Susanne Baumgartner

Facial emotion recognition and its relationship to subjective and functional outcomes in remitted patients with bipolar I disorder

Hoertnagl CM, Muehlbacher M, Biedermann F, Yalcin N, Baumgartner S, Schwitzer G, Deisenhammer EA, Hausmann A, Kemmler G, Benecke C, Hofer A. Facial emotion recognition and its relationship to subjective and functional outcomes in remitted patients with bipolar I disorder. Bipolar Disord 2011: 13: 537–544.

Switching between second-generation antipsychotics: why and how?

The introduction of second-generation antipsychotics represents an important advance in the treatment of schizophrenia. Although these drugs are generally very effective, not all patients respond in the same way. Partial response with persistent positive and negative symptoms and residual symptoms may force physicians to change antipsychotic medication. As more and more second-generation antipsychotics are introduced, the need for practical guidelines on switching these medications becomes increasingly important.In this article we provide a short summary of the second-generation antipsychotics, focusing on efficacy, adverse effect profile and safety. Indications for switching antipsychotic medication are outlined, as well as recommendations when switching is disadvantageous. Three basic switching strategies (abrupt, gradual and overlapping switching) and their potential risks and benefits are described. We review the available evidence concerning techniques, problems and consequences when switching from one second-generation antipsychotic agent to another and discuss potential difficulties.

Alterations of glucose metabolism during treatment with clozapine or amisulpride: results from a prospective 16-week study

Although second-generation antipsychotics have notabLe benefits as compared to typical antipsychotics, their use has been associated with metaboLic disturbances, such as alterations of glucose homeostasis. It is still being debated whether this is a class effect of second-generation antipsychotics. We conducted a prospective, open study comparing body weight, parameters of insuLin resistance in schizophrenia patients treated with either clozapine (n = 10) or amisuLpride ( n = 12). All parameters were assessed monthly over a period of 12 to 16 weeks. Body mass index (BMI), fasting serum insulin Levels and the Homeostasis Model Assessment (HOMA) index for insulin resistance increased significantly in patients treated with clozapine. None of these parameters increased significantly in patients treated with amisulpride. This study indicates that treatment with clozapine appears to have a higher risk to Lead to metabolic disturbances than amisupride.

Association between antipsychotic-induced elevation of liver enzymes and weight gain: a prospective study.

Abstract: We conducted a prospective, open study in schizophrenia patients treated with second-generation antipsychotics in order to investigate the risk for elevation of liver enzymes and its correlation to antipsychotic-induced weight gain. Body mass index, serum transaminases, plasma serum levels of the antipsychotic used, and blood cell counts were measured weekly during the first 6 weeks of treatment and monthly thereafter. A considerable proportion of subjects showed an increase beyond normal levels of at least one of the measured transaminases. In all but one case, the elevation of liver enzymes was transient. We found a statistically significant correlation between weight gain and liver enzyme elevation. The group of patients that had gained at least 7% of the baseline body weight showed significantly higher increases of transaminases as compared with those who had gained less than 7% weight. We conclude that antipsychotic-induced elevation of liver enzymes is mostly transient and could be associated with weight gain.

Combined clozapine and electroconvulsive therapy in clozapine-resistant schizophrenia: clinical and cognitive outcomes.

Abstract For treatment-refractory schizophrenia, electroconvulsive therapy (ECT) remains controversial because of its cognitive adverse effects. We report here on clinical and cognitive outcomes of a treatment-resistant schizophrenia patient treated with clozapine and right unilateral ECT. The patient was administered 300 mg of clozapine and 12 right unilateral ECT sessions. Psychopathology was rated by means of the Positive and Negative Syndrome Scale. The neurocognitive test battery included the Wisconsin Card Sorting Test, the Münchner Gedächtnis Test, an attentional performance test, the Trail Making Test, and the Hamburger-Wechsler Intelligence Test. The Positive and Negative Syndrome Scale total score decreased, and all cognitive measures improved. Electroconvulsive therapy would seem to be a safe treatment option for treatment-refractory schizophrenia patients.

Affective prosody perception in symptomatically remitted patients with schizophrenia and bipolar disorder

Affect perception has frequently been shown to be impaired in patients suffering from schizophrenia or bipolar disorder (BD), but it remains unclear whether these impairments exist during symptomatic remission and whether the two disorders differ from each other in this regard. Most previous studies have investigated facial affect recognition, but not the ability to decode mental states from emotional tone of voice, i.e. affective prosody perception (APP). Accordingly, the present study directly compared APP in symptomatically remitted patients with schizophrenia or BD and healthy control subjects and investigated its relationship with residual symptomatology in patients. Patients with schizophrenia and BD showed comparable APP impairments despite being symptomatically remitted. In comparison to healthy control subjects, overall APP deficits were found in BD but not in schizophrenia patients. Both patient groups were particularly impaired in the identification of anger and confounded it with neutral prosody. In addition, schizophrenia patients frequently confused sadness with happiness, anger, or fright. There was an inverse association between the degree of residual positive symptoms and the ability to correctly recognize happiness in schizophrenia patients. Overall, these data indicate that impairments in APP represent an enduring deficit and a trait marker of both schizophrenia and BD and that the level of impairment is comparable between disorders.

Bilirubin concentration correlates with positive symptoms in patients with schizophrenia.

OBJECTIVE Besides its toxic effects, bilirubin has been demonstrated to have antioxidant properties to counteract oxidative stress, which has been suggested to play a role in the pathophysiology of schizophrenia. METHODS This study investigated the potential association between changes in psychopathology measured by the Lindenmayer model of the Positive and Negative Syndrome Scale (PANSS) and changes in total plasma bilirubin concentrations. Data of patients with schizophrenia (ICD-10) starting monotherapy with a new-generation antipsychotic were analyzed at baseline (N = 52) and 2 (n = 40), 4 (n = 46), and 12 weeks (n = 30) after the initiation of treatment. Data were collected between December 1997 and October 2007 and analyzed retrospectively. RESULTS The PANSS total score decreased significantly from baseline to weeks 2, 4, and 12 of treatment (all P values ≤ .001). Total plasma bilirubin concentration also dropped significantly from baseline to week 2 (P = .015) and decreased further until week 4 (P = .013); no significant decrease was observed between baseline and week 12. Spearman rank correlation revealed a significant association of bilirubin concentration with the PANSS positive (r = 0.371, P = .007) and excitement (r = 0.322, P = .020) components at baseline. No further correlations were found. From baseline to weeks 2, 4, and 12, changes in the PANSS positive component correlated significantly with changes in plasma bilirubin concentration (all P values < .05), whereas correlations between changes in the remaining PANSS components and bilirubin were less consistent. CONCLUSIONS Assuming that positive symptoms are associated with the subjective experience of psychological distress, our findings indirectly expand the evidence on potential antioxidant properties of bilirubin in patients with schizophrenia.

Therapeutic Alliance in Patients With Schizophrenia: Introduction of a New Rating Instrument.

Objective: The quality of the patient-psychiatrist relationship can be seen as a cornerstone of adherence to medications in patients with chronic psychiatric disorders. Although therapeutic alliance in psychotherapy has been investigated broadly, it has received little attention in the context of medication adherence. The goal of this study was to develop and validate a user-friendly questionnaire for the assessment of therapeutic alliance in clinically stable outpatients with schizophrenia. Methods: The “Brief Questionnaire on Therapeutic Alliance” (BQTA) addresses both the physician and the patient, each of whom responds to 5 items that focus on important domains of the therapeutic alliance. Psychopathology was assessed using the Positive and Negative Syndrome Scale (PANSS) and patients’ attitudes toward the illness and medication were assessed using the Drug Attitude Inventory (DAI). Results: A total of 61 patients who met ICD-10 criteria for schizophrenia spectrum disorders and their treating psychiatrists were included in the study. Overall, patients and psychiatrists gave high (ie, favorable) ratings on all BQTA items. The 5 patient-related items showed high internal consistency (Cronbach &agr;=0.77), whereas physician-related items showed slightly less internal consistency (Cronbach &agr;=0.68). The concordance between patient and physician ratings was fair, although statistically significant (&kgr;=0.33, P=0.007). Physicians’ total score on the BQTA was moderately correlated with patients’ PANSS total score and with the DAI total score and its compliance subscale, whereas patients’ total score on the BQTA did not correlate with DAI or PANSS scores. Conclusion: The BQTA was found to cover crucial aspects of the doctor-patient relationship in chronically ill individuals with schizophrenia. Further validation will shed more light on the usefulness of this questionnaire.

Alterations of glucose metabolism during treatment with clozapine versus amisulpride

Alterations of glucose metabolism during treatment with second generation antipsychotics have been recently reported. Until now there are no reports about alterations of glucose metabolism during treatment with amisulpride. We conducted a prospective investigation on patients with diagnosis of schizophrenic disorder (ICD 10) who received either amisulpride or clozapine in order to study alterations of glucose metabolism. Until now the data of 15 patients are available for statitsical analysis. Mean age was 37.7 years (+/-8). Four patients were male and eleven female. Mean duration of illness was 7.1 (+/-6.1) years. Six patients received amisulpride with a mean dose of 338 mg/d (+/-141) and nine patients received clozapine with a mean dose of 233 mg/d (+/-134). The BMI in the clozapine group was 25.1 (+/-4.6) at base line and 25.2 (SD:+/-4.3) at endpoint while BMI in the amisulpride group was 30.9 (+/-9.8) at baseline and 29.6 (+/9) at end point. Mean duration of the investigation was 18.9 weeks (+/-9.4). Our results show that there was no elevation of fasting glucose and of glucose levels after OGTT in the amisulpride group while there were 2 patients (22%) in the clozapine group who had elevated fasting glucose and elevated glucose-levels after OGTT, approximately 50 % of patients in both groups showed elevated HOMA indices at least once during the time of observation. The similar HOMA indices in both groups might be explained by the fact that the amisulpride group had a considerably higher base line BMI as compared to the clozapine group.