Competence to Consent and Its Relationship With Cognitive Function in Patients With Schizophrenia

Decisional capacity to consent is an emerging ethical and legal concept, and is closely related to self-determination of patients facing important medical decisions or research participations. Recently, the MacArthur Competence Assessment Tool (MacCAT), a semi-structured interview consisting of four dimensions (Understanding, Appreciation, Reasoning, and Expression of a Choice), was developed to assess the decisional capacity. Decision-making capacity in a group of patients with schizophrenia, as measured by the MacCAT, has been shown to be impaired in comparison with healthy control people. However, this does not necessarily mean the presence of impaired decisional capacity in all cases. Considering the real-world practice of obtaining informed consent from patients with schizophrenia, it is important to evaluate the relationship between psychopathological features and decisional capacity of the illness. Negative symptoms of schizophrenia have been demonstrated to be related to the ability to understand information relevant to the decision, reason rationally, and appreciate a situation and its consequences. On the other hand, positive symptoms, such as delusions and hallucinations have been an inconsistent correlate of poor capacity. Furthermore, some studies indicate that impairment of cognitive function, a core symptom of schizophrenia, could be more largely associated with decisional capacity than positive and negative symptoms. Therefore, it is reasonable to assume cognitive enhancement would enlarge the capacity to consent and promote autonomy in medical treatment and research participation in patients with schizophrenia. Further studies are warranted to elucidate this and related issues

Comparison of prevalence of metabolic syndrome in hospital and community-based Japanese patients with schizophrenia

<p>Abstract</p> <p>Background</p> <p>Lifestyle factors, such as an unbalanced diet and lack of physical activity, may affect the prevalence of metabolic syndrome (MetS) in schizophrenic patients. The aim of this study was to compare the MetS prevalence between inpatients and outpatients among schizophrenic population in Japan.</p> <p>Methods</p> <p>We recruited inpatients (n = 759) and outpatients (n = 427) with a <it>Diagnostic and Statistical Manual of Mental Disorders</it>, fourth edition (DSM-IV) diagnosis of schizophrenia or schizoaffective disorder from 7 psychiatric hospitals using a cross-sectional design. MetS prevalence was assessed using three different definitions, including the adapted National Cholesterol Education Program Adult Treatment Panel (ATP III-A).</p> <p>Results</p> <p>The overall MetS prevalences based on the ATP III-A definition were 15.8% in inpatients and 48.1% in outpatients. In a logistic regression model with age and body mass index as covariates, being a schizophrenic outpatient, compared to being a schizophrenic inpatient, was a significant independent factor (odds ratio = 3.66 for males, 2.48 for females) in the development of MetS under the ATP III-A definition. The difference in MetS prevalence between inpatients and outpatients was observed for all age groups in males and for females over 40 years of age.</p> <p>Conclusions</p> <p>Outpatients with schizophrenia or schizoaffective disorder in Japan had a high prevalence of MetS compared to inpatients. MetS in schizophrenic outpatients should be carefully monitored to minimize the risks. A change of lifestyle might improve MetS in schizophrenic patients.</p

Effect of age and disease on bone mass in Japanese patients with schizophrenia

BACKGROUND: There have been a limited number of studies comparing bone mass between patients with schizophrenia and the general population. The aim of this study was to compare the bone mass of schizophrenia patients with that of healthy subjects in Japan. METHODS: We recruited patients (n = 362), aged 48.8 ± 15.4 (mean ± SD) years who were diagnosed with schizophrenia or schizoaffective disorder based on the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV). Bone mass was measured using quantitative ultrasound densitometry of the calcaneus. The osteosono-assessment index (OSI) was calculated as a function of the speed of sound and the transmission index. For comparative analysis, OSI data from 832 adults who participated in the Iwaki Health Promotion Project 2009 was used as representative of the general community. RESULTS: Mean OSI values among male schizophrenic patients were lower than those in the general population in the case of individuals aged 40 and older. In females, mean OSI values among schizophrenic patients were lower than those in the general community in those aged 60 and older. In an analysis using the general linear model, a significant interaction was observed between subject groups and age in males. CONCLUSIONS: Older schizophrenic patients exhibit lower bone mass than that observed in the general population. Our data also demonstrate gender and group differences among schizophrenic patients and controls with regard to changes in bone mass associated with aging. These results indicate that intervention programs designed to delay or prevent decreased bone mass in schizophrenic patients might be tailored according to gender

A positive correlation between serum amyloid &beta; levels and depressive symptoms among community-dwelling elderly individuals in Japan

Koji Tsuruga,1 Norio Sugawara,1 Norio Yasui-Furukori,1 Ippei Takahashi,2 Shoko Tsuchimine,1 Ayako Kaneda,1 Shigeyuki Nakaji,2 Kazuhiko Nakamura1 1Department of Neuropsychiatry, 2Department of Social Medicine, Hirosaki University School of&nbsp;Medicine, Hirosaki, Japan Background: Amyloid beta (A&beta;) levels have been associated with an increased risk of Alzheimer&rsquo;s disease (AD). As depression is common before the onset of AD, serum A&szlig; levels could be associated with depressive symptoms. The aim of this study was to investigate whether serum A&beta; levels are associated with depressive symptoms and/or cognitive function in community-dwelling elderly individuals. Methods: We examined the association between serum A&beta; levels and depression among 419&nbsp;Japanese community-dwelling elderly individuals aged 60 years and over. Subjects were divided into two subgroups: younger elderly between 60 and 69 years old and older elderly over 69 years old. The Mini-Mental State Examination (MMSE) was used to assess cognitive function, and symptoms of depression were assessed using the Center for Epidemiologic Studies Depression Scale (CES-D). The ability to perform activities of daily living was evaluated using the Tokyo Metropolitan Institute of Gerontology Index of Competence. Serum A&beta; levels were measured with a human amyloid beta enzyme-linked immunosorbent assay kit. Results: After controlling for potential confounding variables, a multiple linear regression analysis showed that increased levels of serum A&beta;40 and A&beta;42 were associated with higher CES-D scores in the older elderly subgroup. Under the same condition, multiple regression showed that serum A&beta; levels were not associated with MMSE scores among the total subjects, younger elderly, or older elderly. Conclusion: Serum A&beta; levels were associated with depressive symptoms in community-dwelling elderly individuals. The present study indicates the possibility that serum A&beta; may be involved in the development of late-onset depression. Keywords: Alzheimer&rsquo;s disease, depression, dementia, Japanes