Impaired Flush Response to Niacin Skin Patch Among Schizophrenia Patients and Their Nonpsychotic Relatives: The Effect of Genetic Loading

We previously reported familial aggregation in flush response to niacin skin patch among schizophrenia patients and their nonpsychotic relatives. However, little is known about whether this abnormal skin response is associated with genetic loading for schizophrenia. This study compared the niacin flush response in subjects from families with only one member affected with schizophrenia (simplex families) with those from families having a sib-pair with schizophrenia (multiplex families). Subjects were patients with schizophrenia and their nonpsychotic first-degree relatives from simplex families (176 probands, 260 parents, and 80 siblings) and multiplex families (311 probands, 180 parents, and 52 siblings) as well as 94 healthy controls. Niacin patches of 3 concentrations (0.001M, 0.01M, and 0.1M) were applied to forearm skin, and the flush response was rated at 5, 10, and 15 minutes, respectively, with a 4-point scale. More attenuated flush response to topical niacin was shown in schizophrenia probands and their relatives from multiplex families than in their counterparts from simplex families, and the differentiation was better revealed using 0.1M concentration of niacin than 0.01M or 0.001M. For the highest concentration of 0.1M and the longest time lag of 15 minutes, a subgroup of probands (23%), parents (27%), and siblings (19%) still exhibited nonflush response. Flush response to niacin skin patch is more impaired in schizophrenia patients and their relatives from families with higher genetic loading for schizophrenia, and this finding has implications for future genetic dissection of schizophrenia

Evaluation of client progress in music therapy:An illustration of an N-of-1 design in individual short-term improvisational music therapy with clients with depression

This article introduces music therapy clinicians to a research design that can be easily implemented in clinical practice to evaluate and monitor the impact of interventions on individual clients: the systemic N-of-1 design. In this single-case design, the client’s network, consisting of professional and non-professional network members, assumes the role of evaluators of the given treatments. The systemic N-of-1 design is illustrated with a small empirical study with nine clients with symptoms of depression within a single private practice. The study participants received individual short-term improvisational music therapy (ISIMT) consisting of seven weekly sessions. One week before the first session and one week after the last session, the Inventory of Depressive Symptomatology (IDS) was completed by the clients, their professionals and network members. Applying the systemic N-of-1 design produced valuable individualised and group information about the effects of ISIMT on depressive symptoms. The systemic N-of-1 design can be used in clinical practice by music therapists to systematically monitor the outcome of their therapies. Pooling systemic N-of-1 designs by collaborating music therapists may provide valuable information about the efficacy of music therapy. Keywords: Single-case design, systemic N-of-1 design, improvisational music therapy, depressio

Niacin skin flushing in schizophrenic and depressed patients and healthy controls

This study compares the skin reactions to the niacin flushing test of 16 schizophrenic patients with those of 17, depressed patients and 16 healthy controls. Methyl nicotinate (niacin) in a concentration of 0.1 M was applied to the forearm for 5 min. Significant differences could be observed between the group of schizophrenic patients (less flushing) in comparison to the other groups. There were no statistical differences in niacin flushing between patients with depression and healthy controls. Gender, age and the use of antipsychotic agents did not appear to be confounders. The differences in flushing within the group of schizophrenic patients were striking, however. Most patients showed little or no flushing, but some patients reacted strongly. Although the three groups could be differentiated by the niacin flushing test, to develop a reliable clinical application of this test, further research is necessary. (c) 2005 Elsevier Ireland Ltd. All rights reserved

Reasoning about the optimal duration of prophylactic antipsychotic medication in schizophrenia: evidence and arguments

Objective: To review evidence-based literature regarding the necessary duration of antipsychotic relapse prevention in schizophrenia and related psychoses. Method: A computerized search was performed on Medline, Embase Psychiatry and PsycLIT which covered the period 1974-99. We also used cross-references. Results: Although schizophrenia refers mainly to an intrinsic biological vulnerability, only maintenance studies with a follow-up of 2 years at most are available. Relapses appear unpredictable and occur even after long-term successful remission during antipsychotic treatment. Conclusion: Since rehabilitation efforts have effects only after long-term endeavours, antipsychotic relapse prevention should be maintained for long periods. It is reasonable to treat patients suffering from schizophrenia and related psychoses for longer periods than indicated by the current guidelines