Kei Sakuma

Effects of the CYP2D6*10 alleles and co‐medication with CYP2D6‐dependent drugs on risperidone metabolism in patients with schizophrenia

Risperidone is converted to 9‐hydroxyrisperidone by CYP2D6. Two parameters were used to examine the influences of CYP2D6 polymorphism and of co‐medication on risperidone metabolism: the risperidone:9‐hydroxyrisperidone concentration ratio (R:9‐OHR ratio) and the sum of the risperidone and 9‐hydroxyrisperidone concentrations divided by the dose (C:D ratio). We evaluated the effect of the CYP2D6*10 allele, which is a prevalent mutant allele among East Asians.

Long-term course of cognitive function in chronically hospitalized patients with schizophrenia transitioning to community-based living

Schizophrenia is associated with impairments in social interactions, and the conditions under which patients live and undergo treatment appear to have an important role in the course of the disease. However, the influences of care settings on the course of cognition remain controversial. The closure of psychiatric hospitals and the transition to community-based living is a golden opportunity to address this issue. The aims of the present study were to examine (1) the longitudinal course of cognition as well as the psychopathology and social functioning of schizophrenia patients who had been chronically hospitalized and then discharged, and (2) the key cognitive predictors of the functional outcome of such patients. Seventy-eight patients were transferred to the community after the closure of a psychiatric hospital. These patients were followed-up for 5 years and underwent annual examinations that included measures of cognition, psychiatric symptoms, and social functioning. Fifty-six patients completed all the assessments. Although consistent improvements were shown in the cognitive domains for attention and memory, the initial improvements in global cognition and processing speed ultimately began to decline. Symptoms and global functioning improved almost consistently over the course of the follow-up period. Stepwise multiple regressions revealed category fluency at baseline predicted social functioning at 5 years. However, this correlation was no longer significant when psychopathological variables were included as predictors. These results suggest that care settings affect the course of cognition, and addressing these conditions may lead to a certain degree of cognitive improvement even among schizophrenia patients who have been chronically institutionalized.

Successful aging in individuals with schizophrenia dwelling in the community: A study on attitudes toward aging and preparing behavior for old age

Aim:  ‘Successful aging’ in individuals with schizophrenia has been attracting attention. We examined two forward‐looking factors of successful aging among schizophrenia patients: ‘attitude toward aging’ and ‘preparing behavior for old age’.

F238. COMPETENCE-PERFORMANCE DISCREPANCY IN SOCIAL FUNCTIONING IN PATIENTS WITH SCHIZOPHRENIA: THE IMPACT OF SOCIAL ANXIETY

Abstract Background Social functioning deficits are of critical importance in patients with schizophrenia, because they affect the long-term outcomes and quality of life (QOL) of the patients. Two aspects of social functioning, namely, competence (ability to perform skilled activities, that is, what one can do) and performance (actual performance of skilled activities, that is, what one actually does) are considered to have a significant influence on how well the patients can live independently in the community. Although the two aspects are usually thought to go hand in hand, discrepancy between the two is often observed in patients with schizophrenia in clinical practice. Some patients are not able to function in the community to the best of their ability; some patients appear to get along everyday living better than they would be expected to. The aim of the present study was to identify factors influencing the occurrence of such discrepancy of social functioning in patients with schizophrenia. Methods A total of 205 stable outpatients with schizophrenia aged 40 years old or under were recruited at the Toho University Omori Medical Center, Tokyo. Of the 205 patients, 100 were male (48.8%) and 105 (51.2%) were female. The mean age of the participants was 29.3 years and the mean estimated premorbid IQ was 100.8. The mean age at disease onset was 22.0 years old, and the mean duration of illness at the start of the study was 6.7 years. The social functioning, psychiatric symptoms, social anxiety, cognitive function, and QOL of the participants were assessed. The patients were divided into 4 groups by the cutoff points for competence and performance calculated using a comprehensive dataset of the Social Functioning Scale (SFS) obtained from multiple facilities. Results The subjects were divided according to their level of competence and performance as follows: good competence and good performance (CP) group, 108 (52.7%) patients; good competence but poor performance (Cp) group, 40 (19.5%) patients; poor competence but good performance (cP) group, 13 (6.3%) patients; poor competence and poor performance (cp) group, 44 (21.5%) patients. Among the 4 groups, the objects of particular interest in this study were the differences between CP and Cp groups and between the cP and cp groups. One-way ANOVA revealed significant differences among the groups in the scores on the Positive and Negative Syndrome Scale (PANSS), Liebowitz Social Anxiety Scale (LSAS), Global Assessment of Functioning Scale (GAF), World Health Organization-Quality of Life 26 (WHOQOL26), and Social Functioning Scale (SFS). Post-hoc comparisons revealed that the PANSS negative symptoms and general psychopathology scores, GAF score, WHOQOL26 score, and SFS total score were significantly worse in the Cp group than in the CP group, and that the LSAS score, GAF score, WHOQOL26 score, and SFS total score were significantly better in the cP group than in the cp group. Discussion In patients who are capable of living well in the community but do not perform well, negative symptoms may be involved in this discrepancy of social functioning. Patients who are able to maintain themselves well despite their poor social competence appear to have milder social anxiety symptoms as compared to patients who are neither competent nor capable of performing well in terms of social functioning in the community. Suitable and personalized approaches based on the patients’ profile of dysfunction would seem to be indispensable for the recovery of such patients.