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Fulltext Medication adherence in schizophrenia: a comparison between outpatients and relapse cases

Razali SM, Yusoff MZ

East Asian Arch Psychiatry, 2014 Jun;24(2):68-74.
PMID: 24986201

Objective: Adherence to medication is essential for maximising the outcomes of patients with schizophrenia as the consequences of poor adherence are devastating. The study aimed to compare medication adherence between patients with relapse schizophrenia and those attending psychiatric follow-up clinics, and to determine the factors affecting adherence.
Methods: This was a cross-sectional study involving 70 patients with schizophrenia who were divided equally into 2 groups. Medication adherence was assessed with the Medication Adherence Rating Scale. Appropriate instruments were used to measure insight, social support, and psychopathology. Various socio-demographic and clinical variables were explored to find associations with medication adherence.
Results: Medication adherence among patients with schizophrenia was poor; 51% of the patients did not adhere to a medication regimen. Adherence was better in outpatients with schizophrenia (61%) than in relapse cases (39%), although the difference was not statistically significant (t = 1.70; p = 0.09). Besides, relapse patients had significant higher number of admission (X2 = 22.95; p < 0.05) and severe psychopathology (t = –29.96; p < 0.05), while perceived social support was significantly better in outpatients with schizophrenia (t = 2.90; p < 0.05). Frequency of admission (adjusted b = –0.55; 95% confidence interval [CI], -0.99 to -0.10; p < 0.05) and psychopathology (adjusted b = –0.12; 95% CI, -0.24 to -0.01; p < 0.05) were also significantly associated with medication adherence.
Conclusion: Medication adherence among both groups of patients with schizophrenia was poor. If adherence is addressed appropriately, the number of admissions and severity of psychopathology could be improved.
Key words: Patient compliance; Psychopathology; Schizophrenia; Social support
Study site: Psychiatric clinic, Hospital Universiti Sains Malaysia (HUSM)

Matched MeSH terms: Schizophrenic Psychology*
Compliance with treatment in schizophrenia: a drug intervention program in a developing country

Razali MS, Yahya H

Acta Psychiatr Scand, 1995 May;91(5):331-5.
PMID: 7639089

The compliance with drug regimens and follow-up visits of 225 known cases of relapsed schizophrenia was assessed. About 27% of the patients met the criteria for good compliance. The compliance was found to be significantly related to the patients' view of usefulness of the medication, treatment duration of less than 5 years, dosage schedule of once or twice per day and the supervision of medication at home. Patients with poor compliance who were prescribed drug dosage of not more than twice per day throughout follow-up and underwent counseling to enhance treatment compliance had a significantly lower relapse rate than the controlled group at the end of 1 year of follow-up. The importance of family support and understanding patients' cultural background in ensuring good compliance was highlighted.

Matched MeSH terms: Schizophrenic Psychology
Fulltext Antipsychotic-like activity of scopoletin and rutin against the positive symptoms of schizophrenia in mouse models

Pandy V, Vijeepallam K

Exp Anim, 2017 Oct 30;66(4):417-423.
PMID: 28701621 DOI: 10.1538/expanim.17-0050

In an earlier report, we demonstrated an antipsychotic-like activity of a methanolic extract of Morinda citrifolia Linn fruit in mouse models and postulated the contribution of its bioactive principles, scopoletin and rutin. Moreover, the antidopaminergic activities of scopoletin and rutin were reported in isolated vas deferens preparations. In the present study, scopoletin and rutin were assessed for antipsychotic-like activity using apomorphine-induced climbing behavior and methamphetamine-induced stereotypy in mice. The results of this study revealed that scopoletin and rutin (0.05, 0.1, 0.5, and 1 mg/kg, p.o.) had a "U-shaped" dose-dependent effect on climbing and stereotyped behaviors induced by apomorphine and methamphetamine, respectively, in mice. A significant reduction in climbing and stereotyped behaviors caused by scopoletin and rutin was observed only at a dose 0.1 mg/kg. This study suggests that scopoletin and rutin can alleviate positive symptoms of schizophrenia only at a specific dose. Further studies evaluating the effects of scopoletin and rutin on animal models for negative symptoms of schizophrenia are required for a novel drug discovery in the treatment of neuropsychiatric diseases.

Matched MeSH terms: Schizophrenic Psychology
Suicide in the island of Singapore

Kua EH, Tsoi WF

Acta Psychiatr Scand, 1985 Mar;71(3):227-9.
PMID: 3984765

In a study of suicide in Singapore in 1980 there were 230 cases and the suicide rate for the general population was 9.5 per 100,000. The age-specific rates increased steeply after 50 years and there was a male preponderance especially in the age group 60 years and over. Comparing the three major ethnic groups in Singapore, the highest rate was seen in the Indians and Chinese, whereas the Malays had the lowest. Amongst the suicides there were 59 (25.7%) with mental illness, mainly schizophrenia, and they were of a younger age group, 20-39 years. The commonest method of suicide was jumping from high-rise flats.

Matched MeSH terms: Schizophrenic Psychology
Relationship of psychological symptoms, antipsychotics and social data with psychosocial function in schizophrenia patients in Malaysia

Norlelawati AT, Kartini A, Norsidah K, Ramli M, Wan Azizi WS, Tariq AR

Asia Pac Psychiatry, 2015 Mar;7(1):45-53.
PMID: 23857669 DOI: 10.1111/appy.12089

INTRODUCTION: The present study investigated the relationship between psychological symptoms and psychosocial function and the role of relevant sociodemographic data and antipsychotic use in the prediction of psychosocial function among multiracial schizophrenia outpatients in Malaysia.
METHODS: A total of 223 participants were recruited in this cross-sectional study conducted from December 2010 to April 2011. Psychological symptoms were assessed using the Positive and Negative Syndrome Scale whilst the psychosocial function was assessed using the Personal and Social Performance scale. Sociodemographic and treatment variables were gathered through interview or review of the medical records.
RESULTS: All dimensions of psychosocial functions were inversely correlated with Positive and Negative Syndrome Scale sub-domains. Only the disorganization sub-domain significantly predicts all dimensions of psychosocial function. For social data, body mass index and employment status were significant predictors of all dimensions of psychosocial functions. Typical antipsychotics significantly predict social function negatively as compared to sulpiride (β = -0.152, P = 0.028).
DISCUSSION: We found that the relationship between psychological symptoms and psychosocial functions were relatively consistent with the findings from the Caucasian population. Additionally, disorganization was the only significant predictor of all dimensions of psychosocial functions. This further emphasized the importance of cognition in psychosocial function. The roles of sulpiride, body mass index and employment status as predictors of psychosocial function were also discussed.
KEYWORDS: antipsychotics; psychosocial function; schizophrenia; symptoms
Study site: Psychiatric clinic, Hospital Tengku Ampuan Afzan, Kuantan, Pahang, Malaysia

Matched MeSH terms: Schizophrenic Psychology*
Identification of AKT1 3'UTR variants in two Indian schizophrenia patients with poor executive functioning

Chow TJ, Tee SF, Loh SY, Yong HS, Abu Bakar AK, Song SL, et al.

Asian J Psychiatr, 2018 Aug;36:17-18.
PMID: 29864676 DOI: 10.1016/j.ajp.2018.05.025
Matched MeSH terms: Schizophrenic Psychology
Fulltext When all else fails: supervised treatment in outpatient for schizophrenia (STOPS)

Tan HJR

BMJ Case Rep, 2017 Sep 23;2017.
PMID: 28942410 DOI: 10.1136/bcr-2017-221518

This was about a case of a patient requiring admission to psychiatry ward twice a year for relapse schizophrenia due to medication non-compliance. Medication adherence was previously monitored by her husband. However, following the death of her husband, she stopped treatment. The lack of insight and poor family support further contributed to her relapse. She presented with positive and negative symptoms of schizophrenia during her relapse, neglecting her hygiene and oral intake. She was also found to have anaemia as a result of poor diet when she was in relapse. Community psychiatry services had attempted to ensure compliance with postdischarge plan but failed as patient was not present every home visits. Supervised treatment in outpatient for schizophrenia (STOPS) provided an alternative method to ensure compliance in this patient. Patient has remained in remission for 1 year since the use of STOPS.

Matched MeSH terms: Schizophrenic Psychology
Psychiatric morbidity in the first-degree relatives of schizophrenic patients

Varma SL, Sharma I

Br J Psychiatry, 1993 May;162:672-8.
PMID: 8149120

First-degree relatives (FDRs) of 162 schizophrenic and 106 control probands were investigated [corrected]. Psychiatric morbidity was present in 34.8% of FDRs of schizophrenic probands and in 9.2% of FDRs of controls. There was significantly more psychiatric illness in the siblings and parents than in the offspring of both schizophrenic and control subjects. The morbidity risks for schizoid-schizotypal personality disorders, cannabis-use disorder and paranoid personality disorder were significantly higher in the FDRs of schizophrenic patients than in those of controls, suggesting a biological relationship.

Matched MeSH terms: Schizophrenic Psychology*
The burden of care of schizophrenia in Malay families

Salleh MR

Acta Psychiatr Scand, 1994 Mar;89(3):180-5.
PMID: 8178676 DOI: 10.1111/j.1600-0447.1994.tb08089.x

Deinstitutionalization has shifted much of the burden of care of chronic schizophrenia from mental institutions to the family. The aim of this study is to asses the prevalence of mental disorders among 210 primary carers of Malay schizophrenic patients, explored the burden and hardship experienced by them. This is a two-stage psychiatric screening procedure. All the cases suspected from initial screening with WHO Self-Reporting Questionnaires (SRQ-20) were called for clinical interview. Patients' behavioural problems and the burden of relatives were assessed by the Social Behaviour Schedule and the Interview Schedule respectively. It was found that about 23% of the carers developed neurotic disorders resulting from the stress; nearly half of them had neurotic depression. Despite their burden, they do not complaint about it. Neurotic carers compared with non-neurotic carers had significantly more subjective burden and distress related to the product of active psychosis. The carers were generally able to tolerate the negative symptoms of schizophrenia. The number of problem behaviours and previous admissions were significantly correlated with the severity of burden.

Matched MeSH terms: Schizophrenic Psychology*
Capgras syndrome in a very late onset, treatment resistant schizophrenia

Ain MK, Rosdinom R, Raynuha M

Int Psychogeriatr, 2015 Sep;27(9):1573-5.
PMID: 25794136 DOI: 10.1017/S1041610215000332

We report a Malay man, with underlying chronic medical illnesses, presenting with positive symptoms of schizophrenia, including Capgras syndrome (CS) at the age of 73. Physical examination and blood investigations were normal and brain CT scan showed age-related cerebral atrophy. Neuropsychological assessment showed probable right hemisphere lesions but relatively intact memory and intellectual functions. Several neuroleptics including depot injections were tried but ineffective. Positive symptoms including CS eventually improved with clozapine before his death from myocardial infarction. This case report highlights the uncommon occurrence of CS in treatment resistant schizophrenia (TRS) of very late onset and its treatment challenges.

Matched MeSH terms: Schizophrenic Psychology
Common cultural medical complaint presenting as a delusion

George P, Ramasamy P

Malaysian Journal of Psychiatry, 2006;14(1):41-42.
MyJurnal

Symptoms presented by patients suffering from Schizophrenia can be influenced by cultural factors. A case of Schizophrenia presenting with a common cultural medical complaint as a delusion, is described here. The appropriate assessment, identification and treatment have led to an improved out.

Matched MeSH terms: Schizophrenic Psychology
High prevalence of thyroid function test abnormalities in chronic schizophrenia

Othman SS, Abdul Kadir K, Hassan J, Hong GK, Singh BB, Raman N

Aust N Z J Psychiatry, 1994 Dec;28(4):620-4.
PMID: 7794205

The thyroid status of 249 patients with chronic schizophrenia (males = 136, females = 113) with a median age of 36 years (range: 16 to 58 years) and a median duration of hospitalisation of 10 years (range: 1 to 30 years) was assessed. Thyroid antibodies (TAb) were found in 51 patients (20%). In female patients, 32 (28%) were TAb positive compared to 13% (n = 152, p = 0.01) in healthy female blood donors. In male patients, the prevalence of TAb was 14% compared to 7% (n = 449, p = 0.01) in healthy male blood donors. Of the 183 patients who had thyroid hormone measurements, 60% had normal test, 5% had elevated TSH and 17% had low TSH. The T4, FT41 and FT31 were significantly lower in those with low or high TSH (p < 0.001) compared to those with normal TSH. Of the 143 patients with normal TSH, 33 (23%) had low T3. In conclusion, there is a spectrum of thyroid function test abnormalities in chronic schizophrenia; this may be related to an abnormality in the central regulation of the hypothalamo-pituitary thyroid axis as well as at the peripheral level. However the association between chronic schizophrenia and the presence of thyroid antibodies, and the clinical relevance of these biochemical abnormalities, are still not clear.

Matched MeSH terms: Schizophrenic Psychology*
Fulltext Offenders with schizophrenia: relationship to psychopathology

Surina, Z.H., Zahiruddin, O., MohdAzhar, M.Y., Rabaiah, M.S.

Malaysian Journal of Psychiatry, 2013;22(1):1-6.
MyJurnal

Objectives: To study the relationship between psychopathology and characteristics of offenders with schizophrenia. Methods: In this cross sectional study, 70 consecutive offenders with schizophrenia (aged 18-65) admitted to Hospital Bahagia Ulu Kinta within a six-month period were studied. Subjects’ psychopathology was assessed using Positive and Negative Syndrome Scale (PANSS). Results: Offenders against person group received treatment at later age (p=0.043) compared to against property and drug or firearm-related offenders groups. Offenders in drug or firearm-related group had significantly higher PANSS negative scores (p=0.015). Unsound mind at the time of offense was significantly associated with high PANSS positive scores (p=0.011) and offenders against person or property groups (p=0.004). Conclusion: Offenders against person had a significantly later age of treatment and probably onset of illness. Unsoundness of mind was significantly associated with positive symptoms and more frequently reported among offenders against person or property. Offenders in drug or firearmrelated
group were significantly associated with negative symptoms.

Matched MeSH terms: Schizophrenic Psychology
Fulltext Seasonality shows evidence for polygenic architecture and genetic correlation with schizophrenia and bipolar disorder

Byrne EM, Psychiatric Genetics Consortium Major Depressive Disorder Working Group, Raheja UK, Stephens SH, Heath AC, Madden PA, et al.

J Clin Psychiatry, 2015 Feb;76(2):128-34.
PMID: 25562672 DOI: 10.4088/JCP.14m08981

OBJECTIVE: To test common genetic variants for association with seasonality (seasonal changes in mood and behavior) and to investigate whether there are shared genetic risk factors between psychiatric disorders and seasonality.
METHOD: Genome-wide association studies (GWASs) were conducted in Australian (between 1988 and 1990 and between 2010 and 2013) and Amish (between May 2010 and December 2011) samples in whom the Seasonal Pattern Assessment Questionnaire (SPAQ) had been administered, and the results were meta-analyzed in a total sample of 4,156 individuals. Genetic risk scores based on results from prior large GWAS studies of bipolar disorder, major depressive disorder (MDD), and schizophrenia were calculated to test for overlap in risk between psychiatric disorders and seasonality.
RESULTS: The most significant association was with rs11825064 (P = 1.7 × 10⁻⁶, β = 0.64, standard error = 0.13), an intergenic single nucleotide polymorphism (SNP) found on chromosome 11. The evidence for overlap in risk factors was strongest for schizophrenia and seasonality, with the schizophrenia genetic profile scores explaining 3% of the variance in log-transformed global seasonality scores. Bipolar disorder genetic profile scores were also associated with seasonality, although at much weaker levels (minimum P value = 3.4 × 10⁻³), and no evidence for overlap in risk was detected between MDD and seasonality.
CONCLUSIONS: Common SNPs of large effect most likely do not exist for seasonality in the populations examined. As expected, there were overlapping genetic risk factors for bipolar disorder (but not MDD) with seasonality. Unexpectedly, the risk for schizophrenia and seasonality had the largest overlap, an unprecedented finding that requires replication in other populations and has potential clinical implications considering overlapping cognitive deficits in seasonal affective disorders and schizophrenia.

Matched MeSH terms: Schizophrenic Psychology*
Fulltext Does Psychoeducation Improve Insight of Patients with Schizophrenia?

Ruzanna, Z., Marhani, M., Parveen, K.

Malaysian Journal of Psychiatry, 2010;19(2):1-14.
MyJurnal

The main aim of the study was to determine the effect of psychoeducation program on insight of patients with schizophrenia and to determine other factors associated with the change of the insight. This was an interventional study of 70 patients with schizophrenia who underwent a psychoeducation program. Diagnosis was confirmed using Mini International Neuropsychiatric Interview (M.I.N.I). Insight was assessed using the Schedule for the Assessment of Insight (SAI) before and after the psychoeducation programme. Effect on insight was measured as the change in SAI scores. There was an improvement in insight after the psychoeducation programme which was significant (p< 0.001). Patient’s age, shorter duration of illness and no previous history of admission to mental institution were significantly related to the improvement of insight (p< 0.05). Conclusion: Psychoeducation is an important tool in improving insight into illness among patients with schizophrenia. It needs to be given as early as possible during the course of the illness.

Matched MeSH terms: Schizophrenic Psychology
Fulltext To use the brief psychiatric rating scale to detect disorganized speech in schizophrenia: Findings from the REAP-AP study

Chon Park Y, Kanba S, Chong MY, Tripathi A, Kallivayalil RA, Avasthi A, et al.

Kaohsiung J. Med. Sci., 2018 Feb;34(2):113-119.
PMID: 29413227 DOI: 10.1016/j.kjms.2017.09.009

Our study aimed to assess the psychometric validity of the conceptual disorganization item and other items of the Brief Psychiatric Rating Scale (BPRS) for detecting disorganized speech in patients with schizophrenia. We included 357 schizophrenia patients with disorganized speech and 1082 without disorganized speech from the survey centers in India, Indonesia, Japan, Malaysia, and Taiwan, using the data from the Research on Asian Psychotropic Patterns for Antipsychotics (REAP-AP) study. After adjusting the effects of confounding variables, a binary logistic regression model was fitted to identify BPRS items independently associated with disorganized speech. Receiver operating characteristic (ROC) curves were used to identify optimum cut-off scores and their sensitivities and specificities for detecting disorganized speech. After adjusting the effects of confounding variables, the fitted binary logistic regression model indicated that conceptual disorganization (P

Matched MeSH terms: Schizophrenic Psychology*
Fulltext Obsessive compulsive schizophrenia (OCS) revisited: a five-year case report

Marhani Midin, Reddy, Jaya Prakash, Nik Ruzyanei Nik Jaafar

ASEAN Journal of Psychiatry, 2009;10(1):95-98.
MyJurnal

Objective: This is a case report discussing the comorbidity of obsessive compulsive disorder (OCD) and schizophrenia. Such clinical phenomenon merits recognition as a distinct subgroup of schizophrenia with unique challenges and treatment needs. Method: A case report presenting schizophrenia with preceding obsessive-compulsive disorder over five years. Results: This report describes the clinical course and treatment challenges of a patient with obsessive compulsive schizophrenia (OCS). Conclusion: This case illustrates that OCS is a complex disorder with atypical clinical characteristics. In managing this patient, several clinical dilemmas including diagnostic ambiguity, problems with pharmacotherapy and difficulties in his rehabilitation were highlighted.

Matched MeSH terms: Schizophrenic Psychology
Fulltext The Time Course of Dorsal and Rostral-Ventral Anterior Cingulate Cortex Activity in the Emotional Stroop Experiment Reveals Valence and Arousal Aberrant Modulation in Patients with Schizophrenia

Feroz FS, Leicht G, Rauh J, Mulert C

Brain Topogr, 2019 01;32(1):161-177.
PMID: 30288663 DOI: 10.1007/s10548-018-0677-0

This paper aims to investigate the temporal dynamics within the dorsal anterior cingulate cortex (dACC) and the rostral-ventral (rv) ACC during the interaction of emotional valence and arousal with cognitive control in patients with Schizophrenia (SZ). Although cognitive deficits in SZ are highly relevant and emotional disturbances are common, the temporal relationship of brain regions involved in the interaction of emotional and cognitive processing in SZ is yet to be determined. To address this issue, the reaction time (RT), event-related potential (ERP) and temporal dynamics of the dACC and rvACC activity were compared between SZ subjects and healthy controls (HC), using a modified emotional Stroop experiment (with factors namely congruence, arousal and valence). EEG was recorded with 64 channels and source localisation was performed using the sLORETA software package. We observed slower initial increase and lower peaks of time course activity within the dACC and rvACC in the SZ group. In this particular group, the dACC activity during late negativity was negatively correlated with a significantly higher RT in the high arousal conflict condition. In contrast to HC subjects, at the N450 window, there was no significant valence (ERP and rvACC ROI) modulation effect in the SZ subjects. Using high density EEG and source localisation, it was possible to distinguish various disturbances within the dACC and rvACC in patients with SZ, during emotion-cognition processing.

Matched MeSH terms: Schizophrenic Psychology*
Fulltext Phencyclidine dose optimisation for induction of spatial learning and memory deficits related to schizophrenia in C57BL/6 mice

Zain MA, Rouhollahi E, Pandy V, Mani V, Majeed ABA, Wong WF, et al.

Exp Anim, 2018 Nov 01;67(4):421-429.
PMID: 29731492 DOI: 10.1538/expanim.18-0006

Phencyclidine (PCP) has been used to model cognitive deficits related to schizophrenia in rats and mice. However, the model in mice is not consistent in terms of the PCP effective dose reported. Furthermore, most of the previous studies in mice excluded the presence of drug washout period in the regime. Thus, we aimed to optimize the dose of PCP in producing robust cognitive deficits by implementing it in a PCP regime which incorporates a drug washout period. The regimen used was 7 days' daily injection of PCP or saline for treatment and vehicle groups, respectively; followed by 24 h drug washout period. After the washout period, the test mice were tested in water maze (5 days of acquisition + 1 day of probe trial) for assessment of spatial learning and memory. Initially, we investigated the effect of PCP at 2mg/kg, however, no apparent impairment in spatial learning and memory was observed. Subsequently, we examined the effect of higher doses of PCP at 5, 10 and 20 mg/kg. We found that the PCP at 10 mg/kg produced a significant increase in "latency to reach the platform" during the acquisition days and a significant increase in "latency of first entry to previous platform" during the probe day. There was no significant change observed in "swim speed" during the test days. Thus, we concluded that PCP at 10 mg/kg produced robust deficits in spatial learning and memory without being confounded by motor disturbances.

Matched MeSH terms: Schizophrenic Psychology*
Is there a schizophasia? A study applying the single case approach to formal thought disorder in schizophrenia

Oh TM, McCarthy RA, McKenna PJ

Neurocase, 2002;8(3):233-44.
PMID: 12119320

It has been suggested that formal thought disorder, the incoherent speech of schizophrenia, may involve a language disturbance among other abnormalities, or even be a form of dysphasia. Six patients with and seven without formal thought disorder were evaluated on an aphasia test battery. Spontaneous speech was also analysed using Brief Syntactic Analysis. Poor performance on the aphasia test battery was found to be associated with general intellectual impairment but not with formal thought disorder. Naming was preserved in both groups. Patients with formal thought disorder, but not those without, produced semantic errors in their spontaneous speech, and these were unrelated to general intellectual status. The disorder of language in formal thought disorder thus appears to be one of expressive semantic abnormality, which, however, spares naming. Further analysis of two intellectually preserved patients suggested that formal thought disorder may be associated with an additional difficulty in constructing an appropriate model for generating one's own speech.

Matched MeSH terms: Schizophrenic Psychology*

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