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Kim J, Yang C, Joo HJ, Park RW, Kim GE, Kim D, Choi J, Lee JH, Kim E, Park SC, Kim K, Kim IB. Risks of complicated acute appendicitis in patients with psychiatric disorders. BMC Psychiatry 2022; 22:763. [PMID: 36471298 PMCID: PMC9721022 DOI: 10.1186/s12888-022-04428-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 11/25/2022] [Indexed: 12/09/2022] Open
Abstract
BACKGROUND Acute appendicitis often presents with vague abdominal pain, which fosters diagnostic challenges to clinicians regarding early detection and proper intervention. This is even more problematic with individuals with severe psychiatric disorders who have reduced sensitivity to pain due to long-term or excessive medication use or disturbed bodily sensation perceptions. This study aimed to determine whether psychiatric disorder, psychotropic prescription, and treatment compliance increase the risks of complicated acute appendicitis. METHODS The diagnosis records of acute appendicitis from four university hospitals in Korea were investigated from 2002 to 2020. A total of 47,500 acute appendicitis-affected participants were divided into groups with complicated and uncomplicated appendicitis to determine whether any of the groups had more cases of psychiatric disorder diagnoses. Further, the ratio of complicated compared to uncomplicated appendicitis in the mentally ill group was calculated regarding psychotropic dose, prescription duration, and treatment compliance. RESULTS After adjusting for age and sex, presence of psychotic disorder (odds ratio [OR]: 1.951; 95% confidence interval [CI]: 1.218-3.125), and bipolar disorder (OR: 2.323; 95% CI: 1.194-4.520) was associated with a higher risk of having complicated appendicitis compared with absence of psychiatric disorders. Patients who are taking high-daily-dose antipsychotics, regardless of prescription duration, show high complicated appendicitis risks; High-dose antipsychotics for < 1 year (OR: 1.896, 95% CI: 1.077-3.338), high-dose antipsychotics for 1-5 years (OR: 1.930, 95% CI: 1.144-3.256). Poor psychiatric outpatient compliance was associated with a high risk of complicated appendicitis (OR: 1.664, 95% CI: 1.014-2.732). CONCLUSIONS This study revealed a close relationship in the possibility of complicated appendicitis in patients with severe psychiatric disorders, including psychotic and bipolar disorders. The effect on complicated appendicitis was more remarkable by the psychiatric disease entity itself than by psychotropic prescription patterns. Good treatment compliance and regular visit may reduce the morbidity of complicated appendicitis in patients with psychiatric disorders.
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Affiliation(s)
- Junmo Kim
- grid.31501.360000 0004 0470 5905Interdisciplinary Program in Bioengineering, Seoul National University, Seoul, Republic of Korea
| | - Chaeyoung Yang
- grid.49606.3d0000 0001 1364 9317Department of Psychiatry, Hanyang University College of Medicine, Seoul, Republic of Korea ,grid.411986.30000 0004 4671 5423Department of Psychiatry, Hanyang University Medical Center, Seoul, Republic of Korea
| | - Hyung Joon Joo
- grid.411134.20000 0004 0474 0479Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Republic of Korea ,grid.222754.40000 0001 0840 2678Department of Medical Informatics, Korea University College of Medicine, Seoul, Republic of Korea
| | - Rae Woong Park
- grid.251916.80000 0004 0532 3933Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Ga Eun Kim
- grid.411076.5Department of Psychiatry, Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Daeho Kim
- grid.49606.3d0000 0001 1364 9317Department of Psychiatry, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Joonho Choi
- grid.49606.3d0000 0001 1364 9317Department of Psychiatry, Hanyang University College of Medicine, Seoul, Republic of Korea ,grid.412145.70000 0004 0647 3212Department of Psychiatry, Hanyang University Guri Hospital, Guri, Republic of Korea
| | - Jun Ho Lee
- grid.49606.3d0000 0001 1364 9317Department of Surgery, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Eunkyung Kim
- grid.412145.70000 0004 0647 3212Department of Psychiatry, Hanyang University Guri Hospital, Guri, Republic of Korea
| | - Seon-Cheol Park
- grid.49606.3d0000 0001 1364 9317Department of Psychiatry, Hanyang University College of Medicine, Seoul, Republic of Korea ,grid.412145.70000 0004 0647 3212Department of Psychiatry, Hanyang University Guri Hospital, Guri, Republic of Korea
| | - Kwangsoo Kim
- Transdisciplinary Department of Medicine and Advanced Technology, Seoul National University Hospital, Seoul, Republic of Korea. .,Department of Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea.
| | - Il Bin Kim
- Department of Psychiatry, Hanyang University Guri Hospital, Guri, Republic of Korea. .,Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea.
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Trab T, Attar R, Jensen SE, Grøntved S, Frøkjær JB, Polcwiartek C, Nielsen RE. Coronary artery calcium in patients with schizophrenia. BMC Psychiatry 2021; 21:422. [PMID: 34425769 PMCID: PMC8381587 DOI: 10.1186/s12888-021-03412-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 08/03/2021] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Coronary heart disease (CHD) is a major cause of increased mortality rates in patients with schizophrenia. Moreover, coronary artery calcium (CAC) score is associated with CHD. We hypothesized that patients with schizophrenia have more CAC than the general population and aimed to investigate the CAC score in patients with schizophrenia compared to norms based on the general population. Additionally, this study investigated if age, sex, diabetes, dyslipidemia and smoking were associated with the CAC score. METHODS In a cross-sectional study, 163 patients with schizophrenia underwent cardiac computed tomography, and the CAC score was measured and compared to norms by classifying the CAC scores in relation to the age- and gender matched norm 50th, 75th and 90th percentiles. Logistic and linear regression were carried out to investigate explanatory variables for the presence and extent of CAC, respectively. RESULTS A total of 127 (77.9%) patients had a CAC score below or equal to the matched 50th, 20 (12.3%) above the 75th and nine (5.5%) above the 90th percentile. Male sex (P < 0.05), age (P < 0.001) and smoking (P < 0.05) were associated with the presence of CAC while age (P < 0.001) and diabetes (P < 0.01) were associated with the extent of CAC. CONCLUSIONS The amount of CAC in patients with schizophrenia follows norm percentiles, and variables associated with the CAC score are similar in patients with schizophrenia and the general population. These findings indicate that the CAC score may not be sufficient to detect the risk of CHD in patients with schizophrenia. Future studies should explore other measures of subclinical CHD, including measures of peripheral atherosclerosis or cardiac autonomic neuropathy to improve early detection and intervention. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02885792 , September 1, 2016.
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Affiliation(s)
- Trine Trab
- Department of Psychiatry, Aalborg University Hospital, Aalborg, Denmark.
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
| | - Rubina Attar
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Svend Eggert Jensen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Simon Grøntved
- Department of Psychiatry, Aalborg University Hospital, Aalborg, Denmark
| | - Jens Brøndum Frøkjær
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Radiology, Aalborg University Hospital, Aalborg, Denmark
| | | | - René Ernst Nielsen
- Department of Psychiatry, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Reyad AA, Girgis E, Ayoub A, Mishriky R. Bruxism and psychotropic medications. PROGRESS IN NEUROLOGY AND PSYCHIATRY 2020. [DOI: 10.1002/pnp.560] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Ayman Antoun Reyad
- Dr Antoun Reyad is a Senior Lecturer in Pharmacology, School of PharmacyUniversity of Wolverhampton
| | - Eriny Girgis
- Dr Girgis is a Dental Officer, Community Dental Service, City of Coventry Health Centre, Coventry and Warwickshire Partnership NHS Trust
| | - Amin Ayoub
- Dr Ayoub is an Associate Professor of DentistryNew York University New York
| | - Raafat Mishriky
- Dr Mishriky is Consultant Psychiatrist, Birmingham and Solihull Mental Health NHS Foundation Trust
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Zhou L, Bi Y, Liang M, Kong Y, Tu Y, Zhang X, Song Y, Du X, Tan S, Hu L. A modality-specific dysfunction of pain processing in schizophrenia. Hum Brain Mapp 2019; 41:1738-1753. [PMID: 31868305 PMCID: PMC7267942 DOI: 10.1002/hbm.24906] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 12/06/2019] [Accepted: 12/11/2019] [Indexed: 12/21/2022] Open
Abstract
Clinical observations showed that schizophrenia (SCZ) patients reported little or no pain under various conditions that are commonly associated with intense painful sensations, leading to a higher risk of morbidity and mortality. However, this phenomenon has received little attention and its underlying neural mechanisms remain unclear. Here, we conducted two experiments combining psychophysics, electroencephalography (EEG), and functional magnetic resonance imaging (fMRI) techniques to investigate neural mechanisms of pain insensitivity in SCZ patients. Specifically, we adopted a stimulus–response paradigm with brief stimuli of different sensory modalities (i.e., nociceptive, non‐nociceptive somatosensory, and auditory) to test whether pain insensitivity in SCZ patients is supra‐modal or modality‐specific, and used EEG and fMRI techniques to clarify its neural mechanisms. We observed that perceived intensities to nociceptive stimuli were significantly smaller in SCZ patients than healthy controls, whereas perceived intensities to non‐nociceptive somatosensory and auditory stimuli were not significantly different. The behavioral results were confirmed by stimulus‐evoked brain responses sampled by EEG and fMRI techniques, thus verifying the modality‐specific nature of the modulation of nociceptive information processing in SCZ patients. Additionally, significant group differences were observed in the spectral power of alpha oscillations in prestimulus EEG and the seed‐based functional connectivity in resting‐state fMRI (seeds: the thalamus and periaqueductal gray that are key nodes in ascending and descending pain pathways respectively), suggesting a possible contribution of cortical–subcortical dysfunction to the phenomenon. Overall, our study provides insight into the neural mechanisms of pain insensitivity in SCZ and highlights a need for systematic assessments of their pain‐related diseases.
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Affiliation(s)
- Lili Zhou
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Yanzhi Bi
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Meng Liang
- School of Medical Imaging and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University, Tianjin, China
| | - Yazhuo Kong
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China.,CAS Key Laboratory of Behavioural Science, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Yiheng Tu
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, Massachusetts
| | - Xiangyang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Yanying Song
- Psychiatry Research Centre, Beijing Huilonguan Hospital, Beijing, China
| | - Xia Du
- Psychiatry Research Centre, Beijing Huilonguan Hospital, Beijing, China
| | - Shuping Tan
- Psychiatry Research Centre, Beijing Huilonguan Hospital, Beijing, China
| | - Li Hu
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China.,Department of Pain Management, The State Key Clinical Specialty in Pain Medicine, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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5
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Benson TL, Brugger P, Park S. Bodily self-disturbance in schizophrenia-spectrum populations: Introducing the Benson et al. Body Disturbances Inventory (B-BODI). Psych J 2019; 8:110-121. [PMID: 30912624 DOI: 10.1002/pchj.280] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 02/18/2019] [Accepted: 02/21/2019] [Indexed: 11/10/2022]
Abstract
Anomalous or weakened sense of self was central to early theories of schizophrenia. Recent studies have also documented disturbances in body ownership and increased susceptibility for dissociative experiences, such as the out-of-body experience in individuals with schizophrenia, but further research is necessary to clarify components of bodily self-disturbances in the schizophrenia spectrum, and the stability of these experiences over time. With respect to methodology, self-disturbances research in schizophrenia tends to rely exclusively on verbal self-report questionnaires and interviews. Given that individuals with schizophrenia suffer from language and communication difficulties, verbal self-report measures may be insufficient. To bridge this gap, we have developed a new picture-based instrument, the Benson et al. Body Disturbances Inventory (B-BODI), designed to quantify bodily self-disturbances with respect to the frequency and vividness of these experiences, as well as the degree of distress associated with them. Drawings that depicted different aspects of aberrant bodily self-experiences were presented with accompanying captions. Participants were asked to indicate the frequency, vividness, and distressfulness of the experience captured by the picture using a 5-point scale. Individuals with schizophrenia, older healthy controls, and college students participated in two alternative versions of the B-BODI. Participants were also asked to complete a battery of established questionnaires that probed psychosis proneness and a range of self, body, and perceptual aberrations. The results suggest that the B-BODI is a useful tool that accurately captures bodily self-disturbances and has the potential to predict psychosis risk in healthy young individuals. Furthermore, anomalous self-disturbances seem to be relatively stable across time in individuals with chronic schizophrenia.
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Affiliation(s)
- Taylor L Benson
- Department of Psychology, Vanderbilt University, Nashville, Tennessee, USA
| | - Peter Brugger
- Neuropsychology Clinic, University Hospital of Zürich, Zürich, Switzerland
| | - Sohee Park
- Department of Psychology, Vanderbilt University, Nashville, Tennessee, USA.,Global Academy for Future Civilizations, Kyung Hee University, Seoul, Korea
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Riquin É, Hubault P, Baize N, Lhuillier JP, Duverger P. Particularités de l’accompagnement en soins palliatifs d’un patient atteint de schizophrénie en secteur psychiatrique. ANNALES MEDICO-PSYCHOLOGIQUES 2017. [DOI: 10.1016/j.amp.2016.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Every‐Palmer S, Newton‐Howes G, Clarke MJ. Pharmacological treatment for antipsychotic-related constipation. Cochrane Database Syst Rev 2017; 1:CD011128. [PMID: 28116777 PMCID: PMC6465073 DOI: 10.1002/14651858.cd011128.pub2] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Antipsychotic-related constipation is a common and serious adverse effect, especially for people taking clozapine. Clozapine has been shown to impede gastrointestinal motility, leading to constipation, and has been reported in up to 60% of patients receiving clozapine. In rare cases, complications can be fatal. Appropriate laxatives should be prescribed to treat constipation in people taking antipsychotics, but there is a lack of guidance on the comparative effectiveness and harms of different agents in this population. An understanding of the effectiveness and safety of treatment for antipsychotic-related constipation is important for clinicians and patients alike. OBJECTIVES To evaluate the effectiveness and safety of pharmacologic treatment (versus placebo or compared against another treatment) for antipsychotic-related constipation (defined as constipated patients of any age, who are treated with antipsychotics, regardless of dose, in which constipation is considered to be an antipsychotic-related side effect). SEARCH METHODS We searched the Cochrane Schizophrenia Group's Trials Register (15 June 2015), which is based on regular searches of MEDLINE, Embase, CINAHL, BIOSIS, AMED, PubMed, PsycINFO, and registries of clinical trials, grey literature, and conference proceedings. There are no language, date, document type, or publication status limitations for inclusion of records in this register. We also handsearched bibliographies and contacted relevant authors for additional information. SELECTION CRITERIA We included all published and unpublished randomised controlled trials (RCTs) investigating the efficacy of pharmacological treatments in patients with antipsychotic-related constipation. Pharmacological treatments included laxatives and other medicines that could reasonably be used to combat constipation in this population (e.g. anticholinergic agents, like bethanecol). DATA COLLECTION AND ANALYSIS Two review authors independently extracted data from all included studies and assessed trials for risk of bias. A third author reviewed 20% of trials. We analysed dichotomous data using relative risks (RR) and the 95% confidence intervals (CI). We assessed risk of bias for included studies and used GRADE to create a 'Summary of findings' table. We discussed any disagreement, documented decisions, and attempted to contact study authors when necessary. MAIN RESULTS We identified two relevant Chinese studies (N = 480) that contributed data to this review. Both studies were over ten years old and poorly reported, lacking descriptions of contemporary CONSORT reporting prerequisites, such as sequence generation, allocation concealment, blinding, participant flow, how the sample size was determined, or how outcomes were measured. The studies also did not report trial registration, pre-specified protocols, consent processes, ethical review, or funding source. We were unsuccessful in making contact with the authors to clarify the missing details. We classified both studies as having an overall high risk of bias.One study compared glycerol suppository with the traditional Chinese medicine (TCM) approaches of tuina massage and acupuncture. Compared to tuina massage, glycerol laxative was less effective in relieving constipation at both two days after treatment (1 RCT; N = 120; RR 2.88, 95% CI 1.89 to 4.39; very low-quality evidence), and three days (1 RCT; N = 120; RR 4.80, CI 1.96 to 11.74, very low-quality evidence). Favourable results were also seen for acupuncture at two days (1 RCT; N = 120; RR 3.50; 95% CI 2.18 to 5.62; very low-quality evidence), and at three days (1 RCT; N = 120; RR 8.00, 95% CI 2.54 to 25.16; very low-quality evidence).The other study compared mannitol, an osmotic laxative, with rhubarb soda or phenolphthalein. Mannitol was more effective than rhubarb soda or phenolphthalein in trelieving constipation within 24 hours of treatment (1 RCT; N = 240; RR 0.07; 95% CI 0.02 to 0.27, very low-quality evidence).No data were reported for our other important outcomes: need for rescue medication, bowel obstruction (a complication of antipsychotic-related constipation), quality of life, adverse events, leaving the study early, and economic costs. AUTHORS' CONCLUSIONS We had hoped to find clinically useful evidence appraising the relative merits of the interventions routinely used to manage antipsychotic-related constipation, a common and potentially serious adverse effect of the use of these drugs. The results were disappointing. There were no data comparing the common pharmacological interventions for constipation, such as lactulose, polyethylene glycol, stool softeners, lubricant laxatives, or of novel treatments such as linaclotide. Data available were very poor quality and the trials had a high risk of bias. Data from these biased studies suggested that mannitol, an osmotic laxative, was more effective than rhubarb soda and phenolphthalein in relieving constipation, and a two-week course of glycerol suppositories was less effective than the TCM approaches of tuina massage and acupuncture.Overall, there is insufficient trial-based evidence to assess the effectiveness and safety of pharmacological interventions for treating antipsychotic-related constipation, due to limited, poor quality data (few studies with high risk of bias and no meta-analyses). The methodological limitations in the included studies were obvious, and any conclusions based on their results should be made with caution. Methodologically rigorous RCTs evaluating interventions for treating antipsychotic-related constipation are needed.
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Affiliation(s)
- Susanna Every‐Palmer
- University of OtagoWellington School of MedicineWellingtonNew Zealand
- Capital and Coast District Health BoardTe Korowai WharikiPapatuanuku, Ratonga Rua‐o‐PoriruaRaiha StreetPoriruaNew Zealand
| | - Giles Newton‐Howes
- University of OtagoPsychological MedicineMein StreetWellingtonNew Zealand
- Imperial College LondonPsychological MedicineLondonUK
| | - Mike J Clarke
- Queen's University BelfastCentre for Public HealthInstitute of Clinical Sciences, Block B, Royal Victoria HospitalGrosvenor RoadBelfastNorthern IrelandUKBT12 6BJ
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Neuregulin-1 mutant mice indicate motor and sensory deficits, indeed few references for schizophrenia endophenotype model. Behav Brain Res 2017; 322:177-185. [PMID: 28089851 DOI: 10.1016/j.bbr.2017.01.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 01/05/2017] [Accepted: 01/10/2017] [Indexed: 11/23/2022]
Abstract
Neuregulins (Nrg) are a gene family that binds to tyrosine kinase receptors of the ErbB family. The protein of Nrg1 is to be involved in heart formation, migration of neurons, axonal pathfinding and synaptic function. A relation between Nrg1 and schizophrenia is assumed. Chronic impairment in schizophrenia is characterized by different positive and negative symptoms. Detectable markers of this disease in human and in animal models are activity, social behavior and sensory processing. In this study we compared heterozygous Nrg1 mutant mice in behavior and quantification of dopaminergic and serotoninergic neurons with wild type-like littermates. In the Nrg1 mutant mice the epidermal growth factor-like domain is replaced by the neomycin resistance gene. We found significant differences in locomotor and pain perception behavior. No differences were found in specific schizophrenia social interaction and prepulse inhibition behavior. The number of dopaminergic and serotoninergic neurons did not differ in the investigated regions ventral tegmental area, substantia nigra, periaqueductal grey and raphe nuclei. In conclusion, this analyzed Nrg1 mutant mice model did not serve as a complete schizophrenia model. Particular aspects of schizophrenia disease in locomotor and sensory behavior deficits could represent in this Nrg1 mutant mice. Beside several different models could Nrg1 deficiency represent an endophenotype of schizophrenia disease.
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Every-Palmer S, Nowitz M, Stanley J, Grant E, Huthwaite M, Dunn H, Ellis PM. Clozapine-treated Patients Have Marked Gastrointestinal Hypomotility, the Probable Basis of Life-threatening Gastrointestinal Complications: A Cross Sectional Study. EBioMedicine 2016; 5:125-34. [PMID: 27077119 PMCID: PMC4816835 DOI: 10.1016/j.ebiom.2016.02.020] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 01/22/2016] [Accepted: 02/09/2016] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Gastrointestinal side effects are particularly common with clozapine and occur with other antipsychotics, ranging from mild constipation to fatal bowel obstruction and/or ischemia. While this adverse-effect spectrum has been attributed to 'gastrointestinal hypomotility', gastrointestinal transit times in antipsychotic-treated patients have not previously been measured, making this mechanism speculative. METHODS Using standardized radiopaque marker ('Metcalf') methods we established colonic transit times of antipsychotic-treated psychiatric inpatients and compared them with population normative values. We analyzed results by antipsychotic type, antipsychotic dose equivalent, anticholinergic load, duration of treatment, gender, ethnicity, and age. OUTCOMES For patients not prescribed clozapine, median colonic transit time was 23 h. For patients prescribed clozapine, median transit time was 104.5 h, over four times longer than those on other antipsychotics or normative values (p < 0.0001). Eighty percent of clozapine-treated patients had colonic hypomotility, compared with none of those prescribed other antipsychotics (olanzapine, risperidone, paliperidone aripiprazole, zuclopenthixol or haloperidol). In the clozapine group, right colon, left colon and rectosigmoid transit times were all markedly abnormal suggesting pan-colonic pathology. Hypomotility occurred irrespective of gender, age, ethnicity, or length of clozapine treatment. Transit times were positively correlated with clozapine plasma level (rho = 0.451, p = 0.045), but not with duration of treatment, total antipsychotic load or demographic factors. INTERPRETATION Clozapine, unlike the other antipsychotics examined, causes marked gastrointestinal hypomotility, as previously hypothesized. Pre-emptive laxative treatment is recommended when starting clozapine.
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Affiliation(s)
- Susanna Every-Palmer
- Te Korowai Whāriki Central Regional Forensic Service, Capital and Coast District Health Board, New Zealand
- Department of Psychological Medicine, University of Otago, Wellington, PO Box 7343, Wellington 6242, New Zealand
| | - Mike Nowitz
- Department of Medicine, University of Otago, Wellington, PO Box 7343, Wellington 6242, New Zealand
| | - James Stanley
- Biostatistics Group, University of Otago, Wellington, PO Box 7343, Wellington 6242, New Zealand
| | - Eve Grant
- Te Korowai Whāriki Central Regional Forensic Service, Capital and Coast District Health Board, New Zealand
| | - Mark Huthwaite
- Department of Psychological Medicine, University of Otago, Wellington, PO Box 7343, Wellington 6242, New Zealand
| | - Helen Dunn
- Pharmacy Department, Capital and Coast District Health Board, Private Bag 7902, Wellington South, New Zealand
| | - Pete M. Ellis
- Department of Psychological Medicine, University of Otago, Wellington, PO Box 7343, Wellington 6242, New Zealand
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Oke V, Schmidt F, Bhattarai B, Basunia M, Agu C, Kaur A, Enriquez D, Quist J, Salhan D, Gayam V, Mungikar P. Unrecognized clozapine-related constipation leading to fatal intra-abdominal sepsis - a case report. Int Med Case Rep J 2015; 8:189-92. [PMID: 26392790 PMCID: PMC4573205 DOI: 10.2147/imcrj.s86716] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Clozapine is the preferred antipsychotic used for the treatment of resistant schizophrenia with suicidal ideation. The drug is started at a low dose and gradually increased to a target dose of 300–450 mg/day. It is well known to cause agranulocytosis and neutropenia. Several cases of fatal sepsis have been reported in neutropenic patients and emphasis is placed on monitoring for agranulocytosis; however, clozapine also causes intestinal hypomotility and constipation, which if unrecognized can lead to intestinal obstruction, bowel necrosis, and intra-abdominal sepsis. Reduced behavioral pain reactivity in schizophrenics may alter the ability to express pain, potentially leading to a delay in the presentation for medical attention. We report a case of fatal intra-abdominal sepsis secondary to an unrecognized case of clozapine-related constipation.
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Affiliation(s)
- Vikram Oke
- Department of Pulmonary Medicine, Interfaith Medical Center, NY, USA
| | - Frances Schmidt
- Department of Pulmonary Medicine, Interfaith Medical Center, NY, USA
| | - Bikash Bhattarai
- Department of Pulmonary Medicine, Interfaith Medical Center, NY, USA
| | - Md Basunia
- Department of Pulmonary Medicine, Interfaith Medical Center, NY, USA
| | - Chidozie Agu
- Department of Pulmonary Medicine, Interfaith Medical Center, NY, USA
| | - Amrit Kaur
- Department of Pulmonary Medicine, Interfaith Medical Center, NY, USA
| | - Danilo Enriquez
- Department of Pulmonary Medicine, Interfaith Medical Center, NY, USA
| | - Joseph Quist
- Department of Pulmonary Medicine, Interfaith Medical Center, NY, USA
| | - Divya Salhan
- Department of Pulmonary Medicine, Interfaith Medical Center, NY, USA
| | - Vijay Gayam
- Department of Pulmonary Medicine, Interfaith Medical Center, NY, USA
| | - Prajakta Mungikar
- Department of Pulmonary Medicine, Interfaith Medical Center, NY, USA
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Abstract
OBJECTIVE Schizophrenia is associated with a reduction of the lifespan by 20 years, with type II diabetes and cardiovascular disease contributing the most to the increased mortality. Unrecognised or silent myocardial infarction (MI) occurs in ~30% of the population, but the rates of unrecognised MI in patients with schizophrenia have only been sparsely investigated. METHOD Electrocardiograms (ECG) from three psychiatric hospitals in Denmark were manually interpreted for signs of previous MI. Subsequently, ECGs were linked to the National Patient Registry in order to determine whether patients had a diagnosis consistent with previous MI. RESULTS A total of 937 ECGs were interpreted, 538 men (57.4%) and 399 women (42.6%). Mean age at the time of ECG acquisition was 40.6 years (95% CI: 39.7-41.5, range: 15.9-94.6). We identified 32 patients with positive ECG signs of MIs. Only two of these patients had a diagnosis of MI in the National Patient Registry. An additional number of eight patients had a diagnosis of MI in the Danish National Patient Registry, but with no ECG signs of previous MI. This means that 30 out of 40 (75%) MIs were unrecognised. Only increasing age was associated with unrecognised MI in a stepwise multiple logistic regression model compared with patients with no history of MI, OR: 1.03 per year of age, 95% CI: 1.00-1.06, p=0.021. CONCLUSION Unrecognised MI is common among patients with schizophrenia and may contribute to the increased mortality found in this patient group.
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Urban-Kowalczyk M, Pigońska J, Śmigielski J. Pain perception in schizophrenia: influence of neuropeptides, cognitive disorders, and negative symptoms. Neuropsychiatr Dis Treat 2015; 11:2023-31. [PMID: 26273205 PMCID: PMC4532169 DOI: 10.2147/ndt.s87666] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES The causes and nature of insensitivity to pain in schizophrenia remain unknown. The role of endorphins and the association of cognitive dysfunction and negative symptoms are postulated. METHODS In this study, 43 patients with schizophrenia, five first-degree relatives, and 34 healthy controls were examined. Participants' plasma concentrations of substance P, β-endorphin, and calcitonin gene-related peptide (CGRP) were assessed. In patients, the Trail-Making Test, the Color Reading Interference Test (Stroop test), and the Positive and Negative Syndrome Scale Negative Syndrome subscale (PANSS N) test were performed. We also evaluated pain threshold using nociceptive reflex (RTIII) testing. RESULTS The mean β-endorphin concentration was about 20% higher in patients than in healthy controls (P<0.05). CGRP concentrations were significantly higher in patients than in controls (5.34 ng/mL versus 4.16 ng/mL; P<0.01). Subjects treated with antipsychotic polytherapy had higher concentrations of CGRP than did patients treated with second-generation antipsychotic monotherapy (5.92 ng/mL versus 5.02 ng/mL; P<0.05). There were no correlations between any biochemical parameters and Trail-Making Test, Stroop test, and PANSS N scores. There were no differences in RTIII among study groups. Strong negative correlation (P<0.001) was found between PANSS N scores and subjective pain threshold on the right lower limb. CONCLUSION The insensitivity to pain in schizophrenia is a complex phenomenon that is probably not related to changes in nociceptive pathways. Increase in β-endorphin level may be related to this issue, but it is uncertain if such concentration ensures analgesic effect. It is unknown if patients with schizophrenia in fact experience less pain. Cognitive impairment and excess negative symptoms may strongly influence the patient's expression of pain.
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Affiliation(s)
| | - Justyna Pigońska
- Department of Neurology and Movement Disorders, Medical University of Łódź, Łódź, Poland
| | - Janusz Śmigielski
- Department of Geriatrics, Healthy Ageing Research Centre (HARC), Medical University of Łódź, Łódź, Poland
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De Fazio P, Gaetano R, Caroleo M, Cerminara G, Maida F, Bruno A, Muscatello MR, Moreno MJJ, Russo E, Segura-García C. Rare and very rare adverse effects of clozapine. Neuropsychiatr Dis Treat 2015; 11:1995-2003. [PMID: 26273202 PMCID: PMC4532211 DOI: 10.2147/ndt.s83989] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Clozapine (CLZ) is the drug of choice for the treatment of resistant schizophrenia; however, its suitable use is limited by the complex adverse effects' profile. The best-described adverse effects in the literature are represented by agranulocytosis, myocarditis, sedation, weight gain, hypotension, and drooling; nevertheless, there are other known adverse effects that psychiatrists should readily recognize and manage. This review covers the "rare" and "very rare" known adverse effects of CLZ, which have been accurately described in literature. An extensive search on the basis of predefined criteria was made using CLZ and its combination with adverse effects as keywords in electronic databases. Data show the association between the use of CLZ and uncommon adverse effects, including ischemic colitis, paralytic ileus, hematemesis, gastroesophageal reflux disease, priapism, urinary incontinence, pityriasis rosea, intertriginous erythema, pulmonary thromboembolism, pseudo-pheochromocytoma, periorbital edema, and parotitis, which are influenced by other variables including age, early diagnosis, and previous/current pharmacological therapies. Some of these adverse effects, although unpredictable, are often manageable if promptly recognized and treated. Others are serious and potentially life-threatening. However, an adequate knowledge of the drug, clinical vigilance, and rapid intervention can drastically reduce the morbidity and mortality related to CLZ treatment.
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Affiliation(s)
- Pasquale De Fazio
- Department of Health Sciences, School of Specialization in Psychiatry, University "Magna Graecia", Catanzaro, Italy
| | - Raffaele Gaetano
- Department of Health Sciences, School of Specialization in Psychiatry, University "Magna Graecia", Catanzaro, Italy
| | - Mariarita Caroleo
- Department of Health Sciences, School of Specialization in Psychiatry, University "Magna Graecia", Catanzaro, Italy
| | - Gregorio Cerminara
- Department of Health Sciences, School of Specialization in Psychiatry, University "Magna Graecia", Catanzaro, Italy
| | - Francesca Maida
- Department of Health Sciences, School of Specialization in Pharmacology, University "Magna Graecia", Catanzaro, Italy
| | - Antonio Bruno
- Department of Neurosciences, School of Specialization in Psychiatry, University of Messina, Messina, Italy
| | - Maria Rosaria Muscatello
- Department of Neurosciences, School of Specialization in Psychiatry, University of Messina, Messina, Italy
| | - Maria Jose Jaén Moreno
- Department of Social Health Sciences, Radiology and Physical Medicine, University of Cordoba, Cordoba, Spain
| | - Emilio Russo
- Department of Health Sciences, School of Specialization in Pharmacology, University "Magna Graecia", Catanzaro, Italy
| | - Cristina Segura-García
- Department of Health Sciences, School of Specialization in Psychiatry, University "Magna Graecia", Catanzaro, Italy
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Stanghellini G, Ballerini M, Blasi S, Mancini M, Presenza S, Raballo A, Cutting J. The bodily self: a qualitative study of abnormal bodily phenomena in persons with schizophrenia. Compr Psychiatry 2014; 55:1703-11. [PMID: 25110342 DOI: 10.1016/j.comppsych.2014.06.013] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 06/25/2014] [Indexed: 11/17/2022] Open
Abstract
Subtle anomalies of bodily experience have for long been described as relevant features of schizophrenia spectrum disorders, however such disturbing and alienating experiences are usually neglected in routine clinical examination. The overarching aim of this qualitative study is to offer an experience-close mapping of abnormal bodily phenomena (ABP) in patients with schizophrenia that might assist clinical examination and inform the development of dedicated assessment tools. We followed a stepwise methodology: first, data from n=550 clinical interviews were analyzed adopting consensual qualitative research (CQR) inductive method in order to identify relevant clusters of ABP. Then, ABP profiled in schizophrenia patients (n=301) were contrasted with ABP identified in patients affected by major depression (n=56). 70% of the interviewees in the schizophrenia sample reported anomalies of lived corporeality, that could be condensed in the following categories: Dynamization, Morbid objectivation, Dysmorphic-like phenomena and Pain-like phenomena. Those appeared to be reducible to two core features that were not paralleled in the affective disorder sample: dynamization (e.g. ongoing bodily feelings of disintegration/violation) and thingness/mechanization (e.g. one's body experienced as a object-like mechanism). We suggest that dynamization and thingness/mechanization might be considered schizophrenia-specific experiential phenotypes that can contribute to early differential diagnosis of somatic complaints in mental health help-seekers.
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Affiliation(s)
- Giovanni Stanghellini
- "G. d'Annunzio" University, Chieti, 66013, Italy; "Diego Portales" University, Santiago, Chile
| | | | | | | | | | - Andrea Raballo
- Department of Mental Health and Pathological Addiction, Reggio Emilia, 42122, Italy
| | - John Cutting
- Kings College Hospital in London and the Institute of Psychiatry, London, WC2R 2LS, United Kingdom
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Every-Palmer S, Newton-Howes G, Clarke MJ. Pharmacological treatment for antipsychotic-related constipation. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2014. [DOI: 10.1002/14651858.cd011128] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Ringen PA, Engh JA, Birkenaes AB, Dieset I, Andreassen OA. Increased mortality in schizophrenia due to cardiovascular disease - a non-systematic review of epidemiology, possible causes, and interventions. Front Psychiatry 2014; 5:137. [PMID: 25309466 PMCID: PMC4175996 DOI: 10.3389/fpsyt.2014.00137] [Citation(s) in RCA: 206] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Accepted: 09/12/2014] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Schizophrenia is among the major causes of disability worldwide and the mortality from cardiovascular disease (CVD) is significantly elevated. There is a growing concern that this health challenge is not fully understood and efficiently addressed. METHODS Non-systematic review using searches in PubMed on relevant topics as well as selection of references based on the authors' experience from clinical work and research in the field. RESULTS In most countries, the standardized mortality rate in schizophrenia is about 2.5, leading to a reduction in life expectancy between 15 and 20 years. A major contributor of the increased mortality is due to CVD, with CVD mortality ranging from 40 to 50% in most studies. Important causal factors are related to lifestyle, including poor diet, lack of physical activity, smoking, and substance abuse. Recent findings suggest that there are overlapping pathophysiology and genetics between schizophrenia and CVD-risk factors, further increasing the liability to CVD in schizophrenia. Many pharmacological agents used for treating psychotic disorders have side effects augmenting CVD risk. Although several CVD-risk factors can be effectively prevented and treated, the provision of somatic health services to people with schizophrenia seems inadequate. Further, there is a sparseness of studies investigating the effects of lifestyle interventions in schizophrenia, and there is little knowledge about effective programs targeting physical health in this population. DISCUSSION The risk for CVD and CVD-related deaths in people with schizophrenia is increased, but the underlying mechanisms are not fully known. Coordinated interventions in different health care settings could probably reduce the risk. There is an urgent need to develop and implement effective programs to increase life expectancy in schizophrenia, and we argue that mental health workers should be more involved in this important task.
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Affiliation(s)
- Petter Andreas Ringen
- NORMENT, KG Jebsen Centre for Psychosis Research, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo , Oslo , Norway ; Division of Mental Health and Addiction, Oslo University Hospital , Oslo , Norway
| | - John A Engh
- Division of Mental Health and Addiction, Vestfold Hospital Trust , Tønsberg , Norway
| | - Astrid B Birkenaes
- NORMENT, KG Jebsen Centre for Psychosis Research, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo , Oslo , Norway
| | - Ingrid Dieset
- NORMENT, KG Jebsen Centre for Psychosis Research, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo , Oslo , Norway ; Division of Mental Health and Addiction, Oslo University Hospital , Oslo , Norway
| | - Ole A Andreassen
- NORMENT, KG Jebsen Centre for Psychosis Research, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo , Oslo , Norway ; Division of Mental Health and Addiction, Oslo University Hospital , Oslo , Norway
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18
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Engels G, Francke AL, van Meijel B, Douma JG, de Kam H, Wesselink W, Houtjes W, Scherder EJA. Clinical pain in schizophrenia: a systematic review. THE JOURNAL OF PAIN 2013; 15:457-67. [PMID: 24365324 DOI: 10.1016/j.jpain.2013.11.005] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Revised: 10/29/2013] [Accepted: 11/26/2013] [Indexed: 10/25/2022]
Abstract
UNLABELLED Studies about clinical pain in schizophrenia are rare. Conclusions on pain sensitivity in people with schizophrenia are primarily based on experimental pain studies. This review attempts to assess clinical pain, that is, everyday pain without experimental manipulation, in people with schizophrenia. PubMed, PsycINFO, Embase.com, and Cochrane were searched with terms related to schizophrenia and pain. Methodological quality was assessed with the Mixed Methods Appraisal Tool. Fourteen studies were included. Persons with schizophrenia appear to have a diminished prevalence of pain, as well as a lower intensity of pain when compared to persons with other psychiatric diseases. When compared to healthy controls, both prevalence and intensity of pain appear to be diminished for persons with schizophrenia. However, it was found that this effect only applies to pain with an apparent medical cause, such as headache after lumbar puncture. For less severe situations, prevalence and intensity of pain appears to be comparable between people with schizophrenia and controls. Possible underlying mechanisms are discussed. Knowledge about pain in schizophrenia is important for adequate pain treatment in clinical practice. PERSPECTIVE This review presents a valuable insight into clinical pain in people with schizophrenia.
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Affiliation(s)
- Gwenda Engels
- Department of Clinical Neuropsychology, Vrije Universiteit, The Netherlands.
| | - Anneke L Francke
- Netherlands Institute for Health Services Research (NIVEL) and EMGO+ VU Medical Center, The Netherlands
| | - Berno van Meijel
- Department of Health, Sports and Welfare, Cluster Nursing, Inholland University of Applied Sciences and Parnassia Psychiatric Institute, The Netherlands
| | - Johanna G Douma
- Department of Clinical Neuropsychology, Vrije Universiteit, The Netherlands
| | - Heidi de Kam
- GGz Centraal, Center for Mental Healthcare, The Netherlands
| | | | - Wim Houtjes
- GGZ-VS School for Masters of Advanced Nursing Practice, The Netherlands
| | - Erik J A Scherder
- Department of Clinical Neuropsychology, Vrije Universiteit, The Netherlands
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Horiguchi N, Ago Y, Asada K, Kita Y, Hiramatsu N, Takuma K, Matsuda T. Involvement of spinal 5-HT1A receptors in isolation rearing-induced hypoalgesia in mice. Psychopharmacology (Berl) 2013; 227:251-61. [PMID: 23274507 DOI: 10.1007/s00213-012-2959-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Accepted: 12/14/2012] [Indexed: 11/26/2022]
Abstract
RATIONALE Isolation rearing in rodents causes not only abnormal behaviors which resemble the clinical symptoms of schizophrenia but also hypoalgesia in thermal nociception models. However, the mechanism of the hypoalgesia is not known. OBJECTIVES The present study investigated the effect of isolation rearing on acute pain and the descending pain inhibitory pathways in mice. RESULTS Rearing in isolation for 6 weeks from post-weaning reduced pain sensitivity in the hot plate test and acetic acid-induced writhing test. Isolation rearing also reduced the intraplantar capsaicin-induced licking behavior. Capsaicin increased c-Fos expression, a neuronal activity marker, in the spinal cord and primary somatosensory cortex both in group- and isolation-reared mice, but this effect did not differ between groups. On the other hand, c-Fos expression in the anterior cingulate cortex, periaqueductal gray matter, and rostral ventromedial medulla, but not in the spinal cord or somatosensory cortex, was enhanced by isolation rearing. Systemic administration of WAY100635 (serotonin (5-HT)1A receptor antagonist), but not of ketanserin (5-HT2 receptor antagonist), prazosin (α1-adrenoceptor antagonist), or yohimbine (α2-adrenoceptor antagonist), attenuated isolation rearing-induced hypoalgesia in capsaicin-induced licking behavior. Attenuation of isolation rearing-induced hypoalgesia was also observed following the intrathecal injection of WAY100635. Naloxone, an opioid receptor antagonist, did not affect the hypoalgesia in isolation-reared mice. CONCLUSIONS These findings suggest that isolation rearing causes hypoalgesia in mouse models of acute pain and imply that the spinal 5-HT1A receptor activation probably through descending serotonergic inhibitory pathway is involved in isolation rearing-induced hypoalgesia.
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Affiliation(s)
- Naotaka Horiguchi
- Laboratory of Medicinal Pharmacology, Graduate School of Pharmaceutical Sciences, Osaka University, 1-6 Yamada-oka, Suita, 565-0871, Osaka, Japan
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Becker A, Geisslinger G, Murín R, Grecksch G, Höllt V, Zimmer A, Schröder H. Cannabinoid-mediated diversity of antinociceptive efficacy of parecoxib in Wistar and Sprague Dawley rats in the chronic constriction injury model of neuropathic pain. Naunyn Schmiedebergs Arch Pharmacol 2013; 386:369-82. [DOI: 10.1007/s00210-013-0839-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Accepted: 01/17/2013] [Indexed: 02/06/2023]
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21
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La perception et l’évaluation de la douleur chez le schizophrène. ONCOLOGIE 2013. [DOI: 10.1007/s10269-013-2247-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Lévesque M, Potvin S, Marchand S, Stip E, Grignon S, Pierre L, Lipp O, Goffaux P. Pain Perception in Schizophrenia: Evidence of a Specific Pain Response Profile. PAIN MEDICINE 2012; 13:1571-9. [DOI: 10.1111/j.1526-4637.2012.01505.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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23
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Jarcho JM, Mayer EA, Jiang ZK, Feier NA, London ED. Pain, affective symptoms, and cognitive deficits in patients with cerebral dopamine dysfunction. Pain 2012; 153:744-754. [PMID: 22386471 DOI: 10.1016/j.pain.2012.01.002] [Citation(s) in RCA: 111] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2011] [Revised: 11/29/2011] [Accepted: 01/04/2012] [Indexed: 11/18/2022]
Abstract
Converging preclinical, and human epidemiological, neuroimaging, and genetic evidence suggests a central role for dopamine neurotransmission in modulating pain perception and analgesia. Dysregulation in dopamine signaling may modulate the experience of pain both directly, by enhancing or diminishing the propagation of nociceptive signals, and indirectly, by influencing affective and cognitive processes, which affect the expectation, experience, and interpretation of nociceptive signals. Hypersensitivity to pain and high rates of comorbid chronic pain are common in disorders linked with deficits in dopamine system function, including disorders of mood and affect, substance abuse, and Parkinson disease. Hyposensitivity to pain, however, is common in patients with schizophrenia, which has been linked with excessive dopamine neurotransmission. Although patients are typically affected most by the primary symptoms of their disorders, alterations in pain perception may further increase the burden of their illness, compromising their quality of life. The present review focuses on this relationship, and discusses clinical and potential therapeutic implications for both patients with dopamine-related disorders and those with chronic pain syndromes.
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Affiliation(s)
- Johanna M Jarcho
- National Institute of Mental Health, Bethesda, MD, USA Department of Medicine, Oppenheimer Family Center for Neurobiology of Stress, University of California, Los Angeles, CA, USA Department of Molecular and Medical Pharmacology, University of California, Los Angeles, CA, USA Brain Research Institute, University of California, Los Angeles, CA, USA
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Retamero C, Paglia C. When patients do not hurt: silent acute abdomen in a patient with schizophrenia. Gen Hosp Psychiatry 2012; 34:210.e9-11. [PMID: 22154657 DOI: 10.1016/j.genhosppsych.2011.10.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2011] [Revised: 10/07/2011] [Accepted: 10/11/2011] [Indexed: 10/14/2022]
Abstract
The phenomenon of pain insensitivity in schizophrenia and other psychotic disorders has been described since the early 20th century. Medical conditions often present atypically in the seriously mentally ill patient. Emergency physicians, primary care practitioners, surgeons and psychiatrists must maintain a high index of suspicion for acute abdomen in seriously mentally ill patients who may exhibit a diminished or absent perception of pain. The authors present a case of an atypical presentation of acute abdomen in a patient with schizophrenia.
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Affiliation(s)
- Carolina Retamero
- Department of Psychiatry and Behavioral Science, Temple University School of Medicine, Philadelphia, PA, USA.
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Abstract
OBJECTIVE Whether schizophrenic patients are hypoalgesic or feel pain in the same manner as unaffected individuals can affect the primary care of schizophrenic patients, which often involves an assessment of pain severity made by a medical provider. This study was developed to explore the pain sensitivity of schizophrenics under conditions similar to those of a medical examination that included investigating for sites of pain. METHODS We developed 2 experimental models of pain induction using either pressure or ischemia and used them with 35 schizophrenic patients and 35 controls to record: (1) the stimulus intensity required to induce moderate pain; and (2) the pain intensity induced by a predetermined level of pressure. Clinical data were also collected for the schizophrenic group. RESULTS Schizophrenic patients needed less pressure (P=0.006) and a shorter duration of ischemia (P<0.001) than controls to record moderate pain, and they felt more pain from a fixed pressure stimulus (P<0.001). Pain histories for the previous 6 months and the heart rate variations that occurred during the tests did not differ between the groups. Pain responses were unrelated to the clinical characteristics of the schizophrenic patients, although hallucination production correlated with the pain felt during the fixed pressure test. DISCUSSION Under these conditions, schizophrenic patients were hypersensitive to pain induction compared with normal individuals. The hypoalgesia typically associated with schizophrenic patients may correspond to fewer than normal reports of pain, rather than to impaired sensations of pain. This should be taken into account during routine medical practice.
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de la Fuente-Sandoval C, Favila R, Gómez-Martín D, León-Ortiz P, Graff-Guerrero A. Neural response to experimental heat pain in stable patients with schizophrenia. J Psychiatr Res 2012; 46:128-34. [PMID: 21955439 DOI: 10.1016/j.jpsychires.2011.09.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2011] [Revised: 09/01/2011] [Accepted: 09/09/2011] [Indexed: 10/17/2022]
Abstract
Diminished pain sensitivity in schizophrenia has been reported in clinical studies. While the role of antipsychotic medications as a cause of the decrease in pain perception has been questioned, little is known about neural pain processing in treated schizophrenia patients. The aim of this pilot study was to examine the blood oxygen level-dependent (BOLD) changes induced by an experimental pain tolerance (endure) hot stimuli vs. non-painful stimuli in clinically stable patients with schizophrenia and in healthy controls. Twelve patients with schizophrenia, treated with risperidone and considered clinically stable, and 13 gender- and age-matched healthy controls were studied using painful and non-painful thermal stimuli in a periodic block design. BOLD changes were assessed using high field, 3 T functional Magnetic Resonance Imaging (fMRI). Pain tolerance in stable patients was not statistically different than healthy controls. Interestingly, patients showed higher activation in the primary somatosensory cortex (S1) and superior prefrontal cortex, and less activation in the posterior cingulate cortex and brainstem than controls. Our pilot study indicates that pain tolerance is similar in clinically stable patients and controls, although the neural processing of pain is not normalized with antipsychotic treatment.
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Canetta SE, Luca E, Pertot E, Role LW, Talmage DA. Type III Nrg1 back signaling enhances functional TRPV1 along sensory axons contributing to basal and inflammatory thermal pain sensation. PLoS One 2011; 6:e25108. [PMID: 21949864 PMCID: PMC3176819 DOI: 10.1371/journal.pone.0025108] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2011] [Accepted: 08/24/2011] [Indexed: 12/15/2022] Open
Abstract
Type III Nrg1, a member of the Nrg1 family of signaling proteins, is expressed in sensory neurons, where it can signal in a bi-directional manner via interactions with the ErbB family of receptor tyrosine kinases (ErbB RTKs). Type III Nrg1 signaling as a receptor (Type III Nrg1 back signaling) can acutely activate phosphatidylinositol-3-kinase (PtdIns3K) signaling, as well as regulate levels of α7* nicotinic acetylcholine receptors, along sensory axons. Transient receptor potential vanilloid 1 (TRPV1) is a cation-permeable ion channel found in primary sensory neurons that is necessary for the detection of thermal pain and for the development of thermal hypersensitivity to pain under inflammatory conditions. Cell surface expression of TRPV1 can be enhanced by activation of PtdIns3K, making it a potential target for regulation by Type III Nrg1. We now show that Type III Nrg1 signaling in sensory neurons affects functional axonal TRPV1 in a PtdIns3K-dependent manner. Furthermore, mice heterozygous for Type III Nrg1 have specific deficits in their ability to respond to noxious thermal stimuli and to develop capsaicin-induced thermal hypersensitivity to pain. Cumulatively, these results implicate Type III Nrg1 as a novel regulator of TRPV1 and a molecular mediator of nociceptive function.
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Affiliation(s)
- Sarah E. Canetta
- Department of Neurobiology and Behavior, Columbia University, New York, New York, United States of America
- Department of Neurobiology and Behavior, State University of New York at Stony Brook, Stony Brook, New York, United States of America
- Center for Nervous System Disorders, State University of New York at Stony Brook, Stony Brook, New York, United States of America
| | - Edlira Luca
- Integrated Department, Columbia University, New York, New York, United States of America
- Department of Neurobiology and Behavior, State University of New York at Stony Brook, Stony Brook, New York, United States of America
- Center for Nervous System Disorders, State University of New York at Stony Brook, Stony Brook, New York, United States of America
| | - Elyse Pertot
- Department of Biological Science, State University of New York at Stony Brook, Stony Brook, New York, United States of America
| | - Lorna W. Role
- Department of Neurobiology and Behavior, Columbia University, New York, New York, United States of America
- Department of Neurobiology and Behavior, State University of New York at Stony Brook, Stony Brook, New York, United States of America
- Center for Nervous System Disorders, State University of New York at Stony Brook, Stony Brook, New York, United States of America
| | - David A. Talmage
- Department of Neurobiology and Behavior, State University of New York at Stony Brook, Stony Brook, New York, United States of America
- Center for Nervous System Disorders, State University of New York at Stony Brook, Stony Brook, New York, United States of America
- Department of Pharmacological Science, State University of New York at Stony Brook, Stony Brook, New York, United States of America
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Abstract
Despite the recent attention to patient safety and quality of care, no prior studies have addressed outcomes of hospitalization for pneumonia among patients with schizophrenia. This study investigated the extent to which clinical outcomes of pneumonia were different among patients with schizophrenia. This study used data from the Taiwan National Health Insurance Research Database. Of the total of 81,599 patients admitted with a principal diagnosis of pneumonia from 2002 to 2004, 949 had previously been admitted with a principal or secondary diagnosis of schizophrenia within the 2 years of their index pneumonia admission. We randomly selected 2847 pneumonia patients matched with the study group in terms of gender, age, year of admission, length of stay, and Charlson Comorbidity Index score as the comparison cohort. Conditional logistic regression models were used for analysis. Findings indicated a higher prevalence of adverse outcomes among patients with schizophrenia. Patients with schizophrenia were independently associated with a 1.81 times greater risk of intensive care unit admission (95% confidence interval [CI] = 1.37-2.40), a 1.37 times greater risk of acute respiratory failure (95% CI = 1.08-1.88), and a 1.34-fold greater risk of mechanical ventilation (95% CI = 1.04-1.92) after adjusting for characteristics of patients, physicians, hospitals, and potential clustering effects. Adjusted odds ratios were further evident among those treated in private hospitals and in regional/district hospitals. Significant barriers to prompt and appropriate medical care for pneumonia persist for patients with schizophrenia. Careful monitoring of physical health and proper integration between psychiatrists and physicians should be stressed to reduce poor clinical outcomes in this vulnerable population.
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Affiliation(s)
- Yi-Hua Chen
- School of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Hsiu-Chen Lin
- Department of Pediatric Infection, Taipei Medical University and Hospital, Taipei, Taiwan
| | - Herng-Ching Lin
- School of Health Care Administration, Taipei Medical University, 250 Wu-Hsing Street, Taipei 110, Taiwan,To whom correspondence should be addressed; tel: 886-2-2736-1661 ext 3613, fax: 886-2-2378-9788, e-mail:
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Autié A, Montreuil M, Moulier V, Braha S, Wojakiewicz A, Januel D. Douleur et schizophrénie : mythe et réalité. Encephale 2009; 35:297-303. [DOI: 10.1016/j.encep.2008.04.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2007] [Accepted: 04/11/2008] [Indexed: 11/25/2022]
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Are Patients With Schizophrenia Insensitive to Pain? A Reconsideration of the Question. Clin J Pain 2009; 25:244-52. [DOI: 10.1097/ajp.0b013e318192be97] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Brouwers EEM, Söhne M, Kuipers S, van Gorp ECM, Schellens JHM, Koks CHW, Beijnen JH, Huitema ADR. Ciprofloxacin Strongly Inhibits Clozapine Metabolism. Clin Drug Investig 2009; 29:59-63. [DOI: 10.2165/0044011-200929010-00006] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Potvin S, Stip E, Tempier A, Pampoulova T, Bentaleb LA, Lalonde P, Lipp O, Goffaux P, Marchand S. Pain perception in schizophrenia: no changes in diffuse noxious inhibitory controls (DNIC) but a lack of pain sensitization. J Psychiatr Res 2008; 42:1010-6. [PMID: 18093615 DOI: 10.1016/j.jpsychires.2007.11.001] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2007] [Revised: 10/31/2007] [Accepted: 11/02/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND Pain is a dynamic phenomenon resulting from the activity of both excitatory (e.g. sensitization) and inhibitory endogenous modulation systems. Preliminary experimental studies have shown diminished pain sensitivity in schizophrenia patients. The objective of the study was to investigate the role of excitatory and inhibitory systems on pain perception in schizophrenia. METHODS Participants were 23 patients with a schizophrenia-spectrum disorder (DSM-IV criteria) and 29 healthy volunteers, who did not differ in age, sex or ethnicity. Excitatory and inhibitory systems were elicited using a temporal summation test (Peltier thermode) administered before and after activation of the diffuse noxious inhibitory control (DNIC) by means of a cold-pressor test. RESULTS Time was a significant predictor of pain scores in controls, but not in patients. That is, pain ratings increased during the tonic thermal stimulation among controls but not in schizophrenia patients. When correlation coefficients (between time and pain ratings) for patients and controls were compared, the correlation coefficient emerged as significantly weaker in the schizophrenia group (Z=12.04; p=0.0001), suggesting a lack of sensitization in schizophrenia. DNIC was similar in magnitude in both patients and controls. CONCLUSIONS Diminished pain sensitivity in schizophrenia may be related to abnormal excitatory mechanisms, but not to DNIC. More studies are needed to better characterize the neurophysiological and neurochemical mechanisms involved in the lack of sensitization in schizophrenia.
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Affiliation(s)
- Stéphane Potvin
- Centre de recherche Fernand-Seguin, University of Montreal, Montreal, Canada
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[Schizophrenia and pain reactivity]. Presse Med 2008; 37:1561-8. [PMID: 18774679 DOI: 10.1016/j.lpm.2008.05.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2007] [Revised: 04/09/2008] [Accepted: 05/07/2008] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Medical practitioners do not for a long time pay enough attention to patient's pain. This approach is in the line of society feelings. Pain was long consider to be a contingency to withstand as showed in Christian's bible or Stoicism's principle. Changes in mentality appear in present times. It Seems obvious that for sociological and scientific reasons pain's care in medical and psychiatric disorders is now an important subject. Recent research in autistic disorders suggest that insensitivity observed in autism is not and analgesic phenomenon but a different behavioural reactivity to pain. Prevalence of schizophrenic disorder is from 0.5 to 1%. It is also a complex disorder that has defied decades of concerted efforts to uncover its origins and attenuate its symptoms. The most promising hypotheses suggest that neurodevelopmental impairment increases the risk of later schizophrenia. Most of recent researches in this topic did focus to trait or state markers. According to the vulnerability models of schizophrenia, trait marker are clinical, psychological, physiological, anatomical or cognitive impairments found in patients with schizophrenia during all the course of the illness and even before the onset. Several lines of evidence (case report, epidemiological studies, experimental studies) suggest that patients with schizophrenia shows a relative insensitivity to physical pain. We will review and critic the scientific literature in this specific topic. We will see if datas are relevant with the neurodevelopmental hypothesis and vulnerability models. METHODS An OLDMEDLINE/MEDLINE query was performed to identify 50 articles relevant to our subject. 9 were case report or case series, 21 were clinical or epidemiological studies, 15 were experimental studies and we also found 5 previous review. RESULTS Clinical and experimental data strongly suggest a decrease of Behavioural Reactivity to Pain (BRP) but there is a lack of argument to prove a real analgesia. Because schizophrenia is a severe disease with impairment in communication and social skills it may be very difficult to affirm that the insensitivity to pain does really exist for patients. It seems inappropriate at this point to speak about insensitivity or analgesia. We could hypothesis that the decrease of BRP is less a consequence of analgesia than a different way to express emotion in general and pain in particular. It is well known that patients with schizophrenia show communication and thinking impairment, not adapted social skills and also a lack of body representation. However, this decrease of behavioural response seems to be frequent and may be explore by objective research protocol to understand if patients don't feel pain or probably don't express pain by adapted social skills. Furthermore, decrease of BRP may take place in a comprehensive theory of schizophrenia. in the line of stress-vulnerability model. Impairment or lack of behavioural pain reactivity could induce an increasing anxiety level for patient with vulnerability to schizophrenia and a higher risk of onset of the pathology. We may argue that pain stimuli would conduct to a nociceptive stress witch couldn't discharge by usual ways of regulation and behavioural expression of pain. Exploration and interview about pain reactivity in vulnerable to schizophrenia subjects could be interesting to increase a the amount of information in a vulnerability check-up. Further studies in this axis may be useful to test this hypothesis.
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Hypoalgesia in schizophrenia is independent of antipsychotic drugs: a systematic quantitative review of experimental studies. Pain 2007; 138:70-78. [PMID: 18160219 DOI: 10.1016/j.pain.2007.11.007] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2007] [Revised: 10/31/2007] [Accepted: 11/13/2007] [Indexed: 11/22/2022]
Abstract
Diminished sensitivity to pain in schizophrenia has been reported since the early works of Bleuler [Bleuler E. Textbook of psychiatry (trans. Brill HA, 1951). New York: Dover Publications; 1911] and Kraepelin [Kraepelin E. Dementia praecox and paraphrenia. Edinburgh, Scotland: E and S Livingstone; 1919]. Over the last decade, experimental studies have measured pain perception in schizophrenia and produced mixed results. This meta-analysis sought to determine if the scientific literature confirms the hypothesized hypoalgesia in schizophrenia. The search was performed with computerised literature databases. A study was retained in the meta-analysis if: (i) it comprised a group of schizophrenia patients, compared to a control group of healthy volunteers; and (ii) pain was measured via experimental procedures (e.g. thermal, electrical, or mechanical stimuli). Using Comprehensive Meta-Analysis-2, effect size estimates of the differences in pain scores (all pain scores derived from all pain tests) between schizophrenia patients and healthy volunteers were calculated. Eleven studies were included in the meta-analysis. For the composite analysis, a positive, moderate, and significant effect size estimate emerged (N=497; Hedges's g=0.437; p=0.005), suggesting that patients with schizophrenia show a diminished response to experimentally-induced pain. Secondary analyses showed that: (i) drug-free patients also have hypoalgesic responses; and that (ii) sensory thresholds are increased in schizophrenia patients. This meta-analysis substantiates the hypothesis of a diminished pain response in schizophrenia. The study also suggests that hypoalgesia in schizophrenia cannot be solely explained by the effects of antipsychotic drugs, and that it may not be a pain-specific blunted response. Further studies are warranted to determine the clinical and biological correlates, and the social and health consequences, of hypoalgesia in schizophrenia.
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Tsay JH, Lee CH, Hsu YJ, Wang PJ, Bai YM, Chou YJ, Huang N. Disparities in appendicitis rupture rate among mentally ill patients. BMC Public Health 2007; 7:331. [PMID: 18005406 PMCID: PMC2190764 DOI: 10.1186/1471-2458-7-331] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2006] [Accepted: 11/15/2007] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Many studies have been carried out that focus on mental patients' access to care for their mental illness, but very few pay attention on these same patients' access to care for their physical diseases. Acute appendicitis is a common surgical emergency. Our population-based study was to test for any possible association between mental illness and perforated appendicitis. We hypothesized that there are significant disparities in access to timely surgical care between appendicitis patients with and without mental illness, and more specifically, between patients with schizophrenia and those with another major mental illness. METHODS Using the National Health Insurance (NHI) hospital-discharge data, we compared the likelihood of perforated appendix among 97,589 adults aged 15 and over who were hospitalized for acute appendicitis in Taiwan between the years 1997 to 2001. Among all the patients admitted for appendicitis, the outcome measure was the odds of appendiceal rupture vs. appendicitis that did not result in a ruptured appendix. RESULTS After adjusting for age, gender, ethnicity, socioeconomic status (SES) and hospital characteristics, the presence of schizophrenia was associated with a 2.83 times higher risk of having a ruptured appendix (odds ratio [OR], 2.83; 95% confidence interval [CI], 2.20-3.64). However, the presence of affective psychoses (OR, 1.15; 95% CI: 0.77-1.73) or other mental disorders (OR, 1.58; 95% CI: 0.89-2.81) was not a significant predictor for a ruptured appendix. CONCLUSION These findings suggest that given the fact that the NHI program reduces financial barriers to care for mentally ill patients, they are still at a disadvantage for obtaining timely treatment for their physical diseases. Of patients with a major mental illness, schizophrenic patients may be the most vulnerable ones for obtaining timely surgical care.
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Affiliation(s)
- Jen-Huoy Tsay
- Department of Social Work, College of Social Science, National Taiwan University, Taipei, Taiwan, R.O.C.
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Howard PB, El-Mallakh P, Rayens MK, Clark JJ. Comorbid medical illnesses and perceived general health among adult recipients of Medicaid Mental Health Services. Issues Ment Health Nurs 2007; 28:255-74. [PMID: 17454279 DOI: 10.1080/01612840601172593] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The purpose of this retrospective, cross-sectional, descriptive study was to measure self-reported frequencies of medical problems, overall health, and health-related quality of life among mental health consumers. The sample included 787 adults who had received a mental health service paid for by Medicaid over a one-year period. The self-administered questionnaire included the 12-item Medical Outcomes Study (MOS) Short-Form (SF) Physical and Mental Health Summary Scales, and items about physical health problems and health-related quality of life. The majority of respondents (83.3%) reported that their general health was poor or fair. Frequently reported medical problems included arthritis, migraines, and high blood pressure. Knowledge of physical problems in persons with mental illness is essential for advanced practice nurses.
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Affiliation(s)
- Patricia B Howard
- College of Nursing, University of Kentucky, Lexington, KY 40536-0232, USA.
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Cooke BK, Magas LT, Virgo KS, Feinberg B, Adityanjee A, Johnson FE. Appendectomy for appendicitis in patients with schizophrenia. Am J Surg 2007; 193:41-8. [PMID: 17188086 DOI: 10.1016/j.amjsurg.2006.06.034] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2006] [Revised: 06/05/2006] [Accepted: 06/05/2006] [Indexed: 01/07/2023]
Abstract
BACKGROUND Anecdotal evidence suggests that schizophrenia patients who require surgery have a high rate of adverse outcomes. We searched the Department of Veterans Affairs national datasets to determine the clinical course of schizophrenia patients with appendicitis who underwent appendectomy. METHODS The Patient Treatment File (the nationwide inpatient database for the Department of Veterans Affairs) and the Beneficiary Identification and Records Location System were searched to identify all patients with International Classification of Diseases, Ninth Revision, Clinical Modification diagnostic codes for schizophrenia or schizoaffective disorder diagnosed with appendicitis during fiscal years 1995 to 1999. Computer-based information was supplemented with chart-based data. We sought data on six common preoperative risk factors and 25 specific adverse outcomes, including death. RESULTS There were 55 patients identified. The mean age was 49, and 96% were men. The median time from symptom onset to diagnosis of appendicitis was 3 days. A history of substance abuse was obtained in 16 (29%). Disruptive behavior was documented in 16 (29%). Restraints were used in 9 (9%). The appendix was perforated in 36 (66%) and gangrenous in 9 (16%). Thirty-one (56%) had > or = 1 complication; there were 2 in-hospital deaths (4%). CONCLUSIONS This is the first report on this topic in the medical literature. Appendicitis is typically diagnosed late in schizophrenic patients. Adverse patient behaviors are frequent. The complication and death rates are high.
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Affiliation(s)
- Brian K Cooke
- Department of Veterans Affairs Medical Center, St Louis, MO, USA
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Winocur E, Hermesh H, Littner D, Shiloh R, Peleg L, Eli I. Signs of bruxism and temporomandibular disorders among psychiatric patients. ACTA ACUST UNITED AC 2007; 103:60-3. [PMID: 17178495 DOI: 10.1016/j.tripleo.2006.03.019] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2005] [Revised: 03/04/2006] [Accepted: 03/20/2006] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To investigate the prevalence of bruxism and signs of temporomandibular disorders (TMDs) among psychiatric patients compared with a healthy population and to assess the effect of psychiatric medications on the parameters studied. STUDY DESIGN Subjects included 77 psychiatric patients under treatment at 2 psychiatric hospitals in Israel and 50 healthy individuals (control). One experienced calibrated examiner performed the clinical examination (presence of bruxism and signs of TMD). RESULTS Abnormal attrition was evident in 46.8% of the psychiatric patients compared with 20% in the controls (P < .005). Significant differences between groups were apparent for mean muscle sensitivity to palpation, joint sensitivity to palpation, and range of mouth opening. There were no differences between groups in the prevalence of joint clicks and no association between time of receiving treatment with dopamine antagonists (or any other psychotropic drugs) and TMD signs and symptoms. CONCLUSION The higher prevalence of bruxism and signs of TMD in psychiatric patients is a major clinical comorbidity. Whether it is a manifestation of the abnormal central nervous system of psychiatric patients or neuroleptic-induced phenomenon deserves further attention. The exact factors that affect the pain experience in these patients should be evaluated as well.
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Affiliation(s)
- Ephraim Winocur
- Department of Oral Rehabilitation, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel.
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Becker A, Grecksch G, Schröder H. Pain sensitivity is altered in animals after subchronic ketamine treatment. Psychopharmacology (Berl) 2006; 189:237-47. [PMID: 17016710 DOI: 10.1007/s00213-006-0557-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2006] [Accepted: 08/08/2006] [Indexed: 12/20/2022]
Abstract
RATIONALE Clinical observations have shown that pain sensitivity is altered in some schizophrenic patients. OBJECTIVES To study alterations in pain sensitivity, the ketamine model in schizophrenia research was employed. MATERIALS AND METHODS Rats were subchronically injected with the dissociative anaesthetic ketamine (Ket, ten injections of 30 mg/kg, one injection per day over a period of 10 days). Two weeks after treatment completion, the animals' pain sensitivity was assayed in the hot plate test and they were subjected to electrical stimulation of the tail root. In addition, the effect of morphine was studied. RESULTS In group-housed animals, there was no difference between Ket-injected animals and control rats as measured in both nociceptive tests. In singly housed Ket-injected rats, pain threshold was increased in the electrical stimulation test. This suggests that stress due to single housing might be essential for modifications of pain sensitivity. Moreover, the antinociceptive effect of morphine was modified after single housing. Interestingly, the effect of morphine on locomotor activity was similar in both groups. In group-housed rats, mu receptor binding was unchanged in the frontal cortex, whereas Ket-injected animals had decreased levels in the hippocampus. In singly housed animals, mu receptor binding in Ket-injected rats increased in the frontal cortex and decreased in the hippocampus. (35)S-GTPgamma-S binding increased in the frontal cortex in both singly housed groups, but remained unchanged in the hippocampus. CONCLUSIONS The data suggest that the ketamine model might be useful for studying altered pain sensitivity in schizophrenia. Moreover, the data suggest that modifications in mu opioid receptor binding contribute to this phenomenon.
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Affiliation(s)
- Axel Becker
- Faculty of Medicine, Institute of Pharmacology and Toxicology, Otto-von-Guericke University Magdeburg, 39120, Magdeburg, Germany.
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Elman I, Borsook D, Lukas SE. Food intake and reward mechanisms in patients with schizophrenia: implications for metabolic disturbances and treatment with second-generation antipsychotic agents. Neuropsychopharmacology 2006; 31:2091-120. [PMID: 16541087 DOI: 10.1038/sj.npp.1301051] [Citation(s) in RCA: 107] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Obesity is highly prevalent among patients with schizophrenia and is associated with detrimental health consequences. Although excessive consumption of fast food and pharmacotherapy with such second-generation antipsychotic agents (SGAs) as clozapine and olanzapine has been implicated in the schizophrenia/obesity comorbidity, the pathophysiology of this link remains unclear. Here, we propose a mechanism based on brain reward function, a relevant etiologic factor in both schizophrenia and overeating. A comprehensive literature search on neurobiology of schizophrenia and of eating behavior was performed. The collected articles were critically reviewed and relevant data were extracted and summarized within four key areas: (1) energy homeostasis, (2) food reward and hedonics, (3) reward function in schizophrenia, and (4) metabolic effects of the SGAs. A mesolimbic hyperdopaminergic state may render motivational/incentive reward system insensitive to low salience/palatability food. This, together with poor cognitive control from hypofunctional prefrontal cortex and enhanced hedonic impact of food, owing to exaggerated opioidergic drive (clinically manifested as pain insensitivity), may underlie unhealthy eating habits in patients with schizophrenia. Treatment with SGAs purportedly improves dopamine-mediated reward aspects, but at the cost of increased appetite and worsened or at least not improved opiodergic capacity. These effects can further deteriorate eating patterns. Pathophysiological and therapeutic implications of these insights need further validation via prospective clinical trials and neuroimaging studies.
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Affiliation(s)
- Igor Elman
- Behavioral Psychopharmacology Research Laboratory, Department of Psychiatry, McLean Hospital and Harvard Medical School, Belmont, MA 02478, USA.
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Too much or too little pain: The dichotomy of pain sensitivity in psychotic versus other psychiatric disorders. ACTA ACUST UNITED AC 2006. [DOI: 10.1007/bf02629336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Jochum T, Letzsch A, Greiner W, Wagner G, Sauer H, Bär KJ. Influence of antipsychotic medication on pain perception in schizophrenia. Psychiatry Res 2006; 142:151-6. [PMID: 16631931 DOI: 10.1016/j.psychres.2005.09.004] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2004] [Accepted: 09/17/2005] [Indexed: 10/24/2022]
Abstract
A number of clinical observations indicate that pain processing might be disturbed in psychotic disorders such as schizophrenia. Only a few studies have investigated pain perception in schizophrenia. The main objective of this study was the investigation of thresholds of warmth perception (WP), thermal pain onset (TPO) and thermal pain tolerance (TPT) in acute schizophrenic patients and the influence of antipsychotic medication on the patients' responses. We investigated 23 schizophrenic subjects who had been not received antipsychotic treatment for 8 weeks, and we then reassessed them 3 days later after the introduction of neuroleptics. Acute symptoms of schizophrenia were measured using the Scales for the Assessment of Positive and Negative Symptoms. Thresholds were determined by a contact thermode on both volar wrists. Schizophrenic patients showed significantly increased thresholds of WP and TPO relative to healthy controls. Antipsychotics did not alter pain thresholds. We found no correlation between pain perception and psychometric scales. Our findings demonstrate altered warmth and heat pain perception in acute schizophrenia. We believe that our findings can be attributed to information-processing abnormalities of the disorder and that they are not specific to pain processing, per se, since both WP and TPO were significantly different. Future studies should evaluate attentional deficits in schizophrenia in relation to pain perception.
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Affiliation(s)
- Thomas Jochum
- Department of Psychiatry, Friedrich-Schiller-University of Jena, Germany
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Abstract
OBJECTIVES As early as the turn of the 20th century, clinicians observed patients with schizophrenia failing to respond to the pain of a myocardial infarction, ruptured appendix, or perforated bowel. Although this pain insensitivity in individuals with psychosis has been described in the literature for many years, the phenomenon is still poorly understood. We therefore reviewed the literature for findings concerning whether pain insensitivity in schizophrenia represents a state or a trait marker. METHODS A comprehensive Medline search of the literature on pain insensitivity in subjects with schizophrenia was conducted. RESULTS While the literature contains anecdotal observations, case reports, and a few rigorous clinical studies concerning patients with schizophrenia being relatively indifferent to pain, there is a dearth of empirical, well-controlled studies in this area. Although early studies that examined the response of individuals with schizophrenia to thermal or electrical pain were constrained by a variety of methodological confounders, studies on this topic suggest that the higher pain thresholds observed in schizophrenia are best explained by a complex, multifactorial model. Most intriguing are the results of one recent study that found pain insensitivity in family members of persons with schizophrenia, suggesting that this phenomenon may be a trait or endophenotype rather than being due to a psychotic state. CONCLUSIONS Pain insensitivity in individuals with schizophrenia, which is associated with increased morbidity and mortality, is poorly understood. It is possible that pain insensitivity might serve as a prodromal predictor of susceptibility for schizophrenia. Future studies are needed to further clarify the neurobiology, pathophysiology, and practical clinical implications of this phenomenon.
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Affiliation(s)
- Manpreet K Singh
- University of Cincinnati College of Medicine and Cincinnati Children's Hospital Medical Center, 45267, USA
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Al Amin HA, Atweh SF, Jabbur SJ, Saadé NE. Effects of ventral hippocampal lesion on thermal and mechanical nociception in neonates and adult rats. Eur J Neurosci 2004; 20:3027-34. [PMID: 15579157 DOI: 10.1111/j.1460-9568.2004.03762.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The proper maturation of the hippocampus is essential for the development of different behaviours, including memory, pain responses and avoidance. The mechanisms involved in the neurodevelopment of nociception have also been implicated in several neuropsychiatric disorders. The neonatal lesion of the ventral hippocampus (VH) in rats, an animal model of schizophrenia, can be utilized to study the developmental neurobiology of animal behaviour. We examined the nociceptive responses in this animal model at different stages of development. Rat pups were lesioned at postnatal day 7 by injecting ibotenic acid into the VH bilaterally, and then tested for thermal and mechanical nociception at the age of 35, 65 and 180 days. The nociceptive tests used were the hot plate (HP), paw pressure (PP) and tail flick (TF) tests. Another group of adult rats had the same lesion in the VH and then underwent the same tests at 28, 56 and 168 days post-lesions. When compared with sham controls, the rats with neonatal VH lesion showed decreased latency for the HP and PP tests only after puberty. The TF test showed significant increase in latency for both groups at age 65 and 180 days. The adult rats with VH lesion showed no major changes over all periods of testing. These results suggest that early lesion of VH can alter the development of the neural mechanisms involved in the processing of thermal and mechanical nociception.
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Affiliation(s)
- Hassen A Al Amin
- Department of Psychiatry, Faculty of Medicine, American University of Beirut, Beirut, Lebanon.
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Bär KJ, Greiner W, Letsch A, Köbele R, Sauer H. Influence of gender and hemispheric lateralization on heat pain perception in major depression. J Psychiatr Res 2003; 37:345-53. [PMID: 12765857 DOI: 10.1016/s0022-3956(03)00051-7] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Increased incidence of clinical pain complaints from patients with major depression, as well as increased experimental pain thresholds have been reported. The basis of this phenomenon remains unclear, as well as its relation to medication, clinical recovery, gender and lateralization of hemispheric function. We aimed to further elucidate heat pain perception in depression applying a testing battery including assessment (on both arms) of warmth perception, heat pain perception and heat pain tolerance, and the jaw opening reflex (duration of ES2 component) as a putative indicator of descending pain inhibition. The battery was applied to 20 patients and 20 age- and sex-matched controls. Patients were assessed: on admission (acutely depressed, off-medication), few days after admission (depressed, on medication), and after clinical recovery (mostly on medication), and controls at corresponding intervals. Significant elevated heat pain thresholds were found off and on medication in the acute stage (mainly in women) and after recovery on the right arm only. Elevated heat pain tolerance (on the right arm only) was seen in medicated patients in the acute and recovered stage. Significant prolongation of ES2 duration was only found in acutely depressed patients off medication. While confirming hypalgesia to heat pain in major depression, our findings demonstrate a close relation to gender and strong influence of lateralization after recovery. Altered pain processing at brain stem level might only partially be responsible for the observed finding.
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Affiliation(s)
- K J Bär
- Department of Psychiatry, Friedrich-Schiller-University of Jena, Philosophenweg 3, 07743 Jena, Germany.
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Affiliation(s)
- Rachel Blumensohn
- Department of Adolescent Psychiatry, Ness-Ziona Psychiatric Hospital, Ness-Ziona, Israel
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Abstract
Historically, schizophrenics' body image problems were regarded as related particularly to delusions and hallucinations. However, during the 1980s, the predominant view of the phenomenology of the disorder broadened to include negative symptoms; deviations in schizophrenics' body image underlie various behaviors or allegations concerning the body and should be refocused. The present study attempted to detect body image deviations in chronic schizophrenia using the Body Image Questionnaire (BIQ), which comprises three hypothetical components (anatomical, functional and other psychological components), and to clarify their related clinical characteristics in symptoms and insight. The BIQ was administered to 93 chronic schizophrenics (diagnosed according to DSM IV; 44 men and 49 women) and 177 normals (78 men and 99 women) adults. The combined data of the three BIQ components in schizophrenic and normal subjects were factor-analyzed separately, and factor scores obtained were compared between schizophrenic and normal groups. The factor scores that differentiated groups were further compared between schizophrenic subgroups, determined by high or low scores for positive symptoms assessed by Scale for the Assessment of Positive Symptoms, negative symptoms by Scale for the Assessment of Negative Symptoms and insight by the Schedule for Assessing Insight. Significant differences between diagnostic groups were found in five of nine factor scores. Dullness in movement, powerlessness, unusually strong gastrointestinal function, lifelessness and fragility proved to be the deviated body images in chronic schizophrenic patients. Powerlessness and lifelessness proved to be related to positive and negative symptoms, and unusually strong gastrointestinal function and fragility to insight.
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Affiliation(s)
- Reiko Koide
- Department of Neurology, Institute of Clinical Medicine, Tsukuba University, Tsukuba-shi, Ibaraki-Ken, Japan.
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Levin TT, Barrett J, Mendelowitz A. Death from clozapine-induced constipation: case report and literature review. PSYCHOSOMATICS 2002; 43:71-3. [PMID: 11927763 DOI: 10.1176/appi.psy.43.1.71] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Tomer T Levin
- Department of Consultation-Liaison Psychiatry, Long Island Jewish Medical Center, 270-05 76th Avenue, Hyde Park, NY 11040, USA.
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49
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Abstract
The psychiatric literature contains anecdotal reports of diminished pain sensitivity in schizophrenia that date back to Kraepelin. Yet, the phenomenon of pain insensitivity in schizophrenia remains largely unstudied. For example, it is not clear if pain insensitivity is a consequence of the illness or if it is also present in the well relatives of schizophrenia patients. To explore this issue, we examined pain thresholds and pain tolerances in healthy young adults. Compared with controls with no family history of psychopathology (n=21), participants with a family history of schizophrenia (n=32) showed elevated pain thresholds and pain tolerances to finger pressure. Pain insensitivity was also significantly correlated with elevated scores on measures of self-referential thinking, magical ideation, and perceptual disturbances. Finally, a sizeable minority (19%) of well relatives of schizophrenia patients showed extreme pain insensitivity compared to other participants. The pattern of findings suggests that pain insensitivity may warrant further exploration as a potential marker of underlying liability to psychosis.
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Affiliation(s)
- J M Hooley
- Department of Psychology, Harvard University, 33 Kirkland Street, Cambridge, MA 02138, USA.
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50
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Kudoh A, Ishihara H, Matsuki A. Current Perception Thresholds and Postoperative Pain in Schizophrenic Patients. Reg Anesth Pain Med 2000. [DOI: 10.1097/00115550-200009000-00007] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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