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BackgroundWhile early intervention shows a better outcome in patients with schizophrenia, the benefit of early administration of long-acting injectable antipsychotics (LAI) in schizophrenia is not well-studied. Paliperidone Palmitate is one of the most frequently used LAI, and it is usually administered in the later stage of the illness than oral medication. In this study, the difference in clinical and functional improvement by illness duration after the administration of Paliperidone LAI was evaluated.MethodsPatients with schizophrenia who planned to switch their antipsychotic treatment from oral ones to once-monthly Paliperidone LAI were recruited from hospitals in South Korea from 26 July 2010 to 25 July 2017. The clinical and functional change was measured every 4 weeks with Clinical Global Impression Severity (CGI-S) scale and Personal and Social Performance (PSP) scale for 6 months after initiation of Paliperidone LAI. Compared to baseline, improvements after switching to Paliperidone LAI were analyzed based on the duration of illness (DI) (less than 3 years, 3 to 10 years, over 10 years).Results1166 participants (DI≤3 years, N=240; 310 years, N=484) were enrolled. The change in CGI-S score was significantly different according to the DI and those with DI less than 3 years showed the most improvement in the aspect of clinical symptoms (DI, p<0.001; week, p<0.001; DI*week, p=0.013). All three groups showed significant improvements in PSP scores after the treatment with Paliperidone LAI and patients with DI less than 3 years demonstrated the highest PSP scores (DI, p<0.001; DI*week, p=0.436; week, p<0.001).DiscussionSwitching to Paliperidone LAI showed significantly better outcomes in schizophrenia patients especially with those with shorter DI. This result suggests that earlier administration of LAI in schizophrenia might lead to better clinical and functional outcomes.

Abstract This paper discusses the current evidence from animal and human studies for a central role of inflammation in schizophrenia. In animal models, pre- or perinatal elicitation of the immune response may increase immune reactivity throughout life, and similar findings have been described in humans. Levels of pro-inflammatory markers, such as cytokines, have been found to be increased in the blood and cerebrospinal fluid of patients with schizophrenia. Numerous epidemiological and clinical studies have provided evidence that various infectious agents are risk factors for schizophrenia and other psychoses. For example, a large-scale epidemiological study performed in Denmark clearly showed that severe infections and autoimmune disorders are such risk factors. The vulnerability-stress-inflammation model may help to explain the role of inflammation in schizophrenia because stress can increase pro-inflammatory cytokines and may even contribute to a chronic pro-inflammatory state. Schizophrenia is characterized by risk genes that promote inflammation and by environmental stress factors and alterations of the immune system. Typical alterations of dopaminergic, serotonergic, noradrenergic, and glutamatergic neurotransmission described in schizophrenia have also been found in low-level neuroinflammation and consequently may be key factors in the generation of schizophrenia symptoms. Further support for the relevance of a low-level neuroinflammatory process in schizophrenia is provided by the loss of central nervous system volume and microglial activation demonstrated in neuroimaging studies. Last but not least, the benefit of anti-inflammatory medications found in some studies and the intrinsic anti-inflammatory and immunomodulatory effects of antipsychotics provide further support for the role of inflammation in this debilitating disease.

\"This second edition of Models of Madness challenges those who hold to simplistic, pessimistic and often damaging theories and treatments of madness. In particular it challenges beliefs that madness can be explained without reference to social causes and challenges the excessive preoccupation with chemical imbalances and genetic predispositions as causes of human misery, including the conditions that are given the name 'schizophrenia'. This edition updates the now extensive body of research showing that hallucinations, delusions etc. are best understood as reactions to adverse life events and that psychological and social approaches to helping are more effective and far safer than psychiatric drugs and electroshock treatment. A new final chapter discusses why such a damaging ideology has come to dominate mental health and, most importantly, how to change that.\" -- Publisher's description.

There hasn't been much study on the link between schizophrenia (SCZ) and neurexin 3 (NRXN3) genetic variations. The first association study of the NRXN3 rs12879016 G>C,T and rs2270964 C>A,T single-nucleotide polymorphisms (SNP)in a Saudi population is shown here.We used real-time PCR to assess the genotypes for the polymorphisms in one hundred seventeen patients with SCZ and Seventy-eight healthy controls. We used endonuclease digestion of amplified genomic DNA to establish the genotypes for the polymorphisms in 117 patients with DSM-IV and PANSS (Positive and Negative Syndrome Scale) evaluations of schizophrenia and 78 healthy controls.We aim to find out if there is a relation between NRXN3 variations (rs12879016 and rs2270964) and susceptibility of developing SCZ in a Saudi population.We hypothesis that SCZ can be related to patients with NRXN3 variations (rs12879016 / rs2270964) among Saudi population.According to our result both rs12879016 and rs2270964 polymorphisms were shown to be unrelated to the risk of schizophrenia.

Abstract Background Negative symptoms of schizophrenia are key predictors of long-term disability. It is important to understand whether treatment with long-acting injectable antipsychotics can improve negative symptom psychopathology. Paliperidone palmitate 3-month formulation (PP3M) provides a sustained release of paliperidone, permitting a significantly extended dosing interval of only 4 doses per year in patients with schizophrenia. The efficacy of PP3M as assessed by relapse rate is comparable to the paliperidone palmitate 1-month formulation (PP1M). The purpose of this post-hoc analysis was to compare the improvement in negative symptoms in patients treated with PP1M and PP3M. Methods Data from a randomized, double-blind (DB), parallel-group, multicenter, phase 3 study in patients with schizophrenia were analyzed. Patients aged 18 to 70 years with schizophrenia (DSM-IV-TR) and a total Positive and Negative Syndrome Scale (PANSS) score of 70–120 at screening were enrolled. After screening (3 weeks), patients entered a 17-week open-label (OL) phase, to receive PP1M (day 1 [150 mg eq. deltoid], day 8 [100 mg eq. deltoid], weeks 5, 9 and 13 [50, 75, 100, or 150 mg eq., deltoid/gluteal]) and entered a 48-week DB phase and were randomized (1:1) to receive fixed doses of either PP1M (50, 75, 100, or 150 mg eq., stabilized in OL) or PP3M (175, 263, 350, or 525 mg eq.) in deltoid or gluteal muscle until they relapsed or withdrew from study. The PANSS total scores with emphasis on 7-item negative subscale scores for PP1M vs PP3M were assessed. Results Of 1429 patients enrolled, 1016 were randomized to receive PP3M (n=504) or PP1M (n=512) in DB phase. Majority of patients were men and white (both 55%), with a mean (SD) age of 38.4 (11.86) years. At baseline, the mean (SE) negative subscale total was 23.2 (0.12), indicating a moderate to severe level of negative symptoms. Negative subscale and negative symptoms factor scores showed continuous improvements throughout the OL and double-blind phases of the study - mean (SD) at OL baseline and DB endpoint for total negative subscale score and symptom factor score were 23.2 (4.60) and 22.3 (4.87), and 15.9 (4.99) and 14.9 (4.81), both R2:0.16, respectively. The mean (SD) PANSS negative subscale score changes from DB baseline for PP1M vs PP3M were similar over time (mean change from baseline to DB endpoint was -1.4 (3.67), R2:0.06 vs -1.4 (3.63), R2:0.05). Discussion Development of an LAI antipsychotic with less frequent dosing than those currently available would be of potential advantage to patients, caregivers, and prescribers. PP3M and PP1M demonstrated consistent and similar efficacy in patients with moderate to severe negative symptoms of schizophrenia over the observed timepoints, including impact on patients with predominantly negative symptoms. Longer continuous treatment with PP3M showed greater benefit. This indicates that long-acting therapies are associated with continued improvement in negative symptoms over time. Treatment with LAIs for longer than a year was associated with the greatest improvements in negative symptoms.

People with schizophrenia often show deficits in recognizing facial emotions, which contributes to poor social functioning. In this experiment we directly investigated how 20 people being treated for schizophrenia categorized emotional faces. In a control group of healthy people who had no mental illness, happy faces were classified faster than sad faces, that is, there was a positive classification advantage. However, this phenomenon was not present for inverted faces. Compared with the control group, the people with schizophrenia categorized emotional faces more slowly, with less accuracy, and without a positive classification advantage, except for an overall delayed response for inverted rather than right-way-up conditions. Although face inversion delayed the categorization of neutral faces in the group with schizophrenia, inversion effects for both happy and sad faces did not differ between the 2 groups. These results suggest a dysfunction of categorization of emotional faces in people with schizophrenia, although these individuals could adopt the same criterion pattern emotions as the control group did on faces shown inverted and the right way up. Our findings provide new evaluation evidence for practitioners treating people with schizophrenia.