CORRELATION BETWEEN PROLACTIN AND SYMPTOM PROFILE IN ACUTE ADMITTED WOMEN WITH RECURRENT SCHIZOPHRENIA

Background: The prevalence of hyperprolactinemia among psychiatric patients receiving antipsychotic medications was estimated to be between 30% and 70%. A review of the literature on prolactin and schizophrenia symptoms suggests that the correlation between them is complex and not limited to the adverse effects of antipsychotics. Relations with specific symptom dimensions have not been found consistently across studies. The association between increased prolactin and recurrent episodes of schizophrenia needs to be replicated in larger samples and in a population of female patients. The aim of this study was to find out whether elevated prolactin is related to specific symptoms or dimensions of schizophrenia, which is a heterogenic entity. Subjects and methods: The sample consisted of 119 consecutively acute admitted women, aged 18 to 45 years with recurrent schizophrenia diagnosed on bases of DSM-5 criteria. Assessment for all the enrolled subjects comprised a psychiatric evaluation and blood draw to determine the prolactin level. Symptoms of schizophrenia were determined using the Positive and Negative Syndrome Scale (PANSS). Data were analyzed by regression analysis and the Independent Samples t Test. Values are given as means ±SD. Results: Hyperprolactinemia was detected in 74.79% patients (n=89), whereas the group without hyperprolactinemia comprised 25.21% of the sample. When plasma prolactin levels and clinical features between groups were compared, there was a statistically significant difference in the negative subscale scores of the PANSS (p=0.0011), positive subscale scores of the PANNS (p=0.0043), general subscale scores of the PANSS (p=0.0226) and total scores of the PANNS (p=0.0003). Conclusion: There were statistically significant differences in the clinical symptoms between two compared groups in total score and in the positive, negative and general subscores

TREATMENT OF RESISTANT AND ULTRA RESISTANT SCHIZOPHRENIA

Schizophrenia is a psychiatric disease which affects one percent of population. It is most common in young adults. It is primarily treated with typical and atypical antipsychotics. Resistant schizophrenia is a condition diagnosed after no response is noticed to two different antipsychotics of which one is atypical. The treatment has to be undertaken with adequate doses and duration of therapy. Clozapine is the golden standard in the treatment of therapy-resistant schizophrenia. It has shown its superiority among other antipsychotics in various studies. Aside from greater effectiveness, advantages include absence of extrapyramidal side effects. During clozapine treatment, regular blood tests should be performed as a screening method for agranulocytosis. Twenty to thirty percent od schizophrenia patients suffer from treatment resistant schizophrenia. Sixty percent of the latter ones show no therapeutic response to clozapine. In conclusion twelve to eighteen percent of all patients suffering from schizophrenia show no response to any form of treatment. Attempts to augment clozapine effectiveness are being made by increasing the dose of monotherapy, using antipsychotic polipharmacy or adding other types of drugs to clozapine. Unfortunately, these augmentation methods have not yet proven themselves to be effective enough to be added to standard therapy algorythms. On the other hand, electroconvulsive therapy is neuromodulatory method that shows promise in increasing therapeutic success. Although many methods of treatment are being researched, therapy-resistant schizophrenia remains a clinical challenge which affects a significant percentage of population and will require additional research

INFLUENCE OF HORMONAL STATUS AND MENSTRUAL CYCLE PHASE ON PSYCHOPATOLOGY IN ACUTE ADMITTED PATIENTS WITH SCHIZOPHRENIA

Background: The gender differences in onset, symptom severity, and outcome of schizophrenia are now thought to support the hypothesis that sex hormones may also have a role in etiology, as well as treatment, of schizophrenia. A number of reproductive hormones may be implicated, including testosterone, progesterone, or luteinising hormone, and thus it is important to acknowledge that there is a complex interplay of hormones occurring. This study was introduced to highlight the effect of the menstrual cycle, and sex hormones on female patients with schizophrenia. Subjects and methods: The sample consisted of 31 consecutively acute admitted women, aged 18 to 45 years with schizophrenia diagnosed by DSM-5 criteria. The sample consisted of women who were regulary menstruating and to be undergoing regular hormonal fluxes. Each subject was enrolled and received psychopathology and hormone (estradiole, progesterone, testosterone) assessments. Psychopathology was measured with Positive end Negative Syndrome Scale (PANSS). The subjects were divided into folicular (high estrogen) and luteal (low estrogen) phase admissions. Data were analyzed by regression analysis and t-test for independent samples. Values are given as means ±SD. Results: There were no differences between the folicular and luteal phase admission grups with regard to age, duration of illness and age at onset of illness. We found that significantly more women were admitted during the luteal (low estrogen) phase of menstrual cycle (68%) as compared to follicular (high estrogen) phase (32%). Conclusion: There was a significant increase in hospital admissions in the luteal phase of menstrual cycle in women suffering from exacerbation of schizophrenia. The influence of particulary sex hormones (estrogen, progesterone and testosterone) on admission rate and clinical psychopatology was found insignificant

Uloga vrste antipsihotika i drugih čimbenika na rehospitalizaciju bolesnika nakon prve epizode shizofrenije

Introduction: The problem of rehospitalization of patients after the first episode of schizophrenia is one of the major problems influencing the course and outcome of the treatment as well as treatment expenses. Although highly efficient antipsychotic medications have been in use for over 40 years, half of the patients with schizophrenia receiving the usual therapy relapse within a year of the last psychotic episode. The aim of the study was to determine the influence of individual antipsychotic medications on the one-year rehospitalization rate for first-episode schizophrenia patients and to collect relevant data on possible risk factors for rehospitalization, such as demographic data including gender, age, marital status, and employment status, and clinical data including duration of hospital stay, time between the disease onset and introduction of treatment, severity of clinical presentation, psychiatric heredity, psychiatric and somatic comorbidity, and frequency of outpatient control visits. Protocol and methods: The study was conducted at Vrapče Psychiatric Hospital among 123 patients with first-episode schizophrenia who were treated between January 1, 2007 and January 1, 2008. The patients were prospectively followed-up for rehospitalization during one year after hospital discharge, i.e., until January 1, 2009. Descriptive statistics was used to describe demographic and clinical data, whereas time-to-rehospitalization was analyzed with Kaplan-Meier survival analysis. Results: The one-year rehospitalization rate in first-episode schizophrenia patients (27%) was low in comparison with previous studies (40%-60%). There were differences between male and female patients in the type of antipsychotic medications prescribed, with significantly more male than female patients receiving classic antipsychotic medications (60%) and clozapine (74%). The rehospitalization rates differed based on the group of prescribed antipsychotic medications. The highest rehospitalization rate was found in the group of patients treated with classic antipsychotic medications (60%) and clozapine (74%). There was a significant difference in the rehospitalization rate between the groups of first-episode schizoprenia patients receiving different antipsychotic medications. The patients treated with classic antipsychotic medications had the highest rehospitalization rate (37%), followed by the patients treated with atypical antipsychotic medications (28%), whereas the patients treated with clozapine had the lowest rehospitalization rate (15%). Clozapine-treated patients were the least often rehospitalized in comparison with patients treated other classic or new atypical antipsychotic medications (p=0.035). There was a significant difference between clozapine- and fluphenazine-treated patients (p=0.045). With respect to possible risk factors influencing the rehospitalization rate, there was a significant difference between the rehospitalized and non-rehospitalized patients in the severity of clinical presentation assessed with BPRS scale at the beginning of the treatment (p=0.004) and in the presence of psychiatric comorbidity (p=0.046). Conclusions: In patients treated with the atypical antipsychotic medication clozapine, the one-year rehospitalization rate after the first episode of schizophrenia was the lowest. This finding implies that clozapine could play an important role in the early treatment of the first-episode schizophrenia patients who do not achieve remission of psychotic symptoms after one month of treatment with new atypical or classic antipsychotic medications. Among other rehospitalization risk factors, the severity of clinical presentation and psychiatric comorbidity were found to increase the rehospitalization rate. Psychiatric comorbidity that showed the greatest influence on the rehospitalization rate was alcohol and opiate abuse

INFLUENCE OF SERUM TESTOSTERONE LEVEL ON AGGRESSION IN WOMEN WITH SCHIZOPHRENIA

Background: Unlike in female population, the effect of testosterone on aggression in men has been investigated countless times so far. A scarce number of studies have examined the effect of testosterone on aggression in women. The results obtained so far are inconsistent for some studies indicated a positive, whilst others showed a negative correlation. Since testosterone turned out to be an important factor related to aggression in men, the aim of our study was to investigate whether this correlation existed in aggressive female patients with schizophrenia. Subjects and methods: The sample consisted of 120 women, aged from 18 to 45 years, diagnosed with schizophrenia by DSM-5 criteria. Those who were breastfeeding or suffered from specific hormonal or other physical disorders were excluded from the study. They were divided into two groups of 60 - those with aggressive behavior and those with nonaggressive behavior. Psychopathology was measured by several tests (Positive and Negative Syndrome Scale - PANSS, Overt Aggression Scale - OAS and PANSS Extended Subscale for Aggression Assessment). Serum testosterone hormone assays were performed. Statistical data analysis was done by parametric statistical tests, Kolmogorov-Smirnov test, Student\u27s t-test and simple linear regression. All data were presented as mean values and corresponding standard deviations (SD). Results: Testosterone levels didn\u27t differ significantly between aggressive and nonaggressive subjects. There were no significant differences between testosterone levels in suicidal aggressive subjects compared to nonsuicidal aggressive respondents (t=0.616; p=0.540). The largest number of subjects in both groups had referent testosterone levels. Conclusions: Despite expecting a significant effect of testosterone levels on aggression in women with schizophrenia, conducted by previous studies, no correlation has been found testosterone levels

Implementation of First Croatian Law on Protection of Persons with Mental Disorders

The aim of this article was to examine Croatian psychiatric practice regarding involuntary hospitalization, after the Law on Protection of Persons with Mental Disorders became effective, on January 1, 1998. Data on the practice of involuntary hospitalizations of patients with mental disorders in Vrapče Psychiatric Hospital were collected from the medical records, for the years 1998 and 1999. Data regarding involuntary hospitalizations from other Croatian hospitals and departments were obtained from heads of psychiatric hospitals and departments for the first five months of 1998. The rate of involuntarily hospitalized patients in Vrapče Psychiatric Hospital rose significantly from 1998 to 1999 (p<0.01). The rate of patients involuntarily hospitalized under section 21, subsection 3 rose significantly from 1998 to 1999 (p<0.01), while rate of patients involuntarily hospitalized under section 22, subsection 1 decreased significantly in the same period (p<0.01) in Vrapče Psychiatric Hospital. The implementation of the Law on protection of persons with mental disorders was not applied uniformly in all Croatian psychiatric institutions during first five months of 1998. Further analyses on this subject are necessary in order to investigate the influence of changes and supplements to the Law on the protection of persons with mental disorders on the practice of involuntary hospitalizations