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Lacey C, Manuel J, Schluter PJ, Porter RJ, Pitama S, Jamieson HA. Sociodemographic, environmental characteristics and comorbidities of older adults with schizophrenia who access community health service support: A national cross-sectional study. Aust N Z J Psychiatry 2019; 53:570-580. [PMID: 30754993 DOI: 10.1177/0004867419828480] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Schizophrenia is a serious and chronic mental illness known to have broad ranging impacts for individuals across the lifespan, yet research on the disease in older adults is sparse. This study provides a profile of the sociodemographic, environmental and diagnostic characteristics of older community residents with schizophrenia using a national database. METHODS A cross-sectional sample of individuals who underwent community needs assessment using the standardised Home Care International Residential Assessment Instrument between 1 September 2012 and 31 January 2016 was utilised. Sociodemographic, diagnostic, and social and environmental variables were measured for individuals with a diagnosis of schizophrenia and compared to those without a diagnosis of schizophrenia. Statistical investigations employed bivariable and multivariable logistic regression models. RESULTS A total sample of 71,859 was eligible and 517 (0.7%) had a diagnosis of schizophrenia. The majority of the sociodemographic variables were statistically associated with schizophrenia in the adjusted analysis, except for ethnicity ( p = 0.35). Nearly all the measured social and environmental variables were adversely associated with having a diagnosis of schizophrenia, such as living in squalid conditions (adjusted odds ratio = 2.16; 95% confidence interval = [1.42, 3.28]). Participants with schizophrenia were significantly more likely to be diagnosed with all assessed psychiatric comorbidities ( p < 0.001) and diabetes mellitus ( p = 0.002), whereas coronary heart disease ( p = 0.001) and other physical comorbidities ( p = 0.001) were found at significantly lower rates. CONCLUSION The profile of schizophrenia found here suggests some subtle differences in the demographic profile and distribution of medical comorbidities in the older population with schizophrenia. The results also suggest that this group continues to experience social disadvantage into old age. This requires the attention of policy-makers to ensure that services are tailored to the high social needs of these individuals.
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Affiliation(s)
- Cameron Lacey
- 1 Māori/Indigenous Health Institute (MIHI), University of Otago, Christchurch, New Zealand.,2 Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Jenni Manuel
- 1 Māori/Indigenous Health Institute (MIHI), University of Otago, Christchurch, New Zealand
| | - Philip J Schluter
- 3 School of Health Sciences, University of Canterbury, Christchurch, New Zealand.,4 Primary Care Clinical Unit, School of Clinical Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Richard J Porter
- 2 Department of Psychological Medicine, University of Otago, Christchurch, New Zealand.,5 Specialist Mental Health Services, Canterbury District Health Board, Christchurch, New Zealand
| | - Suzanne Pitama
- 1 Māori/Indigenous Health Institute (MIHI), University of Otago, Christchurch, New Zealand
| | - Hamish A Jamieson
- 5 Specialist Mental Health Services, Canterbury District Health Board, Christchurch, New Zealand.,6 Department of Medicine, University of Otago, Christchurch, New Zealand
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Brain structure, cognition, and brain age in schizophrenia, bipolar disorder, and healthy controls. Neuropsychopharmacology 2019; 44:898-906. [PMID: 30635616 PMCID: PMC6461913 DOI: 10.1038/s41386-018-0298-z] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 12/09/2018] [Accepted: 12/13/2018] [Indexed: 12/24/2022]
Abstract
Schizophrenia and bipolar disorder (BD) may be disorders of accelerated aging. Direct comparison of healthy aging populations with schizophrenia and BD patients across the adult lifespan may help inform this theory. In total, 225 individuals (91 healthy controls, 81 schizophrenia, 53 euthymic BD) underwent 3T T1-weighted magnetic resonance imaging, diffusion tensor imaging, and cognitive testing. We analyzed associations among age, diagnosis, and cognition with cortical thickness and fractional anisotropy (FA) using general linear models. We then assessed "brain age" using a random forest algorithm, which was also assessed in an independent sample (n = 147). Participants with schizophrenia had lower cortical thickness and FA compared with the other two groups, most prominently in fronto-temporal circuitry. These brain changes were more evident in younger participants than in older ones, yet were associated with cognitive performance independent of diagnosis. Predicted age was 8 years greater than chronological age in individuals with schizophrenia in the first sample and 6 years greater in the second sample. Predicted and chronological age were not different in BD. Differences in brain circuitry are present from illness onset most prominently in schizophrenia and to a lesser extent in BD. These results support a non-progressive "early hit" hypothesis/etiology of illness in the major psychoses. Brain age differences support the hypothesized early aging mechanism in schizophrenia but not in BD.
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Brink M, Green A, Bojesen AB, Lamberti JS, Conwell Y, Andersen K. Excess medical comorbidity and mortality across the lifespan in schizophrenia.: A nationwide Danish register study. Schizophr Res 2019; 206:347-354. [PMID: 30527270 DOI: 10.1016/j.schres.2018.10.020] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 10/07/2018] [Accepted: 10/20/2018] [Indexed: 12/16/2022]
Abstract
INTRODUCTION People with severe mental illness have greater risk of un-detected and inadequately treated medical disorders, adding up to the risk of premature death. This study investigated how chronic medical comorbidity evolved across the lifespan in schizophrenia and the associated impact on mortality. METHOD A register-based retrospective nested case-control study was conducted, identifying incident cases of cardiovascular disease (CVD), chronic obstructive pulmonary disease (COPD), cancer and diabetes, as well as mortality due to these diseases, across the lifespan in schizophrenia. SAMPLE A schizophrenia cohort consisting of 4924 individuals aged 18-40 years registered with a diagnosis of schizophrenia (ICD-8: 295.0-3 + 295.9) during admission to a psychiatric hospital unit in 1970-79. Schizophrenia cases were age and gender matched with 22,597 controls in the general population. RESULTS Rate ratio (RR) of CVD and cancer were similar to controls. The RR of COPD and diabetes were increased across the lifespan. The probability of having been diagnosed prior to dying from CVD, cancer, pulmonary diseases or diabetes was markedly reduced in schizophrenia cases compared to controls. The RR of all-cause mortality and mortality from CVD, COPD and diabetes remained elevated in all age groups in schizophrenia. Registration of medical comorbidity was associated with increased survival. CONCLUSION Excess medical comorbidity persists across the lifespan and into older age. No age-related decrease in incidence of major chronic medical comorbidities in schizophrenia was found except for diabetes.
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Affiliation(s)
- Maria Brink
- Research Unit of Psychiatry, Institute of Clinical Research, University of Southern Denmark, Sdr. Boulevard 29, 5000 Odense C, Denmark.
| | - Anders Green
- Odense Patient data Explorative Network, OPEN, OUH Odense University Hospital & SDU University of Southern Denmark, J. B. Winsløws Vej 9A, 3th Floor, DK-5000 Odense C, Denmark
| | - Anders Bo Bojesen
- Mental Health Services in the Region of Southern Denmark, Odense, Denmark
| | - J Steve Lamberti
- Department of Psychiatry, University of Rochester Medical Center, Rochester, 14642, NY, USA
| | - Yeates Conwell
- Office for Aging Research and Health Services, Geriatric Psychiatry Program and Schizophrenia Treatment Research Laboratory, University of Rochester Medical Center (URMC), 300 Crittenden Blvd., Rochester, 14642, NY, USA
| | - Kjeld Andersen
- Research Unit of Psychiatry, Institute of Clinical Research, University of Southern Denmark, Sdr. Boulevard 29, 5000 Odense C, Denmark
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Okazaki S, Otsuka I, Numata S, Horai T, Mouri K, Boku S, Ohmori T, Sora I, Hishimoto A. Epigenetic clock analysis of blood samples from Japanese schizophrenia patients. NPJ SCHIZOPHRENIA 2019; 5:4. [PMID: 30814520 PMCID: PMC6393510 DOI: 10.1038/s41537-019-0072-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 02/07/2019] [Indexed: 01/01/2023]
Abstract
The accelerated aging hypothesis of schizophrenia (SCZ) has been proposed. DNA methylation profiles were developed for determining “epigenetic age.” Here, we assessed intrinsic and extrinsic epigenetic age acceleration (IEAA and EEAA, respectively) in SCZ. We examined two independent cohorts of Japanese ancestry. The first cohort consisted of 80 patients with SCZ under long-term or repeated hospitalization and 40 controls, with the economical DNA pooling technique. The second cohort consisted of 24 medication-free patients with SCZ and 23 controls. Blood of SCZ subjects exhibited decreased EEAA in the first cohort (p = 0.0162), but not in the second cohort. IEAA did not differ in either cohort. We performed replication analyses using publicly available datasets from European ancestry (three blood and one brain datasets). One blood dataset showed increased EEAA in SCZ (p = 0.0228). Overall, our results provide evidence for decreased EEAA in SCZ associated with hospitalization in the Japanese population.
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Affiliation(s)
- Satoshi Okazaki
- Department of Psychiatry, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ikuo Otsuka
- Department of Psychiatry, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shusuke Numata
- Department of Psychiatry, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Tadasu Horai
- Department of Psychiatry, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kentaro Mouri
- Department of Internal Medicine, Division of Biosignal Pathophysiology, Kobe University Graduate School of Medicine, Kobe, Japan.,Medical Center for Student's Health Service, Kobe University, Kobe, Japan
| | - Shuken Boku
- Department of Psychiatry, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tetsuro Ohmori
- Department of Psychiatry, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Ichiro Sora
- Department of Psychiatry, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Akitoyo Hishimoto
- Department of Psychiatry, Kobe University Graduate School of Medicine, Kobe, Japan.
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Zanetti ACG, Vedana KGG, Pereira CCM, de Azevedo Marques JM, da Silva AHS, Martin IDS, Dantas RAS, de Souza J, Galera SAF, Gherardi-Donato ECDS. Expressed emotion and socio-demographic and clinical factors in families of Brazilian patients with schizophrenia. Int J Soc Psychiatry 2019; 65:56-63. [PMID: 30488742 DOI: 10.1177/0020764018815207] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Families are the main caregivers of people with schizophrenia. Family dynamic and expressed emotion (EE) of relatives are fundamental determinants on the course of schizophrenia. METHOD This study analyzed socio-demographic and clinical factors related to EE components. A total of 94 dyads (patients with schizophrenia and their relatives) were recruited from three mental health clinics. A form containing socio-demographic and clinical variables and the Brazilian version of Family Questionnaire were used and the data were analyzed through regression model. RESULTS Results showed that factors such as patients' occupation status and patients' age, as well as relatives' gender and the degree of relatedness, were related to emotional overinvolvement and critical comments levels. CONCLUSION This is the first study in the Brazilian cultural context that evaluates EE components and related factors on families of patients with schizophrenia. Other studies concerning EE on different cultural contexts and possible interventions must be carried out to help health professionals to improve patient and family care.
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Affiliation(s)
- Ana Carolina Guidorizzi Zanetti
- 1 World Health Organization (WHO) Collaborating Centre for Nursing Research Development and Department of Psychiatric Nursing and Human Sciences, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, Brazil
| | - Kelly Graziani Giacchero Vedana
- 1 World Health Organization (WHO) Collaborating Centre for Nursing Research Development and Department of Psychiatric Nursing and Human Sciences, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, Brazil
| | - Camila Corrêa Matias Pereira
- 1 World Health Organization (WHO) Collaborating Centre for Nursing Research Development and Department of Psychiatric Nursing and Human Sciences, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, Brazil
| | | | - Amanda Heloisa Santana da Silva
- 1 World Health Organization (WHO) Collaborating Centre for Nursing Research Development and Department of Psychiatric Nursing and Human Sciences, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, Brazil
| | - Isabela Dos Santos Martin
- 1 World Health Organization (WHO) Collaborating Centre for Nursing Research Development and Department of Psychiatric Nursing and Human Sciences, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, Brazil
| | - Rosana Aparecida Spadoti Dantas
- 3 World Health Organization (WHO) Collaborating Centre for Nursing Research Development and Department of General and Specialized Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, Brazil
| | - Jacqueline de Souza
- 1 World Health Organization (WHO) Collaborating Centre for Nursing Research Development and Department of Psychiatric Nursing and Human Sciences, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, Brazil
| | - Sueli Aparecida Frari Galera
- 1 World Health Organization (WHO) Collaborating Centre for Nursing Research Development and Department of Psychiatric Nursing and Human Sciences, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, Brazil
| | - Edilaine Cristina da Silva Gherardi-Donato
- 1 World Health Organization (WHO) Collaborating Centre for Nursing Research Development and Department of Psychiatric Nursing and Human Sciences, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, Brazil
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Eglit GM, Palmer BW, Jeste DV. Overview of measurement-based positive psychiatry. Nord J Psychiatry 2018; 72:396-403. [PMID: 30744516 PMCID: PMC6373474 DOI: 10.1080/08039488.2018.1459834] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 03/27/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND Psychiatry has traditionally focused on studying psychopathology and treating mental illnesses to relieve symptoms and prevent relapse. Positive psychiatry seeks to expand the scope of psychiatry to broader aspects of mental health and well-being among individuals with or without mental illnesses. Positive psychosocial factors such as well-being, resilience, optimism, wisdom, and social support are central to positive psychiatry. AIM To summarize the emerging science of positive psychiatry, emphasizing the use of measures of positive characteristics and outcomes relevant to mental health. METHODS Overview of recent research in positive psychiatry, focusing on measurements. RESULTS Positive psychosocial factors are associated with better mental and physical health in diverse populations. Among individuals with serious mental illnesses, levels of these factors vary considerably, but positive psychiatry interventions can improve well-being and rates of recovery in at least subsets of the patients. A number of measures of positive factors and outcomes are available; most of them are based on self-reports, which have advantages as well as limitations. CONCLUSIONS Positive psychiatry has the potential to improve the health and well-being of individuals with or without mental illnesses. Further research is needed to provide clinicians and investigators with a full tool-box of validated measures for positive psychosocial factors and outcomes. These measures should be subjected to rigorous psychometric evaluation across populations to help clarify mechanisms underlying positive factors, evaluate their longitudinal trajectories, and examine the impact of interventions on health and well-being over the lifespan in different clinical groups.
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Affiliation(s)
- Graham M.L. Eglit
- Department of Psychiatry, University of California San Diego, La Jolla, CA USA
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA USA
| | - Barton W. Palmer
- Department of Psychiatry, University of California San Diego, La Jolla, CA USA
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA USA
- Veterans Affairs San Diego Healthcare System, San D). St. Paul, Minnesotaiego, CA USA
| | - Dilip V. Jeste
- Department of Psychiatry, University of California San Diego, La Jolla, CA USA
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA USA
- Department of Neurosciences, University of California San Diego, La Jolla, CA USA
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Cohen CI, Murante T. A prospective analysis of the role of cognition in three models of aging and schizophrenia. Schizophr Res 2018; 196:22-28. [PMID: 28679478 DOI: 10.1016/j.schres.2017.06.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 06/12/2017] [Accepted: 06/14/2017] [Indexed: 01/01/2023]
Abstract
OBJECTIVES This study uses longitudinal data from a sample of older adults with schizophrenia spectrum disorder (OAS) to examine the role of cognition in 3 models of aging and schizophrenia-accelerated aging, paradoxical aging, and heterogeneity of course-and their clinical relevance. METHODS The sample consisted of 103 community-dwelling persons aged 55 and over (mean=61years) with early-onset schizophrenia. Mean follow-up was 52.5months (range: 12-116months); 55% were men; 55% were white. We identified 21 potential predictor variables and used the Dementia Rating Scale (DRS) to assess cognition. RESULTS There were no significant differences in the DRS at baseline (T1) and follow-up (T2). However, 20%, 22% and 58% of persons exhibited >0.5 effect size increase or decrease, or no change in their DRS scores, respectively; 19% were rapid decliners (>-2.11pts/year) and 19% were rapid improvers (>+2.11pts/year). In multivariable analysis, there were 3 predictors of higher DRS (T2): DRS (T1), decline in anxiety score, and race (white). CONCLUSIONS The heterogeneity model best characterized the trajectory of cognition in later life. The accelerated aging model did not represent typical cognitive trajectories since most individuals were stable or improved. The heterogeneous trajectories made it difficult to generalize about cognition's role in the paradoxical aging model. Despite the paucity of predictors, our findings suggested that it may be clinically productive to enlist remediation strategies that target anxiety and cognition, and direct more attention to non-white OAS.
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Affiliation(s)
- Carl I Cohen
- SUNY Downstate Medical Center, Brooklyn, NY, United States.
| | - Tessa Murante
- SUNY Downstate Medical Center, Brooklyn, NY, United States
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Avoidance of accelerated aging in schizophrenia?: Clinical and biological characterization of an exceptionally high functioning individual. Schizophr Res 2018; 196:45-52. [PMID: 28801195 PMCID: PMC6424115 DOI: 10.1016/j.schres.2017.07.052] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 07/24/2017] [Accepted: 07/27/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To determine the clinical and biological characteristics of an exceptionally high functioning index person (IP) with schizophrenia in her mid-50s, which may represent compensatory mechanisms, and potentially, avoidance of the accelerated aging typically associated with schizophrenia. METHOD IP, 11 other women with schizophrenia, and 11 non-psychiatric comparison (NC) women were assessed with standard ratings of psychopathology, neurocognitive function, decisional capacity, and functional brain imaging. IP was also compared to a sample of demographically similar NCs (N=45) and persons with schizophrenia (N=42) on a set of blood-based biomarkers of aging related to metabolic function, oxidative stress, and inflammation. RESULTS IP's scores on working memory, and levels of brain activation during an affective face matching task in the left fusiform, right lingual, and left precentral gyri, exceeded NCs. IP was similar to NCs in severity of negative symptoms, most neurocognitive functions, decisional capacity, and brain activation in the left inferior occipital gyrus during a selective stopping task. IP's levels on 11 of 14 metabolic and inflammatory biomarkers of aging were better than NCs and the schizophrenia group. CONCLUSION Although speculative, results suggest a possible model in which superior working memory permits a person to be aware of the potentially psychotic nature of a thought or perception, and adjust response accordingly. Compensatory overactivity of brain regions during affective processing may also reflect heightened meta-awareness in emotional situations. Biomarker levels raise the possibility that IP partially avoided the accelerated biological aging associated with schizophrenia.
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59
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McKinney BC, Lin H, Ding Y, Lewis DA, Sweet RA. DNA methylation age is not accelerated in brain or blood of subjects with schizophrenia. Schizophr Res 2018; 196:39-44. [PMID: 28988914 PMCID: PMC5886835 DOI: 10.1016/j.schres.2017.09.025] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 09/18/2017] [Accepted: 09/21/2017] [Indexed: 01/01/2023]
Abstract
Individuals with schizophrenia (SZ) exhibit multiple premature age-related phenotypes and die ~20years prematurely. The accelerated aging hypothesis of SZ has been advanced to explain these observations, it posits that SZ-associated factors accelerate the progressive biological changes associated with normal aging. Testing the hypothesis has been limited by the absence of robust, meaningful, and multi-tissue measures of biological age. Recently, a method was described in which DNA methylation (DNAm) levels at 353 genomic sites are used to produce "DNAm age", an estimate of biological age with advantages over existing measures. We used this method and 3 publicly-available DNAm datasets, 1 from brain and 2 from blood, to test the hypothesis. The brain dataset was composed of data from the dorsolateral prefrontal cortex of 232 non-psychiatric control (NPC) and 195 SZ subjects. Blood dataset #1 was composed of data from whole blood of 304 NPC and 332 SZ subjects, and blood dataset #2 was composed of data from whole blood of 405 NPC and 260 SZ subjects. DNAm age and chronological age correlated strongly (r=0.92-0.95, p<0.0001) in both NPC and SZ subjects in all 3 datasets. DNAm age acceleration did not differ between NPC and SZ subjects in the brain dataset (t=0.52, p=0.60), blood dataset #1 (t=1.51, p=0.13), or blood dataset #2 (t=0.93, p=0.35). Consistent with our previous findings from a smaller study of postmortem brains, our findings suggest there is no acceleration of brain or blood aging in SZ and, thus, do not support the accelerated aging hypothesis of SZ.
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Affiliation(s)
| | - Huang Lin
- University of Pittsburgh, Department of Biostatistics, Pittsburgh, PA
| | - Ying Ding
- University of Pittsburgh, Department of Biostatistics, Pittsburgh, PA
| | - David A. Lewis
- University of Pittsburgh, Department of Psychiatry, Pittsburgh, PA
| | - Robert A. Sweet
- University of Pittsburgh, Department of Psychiatry, Pittsburgh, PA,University of Pittsburgh, Department of Neurology, Pittsburgh, PA,VISN4 Mental Illness Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA
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60
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Muralidharan A, Finch A, Bowie CR, Harvey PD. Thought, language, and communication deficits and association with everyday functional outcomes among community-dwelling middle-aged and older adults with schizophrenia. Schizophr Res 2018; 196:29-34. [PMID: 28778553 PMCID: PMC5794645 DOI: 10.1016/j.schres.2017.07.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 07/03/2017] [Accepted: 07/06/2017] [Indexed: 11/29/2022]
Abstract
Older adults with schizophrenia experience poorer community integration and social functioning compared to same-age peers with no mental health disorders; these individuals are at elevated risk for functional decline and early institutionalization in long-term care facilities. Deficits in thought, language, and communication (TLC; that is, thought disorder and alogia) are core features of schizophrenia and may worsen with age; however, little research focuses on the functional sequelae of these impairments among older adults with schizophrenia. The present study aimed to examine the relationships among age, TLC deficits, and functional outcomes in a sample of community-dwelling middle-aged and older adults with schizophrenia (N = 245; ages 40-85). Participants completed assessments of symptoms, neurocognition, TLC deficits, and functional outcomes. Two different categories of TLC deficits were examined: verbal underproductivity (i.e., alogia) and disconnected speech. Regression analyses, controlling for gender, age, Veteran status, smoking status, cognitive impairment, and symptom severity, found that disconnected speech predicted occupational functioning, while verbal underproductivity predicted capacity to communicate skillfully in semi-structured social situations, as well as community functioning across interpersonal, occupational, and everyday living domains. Exploratory mediation analyses found significant indirect effects of age, through TLC deficits, on certain functional outcomes. Targeted training to improve TLC deficits, especially verbal underproductivity, among older adults with schizophrenia could have downstream effects on community functioning, improving outcomes for a vulnerable group.
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Affiliation(s)
- Anjana Muralidharan
- VA Capitol Healthcare Network, Mental Illness Research Education and Clinical Center, 10 N. Greene Street, Baltimore, MD 21201, USA; Department of Psychiatry, University of Maryland School of Medicine, 655 W. Baltimore Street, Baltimore, MD 21201, USA.
| | - Anastasia Finch
- VA Capitol Healthcare Network, Mental Illness Research Education and Clinical Center, 10 N. Greene Street, Baltimore, MD 21201, USA
| | - Christopher R Bowie
- Department of Psychology, Department of Psychiatry, Queen's University, Kingston, ON K7L3N6, Canada; Center for Addiction and Mental Health, Toronto, ON, Canada
| | - Philip D Harvey
- Department of Psychiatry, Leonard M. Miller School of Medicine, 1600 NW 10(th) Avenue, Miami, FL 33136, USA; Research Service, Bruce W. Carter VA Medical Center, 1201 NW 16(th) Street, Miami, FL 33125, USA
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Lee EE, Liu J, Tu X, Palmer BW, Eyler LT, Jeste DV. A widening longevity gap between people with schizophrenia and general population: A literature review and call for action. Schizophr Res 2018; 196:9-13. [PMID: 28964652 PMCID: PMC5955767 DOI: 10.1016/j.schres.2017.09.005] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 08/29/2017] [Accepted: 09/01/2017] [Indexed: 10/18/2022]
Abstract
Individuals with schizophrenia have higher mortality rates than the population at large. General mortality rates have declined in developed countries since the early 1970s, extending average lifespan by nearly a decade. This review of eight longitudinal studies of mortality in schizophrenia found that the mean standardized mortality ratio (SMR, a measure of mortality rate in schizophrenia compared to the general population) increased 37%, from 2.2 in the pre-1970s studies to 3.0 in the post-1970s reports. Major changes in societal stigma, healthcare, and economic policy are urgently warranted to ensure that this vulnerable segment of the population participates in the longevity revolution.
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Affiliation(s)
- Ellen E. Lee
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States,Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, United States
| | - Jinyuan Liu
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, United States
| | - Xin Tu
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States,Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, United States
| | - Barton W. Palmer
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States,Veterans Affairs San Diego Healthcare System, San Diego, CA, United States
| | - Lisa T. Eyler
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States,Veterans Affairs San Diego Healthcare System, San Diego, CA, United States
| | - Dilip V. Jeste
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States,Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, United States,Department of Neurosciences, University of California, San Diego, CA, United States
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62
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Mushkin P, Band-Winterstein T, Avieli H. "Like Every Normal Person?!" The Paradoxical Effect of Aging With Schizophrenia. QUALITATIVE HEALTH RESEARCH 2018; 28:977-986. [PMID: 29577846 DOI: 10.1177/1049732318764389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Studies on aging with schizophrenia have focused mainly on the adversities of aging with mental illness. The present study, however, examined the subjective experience of well-being among individuals with schizophrenia. Taking a phenomenological reflective life-world approach, in-depth, semistructured interviews with 18 aging individuals with schizophrenia were thematically analyzed. Four main themes emerged: (a) "I love the pills . . . they are very helpful": A balanced course of the illness as a basis for well-being in old age; (b) "I'm going to have my own exhibition at the museum": Self-fulfillment as promoting well-being; (c) "It's just like a family here": Experiencing a sense of belonging; and (d) "I live like everyone else": Aging as an opportunity for normalization. Alongside hardship, the participants perceived old age as a "window of opportunity," enabling the fulfillment of lifelong desires for a social life, acceptance, and a satisfying occupation. Implications regarding interventions with this unique population are discussed.
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Nguyen TT, Kosciolek T, Eyler LT, Knight R, Jeste DV. Overview and systematic review of studies of microbiome in schizophrenia and bipolar disorder. J Psychiatr Res 2018; 99:50-61. [PMID: 29407287 PMCID: PMC5849533 DOI: 10.1016/j.jpsychires.2018.01.013] [Citation(s) in RCA: 123] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 11/28/2017] [Accepted: 01/19/2018] [Indexed: 12/20/2022]
Abstract
Schizophrenia and bipolar disorder are among the leading causes of disability, morbidity, and mortality worldwide. In addition to being serious mental illnesses, these disorders are associated with considerable systemic physiological dysfunction, including chronic inflammation and elevated oxidative stress. The advent of sophisticated sequencing techniques has led to a growing interest in the potential role of gut microbiota in human health and disease. Advances in this area have transformed our understanding of a number of medical conditions and have generated a new perspective suggesting that gut microbiota might be involved in the development and maintenance of brain/mental health. Animal models have demonstrated strong though indirect evidence for a contributory role of intestinal microbiota in psychiatric symptomatology and have linked the microbiome with neuropsychiatric conditions. We present a systematic review of clinical studies of microbiome in schizophrenia and bipolar disorder. The published literature has a number of limitations; however, the investigations suggest that these disorders are associated with reduced microbial diversity and show global community differences compared to non-psychiatric comparison samples. In some reports, specific microbial taxa were associated with clinical disease characteristics, including physical health, depressive and psychotic symptoms, and sleep, but little information on the functional potential of those community changes. Studies also suggest increased intestinal inflammation and permeability, which may be among the principal mechanisms by which microbial dysbiosis impacts systemic physiological functioning. We highlight gaps in the current literature and implications for diagnosis and therapeutic interventions, and outline future directions for microbiome research in psychiatry.
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Affiliation(s)
- Tanya T Nguyen
- VA San Diego Healthcare System, Mental Illness Research, Education, and Clinical Center (MIRECC), San Diego, CA, United States; Department of Psychiatry, University of California San Diego, California, United States
| | - Tomasz Kosciolek
- Department of Pediatrics, University of California San Diego, California, United States
| | - Lisa T Eyler
- VA San Diego Healthcare System, Mental Illness Research, Education, and Clinical Center (MIRECC), San Diego, CA, United States; Department of Psychiatry, University of California San Diego, California, United States
| | - Rob Knight
- Department of Pediatrics, University of California San Diego, California, United States; Center for Microbiome Innovation, University of California San Diego, California, United States; Department of Computer Science and Engineering, University of California San Diego, California, United States
| | - Dilip V Jeste
- Department of Psychiatry, University of California San Diego, California, United States; Center for Microbiome Innovation, University of California San Diego, California, United States; Department of Neurosciences, University of California San Diego, California, United States; Sam and Rose Stein Institute for Research on Aging, University of California San Diego, California, United States.
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64
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Zechner MR, Birkmann JC, Sperduto J, Pratt C. Sensitizing Inpatient Mental Health Staff to the Challenges of Aging. J Psychosoc Nurs Ment Health Serv 2018; 56:12-16. [DOI: 10.3928/02793695-20180108-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 12/11/2017] [Indexed: 11/20/2022]
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Abstract
A crisis looms as research and clinical programs have not kept pace with dramatic increases in the number of older adults with schizophrenia. This article provides an overview of the advances in the conceptualization and study of schizophrenia in later life. Theoretic and clinical models in psychiatry and gerontology are integrated. Specifically, recovery is examined in the context of aging, how clinical dimensionality affects diagnoses in older adults, how various features of schizophrenia are implicated in models of accelerated and paradoxic aging, and how outcome in later life is a more dynamic and heterogeneous than assumed previously.
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66
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Edmonds EC, Martin AS, Palmer BW, Eyler LT, Rana BK, Jeste DV. Positive mental health in schizophrenia and healthy comparison groups: relationships with overall health and biomarkers. Aging Ment Health 2018; 22:354-362. [PMID: 27834490 DOI: 10.1080/13607863.2016.1251572] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Positive psychological factors (PPFs) have been reported to have a significant impact on health in the general population. However, little is known about the relationship of these factors with mental and physical health in schizophrenia. METHOD One hundred and thirty-five outpatients with schizophrenia and 127 healthy comparison subjects (HCs), aged 26-65 years, were evaluated with scales of resilience, optimism, happiness, and perceived stress. Measures of mental and physical health were also obtained. Regression analyses examined associations of a PPF composite with health variables. RESULTS Relative to the HCs, the schizophrenia group had lower levels of PPFs. However, there was considerable heterogeneity, with over one-third of schizophrenia participants having values within the 'normative' range. The PPF composite was positively related to mental and physical health variables and with biomarkers of inflammation and insulin resistance. The relationship between PPFs and mental health was particularly strong for individuals with schizophrenia. CONCLUSION A sizable minority of adults with chronic schizophrenia have levels of resilience, optimism, happiness, and perceived stress similar to HCs. Psychosocial interventions to enhance PPFs should be tested in patients with serious mental illnesses, with the goal of improving their mental health (beyond controlling symptoms of psychosis) and their physical health.
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Affiliation(s)
- Emily C Edmonds
- a Department of Psychiatry , University of California San Diego , La Jolla , CA , USA
| | - Averria Sirkin Martin
- a Department of Psychiatry , University of California San Diego , La Jolla , CA , USA.,b Sam and Rose Stein Institute for Research on Aging, University of California San Diego , La Jolla , CA , USA
| | - Barton W Palmer
- a Department of Psychiatry , University of California San Diego , La Jolla , CA , USA.,b Sam and Rose Stein Institute for Research on Aging, University of California San Diego , La Jolla , CA , USA.,c VA San Diego Healthcare System , San Diego , CA , USA
| | - Lisa T Eyler
- a Department of Psychiatry , University of California San Diego , La Jolla , CA , USA.,b Sam and Rose Stein Institute for Research on Aging, University of California San Diego , La Jolla , CA , USA
| | - Brinda K Rana
- a Department of Psychiatry , University of California San Diego , La Jolla , CA , USA.,b Sam and Rose Stein Institute for Research on Aging, University of California San Diego , La Jolla , CA , USA
| | - Dilip V Jeste
- a Department of Psychiatry , University of California San Diego , La Jolla , CA , USA.,b Sam and Rose Stein Institute for Research on Aging, University of California San Diego , La Jolla , CA , USA.,d Department of Neurosciences , University of California San Diego , La Jolla , CA , USA
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67
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Nguyen TT, Eyler LT, Jeste DV. Systemic Biomarkers of Accelerated Aging in Schizophrenia: A Critical Review and Future Directions. Schizophr Bull 2018; 44:398-408. [PMID: 29462455 PMCID: PMC5815075 DOI: 10.1093/schbul/sbx069] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Schizophrenia is associated with increased physical morbidity and early mortality, suggesting that the aging process may be accelerated in schizophrenia. However, the biological underpinnings of these alterations in aging in schizophrenia are unclear. METHOD We conducted a detailed search of peer-reviewed empirical studies to evaluate evidence for accelerated biological aging in schizophrenia based on systemic, age-related biomarkers. We included studies that investigated differences between persons with schizophrenia and healthy comparison subjects in levels of biomarkers known to be associated with aging and examined the relationship of these biomarkers to age in the 2 groups. RESULTS Forty-two articles that met our selection criteria were reviewed. Nearly 75% reported abnormal biomarker levels among individuals with schizophrenia, including indices of inflammation, cytotoxicity, oxidative stress, metabolic health, gene expression, and receptor/synaptic function, with medium to large effect sizes reported in many studies. Twenty-nine percent of the studies observed differential age-related decline in schizophrenia. Markers of receptor/synaptic function and gene expression were most frequently differentially related to age in schizophrenia. Schizophrenia patients with greater disease severity and longer illness duration exhibited higher levels of inflammatory and oxidative stress biomarkers and shorter telomere length. CONCLUSIONS Most studies show biomarker abnormalities in schizophrenia, and there is some suggestion for accelerated aging. Although definitive interpretation is limited by cross-sectional design of the published reports, findings in the area of gene expression and synaptic function are promising and pave the way for future longitudinal studies needed to fully test this hypothesis.
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Affiliation(s)
- Tanya T Nguyen
- VA San Diego Healthcare System, Mental Illness Research, Education, and Clinical Center (MIRECC), San Diego, CA,Department of Psychiatry, University of California, San Diego, CA
| | - Lisa T Eyler
- VA San Diego Healthcare System, Mental Illness Research, Education, and Clinical Center (MIRECC), San Diego, CA,Department of Psychiatry, University of California, San Diego, CA
| | - Dilip V Jeste
- Department of Psychiatry, University of California, San Diego, CA,Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, CA,To whom correspondence should be addressed; Estelle and Edgar Levi Chair in Aging, Sam and Rose Stein Institute for Research on Aging, Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive #0664, La Jolla, CA 92093, US; tel: 858-534-4020, fax: 858-543-5475, e-mail:
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68
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Seitz J, Rathi Y, Lyall A, Pasternak O, Del Re EC, Niznikiewicz M, Nestor P, Seidman LJ, Petryshen TL, Mesholam-Gately RI, Wojcik J, McCarley RW, Shenton ME, Koerte IK, Kubicki M. Alteration of gray matter microstructure in schizophrenia. Brain Imaging Behav 2018; 12:54-63. [PMID: 28102528 PMCID: PMC5517358 DOI: 10.1007/s11682-016-9666-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Neuroimaging studies demonstrate gray matter (GM) macrostructural abnormalities in patients with schizophrenia (SCZ). While ex-vivo and genetic studies suggest cellular pathology associated with abnormal neurodevelopmental processes in SCZ, few in-vivo measures have been proposed to target microstructural GM organization. Here, we use diffusion heterogeneity- to study GM microstructure in SCZ. Structural and diffusion magnetic resonance imaging (MRI) were acquired on a 3 Tesla scanner in 46 patients with SCZ and 37 matched healthy controls (HC). After correction for free water, diffusion heterogeneity as well as commonly used diffusion measures FA and MD and volume were calculated for the four cortical lobes on each hemisphere, and compared between groups. Patients with early course SCZ exhibited higher diffusion heterogeneity in the GM of the frontal lobes compared to controls. Diffusion heterogeneity of the frontal lobe showed excellent discrimination between patients and HC, while none of the commonly used diffusion measures such as FA or MD did. Higher diffusion heterogeneity in the frontal lobes in early SCZ may be due to abnormal brain maturation (migration, pruning) before and during adolescence and early adulthood. Further studies are needed to investigate the role of heterogeneity as potential biomarker for SCZ risk.
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Affiliation(s)
- Johanna Seitz
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Harvard Medical School, Brigham and Women's Hospital, 1249 Boylston St, Boston, MA, 02215, USA
- Department of Child and Adolescent Psychiatry, Psychosomatic and Psychotherapy, Ludwig- Maximilians- Universität, Munich, Germany
| | - Yogesh Rathi
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Harvard Medical School, Brigham and Women's Hospital, 1249 Boylston St, Boston, MA, 02215, USA
| | - Amanda Lyall
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Harvard Medical School, Brigham and Women's Hospital, 1249 Boylston St, Boston, MA, 02215, USA
- Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Ofer Pasternak
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Harvard Medical School, Brigham and Women's Hospital, 1249 Boylston St, Boston, MA, 02215, USA
- Department of Radiology, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Elisabetta C Del Re
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Harvard Medical School, Brigham and Women's Hospital, 1249 Boylston St, Boston, MA, 02215, USA
- Clinical Neuroscience Division, Laboratory of Neuroscience, VA Boston Healthcare System, Brockton, MA, USA
| | - Margaret Niznikiewicz
- Clinical Neuroscience Division, Laboratory of Neuroscience, VA Boston Healthcare System, Brockton, MA, USA
| | - Paul Nestor
- Clinical Neuroscience Division, Laboratory of Neuroscience, VA Boston Healthcare System, Brockton, MA, USA
- Department of Psychology, University of Massachusetts, Boston, MA, USA
| | - Larry J Seidman
- Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
- Beth Israel Deaconess Medical Center Public Psychiatry Division at the Massachusetts Mental Health Center Harvard Medical School, Boston, MA, USA
| | - Tracey L Petryshen
- Psychiatric and Neurodevelopmental Genetic Unit, Department of Psychiatry and Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA, USA
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Raquelle I Mesholam-Gately
- Beth Israel Deaconess Medical Center Public Psychiatry Division at the Massachusetts Mental Health Center Harvard Medical School, Boston, MA, USA
| | - Joanne Wojcik
- Beth Israel Deaconess Medical Center Public Psychiatry Division at the Massachusetts Mental Health Center Harvard Medical School, Boston, MA, USA
| | - Robert W McCarley
- Clinical Neuroscience Division, Laboratory of Neuroscience, VA Boston Healthcare System, Brockton, MA, USA
- VA Boston Healthcare System, Brockton Division, Brockton, MA, USA
| | - Martha E Shenton
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Harvard Medical School, Brigham and Women's Hospital, 1249 Boylston St, Boston, MA, 02215, USA
- Department of Radiology, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
- VA Boston Healthcare System, Brockton Division, Brockton, MA, USA
| | - Inga K Koerte
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Harvard Medical School, Brigham and Women's Hospital, 1249 Boylston St, Boston, MA, 02215, USA
- Department of Child and Adolescent Psychiatry, Psychosomatic and Psychotherapy, Ludwig- Maximilians- Universität, Munich, Germany
| | - Marek Kubicki
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Harvard Medical School, Brigham and Women's Hospital, 1249 Boylston St, Boston, MA, 02215, USA.
- Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA.
- Department of Radiology, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA.
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69
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Impact of sample size and matching on single-subject classification of schizophrenia: A meta-analysis. Schizophr Res 2018; 192:479-480. [PMID: 28576547 DOI: 10.1016/j.schres.2017.05.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 05/24/2017] [Accepted: 05/24/2017] [Indexed: 01/19/2023]
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70
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Czepielewski LS, Massuda R, Panizzutti B, Grun LK, Barbé-Tuana FM, Teixeira AL, Barch DM, Gama CS. Telomere Length and CCL11 Levels are Associated With Gray Matter Volume and Episodic Memory Performance in Schizophrenia: Evidence of Pathological Accelerated Aging. Schizophr Bull 2018; 44:158-167. [PMID: 28338779 PMCID: PMC5767949 DOI: 10.1093/schbul/sbx015] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Schizophrenia (SZ) is associated with increased somatic morbidity and mortality, in addition to cognitive impairments similar to those seen in normal aging, which may suggest that pathological accelerated aging occurs in SZ. Therefore, we aim to evaluate the relationships of age, telomere length (TL), and CCL11 (aging and inflammatory biomarkers, respectively), gray matter (GM) volume and episodic memory performance in individuals with SZ compared to healthy controls (HC). One hundred twelve participants (48 SZ and 64 HC) underwent clinical and memory assessments, structural MRI, and had their peripheral blood drawn for biomarkers analysis. Comparisons of group means and correlations were performed. Participants with SZ had decreased TL and GM volume, increased CCL11, and worse memory performance compared to HC. In SZ, shorter TL was related to increased CCL11, and both biomarkers were related to reduced GM volume, all of which were related to worse memory performance. Older age was only associated with reduced GM, but longer duration of illness was related with all the aforementioned variables. Younger age of disease onset was associated with increased CCL11 levels and worse memory performance. In HC, there were no significant correlations except between memory and GM. Our results are consistent with the hypothesis of accelerated aging in SZ. These results may indicate that it is not age itself, but the impact of the disease associated with a pathological accelerated aging that leads to impaired outcomes in SZ.
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Affiliation(s)
- Leticia Sanguinetti Czepielewski
- Molecular Psychiatry Laboratory, Hospital de Clinicas de Porto Alegre, Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Raffael Massuda
- Departamento de Psiquiatria, Universidade Federal do Paraná, Curitiba, Brazil
| | - Bruna Panizzutti
- Molecular Psychiatry Laboratory, Hospital de Clinicas de Porto Alegre, Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Lucas Kich Grun
- Programa de Pós-Graduação em Ciências Biológicas: Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Florencia María Barbé-Tuana
- Programa de Pós-Graduação em Ciências Biológicas: Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Antonio Lucio Teixeira
- Laboratório Interdisciplinar de Investigação Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Deanna M Barch
- Department of Psychological & Brain Sciences, Washington University in St Louis, St Louis, MO,Department of Psychiatry and Radiology, Washington University in St Louis, St Louis, MO
| | - Clarissa S Gama
- Molecular Psychiatry Laboratory, Hospital de Clinicas de Porto Alegre, Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil,To whom correspondence should be addressed; Hospital de Clínicas de Porto Alegre/CPE, Molecular Psychiatry Laboratory, Rua Ramiro Barcelos, 2350, Prédio Anexo, 90035-903 Porto Alegre, Brazil; tel: +55-51-33598845, fax: +55-51-33598846, e-mail:
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71
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Gan DRY. Neighborhood effects for aging in place: a transdisciplinary framework toward health-promoting settings. ACTA ACUST UNITED AC 2017. [DOI: 10.1080/08882746.2017.1393283] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Daniel Rong Yao Gan
- Centre for Ageing Research in the Environment, National University of Singapore, Singapore
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72
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Mathias SR, Knowles EEM, Barrett J, Leach O, Buccheri S, Beetham T, Blangero J, Poldrack RA, Glahn DC. The Processing-Speed Impairment in Psychosis Is More Than Just Accelerated Aging. Schizophr Bull 2017; 43:814-823. [PMID: 28062652 PMCID: PMC5472152 DOI: 10.1093/schbul/sbw168] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Processing speed is impaired in patients with psychosis, and deteriorates as a function of normal aging. These observations, in combination with other lines of research, suggest that psychosis may be a syndrome of accelerated aging. But do patients with psychosis perform poorly on tasks of processing speed for the same reasons as older adults? Fifty-one patients with psychotic illnesses and 90 controls with similar mean IQ (aged 19-69 years, all African American) completed a computerized processing-speed task, reminiscent of the classic digit-symbol coding task. The data were analyzed using the drift-diffusion model (DDM), and Bayesian inference was used to determine whether psychosis and aging had similar or divergent effects on the DDM parameters. Psychosis and aging were both associated with poor performance, but had divergent effects on the DDM parameters. Patients had lower information-processing efficiency ("drift rate") and longer nondecision time than controls, and psychosis per se did not influence response caution. By contrast, the primary effect of aging was to increase response caution, and had inconsistent effects on drift rate and nondecision time across patients and controls. The results reveal that psychosis and aging influenced performance in different ways, suggesting that the processing-speed impairment in psychosis is more than just accelerated aging. This study also demonstrates the potential utility of computational models and Bayesian inference for finely mapping the contributions of cognitive functions on simple neurocognitive tests.
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Affiliation(s)
- Samuel R. Mathias
- Neurocognition, Neurocomputation and Neurogenetics (n3) Division, Department of Psychiatry, Yale University School of Medicine, 40 Temple Street, Room 694, New Haven, CT 06511
| | - Emma E. M. Knowles
- Neurocognition, Neurocomputation and Neurogenetics (n3) Division, Department of Psychiatry, Yale University School of Medicine, 40 Temple Street, Room 694, New Haven, CT 06511;,Olin Neuropsychiatry Research Center, Institute of Living, Hartford, CT
| | - Jennifer Barrett
- Olin Neuropsychiatry Research Center, Institute of Living, Hartford, CT
| | - Olivia Leach
- Olin Neuropsychiatry Research Center, Institute of Living, Hartford, CT
| | | | - Tamara Beetham
- Neurocognition, Neurocomputation and Neurogenetics (n3) Division, Department of Psychiatry, Yale University School of Medicine, 40 Temple Street, Room 694, New Haven, CT 06511
| | - John Blangero
- South Texas Diabetes and Obesity Institute, University of Texas Rio Grande Valley School of Medicine, Brownsville, TX
| | | | - David. C. Glahn
- Neurocognition, Neurocomputation and Neurogenetics (n3) Division, Department of Psychiatry, Yale University School of Medicine, 40 Temple Street, Room 694, New Haven, CT 06511;,Olin Neuropsychiatry Research Center, Institute of Living, Hartford, CT
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73
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Is cerebrovascular disease a silent condition in patients with chronic schizophrenia-related disorders? Int Clin Psychopharmacol 2017; 32:80-86. [PMID: 27755155 DOI: 10.1097/yic.0000000000000153] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Patients with chronic schizophrenia-related disorders are at a heightened risk of developing cardiovascular disease. The presence and interpretation of cerebral vascular lesions in neuroimaging tests in these patients represents a common clinical challenge. Nevertheless, the literature on cerebrovascular disease in this population is scarce and contradictory. The aim of this study was to analyse the relationship between schizophrenia-related disorders and cerebrovascular morbidity. A case-control study compared cerebrovascular morbidity in a group of patients with schizophrenia-related disorder versus a group of patients with another severe mental illness. The risk of presenting cerebrovascular morbidity was four times higher and statistically significant in patients with schizophrenia-related disorders compared with controls, paired by age and sex. However, both groups were homogeneous in terms of cardiovascular risk factors. There were significant differences between the two groups only in the time using first-generation antipsychotic drugs and taking two or more antipsychotic medications simultaneously. The relationship between chronic schizophrenia-related disorders and cerebrovascular disease may be beyond the classic cardiovascular risk factors and related to certain medications. This is one of the first studies to focus on the relation among cerebrovascular morbidity, antipsychotic drugs and disorders related to schizophrenia in middle-aged and elderly adults.
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74
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Wolkowitz OM, Jeste DV, Martin AS, Lin J, Daly RE, Reuter C, Kraemer H. Leukocyte telomere length: Effects of schizophrenia, age, and gender. J Psychiatr Res 2017; 85:42-48. [PMID: 27835738 DOI: 10.1016/j.jpsychires.2016.10.015] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 09/28/2016] [Accepted: 10/03/2016] [Indexed: 01/11/2023]
Abstract
BACKGROUND Schizophrenia is linked with early medical comorbidity and mortality. These observations indicate possible "accelerated biological aging" in schizophrenia, although prior findings are mixed, and few such studies have examined the role of gender. One putative marker of biological aging is leukocyte telomere length (LTL), which typically shortens with age. METHODS We assessed LTL in phenotypically well characterized 134 individuals with schizophrenia (60 women and 74 men) and 123 healthy comparison subjects (HCs) (66 women and 57 men), aged 26 to 65 years. RESULTS Overall, LTL was inversely associated with age (t(249) = -6.2, p < 0.001), and a gender effect on the rate of LTL decrease with age was found (t(249) = 2.20, p = 0.029), with men declining more rapidly than women. No significant overall effect of diagnosis on the rate of decline was detected. However, at the average sample age (48 years), there was a significant gender effect in both schizophrenia and HC groups (t(249) = 2.48, p = 0.014), with women having longer LTL than men, and a significant gender X diagnosis effect (t(249) = 2.43, p = 0.016) - at the average sample age, women with schizophrenia had shorter LTL than HC women. DISCUSSION Gender, not the diagnosis of schizophrenia, was the major factor involved with LTL shortening across the age range studied. We discuss the constraints of a cross-sectional design and other methodological issues, and indicate future directions. Understanding the impact of schizophrenia on biological aging will require separate evaluations in men and women.
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Affiliation(s)
- Owen M Wolkowitz
- University of California San Francisco School of Medicine (UCSF), San Francisco, CA, USA
| | - Dilip V Jeste
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, 92093, USA; Department of Neurosciences, University of California, San Diego, La Jolla, CA, 92093, USA; Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, La Jolla, 92093-0738, USA.
| | - Averria Sirkin Martin
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, 92093, USA; Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, La Jolla, 92093-0738, USA
| | - Jue Lin
- University of California San Francisco School of Medicine (UCSF), San Francisco, CA, USA
| | - Rebecca E Daly
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, 92093, USA; Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, La Jolla, 92093-0738, USA
| | - Chase Reuter
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, 92093, USA; Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, La Jolla, 92093-0738, USA
| | - Helena Kraemer
- Stanford University School of Medicine, Stanford, CA, USA
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75
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Murante T, Cohen CI. Cognitive Functioning in Older Adults With Schizophrenia. FOCUS: JOURNAL OF LIFE LONG LEARNING IN PSYCHIATRY 2017; 15:26-34. [PMID: 31975837 DOI: 10.1176/appi.focus.20160032] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Cognitive deficits are thought to be a core feature in schizophrenia and have been found to be strongly associated with impairments in functioning. It is estimated that more than 70% of patients with schizophrenia have cognitive impairment. The aim of this article is to critically review the emerging literature on cognition in older adults with schizophrenia. Specifically, we address the following questions: Are there differences in cognitive functioning between older adults with schizophrenia and their healthy age peers as well as with younger people with schizophrenia? What are the factors associated with cognitive deficits and their interaction over time? What are the life course trajectories of cognitive deficits, especially in later life? Are older adults with schizophrenia more likely to develop dementia, and, if so, does it differ from other dementias? Are there pharmacological and psychosocial interventions that can successfully treat cognitive deficits in older adults with schizophrenia?
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Affiliation(s)
- Tessa Murante
- Dr. Murante is with the Psychiatric Residency Training Program and Dr. Cohen is with the Division of Geriatric Psychiatry, SUNY Downstate Medical College, Brooklyn, New York. Send correspondence to Dr. Cohen (e-mail: )
| | - Carl I Cohen
- Dr. Murante is with the Psychiatric Residency Training Program and Dr. Cohen is with the Division of Geriatric Psychiatry, SUNY Downstate Medical College, Brooklyn, New York. Send correspondence to Dr. Cohen (e-mail: )
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Lee EE, Hong S, Martin AS, Eyler LT, Jeste DV. Inflammation in Schizophrenia: Cytokine Levels and Their Relationships to Demographic and Clinical Variables. Am J Geriatr Psychiatry 2017; 25:50-61. [PMID: 27840055 PMCID: PMC5164855 DOI: 10.1016/j.jagp.2016.09.009] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 09/26/2016] [Accepted: 09/27/2016] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Inflammation may play a role in the accelerated physical aging reported in schizophrenia, though biomarker findings and associations with demographic and clinical factors are inconsistent. METHODS In a cross-sectional, case-control design, 95 outpatients with schizophrenia (mean age ± SD: 48.1 ± 10.2 years) and 95 demographically comparable healthy comparison subjects (HCs) (mean age ± SD: 48.1 ± 12.1 years) were studied. Sociodemographic and clinical data were collected, and plasma levels of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and interferon-γ (IFN-γ) were assayed. The authors compared cytokine levels, examined demographic and clinical associations, and adjusted for relevant variables with linear models. RESULTS Individuals with schizophrenia had higher levels of TNF-α and IL-6 but not IFN-γ than HCs. Age was not related to cytokine levels, and age relationships did not differ between diagnostic groups. Women had higher levels of IL-6. TNF-α and IL-6 levels were significantly correlated with depressive symptoms, and adjustment for depression reduced the group effect for both. Within the HCs, TNF-α levels were associated with physical comorbidity and body mass index. IL-6 levels were significantly correlated with body mass index and within schizophrenia patients, with worse mental and physical well-being. Accounting for physical morbidity and mental well-being reduced group differences in TNF-α and IL-6 levels, respectively. Worse positive symptoms were associated with higher IL-6 levels. CONCLUSION Higher TNF-α and IL-6 levels in schizophrenia patients were associated with depression, physical comorbidity, and mental well-being. Further longitudinal studies are warranted to assess inflammation as a potential treatment target for a subgroup of schizophrenia.
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Affiliation(s)
- Ellen E. Lee
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States,Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, United States
| | - Suzi Hong
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States,Department of Family Medicine and Public Health, University of California, San Diego
| | - Averria Sirkin Martin
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States,Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, United States
| | - Lisa T. Eyler
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States,Desert-Pacific Mental Illness Research Education and Clinical Center, Veterans Affairs San Diego Healthcare System, San Diego
| | - Dilip V. Jeste
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States,Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, United States,Center for Healthy Aging, University of California San Diego, La Jolla, CA, United States,Department of Neurosciences, University of California, San Diego
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77
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Older adults living with HIV: a valuable resource? AGEING & SOCIETY 2016. [DOI: 10.1017/s0144686x16001070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
ABSTRACTSubjective wellbeing was examined amongst 274 adults living with HIV in Australia and the United States of America. There were 164 adults aged 49 years and under, and 110 adults aged 50 years and over. Participants completed a composite questionnaire comprising the Personal Wellbeing Index-Adult (PWI-A), the HIV-Unsupportive Social Interactions Inventory (USII), and demographic and health-related items. Participants reported mean PWI-A scores of 54.7 points, considerably below the Western population normative range of 70–80 points. Older adults reported significantly greater subjective wellbeing compared to younger adults, but still below the normative range. Experiences of unsupportive social interactions were a significant predictor of reduced subjective wellbeing amongst all participants. Qualitative comments provided a greater understanding of the characteristics and psychological devices that enable some older adults to maintain and/or increase subjective wellbeing, even in the face of negative stressors such as unsupportive social interactions. This provides valuable information for service providers and clinicians as HIV increasingly becomes recognised as a disease affecting older adults in developed nations. Rather than positioning the ageing HIV-population as a potential burden, it is proposed that learning more about the coping mechanisms employed by older adults with HIV could prove beneficial for the HIV-population as a whole.
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78
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Jeste DV, Palmer BW. Mild Neurocognitive Disorder: A Model for Accelerated Biological Aging? Am J Geriatr Psychiatry 2016; 24:987-988. [PMID: 27663126 PMCID: PMC6358012 DOI: 10.1016/j.jagp.2016.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 08/15/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Dilip V. Jeste
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA,Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, USA
| | - Barton W. Palmer
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA,Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, USA,VA San Diego Healthcare System, San Diego, CA, USA
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79
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Lee EE, Eyler LT, Wolkowitz OM, Martin AS, Reuter C, Kraemer H, Jeste DV. Elevated plasma F2-isoprostane levels in schizophrenia. Schizophr Res 2016; 176:320-326. [PMID: 27318521 PMCID: PMC5026902 DOI: 10.1016/j.schres.2016.06.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 06/06/2016] [Accepted: 06/09/2016] [Indexed: 01/02/2023]
Abstract
BACKGROUND Schizophrenia is one of the most disabling psychiatric disorders with increased morbidity and mortality. Both schizophrenia and oxidative stress have been associated with accelerated aging. Previous studies found increased oxidative stress in individuals with schizophrenia, though only one study measured F2-isoprostanes and did so in urine. To our knowledge, the present study is the first to assess plasma F2-isoprostane levels, the putative gold standard measure of systemic oxidative stress in vivo, in schizophrenia. METHODS We compared plasma F2-isoprostane levels in 134 stable outpatients with schizophrenia and 120 age- and gender-matched healthy comparison (HC) subjects. Sociodemographic and clinical data were collected in both groups. RESULTS Plasma F2-isoprostane levels were significantly higher in the schizophrenia group than in the HC group. Women had higher F2-isoprostane levels compared to men, and those with higher body mass index (BMI) had higher levels, within each group. F2-isoprostane levels correlated with BMI, physical functioning, and medical comorbidity but not with severity of psychopathology or executive function. Linear models showed significant effects of diagnosis, gender, and BMI on F2-isoprostane levels, but no interactions. DISCUSSION Our finding of increased oxidative stress in schizophrenia is consistent with reports of increased morbidity and mortality as well as accelerated aging in schizophrenia. The significant associations between F2-isoprostane levels and both gender and BMI warrant further study.
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Affiliation(s)
- Ellen E. Lee
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
| | - Lisa T. Eyler
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States,Desert-Pacific Mental Illness Research Education and Clinical Center, Veterans Affairs San Diego Healthcare System, San Diego
| | | | - Averria Sirkin Martin
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States,Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, La Jolla, CA, United States
| | - Chase Reuter
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States,Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, La Jolla, CA, United States
| | - Helena Kraemer
- Department of Psychiatry, Stanford University, Palo Alto
| | - Dilip V. Jeste
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States,Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, La Jolla, CA, United States,Center for Healthy Aging, University of California, San Diego, La Jolla, CA, United States,Department of Neurosciences, University of California, San Diego
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80
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Bennett ME, Bradshaw KR, Catalano LT. Treatment of substance use disorders in schizophrenia. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2016; 43:377-390. [DOI: 10.1080/00952990.2016.1200592] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Melanie E. Bennett
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
- VA VISN 5 Mental Illness Research, Education, and Clinical Center, Baltimore, MD, USA
| | - Kristen R. Bradshaw
- Department of Psychology, University of Maryland, College Park, College Park, MD, USA
| | - Lauren T. Catalano
- Department of Psychology, University of Maryland, College Park, College Park, MD, USA
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81
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Kochunov P, Ganjgahi H, Winkler A, Kelly S, Shukla DK, Du X, Jahanshad N, Rowland L, Sampath H, Patel B, O'Donnell P, Xie Z, Paciga SA, Schubert CR, Chen J, Zhang G, Thompson PM, Nichols TE, Hong LE. Heterochronicity of white matter development and aging explains regional patient control differences in schizophrenia. Hum Brain Mapp 2016; 37:4673-4688. [PMID: 27477775 DOI: 10.1002/hbm.23336] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 07/21/2016] [Accepted: 07/24/2016] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Altered brain connectivity is implicated in the development and clinical burden of schizophrenia. Relative to matched controls, schizophrenia patients show (1) a global and regional reduction in the integrity of the brain's white matter (WM), assessed using diffusion tensor imaging (DTI) fractional anisotropy (FA), and (2) accelerated age-related decline in FA values. In the largest mega-analysis to date, we tested if differences in the trajectories of WM tract development influenced patient-control differences in FA. We also assessed if specific tracts showed exacerbated decline with aging. METHODS Three cohorts of schizophrenia patients (total n = 177) and controls (total n = 249; age = 18-61 years) were ascertained with three 3T Siemens MRI scanners. Whole-brain and regional FA values were extracted using ENIGMA-DTI protocols. Statistics were evaluated using mega- and meta-analyses to detect effects of diagnosis and age-by-diagnosis interactions. RESULTS In mega-analysis of whole-brain averaged FA, schizophrenia patients had lower FA (P = 10-11 ) and faster age-related decline in FA (P = 0.02) compared with controls. Tract-specific heterochronicity measures, that is, abnormal rates of adolescent maturation and aging explained approximately 50% of the regional variance effects of diagnosis and age-by-diagnosis interaction in patients. Interactive, three-dimensional visualization of the results is available at www.enigma-viewer.org. CONCLUSION WM tracts that mature later in life appeared more sensitive to the pathophysiology of schizophrenia and were more susceptible to faster age-related decline in FA values. Hum Brain Mapp 37:4673-4688, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Peter Kochunov
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland
| | - Habib Ganjgahi
- Department of Statistics, University of Warwick, Warwick, United Kingdom
| | | | - Sinead Kelly
- Imaging Genetics Center, Keck School of Medicine of USC, Marina del Rey, California
| | - Dinesh K Shukla
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland
| | - Xiaoming Du
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland
| | - Neda Jahanshad
- Imaging Genetics Center, Keck School of Medicine of USC, Marina del Rey, California
| | - Laura Rowland
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland
| | - Hemalatha Sampath
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland
| | - Binish Patel
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland
| | - Patricio O'Donnell
- Neuroscience Research Unit, Worldwide Research and Development, Pfizer Inc, 610 Main Street, Cambridge, Massachusetts, 02139
| | - Zhiyong Xie
- Neuroscience Research Unit, Worldwide Research and Development, Pfizer Inc, 610 Main Street, Cambridge, Massachusetts, 02139
| | - Sara A Paciga
- Enterprise Scientific Technology Operations, Worldwide Research and Development, Pfizer Inc, Eastern Point Rd, Groton, Connecticut, 06340
| | - Christian R Schubert
- Enterprise Scientific Technology Operations, Worldwide Research and Development, Pfizer Inc, Eastern Point Rd, Groton, Connecticut, 06340.,Biogen, Cambridge, Massachusetts, 02142
| | - Jian Chen
- Department of Computer Science and Electrical Engineering, University of Maryland, Baltimore County, Maryland, 21250
| | - Guohao Zhang
- Department of Computer Science and Electrical Engineering, University of Maryland, Baltimore County, Maryland, 21250
| | - Paul M Thompson
- Imaging Genetics Center, Keck School of Medicine of USC, Marina del Rey, California
| | - Thomas E Nichols
- Department of Statistics, University of Warwick, Warwick, United Kingdom
| | - L Elliot Hong
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland
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82
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Thomas ML, Kaufmann CN, Palmer BW, Depp CA, Martin AS, Glorioso DK, Thompson WK, Jeste DV. Paradoxical Trend for Improvement in Mental Health With Aging: A Community-Based Study of 1,546 Adults Aged 21-100 Years. J Clin Psychiatry 2016; 77:e1019-25. [PMID: 27561149 PMCID: PMC5461877 DOI: 10.4088/jcp.16m10671] [Citation(s) in RCA: 105] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 05/03/2016] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Studies of aging usually focus on trajectories of physical and cognitive function, with far less emphasis on overall mental health, despite its impact on general health and mortality. This study examined linear and nonlinear trends of physical, cognitive, and mental health over the entire adult lifespan. METHODS Cross-sectional data were obtained from 1,546 individuals aged 21-100 years, selected using random digit dialing for the Successful AGing Evaluation (SAGE) study, a structured multicohort investigation that included telephone interviews and in-home surveys of community-based adults without dementia. Data were collected from 1/26/2010 to 10/07/2011 targeting participants aged 50-100 years and from 6/25/2012 to 7/15/2013 targeting participants aged 21-100 years with an emphasis on adding younger individuals. Data included self-report measures of physical health, measures of both positive and negative attributes of mental health, and a phone interview-based measure of cognition. RESULTS Comparison of age cohorts using polynomial regression suggested a possible accelerated deterioration in physical and cognitive functioning, averaging 1.5 to 2 standard deviations over the adult lifespan. In contrast, there appeared to be a linear improvement of about 1 standard deviation in various attributes of mental health over the same life period. CONCLUSIONS These cross-sectional findings suggest the possibility of a linear improvement in mental health beginning in young adulthood rather than a U-shaped curve reported in some prior studies. Lifespan research combining psychosocial and biological markers may improve our understanding of resilience to mental disability in older age and lead to broad-based interventions promoting mental health in all age groups.
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Affiliation(s)
- Michael L. Thomas
- Department of Psychiatry, University of California, San Diego, La Jolla, CA 92093
| | - Christopher N. Kaufmann
- Department of Psychiatry, University of California, San Diego, La Jolla, CA 92093,Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0738
| | - Barton W. Palmer
- Department of Psychiatry, University of California, San Diego, La Jolla, CA 92093,Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0738,Veterans Affairs San Diego Healthcare System, San Diego, CA 92161
| | - Colin A. Depp
- Department of Psychiatry, University of California, San Diego, La Jolla, CA 92093,Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0738,Veterans Affairs San Diego Healthcare System, San Diego, CA 92161
| | - Averria Sirkin Martin
- Department of Psychiatry, University of California, San Diego, La Jolla, CA 92093,Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0738
| | - Danielle K. Glorioso
- Department of Psychiatry, University of California, San Diego, La Jolla, CA 92093,Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0738
| | - Wesley K. Thompson
- Department of Psychiatry, University of California, San Diego, La Jolla, CA 92093,Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0738
| | - Dilip V. Jeste
- Department of Psychiatry, University of California, San Diego, La Jolla, CA 92093,Department of Neurosciences, University of California, San Diego, La Jolla, CA 92093,Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0738
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83
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Czepielewski LS, Massuda R, Panizzutti B, da Rosa ED, de Lucena D, Macêdo D, Grun LK, Barbé-Tuana FM, Gama CS. Telomere length in subjects with schizophrenia, their unaffected siblings and healthy controls: Evidence of accelerated aging. Schizophr Res 2016; 174:39-42. [PMID: 27131910 DOI: 10.1016/j.schres.2016.04.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 04/01/2016] [Accepted: 04/04/2016] [Indexed: 02/01/2023]
Abstract
Schizophrenia (SZ) is associated with broad burden. The clinical manifestations of SZ are related to pathophysiological alterations similar to what is seen in normal aging. Our aim was to evaluate the differences in telomere length (TL), a biomarker of cellular aging, in subjects with SZ (n=36), unaffected siblings (SB, n=36) and healthy controls (HC, n=47). SZ had shorter TL compared to HC, but no difference was found in SB comparing to SZ. These findings indicate that a pathological accelerated aging profile could be present in the course of SZ and further studies are needed to confirm TL as potential endophenotype, especially in at risk populations.
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Affiliation(s)
- Leticia Sanguinetti Czepielewski
- Laboratório de Psiquiatria Molecular, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Raffael Massuda
- Laboratório de Psiquiatria Molecular, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Departamento de Psiquiatria, Universidade Federal do Paraná, Curitiba, Brazil
| | - Bruna Panizzutti
- Laboratório de Psiquiatria Molecular, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Eduarda Dias da Rosa
- Laboratório de Psiquiatria Molecular, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Programa de Pós-Graduação em Ciências Biológicas: Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - David de Lucena
- Núcleo de Pesquisa e Desenvolvimento de Medicamentos, Departamento de Fisiologia e Farmacologia, Universidade Federal do Ceará, Fortaleza, Brazil
| | - Danielle Macêdo
- Núcleo de Pesquisa e Desenvolvimento de Medicamentos, Departamento de Fisiologia e Farmacologia, Universidade Federal do Ceará, Fortaleza, Brazil
| | - Lucas Kich Grun
- Programa de Pós-Graduação em Ciências Biológicas: Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Florencia María Barbé-Tuana
- Programa de Pós-Graduação em Ciências Biológicas: Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Clarissa Severino Gama
- Laboratório de Psiquiatria Molecular, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
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Abstract
OBJECTIVE Recognizing that needs differ between men and women with schizophrenia and that they vary over time, this review attempts to categorize the needs that are relevant to younger and to older women. METHOD This is a selective literature review focusing on topic areas the two authors determined to be most germane to women with schizophrenia. Articles were selected on the basis of currency, comprehensiveness, and study design. Particular attention was paid to the voices of the women themselves. RESULTS There is considerable overlap between the needs of younger and older women with schizophrenia, but as a general rule, younger women require preventive strategies to stop the escalation of illness while older women require recovery interventions to regain lost hopes and abilities. CONCLUSIONS There is clinical utility in cataloguing the needs of younger and older women with schizophrenia and conceptualizing interventions according to gender and age rather than viewing needed services along purely diagnostic lines.
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Affiliation(s)
- Mary V Seeman
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Rina Gupta
- North East London Foundation Trust, Goodmayes Hospital, Ilford, Essex, UK
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85
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Wang XQ, Petrini MA, Morisky DE. Predictors of quality of life among Chinese people with schizophrenia. Nurs Health Sci 2016; 19:142-148. [PMID: 27109014 DOI: 10.1111/nhs.12286] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 03/15/2016] [Accepted: 03/19/2016] [Indexed: 11/29/2022]
Abstract
This study was designed to investigate the association of quality of life, perceived stigma, and medication adherence among Chinese patients with schizophrenia, and to ascertain the predictors of quality of life. A cross-sectional correlation study was conducted with 146 participants. All participants completed self-report scales: the Schizophrenia Quality of Life Scale, Link's Stigma Scale, and the Morisky Medication Adherence Scale. Pearson parametric correlations and stepwise multiple regressions were performed. The total quality of life score and psychosocial subscale was significantly positively correlated with perceived stigma, coping orientation of withdrawal, and feelings of stigma, and negatively correlated with age and medication adherence. The means of all subscale scores except perceived devaluation-discrimination and different/guilty feelings were significantly higher than the midpoint of 2.5. The best predictors of quality of life and psychosocial domains were stigma-related feelings: feeling misunderstood, feeling different/shame, and age. Our findings suggest that an individual's negative emotional response may strengthen internalized stigma and decrease quality of life. As the best predictor, age indicated that adaptation to mental illness may relieve perceived stigma and achieve favorable quality of life.
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Affiliation(s)
- Xiao Qin Wang
- HOPE School of Nursing, Wuhan University, Wuhan, China
| | | | - Donald E Morisky
- Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, California, USA
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86
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Avieli H, Mushkin P, Araten-Bergman T, Band-Winterstein T. Aging With Schizophrenia: A Lifelong Experience of Multidimensional Losses and Suffering. Arch Psychiatr Nurs 2016; 30:230-6. [PMID: 26992876 DOI: 10.1016/j.apnu.2015.11.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 11/03/2015] [Accepted: 11/07/2015] [Indexed: 10/22/2022]
Abstract
The aim of this study was to explore the subjective experience of suffering in aging individuals with schizophrenia. Qualitative interviews were conducted with 18 participants aged 60-69. Phenomenological content analysis was performed. Nine dimensions of suffering emerged: social rejection; familial rejection; the symptoms of schizophrenia; hospitalisation; the side effects of medication; loss of employment potential; loss of independent accommodation; loss of social life, and loss of hope to be a partner and a parent. The suffering of aging people with schizophrenia is cumulative and ongoing and thus evokes issues such as existential loneliness and feelings of homelessness.
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Affiliation(s)
- Hila Avieli
- Department of Criminology, Ariel University; Department of Gerontology, University of Haifa
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87
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Brandt AS, Unschuld PG, Pradhan S, Lim IAL, Churchill G, Harris AD, Hua J, Barker PB, Ross CA, van Zijl PCM, Edden RAE, Margolis RL. Age-related changes in anterior cingulate cortex glutamate in schizophrenia: A (1)H MRS Study at 7 Tesla. Schizophr Res 2016; 172:101-5. [PMID: 26925800 PMCID: PMC4821673 DOI: 10.1016/j.schres.2016.02.017] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Revised: 02/08/2016] [Accepted: 02/10/2016] [Indexed: 12/27/2022]
Abstract
The extent of age-related changes in glutamate and other neurometabolites in the anterior cingulate cortex (ACC) in individuals with schizophrenia remain unclear. Magnetic resonance spectroscopy (MRS) at 7 T, which yields precise measurements of various metabolites and can distinguish glutamate from glutamine, was used to determine levels of ACC glutamate and other metabolites in 24 individuals with schizophrenia and 24 matched controls. Multiple regression analysis revealed that ACC glutamate decreased with age in patients but not controls. No changes were detected in levels of glutamine, N-acetylaspartate, N-acetylaspartylglutamic acid, myo-inositol, GABA, glutathione, total creatine, and total choline. These results suggest that age may be an important modifier of ACC glutamate in schizophrenia.
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Affiliation(s)
- Allison S Brandt
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Paul G Unschuld
- Laboratory for Aging Neuroscience and Neuroimaging, Division of Psychiatry Research and Psychogeriatric Medicine, University of Zürich, Zurich, Switzerland
| | - Subechhya Pradhan
- Russell H. Morgan Department of Radiology and Radiological Science, Division of MR Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA; F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, United States
| | - Issel Anne L Lim
- Russell H. Morgan Department of Radiology and Radiological Science, Division of MR Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA; F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, United States
| | - Gregory Churchill
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ashley D Harris
- Russell H. Morgan Department of Radiology and Radiological Science, Division of MR Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA; F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, United States
| | - Jun Hua
- Russell H. Morgan Department of Radiology and Radiological Science, Division of MR Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA; F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, United States
| | - Peter B Barker
- Russell H. Morgan Department of Radiology and Radiological Science, Division of MR Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA; F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, United States
| | - Christopher A Ross
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Neurology and Program in Cellular and Molecular Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Departments of Pharmacology and Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Peter C M van Zijl
- Russell H. Morgan Department of Radiology and Radiological Science, Division of MR Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA; F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, United States
| | - Richard A E Edden
- Russell H. Morgan Department of Radiology and Radiological Science, Division of MR Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA; F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, United States
| | - Russell L Margolis
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Neurology and Program in Cellular and Molecular Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Cohen O, Geva D, Lahad M, Bolotin A, Leykin D, Goldberg A, Aharonson-Daniel L. Community Resilience throughout the Lifespan--The Potential Contribution of Healthy Elders. PLoS One 2016; 11:e0148125. [PMID: 26844889 PMCID: PMC4741520 DOI: 10.1371/journal.pone.0148125] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Accepted: 01/13/2016] [Indexed: 11/30/2022] Open
Abstract
An increase in the exposure and predisposition of civilian populations to disasters has been recorded in the last decades. In major disasters, as demonstrated recently in Nepal (2015) and previously in Haiti (2010), external aid is vital, yet in the first hours after a disaster, communities must usually cope alone with the challenge of providing emergent lifesaving care. Communities therefore need to be prepared to handle emergency situations. Mapping the needs of the populations within their purview is a trying task for decision makers and community leaders. In this context, the elderly are traditionally treated as a susceptible population with special needs. The current study aimed to explore variations in the level of community resilience along the lifespan. The study was conducted in nine small to mid-size towns in Israel between August and November 2011 (N = 885). The Conjoint Community Resiliency Assessment Measure (CCRAM), a validated instrument for community resilience assessment, was used to examine the association between age and community resilience score. Statistical analysis included spline and logistic regression models that explored community resiliency over the lifespan in a way that allowed flexible modeling of the curve without prior constraints. This innovative statistical approach facilitated identification of the ages at which trend changes occurred. The study found a significant rise in community resiliency scores in the age groups of 61–75 years as compared with younger age bands, suggesting that older people in good health may contribute positively to building community resiliency for crisis. Rather than focusing on the growing medical needs and years of dependency associated with increased life expectancy and the resulting climb in the proportion of elders in the population, this paper proposes that active "young at heart" older people can be a valuable resource for their community.
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Affiliation(s)
- Odeya Cohen
- Department of Emergency Medicine, Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- PREPARED Center for Emergency Response Research, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Diklah Geva
- Department of Epidemiology, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Mooli Lahad
- Department of Psychology, Tel-Hai Academic College, Kiryat-Shmona, Israel
- The Community Stress Prevention Centre (CSPC), Kiryat-Shmona, Israel
| | - Arkady Bolotin
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Dima Leykin
- PREPARED Center for Emergency Response Research, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Department of Psychology, Tel-Hai Academic College, Kiryat-Shmona, Israel
- The Community Stress Prevention Centre (CSPC), Kiryat-Shmona, Israel
| | - Avishay Goldberg
- Department of Emergency Medicine, Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- PREPARED Center for Emergency Response Research, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Department of Health Systems Management, Faculty of Health Sciences & Guilford Glazer Faculty of Business and Management, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Limor Aharonson-Daniel
- Department of Emergency Medicine, Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- PREPARED Center for Emergency Response Research, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- * E-mail:
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89
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Rowland LM, Krause BW, Wijtenburg SA, McMahon RP, Chiappelli J, Nugent KL, Nisonger SJ, Korenic SA, Kochunov P, Hong LE. Medial frontal GABA is lower in older schizophrenia: a MEGA-PRESS with macromolecule suppression study. Mol Psychiatry 2016; 21:198-204. [PMID: 25824298 PMCID: PMC4591074 DOI: 10.1038/mp.2015.34] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 02/17/2015] [Accepted: 02/24/2015] [Indexed: 01/09/2023]
Abstract
Gamma-butyric acid (GABA) dysfunction has been implicated in the pathophysiology of schizophrenia and its cognitive deficits. Proton magnetic resonance spectroscopy (MRS) was used to test the hypothesis that older participants with schizophrenia have lower anterior cingulate GABA levels compared with older control participants. One-hundred forty-five participants completed this study. For detection of GABA, spectra were acquired from the medial frontal/anterior cingulate cortex using a macromolecule-suppressed MEGA-PRESS sequence. Patients were evaluated for psychopathology and all participants completed neuropsychological tests of working memory, processing speed and functional capacity. GABA levels were significantly lower in the older participants with schizophrenia (n=31) compared with the older control (n=37) group (P=0.003) but not between the younger control (n=40) and schizophrenia (n=29) groups (P=0.994). Age strongly predicted GABA levels in the schizophrenia group accounting for 42% of the variance, but the effect of age was less in the control group accounting for 5.7% of the variance. GABA levels were specifically related to working memory but not processing speed performance, functional capacity, or positive or negative symptom severity. This is the largest MRS study of GABA in schizophrenia and the first to examine GABA without macromolecule contamination, a potentially significant issue in previous studies. GABA levels more rapidly declined with advancing age in the schizophrenia compared with the control group. Interventions targeted at halting the decline or increasing GABA levels may improve functional outcomes and quality of life as patients with schizophrenia age.
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Affiliation(s)
- Laura M Rowland
- Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland School of Medicine,Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine,Department of Psychology, University of Maryland Baltimore County,Corresponding Author. Maryland Psychiatric Research Center, P.O. Box 21247, Baltimore, MD 21228, 410-402-6803,
| | - Benjamin W. Krause
- Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland School of Medicine
| | - S. Andrea Wijtenburg
- Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland School of Medicine
| | - Robert P. McMahon
- Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland School of Medicine
| | - Joshua Chiappelli
- Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland School of Medicine
| | - Katie L. Nugent
- Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland School of Medicine
| | - Sarah J. Nisonger
- Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland School of Medicine
| | - Stephanie A. Korenic
- Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland School of Medicine
| | - Peter Kochunov
- Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland School of Medicine,Department of Physics, University of Maryland Baltimore County
| | - L. Elliot Hong
- Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland School of Medicine
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90
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Depp CA, Harmell AL, Vahia IV, Mausbach BT. Neurocognitive and functional correlates of mobile phone use in middle-aged and older patients with schizophrenia. Aging Ment Health 2016; 20:29-35. [PMID: 25768842 PMCID: PMC4568167 DOI: 10.1080/13607863.2015.1008987] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Our objective was to examine the association of mobile phone use and ownership with psychopathology, cognitive functioning, and functional outcome in 196 outpatients aged 40 years and older who were diagnosed with schizophrenia. METHOD Participants reported their past and current mobile phone use on a standardized self-report scale and they were administered tests of global cognition, functional capacity, and informant-rated functional outcome. RESULTS The great majority of subjects had used a mobile phone (78%) but few currently owned one (27%). After adjusting for age (mean age 51), any past mobile phone use was associated with less severe negative symptoms, and higher global cognitive performance, functional capacity, and functional outcome. A total of 60% of participants reported being comfortable with mobile phones, but comfort was not associated with any cognitive or functional outcomes. CONCLUSION Most of the older patients with schizophrenia have used mobile phones and lifetime mobile phone use is a positive indicator of cognitive and functional status.
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Affiliation(s)
- Colin A Depp
- Department of Psychiatry, UC San Diego, La Jolla, California, VA San Diego Healthcare System, San Diego, California
| | | | - Ipsit V Vahia
- Department of Psychiatry, UC San Diego, La Jolla, California
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91
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Lai CY, Lee SY, Scarr E, Yu YH, Lin YT, Liu CM, Hwang TJ, Hsieh MH, Liu CC, Chien YL, Udawela M, Gibbons AS, Everall IP, Hwu HG, Dean B, Chen WJ. Aberrant expression of microRNAs as biomarker for schizophrenia: from acute state to partial remission, and from peripheral blood to cortical tissue. Transl Psychiatry 2016; 6:e717. [PMID: 26784971 PMCID: PMC5068884 DOI: 10.1038/tp.2015.213] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 11/11/2015] [Accepted: 11/23/2015] [Indexed: 12/11/2022] Open
Abstract
Based on our previous finding of a seven-miRNA (hsa-miR-34a, miR-449a, miR-564, miR-432, miR-548d, miR-572 and miR-652) signature as a potential biomarker for schizophrenia, this study aimed to examine if hospitalization could affect expressions of these miRNAs. We compared their expression levels between acute state and partial remission state in people with schizophrenia (n=48) using quantitative PCR method. Further, to examine whether the blood and brain show similar expression patterns, the expressions of two miRNAs (hsa-miR-34a and hsa-miR-548d) were examined in the postmortem brain tissue of people with schizophrenia (n=25) and controls (n=27). The expression level of the seven miRNAs did not alter after ~2 months of hospitalization with significant improvement in clinical symptoms, suggesting the miRNAs could be traits rather than state-dependent markers. The aberrant expression seen in the blood of hsa-miR-34a and hsa-miR-548d were not present in the brain samples, but this does not discount the possibility that the peripheral miRNAs could be clinically useful biomarkers for schizophrenia. Unexpectedly, we found an age-dependent increase in hsa-miR-34a expressions in human cortical (Brodmann area 46 (BA46)) but not subcortical region (caudate putamen). The correlation between hsa-miR-34a expression level in BA46 and age was much stronger in the controls than in the cases, and the corresponding correlation in the blood was only seen in the cases. The association between the miRNA dysregulations, the disease predisposition and aging warrants further investigation. Taken together, this study provides further insight on the candidate peripheral miRNAs as stable biomarkers for the diagnostics of schizophrenia.
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Affiliation(s)
- C-Y Lai
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan,Center of Genomic Medicine, National Taiwan University, Taipei, Taiwan,The Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia
| | - S-Y Lee
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan,Center of Genomic Medicine, National Taiwan University, Taipei, Taiwan
| | - E Scarr
- The Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia,Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia
| | - Y-H Yu
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan,Center of Genomic Medicine, National Taiwan University, Taipei, Taiwan
| | - Y-T Lin
- Department of Psychiatry, College of Medicine and National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan
| | - C-M Liu
- Department of Psychiatry, College of Medicine and National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan
| | - T-J Hwang
- Department of Psychiatry, College of Medicine and National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan
| | - M H Hsieh
- Department of Psychiatry, College of Medicine and National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan
| | - C-C Liu
- Department of Psychiatry, College of Medicine and National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan
| | - Y-L Chien
- Department of Psychiatry, College of Medicine and National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan
| | - M Udawela
- The Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia
| | - A S Gibbons
- The Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia,Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia
| | - I P Everall
- The Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia,Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia
| | - H-G Hwu
- Department of Psychiatry, College of Medicine and National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan
| | - B Dean
- The Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia,Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia
| | - W J Chen
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan,Center of Genomic Medicine, National Taiwan University, Taipei, Taiwan,Department of Psychiatry, College of Medicine and National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan,Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, 17 Xu-Zhou Road, Taipei 100, Taiwan. E-mail:
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92
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Lindqvist D, Epel ES, Mellon SH, Penninx BW, Révész D, Verhoeven JE, Reus VI, Lin J, Mahan L, Hough CM, Rosser R, Bersani FS, Blackburn EH, Wolkowitz OM. Psychiatric disorders and leukocyte telomere length: Underlying mechanisms linking mental illness with cellular aging. Neurosci Biobehav Rev 2015; 55:333-64. [PMID: 25999120 PMCID: PMC4501875 DOI: 10.1016/j.neubiorev.2015.05.007] [Citation(s) in RCA: 220] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 05/06/2015] [Accepted: 05/10/2015] [Indexed: 10/23/2022]
Abstract
Many psychiatric illnesses are associated with early mortality and with an increased risk of developing physical diseases that are more typically seen in the elderly. Moreover, certain psychiatric illnesses may be associated with accelerated cellular aging, evidenced by shortened leukocyte telomere length (LTL), which could underlie this association. Shortened LTL reflects a cell's mitotic history and cumulative exposure to inflammation and oxidation as well as the availability of telomerase, a telomere-lengthening enzyme. Critically short telomeres can cause cells to undergo senescence, apoptosis or genomic instability, and shorter LTL correlates with poorer health and predicts mortality. Emerging data suggest that LTL may be reduced in certain psychiatric illnesses, perhaps in proportion to exposure to the psychiatric illnesses, although conflicting data exist. Telomerase has been less well characterized in psychiatric illnesses, but a role in depression and in antidepressant and neurotrophic effects has been suggested by preclinical and clinical studies. In this article, studies on LTL and telomerase activity in psychiatric illnesses are critically reviewed, potential mediators are discussed, and future directions are suggested. A deeper understanding of cellular aging in psychiatric illnesses could lead to re-conceptualizing them as systemic illnesses with manifestations inside and outside the brain and could identify new treatment targets.
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Affiliation(s)
- Daniel Lindqvist
- Department of Clinical Sciences, Section for Psychiatry, Lund University, Lund, Sweden; Department of Psychiatry, University of California San Francisco (UCSF), School of Medicine, San Francisco, CA, USA
| | - Elissa S Epel
- Department of Psychiatry, University of California San Francisco (UCSF), School of Medicine, San Francisco, CA, USA
| | - Synthia H Mellon
- Department of OB-GYN and Reproductive Sciences, UCSF School of Medicine, San Francisco, CA, USA
| | - Brenda W Penninx
- Department of Psychiatry and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Dóra Révész
- Department of Psychiatry and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Josine E Verhoeven
- Department of Psychiatry and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Victor I Reus
- Department of Psychiatry, University of California San Francisco (UCSF), School of Medicine, San Francisco, CA, USA
| | - Jue Lin
- Department of Biochemistry and Biophysics, UCSF School of Medicine, San Francisco, CA, USA
| | - Laura Mahan
- Department of Psychiatry, University of California San Francisco (UCSF), School of Medicine, San Francisco, CA, USA
| | - Christina M Hough
- Department of Psychiatry, University of California San Francisco (UCSF), School of Medicine, San Francisco, CA, USA
| | - Rebecca Rosser
- Department of Psychiatry, University of California San Francisco (UCSF), School of Medicine, San Francisco, CA, USA
| | - F Saverio Bersani
- Department of Psychiatry, University of California San Francisco (UCSF), School of Medicine, San Francisco, CA, USA; Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Elizabeth H Blackburn
- Department of Biochemistry and Biophysics, UCSF School of Medicine, San Francisco, CA, USA
| | - Owen M Wolkowitz
- Department of Psychiatry, University of California San Francisco (UCSF), School of Medicine, San Francisco, CA, USA.
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93
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Lohr JB, Palmer BW, Eidt CA, Aailaboyina S, Mausbach BT, Wolkowitz OM, Thorp SR, Jeste DV. Is Post-Traumatic Stress Disorder Associated with Premature Senescence? A Review of the Literature. Am J Geriatr Psychiatry 2015; 23:709-25. [PMID: 25959921 PMCID: PMC4568841 DOI: 10.1016/j.jagp.2015.04.001] [Citation(s) in RCA: 156] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 03/23/2015] [Accepted: 04/01/2015] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Post-traumatic stress disorder (PTSD) has major public health significance. Evidence that PTSD may be associated with premature senescence (early or accelerated aging) would have major implications for quality of life and healthcare policy. We conducted a comprehensive review of published empirical studies relevant to early aging in PTSD. METHOD Our search included the PubMed, PsycINFO, and PILOTS databases for empirical reports published since the year 2000 relevant to early senescence and PTSD, including: 1) biomarkers of senescence (leukocyte telomere length [LTL] and pro-inflammatory markers), 2) prevalence of senescence-associated medical conditions, and 3) mortality rates. RESULTS All six studies examining LTL indicated reduced LTL in PTSD (pooled Cohen's d = 0.76). We also found consistent evidence of increased pro-inflammatory markers in PTSD (mean Cohen's ds), including C-reactive protein = 0.18, Interleukin-1 beta = 0.44, Interleukin-6 = 0.78, and tumor necrosis factor alpha = 0.81. The majority of reviewed studies also indicated increased medical comorbidity among several targeted conditions known to be associated with normal aging, including cardiovascular disease, type 2 diabetes mellitus, gastrointestinal ulcer disease, and dementia. We also found seven of 10 studies indicated PTSD to be associated with earlier mortality (average hazard ratio: 1.29). CONCLUSION In short, evidence from multiple lines of investigation suggests that PTSD may be associated with a phenotype of accelerated senescence. Further research is critical to understand the nature of this association. There may be a need to re-conceptualize PTSD beyond the boundaries of mental illness, and instead as a full systemic disorder.
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Affiliation(s)
- James B. Lohr
- VA Center of Excellence for Stress and Mental Health,University of California, San Diego – Department of Psychiatry and the Sam and Rose Stein Institute for Research on Aging
| | - Barton W. Palmer
- VA Center of Excellence for Stress and Mental Health,University of California, San Diego – Department of Psychiatry and the Sam and Rose Stein Institute for Research on Aging
| | - Carolyn A. Eidt
- VA Center of Excellence for Stress and Mental Health,University of California, San Diego – Department of Psychiatry and the Sam and Rose Stein Institute for Research on Aging
| | - Smitha Aailaboyina
- VA Center of Excellence for Stress and Mental Health,University of California, San Diego – Department of Psychiatry and the Sam and Rose Stein Institute for Research on Aging
| | - Brent T. Mausbach
- University of California, San Diego – Department of Psychiatry and the Sam and Rose Stein Institute for Research on Aging
| | | | - Steven R. Thorp
- VA Center of Excellence for Stress and Mental Health,University of California, San Diego – Department of Psychiatry and the Sam and Rose Stein Institute for Research on Aging
| | - Dilip V. Jeste
- University of California, San Diego – Department of Psychiatry and the Sam and Rose Stein Institute for Research on Aging
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94
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Mapping pathological changes in brain structure by combining T1- and T2-weighted MR imaging data. Neuroradiology 2015; 57:917-28. [PMID: 26104102 PMCID: PMC4572060 DOI: 10.1007/s00234-015-1550-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 06/03/2015] [Indexed: 11/12/2022]
Abstract
Introduction A workflow based on the ratio between standardized T1-weighted (T1-w) and T2-weighted (T2-w) MR images has been proposed as a new tool to study brain structure. This approach was previously used to map structural properties in the healthy brain. Here, we evaluate whether the T1-w/T2-w approach can support the assessment of structural impairments in the diseased brain. We use schizophrenia data to demonstrate the potential clinical utility of the technique. Methods We analyzed T1-w and T2-w images of 36 schizophrenic patients and 35 age-matched controls. These were collected for the Function Biomedical Informatics Research Network (fBIRN) collaborative project, which had an IRB approval and followed the HIPAA guidelines. We computed T1-w/T2-w images for each individual and compared intensities in schizophrenic and control groups on a voxel-wise basis, as well as in regions of interest (ROIs). Results Our results revealed that the T1-w/T2-w image permits to discriminate brain regions showing group-level differences between patients and controls with greater accuracy than conventional T1-w and T2-w images. Both the ROIs and the voxel-wise analysis showed globally reduced gray and white matter values in patients compared to controls. Significantly reduced values were found in regions such as insula, primary auditory cortex, hippocampus, inferior longitudinal fasciculus, and inferior fronto-occipital fasciculus. Conclusion Our findings were consistent with previous meta-analyses in schizophrenia corroborating the hypothesis of a potential “disconnection” syndrome in conjunction with structural alterations in local gray matter regions. Overall, our study suggested that the T1-w/T2-w technique permits to reliably map structural differences between the brains of patients and healthy individuals.
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95
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Talaslahti T, Alanen HM, Hakko H, Isohanni M, Häkkinen U, Leinonen E. Patients with very-late-onset schizoprhenia-like psychosis have higher mortality rates than elderly patients with earlier onset schizophrenia. Int J Geriatr Psychiatry 2015; 30:453-9. [PMID: 24990229 DOI: 10.1002/gps.4159] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Accepted: 05/28/2014] [Indexed: 11/09/2022]
Abstract
OBJECTIVE In this register-based study of schizophrenia patients aged 65 years or above, mortality and causes of death diagnosed at age of 60+ (very-late-onset schizophrenia-like psychosis, VLOSLP) were studied in comparison with sex- and age-matched general Finnish population. Standardized Mortality Ratios (SMRs) of VLOSLP patients were also compared with those of earlier onset (below 60 years) schizophrenia patients, and hazard of death was calculated between these patient groups. METHODS The data was obtained from Finnish nationwide registers and consisted of 918 VLOSLP patients and 6142 earlier onset patients who were at least 65 years on 1 January 1999. The register-based follow-up for mortality covered 10 years between 1999 and 2008. RESULTS Overall SMR was 5.02 (4.61-5.46) in the group of VLOSLP patients and 2.93 (2.83-3.03) in the group of earlier onset patients. In men, SMRs were 8.31 (7.14-9.62; n = 179) and 2.91 (2.75-3.07, n = 1316) and in women 4.21 (3.78-4.66; n = 364) and 2.94 (2.82-3.07, n = 2055). In the VLOSLP group, SMRs were higher in most causes-of-death categories such as accidents, respiratory diseases, dementias, neoplasms and circulatory diseases. However, in direct comparison adjusted for several variables, the difference between these groups was minimal (Hazard Ratio, HR, 1.16 95%CI 1.05-1.27, p = 0.003). CONCLUSION Patients with VLOSLP, especially men, are at even higher risk of death than schizophrenia patients with earlier onset. Physical comorbidities and accidents in the VLOSLP group mostly explained this result. Targeted clinical interventions with effective collaboration between psychiatry and primary and specialist-level somatic care are crucial to reduce their excess mortality
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Affiliation(s)
- Tiina Talaslahti
- Helsinki University Central Hospital, Department of Psychiatry, Finland
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96
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Nakajima S, Caravaggio F, Mamo DC, Mulsant BH, Chung JK, Plitman E, Iwata Y, Gerretsen P, Uchida H, Suzuki T, Mar W, Wilson AA, Houle S, Graff-Guerrero A. Dopamine D₂/₃ receptor availability in the striatum of antipsychotic-free older patients with schizophrenia-A [¹¹C]-raclopride PET study. Schizophr Res 2015; 164:263-7. [PMID: 25757713 PMCID: PMC4409531 DOI: 10.1016/j.schres.2015.02.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 02/21/2015] [Accepted: 02/22/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND No study has examined dopamine D₂/₃ receptor (D₂/₃R) availability in antipsychotic-free older patients with schizophrenia. METHODS We included patients with schizophrenia 50 years or older who were antipsychotic-free for at least 3 months. We compared non-displaceable binding potential (BPND) of [(11)C]-raclopride in the caudate, putamen, ventral striatum, and globus pallidus between patients and age- and sex-matched healthy controls. RESULTS Ten patients participated (antipsychotic-naive=4). No differences in BPND were found between patients and controls in any ROIs (F(1, 72)=.42, p=.52). CONCLUSION The preliminary results suggest no differences in D₂/₃R availability between antipsychotic-free older patients with schizophrenia and controls.
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Affiliation(s)
- Shinichiro Nakajima
- Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, Canada; Geriatric Mental Health Division, Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada; Department of Neuropsychiatry, School of Medicine, Keio University, Tokyo, Japan.
| | - Fernando Caravaggio
- Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada.
| | - David C. Mamo
- Department of Psychiatry, Faculties of Medicine and Health Science, University of Malta, Msida, Malta
| | - Benoit H. Mulsant
- Geriatric Mental Health Division, Centre for Addiction and Mental Health, Toronto, Canada,Department of Psychiatry, University of Toronto, Toronto, Canada,Campbell Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
| | - Jun Ku Chung
- Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada.
| | - Eric Plitman
- Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada.
| | - Yusuke Iwata
- Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada; Department of Neuropsychiatry, School of Medicine, Keio University, Tokyo, Japan.
| | - Philip Gerretsen
- Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, Canada; Geriatric Mental Health Division, Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada.
| | - Hiroyuki Uchida
- Geriatric Mental Health Division, Centre for Addiction and Mental Health, Toronto, Canada; Department of Neuropsychiatry, School of Medicine, Keio University, Tokyo, Japan.
| | - Takefumi Suzuki
- Department of Neuropsychiatry, School of Medicine, Keio University, Tokyo, Japan.
| | - Wanna Mar
- Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, Canada.
| | - Alan A. Wilson
- Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, Canada,Campbell Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
| | - Sylvain Houle
- Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, Canada; Campbell Research Institute, Centre for Addiction and Mental Health, Toronto, Canada.
| | - Ariel Graff-Guerrero
- Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, Canada; Geriatric Mental Health Division, Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada; Campbell Research Institute, Centre for Addiction and Mental Health, Toronto, Canada.
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97
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Cohen CI, Meesters PD, Zhao J. New perspectives on schizophrenia in later life: implications for treatment, policy, and research. Lancet Psychiatry 2015; 2:340-50. [PMID: 26360087 DOI: 10.1016/s2215-0366(15)00003-6] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 01/06/2015] [Indexed: 11/17/2022]
Abstract
Worldwide, in the past few decades, the demographics of older people (ie, people 55 years and over) with schizophrenia have changed completely with respect to absolute numbers of people affected, the proportion of all people with the disorder, life expectancy, and residential status. The ageing schizophrenia population has created vast health-care needs and their medical comorbidity contributes to higher mortality than in the general population. Proposals to classify schizophrenia into early-onset, late-onset, and very-late-onset subtypes now should be tempered by the recognition that comorbid medical and neurological disorders can contribute to psychotic symptoms in later life. The concept of outcome has become more nuanced with an appreciation that various outcomes can occur, largely independent of each other, that need different treatment approaches. Data show that schizophrenia in later life is not a stable end-state but one of fluctuation in symptoms and level of functioning, and show that pathways to improvement and recovery exist. Several novel non-pharmacological treatment strategies have been devised that can augment the clinical options used to address the specific needs of older adults with schizophrenia.
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Affiliation(s)
- Carl I Cohen
- SUNY Downstate Medical Center, Brooklyn, NY, USA.
| | - Paul D Meesters
- Department of Psychiatry, VU University Medical Center, GGZ inGeest and EMGO+, Institute for Health and Care Research, Amsterdam, Netherlands
| | - Jingna Zhao
- SUNY Downstate Medical Center, Brooklyn, NY, USA
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98
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Wijtenburg SA, Yang S, Fischer BA, Rowland LM. In vivo assessment of neurotransmitters and modulators with magnetic resonance spectroscopy: application to schizophrenia. Neurosci Biobehav Rev 2015; 51:276-95. [PMID: 25614132 PMCID: PMC4427237 DOI: 10.1016/j.neubiorev.2015.01.007] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 01/02/2015] [Accepted: 01/08/2015] [Indexed: 12/28/2022]
Abstract
In vivo measurement of neurotransmitters and modulators is now feasible with advanced proton magnetic resonance spectroscopy ((1)H MRS) techniques. This review provides a basic tutorial of MRS, describes the methods available to measure brain glutamate, glutamine, γ-aminobutyric acid, glutathione, N-acetylaspartylglutamate, glycine, and serine at magnetic field strengths of 3T or higher, and summarizes the neurochemical findings in schizophrenia. Overall, (1)H MRS holds great promise for producing biomarkers that can serve as treatment targets, prediction of disease onset, or illness exacerbation in schizophrenia and other brain diseases.
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Affiliation(s)
- S Andrea Wijtenburg
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, PO Box 21247, Baltimore, MD 21228, USA.
| | - Shaolin Yang
- Department of Psychiatry, University of Illinois at Chicago, 1601 W. Taylor Street, Suite 512, Chicago, IL 60612, USA; Department of Radiology, University of Illinois at Chicago, 1601 W. Taylor Street, Suite 512, Chicago, IL 60612, USA; Department of Bioengineering, University of Illinois at Chicago, 1601 W. Taylor Street, Suite 512, Chicago, IL 60612, USA
| | - Bernard A Fischer
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, PO Box 21247, Baltimore, MD 21228, USA; Veterans Affairs Capital Network (VISN 5) Mental Illness Research, Education, and Clinical Center (MIRECC), Department of Veterans Affairs, 10 N. Greene Street, Baltimore, MD 21201, USA
| | - Laura M Rowland
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, PO Box 21247, Baltimore, MD 21228, USA; Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD 21287, USA; Department of Psychology, University of Maryland, Baltimore County, Baltimore, MD 21228, USA
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99
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Abstract
Psychosis is one of the most common conditions in later life with a lifetime risk of 23 %. Despite its high prevalence, late-onset psychosis remains a diagnostic and treatment dilemma. There are no reliable pathognomonic signs to distinguish primary or secondary psychosis. Primary psychosis is a diagnosis of exclusion and the clinician must rule out secondary causes. Approximately 60 % of older patients with newly incident psychosis have a secondary psychosis. In this article, we review current, evidence-based diagnostic and treatment approaches for this heterogeneous condition, emphasizing a thorough evaluation for the "six d's" of late-life psychosis (delirium, disease, drugs dementia, depression, delusions). Treatment is geared towards the specific cause of psychosis and tailored based on comorbid conditions. Frequently, environmental and psychosocial interventions are first-line treatments with the judicious use of pharmacotherapy as needed. There is an enormous gap between the prevalence of psychotic disorders in older adults and the availability of evidence-based treatment. The dramatic growth in the elderly population over the first half of this century creates a compelling need to address this gap.
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100
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Abstract
Cognitive impairment is a common feature of schizophrenia; however, its origin remains controversial. Neurodevelopmental abnormalities clearly play a role in pre-morbid cognitive dysfunction in schizophrenia, yet many authors believe that schizophrenia is characterized by illness-related cognitive decline before and after onset of the psychosis that can be the result of neurodegenerative changes. The main reasons behinds such arguments include, first, the evidence showing that effect sizes of the cognitive deficits in subjects who develop adult schizophrenia gradually increase in the first two decades of life and, second, the fact that there is functional decline in many patients with schizophrenia over the years. In this Editorial, I argue that current evidence suggests that illness-related cognitive impairment is neurodevelopmental in origin and characterized by slower gain (developmental lag) but not cognitive decline continuing throughout the first two decades of life. I introduce a model suggesting that neurodevelopmental abnormality can in fact explain the course of cognitive dysfunction and variations in the trajectory of functional decline throughout the life in individuals with schizophrenia. In this model, the severity of underlying neurodevelopmental abnormality determines the age that cognitive deficits first become apparent and contributes to the cognitive reserve of the individual. Interaction of neurodevelopmental abnormality with clinical symptoms, especially negative symptoms and aging, vascular changes, psychological and iatrogenic factors contributes to the heterogeneity of the functional trajectory observed in this disorder.
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Affiliation(s)
- E Bora
- Melbourne Neuropsychiatry Centre, Department of Psychiatry,The University of Melbourne and Melbourne Health,VIC,Australia
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