不同重复经颅磁刺激模式对慢性精神分裂症阴性症状的疗效及安全性

目的：比较不同重复经颅磁刺激（ rTMS）模式对慢性精神分裂症阴性症状的疗效及安全性研究。方法：将90例慢性精神分裂症患者随机分为5Hz组、10Hz组、伪刺激组,每组30例。3组在维持原有抗精神病药物种类及剂量不变的基础上,刺激部位均选择左侧前额叶背外侧皮质区（ DLPFC）,刺激强度为80％运动阈值,每天1次,每周5次,共2周。治疗前后采用阳性与阴性症状量表（ PANSS）和阴性症状量表（ SANS）量表评定疗效。结果：3组治疗后比较,PANSS总分、阴性因子分、SANS评分差异有统计学意义（F＝22．99,39．73,31．90;P均＜0．05）,10Hz组较伪刺激组PANSS总分、阴性因子分、SANS评分低,差异有统计学意义（ q＝－5．60,－5．70,－7．67;P均＜0．05）;10Hz组较5Hz组PANSS总分、阴性因子分、SANS评分低,差异有统计学意义（ q＝－4．97,－5．80,－7．40;P均＜0．05）。与治疗前比较,10Hz组PANSS总分、阴性因子分、SANS评分降低,差异有统计学意义（ t＝－5．45,－7．03,－7．23;P均＜0．05）;5Hz组和伪刺激组PANSS总分及各因子分、SANS评分差异无统计学意义（P均＞0．05）。结论：10Hz rTMS模式能改善慢性精神分裂症患者阴性症状,有较好的安全性。     

生活质量和社会功能量表评分在强迫症和伴强迫症状的精神分裂症患者临床鉴别诊断

目的：探讨生活质量和社会功能量表评分在强迫症和伴强迫症状的精神分裂症患者临床鉴别诊断中的意义。方法：选取2013年2月－2014年8月在我院就诊的强迫症（ n＝125）和伴强迫症状的精神分裂症患者（ n＝112）,同时从体检中心选取90名健康者作为对照,利用生活质量综合评定问卷－74评估3组研究对象生活质量,利用WHO残疾评定量表评价3组研究对象社会功能,利用临床疗效总评量表中的疾病严重程度分量表评估3组研究对象临床症状严重程度。结果：3组研究对象在躯体功能、社会功能、心理功能、物质生活和总分差异均具有统计学意义（F＝568．314,936．032,1819．747,204．339,811．339;P＜0．05）,经LSD－t两两比较,强迫症组和伴强迫症状的精神分裂症组患者躯体功能、社会功能、心理功能、物质生活和总分均低于健康对照组,差异均具有统计学意义（P＜0．05）,伴强迫症状的精神分裂症组患者社会功能评分（26．7±4．8）低于强迫症组（35．9±3．3）,差异具有统计学意义（P＜0．05）;3组研究对象社会功能和临床症状严重程度评分差异均具有统计学意义（F＝1434．813,363．305;P＜0．05）,经LSD－t两两比较,强迫症组和伴强迫症状的精神分裂症组患者社会功能和临床症状严重程度评分均高于健康对照组,伴强迫症状的精神分裂症组患者社会功能（114．5±10．6）和临床症状严重程度评分（4．47±1．14）均高于强迫症组,差异均具有统计学意义（P＜0．05）;经Pearson相关分析显示,所有患者临床症状严重程度评分与社会功能评分呈正相关（r＝0．317,P＜0．05）,伴强迫症状的精神分裂症组患者临床症状严重程度评分与社会功能评分呈正相关（r＝0．251,P＜0．05）。结论：强迫症和伴强迫症状的精神分裂症患者均表现出生活质量和社会功能受损,且伴强迫症状的精神分裂症组患者社会功能损害程度,以及临床症状严重程度均高于强迫症组。     

Metacognitive Reflective and Insight Therapy for People in Early Phase of a Schizophrenia Spectrum Disorder

Schizophrenia often involves a loss of metacognitive capacity, the ability to form complex and integrated representations of self and others. Independent of symptoms and neurocognition, deficits in synthetic metacognition are related to difficulties of engaging in goal‐directed activities in social and vocational settings. Within this backdrop, we provide a case report of the effects of Metacognitive Reflective Insight Therapy (MERIT) that assisted a patient suffering from first episode schizophrenia during 2 years of individual psychotherapy. A total of 8 elements of MERIT that stimulate and promote metacognitive capacity are presented. As illustrated in this report, these procedures helped the patient move from a state in which he had virtually no complex ideas about himself or others to one in which he had developed integrated and realistic ideas about his own identity and the identity of others. He then could use these representations to understand and effectively respond to life challenges.     

Structural covariance in schizophrenia and first-episode psychosis: An approach based on graph analysis

Schizophrenia is a neurodevelopmental disorder that produces abnormalities across different brain regions. Measuring structural covariance with MRI is a well-established approach to investigate common changes in distinct systems. We investigated structural covariance in schizophrenia in a large Brazilian sample of individuals with chronic schizophrenia (n = 143), First Episode Psychosis (n = 32), and matched healthy controls (n = 82) using a combination of graph analysis and computational neuroanatomy.Firstly, we proposed the connectivity-closeness and integrity-closeness centrality measures and them compared healthy controls with chronic schizophrenia regarding these metrics. We then conducted a second analysis on the mapped regions comparing the pairwise difference between the three groups.Our results show that compared with controls, both patient groups (in pairwise comparisons) had a reduced integrity-closeness in pars orbitalis and insula, suggesting that the relationship between these areas and other brain regions is increased in schizophrenia. No differences were found between the First Episode Psychosis and Schizophrenia groups. Since in schizophrenia the brain is affected as a whole, this may mirror that these regions may be related to the generalized structural alteration seen in schizophrenia.     

Hearing voices in the resting brain: A review of intrinsic functional connectivity research on auditory verbal hallucinations

Resting state networks (RSNs) are thought to reflect the intrinsic functional connectivity of brain regions. Alterations to RSNs have been proposed to underpin various kinds of psychopathology, including the occurrence of auditory verbal hallucinations (AVH). This review outlines the main hypotheses linking AVH and the resting state, and assesses the evidence for alterations to intrinsic connectivity provided by studies of resting fMRI in AVH. The influence of hallucinations during data acquisition, medication confounds, and movement are also considered. Despite a large variety of analytic methods and designs being deployed, it is possible to conclude that resting connectivity in the left temporal lobe in general and left superior temporal gyrus in particular are disrupted in AVH. There is also preliminary evidence of atypical connectivity in the default mode network and its interaction with other RSNs. Recommendations for future research include the adoption of a common analysis protocol to allow for more overlapping datasets and replication of intrinsic functional connectivity alterations.     

A systematic review of multisensory cognitive–affective integration in schizophrenia

The etymology of schizophrenia implies poor functional integration of sensory, cognitive and affective processes. Multisensory integration (MSI) is a spontaneous perceptual–cognitive process by which relevant information from multiple sensory modalities is extracted to generate a holistic experience. Deficits in MSI may hinder prompt and appropriate behavioural responses in a complex and transient environment. Despite extensive investigation of sensory, cognitive and affective processing in patients with schizophrenia, little is known about how MSI is affected in the illness. We systemically searched the PubMed electronic database and reviewed twenty-nine behavioural and neuroimaging studies examining MSI in patients with schizophrenia. The available evidence indicates impaired MSI for non-emotional stimuli in schizophrenia, especially for linguistic information. There is also evidence for altered MSI for emotional stimuli, although findings are inconsistent and may be modality-specific. Brain functional alterations in the superior temporal cortex and inferior frontal cortex appear to underlie the deficits in both non-emotional and emotional MSI. The limitations of the experimental paradigms used and directions for future research are also discussed.     

Total and differential white blood cell counts,high-sensitivity C-reactive protein,and cardiovascular risk in non-affective psychoses

Schizophrenia is associated with increased cardiovascular disease morbidity and mortality. Schizophrenia is also associated with immune and inflammatory abnormalities, including aberrant blood levels of lymphocytes, cytokines and high-sensitivity C-reactive protein (hsCRP). The purpose of this study is to investigate the relationship between total and differential white blood cell (WBC) counts, hsCRP, and indices of cardiovascular disease risk in patients with schizophrenia and related non-affective psychoses. 108 inpatients and outpatients age 18–70 with non-affective psychoses and 44 controls participated in this cross-sectional study. Subjects had a fasting blood draw between 8 and 9 am for glucose, lipids, total and differential WBC counts, and hsCRP. Vital signs and medical history were obtained. Patients with non-affective psychosis had significantly higher hsCRP levels than controls (p = 0.04). In linear regression analyses, lymphocyte and monocyte counts were a significant predictor of the total-to-HDL cholesterol ratio in subjects with non-affective psychosis (p ⩽ 0.02 for each). In binary logistic regression analyses, total WBC count was a significant predictor of an elevated 10-year estimated risk of myocardial infarction and cardiovascular disease in subjects with non-affective psychosis (p ⩽ 0.03 for each). Associations between total and differential WBC counts and cardiovascular disease risk indices were stronger in males than females with non-affective psychosis. Our findings provide further evidence that measurement of total and differential WBC counts may be germane to the clinical care of patients with schizophrenia and related disorders, and support an association between inflammation and cardiovascular disease risk in these patients.     

Fetal programming of schizophrenia: Select mechanisms

Mounting evidence indicates that schizophrenia is associated with adverse intrauterine experiences. An adverse or suboptimal fetal environment can cause irreversible changes in brain that can subsequently exert long-lasting effects through resetting a diverse array of biological systems including endocrine, immune and nervous. It is evident from animal and imaging studies that subtle variations in the intrauterine environment can cause recognizable differences in brain structure and cognitive functions in the offspring. A wide variety of environmental factors may play a role in precipitating the emergent developmental dysregulation and the consequent evolution of psychiatric traits in early adulthood by inducing inflammatory, oxidative and nitrosative stress (IO&NS) pathways, mitochondrial dysfunction, apoptosis, and epigenetic dysregulation. However, the precise mechanisms behind such relationships and the specificity of the risk factors for schizophrenia remain exploratory. Considering the paucity of knowledge on fetal programming of schizophrenia, it is timely to consolidate the recent advances in the field and put forward an integrated overview of the mechanisms associated with fetal origin of schizophrenia.