- Email: [email protected]
P.3.b.037 Convergence insufficiency in schizophrenia and its relationship with cerebellar symptoms
S512
P.3.b. Psychotic disorders and treatment − Psychotic disorders (clinical)
haloperidol and benzodiazepines are the most widely used medications. Antipsychotics, which were applied by a small portion of Hungarian clinicans are also used in some countries. The same study presents that in international settings the use of lorazepam is most widespread in the emergency care of agitated psychotic patients. In Hungary the lack of parenteral form of lorazepam limits its use in emergency cases so the clonazepam is the most widely used medication among these circumstances. The international survey including 21 countries indicate that three countries (India, Romania, Slovenia) regularly use intravenous medications, whereas others do not prefer this mode of medication only the intramuscular therapy. Hungarian clinicians disagree on mode of administration, but the majority would prefer intravenous therapy. References [1] Cunnane JG. (1994) Drug management of disturbed behavior by psychiatrist. Psychiatric Bulletin 18, 138–139. [2] Lepping, P. (2013) The use of emergency psychiatric medication: a survey from 21 countries. J Clin Psychopharmacol, 33:240−2.
P.3.b.036 The psychometric properties of the Night Eating Questionnaire in Korean schizophrenic outpatients B.H. Yoon1 ° , W.M. Bahk2 , J.H. Song1 , Y.H. Sea1 , S.H. Nam1 , S.H. Park1 1 Naju National Hospital, Department of Psychiatry, Naju, South-Korea; 2 The Catholic University of Korea, Department of Psychiatry, Seoul, South-Korea Objective: The Night Eating Syndrome (NES) was first described in 1955 as a stress-related eating disorder consisting of morning anorexia, evening hyperphagia, and insomnia. The presence of nocturnal ingestions (awakening to eat) was added to these criteria later. Prevalence of NES have reported in the following groups: 1.5% of general population, 12.3 among an outpatient psychiatric population, and 3.8% among a type 2 diabetes. The range of prevalence of NES can be attributed to differing diagnostic criteria and different assessment techniques. The purpose of this study was to evaluate psychometric properties of the Night Eating Questionnaire (NEQ) as a measure of the Night Eating Syndrome in schizophrenic outpatients. Methods: The translated and counter-translated Korean version of NEQ was developed. The participants who completed the NEQ were outpatient schizophrenic patients. They were passed through eligible criteria which the authors developed. This study was approved by the Naju National Hospital’s Institutional Review Board (IRB). Participants were informed that their responses would be used in research and also written informed consent was granted by participants. The behavioral and psychological symptoms of NES were assessed with the 14-item self-reported questionnaire (NEQ). The NEQ total score was calculated by reverse coding items 1, 4, and 14, and summing items, except item 13. Item 13 does not assess a degree of NES symptomatology; rather, it is included in the questionnaire as a rule out for sleep-related eating disorder. The NEQ total score provided a range from 0 to 52 points. Body weight and height were measured to assess the body mass index (BMI). The authors completed following tests to find out some correlations between NES and other clinical characteristics. Subjective estimates of depression, binge eating patterns, sleep quality and weight-related quality of life were evaluated using Beck’s Depression Inventory (BDI), Binge Eating
Scale (BES), Pittsburgh Sleep Quality Index (PSQI) and Korean version of Obesity-related Quality of Life scale (KOQoL). Results: Among 223 schizophrenic outpatients who completed the NEQ, 25 (11.2%) patients screened as having NES (total NEQ >25 as the original authors’ criteria). NEQ demonstrated high internal consistency (Cronbach’s alpha=0.74) and item-total correlations (r = 0.29–0.75; p < 0.001, respectively) were acceptable except morning anorexia by reliability. Principal components analysis revealed the presence of four factors (nocturnal ingestions, evening hyperphagia, mood/sleep, and morning anorexia), explaining 56.8% of total variance. Although total score of NEQ was not correlated with BMI, age at onset, duration of illness, use of atypical antipsychotics, it was significantly correlated with total scores of BDI, BES, PSQI and KOQoL. Test-retest reliability which retest was done after 2 weeks from the first test was also good (r = 0.74, p < 0.001). Conclusion: Our results showed that NEQ appears to be an efficient, valid measure of NES in Korean schizophrenic outpatients. It was also revealed that relatively high percentage of schizophrenic patients may have NES. References [1] Allison KC, Lundgre JD, Reardon JP, Martino NS, Sarwer DB, Wadden TA, et al. The Night Eating Questionnaire (NEQ): Psychometric properties of a measure of severity of the Night Eating Syndrome. Eating Behaviors 2008; 9: 62−72.
P.3.b.037 Convergence insufficiency in schizophrenia and its relationship with cerebellar symptoms A. Chrobak1 ° , G. Siwek1 , K. Siuda1 , M. Siwek2 , A. Arciszewska2 , M.W. Pilecki3 , D. Dudek2 1 Jagiellonian University, Students’ Scientific Association of Affective Disorders, Krak´ow, Poland; 2 Jagiellonian University, Department of Affective Disorders, Krak´ow, Poland; 3 Jagiellonian University, Department of Psychiatry, Krak´ow, Poland Purpose: Schizophrenia (SZ) is associated with numerous neurological deficits reflected by gait imbalance, tremor and ataxia. Growing number of research indicates that SZ patients and their unaffected relatives present various oculomotor dysfunctions, most prominently in smooth pursuit and saccadic eye movement. While mentioned oculomotor deficits have been widely explored, no data concerning vergence abnormalities have been found. During our research we have noticed a group of patients presenting striking pattern of convergence insufficiency (unilateral exophoria at near). The purpose of our study was to evaluate incidence of this symptom in SZ patients and to validate its association with other neurological disturbances included in cerebellar ataxia scales. Method: In our study, we included 32 patients meeting DSM-V diagnostic criteria for schizophrenia and 23 healthy controls (HC). SZ patients were treated with antipsychotic drugs from group of dibenzoxazpine (olanzapine, clozapine and quetiapine). Groups were matched for age, gender and ethnicity. Subjects were assessed using International Cooperative Ataxia Rating Scale (ICARS), consisting of four major parts: gait and posture, kinetic functions, dysarthria and oculomotor. Clinical convergence assessment was performed by instructing subjects to follow the cup of a pen with their eyes as it is moved toward the nose. This examination divided patients with SZ into 2 groups − with and without symptom.
P.3.b. Psychotic disorders and treatment − Psychotic disorders (clinical) Results: Incidence of convergence insufficiency was significantly higher in SZ group (14 of 32, 43.75%) than in HC (1 of 22, 1.82%, p = 0.001).Compared to HC, patients with schizophrenia also revealed significantly higher ICARS subscores: posture (p = 0.017), kinetic (p < 0.001), dysarthria (p < 0.01), oculomotor (p < 0.001) as well as total score (p < 0.001). SZ patients with symptom presented significantly higher oculomotor subscore (with symptom x = 2.50, without x = 1.27, p = 0.04) than SZ patients without the symptom. Conclusions: To our best knowledge, there has been no previous study concerning unilateral exophoria in schizophrenia. Observed symptom occurred significantly more often in SZ patients, and was accompanied with ataxia-related neurological deficits. Since only oculomotor subscore differences reached statistical significance, the specificity of this syndrome for SZ patients may be associated with widely described eye movement deficits in SZ, as the vergence and the smooth pursuit are considered to have a common biological background. This phenomenon may be explained by deterioration of the midbrain, cortico-pontocerebellar pathways including cerebellar nuclei (fastigal nucleus). Our findings seem to be coherent with Andreasen theory of cognitive dysmetria, where cerebellum and cerebello-cortical tracts dysfunctions are hypothesized to be involved in pathogenesis of schizophrenia. The limitation of our study was lack of neuroleptic naive group, however atypical antipsychotics were selected due to their minimal effect on motor performance of our patients. Assessment of this symptom is short and applicable in everyday practice and it could be used in order to differentiate patients with higher rate of eye movement deficits.
P.3.b.038 Prevalence of metabolic syndrome in psychotic patients treated with antipsychotics B. Ferreiro Fernandez1 ° , M.C. Garc´ıa Mah´ıa1 , M. Vidal Millares2 Universitario a Coru˜na, Psychiatry, La Coru˜na, Spain; 2 Hospital Universitario Santiago de Compostela, Psychiatry, Santiago de Compostela, Spain
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Patients were classified according to man diagnosis in four groups: schizophrenia, affective psychosis, paranoid disorders and other functional psychosis. Variables analyzed were age, sex, number of hospitalizations, main diagnose, type and dose of currently administered antipsychotics; use of concomitant medication; and diagnosis and treatment of diabetes, hypertension, and/or dyslipidemia. Data were analyzed with statistical package v. 19.0 for windows. Results: From the whole sample 58.9% were male and 41.1% were female, age average 31 years (standard deviation 7.9) years. Comparison of the mean disease duration of the men (15.3±6.9 years) and women (11.5±9.7 years) indicated that there was no significant difference between them. Among all subjects, 12.6% were found to have diabetes, 36.5% hypertension, 72.0% dyslipidemia, and 46.1% central obesity. The frequency of these disorders did not presented significant differences between female and male. However, central obesity rate was higher in women than in men and age influence was detected in diabetes. Schizophrenic group presented higher rate of metabolic syndrome than other groups analyzed, with statistical significance. Metabolic syndrome was more frequent in patients treated with two or more antipsychotics compared to patients with monotherapy and in patients treated with atypical antipsychotics compared to patients with classic antipsychotics. Psychotic patients treated with injectable long acting antipsychotics presented similar rates of metabolic syndrome in comparison to patients treated with oral formulations of antipsychotics. Conclusions: Patients with psychotic disorders have high prevalence of metabolic syndrome. Psychiatric treatment facilities should offer and promote healthy lifestyle intervention early in the course of disease aiming to prevent serious metabolic adverse effects. Awareness of these aspects should be increased among primary healthcare providers and specialists, and physical health problems should be incorporated into psycho-educational programs.
1 Hospital
Introduction: Previous studies show that patients with schizophrenia and bipolar disorders have high levels of medical comorbidity and cardiovascular risk factors. The presence of 3 or more specific factors is indicative of metabolic syndrome, which is a significant factor in future morbidity and mortality. Objectives: To examine the prevalence of metabolic syndrome and its risk factors in patients diagnosed of psychotic illness and included in Diagnostic Related Group (DRG) 430 that were treated with antipsychotics. Methods: Retrospective descriptive study of psychiatric patients with psychosis (N = 126). Patients included in this study were recruited from two clinical settings. One group was obtained from a randomized sample of patients hospitalized in a psychiatric hospital in Santiago de Compostela in a period of two years (n = 60) and another group (n = 66) from ambulatory care. Data were obtained from clinical records. Inclusion criteria were age 18−65 years, continuous use of antipsychotic agents for at least 2 years prior and up to study initiation, and diagnose of psychiatric disorders included in DRG 430. Exclusion criteria were pregnancy, female patients currently taking contraceptives, and female patients on hormone therapy for various reasons.
References [1] Goff DC et al, 2005 Medical morbidity and mortality in schizophrenia: guidelines for psychiatrists. J Clin Psychiatry 66:183−94.
P.3.b.039 Predictors of adherence to antipsychotic treatment in first episode schizophrenia − results of the Romanian cohort in the EUFEST study V. Matei1 ° , A.I. Mihailescu2 , R. Al-Bataineh3 1 University of Medicine and Pharmacy Carol Davila Bucharest, Psychiatry, Bucharest, Romania; 2 University of Medicine and Pharmacy Carol Davila Bucharest, Medical Psychology, Bucharest, Romania; 3 Hospital “Prof. Dr. Al. Obregia”, Department II, Bucharest, Romania Introduction: Adherence to treatment in schizophrenia is a permanent theme of research due to its great importance. Analyzing predictors of antipsychotic adherence could lead to identify potential non-adherent patients, to tailor interventions to improve adherence and to help patients with schizophrenia maintain a satisfactory functioning. Understanding early predictors of antipsychotic adherence could give us information on long term adherence [1] which is of tremendous importance.
P.3.b. Psychotic disorders and treatment − Psychotic disorders (clinical)
haloperidol and benzodiazepines are the most widely used medications. Antipsychotics, which were applied by a small portion of Hungarian clinicans are also used in some countries. The same study presents that in international settings the use of lorazepam is most widespread in the emergency care of agitated psychotic patients. In Hungary the lack of parenteral form of lorazepam limits its use in emergency cases so the clonazepam is the most widely used medication among these circumstances. The international survey including 21 countries indicate that three countries (India, Romania, Slovenia) regularly use intravenous medications, whereas others do not prefer this mode of medication only the intramuscular therapy. Hungarian clinicians disagree on mode of administration, but the majority would prefer intravenous therapy. References [1] Cunnane JG. (1994) Drug management of disturbed behavior by psychiatrist. Psychiatric Bulletin 18, 138–139. [2] Lepping, P. (2013) The use of emergency psychiatric medication: a survey from 21 countries. J Clin Psychopharmacol, 33:240−2.
P.3.b.036 The psychometric properties of the Night Eating Questionnaire in Korean schizophrenic outpatients B.H. Yoon1 ° , W.M. Bahk2 , J.H. Song1 , Y.H. Sea1 , S.H. Nam1 , S.H. Park1 1 Naju National Hospital, Department of Psychiatry, Naju, South-Korea; 2 The Catholic University of Korea, Department of Psychiatry, Seoul, South-Korea Objective: The Night Eating Syndrome (NES) was first described in 1955 as a stress-related eating disorder consisting of morning anorexia, evening hyperphagia, and insomnia. The presence of nocturnal ingestions (awakening to eat) was added to these criteria later. Prevalence of NES have reported in the following groups: 1.5% of general population, 12.3 among an outpatient psychiatric population, and 3.8% among a type 2 diabetes. The range of prevalence of NES can be attributed to differing diagnostic criteria and different assessment techniques. The purpose of this study was to evaluate psychometric properties of the Night Eating Questionnaire (NEQ) as a measure of the Night Eating Syndrome in schizophrenic outpatients. Methods: The translated and counter-translated Korean version of NEQ was developed. The participants who completed the NEQ were outpatient schizophrenic patients. They were passed through eligible criteria which the authors developed. This study was approved by the Naju National Hospital’s Institutional Review Board (IRB). Participants were informed that their responses would be used in research and also written informed consent was granted by participants. The behavioral and psychological symptoms of NES were assessed with the 14-item self-reported questionnaire (NEQ). The NEQ total score was calculated by reverse coding items 1, 4, and 14, and summing items, except item 13. Item 13 does not assess a degree of NES symptomatology; rather, it is included in the questionnaire as a rule out for sleep-related eating disorder. The NEQ total score provided a range from 0 to 52 points. Body weight and height were measured to assess the body mass index (BMI). The authors completed following tests to find out some correlations between NES and other clinical characteristics. Subjective estimates of depression, binge eating patterns, sleep quality and weight-related quality of life were evaluated using Beck’s Depression Inventory (BDI), Binge Eating
Scale (BES), Pittsburgh Sleep Quality Index (PSQI) and Korean version of Obesity-related Quality of Life scale (KOQoL). Results: Among 223 schizophrenic outpatients who completed the NEQ, 25 (11.2%) patients screened as having NES (total NEQ >25 as the original authors’ criteria). NEQ demonstrated high internal consistency (Cronbach’s alpha=0.74) and item-total correlations (r = 0.29–0.75; p < 0.001, respectively) were acceptable except morning anorexia by reliability. Principal components analysis revealed the presence of four factors (nocturnal ingestions, evening hyperphagia, mood/sleep, and morning anorexia), explaining 56.8% of total variance. Although total score of NEQ was not correlated with BMI, age at onset, duration of illness, use of atypical antipsychotics, it was significantly correlated with total scores of BDI, BES, PSQI and KOQoL. Test-retest reliability which retest was done after 2 weeks from the first test was also good (r = 0.74, p < 0.001). Conclusion: Our results showed that NEQ appears to be an efficient, valid measure of NES in Korean schizophrenic outpatients. It was also revealed that relatively high percentage of schizophrenic patients may have NES. References [1] Allison KC, Lundgre JD, Reardon JP, Martino NS, Sarwer DB, Wadden TA, et al. The Night Eating Questionnaire (NEQ): Psychometric properties of a measure of severity of the Night Eating Syndrome. Eating Behaviors 2008; 9: 62−72.
P.3.b.037 Convergence insufficiency in schizophrenia and its relationship with cerebellar symptoms A. Chrobak1 ° , G. Siwek1 , K. Siuda1 , M. Siwek2 , A. Arciszewska2 , M.W. Pilecki3 , D. Dudek2 1 Jagiellonian University, Students’ Scientific Association of Affective Disorders, Krak´ow, Poland; 2 Jagiellonian University, Department of Affective Disorders, Krak´ow, Poland; 3 Jagiellonian University, Department of Psychiatry, Krak´ow, Poland Purpose: Schizophrenia (SZ) is associated with numerous neurological deficits reflected by gait imbalance, tremor and ataxia. Growing number of research indicates that SZ patients and their unaffected relatives present various oculomotor dysfunctions, most prominently in smooth pursuit and saccadic eye movement. While mentioned oculomotor deficits have been widely explored, no data concerning vergence abnormalities have been found. During our research we have noticed a group of patients presenting striking pattern of convergence insufficiency (unilateral exophoria at near). The purpose of our study was to evaluate incidence of this symptom in SZ patients and to validate its association with other neurological disturbances included in cerebellar ataxia scales. Method: In our study, we included 32 patients meeting DSM-V diagnostic criteria for schizophrenia and 23 healthy controls (HC). SZ patients were treated with antipsychotic drugs from group of dibenzoxazpine (olanzapine, clozapine and quetiapine). Groups were matched for age, gender and ethnicity. Subjects were assessed using International Cooperative Ataxia Rating Scale (ICARS), consisting of four major parts: gait and posture, kinetic functions, dysarthria and oculomotor. Clinical convergence assessment was performed by instructing subjects to follow the cup of a pen with their eyes as it is moved toward the nose. This examination divided patients with SZ into 2 groups − with and without symptom.
P.3.b. Psychotic disorders and treatment − Psychotic disorders (clinical) Results: Incidence of convergence insufficiency was significantly higher in SZ group (14 of 32, 43.75%) than in HC (1 of 22, 1.82%, p = 0.001).Compared to HC, patients with schizophrenia also revealed significantly higher ICARS subscores: posture (p = 0.017), kinetic (p < 0.001), dysarthria (p < 0.01), oculomotor (p < 0.001) as well as total score (p < 0.001). SZ patients with symptom presented significantly higher oculomotor subscore (with symptom x = 2.50, without x = 1.27, p = 0.04) than SZ patients without the symptom. Conclusions: To our best knowledge, there has been no previous study concerning unilateral exophoria in schizophrenia. Observed symptom occurred significantly more often in SZ patients, and was accompanied with ataxia-related neurological deficits. Since only oculomotor subscore differences reached statistical significance, the specificity of this syndrome for SZ patients may be associated with widely described eye movement deficits in SZ, as the vergence and the smooth pursuit are considered to have a common biological background. This phenomenon may be explained by deterioration of the midbrain, cortico-pontocerebellar pathways including cerebellar nuclei (fastigal nucleus). Our findings seem to be coherent with Andreasen theory of cognitive dysmetria, where cerebellum and cerebello-cortical tracts dysfunctions are hypothesized to be involved in pathogenesis of schizophrenia. The limitation of our study was lack of neuroleptic naive group, however atypical antipsychotics were selected due to their minimal effect on motor performance of our patients. Assessment of this symptom is short and applicable in everyday practice and it could be used in order to differentiate patients with higher rate of eye movement deficits.
P.3.b.038 Prevalence of metabolic syndrome in psychotic patients treated with antipsychotics B. Ferreiro Fernandez1 ° , M.C. Garc´ıa Mah´ıa1 , M. Vidal Millares2 Universitario a Coru˜na, Psychiatry, La Coru˜na, Spain; 2 Hospital Universitario Santiago de Compostela, Psychiatry, Santiago de Compostela, Spain
S513
Patients were classified according to man diagnosis in four groups: schizophrenia, affective psychosis, paranoid disorders and other functional psychosis. Variables analyzed were age, sex, number of hospitalizations, main diagnose, type and dose of currently administered antipsychotics; use of concomitant medication; and diagnosis and treatment of diabetes, hypertension, and/or dyslipidemia. Data were analyzed with statistical package v. 19.0 for windows. Results: From the whole sample 58.9% were male and 41.1% were female, age average 31 years (standard deviation 7.9) years. Comparison of the mean disease duration of the men (15.3±6.9 years) and women (11.5±9.7 years) indicated that there was no significant difference between them. Among all subjects, 12.6% were found to have diabetes, 36.5% hypertension, 72.0% dyslipidemia, and 46.1% central obesity. The frequency of these disorders did not presented significant differences between female and male. However, central obesity rate was higher in women than in men and age influence was detected in diabetes. Schizophrenic group presented higher rate of metabolic syndrome than other groups analyzed, with statistical significance. Metabolic syndrome was more frequent in patients treated with two or more antipsychotics compared to patients with monotherapy and in patients treated with atypical antipsychotics compared to patients with classic antipsychotics. Psychotic patients treated with injectable long acting antipsychotics presented similar rates of metabolic syndrome in comparison to patients treated with oral formulations of antipsychotics. Conclusions: Patients with psychotic disorders have high prevalence of metabolic syndrome. Psychiatric treatment facilities should offer and promote healthy lifestyle intervention early in the course of disease aiming to prevent serious metabolic adverse effects. Awareness of these aspects should be increased among primary healthcare providers and specialists, and physical health problems should be incorporated into psycho-educational programs.
1 Hospital
Introduction: Previous studies show that patients with schizophrenia and bipolar disorders have high levels of medical comorbidity and cardiovascular risk factors. The presence of 3 or more specific factors is indicative of metabolic syndrome, which is a significant factor in future morbidity and mortality. Objectives: To examine the prevalence of metabolic syndrome and its risk factors in patients diagnosed of psychotic illness and included in Diagnostic Related Group (DRG) 430 that were treated with antipsychotics. Methods: Retrospective descriptive study of psychiatric patients with psychosis (N = 126). Patients included in this study were recruited from two clinical settings. One group was obtained from a randomized sample of patients hospitalized in a psychiatric hospital in Santiago de Compostela in a period of two years (n = 60) and another group (n = 66) from ambulatory care. Data were obtained from clinical records. Inclusion criteria were age 18−65 years, continuous use of antipsychotic agents for at least 2 years prior and up to study initiation, and diagnose of psychiatric disorders included in DRG 430. Exclusion criteria were pregnancy, female patients currently taking contraceptives, and female patients on hormone therapy for various reasons.
References [1] Goff DC et al, 2005 Medical morbidity and mortality in schizophrenia: guidelines for psychiatrists. J Clin Psychiatry 66:183−94.
P.3.b.039 Predictors of adherence to antipsychotic treatment in first episode schizophrenia − results of the Romanian cohort in the EUFEST study V. Matei1 ° , A.I. Mihailescu2 , R. Al-Bataineh3 1 University of Medicine and Pharmacy Carol Davila Bucharest, Psychiatry, Bucharest, Romania; 2 University of Medicine and Pharmacy Carol Davila Bucharest, Medical Psychology, Bucharest, Romania; 3 Hospital “Prof. Dr. Al. Obregia”, Department II, Bucharest, Romania Introduction: Adherence to treatment in schizophrenia is a permanent theme of research due to its great importance. Analyzing predictors of antipsychotic adherence could lead to identify potential non-adherent patients, to tailor interventions to improve adherence and to help patients with schizophrenia maintain a satisfactory functioning. Understanding early predictors of antipsychotic adherence could give us information on long term adherence [1] which is of tremendous importance.