الفهرس 
Introduction and Aim of the Work
SchizophreniaOnly 14 pages are availabe for public view
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Abstract
Schizophrenia is a mental disorder characterized by a breakdown in thinking and poor emotional responses. Common symptoms include delusions, such as paranoia; hearing voices or noises that are not there; disorganized thinking; a lack of emotion and a lack of motivation. Schizophrenia causes significant social and work problems. Symptoms begin typically in young adulthood and about 0.3-0.7% of people are affected during their lifetime. Diagnosis is based on observed behavior and the person’s reported experiences.
The disorder is thought to mainly affect the ability to think, but it also usually contributes to chronic problems with behavior and emotion, Social problems, such as long-term unemployment, poverty, and homelessness are common.
In recent years, there has been a greater appreciation of the elevated prevalence of cardiovascular risk factors in the schizophrenia population and the liability some treatments have for their development. These cardiovascular risk factors, including diabetes mellitus, hypertension, dyslipidemia, and obesity, are also important risk factors in the development of dementia.
Cognitive impairment associated with schizophrenia is now viewed as a potential psychopharmacological target for treatment. Although cognition is not a formal part of the current diagnostic criteria for schizophrenia, the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR includes seven references to cognitive dysfunction in the description of the disorder. Diagnostic and scientific experts increasingly have expressed the idea that neuro-cognitive impairment is a core feature of the illness and not simply the result of the symptoms or the current treatments of schizophrenia.
Although approximately 27% of patients with schizophrenia (and 85% of the general population) are not rated as “impaired” by clinical neuropsychological assessment, these patients tend to have the highest levels of premorbid functioning and demonstrate cognitive functioning that is considerably below what would be expected of them based on their pre-morbid levels and the education level of their parents. Up to 98% of patients with schizophrenia perform more poorly on cognitive tests than would be predicted by their parents’ education level. In addition, comparisons of monozygotic twins discordant for schizophrenia suggest that almost all affected twins perform worse than their unaffected twin on cognitive tests. Therefore, it is likely that almost all patients with schizophrenia are functioning below the level that would be expected in the absence of the illness.
Cognitive functioning is moderately to severely impair in patients with schizophrenia. This impairment is the prime driver of the significant disabilities in occupational, social, and economic functioning in patients with schizophrenia. The profile of deficits in schizophrenia includes many of the most important aspects of human cognition: attention, memory, reasoning, and processing speed.
Obesity was associated with statistically significant worsening of cognitive performance in one or more cognitive domains in 1 out of 3 cross-sectional and 2 out of 3 longitudinal studies. The association between obesity and cognition differed across the individual domains: cognitive flexibility was significantly affected in 67% of the studies assessing that domain, perception and construction in 50%, memory in 40%, processing speed in 33% of the studies.
Diabetes was associated with statistically significant worsening of cognitive performance in one or more cognitive domains in 13 out of 20 cross-sectional and 5 out of l longitudinal studies. The association between diabetes and cognition differed across the individual domains: processing speed was significantly affected in 63% of studies assessing that domain, attention in 50%, memory in 44%, cognitive flexibility in 38%, and language in 33%, general intelligence in 31% and perception and construction in 22% of the studies. For the domains most commonly affected effect sizes ranged from 0 to -1.9, with a median effect size of - 0.4 for processing speed, - 0.5 for attention and - 0.3 for memory.
The current study is a cross-sectional study conducted to detect the degree of cognitive impairment in schizophrenic patients, detect the prevalence of schizophrenic patients with increased BMI, Hypertension or dyslipidemia and to demonstrate the effects of increased BMI hypertension and dyslipidemia on cognitive functions.
The current study included 40 subjects, diagnosed as schizophrenic according to ICD10 from the institute of psychiatry and theAbbasya hospital for psychiatric health, these patients was compared to 20 healthy control subjects.
Comprehensive psychiatric assessment was done to each of the subjects using the psychiatric case sheet including;Personal data; age, sex, place or residence … etc.
Clinical symptoms; were assessed using the Positive and Negative Syndrome Scale (PANSS).
Metabolic profile using body mass index, fasting blood glucose and lipid profile
Cognitive assessment; a cognitive battery was administered to all participants. The battery includes the following five cognitive tests:
Trail make test A & B &The Wechsler Memory Scale-Revised Visual Reproduction Test.
Our study results showed there were no significant difference between case and control as regard BMI, but there were high significant difference between case and control as regard FBG, there were also high significant difference between case and control as regard cognitive functions measured by (TMTA- TMTB- WMS-R).
It also showed that the higher age of the patient, longer duration of illness and the increase in (no of hospitalizations, episodes, ECT and duration of illness) is significantly associated with higher BMI,FBG and has more deficiency in the cognitive functions but there were no relation detected between these clinical data and cholesterol level in our cases and the increase in the BMI & FBG is associated with decrease in cognitive functions, on the other hand cases with increase in the cholesterol level shows no significant effect in results of cognitive function (memory) scales & it was detected that that there was no significant difference between hypertension, DM& dyslipidemia on (TMTA-TMTB -WMS) scores.
Our results also showed that cases receiving atypical and mixed antipsychotic have significant increase in BMI &FBG than cases receiving typical antipsychotic treatment only.
And finally it was detected that increased FBG is the most significant factor in increasing the score of TMTA & that BMI is the next significant factor after FBG, while age of the patient, age of onset of disease and duration of illness all are less significant factors.
Conclusions: Given that patients with schizophrenia have a higher prevalence of vascular risk factors than the general population and are undertreated for them, treatment of these risk factors may significantly improve cognitive outcome in schizophrenia.