Qijing Bo

Risperidone Maintenance Treatment in Schizophrenia: A Randomized, Controlled Trial

OBJECTIVE Prevention of relapse is the crucial task in the maintenance treatment of schizophrenia. The investigators in this study sought to determine the duration of maintenance treatment needed with the initial therapeutic dose, in contrast to a reduced dose. METHOD In a multicenter open-label, randomized, controlled study, patients with schizophrenia who were clinically stabilized following an acute episode were randomly assigned to a no-dose-reduction group (initial optimal therapeutic dose continued throughout the study), a 4-week group (initial optimal therapeutic dose continued for 4 weeks, followed by a 50% dose reduction that was maintained until the end of the study), or a 26-week group (initial optimal therapeutic dose continued for 26 weeks, followed by a 50% dose reduction until the end of the study). All patients continued until the last recruited patient completed the 1-year follow-up. RESULTS Of the 404 patients who met the entry criteria and were randomly assigned, 374 completed the study. The estimated mean time from entry to relapse was 571 days in the 4-week group, 615 days in the 26-week group, and 683 days in the no-dose-reduction group, with estimated relapse rates of 30.5%, 19.5%, and 9.4%, respectively. Patients in the no-dose-reduction group experienced greater reduction in the severity of psychotic symptoms. CONCLUSIONS Patients who continued to receive the full risperidone dose used for their acute episode had fewer relapses than those who had dose reductions after 4 weeks or 26 weeks during the maintenance period. There was negligible difference in side effects among the three groups.

Cigarette smoking in patients with schizophrenia in China: prospective, multicentre study

Objective: The aim of the present study was to explore the rate of cigarette smoking and its sociodemographic and clinical characteristics in Chinese schizophrenia patients. Methods: In a multicentre, randomized, controlled, longitudinal study, 374 clinically stable patients with schizophrenia were interviewed at entry using standardized assessment instruments, and followed up for 1–2 years. Results: The rate of cigarette smoking was 13.9% in the whole sample, and 26.2% in men and 3.5% in women. On univariate analysis, male sex, unemployment, alcohol consumption, older age, older age at onset, longer duration of illness, more frequent admissions, more severe hostility–excitement at entry and less deterioration in hostility–excitement over the study period were significantly associated with cigarette smoking. On multivariate analysis, male sex, unemployment, alcohol consumption, more frequent admissions, less severe positive and negative symptoms at entry, smaller decline in negative symptoms and more deterioration in disorganized thoughts over the study period were independently associated with cigarette smoking. Conclusion: The rate of cigarette smoking in Chinese schizophrenia patients is considerably lower than most figures reported in the Western literature.

Sex differences in patients with schizophrenia: A prospective, multi-center study

This study aimed to determine sex differences in socio-demographic and clinical characteristics of Chinese schizophrenia patients. In a multi-center, randomized, controlled, longitudinal study, 404 clinically stable patients with schizophrenia were randomly assigned to a maintenance group (optimal therapeutic doses continued throughout the study), a 26-week group (optimal therapeutic doses continued for 26 weeks, followed by a 50% dose reduction maintained until the end of the study), or a 4-week group (optimal therapeutic doses continued for 4 weeks, followed by a 50% dose reduction maintained until the end of the study). Participants were interviewed regularly using standardized assessment instruments, and followed up for 12-26 months. In the univariate analyses, the following factors were significantly associated with the male sex: not married, smoking, younger age, earlier age at onset, higher body mass index (BMI) at baseline, and more severe negative and hostility-excitement symptoms at baseline. The following factors were independently associated with the male sex in the multivariate analyses: not being married, smoking, a higher BMI at baseline, less deterioration in disorganized thoughts (4-week group) and positive symptoms (26-week group) and less increase in BMI in all three treatment groups over the study period. The majority of the sex differences in schizophrenia patients in this study are in accordance with results of previous studies worldwide suggesting that sex differences seen in schizophrenia are not dependent on cultural differences between geographically separate patients.

Frequency of Hyperprolactinemia and Its Associations With Demographic and Clinical Characteristics and Antipsychotic Medications in Psychiatric Inpatients in China

PURPOSE No study has investigated hyperprolactinemia and its risk factors in Chinese psychiatric patients. This study examined the prevalence of hyperprolactinemia and its relationship with demographic and clinical characteristics in inpatients in a large psychiatric institution in Beijing, China. DESIGN AND METHODS A consecutive sample of 617 psychiatric inpatients formed the study sample. Basic sociodemographic and clinical data including serum prolactin level were collected. FINDINGS The prevalence of hyperprolactinemia was 55.9% in the whole sample, and 56.8% and 43.2% for women and men, respectively. The corresponding figures were 59.6%, 40.0%, 53.6%, and 50.8% in schizophrenia spectrum disorders, major depression, bipolar disorders, and other psychiatric disorders, respectively (p = 0.09). In univariate analyses, patients having hyperprolactinemia were younger, more likely to receive risperidone, amisulpride, and first-generation antipsychotics, but less likely to receive clozapine and aripiprazole. In multiple logistic regression analysis, hyperprolactinemia was independently associated with younger age, more use of risperidone or amisulpride and first-generation antipsychotics, and less use of clozapine and aripiprazole (r(2) = 0.197). PRACTICE IMPLICATIONS Hyperprolactinemia is very common in Chinese psychiatric inpatients. Given the potentially harmful consequences of hyperprolactinemia and its preventable nature, effective measures to lower the frequency hyperprolactinemia in patients with major psychiatric disorders should be implemented in Chinese mental health facilities.

Extrapyramidal Symptoms During Risperidone Maintenance Treatment in Schizophrenia: A Prospective, Multicenter Study.

Abstract The risperidone maintenance treatment in schizophrenia study was designed to identify the duration of maintenance treatment required with an initial therapeutic dose in contrast to reducing the dose over time. This study investigated extrapyramidal symptoms (EPSs) in different risperidone maintenance treatment paradigms over 1 year. Clinically stabilized patients with schizophrenia (n = 374) were randomized to a no-dose-reduction group and 4-week and 26-week reduction groups, in which the dose was gradually reduced by 50% over 8 weeks and maintained. Extrapyramidal symptoms were assessed at baseline and monthly for 6 months, followed by every 2 months. The Simpson-Angus Scale of Extrapyramidal Symptoms–Chinese version assessed EPS severity. Data were analyzed by a generalized linear mixed model (GLMM). The frequency of EPS at baseline was 23.2%, 20.0%, and 21.3% in the 4-week, 26-week, and no-dose-reduction groups, respectively. Risperidone dosage, positive symptoms, and disorganized thoughts at baseline predicted development of EPS. The GLMM indicated that a significant decrease in EPS was maintained, and different trajectories occurred over time across groups. In the 235 patients who continued treatment after 1 year, the incidence of EPS decreased to 4.1%, 2.8%, and 10.0% in the 4-week, 26-week, and no-dose-reduction groups, respectively, whereas the numbers of dropouts because of intolerable EPS were not significantly different (4.8%, 6.7%, and 6.2%, respectively). These novel findings indicate EPSs were tolerable and differentially decreased depending on the dose paradigm during the 1-year treatment period. Future studies should implement a GLMM to investigate antipsychotic adverse effects during long-term treatment.

Socio-demographic and clinical profiles of paranoid and nonparanoid schizophrenia: a prospective, multicenter study in China.

PURPOSE This study aimed to explore the socio-demographic and clinical characteristics of paranoid and nonparanoid subtypes of schizophrenia. DESIGN AND METHODS In a multicenter, randomized, controlled, longitudinal study, 374 clinically stable schizophrenia patients were interviewed at entry with standardized assessment instruments and followed for 12-26 months. FINDINGS In the multivariate analysis, male sex, married marital status, urban abode, and more frequent relapse over the study period were independently associated with paranoid schizophrenia. PRACTICE IMPLICATIONS The socio-demographic and clinical characteristics of Chinese patients with the paranoid subtype of schizophrenia are different from those of their Caucasian counterparts who are more likely to be women and have a better outcome.

Use of the MATRICS consensus cognitive battery (MCCB) to evaluate cognitive deficits in bipolar disorder: A systematic review and meta-analysis

Background The Measurement and Treatment Research to Improve Cognition Schizophrenia Consensus Cognitive Battery (MCCB) has also been proposed for use in clinical trials to assess cognitive deficits in patients with bipolar disorder (BD). The aim of this study was to evaluate cognitive function assessed by the MCCB in BD. Methods A literature search of the PubMed, Embase, PsycINFO, SCI, Cochrane Library databases and the Cochrane Controlled Trials Register was conducted. Case reports, reviews and meta-analyses were excluded and a systematic review of the remaining studies of cognitive function in BD was carried out. The cognitive outcome measure was the MCCB, including 7 domains and overall cognition. A random-effects model was applied. Results Eighty eight studies were initially identified. Seven clinical studies comprising a total of 487 patients and 570 healthy controls (HC) were included in the meta-analysis. Patients with BD performed worse than HC in overall cognition and processing speed with a large effect size of >0.8; with a medium effect size (0.5–0.8) in attention, working memory, verbal learning and visual learning; and with a small effect size (0.2–0.5) in reasoning and problem solving and social cognition. Conclusion Patients with BD performed worse than HC in overall cognition and all cognitive domains of the MCCB. Cognitive deficits in domains of processing speed and working memory are prominent in patients with BD. Our findings suggest that MCCB can be usefully applied in BD.

The dynamic characteristics of the anterior cingulate cortex in resting-state fMRI of patients with depression

BACKGROUND The anterior cingulate cortex (ACC) is part of the limbic system of the brain. It is a bridge between attentional and emotional processing, which is responsible for the integration of visceral, attentional, and affective information. Lesioning of the ACC, which produces striking changes, is used to treat major depression disorder (MDD). Moreover, the brain dynamically integrates and coordinates functions of its different subparts to realize its cognitive capability. Hence, the spatio-temporal community distribution of the ACC is necessary to completely understand MDD. METHODS First, community structure detection was used to reveal the community distribution of brain regions. Thereafter, the flexibility, i.e., the frequency of community assignment changes of the ACC in such a community, and the module allegiance matrix (MAM) between the ACC and other brain regions, were analyzed. RESULTS Our analysis demonstrated significant differences in the distribution of community assignment and flexibility of the ACC in MDD, compared to healthy controls (HC). The results also showed that the pairwise values of the MAMs between the ACC and the amygdala, insula, precuneus, and thalamus were significantly lower in patients with MDD compared to those in HC. LIMITATIONS The data collected is subject to patient-specific noise because (1) the medication effect varies from patient to patient, and (2) with most fMRI studies, the thoughts of the participants during imaging are difficult to control. CONCLUSION ACC exhibits abnormal flexibility in community structures in MDD. The pairwise abnormal entries in the MAM for the ACC with four other brain regions, i.e., amygdala, insula, precuneus, and thalamus, quantified the role played by the ACC in MDD.

S15. ABNORMAL EYE TRACKING IN PATIENTS WITH SCHIZOPHRENIA UNDER THE SOCIAL SCENE

Abstract Background To investigate whether the eye movement pattern is different between facial emotion recognition and real social scene emotion recognition, and which can better reflect the social function and the clinical symptoms using a novel theme identification task. Methods Total 29 patients with schizophrenia and 31 healthy controls completed the theme identification task, in which subjects selected which word, out of positive, neutral and negative, described the theme of a picture under facial emotion recognition and real social scene emotion recognition. Positive and negative syndrome scale (PANSS) and social function in psychosis inpatients (SSPI) were used to assess the symptom and social function. Results The schizophrenia’s eye movement paradigms under both facial emotion and social scene show decreased number of fixation (t=-3.49, P=0.00; t=-3.62, P=0.00), decreased number of saccades (t=-3.15, P=0.00; t=-3.72, P=0.00), decreased scan path length (t=-2.23, P=0.03; t=-4.18, P=0.03), decreased fixation number in interest area (t=3.01, P=0.00; t=-3.24, P=0.00). Different from facial emotion cognition, the eye movement under social scene cognition showed lower percentage of fixation number in interest area than that in healthy subjects (P=0.01), furthermore, the length of scan path under the negative social scene pictures was associated with the total score of SSPI (r=-0.38, P=0.04), the PANSS total score (r=-0.46, P=0.01), the positive symptoms score (r=-0.39, P=0.04), the general score (r=-0.50, P=0.01). Discussion The patients showed more abnormal eye tracking indicators under social scene than facial emotion. Under negative emotion social scene, the length of scan path related to social function and clinical symptoms, it may be a potential indicator to evaluate social function and degree of disease.

F57. CORRELATION FACTORS OF ABNORMAL MENSES IN SCHIZOPHRENIA TREATMENT WITH RISPERIDONE

Abstract Background A significant percentage of women taking antipsychotic medication may be suffering from abnormal menses during their treatment, which influences both fertility and adherence to medication. It is particularly common in patients prescripted with risperidone. This study aimed to identify the risk factors for abnormal menses in female individuals with schizophrenia during risperidone treatment, especially the relationship between abnormal menses and the dose or the length of the medicine. Methods This study used a retrospective data. 202 female patients diagnosed with schizophrenia using risperidone were screened. Doses and length of treatment with risperidone were various. 38 were excluded for their menstrual irregularities before treatment, in which 4 amenorrhea and 15 menopause. 164 female patients included, but 3 of them absent of data. 161 female patients included in analyses at last. Results Of the 161 patients, 119 were eumenorrhea up to our analyses, and other 42 abnormal menses, including 23 menstrual irregularities, 8 amenorrhea and 11 oligomenorrhea. There was no statistical difference in age (32.0 ± 8.6 vs. 31.4 ± 10.1) (years), education (12.2 ± 2.3 vs. 12.6 ± 2.2) (years), age at onset 26.7 ± 8.0 vs. 24.8 ± 8.4) (years), duration of illness (5.8 ± 5.2 vs. 7.0 ± 7.7) (years), PANSS total score (37.2 ± 8.8 vs. 38.1 ± 7.0) between normal group and abnormal group. There was also no statistical difference in risperidone dose at baseline (4.3 ± 0.7 vs. 4.3 ± 0.5) (mg/d), total treatment in this episode (5.3 ± 4.7 vs. 5.4 ± 5.4) (months), overall length of risperidone treatment in this episode (86.7 ± 62.0 vs. 98.6 ± 73.5) (days), length of risperidone treatment at optimal therapeutic dose (63.0 ± 64.5 vs. 51.3 ± 26.7) (days). Discussion Some research suggests antipsychotic-induced abnormal menses is related to medication-induced high prolactinemia level and low estradiol level pretreatment. But few study reports the relationship between abnormal menses and the dose or the length of the medicine. This study got negative results, which suggest the occurrence of abnormal menses widely depend on individual quality rather than the length and the dose of the antipsychotic. But there are some limits in the study. First, the dosage range among these subjects were relatively narrow. And then, the length of risperidone treatment is generally short. In the next step of research, we will improve these two points.