Schizophrenia: manifestations, incidence and course in different cultures A World Health Organization Ten-Country Study

Jablensky, Assen; Sartorius, Norman; Ernberg, G.; Anker, Martha; Korten, A. E.; Cooper, John E.; Day, Richard; Bertelsen, Aksel

doi:10.1017/s0264180100000904

Cited by 1,452 publications

(1,112 citation statements)

References 55 publications

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“…The first contains dietary information, that is, national dietary report provided by the Food and Agriculture Organization of the United Nations (2002). The second source involves three large-scale multicenter surveys of various schizophrenia outcome measures, namely the International Pilot Study of Schizophrenia (World Health Organization, 1979;Gupta, 1992;Peet, 2004b), the Determinants of Outcomes of Severe Mental Disorders (Jablensky et al, 1992;Gupta, 1992;Peet, 2004b), and the World Health Organization International Follow-up Study (World Health Organization, 1979;Christensen and Christensen, 1988). Although the reasons behind transcultural differences in schizophrenia outcomes detected in these and other studies (Kulhara, 1994;Sartorius et al, 1996) have received less attention than the outcomes themselves, it may be relevant that, taken as a whole, schizophrenia prognosis tends to be substantially worse in the developed Western nations, in comparison to the developing countries, that have not yet adopted the Westernized diet (Peet, 2004a).…”

Section: Dietary Habits Of Schizophrenic Patientsmentioning

confidence: 99%

Food Intake and Reward Mechanisms in Patients with Schizophrenia: Implications for Metabolic Disturbances and Treatment with Second-Generation Antipsychotic Agents

Elman

Borsook

Lukas

2006

Neuropsychopharmacol

138

142

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Obesity is highly prevalent among patients with schizophrenia and is associated with detrimental health consequences. Although excessive consumption of fast food and pharmacotherapy with such second-generation antipsychotic agents (SGAs) as clozapine and olanzapine has been implicated in the schizophrenia/obesity comorbidity, the pathophysiology of this link remains unclear. Here, we propose a mechanism based on brain reward function, a relevant etiologic factor in both schizophrenia and overeating. A comprehensive literature search on neurobiology of schizophrenia and of eating behavior was performed. The collected articles were critically reviewed and relevant data were extracted and summarized within four key areas: (1) energy homeostasis, (2) food reward and hedonics, (3) reward function in schizophrenia, and (4) metabolic effects of the SGAs. A mesolimbic hyperdopaminergic state may render motivational/incentive reward system insensitive to low salience/palatability food. This, together with poor cognitive control from hypofunctional prefrontal cortex and enhanced hedonic impact of food, owing to exaggerated opioidergic drive (clinically manifested as pain insensitivity), may underlie unhealthy eating habits in patients with schizophrenia. Treatment with SGAs purportedly improves dopamine-mediated reward aspects, but at the cost of increased appetite and worsened or at least not improved opiodergic capacity. These effects can further deteriorate eating patterns. Pathophysiological and therapeutic implications of these insights need further validation via prospective clinical trials and neuroimaging studies. INTRODUCTIONObesity has reached pandemic proportions and it is rapidly surpassing smoking as a number one killer in the industrialized world (Sturm, 2002;Skidmore and Yarnell, 2004). Its annual cost to the American society is staggering, and is estimated to be around $117 billion owing to related illnesses and loss of productivity (National Institute of Diabetes and Digestive and Kidney Diseases, 2005).In schizophrenia, obesity is twice as prevalent as in the general public, afflicting over half this patient population (Allison et al, 1999a;Dixon et al, 2000; American Diabetes Association, 2004;Marder et al, 2004;Wirshing, 2004). Besides negative psychosocial impacts (distorted selfesteem and societal stigmatization) and medications noncompliance, schizophrenics appear to be particularly susceptible to the detrimental medical sequelae of obesity such as the 'Metabolic Syndrome', which is a cluster of cardiovascular risk factors, including abdominal adiposity, insulin resistance, impaired, glucose tolerance, dyslipidemia, and hypertension (McKee et al, 1986;Mukherjee et al, 1996;Brown et al, 2000;Haupt and Newcomer, 2002;Ryan and Thakore, 2002;Ryan et al, 2003;Holt et al, 2004;Kohen, 2004;Marder et al, 2004;Lieberman et al, 2005).Excessive body weight gain (BWG) could be attributed to a constellation of endocrine, molecular, genetic, demographic, and lifestyle-related factors. Provided that a common tra...

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Section: Dietary Habits Of Schizophrenic Patientsmentioning

confidence: 99%

Food Intake and Reward Mechanisms in Patients with Schizophrenia: Implications for Metabolic Disturbances and Treatment with Second-Generation Antipsychotic Agents

Elman

Borsook

Lukas

2006

Neuropsychopharmacol

138

142

View full text Add to dashboard Cite

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“…1 Theories of the pathophysiology underlying schizophrenia have centered on neurotransmitters and their receptors and therapeutic drug development has largely targeted dopamine, serotonin and glutamate systems. [2][3][4] While such therapies are proven effective in short-term trials, the vast majority of individuals discontinue treatment over time for lack of effectiveness or development of side effects and not all patients respond similarly to these medications.…”

Section: Introductionmentioning

confidence: 99%

Metabolomic mapping of atypical antipsychotic effects in schizophrenia

Kaddurah‐Daouk

McEvoy

Baillie³

et al. 2007

Mol Psychiatry

238

181

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Schizophrenia is associated with impairments in neurotransmitter systems and changes in neuronal membrane phospholipids. Several atypical antipsychotic drugs induce weight gain and hypertriglyceridemia. To date, there has not been a comprehensive evaluation and mapping of global lipid changes in schizophrenia, and upon treatment with antipsychotics. Such mapping could provide novel insights about disease mechanisms and metabolic side effects of therapies used for its treatment. We used a specialized metabolomics platform 'lipidomics' that quantifies over 300 polar and nonpolar lipid metabolites (across seven lipid classes) to evaluate global lipid changes in schizophrenia and upon treatment with three commonly used atypical antipsychotics. Lipid profiles were derived for 50 patients with schizophrenia before and after treatment for 2-3 weeks with olanzapine (n = 20), risperidone (n = 14) or aripiprazole (n = 16). Patients were recruited in two cohorts (study I, n = 27 and study II, n = 23) to permit an internal replication analyses. The change from baseline to post-treatment was then compared among the three drugs. Olanzapine and risperidone affected a much broader range of lipid classes than aripiprazole. Approximately 50 lipids tended to be increased with both risperidone and olanzapine and concentrations of triacylglycerols increased and free fatty acids decreased with both drugs but not with aripiprazole. Phosphatidylethanolamine concentrations that were suppressed in patients with schizophrenia were raised by all three drugs. Drug specific differences were also detected. A principal component analysis (PCA) identified baseline lipid alterations, which correlated with acute treatment response. A more definitive long-term randomized study of these drugs correlating global lipid changes with clinical outcomes could yield biomarkers that define drug-response phenotypes.

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“…b) Informações sobre o processo de randomização (processo em si) e tabela pós-randomização para os seguintes fatores prognósticos de recaída: forma de instalação do transtorno, estado civil, nível educacional, problemas na escola (sintomas positivos) e ajustamento social pré-mórbido (sintomas negativos) 24,25,26,27 . Não há evidência de que a cronicidade dos pacientes seja fator prognóstico de recaída.…”

Section: Diagnostic and Statistical Manual Of Mental Disorders Fourtunclassified

Meta-análise de ensaios clínicos de intervenção familiar na condição esquizofrenia

2008

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A esquizofrenia é um dos mais graves transtornos mentais e atinge aproximadamente 1% da população mundial. Caracteriza-se por uma desorganização de diversos processos mentais e por alteração do comportamento, evoluindo com recaídas (recorrência de sintomas), na maioria dos casos, que podem resultar em que a vida afetiva, social e produtiva do paciente fique severamente comprometida. Pode representar ainda um impacto importante na vida dos familiares, o que vem sendo conceituado como "sobrecarga familiar", bem como custos relevantes para toda a sociedade. No Brasil, a esquizofrenia corresponde ao 5º lugar na manutenção de auxílio-doença no país 1 .Para o presente trabalho, os procedimentos de atenção à condição esquizofrenia, inclusive a intervenção familiar, foram identificados, inicialmente, a partir do livro-texto de Kaplan & Sadock 2 , e de documentos governamentais do Canadá 3 e dos Estados Unidos 4 . Esse último documento aponta que das intervenções psicossociais testadas para o tratamento da esquizofrenia, a partir da década de 70, apenas para a chamada "intervenção familiar", haveria um volume de ensaios clínicos bem desenhados com resultados consistentes.A análise das propostas de intervenção familiar dos ensaios foi previamente efetuada 5 com ] was equivalent to that of the behavioral therapy subgroup and the "pragmatic" subgroup

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Schizophrenia: manifestations, incidence and course in different cultures A World Health Organization Ten-Country Study

Cited by 1,452 publications

References 55 publications

Food Intake and Reward Mechanisms in Patients with Schizophrenia: Implications for Metabolic Disturbances and Treatment with Second-Generation Antipsychotic Agents

Food Intake and Reward Mechanisms in Patients with Schizophrenia: Implications for Metabolic Disturbances and Treatment with Second-Generation Antipsychotic Agents

Metabolomic mapping of atypical antipsychotic effects in schizophrenia

Meta-análise de ensaios clínicos de intervenção familiar na condição esquizofrenia

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