First-Episode Schizophrenics Benefit From 2 Years of Maintenance Therapy

NEW YORK (Reuters Health) Jul 20 – Even when a year has passed since a first schizophrenia episode, maintenance therapy is better than intermittent drug treatment, according to results from a randomized trial in Germany.

Clinical practice guidelines already recommend antipsychotic maintenance treatment for at least a year after a first schizophrenia episode. “Based on our findings, patients should be advised to further maintain antipsychotic treatment for at least two years, given the otherwise noticeable higher risk for relapse,” lead author Dr. Wolfgang Gaebel from Heinrich-Heine-University, Duesseldorf, told Reuters Health by e-mail.

Dr. Gaebel and colleagues compared a second year of maintenance treatment versus stepwise drug discontinuation and targeted intermittent treatment in 44 patients who had already completed 12 months of antipsychotic therapy.

There were no relapses in the maintenance treatment group, compared with four relapses (19%) in 21 patients in the intermittent treatment group (p = 0.04), the researchers reported online June 29th in the Journal of Clinical Psychiatry.

Gene Protects Cognitive Function in Schizophrenia

Gene Protects Cognitive Function in SchizophreniaA gene has been found in some people with schizophrenia that can help protect cognitive ability.

While it may put individuals at risk for schizophrenia in the first place, schizophrenic patients with the at-risk gene performed better on certain tests of cognitive function than patients with a less risky variant of the same gene.

Dr. James T.R. Walters of the Medical Research Council for Neuropsychiatric Genetics and Genomics at Cardifff University in Wales, and his colleagues found preserved memory with a variation in the gene known as the Zinc Finger Protein 804A.

Prior research has implicated the Zinc Finger Protein 804A gene (ZNF804A) as a risk factor for schizophrenia. Alleles are different variations of the same gene, and one allele of the ZNF804A gene seems to be more commonly present in patients with psychiatric diagnoses such as schizophrenia and bipolar disorder. While its exact function remains elusive, some researchers suspect that the ZNF804A gene affects communication in the brain……

Reported by Jessica Ward Jones, MD, MPH Associate News Editor

Dr. Walter’s results can be found in the July issue of the Archives of General Psychiatry.

Submitted by Anna

‘Cuddle chemical’ eases symptoms of schizophrenia

NASAL sprays containing the hormone oxytocin, nicknamed the “cuddle chemical” because it helps mothers bond with their babies, have helped people with schizophrenia.

Although the 15 participants used the sprays for three weeks only, most reported measurable improvements in their symptoms in this the first trial to test oxytocin in schizophrenia. “It’s proof of concept that there’s therapeutic potential here,” says David Feifel at the University of California in San Diego, head of the team running the trial.

Each participant received oxytocin or a placebo for three weeks, then the opposite treatment for three weeks with a week break in between.

On the basis of two standard tests for schizophrenia, taken before and after each block of treatment, participants averaged improvements of around 8 per cent when taking the oxytocin compared with the placebo (Biological Psychiatry, DOI: 10.1016/j.biopsych.2010.04.039).

Reported by Andy Coghlan
NewScientist Health

submitted by Anna

Dream Team Plans a Blitz on Schizophrenia

Three top neuroscientists are betting big money and their scientific careers on a new approach to studying schizophrenia and other psychiatric diseases. With help from philanthropists, they are launching an institute that will look for treatments by probing early brain development for the origins of mental illness. The nonprofit Lieber Institute for Brain Development will be led by Daniel Weinberger of the National Institute of Mental Health. Ronald McKay of the National Institute of Neurological Disorders and Stroke will be director of basic science. Both will leave government jobs for the new institute, which will be an independent affiliate of the adjacent Johns Hopkins University. The institute’s third founder and elder statesman is Johns Hopkins neuropharmacologist Solomon Snyder. ……

Reported by Jocelyn Kaiser
Science 9 July 2010:
Vol. 329. no. 5988, p. 130

Submitted by Anna

Adding Electroconvulsive Therapy to Clozapine Improves Drug-Resistant Schizophrenia

Adding electroconvulsive therapy (ECT) to clozapine is an effective treatment for patients with clozapine-resistant schizophrenia, researchers reported at the New Clinical Drug Evaluation Unit 50th Anniversary Meeting.

Clozapine is the drug of last resort for patients with treatment-resistant schizophrenia, but up to 70% of patients do not respond, said lead study author Georgios Petrides, MD, from the Zucker Hillside Hospital, Northshore-Long Island Jewish Health System, Glen Oaks, New York.

“We had nothing that works for these patients. They had failed every medication, and they were on clozapine and even then they had psychotic symptoms,” Dr. Petrides told Medscape Psychiatry. “ECT worked before the advent of medications, but we really didn’t have good studies to prove that it did. This is the first ECT study to be done in this population.”

Reported by Fran Lowry
Medscape Medical News

Submitted by Anna

Premature Mortality Linked With Serious Mental Illness

Patients with serious and persistent mental illness have significantly more years of potential life lost (YPLL) than do those without the disorders, according to a new retrospective study.

Although suicide, cancer, accidents, liver disease, and septicemia all contributed to increased premature mortality in the study’s mentally ill participants compared with a general population sample, the leading cause of death for both groups was heart disease, according to the researchers.

“We found that a community-based sample of adults with severe and persistent mental illness lost 14.5 years of potential life, a difference of 4.2 years from the [control] sample,” write lead study author Elizabeth E. Piatt, PhD, from the Department of Behavioral and Community Health Sciences at Northeastern Ohio Universities Colleges of Medicine and Pharmacy in Rootstown, and colleagues.

Reported by Deborah Brauser
Medscape Medical News

Publish in Psychiatr Serv. 2010;61:663-668.

Submitted Anna

Valproic Acid in Pregnancy Linked to Several Congenital Malformations

A new study confirms that first-trimester exposure to valproic acid is associated with an increased risk for spina bifida compared with no use of antiepileptic drugs or with use of other antiepileptic drugs.

The study also links first-trimester valproic acid exposure to increased risk for 5 other congenital malformations: atrial septal defect, cleft palate, hypospadias, polydactyly, and craniosynostosis.

Reoported Megan Brooks
CME Author: Désirée Lie, MD, MSEd
Medscape Clinical Briefs

submitted by Anna

Antidepressant Use During Pregnancy May Increase Miscarriage Risk

Pregnant women who use antidepressants have a 68% increased risk of miscarriage compared with those who do not take the medications, according to results from a new case-control study.

Reported by Deborah Brauser
CME Author: Désirée Lie, MD, MSEd
Medscape Clinical Briefs

submitted by Anna

Schizophrenia-Related Brain Abnormalities Seen in At-Risk Neonates

Results of a new study provide the first evidence that early neonatal brain development may be abnormal in males at increased genetic risk for schizophrenia, the researchers say.

Limitations of Study

The relatively small number of study subjects, which had 0.8 power to detect differences in gray matter volume of about 10%, is 1 limitation of the study.

The fact that most of the mothers of the high-risk infants took antipsychotics during pregnancy is another. Studies in nonhuman primates suggest that long-term antipsychotic exposure can affect cortical gray matter volume.

Mothers of high-risk infants were also more likely to have smoked tobacco or used illicit substances while pregnant, which could have confounded the results. Although there were no differences in volumes between the high-risk neonates exposed to maternal smoking and those not exposed.

Reported by Megan Brooks
Medscape Medical News

Study Published in Am J Psychiatry. Published online June 1, 2010.

Submitted by Anna