Association between schizophrenia and periodontal disease in relation to cortisol levels: an ELISA-based descriptive analysis

Background Schizophrenia is a chronic psychosis marked by multiple bioenvironmental and immunological dysregulation with its intricate role in etiopathogenesis of periodontal disease remaining unclear. Hence, the aim of this study is to determine the association between periodontal disease and schizophrenia in relation with cortisol levels. Methods The study is in descriptive design comprised of 40 subjects randomly selected (20 schizophrenic patients as Group A and 20 healthy volunteers as group B). All the study participants underwent complete periodontal examination including scoring of gingival index (GI), plaque index (PI), Probing depths (PD) and clinical attachment loss (CAL). Salivary cortisol levels are estimated using ELISA. Link between schizophrenia and periodontal disease is described in relation to cortisol levels with elimination of other shared risk factors, such as tobacco smoking and xerostomia. Results Significant higher values of periodontal parameters are observed in Group A with schizophrenic patients (GI 2.467 ± 0.528; PI 2.402 ± 0.526; PD 2.854 ± 0.865; CAL 1.726 ± 3.096) than Group B with healthy subjects (GI 0.355 ± 0.561; PI 0.475 ± 0.678; PD 1.493 ± 0.744; CAL 0.108 ± 0.254). However, cortisol levels are lower in schizophrenic group (0.190 ± 0.059) than non-schizophrenic group (0.590 ± 0.228) ruling out the possible role of cortisol in periodontal disease severity associated with schizophrenic patients. Conclusion Findings of this study, provides ground evidence for consideration of schizophrenia as a risk factor for periodontitis and demands greater emphasis on management of schizophrenic patients in dental setting similar to other comorbid disorders such as diabetes mellitus and also incorporating periodontal care measures in the clinical guidelines for schizophrenia management.

Brain-Specific Oxysterols and Risk of Schizophrenia in Clinical High-Risk Subjects and Patients With Schizophrenia

Accumulating evidence from clinical, genetic, and epidemiologic studies suggest that schizophrenia might be a neuronal development disorder. While oxysterols are important factors in neurodevelopment, it is unknown whether oxysterols might be involved in development of schizophrenia. The present study investigated the relationship between tissue-specifically originated oxysterols and risk of schizophrenia. A total of 216 individuals were recruited in this study, including 76 schizophrenia patients, 39 clinical high-risk (CHR) subjects, and 101 healthy controls (HC). We investigated the circulating levels of brain-specific oxysterol 24(S)-hydroxycholesterol (24OHC) and peripheral oxysterol 27-hydroxycholesterol (27OHC) in all participants and analyzed the potential links between the oxysterols and specific clinical symptoms in schizophrenic patients and CHR. Our data showed an elevation of 24OHC in both schizophrenia patients and CHR than that in HC, while a lower level of 27OHC in the schizophrenia group only. The ratio of 24OHC to 27OHC was only increased in the schizophrenic group compared with CHR and HC. For the schizophrenic patients, the circulating 24OHC levels are significantly associated with disease duration, positively correlated with the positive and negative syndrome total scores, while the 27OHC levels were inversely correlated with the positive symptom scores. Together, our data demonstrated the disruption of tissue-specifically originated cholesterol metabolism in schizophrenia and CHR, suggesting the circulating 24OHC or 24OHC/27OHC ratio might not only be a potential indicator for risk for schizophrenia but also be biomarkers for functional abnormalities in neuropathology of schizophrenia.

Multidimensionality in Executive Function Profiles in Schizophrenia: A Computational Approach Using the Wisconsin Card Sorting Task

Deficits in executive functions (EF) are frequently implicated in the aetiology of schizophrenia. However, no consensus exists regarding the contribution of EF to the dysfunctions observed in these individuals, with competing accounts arguing a primary role for deficits in inhibition, shifting and updating. We examine an alternative proposal referred to as the multidimensional hypothesis – rather than performance on cognitive tasks being primarily dependent on a single EF, the performance is multiply realised by a range of uneven EF profiles. We describe a computational approach, using the WCST, that allows manipulations to ability levels of processes relating to each EF component to be explicitly assessed. Our central objective is to determine whether models exhibiting unique profiles of EF abilities may simulate the performance of three target groups: individuals with schizophrenia, healthy first–degree relatives, and controls. For each target group, we show that of the performance measures yielded by the WCST, perseverative errors (PE; commonly assumed to rely heavily on EF) are simulated by multiple models. For a range of secondary measures (cards sorted, categories completed and non-perseverative errors; assumed less specific to EF abilities) our manipulations show little resemblance to the target groups. We view these results to support the multidimensional hypothesis, in that (1) no single EF process accounts for the poorer performance of the schizophrenic group, and (2) performance of PE in the target groups is achieved in models of diverse EF profiles. The implications of these findings for the study of EF in neuropsychological disorders are discussed

Early Repolarization Pattern is Associated with Schizophrenia: A Single Center Experience in Japan

Introduction Recent studies have shown a high frequency of abnormal electrocardiograms in patients with schizophrenia. The objective of this study was to associate schizophrenia diagnoses with early repolarization patterns in a sample of hospitalized patients from a single hospital in Japan. Methods We conducted a retrospective age, sex and coronary risk factors matched case-control study on 85 patients with schizophrenia and 89 controls from medical checkups. First, we compared the presence of early repolarization patterns in both groups. Secondly, we elucidated an association between the presence of an early repolarization pattern and clinical findings in the patients' groups. We also evaluated J-point elevation patterns. Results As a result, we found that both early repolarization patterns and J-point elevation patterns observed were significantly higher in the schizophrenic group than in the matched control group (early repolarization pattern 23;6 P < 0.001; J-point elevation pattern 34:12; P = 0.001). After multivariable logistic regression among the patients and controls, schizophrenia was the independent predictor for early repolarization pattern (P = 0.001) and J-point elevation (P < 0.001). Among the patients, the independent predictor for early repolarization pattern was psychiatric family history (P = 0.006), while older age (P = 0.038) and psychiatric family history (P = 0.014) were predictors for J-point elevation patterns. Conclusion These findings suggest that an association between early repolarization pattern or J-point elevation pattern and schizophrenia in a single Japanese center.

ELEVATED UNCONJUGATED BILIRUBIN IN SCHIZOPHRENIC PATIENTS

Strategies for schizophrenic treatment still have been developed in order to increase their effectively, based on latest findings in the etio-pathology. Coincidence of hyperbilirubinemia, especially related to Gilbert’s Syndrome (GS), and schizophrenia/other psychiatric disorders, was reported in several studies although the pattern of this alteration is still controversial. Bilirubin could induce microglia to release pro-inflammatory cytokine that cause neuroinflammation, one of hypothetic etio-pathogenesis has been the most extensively studied recently. However, no data have been presented about this phenomenon in Indonesia. Therefore, this study aims to investigate plasma bilirubin concentration in psychotic spectrum.This study is cross sectional design that we examined both the total bilirubin and direct bilirubin of every psychotic patient admitted for the first time to Rumah Sakit Khusus Daerah (RSKD) Provinsi Sulawesi Selatan over a period of July—December 2012, by using health people as control. Diagnostic determination was set based on International Classification of Diseases (ICD) 10. Patients suffering from any disease such as anemia (decreased hemoglobin), liver diseases (elevated liver enzymes), or substance abuse were excluded. From 73 samples, we found that plasma UCB level was significantly elevated, higher in psychotic patients, especially schizophrenic group, than in the control. Total bilirubin rate was slightly increased in schizophrenic group compare to the others and two samples in this group showed hyperbilirubinemia. Further investigations are needed to ensure that whether the elevated UCB was related to GS and whether this condition has inflammatory effect.

Comparisons of psychological characteristics between schizophrenia, bipolar disorder and depressive disorder patients

Introduction and objectivesThis study was conducted to examine the psychological characteristics of the schizophrenia (n = 20), bipolar disorder (n = 20) and depressive disorder (n = 13) patients on MMPI-2 and Rorschach responses.MethodsMMPI-2 and Rorschach was individually administered to all patients, and their Rorschach responses were scored by Exner's comprehensive scoring system. The means of T scores of MMPI-2 subscales and Rorschach scores were compared among the three groups.ResultsThe schizophrenic and bipolar disorder groups showed significantly higher scores on the MMPI-2 K scale than the depressive group, while the depressive group showed significantly higher score on MMPI-2 Si scale than the schizophrenic and bipolar groups. In Rorschach responses, the bipolar and depressive groups obtained significantly higher scores on two variables (FM + m, m) than the schizophrenic group. The bipolar group obtained significantly higher scores on three variables (es, CP, a), suggesting hyperactivity and mood dysregulation.ConclusionsThese results suggested that patients with depressive disorder might subjectively suffer from more severe emotional and social discomfort than patients with the schizophrenia and bipolar disorder, while patients with bipolar disorder and schizophrenia would be more defensive than the depressive patients.Disclosure of interestThe author has not supplied his/her declaration of competing interest.

Randomization and resilience of brain functional networks as systems-level endophenotypes of schizophrenia

Schizophrenia is increasingly conceived as a disorder of brain network organization or dysconnectivity syndrome. Functional MRI (fMRI) networks in schizophrenia have been characterized by abnormally random topology. We tested the hypothesis that network randomization is an endophenotype of schizophrenia and therefore evident also in nonpsychotic relatives of patients. Head movement-corrected, resting-state fMRI data were acquired from 25 patients with schizophrenia, 25 first-degree relatives of patients, and 29 healthy volunteers. Graphs were used to model functional connectivity as a set of edges between regional nodes. We estimated the topological efficiency, clustering, degree distribution, resilience, and connection distance (in millimeters) of each functional network. The schizophrenic group demonstrated significant randomization of global network metrics (reduced clustering, greater efficiency), a shift in the degree distribution to a more homogeneous form (fewer hubs), a shift in the distance distribution (proportionally more long-distance edges), and greater resilience to targeted attack on network hubs. The networks of the relatives also demonstrated abnormal randomization and resilience compared with healthy volunteers, but they were typically less topologically abnormal than the patients’ networks and did not have abnormal connection distances. We conclude that schizophrenia is associated with replicable and convergent evidence for functional network randomization, and a similar topological profile was evident also in nonpsychotic relatives, suggesting that this is a systems-level endophenotype or marker of familial risk. We speculate that the greater resilience of brain networks may confer some fitness advantages on nonpsychotic relatives that could explain persistence of this endophenotype in the population.

High Order Linguistic Features Such as Ambiguity Processing as Relevant Diagnostic Markers for Schizophrenia

Due to the deficits of schizophrenic patients regarding the understanding of vague meanings (D. Ketteler and S. Ketteler (2010)) we develop a special test battery called HOLF (high order linguistic function test), which should be able to detect subtle linguistic performance deficits in schizophrenic patients. HOLF was presented to 40 schizophrenic patients and controls, focussing on linguistic features such as ambiguity, synonymy, hypero-/hyponymy, antinomy, and adages. Using the HOLF test battery we found that schizophrenic patients showed significant difficulties in discriminating ambiguities, hypero- and hyponymy, or synonymy compared to healthy controls. Antonyms and adages showed less significant results in comparing both groups. The more difficult a linguistic task was, the more confusion was measured in the schizophrenic group while healthy controls did not show significant problems in processing high order language tasks.

Polysomnographic parameters as a differentiating biological marker between severe depression and schizophrenia

Background and aimDifferentiation between Severe major depression and schizophrenia is oftenly a problematic issue, whether due to resemblance between negative symptoms of schizophrenia and depressive symptoms or due to presence of psychotic features with psychiatrists subjective assessment of the volume of psychotic features in relation to the whole illness. Our aim is to assess the utility of polysomnography as a differentiating tool that may add diagnostic value.Subjects and methodsPatients were recruited randomly from the outpatient service at Alexandria University Hospital, 20 patients with severe major depression with or without psychotic features and 20 patients with schizophrenia. Diagnosis done in accordance with criteria of DSM IV-TR. Only patients scoring above 4 on the Clinical Global Impression scale for severity were recruited. Polysomnography was done to all patients while at least 1 week off medication.ResultsDepressed group showed a significantly shorter REM latency (26 ± 6.9min) and higher REM intensity (34 ± 14%) compared to schizophrenic group with REM latency (43.9 ± 16.9 min) and REM Intensity (21.4 ± 4.5). On the other hand deep sleep phases 3 and 4 constituted 12 ± 3.8% and 17.8 ± 9.2% of sleep in schizophrenic group compared to 16.4 ± 5% and 9 ± 7.9% in depressed group respectively with significant difference.ConclusionPolysomnography may be of benefit as a diagnostic differentiating tool between schizophrenia and severe Major depression.