Schizophrenia and Hospital Admissions for Cardiovascular Events in a Large Population: The APNA Study

(1) Background: Patients with schizophrenia have higher mortality, with cardiovascular diseases being the first cause of mortality. This study aims to estimate the excess risk of hospital admission for cardiovascular events in schizophrenic patients, adjusting for comorbidity and risk factors. (2) Methods: The APNA study is a dynamic prospective cohort of all residents in Navarra, Spain. A total of 505,889 people over 18 years old were followed for five years. The endpoint was hospital admissions for a cardiovascular event. Direct Acyclic Graphs (DAG) and Cox regression were used. (3) Results: Schizophrenic patients had a Hazard Ratio (HR) of 1.414 (95% CI 1.031–1.938) of hospital admission for a cardiovascular event after adjusting for age, sex, hypertension, type 2 diabetes, dyslipidemia, smoking, low income, obesity, antecedents of cardiovascular disease, and smoking. In non-adherent to antipsychotic treatment schizophrenia patients, the HR was 2.232 (95% CI 1.267–3.933). (4) Conclusions: Patients with schizophrenia have a higher risk of hospital admission for cardiovascular events than persons with the same risk factors without schizophrenia. Primary care nursing interventions should monitor these patients and reduce cardiovascular risk factors.

Effect of Antipsychotic Treatment on Neutrophil-to-Lymphocyte Ratio during Hospitalization for Acute Psychosis in the Course of Schizophrenia—A Cross-Sectional Retrospective Study

Background: Studies have shown that there are deviations in the results of peripheral blood counts, which lead to increased values of the neutrophils-to-lymphocytes ratio (NLR) in schizophrenia. Antipsychotic drugs have proven to lower the levels of pro-inflammatory cytokines and a growing number of studies indicate a similar effect on NLR values. Methods: We identified inpatients with schizophrenia and collected data of NLR at the beginning (NLR1) and end (NLR2) of hospitalization, the status of antipsychotic medication on admission and potential confounding factors. In the statistical analysis, we applied a linear mixed model. Results: After the inclusion and exclusion process the records of 40 patients (np = 40) and 71 hospitalizations (nh = 71) were analyzed. We found that in the group of antipsychotics-naive patients, the NLR1 were significantly higher than the NLR2 values. Such a difference did not occur in the case of non-antipsychotics-naïve patients. Age and the diagnosis of hypothyroidism influenced the value of change in NLR from the beginning to the end of hospitalization in a given patient (ΔNLR). Conclusions: The study confirmed the lowering effect of antipsychotics on NLR values in psychosis. The NLR may potentially be a tool for assessing response to treatment with antipsychotics.

Schizophrenia and Hospital Admissions for Cardiovascular Events in a Large Population. The APNA Study

(1) Background: Patients with schizophrenia have higher mortality, with cardiovascular diseases being the first cause of mortality. This study aims to estimate the excess risk of hospital admission for cardiovascular events in schizophrenic patients, adjusting for comorbidity and risk factors. (2) Methods: The APNA study is a dynamic prospective cohort of all residents in Navarra, Spain. 505889 people over 18 years were followed for five years. The endpoint was hospital admissions for a cardiovascular event. Direct Acyclic Graphs (DAG) and Cox regression were used. (3) Results: Schizophrenic patients had a Hazard Ratio (HR) of 1.414 (95% CI 1.031-1.938) of hospital admission for a cardiovascular event after adjusting for age, sex, hypertension, type 2 diabetes, dyslipidemia, smoking, low income, obesity, antecedents of cardiovascular disease, and smoking. In non-adherent to antipsychotic treatment schizophrenia patients, the HR was 2.232 (95% CI 1.267-3.933). (4) Conclusions: Patients with schizophrenia have a higher risk of hospital admission for cardiovascular events than persons with the same risk factors without schizophrenia. Primary care nursing interventions should monitor these patients and reduce cardiovascular risk factors.

Atypical Antipsychotics Mediate Dynamics of Intrinsic Brain Activity in Early-Stage Schizophrenia? A Preliminary Study

Objective Abnormalities of static brain activity have been reported in schizophrenia, but it remains to be clarified the temporal variability of intrinsic brain activities in schizophrenia and how atypical antipsychotics affect it.Methods We employed a resting-state functional magnetic resonance imaging (rs-fMRI) and a sliding-window analysis of dynamic amplitude of low-frequency fluctuation (dALFF) to evaluate the dynamic brain activities in schizophrenia (SZ) patients before and after 8-week antipsychotic treatment. Twenty-six schizophrenia individuals and 26 matched healthy controls (HC) were included in this study.Results Compared with HC, SZ showed stronger dALFF in the right inferior temporal gyrus (ITG.R) at baseline. After medication, the SZ group exhibited reduced dALFF in the right middle occipital gyrus (MOG.R) and increased dALFF in the left superior frontal gyrus (SFG.L), right middle frontal gyrus (MFG.R), and right inferior parietal lobule (IPL.R). Dynamic ALFF in IPL.R was found to significant negative correlate with the Scale for the Assessment of Negative Symptoms (SANS) scores at baseline.Conclusion Our results showed dynamic intrinsic brain activities altered in schizophrenia after short term antipsychotic treatment. The findings of this study support and expand the application of dALFF method in the study of the pathological mechanism in psychosis in the future.

Twenty-Four Week, Randomized, Double-Blind, Placebo-Controlled Trial of Metformin for Antipsychotic-Induced Weight Gain in Patients with First-Episode Psychosis: A Pilot Study

Excessive weight gain and cardiometabolic dysfunction are common and clinically relevant side effects of antipsychotic medications. In this pilot study, we aimed to establish the feasibility of using metformin and its effectiveness in managing antipsychotic-induced weight gain in patients with first-episode psychosis (FEP) on follow-up with the Singapore Early Psychosis Intervention Programme in a 24-week, randomized, double-blind, placebo-controlled trial, to ascertain the effects of metformin discontinuation on body weight and evaluate the safety and tolerability of metformin. Participants between the ages of 16 and 40 with FEP assessed as clinically stable and who had gained ≥5% of their pre-drug weight after initiation of the antipsychotic treatment were recruited from outpatient clinics between April 2015 and April 2018. Seventeen participants met all the inclusion criteria and were randomized to receive metformin (n = 8) or the placebo (n = 9) at Week 0, with follow up assessments at Weeks 3, 6, 12, 24, and 36. Metformin was generally well-tolerated. Participants in the metformin arm were able to control their weight better than participants receiving the placebo, an effect that did not persist after discontinuation. Our results support the use of metformin as a safe and tolerable weight control measure in a typical outpatient sample of young people with FEP.

Sexual Dysfunction in Schizophrenia: A Narrative Review of the Mechanisms and Clinical Considerations

Psychiatric disorders, in general, have a high prevalence of sexual problems, whether from the psychopathology of the disorder itself, pre-existing or co-morbid sexual disorder or from side effects of the treatment for mental disorders. Many patients report an already existing sexual dysfunction at the onset of diagnosis. The risk association for developing sexual dysfunction in patients with schizophrenia includes antipsychotic use and resulting hyperprolactinemia, age, gender, and disease severity. Medication side effects lead to nonadherence, and relapses lead to structural changes in the brain, treatment resistance, and worsening of symptoms. Findings in certain studies propose serum prolactin and thyroid-stimulating hormone measurement as a tool for assessing patients with schizophrenia for sexual dysfunction. Regarding specific symptoms, females especially reported decreased desire at baseline and galactorrhea after treatment. The findings of this review, therefore, suggest that sexual dysfunction may be present in patients with schizophrenia before starting antipsychotic treatment and that patients, especially those who are female, are likely to develop hyperprolactinemia with antipsychotic treatment. Aripiprazole may be an emergent treatment for sexual dysfunction in those who use antipsychotics. It is important for patients to consider sexual dysfunction prior to prescribing antipsychotics. Since sexual dysfunction can impact a patient’s quality of life and affect treatment adherence, it is important for physicians to be aware and monitor patients for symptoms.

Metabolic Syndrome in a Population of In-Patients with Schizophrenia in the Western Siberia

Background. The relevance of this work is due to the incomplete nature of existing studies on risk factors of metabolic syndrome (MS) in patients with schizophrenia. Aim: to study the MS prevalence in schizophrenia in-patients and their clinical, therapeutic and socio-demographic features. Patients and methods: 517 in-patients diagnosed with schizophrenia according to the ICD-10 criteria were examined. All patients underwent a structured clinical interview (SCID); measurement of waist circumference, blood pressure and assessment of biochemical parameters for verification of MS based on the criteria of the IDF (International Diabetes Fediration). An assessment of the severity of clinical and psychopathological symptoms was performed using the PANSS. Results: the prevalence of MS in in-patients with schizophrenia in the Western Siberia is similar to that reported in the literature. It was found that in-patients with schizophrenia and MS are characterized by a predominance of women and older age, as well as a large proportion of divorced, and a smaller proportion of never married. Women with MS were older, got longer duration of illness, and got later onset of disease than men with MS. The age of disease onset was significantly greater in patients with MS than in patients without MS. Atypical antipsychotics were more often used as the basic antipsychotic treatment in the group of patients with MS but this difference between the groups did not reach statistical significance. Conclusions: the main risk factors in patients with schizophrenia and MS coincide with risk factors of MS in general population. A later onset of the disease can act as an independent risk factor. The relationship and mutual influence of risk factors for the development of MS in patients with schizophrenia needs further study.