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Resilience Improves Neurocognition and Treatment Outcomes in Schizophrenia: A Hypothesis

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Open Journal of Psychiatry 2016年第2期6卷 173-187页

作者： amresh shrivastava Avinash De Sousa Sushma Sonavane Nilesh Shah Department of Psychiatry The Western University Lawson Health Research Institute London Canada Department of Psychiatry Lokmanya Tilak Municipal Medical College Mumbai India

There has been a revolutionary advance in the treatment and management of schizophrenia from a clinical aspect yet the social and functional outcomes remain poor. Cognitive function is impaired in schizophrenia and shows various domains of dysfunction like verbal memory, processing speed and working memory. It is also known to be a factor associated with poor outcome in schizophrenia. Resilience is a new concept psychobiological concept which is defined as individual’s ability to adapt swiftly to adverse life events and bounces back to normalcy. Resilience has genetic, neurobiological, neurochemical and psychological underpinnings. It is the ability to effectively deal with psychosocial stressors and appears to be one of the many factors associated with favourable outcomes in schizophrenia. Besides several neurobiological abnormalities associated with resilience, neucognitive functions are of particular interest. Persistent psychosocial stressors also lead to significant neurobiological changes which may be synergetic to poor outcome due to cognitive changes. Though there has been extensive research in the field of cognitive function in schizophrenia, the trajectory of its pathway of poor outcome remains undetermined. Resilience being a protective factor may be one of the psychobiological functions which modulate the effect of neurocognition on the outcome of schizophrenia. There has been some success with interventions aimed at improving cognitive function in schizophrenia whether pharmacological or non pharmacological. In this paper, we discuss a hypothesis that resilience may be a “linkage” between cognition and outcome. There is a need for interventions aimed at increasing resilience in patients with schizophrenia and we hypothesize giving evidence that this may in turn improve outcome and neurocognitive functioning in schizophrenia.

关键词： Resilience Cognition Neurocognition Schizophrenia Outcomes

Gender Differences in Serum Prolactin Levels in Drug Naïve First Episode Schizophrenia

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Open Journal of Psychiatry 2015年第2期5卷 165-169页

作者： amresh shrivastava Nilesh Shah Avinash De Sousa Sushma Sonavane Department of Psychiatry University of Western Ontario Lawson Health Research Centre London Canada Department of Psychiatry Lokmanya Tilak Municipal Medical College Mumbai India

Objective: To determine if there is a significant rise in serum prolactin (PRL) in acute psychosis related to disease process and weather there is a significant gender difference in the level of PRL and its correlation psychopathology. Procedure: Naturalistic study involved 60 consenting outpatients and inpatients in a tertiary psychiatric setting. Patient base was comprised of men (n?= 30) and women (n?= 30) with 83% in the age range of 21 - 40 years old. All subjects had confirmed first episode diagnosis set forth by the Diagnostic and Statistical Manual of Mental Disorders. Patients were drug free and drug na?ve. Standardization for control was done using 15 control PRL samples obtained from healthy individuals. Methodology involved assessment by radioimmunoassay, the Brief Psychiatric Rating Scale and the Positive and Negative Syndrome Scale at day 1, 3 weeks and again at 6 weeks. All patients were treated with atypical antipsychotic drugs. Results: Serum PRL was elevated on baseline in 75% of first episode psychosis schizophrenia, yet found to have a negative correlation to psychopathology at base week 3 and week 6 samples. Conclusions: Elevated serum PRL is not a potential indicator of acute schizophrenia. Levels are higher in females than in males, yet females respond better to treatment at a lower dose than males.

关键词： Psychoendocrinology Hyperprolactinemia Dopaminergic System Prolactin

Study of negatives symptoms in first episode schizophrenia

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Open Journal of Psychiatry 2013年第3期3卷 323-328页

作者： Vivek Bambole Nilesh Shah Shushma Sonavane Megan Johnston amresh shrivastava Department of Psychiatry Elgin Early Intervention Program for Psychosis Lawson Health Research Institute The University of Western Ontario London Canada Department of Psychiatry LTMG Medical College University of Mumbai Mumbai India Department of Psychology University of Toronto Toronto Canada LTM Medical College University of Mumbai Mumbai India

Background: Prevalence of negative symptoms in the early phase of schizophrenia remains uncertain. Negative symptoms are the primary cause of long term disability and poor functional outcome. The purpose of this study is to examine the presence of negative symptoms in patients with fist episode psychosis in schizophrenia who were hospitalized. Methods: Negative symptoms were measured in 72 patients presenting with FEP using the scale for assessment of negative symptoms (SANS) and ascertained diagnosis using DSM-IV. Prevalence of SANS items and subscales were examined for both schizophrenia and bipolar disorder. Results: This study shows that a significant number of patients with first episode schizophrenia had negative symptoms 66 (87.5%). All five subtypes of negative symptoms were present in 47% of patients suggesting primary negative symptoms, and about 40% have secondary negative symptoms. Independently, each subtype of negative symptoms was seen in 48% - 76% of patients. The most prevalent negative symptom in first-episode schizophrenia was found to be blunting (72%). 46% of patients had significant level of depression, overall psychopathology was severe and level of functioning was poor. We found that 45.8% patients were prescribed anticholinergic medications which indicated that at least 45% subjects had extra-pyramidal symptoms (EPS). Conclusion: Primary negative symptoms are prevalent in about half of First episode Psychosis (FEP) schizophrenia patients. These findings have implications for identification, early treatment, and reduced treatment resistance for negative symptoms in order to increase social and clinical outcome of schizophrenia. Further research is required in this area.

关键词： Negative Symptoms First Episode Psychosis Schizophrenia Symptomatology

Biological Trajectory for Psychosocial Risk Factors in Psychiatric Disorders—A Concept Based Review

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Open Journal of Psychiatry 2015年第1期5卷 7-18页

作者： amresh shrivastava James Boylan Yves Bureau Avinash De Sousa Nilesh Shah Department of Psychiatry University of Western Ontario Lawson Health Research Centre London Canada Department of Psychiatry University of Western Ontario London Canada Department of Psychiatry Lokmanya Tilak Municipal Medical College Mumbai India

Current understanding of mental disorders is based upon “biopsychosocial model”. Research also suggests what biological changes take place in a particular disorder as well as nature of risk which arises from psychological, social and environmental conditions. However it remains unclear how these psychosocial and environmental risk factors interact with biological factors which lead to clinical syndromes. This paper examines interrelationship of psychosocial and environmental risk and biological changes observed in mental disorders and tries to identify the possibility of a pathway of the psychopathology of psychiatric disorders. The review aims to demonstrate that significant advances in the fields of psychosocial, cultural, anthropological and neurobiological research provide novel insights into the etiology of mental disorders. There are neurochemical, functional and structural neurobiological, neurocognitive, immunological findings and findings from gene-environment interaction that appears promising. However these findings are in an isolated manner. Comprehensive studies examining major biological changes together in relation to psychosocial risk factors are lacking. Every individual reacts differently to the same environmental risk while there tends to be similarities in individual outcome in response to such stressors. The findings though robust independently, remain very preliminary to suggest a sequential trajectory for developing a clear pathway for pathogenesis. It is currently unclear whether there is a differential psychopathological impact of psychosocial stressors in different cultures despite the extensive variability both between and within major social groups and societies. Further research investigating modifiable and non-modifiable risk factors in context of prevailing socio-economic conditions is urgently needed to plan effective interventions.

关键词： Psychosocial Stress Resilience Social Cognition Epigenetics Neurobiology Psychosocial Risk Factors

Symptom overlap between schizophrenia and bipolar mood disorder: Diagnostic issues

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Open Journal of Psychiatry 2013年第4期3卷 8-15页

作者： Vivek Bambole Megan Johnston Nilesh Shah Sushma Sonavane Avinash Desouza amresh shrivastava Department of Psychiatry Lokmanya Tilak Municipal Medical College and General Hospital Mumbai India Department of Psychiatry Lokmanya Tilak Municipal Medical College University of Mumbai Mumbai India Department of Psychology University of Toronto Toronto Canada Mental Health Resource Foundation (PRERANA Charitable Trust) and Silver Mind Hospital Mumbai India

Although the Kraepelinian classification paradigm is widely used, observations of overlapping boundaries among the symptoms associated with bipolar disorder and schizophrenia are beginning to challenge this dichotomy. The objective of this research was to explore the symptoms of individuals diagnosed with schizophrenia and with bipolar mood disorder in order to determine the frequency of symptom overlap. One hundred patients of a psychiatry ward were divided into two main groups based on their diagnosis—schizophrenia or bipolar mood disorder. Chi-square analyses were used to determine whether the symptoms measured in this study differed between individuals diagnosed with schizophrenia and those diagnosed with bipolar mood disorder. The results suggest that both positive/manic symptoms and negative/depressive symptoms are present in individuals diagnosed with schizophrenia and with bipolar mood disorder and, consequently, they do not present a reliable means of differentiating between these two groups. These findings have many implications for the ways in which mental illness is conceptualized and classified. Treatment efforts and interventions may be enhanced if a more dimensional approach to diagnosing mental illness is utilized.

关键词： Classification Depressive Symptoms Mania Diagnosis