth and empathy, may alleviate their ever-increasing sense of worthlessness and inadequacy. Most schizophrenia patients experience social isolation, even within their families, and are eager to establish even a tiny interpersonal contact (5). Further, these meetings represent a unique opportunity to check compliance, depressive symptoms, and suicidality. General practitioners and medical staff should always consider the importance of their role when interacting with these people (6). Providing a safe environment to these patients should be paramount, not only among mental health professionals but also among all who interact with them. Such effort no doubt contributes to preventing suicide among schizophrenia patients.