Center for Health and Learning

Electroconvulsive therapy (ECT) exhibits demonstrable effectiveness for psychotic symptoms associated with a broad range of neuropsychiatric conditions. However, the mechanism remains poorly understood particularly with regard to antipsychotic effects. We examined studies of ECT in schizophrenia and mood disorders, as well as from animal models of psychotic disorders, and compared the results to those of antipsychotic medications. This review focuses on 3 potential domains of exploration of ECT's antipsychotic effects: dopamine and serotonin neurotransmitter activity, neurotrophic effects, and immune system modulation. Preliminary results support a putative role for all three of these domains but are limited by a lack of replicated findings, including negative studies. A comparison of the neurophysiologic and molecular properties of antipsychotic drugs and ECT reveals some overlap, but there are also distinctive differences; and the significance of these findings remains uncertain.

Schizophrenia is associated with increased infections across the lifespan. We previously found an association between urinary tract infection (UTI) and acute nonaffective psychosis. The aims of this study were to explore further the relationship between UTI and acute psychosis, including associated clinical features. We identified by chart review subjects aged 18-64 years who were hospitalized between January 2010 and April 2012 for an acute episode of DSM-IV nonaffective psychosis (schizophrenia, schizoaffective disorder, psychosis not otherwise specified, or delusional disorder; n =134), affective psychosis (bipolar or major depressive disorder with psychotic features; n = 101), or alcohol detoxification (n = 105), and we recruited healthy controls (n =39). Urinary tract infection was defined as positive leukocyte esterase and/or positive nitrites on urinalysis and ≥ 5-10 leukocytes/high-powered field on urine microscopy. The prevalence of UTI was 21% in nonaffective psychosis, 18% in affective psychosis, 12% in alcohol use disorders, and 3% in controls. After controlling for potential confounders, UTI was almost 11 times more likely in subjects with nonaffective psychosis than controls (OR = 10.7; 95% CI, 1.4-83.2; P =.02) and almost 9 times more likely in subjects with major depressive disorder with psychotic features than controls (OR = 8.9; 95% CI, 1.1-71.4; P = .04). There were no associations between clinical characteristics and UTI in acute psychosis. We replicated and extended an association between an UTI and acute psychosis. Findings suggest that infections appear relevant to the etiopathophysiology of relapse and increased premature mortality risk in the psychoses. The results also highlight the potential importance of monitoring for comorbid UTI in relevant patient populations.

Antipsychotic medications are associated with an increased risk of diabetes. Previous studies have also found an increased risk of type 2 diabetes mellitus in the relatives of schizophrenia probands. The aim of this study was to explore the metabolic adverse effects of olanzapine in a cohort of patients with newly diagnosed psychosis and minimal or no exposure to antipsychotics. Patients with newly diagnosed psychosis (n = 30) were enrolled in a 16-week open trial of olanzapine. Body mass index, fasting glucose, hemoglobin A1c, fasting insulin, IL-6, and a fasting lipid profile were measured at baseline and at 4-week intervals. There was a significant, linear increase over time in fasting glucose (P = 0.043), weight (P < 0.001), body mass index (P < 0.001), total cholesterol (P = 0.005), triglycerides (P = 0.003), and low-density lipoprotein (P = 0.013), but not hemoglobin A1c (P = 0.691), fasting insulin (P = 0.690), IL-6 (P = 0.877), or high-density lipoprotein (P = 0.446). An abnormal baseline IL-6 was a significant predictor of a greater increase in both total cholesterol (P < 0.01) and low-density lipoprotein (P < 0.01). Otherwise, neither parental history of type 2 diabetes mellitus nor baseline IL-6 predicted changes in metabolic measures. Changes in metabolic measures with olanzapine treatment can be detected early in the treatment of patients who are previously antipsychotic naive. The absence of a change in fasting insulin suggests a failure of pancreatic islet cells to compensate for the increase in fasting glucose.

The experience of childhood cancer can be one of the most severe stressors that parents endure. Studies using illness-specific measures of parental stress indicate that moderate-to-severe parenting stress is quite common in the first year of childhood cancer treatment, and as many as 5% to 10% of these parents go on to develop posttraumatic stress disorder. This review of the literature suggested that although parenting stress symptoms may be relatively transitory for most parents dealing with childhood cancer, the impact of these stress symptoms on parent and child functioning is substantive and worthy of therapeutic attention. The stresses entailed in childhood cancer should be viewed as complex and varied across stages of diagnosis and treatment. Factors associated with increased risk of parental posttraumatic stress symptoms include poor social support, adverse experience with invasive procedures, negative parental beliefs about the child's illness and/or associated treatment, and trait anxiety. For those parents with risk factors that might forebode more severe and enduring stress reactions to their children's cancer, therapeutic strategies are proposed to ameliorate their stress and reduce the development and/or maintenance of posttraumatic stress symptoms.

Although people with schizophrenia display impaired abilities for consent, it is not known how much impairment constitutes incapacity. To assess a method for determining the categorical capacity status of potential participants in schizophrenia research. Expert-judgement validation of capacity thresholds on the sub-scales of the MacArthur Competence Assessment Tool-Clinical Research (MacCAT-CR) was evaluated using receiver operating characteristic (ROC) analysis in 91 people with severe mental illness and 40 controls. The ROC areas under the curve for the understanding, appreciation and reasoning sub-scales of the MacCAT-CR were 0.94 (95% CI 0.88-0.99), 0.85 (95% CI 0.76-0.94) and 0.80 (95% CI 0.70-0.90). These findings yielded negative and positive predictive values of incapacity that can guide the practice of investigators and research ethics committees. By performing such validation studies for a few categories of research with varying risks and benefits, it might be possible to create evidence-based capacity determination guidelines for most schizophrenia research.

Because of growing concern about the physical health status of persons with schizophrenia and uncertainty regarding optimal strategies to manage metabolic side effects of antipsychotic drugs that increase the risk of cardiovascular disease, we developed a protocol to test the effectiveness of a common strategy — switching to an antipsychotic associated with lower risk of metabolic side effects. In this study we will randomly assign individuals with schizophrenia or schizoaffective disorder who have increased BMI (≥27) and elevated non-HDL cholesterol (≥160 mg/dL) to stay on their current stable dose of olanzapine, quetiapine, or risperidone, or to switch to aripiprazole. All study participants will receive a behavioral treatment that is aimed at modifying cardiovascular risk factors, including weight, activity level, blood sugar, blood pressure, and lipids. Because non-HDL cholesterol is a significant predictor of cardiovascular disease and has some advantages over total cholesterol and LDL cholesterol, t...

Little is known about the effects of different intensities of physical training on plasma leptin. This study examined the effect of two intensities of physical training on leptin in obese teenagers, and explored correlates at baseline and in response to 8 months of physical training. The participants were 55 obese youths 12-16 years of age who completed both baseline and posttesting. The youths were randomized to engage in lifestyle education only (LSE), moderate-intensity physical training and LSE, or high-intensity physical training and LSE. Baseline leptin was positively associated with fat mass. Girls had higher leptin levels at lower levels of fasting insulin than boys. The 8-mo physical training doses prescribed to obese teenagers did not result in significant group differences in mean change in leptin, although there was large variability in individual response. The change in leptin was inversely associated with baseline leptin and change in cardiovascular fitness. Diet, physical activity level, visceral adiposity, and glucose concentrations were not associated with leptin, neither at baseline nor in response to physical training. At baseline, total fat mass rather than visceral adiposity was associated with higher leptin levels. Over the 8-mo intervention period, regardless of group membership, youths who had the lowest increase in cardiovascular fitness tended to have the highest increase in leptin.

OBJECTIVE.: To estimate the psychological impact, health and behavior concerns, and coping styles of women awaiting colposcopic examination compared with women awaiting a scheduled primary care appointment. MATERIALS AND METHODS.: A convenience sample of 150 women presenting for a scheduled colposcopy examination and 201 women scheduled for a primary care appointment were assessed for demographic status, depression (Center for Epidemiologic Studies/Depressed Mood Scale), anxiety, health beliefs and concerns, and coping style (Miller Behavioral Style Score). Subjects also completed a postexamination questionnaire. Mean responses were compared using Wilcoxon rank sum test. RESULTS.: Mean anxiety scores were considered "mild" and equivalent for women in the two groups. Although the colposcopy group had a significantly greater mean depression score (36.3) compared with the noncolposcopy group (33.4, p = .03, Wilcoxon test), both mean scores indicated mild depression. Women undergoing colposcopy reported greater mean scores for concern about their disease, the procedure, and potential consequences (p < .01, Wilcoxon test). CONCLUSION.: Women scheduled for colposcopy have a similar level of mild anxiety and mild depression as women scheduled for a primary care appointment. Consequently, universal, instead of selective, use of anxiolytic agents before colposcopy appears unjustified. Avoidance of triage to colposcopy for atypical squamous cells of undetermined significance Pap smear results may be unwarranted based on concerns for causing excessive anxiety. In fact, colposcopy provides substantial reassurance.