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Allebone J, Wilson SJ, Bradlow RCJ, Maller J, O'Brien T, Mullen SA, Cook M, Adams SJ, Vogrin S, Vaughan DN, Connelly A, Kwan P, Berkovic SF, D'Souza WJ, Jackson G, Velakoulis D, Kanaan RA. Increased cortical thickness in nodes of the cognitive control and default mode networks in psychosis of epilepsy. Seizure 2022; 101:244-252. [PMID: 36116283 DOI: 10.1016/j.seizure.2022.09.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 09/07/2022] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE To explore the cortical morphological associations of the psychoses of epilepsy. METHODS Psychosis of epilepsy (POE) has two main subtypes - postictal psychosis and interictal psychosis. We used automated surface-based analysis of magnetic resonance images to compare cortical thickness, area, and volume across the whole brain between: (i) all patients with POE (n = 23) relative to epilepsy-without psychosis controls (EC; n = 23), (ii) patients with interictal psychosis (n = 10) or postictal psychosis (n = 13) relative to EC, and (iii) patients with postictal psychosis (n = 13) relative to patients with interictal psychosis (n = 10). RESULTS POE is characterised by cortical thickening relative to EC, occurring primarily in nodes of the cognitive control network; (rostral anterior cingulate, caudal anterior cingulate, middle frontal gyrus), and the default mode network (posterior cingulate, medial paracentral gyrus, and precuneus). Patients with interictal psychosis displayed cortical thickening in the left hemisphere in occipital and temporal regions relative to EC (lateral occipital cortex, lingual, fusiform, and inferior temporal gyri), which was evident to a lesser extent in postictal psychosis patients. There were no significant differences in cortical thickness, area, or volume between the postictal psychosis and EC groups, or between the postictal psychosis and interictal psychosis groups. However, prior to correction for multiple comparisons, both the interictal psychosis and postictal psychosis groups displayed cortical thickening relative to EC in highly similar regions to those identified in the POE group overall. SIGNIFICANCE The results show cortical thickening in POE overall, primarily in nodes of the cognitive control and default mode networks, compared to patients with epilepsy without psychosis. Additional thickening in temporal and occipital neocortex implicated in the dorsal and ventral visual pathways may differentiate interictal psychosis from postictal psychosis. A novel mechanism for cortical thickening in POE is proposed whereby normal synaptic pruning processes are interrupted by seizure onset.
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Affiliation(s)
- James Allebone
- Melbourne School of Psychological Sciences, University of Melbourne, VIC, Australia; The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia
| | - Sarah J Wilson
- Melbourne School of Psychological Sciences, University of Melbourne, VIC, Australia; The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia; Comprehensive Epilepsy Program, Austin Health, University of Melbourne, Victoria, Australia
| | | | - Jerome Maller
- ANU College of Health and Medicine, Australian National University, Canberra, Victoria, Australia; Monash Alfred Psychiatry Research Centre, The Alfred and Monash University, Melbourne, Australia
| | - Terry O'Brien
- Royal Melbourne Hospital, Melbourne, Victoria, Australia; Department of Neuroscience, Alfred Hospital, Monash University, Melbourne, Australia
| | - Saul A Mullen
- The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia
| | - Mark Cook
- Graeme Clark Institute, University of Melbourne, Melbourne, Australia
| | - Sophia J Adams
- Department of Psychiatry, Austin Health, University of Melbourne, Melbourne, Australia
| | - Simon Vogrin
- St Vincent's Hospital, Melbourne, Victoria, Australia
| | - David N Vaughan
- The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia; Comprehensive Epilepsy Program, Austin Health, University of Melbourne, Victoria, Australia
| | - Alan Connelly
- The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia; Comprehensive Epilepsy Program, Austin Health, University of Melbourne, Victoria, Australia
| | - Patrick Kwan
- Royal Melbourne Hospital, Melbourne, Victoria, Australia; Department of Neuroscience, Alfred Hospital, Monash University, Melbourne, Australia
| | - Samuel F Berkovic
- Comprehensive Epilepsy Program, Austin Health, University of Melbourne, Victoria, Australia
| | - Wendyl J D'Souza
- Department of Medicine, St Vincent's Hospital, The University of Melbourne, Australia
| | - Graeme Jackson
- The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia; Comprehensive Epilepsy Program, Austin Health, University of Melbourne, Victoria, Australia
| | - Dennis Velakoulis
- Neuropsychiatry Unit, Royal Melbourne Hospital, Melbourne, Victoria, Australia; Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Melbourne, Australia
| | - Richard A Kanaan
- The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia; Department of Psychiatry, Austin Health, University of Melbourne, Melbourne, Australia.
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Larsen NY, Vihrs N, Møller J, Sporring J, Tan X, Li X, Ji G, Rajkowska G, Sun F, Nyengaard JR. Layer III pyramidal cells in the prefrontal cortex reveal morphological changes in subjects with depression, schizophrenia, and suicide. Transl Psychiatry 2022; 12:363. [PMID: 36064829 PMCID: PMC9445178 DOI: 10.1038/s41398-022-02128-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 08/15/2022] [Accepted: 08/18/2022] [Indexed: 11/09/2022] Open
Abstract
Brodmann Area 46 (BA46) has long been regarded as a hotspot of disease pathology in individuals with schizophrenia (SCH) and major depressive disorder (MDD). Pyramidal neurons in layer III of the Brodmann Area 46 (BA46) project to other cortical regions and play a fundamental role in corticocortical and thalamocortical circuits. The AutoCUTS-LM pipeline was used to study the 3-dimensional structural morphology and spatial organization of pyramidal cells. Using quantitative light microscopy, we used stereology to calculate the entire volume of layer III in BA46 and the total number and density of pyramidal cells. Volume tensors estimated by the planar rotator quantified the volume, shape, and nucleus displacement of pyramidal cells. All of these assessments were carried out in four groups of subjects: controls (C, n = 10), SCH (n = 10), MDD (n = 8), and suicide subjects with a history of depression (SU, n = 11). SCH subjects had a significantly lower somal volume, total number, and density of pyramidal neurons when compared to C and tended to show a volume reduction in layer III of BA46. When comparing MDD subjects with C, the measured parameters were inclined to follow SCH, although there was only a significant reduction in pyramidal total cell number. While no morphometric differences were observed between SU and MDD, SU had a significantly higher total number of pyramidal cells and nucleus displacement than SCH. Finally, no differences in the spatial organization of pyramidal cells were found among groups. These results suggest that despite significant morphological alterations in layer III of BA46, which may impair prefrontal connections in people with SCH and MDD, the spatial organization of pyramidal cells remains the same across the four groups and suggests no defects in neuronal migration. The increased understanding of pyramidal cell biology may provide the cellular basis for symptoms and neuroimaging observations in SCH and MDD patients.
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Affiliation(s)
- Nick Y. Larsen
- grid.7048.b0000 0001 1956 2722Core Centre for Molecular Morphology, Section for Stereology and Microscopy, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark ,grid.7048.b0000 0001 1956 2722Center of Functionally Integrative Neuroscience, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark ,Sino-Danish Center for Education and Research, Aarhus, Denmark ,grid.410726.60000 0004 1797 8419University of the Chinese Academy of Sciences, Beijing, China ,grid.5117.20000 0001 0742 471XCentre for Stochastic Geometry and Advanced Bioimaging, Aalborg University, Aarhus University and University of Copenhagen, Aarhus, Denmark
| | - Ninna Vihrs
- grid.5117.20000 0001 0742 471XDepartment of Mathematical Sciences, Aalborg University, Aalborg, Denmark
| | - Jesper Møller
- grid.5117.20000 0001 0742 471XCentre for Stochastic Geometry and Advanced Bioimaging, Aalborg University, Aarhus University and University of Copenhagen, Aarhus, Denmark ,grid.5117.20000 0001 0742 471XDepartment of Mathematical Sciences, Aalborg University, Aalborg, Denmark
| | - Jon Sporring
- grid.5117.20000 0001 0742 471XCentre for Stochastic Geometry and Advanced Bioimaging, Aalborg University, Aarhus University and University of Copenhagen, Aarhus, Denmark ,grid.5254.60000 0001 0674 042XDepartment of Computer Science, University of Copenhagen, Copenhagen, Denmark
| | - Xueke Tan
- grid.418856.60000 0004 1792 5640National Key Laboratory of Biomacromolecules, CAS Center for Excellence in Biomacromolecules, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China ,grid.418856.60000 0004 1792 5640Center for Biological Imaging, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China
| | - Xixia Li
- grid.5254.60000 0001 0674 042XDepartment of Computer Science, University of Copenhagen, Copenhagen, Denmark ,grid.418856.60000 0004 1792 5640National Key Laboratory of Biomacromolecules, CAS Center for Excellence in Biomacromolecules, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China
| | - Gang Ji
- grid.5254.60000 0001 0674 042XDepartment of Computer Science, University of Copenhagen, Copenhagen, Denmark ,grid.418856.60000 0004 1792 5640National Key Laboratory of Biomacromolecules, CAS Center for Excellence in Biomacromolecules, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China
| | - Grazyna Rajkowska
- grid.410721.10000 0004 1937 0407Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS USA
| | - Fei Sun
- Sino-Danish Center for Education and Research, Aarhus, Denmark ,grid.410726.60000 0004 1797 8419University of the Chinese Academy of Sciences, Beijing, China ,grid.418856.60000 0004 1792 5640National Key Laboratory of Biomacromolecules, CAS Center for Excellence in Biomacromolecules, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China ,grid.418856.60000 0004 1792 5640Center for Biological Imaging, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China
| | - Jens R. Nyengaard
- grid.7048.b0000 0001 1956 2722Core Centre for Molecular Morphology, Section for Stereology and Microscopy, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark ,Sino-Danish Center for Education and Research, Aarhus, Denmark ,grid.5117.20000 0001 0742 471XCentre for Stochastic Geometry and Advanced Bioimaging, Aalborg University, Aarhus University and University of Copenhagen, Aarhus, Denmark ,grid.154185.c0000 0004 0512 597XDepartment of Pathology, Aarhus University Hospital, Aarhus, Denmark
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Ku BS, Aberizk K, Addington J, Bearden CE, Cadenhead KS, Cannon TD, Carrión RE, Compton MT, Cornblatt BA, Druss BG, Mathalon DH, Perkins DO, Tsuang MT, Woods SW, Walker EF. The Association Between Neighborhood Poverty and Hippocampal Volume Among Individuals at Clinical High-Risk for Psychosis: The Moderating Role of Social Engagement. Schizophr Bull 2022; 48:1032-1042. [PMID: 35689540 PMCID: PMC9434451 DOI: 10.1093/schbul/sbac055] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Reductions in hippocampal volume (HV) have been associated with both prolonged exposure to stress and psychotic illness. This study sought to determine whether higher levels of neighborhood poverty would be associated with reduced HV among individuals at clinical high-risk for psychosis (CHR-P), and whether social engagement would moderate this association. This cross-sectional study included a sample of participants (N = 174, age-range = 12-33 years, 35.1% female) recruited for the second phase of the North American Prodrome Longitudinal Study. Generalized linear mixed models tested the association between neighborhood poverty and bilateral HV, as well as the moderating role of social engagement on this association. Higher levels of neighborhood poverty were associated with reduced left (β = -0.180, P = .016) and right HV (β = -0.185, P = .016). Social engagement significantly moderated the relation between neighborhood poverty and bilateral HV. In participants with lower levels of social engagement (n = 77), neighborhood poverty was associated with reduced left (β = -0.266, P = .006) and right HV (β = -0.316, P = .002). Among participants with higher levels of social engagement (n = 97), neighborhood poverty was not significantly associated with left (β = -0.010, P = .932) or right HV (β = 0.087, P = .473). In this study, social engagement moderated the inverse relation between neighborhood poverty and HV. These findings demonstrate the importance of including broader environmental influences and indices of social engagement when conceptualizing adversity and potential interventions for individuals at CHR-P.
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Affiliation(s)
- Benson S Ku
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GAUSA
| | | | - Jean Addington
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Carrie E Bearden
- Departments of Psychiatry and Biobehavioral Sciences and Psychology, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, USA
| | | | - Tyrone D Cannon
- Department of Psychiatry, Yale University, New Haven, CTUSA
- Department of Psychology, Yale University, New Haven, CTUSA
| | - Ricardo E Carrión
- Division of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
- Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Michael T Compton
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and New York State Psychiatric Institute, New York, NY, USA
| | - Barbara A Cornblatt
- Division of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
- Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Benjamin G Druss
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GAUSA
| | - Daniel H Mathalon
- Department of Psychiatry, University of California, and San Francisco Veterans Affairs Medical Center, San Francisco, CAUSA
| | - Diana O Perkins
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
| | - Ming T Tsuang
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Scott W Woods
- Department of Psychiatry, Yale University, New Haven, CTUSA
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Bighelli I, Rodolico A, Siafis S, Samara MT, Hansen WP, Salomone S, Aguglia E, Cutrufelli P, Bauer I, Baeckers L, Leucht S. Antipsychotic polypharmacy reduction versus polypharmacy continuation for people with schizophrenia. Cochrane Database Syst Rev 2022; 8:CD014383. [PMID: 36042158 PMCID: PMC9427025 DOI: 10.1002/14651858.cd014383.pub2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND In clinical practice, different antipsychotics can be combined in the treatment of people with schizophrenia (polypharmacy). This strategy can aim at increasing efficacy, but might also increase the adverse effects due to drug-drug interactions. Reducing polypharmacy by withdrawing one or more antipsychotics may reduce this problem, but must be done carefully, in order to maintain efficacy. OBJECTIVES To examine the effects and safety of reducing antipsychotic polypharmacy compared to maintaining people with schizophrenia on the same number of antipsychotics. SEARCH METHODS On 10 February 2021, we searched the Cochrane Schizophrenia Group's Study-Based Register of Trials, which is based on CENTRAL, CINAHL, ClinicalTrials.Gov, Embase, ISRCTN, MEDLINE, PsycINFO, PubMed and WHO ICTRP. SELECTION CRITERIA We included randomised controlled trials (RCTs) that compared reduction in the number of antipsychotics to continuation of the current number of antipsychotics. We included adults with schizophrenia or related disorders who were receiving more than one antipsychotic and were stabilised on their current treatment. DATA COLLECTION AND ANALYSIS Two review authors independently screened all the identified references for inclusion, and all the full papers. We contacted study authors if we needed any further information. Two review authors independently extracted the data, assessed the risk of bias using RoB 2 and the certainty of the evidence using the GRADE approach. The primary outcomes were: quality of life assessed as number of participants with clinically important change in quality of life; service use assessed as number of participants readmitted to hospital and adverse effects assessed with number of participants leaving the study early due to adverse effects. MAIN RESULTS We included five RCTs with 319 participants. Study duration ranged from three months to one year. All studies compared polypharmacy continuation with two antipsychotics to polypharmacy reduction to one antipsychotic. We assessed the risk of bias of results as being of some concern or at high risk of bias. A lower number of participants left the study early due to any reason in the polypharmacy continuation group (risk ratio (RR) 0.44, 95% confidence interval (CI) 0.29 to 0.68; I2 = 0%; 5 RCTs, n = 319; low-certainty evidence), and a lower number of participants left the study early due to inefficacy (RR 0.21, 95% CI 0.07 to 0.65; I2 = 0%; 3 RCTs, n = 201). Polypharmacy continuation resulted in more severe negative symptoms (MD 3.30, 95% CI 1.51 to 5.09; 1 RCT, n = 35). There was no clear difference between polypharmacy reduction and polypharmacy continuation on readmission to hospital, leaving the study early due to adverse effects, functioning, global state, general mental state and positive symptoms, number of participants with at least one adverse effect, weight gain and other specific adverse effects, mortality and cognition. We assessed the certainty of the evidence as very low or low across measured outcomes. No studies reported quality of life, days in hospital, relapse, depressive symptoms, behaviour and satisfaction with care. Due to lack of data, it was not possible to perform some planned sensitivity analyses, including one controlling for increasing the dose of the remaining antipsychotic. As a result, we do not know if the observed results might be influenced by adjustment of dose of remaining antipsychotic compound. AUTHORS' CONCLUSIONS This review summarises the latest evidence on polypharmacy continuation compared with polypharmacy reduction. Our results show that polypharmacy continuation might be associated with a lower number of participants leaving the study early, especially due to inefficacy. However, the evidence is of low and very low certainty and the data analyses based on few study only, so that it is not possible to draw strong conclusions based on the results of the present review. Further high-quality RCTs are needed to investigate this important topic.
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Affiliation(s)
- Irene Bighelli
- Section for Evidence Based Medicine in Psychiatry and Psychotherapy, Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
| | - Alessandro Rodolico
- Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Catania, Catania, Italy
| | - Spyridon Siafis
- Section for Evidence Based Medicine in Psychiatry and Psychotherapy, Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
| | - Myrto T Samara
- Department of Psychiatry, Faculty of Medicine, University of Thessaly, Larisa, Greece
| | | | - Salvatore Salomone
- Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| | - Eugenio Aguglia
- Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Catania, Catania, Italy
| | - Pierfelice Cutrufelli
- Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Catania, Catania, Italy
| | - Ingrid Bauer
- Section for Evidence Based Medicine in Psychiatry and Psychotherapy, Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, University of Augsburg, Augsburg, Germany
| | - Lio Baeckers
- Section for Evidence Based Medicine in Psychiatry and Psychotherapy, Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
| | - Stefan Leucht
- Section for Evidence Based Medicine in Psychiatry and Psychotherapy, Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
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Liao S, Macharoen K, McDonald KA, Nandi S, Paul D. Analysis of Variability of Functionals of Recombinant Protein Production Trajectories Based on Limited Data. Int J Mol Sci 2022; 23:ijms23147628. [PMID: 35886973 PMCID: PMC9317391 DOI: 10.3390/ijms23147628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 06/25/2022] [Accepted: 07/06/2022] [Indexed: 11/17/2022] Open
Abstract
Making statistical inference on quantities defining various characteristics of a temporally measured biochemical process and analyzing its variability across different experimental conditions is a core challenge in various branches of science. This problem is particularly difficult when the amount of data that can be collected is limited in terms of both the number of replicates and the number of time points per process trajectory. We propose a method for analyzing the variability of smooth functionals of the growth or production trajectories associated with such processes across different experimental conditions. Our modeling approach is based on a spline representation of the mean trajectories. We also develop a bootstrap-based inference procedure for the parameters while accounting for possible multiple comparisons. This methodology is applied to study two types of quantities—the “time to harvest” and “maximal productivity”—in the context of an experiment on the production of recombinant proteins. We complement the findings with extensive numerical experiments comparing the effectiveness of different types of bootstrap procedures for various tests of hypotheses. These numerical experiments convincingly demonstrate that the proposed method yields reliable inference on complex characteristics of the processes even in a data-limited environment where more traditional methods for statistical inference are typically not reliable.
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Affiliation(s)
- Shuting Liao
- Graduate Group in Biostatistics, University of California, Davis, CA 95616, USA;
| | - Kantharakorn Macharoen
- Department of Chemical Engineering, University of California, Davis, CA 95616, USA; (K.M.); (K.A.M.)
| | - Karen A. McDonald
- Department of Chemical Engineering, University of California, Davis, CA 95616, USA; (K.M.); (K.A.M.)
- Global HealthShare, University of California, Davis, CA 95616, USA
| | - Somen Nandi
- Department of Chemical Engineering, University of California, Davis, CA 95616, USA; (K.M.); (K.A.M.)
- Global HealthShare, University of California, Davis, CA 95616, USA
- Correspondence: (S.N.); (D.P.)
| | - Debashis Paul
- Department of Statistics, University of California, Davis, CA 95616, USA
- Correspondence: (S.N.); (D.P.)
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Further evidence that antipsychotic medication does not prevent long-term psychosis in higher-risk individuals. Eur Arch Psychiatry Clin Neurosci 2022; 272:591-602. [PMID: 34536114 DOI: 10.1007/s00406-021-01331-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 09/09/2021] [Indexed: 01/29/2023]
Abstract
OBJECTIVE Although existing guidelines have discouraged use of antipsychotics for general clinical high-risk (CHR) individuals, it is unclear if antipsychotics can prevent psychosis in higher-risk population. We aimed to study the comparative real-world effectiveness of antipsychotic treatments for preventing psychosis in higher-risk CHR individuals. METHODS A total of 300 CHR individuals were identified using the structured interview for prodromal syndromes (SIPS) and followed the participants for 3 years. In total, 228(76.0%) individuals completed baseline assessments using the NAPLS-2 risk calculator (NAPLS-2-RC), and 210(92.1%) completed the follow-up. The sample was further stratified according to risk level. "Higher-risk" was defined based on the NAPLS-2-RC risk score (≥ 20%) and SIPS positive symptom total scores (≥ 10). The main outcome was conversion to psychosis and poor functional outcomes, defined as a global assessment of function (GAF) score lower than 60 at follow-up. RESULTS In higher-risk CHR individuals, we found no significant difference in the rate of conversion to psychosis or poor functional outcomes between the antipsychotic and no-antipsychotic groups. Low-risk individuals treated with antipsychotic drugs were more likely exhibit poor functional outcomes compared with the no-antipsychotics group(NAPLS-2-RC estimated risk: χ2 = 8.330, p = 0.004; Positive symptom severity: χ2 = 12.997, p < 0.001). No significant effective factors were identified for prevention of the conversion to psychosis; conversely, CHR individuals who were treated with high dose antipsychotics (olanzapine, aripiprazole) showed a significantly increased risk of poor functional outcomes. CONCLUSIONS In CHR individuals, antipsychotic treatment should be provided with caution because of the risk of poor functional outcomes. Further, antipsychotic treatment does not appear to prevent onset of psychosis in real-world settings.
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Read J. How important are informed consent, informed choice, and patient-doctor relationships, when prescribing antipsychotic medication? J Ment Health 2022:1-9. [PMID: 35536145 DOI: 10.1080/09638237.2022.2069708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 02/25/2022] [Accepted: 03/05/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Antipsychotic medications (APs) are used for people with psychosis diagnoses and, increasingly for other problems and groups. AIMS This study examines how APs are prescribed, from the perspective of recipients. METHODS 757 people, from 30 countries, responded to questions about their experiences with APs, in an online survey. RESULTS Most (70%) were told nothing about adverse effects. Fewer than 2% recalled being told about the risks of diabetes, suicidality, sexual dysfunction, or reduced life span. None recalled being told about reduced brain volume or withdrawal effects. Only 28% recalled being offered other treatments; with only 14% offered talking therapies. 46% were not told how long to take the APs; and, of those who were told something, 48% were told to take them forever. Most respondents (76%) were not told how APs work. Only 19% were satisfied with the prescribing process, and only 25% reported a good, or very good, relationship with the prescriber. Information, satisfaction with the process, and the prescriber relationship were all positively related to three self-reported outcomes: reduction of problems the drugs were prescribed for, general helpfulness, and quality of life. CONCLUSIONS Steps need to be taken to ensure people prescribed antipsychotics are fully informed, especially about adverse effects and alternatives.
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Affiliation(s)
- John Read
- School of Psychology, University of East London, London, UK
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Zhang C, Li X, Zhao L, Liang R, Deng W, Guo W, Wang Q, Hu X, Du X, Sham PC, Luo X, Li T. Comprehensive and integrative analyses identify TYW5 as a schizophrenia risk gene. BMC Med 2022; 20:169. [PMID: 35527273 PMCID: PMC9082878 DOI: 10.1186/s12916-022-02363-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 04/04/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Identifying the causal genes at the risk loci and elucidating their roles in schizophrenia (SCZ) pathogenesis remain significant challenges. To explore risk variants associated with gene expression in the human brain and to identify genes whose expression change may contribute to the susceptibility of SCZ, here we report a comprehensive integrative study on SCZ. METHODS We systematically integrated the genetic associations from a large-scale SCZ GWAS (N = 56,418) and brain expression quantitative trait loci (eQTL) data (N = 175) using a Bayesian statistical framework (Sherlock) and Summary data-based Mendelian Randomization (SMR). We also measured brain structure of 86 first-episode antipsychotic-naive schizophrenia patients and 152 healthy controls with the structural MRI. RESULTS Both Sherlock (P = 3. 38 × 10-6) and SMR (P = 1. 90 × 10-8) analyses showed that TYW5 mRNA expression was significantly associated with risk of SCZ. Brain-based studies also identified a significant association between TYW5 protein abundance and SCZ. The single-nucleotide polymorphism rs203772 showed significant association with SCZ and the risk allele is associated with higher transcriptional level of TYW5 in the prefrontal cortex. We further found that TYW5 was significantly upregulated in the brain tissues of SCZ cases compared with controls. In addition, TYW5 expression was also significantly higher in neurons induced from pluripotent stem cells of schizophrenia cases compared with controls. Finally, combining analysis of genotyping and MRI data showed that rs203772 was significantly associated with gray matter volume of the right middle frontal gyrus and left precuneus. CONCLUSIONS We confirmed that TYW5 is a risk gene for SCZ. Our results provide useful information toward a better understanding of the genetic mechanism of TYW5 in risk of SCZ.
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Affiliation(s)
- Chengcheng Zhang
- Mental Health Center and Psychiatric Laboratory, the State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Xiaojing Li
- Mental Health Center and Psychiatric Laboratory, the State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Liansheng Zhao
- Mental Health Center and Psychiatric Laboratory, the State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Rong Liang
- Department of Neurobiology, Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310013, People's Republic of China
| | - Wei Deng
- Department of Neurobiology, Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310013, People's Republic of China
| | - Wanjun Guo
- Mental Health Center and Psychiatric Laboratory, the State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Qiang Wang
- Mental Health Center and Psychiatric Laboratory, the State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Xun Hu
- The Clinical Research Center and Department of Pathology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Xiangdong Du
- Suzhou Psychiatric Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Pak Chung Sham
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, SAR, China.,Centre for PanorOmic Sciences, The University of Hong Kong, Hong Kong, SAR, China.,State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, SAR, China
| | - Xiongjian Luo
- Kunming College of Life Science, University of Chinese Academy of Sciences, Kunming, Yunnan, China
| | - Tao Li
- Department of Neurobiology, Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310013, People's Republic of China. .,NHC and CAMS Key Laboratory of Medical Neurobiology, MOE Frontier Science Center for Brain Science and Brain-machine Integration, School of Brain Science and Brain Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
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59
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He M, Fan J, Zhou R, Gao G, Li R, Zuo Y, Li B, Li Y, Sun T. NLRP3/Caspase-1-Mediated Pyroptosis of Astrocytes Induced by Antipsychotics Is Inhibited by a Histamine H1 Receptor-Selective Agonist. Front Aging Neurosci 2022; 14:847561. [PMID: 35615587 PMCID: PMC9125084 DOI: 10.3389/fnagi.2022.847561] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 04/15/2022] [Indexed: 11/13/2022] Open
Abstract
Emerging data indicate that antipsychotic treatment causes brain volume loss and astrocyte death, but the mechanisms remain elusive. Pyroptosis, inflammatory cell death characterized by the formation of inflammatory bodies, increased expression of nod-like receptor proteins (NLRPs) such as NLRP3, and activation of caspases and gasdermin D (GSDMD) are largely associated with innate immunity, inflammation, and cell injury/death. However, the main effect of antipsychotics on astrocyte pyroptotic signaling and the molecular mechanisms remain obscure. In the present study, 72-h treatment with olanzapine, quetiapine, risperidone, or haloperidol significantly decreased the viability of astrocytes. Twenty-four hour treatment with olanzapine, quetiapine, risperidone, or haloperidol dose-dependently increased the protein expression of astrocytic NLRP3, NLRP6, caspase-1, caspase-4, and GSDMD. Co-treatment with a histamine H1 receptor agonist, 2-(3-trifluoromethylphenyl) histamine (FMPH), dose-dependently reduced the increased expression of NLRP3, caspase-1 and GSDMD induced by olanzapine, quetiapine, risperidone, or haloperidol. Moreover, olanzapine, quetiapine, risperidone, or haloperidol treatment induced pore formation in the membranes of astrocytes, and these effects were inhibited by FMPH co-treatment. Taken together, antipsychotic treatment activated astrocyte pyroptotic signaling, and these effects may be related to antipsychotic-induced astrocyte death. H1 receptor activation is an effective treatment strategy to suppress antipsychotic-induced astrocyte pyroptosis and inflammation.
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Affiliation(s)
- Meng He
- School of Chemistry, Chemical Engineering and Life Sciences, Wuhan University of Technology, Wuhan, China
| | - Jun Fan
- School of Chemistry, Chemical Engineering and Life Sciences, Wuhan University of Technology, Wuhan, China
| | - Ruqin Zhou
- School of Chemistry, Chemical Engineering and Life Sciences, Wuhan University of Technology, Wuhan, China
| | - Guanbin Gao
- State Key Laboratory of Advanced Technology for Materials Synthesis and Processing, Wuhan University of Technology, Wuhan, China
| | - Ruoxi Li
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - YuFeng Zuo
- School of Chemistry, Chemical Engineering and Life Sciences, Wuhan University of Technology, Wuhan, China
| | - Benben Li
- School of Chemistry, Chemical Engineering and Life Sciences, Wuhan University of Technology, Wuhan, China
| | - Yanmei Li
- Hubei Provincial Key Laboratory for Applied Toxicology, Hubei Provincial Center for Disease Control and Prevention, Wuhan, China
- *Correspondence: Taolei Sun,
| | - Taolei Sun
- School of Chemistry, Chemical Engineering and Life Sciences, Wuhan University of Technology, Wuhan, China
- Yanmei Li,
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60
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Adam Yaple Z, Tolomeo S, Yu R. Spatial and chronic differences in neural activity in medicated and unmedicated schizophrenia patients. Neuroimage Clin 2022; 35:103029. [PMID: 35569228 PMCID: PMC9112098 DOI: 10.1016/j.nicl.2022.103029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 04/10/2022] [Accepted: 04/28/2022] [Indexed: 11/07/2022]
Abstract
The medicated schizophrenia group yielded concordant activity among three right lateralized frontal clusters and a left lateralized parietal cluster. The unmedicated schizophrenia group yielded concordant activity among right lateralized frontal-parietal regions. A neural compensatory mechanism in schizophrenia.
A major caveat with investigations on schizophrenic patients is the difficulty to control for medication usage across samples as disease-related neural differences may be confounded by medication usage. Following a thorough literature search (632 records identified), we included 37 studies with a total of 740 medicated schizophrenia patients and 367 unmedicated schizophrenia patients. Here, we perform several meta-analyses to assess the neurofunctional differences between medicated and unmedicated schizophrenic patients across fMRI studies to determine systematic regions associated with medication usage. Several clusters identified by the meta-analysis on the medicated group include three right lateralized frontal clusters and a left lateralized parietal cluster, whereas the unmedicated group yielded concordant activity among right lateralized frontal-parietal regions. We further explored the prevalence of activity within these regions across illness duration and task type. These findings suggest a neural compensatory mechanism across these regions both spatially and chronically, offering new insight into the spatial and temporal dynamic neural differences among medicated and unmedicated schizophrenia patients.
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Affiliation(s)
| | - Serenella Tolomeo
- Social and Cognitive Computing Department, Institute of High Performance Computing, Agency for Science, Technology and Research, Singapore, Singapore
| | - Rongjun Yu
- Department of Management, Hong Kong Baptist University, Hong Kong, China; Department of Sport, Physical Education and Health, Hong Kong Baptist University, Hong Kong, China; Department of Physics, Hong Kong Baptist University, Hong Kong, China.
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61
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Rothschild AJ. Should Antipsychotic Medications Be Prescribed to Patients With Nonpsychotic Depression? J Clin Psychopharmacol 2022; 42:231-233. [PMID: 35475846 DOI: 10.1097/jcp.0000000000001550] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Anthony J Rothschild
- From the Department of Psychiatry, University of Massachusetts Chan Medical School and UMass Memorial Health Care, Worcester, MA
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62
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Murray RM, Bora E, Modinos G, Vernon A. Schizophrenia: A developmental disorder with a risk of non-specific but avoidable decline. Schizophr Res 2022; 243:181-186. [PMID: 35390609 DOI: 10.1016/j.schres.2022.03.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/08/2022] [Accepted: 03/11/2022] [Indexed: 12/31/2022]
Abstract
The onset of schizophrenia is determined by biological and social risk factors operating predominantly during development. These result in subtle deviations in brain structure and cognitive function. Striatal dopamine dysregulation follows, causing abnormal salience and resultant psychotic symptoms. Most people diagnosed as having schizophrenia do not progressively deteriorate; many improve or recover. However, poor care can allow a cycle of deterioration to be established, stress increasing dopamine dysregulation, leading to more stress consequent on continuing psychotic experiences, and so further dopamine release. Additionally, long-term antipsychotics can induce dopamine supersensitivity with resultant relapse and eventually treatment resistance. Some patients suffer loss of social and cognitive function, but this is a consequence of the hazards that afflict the person with schizophrenia, not a direct consequence of genetic predisposition. Thus, brain health and cognition can be further impaired by chronic medication effects, cardiovascular and cerebrovascular events, obesity, poor diet, and lack of exercise; drug use, especially of tobacco and cannabis, are likely to contribute. Poverty, homelessness and poor nutrition which become the lot of some people with schizophrenia, can also affect cognition. Regrettably, the model of progressive deterioration provides psychiatry and its funders with an alibi for the effects of poor care.
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Affiliation(s)
- R M Murray
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom.
| | - E Bora
- Dokuz Eylül Üniversitesi, Izmir, Izmir, Turkey
| | - G Modinos
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - A Vernon
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
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63
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Alphs L, Brown B, Turkoz I, Baker P, Fu DJ, Nuechterlein KH. The Disease Recovery Evaluation and Modification (DREaM) study: Effectiveness of paliperidone palmitate versus oral antipsychotics in patients with recent-onset schizophrenia or schizophreniform disorder. Schizophr Res 2022; 243:86-97. [PMID: 35247794 DOI: 10.1016/j.schres.2022.02.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 01/28/2022] [Accepted: 02/13/2022] [Indexed: 11/27/2022]
Abstract
We report primary results of the Disease Recovery Evaluation and Modification (DREaM) study, a randomized, open-label, delayed-start trial designed to compare the effectiveness of paliperidone palmitate (PP) versus oral antipsychotics (OAP) in delaying time to first treatment failure (TtFTF) in participants with recent-onset schizophrenia or schizophreniform disorder. DREaM included: Part I, 2-month oral run-in; Part II, 9-month disease progression phase (PP or OAP); Part III, 9 months of additional treatment (PP/PP; OAP rerandomized: OAP/OAP or OAP/PP). PP/PP and OAP/OAP comprised the 18-month extended disease progression (EDP) analysis. A total of 235 participants were randomized to PP (n = 78) or OAP (n = 157) in Part II. No statistically significant differences in TF between treatment groups were identified during Part II (PP 29.5%, OAP 24.8%; P = 0.377), Part III (PP/PP 14.3%, OAP/PP 15.8%, OAP/OAP 28.6%; P = 0.067) or the EDP analysis (PP/PP 28.6%, OAP/OAP 44.4%; NNT = 6; P = 0.080). Using a modified definition of TF excluding treatment supplementation with another antipsychotic, a common approach to managing dose adjustments, significant differences were observed between treatment groups in Part III (PP/PP 4.1%, OAP/PP 14.0%, OAP/OAP 27.0%; P = 0.002) and EDP (PP/PP 14.3%, OAP/OAP 42.9%; P = 0.001). Safety results were consistent with the known safety profile of PP. Although significant treatment differences were not observed during the first 9 months of DREaM, numerical differences favoring PP emerged in the last 9 months and significant differences were observed when TF criteria were limited to their most impactful components. These results highlight the potential benefit of initiating PP early in the course of schizophrenia and provide valuable insights for future clinical trials in recent-onset schizophrenia or schizophreniform disorder. Clinicaltrials.gov identifier: NCT02431702.
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Affiliation(s)
- Larry Alphs
- Janssen Scientific Affairs, LLC, 1125 Trenton-Harbourton Road, Titusville, NJ 08560, USA
| | - Brianne Brown
- Janssen Scientific Affairs, LLC, 1125 Trenton-Harbourton Road, Titusville, NJ 08560, USA.
| | - Ibrahim Turkoz
- Janssen Research and Development, LLC, 1125 Trenton-Harbourton Road, Titusville, NJ 08560, USA.
| | - Pamela Baker
- Janssen Scientific Affairs, LLC, 1125 Trenton-Harbourton Road, Titusville, NJ 08560, USA.
| | - Dong-Jing Fu
- Janssen Research and Development, LLC, 1125 Trenton-Harbourton Road, Titusville, NJ 08560, USA.
| | - Keith H Nuechterlein
- Departments of Psychiatry and Psychology, University of California at Los Angeles, 150 Medical Plaza Driveway, Los Angeles, CA 90095, USA.
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64
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Saoud H, Aflouk Y, Ben Afia A, Gaha L, Bel Hadj Jrad B. Association of VEGF-A and KDR polymorphisms with the development of schizophrenia. Hum Immunol 2022; 83:528-537. [DOI: 10.1016/j.humimm.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 04/05/2022] [Accepted: 04/06/2022] [Indexed: 11/04/2022]
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65
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Shoshina II, Almeida NL, Oliveira MEC, Trombetta BNT, Silva GM, Fars J, Santos NA, Fernandes TP. Serum levels of olanzapine are associated with acute cognitive effects in bipolar disorder. Psychiatry Res 2022; 310:114443. [PMID: 35286918 DOI: 10.1016/j.psychres.2022.114443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 02/03/2022] [Accepted: 02/12/2022] [Indexed: 11/16/2022]
Abstract
Bipolar (BPD) patients have deficits in cognition, but there are still controversies about the effects of some medications on their cognitive performance. Here, we investigated the relationship between cognition in terms of executive functions, memory, and attention in both first-episode medication-naive BPD patients and BPD patients taking olanzapine. Forty-one healthy controls, 40 unmedicated drug-naive BPD patients, and 34 BPD patients who took only olanzapine were recruited for the study. Cognitive performance was assessed using the Flanker test, Stroop test, and Corsi-block test. Bayesian multivariate regression analysis was run considering maximum robustness to avoid bias and to predict the outcomes. Our results revealed that unmedicated medication-naive BPD patients performed worse than healthy controls and the olanzapine group in some tasks. Additionally, BPD patients who took olanzapine had better cognitive performance than healthy controls and unmedicated BPD patients. The acute cognitive effects were predicted by olanzapine dosage and serum levels (i.e., large effects). The potential pro-cognitive effects of olanzapine in BPD patients should be carefully interpreted by considering various other clinical variables. We expect that our findings will contribute to further research in this area, with the goal of helping other researchers, patients, and the population.
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Affiliation(s)
- Irina I Shoshina
- Pavlov Institute of Physiology, RAS, Laboratory of Vision Physiology, Saint-Petersburg, Russia; St. Petersburg State University, Institute for Cognitive Research, Saint-Petersburg, Russia
| | - Natalia L Almeida
- Department of Psychology, Federal University of Paraiba, Joao Pessoa, Brazil; Perception, Neuroscience and Behaviour Laboratory, Federal University of Paraiba, Brazil
| | - Milena E C Oliveira
- Department of Psychology, Federal University of Paraiba, Joao Pessoa, Brazil; Perception, Neuroscience and Behaviour Laboratory, Federal University of Paraiba, Brazil
| | - Bianca N T Trombetta
- Department of Psychology, Federal University of Paraiba, Joao Pessoa, Brazil; Perception, Neuroscience and Behaviour Laboratory, Federal University of Paraiba, Brazil
| | - Gabriella M Silva
- Department of Psychology, Federal University of Paraiba, Joao Pessoa, Brazil; Perception, Neuroscience and Behaviour Laboratory, Federal University of Paraiba, Brazil
| | - Julien Fars
- Department of Ophthalmology, University Hospital Erlangen, Erlangen, Germany
| | - Natanael A Santos
- Department of Psychology, Federal University of Paraiba, Joao Pessoa, Brazil; Perception, Neuroscience and Behaviour Laboratory, Federal University of Paraiba, Brazil
| | - Thiago P Fernandes
- Department of Psychology, Federal University of Paraiba, Joao Pessoa, Brazil; Perception, Neuroscience and Behaviour Laboratory, Federal University of Paraiba, Brazil.
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66
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Fountoulakis KN, Stahl SM. The effect of first- and second-generation antipsychotics on brain morphology in schizophrenia: A systematic review of longitudinal magnetic resonance studies with a randomized allocation to treatment arms. J Psychopharmacol 2022; 36:428-438. [PMID: 35395911 DOI: 10.1177/02698811221087645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Schizophrenia manifests as loss of brain volume in specific areas in a progressive nature and an important question concerns whether long-term treatment with medications contributes to this. The aim of the current PRISMA systematic review was to search for prospective studies involving randomization to treatment. PROSPERO ID: CRD42020197874. The MEDLINE/PUBMED was searched and it returned 2638 articles; 3 were fulfilling the inclusion criteria. A fourth was published later; they included 359 subjects, of whom 86 were healthy controls, while the rest were first-episode patients, with 91 under olanzapine, 93 under haloperidol, 48 under risperidone, 5 under paliperidone, 6 under ziprasidone, and 30 under placebo. Probably one-third of patients were suffering from a psychotic disorder other than schizophrenia. The consideration of their results suggested that there is no significant difference between these medications concerning their effects on brain structure and also in comparison to healthy subjects. There does not seem to be any strong support to the opinion that medications that treat psychosis cause loss of brain volume in patients with schizophrenia. On the contrary, the data might imply the possible presence of a protective effect for D2, 5-HT2, and NE alpha-2 antagonists (previously called SGAs). However, the literature is limited and focused research in large study samples is essential to clarify the issue, since important numerical differences do exist. The possibility of the results and their heterogeneity to be artifacts secondary to a modification of magnetic resonance imaging (MRI) signal by antipsychotics should not be easily rejected until relevant data are available.
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Affiliation(s)
- Konstantinos N Fountoulakis
- 3rd Department of Psychiatry, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stephen M Stahl
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA.,Department of Psychiatry, Cambridge University, Cambridge, UK
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67
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Abé C, Ching CRK, Liberg B, Lebedev AV, Agartz I, Akudjedu TN, Alda M, Alnæs D, Alonso-Lana S, Benedetti F, Berk M, Bøen E, Bonnin CDM, Breuer F, Brosch K, Brouwer RM, Canales-Rodríguez EJ, Cannon DM, Chye Y, Dahl A, Dandash O, Dannlowski U, Dohm K, Elvsåshagen T, Fisch L, Fullerton JM, Goikolea JM, Grotegerd D, Haatveit B, Hahn T, Hajek T, Heindel W, Ingvar M, Sim K, Kircher TTJ, Lenroot RK, Malt UF, McDonald C, McWhinney SR, Melle I, Meller T, Melloni EMT, Mitchell PB, Nabulsi L, Nenadić I, Opel N, Overs BJ, Panicalli F, Pfarr JK, Poletti S, Pomarol-Clotet E, Radua J, Repple J, Ringwald KG, Roberts G, Rodriguez-Cano E, Salvador R, Sarink K, Sarró S, Schmitt S, Stein F, Suo C, Thomopoulos SI, Tronchin G, Vieta E, Westlye LT, White AG, Yatham LN, Zak N, Thompson PM, Andreassen OA, Landén M. Longitudinal Structural Brain Changes in Bipolar Disorder: A Multicenter Neuroimaging Study of 1232 Individuals by the ENIGMA Bipolar Disorder Working Group. Biol Psychiatry 2022; 91:582-592. [PMID: 34809987 DOI: 10.1016/j.biopsych.2021.09.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 08/24/2021] [Accepted: 09/10/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Bipolar disorder (BD) is associated with cortical and subcortical structural brain abnormalities. It is unclear whether such alterations progressively change over time, and how this is related to the number of mood episodes. To address this question, we analyzed a large and diverse international sample with longitudinal magnetic resonance imaging (MRI) and clinical data to examine structural brain changes over time in BD. METHODS Longitudinal structural MRI and clinical data from the ENIGMA (Enhancing Neuro Imaging Genetics through Meta Analysis) BD Working Group, including 307 patients with BD and 925 healthy control subjects, were collected from 14 sites worldwide. Male and female participants, aged 40 ± 17 years, underwent MRI at 2 time points. Cortical thickness, surface area, and subcortical volumes were estimated using FreeSurfer. Annualized change rates for each imaging phenotype were compared between patients with BD and healthy control subjects. Within patients, we related brain change rates to the number of mood episodes between time points and tested for effects of demographic and clinical variables. RESULTS Compared with healthy control subjects, patients with BD showed faster enlargement of ventricular volumes and slower thinning of the fusiform and parahippocampal cortex (0.18 <d < 0.22). More (hypo)manic episodes were associated with faster cortical thinning, primarily in the prefrontal cortex. CONCLUSIONS In the hitherto largest longitudinal MRI study on BD, we did not detect accelerated cortical thinning but noted faster ventricular enlargements in BD. However, abnormal frontocortical thinning was observed in association with frequent manic episodes. Our study yields insights into disease progression in BD and highlights the importance of mania prevention in BD treatment.
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Affiliation(s)
- Christoph Abé
- Department of Clinical Neuroscience, Osher Center, Karolinska Institutet, Stockholm, Sweden.
| | - Christopher R K Ching
- Imaging Genetics Center, Mark and Mary Stevens Institute for Neuroimaging and Informatics, University of Southern California, Los Angeles, California
| | - Benny Liberg
- Department of Clinical Neuroscience, Osher Center, Karolinska Institutet, Stockholm, Sweden
| | - Alexander V Lebedev
- Department of Clinical Neuroscience, Osher Center, Karolinska Institutet, Stockholm, Sweden
| | - Ingrid Agartz
- Department of Clinical Neuroscience, Centre for Psychiatric Research, Karolinska Institutet, Stockholm, Sweden; Norwegian Centre for Mental Disorders Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; KG Jebsen Centre for Neurodevelopmental Disorders, Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Theophilus N Akudjedu
- Institute of Medical Imaging and Visualisation, Bournemouth University, Bournemouth, United Kingdom; Centre for Neuroimaging and Cognitive Genomics, Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, College of Medicine, Nursing, and Health Sciences, National University of Ireland, Galway, Ireland
| | - Martin Alda
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia; National Institute of Mental Health, Klecany, Czech Republic
| | - Dag Alnæs
- Norwegian Centre for Mental Disorders Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; Bjørknes College, Oslo, Norway
| | - Silvia Alonso-Lana
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental, Barcelona, Spain
| | - Francesco Benedetti
- Psychiatry and Clinical Psychobiology Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milano, Italy; University Vita-Salute San Raffaele, Milano, Italy; Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Michael Berk
- Orygen, the National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, Florey Institute for Neuroscience and Mental Health and the Department of Psychiatry, the University of Melbourne, Melbourne, Victoria, Australia; Department of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Deakin University, the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Victoria, Australia
| | - Erlend Bøen
- Unit of Psychosomatic and CL Psychiatry, Oslo University Hospital, Oslo, Norway
| | - Caterina Del Mar Bonnin
- Centro de Investigación Biomédica en Red de Salud Mental, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain; Barcelona Bipolar Disorders and Depressive Unit, Hospital Clínic, Institute of Neurosciences, Barcelona, Spain; University of Barcelona, Barcelona, Spain
| | - Fabian Breuer
- Psychiatry and Clinical Psychobiology Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milano, Italy; University Vita-Salute San Raffaele, Milano, Italy; Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Katharina Brosch
- Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany; Center for Mind, Brain and Behavior, University of Marburg and Justus Liebig, University of Giessen, Giessen, Germany
| | - Rachel M Brouwer
- Department of Psychiatry, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, the Netherlands; Complex Trait Genetics, Center for Neurogenomics and Cognitive Research, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Erick J Canales-Rodríguez
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental, Barcelona, Spain; Signal Processing Laboratory, École polytechnique fédérale de Lausanne, Lausanne, Switzerland
| | - Dara M Cannon
- Centre for Neuroimaging and Cognitive Genomics, Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, College of Medicine, Nursing, and Health Sciences, National University of Ireland, Galway, Ireland
| | - Yann Chye
- Turner Institute for Brain and Mental Health, School of Psychological Science and Monash Biomedical Imaging Facility, Monash University, Melbourne, Victoria, Australia
| | - Andreas Dahl
- Norwegian Centre for Mental Disorders Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; Department of Psychology, University of Oslo, Oslo, Norway
| | - Orwa Dandash
- Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia
| | - Udo Dannlowski
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Katharina Dohm
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Torbjørn Elvsåshagen
- Norwegian Centre for Mental Disorders Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; Norwegian Centre for Mental Disorders Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; Department of Neurology, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
| | - Lukas Fisch
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Janice M Fullerton
- School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia; Neuroscience Research Australia, Sydney, New South Wales, Australia
| | - Jose M Goikolea
- Centro de Investigación Biomédica en Red de Salud Mental, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain; Barcelona Bipolar Disorders and Depressive Unit, Hospital Clínic, Institute of Neurosciences, Barcelona, Spain; University of Barcelona, Barcelona, Spain
| | - Dominik Grotegerd
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Beathe Haatveit
- Norwegian Centre for Mental Disorders Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; Norwegian Centre for Mental Disorders Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Tim Hahn
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia; National Institute of Mental Health, Klecany, Czech Republic; Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Tomas Hajek
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia; National Institute of Mental Health, Klecany, Czech Republic; Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Walter Heindel
- Clinic for Radiology, University of Münster, Münster, Germany
| | - Martin Ingvar
- Department of Clinical Neuroscience, Osher Center, Karolinska Institutet, Stockholm, Sweden; Karolinska University Hospital, Department of Neuroradiology, Stockholm, Sweden
| | - Kang Sim
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; West Region, Institute of Mental Health, Singapore, Singapore; Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Tilo T J Kircher
- Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany; Center for Mind, Brain and Behavior, University of Marburg and Justus Liebig, University of Giessen, Giessen, Germany
| | | | - Ulrik F Malt
- Department of Neurology, Oslo University Hospital, Oslo, Norway; Department of Psychiatry and Addiction, Section for C-L Psychiatry and Psychosomatics, Oslo University Hospital, Oslo, Norway
| | - Colm McDonald
- Centre for Neuroimaging and Cognitive Genomics, Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, College of Medicine, Nursing, and Health Sciences, National University of Ireland, Galway, Ireland
| | - Sean R McWhinney
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia
| | - Ingrid Melle
- Norwegian Centre for Mental Disorders Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; Norwegian Centre for Mental Disorders Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Tina Meller
- Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany; Center for Mind, Brain and Behavior, University of Marburg and Justus Liebig, University of Giessen, Giessen, Germany
| | - Elisa M T Melloni
- Psychiatry and Clinical Psychobiology Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milano, Italy; University Vita-Salute San Raffaele, Milano, Italy
| | - Philip B Mitchell
- School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Leila Nabulsi
- Imaging Genetics Center, Mark and Mary Stevens Institute for Neuroimaging and Informatics, University of Southern California, Los Angeles, California; Centre for Neuroimaging and Cognitive Genomics, Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, College of Medicine, Nursing, and Health Sciences, National University of Ireland, Galway, Ireland
| | - Igor Nenadić
- Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany; Center for Mind, Brain and Behavior, University of Marburg and Justus Liebig, University of Giessen, Giessen, Germany
| | - Nils Opel
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Bronwyn J Overs
- Neuroscience Research Australia, Sydney, New South Wales, Australia
| | - Francesco Panicalli
- Hospital general de Granollers, Barcelona, Spain; Benito Menni CASM, Barcelona, Spain
| | - Julia-Katharina Pfarr
- Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany; Center for Mind, Brain and Behavior, University of Marburg and Justus Liebig, University of Giessen, Giessen, Germany
| | - Sara Poletti
- Psychiatry and Clinical Psychobiology Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milano, Italy
| | - Edith Pomarol-Clotet
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental, Barcelona, Spain
| | - Joaquim Radua
- Center for Psychiatric Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden; Early Psychosis: Interventions and Clinical-detection lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom; Centro de Investigación Biomédica en Red de Salud Mental, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain; Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Jonathan Repple
- Center for Psychiatric Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden; Early Psychosis: Interventions and Clinical-detection lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom; Centro de Investigación Biomédica en Red de Salud Mental, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain; Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Kai G Ringwald
- Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany; Center for Mind, Brain and Behavior, University of Marburg and Justus Liebig, University of Giessen, Giessen, Germany
| | - Gloria Roberts
- School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Elena Rodriguez-Cano
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain; Benito Menni CASM, Barcelona, Spain
| | - Raymond Salvador
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental, Barcelona, Spain
| | - Kelvin Sarink
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; West Region, Institute of Mental Health, Singapore, Singapore; Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Salvador Sarró
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental, Barcelona, Spain; Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany; Center for Mind, Brain and Behavior, University of Marburg and Justus Liebig, University of Giessen, Giessen, Germany
| | - Simon Schmitt
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental, Barcelona, Spain; Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany; Center for Mind, Brain and Behavior, University of Marburg and Justus Liebig, University of Giessen, Giessen, Germany; Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Frederike Stein
- Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany; Center for Mind, Brain and Behavior, University of Marburg and Justus Liebig, University of Giessen, Giessen, Germany
| | - Chao Suo
- Turner Institute for Brain and Mental Health, School of Psychological Science and Monash Biomedical Imaging Facility, Monash University, Melbourne, Victoria, Australia
| | - Sophia I Thomopoulos
- Imaging Genetics Center, Mark and Mary Stevens Institute for Neuroimaging and Informatics, University of Southern California, Los Angeles, California
| | - Giulia Tronchin
- Centre for Neuroimaging and Cognitive Genomics, Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, College of Medicine, Nursing, and Health Sciences, National University of Ireland, Galway, Ireland
| | - Eduard Vieta
- Centro de Investigación Biomédica en Red de Salud Mental, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain; Barcelona Bipolar Disorders and Depressive Unit, Hospital Clínic, Institute of Neurosciences, Barcelona, Spain; University of Barcelona, Barcelona, Spain
| | - Lars T Westlye
- Norwegian Centre for Mental Disorders Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; KG Jebsen Centre for Neurodevelopmental Disorders, Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Norwegian Centre for Mental Disorders Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; Department of Psychology, University of Oslo, Oslo, Norway
| | - Adam G White
- Djavad Mowafaghian Centre for Brain Health, Vancouver, British Columbia, Canada
| | - Lakshmi N Yatham
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nathalia Zak
- Norwegian Centre for Mental Disorders Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Paul M Thompson
- Imaging Genetics Center, Mark and Mary Stevens Institute for Neuroimaging and Informatics, University of Southern California, Los Angeles, California
| | - Ole A Andreassen
- KG Jebsen Centre for Neurodevelopmental Disorders, Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Norwegian Centre for Mental Disorders Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Mikael Landén
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Krajner F, Hadaya L, McQueen G, Sendt KV, Gillespie A, Avila A, Lally J, Hedges EP, Diederen K, Howes OD, Barker GJ, Lythgoe DJ, Kempton MJ, McGuire P, MacCabe JH, Egerton A. Subcortical volume reduction and cortical thinning 3 months after switching to clozapine in treatment resistant schizophrenia. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2022; 8:13. [PMID: 35236831 PMCID: PMC8891256 DOI: 10.1038/s41537-022-00230-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 12/06/2021] [Indexed: 11/29/2022]
Abstract
The neurobiological effects of clozapine are under characterised. We examined the effects clozapine treatment on subcortical volume and cortical thickness and investigated whether macrostructural changes were linked to alterations in glutamate or N-acetylaspartate (NAA). Data were acquired in 24 patients with treatment-resistant schizophrenia before and 12 weeks after switching to clozapine. During clozapine treatment we observed reductions in caudate and putamen volume, lateral ventricle enlargement (P < 0.001), and reductions in thickness of the left inferior temporal cortex, left caudal middle frontal cortex, and the right temporal pole. Reductions in right caudate volume were associated with local reductions in NAA (P = 0.002). None of the morphometric changes were associated with changes in glutamate levels. These results indicate that clozapine treatment is associated with subcortical volume loss and cortical thinning and that at least some of these effects are linked to changes in neuronal or metabolic integrity.
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Affiliation(s)
- Fanni Krajner
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK
| | - Laila Hadaya
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK
| | - Grant McQueen
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK
| | - Kyra-Verena Sendt
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK
| | - Amy Gillespie
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Alessia Avila
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK
| | - John Lally
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Emily P Hedges
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK
| | - Kelly Diederen
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK
| | - Oliver D Howes
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK
- South London and Maudsley NHS Trust, London, UK
| | - Gareth J Barker
- Department of Neuroimaging, Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK
| | - David J Lythgoe
- Department of Neuroimaging, Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK
| | - Matthew J Kempton
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK
| | - Philip McGuire
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK
- South London and Maudsley NHS Trust, London, UK
| | - James H MacCabe
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK
- South London and Maudsley NHS Trust, London, UK
| | - Alice Egerton
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK.
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Read J. The experiences of 585 people when they tried to withdraw from antipsychotic drugs. Addict Behav Rep 2022; 15:100421. [PMID: 35434245 PMCID: PMC9006667 DOI: 10.1016/j.abrep.2022.100421] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 02/28/2022] [Accepted: 03/12/2022] [Indexed: 12/14/2022] Open
Abstract
72% of an international sample of 585 antipsychotics users report withdrawal effects when they try to stop taking them. none recall being told anything about withdrawal effects, dependence, rebound psychosis, the need to reduce gradually, by the prescriber. 26% report positive effects of withdrawing, such as feeling more alive and more like themselves.
Introduction Many recipients of antipsychotic drugs try to stop taking them, primarily because of distressing adverse effects. Little research has been undertaken into the withdrawal symptoms that ensue. Methods In an online survey 585 antipsychotic users, from 29 countries, who had tried to stop taking the drugs, were asked specific questions about the process and the open question: ‘What were the effects of withdrawing from the medication?’ 44% had a diagnosis in the ‘schizophrenia’ spectrum. Results Responding to specific questions, 72% reported classical withdrawal effects of the kind associated with other central nervous system medications, including nausea, tremors, anxiety, agitation and headaches. 52% of these categorized those effects as ‘severe’. 26% had tried four or more times to discontinue, and 23% took at least one year to successfully withdraw completely. In response to the open question, 73% reported one or more withdrawal effects, most frequently, insomnia, nervousness and extreme feelings; 26% reported one or more positive outcomes, most frequently more energy/alive and clearer thinking; and 18% reported psychosis. Conclusion These findings are consistent with a small but growing body of literature on this topic. Prescribers need to inform themselves about the nature, frequency and intensity of withdrawal effects from APs, and about withdrawal psychosis. National guidelines, professional bodies’ statements, and drug company information urgently need to be updated to prevent the suffering that can occur when withdrawal is minimised, misunderstood or unsupported.
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Pai N, Acar M, Juneja P, Kouhkamari MH, Siva S, Mullan J. Antipsychotic prescribing patterns in Australia: a retrospective analysis. BMC Psychiatry 2022; 22:110. [PMID: 35148707 PMCID: PMC8840322 DOI: 10.1186/s12888-022-03755-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 01/28/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND To examine real-world patterns of antipsychotic use in patients with schizophrenia Australia. METHODS This retrospective cohort analysis was conducted using the Australian Commonwealth Department of Human Services Pharmaceutical Benefits Scheme (PBS) 10% sample data. Included data were for patients aged 16-years or older who initiated treatment for the first time with a PBS-reimbursed antipsychotic medication for schizophrenia between July 2013 and September 2017. Patterns of treatment usage were summarised descriptively. Differences in prescribing patterns by age and prescribing year were reported. Treatment persistence was estimated using Kaplan-Meier methods, with differences explored using log-rank tests. Values of p < 0.05 were considered statistically significant. RESULTS 6,740 patients, representing 8,249 non-unique patients, received prescriptions for antipsychotic medications. Patients were aged 16 years to over 85 years (54.5% were < 55 years) and two-thirds of patients were male (61%). The majority of treatment episodes (62%, n = 5,139/8,249) were prescribed an atypical oral antipsychotic. Typical long-acting antipsychotic therapies (LATs) were prescribed 19% of the treatment episodes (n = 1,608/8,249. There was a small increase in prescribing of atypical LAT and typical LAT and a small decrease in atypical oral and clozapine prescribing over the study period. Treatment persistence was greatest in patients treated with clozapine, than in those treated with atypical LATs. CONCLUSIONS While the majority of patients receive atypical antipsychotic medications, one in five continue to use older typical LAT therapies. Patient age and time on therapy may be associated with choice of therapy. Persistence to atypical LAT therapy is better than for other treatment modalities in this real-world cohort.
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Affiliation(s)
- Nagesh Pai
- School of Medicine, University of Wollongong (UOW), Wollongong, Australia. .,Illawarra Shoalhaven Local Health District (ISLHD), Wollongong, Australia.
| | - Mustafa Acar
- Janssen-Cilag Pty Ltd, North Ryde, NSW Australia
| | | | | | | | - Judy Mullan
- grid.1007.60000 0004 0486 528XSchool of Medicine, University of Wollongong (UOW), Wollongong, Australia
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Chen Y, Womer FY, Feng R, Zhang X, Zhang Y, Duan J, Chang M, Yin Z, Jiang X, Wei S, Wei Y, Tang Y, Wang F. A Real-World Observation of Antipsychotic Effects on Brain Volumes and Intrinsic Brain Activity in Schizophrenia. Front Neurosci 2022; 15:749316. [PMID: 35221884 PMCID: PMC8863862 DOI: 10.3389/fnins.2021.749316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 11/30/2021] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe confounding effects of antipsychotics that led to the inconsistencies of neuroimaging findings have long been the barriers to understanding the pathophysiology of schizophrenia (SZ). Although it is widely accepted that antipsychotics can alleviate psychotic symptoms during the early most acute phase, the longer-term effects of antipsychotics on the brain have been unclear. This study aims to look at the susceptibility of different imaging measures to longer-term medicated status through real-world observation.MethodsWe compared gray matter volume (GMV) with amplitude of low-frequency fluctuations (ALFFs) in 89 medicated-schizophrenia (med-SZ), 81 unmedicated-schizophrenia (unmed-SZ), and 235 healthy controls (HC), and the differences were explored for relationships between imaging modalities and clinical variables. We also analyzed age-related effects on GMV and ALFF values in the two patient groups (med-SZ and unmed-SZ).ResultsMed-SZ demonstrated less GMV in the prefrontal cortex, temporal lobe, cingulate gyri, and left insula than unmed-SZ and HC (p < 0.05, family-wise error corrected). Additionally, GMV loss correlated with psychiatric symptom relief in all SZ. However, medicated status did not influence ALFF values: all SZ showed increased ALFF in the anterior cerebrum and decreased ALFF in posterior visual cortices compared with HC (p < 0.05, family-wise error corrected). Age-related GMV effects were seen in all regions, which showed group-level differences except fusiform gyrus. No significant correlation was found between ALFF values and psychiatric symptoms.ConclusionGMV loss appeared to be pronounced to longer-term antipsychotics, whereby imbalanced alterations in regional low-frequency fluctuations persisted unaffected by antipsychotic treatment. Our findings may help to understand the disease course of SZ and potentially identify a reliable neuroimaging feature for diagnosis.
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Affiliation(s)
- Yifan Chen
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, China
- Early Intervention Unit, Department of Psychiatry, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China
- Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Fay Y. Womer
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
| | - Ruiqi Feng
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, China
- School of Biomedical Engineering and Informatics, Nanjing Medical University, Nanjing, China
| | - Xizhe Zhang
- Early Intervention Unit, Department of Psychiatry, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China
- Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China
| | - Yanbo Zhang
- Functional Brain Imaging Institute of Nanjing Medical University, Nanjing, China
| | - Jia Duan
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, China
- Early Intervention Unit, Department of Psychiatry, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China
- Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Miao Chang
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, China
- School of Biomedical Engineering and Informatics, Nanjing Medical University, Nanjing, China
| | - Zhiyang Yin
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Xiaowei Jiang
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Shengnan Wei
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Yange Wei
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, China
- Early Intervention Unit, Department of Psychiatry, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China
- Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Yanqing Tang
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, China
- *Correspondence: Yanqing Tang,
| | - Fei Wang
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, China
- Early Intervention Unit, Department of Psychiatry, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China
- Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang, China
- Fei Wang,
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Abstract
Schizophrenia, characterised by psychotic symptoms and in many cases social and occupational decline, remains an aetiological and therapeutic challenge. Contrary to popular belief, the disorder is modestly more common in men than in women. Nor is the outcome uniformly poor. A division of symptoms into positive, negative, and disorganisation syndromes is supported by factor analysis. Catatonic symptoms are not specific to schizophrenia and so-called first rank symptoms are no longer considered diagnostically important. Cognitive impairment is now recognised as a further clinical feature of the disorder. Lateral ventricular enlargement and brain volume reductions of around 2% are established findings. Brain functional changes occur in different subregions of the frontal cortex and might ultimately be understandable in terms of disturbed interaction among large-scale brain networks. Neurochemical disturbance, involving dopamine function and glutamatergic N-methyl-D-aspartate receptor function, is supported by indirect and direct evidence. The genetic contribution to schizophrenia is now recognised to be largely polygenic. Birth and early life factors also have an important aetiological role. The mainstay of treatment remains dopamine receptor-blocking drugs; a psychological intervention, cognitive behavioural therapy, has relatively small effects on symptoms. The idea that schizophrenia is better regarded as the extreme end of a continuum of psychotic symptoms is currently influential. Other areas of debate include cannabis and childhood adversity as causative factors, whether there is progressive brain change after onset, and the long-term success of early intervention initiatives.
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Affiliation(s)
- Sameer Jauhar
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College, London, UK
| | - Mandy Johnstone
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College, London, UK; National Psychosis Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Peter J McKenna
- FIDMAG Hermanas Hospitalarias Research Foundation, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain.
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Schaub AC, Kirschner M, Schweinfurth N, Mählmann L, Kettelhack C, Engeli EE, Doll JPK, Borgwardt S, Lang UE, Kaiser S, Walter M, Herdener M, Wrege J, Schmidt A. Neural mapping of anhedonia across psychiatric diagnoses: A transdiagnostic neuroimaging analysis. Neuroimage Clin 2022; 32:102825. [PMID: 34544030 PMCID: PMC8455863 DOI: 10.1016/j.nicl.2021.102825] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 08/16/2021] [Accepted: 09/08/2021] [Indexed: 01/12/2023]
Abstract
Anhedonia is present in many different psychiatric disorders. Anhedonia has been associated with abnormal reward-related striatal dopamine functioning. This study tested whether transdiagnostic anhedonia expression mapped onto striatal volume. Our findings suggest volumetric abnormalities in the putamen and cerebellum as a common neural substrate of anhedonia severity that cut across psychiatric entities.
Anhedonia has been associated with abnormal reward-related striatal dopamine functioning in patients with different psychiatric disorders. Here, we tested whether anhedonia expression mapped onto striatal volume across several psychiatric diagnoses. T1-weighted images from 313 participants including 89 healthy controls (HC), 22 patients with opioid use disorder (OUD), 50 patients with major depressive disorder (MDD), 45 patients with borderline personality disorder (BPD), 49 patients with first-episode psychosis (FEP), 43 patients with cocaine use disorder (CUD) and 15 patients with schizophrenia (SZ) were included. Anhedonia was assessed with subscores of the Beck Depression Inventory (BDI) and/or the Scale for the Assessment of Negative Symptoms (SANS). Voxel-based morphometry (VBM) was conducted for identifying dimensional symptom-structure associations using region of interest (ROI, dorsal and ventral striatum) and whole-brain analyses, as well as for group comparisons of striatal volume. ROI analyses revealed significant negative relationships between putamen volume and BDI and SANS anhedonia scores across OUD, MDD, BPD, CUD and SZ patients (n = 175) and MDD, FEP and SZ patients (n = 114), respectively. Whole-brain VBM analyses confirmed these associations and further showed negative relationships between anhedonia severity and volume of the bilateral cerebellum. There were group differences in right accumbens volume, which however were not related to anhedonia expression across the different diagnoses. Our findings indicate volumetric abnormalities in the putamen and cerebellum as a common neural substrate of anhedonia severity that cut across psychiatric entities.
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Affiliation(s)
| | - Matthias Kirschner
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland
| | - Nina Schweinfurth
- University of Basel, Department of Psychiatry (UPK), Basel, Switzerland
| | - Laura Mählmann
- University of Basel, Department of Psychiatry (UPK), Basel, Switzerland
| | - Cedric Kettelhack
- University of Basel, Department of Psychiatry (UPK), Basel, Switzerland
| | - Etna E Engeli
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland
| | - Jessica P K Doll
- University of Basel, Department of Psychiatry (UPK), Basel, Switzerland
| | - Stefan Borgwardt
- University of Basel, Department of Psychiatry (UPK), Basel, Switzerland; Department of Psychiatry and Psychotherapy, University of Lübeck, Germany
| | - Undine E Lang
- University of Basel, Department of Psychiatry (UPK), Basel, Switzerland
| | - Stefan Kaiser
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland; Division of Adult Psychiatry, Department of Psychiatry, Geneva University Hospitals, Switzerland
| | - Marc Walter
- University of Basel, Department of Psychiatry (UPK), Basel, Switzerland
| | - Marcus Herdener
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland
| | - Johannes Wrege
- University of Basel, Department of Psychiatry (UPK), Basel, Switzerland
| | - André Schmidt
- University of Basel, Department of Psychiatry (UPK), Basel, Switzerland.
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Present and future antipsychotic drugs: a systematic review of the putative mechanisms of action for efficacy and a critical appraisal under a translational perspective. Pharmacol Res 2022; 176:106078. [PMID: 35026403 DOI: 10.1016/j.phrs.2022.106078] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 12/23/2021] [Accepted: 01/07/2022] [Indexed: 01/10/2023]
Abstract
Antipsychotics represent the mainstay of schizophrenia pharmacological therapy, and their role has been expanded in the last years to mood disorders treatment. Although introduced in 1952, many years of research were required before an accurate picture of how antipsychotics work began to emerge. Despite the well-recognized characterization of antipsychotics in typical and atypical based on their liability to induce motor adverse events, their main action at dopamine D2R to elicit the "anti-psychotic" effect, as well as the multimodal action at other classes of receptors, their effects on intracellular mechanisms starting with receptor occupancy is still not completely understood. Significant lines of evidence converge on the impact of these compounds on multiple molecular signaling pathways implicated in the regulation of early genes and growth factors, dendritic spine shape, brain inflammation, and immune response, tuning overall the function and architecture of the synapse. Here we present, based on PRISMA approach, a comprehensive and systematic review of the above mechanisms under a translational perspective to disentangle those intracellular actions and signaling that may underline clinically relevant effects and represent potential targets for further innovative strategies in antipsychotic therapy.
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Białkowski J, Clark J. The effects of drug safety warnings on drug sales and share prices. HEALTH ECONOMICS 2022; 31:174-196. [PMID: 34697859 DOI: 10.1002/hec.4440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 07/25/2021] [Accepted: 09/04/2021] [Indexed: 06/13/2023]
Abstract
Current regulations require that when seeking approval for new drugs, pharmaceutical companies must demonstrate their short- but not long-term safety and efficacy. Instead, post-approval, clinicians report adverse reactions to regulators, who may issue additional safety warnings. We investigate the incentives this creates for pharmaceutical companies to seek approval for new drugs with unknown long-term effects. We first construct models predicting that (1) long-run effects can be reasonably approximated from observational follow-up of short-term randomized control trials, and (2) companies will trade-off short-term sales against possible later adverse demand effects. We then test whether regulator warnings over diabetic, analgesic, analeptic, or psychoanaleptic drugs sold in the US and UK hospital and retail sectors affect the sales of individual drugs or the share prices of companies that sell them. With some exceptions, we find that pharmaceutical companies generally face no adverse market reaction in sales or share price from newly issued warnings in these four drug categories.
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Affiliation(s)
- Jędrzej Białkowski
- Department of Economics and Finance, University of Canterbury, Christchurch, New Zealand
| | - Jeremy Clark
- Department of Economics and Finance, University of Canterbury, Christchurch, New Zealand
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76
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Kanahara N, Yamanaka H, Shiko Y, Kawasaki Y, Iyo M. The effects of cumulative antipsychotic dose on brain structures in patients with schizophrenia: Observational study of multiple CT scans over a long-term clinical course. Psychiatry Res Neuroimaging 2022; 319:111422. [PMID: 34856453 DOI: 10.1016/j.pscychresns.2021.111422] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 10/23/2021] [Accepted: 10/28/2021] [Indexed: 10/19/2022]
Abstract
Multiple lines of evidence indicate that antipsychotic agents could affect brain structures of schizophrenia patients. However, the effect of antipsychotic dosage or type on brain structure is uncertain. The present study retrospectively analyzed brain computed tomography (CT) images from a psychiatric hospital to examine the relationship between cumulative dose of antipsychotics and brain volume reduction in schizophrenia patients. A total of 43 patients with repeated relapse episode of psychosis were included and CT scans that were performed an average of 3.2 times per patient during nearly 13 years of follow-up were analyzed. The results revealed significant positive relationships of expansion of cerebrospinal fluid space with cumulative dosage of all antipsychotics and that of typical antipsychotics. Patients treated with antipsychotics including typical antipsychotics exhibited a greater volume reduction compared to patients treated with only atypical antipsychotics. The present study was one of the longest longitudinal studies examining the effects of antipsychotics on brain volume in schizophrenia patients. These results suggest a relation between cumulative lifetime antipsychotic dosage and progressive brain volume reduction in patients with schizophrenia. However, the effects of specific agent on brain structure are still uncertain, and more detailed analysis is needed.
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Affiliation(s)
- Nobuhisa Kanahara
- Division of Medical Treatment and Rehabilitation, Center for Forensic Mental Health, Chiba University, Chiba, Japan; Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba, Japan.
| | - Hiroshi Yamanaka
- Department of Psychiatry, Chiba Psychiatric Medical Center, Chiba, Japan
| | - Yuki Shiko
- Biostatistics Section, Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Yohei Kawasaki
- Biostatistics Section, Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Masaomi Iyo
- Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba, Japan
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77
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Liu C, Kim WS, Shen J, Tsogt U, Kang NI, Lee KH, Chung YC. Altered Neuroanatomical Signatures of Patients With Treatment-Resistant Schizophrenia Compared to Patients With Early-Stage Schizophrenia and Healthy Controls. Front Psychiatry 2022; 13:802025. [PMID: 35664476 PMCID: PMC9158464 DOI: 10.3389/fpsyt.2022.802025] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 04/12/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The relationship between brain structural changes and cognitive dysfunction in schizophrenia is strong. However, few studies have investigated both neuroanatomical abnormalities and cognitive dysfunction in treatment-resistant schizophrenia (TRS). We examined neuroanatomical markers and cognitive function between patients with TRS or early-stage schizophrenia (ES-S) and healthy controls (HCs). Relationships between neuroanatomical markers and cognitive function in the patient groups were also investigated. METHODS A total of 46 and 45 patients with TRS and ES-S and 61 HCs underwent structural magnetic resonance imaging (MRI) brain scanning and comprehensive cognitive tests. MRI scans were analyzed using the FreeSurfer to investigate differences in cortical surface area (CSA), cortical thickness (CT), cortical volume (CV), and subcortical volume (SCV) among the groups. Four cognitive domains (attention, verbal memory, executive function, and language) were assessed. Comparisons of neuroanatomical and cognitive function results among the three groups were performed. RESULTS A widespread reduction in CT was observed in patients with TRS compared to HCs, but differences in cortical thinning between TRS and ES-S patients were mainly limited to the inferior frontal gyrus and insula. Several subcortical structures (accumbens, amygdala, hippocampus, putamen, thalamus and ventricles) were significantly altered in TRS patients compared to both ES-S patients and HCs. Performance in the verbal memory domain was significantly worse in TRS patients compared to ES-S patients. A positive relationship between the thickness of the left middle temporal gyrus and the composite score for language was identified in patients with ES-S. CONCLUSIONS Our findings suggest significant cognitive impairment and reductions in CT and SCV in individuals with TRS compared to those with ES-S and HCs. These abnormalities could act as biomarkers for earlier identification of TRS.
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Affiliation(s)
- Congcong Liu
- Department of Psychiatry, Medical School, Jeonbuk National University, Jeonju, South Korea
| | - Woo-Sung Kim
- Department of Psychiatry, Medical School, Jeonbuk National University, Jeonju, South Korea.,Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, South Korea
| | - Jie Shen
- Department of Psychiatry, Medical School, Jeonbuk National University, Jeonju, South Korea
| | - Uyanga Tsogt
- Department of Psychiatry, Medical School, Jeonbuk National University, Jeonju, South Korea
| | - Nam-In Kang
- Department of Psychiatry, Maeumsarang Hospital, Wanju, South Korea
| | - Keon-Hak Lee
- Department of Psychiatry, Maeumsarang Hospital, Wanju, South Korea
| | - Young-Chul Chung
- Department of Psychiatry, Medical School, Jeonbuk National University, Jeonju, South Korea.,Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, South Korea.,Department of Psychiatry, Jeonbuk National University Hospital, Jeonju, South Korea
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78
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Sharaev M, Malashenkova I, Maslennikova A, Zakharova N, Bernstein A, Burnaev E, Mamedova G, Krynskiy S, Ogurtsov D, Kondrateva E, Druzhinina P, Zubrikhina M, Arkhipov A, Strelets V, Ushakov V. Diagnosis of Schizophrenia Based on the Data of Various Modalities: Biomarkers and Machine Learning Techniques (Review). Sovrem Tekhnologii Med 2022; 14:53-75. [PMID: 37181835 PMCID: PMC10171060 DOI: 10.17691/stm2022.14.5.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Indexed: 05/16/2023] Open
Abstract
Schizophrenia is a socially significant mental disorder resulting frequently in severe forms of disability. Diagnosis, choice of treatment tactics, and rehabilitation in clinical psychiatry are mainly based on the assessment of behavioral patterns, socio-demographic data, and other investigations such as clinical observations and neuropsychological testing including examination of patients by the psychiatrist, self-reports, and questionnaires. In many respects, these data are subjective and therefore a large number of works have appeared in recent years devoted to the search for objective characteristics (indices, biomarkers) of the processes going on in the human body and reflected in the behavioral and psychoneurological patterns of patients. Such biomarkers are based on the results of instrumental and laboratory studies (neuroimaging, electro-physiological, biochemical, immunological, genetic, and others) and are successfully being used in neurosciences for understanding the mechanisms of the emergence and development of nervous system pathologies. Presently, with the advent of new effective neuroimaging, laboratory, and other methods of investigation and also with the development of modern methods of data analysis, machine learning, and artificial intelligence, a great number of scientific and clinical studies is being conducted devoted to the search for the markers which have diagnostic and prognostic value and may be used in clinical practice to objectivize the processes of establishing and clarifying the diagnosis, choosing and optimizing treatment and rehabilitation tactics, predicting the course and outcome of the disease. This review presents the analysis of the works which describe the correlates between the diagnosis of schizophrenia, established by health professionals, various manifestations of the psychiatric disorder (its subtype, variant of the course, severity degree, observed symptoms, etc.), and objectively measured characteristics/quantitative indicators (anatomical, functional, immunological, genetic, and others) obtained during instrumental and laboratory examinations of patients. A considerable part of these works has been devoted to correlates/biomarkers of schizophrenia based on the data of structural and functional (at rest and under cognitive load) MRI, EEG, tractography, and immunological data. The found correlates/biomarkers reflect anatomic disorders in the specific brain regions, impairment of functional activity of brain regions and their interconnections, specific microstructure of the brain white matter and the levels of connectivity between the tracts of various structures, alterations of electrical activity in various parts of the brain in different EEG spectral ranges, as well as changes in the innate and adaptive links of immunity. Current methods of data analysis and machine learning to search for schizophrenia biomarkers using the data of diverse modalities and their application during building and interpretation of predictive diagnostic models of schizophrenia have been considered in the present review.
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Affiliation(s)
- M.G. Sharaev
- Senior Researcher; Skolkovo Institute of Science and Technology (Skoltech), Territory of Skolkovo Innovation Center, Bldg 1, 30 Bolshoy Boulevard, Moscow, 121205, Russia; Department Senior Researcher; N.A. Alekseyev Psychiatric Clinical Hospital No.1, 2 Zagorodnoye Shosse, Moscow, 117152, Russia
- Corresponding author: Maksim G. Sharaev, e-mail:
| | - I.K. Malashenkova
- Head of the Laboratory of Molecular Immunology and Virology; National Research Center “Kurchatov Institute”, 1 Akademika Kurchatova Square, Moscow, 123182, Russia; Senior Researcher, Laboratory of Clinical Immunology; Federal Research and Clinical Center of Physical-Chemical Medicine, Federal Medical Biological Agency of Russia, 1A Malaya Pirogovskaya St., Moscow, 119435, Russia
| | - A.V. Maslennikova
- Researcher, Laboratory of Human Higher Nervous Activity; Institute of Higher Nervous Activity and Neurophysiology, Russian Academy of Sciences, 5A Butlerova St., Moscow, 117485, Russia
| | - N.V. Zakharova
- Head of the Laboratory for Fundamental Research Methods, Research Clinical Center of Neuropsychiatry; N.A. Alekseyev Psychiatric Clinical Hospital No.1, 2 Zagorodnoye Shosse, Moscow, 117152, Russia
| | - A.V. Bernstein
- Professor, Professor of the Center of Applied Artificial Intelligence; Skolkovo Institute of Science and Technology (Skoltech), Territory of Skolkovo Innovation Center, Bldg 1, 30 Bolshoy Boulevard, Moscow, 121205, Russia
| | - E.V. Burnaev
- Associate Professor, Professor of the Center of Applied Artificial Intelligence; Skolkovo Institute of Science and Technology (Skoltech), Territory of Skolkovo Innovation Center, Bldg 1, 30 Bolshoy Boulevard, Moscow, 121205, Russia
| | - G.S. Mamedova
- Junior Researcher, Laboratory for Fundamental Research Methods, Research Clinical Center of Neuropsychiatry; N.A. Alekseyev Psychiatric Clinical Hospital No.1, 2 Zagorodnoye Shosse, Moscow, 117152, Russia
| | - S.A. Krynskiy
- Researcher, Laboratory of Molecular Immunology and Virology; National Research Center “Kurchatov Institute”, 1 Akademika Kurchatova Square, Moscow, 123182, Russia
| | - D.P. Ogurtsov
- Researcher, Laboratory of Molecular Immunology and Virology; National Research Center “Kurchatov Institute”, 1 Akademika Kurchatova Square, Moscow, 123182, Russia
| | - E.A. Kondrateva
- PhD Student; Skolkovo Institute of Science and Technology (Skoltech), Territory of Skolkovo Innovation Center, Bldg 1, 30 Bolshoy Boulevard, Moscow, 121205, Russia
| | - P.V. Druzhinina
- PhD Student; Skolkovo Institute of Science and Technology (Skoltech), Territory of Skolkovo Innovation Center, Bldg 1, 30 Bolshoy Boulevard, Moscow, 121205, Russia
| | - M.O. Zubrikhina
- PhD Student; Skolkovo Institute of Science and Technology (Skoltech), Territory of Skolkovo Innovation Center, Bldg 1, 30 Bolshoy Boulevard, Moscow, 121205, Russia
| | - A.Yu. Arkhipov
- Researcher, Laboratory of Human Higher Nervous Activity; Institute of Higher Nervous Activity and Neurophysiology, Russian Academy of Sciences, 5A Butlerova St., Moscow, 117485, Russia
| | - V.B. Strelets
- Chief Researcher, Laboratory of Human Higher Nervous Activity; Institute of Higher Nervous Activity and Neurophysiology, Russian Academy of Sciences, 5A Butlerova St., Moscow, 117485, Russia
| | - V.L. Ushakov
- Associate Professor, Chief Researcher, Institute for Advanced Brain Research; Lomonosov Moscow State University, 27/1 Lomonosov Avenue, Moscow, 119192, Russia; Head of the Department; N.A. Alekseyev Psychiatric Clinical Hospital No.1, 2 Zagorodnoye Shosse, Moscow, 117152, Russia; Senior Researcher; National Research Nuclear University MEPhI, 31 Kashirskoye Shosse, Moscow, 115409, Russia
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79
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Lang X, Wang D, Chen D, Xiu M, Zhou H, Wang L, Cao B, Zhang X. Association Between Hippocampal Subfields and Clinical Symptoms of First-Episode and Drug Naive Schizophrenia Patients During 12 Weeks of Risperidone Treatment. Neurotherapeutics 2022; 19:399-407. [PMID: 35099766 PMCID: PMC9130442 DOI: 10.1007/s13311-021-01174-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2021] [Indexed: 01/03/2023] Open
Abstract
Small hippocampal size may be implicated in the pathogenesis and psychopathology of schizophrenia (SCZ). However, does the volume of hippocampal subfields in SCZ patients affect response to antipsychotic treatment? In this study, we used risperidone to treat first-episode drug naïve (FEDN) SCZ patients for 12 weeks, and then explored the relationship between baseline hippocampal subfield volumes, as well as any changes in these hippocampal subfield volumes during treatment, and improvement in their psychopathological symptoms. By adopting a state-of the-art automated algorithm, the hippocampal subfields were segmented in 43 FEDN SCZ inpatients at baseline and after 12 weeks of risperidone monotherapy, as well as in 30 matched healthy controls. We adopted the Positive and Negative Syndrome Scale (PANSS) to assess psychopathological symptoms in patients at baseline and at post-treatment. Before treatment, SCZ patients had no significant differences in total or subfield hippocampal volumes compared with healthy volunteers. However, we found a significant correlation between a smaller left CA1 at baseline and a lower PANSS total score and general psychopathology sub-score at post-treatment (both p < 0.05). Furthermore, the left CA1 at baseline was significantly smaller in responders, who had >50% improvement in PANSS total score, than in non-responders (p < 0.05). Our results suggest that smaller left CA1 volume may be a predicator for improvement in psychotic symptoms of FEDN SCZ patients.
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Affiliation(s)
- Xiaoe Lang
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China.
| | - Dongmei Wang
- Institute of Psychology, Key Laboratory of Mental Health, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Dachun Chen
- Beijing HuiLongGuan Hospital, Peking University, Beijing, China
| | - Meihong Xiu
- Beijing HuiLongGuan Hospital, Peking University, Beijing, China
| | - Huixia Zhou
- Institute of Psychology, Key Laboratory of Mental Health, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Li Wang
- Institute of Psychology, Key Laboratory of Mental Health, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Bo Cao
- Department of Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, T6G 2B7, Canada.
| | - Xiangyang Zhang
- Institute of Psychology, Key Laboratory of Mental Health, Chinese Academy of Sciences, Beijing, China.
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China.
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80
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Cortical morphology and illness insight in patients with schizophrenia. Eur Arch Psychiatry Clin Neurosci 2022; 272:985-995. [PMID: 34518921 PMCID: PMC9388450 DOI: 10.1007/s00406-021-01328-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 08/27/2021] [Indexed: 11/07/2022]
Abstract
Insight into illness in schizophrenia (SZ) patients has a major impact on treatment adherence and outcome. Previous studies have linked distinct deviations of brain structure to illness insight, specifically in frontoparietal and subcortical regions. Some of these abnormalities are thought to reflect aberrant cortical development. In this study, we used cross-sectional data to examine associations between illness insight and two cortical surface markers that are known to follow distinct neurodevelopmental trajectories, i.e. cortical gyrification (CG) and thickness (CT). CG and CT was investigated in SZ patients (n = 82) and healthy controls (HC, n = 48) using 3 T structural magnetic resonance imaging. Illness insight in SZ patients was measured using the OSSTI scale, an instrument that provides information on two distinct dimensions of illness insight, i.e. treatment adherence (OSSTI-A) and identification of disease-related symptoms (OSSTI-I). CT and CG were computed using the Computational Anatomy Toolbox (CAT12). Whole-brain and regions-of-interest (ROI)-based analyses were performed. SZ patients showed higher CG in anterior cingulate, superior frontal and temporal gyrus and reduced CG in insular and superior frontal cortex when compared to HC. SZ patients showed decreased CT in pre- and paracentral, occipital, cingulate, frontoparietal and temporal regions. Illness insight in SZ patients was significantly associated with both CG and CT in the left inferior parietal lobule (OSSTI-A) and the right precentral gyrus (CG/OSSTI-A, CT/OSSTI-I). The data support a multi-parametric neuronal model with both pre- and postnatal brain developmental factors having an impact on illness insight in patients with SZ.
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81
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Yen K, Liu CC, Lin YT, Chien YL, Hsieh MH, Liu CM, Hwang TJ, Liao WH, Hwu HG. Discontinuing Antipsychotic Medication After Remission from First-Episode Psychosis: A Survey of Psychiatrists' Attitudes in Taiwan. Neuropsychiatr Dis Treat 2022; 18:465-475. [PMID: 35261544 PMCID: PMC8898187 DOI: 10.2147/ndt.s339866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 12/26/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Patients in remission after first-episode psychosis are inclined to discontinue antipsychotic treatment, which may lead to higher risk of relapse and unfavorable outcomes. Paradoxically, also there are evidences suggesting that certain patients may stay well in drug-free condition. Psychiatrists' views towards this dilemma might affect their approaches to these patients, and discrepant attitudes are noted between Western and Asian clinicians. This study aimed to examine psychiatrists' attitudes about discontinuing antipsychotic medications after remission from first-episode psychosis. METHODS Psychiatrists were recruited for this study using convenience sampling. A cross-sectional survey was conducted using a set of questionnaires comprising nine items for attitudes toward medication discontinuation, six vignettes for probing psychiatrists' practice in designated clinical scenarios, and a list of criteria that may affect their responses. RESULTS Responses were provided by 118 psychiatrists, two-thirds men, mean age 39.8 ± 10.1 years and mean experience 12.7 ± 9.7 years. Half of the participants endorsed that fewer than 20% of the remitted patients should stop medication completely; the majority advised that an observation period of 1 year or longer is necessary while discontinuing medication. The majority would not initiate discussion with patients about discontinuing medication. Responding to two case vignettes, those who endorsed that more patients could stop antipsychotics were also more inclined to discuss it with patients, but not consistently in response to the other four case vignettes. Taiwan psychiatrists expressed a wide range of decision-making considerations for discontinuing antipsychotics. CONCLUSION The majority of Taiwan psychiatrists thought it was not feasible to stop medications completely but were willing to consider this option. Once being presented with actual clinical scenarios, many participants hesitated to discontinue antipsychotic medications for various reasons. The proactive attitude of psychiatrists towards conducting clinical trials to test the feasibility of medication discontinuation may help to provide better reference for this clinical dilemma.
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Affiliation(s)
- Ko Yen
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
| | - Chen-Chung Liu
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan.,Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Psychiatry, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Yi-Ting Lin
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan.,Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yi-Ling Chien
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan.,Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ming H Hsieh
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan.,Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chih-Min Liu
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan.,Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Tzung-Jeng Hwang
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan.,Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Wei-Hsiang Liao
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan.,Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Hai-Gwo Hwu
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan.,Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan
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82
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Gutman BA, van Erp TG, Alpert K, Ching CRK, Isaev D, Ragothaman A, Jahanshad N, Saremi A, Zavaliangos‐Petropulu A, Glahn DC, Shen L, Cong S, Alnæs D, Andreassen OA, Doan NT, Westlye LT, Kochunov P, Satterthwaite TD, Wolf DH, Huang AJ, Kessler C, Weideman A, Nguyen D, Mueller BA, Faziola L, Potkin SG, Preda A, Mathalon DH, Bustillo J, Calhoun V, Ford JM, Walton E, Ehrlich S, Ducci G, Banaj N, Piras F, Piras F, Spalletta G, Canales‐Rodríguez EJ, Fuentes‐Claramonte P, Pomarol‐Clotet E, Radua J, Salvador R, Sarró S, Dickie EW, Voineskos A, Tordesillas‐Gutiérrez D, Crespo‐Facorro B, Setién‐Suero E, van Son JM, Borgwardt S, Schönborn‐Harrisberger F, Morris D, Donohoe G, Holleran L, Cannon D, McDonald C, Corvin A, Gill M, Filho GB, Rosa PGP, Serpa MH, Zanetti MV, Lebedeva I, Kaleda V, Tomyshev A, Crow T, James A, Cervenka S, Sellgren CM, Fatouros‐Bergman H, Agartz I, Howells F, Stein DJ, Temmingh H, Uhlmann A, de Zubicaray GI, McMahon KL, Wright M, Cobia D, Csernansky JG, Thompson PM, Turner JA, Wang L. A meta-analysis of deep brain structural shape and asymmetry abnormalities in 2,833 individuals with schizophrenia compared with 3,929 healthy volunteers via the ENIGMA Consortium. Hum Brain Mapp 2022; 43:352-372. [PMID: 34498337 PMCID: PMC8675416 DOI: 10.1002/hbm.25625] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 07/13/2021] [Accepted: 07/14/2021] [Indexed: 01/06/2023] Open
Abstract
Schizophrenia is associated with widespread alterations in subcortical brain structure. While analytic methods have enabled more detailed morphometric characterization, findings are often equivocal. In this meta-analysis, we employed the harmonized ENIGMA shape analysis protocols to collaboratively investigate subcortical brain structure shape differences between individuals with schizophrenia and healthy control participants. The study analyzed data from 2,833 individuals with schizophrenia and 3,929 healthy control participants contributed by 21 worldwide research groups participating in the ENIGMA Schizophrenia Working Group. Harmonized shape analysis protocols were applied to each site's data independently for bilateral hippocampus, amygdala, caudate, accumbens, putamen, pallidum, and thalamus obtained from T1-weighted structural MRI scans. Mass univariate meta-analyses revealed more-concave-than-convex shape differences in the hippocampus, amygdala, accumbens, and thalamus in individuals with schizophrenia compared with control participants, more-convex-than-concave shape differences in the putamen and pallidum, and both concave and convex shape differences in the caudate. Patterns of exaggerated asymmetry were observed across the hippocampus, amygdala, and thalamus in individuals with schizophrenia compared to control participants, while diminished asymmetry encompassed ventral striatum and ventral and dorsal thalamus. Our analyses also revealed that higher chlorpromazine dose equivalents and increased positive symptom levels were associated with patterns of contiguous convex shape differences across multiple subcortical structures. Findings from our shape meta-analysis suggest that common neurobiological mechanisms may contribute to gray matter reduction across multiple subcortical regions, thus enhancing our understanding of the nature of network disorganization in schizophrenia.
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Affiliation(s)
- Boris A. Gutman
- Department of Biomedical EngineeringIllinois Institute of TechnologyChicagoIllinoisUSA
- Institute for Information Transmission Problems (Kharkevich Institute)MoscowRussia
| | - Theo G.M. van Erp
- Clinical Translational Neuroscience Laboratory, Department of Psychiatry and Human BehaviorUniversity of California IrvineIrvineCaliforniaUSA
- Center for the Neurobiology of Learning and MemoryUniversity of California IrvineIrvineCaliforniaUSA
| | - Kathryn Alpert
- Department of Psychiatry and Behavioral SciencesNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Christopher R. K. Ching
- Imaging Genetics Center, Mark & Mary Stevens Neuroimaging & Informatics Institute, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Dmitry Isaev
- Department of Biomedical EngineeringDuke UniversityDurhamNorth CarolinaUSA
| | - Anjani Ragothaman
- Department of biomedical engineeringOregon Health and Science universityPortlandOregonUSA
| | - Neda Jahanshad
- Imaging Genetics Center, Mark & Mary Stevens Neuroimaging & Informatics Institute, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Arvin Saremi
- Imaging Genetics Center, Mark & Mary Stevens Neuroimaging & Informatics Institute, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Artemis Zavaliangos‐Petropulu
- Imaging Genetics Center, Mark & Mary Stevens Neuroimaging & Informatics Institute, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - David C. Glahn
- Department of PsychiatryBoston Children's Hospital and Harvard Medical SchoolBostonMassachusettsUSA
| | - Li Shen
- Department of Biostatistics, Epidemiology and InformaticsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Shan Cong
- Department of Biostatistics, Epidemiology and InformaticsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Dag Alnæs
- NORMENT, Division of Mental Health and AddictionOslo University Hospital & Institute of Clinical Medicine, University of OsloOsloNorway
| | - Ole Andreas Andreassen
- NORMENT, Division of Mental Health and AddictionOslo University Hospital & Institute of Clinical Medicine, University of OsloOsloNorway
| | - Nhat Trung Doan
- NORMENT, Division of Mental Health and AddictionOslo University Hospital & Institute of Clinical Medicine, University of OsloOsloNorway
| | - Lars T. Westlye
- NORMENT, Division of Mental Health and AddictionOslo University Hospital & Institute of Clinical Medicine, University of OsloOsloNorway
- Department of PsychologyUniversity of OsloOsloNorway
| | - Peter Kochunov
- Department of PsychiatryUniversity of Maryland School of MedicineBaltimoreMarylandUSA
| | - Theodore D. Satterthwaite
- Department of PsychiatryUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
| | - Daniel H. Wolf
- Department of PsychiatryUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
| | - Alexander J. Huang
- Clinical Translational Neuroscience Laboratory, Department of Psychiatry and Human BehaviorUniversity of California IrvineIrvineCaliforniaUSA
| | - Charles Kessler
- Clinical Translational Neuroscience Laboratory, Department of Psychiatry and Human BehaviorUniversity of California IrvineIrvineCaliforniaUSA
| | - Andrea Weideman
- Clinical Translational Neuroscience Laboratory, Department of Psychiatry and Human BehaviorUniversity of California IrvineIrvineCaliforniaUSA
| | - Dana Nguyen
- Department of PediatricsUniversity of California IrvineIrvineCaliforniaUSA
| | - Bryon A. Mueller
- Department of Psychiatry and Behavioral SciencesUniversity of MinnesotaMinneapolisMinnesotaUSA
| | - Lawrence Faziola
- Department of Psychiatry and Human BehaviorUniversity of California IrvineIrvineCaliforniaUSA
| | - Steven G. Potkin
- Department of Psychiatry and Human BehaviorUniversity of California IrvineIrvineCaliforniaUSA
| | - Adrian Preda
- Department of Psychiatry and Human BehaviorUniversity of California IrvineIrvineCaliforniaUSA
| | - Daniel H. Mathalon
- Department of Psychiatry and Weill Institute for NeurosciencesUniversity of California San FranciscoSan FranciscoCaliforniaUSA
- Judith Ford Mental HealthVA San Francisco Healthcare SystemSan FranciscoCaliforniaUSA
| | - Juan Bustillo
- Departments of Psychiatry & NeuroscienceUniversity of New MexicoAlbuquerqueNew MexicoUSA
| | - Vince Calhoun
- Tri‐institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS) [Georgia State University, Georgia Institute of Technology]Emory UniversityAtlantaGeorgiaUSA
- Department of Electrical and Computer EngineeringThe University of New MexicoAlbuquerqueNew MexicoUSA
| | - Judith M. Ford
- Judith Ford Mental HealthVA San Francisco Healthcare SystemSan FranciscoCaliforniaUSA
- Department of Psychiatry and Behavioral SciencesUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | | | - Stefan Ehrlich
- Division of Psychological & Social Medicine and Developmental NeurosciencesFaculty of Medicine, TU‐DresdenDresdenGermany
| | | | - Nerisa Banaj
- Laboratory of NeuropsychiatryIRCCS Santa Lucia FoundationRomeItaly
| | - Fabrizio Piras
- Laboratory of NeuropsychiatryIRCCS Santa Lucia FoundationRomeItaly
| | - Federica Piras
- Laboratory of NeuropsychiatryIRCCS Santa Lucia FoundationRomeItaly
| | - Gianfranco Spalletta
- Laboratory of NeuropsychiatryIRCCS Santa Lucia FoundationRomeItaly
- Menninger Department of Psychiatry and Behavioral SciencesBaylor College of MedicineHoustonTexasUSA
| | | | | | | | - Joaquim Radua
- FIDMAG Germanes Hospitalàries Research FoundationCIBERSAMBarcelonaSpain
- Institut d'Investigacions Biomdiques August Pi i Sunyer (IDIBAPS)BarcelonaSpain
| | - Raymond Salvador
- FIDMAG Germanes Hospitalàries Research FoundationCIBERSAMBarcelonaSpain
| | - Salvador Sarró
- FIDMAG Germanes Hospitalàries Research FoundationCIBERSAMBarcelonaSpain
| | - Erin W. Dickie
- Centre for Addiction and Mental Health (CAMH)TorontoCanada
| | | | | | | | | | | | - Stefan Borgwardt
- Department of PsychiatryUniversity of BaselBaselSwitzerland
- Department of Psychiatry and PsychotherapyUniversity of LübeckLübeckGermany
| | | | - Derek Morris
- Centre for Neuroimaging and Cognitive Genomics, Discipline of BiochemistryNational University of Ireland GalwayGalwayIreland
| | - Gary Donohoe
- Centre for Neuroimaging and Cognitive Genomics, School of PsychologyNational University of Ireland GalwayGalwayIreland
| | - Laurena Holleran
- Centre for Neuroimaging and Cognitive Genomics, School of PsychologyNational University of Ireland GalwayGalwayIreland
| | - Dara Cannon
- Clinical Neuroimaging Laboratory, Centre for Neuroimaging and Cognitive GenomicsNational University of Ireland GalwayGalwayIreland
| | - Colm McDonald
- Clinical Neuroimaging Laboratory, Centre for Neuroimaging and Cognitive GenomicsNational University of Ireland GalwayGalwayIreland
| | - Aiden Corvin
- Neuropsychiatric Genetics Research Group, Department of PsychiatryTrinity College DublinDublinIreland
- Trinity College Institute of NeuroscienceTrinity College DublinDublinIreland
| | - Michael Gill
- Neuropsychiatric Genetics Research Group, Department of PsychiatryTrinity College DublinDublinIreland
- Trinity College Institute of NeuroscienceTrinity College DublinDublinIreland
| | - Geraldo Busatto Filho
- Laboratory of Psychiatric Neuroimaging (LIM‐21), Departamento e Instituto de PsiquiatriaHospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao PauloSao PauloSPBrazil
| | - Pedro G. P. Rosa
- Laboratory of Psychiatric Neuroimaging (LIM‐21), Departamento e Instituto de PsiquiatriaHospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao PauloSao PauloSPBrazil
| | - Mauricio H. Serpa
- Laboratory of Psychiatric Neuroimaging (LIM‐21), Departamento e Instituto de PsiquiatriaHospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao PauloSao PauloSPBrazil
| | - Marcus V. Zanetti
- Laboratory of Psychiatric Neuroimaging (LIM‐21), Departamento e Instituto de PsiquiatriaHospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao PauloSao PauloSPBrazil
- Hospital Sirio‐LibanesSao PauloSPBrazil
| | - Irina Lebedeva
- Laboratory of Neuroimaging and Multimodal AnalysisMental Health Research CenterMoscowRussia
| | - Vasily Kaleda
- Department of Endogenous Mental DisordersMental Health Research CenterMoscowRussia
| | - Alexander Tomyshev
- Laboratory of Neuroimaging and Multimodal AnalysisMental Health Research CenterMoscowRussia
| | - Tim Crow
- Department of PsychiatryUniversity of OxfordOxfordUK
| | - Anthony James
- Department of PsychiatryUniversity of OxfordOxfordUK
| | - Simon Cervenka
- Centre for Psychiatry Reserach, Department of Clinical NeuroscienceKarolinska Institutet, & Stockholm Health Care Services, Region StockholmStockholmSweden
| | - Carl M Sellgren
- Department of Physiology and PharmacologyKarolinska InstitutetStockholmSweden
| | - Helena Fatouros‐Bergman
- Centre for Psychiatry Reserach, Department of Clinical NeuroscienceKarolinska Institutet, & Stockholm Health Care Services, Region StockholmStockholmSweden
| | - Ingrid Agartz
- NORMENT, Division of Mental Health and AddictionOslo University Hospital & Institute of Clinical Medicine, University of OsloOsloNorway
| | - Fleur Howells
- Department of Psychiatry and Mental Health, Faculty of Health SciencesUniversity of Cape TownCape TownWCSouth Africa
- Neuroscience InstituteUniversity of Cape Town, Cape TownWCSouth Africa
| | - Dan J. Stein
- Department of Psychiatry and Mental Health, Faculty of Health SciencesUniversity of Cape TownCape TownWCSouth Africa
- Neuroscience InstituteUniversity of Cape Town, Cape TownWCSouth Africa
- SA MRC Unit on Risk & Resilience in Mental DisordersUniversity of Cape TownCape TownWCSouth Africa
| | - Henk Temmingh
- Department of Psychiatry and Mental Health, Faculty of Health SciencesUniversity of Cape TownCape TownWCSouth Africa
| | - Anne Uhlmann
- Department of Psychiatry and Mental Health, Faculty of Health SciencesUniversity of Cape TownCape TownWCSouth Africa
- Department of Child and Adolescent PsychiatryTU DresdenGermany
| | - Greig I. de Zubicaray
- School of Psychology, Faculty of HealthQueensland University of Technology (QUT)BrisbaneQLDAustralia
| | - Katie L. McMahon
- School of Clinical SciencesQueensland University of Technology (QUT)BrisbaneQLDAustralia
| | - Margie Wright
- Queensland Brain InstituteUniversity of QueenslandBrisbaneQLDAustralia
| | - Derin Cobia
- Department of Psychiatry and Behavioral SciencesNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
- Department of Psychology and Neuroscience CenterBrigham Young UniversityProvoUtahUSA
| | - John G. Csernansky
- Department of Psychiatry and Behavioral SciencesNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Paul M. Thompson
- Imaging Genetics Center, Mark & Mary Stevens Neuroimaging & Informatics Institute, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | | | - Lei Wang
- Department of Psychiatry and Behavioral SciencesNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
- Department of Psychiatry and Behavioral HealthOhio State University Wexner Medical CenterColumbusOhioUSA
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Brosch K, Stein F, Schmitt S, Pfarr JK, Ringwald KG, Thomas-Odenthal F, Meller T, Steinsträter O, Waltemate L, Lemke H, Meinert S, Winter A, Breuer F, Thiel K, Grotegerd D, Hahn T, Jansen A, Dannlowski U, Krug A, Nenadić I, Kircher T. Reduced hippocampal gray matter volume is a common feature of patients with major depression, bipolar disorder, and schizophrenia spectrum disorders. Mol Psychiatry 2022; 27:4234-4243. [PMID: 35840798 PMCID: PMC9718668 DOI: 10.1038/s41380-022-01687-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 06/22/2022] [Accepted: 06/27/2022] [Indexed: 02/07/2023]
Abstract
Major depressive disorder (MDD), bipolar disorder (BD), and schizophrenia spectrum disorder (SSD, schizophrenia, and schizoaffective disorder) overlap in symptomatology, risk factors, genetics, and other biological measures. Based on previous findings, it remains unclear what transdiagnostic regional gray matter volume (GMV) alterations exist across these disorders, and with which factors they are associated. GMV (3-T magnetic resonance imaging) was compared between healthy controls (HC; n = 110), DSM-IV-TR diagnosed MDD (n = 110), BD (n = 110), and SSD patients (n = 110), matched for age and sex. We applied a conjunction analysis to identify shared GMV alterations across the disorders. To identify potential origins of identified GMV clusters, we associated them with early and current risk and protective factors, psychopathology, and neuropsychology, applying multiple regression models. Common to all diagnoses (vs. HC), we identified GMV reductions in the left hippocampus. This cluster was associated with the neuropsychology factor working memory/executive functioning, stressful life events, and with global assessment of functioning. Differential effects between groups were present in the left and right frontal operculae and left insula, with volume variances across groups highly overlapping. Our study is the first with a large, matched, transdiagnostic sample to yield shared GMV alterations in the left hippocampus across major mental disorders. The hippocampus is a major network hub, orchestrating a range of mental functions. Our findings underscore the need for a novel stratification of mental disorders, other than categorical diagnoses.
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Affiliation(s)
- Katharina Brosch
- Department of Psychiatry and Psychotherapy, Philipps-University Marburg, University Hospital Marburg, UKGM, Marburg, Germany. .,Center for Mind, Brain and Behavior (CMBB), Marburg, Germany.
| | - Frederike Stein
- grid.10253.350000 0004 1936 9756Department of Psychiatry and Psychotherapy, Philipps-University Marburg, University Hospital Marburg, UKGM, Marburg, Germany ,grid.513205.0Center for Mind, Brain and Behavior (CMBB), Marburg, Germany
| | - Simon Schmitt
- grid.10253.350000 0004 1936 9756Department of Psychiatry and Psychotherapy, Philipps-University Marburg, University Hospital Marburg, UKGM, Marburg, Germany ,grid.513205.0Center for Mind, Brain and Behavior (CMBB), Marburg, Germany ,grid.10423.340000 0000 9529 9877Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Julia-Katharina Pfarr
- grid.10253.350000 0004 1936 9756Department of Psychiatry and Psychotherapy, Philipps-University Marburg, University Hospital Marburg, UKGM, Marburg, Germany ,grid.513205.0Center for Mind, Brain and Behavior (CMBB), Marburg, Germany
| | - Kai G. Ringwald
- grid.10253.350000 0004 1936 9756Department of Psychiatry and Psychotherapy, Philipps-University Marburg, University Hospital Marburg, UKGM, Marburg, Germany ,grid.513205.0Center for Mind, Brain and Behavior (CMBB), Marburg, Germany
| | - Florian Thomas-Odenthal
- grid.10253.350000 0004 1936 9756Department of Psychiatry and Psychotherapy, Philipps-University Marburg, University Hospital Marburg, UKGM, Marburg, Germany ,grid.513205.0Center for Mind, Brain and Behavior (CMBB), Marburg, Germany
| | - Tina Meller
- grid.10253.350000 0004 1936 9756Department of Psychiatry and Psychotherapy, Philipps-University Marburg, University Hospital Marburg, UKGM, Marburg, Germany ,grid.513205.0Center for Mind, Brain and Behavior (CMBB), Marburg, Germany
| | - Olaf Steinsträter
- grid.10253.350000 0004 1936 9756Department of Psychiatry and Psychotherapy, Philipps-University Marburg, University Hospital Marburg, UKGM, Marburg, Germany ,grid.10253.350000 0004 1936 9756Core-Facility BrainImaging, Faculty of Medicine, Philipps-University Marburg, Marburg, Germany
| | - Lena Waltemate
- grid.5949.10000 0001 2172 9288Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Hannah Lemke
- grid.5949.10000 0001 2172 9288Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Susanne Meinert
- grid.5949.10000 0001 2172 9288Institute for Translational Psychiatry, University of Münster, Münster, Germany ,grid.5949.10000 0001 2172 9288Institute for Translational Neuroscience, University of Münster, Münster, Germany
| | - Alexandra Winter
- grid.5949.10000 0001 2172 9288Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Fabian Breuer
- grid.5949.10000 0001 2172 9288Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Katharina Thiel
- grid.5949.10000 0001 2172 9288Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Dominik Grotegerd
- grid.5949.10000 0001 2172 9288Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Tim Hahn
- grid.5949.10000 0001 2172 9288Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Andreas Jansen
- grid.10253.350000 0004 1936 9756Department of Psychiatry and Psychotherapy, Philipps-University Marburg, University Hospital Marburg, UKGM, Marburg, Germany ,grid.513205.0Center for Mind, Brain and Behavior (CMBB), Marburg, Germany ,grid.10253.350000 0004 1936 9756Core-Facility BrainImaging, Faculty of Medicine, Philipps-University Marburg, Marburg, Germany
| | - Udo Dannlowski
- grid.5949.10000 0001 2172 9288Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Axel Krug
- grid.10253.350000 0004 1936 9756Department of Psychiatry and Psychotherapy, Philipps-University Marburg, University Hospital Marburg, UKGM, Marburg, Germany ,grid.10388.320000 0001 2240 3300Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany
| | - Igor Nenadić
- grid.10253.350000 0004 1936 9756Department of Psychiatry and Psychotherapy, Philipps-University Marburg, University Hospital Marburg, UKGM, Marburg, Germany ,grid.513205.0Center for Mind, Brain and Behavior (CMBB), Marburg, Germany
| | - Tilo Kircher
- grid.10253.350000 0004 1936 9756Department of Psychiatry and Psychotherapy, Philipps-University Marburg, University Hospital Marburg, UKGM, Marburg, Germany ,grid.513205.0Center for Mind, Brain and Behavior (CMBB), Marburg, Germany
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Yang B, Zhang W, Lencer R, Tao B, Tang B, Yang J, Li S, Zeng J, Cao H, Sweeney JA, Gong Q, Lui S. Grey matter connectome abnormalities and age-related effects in antipsychotic-naive schizophrenia. EBioMedicine 2021; 74:103749. [PMID: 34906839 PMCID: PMC8671864 DOI: 10.1016/j.ebiom.2021.103749] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/12/2021] [Accepted: 11/29/2021] [Indexed: 02/05/2023] Open
Abstract
Background Convergent evidence is increasing to indicate progressive brain abnormalities in schizophrenia. Knowing the brain network features over the illness course in schizophrenia, independent of effects of antipsychotic medications, would extend our sight on this question. Methods We recruited 237 antipsychotic-naive patients with schizophrenia range from 16 to 73 years old, and 254 healthy controls. High-resolution T1 weighted images were obtained with a 3.0T MR scanner. Grey matter networks were constructed individually based on the similarities of regional grey matter measurements. Network metrics were compared between patient groups and healthy controls, and regression analyses with age were conducted to determine potential differential rate of age-related changes between them. Findings Nodal centrality abnormalities were observed in patients with untreated schizophrenia, particularly in the central executive, default mode and salience networks. Accelerated age-related declines and illness duration-related declines were observed in global assortativity, and in nodal metrics of left superior temporal pole in schizophrenia patients. Although no significant intergroup differences in age-related regression were observed, the pattern of network metric alternation of left thalamus indicated higher nodal properties in early course patients, which decreased in long-term ill patients. Interpretations Global and nodal alterations in the grey matter connectome related to age and duration of illness in antipsychotic-naive patients, indicating potentially progressive network organizations mainly involving temporal regions and thalamus in schizophrenia independent from medication effects. Funding The National Natural Science Foundation of China, Sichuan Science and Technology Program, the Fundamental Research Funds for the Central Universities, Post-Doctor Research Project, West China Hospital, Sichuan University , the Science and Technology Project of the Health Planning Committee of Sichuan, Postdoctoral Interdisciplinary Research Project of Sichuan University and 1.3.5 Project for Disciplines of Excellence, West China Hospital, Sichuan University.
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Affiliation(s)
- Beisheng Yang
- Department of Radiology, Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, China; Psychoradiology Research Unit of Chinese Academy of Medical Sciences, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, China
| | - Wenjing Zhang
- Department of Radiology, Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, China; Psychoradiology Research Unit of Chinese Academy of Medical Sciences, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, China
| | - Rebekka Lencer
- Department of Psychiatry and Psychotherapy, University of Muenster, Germany
| | - Bo Tao
- Department of Radiology, Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, China; Psychoradiology Research Unit of Chinese Academy of Medical Sciences, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, China
| | - Biqiu Tang
- Department of Radiology, Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, China; Psychoradiology Research Unit of Chinese Academy of Medical Sciences, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, China
| | - Jing Yang
- Department of Radiology, Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, China; Psychoradiology Research Unit of Chinese Academy of Medical Sciences, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, China
| | - Siyi Li
- Department of Radiology, Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, China; Psychoradiology Research Unit of Chinese Academy of Medical Sciences, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, China
| | - Jiaxin Zeng
- Department of Radiology, Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, China; Psychoradiology Research Unit of Chinese Academy of Medical Sciences, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, China
| | - Hengyi Cao
- Department of Radiology, Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, China; Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, NY, United States
| | - John A Sweeney
- Department of Radiology, Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, China; Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, OH, United States
| | - Qiyong Gong
- Department of Radiology, Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, China; Psychoradiology Research Unit of Chinese Academy of Medical Sciences, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, China.
| | - Su Lui
- Department of Radiology, Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, China; Psychoradiology Research Unit of Chinese Academy of Medical Sciences, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, China.
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85
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Astrocytes in Neuropsychiatric Disorders: A Review of Postmortem Evidence. ADVANCES IN NEUROBIOLOGY 2021; 26:153-172. [PMID: 34888835 DOI: 10.1007/978-3-030-77375-5_8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Glial cell types in the central nervous system (CNS) include microglia, oligodendrocytes and the most diverse type, astrocytes. Clinical and experimental evidence suggest critical roles for astrocytes in the pathogenesis of CNS disease. Here, we summarize the extensive morphological heterogeneity and physiological properties of different astrocyte subtypes. We review postmortem studies, discussing astrocyte-related changes found in the brain in subjects diagnosed with the neuropsychiatric disorders schizophrenia, major depressive disorder and bipolar disorder. Finally, we discuss the potential effects of psychotropic medication on these findings. In summary, postmortem studies highlight that the morphology of astrocytes and the expression of functionally important astrocyte markers are altered in the brain in neuropsychiatric disorders and may play a role in the pathophysiology of these serious mental illnesses.
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86
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Mapping thalamocortical functional connectivity with large-scale brain networks in patients with first-episode psychosis. Sci Rep 2021; 11:19815. [PMID: 34615924 PMCID: PMC8494789 DOI: 10.1038/s41598-021-99170-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 09/16/2021] [Indexed: 11/09/2022] Open
Abstract
Abnormal thalamocortical networks involving specific thalamic nuclei have been implicated in schizophrenia pathophysiology. While comparable topography of anatomical and functional connectivity abnormalities has been reported in patients across illness stages, previous functional studies have been confined to anatomical pathways of thalamocortical networks. To address this issue, we incorporated large-scale brain network dynamics into examining thalamocortical functional connectivity. Forty patients with first-episode psychosis and forty healthy controls underwent T1-weighted and resting-state functional magnetic resonance imaging. Independent component analysis of voxelwise thalamic functional connectivity maps parcellated the cortex into thalamus-related networks, and thalamic subdivisions associated with these networks were delineated. Functional connectivity of (1) networks with the thalamus and (2) thalamic subdivision seeds were examined. In patients, functional connectivity of the salience network with the thalamus was decreased and localized to the ventrolateral (VL) and ventroposterior (VP) thalamus, while that of a network comprising the cerebellum, temporal and parietal regions was increased and localized to the mediodorsal (MD) thalamus. In patients, thalamic subdivision encompassing the VL and VP thalamus demonstrated hypoconnectivity and that encompassing the MD and pulvinar regions demonstrated hyperconnectivity. Our results extend the implications of disrupted thalamocortical networks involving specific thalamic nuclei to dysfunctional large-scale brain network dynamics in schizophrenia pathophysiology.
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87
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Zhang X, Alnafisah RS, Hamoud ARA, Shukla R, Wen Z, McCullumsmith RE, O'Donovan SM. Role of Astrocytes in Major Neuropsychiatric Disorders. Neurochem Res 2021; 46:2715-2730. [PMID: 33411227 DOI: 10.1007/s11064-020-03212-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 12/17/2020] [Accepted: 12/21/2020] [Indexed: 12/30/2022]
Abstract
Astrocytes are the primary homeostatic cells of the central nervous system, essential for normal neuronal development and function, metabolism and response to injury and inflammation. Here, we review postmortem studies examining changes in astrocytes in subjects diagnosed with the neuropsychiatric disorders schizophrenia (SCZ), major depressive disorder (MDD), and bipolar disorder (BPD). We discuss the astrocyte-related changes described in the brain in these disorders and the potential effects of psychotropic medication on these findings. Finally, we describe emerging tools that can be used to study the role of astrocytes in neuropsychiatric illness.
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Affiliation(s)
- Xiaolu Zhang
- Department of Neurosciences, University of Toledo College of Medicine, Block Health Science Building, 3000 Arlington Avenue, Toledo, OH, 43614, USA
| | - Rawan S Alnafisah
- Department of Neurosciences, University of Toledo College of Medicine, Block Health Science Building, 3000 Arlington Avenue, Toledo, OH, 43614, USA
| | - Abdul-Rizaq A Hamoud
- Department of Neurosciences, University of Toledo College of Medicine, Block Health Science Building, 3000 Arlington Avenue, Toledo, OH, 43614, USA
| | - Rammohan Shukla
- Department of Neurosciences, University of Toledo College of Medicine, Block Health Science Building, 3000 Arlington Avenue, Toledo, OH, 43614, USA
| | - Zhexing Wen
- Departments of Psychiatry and Behavioral Sciences, Cell Biology, and Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Robert E McCullumsmith
- Department of Neurosciences, University of Toledo College of Medicine, Block Health Science Building, 3000 Arlington Avenue, Toledo, OH, 43614, USA.,Neurosciences Institute, ProMedica, Toledo, OH, USA
| | - Sinead M O'Donovan
- Department of Neurosciences, University of Toledo College of Medicine, Block Health Science Building, 3000 Arlington Avenue, Toledo, OH, 43614, USA.
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88
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Abstract
This viewpoint is a continuation of the debate on the early intervention movement in psychiatry. The criticisms of Malhi and colleagues have generated some fundamental questions about the priorities of the early intervention movement and the need for further work. In particular, the summons sent to neuroscience need to be more specific in the near future. We may be doing well with what we have, but more directed efforts are needed to purposefully seek what we do not.
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Affiliation(s)
- Lena Palaniyappan
- Robarts Research Institute, London, ON, Canada,Department of Psychiatry, Western University, London, ON, Canada,The Prevention and Early Intervention Program for Psychoses, London Health Sciences Centre, London, ON, Canada,Department of Medical Biophysics, Western University, London, ON, Canada,Lena Palaniyappan, Robarts Research Institute, Room 1232D, 1151 Richmond Street N, London, ON N6A 5B7, Canada.
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89
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Shan X, Zhang H, Dong Z, Chen J, Liu F, Zhao J, Zhang H, Guo W. Increased subcortical region volume induced by electroconvulsive therapy in patients with schizophrenia. Eur Arch Psychiatry Clin Neurosci 2021; 271:1285-1295. [PMID: 34275006 DOI: 10.1007/s00406-021-01303-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 07/04/2021] [Indexed: 02/08/2023]
Abstract
Electroconvulsive therapy (ECT) has been widely used to treat patients with schizophrenia. However, the underlying mechanisms of ECT remain unknown. In the present study, the treatment effects of ECT on brain structure in patients with schizophrenia were explored. Seventy patients with schizophrenia were scanned using structural magnetic resonance imaging. Patients in the drug group were scanned at baseline (time 1) and follow-up (time 2, 6 weeks of treatment). Patients in the ECT group were scanned before ECT treatment (baseline, time 1) and 10-12 h after the last ECT treatment (time 2). Voxel-based morphometry was applied to analyze the imaging data. Patients in the ECT group showed significantly increased gray matter volume (GMV) in the bilateral hippocampus/amygdala and left superior temporal gyrus (STG)/middle temporal gyrus (MTG) after ECT combined with antipsychotic therapy at time 2. In contrast, patients in the drug group showed decreased GMV in widespread brain regions. Correlation analysis results showed significantly negative correlations between the increased GMV in the bilateral hippocampus/amygdala and PANSS scores at baseline in the ECT group. ECT may modulate brain structure in patients with schizophrenia. The GMV in distinct subcortical regions was related to the individual therapeutic response in patients with schizophrenia.
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Affiliation(s)
- Xiaoxiao Shan
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Haisan Zhang
- The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, 453002, Henan, China.,Xinxiang Key Laboratory of Multimodal Brain Imaging, Xinxiang, 453002, Henan, China
| | - Zhao Dong
- The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, 453002, Henan, China.,Zhumadian Psychiatric Hospital, Zhumadian, 463000, Henan, China
| | - Jindong Chen
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Feng Liu
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin, 300000, China
| | - Jingping Zhao
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Hongxing Zhang
- The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, 453002, Henan, China. .,Xinxiang Key Laboratory of Multimodal Brain Imaging, Xinxiang, 453002, Henan, China. .,School of Psychology, Xinxiang Medical University, Xinxiang, 453003, Henan, China.
| | - Wenbin Guo
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China. .,Department of Psychiatry, The Third People's Hospital of Foshan, Foshan, 528000, Guangdong, China.
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90
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Xiao Y, Liao W, Long Z, Tao B, Zhao Q, Luo C, Tamminga CA, Keshavan MS, Pearlson GD, Clementz BA, Gershon ES, Ivleva EI, Keedy SK, Biswal BB, Mechelli A, Lencer R, Sweeney JA, Lui S, Gong Q. Subtyping Schizophrenia Patients Based on Patterns of Structural Brain Alterations. Schizophr Bull 2021; 48:241-250. [PMID: 34508358 PMCID: PMC8781382 DOI: 10.1093/schbul/sbab110] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Schizophrenia is a complex and heterogeneous syndrome. Whether quantitative imaging biomarkers can identify discrete subgroups of patients as might be used to foster personalized medicine approaches for patient care remains unclear. Cross-sectional structural MR images of 163 never-treated first-episode schizophrenia patients (FES) and 133 chronically ill patients with midcourse schizophrenia from the Bipolar and Schizophrenia Network for Intermediate Phenotypes (B-SNIP) consortium and a total of 403 healthy controls were recruited. Morphometric measures (cortical thickness, surface area, and subcortical structures) were extracted for each subject and then the optimized subtyping results were obtained with nonsupervised cluster analysis. Three subgroups of patients defined by distinct patterns of regional cortical and subcortical morphometric features were identified in FES. A similar three subgroup pattern was identified in the independent dataset of patients from the multi-site B-SNIP consortium. Similarities of classification patterns across these two patient cohorts suggest that the 3-group typology is relatively stable over the course of illness. Cognitive functions were worse in subgroup 1 with midcourse schizophrenia than those in subgroup 3. These findings provide novel insight into distinct subgroups of patients with schizophrenia based on structural brain features. Findings of different cognitive functions among the subgroups support clinical differences in the MRI-defined illness subtypes. Regardless of clinical presentation and stage of illness, anatomic MR subgrouping biomarkers can separate neurobiologically distinct subgroups of schizophrenia patients, which represent an important and meaningful step forward in differentiating subtypes of patients for studies of illness neurobiology and potentially for clinical trials.
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Affiliation(s)
- Yuan Xiao
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China,Department of Psychiatry, University of Münster, Münster, Germany
| | - Wei Liao
- Center for Information in BioMedicine, School of Life Science and Technology, University of Electronic Science and Technology, Chengdu, Sichuan, China
| | - Zhiliang Long
- Center for Information in BioMedicine, School of Life Science and Technology, University of Electronic Science and Technology, Chengdu, Sichuan, China
| | - Bo Tao
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Qiannan Zhao
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Chunyan Luo
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Carol A Tamminga
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Matcheri S Keshavan
- Department of Psychiatry, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Godfrey D Pearlson
- Departments of Psychiatry and Neurobiology, Yale University and Olin Neuropsychiatric Research Center, Hartford, CT, USA
| | - Brett A Clementz
- Department of Psychology, University of Georgia, Athens, GA, USA
| | - Elliot S Gershon
- Department of Psychiatry, University of Chicago, Chicago, IL, USA
| | - Elena I Ivleva
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Sarah K Keedy
- Department of Psychiatry, University of Chicago, Chicago, IL, USA
| | - Bharat B Biswal
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, NJ, USA
| | - Andrea Mechelli
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Rebekka Lencer
- Department of Psychiatry, University of Münster, Münster, Germany
| | - John A Sweeney
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China,Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, OH, USA
| | - Su Lui
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China,To whom correspondence should be addressed; #37 GuoXue Xiang, Chengdu 610041, China; Tel: 86-28-85423960, Fax: 86-28-85423503; e-mail:
| | - Qiyong Gong
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
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91
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Uscătescu LC, Kronbichler L, Stelzig-Schöler R, Pearce BG, Said-Yürekli S, Reich LA, Weber S, Aichhorn W, Kronbichler M. Effective Connectivity of the Hippocampus Can Differentiate Patients with Schizophrenia from Healthy Controls: A Spectral DCM Approach. Brain Topogr 2021; 34:762-778. [PMID: 34482503 PMCID: PMC8556208 DOI: 10.1007/s10548-021-00868-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 08/22/2021] [Indexed: 12/01/2022]
Abstract
We applied spectral dynamic causal modelling (Friston et al. in Neuroimage 94:396–407. 10.1016/j.neuroimage.2013.12.009, 2014) to analyze the effective connectivity differences between the nodes of three resting state networks (i.e. default mode network, salience network and dorsal attention network) in a dataset of 31 male healthy controls (HC) and 25 male patients with a diagnosis of schizophrenia (SZ). Patients showed increased directed connectivity from the left hippocampus (LHC) to the: dorsal anterior cingulate cortex (DACC), right anterior insula (RAI), left frontal eye fields and the bilateral inferior parietal sulcus (LIPS & RIPS), as well as increased connectivity from the right hippocampus (RHC) to the: bilateral anterior insula (LAI & RAI), right frontal eye fields and RIPS. In SZ, negative symptoms predicted the connectivity strengths from the LHC to: the DACC, the left inferior parietal sulcus (LIPAR) and the RHC, while positive symptoms predicted the connectivity strengths from the LHC to the LIPAR and from the RHC to the LHC. These results reinforce the crucial role of hippocampus dysconnectivity in SZ pathology and its potential as a biomarker of disease severity.
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Affiliation(s)
- Lavinia Carmen Uscătescu
- Centre for Cognitive Neuroscience and Department of Psychology, University of Salzburg, Salzburg, Austria
| | - Lisa Kronbichler
- Centre for Cognitive Neuroscience and Department of Psychology, University of Salzburg, Salzburg, Austria
- Neuroscience Institute, Christian-Doppler Medical Centre, Paracelsus Medical University, Salzburg, Austria
| | - Renate Stelzig-Schöler
- Department of Psychiatry, Psychotherapy and Psychosomatics, Christian-Doppler Medical Centre, Paracelsus Medical University, Salzburg, Austria
| | - Brandy-Gale Pearce
- Department of Psychiatry, Psychotherapy and Psychosomatics, Christian-Doppler Medical Centre, Paracelsus Medical University, Salzburg, Austria
| | - Sarah Said-Yürekli
- Centre for Cognitive Neuroscience and Department of Psychology, University of Salzburg, Salzburg, Austria
- Neuroscience Institute, Christian-Doppler Medical Centre, Paracelsus Medical University, Salzburg, Austria
| | | | - Stefanie Weber
- Department of Psychiatry, Psychotherapy and Psychosomatics, Christian-Doppler Medical Centre, Paracelsus Medical University, Salzburg, Austria
| | - Wolfgang Aichhorn
- Department of Psychiatry, Psychotherapy and Psychosomatics, Christian-Doppler Medical Centre, Paracelsus Medical University, Salzburg, Austria
| | - Martin Kronbichler
- Centre for Cognitive Neuroscience and Department of Psychology, University of Salzburg, Salzburg, Austria
- Neuroscience Institute, Christian-Doppler Medical Centre, Paracelsus Medical University, Salzburg, Austria
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92
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Seitz-Holland J, Cetin-Karayumak S, Wojcik JD, Lyall A, Levitt J, Shenton ME, Pasternak O, Westin CF, Baxi M, Kelly S, Mesholam-Gately R, Vangel M, Pearlson G, Tamminga CA, Sweeney JA, Clementz BA, Schretlen D, Viher PV, Stegmayer K, Walther S, Lee J, Crow T, James A, Voineskos A, Buchanan RW, Szeszko PR, Malhotra AK, Rathi Y, Keshavan M, Kubicki M. Elucidating the relationship between white matter structure, demographic, and clinical variables in schizophrenia-a multicenter harmonized diffusion tensor imaging study. Mol Psychiatry 2021; 26:5357-5370. [PMID: 33483689 PMCID: PMC8329919 DOI: 10.1038/s41380-021-01018-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 11/24/2020] [Accepted: 01/05/2021] [Indexed: 01/30/2023]
Abstract
White matter (WM) abnormalities are repeatedly demonstrated across the schizophrenia time-course. However, our understanding of how demographic and clinical variables interact, influence, or are dependent on WM pathologies is limited. The most well-known barriers to progress are heterogeneous findings due to small sample sizes and the confounding influence of age on WM. The present study leverages access to the harmonized diffusion magnetic-resonance-imaging data and standardized clinical data from 13 international sites (597 schizophrenia patients (SCZ)). Fractional anisotropy (FA) values for all major WM structures in patients were predicted based on FA models estimated from a healthy population (n = 492). We utilized the deviations between predicted and real FA values to answer three essential questions. (1) "Which clinical variables explain WM abnormalities?". (2) "Does the degree of WM abnormalities predict symptom severity?". (3) "Does sex influence any of those relationships?". Regression and mediator analyses revealed that a longer duration-of-illness is associated with more severe WM abnormalities in several tracts. In addition, they demonstrated that a higher antipsychotic medication dose is related to more severe corpus callosum abnormalities. A structural equation model revealed that patients with more WM abnormalities display higher symptom severity. Last, the results exhibited sex-specificity. Males showed a stronger association between duration-of-illness and WM abnormalities. Females presented a stronger association between WM abnormalities and symptom severity, with IQ impacting this relationship. Our findings provide clear evidence for the interaction of demographic, clinical, and behavioral variables with WM pathology in SCZ. Our results also point to the need for longitudinal studies, directly investigating the casualty and sex-specificity of these relationships, as well as the impact of cognitive resiliency on structure-function relationships.
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Affiliation(s)
- Johanna Seitz-Holland
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Suheyla Cetin-Karayumak
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Joanne D Wojcik
- Department of Psychiatry, Beth Israel Deaconess Medical Centre, Harvard Medical School, Boston, MA, USA
| | - Amanda Lyall
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - James Levitt
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- VA Boston Healthcare System, Brockton, MA, USA
| | - Martha E Shenton
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- VA Boston Healthcare System, Brockton, MA, USA
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ofer Pasternak
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Carl-Fredrik Westin
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Madhura Baxi
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Graduate Program of Neuroscience, Boston University, Boston, MA, USA
| | - Sinead Kelly
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Beth Israel Deaconess Medical Centre, Harvard Medical School, Boston, MA, USA
| | - Raquelle Mesholam-Gately
- Department of Psychiatry, Beth Israel Deaconess Medical Centre, Harvard Medical School, Boston, MA, USA
| | - Mark Vangel
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Carol A Tamminga
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA
| | - John A Sweeney
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, OH, USA
| | - Brett A Clementz
- Department of Psychology and Neuroscience, Bio-Imaging Research Center, University of Georgia, Athens, GA, USA
| | - David Schretlen
- Department of Psychiatry and Behavioral Sciences, Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Petra Verena Viher
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Katharina Stegmayer
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Sebastian Walther
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Jungsun Lee
- Department of Psychiatry, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Tim Crow
- Department of Psychiatry, SANE POWIC, Warneford Hospital, University of Oxford, Oxford, UK
| | - Anthony James
- Department of Psychiatry, SANE POWIC, Warneford Hospital, University of Oxford, Oxford, UK
| | - Aristotle Voineskos
- Center for Addiction and Mental Health, Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Robert W Buchanan
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Philip R Szeszko
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Mental Illness Research, Education and Clinical Center, James J. Peters VA Medical Center, Bronx, New York, NY, USA
| | - Anil K Malhotra
- The Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Yogesh Rathi
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Matcheri Keshavan
- Department of Psychiatry, Beth Israel Deaconess Medical Centre, Harvard Medical School, Boston, MA, USA
| | - Marek Kubicki
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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93
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Nour MM, Liu Y, Arumuham A, Kurth-Nelson Z, Dolan RJ. Impaired neural replay of inferred relationships in schizophrenia. Cell 2021; 184:4315-4328.e17. [PMID: 34197734 PMCID: PMC8357425 DOI: 10.1016/j.cell.2021.06.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 04/09/2021] [Accepted: 06/10/2021] [Indexed: 12/19/2022]
Abstract
An ability to build structured mental maps of the world underpins our capacity to imagine relationships between objects that extend beyond experience. In rodents, such representations are supported by sequential place cell reactivations during rest, known as replay. Schizophrenia is proposed to reflect a compromise in structured mental representations, with animal models reporting abnormalities in hippocampal replay and associated ripple activity during rest. Here, utilizing magnetoencephalography (MEG), we tasked patients with schizophrenia and control participants to infer unobserved relationships between objects by reorganizing visual experiences containing these objects. During a post-task rest session, controls exhibited fast spontaneous neural reactivation of presented objects that replayed inferred relationships. Replay was coincident with increased ripple power in hippocampus. Patients showed both reduced replay and augmented ripple power relative to controls, convergent with findings in animal models. These abnormalities are linked to impairments in behavioral acquisition and subsequent neural representation of task structure.
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Affiliation(s)
- Matthew M Nour
- Max Planck University College London Centre for Computational Psychiatry and Ageing Research, London WC1B 5EH, UK; Wellcome Centre for Human Neuroimaging (WCHN), University College London, London WC1N 3AR, UK; Department of Psychosis Studies, Institute of Psychiatry Psychology and Neuroscience, King's College London, London SE5 8AF, UK.
| | - Yunzhe Liu
- State Key Laboratory of Cognitive Neuroscience and Learning, IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing 100875, China; Chinese Institute for Brain Research, Beijing 102206, China
| | - Atheeshaan Arumuham
- Department of Psychosis Studies, Institute of Psychiatry Psychology and Neuroscience, King's College London, London SE5 8AF, UK
| | - Zeb Kurth-Nelson
- Max Planck University College London Centre for Computational Psychiatry and Ageing Research, London WC1B 5EH, UK; Deepmind, London NC1 4AG, UK
| | - Raymond J Dolan
- Max Planck University College London Centre for Computational Psychiatry and Ageing Research, London WC1B 5EH, UK; Wellcome Centre for Human Neuroimaging (WCHN), University College London, London WC1N 3AR, UK; State Key Laboratory of Cognitive Neuroscience and Learning, IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing 100875, China; BIH Visiting Professor, Stiftung Charité, Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité - Universitätsmedizin, Berlin, Germany
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94
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Korda AI, Ruef A, Neufang S, Davatzikos C, Borgwardt S, Meisenzahl EM, Koutsouleris N. Identification of voxel-based texture abnormalities as new biomarkers for schizophrenia and major depressive patients using layer-wise relevance propagation on deep learning decisions. Psychiatry Res Neuroimaging 2021; 313:111303. [PMID: 34034096 PMCID: PMC9060641 DOI: 10.1016/j.pscychresns.2021.111303] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 05/03/2021] [Accepted: 05/07/2021] [Indexed: 01/27/2023]
Abstract
Non-segmented MRI brain images are used for the identification of new Magnetic Resonance Imaging (MRI) biomarkers able to differentiate between schizophrenic patients (SCZ), major depressive patients (MD) and healthy controls (HC). Brain texture measures such as entropy and contrast, capturing the neighboring variation of MRI voxel intensities, were computed and fed into deep learning technique for group classification. Layer-wise relevance was applied for the localization of the classification results. Texture feature map of non-segmented brain MRI scans were extracted from 141 SCZ, 103 MD and 238 HC. The gray level co-occurrence matrix (GLCM) was calculated on a voxel-by-voxel basis in a cube of voxels. Deep learning tested if texture feature map could predict diagnostic group membership of three classes under a binary classification (SCZ vs. HC, MD vs. HC, SCZ vs. MD). The method was applied in a repeated nested cross-validation scheme and cross-validated feature selection. The regions with the highest relevance (positive/negative) are presented. The method was applied on non-segmented images reducing the computation complexity and the error associated with segmentation process.
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Affiliation(s)
- A I Korda
- Department of Psychiatry and Psychotherapy, University Hospital Lübeck (UKSH), Ratzeburger Allee 160, 23562 Lübeck, Germany.
| | - A Ruef
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University, Nussbaumstr. 7, 80336 Munich, Germany
| | - S Neufang
- Department of Psychiatry and Psychotherapy, University Hospital Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, Germany
| | - C Davatzikos
- Department of Radiology, University of Pennsylvania School of Medicine, 3700 Hamilton Walk, Philadelphia, PA 19104, United States
| | - S Borgwardt
- Department of Psychiatry and Psychotherapy, University Hospital Lübeck (UKSH), Ratzeburger Allee 160, 23562 Lübeck, Germany
| | - E M Meisenzahl
- Department of Psychiatry and Psychotherapy, University Hospital Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, Germany
| | - N Koutsouleris
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University, Nussbaumstr. 7, 80336 Munich, Germany
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95
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Chopra S, Fornito A, Francey SM, O'Donoghue B, Cropley V, Nelson B, Graham J, Baldwin L, Tahtalian S, Yuen HP, Allott K, Alvarez-Jimenez M, Harrigan S, Sabaroedin K, Pantelis C, Wood SJ, McGorry P. Differentiating the effect of antipsychotic medication and illness on brain volume reductions in first-episode psychosis: A Longitudinal, Randomised, Triple-blind, Placebo-controlled MRI Study. Neuropsychopharmacology 2021; 46:1494-1501. [PMID: 33637835 PMCID: PMC8209146 DOI: 10.1038/s41386-021-00980-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 01/17/2021] [Accepted: 01/20/2021] [Indexed: 01/31/2023]
Abstract
Changes in brain volume are a common finding in Magnetic Resonance Imaging (MRI) studies of people with psychosis and numerous longitudinal studies suggest that volume deficits progress with illness duration. However, a major unresolved question concerns whether these changes are driven by the underlying illness or represent iatrogenic effects of antipsychotic medication. In this study, 62 antipsychotic-naïve patients with first-episode psychosis (FEP) received either a second-generation antipsychotic (risperidone or paliperidone) or a placebo pill over a treatment period of 6 months. Both FEP groups received intensive psychosocial therapy. A healthy control group (n = 27) was also recruited. Structural MRI scans were obtained at baseline, 3 months and 12 months. Our primary aim was to differentiate illness-related brain volume changes from medication-related changes within the first 3 months of treatment. We secondarily investigated long-term effects at the 12-month timepoint. From baseline to 3 months, we observed a significant group x time interaction in the pallidum (p < 0.05 FWE-corrected), such that patients receiving antipsychotic medication showed increased volume, patients on placebo showed decreased volume, and healthy controls showed no change. Across the entire patient sample, a greater increase in pallidal grey matter volume over 3 months was associated with a greater reduction in symptom severity. Our findings indicate that psychotic illness and antipsychotic exposure exert distinct and spatially distributed effects on brain volume. Our results align with prior work in suggesting that the therapeutic efficacy of antipsychotic medications may be primarily mediated through their effects on the basal ganglia.
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Affiliation(s)
- Sidhant Chopra
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC, Australia.
- Monash Biomedical Imaging, Monash University, Clayton, VIC, Australia.
| | - Alex Fornito
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
- Monash Biomedical Imaging, Monash University, Clayton, VIC, Australia
| | - Shona M Francey
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Brian O'Donoghue
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Vanessa Cropley
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne & Melbourne Health, Melbourne, VIC, Australia
| | - Barnaby Nelson
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Jessica Graham
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Lara Baldwin
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Steven Tahtalian
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne & Melbourne Health, Melbourne, VIC, Australia
| | - Hok Pan Yuen
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Kelly Allott
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Mario Alvarez-Jimenez
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Susy Harrigan
- Department of Social Work, Monash University, Clayton, VIC, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia
| | - Kristina Sabaroedin
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
- Monash Biomedical Imaging, Monash University, Clayton, VIC, Australia
| | - Christos Pantelis
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne & Melbourne Health, Melbourne, VIC, Australia
- The Florey Institute for Neuroscience and Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Stephen J Wood
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
- School of Psychology, University Birmingham, Edgbaston, UK
| | - Patrick McGorry
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
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96
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The effect of antipsychotic medications on white matter integrity in first-episode drug-naïve patients with psychosis: A review of DTI studies. Asian J Psychiatr 2021; 61:102688. [PMID: 34000500 DOI: 10.1016/j.ajp.2021.102688] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 04/29/2021] [Accepted: 05/06/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND Psychotic episodes have been associated with damage to both grey matter (GM) and white matter (WM). Although a recent meta-analysis suggest that in long term treatment, first generation antipsychotics (FGA) are associated with progressive reduction in GM, second generation antipsychotics (SGA) seem to have benefits to WM microstructure. METHODS A search was conducted to identify controlled trials published from January 2000 to January 2021, which assessed WM integrity as measured by DTI in drug-naïve patients with FEP before and after antipsychotic administration. RESULTS 3 studies met the criteria for inclusion. All studies demonstrated lower FA in psychotic patients vs HC. A 6-week study reported that antipsychotic medication results in a further decrease in FA within the bilateral ACG and right ACR, regions important in emotional processing. An 8-week study found that antipsychotic treatment increase FA in the SLF, resulting in improved symptoms and increased processing speed. A 3rd study found an increase in FA in several regions along with a negative correlation between FA and PANSS at remission. CONCLUSIONS Drug-naïve FEP patients have WM dysfunction at baseline and antipsychotic medications appear to alter or improve WM especially at remission. More controlled trials are warranted to validate these conclusions.
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97
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Cuesta MJ, Lecumberri P, Moreno-Izco L, López-Ilundain JM, Ribeiro M, Cabada T, Lorente-Omeñaca R, de Erausquin G, García-Martí G, Sanjuan J, Sánchez-Torres AM, Gómez M, Peralta V. Motor abnormalities and basal ganglia in first-episode psychosis (FEP). Psychol Med 2021; 51:1625-1636. [PMID: 32114994 DOI: 10.1017/s0033291720000343] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Motor abnormalities (MAs) are the primary manifestations of schizophrenia. However, the extent to which MAs are related to alterations of subcortical structures remains understudied. METHODS We aimed to investigate the associations of MAs and basal ganglia abnormalities in first-episode psychosis (FEP) and healthy controls. Magnetic resonance imaging was performed on 48 right-handed FEP and 23 age-, gender-, handedness-, and educational attainment-matched controls, to obtain basal ganglia shape analysis, diffusion tensor imaging techniques (fractional anisotropy and mean diffusivity), and relaxometry (R2*) to estimate iron load. A comprehensive motor battery was applied including the assessment of parkinsonism, catatonic signs, and neurological soft signs (NSS). A fully automated model-based segmentation algorithm on 1.5T MRI anatomical images and accurate corregistration of diffusion and T2* volumes and R2* was used. RESULTS FEP patients showed significant local atrophic changes in left globus pallidus nucleus regarding controls. Hypertrophic changes in left-side caudate were associated with higher scores in sensory integration, and in right accumbens with tremor subscale. FEP patients showed lower fractional anisotropy measures than controls but no significant differences regarding mean diffusivity and iron load of basal ganglia. However, iron load in left basal ganglia and right accumbens correlated significantly with higher extrapyramidal and motor coordination signs in FEP patients. CONCLUSIONS Taken together, iron load in left basal ganglia may have a role in the emergence of extrapyramidal signs and NSS of FEP patients and in consequence in the pathophysiology of psychosis.
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Affiliation(s)
- Manuel J Cuesta
- Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Pablo Lecumberri
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
- Movalsys S. L., NavarraBiomed, Pamplona, Spain
| | - Lucia Moreno-Izco
- Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Jose M López-Ilundain
- Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - María Ribeiro
- Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Teresa Cabada
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
- Department of Neuroradiology, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Ruth Lorente-Omeñaca
- Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Gabriel de Erausquin
- Zachry Foundation, The Glenn Biggs Institute of Alzheimer's & Neurodegenerative Disorders, UT Heath San Antonio, Texas, USA
| | - Gracian García-Martí
- Radiology Department, CIBERSAM, Valencia, España, Quirón Salud Hospital, Valencia, España
| | - Julio Sanjuan
- Research Institute of Clinic University Hospital of Valencia (INCLIVA), Valencia, Spain
- CIBERSAM, Biomedical Research Network on Mental Health Area, Madrid, Spain
- Department of Psychiatric, University of Valencia School of Medicine, Valencia, Spain
| | - Ana M Sánchez-Torres
- Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Marisol Gómez
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
- Movalsys S. L., NavarraBiomed, Pamplona, Spain
- Department of Statistics, Computer Science and Mathematics, Universidad Pública de Navarra (UPNA), Pamplona, Spain
| | - Victor Peralta
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
- Mental Health Department, Servicio Navarro de Salud, Pamplona, Spain
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98
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Rampino A, Annese T, Torretta S, Tamma R, Maria Falcone R, Ribatti D. Involvement of vascular endothelial growth factor in schizophrenia. Neurosci Lett 2021; 760:136093. [PMID: 34216717 DOI: 10.1016/j.neulet.2021.136093] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 06/22/2021] [Accepted: 06/28/2021] [Indexed: 12/13/2022]
Abstract
Vascular endothelial growth factor (VEGF), which acts as an angiogenic and neurotrophic factor, is involved the regulation of cerebral blood volume and flow in Schizophrenia (SCZ). Several evidence indicates that modification of brain blood circulation due to alterations in the VEGF system affects cognitive performance and brain function in patients with SCZ. The aim of this study is: 1) To analyze the literature data concerning the role of VEGF in modulating the angiogenic response in SCZ. These data are controversial because some studies found elevated VEGF serum levels of VEGF in patients with SCZ, whereas others demonstrated no significant differences between SCZ patients and controls. 2)To analyze the role of VEGF as a predictive factor on the effects of antipsychotics agents used in the treatment of SCZ. In this context, high VEGF levels, associated to better responses to antipsychotics, might be predictive of the use of first generation antipsycotic drugs, whereas low VEGF levels, expression of resistance to therapy, might be predictive for the use of second generation antipsycotic drugs.
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Affiliation(s)
- Antonio Rampino
- Department of Basic Medical Sciences, Neurosciences and Sensory Organs, University of Bari Medical School, Bari, Italy
| | - Tiziana Annese
- Department of Basic Medical Sciences, Neurosciences and Sensory Organs, University of Bari Medical School, Bari, Italy
| | - Silvia Torretta
- Department of Basic Medical Sciences, Neurosciences and Sensory Organs, University of Bari Medical School, Bari, Italy
| | - Roberto Tamma
- Department of Basic Medical Sciences, Neurosciences and Sensory Organs, University of Bari Medical School, Bari, Italy
| | - Rosa Maria Falcone
- Department of Basic Medical Sciences, Neurosciences and Sensory Organs, University of Bari Medical School, Bari, Italy
| | - Domenico Ribatti
- Department of Basic Medical Sciences, Neurosciences and Sensory Organs, University of Bari Medical School, Bari, Italy.
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99
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Pigoni A, Dwyer D, Squarcina L, Borgwardt S, Crespo-Facorro B, Dazzan P, Smesny S, Spaniel F, Spalletta G, Sanfelici R, Antonucci LA, Reuf A, Oeztuerk OF, Schmidt A, Ciufolini S, Schönborn-Harrisberger F, Langbein K, Gussew A, Reichenbach JR, Zaytseva Y, Piras F, Delvecchio G, Bellani M, Ruggeri M, Lasalvia A, Tordesillas-Gutiérrez D, Ortiz V, Murray RM, Reis-Marques T, Di Forti M, Koutsouleris N, Brambilla P. Classification of first-episode psychosis using cortical thickness: A large multicenter MRI study. Eur Neuropsychopharmacol 2021; 47:34-47. [PMID: 33957410 DOI: 10.1016/j.euroneuro.2021.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 03/21/2021] [Accepted: 04/06/2021] [Indexed: 12/19/2022]
Abstract
Machine learning classifications of first-episode psychosis (FEP) using neuroimaging have predominantly analyzed brain volumes. Some studies examined cortical thickness, but most of them have used parcellation approaches with data from single sites, which limits claims of generalizability. To address these limitations, we conducted a large-scale, multi-site analysis of cortical thickness comparing parcellations and vertex-wise approaches. By leveraging the multi-site nature of the study, we further investigated how different demographical and site-dependent variables affected predictions. Finally, we assessed relationships between predictions and clinical variables. 428 subjects (147 females, mean age 27.14) with FEP and 448 (230 females, mean age 27.06) healthy controls were enrolled in 8 centers by the ClassiFEP group. All subjects underwent a structural MRI and were clinically assessed. Cortical thickness parcellation (68 areas) and full cortical maps (20,484 vertices) were extracted. Linear Support Vector Machine was used for classification within a repeated nested cross-validation framework. Vertex-wise thickness maps outperformed parcellation-based methods with a balanced accuracy of 66.2% and an Area Under the Curve of 72%. By stratifying our sample for MRI scanner, we increased generalizability across sites. Temporal brain areas resulted as the most influential in the classification. The predictive decision scores significantly correlated with age at onset, duration of treatment, and positive symptoms. In conclusion, although far from the threshold of clinical relevance, temporal cortical thickness proved to classify between FEP subjects and healthy individuals. The assessment of site-dependent variables permitted an increase in the across-site generalizability, thus attempting to address an important machine learning limitation.
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Affiliation(s)
- A Pigoni
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, via F. Sforza 35, 20122 Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy; MoMiLab Research Unit, IMT School for Advanced Studies Lucca, Lucca, Italy
| | - D Dwyer
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | - L Squarcina
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, via F. Sforza 35, 20122 Milan, Italy
| | - S Borgwardt
- Department of Psychiatry (UPK), University of Basel, Basel, Switzerland; Department of Psychiatry and Psychotherapy, University of Lübeck, Germany
| | - B Crespo-Facorro
- Department of Psychiatry, University Hospital Marqués de Valdecilla, School of Medicine, University of Cantabria-IDIVAL, Santander, Spain; University Hospital Virgen del Rocio, Department of Psychiatry, School of Medicine, University of Sevilla-IBiS, CIBERSAM, Sevilla, Spain
| | - P Dazzan
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - S Smesny
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany
| | - F Spaniel
- Department of Applied Neurosciences and Brain Imaging, National Institute of Mental Health, Klecany Czechia
| | - G Spalletta
- Department of Clinical and Behavioural Neurology, IRCCS Santa Lucia Foundation, Rome, Italy
| | - R Sanfelici
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany; Max Planck School of Cognition, Stephanstrasse 1a, Leipzig, Germany
| | - L A Antonucci
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany; Department of Education, Psychology, Communication, University of Bari Aldo Moro, Bari, Italy
| | - A Reuf
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | - Oe F Oeztuerk
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany; International Max Planck Research School for Translational Psychiatry, Munich, Germany
| | - A Schmidt
- Department of Psychiatry (UPK), University of Basel, Basel, Switzerland
| | - S Ciufolini
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | | | - K Langbein
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany
| | - A Gussew
- Department of Radiology, University Hospital Halle (Saale), Germany
| | - J R Reichenbach
- Medical Physics Group, Department of Diagnostic and Interventional Radiology, Jena University Hospital, Jena, Germany
| | - Y Zaytseva
- Department of Applied Neurosciences and Brain Imaging, National Institute of Mental Health, Klecany Czechia
| | - F Piras
- Department of Clinical and Behavioural Neurology, IRCCS Santa Lucia Foundation, Rome, Italy
| | - G Delvecchio
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - M Bellani
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Italy; UOC of Psychiatry, Azienda Ospedaliera Universitaria Integrata (AOUI) of Verona, Italy
| | - M Ruggeri
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Italy; UOC of Psychiatry, Azienda Ospedaliera Universitaria Integrata (AOUI) of Verona, Italy
| | - A Lasalvia
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Italy; UOC of Psychiatry, Azienda Ospedaliera Universitaria Integrata (AOUI) of Verona, Italy
| | - D Tordesillas-Gutiérrez
- Department of Radiology, Marqués de Valdecilla University Hospital, Valdecilla Biomedical Research Institute IDIVAL, Spain
| | - V Ortiz
- Department of Psychiatry, University Hospital Marqués de Valdecilla, School of Medicine, University of Cantabria-IDIVAL, Santander, Spain
| | - R M Murray
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - T Reis-Marques
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - M Di Forti
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - N Koutsouleris
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | - P Brambilla
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, via F. Sforza 35, 20122 Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
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100
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Sampedro F, Roldán A, Alonso-Solís A, Grasa E, Portella MJ, Aguilar EJ, Núñez-Marín F, Gómez-Ansón B, Corripio I. Grey matter microstructural alterations in schizophrenia patients with treatment-resistant auditory verbal hallucinations. J Psychiatr Res 2021; 138:130-138. [PMID: 33852993 DOI: 10.1016/j.jpsychires.2021.03.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 03/16/2021] [Accepted: 03/19/2021] [Indexed: 01/07/2023]
Abstract
Treatment-resistant auditory verbal hallucinations (TRAVH) are a relatively prevalent and devastating symptom in patients with schizophrenia (SCZ). Even though their pathological mechanisms are poorly understood, they seem to differ from those underlying non-hallucinating SCZ. In this study, we characterise structural brain changes in SCZ patients with TRAVH. With respect to non-hallucinating patients and healthy controls, we studied macrostructural grey matter changes through cortical thickness and subcortical volumetric data. Additionally, we analysed microstructural differences across groups using intracortical and subcortical mean diffusivity data. This latter imaging metric has been claimed to detect incipient neuronal damage, as water can diffuse more freely in regions with reduced neural density. We found brain macrostructrural and microstructural alterations in SCZ patients with TRAVH (n = 29), both with respect to non-hallucinating (n = 20) patients and healthy controls (n = 27). Importantly, a microstructural -rather than a macrostructural- compromise was found in key brain regions such as the ventral ACC, the NAcc and the hippocampus. These microstructural alterations correlated, in turn, with clinical severity. TRAVH patients also showed accentuated age-related cortical deterioration and an abnormal longitudinal loss of cortical integrity over a one-year period. These findings highlight the potential role of microstructural imaging biomarkers in SCZ. Notably, they could be used both to detect and to monitor subtle grey matter alterations in critical brain regions such as deep brain stimulation targets. Moreover, our results support the existence of a more aggressive and active pathological mechanism in patients with TRAVH, providing new insight into the aetiology of this debilitating illness.
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Affiliation(s)
- Frederic Sampedro
- Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain; Biomedical Research Networking Centre in Neurodegenerative Diseases (CIBERNED), Spain
| | - Alexandra Roldán
- Psychiatry Department, Institut d'Investigació Biomèdica-Sant Pau (IIB-SANT PAU), Hospital de la Santa Creu i Sant Pau; Universitat Autònoma de Barcelona (UAB), Department of Psychiatry and Forensic Medicine, Barcelona, Spain
| | - Anna Alonso-Solís
- Psychiatry Department, Institut d'Investigació Biomèdica-Sant Pau (IIB-SANT PAU), Hospital de la Santa Creu i Sant Pau; Universitat Autònoma de Barcelona (UAB), Department of Psychiatry and Forensic Medicine, Barcelona, Spain; Biomedical Research Networking Centre in Mental Health (CIBERSAM), Spain.
| | - Eva Grasa
- Psychiatry Department, Institut d'Investigació Biomèdica-Sant Pau (IIB-SANT PAU), Hospital de la Santa Creu i Sant Pau; Universitat Autònoma de Barcelona (UAB), Department of Psychiatry and Forensic Medicine, Barcelona, Spain; Biomedical Research Networking Centre in Mental Health (CIBERSAM), Spain
| | - Maria J Portella
- Psychiatry Department, Institut d'Investigació Biomèdica-Sant Pau (IIB-SANT PAU), Hospital de la Santa Creu i Sant Pau; Universitat Autònoma de Barcelona (UAB), Department of Psychiatry and Forensic Medicine, Barcelona, Spain; Biomedical Research Networking Centre in Mental Health (CIBERSAM), Spain
| | - Eduardo J Aguilar
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Spain; INCLIVA, School of Medicine, University of Valencia, Valencia, Spain
| | - Fidel Núñez-Marín
- Neuroradiology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (UAB) Barcelona, Spain
| | - Beatriz Gómez-Ansón
- Biomedical Research Networking Centre in Neurodegenerative Diseases (CIBERNED), Spain; Neuroradiology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (UAB) Barcelona, Spain
| | - Iluminada Corripio
- Psychiatry Department, Institut d'Investigació Biomèdica-Sant Pau (IIB-SANT PAU), Hospital de la Santa Creu i Sant Pau; Universitat Autònoma de Barcelona (UAB), Department of Psychiatry and Forensic Medicine, Barcelona, Spain; Biomedical Research Networking Centre in Mental Health (CIBERSAM), Spain
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