Has the prevalence, clinical presentation and social functioning of schizophrenia changed over the last 25 years? Nithsdale schizophrenia survey revisited.

Background: Major changes in the treatment of schizophrenia have taken place in recent years, including a shift from inpatient to community care, and the introduction of second-generation antipsychotics and psychosocial interventions. Recent evidence has questioned the superiority of these interventions over older treatments.

Aims: We wished to ascertain the impact of changes in the treatment of schizophrenia in a geographically-defined area, focusing on clinical symptoms and psychosocial outcome.

Nicotine dependence and illness severity in schizophrenia.

Background: Reasons for the increased prevalence of cigarette smoking in schizophrenia are unclear. Studies assessing clinical symptoms have sampled heterogeneous populations, with discrepant findings.

Aims: To examine the relationship between clinical features, social adjustment and nicotine dependence in a geographically defined population of people with schizophrenia.

Low prevalence of obesity and metabolic syndrome in never-treated chronic schizophrenia.

Introduction: Antipsychotic medication and lifestyle factors are implicated in the high rates of obesity and metabolic syndrome in schizophrenia. While the two Consensus Statements made in 2004 concluded they were unclear whether psychiatric disorders per se accounted for increased prevalence of metabolic disorders several later studies have presented the case for an association between schizophrenia and metabolic disorders, especially impaired glucose metabolism and Type 2 diabetes mellitus, independent of antipsychotic drug treatment.

Methods: This is a comparative study of 51 patients with chronic schizophrenia who never received antipsychotic drug treatment and 51 healthy controls.

Evidence that better outcome of psychosis in women is reversed with increasing age of onset: a population-based 5-year follow-up study.

Background: Female gender and later onset of psychosis are both associated with better outcome. However whether their effects are independent, is not known.

Method: In 379 incident cases of psychoses, from an epidemiologically defined catchment area, admixture analysis was employed to generate age of onset classes.

Are obstetric complications related to adult schizophrenia? A case-control study.

Background: Early environmental events may be relevant to the etiology of schizophrenia. Among such events, interest has focused especially on obstetric complications (OCs).

Objective: Aims of the study were to compare the incidence of OCs in patients, siblings and normal controls and to examine the relationship between OCs and later schizophrenia.

Do symptom dimensions or categorical diagnoses best discriminate between known risk factors for psychosis?

Objective: To describe symptom dimensions of psychosis using detailed psychopathological information from epidemiologically defined incident cases which include the full spectrum of functional psychosis across all age ranges. Then, assess the comparative usefulness of the dimensional and categorical representations of psychosis in discriminating between demographic and pre-morbid risk factors.

Method: A total of 464 incident cases of psychosis assessed with OPCRIT (Operational Checklist for Psychotic Symptoms) were included in an exploratory factor analysis.

Insight and psychopathology in never-treated schizophrenia.

Insight is a feature of schizophrenia related to psychopathology, which could be modified by treatment. The real relationship will be more evident in the never-treated state. This study compared insight and its relationship to psychopathology in 143 never-treated patients with chronic schizophrenia with 183 treated patients.

Long-term course of cognitive impairment in schizophrenia.

The aim of this study was to examine the long-term course of cognitive impairment in people with schizophrenia. Forty-three people with schizophrenia were followed up over an average of 33 years along with a control group of 12 matched individuals free from psychosis. Cognitive function was assessed at baseline and follow-up.

Psychopathology in never-treated schizophrenia.

The effect of drug treatment and its adverse effects confound studies on symptoms and associated factors in schizophrenia. Knowledge of psychopathology in the untreated state would identify the natural state of the illness and is relevant to understand pathology underlying the illness. We report here symptoms of schizophrenia as measured by Positive and Negative Syndrome Scale in 143 patients with schizophrenia living in the community never treated with antipsychotic drugs.

Dietary improvement in people with schizophrenia: randomised controlled trial.

Background: People with schizophrenia make poor dietary choices.

Aims: To measure the impact of giving free fruit and vegetables for 6 months on eating habits in schizophrenia.

Method: We randomly allocated 102 people with schizophrenia in two areas of Scotland to receive free fruit and vegetables for 6 months, supported by instruction in meal planning and food preparation; free fruit and vegetables alone; or to continue as before.

Extrapyramidal symptoms in unmedicated schizophrenia.

Studies of spontaneous extrapyramidal symptoms, dyskinesia and parkinsonism, in unmedicated schizophrenia are of importance in understanding their underlying pathology and relation to the psychosis. This is a study of extrapyramidal symptoms using Abnormal Involuntary Movements Scale for dyskinesia and Simpson-Angus Scale for parkinsonism in 143 schizophrenia patients who never received antipsychotic medication. Psychopathology was measured using the Positive and Negative Syndrome Scale.

Support for RGS4 as a susceptibility gene for schizophrenia.

Background: The gene encoding the regulator of G-protein signaling 4 has recently been associated with susceptibility to schizophrenia. This finding is particularly interesting, because it was replicated within the same study and also because there are functional, positional, and expression data to support the regulator of G-protein signaling 4 as a schizophrenia candidate gene. Although the original report was highly suggestive, a limitation was that the study was conducted on rather small samples.

Spontaneous dyskinesia in first-degree relatives of chronically ill, never-treated people with schizophrenia.

Background: We have suggested recently that there may be a subgroup of schizophrenia, namely schizophrenia with dyskinesia and striatal pathology. Might movement disorders be more common in relatives of those with schizophrenia and dyskinesia than in relatives of those without dyskinesia? Aims To determine the prevalence of abnormal movements in first-degree relatives of people with schizophrenia who themselves do or do not have abnormal movements.

Method: Chronically ill, never-treated people with schizophrenia in south India (n=70) and their first-degree relatives (n=181) were examined for dyskinesia using the Abnormal Involuntary Movements Scale (AIMS) and for parkinsonism by the Simpson and Angus scale.

Nithsdale Schizophrenia Surveys 23: movement disorders. 20-year review.

Background: In the past 10 years the new atypical antipsychotic drugs have stimulated further interest in the pharmacological management of schizophrenia. The risk of movement disorders has been reported to be less with these new agents.

Aims: To examine the current prevalence of movement disorders among all people with schizophrenia in a discrete geographical area, to compare the prevalence in patients receiving and not receiving atypical antipsychotic drugs; and to compare current prevalence with prevalence over the past 20 years.

Use of drugs, alcohol and tobacco by people with schizophrenia: case-control study.

Background: Specialised services should be developed to help people with schizophrenia and associated substance misuse. The extent of the problem therefore needs to be known.

Aims: To determine the use of drugs, alcohol and tobacco by people with schizophrenia drawn from rural, suburban and urban settings, and to compare use by general population control subjects.

Summer birth and deficit schizophrenia in Dumfries and Galloway, southwestern Scotland.

Objective: An association between deficit schizophrenia and summer birth has previously been reported. Confirmation of a separate risk factor for this group of patients is potentially important, but the number of subjects with deficit schizophrenia in previous reports has been small. This analysis used data from an epidemiological study of incident cases of psychosis to test the hypothesis that deficit schizophrenia is associated with summer birth.

Pharmacogenetics of tardive dyskinesia: combined analysis of 780 patients supports association with dopamine D3 receptor gene Ser9Gly polymorphism.

Variability among individuals in their therapeutic response to psychotropic drugs and in susceptibility to adverse effects is considerable. Pharmacogenetics addresses the contribution of genetic factors to this variability. An important focus of interest in pharmacogenetics has been on candidate genes that play a role in susceptibility to the antipsychotic drug-induced adverse effect, tardive dyskinesia (TD).

Structural brain differences between never-treated patients with schizophrenia, with and without dyskinesia, and normal control subjects: a magnetic resonance imaging study.

Background: In south India, abnormal movements indistinguishable from tardive dyskinesia have been observed in chronically ill patients with schizophrenia who have never received antipsychotic medication. The present study, using magnetic resonance imaging, examines brain structure in such patients, in those without dyskinesia, and in normal control subjects.

Methods: Chronically ill patients with schizophrenia with and without dyskinesia and controls were identified in villages south of Chennai, India (each group, n = 31).