Violent behavior in individuals with schizophrenia

Violence in individuals with schizophrenia and other psychotic disorders is known to be higher than in the general population, according to various definitions of violence, although most people with schizophrenia are not violent. Various factors are reported to increase the risk of violence: demographic characteristics such as male gender, young age, and low socioeconomic status; antisocial personality and history of conduct disorder; comorbidity of substance abuse; psychopathological-clinical variables including positive psychotic symptoms, duration of the untreated psychosis, and the first episode of psychosis; and cognitive disorders. There are 3 types of violent patients with schizophrenia: 1) violent patients with a history of conduct disorder prior to the onset of schizophrenia; 2) violent patients in an acute psychotic episode, with no history of conduct disorder prior to the onset of schizophrenia; and 3) chronically violent patients who show no aggressive behavior prior to their thirties and early forties, and then are engaged in serious violence often including homicide. There are some identified triggering factors including exposure to violence, traumatic brain injury, self-harm, unintentional injury, substance intoxication and parental bereavement. The preventive and treatment strategies will be discussed according to the two different pathways of violence that are classified by the history of conduct disorder. A scientific approach is essential to reduce the rates of violent behaviors and potentially related stigma in patients with schizophrenia.ope

Designs and Methods for the Development of Korean Medication Algorithm for Schizophrenic Patients

As a solution about many problems of pharmacotherapy for Korean patients with major psychiatric disorders, Korean Medication Algorithm Project for Major Psychiatric Disorders (KMAP) was launched. Recently, a medication algorithm for schizophrenic patients was developed and distributed. This review article showed the designs, processes and methods for developing this algorithm. Also we compared the development of Korean algorithm for schizophrenics with other foreign representative algorithms or clinical practice guidelines. We hope that this review elicit the productive criticism about the rigour, the system of development and the objectivity of content. The limitations and problems of Korean algorithm are also discussed in this review.ope

Individualized Prediction of Transition to Psychosis in 1,676 Individuals at Clinical High Risk: Development and Validation of a Multivariable Prediction Model Based on Individual Patient Data Meta-Analysis

Background: The Clinical High Risk state for Psychosis (CHR-P) has become the cornerstone of modern preventive psychiatry. The next stage of clinical advancements rests on the ability to formulate a more accurate prognostic estimate at the individual subject level. Individual Participant Data Meta-Analyses (IPD-MA) are robust evidence synthesis methods that can also offer powerful approaches to the development and validation of personalized prognostic models. The aim of the study was to develop and validate an individualized, clinically based prognostic model for forecasting transition to psychosis from a CHR-P stage. Methods: A literature search was performed between January 30, 2016, and February 6, 2016, consulting PubMed, Psychinfo, Picarta, Embase, and ISI Web of Science, using search terms ("ultra high risk" OR "clinical high risk" OR "at risk mental state") AND [(conver* OR transition* OR onset OR emerg* OR develop*) AND psychosis] for both longitudinal and intervention CHR-P studies. Clinical knowledge was used to a priori select predictors: age, gender, CHR-P subgroup, the severity of attenuated positive psychotic symptoms, the severity of attenuated negative psychotic symptoms, and level of functioning at baseline. The model, thus, developed was validated with an extended form of internal validation. Results: Fifteen of the 43 studies identified agreed to share IPD, for a total sample size of 1,676. There was a high level of heterogeneity between the CHR-P studies with regard to inclusion criteria, type of assessment instruments, transition criteria, preventive treatment offered. The internally validated prognostic performance of the model was higher than chance but only moderate [Harrell's C-statistic 0.655, 95% confidence interval (CIs), 0.627-0.682]. Conclusion: This is the first IPD-MA conducted in the largest samples of CHR-P ever collected to date. An individualized prognostic model based on clinical predictors available in clinical routine was developed and internally validated, reaching only moderate prognostic performance. Although personalized risk prediction is of great value in the clinical practice, future developments are essential, including the refinement of the prognostic model and its external validation. However, because of the current high diagnostic, prognostic, and therapeutic heterogeneity of CHR-P studies, IPD-MAs in this population may have an limited intrinsic power to deliver robust prognostic models.ope

A neurocognitive assessment : mild dementia of alzheimer type, questionable dementia, and non-demented elderly women

The objective of this study is to differentiate the mild dementia of Alzheimer type from the questionable dementia and non-demented elderly using the neurocognitive assessment. Subjects of 28 women who were registered to kwangju Community Mental Health Center were as follows：14 nondemented, 9 questionable dementia, 5 mild dementia of Alzheimer type. The diagnosis were made using DSM-Ⅳ, Clinical Dementia Rating Scale. The neurocognitive functions were assessed with following test tools 1) attention：Digit span, Visual span, Continuous attention；2) memory：Logical memroy, Verbal paired associates-easy/hard 3) visual perception and visuospatial ability：Visual recognition test, Construction；and 4) language：Comprehension and Aphasia severity rating scale；5) higher cortical function：Hypothesis formation, Perseveration, Similarity, Judgment, and Go-No-Go test. Group differences were analyzed with one way ANOVA test in SPSS 8.0 for win and LSD method as post-hoc analysis. The questionable dementia group showed significant difference in Verbal paired associateseasy pair, Construction, Aphasia severity rating scale and Similarity from the non-demented normal control group but showed no difference from the mildly demented group. These results suggest that the questionable dementia is actually very early or very mild stage of dementia of the Alzheimer type.ope

Predicting Working Memory Capacity in Older Subjects Using Quantitative Electroencephalography

Objective: We utilized a spectral and network analysis technique with an integrated support vector classification algorithm for the automated detection of cognitive capacity using resting state electroencephalogram (EEG) signals. Methods: An eyes-closed resting EEG was recorded in 158 older subjects, and spectral EEG parameters in seven frequency bands, as well as functional brain network parameters were, calculated. In the feature extraction stage, the statistical power of the spectral and network parameters was calculated for the low-, moderate-, and high-performance groups. Afterward, the highly-powered features were selected as input into a support vector machine classifier with two discrete outputs: low- or high-performance groups. The classifier was then trained using a training set and the performance of the classification process was evaluated using a test set. Results: The performance of the Support Vector Machine was evaluated using a 5-fold cross-validation and area under the curve values of 70.15% and 74.06% were achieved for the letter numbering task and the spatial span task. Conclusion: In this study, reliable results for classification accuracy and specificity were achieved. These findings provide an example of a novel method for parameter analysis, feature extraction, training, and testing the cognitive function of elderly subjects based on a quantitative EEG signal.ope

Ultra-High Risk for Psychosis : Clinical Characteristics and Diagnosis

Early detection is a crucial milestone in the prevention and treatment of schizophrenia spectrum psychosis, which might alter the course of schizophrenia. Currently, there are two complementary approaches to characterizing the clinical-high risk state of psychosis : the ultra-high risk (UHR) and basic symptoms criteria. Individuals at UHR have two phase-specific problems : heightened risk for the potential pathology of schizophrenia spectrum psychosis and the symptoms, distress and psychosocial functional impairment, which make them seek help. The clinical characteristics of UHR are similar to those of overt psychotic disorders in terms of psychopathological symptoms dimensions, psychosocial disability, neurocognitive and socio-cognitive impairments, history of trauma and abuse experience, lack of protective factors and dysfunctional metacognitive beliefs, and the comorbidity of psychiatric illness. Regarding the risk, the pretest risk probability of a psychotic disorder in each high-risk clinic is considered an important factor for predicting the power of an early detection strategy. For the distress and psychosocial disability, the strategies of the therapeutic intervention will be a focus of clinical attention. On the follow-up, one of third of the UHR individuals have sufficient positive symptom to fulfil the at-risk criteria. Most of the UHR individuals have suffered from comorbid psychiatric illness at the times of both baseline and follow-up, and there is no improvement of psychosocial functioning. Currently, it is essential to optimize the early detection and intervention strategy according to the referring and recruitment characteristics of each high-risk clinic in Korean practice situations.ope

Status of the Early Psychosis Movement in Korea

Two key philosophical questions face the early psychosis movement: 1) Can we really prevent or decrease the incidence of schizophrenia using early interventions with those at high risk for psychosis? and 2) Can optimal biopsychosocial treatment during the critical period of 5 years after onset really stop the progression of the illness after the first episode? Although the correlations between decreased duration of untreated psychotic symptoms and good treatment outcomes and between early intervention with individuals at high risk for psychosis and prevention of the onset of schizophrenia remain controversial. Clinicians agree that earlier treatment is better than later treatment. Thus, the early psychosis movement has emerged from certain philosophical commitments and humanistic perspectives. This article describes developments occurring in Korea with respect to research on and treatment of early psychosisope

Empathic Tendency and Theory of Mind Skills in Young Individuals with Schizophrenia: Its’ Associations with Self-Reported Schizotypy and Executive Function

Objectives Social function deficit is known as a core feature of schizophrenia. This study aimed to investigate differences in empathic tendencies and theory of mind (ToM) skills between healthy controls and young individuals with schizophrenia, and to examine the associations between empathic tendencies, ToM skills and schizotypy, and executive function in schizophrenia. Methods Thirty patients with schizophrenia and 30 healthy controls were enrolled and assessed using the interpersonal relationship index (IRI; perspective taking, fantasy, empathic concern, and personal distress subscales), ToM-Picture Story Task (ToM-PST; sequence and cognitive questionnaire), Wisconsin schizotypy scale (revised physical anhedonia and perceptual aberration), and Stroop tests for empathic tendencies, ToM skills, schizotypy, and executive function. Results In individuals with schizophrenia, the IRI for perspective taking and ToM-PST score for cognitive function were lower, and the IRI for personal distress was higher than those in healthy controls. The IRIs for perspective taking and fantasy were related to revised physical anhedonia, and that for empathic concern was associated with revised physical anhedonia and perceptual aberration. The ToM-PST score for sequence was associated with the Stroop test score for schizophrenia. Conclusion These findings indicate deficits in empathic tendencies and ToM skills, which may be independently and primarily associated with schizotypy and executive function in young individuals with schizophrenia.ope

Mood-Congruent Bias to Emotional Word, Face, and Scene Stimuli in Patients with Bipolar Mania : Comparison to Normal and Schizophrenia Subjects

OBJECTIVE: Patients with bipolar mania have difficulty in recognizing or attending to negatively affective stimuli and have an affective bias, which is congruent with the current mood. However, previous reports have adopted words or facial pictures, not scenic pictures as affective stimuli. In this study, patients with mania performed the word, face and scenic picture-based affective go-nogo tasks respectively. The results were compared to those of patients with schizophrenia and healthy controls. 0aMETHODS: Twenty patients with bipolar mania, 20 patients with schizophrenia, and 20 healthy comparison subjects, matched for age, gender and intelligence, performed affective gonogo tasks which contained happy/sad words, facial pictures, and scenic pictures respectively. 0aRESULTS: On the scenic picturebased affective go-nogo task, a significant interaction between subject group and target valence emerged {F (2, 57)ond to sad than to happy stimuli (td-congruent bias toward affective scenic pictures, but not toward affective word or facial pictures. This finding suggests that complex and scenic stimuli may give a more influence on the affective arousal state and therefore increase the mood-congruent bias in manic patients.ope

Korean Medication Algorithm Projects for Major Psychiatric Disorders(Ⅱ) - Background, Basic Plan, Organization of KMAP and Principles, Methods of Algorithm Development and Limitation, Caution when using KMAP -

In this special article we present Korean medication algorithm development project for major psychiatric disorder (KMAP), basic plan, organization, basic principles of algorithm developments, methods of development, limitations and cautions of using this algorithm. The Korean Society of Psychopharmcology and Korean Academy of Schizophrenia as a co-worker started to make Korean algorithm project that is helpful to treat major mental disorder (schizophrenia, bipolar disorder) patients by the better psychopharmacologic treatments. In spite of many advantages of algorithm, these projects have many limitations and problems simultaneously；we needed to introduce the goal of algorithm, details of development methods in this special article. KMAP have employed the latest survey techniques and reflect only the most current clinical standards. The results are a practical reference tool not only for clinicians but also for mental health educators and other healthcare professionals involved in the care of patients who have major mental disorders. This algorithm projects can have problems and shortcomings. but we will revise this issues by correction and amendment.ope