Minor Physical Anomalies and Treatment Resistance in Schizophrenia
Date Issued
2011
Date
2011
Author(s)
Lin, An-Sheng
Abstract
Objective
Schizophrenia is postulated to be a neurodevelopmental disorder with varying disease courses. It was estimated that about 20% to 30% of patients with schizophrenia respond poorly to treatment. Literature reviews also indicated that treatment resistant schizophrenia (TRS) correlates with neurobiological, psychological and social factors. Meanwhile, higher rates of minor physical anomalies (MPAs) among patients with schizophrenia have been documented, supporting the neurodevelopmental model of schizophrenia. However, little is known about whether MPAs are associated with treatment outcomes. This study aimed to investigate whether there are associations between MPAs and treatment resistance in schizophrenia.
Methods
Participants were recruited from both inpatients and outpatients with schizophrenia receiving treatments in a psychiatric center in northern Taiwan during the period between April, 2010 and October, 2010. A total of 108 patients for the TRS with a mean age of 44.9 years (SD = 9.1) and 104 patients for the non-TRS group with a mean age of 43.6 (SD = 8.6) were recruited, with a frequency matching on age and sex. For each individual, a systemic chart review was conducted by a board-certified psychiatrist. Patients’ clinical information was collected to determine the status of treatment resistance according to the criteria proposed by Conley and Kelly in 2001. The patients underwent both qualitative and quantitative measurements of MPAs by a well-trained research assistant using a comprehensive scale adapted from Waldrop and Lane scales. A brief cognitive assessment using Continuous Performance Test was also done.
Results
The TRS group had an earlier mean onset age by 3.8 years, more hospitalizations and a poorer sustained attention performance than the non-TRS group. For the qualitative measures of MPAs, the TRS group had more physical anomalies in the region of mouth and hands, compared with the non-TRS group. For the quantitative measurements of craniofacial MPAs, there were significant increases in terms of lower facial height, facial height, bilateral palpebral fissure length, length of the philtrum and length of mouth, as well as significant decreases in terms of facial width, skull height, and right ear width in the TRS group. For the logistic regression analysis of treatment resistant status, a model contained the MPAs scores of mouth region, facial width, lower facial height and left palpebral fissure length with the covariates of sex, age and the binary variable of early onset had good prediction with an area under the curve of around 0.85. The prediction power the MPAs remained similar after adding a binary sustained attention deficit to the model.
Conclusions
Our results showed that the TRS group had more physical anomalies manifested mainly as a narrower facial width and longer lower facial height than the non-TRS group. These findings suggest that MPAs may play a role in the development of treatment resistance in schizophrenia and imply a neurodevelopmental mechanism underlying such resistance.
Subjects
minor physical anomalies
schizophrenia
treatment resistance
treatment resistant schizophrenia
SDGs
Type
thesis
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