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Baruth JM, Bateman DR, Kovacs RJ, Bateman PV, Pazdernik VM, Santivasi WL, Dunlay SM, Lapid MI. Cardiac healthcare disparities and electrocardiography (ECG) differences in schizophrenia at end of life. Schizophr Res 2023; 262:60-66. [PMID: 37925752 DOI: 10.1016/j.schres.2023.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 09/11/2023] [Accepted: 10/22/2023] [Indexed: 11/07/2023]
Abstract
Schizophrenia is associated with early mortality of 15 to 20 years, and 80 % of deaths are due to cardiovascular disease with a three-times greater risk of sudden-cardiac-death. While lifestyle, medications, genetics, and healthcare disparities are contributing factors, the etiology of this complex process is not fully understood. The aim of this study is to examine cardiac-related healthcare utilization and electrocardiogram (ECG) outcomes in schizophrenia at the end of life (EOL). A cohort of individuals with schizophrenia (SG) (n = 610, ≥50 years) were identified retrospectively from a unified clinical data platform and measures of cardiovascular healthcare utilization were evaluated within a 12-month period prior to death. Similarly, a control group (n = 610) was randomly identified and matched by gender (53 % females) and age of death (72.8 ± 12.4 years). Statistical methods included Cochran-Mantel-Haenszel and mixed-effects logistic & linear regression tests with adjustments for match strata and marital status, race, age, and gender as covariates. Results indicate that SG was more likely to be unmarried, unemployed, or from minority groups (all p < 0.001), and more likely to have diabetes and/or cardiovascular disease (p < 0.001). SG was less likely to receive an ECG (p = 0.001) or cardiac catheterization procedure (p < 0.001). SG had a greater mean QTc (447.2 ms vs. 434.6 ms; p = 0.001) and were twice as likely to have "prolonged QT" on ECG report (p = 0.006). In conclusion, SG had reduced likelihood of cardiac-related healthcare interventions, and despite greater likelihood of prolonged QTc, a recognized biomarker of cardiac risk, ECG was less likely at EOL. Given greater cardiac comorbidity and risk of sudden cardiac death in schizophrenia, improved practice guidelines are needed.
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Affiliation(s)
- Joshua M Baruth
- Dept. of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA.
| | - Daniel R Bateman
- Dept. of Behavioral Health, Indiana University, Indianapolis, IN, USA
| | | | | | | | - Wil L Santivasi
- Center for Palliative Care, Department of Medicine, Duke University, Durham, NC, USA
| | - Shannon M Dunlay
- Dept. of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Maria I Lapid
- Dept. of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
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2
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Ramesh A, Nayak T, Beestrum M, Quer G, Pandit JA. Heart Rate Variability in Psychiatric Disorders: A Systematic Review. Neuropsychiatr Dis Treat 2023; 19:2217-2239. [PMID: 37881808 PMCID: PMC10596135 DOI: 10.2147/ndt.s429592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 10/11/2023] [Indexed: 10/27/2023] Open
Abstract
Introduction Heart rate variability (HRV) is a measure of the fluctuation in time interval between consecutive heart beats. Decreased heart rate variability has been shown to have associations with autonomic dysfunction in psychiatric conditions such as depression, substance abuse, anxiety, and schizophrenia, although its use as a prognostic tool remains highly debated. This study aims to review the current literature on heart rate variability as a diagnostic and prognostic tool in psychiatric populations. Methods A literature search was conducted using the MEDLINE, EMBASE, Cochrane, and PsycINFO libraries to identify full-text studies involving adult psychiatric populations that reported HRV measurements. From 1647 originally identified, 31 studies were narrowed down through an abstract and full-text screen. Studies were excluded if they enrolled adolescents or children, used animal models, enrolled patients with another primary diagnosis other than psychiatric as outlined by the diagnostic and statistical manual of mental disorders (DSM) V, or if they assessed HRV in the context of treatment rather than diagnosis. Study quality assessment was conducted using a modified Downs and Blacks quality assessment tool for observational rather than interventional studies. Data were reported in four tables: 1) summarizing study characteristics, 2) methods of HRV detection, 3) key findings and statistics, and 4) quality assessment. Results There is significant variability between studies in their methodology of recording as well as reporting HRV, which makes it difficult to meaningfully interpret data that is clinically applicable due to the presence of significant bias in existing studies. The presence of an association between HRV and the severity of various psychiatric disorders, however, remains promising. Conclusion Future studies should be done to further explore how HRV parameters may be used to enhance the diagnosis and prognosis of several psychiatric disorders.
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Affiliation(s)
- Ashvita Ramesh
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Tanvi Nayak
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Molly Beestrum
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Giorgio Quer
- Scripps Research Translational Institute, La Jolla, CA, USA
| | - Jay A Pandit
- Scripps Research Translational Institute, La Jolla, CA, USA
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3
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Hattori S, Suda A, Kishida I, Miyauchi M, Shiraishi Y, Noguchi N, Furuno T, Asami T, Fujibayashi M, Tsujita N, Ishii C, Ishii N, Saeki T, Fukushima T, Moritani T, Saigusa Y, Hishimoto A. Differences in autonomic nervous system activity between long-acting injectable aripiprazole and oral aripiprazole in schizophrenia. BMC Psychiatry 2023; 23:135. [PMID: 36869320 PMCID: PMC9983165 DOI: 10.1186/s12888-023-04617-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 02/20/2023] [Indexed: 03/05/2023] Open
Abstract
BACKGROUND Distinct oral atypical antipsychotics have different effects on autonomic nervous system (ANS) activity. Among them, oral aripiprazole has been linked to dysfunction of the ANS in schizophrenia. Long-acting injectable aripiprazole is a major treatment option for schizophrenia, but the effect of the aripiprazole formulation on ANS activity remains unclear. In this study, we compared ANS activity between oral aripiprazole and aripiprazole once-monthly (AOM) in schizophrenia. METHODS Of the 122 patients with schizophrenia who participated in this study, 72 received oral aripiprazole and 50 received AOM as monotherapy. We used power spectral analysis of heart rate variability to assess ANS activity. RESULTS Patients who received oral aripiprazole showed significantly diminished sympathetic nervous activity compared with those who received AOM. Multiple regression analysis revealed that the aripiprazole formulation significantly influenced sympathetic nervous activity. CONCLUSION Compared with oral aripiprazole, AOM appears to have fewer adverse effects, such as sympathetic nervous dysfunction.
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Affiliation(s)
- Saki Hattori
- Department of Psychiatry, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Kanagawa, Japan. .,Fujisawa Hospital, 383 Kotsuka Fujisawa, Yokohama, 251-8530, Fujisawa, Japan.
| | - Akira Suda
- Department of Psychiatry, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Kanagawa, Japan
| | - Ikuko Kishida
- Department of Psychiatry, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Kanagawa, Japan.,Fujisawa Hospital, 383 Kotsuka Fujisawa, Yokohama, 251-8530, Fujisawa, Japan
| | - Masatoshi Miyauchi
- Department of Psychiatry, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Kanagawa, Japan
| | - Yohko Shiraishi
- Department of Psychiatry, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Kanagawa, Japan
| | - Nobuhiko Noguchi
- Department of Psychiatry, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Kanagawa, Japan
| | - Taku Furuno
- Department of Psychiatry, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Kanagawa, Japan
| | - Takeshi Asami
- Department of Psychiatry, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Kanagawa, Japan
| | - Mami Fujibayashi
- Division of Physical and Health Education, Setsunan University, 17-8 Ikedanakamachi, Neyagawa, 572- 8508, Osaka, Japan
| | - Natsuki Tsujita
- Graduate School of Human and Environmental Studies, Kyoto University, Yoshidanihonmatsucho, Sakyo-ku, Kyoto, 606-8316, Japan
| | - Chie Ishii
- Fujisawa Hospital, 383 Kotsuka Fujisawa, Yokohama, 251-8530, Fujisawa, Japan
| | - Norio Ishii
- Fujisawa Hospital, 383 Kotsuka Fujisawa, Yokohama, 251-8530, Fujisawa, Japan
| | - Takashi Saeki
- Asahinooka Hospital, 128-1 Kawaihonchou, Asahi-ku, Yokohama, 251-8530, Kanagawa, Japan
| | - Tadashi Fukushima
- Asahinooka Hospital, 128-1 Kawaihonchou, Asahi-ku, Yokohama, 251-8530, Kanagawa, Japan
| | - Toshio Moritani
- Graduate School of Human and Environmental Studies, Kyoto University, Yoshidanihonmatsucho, Sakyo-ku, Kyoto, 606-8316, Japan
| | - Yusuke Saigusa
- Department of Biostatistics, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Kanagawa, Japan
| | - Akitoyo Hishimoto
- Department of Psychiatry, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Kanagawa, Japan
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4
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Büki A, Kekesi G, Horvath G, Vécsei L. A Potential Interface between the Kynurenine Pathway and Autonomic Imbalance in Schizophrenia. Int J Mol Sci 2021; 22:10016. [PMID: 34576179 PMCID: PMC8467675 DOI: 10.3390/ijms221810016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 09/08/2021] [Accepted: 09/09/2021] [Indexed: 02/07/2023] Open
Abstract
Schizophrenia is a neuropsychiatric disorder characterized by various symptoms including autonomic imbalance. These disturbances involve almost all autonomic functions and might contribute to poor medication compliance, worsened quality of life and increased mortality. Therefore, it has a great importance to find a potential therapeutic solution to improve the autonomic disturbances. The altered level of kynurenines (e.g., kynurenic acid), as tryptophan metabolites, is almost the most consistently found biochemical abnormality in schizophrenia. Kynurenic acid influences different types of receptors, most of them involved in the pathophysiology of schizophrenia. Only few data suggest that kynurenines might have effects on multiple autonomic functions. Publications so far have discussed the implication of kynurenines and the alteration of the autonomic nervous system in schizophrenia independently from each other. Thus, the coupling between them has not yet been addressed in schizophrenia, although their direct common points, potential interfaces indicate the consideration of their interaction. The present review gathers autonomic disturbances, the impaired kynurenine pathway in schizophrenia, and the effects of kynurenine pathway on autonomic functions. In the last part of the review, the potential interaction between the two systems in schizophrenia, and the possible therapeutic options are discussed.
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Affiliation(s)
- Alexandra Büki
- Department of Physiology, Albert Szent-Györgyi Medical School, University of Szeged, Dóm tér 10., H-6720 Szeged, Hungary; (A.B.); (G.K.); (G.H.)
| | - Gabriella Kekesi
- Department of Physiology, Albert Szent-Györgyi Medical School, University of Szeged, Dóm tér 10., H-6720 Szeged, Hungary; (A.B.); (G.K.); (G.H.)
| | - Gyongyi Horvath
- Department of Physiology, Albert Szent-Györgyi Medical School, University of Szeged, Dóm tér 10., H-6720 Szeged, Hungary; (A.B.); (G.K.); (G.H.)
| | - László Vécsei
- Department of Neurology, Albert Szent-Györgyi Medical School, University of Szeged, Semmelweis u. 6., H-6725 Szeged, Hungary
- MTA-SZTE Neuroscience Research Group, H-6725 Szeged, Hungary
- Interdisciplinary Excellence Center, Department of Neurology, Albert Szent-Györgyi Medical School, University of Szeged, Semmelweis u. 6., H-6725 Szeged, Hungary
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5
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Campana M, Wagner E, Wobrock T, Langguth B, Landgrebe M, Eichhammer P, Frank E, Cordes J, Wölwer W, Winterer G, Gaebel W, Hajak G, Ohmann C, Verde PE, Rietschel M, Malchow B, Ahmed R, Strube W, Häckert J, Schneider-Axmann T, Falkai P, Hasan A. Effects of high-frequency prefrontal rTMS on heart frequency rates and blood pressure in schizophrenia. J Psychiatr Res 2021; 140:243-249. [PMID: 34119909 DOI: 10.1016/j.jpsychires.2021.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/27/2021] [Accepted: 06/04/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Repetitive transcranial magnetic stimulation (rTMS) is a safe non-invasive neuromodulation technique used for the treatment of various neuropsychiatric disorders. The effect of rTMS applied to the cortex on autonomic functions has not been studied in detail in patient cohorts, yet patients who receive rTMS may have disease-associated impairments in the autonomic system and may receive medication that may pronounce autonomic dysfunctions. METHODS Using data from the 'rTMS for the Treatment of Negative Symptoms in Schizophrenia' (RESIS) trial we evaluated the effect of rTMS applied to the left dorsolateral prefrontal cortex (DLPFC) on autonomic nervous system-related parameters such as blood pressure (BP) and heart rate (HR) in both reclining and standing postures from screening up to 105 days after intervention among patients with schizophrenia. RESULTS 157 patients received either active (n = 76) or sham (n = 81) rTMS treatment. Apart from gender no significant group differences were observed. During intervention, Linear Mixed Model (LMM) analyses showed no significant time × group interactions nor time effects for any of the variables (all p > 0.055). During the whole trial beside a significant time × group interaction for diastolic BP (p = 0.017) in the standing posture, no significant time × group interactions for other variables (all p > 0.140) were found. CONCLUSION These secondary analyses of the largest available rTMS trial on the treatment of negative symptoms in schizophrenia did not show a significant effect of active rTMS compared to sham rTMS on heart rate or blood pressure, neither during the intervention period nor during the follow-up period.
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Affiliation(s)
- Mattia Campana
- Department of Psychiatry and Psychotherapy, Klinikum der Universität München, Ludwig-Maximilians-University, München, Germany.
| | - Elias Wagner
- Department of Psychiatry and Psychotherapy, Klinikum der Universität München, Ludwig-Maximilians-University, München, Germany
| | - Thomas Wobrock
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Germany; County Hospitals Darmstadt-Dieburg, Groß-Umstadt, 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
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité- Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, 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
| | - Berend Malchow
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Germany
| | - Raees Ahmed
- University Medical Center, Goettingen, Germany
| | - Wolfgang Strube
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, University of Augsburg, BKH, Augsburg, Germany
| | - Jan Häckert
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, University of Augsburg, BKH, Augsburg, 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, Psychotherapy and Psychosomatics, Medical Faculty, University of Augsburg, BKH, Augsburg, Germany
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6
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Stogios N, Gdanski A, Gerretsen P, Chintoh AF, Graff-Guerrero A, Rajji TK, Remington G, Hahn MK, Agarwal SM. Autonomic nervous system dysfunction in schizophrenia: impact on cognitive and metabolic health. NPJ SCHIZOPHRENIA 2021; 7:22. [PMID: 33903594 PMCID: PMC8076312 DOI: 10.1038/s41537-021-00151-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 03/18/2021] [Indexed: 12/17/2022]
Abstract
Schizophrenia (SCZ) is a psychiatric disorder characterized by a wide range of positive, negative and cognitive symptoms, along with an increased risk of metabolic syndrome and cardiovascular disease that contribute to a 15-20-year reduced life expectancy. Autonomic dysfunction, in the form of increased sympathetic activity and decreased parasympathetic activity, is postulated to be implicated in SCZ and its treatment. The aim of this narrative review is to view SCZ through an autonomic lens and synthesize the evidence relating autonomic dysfunction to different domains of SCZ. Using various methods of assessing autonomic activity, autonomic dysfunction was found to be associated with multiple aspects of SCZ pathophysiology, including symptom severity, cognitive impairment, and the development of cardiometabolic comorbidities, such as metabolic syndrome and high BMI. The strongest association of low heart rate variability was noted among patients on antipsychotic treatment with high-affinity muscarinic antagonism (i.e., clozapine, olanzapine and quetiapine). The review will also suggest ways in which studying autonomic dysfunction can help reduce morbidity and mortality associated with SCZ and its treatment.
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Affiliation(s)
- Nicolette Stogios
- Institute of Medical Science, University of Toronto, Toronto, Canada.,Center for Addiction and Mental Health (CAMH), Toronto, Canada
| | | | - Philip Gerretsen
- Institute of Medical Science, University of Toronto, Toronto, Canada.,Center for Addiction and Mental Health (CAMH), Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Araba F Chintoh
- Center for Addiction and Mental Health (CAMH), Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Ariel Graff-Guerrero
- Institute of Medical Science, University of Toronto, Toronto, Canada.,Center for Addiction and Mental Health (CAMH), Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Tarek K Rajji
- Institute of Medical Science, University of Toronto, Toronto, Canada.,Center for Addiction and Mental Health (CAMH), Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Gary Remington
- Institute of Medical Science, University of Toronto, Toronto, Canada.,Center for Addiction and Mental Health (CAMH), Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Margaret K Hahn
- Institute of Medical Science, University of Toronto, Toronto, Canada.,Center for Addiction and Mental Health (CAMH), Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Sri Mahavir Agarwal
- Institute of Medical Science, University of Toronto, Toronto, Canada. .,Center for Addiction and Mental Health (CAMH), Toronto, Canada. .,Department of Psychiatry, University of Toronto, Toronto, Canada.
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7
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Cognitive ability and metabolic physical health in first-episode psychosis. SCHIZOPHRENIA RESEARCH-COGNITION 2021; 24:100194. [PMID: 33659191 PMCID: PMC7895837 DOI: 10.1016/j.scog.2021.100194] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 01/14/2021] [Accepted: 01/27/2021] [Indexed: 11/23/2022]
Abstract
Cognitive impairments are a core feature of first-episode psychosis (FEP), arising before illness onset and antipsychotic exposure. Individuals with chronic psychosis experience poorer physical health while taking antipsychotic medication, but health disparities may be evident at FEP onset, prior to antipsychotic exposure. Given the links between cognition and physical health in healthy populations, the aim was to explore whether cognition and physical health are associated in FEP, which could inform early physical health interventions for cognition in FEP. Participants were aged 15 to 25 and included 86 individuals experiencing FEP with limited antipsychotic exposure and duration of untreated psychosis of ≤six months, and 43 age- and sex-matched controls. Individuals with FEP performed significantly poorer than controls in most cognitive domains (Cohen's d = 0.38 to 1.59). Groups were similar in metabolic health measures, excluding a significantly faster heart rate in FEP (d = 0.68). Through hierarchical regression analyses, we found that in the overall sample, BMI was negatively related to current IQ after controlling for education and group (FEP/control). Relationships between BMI and cognition were consistent across the FEP and healthy control groups. In FEP, current IQ and working memory were negatively correlated with lipid profiles. Findings suggest that in FEP, impaired cognition is exhibited earlier than physical health problems, and that compared to controls, similar relationships with cognition are demonstrated. Causal pathways and trajectories of relationships between health and cognition in FEP require investigation, especially as antipsychotic medications are introduced. The findings have implications for cognitive and health interventions.
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8
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Vohra J. Sudden Cardiac Death in Schizophrenia: A Review. Heart Lung Circ 2020; 29:1427-1432. [DOI: 10.1016/j.hlc.2020.07.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 07/16/2020] [Accepted: 07/20/2020] [Indexed: 01/08/2023]
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9
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Huang WC, Liu WS, Chen TT, Chen WH, Huang WL. Parasympathetic activity as a potential biomarker of negative symptoms in patients with schizophrenia. Asia Pac Psychiatry 2020; 12:e12392. [PMID: 32452616 DOI: 10.1111/appy.12392] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 03/26/2020] [Accepted: 04/22/2020] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Autonomic dysfunction in patients with schizophrenia has raised concern considering the higher cardiovascular mortality and morbidity rate. This phenomenon has been demonstrated using various measurements and is inferred to be associated with demographics, medical treatment, and psychopathology. However, few have targeted the role of negative symptoms within schizophrenia. METHODS Schizophrenia patients with stationary psychopathology were recruited from a chronic ward, a daycare center, and a nonintensive case management program. Demographic data, medication history, the Positive and Negative Syndrome Scale (PANSS) score, the Personal and Social Performance Scale (PSP) score, and the five-minute resting-state heart rate variability (HRV) were collected at trial initiation (Time 1) and a year later (Time 2). The relationships between variables and HRV indices were evaluated using correlation and regression analyses. RESULTS A total of 63 participants were recruited at Time 1, with 29 participants remaining at Time 2. Correlation analyses showed a negative correlation between the PANSS negative score (PANSS-N) and total power (TP), low-frequency power (LF), and high-frequency power (HF) at Time 1. The results were further examined with multiple linear regression analysis and remained significant between the PANSS-N score and HF (β = -0.306, P = .012). A generalized estimating equation model revealed the above negative association to be significant considering both timepoints. DISCUSSION The negative association between negative symptom severity and parasympathetic activity was significant, which may inspire further research into the corresponding treatment, the mechanisms, and the use of HRV as an applicable biomarker for treatment response.
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Affiliation(s)
- Wei-Chia Huang
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
| | - Wei-Shih Liu
- Department of Psychiatry, National Taiwan University Hospital, Yun-Lin Branch, Yunlin, Taiwan
| | - Tzu-Ting Chen
- Department of Psychiatry, National Taiwan University Hospital, Yun-Lin Branch, Yunlin, Taiwan
| | - Wen-Hao Chen
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
| | - Wei-Lieh Huang
- Department of Psychiatry, National Taiwan University Hospital, Yun-Lin Branch, Yunlin, Taiwan.,Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan
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10
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Abstract
PURPOSE OF REVIEW The current review examines the recent literature on the causes of premature mortality in schizophrenia. RECENT FINDINGS People with schizophrenia have higher premature mortality rates compared with the general population. Suicides and accidents account for a nontrivial part of the excess mortality, but the largest part is attributable to natural causes of death. Five major causes have been identified: first, adverse effects of medication; second, suboptimal lifestyle; third, somatic comorbidity; fourth, suboptimal treatment of somatic disorders; and fifth, accelerated ageing/genetic explanations. The positive aspect is that people with schizophrenia have increasing life expectancy, at least in high-income countries, and this development seems to largely follow the increase in the general population. Especially mortality rates from unnatural causes appear to have a positive impact. Nevertheless, despite more than 100 years of research and progress, the excess mortality in persons with schizophrenia remains unacceptably high, with no prospects of reaching the level in the general population. SUMMARY The excess mortality in schizophrenia has received much focus. Future studies should explore the reasons for the high rates of natural causes of death, while aiming to disentangle the complex interplay between medication, lifestyle, comorbidity, treatment of somatic disorders, and genetic effects.
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11
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Mohandoss AA, Thavarajah R. Salivary Flow Alteration in Patients Undergoing Treatment for Schizophrenia: Disease-Drug-Target Gene/Protein Association Study for Side-effects. J Oral Biol Craniofac Res 2019; 9:286-293. [PMID: 31289718 PMCID: PMC6593211 DOI: 10.1016/j.jobcr.2019.06.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 06/14/2019] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Salivary flow alteration (SA), is a known unwarranted effect of schizophrenic medications. It manifest either as reduced (xerostomia) or increased (sialorrhea) SA, among treated schizophrenic patients. It is believed that the SA is due to action of the drugs/disease process involving the muscarinic receptor-3 to process acetyl choline, the common neurotransmitter. The genetic mediation behind the SA in such patients remains largely unexplored. We aimed to address the same by using curated literary databases to identify such relationship, if any existed. MATERIAL AND METHODS Curated databases of Gene-Disease Association, www.DisGeNet.org and www.networkanalyst.ca were effectively used to identify the probable genes, strength of association and the drug-genes pathway that could be possibly be involved. The genes associated with schizophrenia and SA were analyzed in detail. Protein-Protein interaction (PPI) network proven experimentally in humans were used to identify the missing or unreported links. RESULTS In all 28 genes associated with schizophrenia were linked to SA. The genetic network of schizophrenia and xerostomia involved FGFR2 gene prominently and network module was statistically significant (P = 9.87*10-8) was achieved that had xerostomia as a node, while schizophrenia (P = 0.025) had statistical significance. Sialorrhea had no statistical significance (P = 0.555). When schizophrenia and sialorrhea connections were analyzed for genetic interaction, only gene GCH1 emerged. On combining the three disease entities, the association of TAC1 gene with sialorrhea was also identified. Using PPI, the coordination of CHRM3, TAC1 and GPRASP1 gene were identified. This network involved several genes that has significant influence on calcium signaling pathway (P = 7.74*10-16), cholingeric synapse(P = 6 × 10-4), salivary secretion(P = 4.38*10-3), endocytosis(P = 8.23*10-4), TGFβ signaling pathway(P = 0.0031), gap junction (P = 4.08*10-3) and glutamergic synapse(P = 6.4*10-3). The involvement of G-receptor signaling protein product, GNAQ was established. DISCUSSION AND CONCLUSION The possible genetic pathway of SA in schizophrenic patients are discussed in light of pharmacotherapeutics. Using the knowledge effectively would help to increase the quality of life of schizophrenic besides increasing the understanding to use saliva as a biomarker of prognosis of schizophrenia and its drug effects.
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Affiliation(s)
- Anusa Arunachalam Mohandoss
- Dept of Psychiatry, Shri Satya Sai Medical College and Research Institute, Affiliated to Shri Balaji Vidyapeeth, Ammapettai, Kanchipuram, India
| | - Rooban Thavarajah
- Marundeeshwara Oral Pathology Services and Analytics, B-1, Mistral Apartments, Wipro Street, Shollinganallur, Chennai, 600 119, India
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