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Abstract: This study examined the longitudinal patterns in the sustained attention deficits detected by the Continuous Performance Test (CPT) and the factors influencing such changes in consecutively admitted schizophrenia patients (n =224) followed up for 4–7 year. Exploratory growth mixture modeling analyses of subjects’ CPT performances over successive follow-ups revealed that three major (accounting for 92.8%) plus one minor subgroups could be delineated. Subgrouping was then performed on a subsample of 104 subjects who had at least 3 times of CPT data. Based on subjects’ adjusted z score of the test sensitivity index d′ derived from comparing with a community sample, patients were divided into three subgroups: no impairment (⩾−1), moderate impairment (−2.5 to −1), and severe impairment (<−2.5). The trajectory taken by individual patient was analyzed according to the initial subgroup status and subsequent changes, controlling for relevant basic and clinical characteristics. Both growth mixture modeling and subgroup status analyses found that around one third of those with severe impairment at baseline showed persistent severe impairment. Those with no impairment were stable and exhibited least tendency for further performance deterioration. Those with moderate impairment tended to fluctuate markedly, mainly towards the better rather than the worse. Previous subgrouping status and concurrent task-taking strategy predicted the performance subgroup status at follow-ups, while clinical symptoms and disease course factors did not. We concluded that there is substantial heterogeneity in schizophrenia patients’ long term pattern in sustained attention deficits and those with severe impairment might represent a subgroup with stable vulnerability to schizophrenia. [Copyright &y& Elsevier]

In the last decade, long-acting injectable antipsychotics has been widely used in schizophrenia. Aripiprazole long-acting once-monthly (AOM) is the only long-acting dopamine partial agonist antipsychotic approved for schizophrenia; however, a literature search revealed no guidance on safely switching from oral and long-acting injectable antipsychotics to AOM. This study aimed to develop recommendations of AOM use based on existing data and expert consensus. A committee of 30 experts in psychopharmacology from major hospitals across Taiwan was invited. A modified Delphi method was conducted, consisting of two rounds of questionnaires, literature review, three rounds of face-to-face discussion meeting, and two rounds of anonymous voting. The consensus recommendations were developed based on existing data, clinical experiences, and consensus opinions, with 80% agreement among panel members required for final adoption. The panel developed nine consensus statements of switching to AOM for both acute and stable schizophrenia patients receiving oral or long-acting injectable atypical antipsychotics. Recommendations regarding dose adjustment of oral medication and pregnancy/breastfeeding were also included. The nine consensus recommendations provide a guidance on safely switching to AOM. Substantial gaps in knowledge, and more research is necessary. [ABSTRACT FROM AUTHOR]

Abstract: Sustained attention deficits measured by the Continuous Performance Test (CPT) have been proposed as an endophenotype of schizophrenia. However, little is known about whether sustained attention deficits in first-degree relatives of schizophrenic patients are associated with familial loading for schizophrenia. We examined 107 parents and 84 siblings of simplex schizophrenia families as well as 72 parents and 56 siblings of multiplex schizophrenia families, all nonpsychotic, using the Diagnostic Interview for Genetic Studies and two sessions of the CPT (undegraded and degraded). The effect of perceptual load was assessed using the residual of the regression of the degraded score on the undegraded one. Statistical models that can adjust for familial correlations were used to compare the CPT performance of relatives between the two types of families. Siblings from multiplex families exhibited worse performance on the degraded CPT and less proficiency in processing the perceptual load than those from simplex families. No such difference was observed for the parents on either CPT version. We concluded that sustained attention along with perceptual load processing is more impaired in the siblings of schizophrenic patients with high familial loading and that this finding might be useful for future genetic dissection of schizophrenia. [Copyright &y& Elsevier]