During a 5-month period, 18 (8%) of 212 patients admitted to a psychiatric unit affiliated to a teaching hospital were found to have a catatonic syndrome associated with various nonorganic mental ...disorders. Signs and symptoms of motor retardation predominated the clinical presentations. In the course of a prospective, open study, all 18 patients were challenged by a small dose of oral lorazepam or intramuscular diazepam. Catatonic signs and symptoms in 2 patients showed an immediate, complete, and sustained response to the medication. The remaining 16 patients were maintained on 1 of the 2 benzodiazepines for the next 48 h when their motor status was re-evaluated. Significant clinical improvement was detected in all but 2 patients. However, 9 patients needed electroconvulsive treatment to achieve further improvement. Short-term benzodiazepine administration proved to be a safe and effective treatment of the catatonic syndrome.
The purpose of this international collaborative study was to investigate the prescription patterns of antipsychotic drugs for schizophrenia in East Asia and to analyze factors that affect these ...patterns. Prescription patterns for patients admitted for treatment of schizophrenia were surveyed using a standardized protocol from six East‐Asian region/countries: China, Hong Kong, Japan, Korea, Singapore and Taiwan. Patients’ social and clinical characteristics, psychiatric symptoms, course of illness, and adverse effects of medications were systematically assessed and recorded. Prescriptions of the first‐ and second‐generation antipsychotic drugs were compared. A total of 2399 patients were recruited. The second‐generation drugs comprised 28.1% of all prescribed antipsychotics, and 46% of the antipsychotic prescriptions were in the context of polypharmacy. The mean dosage of antipsychotics for the whole sample was 675.3 + 645.1 mg chlorpromazine equivalents. Japan had a high frequency of prescribing high doses and polypharmacy; Singapore had a high utilization of depot injections while China had a higher prescription of clozapine. Using multiple logistic regression analysis, distinctions in the prescription patterns of antipsychotic drugs were found: first‐generation drugs were mainly for controlling aggressive behavior, while second‐generation drugs were targeted at the alleviation of positive, negative psychotic symptoms as well as disruptive behavior in schizophrenia. The present collaborative study highlighted differences in the prescription patterns, especially the under‐utilization of second‐generation antipsychotic drugs in East Asia. The pattern of antipsychotic medication use varied from country to country and is likely to be influenced by the prevailing health‐care system, the availability and cost of the drugs.
Aims: To investigate the pattern of sleep duration and its clinical variables related to lifestyle, mental health, and chronic diseases in an adult population Methods: A multistage stratified cluster ...sampling was used for this cross-sectional study design. The study recruited 17,320 participants from a province in China. Demographic and clinical data were collected and subjects were interviewed using standardized assessment tools. Sleep duration was defined as short (<7 h/day), long (>9 h/day) and medium sleep (7-9 h/day). Results: The mean age of the sample was 42.60 ± 10.60 y, with 51.4% being female. In the overall sample, 30.9% and 6.9% had short and long sleep duration, respectively with the mean sleep duration being 7.31 ± 1.44 h. Older age, current smoking, irregular meal pattern, lack of physical exercise, poor mental health, and chronic diseases or multimorbidity were positively associated with short sleep. On the contrary, being married and living in rural areas were negatively associated with short sleep. Living in rural area, current smoking, current alcohol use and lack of physical exercise were positively associated with long sleep, while older age and lower education were negatively associated with long sleep. Conclusion: Considering the association of short sleep with mental health and chronic diseases, more attention is needed to adddress to sleep patterns in general health care. Future surveys and cohort studies are warranted to examine the effect of short and long sleep on physical and mental health.
This study surveyed the use of adjunctive mood stabilizers (MS) and benzodiazepines (BZD) in older Asian schizophrenia patients and examined their demographic and clinical correlates.
Information on ...hospitalized schizophrenia patients aged 55 years or more were extracted from the database of the Research on Asian Psychotropic Prescription Patterns (REAP) study. A total of 1,452 patients from 9 Asian countries and territories was included in the study. The patients' sociodemographic and clinical characteristics and the prescriptions of antipsychotics, MS and BZD were recorded using a standardized protocol and data collection procedure.
The frequency of MS prescription was 26.7% in the pooled sample, with 25.5% in 2001, 26.9% in 2004 and 27.7% in 2009. The corresponding figures for BZD were 20.7%, 20.2%, 18.4% and 23.1%, respectively. Multiple logistic regression analysis of the whole sample revealed that patients on MS were younger and more likely to be men and to have extrapyramidal side effects (EPS) and a longer duration of illness. Compared to patients in China, those in Japan were more likely to receive MS, while Korean patents were prescribed less MS. In contrast, there were no significant sociodemographic or clinical correlates of BZD use. Compared to patients in China, their Korean and Singaporean counterparts were more likely to be on BZD.
The use of MS and BZD is not uncommon in older Asian patients with schizophrenia. Given the paucity of empirical data on the efficacy of these agents in individuals with schizophrenia of any age and concerns about added side effects in older patients in particular, the rationale for the prescription of these agents in this population warrants further examination.
Schizophrenia is a complex illness with unknown aetiology and pathogenesis. Currently, a considerable number of patients with schizophrenia do not receive standardised and systematic treatment in ...China. In the past years, many controlled trials have been conducted in chronic schizophrenia. In contrast, research on first-episode schizophrenia is lacking. This paper describes the background and design of the Chinese First-Episode Schizophrenia Trial project - a multicentre, randomised, open-label clinical trial. A total of 600 first-episode schizophrenia patients were randomly divided into 3 groups and treated with risperidone, aripiprazole, and olanzapine for 1 year. During the study period, only 1 medication change of the 3 antipsychotic medications was allowed.
Despite extensive research on post-stroke depression (PSD), the role of white matter hyperintensities (WMHs) in its pathogenesis remains uncertain. The aim of this study was to evaluate the ...relationship between WMHs and PSD in Chinese patients with first or recurrent stroke.
A cohort of 994 patients with acute ischaemic stroke admitted to the acute stroke unit of a university-affiliated regional hospital in Hong Kong was recruited. A psychiatrist administered the Structural Clinical Interview for DSM-IV to all patients and made a diagnosis of PSD 3 months after the index stroke. 78 (7.8%) patients had PSD; 78 stroke patients matched according to age and sex but without PSD served as a control group. The severity and location of WMHs were evaluated with MRI.
In comparison with the non-PSD group, patients in the PSD group were more likely to have severe deep WMHs (12.8% vs 1.3%; p=0.009). Severe deep WMHs remained an independent predictor of PSD in the multivariate analysis with an OR of 13.8 (p=0.016).
The results suggest that WMHs may play a role in the development of PSD. The importance of WMHs in the treatment and outcome of PSD warrants further investigation.
This study compares prescription practices for acute inpatients with schizophrenia among six academic departments located in China, Japan, Hungary, and the U.S.
Prescription data for a sample of 429 ...inpatients from six academic departments were collected on a randomly chosen census day. All patients met criteria for schizophrenia according to DSM-IV and had a length of illness of at least two years.
While patients at the different centers varied in their demographic and clinical characteristics, i. e., age, sex, and length of illness, a great variation in prescription patterns for antipsychotic and other psychotropic drugs among centers was observed even within the same country for all the variables studied (i. e., number and dose antipsychotics, atypical and depot antipsychotics, other psychotropic drugs, multiple antipsychotics, and daily dose) except antidepressant use. In most cases these differences persisted even after adjusting for demographic and clinical characteristics (age, sex, and length of illness) of the subjects. Antipsychotics were usually prescribed in divided daily doses in combination with one or more other psychotropic drugs, including anticholinergics, anticonvulsants, benzodiazepines, and non-benzodiazepine hypnotics. Anticholinergic use was more common with typical antipsychotics. Rates of atypical antipsychotic drug use were lowest in the Japanese center. The Japanese center had by far the highest mean daily dose of antipsychotics.
The results indicate that prescription patterns in different centers do not follow any specific guidelines for the treatment of schizophrenia. The results also confirm previous findings that prescribing practices for schizophrenia vary greatly among centers and countries. A common prescribing pattern found was the use of atypical antipsychotic drugs in combination with psychotropic drugs, such as anticholinergics, hypnotics, anticonvulsants, and benzodiazepines, administered in multiple daily doses.
To survey major aspects of obtaining informed consent to electroconvulsive therapy (ECT) in the countries of the European Union.
Leading professionals in the field of biological psychiatry in all ...European Union countries and Norway and Switzerland were approached by e-mail asking about the national practice of obtaining consent to ECT including the form of consent, the legality of consent by proxy, and consent to anesthesia and maintenance treatment.
A considerable diversity was found across Europe regarding consent to ECT. In Slovenia and Luxembourg, ECT is not available at all. Informed consent is needed in written form in most European countries except for Sweden, Denmark, Finland, and Slovakia, where verbal consent is sufficient. Italy, Ireland, and Latvia are stricter in their approach because separate written consent is required before each ECT session.
The practice of obtaining informed consent varies from country to country reflecting the individual European Union countries' jurisdiction and their sociocultural traditions as well as their different development of psychiatric services. In line with the increasing cooperation in health care, developing a unified way of obtaining consent for ECT is recommended.
Prospective memory (PM) is the ability to remember to do something in the future without explicit prompts. Extending the number of subjects and the scope of our previously published study, this ...investigation examined the relationship between PM and socio-demographic and clinical factors, activities of daily living (ADL) and frontal lobe functions in patients with chronic schizophrenia.
One hundred and ten Chinese schizophrenia patients, 60 from the previous study and 50 additional patients recruited for this study, and 110 matched healthy comparison subjects (HC) formed the study sample. Patients’ clinical condition and activity of daily living were evaluated with the Brief Psychiatric Rating Scale (BPRS) and the Functional Needs Assessment (FNA). Time- and event-based PM tasks and three tests of prefrontal lobe functions (Design Fluency Test DFT, Tower of London TOL, Wisconsin Card Sorting Test WCST) were also administered.
Patients’ level of ADL and psychopathology were not associated with PM functions and only anticholinergic medications (ACM) showed a significant negative correlational relationship with PM tasks. Confirming the findings of the previous study, patients performed significantly more poorly on all two PM tasks than HC. Performance on time-based PM task significantly correlated with age, education level and DFT in HC and with age, DFT, TOL and WCST in patients. Patients’ performance on the event-based PM correlated with DFT and one measure of WCST. In patients, TOL and age predicted the performance on time-based PM task; DFT and WCST predicted the event-based task.
Involving a large sample of patients with matched controls, this study confirmed that PM is impaired in chronic schizophrenia. Deficient PM functions were related to prefrontal lobe dysfunction in both HC and patients but not to the patients’ clinical condition, nor did they significantly affect ADL. ACMs determined certain aspects of PM.
Accessible summary
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Insight is a multidimensional concept that is defined as a patient's recognition of having a psychiatric disorder, of the social consequences of that disorder and of the need ...for treatment.
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Improving insight is one of the major aims of pharmacotherapy and psychosocial interventions in schizophrenia because it is pivotal in engaging patients in treatment and also has implications for prognosis.
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Core psychiatric concepts as insight is not independent of the socio‐cultural environment, and to date there is no study that explores that relationship between insight and socio‐demographic characteristics, psychotic symptoms, depression, executive functions and quality of life in schizophrenia patients in China.
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Standard psychiatric care does not improve the level of insight in clinically stable Chinese schizophrenia outpatients, which warrants the introduction of specific therapeutic interventions that enhance insight.
This study aimed to assess insight in Chinese schizophrenia patients and to identify its relationship with socio‐demographic and clinical factors, executive functions and quality of life (QOL). A cohort of 139 clinically stable schizophrenia patients was selected by consecutively screening patients diagnosed with schizophrenia who were attending the outpatient department of a university‐affiliated psychiatric hospital in China. Participants' socio‐demographic and clinical characteristics, including psychotic symptoms, depression and insight, as well as QOL and executive functions, were periodically assessed with standardized rating instruments. Patients received standard psychiatric care and were followed up for 1 year. Impaired insight was found to be common in stable Chinese schizophrenia patients (76.3%), with merely 5% showing improvement over the 1‐year follow‐up. Insight was inversely correlated with positive and negative symptoms at all but the 12‐month assessment and with both the physical and mental components of QOL at baseline and the 12‐month assessment. Insight was not associated with depressive symptoms or executive functions. Standard psychiatric care does not improve the level of insight in clinically stable Chinese schizophrenia outpatients, which warrants the introduction of specific therapeutic interventions that enhance insight.
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