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Psychopathological and demographic characteristics of hallucinating patients with schizophrenia and schizoaffective disorder: an analysis based on AMDP data. Eur Arch Psychiatry Clin Neurosci 2017; 267:295-301. [PMID: 27752826 DOI: 10.1007/s00406-016-0738-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 09/25/2016] [Indexed: 01/19/2023]
Abstract
Hallucinations are at the core of the diagnosis of schizophrenia and schizoaffective disorders, and many neuroscience studies focus on hallucinations. However, there is a lack of data on prevalence, subtyping, and clinical correlates of hallucinations as well as on the comparison of hallucinating schizophrenia versus hallucinating schizoaffective patients. Analysis of all psychopathology evaluations is based on the AMDP scale in a German psychiatric university hospital between 2007 and 2013 regarding patients with schizophrenia or schizoaffective disorder (diagnosed according to ICD-10). Hallucinating versus non-hallucinating patients and age- and gender-matched hallucinating schizophrenic versus schizoaffective patients were compared with regard to key psychopathological and demographic characteristics. Relative to patients with schizoaffective disorder, patients with schizophrenia more often hallucinated at admission (36.6 vs. 16.2 %, RR: 2.3, p < 0.001). By subtype, frequency of hallucinations ranked auditory verbal > other auditory > visual > somatic/tactile > olfactory/gustatory. Hallucinating patients of either disorder were more often affected with respect to delusions (83 vs. 62 % and 81 vs. 48 % among patients with schizophrenia and schizoaffective disorder, respectively [both p < 0.0001]) and anxiety. Hallucinating patients with schizoaffective disorder did not differ from hallucinating patients with schizophrenia. This is one of the few studies providing data on hallucinations in a routine clinical care setting. Hallucinations are a sign and likely a cause of greater illness severity. Patients with schizoaffective disorder less often experience hallucinations than patients with schizophrenia, but if they do, they seem to resemble patients with schizophrenia with regard to illness severity.
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Santelmann H, Franklin J, Bußhoff J, Baethge C. Diagnostic shift in patients diagnosed with schizoaffective disorder: a systematic review and meta-analysis of rediagnosis studies. Bipolar Disord 2016; 18:233-46. [PMID: 27226263 DOI: 10.1111/bdi.12388] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 03/09/2016] [Accepted: 04/09/2016] [Indexed: 01/15/2023]
Abstract
OBJECTIVES The diagnosis of schizoaffective disorder (SAD) is well established in clinical practice but is heavily disputed on theoretical grounds. We analyzed the extent and direction of diagnostic shift in SAD patients. METHODS We searched Medline, Embase, and PsycINFO systematically for all studies documenting two diagnostic assessments at different points in time (rediagnosis studies) and used meta-analytic methods to quantify diagnostic shift. Multiple prespecified and post-hoc subgroup analyses (e.g., rater blinding) and meta-regressions (e.g., year of publication) were carried out. RESULTS We included 31 studies out of 4,415 articles screened: 27 studies on the shift from and 23 studies on the shift to SAD (median time span was two years). A total of 36% of patients with a diagnosis of SAD at first assessment switch, many to schizophrenia (19%), 14% to affective disorders, and 6% to other disorders. Among patients diagnosed with SAD at second assessment, 55% had received a different diagnosis at first assessment, a large portion of whom had been initially diagnosed with affective disorder (24%), schizophrenia (18%), and other disorders (12%). CONCLUSIONS Diagnostic shift in SAD patients is substantial. Psychiatrists need to reassess the diagnosis during the course of the illness and to adjust treatment. Slightly more diagnoses of SAD are changed to schizophrenia than to affective disorders, and among patients rediagnosed with SAD, fewer have been diagnosed with schizophrenia than with affective disorders. Thus, at the diagnostic level, there seems to be a slight trend toward schizophrenia during the course of functional psychoses.
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Affiliation(s)
- Hanno Santelmann
- Department of Psychiatry and Psychotherapy, University of Cologne Medical School, Cologne, NRW, Germany
| | - Jeremy Franklin
- Institute of Medical Statistics, Informatics and Epidemiology, University of Cologne Medical School, Cologne, NRW, Germany
| | - Jana Bußhoff
- Department of Psychiatry and Psychotherapy, University of Cologne Medical School, Cologne, NRW, Germany
| | - Christopher Baethge
- Department of Psychiatry and Psychotherapy, University of Cologne Medical School, Cologne, NRW, Germany
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Rink L, Pagel T, Franklin J, Baethge C. Characteristics and heterogeneity of schizoaffective disorder compared with unipolar depression and schizophrenia - a systematic literature review and meta-analysis. J Affect Disord 2016; 191:8-14. [PMID: 26599364 DOI: 10.1016/j.jad.2015.10.045] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Revised: 10/25/2015] [Accepted: 10/27/2015] [Indexed: 01/26/2023]
Abstract
BACKGROUND Comparisons of illness characteristics between patients with schizoaffective disorder (SAD) patients and unipolar depression (UD) are rare, even though UD is one of the most important differential diagnoses of SAD. Also, the variability of illness characteristics (heterogeneity) has not been compared. We compared illness characteristics and their heterogeneity among SAD, UD, and - as another important differential diagnosis - schizophrenia (S). METHODS In order to reduce sampling bias we systematically searched for studies simultaneously comparing samples of patients with SAD, UD, and S. Using random effects and Mantel-Haenszel models we estimated and compared demographic, illness course and psychopathology parameters, using pooled standard deviations as a measurement of heterogeneity. RESULTS Out of 155 articles found by an earlier meta-analysis, 765 screened in Medline, 2738 screened in EMBASE, and 855 screened in PsycINFO we selected 24 studies, covering 3714 patients diagnosed according to RDC, DSM-III, DSM-IIIR, DSM-IV, or ICD-10. In almost all key characteristics, samples with schizoaffective disorders fell between unipolar depression and schizophrenia, with a tendency towards schizophrenia. On average, UD patients were significantly older at illness onset (33.0 years, SAD: 25.2, S: 23.4), more often women (59% vs. 57% vs. 39%) and more often married (53% vs. 39% vs. 27%). Their psychopathology was also less severe, as measured by BPRS, GAS, and HAMD. In demographic and clinical variables heterogeneity was roughly 5% larger in UD than in SAD, and samples of patients with schizophrenia had the lowest pooled heterogeneity. A similar picture emerged in a sensitivity analysis with coefficient of variation as the measurement of heterogeneity. LIMITATIONS Relative to bipolar disorder there are fewer studies including unipolar patients. No studies based on DSM-5 could be included. CONCLUSIONS Regarding unipolar affective disorder this study confirms what we have shown for bipolar disorders in earlier studies: schizoaffective disorder falls between schizophrenia and affective disorders, and there are relevant quantitative differences in key illness characteristics, which supports the validity of the schizoaffective disorder concept. Contrary to our expectations heterogeneity is not larger in SAD than in UD and not substantially higher than in S. Lower reliability of the diagnosis of SAD therefore cannot be ascribed to higher variability of illness characteristics in SAD.
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Affiliation(s)
- Lena Rink
- University of Cologne Medical School, Germany
| | - Tobias Pagel
- Department of Internal Medicine, St. Hildegardis Hospital, Germany
| | - Jeremy Franklin
- Institute of Medical Statistics, Informatics, and Epidemiology, University of Cologne Medical School, Germany
| | - Christopher Baethge
- Department of Psychiatry and Psychiatry, University of Cologne Medical School Cologne, Germany.
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Tondo L, Vázquez GH, Baethge C, Baronessa C, Bolzani L, Koukopoulos A, Mazzarini L, Murru A, Pacchiarotti I, Pinna M, Salvatore P, Sani G, Selle V, Spalletta G, Girardi P, Tohen M, Vieta E, Baldessarini RJ. Comparison of psychotic bipolar disorder, schizoaffective disorder, and schizophrenia: an international, multisite study. Acta Psychiatr Scand 2016; 133:34-43. [PMID: 26096273 DOI: 10.1111/acps.12447] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/30/2015] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Nosological distinctions among schizoaffective disorder (SA), bipolar I disorder with psychotic features (BDp), and schizophrenia (SZ) remain unresolved. METHOD We compared 2269 subjects with psychotic features in DSM-IV-TR diagnoses (1435 BDp, 463 SZ, 371 SA) from 8 collaborating international sites, by 12 sociodemographic and clinical measures, all between diagnostic pairs. RESULTS In bivariate comparisons, SA was consistently intermediate between BDp and SZ for 11/12 features (except onset stressors), and SZ vs. BDp differed in all 12 factors. SA differed from both BDp and SZ in 9/12 factors: SA and BDp were similar in education and suicidal ideation or acts; SA and SZ were similar in education, onset stressors, and substance abuse. Meta-analytic comparisons of diagnostic pairs for 10 categorical factors indicated similar differences of SA from both SZ and BDp. Multivariate modeling indicated significantly independent differences between BDp and SZ (8 factors), SA vs. SZ (5), and BDp vs. SA (3). Measurement variance was similar for all diagnoses. CONCLUSION SA was consistently intermediate between BDp and SZ. The three diagnostic groups ranked: BDp > SA > SZ related to lesser morbidity or disability. The findings are not consistent with a dyadic Kraepelinian categorization, although the considerable overlap among the three DSM-IV diagnostic groups indicates uncertain boundaries if they represent distinct disorders.
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Affiliation(s)
- L Tondo
- Department of Psychiatry, Harvard Medical School, International Consortium for Bipolar & Psychotic Disorder Research, Boston, MA, USA.,Lucio Bini Mood Disorder Center, Cagliari, Italy
| | - G H Vázquez
- Department of Psychiatry, Harvard Medical School, International Consortium for Bipolar & Psychotic Disorder Research, Boston, MA, USA.,Department of Neuroscience, Palermo University, Buenos Aires, Argentina
| | - C Baethge
- Department of Psychiatry, University of Köln, Köln, Germany
| | - C Baronessa
- Viarnetto Psychiatric Clinic, Lugano, Switzerland
| | - L Bolzani
- Viarnetto Psychiatric Clinic, Lugano, Switzerland
| | - A Koukopoulos
- NeSMOS Department, Sant'Andrea Medical Center, University of Rome (Sapienza), Rome, Italy.,Lucio Bini Mood Disorder Center, Rome, Italy
| | - L Mazzarini
- NeSMOS Department, Sant'Andrea Medical Center, University of Rome (Sapienza), Rome, Italy
| | - A Murru
- Bipolar Disorders Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - I Pacchiarotti
- Bipolar Disorders Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - M Pinna
- Lucio Bini Mood Disorder Center, Cagliari, Italy
| | - P Salvatore
- Department of Psychiatry, Harvard Medical School, International Consortium for Bipolar & Psychotic Disorder Research, Boston, MA, USA.,Section of Psychiatry, Department of Neuroscience, University of Parma, Parma, Italy
| | - G Sani
- NeSMOS Department, Sant'Andrea Medical Center, University of Rome (Sapienza), Rome, Italy.,Lucio Bini Mood Disorder Center, Rome, Italy
| | - V Selle
- Viarnetto Psychiatric Clinic, Lugano, Switzerland
| | - G Spalletta
- Neuropsychiatry Laboratory, Department of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, Rome, Italy.,Beth K. and Stuart C. Yudofsky Division of Neuropsychiatry, Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - P Girardi
- NeSMOS Department, Sant'Andrea Medical Center, University of Rome (Sapienza), Rome, Italy.,Lucio Bini Mood Disorder Center, Rome, Italy
| | - M Tohen
- Department of Psychiatry, University of New Mexico, Albuquerque, NM, USA
| | - E Vieta
- Bipolar Disorders Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - R J Baldessarini
- Department of Psychiatry, Harvard Medical School, International Consortium for Bipolar & Psychotic Disorder Research, Boston, MA, USA
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Santelmann H, Franklin J, Bußhoff J, Baethge C. Test-retest reliability of schizoaffective disorder compared with schizophrenia, bipolar disorder, and unipolar depression--a systematic review and meta-analysis. Bipolar Disord 2015; 17:753-68. [PMID: 26498139 DOI: 10.1111/bdi.12340] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 09/05/2015] [Indexed: 01/21/2023]
Abstract
OBJECTIVES Schizoaffective disorder is a frequent diagnosis, and its reliability is subject to ongoing discussion. We compared the diagnostic reliability of schizoaffective disorder with its main differential diagnoses. METHODS We systematically searched Medline, Embase, and PsycInfo for all studies on the test-retest reliability of the diagnosis of schizoaffective disorder as compared with schizophrenia, bipolar disorder, and unipolar depression. We used meta-analytic methods to describe and compare Cohen's kappa as well as positive and negative agreement. In addition, multiple pre-specified and post hoc subgroup and sensitivity analyses were carried out. RESULTS Out of 4,415 studies screened, 49 studies were included. Test-retest reliability of schizoaffective disorder was consistently lower than that of schizophrenia (in 39 out of 42 studies), bipolar disorder (27/33), and unipolar depression (29/35). The mean difference in kappa between schizoaffective disorder and the other diagnoses was approximately 0.2, and mean Cohen's kappa for schizoaffective disorder was 0.50 (95% confidence interval: 0.40-0.59). While findings were unequivocal and homogeneous for schizoaffective disorder's diagnostic reliability relative to its three main differential diagnoses (dichotomous: smaller versus larger), heterogeneity was substantial for continuous measures, even after subgroup and sensitivity analyses. CONCLUSIONS In clinical practice and research, schizoaffective disorder's comparatively low diagnostic reliability should lead to increased efforts to correctly diagnose the disorder.
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Affiliation(s)
- Hanno Santelmann
- Department of Psychiatry and Psychotherapy, University of Cologne Medical School, Cologne, NRW, Germany
| | - Jeremy Franklin
- Institute of Medical Statistics, Informatics and Epidemiology, University of Cologne Medical School, Cologne, NRW, Germany
| | - Jana Bußhoff
- Department of Psychiatry and Psychotherapy, University of Cologne Medical School, Cologne, NRW, Germany
| | - Christopher Baethge
- Department of Psychiatry and Psychotherapy, University of Cologne Medical School, Cologne, NRW, Germany
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Taylor CL, Stewart R, Ogden J, Broadbent M, Pasupathy D, Howard LM. The characteristics and health needs of pregnant women with schizophrenia compared with bipolar disorder and affective psychoses. BMC Psychiatry 2015; 15:88. [PMID: 25886140 PMCID: PMC4406022 DOI: 10.1186/s12888-015-0451-8] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 03/19/2015] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Most women with psychotic disorders and bipolar disorders have children but their pregnancies are at risk of adverse psychiatric and fetal outcome. The extent of modifiable risk factors - both clinical and socio-demographic - is unclear as most studies have used administrative data or recruited from specialist tertiary referral clinics. We therefore aimed to investigate the socio-demographic and clinical characteristics of an epidemiologically representative cohort of pregnant women with affective and non-affective severe mental illness. METHODS Women with severe mental illness were identified from a large electronic mental health case register in south London, and a data linkage with national maternity Hospital Episode Statistics identified pregnancies in 2007-2011. Data were extracted using structured fields, text searching and natural language processing applications. RESULTS Of 456 pregnant women identified, 236 (51.7%) had schizophrenia and related disorders, 220 (48.3%) had affective psychosis or bipolar disorder. Women with schizophrenia and related disorders were younger, less likely to have a partner in pregnancy, more likely to be black, to smoke or misuse substances and had significantly more time in the two years before pregnancy in acute care (inpatient or intensive home treatment) compared with women with affective disorders. Both groups had high levels of domestic abuse in pregnancy (recorded in 18.9%), were from relatively deprived backgrounds and had impaired functioning measured by the Health of the Nation Outcome Scale. Women in the affective group were more likely to stop medication in the first trimester (39% versus 25%) whereas women with non-affective psychoses were more likely to switch medication. CONCLUSIONS A significant proportion of women, particularly those with non-affective psychoses, have modifiable risk factors requiring tailored care to optimize pregnancy outcomes. Mental health professionals need to be mindful of the possibility of pregnancy in women of childbearing age and prescribe and address modifiable risk factors accordingly.
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Affiliation(s)
- Clare L Taylor
- Section of Women's Mental Health/Women's Health Academic Centre, Department of Health Service and Population Research, King's College London, Institute of Psychiatry, London, UK.
| | - Robert Stewart
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, London, UK.
| | - Jack Ogden
- Section of Women's Mental Health/Women's Health Academic Centre, Department of Health Service and Population Research, King's College London, Institute of Psychiatry, London, UK.
| | | | | | - Louise M Howard
- Section of Women's Mental Health/Women's Health Academic Centre, Department of Health Service and Population Research, King's College London, Institute of Psychiatry, London, UK.
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Laidi C, d’Albis MA, Wessa M, Linke J, Phillips M, Delavest M, Bellivier F, Versace A, Almeida J, Sarrazin S, Poupon C, Le Dudal K, Daban C, Hamdani N, Leboyer M, Houenou J. Cerebellar volume in schizophrenia and bipolar I disorder with and without psychotic features. Acta Psychiatr Scand 2015; 131:223-33. [PMID: 25430729 PMCID: PMC4329064 DOI: 10.1111/acps.12363] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/13/2014] [Indexed: 01/28/2023]
Abstract
OBJECTIVE There is growing evidence that cerebellum plays a crucial role in cognition and emotional regulation. Cerebellum is likely to be involved in the physiopathology of both bipolar disorder and schizophrenia. The objective of our study was to compare cerebellar size between patients with bipolar disorder, patients with schizophrenia, and healthy controls in a multicenter sample. In addition, we studied the influence of psychotic features on cerebellar size in patients with bipolar disorder. METHOD One hundred and fifteen patients with bipolar I disorder, 32 patients with schizophrenia, and 52 healthy controls underwent 3 Tesla MRI. Automated segmentation of cerebellum was performed using FreeSurfer software. Volumes of cerebellar cortex and white matter were extracted. Analyses of covariance were conducted, and age, sex, and intracranial volume were considered as covariates. RESULTS Bilateral cerebellar cortical volumes were smaller in patients with schizophrenia compared with patients with bipolar I disorder and healthy controls. We found no significant difference of cerebellar volume between bipolar patients with and without psychotic features. No change was evidenced in white matter. CONCLUSION Our results suggest that reduction in cerebellar cortical volume is specific to schizophrenia. Cerebellar dysfunction in bipolar disorder, if present, appears to be more subtle than a reduction in cerebellar volume.
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Affiliation(s)
- Charles Laidi
- AP-HP, Hôpital H. Mondor - A. Chenevier, Pôle de Psychiatrie, Créteil, France,INSERM, U955, IMRB, Psychiatrie Génétique, Créteil, France,Faculté de médecine, Université Paris Est, Créteil, France,Fondation Fondamental, Créteil, France,UNIACT, Neurospin, I2BM, CEA Saclay, Gif sur Yvette, France
| | - Marc-Antoine d’Albis
- AP-HP, Hôpital H. Mondor - A. Chenevier, Pôle de Psychiatrie, Créteil, France,INSERM, U955, IMRB, Psychiatrie Génétique, Créteil, France,Faculté de médecine, Université Paris Est, Créteil, France,Fondation Fondamental, Créteil, France,UNIACT, Neurospin, I2BM, CEA Saclay, Gif sur Yvette, France
| | - Michèle Wessa
- Section for Experimental Psychopathology and Neuroimaging, Department of General Psychiatry, Center For Psychosocial Medicine, Heidelberg University, Heidelberg, Germany
| | - Julia Linke
- Section for Experimental Psychopathology and Neuroimaging, Department of General Psychiatry, Center For Psychosocial Medicine, Heidelberg University, Heidelberg, Germany
| | - Mary Phillips
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Marine Delavest
- Fondation Fondamental, Créteil, France,AP-HP, Groupe Saint-Louis, Lariboisière-Fernand Widal, Pôle Neurosciences, Paris, France
| | - Frank Bellivier
- Fondation Fondamental, Créteil, France,AP-HP, Groupe Saint-Louis, Lariboisière-Fernand Widal, Pôle Neurosciences, Paris, France
| | - Amelia Versace
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jorge Almeida
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Samuel Sarrazin
- AP-HP, Hôpital H. Mondor - A. Chenevier, Pôle de Psychiatrie, Créteil, France,INSERM, U955, IMRB, Psychiatrie Génétique, Créteil, France,Faculté de médecine, Université Paris Est, Créteil, France,Fondation Fondamental, Créteil, France,UNIACT, Neurospin, I2BM, CEA Saclay, Gif sur Yvette, France
| | - Cyril Poupon
- UNIRS, Neurospin, I2BM, CEA Saclay, Gif-Sur-Yvette, France
| | - Katia Le Dudal
- Centre d’Investigation Clinique 1430 et Plateforme de Ressources Biologiques, Hôpital Henri Mondor, Créteil, France
| | - Claire Daban
- AP-HP, Hôpital H. Mondor - A. Chenevier, Pôle de Psychiatrie, Créteil, France,INSERM, U955, IMRB, Psychiatrie Génétique, Créteil, France,Fondation Fondamental, Créteil, France
| | - Nora Hamdani
- AP-HP, Hôpital H. Mondor - A. Chenevier, Pôle de Psychiatrie, Créteil, France,INSERM, U955, IMRB, Psychiatrie Génétique, Créteil, France,Fondation Fondamental, Créteil, France
| | - Marion Leboyer
- AP-HP, Hôpital H. Mondor - A. Chenevier, Pôle de Psychiatrie, Créteil, France,INSERM, U955, IMRB, Psychiatrie Génétique, Créteil, France,Faculté de médecine, Université Paris Est, Créteil, France,Fondation Fondamental, Créteil, France
| | - Josselin Houenou
- AP-HP, Hôpital H. Mondor - A. Chenevier, Pôle de Psychiatrie, Créteil, France,INSERM, U955, IMRB, Psychiatrie Génétique, Créteil, France,Fondation Fondamental, Créteil, France,UNIACT, Neurospin, I2BM, CEA Saclay, Gif sur Yvette, France,*Corresponding author: Josselin Houenou, MD, PhD, INSERM U955, Pôle de psychiatrie, Hôpitaux Universitaires Mondor, 40 rue de Mesly 94000 Créteil France, Phone: +33 1 49 81 30 51, Fax: +33 1 49 81 30 59,
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