Schizophrenia is a severe illness whose clinical course is characterized by various numbers of psychotic episodes (PE). The neurotoxic hypothesis (NH) of schizophrenia assumes that psychosis is ...biologically toxic. The aim of the study was to investigate whether schizophrenia patients (SP) with multiple PE have greater grey matter volume (GMV) reduction compared to SP with fewer PE.
We enrolled 106 adult SP and 63 healthy controls. Demographic and clinical data were collected and statistically analysed for all included subjects. Magnetic resonance imaging (MRI) of the brain was acquired on a 1.5 T scanner. SP were grouped according to the number of PE into a group with up to 3 PE (SCHG-1) and with 4 or more PE (SCHG-2). SCHG-1 was further subdivided into two groups regarding to disease duration (DD). Voxel-based morphometry (VBM) analyses were performed between SP groups as well as between SP groups and the healthy controls group (HCG).
No relevant GMV differences were detected between SP groups. Comparison between HCG and SCHG-1 showed only 3 regions with reduced GMV, while multiple regions with reduced GMV were detected when comparing HCG and SCHG-2.
GMV reduction in schizophrenia varies depending on the number of PE when compared to HCG, regardless of disease duration (DD), but PE is not the only contributing factor that leads to neurotoxicity.
Cilj: Osvijestiti mogućnost postojanja ekscitirajućeg delirantnog sindroma u psihotičnog pacijenta s povišenom tjelesnom temperaturom. Prikaz slučaja: Pacijent u dobi od 32 godine prisilno je ...hospitaliziran pet puta u posljednjih 11 godina na Klinici za psihijatriju KBC-a Rijeka. Unazad 14 godina u psihijatrijskom je tretmanu pod dijagnozom paranoidne shizofrenije, a ekscitirajući delirantni sindrom javio se tri godine od početka liječenja. U posljednje dvije prisilne hospitalizacije prezentirao se uz kliničku sliku psihotičnosti i poremećene svijesti (po opisu delirantnu), psihomotorne agitiranosti, nesuradljivosti, uz simptome autonomne hiperreaktivnosti (tahikardija, tahipneja, znojenje, povišenje krvnog tlaka) te zakočene muskulature. Osim toga, pacijent ima stalnu potrebu za razodijevanjem i izraženu privučenost ogledalima. Trećeg dana posljednje hospitalizacije razvila se povišena tjelesna temperatura koja se poklapa s primjenom veće doze antipsihotika. Najprije je postavljena sumnja na maligni neuroleptični sindrom i ukinuta je antipsihotična terapija, ali bez značajnijeg učinka na psihičko i tjelesno stanje. Dijagnostička obrada nije pokazala značajno povišenje razine kreatin fosfokinaza niti nalaz mioglobina u urinu. S obzirom na to, ponovno su primijenjeni antipsihotici u liječenju te postupno dolazi do poboljšanja i psihičkog i tjelesnog stanja bolesnika te se tada počinje sumnjati da se radi o jedinstvenom ekscitiranom delirantnom sindromu. Zaključak: Pojava vrućice u psihijatrijskih bolesnika dijagnostički je i terapijski izazovna. Rano razmatranje sindroma hipertermije povezanih s liječenjem od vitalne je važnosti. Dijagnostička dvojba između malignog neuroleptičkog sindroma i ekscitirajućeg delirantnog sindroma značajna je jer su uključeni različiti terapijski pristupi, a radi se o dvama potencijalno letalnim sindromima.
Aim: To raise awareness about the existence of excitated delirium syndrome in a psychotic patient with fever. Case report: A 32-year-old patient was forcibly hospitalized five times in the last 11 years at the Clinic for Psychiatry at the University Hospital Center Rijeka. For the past 14 years, he has undergone sychiatric treatment with the diagnosis of paranoid schizophrenia, and the excitatory delirium syndrome occurred three years after the beginning of the treatment. In the last two involuntary hospitalizations, the patient was presented with a clinical picture of psychosis and impaired consciousness (delirious by description), psychomotor agitation, non-cooperation with symptoms of autonomic hyperreactivity (tachycardia, tachypnea, sweating, increased blood pressure) muscle rigidity. In addition, the patient had a constant need for undressing and a pronounced attraction to mirrors. On the third day of the last hospitalization, there was elevated body temperature which coincided with the administration of a higher dose of antipsychotics. Malignant neuroleptic syndrome was first suspected and antipsychotic therapy was discontinued, but without a significant effect on mental and physical condition. Diagnostic processing did not show a significant increase in creatine phosphokinase levels or the finding of myoglobin in the urine. Taking this into account, antipsychotics were reintroduced in the treatment, and the mental and physical condition of the patient gradually improved, and then a unique excited delirium syndrome was suspected. Conclusion: The occurrence of fever in psychiatric patients is diagnostically and therapeutically challenging. Early consideration of treatment-related hyperthermia syndromes is vital. The diagnostic dilemma between malignant neuroleptic syndrome and excitatory delirium syndrome is significant because different therapeutic approaches are involved, and these are two potentially lethal syndromes.
Cilj: Prikazati slučaj trudnice oboljele od bipolarnog afektivnog poremećaja (BAP) te terapijske izazove u njezinu liječenju. Prikaz slučaja: Trudnica u dobi od 35 godina hospitalizirana je na ...Klinici za psihijatriju zbog psihotične dekompenzacije od ranije dijagnosticiranog BAP-a. Pacijentica se u više navrata bolnički liječila zbog BAP-a. Prvi put je bila hospitalizirana u 25. godini života. Od tada je, unatoč redovitim kontrolama i medikaciji, došlo do nekoliko pogoršanja psihičkog stanja i to u vidu maničnih epizoda. U 35. godini života kod pacijentice je ustanovljena trudnoća te se ambulantno korigirala prethodno preporučena terapija. Ukinuo se litij i uveo se natrijev valproat. Nakon četiri tjedna pacijentica je hospitalizirana radi manične epizode s psihotičnim elementima. Hospitalno se terapija korigirala u skladu sa svjetskim iskustvima u liječenju BAP-a tijekom trudnoće. Tako se tijekom hospitalizacije kod ove pacijentice doza natrijeva valproata reducirala, a u terapiju se uveo antipsihotik kvetiapin, čija se doza titrirala do ukidanja simptoma bolesti. Pacijentica je na termin, carskim rezom, rodila zdravu djevojčicu. Do danas više nije bila hospitalno liječena, a podaci pedijatra ukazuju na uredan psihofizički razvoj djevojčice. Zaključak: Duševna bolest i njeno liječenje prije i/ili tijekom trudnoće predstavljaju rizične faktore za majku i za novorođenče. Stoga pojačani nadzor ovog tipa rizične trudnoće te propisivanje adekvatne psihofarmakoterapije s najmanjim mogućim posljedicama za majku i dijete predstavlja poseban izazov, ali i dužnost liječnika.
Aim: To report a case of a pregnant woman with bipolar affective disorder (BAD) and therapeutic challenges in her treatment. Case report: A 35-year-old pregnant woman was hospitalized at the psychiatric clinic due to psychotic decompensation from a previously diagnosed BAD. The patient was hospitalized several times due to BAD. She was first hospitalized at the age of 25. Since than, despite regular check-ups and medication, there have been several deteriorations in mental health, mostly manic episodes. At the age of 35 the patient got pregnant and the previously recommended therapy was corrected. Lithium was abolished and sodium valproate was introduced. After four weeks, the patient was hospitalized due to manic episode with psychotic elements. The therapy was adjusted in accordance with world experience in the treatment of BAD during pregnancy. During hospitalization the dose of sodium valproate was reduced and the antipsychotic quetiapine was introduced into the therapy. The dose of quetiapine was titrated until the symptoms of the disease disappeared. The patient gave birth to a healthy baby girl by C-section. So far she has not been hospitalized. The pediatrician`s data indicate normal psychophysical development of the girl. Conclusion: Mental illness before and during pregnancy is a risk factor both for the mother and her newborn. Therefore, careful monitoring of pregnancy, as well as prescribing adequate psychopharmacotherapy with the least possible consequences for the mother and her child is a special challenge, but also a doctor`s duty.
An emerging phenomenon in our understanding of the pathophysiology of mental illness is the idea that specific proteins may form insoluble aggregates in the brains of patients, in partial analogy to ...similar proteinopathies in neurodegenerative diseases. Several proteins have now been detected as forming such aggregates in the brains of patients, including DISC1, dysbindin-1 and TRIOBP-1. Recently, neuronal PAS domain protein 3 (NPAS3), a known genetic risk factor for schizophrenia, was implicated through a V304I point mutation in a family with major mental illness. Investigation of the mutation revealed that it may lead to aggregation of NPAS3. Here we investigated NPAS3 aggregation in insular cortex samples from 40 individuals, by purifying the insoluble fraction of these samples and testing them by Western blotting. Strikingly, full-length NPAS3 was found in the insoluble fraction of 70% of these samples, implying that aggregation is far more widely spread than can be accounted for by this rare mutation. We investigated the possible mechanism of aggregation further in neuroblastoma cells, finding that oxidative stress plays a larger role than the V304I mutation. Finally, we tested to see if NPAS3 aggregation could also be seen in blood serum, as a more accessible tissue than the human brain for future diagnosis. While no indication of NPAS3 aggregation was seen in the serum, soluble NPAS3 was detected, and was more prevalent in patients with schizophrenia than in those with major depressive disorder or controls. Aggregation of NPAS3 therefore appears to be a widespread and multifactorial phenomenon. Further research is now needed to determine whether it is specifically enhanced in schizophrenia or other mental illnesses.
It has been proposed that aggregation of specific proteins in the brain may be a pathological element in schizophrenia and other chronic disorders. Multiple such aggregating proteins have now been ...implicated through post mortem investigation, including NPAS3 (Neuronal PAS domain protein 3), dysbindin-1 (encoded by the DTNBP1, Dystrobrevin Binding Protein 1, gene) and TRIOBP (Trio-Binding Protein, multiple isoforms). While the presence of protein aggregates in the brain is interesting in terms of understanding pathology, it is impractical as a biomarker. These proteins were therefore investigated recently in blood serum of schizophrenia patients and controls, showing patients to have higher levels of NPAS3 in their serum generally. TRIOBP-1 and dysbindin-1 were also found in an insoluble state, implying aggregation, but did not clearly corresponding to disease state.
We revisit 47 of the originally recruited 50 patients with schizophrenia, all of whom are Croatian and aged between 18 and 72. We assessed their symptom specificity and severity using PANSS (the Positive and Negative Symptoms Scale), comparing those with NPAS3, insoluble dysbindin-1 and/or insoluble TRIOBP-1 in their blood serum to those lacking any such protein dysregulation.
The frequency of each individual potential protein pathology among these patients was too low for meaningful statistical analysis, however the 11 patients that displayed one or more of these pathologies (NPAS3, dysbindin-1, TRIOBP-1 and/or TRIOBP-5/6) showed a subtle but significant increase in total PANSS scores compared to the 36 patients displaying none of the pathologies (p = 0.031), seemingly driven principally by increased scores on the general psychopathology scale.
While the numbers of patients involved do not allow firm conclusions to be drawn at this time, this provides the first indication that disturbed proteostasis in blood serum, of proteins that aggregate in the brains of schizophrenia patients, may correlate with the severity of schizophrenia symptoms.
The purpose of this study was to examine the differences in satisfaction with life and coping strategies between patients with acute and chronic urticaria.
Sixty patients with urticaria were divided ...into 2 groups after 6 weeks of standardized dermatology treatment (33 patients with acute and 27 patients with chronic urticaria). At baseline, all patients answered the following questionnaires: Satisfaction with Life Scale (SWLS), Personal Wellbeing Index (PWI-A), The Multidimensional Coping Inventory (COPE) and General questionnaire (age, gender, education, employment, marital status). After six weeks all the participants were re-tested with 2 questionnaires: SWLS and PWI-A.
Six weeks after the initial testing there was a statistically significant difference in satisfaction with life between patients with acute and chronic urticaria. Patients with acute urticaria were more satisfied with their lives than patients with chronic urticaria. Also, there was a statistically significant difference in the use of emotion-focused coping, seeking social support for emotional reasons and seeking social support for instrumental reasons. Patients with acute urticaria used emotion-focused coping and sought social support for emotional and instrumental reasons to a greater degree than patients with chronic urticaria.
Patients with acute urticaria were more satisfied with their lives than patients with chronic urticaria. Patients with acute urticaria used emotion-focused coping and sought social support for emotional and instrumental reasons to a greater degree than patients with chronic urticaria.
A body of biochemical evidence suggests that abnormal phospholipid metabolism may play a role in the etiology of schizophrenia, and possibly, other psychiatric and neurological diseases. Niacin, a ...B-complex vitamin, induces prostaglandin synthesis, vasodilatation, and skin flushing when applied as a solution on the skin or taken orally. In schizophrenia, diminished or absent skin response to niacin represents a robust finding.
Attenuated niacin skin-flush response has been analysed as a potential biochemical marker of impaired prostaglandin signaling in schizophrenia. Diminished skin redness after topical application of niacin might be caused by a reduced level of the precursor arachidonic acid in the peripheral membranes, increased activity of the enzyme phospholipase A2, abnormal expression of niacin or prostaglandin receptors, or poor vasomotor activity of cutaneous capillary walls. Heritability estimates established in several studies support niacin skin flush response as a vulnerability trait for the development of psychosis. However, the exact mechanism of a reduced skin flush, the possible influence of the long-term use of antipsychotics, and the usefulness of the test for diagnostic purpose are not clear yet.
Niacin skin flush test is a simple, non-invasive and easily replicable method in the research of schizophrenia. The studies investigating niacin flushing in schizophrenia are numerous but incoherent regarding methods of niacin application and evaluation of the results. New studies, controlling adequately for age, sex, drug abuse, diet, as well as genetic factors that may influence the intensity and reaction time, are necessary to clarify the usefulness of niacin testing in psychiatry.
The aim of this study was to investigate the possible influence of hemochromatosis gene mutations (HFE-C282Y and H63D) and transferrin gene C2 variant (TF-C2) on susceptibility to schizophrenia and ...schizoaffective disorder and/or age at first hospital admission. Genotyping was performed in 176 Croatian patients and 171 non-psychiatric Croatian controls using PCR-RFLP analyses. Regarding the H63D mutation, allele and genotype frequencies reached boundary statistical significance. Other allele and genotype distributions were not significantly different between two groups. We also analyzed age at first hospital admission as a continuous variable using the non-parametric Mann–Whitney
U
-test and Kruskal–Wallis test, and multiple regression analysis. The results of these tests were negative. We concluded that investigated HFE mutations and TF-C2 variant are not high-risk genetic variants for schizophrenia/schizoaffective disorder in our population. Also our data do not support their impact on age at onset of the first psychotic symptoms.
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