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Correll CU, Schooler NR. Negative Symptoms in Schizophrenia: A Review and Clinical Guide for Recognition, Assessment, and Treatment. Neuropsychiatr Dis Treat 2020; 16:519-534. [PMID: 32110026 PMCID: PMC7041437 DOI: 10.2147/ndt.s225643] [Citation(s) in RCA: 348] [Impact Index Per Article: 87.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 01/29/2020] [Indexed: 12/11/2022] Open
Abstract
Schizophrenia is frequently a chronic and disabling disorder, characterized by heterogeneous positive and negative symptom constellations. The objective of this review was to provide information that may be useful for clinicians treating patients with negative symptoms of schizophrenia. Negative symptoms are a core component of schizophrenia that account for a large part of the long-term disability and poor functional outcomes in patients with the disorder. The term negative symptoms describes a lessening or absence of normal behaviors and functions related to motivation and interest, or verbal/emotional expression. The negative symptom domain consists of five key constructs: blunted affect, alogia (reduction in quantity of words spoken), avolition (reduced goal-directed activity due to decreased motivation), asociality, and anhedonia (reduced experience of pleasure). Negative symptoms are common in schizophrenia; up to 60% of patients may have prominent clinically relevant negative symptoms that require treatment. Negative symptoms can occur at any point in the course of illness, although they are reported as the most common first symptom of schizophrenia. Negative symptoms can be primary symptoms, which are intrinsic to the underlying pathophysiology of schizophrenia, or secondary symptoms that are related to psychiatric or medical comorbidities, adverse effects of treatment, or environmental factors. While secondary negative symptoms can improve as a consequence of treatment to improve symptoms in other domains (ie, positive symptoms, depressive symptoms or extrapyramidal symptoms), primary negative symptoms generally do not respond well to currently available antipsychotic treatment with dopamine D2 antagonists or partial D2 agonists. Since some patients may lack insight about the presence of negative symptoms, these are generally not the reason that patients seek clinical care, and clinicians should be especially vigilant for their presence. Negative symptoms clearly constitute an unmet medical need in schizophrenia, and new and effective treatments are urgently needed.
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Affiliation(s)
- Christoph U Correll
- The Zucker Hillside Hospital, Division of Psychiatry Research, Northwell Health, Glen Oaks, NY, USA.,The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Department of Psychiatry and Molecular Medicine, New York, NY, USA.,Charité Universitätsmedizin, Department of Child and Adolescent Psychiatry, Berlin, Germany
| | - Nina R Schooler
- State University of New York, Downstate Medical Center, Brooklyn, NY, USA
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102
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Le TP, Cowan T, Schwartz EK, Elvevåg B, Holmlund TB, Foltz PW, Barkus E, Cohen AS. The importance of loneliness in psychotic-like symptoms: Data from three studies. Psychiatry Res 2019; 282:112625. [PMID: 31662188 DOI: 10.1016/j.psychres.2019.112625] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 10/18/2019] [Accepted: 10/18/2019] [Indexed: 12/26/2022]
Abstract
Poor social connection or loneliness is a prominent feature of schizotypy and may exacerbate psychosis risk. Previous studies have examined the inter-relationships between loneliness and psychosis risk, but critically, they have largely been conducted in non-clinical samples or exclusively used laboratory questionnaires with limited consideration of the heterogeneity within schizotypy (i.e., positive, negative, disorganized factors). The present study examined links between loneliness and psychotic-like symptoms across the dimensions of schizotypy through cross-sectional, laboratory-based questionnaires (Study 1; N = 160), ambulatory assessment (Study 2; N = 118) in undergraduates, and ambulatory assessment in inpatients in a substance abuse treatment program (Study 3; N = 48). Trait positive schizotypy consistently predicted cross-sectional and state psychotic-like symptoms. Loneliness, assessed via cross-sectional and ambulatory means, was largely linked with psychotic-like symptoms. Importantly, psychotic-like symptoms were dynamic: psychotic-like symptoms largely increased with loneliness in individuals with elevated positive and disorganized schizotypal traits, though there were some inconsistency related to disorganized schizotypy and state psychotic-like symptoms. Negative schizotypy and loneliness did not significantly interact to predict psychotic-like symptoms, suggesting specificity to positive schizotypy. Ambulatory approaches provide the opportunity for ecologically valid identification of risk states across psychopathology, thus informing early intervention.
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Affiliation(s)
- Thanh P Le
- Department of Psychology, Louisiana State University, United States.
| | - Tovah Cowan
- Department of Psychology, Louisiana State University, United States
| | - Elana K Schwartz
- Department of Psychology, Louisiana State University, United States
| | - Brita Elvevåg
- Department of Clinical Medicine, University of Tromsø - the Arctic University of Norway, Norway; The Norwegian Centre for eHealth Research, University Hospital of North Norway, Norway
| | - Terje B Holmlund
- Department of Clinical Medicine, University of Tromsø - the Arctic University of Norway, Norway
| | - Peter W Foltz
- Institute of Cognitive Science, University of Colorado, United States
| | - Emma Barkus
- School of Psychology, University of Wollongong, United States
| | - Alex S Cohen
- Department of Psychology, Louisiana State University, United States
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103
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Engen MJ, Simonsen C, Melle I, Færden A, Lyngstad SH, Haatveit B, Vaskinn A, Ueland T. Cognitive functioning in patients with first-episode psychosis stratified by level of negative symptoms: A 1-year follow-up study. Psychiatry Res 2019; 281:112554. [PMID: 31499342 DOI: 10.1016/j.psychres.2019.112554] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 09/02/2019] [Accepted: 09/03/2019] [Indexed: 01/02/2023]
Abstract
We investigate negative symptoms over a 1-year follow-up period with the objective to see how groups defined according to level of symptom severity are related to cognition. Eighty-seven participants with first-episode psychosis (FEP) and matched healthy controls were assessed at baseline and follow-up. FEP participants were sub-grouped based on negative symptom items from the Positive and Negative Syndrome Scale (PANSS-R) with either no, mild, transitory or sustained symptoms over one year. Following an overall MANOVA, groups were compared on cognitive domains and a cognitive composite using ANOVAs. Cognitive course was explored with a MANOVA. We found a group effect on cognition. Participants who sustained negative symptoms were significantly outperformed by participants with no negative symptoms on executive functions and processing speed, and by those with mild or transitory symptoms on verbal learning and memory. Participants with sustained negative symptoms performed significantly poorer on the cognitive composite than those with no or mild negative symptoms. The group with no negative symptoms did not differ significantly from healthy controls on any cognitive measure, and the groups did not differ in cognitive course. Early course of negative symptoms is associated with cognition and could guide clinicians when evaluating need for cognitive assessment.
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Affiliation(s)
- Magnus Johan Engen
- NORMENT, Division of Mental Health and Addiction, University of Oslo and Oslo University Hospital, 0407 Oslo, Norway.
| | - Carmen Simonsen
- NORMENT, Division of Mental Health and Addiction, University of Oslo and Oslo University Hospital, 0407 Oslo, Norway; Early Intervention in Psychosis Advisory Unit for South East Norway, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Ingrid Melle
- NORMENT, Division of Mental Health and Addiction, University of Oslo and Oslo University Hospital, 0407 Oslo, Norway
| | - Ann Færden
- NORMENT, Division of Mental Health and Addiction, University of Oslo and Oslo University Hospital, 0407 Oslo, Norway
| | - Siv Hege Lyngstad
- NORMENT, Division of Mental Health and Addiction, University of Oslo and Oslo University Hospital, 0407 Oslo, Norway
| | - Beathe Haatveit
- NORMENT, Division of Mental Health and Addiction, University of Oslo and Oslo University Hospital, 0407 Oslo, Norway
| | - Anja Vaskinn
- NORMENT, Division of Mental Health and Addiction, University of Oslo and Oslo University Hospital, 0407 Oslo, Norway
| | - Torill Ueland
- NORMENT, Division of Mental Health and Addiction, University of Oslo and Oslo University Hospital, 0407 Oslo, Norway; Department of Psychology, Faculty of Social Sciences, University of Oslo, 0373 Oslo, Norway
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104
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Liu J, He J, Cheng M, Cao H, Zhang X. Prevalence, Sociodemographic, and Clinical Correlates of Older Chinese Patients With Deficit Schizophrenia. J Geriatr Psychiatry Neurol 2019; 32:298-303. [PMID: 31480981 DOI: 10.1177/0891988719870321] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE No study has investigated the frequency and risk factors for deficit schizophrenia (DS) in Chinese Han population. We investigated the prevalence of DS among community-dwelling older Chinese patients with schizophrenia and examined the sociodemographic and clinical correlates of DS in this population. METHODS A total of 326 community-dwelling older patients with schizophrenia were recruited in this cross-sectional study. Deficit schizophrenia was confirmed using the Chinese version of the Schedule for the Deficit Syndrome. Data pertaining to sociodemographic and clinical characteristics were collected. Psychopathology was assessed using the Positive and Negative Syndrome Scale (PANSS). RESULTS The prevalence of DS in the study population was 26.7% (31.2% among male patients and 21.6% among female patients with schizophrenia). Patients with DS had significantly higher current smoking rate, hospitalizations, PANSS negative score, PANSS total score, and had earlier age at onset than patients with non-deficit schizophrenia (N-DS). The N-DS patients had higher PANSS positive scores and a greater proportion of married patients. Multiple logistic regression analysis indicated that negative PANSS score (odds ratio [OR] = 1.10, 95% confidence interval [CI] = 1.04-1.16, P < .001), male sex (OR = 1.71, 95% CI = 1.53-1.91, P = .037), age at onset (OR = 0.88, 95% CI = 0.82-0.94, P = .035), and current smoking (OR = 1.37, 95% CI = 1.15-1.63, P = .041) were independently associated with DS. CONCLUSION Deficit schizophrenia is relatively common among older community-dwelling Chinese patients with schizophrenia. High negative symptom scores, male sex, early onset, and smoking were independent correlates for DS.
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Affiliation(s)
- Junjun Liu
- 1 Department of Psychiatry, Nanjing Meishan Hospital, Nanjing, Jiangsu Province, China
| | - Jinfeng He
- 2 Department of Gastroenterology, Nanjing Meishan Hospital, Nanjing, Jiangsu Province, China
| | - Min Cheng
- 3 Department of Pharmacy, Nanjing Meishan Hospital, Nanjing, Jiangsu Province, China
| | - Hui Cao
- 4 Yuhuatai District Center for Disease Control and Prevention, Nanjing, Jiangsu Province, China
| | - Xiangrong Zhang
- 5 Department of Clinical Psychology, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, China
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Palaniyappan L. Inefficient neural system stabilization: a theory of spontaneous resolutions and recurrent relapses in psychosis. J Psychiatry Neurosci 2019; 44:367-383. [PMID: 31245961 PMCID: PMC6821513 DOI: 10.1503/jpn.180038] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 02/07/2019] [Accepted: 03/05/2019] [Indexed: 12/21/2022] Open
Abstract
A striking feature of psychosis is its heterogeneity. Presentations of psychosis vary from transient symptoms with no functional consequence in the general population to a tenacious illness at the other extreme, with a wide range of variable trajectories in between. Even among patients with schizophrenia, who are diagnosed on the basis of persistent deterioration, marked variation is seen in response to treatment, frequency of relapses and degree of eventual recovery. Existing theoretical accounts of psychosis focus almost exclusively on how symptoms are initially formed, with much less emphasis on explaining their variable course. In this review, I present an account that links several existing notions of the biology of psychosis with the variant clinical trajectories. My aim is to incorporate perspectives of systems neuroscience in a staging framework to explain the individual variations in illness course that follow the onset of psychosis.
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Affiliation(s)
- Lena Palaniyappan
- From the Department of Psychiatry and Robarts Research Institute, University of Western Ontario and Lawson Health Research Institute, London, Ont., Canada
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106
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Rodríguez-Testal JF, Perona-Garcelán S, Dollfus S, Valdés-Díaz M, García-Martínez J, Ruíz-Veguilla M, Senín-Calderón C. Spanish validation of the self-evaluation of negative symptoms scale SNS in an adolescent population. BMC Psychiatry 2019; 19:327. [PMID: 31664965 PMCID: PMC6819523 DOI: 10.1186/s12888-019-2314-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 10/09/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Negative symptoms (NS) may be observed in the general population in an attenuated form and in high-risk mental states. However, they have been less studied in the general population than positive symptoms, in spite of their importance at the insidious onset of schizophrenia and their appearance before positive symptoms. This study aimed to analyze the empirical structure of the Spanish version of the Self-Evaluation of Negative Symptoms (SNS) Scale and find its psychometric properties and invariance of measurement across sex and age in a sample of adolescents. METHODS The sample consisted of 4521 adolescents (53.6% female) from 11 to 18 years of age. RESULTS Confirmatory Factor Analysis of the SNS confirmed an internal structure of five first-order factors by the characteristic dimensions of NS: avolition, social withdrawal, diminished emotional range, anhedonia, alogia, and one second-order factor which includes the total NS score. Multi-group confirmatory factor analysis showed that the scale was invariant across sex and age. Total scale reliability was adequate. A strong relationship was found between the SNS with depressive symptomatology, moderate with ideas of reference and low with aberrant salience. CONCLUSION The results back use of the Spanish version of the SNS scale for detection of NS in the general population of adolescents.
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Affiliation(s)
- Juan F. Rodríguez-Testal
- Personality, Evaluation and Psychological Treatment Department, University of Seville, Seville, Spain. Av. Camilo José Cela, 41018 Seville, SN Spain
| | - Salvador Perona-Garcelán
- Virgen del Rocío Outpatient Mental Hospital, University Hospital Virgen del Rocío, Avenue Manuel Siurot, 41013 Seville, SN Spain
| | - Sonia Dollfus
- CHU de Caen, Service universitaire de Psychiatrie, Centre Esquirol, Avenue Côte de Nacre, F-14000 Caen, France
- UNICAEN, UFR Médecine, F-14074 Caen, France
| | - María Valdés-Díaz
- Department of Psychology, University of Cadiz, Avenue República Árabe Saharaui SN. 11510 Puerto Real, Cádiz, Spain
| | - Jesús García-Martínez
- Department of Psychology, University of Cadiz, Avenue República Árabe Saharaui SN. 11510 Puerto Real, Cádiz, Spain
| | - Miguel Ruíz-Veguilla
- Virgen del Rocío Outpatient Mental Hospital, University Hospital Virgen del Rocío, Avenue Manuel Siurot, 41013 Seville, SN Spain
| | - Cristina Senín-Calderón
- Department of Psychology, University of Cadiz, Avenue República Árabe Saharaui SN. 11510 Puerto Real, Cádiz, Spain
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107
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Bitter I, Lieberman JA, Gaudoux F, Sokoloff P, Groc M, Chavda R, Delsol C, Barthe L, Brunner V, Fabre C, Fagard M, Montagne A, Tonner F. Randomized, double-blind, placebo-controlled study of F17464, a preferential D 3 antagonist, in the treatment of acute exacerbation of schizophrenia. Neuropsychopharmacology 2019; 44:1917-1924. [PMID: 30822774 PMCID: PMC6785149 DOI: 10.1038/s41386-019-0355-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 02/20/2019] [Accepted: 02/21/2019] [Indexed: 12/30/2022]
Abstract
F17464, a highly potent preferential D3 antagonist, is a novel compound in development for schizophrenia treatment. This phase II, double-blind, randomized, placebo-controlled, parallel-group study in five European countries evaluated the efficacy and safety of F17464, 20 mg twice daily, versus placebo over 6 weeks in patients with acute exacerbation of schizophrenia. Change from baseline to Day 43 of the Positive and Negative Syndrome Scale (PANSS) total score was the primary outcome. The data from 134 randomized patients (67 per group) were analyzed (efficacy/safety). Using analysis of covariance (ANCOVA) after last observation carried forward (LOCF) imputation (primary analysis), the PANSS total score reduction was statistically significantly greater for F17464 than placebo treated subjects at endpoint (p = 0.014); using ANCOVA with Multiple Imputation (MI) method, the between-group difference was in favor of F17464 but did not reach statistical significance. Differences in PANSS positive and general psychopathology subscale score, Marder positive factor score, PANSS response, and PANSS resolution criteria were also statistically significant in favor of F17464 (p values < 0.05) using the LOCF method, with similar results as for the primary analysis using the MI method. Treatment-related adverse events (AEs) were reported in 49.3% and 46.3% of patients on F17464 and placebo, respectively. The most common AEs in F17464 group: insomnia, agitation, and increased triglycerides; worsening of schizophrenia/drug ineffective was less frequent in F17464. Interestingly, no weight gain, no extrapyramidal disorder except rare akathisia were observed under F17464. This 6-week trial demonstrated therapeutic efficacy of 40 mg/day F17464 in improving symptoms of acute exacerbation of schizophrenia with a favorable safety profile.
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Affiliation(s)
- Istvan Bitter
- 0000 0001 0942 9821grid.11804.3cDepartment of Psychiatry and Psychotherapy, Semmelweis University, Balassa u.6, Budapest, 1083 Hungary
| | - Jeffrey A. Lieberman
- 0000 0000 8499 1112grid.413734.6New York Presbyterian Hospital – Columbia University Medical Center, 1051 Riverside Drive, New York, NY 10032 USA
| | - Florence Gaudoux
- 0000 0001 2188 9169grid.417944.bInstitut de Recherche Pierre Fabre, 3 avenue Hubert Curien, Toulouse, 31000 France
| | | | - Mélanie Groc
- 0000 0001 2188 9169grid.417944.bInstitut de Recherche Pierre Fabre, 3 avenue Hubert Curien, Toulouse, 31000 France
| | - Rajeev Chavda
- Galderma, Rue D’Entre-deux-Villes 10, La Tour de Peilz, 1814 Switzerland
| | - Cécile Delsol
- 0000 0001 2188 9169grid.417944.bInstitut de Recherche Pierre Fabre, 3 avenue Hubert Curien, Toulouse, 31000 France
| | - Laurence Barthe
- 0000 0001 2188 9169grid.417944.bInstitut de Recherche Pierre Fabre, 3 avenue Hubert Curien, Toulouse, 31000 France
| | | | - Carine Fabre
- 0000 0001 2188 9169grid.417944.bInstitut de Recherche Pierre Fabre, 3 avenue Hubert Curien, Toulouse, 31000 France
| | - Marine Fagard
- 0000 0001 2188 9169grid.417944.bInstitut de Recherche Pierre Fabre, 3 avenue Hubert Curien, Toulouse, 31000 France
| | - Agnès Montagne
- 0000 0001 2188 9169grid.417944.bInstitut de Recherche Pierre Fabre, 3 avenue Hubert Curien, Toulouse, 31000 France
| | - Françoise Tonner
- Institut de Recherche Pierre Fabre, 3 avenue Hubert Curien, Toulouse, 31000, France.
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108
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Leucht S, Barabássy Á, Laszlovszky I, Szatmári B, Acsai K, Szalai E, Harsányi J, Earley W, Németh G. Linking PANSS negative symptom scores with the Clinical Global Impressions Scale: understanding negative symptom scores in schizophrenia. Neuropsychopharmacology 2019; 44:1589-1596. [PMID: 30836381 PMCID: PMC6785000 DOI: 10.1038/s41386-019-0363-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 01/29/2019] [Accepted: 02/25/2019] [Indexed: 12/29/2022]
Abstract
Understanding how rating scale improvement corresponds to a clinical impression in patients with negative symptoms of schizophrenia may help define the clinical relevance of change in this patient population. We conducted post hoc equipercentile linking analyses of Positive and Negative Syndrome Scale (PANSS) outcomes (e.g., PANSS-Factor Score for Negative Symptoms [FSNS]) with Clinical Global Impressions-Improvement (CGI-I) and -Severity (CGI-S) ratings on data from patients treated with cariprazine (n = 227) or risperidone (n = 229) in a clinical study evaluating negative symptoms in schizophrenia. Patients were prospectively selected for persistent, predominant negative symptoms of schizophrenia (PNS), and minimal positive/depressive/extrapyramidal symptoms. Linking results demonstrated that greater improvement on PANSS-derived measures corresponded to clinical impressions of greater improvement, as measured by the CGI-I, and less severe disease states, as measured by the CGI-S. For example, CGI-S scores of 1 (normal), 2, 3, 4, 5, and 6 (severely ill) corresponded to PANSS-FSNS scores of 7, 13, 19, 24, 29, and 35, respectively. Likewise, CGI-I scores of minimally improved, much improved, and very much improved corresponded to a change from baseline in PANSS-FSNS scores of -27%, -49%, and -100%, respectively. These are important findings for the interpretation of the results of trials in patients with persistent negative symptoms.
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Affiliation(s)
- Stefan Leucht
- Department of Psychiatry and Psychotherapy, Technische Universität München, Munich, Germany.
| | - Ágota Barabássy
- 0000 0004 0621 5862grid.418137.8Medical Division, Gedeon Richter Plc, Budapest, Hungary
| | - István Laszlovszky
- 0000 0004 0621 5862grid.418137.8Medical Division, Gedeon Richter Plc, Budapest, Hungary
| | - Balázs Szatmári
- 0000 0004 0621 5862grid.418137.8Medical Division, Gedeon Richter Plc, Budapest, Hungary
| | - Károly Acsai
- 0000 0004 0621 5862grid.418137.8Medical Division, Gedeon Richter Plc, Budapest, Hungary
| | - Erzsébet Szalai
- 0000 0004 0621 5862grid.418137.8Medical Division, Gedeon Richter Plc, Budapest, Hungary
| | - Judit Harsányi
- 0000 0004 0621 5862grid.418137.8Medical Division, Gedeon Richter Plc, Budapest, Hungary
| | | | - György Németh
- 0000 0004 0621 5862grid.418137.8Medical Division, Gedeon Richter Plc, Budapest, Hungary
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Mucci A, Vignapiano A, Bitter I, Austin SF, Delouche C, Dollfus S, Erfurth A, Fleischhacker WW, Giordano GM, Gladyshev I, Glenthøj B, Gütter K, Hofer A, Hubeňák J, Kaiser S, Libiger J, Melle I, Nielsen MØ, Papsuev O, Rybakowski JK, Sachs G, Üçok A, Wojciak P, Galderisi S. A large European, multicenter, multinational validation study of the Brief Negative Symptom Scale. Eur Neuropsychopharmacol 2019; 29:947-959. [PMID: 31255394 DOI: 10.1016/j.euroneuro.2019.05.006] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 04/11/2019] [Accepted: 05/29/2019] [Indexed: 12/18/2022]
Abstract
Negative symptoms represent an unmet need of treatment in schizophrenia. Although a consensus exists on negative symptom construct, and second generation assessment instruments reflecting the consensus are available, studies still rely upon old assessment instruments, that do not reflect recent conceptualizations and might limit progress in the search for effective treatments. This is often the case in the European context, where one of the challenges encountered in designing large studies is the availability of validated instruments in the many languages of the continent. To address this challenge and promote sound research on negative symptoms in Europe, the ECNP Schizophrenia Network coordinated a large multicenter, multinational validation study of the Brief Negative Symptom Scale (BNSS). Clinically-stable subjects with schizophrenia (SCZ, N = 249) were recruited from 10 European Countries. Apart from BNSS, subjects were administered the Positive and Negative Syndrome Scale (PANSS) and standardized instruments for depression, extrapyramidal symptoms and psychosocial functioning. Results showed an excellent internal consistency, convergent and discriminant validity of BNSS and replicated a 5 factor-model. A larger number of subjects with predominant negative symptoms, i.e. the target population for clinical trials, was identified by using the BNSS compared to the PANSS. Regression analysis showed that BNSS-avolition, a key negative symptom poorly assessed by PANSS, explained 23.9% of psychosocial functioning, while no combination of the PANSS core negative symptoms showed the same impact on functioning. The study demonstrated that BNSS has substantial advantages with respect to PANSS for the identification of the avolition domain and subjects with predominant negative symptoms.
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Affiliation(s)
- Armida Mucci
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Largo Madonna delle Grazie, 80138 Naples, Italy.
| | - Annarita Vignapiano
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Largo Madonna delle Grazie, 80138 Naples, Italy
| | - István Bitter
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | - Stephen F Austin
- Psychiatric Research Unit, Psychiatry Region Zealand, Hillerød, Denmark
| | - Camille Delouche
- Service de Psychiatrie, CHU de Caen, Caen, France; UFR de Médecine, UNICAEN, Normandie Université, Caen, France; ISTS, UNICAEN, Normandie Université, Caen, France
| | - Sonia Dollfus
- Service de Psychiatrie, CHU de Caen, Caen, France; UFR de Médecine, UNICAEN, Normandie Université, Caen, France; ISTS, UNICAEN, Normandie Université, Caen, France
| | - Andreas Erfurth
- 6th Psychiatric Department, Otto-Wagner-Spital, Vienna, Austria
| | - W Wolfgang Fleischhacker
- Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Medical University Innsbruck, Innsbruck, Austria
| | - Giulia M Giordano
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Largo Madonna delle Grazie, 80138 Naples, Italy
| | - Igor Gladyshev
- Department of Socio-clinical and Biological Research of Psychotic spectrum disorders, Moscow Research Institute of Psychiatry, Moscow, Russia
| | - Birte Glenthøj
- Center for Neuropsychiatric Schizophrenia Research (CNSR) and Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Mental Health Center Glostrup, Glostrup, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Karoline Gütter
- Department of Psychiatry and Psychotherapy, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Alex Hofer
- Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Medical University Innsbruck, Innsbruck, Austria
| | - Jan Hubeňák
- Psychiatric Department, Charles University Medical School and Faculty Hospital Hradec Králové, Hradec Králové, Czechia
| | - Stefan Kaiser
- Adult Psychiatry Division, Department of Psychiatry, University of Geneva Hospitals, Geneva, Switzerland
| | - Jan Libiger
- Psychiatric Department, Charles University Medical School and Faculty Hospital Hradec Králové, Hradec Králové, Czechia
| | - Ingrid Melle
- NORMENT Centre, Institute of Clinical Psychiatry, University of Oslo and Oslo University Hospital, Oslo, Norway
| | - Mette Ø Nielsen
- Center for Neuropsychiatric Schizophrenia Research (CNSR) and Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Mental Health Center Glostrup, Glostrup, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Oleg Papsuev
- Department of Socio-clinical and Biological Research of Psychotic spectrum disorders, Moscow Research Institute of Psychiatry, Moscow, Russia
| | - Janusz K Rybakowski
- Department of Adult Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
| | - Gabriele Sachs
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Alp Üçok
- Istanbul Faculty of Medicine, Psychotic Disorders Research Program, Istanbul University, Istanbul, Turkey
| | - Pawel Wojciak
- Department of Adult Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
| | - Silvana Galderisi
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Largo Madonna delle Grazie, 80138 Naples, Italy
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Cerveri G, Gesi C, Mencacci C. Pharmacological treatment of negative symptoms in schizophrenia: update and proposal of a clinical algorithm. Neuropsychiatr Dis Treat 2019; 15:1525-1535. [PMID: 31239687 PMCID: PMC6556563 DOI: 10.2147/ndt.s201726] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 05/02/2019] [Indexed: 12/16/2022] Open
Abstract
The clinical presentation of schizophrenia encompasses symptoms divided into three dimensions: positive, negative, and cognitive. Negative symptoms (NS), in particular, have a major impact on the quality of life of the affected subject, and, differing from positive symptoms, are often associated with a limited response to pharmacotherapy. To date, studies specifically investigating NS in schizophrenia are scant; therefore, proper selection of therapy for NS remains a major unmet medical need. Given the heterogeneity of the clinical presentation of schizophrenia, the treatment of NS, as well as therapy for other associated symptoms, should be largely individualized according to a patient's specific characteristics. In this paper, we review current knowledge on NS and construct a clinical algorithm for the treatment of schizophrenic conditions with pronounced NS. Overall, data from the literature suggest that second-generation antipsychotics, such as cariprazine and amisulpride, should be preferred over first-generation antipsychotics (FGAs), as they are associated with better functional outcomes and lower cognitive impairment. The combination of antipsychotics and antidepressants may also improve NS while addressing some affective disorders associated with schizophrenia; however, no clear information is available on the effects of this combination on primary NS or on the mechanism of action of the combination. In the proposed clinical algorithm, we suggest that cariprazine should be used as first-line treatment for patients with predominant NS, and that amisulpride should be considered as an alternative in cases of cariprazine failure. Further treatment lines may include the use of olanzapine and quetiapine, and add-on therapy with antidepressants.
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Affiliation(s)
| | - Camilla Gesi
- Mental Health Department, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Claudio Mencacci
- Mental Health Department, ASST Fatebenefratelli-Sacco, Milan, Italy
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111
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Mathews M, Gopal S, Nuamah I, Hargarter L, Savitz AJ, Kim E, Tan W, Soares B, Correll CU. Clinical relevance of paliperidone palmitate 3-monthly in treating schizophrenia. Neuropsychiatr Dis Treat 2019; 15:1365-1379. [PMID: 31190840 PMCID: PMC6535080 DOI: 10.2147/ndt.s197225] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 04/02/2019] [Indexed: 12/11/2022] Open
Abstract
Antipsychotics are the mainstay in schizophrenia management, and long-acting injectable (LAI) antipsychotics contribute to the successful maintenance of treatment by improving non-adherence and preventing relapses. Paliperidone palmitate 3-monthly (PP3M) formulation is the only available LAI antipsychotic that offers an extended 3-month window of stable plasma drug concentration, enabling only four injections per year. This paper summarizes clinically relevant endpoints from available evidence for PP3M to bridge translational research gaps and provide measurable outcomes that can be interpreted in clinical practice. Low number-needed-to-treat (NNT) for relapse prevention (NNT [95% CI] 6-month estimate: 4.8 [3.2; 10.0]; 12-month estimate: 3.4 [2.2; 7.0]), and high number-needed-to-harm (NNH [95% CI] akathisia, 27.1 [12.3; -667.1]; tremor, 80.0 [22.5; 67.3]; dyskinesia, -132.6 [44.5; -23.2]; parkinsonism, 160.0 [28.9; -49.8]) quantify the relative benefits and low propensity for adverse events with PP3M. Symptom remission and reductions in positive and negative symptoms indicate treatment stability. Additionally, meaningful functional remission, reduced dosing frequency, and freedom from daily negotiations favorably impact patient preference and attenuate burdensome aspects of caregiving, representing important healthcare determinants that enhance prospects of treatment continuity in schizophrenia. This information can potentially improve clinicians' judgment of treatment choices, clinical response, and patient selection in routine care. Taken together, PP3M is a valuable antipsychotic treatment option, meriting consideration for a broader role in the long-term management of schizophrenia; its utility should not be limited to patients with poor adherence or when oral antipsychotics have failed.
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Affiliation(s)
- Maju Mathews
- Department of Neuroscience, Janssen Research & Development, LLC, Raritan, NJ, USA
| | - Srihari Gopal
- Department of Neuroscience, Janssen Research & Development, LLC, Raritan, NJ, USA
| | - Isaac Nuamah
- Department of Neuroscience, Janssen Research & Development, LLC, Raritan, NJ, USA
| | - Ludger Hargarter
- Department of Neuroscience, Janssen-Cilag EMEA, Neuss, Deutschland
| | - Adam J Savitz
- Department of Neuroscience, Janssen Research & Development, LLC, Raritan, NJ, USA
| | - Edward Kim
- Janssen Scientific Affairs, LLC, Hopewell, NJ, USA
| | - Wilson Tan
- Regional Medical Affairs, Janssen Pharmaceutical Companies of Johnson and Johnson, Singapore
| | - Bernardo Soares
- Neuroscience Medical Affairs, Janssen-Cilag, High Wycombe, Buckinghamshire, UK
| | - Christoph U Correll
- The Zucker Hillside Hospital, Psychiatry Research, Glen Oaks, NY, USA
- Department of Psychiatry and Molecular Medicine, Hofstra Northwell School of Medicine, East Garden City, NY, USA
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
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112
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Willborn RJ, Hall CP, Fuller MA. Recycling N-acetylcysteine: A review of evidence for adjunctive therapy in schizophrenia. Ment Health Clin 2019; 9:116-123. [PMID: 31123658 PMCID: PMC6513056 DOI: 10.9740/mhc.2019.05.116] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Introduction All symptoms in schizophrenia may impact functioning. Although Food and Drug Administration-approved medications typically benefit positive symptoms, negative symptoms are generally refractory to medication interventions. N-acetylcysteine's (NAC) influence on glutamatergic neurotransmission has been established. An emerging body of research has attempted to correlate this action with reduction in symptom severity, evaluating response in positive, negative, and cognitive symptom domains. Methods A literature review was performed to analyze available data on NAC intervention and improvement in the positive, negative, and cognitive symptom domains in patients with schizophrenia. Quality of evidence was systematically assessed to determine level of certainty in results. Results Three randomized controlled trials were identified. Across studies, negative symptoms decreased more with NAC compared to placebo; ranging between 11.9% and 24.1%. The assessment determined a low level of certainty regarding benefit of NAC on negative and cognitive symptoms and moderate certainty for NAC regarding findings of side effects and lack of benefit on positive symptoms. Discussion Consistent reporting of benefit in negative symptoms is found across studies of NAC intervention. These improvements are notable for symptoms that have generally remained refractory to medication intervention. Inconsistent benefit was reported in positive and cognitive symptoms. GRADE (grading of recommendations assessment, development and evaluation) assessment of current evidence indicates a low certainty of benefit for negative symptoms with standard use of NAC in patients with schizophrenia. However, a trial of this low-risk intervention may be warranted in patients with resistant negative symptoms and subsequent impaired functioning despite appropriate antipsychotic therapy as they may experience additional benefit in this symptom domain.
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113
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Yung AR, Nelson B, McGorry PD, Wood SJ, Lin A. Persistent negative symptoms in individuals at Ultra High Risk for psychosis. Schizophr Res 2019; 206:355-361. [PMID: 30482643 PMCID: PMC6542412 DOI: 10.1016/j.schres.2018.10.019] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 10/16/2018] [Accepted: 10/20/2018] [Indexed: 12/18/2022]
Abstract
Persistent negative symptoms (PNS) defined as negative symptoms that persist for at least six months in the absence of high levels of positive, depressive and extrapyramidal symptoms, are evident early in the course of schizophrenia from the first episode of psychosis. However, their presence even earlier in the illness, in those at Ultra High Risk of psychosis, has not been investigated. In this study, we examined the prevalence, baseline correlates and outcome of PNS in 363 Ultra High Risk individuals. Assessments were conducted at baseline and 2-14 years later (mean follow up time 7.4 years). Baseline assessments included demographic, clinical and neurocognitive measures, which were repeated at follow up. The prevalence of PNS in the UHR group was 6.1%. Poor premorbid social adjustment, deficits in verbal fluency and childhood maltreatment, specifically emotional neglect, were evident at baseline in the PNS group compared to the group without PNS. PNS were associated with poor psychosocial functioning and deficits in processing speed at follow up. Our findings suggest that PNS can be detected early, allowing for the identification of a subset of Ultra High Risk patients who are likely to have poor outcome. These individuals could be the target for specific intervention. Further research is needed into the pathophysiology of these PNS to develop specific interventions.
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Affiliation(s)
- Alison R Yung
- Division of Psychology and Mental Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Greater Manchester Mental Health NHS Trust, Manchester, UK; Orygen, The National Centre of Excellence in Youth Mental Health, Australia; Centre for Youth Mental Health, The University of Melbourne, Australia.
| | - Barnaby Nelson
- Orygen, The National Centre of Excellence in Youth Mental Health, Australia; Centre for Youth Mental Health, The University of Melbourne, Australia
| | - Patrick D McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, Australia; Centre for Youth Mental Health, The University of Melbourne, Australia
| | - Stephen J Wood
- Orygen, The National Centre of Excellence in Youth Mental Health, Australia; Centre for Youth Mental Health, The University of Melbourne, Australia; School of Psychology, University of Birmingham, UK
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114
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Chang WC, Ho RWH, Tang JYM, Wong CSM, Hui CLM, Chan SKW, Lee EMH, Suen YN, Chen EYH. Early-Stage Negative Symptom Trajectories and Relationships With 13-Year Outcomes in First-Episode Nonaffective Psychosis. Schizophr Bull 2019; 45:610-619. [PMID: 30124959 PMCID: PMC6483573 DOI: 10.1093/schbul/sby115] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Negative symptoms are a key treatment target in early psychosis intervention. There is a paucity of research examining longitudinal course of negative symptoms across the initial years of treatment for first-episode psychosis using individual-based trajectory analysis. No study has been conducted investigating differential relationships of early-stage negative symptom trajectories with long-term distal outcomes. This study examined patterns and baseline predictors of negative symptom trajectories over the first 3 years of treatment in 138 patients aged 18-55 years presenting with first-episode nonaffective psychosis, using latent class growth analysis based on symptom ratings measured at 4 different time points (baseline, 1, 2, and 3 years). We further explored prospective relationships of identified trajectory classes with functional and negative symptom outcomes at 13-year follow-up. Our results revealed 3 distinct negative symptom trajectories including minimal-stable (59.6%), mild-stable (29.4%), and high-increasing (11.0%) trajectories. Poorer premorbid adjustment, more severe global cognitive impairment, and depressive symptoms at baseline were found to predict high-increasing trajectory. Among 3 trajectory classes, patients in high-increasing trajectory had the worst functional and negative symptom outcomes at 13-year follow-up, with post hoc analyses demonstrating significant outcome differences between high-increasing and minimal-stable trajectories. Our findings thus affirm a heterogeneous course of negative symptoms in first-episode psychosis and indicate that early-stage negative symptom trajectories are critically associated with long-term outcomes. Patients displaying persistently high negative symptom levels in the initial 3 years of treatment may represent a specific subgroup who necessitates an extended period of early intervention specifically targeting at negative symptoms to promote early functional recovery.
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Affiliation(s)
- Wing Chung Chang
- Department of Psychiatry, University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong, China,State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Pokfulam, Hong Kong, China,To whom correspondence should be addressed; Department of Psychiatry, University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong; tel: 852-2255-4486, fax: 852-2855-1345, e-mail:
| | - Ryan Wui Hang Ho
- Department of Psychiatry, University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong, China
| | | | - Corine Sau Man Wong
- Department of Psychiatry, University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong, China
| | - Christy Lai Ming Hui
- Department of Psychiatry, University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong, China
| | - Sherry K W Chan
- Department of Psychiatry, University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong, China,State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Pokfulam, Hong Kong, China
| | - Edwin M H Lee
- Department of Psychiatry, University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong, China
| | - Yi Nam Suen
- Department of Psychiatry, University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong, China
| | - Eric Y H Chen
- Department of Psychiatry, University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong, China,State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Pokfulam, Hong Kong, China
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115
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Lee H, Lee DK, Park K, Kim CE, Ryu S. Default mode network connectivity is associated with long-term clinical outcome in patients with schizophrenia. NEUROIMAGE-CLINICAL 2019; 22:101805. [PMID: 30991621 PMCID: PMC6451190 DOI: 10.1016/j.nicl.2019.101805] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 03/17/2019] [Accepted: 03/30/2019] [Indexed: 10/27/2022]
Abstract
This study investigated whether resting-state functional connectivity is associated with long-term clinical outcomes of patients with schizophrenia. Resting-state brain images were obtained from 79 outpatients with schizophrenia and 30 healthy controls (HC), using a 3 T-MRI scanner. All patients were 20-50 years old with >3 years' duration of illness and appeared clinically stable. We assessed their psychopathology using the 18-item Brief Psychiatric Rating Scale (BPRS-18) and divided them into "good," "moderate," and "poor" outcome (SZ-GO, SZ-MO, and SZ-PO) groups depending on BPRS-18 total score. We obtained individual functional connectivity maps between a seed region of the bilateral posterior cingulate cortex (PCC) and all other brain regions and compared the functional connectivity of the default mode network (DMN) among the HC and 3 schizophrenia outcome groups, with a voxel-wise threshold of P < .001 within a cluster-extent threshold of 114 voxels. Additionally, we assessed correlations between functional connectivity and BPRS-18 scores. The SZ-MO and SZ-PO groups showed decreased functional connectivity between PCC and right ventromedial prefrontal cortex (vmPFC), left middle cingulate cortex, and left frontopolar cortex (FPC) compared to the SZ-GO and HC groups. DMN connectivity in the right vmPFC and left FPC negatively correlated with subscale scores of the BPRS-18, except the negative symptoms subscale. In this study, poorer clinical outcomes in patients with schizophrenia were associated with decreased DMN connectivity. In particular, the decreased functional connectivity might be related to the severity of positive and mood symptoms rather than negative symptoms.
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Affiliation(s)
- Hyeongrae Lee
- Department of Mental Health Research, National Center for Mental Health, Seoul, Republic of Korea
| | - Dong-Kyun Lee
- Department of Mental Health Research, National Center for Mental Health, Seoul, Republic of Korea
| | - Kyeongwoo Park
- Department of Mental Health Research, National Center for Mental Health, Seoul, Republic of Korea
| | - Chul-Eung Kim
- Mental Health Research Institute, National Center for Mental Health, Seoul, Republic of Korea
| | - Seunghyong Ryu
- Department of Mental Health Research, National Center for Mental Health, Seoul, Republic of Korea.
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116
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Boutros NN, Gjini K, Wang F, Bowyer SM. Evoked Potentials Investigations of Deficit Versus Nondeficit Schizophrenia: EEG-MEG Preliminary Data. Clin EEG Neurosci 2019; 50:75-87. [PMID: 30175598 DOI: 10.1177/1550059418797868] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Heterogeneity of schizophrenia is a major obstacle toward understanding the disorder. One likely subtype is the deficit syndrome (DS) where patients suffer from predominantly negative symptoms. This study investigated the evoked responses and the evoked magnetic fields to identify the neurophysiological deviations associated with the DS. Ten subjects were recruited for each group (Control, DS, and Nondeficit schizophrenia [NDS]). Subjects underwent magnetoencephalography (MEG) and electroencephalography (EEG) testing while listening to an oddball paradigm to generate the P300 as well as a paired click paradigm to generate the mid-latency auditory-evoked responses (MLAER) in a sensory gating paradigm. MEG-coherence source imaging (CSI) during P300 task revealed a significantly higher average coherence value in DS than NDS subjects in the gamma band (30-80 Hz), when listening to standard stimuli but only NDS subjects had a higher average coherence level in the gamma band than controls when listening to the novel sounds. P50, N100, and P3a ERP amplitudes (EEG analysis) were significantly decreased in NDS compared with DS subjects. The data suggest that the deviations in the 2 patient groups are qualitatively different. Deviances in NDS patients suggest difficulty in both early (as in the gating paradigm), as well as later top-down processes (P300 paradigm). The main deviation in the DS group was an exaggerated responsiveness to ongoing irrelevant stimuli detected by EEG whereas NDS subjects had an exaggerated response to novelty.
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Affiliation(s)
- Nash N Boutros
- Department of Psychiatry, University of Missouri-Kansas City (UMKC), Kansas City, MO, USA.,Saint Luke's Marion Bloch Neuroscience Institute, Kansas City, MO, USA
| | - Klevest Gjini
- Department of Neurology, University of Wisconsin-Madison, Madison, WI, USA
| | - Frank Wang
- Department of Neurology, Henry Ford Hospital, Detroit, MI, USA.,Wayne State University, Detroit, MI, USA
| | - Susan M Bowyer
- Department of Neurology, Henry Ford Hospital, Detroit, MI, USA.,Wayne State University, Detroit, MI, USA
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117
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Hagenmuller F, Heekeren K, Roser P, Haker H, Theodoridou A, Walitza S, Rössler W, Kawohl W. Early Somatosensory Processing Over Time in Individuals at Risk to Develop Psychosis. Front Psychiatry 2019; 10:47. [PMID: 30890966 PMCID: PMC6413704 DOI: 10.3389/fpsyt.2019.00047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 01/23/2019] [Indexed: 12/16/2022] Open
Abstract
Objective: Somatosensory evoked potentials (SEPs) enable the investigation of thalamocortical and early cortical processing. Previous studies reported alterations of SEPs in patients with schizophrenia as well as in individuals in the prodromal stage. Moreover, cannabis use as an environmental risk factor for the development of schizophrenia has been demonstrated to influence SEP parameters in individuals at risk to develop psychosis. The aim of this study was to explore the course of SEP changes and the impact of concomitant cannabis use in individuals at risk to develop psychosis who sought medical help. Methods: Median nerve SEPs including high-frequency oscillations (HFOs) superimposed on the primary cortical response (N20) were investigated using multichannel EEG in individuals (n = 54 at baseline) remaining at risk to develop psychosis at follow-up after 1 year (high-risk: n = 19; ultra-high-risk: n = 27) vs. subjects with conversion to psychosis (n = 8) and a healthy control group (n = 35). Longitudinal and cross-sectional analyses of SEP components as estimated by dipole source analysis were performed. Results: The longitudinal development of the N20 strength depended on cannabis use. In cannabis non-users, a greater decrease of N20 strengths over time was associated with more negative symptoms at baseline. At baseline, converters did not differ from subjects remaining at risk. At follow-up, converters showed increased low- and high-frequency activity than at-risk subjects and did not differ from controls. Conclusion: The results of this study lead to the suggestion that the deficits in early somatosensory processing in individuals at risk to develop psychosis may not represent a marker for a genetic risk for psychosis but rather reflect state-dependent factors such as negative symptoms. On the other hand, the transition to psychosis seems to represent an interstage between reduced sensory registration from the at-risk state and gating deficits in the chronic state.
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Affiliation(s)
- Florence Hagenmuller
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University of Zurich, Zurich, Switzerland
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland
| | - Karsten Heekeren
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University of Zurich, Zurich, Switzerland
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland
| | - Patrik Roser
- Department of Psychiatry and Psychotherapy, Psychiatric Services Aargau, Academic Hospital of the University of Zurich, Brugg, Switzerland
| | - Helene Haker
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University of Zurich, Zurich, Switzerland
- Translational Neuromodeling Unit, Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Zurich, Switzerland
| | - Anastasia Theodoridou
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University of Zurich, Zurich, Switzerland
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland
| | - Susanne Walitza
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University of Zurich, Zurich, Switzerland
- Department of Child and Adolescent Psychiatry, University of Zurich, Zurich, Switzerland
| | - Wulf Rössler
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University of Zurich, Zurich, Switzerland
- Laboratory of Neuroscience (LIM 27), Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
- Department of Psychiatry and Psychotherapy, Charité University Medicine, Berlin, Germany
| | - Wolfram Kawohl
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University of Zurich, Zurich, Switzerland
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland
- Department of Psychiatry and Psychotherapy, Psychiatric Services Aargau, Academic Hospital of the University of Zurich, Brugg, Switzerland
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118
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Fleischhacker W, Galderisi S, Laszlovszky I, Szatmári B, Barabássy Á, Acsai K, Szalai E, Harsányi J, Earley W, Patel M, Németh G. The efficacy of cariprazine in negative symptoms of schizophrenia: Post hoc analyses of PANSS individual items and PANSS-derived factors. Eur Psychiatry 2019; 58:1-9. [PMID: 30738380 DOI: 10.1016/j.eurpsy.2019.01.015] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 01/09/2019] [Accepted: 01/12/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Negative symptoms in schizophrenia are heterogeneous and multidimensional; effective treatments are lacking. Cariprazine, a dopamine D3-preferring D3/D2 receptor partial agonist and serotonin 5-HT1A receptor partial agonist, was significantly more effective than risperidone in treating negative symptoms in a prospectively designed trial in patients with schizophrenia and persistent, predominant negative symptoms. METHODS Using post hoc analyses, we evaluated change from baseline at week 26 in individual items of the Positive and Negative Syndrome Scale (PANSS) and PANSS-derived factor models using a mixed-effects model for repeated measures (MMRM) in the intent-to-treat (ITT) population (cariprazine = 227; risperidone = 227). RESULTS Change from baseline was significantly different in favor of cariprazine versus risperidone on PANSS items N1-N5 (blunted affect, emotional withdrawal, poor rapport, passive/apathetic social withdrawal, difficulty in abstract thinking) (P < .05), but not on N6 (lack of spontaneity/flow of conversation) or N7 (stereotyped thinking). On all PANSS-derived negative symptom factor models evaluated (PANSS-Factor Score for Negative Symptoms, Liemburg factors, Khan factors, Pentagonal Structure Model Negative Symptom factor), statistically significant improvement was demonstrated for cariprazine versus risperidone (P < .01). Small and similar changes in positive/depressive/EPS symptoms suggested that negative symptom improvement was not pseudospecific. Change from baseline was significantly different for cariprazine versus risperidone on PANSS-based factors evaluating other relevant symptom domains (disorganized thoughts, prosocial function, cognition; P < .05). CONCLUSIONS Since items representing different negative symptom dimensions may represent different fundamental pathophysiological mechanisms, significant improvement versus risperidone on most PANSS Negative Subscale items and across all PANSS-derived factors suggests broad-spectrum efficacy for cariprazine in treating negative symptoms of schizophrenia.
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Affiliation(s)
- Wolfgang Fleischhacker
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University Innsbruck, Innsbruck, Austria
| | | | | | | | | | - Károly Acsai
- Medical Division, Gedeon Richter Plc, Budapest, Hungary
| | | | | | | | | | - György Németh
- Medical Division, Gedeon Richter Plc, Budapest, Hungary
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119
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Affective modulation of target detection in deficit and non-deficit schizophrenia. Schizophr Res 2019; 204:138-145. [PMID: 30126815 PMCID: PMC6378118 DOI: 10.1016/j.schres.2018.08.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 07/20/2018] [Accepted: 08/13/2018] [Indexed: 11/22/2022]
Abstract
Emotional deficits are an integral feature of schizophrenia (SZ), but our understanding of these deficits is limited. In the present study, we examined whether the severity of emotional deficits reflects difficulty in the cognitive processing of affectively valenced stimuli. Healthy controls (HC; N = 170) and stable outpatients with SZ (N = 245), characterized as either deficit syndrome (DS; N = 62) or non-deficit syndrome (NDS; N = 183), completed an Affective Go/NoGo task requiring discrimination of positively, negatively or neutrally valenced words. Accuracy (d') and response bias (c) were calculated for each of the three conditions, and a series of ANOVAs were carried out to examine group differences. Examination of accuracy revealed significant main effects of group and valence and a significant valence × group interaction, indicating that while affective valence impacted accuracy for the HC and NDS groups, the DS group maintained the same low level of accuracy across all levels of affective valence. Examination of response bias also revealed significant main effects of group and valence and a significant valence × group interaction. Specifically, within the HC and NDS groups, response bias did not differ between negatively and positively valenced words while response bias in the DS group was lowest for neutral, higher for negatively valenced and higher still for positively valenced words. These results suggest that emotional deficits in DS may be directly related to deficits in processing affective information. Moreover, although this deficit is observed across both positively and negatively valenced stimuli, it is most pronounced for positively valenced material.
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120
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Carrà G, Crocamo C, Angermeyer M, Brugha T, Toumi M, Bebbington P. Positive and negative symptoms in schizophrenia: A longitudinal analysis using latent variable structural equation modelling. Schizophr Res 2019; 204:58-64. [PMID: 30177344 DOI: 10.1016/j.schres.2018.08.018] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 07/06/2018] [Accepted: 08/13/2018] [Indexed: 01/29/2023]
Abstract
BACKGROUND Recent network models of schizophrenia propose it is the consequence of mutual interaction between its symptoms. While cross-sectional associations between negative and positive symptoms are consistent with this idea, they may merely reflect their involvement in the diagnostic process. Longitudinal analyses however may allow the identification of possible causal relationships. The European Schizophrenia Cohort (EuroSC) provides data suitable for this purpose. METHODS EuroSC includes 1208 patients randomly sampled from outpatient services in France, Germany and the UK. Initial measures were repeated after 12 and 24 months. Latent variable structural equation modelling was used to investigate the direction of effect between positive and negative symptoms assessed with the Positive and Negative Syndrome Scale, controlling for the effects of depressed mood and antipsychotic medication. RESULTS The structural model provided acceptable overall fit [χ2 (953) = 2444.32, P < 0.001; CFI = 0.909; RMSEA = 0.046 (90% CI: 0.043, 0.048); SRMR = 0.052]. Both positive and negative symptoms were persistent, and strongly auto-correlated. There were also persistent cross-sectional associations between positive and negative symptoms. While the path from latent positive to negative symptoms from T1 to T2 approached conventional levels of statistical significance (P = 0.051), that from T2 to T3 did not (P = 0.546). Pathways in the reverse direction were uniformly non-significant. CONCLUSIONS There was no evidence that negative symptoms predict later positive symptoms. The prediction of negative symptoms by positive symptoms was ambiguous. We discuss implications for conceptualization of schizophrenic processes.
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Affiliation(s)
- Giuseppe Carrà
- Division of Psychiatry, University College London, 149 Tottenham Court Road, London W1T 7NF, UK; Department of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, Monza 20900, Italy
| | - Cristina Crocamo
- Department of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, Monza 20900, Italy.
| | - Matthias Angermeyer
- Department of Psychiatry, University of Leipzig, Johannisallee 20, 04137 Leipzig, Germany
| | - Traolach Brugha
- Department of Health Sciences, College of Life Sciences, University of Leicester, University Road, Leicester LE1 7RH, UK
| | - Mondher Toumi
- Laboratoire de Santé Publique, Université de la Méditerranée, Marseille, France
| | - Paul Bebbington
- Division of Psychiatry, University College London, 149 Tottenham Court Road, London W1T 7NF, UK
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Rakitzi S, Georgila P. Integrated Psychological Therapy and Treatment-Resistant Schizophrenia: Initial Findings. Psychiatry 2019; 82:354-367. [PMID: 31385737 DOI: 10.1080/00332747.2019.1616658] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: The aim of this Randomized Controlled Trial (RCT) is to present the initial findings of a larger RCT study conducted internationally for the first time, regarding the hypothesis, when the Integrated Psychological Therapy (IPT) for individuals with schizophrenia is more and when it is less effective, regarding Treatment-Resistant Schizophrenia (TRS) and nontreatment resistant schizophrenia (NTRS).Methods: Forty-eight outpatients with schizophrenia of an adult psychiatric department participated in this RCT study. Eleven outpatients of IPT and 11 of the Treatment as Usual (TAU) belong to TRS. Thirteen patients of IPT and 13 of TAU belong to NTRS. A test battery was given at baseline after therapy (10 weeks) and at 3 months' follow-up. Neurocognition, social cognition, psychopathology, and functional outcome were assessed. The General Linear Model (GLM) for repeated measurements was used. Effect sizes, z-scores, and the sign test were calculated.Results: There was a statistical significance for verbal memory; positive, negative symptoms and general psychopathology; Global Assessment and Functioning scale (GAF) and quality of life favoring NTRS. Effect sizes showed superiority of NTRS in comparison to TRS. The sign test showed a significant improvement in Integrated Psychological Therapy treatment-resistant schizophrenia (IPTTRS) that was maintained in the follow-up, in Integrated Psychological Therapy nontreatment resistant schizophrenia (IPTNTRS) and in Treatment as Usual nontreatment resistant schizophrenia (TAUNTRS).Conclusion: The IPT is more effective in NTRS in comparison to TRS, although IPTTRS showed some improvements, maintained at follow-up. Further RCT studies with larger samples are needed.
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Lutgens D, Joober R, Iyer S, Lepage M, Norman R, Schmitz N, Mustafa S, Abadi S, Malla A. Progress of negative symptoms over the initial 5 years of a first episode of psychosis. Psychol Med 2019; 49:66-74. [PMID: 29534765 DOI: 10.1017/s003329171800048x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Specialized early intervention (EI) following a first episode of psychosis (FEP) are effective at reducing negative symptoms, although its trajectory warrants systematic assessment. However, findings are equivocal as to whether extended gains are made post 2 years of EI and whether there is additional benefit of extending EI for an additional 3 years. METHODS Data on 178 FEP patients, from a randomized controlled trial of a 3-year extension of EI service v. transfer to regular care following 2 years of EI service, were used for this report. Repeated measures analysis of variance were conducted separately for the initial 2 years of treatment in an EI service, and for the 3-year post-randomization to examine trajectories of negative symptoms over the two periods in the two arms of the study. RESULTS There were significant improvements in total negative symptoms over the first 2 years of EI F(4.612, 797.905) = 25.263, p < 0.001 and in domains of 'expressivity' and 'motivation'. In the following 3 years, there were further significant improvements in negative symptoms F(4.318, 759.908) = 4.182, p = 0.002 with no difference between groups F(4.318, 759.908) = 1.073, p = 0.371. Changes in negative symptoms over the extension period were driven by expressivity F(4.01, 674.73) = 7.19, p < 0.01, but not motivation F(6.58, 1112.18) = 0.95, p = 0.46. CONCLUSION Negative symptoms improve significantly over the first 2 years of EI. Subsequent amelioration was largely the result of expressivity. Motivation deficits remained stable. Extended EI offered no advantage over regular care post-randomization.
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Affiliation(s)
- Danyael Lutgens
- Department of Psychiatry,McGill University,Douglas Mental Health University Institute; Prevention and Early Intervention Program for Psychosis (PEPP-Montreal),Montreal,QC,Canada
| | - Ridha Joober
- Department of Psychiatry,McGill University,Douglas Mental Health University Institute; Prevention and Early Intervention Program for Psychosis (PEPP-Montreal),Montreal,QC,Canada
| | - Srividya Iyer
- Department of Psychiatry,McGill University,Douglas Mental Health University Institute; Prevention and Early Intervention Program for Psychosis (PEPP-Montreal),Montreal,QC,Canada
| | - Martin Lepage
- McGill University,Douglas Hospital Research Centre,Montreal,QC,Canada
| | - Ross Norman
- Department of Psychiatry,Western University; Prevention and Early Intervention Program for Psychosis (PEPP-London) London,Ontario,Canada
| | - Norbert Schmitz
- Department of Psychiatry,McGill University,Douglas Mental Health University Institute; Prevention and Early Intervention Program for Psychosis (PEPP-Montreal),Montreal,QC,Canada
| | - Sally Mustafa
- Department of Psychiatry,McGill University,Douglas Mental Health University Institute; Prevention and Early Intervention Program for Psychosis (PEPP-Montreal),Montreal,QC,Canada
| | - Sherezad Abadi
- Department of Psychiatry,McGill University,Douglas Mental Health University Institute; Prevention and Early Intervention Program for Psychosis (PEPP-Montreal),Montreal,QC,Canada
| | - Ashok Malla
- Department of Psychiatry,McGill University,Douglas Mental Health University Institute; Prevention and Early Intervention Program for Psychosis (PEPP-Montreal),Montreal,QC,Canada
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Watters AJ, Rupert PE, Wolf DH, Calkins ME, Gur RC, Gur RE, Turetsky BI. Social aversive conditioning in youth at clinical high risk for psychosis and with psychosis: An ERP study. Schizophr Res 2018; 202:291-296. [PMID: 29937326 DOI: 10.1016/j.schres.2018.06.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Revised: 03/29/2018] [Accepted: 06/10/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Social cognition and emotion processing are compromised in schizophrenia. Disruptions in these domains may also be present during the psychosis-risk state. Aversive conditioning is an established translational research paradigm to investigate affective reactivity and learning. Using an aversive conditioning ERP paradigm with social cues, we examined whether psychosis patients and at-risk youths differentially respond to aversively conditioned faces. METHODS Participants (ages 10-30) were enrolled into three demographically-matched groups: clinical risk for psychosis (CR, n = 32), psychosis (PS, n = 26), and healthy control (HC, n = 33). EEGs were recorded during a delay aversive conditioning task in which three neutral faces were paired with an aversive tone at 100%, 50% and 0% contingencies. Analysis focused on group differences in ERP peaks representing visual processing (occipital P120), emotional valence (frontal VPP), and directed attention (parietal-occipital P300), for dimensions of aversiveness (100% vs. 0%) and unpredictability (50% vs. 100% + 0%). RESULTS HC, but not CR or PS, showed increased P300 amplitude to aversive vs. non-aversive conditioned stimuli. CR, but not PS or HC, showed increased VPP amplitude to unpredictable vs. predictable stimuli. CONCLUSIONS PS and CR both fail to allocate appropriate salience to social cues that are predictably aversive. CR, but not PS exhibit heightened emotional reactivity to social cues that are of uncertain salience. Clinical risk for schizophrenia may involve neural abnormalities distinct from both healthy and fully-established disease states.
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Affiliation(s)
- Anna J Watters
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.
| | - Petra E Rupert
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Daniel H Wolf
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Monica E Calkins
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Ruben C Gur
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Raquel E Gur
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Bruce I Turetsky
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
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Li Y, Li WX, Zou YM, Yang ZY, Xie DJ, Yang Y, Lui SSY, Strauss GP, Cheung EFC, Chan RCK. Revisiting the persistent negative symptoms proxy score using the Clinical Assessment Interview for Negative Symptoms. Schizophr Res 2018; 202:248-253. [PMID: 29996973 DOI: 10.1016/j.schres.2018.07.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 06/18/2018] [Accepted: 07/01/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The present study aimed to validate a severity cut-off of negative symptoms for persistent negative symptoms (PNS) identification using the Clinical Assessment Interview for Negative Symptoms (CAINS). METHOD A total of 206 patients with schizophrenia were recruited and divided into the PNS group (n = 57) and the Non-PNS group (n = 149) using PNS criteria based on the SANS and the SAPS. To determine the appropriate cut-offs on the CAINS in identifying PNS, Receiver Operating Characteristic (ROC) curve analysis was conducted in the PNS and Non-PNS groups. RESULTS Our results showed that the cutoffs for identifying PNS on the CAINS total score, the Motivation and Pleasure (MAP) subscale score and the Expression (EXP) subscale score were 25, 17, and 5 respectively. Area Under the Curve (AUC) analysis indicated excellent discrimination of the PNS group from the Non-PNS group using the cut-off for the CAINS total score. However, discrimination was somewhat better for the MAP subscale score than the EXP subscale score. The Positive Predictive Value (PPV) and Negative Predictive Value (NPV) of the MAP subscale were 81.54% and 97.16%. CONCLUSION We found that the cut-off scores derived from the CAINS to identify PNS are comparable to existing scales. The CAINS offers an alternative means in identifying PNS patients in clinical trials that overcomes methodological and conceptual limitations of older scales.
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Affiliation(s)
- Ying Li
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China; Haidian District Mental Health Prevent-Treatment Hospital, Beijing, China
| | - Wen-Xiu Li
- Haidian District Mental Health Prevent-Treatment Hospital, Beijing, China
| | - Ying-Min Zou
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Zhuo-Ya Yang
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Dong-Jie Xie
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Yin Yang
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China
| | - Simon S Y Lui
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China; Castle Peak Hospital, Hong Kong Special Administrative Region, China
| | - Gregory P Strauss
- Department of Psychology, University of Georgia, United States of America
| | - Eric F C Cheung
- Castle Peak Hospital, Hong Kong Special Administrative Region, China
| | - Raymond C K Chan
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China.
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Cho JM, Lee K. Effects of motivation interviewing using a group art therapy program on negative symptoms of schizophrenia. Arch Psychiatr Nurs 2018; 32:878-884. [PMID: 30454632 DOI: 10.1016/j.apnu.2018.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 06/24/2018] [Accepted: 07/16/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND We investigated the effect of motivation interviewing using group art therapy on the negative symptoms of schizophrenia. METHODS Participants were patients with chronic schizophrenia admitted to the D psychiatric wards in D city, Korea. There were 17 and 18 patients in the experimental and control groups, respectively. The data collection period was from November 28, 2016 to January 28, 2017. Motivation interviewing using group art therapy was conducted twice per week over 6 weeks (12 sessions in total). RESULTS The significance of the intervention effects were confirmed via measures of negative symptoms, motivation and pleasure, interpersonal relationships, personal hygiene, and hospital program attendance. The experimental group exhibited significantly greater improvements in negative symptoms, motivation and pleasure, interpersonal relationships, personal hygiene, and hospital program attendance than did the control group. CONCLUSIONS The results showed that the motivation interviewing using group art therapy was an effective nursing intervention for the negative symptoms of schizophrenia.
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Abstract
Objectives:Schizophrenia is a predominant product of pathological alterations distributed throughout interconnected neural systems. Functional connections (FCs) methodology is an effective lever to investigate macroscopic neural activity patterns underlying critical aspects of cognition and behaviour. However, region properties of brain architecture have been less investigated by special markers of dynamical graph in general mental disorders. Methods:Embracing the eigenvector centrality in holism significance, our important process is to uncover noticeable edges and regions with antagonistic stance between morbid and normal FCs of 67 healthy controls (HCs) and 53 chronic schizophrenia patients (SZs). Results: Results suggest that, there are 12 abnormal edges with significant p value of FCs weight, such as lingual gyrus L versus cuneus L, thalamus L versus middle frontal gyrus R, superior temporal gyrus R versus thalamus R. Importantly, SZs' superior temporal gyrus R, parahippocampal gyrus L and parahippocampal gyrus R are endowed with different eigenvector centrality scores. Conclusion: Consistent with SZs' positive symptoms of hallucinations, and negative symptoms of thinking impairment, it can be infer that the functional separation and integration are destroyed in schizophrenia. Thought the strict contrastive study, it is worth stressing that eigenvector centrality is a meaningful biological marker to excavating schizophrenic psychopathology.
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Affiliation(s)
- Bo Chen
- a School of Science , Hangzhou Dianzi University , Hangzhou , PR China
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127
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Preda A, Nguyen DD, Bustillo JR, Belger A, O'Leary DS, McEwen S, Ling S, Faziola L, Mathalon DH, Ford JM, Potkin SG, van Erp TGM. A positive take on schizophrenia negative symptom scales: Converting scores between the SANS, NSA and SDS. Schizophr Res 2018; 201:113-119. [PMID: 29935887 PMCID: PMC7039318 DOI: 10.1016/j.schres.2018.06.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2017] [Revised: 03/30/2018] [Accepted: 06/08/2018] [Indexed: 10/28/2022]
Abstract
AIMS To provide quantitative conversions between commonly used scales for the assessment of negative symptoms in schizophrenia. METHOD Linear regression analyses generated conversion equations between symptom scores from the Scale for the Assessment of Negative Symptoms (SANS), the Schedule for the Deficit Syndrome (SDS), the Positive and Negative Syndrome Scale (PANSS), or the Negative Symptoms Assessment (NSA) based on a cross sectional sample of 176 individuals with schizophrenia. Intraclass correlations assessed the rating conversion accuracy based on a separate sub-sample of 29 patients who took part in the initial study as well as an independent sample of 28 additional subjects with schizophrenia. RESULTS Between-scale negative symptom ratings were moderately to highly correlated (r = 0.73-0.91). Intraclass correlations between the original negative symptom rating scores and those obtained via using the conversion equations were in the range of 0.61-0.79. CONCLUSIONS While there is a degree of non-overlap, several negative symptoms scores reflect measures of similar constructs and may be reliably converted between some scales. The conversion equations are provided at http://www.converteasy.org and may be used for meta- and mega-analyses that examine negative symptoms.
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Affiliation(s)
- Adrian Preda
- Department of Psychiatry and Human Behavior, University of California Irvine, Irvine, CA, USA.
| | - Dana D Nguyen
- Department of Pediatrics, University of California Irvine, Irvine, CA, USA
| | - Juan R Bustillo
- Department of Psychiatry, University of New Mexico, Albuquerque, NM, USA
| | - Aysenil Belger
- Department of Psychiatry and Psychology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Daniel S O'Leary
- Department of Psychiatry, University of Iowa, Iowa City, IA, USA
| | - Sarah McEwen
- Department of Psychiatry, University of California, San Diego, La Jolla, CA 92093, USA
| | - Shichun Ling
- Department of Psychiatry and Human Behavior, University of California Irvine, Irvine, CA, USA
| | - Lawrence Faziola
- Department of Psychiatry and Human Behavior, University of California Irvine, Irvine, CA, USA
| | - Daniel H Mathalon
- Department of Psychiatry, UCSF, San Francisco, San Francisco, CA, USA
| | - Judith M Ford
- Department of Psychiatry, UCSF, San Francisco, San Francisco, CA, USA; San Francisco Veterans Affairs Medical Center, San Francisco, CA 94121, USA
| | - Steven G Potkin
- Department of Psychiatry and Human Behavior, University of California Irvine, Irvine, CA, USA
| | - Theo G M van Erp
- Clinical Translational Neuroscience Laboratory, Department of Psychiatry and Human Behavior, University of California Irvine, Irvine, CA, USA
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128
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Chen B. Abnormal cortical region and subsystem complexity in dynamical functional connectivity of chronic schizophrenia: A new graph index for fMRI analysis. J Neurosci Methods 2018; 311:28-37. [PMID: 30316890 DOI: 10.1016/j.jneumeth.2018.10.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 10/10/2018] [Accepted: 10/10/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Schizophrenia is a predominant product of pathological alterations distributed throughout interconnected neural systems. Designing new objectively diagnostic methods are burning questions. Dynamical functional connectivity (DFCs) methodology based on fMRI data is an effective lever to investigate changeability evolution in macroscopic neural activity patterns underlying critical aspects of cognition and behavior. However, region properties of brain architecture have been less investigated by special indexes of dynamical graph in general mental disorders. METHODS Embracing the network dynamics concept, we introduce topology entropy index (TE-scores) which is focused on time-varying aspects of FCs, hence develop a new framework for researching the dysfunctional roots of schizophrenia in holism significance. In this work, the important process is to uncover noticeable regions endowed with antagonistic stance in TE-scores of between morbid and normal DFCs of 63 healthy controls (HCs) and 57 chronic schizophrenia patients (SZs). RESULTS For the whole brain region levels, right olfactory, right hippocampus, left parahippocampal gyrus, right parahippocampal gyrus, left amygdala, and left cuneus in SZs are endowed with significantly different TE-scores. At brain subsystems level, TE-scores in DMN are abnormal in the SZs. Comparison with existing method(s): Topology entropy in DFCs is introduced to explore the dynamical information organization of diverse regions and their abnormal changes in mental illness. Several classical graph indexes (such as degree strength, betweenness, centrality) in the static brain network measure the region importance of FCs under senses of information integration and separation process. Although highly related to degree strength by comparing the corresponding values, topology entropy further explores the regions' aberrant adaptability of functional contact and function switching. CONCLUSION TE-scores of abnormal regions in SZs are associated to the passive apathetic social withdrawal, unusual thought content, disturbance of volition, preoccupation, active social avoidance and hallucinatory symptoms. Thought the strict contrastive study, it is worth stressing that topology entropy is a meaningful biological marker to excavating schizophrenic psychopathology.
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Affiliation(s)
- Bo Chen
- School of Science, Hangzhou Dianzi University, Hangzhou, Zhejiang, 310018, PR China.
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129
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Krause M, Zhu Y, Huhn M, Schneider-Thoma J, Bighelli I, Nikolakopoulou A, Leucht S. Antipsychotic drugs for patients with schizophrenia and predominant or prominent negative symptoms: a systematic review and meta-analysis. Eur Arch Psychiatry Clin Neurosci 2018; 268:625-639. [PMID: 29368205 DOI: 10.1007/s00406-018-0869-3] [Citation(s) in RCA: 120] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 01/15/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Negative symptoms are the core of schizophrenia, but whether antipsychotics are efficacious for their treatment is unclear. Moreover, there is debate whether patients in relevant trials should have predominant negative symptoms or whether prominent negative symptoms are also acceptable. METHODS We systematically reviewed randomised, blinded antipsychotic drug trials in patients with schizophrenia and either predominant or prominent negative symptoms (last search Dec 12, 2017). Separate pairwise meta-analyses were conducted in these two populations. The primary outcome was negative symptoms. Depressive, symptoms, positive symptoms, and extrapyramidal side-effects were analysed as causes of secondary negative symptoms. FINDINGS We included 21 randomized-controlled trials with 3451 participants which revealed the following significant differences in the primary outcome: in patients with predominant negative symptoms amisulpride was superior to placebo (N = 4; n = 590, SMD 0.47, CI 0.23, 0.71), olanzapine was superior to haloperidol in a small trial (n = 35) and cariprazine outperformed risperidone (N = 1, n = 456, SMD - 0.29, CI - 0.48, - 0.11). In patients with prominent negative symptoms, olanzapine and quetiapine were superior to risperidone in single trials. Overall, studies in prominent negative symptoms were potentially more confounded by improvements of secondary negative symptoms. INTERPRETATION Amisulpride is the only antipsychotic that outperformed placebo in the treatment of predominant negative symptoms, but there was a parallel reduction of depression. Cariprazine was better than risperidone in a large trial that was well-controlled for secondary negative symptoms, but the trial was sponsored by its manufacturer. Future trials should apply scientifically developed definitions such as the deficit syndrome and the persistent negative symptoms concept.
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Affiliation(s)
- Marc Krause
- Department of Psychiatry and Psychotherapy, Technical University of Munich, Klinikum rechts der Isar, Ismaningerstraße 22, 81675, Munich, Germany
- Ludwig-Maximilians-Universität München, Munich, Germany
| | - Yikang Zhu
- Department of Psychiatry and Psychotherapy, Technical University of Munich, Klinikum rechts der Isar, Ismaningerstraße 22, 81675, Munich, Germany
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong, University School of Medicine, South Wan Ping Road 600, Shanghai, 200030, China
| | - Maximilian Huhn
- Department of Psychiatry and Psychotherapy, Technical University of Munich, Klinikum rechts der Isar, Ismaningerstraße 22, 81675, Munich, Germany
| | - Johannes Schneider-Thoma
- Department of Psychiatry and Psychotherapy, Technical University of Munich, Klinikum rechts der Isar, Ismaningerstraße 22, 81675, Munich, Germany
| | - Irene Bighelli
- Department of Psychiatry and Psychotherapy, Technical University of Munich, Klinikum rechts der Isar, Ismaningerstraße 22, 81675, Munich, Germany
| | | | - Stefan Leucht
- Department of Psychiatry and Psychotherapy, Technical University of Munich, Klinikum rechts der Isar, Ismaningerstraße 22, 81675, Munich, Germany.
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130
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Azar M, Pruessner M, Baer LH, Iyer S, Malla AK, Lepage M. A study on negative and depressive symptom prevalence in individuals at ultra-high risk for psychosis. Early Interv Psychiatry 2018; 12:900-906. [PMID: 27653624 DOI: 10.1111/eip.12386] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 05/19/2016] [Accepted: 08/11/2016] [Indexed: 01/30/2023]
Abstract
BACKGROUND Negative symptoms are known to be present in the prodromal stage of psychotic disorders, yet little is known about their prevalence. Studies examining the presence of negative symptoms in ultra-high risk (UHR) populations have shown some limitations, notably failing to control depression. The objective of this study was to examine the prevalence of negative symptoms in the presence of significant levels of depression and in the absence of such symptoms (primary negative symptoms) over 1 year and to examine differences in negative symptoms in psychosis converters and non-converters. METHODS Participants were 123 individuals at UHR for the development of psychosis receiving follow-up for a period of 2 years. Negative symptoms and depression were measured using the Scale for the Assessment of Negative Symptoms and the Montgomery-Asberg Depression Scale at baseline, 6 and 12 months post-admission. RESULTS At baseline, the prevalence of negative symptoms and primary negative symptoms was 76.4% and 32.7%, respectively. Whereas the prevalence of negative symptoms was significantly decreased at 6 months, the prevalence of primary negative symptoms was similar at all time points. Negative symptoms at baseline were not different between later converters and non-converters to psychosis. CONCLUSION Our findings confirm the presence of secondary and primary negative symptoms in individuals at UHR, but suggest a differential trajectory of both measures over time. Future studies should include larger UHR groups and focus on the investigation of intra-individual changes in primary negative symptoms over time and further explore their potential role for psychosis conversion.
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Affiliation(s)
- Marleine Azar
- Prevention and Early Intervention Program for Psychoses, Douglas Mental Health University Institute, Verdun, Canada
| | - Marita Pruessner
- Prevention and Early Intervention Program for Psychoses, Douglas Mental Health University Institute, Verdun, Canada.,Department of Psychiatry, McGill University, Montreal, Canada
| | - Lawrence H Baer
- Prevention and Early Intervention Program for Psychoses, Douglas Mental Health University Institute, Verdun, Canada.,Department of Psychiatry, McGill University, Montreal, Canada
| | - Srividya Iyer
- Prevention and Early Intervention Program for Psychoses, Douglas Mental Health University Institute, Verdun, Canada.,Department of Psychiatry, McGill University, Montreal, Canada
| | - Ashok K Malla
- Prevention and Early Intervention Program for Psychoses, Douglas Mental Health University Institute, Verdun, Canada.,Department of Psychiatry, McGill University, Montreal, Canada
| | - Martin Lepage
- Prevention and Early Intervention Program for Psychoses, Douglas Mental Health University Institute, Verdun, Canada.,Department of Psychiatry, McGill University, Montreal, Canada
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131
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Lyngstad SH, Gardsjord ES, Simonsen C, Engen MJ, Romm KL, Melle I, Færden A. Consequences of persistent depression and apathy in first-episode psychosis - A one-year follow-up study. Compr Psychiatry 2018; 86:60-66. [PMID: 30081208 DOI: 10.1016/j.comppsych.2018.07.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 06/27/2018] [Accepted: 07/26/2018] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Apathy and depression are prevalent in first-episode psychosis (FEP), have overlapping clinical features and are linked to social dysfunction, with indications that persisting symptoms have an even more negative impact. Our objective was to investigate the prevalence of persisting depression (PD), persisting apathy (PA), to what extent they overlap and their relative associations to functioning during a one-year follow-up. METHODS One hundred and twenty-five participants with a FEP were recruited, and 88 (70%) were reassessed at follow-up. Functional outcome was assessed with the Global Assessment of Functioning Scale-split version, functioning sub-scale, apathy with the Apathy Evaluation Scale, Clinician version (AES-C), and depression with the Calgary Depression Scale for Schizophrenia (CDSS). Persisting depression was defined as a CDSS sum-score > 7 at baseline and follow-up, and persisting apathy as an AES-C sum-score ≥ 27 at baseline and follow-up. Multiple linear regression analyses were used to investigate symptoms' contributions to functioning. Differences in functioning between groups were explored with Kruskal-Wallis test and Mann-Whitney U test. RESULTS We found PD in 17 (19%) and PA in 28 (32%) of participants. The likelihood of PD was increased if PA was also present (p = 0.008, phi = 0.28). Ten participants (11%) experienced overlapping PD and PA. Participants with PD (r = -0.38, p = 0.004), PA (r = -0.51, p < 0.000) or both (r = -0.52, p < 0.000) had poorer functioning at follow-up than participants without persisting symptoms. CONCLUSION PD, PA and overlapping PD/PA is highly prevalent and associated with severely impaired functioning in FEP. Correct identification of these patients is a prerequisite for initiating relevant treatment early in the course of illness.
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Affiliation(s)
- Siv Hege Lyngstad
- Division of Mental Health and Addiction, Oslo University Hospital, 0407 Oslo, Norway.
| | - Erlend Strand Gardsjord
- Division of Mental Health and Addiction, Oslo University Hospital, 0407 Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0318 Oslo, Norway
| | - Carmen Simonsen
- Division of Mental Health and Addiction, Oslo University Hospital, 0407 Oslo, Norway
| | - Magnus Johan Engen
- Division of Mental Health and Addiction, Oslo University Hospital, 0407 Oslo, Norway
| | - Kristin Lie Romm
- Division of Mental Health and Addiction, Oslo University Hospital, 0407 Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0318 Oslo, Norway
| | - Ingrid Melle
- Division of Mental Health and Addiction, Oslo University Hospital, 0407 Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0318 Oslo, Norway
| | - Ann Færden
- Division of Mental Health and Addiction, Oslo University Hospital, 0407 Oslo, Norway
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Haro JM, Altamura C, Corral R, Elkis H, Evans J, Krebs MO, Zink M, Malla A, Méndez JI, Bernasconi C, Lalonde J, Nordstroem AL. Understanding the course of persistent symptoms in schizophrenia: Longitudinal findings from the pattern study. Psychiatry Res 2018; 267:56-62. [PMID: 29883861 DOI: 10.1016/j.psychres.2018.04.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 03/31/2018] [Accepted: 04/02/2018] [Indexed: 02/02/2023]
Abstract
The Pattern study was conducted to provide longitudinal observational data for individual patients with persistent symptoms of schizophrenia. Pattern is an international, multicenter, non-interventional, prospective cohort study of schizophrenia outpatients who were not considered to be in recovery. In the longitudinal phase reported herein, patients were assessed over 1 year using different clinical rating scales. Patient management followed routine local clinical practice. Primary outcome was disease state, defined by the Positive and Negative Syndrome Scale (PANSS), Negative Symptom Factor Score (NSFS), Positive Symptom Factor Score (PSFS), and Personal and Social Performance (PSP) Scale. In total, 1344 protocol-compliant patients (70.9% male) were included. Patients showed a high stability in disease state between consecutive study visits. Persistent negative persistent symptoms and symptomatic remission were the most prevalent and stable disease states. Patients in relapse generally transitioned to negative persistent symptoms or to symptomatic remission. PANSS, PSP, and quality of life ratings remained relatively stable. Relapses occurred in 10% of patients; probability of relapse was associated with younger age, extra-pyramidal symptoms, and more antipsychotic medications. Despite treatment, schizophrenia symptoms tend to remain stable over time, without overall improvement. One of the greatest challenges in schizophrenia is attainment of full symptom remission.
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Affiliation(s)
- Josep Maria Haro
- Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Sant Boi de Llobregat, Barcelona, Spain.
| | - Carlo Altamura
- University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, Milano 20122, Italy
| | - Ricardo Corral
- Fundación para el Estudio y Tratamiento de las Enfermedades Mentales (FETEM), Cerviño 4634 5th floor Apt. B, Buenos Aires C1425AHQ, Argentina
| | - Helio Elkis
- Departamento e Instituto de Psiquiatria-FMUSP, Sao Paulo, Brazil
| | - Jonathan Evans
- Centre for Academic Mental Health, University of Bristol, Bristol BS8 2BN, UK
| | - Marie-Odile Krebs
- Service Hospitalo Universitaire, Laboratoire de Physiopathologie des Maladies Psychiatriques, Inserm, Université Paris Descartes, Hôpital Sainte-Anne, Paris, France
| | - Mathias Zink
- Central Institute of Mental Health, Department of Psychiatry and Psychotherapy, Medical Faculty Mannheim, Heidelberg University, Bezirkskrankenhaus Ansbach, Mannheim, Germany
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133
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Lyne J, O'Donoghue B, Roche E, Renwick L, Cannon M, Clarke M. Negative symptoms of psychosis: A life course approach and implications for prevention and treatment. Early Interv Psychiatry 2018; 12:561-571. [PMID: 29076240 DOI: 10.1111/eip.12501] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 07/29/2017] [Accepted: 08/20/2017] [Indexed: 01/09/2023]
Abstract
AIM Negative symptoms are a cause of enduring disability in serious mental illness. In spite of this, the development of effective treatments for negative symptoms has remained slow. The challenge of improving negative symptom outcomes is compounded by our limited understanding of their aetiology and longitudinal development. METHODS A literature search was conducted for life course approach of negative symptoms using PubMed. Further articles were included following manual checking of reference lists and other search strategies. The paper contains a theoretical synthesis of the literature, summarized using conceptual models. RESULTS Negative symptom definitions are compared and considered within a context of the life course. Previous studies suggest that several illness phases may contribute to negative symptoms, highlighting our uncertainty in relation to the origin of negative symptoms. CONCLUSIONS Similar to other aspects of schizophrenia, negative symptoms likely involve a complex interplay of several risk and protective factors at different life phases. Concepts suggested in this article, such as "negative symptom reserve" theory, require further research, which may inform future prevention and treatment strategies.
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Affiliation(s)
- John Lyne
- Royal College of Surgeons in Ireland, North Dublin Mental Health Service, Ashlin Centre, Dublin, Ireland.,Dublin and East Treatment and Early Care Team (DETECT), Dublin, Ireland
| | - Brian O'Donoghue
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre of Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Eric Roche
- Dublin and East Treatment and Early Care Team (DETECT), Dublin, Ireland
| | - Laoise Renwick
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Mary Cannon
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Mary Clarke
- Dublin and East Treatment and Early Care Team (DETECT), Dublin, Ireland.,School of Medicine and Medical Science, University College Dublin, Dublin, Ireland.,Saint John of God Community Services Ltd, Blackrock, Co., Dublin, Ireland
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134
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Identifying the "Therapy Targets" for Treating the Negative Symptoms of Psychosis Using Cognitive Behavioral Therapy. J Cogn Psychother 2018; 32:203-220. [PMID: 32746436 DOI: 10.1891/0889-8391.32.3.203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The division of psychotic symptoms into positive and negative categories has largely divided the research on them. While the research on positive symptoms of psychosis has rapidly developed over the last three decades, the literature on negative symptoms has noticeably lagged behind. Negative symptoms have likely been ignored in the treatment literature because they were previously thought to remit following the treatment of positive symptoms. Recent evidence does not consistently support this theory and indicates that the different manifestations of negative symptoms require distinct approaches to treatment. The current review provides a re-evaluation of the theoretical literature on negative symptoms to inform and identify "treatment targets" to reduce them. The "treatment targets" are then translated into intervention strategies using a cognitive behavioral framework. A review of the empirical literature on cognitive behavior therapy for treating negative symptoms is then offered along with a critical discussion of where cognitive behavior therapy stands compared to other interventions and what research is still needed.
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135
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Galderisi S, Mucci A, Buchanan RW, Arango C. Negative symptoms of schizophrenia: new developments and unanswered research questions. Lancet Psychiatry 2018; 5:664-677. [PMID: 29602739 DOI: 10.1016/s2215-0366(18)30050-6] [Citation(s) in RCA: 256] [Impact Index Per Article: 42.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 10/03/2017] [Accepted: 12/13/2017] [Indexed: 01/05/2023]
Abstract
Negative symptoms of schizophrenia are associated with poor functional outcome and place a substantial burden on people with this disorder, their families, and health-care systems. We summarise the evolution of the conceptualisation of negative symptoms, the most important findings, and the remaining open questions. Several studies have shown that negative symptoms might be primary to schizophrenia or secondary to other factors, and that they cluster in the domains of avolition-apathy and expressive deficit. Failure to take this heterogeneity into account might hinder progress in research on neurobiological substrates and discoveries of treatments for primary or enduring negative symptoms. Improvement in recognition and routine assessment of negative symptoms is instrumental for correct management of secondary negative symptoms that are amenable to treatment. If substantial progress is to be made in the understanding and treatment of negative symptoms, then advances in concepts and assessment should be integrated into the design of future studies of these symptoms.
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Affiliation(s)
- Silvana Galderisi
- Department of Psychiatry, University of Campania Luigi Vanvitelli, Naples, Italy.
| | - Armida Mucci
- Department of Psychiatry, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Robert W Buchanan
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Celso Arango
- Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, Centro de Investigación en Red de Salud Mental, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
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136
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Ghajar A, Gholamian F, Tabatabei-Motlagh M, Afarideh M, Rezaei F, Ghazizadeh-Hashemi M, Akhondzadeh S. Citicoline (CDP-choline) add-on therapy to risperidone for treatment of negative symptoms in patients with stable schizophrenia: A double-blind, randomized placebo-controlled trial. Hum Psychopharmacol 2018; 33:e2662. [PMID: 29901250 DOI: 10.1002/hup.2662] [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: 09/01/2017] [Revised: 05/01/2018] [Accepted: 05/02/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVE We aimed to evaluate the efficacy and tolerability of citicoline add-on therapy in treatment of negative symptoms in patients with stable schizophrenia. METHODS In a double-blind and placebo-controlled study, patients with stable schizophrenia (DSM-5) were randomized to receive either 2,500 mg/day citicoline or placebo in addition to risperidone for 8 weeks. The patients were assessed using the positive and negative syndrome scale (PANSS), the extrapyramidal symptom rating scale (ESRS), and Hamilton depression rating scale (HDRS). The primary outcome was the difference in PANSS negative subscale score reduction from baseline to week 8 between the citicoline and the placebo groups. RESULTS Sixty-six individuals (out of 73 enrolled) completed the trial. The citicoline group demonstrated significantly greater improvement in negative scores, F(1.840, 118.360) = 8.383, p = .001, as well as general psychopathology, F(1.219, 78.012) = 6.636, p = .008; change in general psychopathology did not remain significant after adjustment, and total PANSS scores, F(1.633, 104.487) = 15.400, p < .001, compared with the placebo. HDRS scores and its changes, ESRS score, and frequency of other side effects were not significantly different between the two groups. CONCLUSIONS Citicoline add-on therapy to risperidone can effectively improve the primary negative symptoms of patients with schizophrenia.
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Affiliation(s)
- Alireza Ghajar
- Psychiatric Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Faezeh Gholamian
- Psychiatric Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Tabatabei-Motlagh
- Psychiatric Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Afarideh
- Psychiatric Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Farzin Rezaei
- Qods Hospital, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | | | - Shahin Akhondzadeh
- Psychiatric Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
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137
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Compton MT, Lunden A, Cleary SD, Pauselli L, Alolayan Y, Halpern B, Broussard B, Crisafio A, Capulong L, Balducci PM, Bernardini F, Covington MA. The aprosody of schizophrenia: Computationally derived acoustic phonetic underpinnings of monotone speech. Schizophr Res 2018; 197:392-399. [PMID: 29449060 PMCID: PMC6087691 DOI: 10.1016/j.schres.2018.01.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 01/11/2018] [Accepted: 01/14/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Acoustic phonetic methods are useful in examining some symptoms of schizophrenia; we used such methods to understand the underpinnings of aprosody. We hypothesized that, compared to controls and patients without clinically rated aprosody, patients with aprosody would exhibit reduced variability in: pitch (F0), jaw/mouth opening and tongue height (formant F1), tongue front/back position and/or lip rounding (formant F2), and intensity/loudness. METHODS Audiorecorded speech was obtained from 98 patients (including 25 with clinically rated aprosody and 29 without) and 102 unaffected controls using five tasks: one describing a drawing, two based on spontaneous speech elicited through a question (Tasks 2 and 3), and two based on reading prose excerpts (Tasks 4 and 5). We compared groups on variation in pitch (F0), formant F1 and F2, and intensity/loudness. RESULTS Regarding pitch variation, patients with aprosody differed significantly from controls in Task 5 in both unadjusted tests and those adjusted for sociodemographics. For the standard deviation (SD) of F1, no significant differences were found in adjusted tests. Regarding SD of F2, patients with aprosody had lower values than controls in Task 3, 4, and 5. For variation in intensity/loudness, patients with aprosody had lower values than patients without aprosody and controls across the five tasks. CONCLUSIONS Findings could represent a step toward developing new methods for measuring and tracking the severity of this specific negative symptom using acoustic phonetic parameters; such work is relevant to other psychiatric and neurological disorders.
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Affiliation(s)
- Michael T Compton
- Columbia University College of Physicians & Surgeons, Department of Psychiatry, New York, NY, USA.
| | - Anya Lunden
- College of William and Mary, Department of English, Linguistics Program, Williamsburg, VA, USA
| | - Sean D Cleary
- The George Washington University Milken Institute School of Public Health, Department of Epidemiology and Biostatistics, Washington, DC, USA
| | - Luca Pauselli
- Columbia University College of Physicians & Surgeons, Department of Psychiatry, New York, NY, USA
| | - Yazeed Alolayan
- Case Western Reserve University, Department of Neurology, Cleveland, OH, USA
| | | | | | - Anthony Crisafio
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | | | | | - Francesco Bernardini
- Université Libre de Bruxelles, Erasme Hospital, Department of Psychiatry, Anderlecht, Belgium
| | - Michael A Covington
- The University of Georgia, Institute for Artificial Intelligence, Athens, GA, USA
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138
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Kantrowitz JT, Swerdlow NR, Dunn W, Vinogradov S. Auditory System Target Engagement During Plasticity-Based Interventions in Schizophrenia: A Focus on Modulation of N-Methyl-D-Aspartate-Type Glutamate Receptor Function. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2018; 3:581-590. [PMID: 29656951 PMCID: PMC6062454 DOI: 10.1016/j.bpsc.2018.02.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 01/24/2018] [Accepted: 02/12/2018] [Indexed: 12/31/2022]
Abstract
Cognitive deficits are predictive of long-term social and occupational functional deficits in schizophrenia but are currently without gold-standard treatments. In particular, augmentation of auditory cortical neuroplasticity may represent a rate-limiting first step before addressing higher-order cognitive deficits. We review the rationale for N-methyl-d-aspartate-type glutamate receptor (NMDAR) modulators as treatments for auditory plasticity deficits in schizophrenia, along with potential serum and electroencephalographic target engagement biomarkers for NMDAR function. Several recently published NMDAR-modulating treatment studies are covered, involving D-serine, memantine, and transcranial direct current stimulation. While all three interventions appear to modulate auditory plasticity, direct agonists (D-serine) appear to have the largest and most consistent effects on plasticity, at least acutely. We hypothesize that there may be synergistic effects of combining procognitive NMDAR-modulating approaches with auditory cortical neuroplasticity cognitive training interventions. Future studies should assess biomarkers for target engagement and patient stratification, along with head-to-head studies comparing putative interventions and potential long-term versus acute effects.
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Affiliation(s)
- Joshua T Kantrowitz
- Schizophrenia Research Center, Nathan Kline Institute for Psychiatric Research, Orangeburg, New York; Division of Experimental Therapeutics, Department of Psychiatry, Columbia University, New York, New York.
| | - Neal R Swerdlow
- Department of Psychiatry, University of California, San Diego, La Jolla
| | - Walter Dunn
- Department of Psychiatry, University of California, Los Angeles, Los Angeles, California
| | - Sophia Vinogradov
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota
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139
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Ganguly P, Soliman A, Moustafa AA. Holistic Management of Schizophrenia Symptoms Using Pharmacological and Non-pharmacological Treatment. Front Public Health 2018; 6:166. [PMID: 29930935 PMCID: PMC5999799 DOI: 10.3389/fpubh.2018.00166] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 05/17/2018] [Indexed: 12/16/2022] Open
Abstract
Individuals with schizophrenia lead a poor quality of life, due to poor medical attention, homelessness, unemployment, financial constraints, lack of education, and poor social skills. Thus, a review of factors associated with the holistic management of schizophrenia is of paramount importance. The objective of this review is to improve the quality of life of individuals with schizophrenia, by addressing the factors related to the needs of the patients and present them in a unified manner. Although medications play a role, other factors that lead to a successful holistic management of schizophrenia include addressing the following: financial management, independent community living, independent living skill, relationship, friendship, entertainment, regular exercise for weight gained due to medication administration, co-morbid health issues, and day-care programmes for independent living. This review discusses the relationship between different symptoms and problems individuals with schizophrenia face (e.g., homelessness and unemployment), and how these can be managed using pharmacological and non-pharmacological methods. Thus, the target of this review is the carers of individuals with schizophrenia, public health managers, counselors, case workers, psychiatrists, and clinical psychologists aiming to enhance the quality of life of individuals with schizophrenia.
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Affiliation(s)
- Pronab Ganguly
- School of Social Sciences and Psychology, Western Sydney University, Sydney, NSW, Australia
| | - Abdrabo Soliman
- Department of Social Sciences, College of Arts and Sciences, Qatar University, Doha, Qatar
| | - Ahmed A Moustafa
- School of Social Sciences and Psychology, Western Sydney University, Sydney, NSW, Australia.,Marcs Institute for Brain and Behaviour, Western Sydney University, Sydney, NSW, Australia
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140
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Hansbauer M, Wobrock T, Kunze B, Langguth B, Landgrebe M, Eichhammer P, Frank E, Cordes J, Wölwer W, Winterer G, Gaebel W, Hajak G, Ohmann C, Verde PE, Rietschel M, Ahmed R, Honer WG, Malchow B, Strube W, Schneider-Axmann T, Falkai P, Hasan A. Efficacy of high-frequency repetitive transcranial magnetic stimulation on PANSS factors in schizophrenia with predominant negative symptoms - Results from an exploratory re-analysis. Psychiatry Res 2018; 263:22-29. [PMID: 29482042 DOI: 10.1016/j.psychres.2018.02.030] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 02/13/2018] [Accepted: 02/14/2018] [Indexed: 10/18/2022]
Abstract
Repetitive transcranial magnetic stimulation (rTMS) applied to the left frontal lobe is discussed to be a promising add-on treatment for negative symptoms in schizophrenia. The Positive and Negative Syndrome Scale (PANSS) has been used as outcome parameter in several previous rTMS trials, but studies focusing on PANSS factor analyses are lacking. For this purpose, we used the available PANSS data of the 'rTMS for the Treatment of Negative Symptoms in Schizophrenia' (RESIS) trial to calculate different literature-based PANSS factors and to re-evaluate the impact of rTMS on negative symptoms in this trial. In an exploratory re-analysis of published data from the RESIS study (Wobrock et al. 2015), we tested the impact of rTMS applied to the left dorsolateral prefrontal cortex on two PANSS factors for negative symptoms in psychotic disorders as well as on a PANSS five-factor consensus model intending to show that active rTMS treatment improves PANSS negative symptom subscores. In accordance to the original analysis, all PANSS factors showed an improvement over time in the active and, to a considerable extent, also in the sham rTMS group. However, comparing the data before and directly after the rTMS intervention, the PANSS excitement factor improved in the active rTMS group significantly more than in the sham group, but this finding did not persist if follow-up data were taken into account. These additional analyses extend the previously reported RESIS trial results showing unspecific improvements in the PANSS positive subscale in the active rTMS group. Our PANSS factor-based approach to investigate the impact of prefrontal rTMS on different negative symptom domains confirmed no overall beneficial effect of the active compared to sham rTMS.
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Affiliation(s)
- Maximilian Hansbauer
- Department of Psychiatry and Psychotherapy, Klinikum der Universität München, Ludwig-Maximilians-University, München, Germany.
| | - Thomas Wobrock
- Department of Psychiatry and Psychotherapy, Georg-August-University Goettingen, Germany; County Hospitals Darmstadt-Dieburg, Groß-Umstadt, Germany
| | - Birgit Kunze
- Department of Psychiatry and Psychotherapy, Georg-August-University Goettingen, Germany
| | - Berthold Langguth
- Department of Psychiatry and Psychotherapy, University of Regensburg, Germany
| | - Michael Landgrebe
- Department of Psychiatry and Psychotherapy, University of Regensburg, Germany; Department of Psychiatry, Psychosomatics and Psychotherapy, kbo-Lech-Mangfall-Klinik Agatharied, Germany
| | - Peter Eichhammer
- Department of Psychiatry and Psychotherapy, University of Regensburg, Germany
| | - Elmar Frank
- Department of Psychiatry and Psychotherapy, University of Regensburg, Germany
| | - Joachim Cordes
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Wolfgang Wölwer
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Georg Winterer
- Experimental & Clinical Research Center (ECRC), Charite - University Medicine Berlin, Germany
| | - Wolfgang Gaebel
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Göran Hajak
- Department of Psychiatry, Psychosomatics and Psychotherapy, Sozialstiftung Bamberg, Bamberg, Germany
| | | | - Pablo E Verde
- Coordination Centre for Clinical Trials, Heinrich-Heine University, Düsseldorf, Germany
| | - Marcella Rietschel
- Department of Genetic Epidemiology in Psychiatry, Institute of Central Mental Health, Medical Faculty Mannheim, University of Heidelberg, Germany
| | - Raees Ahmed
- Referat Klinische Studien Management, Universitätsmedizin Göttingen, Germany
| | - William G Honer
- Institute of Mental Health, The University of British Columbia, Vancouver, BC, Canada
| | - Berend Malchow
- Department of Psychiatry and Psychotherapy, Klinikum der Universität München, Ludwig-Maximilians-University, München, Germany
| | - Wolfgang Strube
- Department of Psychiatry and Psychotherapy, Klinikum der Universität München, Ludwig-Maximilians-University, München, Germany
| | - Thomas Schneider-Axmann
- Department of Psychiatry and Psychotherapy, Klinikum der Universität München, Ludwig-Maximilians-University, München, Germany
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, Klinikum der Universität München, Ludwig-Maximilians-University, München, Germany
| | - Alkomiet Hasan
- Department of Psychiatry and Psychotherapy, Klinikum der Universität München, Ludwig-Maximilians-University, München, Germany
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141
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Affiliation(s)
- Eric Granholm
- Department of Psychiatry, University of California, San Diego, San Diego, CA,Psychology Service, VA San Diego Healthcare System, San Diego, CA,To whom correspondence should be addressed; Department of Psychiatry, University of California, San Diego, 3350 La Jolla Village Drive, San Diego, CA 92161, US; tel: 858-552-8585 x7563, fax: 858-642-6416, e-mail:
| | - Philip D Harvey
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL,Research Service, Bruce W. Carter VA Medical Center, Miami, FL
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142
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Ghajar A, Khoaie-Ardakani MR, Shahmoradi Z, Alavi AR, Afarideh M, Shalbafan MR, Ghazizadeh-Hashemi M, Akhondzadeh S. L-carnosine as an add-on to risperidone for treatment of negative symptoms in patients with stable schizophrenia: A double-blind, randomized placebo-controlled trial. Psychiatry Res 2018; 262:94-101. [PMID: 29427913 DOI: 10.1016/j.psychres.2018.02.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Revised: 01/08/2018] [Accepted: 02/02/2018] [Indexed: 01/11/2023]
Abstract
Since l-carnosine has shown effectiveness in improvement of cognition in patients with schizophrenia, this 8-week, randomized, double-blind, placebo-controlled pilot study was conducted. Sixty-three patients with chronic schizophrenia, who were clinically stable on a stable dose of risperidone, entered the study. The patients were randomly assigned to l-carnosine (2 gr/day in two divided doses) or placebo for eight weeks. The patients were assessed using the positive and negative syndrome scale (PANSS), extrapyramidal symptom rating scale (ESRS), and Hamilton depression rating scale (HDRS) during the study course. Sixty patients completed the trial. L-carnosine resulted in greater improvement of negative scores as well as total PANSS scores but not positive subscale scores compared to placebo. HDRS scores and its changes did not differ between the two groups. Both groups demonstrated a constant ESRS score during the trial course. Frequency of other side effects was not significantly different between the two groups. In a multiple regression analysis model (controlled for positive, general psychopathology, depressive and extrapyramidal symptoms, as well as other variables), the treatment group significantly predicted changes in primary negative symptoms. In conclusion, l-carnosine add-on therapy can safely and effectively reduce the primary negative symptoms of patients with schizophrenia.
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Affiliation(s)
- Alireza Ghajar
- Psychiatric Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Zahara Shahmoradi
- Psychiatric Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir-Reza Alavi
- Razi Hospital, University of Social Welfare and Rehabilitation, Tehran, Iran
| | - Mohsen Afarideh
- Psychiatric Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad-Reza Shalbafan
- Mental Health Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Ghazizadeh-Hashemi
- Mental Health Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Shahin Akhondzadeh
- Psychiatric Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran.
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143
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Toner S, Cassidy M, Chevalier A, Farreny A, Leverton M, da Costa MP, Priebe S. Preferences for befriending schemes: a survey of patients with severe mental illness. BMC Psychiatry 2018; 18:64. [PMID: 29523114 PMCID: PMC5845380 DOI: 10.1186/s12888-018-1643-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 02/27/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Befriending has become a widely used method for tackling social isolation in individuals with severe mental illness (SMI), and evidence exists to support its effectiveness. However, patient preferences for befriending remain unclear. We aimed to determine whether patients with SMI want a volunteer befriender and, if so, the volunteer characteristics and character of the relationship they would prefer. METHODS A survey of outpatients was conducted across London-based community mental health teams, for individuals diagnosed with affective or psychotic disorders. Questions consisted of measures of demographic characteristics, befriending preferences and social context, including measures of time spent in activities, number of social contacts, loneliness and subjective quality of life (SQOL). Binary logistic regressions were used to investigate potential predictors of willingness to participate in befriending. RESULTS The sample comprised of 201 participants with a mean age of 43 years. The majority (58%) of the sample indicated willingness to participate in befriending. In univariable analyses this was associated with less time spent in activities in the previous week, higher level of loneliness and lower SQOL. When all three variables were tested as predictors in a multivariable analysis, only lower SQOL remained significantly associated with willingness to take part in befriending. Relative to other options presented, large proportions of participants indicated preference for weekly (44%), 1-hour (39%) meetings with a befriender, with no limits on the relationship duration (53%). Otherwise, patient preferences exhibited great variability in relation to other characteristics of befriending schemes. CONCLUSIONS A substantial number of patients with SMI appear willing to take part in a befriending scheme. Patients with lower SQOL are more likely to accept befriending, so that befriending schemes may be a realistic option to help patients with particularly low SQOL. The large variability in preferences for different types of befriending suggests that there is no one-size-fits-all formula and that schemes may have to be flexible and accommodate different individual preferences.
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Affiliation(s)
- Sarah Toner
- Unit for Social and Community Psychiatry (WHO Collaborating Centre for Mental Health Service Development), Newham Centre for Mental Health, Queen Mary University of London, London, UK
| | - Megan Cassidy
- Unit for Social and Community Psychiatry (WHO Collaborating Centre for Mental Health Service Development), Newham Centre for Mental Health, Queen Mary University of London, London, UK
| | - Agnes Chevalier
- Unit for Social and Community Psychiatry (WHO Collaborating Centre for Mental Health Service Development), Newham Centre for Mental Health, Queen Mary University of London, London, UK
| | - Aida Farreny
- Unit for Social and Community Psychiatry (WHO Collaborating Centre for Mental Health Service Development), Newham Centre for Mental Health, Queen Mary University of London, London, UK
| | - Monica Leverton
- Unit for Social and Community Psychiatry (WHO Collaborating Centre for Mental Health Service Development), Newham Centre for Mental Health, Queen Mary University of London, London, UK
| | - Mariana Pinto da Costa
- Unit for Social and Community Psychiatry (WHO Collaborating Centre for Mental Health Service Development), Newham Centre for Mental Health, Queen Mary University of London, London, UK
- Hospital de Magalhães Lemos, Porto, Portugal
- Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Porto, Portugal
| | - Stefan Priebe
- Unit for Social and Community Psychiatry (WHO Collaborating Centre for Mental Health Service Development), Newham Centre for Mental Health, Queen Mary University of London, London, UK
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144
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Stiekema APM, Islam MA, Liemburg EJ, Castelein S, van den Heuvel ER, van Weeghel J, Aleman A, Bruggeman R, van der Meer L. Long-term course of negative symptom subdomains and relationship with outcome in patients with a psychotic disorder. Schizophr Res 2018. [PMID: 28648915 DOI: 10.1016/j.schres.2017.06.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The longitudinal course of the negative symptoms subdomains social amotivation (SA) and expressive deficits (ED) remains largely unknown. We investigated i) the longitudinal course of SA and ED subdomain scores, ii) whether subgroups based on the course of SA and ED subdomain scores could be identified, iii) whether baseline SA and ED subdomain scores were related to functioning and quality of life six years later and iv) the longitudinal relationship between subgroups and outcomes. METHODS Measurements at baseline, three and six years from 1067 patients participating in the Genetic Risk and Outcome of Psychosis (GROUP) project were used. We applied mixed models analysis, regression analysis and trajectory analyses. RESULTS SA and ED subdomain scores decreased over time. Within both subdomains, four subgroups were identified: for both SA and ED a steady low course (±60%), increased (±15%) and decreased course (±15%). Within SA only, a higher level decreased course (±6%) and within ED only, a course with relatively stable high ED scores (±6%) was found. Lower symptom levels at baseline were related to better functioning (SA & ED) and quality of life (SA) at six years. Overall, low SA and low ED subgroups showed better outcomes than the other subgroups. CONCLUSION In many patients the course of negative symptoms is unstable and related to the course of outcome. Patients who do show steady low negative symptom levels (60%) may complicate the interpretation of treatment evaluation studies, as they may average out possible effects in subgroups with fluctuating symptom levels.
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Affiliation(s)
- Annemarie P M Stiekema
- Department of Rehabilitation, Lentis Psychiatric Institute, Zuidlaren, The Netherlands; School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Centre, Maastricht, The Netherlands.
| | - Md Atiqul Islam
- University of Groningen, University Center for Psychiatry, University Medical Center Groningen, Groningen, The Netherlands; University of Groningen, Rob Giel Research Center, University Medical Center Groningen, Groningen, The Netherlands; Department of Statistics, Shahjalal University of Science and Technology, Sylhet 3114, Bangladesh
| | - Edith J Liemburg
- University of Groningen, University Center for Psychiatry, University Medical Center Groningen, Groningen, The Netherlands; University of Groningen, Rob Giel Research Center, University Medical Center Groningen, Groningen, The Netherlands; University of Groningen, Department of Neuroscience, Groningen, University Medical Center Groningen, The Netherlands; Research Department, Lentis Psychiatric Institute, Groningen, The Netherlands
| | - Stynke Castelein
- University of Groningen, University Center for Psychiatry, University Medical Center Groningen, Groningen, The Netherlands; Research Department, Lentis Psychiatric Institute, Groningen, The Netherlands
| | - Edwin R van den Heuvel
- Department of Mathematics and Computer Science, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Jaap van Weeghel
- Parnassia Group, Dijk en Duin Mental Health Center, Castricum, The Netherlands; Department of TRANZO, Tilburg School of Social and Behavioral Sciences, Tilburg University, The Netherlands
| | - André Aleman
- University of Groningen, Department of Neuroscience, Groningen, University Medical Center Groningen, The Netherlands; Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands
| | - Richard Bruggeman
- University of Groningen, University Center for Psychiatry, University Medical Center Groningen, Groningen, The Netherlands; University of Groningen, Rob Giel Research Center, University Medical Center Groningen, Groningen, The Netherlands
| | - Lisette van der Meer
- Department of Rehabilitation, Lentis Psychiatric Institute, Zuidlaren, The Netherlands; University of Groningen, University Center for Psychiatry, University Medical Center Groningen, Groningen, The Netherlands
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145
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What Therapies are Favored in the Treatment of the Psychological Sequelae of Trauma in Human Trafficking Victims? J Psychiatr Pract 2018; 24:87-96. [PMID: 29509178 DOI: 10.1097/pra.0000000000000288] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Human trafficking is a major public health concern that brings about deleterious psychological consequences and sequelae. Although a number of risk and protective factors for the health consequences of human trafficking victims have been identified, there is a dearth of information in the area of treatment. Specifically, we found no articles comparing the different components of prevailing trauma treatment strategies, and the potential usefulness of these strategies in the treatment of human trafficking victims. To this end, we compared and contrasted the different therapeutic treatments typically implemented with victims of trauma (including domestic violence victims and torture victims), and discussed how the different components of these treatments may or may not be helpful for human trafficking victims. We assessed the impact of these treatments on the psychological consequences of trauma and, in particular on posttraumatic stress disorder. We also assessed the potential usefulness of these treatments with co-occurring problems such as substance use, psychosis, dissociation, and other mood and anxiety disorders. On the basis of the prevailing research, we highlighted cognitive therapies as being preferred in addressing the needs of human trafficking victims. Mental health providers who work with human trafficking victims should become aware of and practiced in the use of cognitive therapeutic approaches in treating this population. Efficacy and effectiveness studies are needed to validate our recommendations.
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146
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Abstract
Persistent negative and cognitive symptoms in patients with schizophrenia pose a significant challenge to clinicians. Being a heterogeneous cluster of symptoms with potentially distinct underlying pathogenesis, it is important to examine novel therapies based on emerging neurobiological evidence. Eszopiclone is known to enhance the deficient sleep spindles that are related to impairments in learning and memory in schizophrenia. In this report we highlight the potential utility of eszopiclone in treating persistent negative symptoms in a patient with chronic schizophrenia. The unintended N-of-1 design that spanned out over a period of 24weeks demonstrated improvements in negative symptoms while the patient was on eszopiclone and worsening of these symptoms while unintentionally being off eszopiclone treatment. These observations suggest a reasonable degree of specificity of our patient's response to eszopiclone, thus warranting future sleep-EEG guided systematic studies.
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Affiliation(s)
- Urvakhsh Meherwan Mehta
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bengaluru, Karnataka, India.
| | - Vinutha Ravishankar
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Jagadisha Thirthalli
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bengaluru, Karnataka, India
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147
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Grey matter reduction in the caudate nucleus in patients with persistent negative symptoms: An ALE meta-analysis. Schizophr Res 2018; 192:9-15. [PMID: 28390850 DOI: 10.1016/j.schres.2017.04.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 03/20/2017] [Accepted: 04/01/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES In the present study, we used Activation Likelihood Estimation (ALE) meta-analysis to quantitatively examine brain grey matter reduction in schizophrenia patients with persistent negative symptoms (PNS). METHOD A total of 12 voxel-based morphometry (VBM) studies were included in ALE meta-analysis using more stringent criterion of PNS. RESULTS Significant grey matter reduction in the PNS group relative to controls was observed in the left caudate nucleus, the left precentral region, the left middle frontal region, the bilateral parahippocampal region, the left anterior cingulate region, the bilateral medial frontal gyrus, the thalamus and the insula. CONCLUSION Our results suggest that brain regions in the reward network may be specifically related to PNS, especially the left caudate nucleus. It is possible that abnormality in reward processing may constitute the neural basis of PNS.
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148
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Ahmed AO, Strauss GP, Buchanan RW, Kirkpatrick B, Carpenter WT. Schizophrenia heterogeneity revisited: Clinical, cognitive, and psychosocial correlates of statistically-derived negative symptoms subgroups. J Psychiatr Res 2018; 97:8-15. [PMID: 29156414 DOI: 10.1016/j.jpsychires.2017.11.004] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Revised: 11/07/2017] [Accepted: 11/10/2017] [Indexed: 10/18/2022]
Abstract
Traditional efforts to delineate the clinical heterogeneity of schizophrenia have been unsuccessful because of the absence of a valid, stable, and meaningful subtyping scheme. A clinically-informed nosology supported by multivariate statistical classification methods may provide a better approach for classifying schizophrenia. The goals of the current study were to 1) use multivariate classification methods to validate a clinical subtyping scheme based on the profile of negative symptoms; and 2) following validation to contrast the statistically-derived subgroups to ascertain distinguishing demographic, clinical, cognitive, and functional characteristics. In the current study, 706 people with schizophrenia completed measures of positive and negative symptoms, premorbid adjustment, cognition, and psychosocial functioning. Latent class analysis served to identify the number of negative symptom subgroups in schizophrenia. Next, statistical classification methods-Bayes Theorem and the Base Rate Classification Technique-were used to assign participants into the identified subgroups. Subgroups were compared on external validation variables not used in the classification process via logistic regression and discriminant function analysis. Latent class analysis supported a three-class model of schizophrenia that included deficit, persistent, and transient negative symptom subgroups. Posthoc comparisons showed that demographic characteristics, positive symptoms, premorbid adjustment, and cognitive profiles can distinguish the schizophrenia subgroups with moderate accuracy. The deficit subgroup had the greatest impairments in psychosocial functioning and quality of life variables. Findings suggest that schizophrenia encapsulates qualitatively distinct negative symptom subgroups that differ in their demographic, symptomatic, neuropsychological, and functional profiles. Schizophrenia heterogeneity reflects a combination of non-arbitrary subgroups and severity-based differences in negative symptoms.
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Affiliation(s)
| | | | - Robert W Buchanan
- Department of Psychiatry, University of Maryland School of Medicine, Maryland Psychiatric Research Center, USA
| | - Brian Kirkpatrick
- Department of Psychiatry, University of Nevada School of Medicine, USA
| | - William T Carpenter
- Department of Psychiatry, University of Maryland School of Medicine, Maryland Psychiatric Research Center, USA
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149
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İnce E, Üçok A. Relationship Between Persistent Negative Symptoms and Findings of Neurocognition and Neuroimaging in Schizophrenia. Clin EEG Neurosci 2018; 49:27-35. [PMID: 29243526 DOI: 10.1177/1550059417746213] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Negative symptoms are defined as loss or reduction of otherwise present behaviors or functions in illness situation, and they have constituted an important aspect of schizophrenia. Although negative symptoms have usually been considered as a single entity, neurobiological investigations yielded discrepant results. To overcome challenges that derive from this discrepancy, researchers have proposed several approaches to structure negative symptoms into more homogenous constructs. Concept of persistent negative symptoms (PNS) is one of the proposed approaches, and includes both primary and secondary negative symptoms that persist after adequate treatment. PNS is relatively easy to assess, and by definition, more inclusive; yet it represents an unmet therapeutic need. Therefore, it is a target of several neurobiological and pharmacological studies. There are several structural and functional brain alterations associated with negative symptoms. On the other hand, neurocognitive investigations in patients with schizophrenia have revealed deficits in several domains that showed correlations with negative symptoms. There are several shared features between negative symptoms and neurocognitive deficits in schizophrenia such as prevalence rates, course through the illness, prognostic importance, and impact on social functioning. However, exact mechanisms behind the neurobiology of PNS and how it interacts with neurocognition remain to be explained. Earlier reviews on neuroimaging and neurocognitive correlates of PNS have been focused on studies with broadly defined negative symptoms that were selected by methodological closeness to PNS. In this review, we focus on neural correlates and neurocognitive associations of PNS, and we discuss PNS findings available to date.
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Affiliation(s)
- Ezgi İnce
- 1 Department of Psychiatry, Faculty of Medicine, Istanbul University, Çapa, Istanbul, Turkey
| | - Alp Üçok
- 1 Department of Psychiatry, Faculty of Medicine, Istanbul University, Çapa, Istanbul, Turkey
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150
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Wang PW, Lin HC, Su CY, Chen MD, Lin KC, Ko CH, Yen CF. Effect of Aerobic Exercise on Improving Symptoms of Individuals With Schizophrenia: A Single Blinded Randomized Control Study. Front Psychiatry 2018; 9:167. [PMID: 29867600 PMCID: PMC5962673 DOI: 10.3389/fpsyt.2018.00167] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 04/12/2018] [Indexed: 02/03/2023] Open
Abstract
Introduction: Antipsychotic treatment can improve the symptoms of schizophrenia; however, residual symptoms after antipsychotic treatment are frequent. The effects of exercise on the symptoms of schizophrenic patients under antipsychotic treatment are inconclusive. The aim of this randomized case-control study was to examine the effects of aerobic exercise (AE) on the symptoms of schizophrenic patients receiving antipsychotic treatment. Methods: In total, 33 and 29 participants being treated with antipsychotics for schizophrenia were randomly assigned into the aerobic exercise (AE) group and the control group, respectively. The severities of schizophrenic symptoms were measured using the Chinese version of the Positive and Negative Syndrome Scale (PANSS) before, immediately after, and 3 months after the intervention in both groups. Results: In total, 24 participants (72.7%) in the AE group and 22 (75.9%) in the control group completed the study. The results indicated that the severities of positive symptoms and general psychopathology in the AE group significantly decreased during the 12 weeks of intervention but did not further significantly change during the 3-month follow-up period. The severities of negative symptoms in the AE group decreased significantly after 12 weeks of intervention and continued decreasing during the 3-month follow-up period. Interaction effects between time and group on the severities of symptoms on the negative and general psychopathology scales were observed. Conclusion: AE can improve the severities of symptoms on the negative and general psychopathology scales in individuals with schizophrenia being treated with antipsychotics.
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Affiliation(s)
- Peng-Wei Wang
- Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Psychiatry, Faculty of Medicine and Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Huang-Chi Lin
- Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Psychiatry, Faculty of Medicine and Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chwen-Yng Su
- Department of Occupational Therapy, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ming-De Chen
- Department of Occupational Therapy, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Kuo C Lin
- Division of Physical and Health Education, Center for General Education, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Chih-Hung Ko
- Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Psychiatry, Faculty of Medicine and Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Occupational Therapy, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Cheng-Fang Yen
- Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Psychiatry, Faculty of Medicine and Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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