OBJECTIVES: Thyroid hormone deficiency during the neurodevelopmental period can impair brain development and induce psychiatric symptoms. This study examined the association between thyroid dysfunction and the severity of symptoms in schizophrenia patients, and the treatment response of patients with schizophrenia. METHODS: Three hundred thirty-eight schizophrenia patients, with no prior history of thyroid disease or taking medication associated with it, were studied. We assessed the blood thyroid hormone level, the Brief Psychiatric Rating Scale (BPRS) scores on the day of admission and discharge, admission period, dose of administered antipsychotics, and the number of antipsychotic combinations. The collected data were subsequently analyzed using the Kruskal-Wallis test and Pearson's chi-square test. RESULTS: The percentage of schizophrenia patients who presented with abnormal thyroid hormone level was 24.6%. High total triiodothyronine (TT3) (p = 0.003), low TT3 (p = 0.001), and high free thyroxine (fT4) (p < 0.001) groups showed a higher BPRS score on admission than did the normal thyroid hormone group, while thyroid stimulating hormone (TSH) levels were not significantly correlated with the severity of symptoms. Furthermore, thyroid hormone was not associated with the treatment response assessed by the rate of BPRS score reduction, admission days, use of clozapine, and dose of antipsychotics. CONCLUSIONS: The TT3 and fT4 hormone levels were significantly associated with the severity of symptoms in schizophrenia patients. These relations suggested that thyroid dysfunction may be associated with the severity of schizophrenia. And hence, further analysis of the results of the thyroid function test, which is commonly used in cases of psychiatric admission, is required.
Antipsychotic Agents ; Brain ; Brief Psychiatric Rating Scale ; Clozapine ; Humans ; Inpatients ; Schizophrenia ; Thyroid Diseases ; Thyroid Function Tests ; Thyroid Gland ; Thyroid Hormones ; Thyrotropin ; Thyroxine ; Triiodothyronine

OBJECTIVE: This study was performed to investigate the efficacy and tolerability of blonanserin in schizophrenic patients who were previously treated with other antipsychotics but, due to insufficient response, were switched to blonanserin. METHODS: A total of 52 patients with schizophrenia who were unresponsive to treatment with antipsychotic monotherapy or combination therapy were recruited into this 12-week, open-label, prospective, multicenter study. Patients were switched to blonanserin from their existing antipsychotics over a maximum 2-week tapering-off period. Efficacy was primarily evaluated using the 18-item Brief Psychiatric Rating Scale (BPRS). Assessments were performed at baseline, and at weeks 1, 2, 4, 8, and 12. RESULTS: Switching to blonanserin resulted in a significant decrease in the mean total score on the BPRS from baseline (56.8 ± 9.4) to week 12 (42.1 ± 13.8, p < 0.001). The most common adverse events were extrapyramidal symptoms (n = 12, 23.1%), insomnia (n = 10, 19.2%), and emotional arousal (n = 6, 11.5%). Overweight or obese patients (body mass index ≥ 23 kg/m2, n = 33) who switched to blonanserin exhibited significant weight loss from 75.2 ± 9.3 kg at baseline to 73.5 ± 9.2 kg at week 12 (p = 0.006). The total cholesterol (baseline, 236.1 ± 47.6 mg/dl; endpoint [week 12], 209.9 ± 28.0 mg/dl; p = 0.005) and prolactin levels (baseline, 80.0 ± 85.2 ng/ml; endpoint [week 12], 63.2 ± 88.9 ng/ml; p = 0.003) were also significantly improved in patients with hypercholesterolemia or hyperprolactinemia. CONCLUSION: The results of the present study suggest that switching to blonanserin may be an effective strategy for schizophrenic patients unresponsive to other antipsychotic treatments.
Antipsychotic Agents ; Arousal ; Body Weight ; Brief Psychiatric Rating Scale ; Cholesterol ; Humans ; Hypercholesterolemia ; Hyperprolactinemia ; Overweight ; Prolactin ; Prospective Studies ; Schizophrenia ; Sleep Initiation and Maintenance Disorders ; Treatment Outcome ; Weight Loss

OBJECTIVES: This study examined the functional disabilities of patients with chronic schizophrenia using WHO Disability Assessment Schedule 2.0 (WHODAS 2.0) and its related factors. METHODS: The subjects consisted of 86 patients with schizophrenia with more than 10 years' duration of illness and 40 healthy volunteers. The functional disabilities and psychopathology were evaluated using the WHODAS 2.0 and 18-items Brief Psychiatric Rating Scale (BPRS-18), respectively. This study analyzed the six sub-domains ('cognition', 'mobility', 'self-care', 'getting along', 'life activities', and 'participation') of WHODAS 2.0 and the four sub-scales ('positive symptoms', 'negative symptoms', 'affect', and 'resistance') of BPRS-18. RESULTS: Patients with chronic schizophrenia experienced severe functional disabilities across all six sub-domains of WHODAS 2.0 compared to healthy people. Hierarchical regression showed that 'negative symptoms' explained the disabilities in the WHODAS 2.0 sub-domains of 'cognition' (p<0.05), 'self-care' (p<0.05), 'getting along' (p<0.01), and 'life activities' (p<0.05). 'Positive symptoms' and 'affect' explained the disabilities in 'cognition' (p<0.01 and p<0.05, respectively) and 'participation' (p<0.05 and p<0.01, respectively). 'Resistance' was found to be a predictor of 'getting along' disabilities (p<0.01). CONCLUSION: Negative symptoms mainly accounted for the multiple domains of functional disabilities in the WHODAS 2.0 but residual positive and affective symptoms could also deteriorate the cognition and social participation of patients with chronic schizophrenia.
Affective Symptoms ; Appointments and Schedules ; Brief Psychiatric Rating Scale ; Cognition ; Disability Evaluation ; Global Health ; Healthy Volunteers ; Humans ; Psychopathology ; Schizophrenia ; Social Participation ; World Health Organization

OBJECTIVES: This study examined the admission type and its related factors among patients with psychotic disorders defined based on the revised mental health welfare law. METHODS: This study was conducted on a total of 100 patients diagnosed on the schizophrenia spectrum and other psychotic disorders. The admission type and sociodemographic characteristics were examined. Social support, psychopathology, excitement, insight, and social functioning were evaluated using the Social Support Scale, Positive and Negative Syndrome Scale (PANSS), PANSS excitement component, Brief Psychiatric Rating Scale, Global Assessment Functioning Scale, Strauss-Carpenter scale, Korean version of the Scale to Assess Unawareness of Mental Disorder, and Korean version of Beck Cognitive Insight Scale. RESULTS: The severity of psychotic symptoms, excitement, social functioning, and insight were significantly different between involuntary and voluntary admissions (p<0.05). Excitement and insight were found to be factors affecting the admission type (p<0.05). CONCLUSION: Excitement and insight were factors mainly accounting for the admission type in patients with psychotic disorder. This study could be helpful in improving clinical decision-making and community mental health care.
Brief Psychiatric Rating Scale ; Clinical Decision-Making ; Humans ; Jurisprudence ; Mental Disorders ; Mental Health ; Patient Admission ; Psychopathology ; Psychotic Disorders ; Schizophrenia Spectrum and Other Psychotic Disorders ; Schizophrenia

OBJECTIVE: Schizophrenia (SZ) has been associated with the inflammatory-related and immunological pathogenesis. This study investigates the aberration of cytokines in patients with SZ. METHODS: Thirty patients with SZ without antipsychotic treatment for at least two weeks participated. We measured the serum levels of fourteen cytokines at hospital admission and after 8-week antipsychotic treatment. Severity was measured by expanded version of 24-items brief psychiatric rating scale (BPRS-E). Repeated measure analyses of variance were conducted. RESULTS: The interleukin-1 receptor antagonist (IL-1ra) was significantly decreased after 8-week antipsychotic treatment than those of before antipsychotic treatment (F=12.15, df=1/30, p=0.002). Neural cell adhesion molecule 1/CD56 (NCAM-1/CD56) was significantly decreased (F=6.61, df=1/30, p=0.016) among those with second-generation antipsychotics but not first-generation antipsychotics treatment. The changes of BPRS-E-manic and BPRS-E-anxiety scores correlated with the baseline IL-1ra (r=-0.393), IL-6 (r=-0.407), and insulin like growth factor binding protein 3 (r=-0.446). Additionally, the changes of BPRS-E and BPRS-E-negative scores correlated with the changes of brain-derived neurotrophic factor (r=0.372) and interferon-gamma (r=0.375). CONCLUSION: Our study supports that IL-1ra and NCAM-1/CD56 may be considered as markers of developing SZ.
Antipsychotic Agents ; Brain-Derived Neurotrophic Factor ; Brief Psychiatric Rating Scale ; Carrier Proteins ; Cytokines ; Humans ; Insulin ; Interferon-gamma ; Interleukin 1 Receptor Antagonist Protein* ; Interleukin-1 ; Interleukin-6 ; Neural Cell Adhesion Molecules ; Schizophrenia*

OBJECTIVES: The aim of this study was to evaluate the psychopathological features such as depression and anxiety in schizophrenics with obsessive-compulsive symptoms (OCS) as well as the severity of OCS according to duration of schizophrenia. METHODS: We randomly selected sixty four inpatients with schizophrenia. We classified the patients into two groups (OCS group, non-OCS group) according to the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). Clinical and demographic features were evaluated. To assess OCS, Y-BOCS were performed. The Korean version of the Positive and Negative Syndrome Scale(K-PANSS), the Brief Psychiatric Rating Scale (BPRS), the Korean version of the Calgary Depression Scale for Schizophrenia (K-CDSS), the Beck Anxiety Inventory (BAI) and the Satisfaction With Life Scale (SWLS) were conducted. Independent t-test and chi-square test were conducted to compare the two groups. Pearson correlation analysis was performed to examine the relationship between the duration of schizophrenia and the Y-BOCS score. RESULTS: The Y-BOCS, K-CDSS, and BAI scores were higher in the OCS group. There was a significant correlation between the duration of schizophrenia and the Y-BOCS score. CONCLUSIONS: Anxiety and depression symptoms were severe in the OCS group. In addition, the results of this study indicate that the longer duration of schizophrenia, the more severe the OCS. Therefore, the evaluation of OCS in schizophrenics should be accompanied by treatment intervention.
Anxiety ; Brief Psychiatric Rating Scale ; Depression ; Humans ; Inpatients ; Schizophrenia*

OBJECTIVES: Patient insight is a very important factor in the management of schizophrenia. Manic symptoms can occasionally be identified by the patient, even in cases of schizophrenia. The aim of this study is to examine the relationship among patient insight, the psychotic and manic symptoms, and the demographic clinical variables.METHODS: Seventy-four participants (male 44, female 30) with chronic schizophrenia in community mental health facilities were evaluated according to the Korean version of the Scale to assess Unawareness of Mental Disorder (SUMD-K), the Korean version of Mood Disorder Questionnaire (K-MDQ), and the Brief Psychiatric Rating Scale (BPRS).RESULTS: The mean number of previous admissions was 3.85. The mean CGI-S score was 3.8 and a significant negative correlation (r=0.26) was shown with “awareness of mental disorder”. Thirty-five percent of subjects were K-MDQ positive (cutoff point=7 or more). Among the SUMD-K, “awareness of effect of medication” showed a significant negative correlation (r=−0.33) with the total K-MDQ score, but not with the total BPRS score. The negative correlation was more obvious in participants with negative K-MDQ (total K-MDQ score 6 or less, r=−0.31).CONCLUSION: A possible relationship was observed between these manic symptoms and patient insight. Identification of manic symptoms in schizophrenia would be considerable in a clinical setting.
Brief Psychiatric Rating Scale ; Female ; Humans ; Mental Disorders ; Mental Health ; Mood Disorders ; Schizophrenia

OBJECTIVE: The aim of this study was to validate the psychotic depression assessment scale (PDAS), which includes the six-item melancholia subscale from the Hamilton depression rating scale (HAMD-6) and the five-item psychosis subscale from the brief psychiatric rating scale (BPRS-5). Data from the Clinical Research Center for Depression (CRESCEND) study, which is a 52-week naturalistic trial, were analyzed. METHODS: Fifty-two patients with psychotic depression from the CRESCEND study met our inclusion criteria. The patients underwent the following psychometric assessments: the PDAS, including HAMD-6 and BPRS-5, the clinical global impression scales, the HAMD, the positive symptom subscale, and the negative symptom subscale. Assessments were performed at the baseline and then at weeks 1, 2, 4, 8, 12, 24, and 52. Spearman correlation analyses were used to assess the clinical validity and responsiveness of the PDAS. RESULTS: The clinical validity and responsiveness of the PDAS, including HAMD-6 and BPRS-5, were acceptable, with the exception of the clinical responsiveness of the PDAS for positive symptoms and the clinical responsiveness of BPRS-5 for negative symptoms. CONCLUSION: The clinical relevance of the PDAS has been confirmed and this clinical validation will enhance its clinical utility and availability.
Brief Psychiatric Rating Scale ; Depression* ; Depressive Disorder ; Humans ; Psychometrics ; Psychotic Disorders ; Weights and Measures

OBJECTIVE: Clinical Assessment Interview for Negative Symptoms (CAINS) has recently been developed to improve measurement of negative symptoms in schizophrenia. We performed a multi-center study to validate the Korean version of the CAINS (CAINS-K) and explore potential cultural variation. METHODS: One hundred eighty schizophrenia patients diverse in demographic and illness profile were recruited from four centers in Korea. Along with the CAINS-K, the Scale for the Assessment of Negative Symptoms (SANS), Brief Psychiatric Rating Scale (BPRS), Calgary Depression Scale for Schizophrenia (CDSS), a self-report measure of behavioral inhibition and activation (BIS/BAS) and neurocognitive tasks were administered to verify external validities. RESULTS: The CAINS-K showed high internal-consistency (0.92) and inter-rater reliability (0.77). Exploratory Factor Analysis replicated a two-factor structure of the original scale including motivation/pleasure and expression deficits dimensions. Korean patients tended to report lower pleasure compared to American patients in the prior study. The CAINS-K showed an adequate convergent validity with the SANS, negative symptoms of the BPRS, and BAS. A divergent validity was supported as the CAINS-K showed zero or only weak correlations with other symptoms of the BPRS, depression from the CDSS, and neurocognitive tasks. CONCLUSION: The CAINS-K demonstrated high internal consistency and adequate external validities, and is expected to promote studies on negative symptoms in Korean patients with schizophrenia.
Brief Psychiatric Rating Scale ; Depression ; Humans ; Korea ; Pleasure ; Schizophrenia

OBJECTIVE: Our pilot study aims to investigate the efficacy of a Short-Term (4 weeks) Psychiatric Rehabilitation Program (S-T PsyRP), without specific cognitive remediation trainings, on the neuropsychological performance and psychosocial functioning of inpatients with Major Depressive Disorder (MDD) or Bipolar Disorder (BD). Published studies with similar aims are lacking. METHODS: Fifty-three inpatients with MDD and 27 with BD (type I/II) were included. The S-T PsyRP was usually performed as clinical practice at Villa San Benedetto Menni Hospital and included a variety of activities aimed at promoting personal autonomies, interpersonal/social skills, and self-care. At the beginning and the end of the hospitalization we evaluated: neuropsychological performance (cognitive tests on verbal/visual working memory, attention, visual-constructive ability, language fluency, and comprehension); psychosocial functioning by the Rehabilitation Areas Form (RAF, handbook VADO); illness severity by the Brief Psychiatric Rating Scale (BPRS). Repeated-measure ANOVA and Pearson's linear correlation were used. RESULTS: We found significant improvement (p<0.01) in all the neuropsychological tests except for one, in 4 out of 6 RAF psychosocial areas (“involvement in ward activities”, “autonomies”, “self-care”, and “self-management of health”) and in clinical symptoms severity. No associations were found between the amelioration of clinical symptoms and neuropsychological or psychosocial improvement. CONCLUSION: A S-T PsyRP without specific cognitive remediation trainings may improve several cognitive/functional domains in MDD or BD inpatients, probably by offering opportunities to engage in demanding problem-solving conditions and cognitively stimulating activities.
Bipolar Disorder* ; Brief Psychiatric Rating Scale ; Depression ; Depressive Disorder, Major ; Hospitalization ; Humans ; Inpatients ; Memory, Short-Term ; Neuropsychological Tests ; Neuropsychology ; Pilot Projects ; Psychiatric Rehabilitation* ; Rehabilitation ; Self Care