Faculty Bibliography

The present study examined the hypothesis that elevated serum levels of C-reactive protein (CRP) would be associated with more severe clinical symptoms in patients with schizophrenia. Twenty-six inpatients with schizophrenia or schizoaffective disorder were enrolled. Serum levels of CRP were measured, and each patient was assessed with the Positive and Negative Syndrome Scale (PANSS). Subjects with CRP levels above the normal range (CRP>0.50 mg/dl, elevated CRP group, N=5) scored significantly higher than those with CRP levels in the normal range (CRP<or=0.50 mg/dl, normal CRP group, N=21) on the PANSS total score, negative symptom subscale score and general psychopathology subscale score. There was no significant difference between the two groups on the PANSS positive symptom subscale score. An inflammatory process, as reflected by elevated serum levels of CRP, might be associated with more severe psychopathology in a subgroup of patients with schizophrenia

Catatonia may be monosymptomatic at presentation, with stupor or coma as the cardinal and only manifestation. A case of catatonic coma with profound bradycardia is presented to help clinicians recognize this entity and include catatonia in the differential diagnosis of coma as a rare etiology after other more common causes of coma have been excluded. Cases of catatonic coma are nevertheless important to identify because treatment with intravenous benzodiazepines is simple and highly effective. The authors argue that the descriptive term 'catatonic coma' is preferable over terms implying psychogenesis, such as 'psychogenic' or 'hysterical' coma; for catatonia, the authors have a specific treatment, in the form of benzodiazepines; for 'psychogenesis,' there is none

Persons with serious mental illness represent a special at-risk population, with elevated medical comorbidity and mortality rates, mainly due to cardiovascular disease. For this reason, the treatment plan for patients with mental illness must include the assessment of medical risk factors, beginning at the time of the initial psychiatric evaluation. Follow-up assessments should proceed as recommended by the Expert Consensus Development Panel convened by the American Diabetes Association, the American Psychiatric Association, and other relevant specialty organizations. Because the various second-generation antipsychotics (SGAs) have unique side effect profiles with respect to cardiometabolic risk factors, such as weight gain and dyslipidemia, the selection of an SGA always should weigh efficacy versus potential risks. Prior to initiating antipsychotic therapy, the psychiatrist should not only explain to the patient the risks of the medication and alternative treatments, but also address preventive strategies and the importance of monitoring. To help evaluate the patient's response and manage SGA-related adverse effects, the psychiatrist should spend considerable time in contact with the patient, the patient's family and/or caregivers (as appropriate), and the patient's primary care physician. To enhance overall patient care, the psychiatrist in private practice should implement procedures to ensure adequate patient education and address overall health monitoring. Furthermore, the psychiatrist must serve as a patient advocate, actively working to foster communication with medical colleagues, especially primary care practitioners, and identify resources in the community that facilitate preventive health care

BACKGROUND: Insulin has emerged as an important determinant of food intake, energy expenditure, and weight control. This study examined the relationship between fasting serum insulin level and resting energy expenditure (REE) in a cross-sectional sample of nondiabetic schizophrenia patients. METHODS: Subjects were recruited from an urban community mental health clinic. Each subject underwent a series of anthropometric measures and an indirect calorimetry measure. A fasting blood sample was taken for plasma glucose, serum insulin, and lipid profile. RESULTS: Seventy-one subjects (54 male, 17 female) were included in the study. There was a significant positive relationship between REE and fasting serum insulin level (r = .39, p = .001). Stepwise multiple regression analysis was performed with various characteristics such as age, race, antipsychotic agent used, fat-free mass, BMI, waist circumference, waist-hip ratio, physical activity level, and fasting serum insulin as candidate predictors for REE. Only fat-free mass and insulin were able to enter into the regression model, which indicates that higher fat-free mass and higher fasting serum insulin level predict increased REE. CONCLUSIONS: A higher fasting serum insulin level is associated with an increased REE, which may prevent further weight gain in nondiabetic patients with schizophrenia

BACKGROUND: Patients with schizophrenia have difficulty using contextual information to recall the source of information. Given the importance of the hippocampus and prefrontal cortex (PFC) in this type of memory, we hypothesized that this cognitive deficit stemmed from aberrant fronto-hippocampal activation during memory retrieval. METHODS: Patients with schizophrenia (n = 16) and age-matched comparison subjects (n = 16) underwent functional magnetic resonance imaging while performing a verbal memory task that requires intact use of temporal context. Blood oxygen-level dependent (BOLD) signal during correct memory decisions was compared between the two groups with statistical parametric mapping. RESULTS: Contrary to our hypotheses, patients with schizophrenia demonstrated nearly identical memory performance to that of the comparison subjects. Despite this, there were significant between-group BOLD signal differences, including a pattern of task-dependent hypofrontality or hyperfrontality. In addition, whereas the highest-performing subset of the comparison group demonstrated robust modulation of hippocampal activity, this pattern was not seen in the highest-performing patients with schizophrenia. CONCLUSIONS: Despite memory performance similar to that of comparison subjects, patients with schizophrenia activated different neural pathways to achieve this success. This might reflect underlying neuropathology in fronto-hippocampal circuitry, the use of an alternate cognitive strategy to accomplish task performance, or both.