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The present study in an African Xhosa sample examined whether familial vulnerability to schizophrenia is associated with deficits in facial affect recognition. Healthy comparison subjects, unaffected siblings of schizophrenia patients, and schizophrenia patients were tested with a task requiring rapid recognition of matched positive (happy), negative (angry), and neutral facial expressions. Siblings and patients demonstrated impaired recognition of negative relative to positive facial expressions whereas comparison subjects recognized negative and positive expressions at an equal level of accuracy. These results suggest that deficits in the processing negative affect from social cues are transmitted in families and may represent a heritable endophenotype of schizophrenia.

Careful phenotyping and the identification of subtypes of schizophrenia can contribute significantly to the success of genetic studies in schizophrenia. The phenomenology of schizophrenia in affected sib pairs has been well-described in Caucasian populations, however a paucity of data exists for African populations. This study therefore investigated symptom dimensions in a sizeable group of affected Xhosa sib pairs as a means of evaluating the role of shared familial factors in the psychosis of schizophrenia. Five hundred and thirteen participants were interviewed with the Diagnostic Interview for Genetic Studies (DIGS), which included the Schedules for the Assessment of Negative and Positive symptoms (SANS/SAPS). One hundred and four sib pairs were then extracted (N = 208) for analysis of concordance for lifetime psychotic symptoms and an exploratory factor analysis of the SANS/SAPS. Concordance analysis of life-time symptoms indicated a significant concordance for olfactory hallucinations, persecutory delusions, jealousy, somatic, reference and control delusions as well as thought insertion and withdrawal. The factor analysis of the global scores of the SAPS and SANS revealed a five factor best-fit model and accounted for 92.5% of variance. The factors included a negative symptom factor, a positive symptom factor, a positive thought disorder and a bizarre behaviour component. The core symptomatology of schizophrenia in this sib pair sample was similar to that reported in Caucasian populations with the exception of higher rates of auditory hallucinations and delusions of persecution. In summary therefore; although the factor analysis only supported the concept of the universality of psychotic symptoms in schizophrenia, the concordance analysis of these symptoms did reveal hallucinations as well as delusions of control as possible candidates relevant for future research into genotype-phenotype relationships.

Most studies investigating the symptom dimensions of schizophrenia utilising the Scale for the Assessment of Negative Symptoms (SANS) and the Scale for the Assessment of Positive Symptoms (SAPS) favour a three factor model. This study sought to investigate the factor structure of both the global and individual items of the SANS and SAPS in a large sample of South African Xhosa patients with schizophrenia. A total of 422 subjects participated. Both principal components and factor analytical procedures were applied. For the global items, a two-factor solution representing positive and negative symptoms accounted for 59.9% of the variance. Alternatively, the three-dimensional model of negative, psychotic and disorganisation factors was supported by a five-factor solution if the more heterogeneous items of attention and alogia were ignored. Analysis of the individual items yielded a five-factor solution with the negative symptoms splitting into diminished expression and disordered relating, and the positive symptoms separating into factors for psychosis, thought disorder and bizarre behaviour. Our findings are very similar to those from other parts of the world, providing evidence that the factor structure for the symptoms of schizophrenia is relatively resistant to cultural influences. This is particularly true for negative symptoms.

Background: An important unanswered question in the management of schizophrenia is how long antipsychotic treatment should be continued after a first psychotic episode. This study assessed the clinical consequences of antipsychotic discontinuation after 2 years of uninterrupted treatment in patients treated for a first episode of schizophrenia or related illness. This is a pre-specified interim analysis after 1 year of treatment discontinuation. Methods: This study is an extension of a previously published 24month, open-label study in which 50 patients with first-episode schizophrenia, schizophreniform disorder, or schizoaffective disorder were treated with flexible doses of risperidone long-acting injection (RLAI). At the completion of that study, patients were offered enrolment in this follow-up study evaluating the effects of treatment discontinuation. Patients opting to participate in the discontinuation trial had RLAI tapered over a period of up to 6 weeks, with follow-up while off antipsychotic therapy or until relapse, defined operationally. Following RLAI discontinuation, patients were assessed every 2 months. RLAI was immediately re-instituted when relapse was identified. This is a pre-specified interim analysis of all subjects who completed 1 year of follow-up. Relapse rates, time to relapse, and antecedents to relapsewere evaluatedwith Positive and Negative Syndrome Scale (PANSS) and Patient-assessed Global Impression of Change (PGI-C) scores. Results: Of the 50 patients who completed the 2-year treatment study,19men and 14women (mean age 27.5±7.9 years and baseline PANSS score of 45.0±7.4) entered the discontinuation study and were followed for 1 year or until relapse. At baseline, 28 patients (84.8%) were in remission. 26 patients (79%) relapsed within 1 year. Kaplan-Meier estimate of median time to relapse was 163 days (95% CI 96–199). 8 patients were hospitalized as a result of relapse. There were no differences between those who relapsed and those who did not in terms of baseline PANSS scores or remission status. PANSS total scores remained similar to those at baseline up until (and including) the visit prior to relapse. Discussion: Similar to previously reported studies with oral and depot antipsychotics,2,3 relapse rates were high within 1 year of treatment discontinuation in patients who had been treated with RLAI for firstepisode of schizophrenia for 2 years. First relapses occurred suddenly, without clear-cut warning signs. These findings have important clinical implications, suggesting that antipsychotic discontinuationafter 2 years of treatment may not be in the best interest of the majority of patients.