1. Chi MH, Hsiao CY, Chen KC, Lee L-T, Tsai HC, Lee IH, Chen PS, Yang YK*: The readmission rate and medical cost of patients with schizophrenia after first hospitalization — a 10-year follow-up population-based study. Schizophrenia Research 2016 Jan;170(1):184-90
2. Tseng H-H, Chen KC, Chen PS, Lee IH, Chang WH, Yao WJ, Chiu NT, Yang YK*: Dopamine transportera availability in drug-naïve patients with schizophrenia and later psychotic symptoms severity. Schizophrenia Research (in press)
3. Chang WH, Chen KC, Lee IH, Chi MH, Chen PS, Yao WJ, Chiu NT, Yang YK*: Unaltered dopamine transporter availability in drug-naïve patients with schizophrenia after 6 months of antipsychotics treatment: a naturalistic study. Journal of Clinical
Psychopharmacology 2017 Feb;37(1):21-6
4.
Estimation of Lifetime Duration of Dysfunction in Patients with Schizophrenia
Chien-Chou Su, Ya Mei Bai, Ming-Hui Chou, Jung-Der Wang, Yen Kuang Yang
We applied a method in which the proportion of patients with functional disability is multiplied by the survival probability to estimate the lifetime duration of functional disability in patients with schizophrenia.
This measurement provides information regarding how long patients with schizophrenia require psychiatric healthcare and the dynamic change in the proportion of patients with functional disability over time.
Estimation of the expected years of living with disabilities in personal and social functioning is useful for outcome evaluation and healthcare resources allocation for the long-term care of patients with schizophrenia.
Abstract
Background: Disturbance of functionality is one of core features of schizophrenia.
Aim: To estimate the lifetime duration of disability in personal and social functioning in patients with schizophrenia.
Methods: A nationwide database and cross-sectional schizophrenia survey data were used. Lifetime duration of disability was obtained by multiplying the proportion of patients with functional disability by the survival probability over time and summing throughout the patient’s lifetime.
Results: The average lifetime during manifested disability of global functioning was estimated to be 20.9 years, which represents approximately 73% of the whole lifetime of patients. The duration of disability in socially-useful activity was estimated to be 15.6 years, while that of personal and social relationships was 17.5 years. The female patients had a longer duration of manifested disability (22.9 years) than the male patients (19.5 years).
Conclusion: The results indicated a need for lifelong care for patients with schizophrenia.
Declaration of interest: None.
Keywords: Expected years of living with disability; long-term care need; personal and social performance;
schizophrenia; statistical method.
5. The correlations between brain volume variations and dopamine transporter availability in patients with drug naïve schizophrenia- A SPECT and MRI study
Running title: DAT may correlate with brain volume variations
Wei Hung Chang, I Hui Lee, Kao Chin Chen, Po See Chen,Yen Kuang Yang
Abstract
Background Brain volume variations have been studied in patients with schizophrenia previously. However, the differences of white matter and gray matter volume variations and their correlations with dopamine transporter availability in patients with drug naïve schizophrenia are still unclear.
Methods Fifty-nine patients with drug naïve schizophrenia and 62 normal healthy subjects were recruited in our study. [99mTc]TRODAT-1 single photon emission computed tomography (SPECT) was used to measure the striatal DAT availability and the structure of brain volumes were measured by MRI. The volumetric analysis were performed by using FreeSurfer 5.3.0 (Martinos Imaging Center, Charlestown MA)
Results Significant DAT availability existed between groups. For the volumetric differences, the patient groups had generally significant larger volume of white matters compared to healthy control subjects in several brain sub-regions, while the gray matter has reduced volume in different regions for patients with drug naïve schizophrenia, but enlarged volume in left superior parietal regions. Furthermore, only the volumes of the enlarged regions had significant correlation with the DAT availability, with different directionality between gray and white matter volumes.
Conclusions The possible hyperdopaminergic activities may be modulate the brain volume, especially the neuroblastic effects, for patients with drug naïve schizophrenia.
Keywords: drug naïve schizophrenia, SPECT, dopamine transporter, MRI
6. Higher Mortality and Years of Potential Life Lost of Physical Illnesses in Patients with Schizophrenia
KoYS, Tsai HC, Chi MH, Su CC, Lee IH, Chen PS, Chen KC*, Yang YK
Abstract
Background: Patients with schizophrenia have a significantly increased risk of mortality compared to the general population. However, there is still limited data about mortality of schizophrenia in Asia.
Aims: We compared the risks of mortality from various causes between patients with schizophrenia and the general population, and also compared patients’ risks of overall and age- and sex-specific mortalities to those of the general population. The years of potential life lost (YPLL) from various causes of death and from sex-specific death between patients with schizophrenia and the general population were also explored.
Method: A total of 4,298 patients with schizophrenia who aged elder than 15 were included, including 2,297 men and 2,001 women, treated at a university hospital in southern Taiwan from 1998 to 2010. The cohort was linked to Taiwan Death Register between 1998 and 2010 by using personal identification number. The linkage showed 367 patients with schizophrenia died by the end of 2010. Information of underlying causes of death according to the International Classification of Disease 9th or 10th Clinical Modification (ICD-9 CM for 1998-2007 and ICD-10 CM for 2008-2010) was retrieved from TDR. The standard mortality ratio (SMR) and years of potential life lost (YPLL) from causes of mortality and causes with age- and sex-specific were analyzed.
Results: The overall SMR significantly increased in patients with schizophrenia (SMR, 8.8; 95% CI, 7.8 -9.6).
Suicide had the most significantly increased SMR (SMR, 31.3; 95% CI, 23.3 -38.0). Malignant neoplasms (SMR, 4.8; 95% CI, 3.5-5.9), cardiovascular diseases (SMR, 8.2; 95% CI, 5.1-11.2), cerebrovascular diseases (SMR, 5.5; 95% CI, 2.8-8.5), diabetes mellitus (SMR, 8.6; 95% CI, 4.7-12.5), pneumonia (SMR, 10.7; 95%
CI, 4.5-11.9), hepatitis and liver cirrhosis (SMR, 6.2; 95% CI, 3.1-5.9), accidents and injuries (SMR, 7.7; 95%
CI, 5.1-10.2) all significantly increased in patients with schizophrenia. The suicide-specific SMR significantly increased in all groups of age in patients with schizophrenia, especially the most increased SMR for suicide was noted in the group aged from 15 to 39. Suicide had the largest YPLL/deaths among all causes of mortality in patients with schizophrenia (mean±SD, 39.6±12.2).
Conclusion: Suicide was the first and remarkable risk of mortality among patients with schizophrenia. Other causes of mortality related to physical illnesses all have increased SMR. Patients with schizophrenia are highly vulnerable and need special attention in general care beside their psychotropic intervention.
7.
Striatal Dopamine D
2/3Receptor Availability in Drug Naïve Patients with Schizophrenia: a Case-control SPECT Study with [
123I] iodobenzamide (IBZM)
Chen KC, Yang YK＊, Howes O, Lee IH, Yeh TL, Yao WJ, Chiu NT, Chen PS, Lu RB, David AS, Bramon E.
Abstract
Background: Central dopaminergic hyperactivity continues to be one of the key hypotheses of the pathophysiology of schizophrenia. Excess transmission at dopamine receptors and blockade of these receptors to treat psychosis were the primary focus in initial formulations. The hyper-function of the striatal dopamine system has been suggested to play key pathophysiological mechanisms in schizophrenia. Moreover, patients have also been observed to present a significant elevation of dopamine receptor availability compared to healthy controls. Although it is difficult to measure dopamine levels directly in humans, neurochemical imaging techniques such as single photon emission computed tomography (SPECT) provide indirect indices of in vivo dopamine synthesis and release, and putative synaptic levels.
Aims & Method: Our study focused on the role of dopamine postsynaptic regulation using [123I]
iodobenzamide (IBZM) SPECT. We compared D2/3 receptor availability between 53 healthy controls and 21 drug-naive patients with recent-onset schizophrenia.
Results: Compared to controls, the patients were significantly younger (t =-2.33, df=72; p= 0.02), less likely to be married (χ2 =7.71; p=0.005) and had fewer years of education (t=-3.44, df=71; p=0.001). After controlling for age, sex and tobacco smoking, the mean specific striatal binding showed no significant difference between patients and controls (estimated difference = 0.001; 95% CI= -0.11, 0.12; F=0.00, df=1, 69;
p=0.99). There was a highly significant effect of age whereby IBZM binding declined with advancing age (estimated change per decade of age = -0.01; 95% CI= -0.14, -0.04; F=11.5, df=1, 69; p=0.001). No significant correlations were found between the mean specific striatal binding and psychopathological rating scores. But a statistical trend was noted the high ROI group had better masked CPT performance than the low ROI group (χ2=-1.79; p=0.07).
Conclusion: The specific striatal binding ratio of drug-naive patients with schizophrenia was not significantly different from that of normal controls, indicating that both groups had similar D2/3 receptor availability. Our findings suggest rather than focusing exclusively on postsynaptic receptors, future treatments should target the presynaptic control of dopamine synthesis and release.