REMISSION AND EMPLOYMENT STATUS IN SCHIZOPHRENIA AND OTHER PSYCHOSES: ONE-YEAR PROSPECTIVE STUDY IN CROATIAN PATIENTS TREATED WITH RISPERIDONE LONG ACTING INJECTION

Background: While numerous studies have confirmed the efficacy of risperidone long-acting injectable (RLAI) on many clinical outcomes in patients with schizophrenia, there is no data regarding its influence on employment status. Subject and methods: This was a 12-month observational study with flexible doses of RLAI on a Croatian population of patients with schizophrenia and other psychoses. Visits were at baseline and after 1, 3, 6 and 12 months of treatment. Treatment response was evaluated using Clinical Global Impression of Illness Severity (CGI-S) and Improvement (CGI-I) scales, while remission was defined by 8 items of Positive and Negative Syndrome Scale (PANSS). Employment status was determined at baseline and at study endpoint. Results: A total of 362 patients were included, with a median age of 37 (interquartile range 29-47) years, 63.5 % were males and 67.4% were hospitalised at baseline. Overall 258 (71.3%) patients completed the study. Improvements in CGI-S scores from baseline were significant (p<0.001) at all visits. Remission criteria were met in 9 (2.5%) patients at baseline, and in 199 (54.9%) at endpoint, while 144 patients (52.7%) achieved symptomatic remission. Female patients were five times more likely to achieve symptomatic remission (OR=5.2; 95%CI=2.64-10.19). At baseline, 74/362 (20.4%) patients were employed, compared to 77/257 (30.0%) at endpoint (p<0.001). Adverse events were spontaneously reported in 55 (15.2%) patients. Three patients died (judged not to be related to RLAI) and one patient committed homicide. Conclusions: Patients treated with RLAI had significant improvements in CGI-S scale scores, hospitalization status, rates of remission and employment status, indicating the benefits of continuous treatment over time. Further studies on the comparative impact of different treatment strategies on functional recovery are needed

THE PRESENCE OF MINOR PHYSICAL ANOMALIES OF A HAND IN PATIENTS WITH MENTAL DISORDERS

Introduction: Minor physical anomalies (MPA) are subtle morphological deviations with little to none clinical significance that are developed prenatally and therefore could be an indicator of structural changes in the brain developing at the same time. Aim of this study was to determine whether the MPA of the hand can distinguish psychotic patients from patients with non-psychotic diagnoses as well as from the healthy individuals. Subjects and methods: 100 consecutive patients from the University Hospital Center Zagreb, Department of psychiatry, were included in this case-control study along with 100 healthy control subjects. Investigators examined the dorsal and palmar side of the hand and were blind to the patient’s diagnoses previous to the examination. Examined MPA included thenar crease, proximal transverse crease, proximal interphalangeal joint, eponychium of the middle digit, fingernail size and digital flexibility. Results: Results showed significant differences in the quantity of MPA between the patients and the control group, as well as differences between patients with psychosis and the healthy subjects. Conclusions: Despite the fact that previous studies demonstrated characteristic distribution of specific MPA in schizophrenia, this study did not prove such results. Moreover, this study showed that all the MPA are equally common in both schizophrenia and other psychoses

REMISSION IS NOT ASSOCIATED WITH DRD2 RS1800497 AND DAT1 RS28363170 GENETIC VARIANTS IN MALE SCHIZOPHRENIC PATIENTS AFTER 6-MONTHS MONOTHERAPY WITH OLANZAPINE

Background: Symptomatic remission is an achievable goal in the treatment of schizophrenia. The type of antipsychotic medication and particular genetic variants of the dopaminergic system might be associated with remission. Potential pharmacogenetic markers of the treatment response to antipsychotic medication are missing. This study assessed the possible association between dopamine receptor type 2 (DRD2 rs1800497) and dopamine transporter (DAT1 rs28363170) gene variants with symptomatic remission in schizophrenia. Subjects and methods: Olanzapine (5-20 mg/d) monotherapy was administered for 6 months to 150 male Caucasian subjects with schizophrenia. Remission was evaluated according to "Remission in Schizophrenia Working Group" criteria. Genotyping was performed by PCR-RFLP. Results: Symptomatic remission was found in 31% of patients. DRD2 rs1800497 and DAT1 rs28363170 gene variants were not significantly associated with symptomatic remission. The limitations are a relatively small sample size of patients with schizophrenia (N=150), especially of group with symptomatic remission (N=45). However, the study had moderate but adequate sample sizes for most of the comparisons. Only two dopaminergic polymorphisms were analyzed, and plasma concentration of olanzapine was not determined. Conclusion: These results revealed a lack of association between DRD2 rs1800497 and DAT1 rs28363170 genetic variants and symptomatic remission in male patients treated with olanzapine, suggesting that these genetic variants could not be used to predict symptomatic remission to olanzapine monotherapy. Negative results should be further confirmed or rejected in the larger samples, including haplotype analyses, to detect clinically useful and easy obtainable pharmacogenetic markers that might predict therapeutic response or remission in schizophrenia

INTEGRATION OF COMPLEMENTARY BIOMARKERS IN PATIENTS WITH FIRST EPISODE PSYCHOSIS: RESEARCH PROTOCOL OF A PROSPECTIVE FOLLOW UP STUDY

In this project, we recruited a sample of 150 patients with first episode of psychosis with schizophrenia features (FEP) and 100 healthy controls. We assessed the differences between these two groups, as well as the changes between the acute phase of illness and subsequent remission among patients over 18-month longitudinal follow-up. The assessments were divided into four work packages (WP): WP1- psychopathological status, neurocognitive functioning and emotional recognition; WP2- stress response measured by saliva cortisol during a stress paradigm; cerebral blood perfusion in the resting state (with single photon emission computed tomography (SPECT) and during activation paradigm (with Transcranial Ultrasonography Doppler (TCD); WP3-post mortem analysis in histologically prepared human cortical tissue of post mortem samples of subjects with schizophrenia in the region that synaptic alteration was suggested by WP1 and WP2; WP4- pharmacogenetic analysis (single gene polymorphisms and genome wide association study (GWAS). We expect that the analysis of these data will identify a set of markers that differentiate healthy controls from patients with FEP, and serve as an additional diagnostic tool in the first episode of psychosis, and prediction tool which can be then used to help tailoring individualized treatment options. In this paper, we describe the project protocol including aims and methods and provide a brief description of planned post mortem studies and pharmacogenetic analysis

Clinical decision-making style preferences of European psychiatrists : Results from the Ambassadors survey in 38 countries

Background While shared clinical decision-making (SDM) is the preferred approach to decision-making in mental health care, its implementation in everyday clinical practice is still insufficient. The European Psychiatric Association undertook a study aiming to gather data on the clinical decision-making style preferences of psychiatrists working in Europe. Methods We conducted a cross-sectional online survey involving a sample of 751 psychiatrists and psychiatry specialist trainees from 38 European countries in 2021, using the Clinical Decision-Making Style - Staff questionnaire and a set of questions regarding clinicians' expertise, training, and practice. Results SDM was the preferred decision-making style across all European regions ([central and eastern Europe, CEE], northern and western Europe [NWE], and southern Europe [SE]), with an average of 73% of clinical decisions being rated as SDM. However, we found significant differences in non-SDM decision-making styles: participants working in NWE countries more often prefer shared and active decision-making styles rather than passive styles when compared to other European regions, especially to the CEE. Additionally, psychiatry specialist trainees (compared to psychiatrists), those working mainly with outpatients (compared to those working mainly with inpatients) and those working in community mental health services/public services (compared to mixed and private settings) have a significantly lower preference for passive decision-making style. Conclusions The preferences for SDM styles among European psychiatrists are generally similar. However, the identified differences in the preferences for non-SDM styles across the regions call for more dialogue and educational efforts to harmonize practice across Europe.Peer reviewe

The Association of Preoperative Depression, and C-Reactive Protein Levels with a Postoperative Length of Stay in Patients Undergoing Coronary Artery Bypass Grafting

This study aimed to explore the role of preoperative and postoperative C-reactive protein (CRP) levels in mediating the association between the preoperative depression symptoms and postoperative length of stay in patients undergoing coronary artery bypass grafting (CABG). Preoperative depression symptoms of 212 elective CABG patients were measured using the Beck Depression Inventory (BDI-II). The patient’s demographic and clinical parameters were collected from medical records prior to surgery. Patients were followed up during their in-hospital stay to measure early (1–3 days post-surgery) and persistent (4–6 days post-surgery) CRP response to CABG surgery. The higher persistent CRP response was significantly (p p = 0.009). However, when the gender subgroups were analyzed separately, that remained significant (OR = 1.016, 95% CI = 1.004–1.028, p = 0.005) only for the male subgroup. There was no significant association between elevated BDI-II depression scores and longer postoperative hospital stay. Additionally, no significant influence of BDI-II scores on preoperative or postoperative CRP levels, or vice versa, was detected. Further work is needed to explore the extent and pathways through which depression might influence the postoperative recovery of CABG patients

The lack of effect of ziprasidone on platelet serotonin concentration in schizophrenic patients

Rationale Ziprasidone is an atypical antipsychotic, with the unique multireceptor-binding profile. If affects multiple serotonergic (5-HT) receptors, inhibits 5-HT transporter (5-HTT) and inhibits synaptic 5-HT reuptake. These effects might be responsible for the antidepressant effect of ziprasidone. Objectives Since there is a lack of in vivo data on the effects of ziprasidone on 5-HT concentration in humans, the aim of the study was to investigate the effect of ziprasidone treatment on platelet 5-HT concentration in patients with schizophrenia or schizoaffective disorders. Methods In and open-label study, the effect of ziprasidone (average dose of 109 mg/day) on platelet 5-HT concentration (determined fluorimetrically) was evaluated at baseline and after 7 and 28 days of treatment in 21 male and female patients with schizophrenia or schizoaffective disorders. Results Ziprasidone treatment for 7 or 28 days did not significantly change baseline platelet 5-HT concentration in male and female schizophrenic patients. Platelet 5-HT concentration was not correlated with gender, age and smoking status of patients. Conclusions There was a lack of effect of ziprasidone treatment on platelet 5-HT concentration in male and female schizophrenic patients. Although the clinical effects of ziprasidone were evident after 28 days of treatment, and ziprasidone has the highest potency among atypical antipsychotics to block 5-HTT, our data did not confirm the hypothesis that ziprasidone treatment decreases platelet 5-HT concentration, at least not in the doses used in our study

Lipid levels in female patients with affective disorders

The role of serum lipids [total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and triglycerides (TG)] in the pathophysiology of mood disorders is not clear. The aim of this study was to determine lipid profiles in patients with affective disorders. The study included medication-free female subjects (41 patients with bipolar disorder, 22 in a manic and 19 in a depressive phase), 34 patients with major depression, and 50 healthy controls. Serum lipid levels were determined using standard laboratory tests. All patients had significantly lower HDL-C values than control subjects. Increased TG levels were found in patients with bipolar disorder compared with healthy subjects. The changes in lipid profiles persisted when data were adjusted for age, smoking and menopausal status. The results revealed no differences in cholesterol and LDL-C levels and body mass index, but significant differences in the ratios of cholesterol/HDL-C and LDL-C/HDL-C (atherogenic index) among groups. Our results suggest that low HDL-C levels and a high atherogenic index might be a hallmark of affective disorders. Since low HDL-C levels could be a risk factor for the development of coronary heart disease, further investigation of lipid metabolism in affective disorders is warranted

The lack of association between catechol-O-methyl-transferase Val108/158Met polymorphism and smoking in schizophrenia and alcohol dependence

The study elucidated the association between the COMT Val108/158Met polymorphism and smoking in patients with schizophrenia, patients with alcohol dependence and healthy control subjects. The stepwise logistic regression (odds ratio (OR)=1.56, 95% confidence interval (CI)=1.10–2.23, P=0.014) and the χ2 test (P=0.008) revealed that the COMT Val/Val genotype was significantly associated with smoking in healthy male subjects. Although the hypothesis of the study was that COMT Val108/158Met genotypes will be significantly associated with smoking in schizophrenia and alcohol dependence, our study showed for the first time the lack of significant association between smoking and COMT Val108/158Met polymorphism in schizophrenia, and confirmed no association between smoking and COMT Val108/158Met in alcoholism