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Fulltext Current trends in the management of schizophrenia

George PP

Med J Malaysia, 2002 Mar;57(1):128-31; quiz 132.

Schizophrenia is a common and devastating illness. Patients with schizophrenia may develop many disabilities both due to the disease process as well as due to side effects of the medication used. There are many advances in the treatment of schizophrenia, which can effectively reduce many of these disabilities. Treatment of schizophrenia is a primary health care responsibility and thus all health care personnel need to equip themselves with the latest knowledge on management issues. This article outlines the current management issues in schizophrenia.

Matched MeSH terms: Schizophrenia/diagnosis*

Fulltext A psychiatric rating scale for schizophrenia in Singapore (Woodbridge Hospital rating scale for schizophrenia)

Tsoi WF, Kua EH

Med J Malaysia, 1982 Dec;37(4):300-5.

PMID: 7167079

This scale is constructed to meet the need for an efficient, rapid and economical method of
measuring change in schizophrenic patients during the course of psychotropic medication (drug trial) in a multi-cultural, multi-lingual population of low educational level. Items are included only if (1) they can be elicited objectively, (2) they are important symptoms of schizophrenia and (3) they are frequent maniJestatz'on of the schizophrenic syndrome as recorded in Woodbridge Hospital. It could be used by a single rater but its reliability should be further improved if two raters are involved.

Matched MeSH terms: Schizophrenia/diagnosis*

Schizophrenia or frontotemporal dementia in a young Chinese female: a purview of possible diagnoses

Grewal GS, Kanagasundram S, Jambunathan S

Turk Psikiyatri Derg, 2011;22(4):266-8.

PMID: 22143952

Frontotemporal dementia (FTD) is now increasingly being recognized as one of the causes of young onset dementia (YOD). The presentation of FTD can be subtle with a broad range of symptoms. This frequently causes misdiagnosis and a delay in initiating the correct treatment. While subtle personality changes, disinhibition and problems in executive functioning are frequently encountered in FTD, frank psychotic symptoms resembling schizophrenia are unusual. This is a case of a 38 year old Chinese female that highlights how obsessive compulsive symptoms which progressed to florid psychosis and disorganized speech and behavior can be a presenting picture in FTD. For seven years, this patient was treated as a case of schizophrenia and was thought to have poor response to electroconvulsive therapy (ECT) as well as antipsychotic medication. Her blood work and electroencephalogram (EEG) were normal. Magnetic resonance imaging (MRI) showed progressive cerebral atrophy. This case report suggests that psychosis should be investigated in detail especially when the clinical presentation is not typical of a functional disorder and more so when the patient is not responsive to conventional treatment. This report also highlights the importance of eliciting symptoms suggestive of an "organic" etiology, such as incontinence and disorientation. In addition, the usefulness of repeated imaging to show the rapidly progressive course of FTD has been illustrated. Other possible differential diagnoses of this patient are also discussed.

Matched MeSH terms: Schizophrenia/diagnosis*

Population screening in Asia: A unique opportunity to enhance early detection of psychosis?

Woodberry KA

Asian J Psychiatr, 2015 Dec;18:97-8.

PMID: 26498721 DOI: 10.1016/j.ajp.2015.09.005

A recent article in this journal (Razali et al., 2015) reports the results of a 2-stage study screening for psychosis risk in Malaysia. The researchers incorporated both selective and indicated prevention strategies and included self-report items probing non-specific "early" experiences as well as attenuated psychotic symptoms associated with the prodromal phase of schizophrenia. Given that increased stigma and reduced services may reduce help-seeking in many Asian countries, population screening may be more important to early detection of individuals at risk for psychosis. In fact, the availability of large population centers and greater trust of providers may make Asian research centers uniquely suited for conducting badly needed research on screening strategies and the role of cultural factors in the emergence of psychosis.

Matched MeSH terms: Schizophrenia/diagnosis*

Assessment of documentation of DSM-IV-TR Criteria A for diagnosis of schizophrenia in psychiatric unit, tertiary hospital, Malaysia

Maung K, Ohnmar H, Than W, Ramli M, Najwa Hanim MR, Ali Sabri R, et al.

Clin Ter, 2015;166(2):87-90.

PMID: 25945438 DOI: 10.7417/CT.2015.1823

OBJECTIVE: The purposes of this study were to investigate the documentation of the DSM-IV-TR- Criteria A in diagnoses of schizophrenia and to identify the symptoms associated with over diagnosis of schizophrenia.

METHOD: This study involved a retrospective review and analysis of data from case notes.

RESULTS: Data of 107 newly diagnosed patients with schizophrenia were keyed in and analyzed using SPSS v 19. The cases were then evaluated for the use of the DSM-IV-TR- Criteria A. Over diagnosis was noted in 37.39% of the patients. Disorganised behaviour (12.5%), affective flattening (12.5%), hallucination (16%) and non-bizarre delusion (18.3%) significantly contributed to the over-diagnosis of schizophrenia. Symptoms such as non-bizarre delusion and hallucination were the most commonly used in over-diagnosing schizophrenia and were statistically significant with p ≤0.05.

CONCLUSIONS: There was a significant lack of DSM-IV-TR Criteria A among the data documented to diagnose schizophrenia and non-bizarre delusion and hallucination were the most commonly used in over-diagnosing schizophrenia. This key problem needs to be addressed. The reliability of a diagnosis is indispensable and achievable with the proper clinical application of DSM-IV-TR Criteria A. The DSM-IV-TR Criteria have been perceived to be useful and reliable and is most widely used throughout the world.

Matched MeSH terms: Schizophrenia/diagnosis*

Specificity of Schneider's first rank symptoms for schizophrenia in Malay patients

Salleh MR

Psychopathology, 1992;25(4):199-203.

PMID: 1492143

The frequency of Schneider's first rank symptoms (FRS) was studied in 221 Malay patients with functional psychosis. The prevalence of FRS in schizophrenia was 26.7%. The most common symptoms were voice arguing, passivity phenomena and somatic passivity. In the absence of organic brain dysfunction, the specificity of FRS for schizophrenia was 87.8%, and their positive predictive value was 90.6%. These findings indicate that although FRS is not pathognomonic of schizophrenia, their presence should be regarded as strongly suggestive of schizophrenia in the absence of organic etiology. FRS do not however occur with sufficient frequency to have potential diagnostic in schizophrenia.

Matched MeSH terms: Schizophrenia/diagnosis*

Fractal-based classification of electroencephalography (EEG) signals in healthy adolescents and adolescents with symptoms of schizophrenia

Namazi H, Aghasian E, Ala TS

Technol Health Care, 2019;27(3):233-241.

PMID: 30829625 DOI: 10.3233/THC-181497

Brain activity analysis is an important research area in the field of human neuroscience. Moreover, a subcategory in this field is the classification of brain activity in terms of different brain disorders. Since the Electroencephalography (EEG) signal is, in fact, a non-linear time series, employing techniques to investigate its non-linear structure is rather crucial. In this study, we evaluate the non-linear structure of the EEG signal between healthy and schizophrenic adolescents using fractal theory. The results of our analysis revealed that in terms of all recording channels, the EEG signal of healthy subjects is more complex compared to the ones suffering from schizophrenia. The statistical analysis also indicated that there is a significant difference in the complex structure of the EEG signal between these two groups of subjects. We also utilized approximate entropy in our analysis in order to verify the obtained results of the fractal analysis. The result of the entropy analysis suggested that EEG signal for healthy subjects is less random compared to the EEG signal in schizophrenic individuals. In addition, the employed methodology in this research can be further investigated in order to classify the brain activity in terms of other brain disorders, where one can explore how the complex structure of the EEG signal alters between them.

Matched MeSH terms: Schizophrenia/diagnosis*

Fulltext Comparing schizophrenia symptoms in the Iban of Sarawak with other populations to elucidate clinical heterogeneity

McLean D, Barrett R, Loa P, Thara R, John S, McGrath J, et al.

Asia Pac Psychiatry, 2015 Mar;7(1):36-44.

PMID: 24038814 DOI: 10.1111/appy.12093

INTRODUCTION: The symptom profile of schizophrenia can vary between ethnic groups. We explored selected symptom variables previously reported to be characteristic of schizophrenia in the Iban of Sarawak in transethnic populations from Australia, India, and Sarawak, Malaysia. We tested site differences to confirm previous research, and to explore implications of differences across populations for future investigations.

METHODS: We recruited schizophrenia samples in Australia (n = 609), India (n = 310) and Sarawak (n = 205) primarily for the purposes of genetic studies. We analyzed seven identified variables and their relationship to site using logistic regression, including: global delusions, bizarre delusions, thought broadcast/insertion/withdrawal delusions, global hallucinations, auditory hallucinations, disorganized behavior, and prodromal duration.

RESULTS: We identified a distinct symptom profile in our Sarawak sample. Specifically, the Iban exhibit: low frequency of thought broadcast/insertion/withdrawal delusions, high frequency of auditory hallucinations and disorganized behavior, with a comparatively short prodrome when compared with Australian and Indian populations.

DISCUSSION: Understanding between-site variation in symptom profile may complement future transethnic genetic studies, and provide important clues as to the nature of differing schizophrenia expression across ethnically distinct groups. A comprehensive approach to subtyping schizophrenia is warranted, utilizing comprehensively ascertained transethnic samples to inform both schizophrenia genetics and nosology.

Matched MeSH terms: Schizophrenia/diagnosis*

Effect of semantic coherence on episodic memory processes in schizophrenia

Battal Merlet L, Morel S, Blanchet A, Lockman H, Kostova M

Psychiatry Res, 2014 Dec 30;220(3):752-9.

PMID: 25240943 DOI: 10.1016/j.psychres.2014.08.034

Schizophrenia is associated with severe episodic retrieval impairment. The aim of this study was to investigate the possibility that schizophrenia patients could improve their familiarity and/or recollection processes by manipulating the semantic coherence of to-be-learned stimuli and using deep encoding. Twelve schizophrenia patients and 12 healthy controls of comparable age, gender, and educational level undertook an associative recognition memory task. The stimuli consisted of pairs of words that were either related or unrelated to a given semantic category. The process dissociation procedure was used to calculate the estimates of familiarity and recollection processes. Both groups showed enhanced memory performances for semantically related words. However, in healthy controls, semantic relatedness led to enhanced recollection, while in schizophrenia patients, it induced enhanced familiarity. The familiarity estimates for related words were comparable in both groups, indicating that familiarity could be used as a compensatory mechanism in schizophrenia patients.

Matched MeSH terms: Schizophrenia/diagnosis*

Determinants of subjective quality of life in first-episode schizophrenia: perspective from Malaysia

Chee KY

Early intervention in psychiatry, 2010 May;4(2):111-8.

PMID: 20536966 DOI: 10.1111/j.1751-7893.2010.00176.x

This study sought to examine the determinants of subjective quality of life among patients with first-episode schizophrenia in a developing country.

Matched MeSH terms: Schizophrenia/diagnosis*

Schizophrenia relapse in Kuala Lumpur, Malaysia: do relatives' expressed emotion and personality traits matter?

Roseliza-Murni A, Oei TP, Fatimah Y, Asmawati D

Compr Psychiatry, 2014 Jan;55(1):188-98.

PMID: 23374905 DOI: 10.1016/j.comppsych.2012.12.026

Schizophrenia which is perhaps the most disabling and puzzling form of a mental disorder is often conceptualized as 'gila' (lunacy or madness) by the Malaysian society. The debilitating nature of the disorder and recurrent relapse of its psychotic episodes have often been misunderstood and lead to confusion among the family members, who play the role as primary caregivers. While expressed emotion (EE) has been widely studied in the Western world, it is not well understood in Malaysia.

Matched MeSH terms: Schizophrenia/diagnosis*

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: Schizophrenia/diagnosis*

Dermatoglyphic patterns in schizophrenic patients

Varma SL, Chary TV, Singh S, Azhar MZ, Dharap AS

Acta Psychiatr Scand, 1995 Mar;91(3):213-5.

PMID: 7625199

Schizophrenics (n = 250) and normal controls (n = 90) were studied to investigate and compare their dermatoglyphic patterns. Their fingerprint patterns were studied. The frequency of arches in the patient and control groups was similar. The frequency of loops in the control group was higher than in the patient group, and the trend was consistent in all the digits. The whorls in the patient group showed an increase over the control group in all the digits, although this finding was not statistically significant.

Matched MeSH terms: Schizophrenia/diagnosis

A comparative study of thought disorder in acute and chronic schizophrenia

Mazumdar PK, Chaturvedi SK, Gopinath PS

Psychopathology, 1995;28(4):185-9.

PMID: 7480574

A differential phenomenological study of acute and chronic schizophrenia is scanty. Thought disorder was assessed in 22 acute and 23 chronic schizophrenics. The scale for the assessment of thought, language and communication was used. Poverty of speech was significantly more frequent in acute schizophrenia. Positive formal thought disorder was unusually found to be severer in chronic schizophrenia. No other significant difference was found. From the perspective of thought disorder, acute and chronic forms of schizophrenia seem to be in a continuum with minimal difference.

Matched MeSH terms: Schizophrenia/diagnosis*

Thought disorder and its correlation with clinicodemographic variables in schizophrenia

Mazumdar PK, Chaturvedi SK, Gopinath PS

Psychopathology, 1994;27(1-2):37-42.

PMID: 7972638

The correlation of clinical and demographic variables of thought disorder was studied in 45 Research Diagnostic Criteria (RDC) schizophrenics. Thought disorder was assessed by the scale for the assessment of Thought, Language and Communication (TLC). Negative thought disorder was significantly correlated with the rural background. Individual TLC items like Distractible speech, Illogicality, Clanging, Neologisms, etc. were correlated with the literate group and perseveration with the illiterate group. No significant correlation was noted between thought disorder and clinical variables.

Matched MeSH terms: Schizophrenia/diagnosis*

Knowledge about schizophrenia, insight into illness, and internalized stigma and their associated factors among people diagnosed with schizophrenia in a long-term care facility

Alhadidi M, Abdullah KL, Tang LY, Danaee M, Al Hadid LAR

Perspect Psychiatr Care, 2021 Jan;57(1):225-234.

PMID: 32502330 DOI: 10.1111/ppc.12553

PURPOSE: This study assessed the level of knowledge about schizophrenia, insight into illness, and internalized stigma and their associated factors among patients with schizophrenia in Jordan.

DESIGN AND METHODS: A cross-sectional survey was conducted on 135 patients diagnosed with schizophrenia, who had been admitted to the largest psychiatric hospital in Jordan.

FINDINGS: The participants had a low level of knowledge, insight, and a high level of internalized stigma. No correlation was found between these variables. Meanwhile, the educational level and vacation were found to be predictors of knowledge.

PRACTICE IMPLICATIONS: This can help psychiatric nurses to identify which area needs to be improved to ensure the best service and care is provided to patients diagnosed with schizophrenia.

Matched MeSH terms: Schizophrenia/diagnosis*

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: Schizophrenia/diagnosis

Fulltext Cultural adaptation and validity of the Malay version of the brief psychiatric rating scale (BPRS-M) among patients with schizophrenia in a psychiatric clinic

Yee A, Ng BS, Hashim HMH, Danaee M, Loh HH

BMC Psychiatry, 2017 Dec 02;17(1):384.

PMID: 29197359 DOI: 10.1186/s12888-017-1553-2

BACKGROUND: This study evaluates the psychometric properties of the Malay version of the Brief Psychiatric Rating Scale (BPRS-M) among patients with schizophrenia in a psychiatric outpatient clinic.
METHODS: Ninety-nine schizophrenia outpatients were administered the Malay version of the Brief Psychiatric Rating Scale (BPRS-M), Malay version of Positive and Negative Syndrome Scale (PANSS), Malay version of Calgary Depression Scale for Schizophrenia (CDSS) and Malay version of World Health Organization Quality of Life - Brief Version (WHOQOL-BREF).
RESULTS: An exploratory factor analysis (EFA) of BPRS-M produced a seven-factor solution which accounted for 71.4% of the total variance. It exhibited fair internal consistency (Cronbach's alpha coefficient of 0.75). "Positive symptoms" and "Resistance" factors had association with unemployment and number of antipsychotics, positively correlated with PANSS but negatively correlated with WHOQOL-BREF. "Mood disturbance" factor correlated with lifetime history of suicide attempts, Malay version of CDSS and WHOQOL-BREF (psychological). Both "Negative symptoms" and "Activation" factors were associated with male, lower education, unemployment and positively correlated with Malay version of PANSS but negatively correlated with WHOQOL-BREF.
CONCLUSIONS: The BPRS-M demonstrated promising psychometric properties in terms of dimensionality, reliability, and validity that generally justifies its use in routine clinical practice in Malaysia.
Study site: psychiatric clinic, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia

Matched MeSH terms: Schizophrenia/diagnosis*

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: Schizophrenia/diagnosis*

Cultural formulation of psychiatric diagnosis. Sakit Gila in an Iban longhouse: chronic schizophrenia

Barrett RJ

Cult Med Psychiatry, 1997 Sep;21(3):365-79.

PMID: 9352169

Matched MeSH terms: Schizophrenia/diagnosis*

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