Some 25%–30% of patients with schizophrenia have auditory verbal hallucinations that are refractory to antipsychotic drugs. Outcomes in studies of repetitive transcranial magnetic stimulation suggest ...the possibility that application of transcranial direct-current stimulation (tDCS) with inhibitory stimulation over the left temporo-parietal cortex and excitatory stimulation over the left dorsolateral prefrontal cortex could affect hallucinations and negative symptoms, respectively. The authors investigated the efficacy of tDCS in reducing the severity of auditory verbal hallucinations as well as negative symptoms.
Thirty patients with schizophrenia and medication-refractory auditory verbal hallucinations were randomly allocated to receive 20 minutes of active 2-mA tDCS or sham stimulation twice a day on 5 consecutive weekdays. The anode was placed over the left dorsolateral prefrontal cortex and the cathode over the left temporo-parietal cortex.
Auditory verbal hallucinations were robustly reduced by tDCS relative to sham stimulation, with a mean diminution of 31% (SD=14; d=1.58, 95% CI=0.76–2.40). The beneficial effect on hallucinations lasted for up to 3 months. The authors also observed an amelioration with tDCS of other symptoms as measured by the Positive and Negative Syndrome Scale (d=0.98, 95% CI=0.22–1.73), especially for the negative and positive dimensions. No effect was observed on the dimensions of disorganization or grandiosity/excitement.
Although this study is limited by the small sample size, the results show promise for treating refractory auditory verbal hallucinations and other selected manifestations of schizophrenia.
The aim of this study was to determine glutathione levels and antioxidant enzyme activities in the drug-naive first-episode patients with schizophrenia in comparison with healthy control subjects.
It ...was a case-controlled study carried on twenty-three patients (20 men and 3 women, mean age = 29.3 ± 7.5 years) recruited in their first-episode of schizophrenia and 40 healthy control subjects (36 men and 9 women, mean age = 29.6 ± 6.2 years). In patients, the blood samples were obtained prior to the initiation of neuroleptic treatments. Glutathione levels: total glutathione (GSHt), reduced glutathione (GSHr) and oxidized glutathione (GSSG) and antioxidant enzyme activities: superoxide dismutase (SOD), glutathione peroxidase (GPx), catalase (CAT) were determined by spectrophotometry.
GSHt and reduced GSHr were significantly lower in patients than in controls, whereas GSSG was significantly higher in patients. GPx activity was significantly higher in patients compared to control subjects. CAT activity was significantly lower in patients, whereas the SOD activity was comparable to that of controls.
This is a report of decreased plasma levels of GSHt and GSHr, and impaired antioxidant enzyme activities in drug-naive first-episode patients with schizophrenia. The GSH deficit seems to be implicated in psychosis, and may be an important indirect biomarker of oxidative stress in schizophrenia early in the course of illness. Finally, our results provide support for further studies of the possible role of antioxidants as neuroprotective therapeutic strategies for schizophrenia from early stages.
There is substantial evidence found in the literature that supports the fact that the presence of oxidative stress may play an important role in the physiopathology of schizophrenia. Previous studies ...have reported the occurrence of impairments in the glutathione levels and the activities of the antioxidant enzymes in patients suffering from schizophrenia. However, most of these studies were performed on treated patients. The present study evaluated treated schizophrenic patients (
n
=
52) along with neuroleptic-free or untreated schizophrenic patients (
n
=
36) and healthy controls (
n
=
46). The blood glutathione levels: total glutathione (GSHt), reduced glutathione (GSHr), and oxidized glutathione (GSSG) as well as the activities of the antioxidant enzymes: superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), and catalase (CAT) were measured. The psychopathology of the patients was assessed through the Clinical Global Impressions-severity (CGI-severity). The tests revealed that in comparison with the healthy controls, the schizophrenic patients showed significantly lower levels of GSHr, SOD, and CAT. Among the schizophrenic patients, the activities of the antioxidant enzymes SOD and CAT were recorded to be significantly lower in untreated patients than in the treated ones. In addition, the levels of both GSHt and GSHr were found to be inversely correlated with the obtained CGI-severity score. These results evidently suggest that a decrease in the glutathione levels and the activities of the antioxidant enzymes in patients diagnosed with schizophrenia is not related to neuroleptic treatment and could be considered as a biological indicator of the degree of severity of the symptoms of schizophrenia.
Abstract Background Recent studies have suggested that clinicians may under diagnose bipolarity in a substantial proportion of depressive patients, and proposed that affective temperaments ...particularly cyclothymic temperament (CT), may predict bipolarity in these patients. The objectives of this study were to assess CT in patients with recurrent depressive disorder (RDD) and to explore its associations with clinical predictors of bipolarity. Methods 98 patients (43 men and 55 women, mean age = 46.8 ± 9.9 years), followed for RDD according to DSM-IV-TR criteria, were recruited. CT was assessed using the Tunisian version of the TEMPS cyclothymic subscale with the threshold score of 10/21. Results The mean score of CT was 6.5 ± 5.2. One-third of patients (33.7%) had a CT score ≥ 10. These patients with high CT scores had significantly early age at onset of first depressive episode and high number of previous depressive episodes, and had more psychotic and melancholic features and suicidal ideations and attempts during the last depressive episode compared to patients with low CT scores. The multiple regression analysis showed an association between CT scores and psychotic, melancholic and atypical features and suicide attempts during the last depressive episode. Limitations This is a cross-sectional study with a relatively small number of patients. The Tunisian version of the CT subscale was not yet validated. Conclusions CT was associated with some clinical predictive factors of bipolarity. These results suggest the relevance of the CT screening in RDD, considering the change of polarity risk and misdiagnosis of unipolar depression.
This study aims to investigate the effect of cigarette smoking on paraoxonase 1 (PON1) activity according to PON1 L55M and PON1 Q192R gene polymorphisms.
Our sample included 300 voluntary subjects: ...138 nonsmokers and 162 current smokers aged 38.47 ± 21.91 and 35.55 ± 16.03 years, respectively. PON1 activity was determined by kinetic methods. L55M and Q192R gene polymorphisms of PON1 were determined by multiplex polymerase chain reaction (PCR) restriction fragment length polymorphism (RFLP).
We found in smokers a significant decrease of PON1 activity before and after adjustment. We noted a significant association between smoking status and lower PON1 activity odds ratio (OR) = 3.03, confidence interval 95% = 1.5-5.9, p = 0.001. In smokers, there was significant association between PON1 activity and PON1 L55M polymorphisms (p = 0.01). Also, the 55MM genotype presented the lowest paraoxonase activity, while the 55LL genotype showed the highest one. After adjustment for confounding variables, smokers with PON1 L55M polymorphism had the highest risk for lower PON1 activity; however, PON1 Q192R genotype might protect smokers from decrease in PON1 activity. We found significant interaction between the effect of cigarette smoking and both PON1 L55M and PON1 Q192R polymorphisms on lower PON1 activity.
Cigarette smoking was significantly associated with decrease in PON1 activity. Moreover, PON1 L55M polymorphism predisposes smokers to decreased PON1 activity in contrast to PON1 Q192R genotype.
The associations of individualistic versus collectivistic value orientations with suicidal ideation and attempts, attitudes towards suicide and towards suicidal individuals, and psychological ...distress were investigated across 12 nations (
= 5572 university students). We expected differential associations of value orientations with suicidal behavior and moderating effects of the prevailing value orientations in the various countries. Findings showed that intermediate levels of individualism appeared protective against suicide attempts across all investigated nations, but that, otherwise, there seemingly are no universal associations of individualism and collectivism with suicidal behaviors. High collectivism was associated with less suicidal ideation only in individualistic countries. Low individualism appeared to be a risk factor for suicidal ideation specifically in Muslim collectivistic cultures, whereas high individualism in Asian collectivistic cultures. Collectivistic values are uniformly associated with less permissive attitudes to suicide, whereas individualistic values with a more stigmatized view of suicidal behavior. Both individualistic and collectivistic values were associated with socially accepting attitudes to a suicidal peer, helping a suicidal friend, and emotional involvement. The associations of individualistic and collectivistic values with disapproving attitudes to suicidal disclosure were complex. Beliefs in punishment after death for suicide, seeing suicide as mental illness, and emotional involvement with a suicidal friend were lower in high-suicide-rate countries. These evidence patterns are discussed in the light of related research evidence, along with directions for future research in this area.
Les objectifs de cette étude étaient de décrire les modalités pratiques de l’électroconvulsivothérapie (ECT) à l’hôpital universitaire de Monastir (Tunisie). Il s'agit d'une étude rétrospective ...portant sur tous les patients traités par ECT à l’hôpital universitaire de Monastir entre 2002 et 2013. Le nombre des patients était de 80 patients (60 hommes et 20 femmes, d’âge moyen de 42,1±15,7 ans), représentant 1,4% de l’ensemble des patients hospitalisés en psychiatrie durant la période d’étude. Le nombre total des séances d’ECT était de 784. Le diagnostic principal était le trouble dépressif majeur isolé ou récurrent chez 50% des patients. La majorité des patients (78,8%) avait reçu une seule cure d’ECT avec un nombre moyen de séances de 8,1 ± 4,9. Le produit anesthésique le plus utilisé était le propofol (97,4%). L’énergie délivrée était comprise entre 40 et 80 joules dans 71% des cas et elle était positivement corrélée à l’âge des patients. La durée moyenne de la crise motrice était de 22,3 ± 7,2 secondes et elle était négativement corrélée à l’âge des patients. Le taux de réponse le plus élevé a été constaté au niveau des scores de dépression (64,3%). Des effets indésirables immédiats ont été mentionnés chez 51,2% des patients. Enfin, 20% des patients poursuivaient des séances d’ECT d’entretien avec un rythme uni ou bimensuel. La pratique de l’ECT à l’hôpital universitaire de Monastir reste peu développée en termes de nombre des patients et des séances d’ECT. Des efforts doivent être déployés pour promouvoir l’utilisation de cette méthode.
There is substantial evidence found in the literature that supports the fact that the presence of oxidative stress may play an important role in the pathophysiology of schizophrenia. The glutathione ...S-transferases (GSTs) forms one of the major detoxifying groups of enzymes responsible for eliminating products of oxidative stress. Interindividual differences observed in the metabolism of xenobiotics have been attributed to the genetic polymorphism of genes coding for enzymes involved in detoxification. Thus, in this study we investigated the association of glutathione S-transferase Mu-1 (GSTM1) and glutathione S-transferase theta-1 (GSTT1) gene deletion polymorphisms and schizophrenia in a Tunisian population. A case–control study including 138 schizophrenic patients and 123 healthy controls was enrolled. The GSTM1 and GSTT1 polymorphisms were analyzed by multiplex polymerase chain reaction (PCR). No association was found between the GSTM1 genotype and schizophrenia, whereas the prevalence of the GSTT1 active genotype was significantly higher in the schizophrenic patients (57.2%) than in the controls (45.5%) with (OR=0.6, IC 0.37–0.99, p=0.039). Thus, we noted a significant association between schizophrenia and GSTT1 active genotype. Furthermore, the combination of the GSTM1 and GSTT1 null genotypes showed a non-significant trend to an increased risk of schizophrenia. The present finding indicated that GSTT1 seems to be a candidate gene for susceptibility to schizophrenia in at least Tunisian population.
► No association was found between the GSTM1 genotype and schizophrenia. ► The GSTT1 active genotype was significantly associated with schizophrenia. ► GSTT1 seems to be a candidate gene for susceptibility to schizophrenia in Tunisian population.
The schizotypal personality disorder is considered as a marker of schizophrenia proneness. The schizotypal personality questionnaire (SPQ) is an instrument to help to the diagnosis of schizotypal ...personality disorder extensively studied in the literature. aim: To assess psychometric properties (reliability and factor structure) of the Arabic version of the SPQ in a sample of Tunisian university students. method: The sample included 490 students (145 males and 345 females; mean age: 20.4 ± 1.4 years), from the faculty of medicine and the health sciences school of Monastir. Thirty-three students participated in the second assessment of the SPQ three months later. results: Cronbach's (α) internal consistency reliability coefficients were 0.92 for the total SPQ and from 0.62 to 0.75 for the SPQ subscales. The test-retest reliability was good with the intraclass correlation coefficients equal to 0.83 for the total SPQ and from 0.67 to 0.87 for the SPQ subscales (P<0.0001). Factor analysis indicated that the three-factor model (positive or cognitive-perceptual, negative or interpersonal, and disorganized) and the four-factor model (cognitive-perceptual, paranoid, interpersonal, and disorganized) have provided a good fit to the data, accounting for 70.7% and 77.3% of the total variance of the scale, respectively.
The results showed that the Arabic version of the SPQ had adequate psychometric properties and confirmed the multidimensional structure of the schizotypal personality in nonclinical populations.
Aims: The aim of the present study was to investigate hyperhomocysteinemia in Tunisian bipolar I patients according to 5,10‐methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism.
Methods: ...The subjects consisted of 92 patients with bipolar I disorder diagnosed according to DSM‐IV, and 170 controls. Plasma total homocysteine, folate and vitamin B12 were measured. MTHFR C677T polymorphism was determined by polymerase chain reaction–restriction fragment length polymorphism.
Results: Compared with controls, patients had a significantly higher homocysteine level (16.4 ± 9.8 vs 9.6 ± 4.5 µmol/L; P < 0.001) and a significantly lower folate level (3.2 ± 0.9 vs 6.5 ± 3.2 µg/L; P < 0.001). C677T MTHFR polymorphism genotype frequencies were in Hardy–Weinberg equilibrium. After adjustment for MTHFR C677T genotypes, hypofolatemia, hypovitamin B12 and for potential confounding factors, the odds ratio (OR) of hyperhomocysteinemia associated with bipolar disorder remained significant (OR, 5.53; 95% confidence interval: 1.92–15.86; P = 0.001). In patients, there was no significant change in hyperhomocysteinemia, hypofolatemia and hypovitamin B12 with regard to the clinical and therapeutic characteristics, whereas the highest prevalence of hyperhomocysteinemia was found in depressive patients and when illness duration was >12 years. Hypofolatemia was seen in all patients on lithium and in the majority of patients on carbamazepine, and the highest prevalence of hypovitamin B12 was noted in patients taking carbamazepine.
Conclusion: Hyperhomocysteinemia was more frequent in bipolar I patients independent of C677T polymorphism. Patients had reduced levels of folate, which modulates homocysteine metabolism. Indeed, this finding indicates that folate supplementation may be appropriate for bipolar patients with hyperhomocysteinemia.
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