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The aim of the current study was to investigate an association of physical and social hedonic deficits with health-related quality of life (HRQL), controlling for related distressing and protective factors. Eighty-seven stable patients with schizophrenia (SZ) and schizoaffective disorder (SA) were assessed using the revised Physical Anhedonia Scale (PAS) and the Social Anhedonia Scale (SAS), the Quality of Life Enjoyment and Life Satisfaction Questionnaire (Q-LES-Q), and related factors. Hedonic and HRQL deficit scores did not reach significant differences between SZ and SA patients. General and domain-specific Q-LES-Q scores were significantly correlated with PAS and SAS scores independent of the adverse effects and psychopathological symptoms. Dissatisfaction with HRQL increased from 'normal hedonics' (4.8%) to 'hypohedonics' (28.6%) and 'double anhedonics' (66.7%). Permanently dissatisfied patients who revealed deterioration in general quality of life across 10 years had significantly higher PAS and SAS scores than did patients who were permanently satisfied and improved. An exploratory factor analysis yielded a three-factor solution; PAS and SAS scores were joined to the second factor together with Q-LES-Q, self-efficacy, coping styles, and social support scores. PAS scores accounted for 7% to 13% of the total variance in three domains and in the general quality-of-life alterations. SAS scores did not predict variability in the Q-LES-Q domains. Therefore, physical and social hedonic deficits significantly associated with poor HRQL independent of the adverse effects and psychopathological symptoms of SZ/SA. Physical anhedonia may be a predictor for quality-of-life deficit. [ABSTRACT FROM AUTHOR]

This study sought to evaluate predischarge anhedonia level and its predictors in 125 inpatients with schizophrenia and schizoaffective disorders. Consecutively admitted inpatients were assessed before discharge from the hospital using the Specific Loss of Interest and Pleasure Scale (SLIPS) and a battery of measures for clinical and psychosocial variables. When symptoms, distress, and social anhedonia scores were controlled, the SLIPS score inversely correlated with self-constructs, social support, quality of life, recovery, and unmet needs. Using two cutoff points of the data set of SLIPS, we identified three groups: 19 (15.2%) patients reported "no loss of pleasure"; 46 (36.8%), "some loss of pleasure"; and 60 (48.0%), "marked diminishment of pleasure." The SLIPS score is predicted by sensitivity, unmet needs, deficient interpersonal pleasure, poor quality of life, and friend support. The study underlines the importance of assessing anhedonia and related psychosocial factors in patients with serious mental illness.

Although social hedonic capacity is often assessed in clinical settings, its operational definitions have not been evaluated for concurrent validity. One hundred and twenty-five patients with schizophrenia and schizoaffective disorder were classified according to their self-reported social hedonic functioning into three groups on the basis of their total scores on the Anticipatory and Consummatory Interpersonal Pleasure Scale (ACIPS). Participants were assessed before discharge using questionnaires and psychiatric rating scales. Using an empirically based cutoff score, we identified three groups: an intact social hedonic group (WNL), a socially anhedonic group (SA), and a socially hypohedonic group (i.e., those with scores intermediate between normal functioning and aberrantly low functioning, H). The SA patients were significantly different from the two other groups (WNL and H) by their higher severity of psychopathology, lower levels of self-efficacy, and less self-esteem. The SA patients also reported less perceived social support, poorer quality of life, and less subjective recovery. Our findings indicate that social anhedonia is a meaningful target for intervention. Further implications of our findings are discussed., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Background: Patients' perception of psychiatric healthcare is a critical indicator in measuring service quality. The aim of the study was to determine patient's level of satisfaction with the quality of health care delivered at the inpatient departments, and to identify the service quality factors that were important to patients., Method: The Satisfaction with Psychiatry Care Questionnaire-22 was administered to 125 consecutive inpatients with schizophrenia or schizoaffective disorder in a stable condition. Sociodemographic and background variables, illness and symptom severity, insight, social anhedonia, self-esteem, perceived social support, and satisfaction with quality of life were collected., Results: Although the participants generally expressed satisfaction with the inpatient services, they indicated that the weakest aspects of the service were in the domains of 'personal experience', 'information' and 'activity'. Women were significantly more dissatisfied than men with 'staff', 'care', and by general satisfaction. Multiple regression analysis revealed that satisfaction with hospital health care was associated with five indicators: insight, satisfaction with physical health, self-efficacy, family support, and social anhedonia., Conclusion: Personality related factors rather than psychopathological symptoms were associated with a satisfaction with care of admitted patients with severe mental illness. These factors could be targets for interventions aimed to improve treatment and hospital services., (Copyright © 2018. Published by Elsevier B.V.)

This cross-sectional study compared the levels of needs, care satisfaction, quality of life, and social support of compulsory admitted patients with severe mental disorders to a comparable group of voluntary admitted patients. One hundred and twenty-five patients with schizophrenia and schizoaffective disorder were admitted to a hospital by district psychiatrist order (DPO), court observation order (COO), or voluntary (VA). Participants were assessed before discharge using questionnaires, and psychiatric rating scales. A linear discriminant analysis revealed eight variables that best differentiated the three groups. COO patients were significantly discriminated from the two other groups (DPO and VA) by severe negative symptoms, better satisfaction with both nursing staff and family support. COO subjects had more non-illness unmet needs, while reported better hedonic capacity for social and interpersonal pleasure - compared to VA patients. DPO patients were significantly indicated by poorer awareness to illness, but better satisfaction with subjective feelings. VA subjects were significantly discriminated from compulsory admitted patients by higher illness severity scores. Assessment of unmet needs, satisfaction with care, quality of life, hedonic capacity, and social support constitute the factors that differentiate compulsory admitted patients and could be targets for interventions aimed to reduce the negative effects of compulsory admissions., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Aims: Pregnenolone (PREG) and L-theanine (LT) have shown ameliorative effects on various schizophrenia symptoms. This is the first study to evaluate the efficacy and safety of augmentation of antipsychotic treatment among patients with chronic schizophrenia or schizoaffective disorder with PREG-LT., Methods: Double-blind, placebo-controlled trial of PREG-LT or placebo augmentation was conducted for eight weeks with 40 chronic DSM-IV schizophrenia and schizoaffective disorder patients with suboptimal response to antipsychotics. Oral PREG (50 mg/day) with LT (400 mg/day) or placebo were added to a stable regimen of antipsychotic medication from March 2011 to October 2013. The participants were rated using the Scale for the Assessment of Negative Symptoms (SANS), the Hamilton Scale for Anxiety (HAM-A), and the Positive and Negative Syndrome Scale (PANSS) scales bi-weekly. The decrease of SANS and HAM-A scores were the co-primary outcomes. Secondary outcomes included assessments of general functioning and side effects., Results: Negative symptoms such as blunted affect, alogia, and anhedonia (SANS) were found to be significantly improved with moderate effect sizes among patients who received PREG-LT, in comparison with the placebo group. Add-on PREG-LT also significantly associated with a reduction of anxiety scores such as anxious mood, tension, and cardiovascular symptoms (HAM-A), and elevation of general functioning (GAF). Positive symptoms, antipsychotic agents, concomitant drugs, and illness duration did not associate significantly with effect of PREG-LT augmentation. PREG-LT was well-tolerated., Conclusions: Pregnenolone with L-theanine augmentation may offer a new therapeutic strategy for treatment of negative and anxiety symptoms in schizophrenia and schizoaffective disorder. Further studies are warranted., Trial Registration: clinicaltrials.gov Identifier: NCT01831986.

Purpose: This study aimed to examine the effect of add-on treatment with the neurosteroid pregnenolone (PREG) on neurocognitive dysfunctions of patients with recent-onset schizophrenia (SZ) and schizoaffective disorder (SA)., Method: Sixty out- and inpatients that met DSM-IV criteria for SZ/SA were randomized to an 8-week, double-blind, randomized, placebo-controlled, 2-center trial. Participants received either pregnenolone (50 mg/d) or placebo added on to antipsychotic medications. Computerized Cambridge Automated Neuropsychological Test Battery measures were administered at baseline and after 4 and 8 weeks of treatment. ANOVA and paired t- or z-tests were applied to examine between- and within-group differences over time., Results: Compared to placebo, adjunctive PREG significantly reduced the deficits in visual attention measured with the Matching to Sample Visual Search task (p=0.002), with moderate effect sizes (d=0.42). In addition, a significant improvement was observed from baseline to end-of-study with respect to the visual (p=0.008) and sustained attention (Rapid Visual Information Processing, p=0.038) deficits, and executive functions (Stockings of Cambridge, p=0.049; Spatial Working Memory, p<0.001) among patients receiving PREG but not among those receiving placebo (all p's>0.05). This beneficial effect of PREG was independent of the type of antipsychotic agents, gender, age, education, and illness duration., Conclusions: Pregnenolone augmentation demonstrated significant amelioration of the visual attention deficit in recent-onset SZ/SA. Long-term, large-scale studies are required to obtain greater statistical significance and more confident clinical generalization.

Purpose: The aim of the current study was to explore the concurrent attribution of illness- and personality-related variables to the levels of physical and social anhedonia in patients with schizophrenia (SZ) and schizoaffective disorder (SA)., Method: Eighty-seven stable patients with SZ/SA were assessed using the revised Physical Anhedonia Scale (PAS) and the Social Anhedonia Scale (SAS) illness- and personality-related variables. Correlation and regression analyses were performed., Results: Three subgroups of patients were stratified by level of hedonic functioning: 52.9% passed the PAS and SAS cut-off ("double anhedonics"), 14.9% the PAS cut-off and 18.4% the SAS cut-off ("hypohedonics"), and 13.8% did not reach the PAS or SAS cut-off ("normal hedonics"). Increased negative and emotional distress symptoms together with low levels of task-oriented and avoidance-coping styles, self-efficacy, and social support were significantly correlated with PAS/SAS scores. Multivariate regression analysis indicated that the contribution of illness-related predictors was 4.1% to the variance of PAS and 5.5% to SAS scores, whereas the contribution of personality-related predictors was 24.1% for PAS and 14.1% for SAS scores. The predictive value of negative symptoms did not reach significant levels., Conclusions: The hedonic functioning of SZ/SA patients is attributed to a number of personality-related factors rather than to state-dependent clinical symptoms. These findings enable better understanding of the multifactorial nature of anhedonia and might be of therapeutic relevance.

This review provides the rationale and reports on the progress to date regarding the targeting of retinoid receptors for the treatment of schizophrenia and schizoaffective disorder and the role of retinoic acid in functions of the normal brain, and in psychotic states. After a brief introduction, we describe the normal function of retinoic acid in the brain. We then examine the evidence regarding retinoid dysregulation in schizophrenia. Finally, findings from two add-on clinical trials with a retinoid (bexarotene) are discussed. The authors of this review suggest that targeting retinoid receptors may be a novel approach to treat schizophrenia and schizoaffective disorder. Further studies are warranted.

Purpose: The present study examined the relationship between unmet needs and current as well as long-term quality of life (QOL) of patients with schizophrenia (SZ) and schizoaffective (SA) disorders., Methods: Ninety-five stable SZ/SA patients were evaluated using the Quality of Life Enjoyment and Life Satisfaction Questionnaire (Q-LES-Q), the Positive and Negative Syndrome Scale (PANSS), the Multidimensional Scale of Perceived Social Support (MSPSS), and the Coping Inventory for Stressful Situations (CISS). At the 10-year evaluation participants also completed the Camberwell Assessment of Need scale. Correlation and multivariate regression analyses were performed., Results: The number of unmet needs negatively correlated with Q-LES-Q domains; however, the predictive value for general quality of life did not reach significant levels controlling for MSPSS and CISS scores. Patterns of individual needs included assistance with psychological distress, daytime activities, welfare benefits, physical health, food, and intimate relationships, and emerged as significant predictors of current general QOL, even after controlling for PANSS, MSPSS, and CISS scores. Patients who had worsened and had dissatisfied courses of general QOL over time expressed many more unmet needs compared to those who were satisfied and had an improved course of QOL. Individual unmet needs concerning daytime activities, psychological distress, psychotic symptoms, information about treatment, company, and money were associated with worsened and dissatisfied general QOL outcomes., Conclusions: Unmet needs of SZ/SA patients show a strong relationship with prior long-term and current quality-of-life outcome. The pattern of individual unmet needs rather than the number of unmet needs had a greater predictive value for current subjective quality of life.

Aims: Management of recent-onset schizophrenia (SZ) and schizoaffective disorder (SA) is challenging owing to frequent insufficient response to antipsychotic agents. This study aimed to test the efficacy and safety of the neurosteroid pregnenolone in patients with recent-onset SZ/SA., Methods: Sixty out- and inpatients who met DSM-IV criteria for SZ/SA, with suboptimal response to antipsychotics were recruited for an 8-week, double-blind, randomized, placebo-controlled, two-center add-on trial, that was conducted between 2008 and 2011. Participants were randomized to receive either pregnenolone (50 mg/day) or placebo added on to antipsychotic medications. The primary outcome measures were the Positive and Negative Symptoms Scale and the Assessment of Negative Symptoms scores. Secondary outcomes included assessments of functioning, and side-effects., Results: Analysis was by linear mixed model. Fifty-two participants (86.7%) completed the trial. Compared to placebo, adjunctive pregnenolone significantly reduced Positive and Negative Symptoms Scale negative symptom scores with moderate effect sizes (d = 0.79). Significant improvement was observed in weeks 6 and 8 of pregnenolone therapy among patients who were not treated with concomitant mood stabilizers (arms × visit × mood stabilizers; P = 0.010). Likewise, pregnenolone significantly reduced Assessment of Negative Symptoms scores compared to placebo (d = 0.57), especially on blunted affect, avolition and anhedonia domain scores. Other symptoms, functioning, and side-effects were not significantly affected by adjunctive pregnenolone. Antipsychotic agents, benzodiazepines and sex did not associate with pregnenolone augmentation. Pregnenolone was well tolerated., Conclusions: Thus, add-on pregnenolone reduces the severity of negative symptoms in recent-onset schizophrenia and schizoaffective disorder, especially among patients who are not treated with concomitant mood stabilizers. Further studies are warranted., (© 2014 The Authors. Psychiatry and Clinical Neurosciences © 2014 Japanese Society of Psychiatry and Neurology.)

Aims: This study aimed to determine predictors for 10-year good versus poor perceived general quality of life (QOL) outcomes from baseline variables in people with schizophrenia and schizoaffective disorder., Methods: We compared patients with poor versus good 10-year QOL outcomes using baseline clinical, personality-related variables, demographic and background characteristics. Logistic regression analysis was used for predicting the 10-year QOL outcomes from baseline data. One-hundred-eight patients completed the Quality-of-Life Enjoyment and Life Satisfaction Questionnaire, the Positive and Negative Syndromes Scale (PANSS), the Talbieh Brief Distress Inventory, and psychosocial questionnaires at baseline and 10 years later., Results: Logistic regression revealed six predictors of QOL outcomes: paranoid ideations (odds ratio [OR] 3.1), PANSS general psychopathology (OR 1.1), obsessiveness (OR 0.84), hostility (OR 0.4), PANSS positive scale scores (OR 0.4), and general QOL index (OR 0.4). This model classified 80.6% of the sample with good sensitivity (87% correctly identified 'poor outcome'), and specificity (71% correctly identified 'good outcome')., Conclusion: This study provides a pattern of baseline predictors for long-term QOL outcomes. Identified predictors are factors that can potentially be ameliorated, and thereby enhance the QOL of people with schizophrenia and schizoaffective disorder., (© 2014 The Authors. Psychiatry and Clinical Neurosciences © 2014 Japanese Society of Psychiatry and Neurology.)

Objective: The limitations of antipsychotic therapy in schizophrenia and schizoaffective disorder led to the investigation of the putative utility of pharmacologic augmentation strategies. The antitumor agent bexarotene via nuclear retinoid X receptor (RXR) activation might modulate numerous metabolic pathways involved in the pathogenesis of schizophrenia and schizoaffective disorder. This trial aimed to investigate efficacy and safety of add-on bexarotene to ongoing antipsychotic treatment of patients with schizophrenia or schizoaffective disorder., Method: Ninety inpatients and outpatients that met DSM-IV-TR criteria for schizophrenia or schizoaffective disorder participated in a 6-week, double-blind, randomized, placebo-controlled multicenter study. Bexarotene (75 mg/d) was added to ongoing antipsychotic treatment from October 2008 to December 2010. The reduction in the severity of symptoms on the Positive and Negative Syndrome Scale (PANSS) was a primary outcome. Secondary outcomes included general functioning, quality of life, and side effect scales., Results: Seventy-nine participants (88%) completed the protocol. Controlling for antipsychotic agents, a mixed model showed that patients who received adjunctive bexarotene had significantly lower PANSS positive scale scores compared to patients who received placebo (F = 8.6, P = .003; treatment arms × time, F = 2.7, P = .049), with moderate effect size (d = 0.48; 95% CI,0.04-0.93). Patients with mean or higher baseline PANSS positive scale scores and patients who did not take lipid-reducing agents revealed greater amelioration of positive symptoms (F = 7.4, P = .008). Other symptoms and secondary outcome measures were not affected by adjunctive bexarotene. Bexarotene was well tolerated, though 2 reversible side effects were reported: a significant increase in total cholesterol levels (P < .001) and a decrease in total thyroxine levels (P < .001)., Conclusions: Bexarotene might potentially be a novel adjuvant therapeutic strategy for schizophrenia, particularly for the reduction of positive symptoms. The potential benefits and risks of ongoing administration of bexarotene warrant further evaluation., Trial Registration: ClinicalTrials.gov identifier: NCT00535574., (© Copyright 2013 Physicians Postgraduate Press, Inc.)

Innovations in DSM5 include dimensional diagnosis of schizophrenia (SZ) and other psychotic (OP) disorders using the symptom severity scale (SS-DSM5). We evaluated the psychometric properties and diagnostic validity of the SS-DSM5 scale using a cross-sectional design and an unselected convenience unselected sample of 314 inpatients and outpatients with SZ/OP and mood disorders who received standard care in routine clinical practice. The SS-DSM5 scale, the Clinical Global Impression-Severity scale (CGI-S), the Positive and Negative Syndrome Scale (PANSS), and the Bech-Rafaelsen Mania Scale (BRMS) were administered. Factor structure, reliability, internal consistency, convergent and diagnostic ability of the DSM5-SS were evaluated. Factor analysis indicated two latent factors underlying the SS-DSM5 (Psychotic and Deficit sub-scales). Cronbach's alpha was >0.70. Convergent validity of the SS-DSM5 was highly significant. Patients with SZ/PO disorders were correctly diagnosed (77.9%) using the SS-DSM5 scale (72% using PANSS). The agreement of the diagnostic decisions between the SS-DSM5 and PANSS was substantial for SZ/PO disorders (Kappa=0.75). Classifying participants with SZ/PO versus mood disorders using SS-DSM5 provided a sensitivity of 95%, and specificity of 34%. Thus, this study suggests that the SS-DSM5 has acceptable psychometric properties and that its use in clinical practice and research is feasible in clinical settings. The dimensional option for the diagnosis of schizophrenia and related disorders using SS-DSM5 is discussed., (Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.)

Aim: To investigate the factor structure underlying the Camberwell Assessment of Need-Patient Version (CANSAS-P) items in schizophrenia and schizoaffective disorder., Method: Factor, correlation and regression analyses were performed for dimensions of CANSAS-P, illness, personality and quality of life (QOL) related variables in 95 stabilized patients with chronic schizophrenia and schizoaffective disorder., Results: Exploratory factor analysis revealed a four-factor model that explains 50.4% of the total variance of the 20 CANSAS-P items. The factors 'Social disability', 'Information processing disability', 'Emotional processing disability', and 'Coping disability' showed acceptable internal consistency (Cronbach's α coefficient 0.67-0.77). The CANSAS-P subscale scores positively correlated with severity of symptoms, distress (r ranged from 0.34 to 0.45), while negatively associated with general functioning (r = -0.34), friend (r = -0.46) and family support (r = -0.41), satisfaction with medicine (r = -0.35), general activities (r = -0.40), and general QOL (r = -0.35) (all P < 0.001). Severity of illness, symptoms, emotional distress and emotion-oriented coping were positive predictors; friend support, QOL general activities, life satisfaction and satisfaction with medicine were negative predictors of the CANSAS-P subscale scores. The effect size (f(2)) for these predictors ranged from medium to quite large (f(2) = 0.28-1.13), and they explain from 23% to 46% of the variability in CANSAS-P subscales., Conclusions: A four-factor structure mode, including social and cognitive functioning, emotion responsivity and coping with daily challenges, appears to fit CANSAS-P items. These subscales may contribute to research and improve treatment of psychiatric patients., (© 2012 The Authors. Psychiatry and Clinical Neurosciences © 2012 Japanese Society of Psychiatry and Neurology.)

Purpose: To identify psychosocial predictors of change in health-related quality of life among patients with schizophrenia (SZ) and schizoaffective (SA) disorders over a 10-year period., Methods: In a naturalistic longitudinal design, 108 patients with SZ/SA disorders completed a comprehensive rating scale battery including self-reported quality of life, emotional distress symptoms, coping styles, sense of self-efficacy, and social support, as well as observer-rated psychopathology, medication side effects, and general functioning at 2 time points, baseline and 10 years later., Results: Regression models revealed that reduction in self-reported symptoms of depression, sensitivity or anxiety along with increase in self-efficacy, social support, and emotion-oriented coping scores predicted improvement in domain-specific perceived quality of life. Adjustment of the psychosocial models for the effects of disorder-related factors (psychopathology, functioning, and medication side effects) confirmed the above findings and amplified their statistical power., Conclusions: In the long-term course of severe mental disorders (SZ/SA), changes in the psychosocial factors are stronger predictors of subjective quality of life outcome than disorder-related changes. The findings enable better understanding of the combined effects of psychopathology and psychosocial factors on quality of life outcome over a 10-year period.

Purpose: To provide data on long-term health-related quality of life (HRQL) outcomes among patients with schizophrenia (SZ) and schizoaffective (SA) disorders and determine the predictive value of disorder-related factors., Methods: A total of 108 patients with SZ/SA were assessed during stabilization phase and over 10 years with the Quality of Life Enjoyment and Life Satisfaction Questionnaire (Q-LES-Q), Clinical Global Impression Scale, Positive and Negative Syndromes Scale (PANSS), Distress Scale for Adverse Symptoms (DSAS), Talbieh Brief Distress Inventory (TBDI), Brief Symptom Inventory-Somatization Scale (BSI-S), and Global Assessment of Functioning Scale (GAF). Variability and relationships between Q-LES-Q and disorder-related dimensions over time were analyzed., Results: There were no differences in Q-LES-Q dimensions between patients with SZ and SA disorders. Poor outcomes were found among 76% of the patients with SZ/SA disorders who remained dissatisfied (64%) or worsened (12%) with their HRQL over time. However, 24% of patients reported improved quality of life (16%), or remained satisfied (8%). Changes in TBDI, DSAS, BSI-S, PANSS, and GAF measures accounted for 20-50% of the total variance in satisfaction changes in Q-LES-Q domains across time., Conclusions: Long-term quality of life outcomes are characterized by four different types that fit changes over time in emotional distress, side effects, somatization, symptom dimensions, and general functioning scores. Revealed predictors are factors that can be ameliorated and thereby enhance satisfaction with quality of life over time.

Neurosteroids such as dehydroepiandrosterone (DHEA), pregnenolone (PREG), and their sulfates (DHEAS and PREGS) display multiple effects on the central nervous system. Specifically, neurosteroids have various functions associated with neuroprotection, response to stress, mood regulation, and cognitive performance. In addition, neurosteroid levels are altered in stress-related neuropsychiatric disorders. This review focuses on the alterations of these neurosteroids in schizophrenia and on their association with clinical and neurocognitive manifestations. As described henceforth, findings from clinical studies have revealed that PREG, DHEA, and their sulfates might be involved in the pathophysiology of schizophrenia, and in some of its manifestations. Clinical trials for the evaluation of these neurosteroids face challenges in terms of experimental design, dosing strategy, data analysis, and interpretation. The review concludes with a list of suggested topics for future research. This article is part of a Special Issue entitled: Neuroactive Steroids: Focus on Human Brain., (Copyright © 2011. Published by Elsevier Ltd.)

Objectives: L-Theanine (γ-glutamylethylamide) augmentation to antipsychotic therapy ameliorates positive, activation, and anxiety symptoms in schizophrenia and schizoaffective disorder patients. This study examines the association between circulating levels of neurochemical indicators and the beneficial clinical effects of L-theanine augmentation., Methods: Serum levels of neurochemical indicators such as brain-derived neurotrophic factor (BDNF), dehydroepiandrosterone (DHEA), its sulfate (DHEAS), cortisol, cholesterol, and insulin were monitored in 40 schizophrenia and schizoaffective disorder patients during an 8-week, double-blind, randomized, placebo-controlled trial with L-theanine (400 mg/d). Multiple regression analysis was applied for searching association between improvement in symptom scores and changes in circulating levels of neurochemical indicators for an 8-week trial., Results: Regression models among L-theanine-treated patients indicate that circulating levels of BDNF and cortisol-to-DHEAS*100 molar ratio were significantly associated with the beneficial clinical effects of L-theanine augmentation. Variability of serum BDNF levels accounted for 26.2% of the total variance in reduction of dysphoric mood and 38.2% in anxiety scores. In addition, the changes in cortisol-to-DHEAS*100 molar ratio accounted for 30% to 34% of the variance in activation factor and dysphoric mood scores and for 15.9% in anxiety scores. Regression models among placebo-treated patients did not reach significant level., Conclusions: These preliminary results indicate that circulating BDNF and cortisol-to-DHEAS*100 molar ratio may be involved in the beneficial clinical effects of L-theanine as augmentation of antipsychotic therapy in schizophrenia and schizoaffective disorder patients.

Objective: L-theanine is a unique amino acid present almost exclusively in the tea plant. It possesses neuroprotective, mood-enhancing, and relaxation properties. This is a first study designed to evaluate the efficacy and tolerability of L-theanine augmentation of antipsychotic treatment of patients with chronic schizophrenia and schizoaffective disorder., Method: 60 patients with DSM-IV schizophrenia or schizoaffective disorder participated in an 8-week, double-blind, randomized, placebo-controlled study. 400 mg/d of L-theanine was added to ongoing antipsychotic treatment from February 2006 until October 2008. The outcome measures were the Positive and Negative Syndrome Scale (PANSS), the Hamilton Anxiety Rating Scale (HARS), the Cambridge Neuropsychological Test Automated Battery (CANTAB) for neurocognitive functioning, and additional measures of general functioning, side effects, and quality of life., Results: 40 patients completed the study protocol. Compared with placebo, L-theanine augmentation was associated with reduction of anxiety (P = .015; measured by the HARS scale) and positive (P = .009) and general psychopathology (P < .001) scores (measured by the PANSS 3-dimensional model). According to the 5-dimension model of psychopathology, L-theanine produced significant reductions on PANSS positive (P = .004) and activation factor (P = .006) scores compared to placebo. The effect sizes (Cohen d) for these differences ranged from modest to moderate (0.09-0.39). PANSS negative and CANTAB task scores, general functioning, side effect, and quality of life measures were not affected by L-theanine augmentation. L-theanine was found to be a safe and well-tolerated medication., Conclusions: L-theanine augmentation of antipsychotic therapy can ameliorate positive, activation, and anxiety symptoms in schizophrenia and schizoaffective disorder patients. Further long-term studies of L-theanine are needed to substantiate the clinically significant benefits of L-theanine augmentation., (© Copyright 2011 Physicians Postgraduate Press, Inc.)

Objective: Pregnenolone (PREG) and dehydroepiandrosterone (DHEA) are reported to have a modulatory effect on neuronal excitability, synaptic plasticity, and response to stress; they are associated with mood regulation and cognitive performance. We investigated the influence of PREG and DHEA on psychotic symptoms and cognitive functioning as an add-on to ongoing antipsychotic treatment of patients with chronic schizophrenia or schizoaffective disorder., Method: This 8-week, double-blind, randomized, placebo-controlled, 2-center study compared 30 mg/d of PREG (PREG-30), 200 mg/d of PREG (PREG-200), 400 mg/d of DHEA, and placebo as an adjunctive treatment of 58 chronic schizophrenia or schizoaffective disorder patients (DSM-IV). The data were collected from February 2005 until June 2007. The outcome measures were symptomatic and neurocognitive changes, functioning, and tolerability as assessed primarily by the Clinical Global Impressions-Severity of Illness scale and the Positive and Negative Syndrome Scale. Analyses are presented for 44 patients who completed 8 weeks of treatment and for 14 noncompleters., Results: Compared with subjects who received placebo, those administered PREG-30 had significant reductions in positive symptom scores and extrapyramidal side effects (EPS) and improvement in attention and working memory performance, whereas subjects treated with PREG-200 did not differ on outcome variable scores for the study period. The general psychopathology severity and general functioning of patients receiving placebo and PREG-30 improved more than that of those subjects treated with DHEA, while EPS improved more in subjects treated with DHEA than in patients receiving placebo. Negative symptoms and akathisia were not significantly benefited by any treatment. The administration of PREG and DHEA was well tolerated., Conclusions: Low-dose PREG augmentation demonstrated significant amelioration of positive symptoms and EPS and improvement in attention and working memory performance of schizophrenia and schizoaffective disorder patients. Further double-blind controlled studies are needed to investigate the clinical benefit of pregnenolone augmentation., Trial Registration: clinicaltrials.gov Identifier: NCT00174889., (© Copyright 2010 Physicians Postgraduate Press, Inc.)

Neurosteroids, such as pregnenolone (PREG), dehydroepiandrosterone (DHEA), and their sulfates (PREGS and DHEAS) are reported to have a modulatory effect on neuronal excitability and synaptic plasticity. They also have many other functions associated with neuroprotection, response to stress, mood regulation, and cognitive performance. Furthermore, these neurosteroids have been linked to, and their levels are altered in, neuropsychiatric disorders. This review highlights what is currently known about the metabolism and mode of action of PREG and DHEA, as well as about alterations of these neurosteroids in schizophrenia. This review also provides substantial information about clinical trials with DHEA and PREG augmentation with of antipsychotic agents in schizophrenia.

Background: While neurosteroids exert multiple effects in the central nervous system, their associations with neurocognitive deficits in schizophrenia are not yet fully understood. The purpose of this study was to identify the contribution of circulating levels of dehydroepiandrosterone (DHEA), its sulfate (DHEAS), androstenedione, and cortisol to neurocognitive deficits through DHEA administration in schizophrenia., Methods: Data regarding cognitive function, symptom severity, daily doses, side effects of antipsychotic agents and blood levels of DHEA, DHEAS, androstenedione and cortisol were collected among 55 schizophrenia patients in a double-blind, randomized, placebo-controlled, crossover trial with DHEA at three intervals: upon study entry, after 6weeks of DHEA administration (200mg/d), and after 6weeks of a placebo period. Multiple regression analysis was applied for predicting sustained attention, memory, and executive function scores across three examinations controlling for clinical, treatment and background covariates., Results: Findings indicated that circulating DHEAS and androstenedione levels are shown as positive predictors of cognitive functioning, while DHEA level as negative predictor. Overall, blood neurosteroid levels and their molar ratios accounted for 16.5% of the total variance in sustained attention, 8-13% in visual memory tasks, and about 12% in executive functions. In addition, effects of symptoms, illness duration, daily doses of antipsychotic agents, side effects, education, and age of onset accounted for variability in cognitive functioning in schizophrenia., Conclusions: The present study suggests that alterations in circulating levels of neurosteroids and their molar ratios may reflect pathophysiological processes, which, at least partially, underlie cognitive dysfunction in schizophrenia., (Copyright 2009 Elsevier Ltd. All rights reserved.)

S-adenosyl-methionine (SAM-e), functions as a primary methyl group donor for several metabolic compounds. Since SAM-e is involved in several metabolic processes, its administration may have a role in the amelioration of several disorders. In addition, SAM-e increases catechol-O-methyltransferase (COMT) enzyme activity, which may ameliorate aggressive symptoms in certain patients. We have therefore investigated the efficacy of SAM-e in managing schizophrenia symptomatology in patients with the low activity COMT polymorphism. Eighteen patients with chronic schizophrenia were randomly assigned to receive either SAM-e (800 mg) or placebo for 8 weeks in double-blind fashion. Results indicated some reduction in aggressive behavior and improved quality of life following SAM-e administration. Female patients showed improvement of depressive symptoms. Clinical improvement did not correlate with serum SAM-e levels. Two patients receiving SAM-e exhibited some exacerbation of irritability. This preliminary pilot short-term study cautiously supports SAM-e as an adjunct in management of aggressive behavior and quality of life impairment in schizophrenia.

Objective: Two questions were addressed in the present report: whether cognitive improvement would occur during 12-month ziprasidone treatment and whether the changes in cognitive functioning are dependent of changes in the illness-related variables., Methods: Seventy schizophrenia patients with persistent symptoms or troublesome side effects were assigned to a 12-month, open-label, flexible-dosage (40-160 mg/d) trial. Outcome measures were taken at baseline, 6, and 12 months and included the Mindstreams Computerized Cognitive Battery, the Wisconsin Card Sorting Test, the Clinical Global Impression Scale, the Positive and Negative Syndrome Scale, and the Extrapyramidal Symptom Rating Scale., Results: Baseline performance was impaired across all cognitive tasks on average without significant differences between 32 completers and 38 discontinued patients. At the end of the study, significant improvement in performance of executive functions, attention, and information processing domains among ziprasidone-completed patients was observed. The effect sizes for these changes were moderate (0.61). Improvement in the executive performances was associated with a reduction in the severity of positive, activation, and dysphoric mood symptoms but was unrelated to the ziprasidone daily dose, Clinical Global Impression Scale and Extrapyramidal Symptom Rating Scale scores, and concomitantly prescribed antidepressants, anxiolytics, mood stabilizers, or antiparkinson drugs., Conclusions: Ziprasidone had a long-term neurocognitive effect among patients with chronic schizophrenia undergoing the usual care. This effect tended to increase over time and was associated, at least partly, with changes in symptoms, but not with changes in the severity of illness, side effects, the ziprasidone daily dose, and concomitant medicines.

Objectives: Bexarotene is a synthetic retinoid used for treatment of neoplastic or dermatologic disorders. Based on the retinoid dysregulation hypothesis, it was hypothesized that bexarotene augmentation would have a beneficial effect in the antipsychotic treatment of schizophrenia patients. This study is the first to investigate the safety and efficacy of add-on oral bexarotene to ongoing antipsychotic treatment in chronic schizophrenia patients who were stabilized on regular antipsychotic treatment., Methods: A 6-week open label trial was conducted in 2 mental health centers from October 2005 to October 2006. Twenty-five patients with chronic schizophrenia received a low dose of bexarotene (75 mg/d) augmentation. Mental condition and laboratory tests were assessed at baseline and after weeks 2, 4, and 6 of the study. The primary outcome measure was change from baseline in 4 symptom scales: the Positive and Negative Symptom Scale, Extrapyramidal Symptom Rating Scale, Abnormal Involuntary Movement Scale, and Barnes Akathisia Scale. Blood cell count, liver and thyroid functions, cholesterol, and triglyceride rates were followed., Results: Significant improvement from baseline to endpoint was observed on total Positive and Negative Symptom Scale score (P = 0.022), general psychopathology (P = 0.024), positive (P = 0.012), and the dysphoric mood (P = 0.028) factor scores. Furthermore, a trend to a diminishing Extrapyramidal Symptom Rating Scale score (P = 0.053) was found. Bexarotene was found to be a safe medication as measured by all laboratory parameters with the exception of increased total cholesterol serum level., Conclusions: This short-term pilot study supports bexarotene as a potential valuable adjunct in management of schizophrenia. Low doses of bexarotene were well tolerated. A double-blind controlled study should be performed to replicate these preliminary positive results.

There is some evidence that emotional reactivity to daily life stress is related to a genetic or familial liability to develop schizophrenia. However, it is unclear whether the emotional distress is elevated in schizophrenia patients with positive compared to negative family history. The aim of the study was to test the hypothesis that a persistent higher level of emotional distress in schizophrenia subjects is associated with a positive family history of schizophrenia. This study used the Talbieh Brief Distress Inventory (TBDI), the Positive and Negative Syndrome Scale (PANSS; including dysphoric mood, positive and negative subscales), Montgomery-Asberg Depression Rating Scale (MADRS), and the Distress Scale for Adverse Symptoms (DSAS) to investigate the difference in the magnitude of emotional distress scores between schizophrenia subjects with and without a positive family history of schizophrenia over time. Data were recorded for 69 multiplex family and 79 singleton patients at admission and about 16 months thereafter. No between-group differences were obtained in PANSS and DSAS scores. With regard to the TBDI: (a) both group of patients had no significant differences in emotional distress scores at admission; (b) patients with negative family history reported improvement in distress severity and depression severity (MADRS) 16 months after admission, while those with positive family history experienced persistent elevated emotional distress, mainly, on obsessiveness, and depression subscales; and (c) both groups of patients are characterized by elevated emotional distress at follow-up examination compared to healthy subjects. Thus, it appears that there is a strong association between positive family history and persistent elevated emotional distress. Because patients with positive and negative family history are likely to differ in genetic risk, our results suggest that long-term elevated levels of emotional distress may be related to a familial (environmental)/genetic vulnerability to schizophrenia.

Objective: Health related quality of life (HRQL) has become an important outcome measure in the treatment of psychiatric disorders. This long-term observational study examined ziprasidone-induced improvement in satisfaction with HRQL in schizophrenia patients treated under real-world conditions., Method: Seventy schizophrenia patients with persistent symptoms or troublesome side effects were assigned to a 12-month, open-label, flexible-dose (40-160 mg/d), large-scale, naturalistic trial. Outcome measures were taken at baseline, 6, and 12 months, and included the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q), severity of symptoms, distress, and side effects., Results: Thirty-two patients fully completed the study protocol. Patients reported poorer general HRQL compared with healthy subjects. At the end of the study, significant improvement in general activity, and satisfaction with life was observed. The effect sizes for these changes were moderate (0.55, and 0.72, respectively). After Bonferroni correction for multiple comparisons improvement in satisfaction with general activity remained significant. No significant changes were noted in other Q-LES-Q dimensions. Improvement in general activity was associated with a reduction in the severity of symptoms and emotional distress, but was unrelated to the ziprasidone daily dose, side effect scores, and concomitantly prescribed antidepressants, anxiolytics, mood stabilizers, or antiparkinson drugs., Conclusion: This study indicates that ziprasidone treatment resulted in the improvement of the satisfaction with general activity that tended to increase over time, from month 6 onwards. This effect was associated with reduction in the severity of clinical symptoms, and emotional distress.

Objective: This is a first report from a long-term study aimed to evaluate efficacy, safety, tolerability, cognitive functioning, and quality of life outcomes during ziprasidone treatment of chronic schizophrenia patients in the "real-world"., Method: Seventy clinically unstable schizophrenia patients with persistent symptoms or troublesome side effects were assigned to a 12-month, open-label, flexible-dose (40-160 mg/day), large-scale, naturalistic trial. Outcome measures were taken at baseline, 6, and 12 months, and included the Positive and Negative Syndrome Scale (PANSS), the Clinical Global Impression (CGI-S) scale, the Global Assessment of Functioning Scale (GAF) scores, treatment-emergent adverse events, body weight, and drug attitude., Results: Thirty-two patients fully completed the study protocol. A discontinuation of treatment for any cause occurred in 54.3% of patients; the mean time until discontinuation was 4.4 +/- 2.7 months. A discontinuation due to lack of clinical efficacy was more predominantly linked to patient perception (25.7%) than to physicians' conclusions alone (8.6%), adverse events (11.4%), and other reasons (8.6%). After controlling daily dose of ziprasidone, concomitant medications and sex, ANCOVA revealed improvement in PANSS factors, and global functioning among patients who had completed the study. Improvement in PANSS and GAF dimensions was evident at a 6-month visit, and it continued until the endpoint. When a cutoff of 20% improvement of PANSS total scores was used, the response rate among completers was 43.8%. Most common side effects were: fatigue, sleep disturbances, and headache. Ziprasidone did not appear to be linked to weight gain., Conclusion: This study suggests that ziprasidone may be beneficial for long-term treatment of schizophrenia patients in terms of severity of symptoms, and general functioning. Ziprasidone is well tolerated during the long-term treatment of chronic schizophrenia patients undergoing usual care.

Background: The aim of this study was to see whether and how cognition deficit predicts quality of life impairments in schizophrenia patients., Method: The Computerized Cambridge Automated Neuropsychological Test Battery, the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q) and the Quality of Life Scale (QLS) were used to assess 62 patients with chronic schizophrenia. Step-wise multiple regression analysis was used in order to determine cognitive variables that would predict the scores of each Q-LES-Q and QLS domain scores., Results: Regression analysis revealed a significant association of the cognitive deficits with both general and domain-specific quality of life impairment measured with Q-LES-Q and QLS. Deficits in executive functions, visual sustained attention, memory and motor skills have been found to be valid predictors both before and after controlling for the severity of symptoms, emotional distress, side effects, age, education, and illness duration., Conclusions: This study suggests that deficits in executive functioning, attention, memory and motor skills substantially contributes to predicting impairments across a wide range of HRQL domains, and, consequently, to quality of life appraisal in schizophrenia. Cognitive predictors cannot be attributed to illness-related and background variables. It can be concluded that, when aiming at the improvement of quality of life in schizophrenia patients, cognitive functioning should be targeted.

This study examines the contribution of various neurocognitive functions, clinical characteristics, and personality traits to the prediction of three insight dimensions. Clinically stable schizophrenia patients (n=107) residing in the community were evaluated using the Positive and Negative Syndrome Scale, the Scale for the Assessment of Unawareness of Mental Disorder, and a comprehensive battery of instruments to measure personality related variables and neurocognitive functioning. Step-wise multivariate regression analysis indicates significant association of variability in insight dimensions with neurocognitive functioning (20-41%), personality related traits (8-18% temperament factors, 4-7% self-constructs, 10-14% coping styles), severity of symptoms (about 7%), illness duration (6%), and education (about 5%). Poor insight was attributed to impairment in visual and movement skills, sustained attention, executive functions, intensity of autistic preoccupations and positive symptoms, as well as increased novelty seeking behavior, task and emotion oriented coping styles, better self-esteem, self-efficacy, and higher education. Better awareness was related to better performance of neurocognitive tasks, reward dependence behavior, avoidant coping style, and longer illness duration. Aside from common indicators for the various insight dimensions, we defined specific indicators for each insight dimension. Thus, insight dimensions in schizophrenia patients residing in the community were attributed to neurocognitive and personality related factors rather than to psychopathological symptoms. The findings enable better understanding of the multifactorial nature of insight and highlight targets for more effective intervention and rehabilitation.

Objective: This study examined specific predictors of the efficacy of risperidone (RP), olanzapine (OL) and first-generation antipsychotic agents (FGAs), the role of confounding factors, and concomitant agents such as antidepressants, anxiolytics, and mood stabilizers in the treatment of health related quality of life (HRQL) impairment of schizophrenia patients., Method: This was a community-based, open label, parallel group naturalistic study of 124 schizophrenia outpatients who received either RP, OL, FGA, or combined agents (CA). Evaluations were performed at baseline and 12 months later. They included the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q), the Positive and Negative Syndrome Scale (PANSS), the Distress Scale for Adverse Symptoms, and inventories for the assessment of distress severity, subjective tolerability, and self-efficacy., Results: OL was found to be superior to RP, FGAs and CA in terms of quality of life. FGAs revealed greater therapeutic benefit than RP, which was more beneficial than combined therapy. Improvement in Q-LES-Q was revealed in patients who received antidepressants and anxiolytics, but not mood stabilizers, or anti-Parkinson drugs. This effect was independent of treatment groups and gender. Regression models revealed that changes in emotional distress and side effects were common predictors for HRQL changes across treatment groups. Specific predictors of HRQL efficacy included self-efficacy for OL, negative and positive symptoms for RP, dysphoric mood and positive symptoms, daily doses and self-efficacy for FGA treated patients., Conclusion: These findings suggest that OL is beneficial in the treatment of HRQL impairment in schizophrenia compared with RP, FGAs and CA. Special attention should be paid to specific predictors of HRQL efficacy for each antipsychotic agent, and to concomitant treatment with antidepressants and anxiolytics.

This study aimed to identify coping patterns used by schizophrenia inpatients in comparison with those used by healthy individuals, and to explore their association with selected clinical and psychosocial variables. The Coping Inventory for Stressful Situations (CISS) was used to assess coping strategies among 237 inpatients who met DSM-IV criteria for schizophrenia and 175 healthy individuals. Severity of psychopathology and distress, insight into illness, feelings of self-efficacy and self-esteem (self-construct variables), social support, and quality of life were also examined. Factor analysis, analysis of covariance and correlations were used to examine the relationships between the parameters of interest. Using dimensional measures, we found that emotion-oriented coping style and emotional distress were significantly higher in the schizophrenia group, whereas the task-oriented coping style, self-efficacy, perceived social support and satisfaction with quality of life were lower compared with controls. When eight CISS coping patterns were defined, the results revealed that patients used emotion coping patterns 5.5 times more frequently, and task and task-avoidance coping patterns significantly less often than healthy subjects. Coping patterns have different associations with current levels of dysphoric mood and emotional distress, self-construct variables, and satisfaction with quality of life. Thus, the identified coping patterns may be an additional useful presentation of the diversity of coping strategies used by schizophrenia patients. Coping patterns may be considered an important source of knowledge for patients who struggle with the illness and for mental health professionals who work with schizophrenia patients.

Background: Dehydroepiandrosterone (DHEA) augmentation has been reported, in a preliminary fashion, to be useful in the management of schizophrenia symptoms and side effects. In this study, the intention was to investigate the efficacy and safety of DHEA administration to ongoing antipsychotic medication in a multicenter, 12-week, double-blind, randomized, placebo-controlled, crossover trial., Methods: Fifty-five of 62 inpatients and outpatients with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, diagnosis of schizophrenia completed the trial. Patients were randomly allocated to 2 treatment groups receiving either DHEA (200 mg/d) or placebo for 6 weeks with the crossover between DHEA and placebo occurring after 6 weeks. Patients continued to receive their regular antipsychotic medication for the duration of the study., Results: Compared with placebo, DHEA administration did not produce significant improvement in clinical symptoms, side effects, and quality-of-life scores. However, 6 weeks of DHEA administration (but not placebo) was associated with a significant improvement in Positive and Negative Symptom Scale ratings compared with baseline. Furthermore, 6 weeks of DHEA treatment was associated with significant improvement in cognitive functions of visual sustained attention and visual and movement skills compared with placebo conditions. The DHEA augmentation was associated with elevations of serum concentrations of both DHEA and its sulfate ester. The DHEA treatment was well tolerated without any serious adverse effects., Conclusion: This short-term study does not support DHEA's value as an effective adjunct in the treatment of symptoms, side effects, and quality-of-life impairment in schizophrenia, while suggesting that DHEA improves sustained attention and visual and movement skills. A long-term, large-scale study with a broader dose range is warranted to further investigate DHEA's role in the management of schizophrenia.

This prospective study aimed to define the long-term changes in coping strategies used by schizophrenia patients and their relation to clinical and psychosocial factors. The Coping Inventory for Stressful Situations, psychiatric scales, and self-report questionnaires were administered to 148 schizophrenia patients at admission and 16 months thereafter. Based on trends of individual coping patterns to show change over time, four temporal coping types were distinguished: stable favorable and unfavorable, and becoming favorable and unfavorable. We found that coping patterns of 62.2% of patients remained stable over time, became unfavorable among 19.6% of patients, and became favorable among 18.2% of patients. Each temporal coping type is associated with a specific pattern of changes in clinical and psychosocial variables. The findings underscore the clinical relevance of temporal coping types and corroborate the appropriateness of focusing on aspects of coping behavior in treatment and rehabilitation of schizophrenia patients.

Background: The Mindstreams Computerized Cognitive Test Battery (Mindstreams) is a standardized computer-based battery that was designed for widespread clinical and research use. The capability of Mindstreams to test cognitive impairment in schizophrenia has yet to be evaluated. The aim of the present study was to determine the ability of Mindstreams in detecting cognitive dysfunction in schizophrenia patients and to compare it to the Cambridge Neuropsychological Test Automated Battery (CANTAB)., Method: Fifty-five schizophrenia patients and 63 healthy subjects were enrolled in the study. The Positive and Negative Syndrome Scale (PANSS) was used to quantify symptom severity. Neurocognitive functions were assessed using Mindstreams and CANTAB., Results: The schizophrenia patients scored significantly more poorly than healthy subjects on all tests comprising the Mindstreams battery. Comparable tasks of the Mindstreams and CANTAB batteries significantly correlated on raw scores and the standardized cognitive indices. The Mindstreams executive function tasks had significant correlations with the PANSS negative, autistic preoccupation and activation cluster scores, and with global functioning. Two-week test-retest reliability correlations were all significant (N=17, p<0.05-p<0.001)., Conclusions: This study indicates that Mindstreams is reliable in assessing the cognitive function of patients with schizophrenia and may play a role in standardizing the cognitive assessment of these patients in clinical and research settings.

Loneliness has been recognized as a public health problem that requires the attention of clinicians and researchers both as a condition in itself and in its relation to other conditions. This study sought to examine the relationship between self-reported loneliness, psychological distress, and social support among immigrants. A community survey of 386 recent immigrants to Israel from the former Soviet Union was conducted using the Revised UCLA Loneliness Scale (R-UCLA-LS), Talbieh Brief Distress Inventory (TBDI), and Multidimensional Scale of Perceived Social Support (MSPSS). A cross-sectional design, and correlation and factor analyses were used to study the relationship between the studied variables. The distress-related and distress-free patterns of loneliness were distinguished as independent constructs, each with a specific sphere of influence. Distress-related loneliness accounted for 56.3% and distress-free for 18.2% of the total variance in individual loneliness scores. Distress-related loneliness is a generalized negative experience embedded in an array of distress symptoms, while distress-free loneliness appears to be a normal psychological reaction to dissatisfaction with current friend support. An important implication of this study in mental health practice is the sensitivity to these differences when treating recent immigrants.

The phospholipid composition of red blood cells (RBC) from 32 haloperidol-treated schizophrenic patients, classified according to the positive and negative syndrome scale (PANSS) as showing either predominantly positive or predominantly negative symptoms, was determined and compared with that of normal controls. While the levels of phosphatidylcholine and phosphatidylserine were similar in all three groups, sphingomyelin (SM) and phosphatidylethanolamine (PE) were, respectively, increased and decreased in RBCs of schizophrenic patients. In both patient groups, the SM/PE ratios correlated directly with the PANSS negative symptom scale scores and inversely with the positive symptom scale scores. However, the inverse changes in the contents of SM and PE were much more expressed in the negative group. It is suggested that a main source of that difference is a higher activity of the polyunsaturated acid-selective phospholipase A(2) in the negative syndrome patients than in the positive syndrome and control groups.

This paper reports results of a national community survey of self-reported suicide ideation and attempts and their relation to psychological distress, depression, social support, and adjustment difficulties in a sample of recent immigrants from the former Soviet Union (FSU) to Israel. Using a door-to-door sampling procedure, a sample of 788 Russian-born Jewish immigrants, ages 18-74 years, was selected to match the age and sex structure of the total immigrant population. An indigenous sample of Jews in Russia (n = 411) was matched with the immigrants for comparison. Parameters of interest were measured with the Demographic Inventory, Talbieh Brief Distress Inventory, Beck Depression Inventory, and Multidimensional Scale of Perceived Social Support. The 1-month prevalence rate of suicide ideation in the immigrant sample (15.1%) was found to be significantly higher than that in Russian controls (6.6%). A total of 5.5% of immigrants but only 0.5% of controls had made a suicide attempt at some time in their lives. Risk factors for suicide ideation included younger age, living without a spouse, low level of social support, being a physician or teacher, a history of immigration from the Baltic countries or Moscow, or duration of stay in Israel from 2 to 3 years. The strongest risk factors were higher level of psychological distress and symptoms such as depression, hostility, and paranoid ideation. These findings can be used as a point of departure for the development of community-based suicide prevention programs for recent immigrants.

Objective: A community survey was conducted to examine suicidal ideation and suicide attempts, behavior problems, psychological distress, social support, and adjustment difficulties in a sample of adolescents., Method: Four hundred six Russian-born Jewish immigrants to Israel, aged 11 to 18 years, were selected to match the age and sex distribution of the total immigrant adolescent population. Two indigenous samples of Jewish adolescents in Russia (n = 203) and in Israel (n = 104) were matched with immigrants for comparison. Parameters of interest were measured with self-administered questionnaires., Results: The 6-month prevalence rate of suicidal ideation in the immigrant sample (10.9%) was significantly higher than that for Russian controls (3.5%) but not for Israeli natives (8.7%). There were few gender differences in suicidal ideation and suicide attempts. Older adolescents reported suicidal ideation 2 times more frequently than their younger counterparts. Suicide ideators scored significantly higher than nonideators on all scales of psychological distress and behavior problems. They rated higher sources of immigration difficulties concerning language, physical health, personality characteristics, and family problems but had less socioeconomic and intercultural problems of migration and lower social support from the family but not from other sources., Conclusions: Results clearly support the migration-convergence hypothesis of suicide risk among adolescents.

The ascertainment of probands according to place of residence in hospitals or in the community has enabled our sampling to be representative of whole subpopulations of patients. Probands from psychiatric hospitals are characterized by biased clinical parameters. Our sampling procedure provides important preliminary results which appear to be contradictory to those produced by conventional sampling methods.

The contribution of genetic, constitutional and environmental factors to the clinical polymorphism of schizophrenia was analysed. A sample from 353 pedigrees of the patients suffering from the manifest forms of schizophrenia which inhabited five districts of Tomsk region was studied using multifactorial threshold and single locus diallele models. It is established that the severity of the psychosis is mainly determined by autosomal genetic factors, the proportion of the affective disorders being specified by gonosomal factors. The type of the course of schizophrenia is closely connected with the patients' somatotype. Common environmental influences and peculiarities of personality before onset are linked with no characteristics of the clinical polymorphism studied.

Analysis of the character of the linear relation between the totality and some factors (the number of beds, psychiatrists working at hospitals and on an outpatient basis) that characterize the psychiatric services in 18 regions of Siberia and the Far East over 16 years as well as between the identification of new cases of schizophrenia, epilepsy, alcoholism, neuroses, psychoses and oligophrenia has demonstrated a high efficacy of the totality of factors. The differences have been shown between the regions in respect to the relation of the factors to the disease incidence, explained by the authors by the specificity of the organizational structure of the psychiatric services and by a number of other factors.

The author conducted a study of the tyrosine balance and the urine excretion of its metabolites: paraoxyphenylpyruvic and homogentistic acid in 39 oligophrenic patients of a nontypical and of 90 with an exogenous genesis. In exogenic forms of oligophrenia the oxidation of tyrosine was characterized by hypertyrosinemia, hypertyrosinuria, a drop of paraoxyphenylpyruvic acid excretion. In genotypical oligophrenia the most typical were high indices of tyrosinemia, tyrosinuria, excretion of paraphenylpyruvic acid and homogentistic acid.

Complex genetic-mathematical analysis (component decomposition of the phenotype variance, segregation analysis, estimation of penetrance parameters) of 324 probands' families with neurologic manifestation of spinal osteochondrosis (3437 relatives of I-III degree) has been carried out is shown that the structure of liability to the disease studied is better approximated by semi-continuous phenotype model within the limits of which contribution of genetic factors reaches 80% (63-66% owing to autosomes and 14-17% owing to gonosomes) under considerable influence (20%) of environmental force (14% accidental and 6% systematic).