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Objective: This study aimed to examine the alterations of cortical connectivity in first-episode schizophrenia (FES) with auditory hallucinations at early response of antipsychotics., Methods: This was a nonexperimental control of medication study. We measured the cortical activity of 20 medicated patients with FES (medicated group), 19 nonmedicated patients with FES (nonmedicated group), and 22 healthy controls using electroencephalogram during eye-open resting state. Source reconstruction analysis was performed to determine the brain regions that showed significant group difference. A dynamic causal modelling (DCM) analysis was used to estimate the effective connectivity between sources., Result: Both FES groups expressed increased activity in the right middle frontal gyrus (RMFG) and left/right superior temporal gyrus (L/RSTG) relative to that in the controls (p<0.05), and the nonmedicated group presented even higher activity than the medicated group (p<0.05). The effective connectivity from RMFG to LSTG was weaker in the nonmedicated group relative to that in the medicated group (p<0.01), although patients in the medicated group showed no difference with healthy controls in RMFG to L/RSTG connections. The Bayesian model selection analysis found modulatory lateralization in the nonmedicated group., Conclusion: The patients with FES showed frontotemporal hyperactivity and disconnectivity. The effective connections accompanied with modulation were improved when hallucination diminished at early response of routine medication., Significance: This study provided the first evidence of early drug response-related alterations in effective brain connectivity., (Copyright © 2017 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. All rights reserved.)

Delusions of schizophrenia have been found to be associated with alterations of some brain regions in structure and task-induced activation. However, the relationship between spontaneously occurring symptoms and spontaneous brain activity remains unclear. In the current study, 14 schizophrenic patients with delusions and 14 healthy controls underwent a resting-state functional magnetic resonance imaging (RS-fMRI) scan. Patients with delusions of schizophrenia patients were rated with Positive and Negative Syndrome Scale (PANSS) and Characteristics of Delusional Rating Scale (CDRS). Regional homogeneity (ReHo) was calculated to measure the local synchronization of the spontaneous activity in a voxel-wise way. A two-sample t-test showed that ReHo of the right anterior cingulate gyrus and left medial superior frontal gyrus were higher in patients, and ReHo of the left superior occipital gyrus was lower, compared to healthy controls. Further, among patients, correlation analysis showed a significant difference between delusion scores of CRDS and ReHo of brain regions. ReHo of the left medial superior frontal gyrus was negatively correlated with patients' CDRS scores but not with delusional PANSS scores. These results suggested that altered local synchronization of spontaneous brain activity may be related to the pathophysiology of delusion in schizophrenia.

The study focused on the predictive value of baseline metabolite ratios in bilateral hippocampus of first-episode schizophrenia by using proton magnetic resonance spectroscopy ((1)H MRS). (1)H MRS data were acquired from 23 hallucination and 17 non-hallucination first-episode schizophrenia patients compared with 17 healthy participants. Clinical characteristics of patients were rated using the Positive and Negative Syndrome Scale (PANSS) before and after 3-month treatment. The schizophrenia patients showed lower NAA/Cr ratio than healthy participants respectively (p=0.024; p=0.001), and non-hallucination patients had even lower NAA/Cr ratio than hallucination patients (p=0.033). After 3-month treatment, hallucination patients had greater improvement in negative symptoms than non-hallucination patients (p=0.018). The reduction of PANSS total score and negative factor score was positively correlated with the left NAA/Cr in both group patients (p<0.05). Given that the bilateral hippocampal baseline NAA/Cr had predictive value for the whole treatment response, and the left hippocampal NAA/Cr can predict the prognosis of negative symptoms during acute phase medication in first-episode schizophrenia., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Introduction: Gitelman syndrome(GS) is a rare inherited tubular disorder which is characterized by hypokalemia, metabolic alkalosis, hypomagnesemia, and hypocalciuria. Here, we report a case of schizophrenia-like psychosis concomitant with GS and related literatures are reviewed. Case description: An 18-year-old male patient with 1-week history of auditory hallucinations, sense of insecurity, delusions of reference and feelings of being followed and controlled by others unknown, insomnia was admitted to Psychiatry department in December, 2013. Hypokalemia and hypomagnesemia were noted. He was diagnosed as schizophrenia-like psychosis. Treatment with paliperidone at the dose of 6 mg/day and magnesium and potassium supplementations was commenced. However, electrolyte disturbances failed to improve following psychosis remission. Therefore, other underlying diseases resulting in electrolyte disturbances were suspected. Along with hypokalemia and hypomagnesemia, additional investigation showing metabolic alkalosis, hypocalciuria, renal loss of potassium, were consistent with GS. Gene analysis revealed this patient carried out c. 2687 G > A homozygous mutation of exon 23 in the SLC12A3 gene which led to p.Arg896Gln. Eventually, GS was identified. Thus, additional spironolactone (40 mg/day) combined with increased doses of oral potassium chloride sustained-release tablets (3.0 g/day) and potassium magnesium aspartate (0.3 g/day) were administered. During next half a year, fatigue resolved, paliperidone gradually tapered and eventually discontinued while psychosis maintained complete remission. His serum potassium was near normal (3.2-3.5 mmol/L), hypomagnesemia significantly improved (0.57-0.67 mmol/L). Discussion and evaluation: Electrolyte abnormalities secondary to GS might cause or contribute to development of neuropsychiatric symptoms. In turn, hypokalemia was common among acute psychiatric inpatients. As a consequence, when concomitant with psychosis, GS was readily concealed. Conclusion: Electrolyte disturbances are common in acute psychiatric patients. However, when electrolyte disturbances are not improved following psychosis remission, other underlying diseases such as GS should be considered. [ABSTRACT FROM AUTHOR]

Objectives: Personality disorder functioning styles might contribute to the inconclusive findings about alexithymic features in schizophrenia. We therefore studied the relationship between alexithymia and personality styles in paranoid schizophrenia. Methods: We administered the Chinese versions of the Toronto Alexithymia Scale (TAS-20), the Parker Personality Measure (PERM), the Positive and Negative Syndrome Scale as well as the Hamilton Anxiety and Depression Scales to 60 paranoid schizophrenia patients and 60 healthy control subjects. Results: Patients scored significantly higher on the Positive and Negative Syndrome Scale, TAS 'difficulty identifying feelings' and 'difficulty describing feelings', Hamilton Depression Scale and most PERM scales. In healthy subjects, difficulty identifying feelings predicted the PERM 'dependent' style, and the Hamilton Anxiety Scale predicted difficulty identifying feelings and difficulty describing feelings. In patients, difficulty identifying feelings nonspecifically predicted all the PERM scales; by contrast, the PERM 'antisocial' style predicted difficulty identifying feelings, the 'avoidant' style predicted difficulty describing feelings, and the 'histrionic' and 'paranoid (-)' styles predicted 'externally oriented thinking'. Conclusions: Personality disorder functioning styles - instead of anxiety, depression, psychotic symptoms or disease duration - were specifically associated with alexithymia scales in our patients, which sheds light on a cognitive-personological substrate in paranoid schizophrenia on the one hand, and calls for a longitudinal design to discover how premorbid or postacute residual personality styles contribute to the sluggish disorder on the other. Copyright © 2011 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]