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Martínez-Cao C, Sánchez-Lasheras F, García-Fernández A, González-Blanco L, Zurrón-Madera P, Sáiz PA, Bobes J, García-Portilla MP. PsiOvi Staging Model for Schizophrenia (PsiOvi SMS): A New Internet Tool for Staging Patients with Schizophrenia. Eur Psychiatry 2024; 67:e36. [PMID: 38599765 PMCID: PMC11059252 DOI: 10.1192/j.eurpsy.2024.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 01/22/2024] [Accepted: 01/31/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND One of the challenges of psychiatry is the staging of patients, especially those with severe mental disorders. Therefore, we aim to develop an empirical staging model for schizophrenia. METHODS Data were obtained from 212 stable outpatients with schizophrenia: demographic, clinical, psychometric (PANSS, CAINS, CDSS, OSQ, CGI-S, PSP, MATRICS), inflammatory peripheral blood markers (C-reactive protein, interleukins-1RA and 6, and platelet/lymphocyte [PLR], neutrophil/lymphocyte [NLR], and monocyte/lymphocyte [MLR] ratios). We used machine learning techniques to develop the model (genetic algorithms, support vector machines) and applied a fitness function to measure the model's accuracy (% agreement between patient classification of our model and the CGI-S). RESULTS Our model includes 12 variables from 5 dimensions: 1) psychopathology: positive, negative, depressive, general psychopathology symptoms; 2) clinical features: number of hospitalizations; 3) cognition: processing speed, visual learning, social cognition; 4) biomarkers: PLR, NLR, MLR; and 5) functioning: PSP total score. Accuracy was 62% (SD = 5.3), and sensitivity values were appropriate for mild, moderate, and marked severity (from 0.62106 to 0.6728). DISCUSSION We present a multidimensional, accessible, and easy-to-apply model that goes beyond simply categorizing patients according to CGI-S score. It provides clinicians with a multifaceted patient profile that facilitates the design of personalized intervention plans.
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Affiliation(s)
- Clara Martínez-Cao
- Department of Psychiatry, University of Oviedo, Oviedo, Spain
- Health Research Institute of the Principality of Asturias (ISPA), Oviedo, Spain
- Institute of Neurosciences of the Principality of Asturias (INEUROPA), University of Oviedo, Oviedo, Spain
| | - Fernando Sánchez-Lasheras
- Department of Mathematics, University of Oviedo, Oviedo, Spain
- Institute of Space Sciences and Technologies of Asturias (ICTEA), University of Oviedo, Oviedo, Spain
| | - Ainoa García-Fernández
- Department of Psychiatry, University of Oviedo, Oviedo, Spain
- Health Research Institute of the Principality of Asturias (ISPA), Oviedo, Spain
- Institute of Neurosciences of the Principality of Asturias (INEUROPA), University of Oviedo, Oviedo, Spain
| | - Leticia González-Blanco
- Department of Psychiatry, University of Oviedo, Oviedo, Spain
- Health Research Institute of the Principality of Asturias (ISPA), Oviedo, Spain
- Institute of Neurosciences of the Principality of Asturias (INEUROPA), University of Oviedo, Oviedo, Spain
- Health Service of the Principality of Asturias (SESPA), Oviedo, Spain
- Centro de Investigación Biomédica en Red, Salud Mental (CIBERSAM), Madrid, Spain
| | - Paula Zurrón-Madera
- Department of Psychiatry, University of Oviedo, Oviedo, Spain
- Health Research Institute of the Principality of Asturias (ISPA), Oviedo, Spain
- Institute of Neurosciences of the Principality of Asturias (INEUROPA), University of Oviedo, Oviedo, Spain
- Health Service of the Principality of Asturias (SESPA), Oviedo, Spain
| | - Pilar A. Sáiz
- Department of Psychiatry, University of Oviedo, Oviedo, Spain
- Health Research Institute of the Principality of Asturias (ISPA), Oviedo, Spain
- Institute of Neurosciences of the Principality of Asturias (INEUROPA), University of Oviedo, Oviedo, Spain
- Health Service of the Principality of Asturias (SESPA), Oviedo, Spain
- Centro de Investigación Biomédica en Red, Salud Mental (CIBERSAM), Madrid, Spain
| | - Julio Bobes
- Department of Psychiatry, University of Oviedo, Oviedo, Spain
- Health Research Institute of the Principality of Asturias (ISPA), Oviedo, Spain
- Institute of Neurosciences of the Principality of Asturias (INEUROPA), University of Oviedo, Oviedo, Spain
- Health Service of the Principality of Asturias (SESPA), Oviedo, Spain
- Centro de Investigación Biomédica en Red, Salud Mental (CIBERSAM), Madrid, Spain
| | - María Paz García-Portilla
- Department of Psychiatry, University of Oviedo, Oviedo, Spain
- Health Research Institute of the Principality of Asturias (ISPA), Oviedo, Spain
- Institute of Neurosciences of the Principality of Asturias (INEUROPA), University of Oviedo, Oviedo, Spain
- Health Service of the Principality of Asturias (SESPA), Oviedo, Spain
- Centro de Investigación Biomédica en Red, Salud Mental (CIBERSAM), Madrid, Spain
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2
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Korchia T, Tastevin M, Sunhary de Verville PL, Joober R, Andrieu-Haller C, Faugere M, Godin O, Etchecopar-Etchart D, Berna F, Aouizerate B, Capdevielle D, Chereau I, Clauss-Kobayashi J, Coulon N, Dorey JM, Dubertret C, Dubreucq J, Mallet J, Misdrahi D, Passerieux C, Rey R, Schürhoff F, Szoke A, Urbach M, Leboyer M, Llorca PM, Lançon C, Richieri R, Boyer L, Fond G. Precision-medicine findings from the FACE-SZ cohort to develop motivation-enhancing programs in real-world schizophrenia. World J Biol Psychiatry 2022; 23:703-714. [PMID: 35057713 DOI: 10.1080/15622975.2022.2031286] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND In people with schizophrenia, major areas of everyday life are impaired, including independent living, productive activities, social relationships and overall quality of life. Enhanced understanding of factors that hinder real-life functioning is vital for treatments to translate into more positive outcomes. AIM The goal of the present study was to identify factors associated with motivation deficits in real-life schizophrenia, and to assess its contribution to impaired functioning and quality of life. METHODS Based on previous literature and clinical experience, several factors were selected and grouped into factors potentially explaining motivation deficits. Some of these variables were never investigated before in relationship with motivation deficits. RESULTS In 561 patients with schizophrenia of the national FACE-SZ cohort living in the community, 235 (41.9%) reported severe motivation deficits. These deficits were found to be significantly associated with impaired socially useful activities, psychological and physical quality of life (in almost all domains), alcohol use disorder (aOR = 2.141, p = 0.021), severe nicotine dependence (aOR = 2.906, p < 0.001) independently of age and sex. No significant association was found for body mass index, metabolic syndrome or physical activity level. In the second model, we identified the following modifiable factors associated with motivation deficits: history of suicide attempt (aOR = 2.297, p = 0.001), positive symptoms (aOR = 1.052, p = 0.006), current major depressive episode (aOR = 2.627, p < 0.001), sleep disorders (aOR = 1.474, p = 0.024) and lower medication adherence (aOR = 0.836, p = 0.001) independently of gender, current alcohol use disorder, second-generation antipsychotics and akathisia. No significant association was found for negative symptoms, childhood trauma and inflammation. These results were maintained after removing patients with schizoaffective disorders or those with major depressive disorder. INTERPRETATION Motivation deficits are frequent and remain persistent unmet need in real-world schizophrenia that should be addressed in future guidelines. Based on our results, literature and clinical experience, we recommend to address in priority major depression, sleep, suicide, positive symptoms (when present and as early as possible) and medication adherence to improve motivation deficits of schizophrenia.
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Affiliation(s)
- Théo Korchia
- Fondation FondaMental, Créteil, France.,Secteur Timone, EA 327, Faculté de Médecine, CEReSS-Centre d'Etude et de Recherche sur les Services de Santé et la Qualité de vie, AP-HM, Aix-Marseille Université, Marseille, France
| | - Maud Tastevin
- Fondation FondaMental, Créteil, France.,Secteur Timone, EA 327, Faculté de Médecine, CEReSS-Centre d'Etude et de Recherche sur les Services de Santé et la Qualité de vie, AP-HM, Aix-Marseille Université, Marseille, France
| | - Pierre-Louis Sunhary de Verville
- Secteur Timone, EA 327, Faculté de Médecine, CEReSS-Centre d'Etude et de Recherche sur les Services de Santé et la Qualité de vie, AP-HM, Aix-Marseille Université, Marseille, France
| | - Ridha Joober
- Prevention and Early Intervention Program for Psychosis (PEPP-Montréal), Department of Psychiatry, Douglas Mental Health University Institute, McGill University, Montréal, Canada
| | - Christelle Andrieu-Haller
- Fondation FondaMental, Créteil, France.,Secteur Timone, EA 327, Faculté de Médecine, CEReSS-Centre d'Etude et de Recherche sur les Services de Santé et la Qualité de vie, AP-HM, Aix-Marseille Université, Marseille, France
| | - Mélanie Faugere
- Fondation FondaMental, Créteil, France.,Secteur Timone, EA 327, Faculté de Médecine, CEReSS-Centre d'Etude et de Recherche sur les Services de Santé et la Qualité de vie, AP-HM, Aix-Marseille Université, Marseille, France
| | | | - Damien Etchecopar-Etchart
- Fondation FondaMental, Créteil, France.,Secteur Timone, EA 327, Faculté de Médecine, CEReSS-Centre d'Etude et de Recherche sur les Services de Santé et la Qualité de vie, AP-HM, Aix-Marseille Université, Marseille, France
| | - Fabrice Berna
- Fondation FondaMental, Créteil, France.,INSERM U1114, Fédération de Médecine Translationnelle de Strasbourg, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Bruno Aouizerate
- Fondation FondaMental, Créteil, France.,Centre Hospitalier Charles Perrens, F-33076 Université de Bordeaux, CNRS UMR 5287-INCIA, Pôle de psychiatrie Générale et Universitaire, Bordeaux, France.,INRA, NutriNeuro, University of Bordeaux, Bordeaux, France
| | - Delphine Capdevielle
- Fondation FondaMental, Créteil, France.,Service Universitaire de Psychiatrie Adulte, Hôpital la Colombière, CHRU Montpellier, IGF, CNRS, INSERM, Université Montpellier, Montpellier, France
| | - Isabelle Chereau
- Fondation FondaMental, Créteil, France.,CMP-B, CHU, CNRS, Clermont Auvergne INP, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Julie Clauss-Kobayashi
- Fondation FondaMental, Créteil, France.,INSERM U1114, Fédération de Médecine Translationnelle de Strasbourg, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Nathalie Coulon
- Fondation FondaMental, Créteil, France.,Centre Référent de Réhabilitation Psychosociale, CH Alpes Isère, Grenoble, France
| | - Jean-Michel Dorey
- Fondation FondaMental, Créteil, France.,INSERM U1028, CNRS UMR5292, Centre de Recherche en Neurosciences de Lyon, Université Claude Bernard Lyon 1, Bron Cedex, France
| | - Caroline Dubertret
- Fondation FondaMental, Créteil, France.,Department of Psychiatry, Louis Mourier Hospital, Université de Paris, AP-HP, Colombes, Paris, France
| | - Julien Dubreucq
- Fondation FondaMental, Créteil, France.,Centre Référent de Réhabilitation Psychosociale, CH Alpes Isère, Grenoble, France
| | - Jasmina Mallet
- Fondation FondaMental, Créteil, France.,Department of Psychiatry, Louis Mourier Hospital, Université de Paris, AP-HP, Colombes, Paris, France
| | - David Misdrahi
- Fondation FondaMental, Créteil, France.,Centre Hospitalier Charles Perrens, F-33076 Université de Bordeaux, CNRS UMR 5287-INCIA, Pôle de psychiatrie Générale et Universitaire, Bordeaux, France.,CNRS UMR 5287-INCIA, Université de Bordeaux, Bordeaux, France
| | - Christine Passerieux
- Fondation FondaMental, Créteil, France.,Centre Hospitalier de Versailles, Service Universitaire de Psychiatrie d'Adultes et d'Addictologie, Le Chesnay, France.,DisAP-DevPsy-CESP, INSERM UMR1018, Université Paris-Saclay, Villejuif, France
| | - Romain Rey
- Fondation FondaMental, Créteil, France.,INSERM U1028, CNRS UMR5292, Centre de Recherche en Neurosciences de Lyon, Université Claude Bernard Lyon 1, Bron Cedex, France
| | - Frank Schürhoff
- Fondation FondaMental, Créteil, France.,Hôpitaux Universitaires « H. Mondor », DMU IMPACT, INSERM, IMRB, translational Neuropsychiatry, Fondation FondaMental, Université Paris Est Creteil (UPEC), AP-HP, Creteil, France
| | - Andrei Szoke
- Fondation FondaMental, Créteil, France.,Hôpitaux Universitaires « H. Mondor », DMU IMPACT, INSERM, IMRB, translational Neuropsychiatry, Fondation FondaMental, Université Paris Est Creteil (UPEC), AP-HP, Creteil, France
| | - Mathieu Urbach
- Fondation FondaMental, Créteil, France.,Centre Hospitalier de Versailles, Service Universitaire de Psychiatrie d'Adultes et d'Addictologie, Le Chesnay, France.,DisAP-DevPsy-CESP, INSERM UMR1018, Université Paris-Saclay, Villejuif, France
| | - Marion Leboyer
- Fondation FondaMental, Créteil, France.,Hôpitaux Universitaires « H. Mondor », DMU IMPACT, INSERM, IMRB, translational Neuropsychiatry, Fondation FondaMental, Université Paris Est Creteil (UPEC), AP-HP, Creteil, France
| | - Pierre-Michel Llorca
- Fondation FondaMental, Créteil, France.,CMP-B, CHU, CNRS, Clermont Auvergne INP, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Christophe Lançon
- Fondation FondaMental, Créteil, France.,Secteur Timone, EA 327, Faculté de Médecine, CEReSS-Centre d'Etude et de Recherche sur les Services de Santé et la Qualité de vie, AP-HM, Aix-Marseille Université, Marseille, France
| | - Raphaelle Richieri
- Fondation FondaMental, Créteil, France.,Secteur Timone, EA 327, Faculté de Médecine, CEReSS-Centre d'Etude et de Recherche sur les Services de Santé et la Qualité de vie, AP-HM, Aix-Marseille Université, Marseille, France
| | - Laurent Boyer
- Fondation FondaMental, Créteil, France.,Secteur Timone, EA 327, Faculté de Médecine, CEReSS-Centre d'Etude et de Recherche sur les Services de Santé et la Qualité de vie, AP-HM, Aix-Marseille Université, Marseille, France
| | - Guillaume Fond
- Fondation FondaMental, Créteil, France.,Secteur Timone, EA 327, Faculté de Médecine, CEReSS-Centre d'Etude et de Recherche sur les Services de Santé et la Qualité de vie, AP-HM, Aix-Marseille Université, Marseille, France
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3
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Byrne JF, Healy C, Mongan D, Susai SR, Zammit S, Fӧcking M, Cannon M, Cotter DR. Transdiagnostic inflammatory subgroups among psychiatric disorders and their relevance to role functioning: a nested case-control study of the ALSPAC cohort. Transl Psychiatry 2022; 12:377. [PMID: 36085284 PMCID: PMC9463145 DOI: 10.1038/s41398-022-02142-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 08/22/2022] [Accepted: 08/25/2022] [Indexed: 11/29/2022] Open
Abstract
Individuals with psychotic disorders and depressive disorder exhibit altered concentrations of peripheral inflammatory markers. It has been suggested that clinical trials of anti-inflammatory therapies for psychiatric disorders should stratify patients by their inflammatory profile. Hence, we investigated whether different subgroups of individuals exist across psychiatric disorders, based on their inflammatory biomarker signatures. We measured the plasma concentrations of 17 inflammatory markers and receptors in 380 participants with psychotic disorder, depressive disorder or generalised anxiety disorder and 399 controls without psychiatric symptoms from the ALSPAC cohort at age 24. We employed a semi-supervised clustering algorithm, which discriminates multiple clusters of psychiatric disorder cases from controls. The best fit was for a two-cluster model of participants with psychiatric disorders (Adjusted Rand Index (ARI) = 0.52 ± 0.01) based on the inflammatory markers. Permutation analysis indicated the stability of the clustering solution performed better than chance (ARI = 0.43 ± 0.11; p < 0.001), and the clusters explained the inflammatory marker data better than a Gaussian distribution (p = 0.021). Cluster 2 exhibited marked increases in sTNFR1/2, suPAR, sCD93 and sIL-2RA, compared to cluster 1. Participants in the cluster exhibiting higher inflammation were less likely to be in employment, education or training, indicating poorer role functioning. This study found evidence for a novel pattern of inflammatory markers specific to psychiatric disorders and strongly associated with a transdiagnostic measure of illness severity. sTNFR1/2, suPAR, sCD93 and sIL-2RA could be used to stratify clinical trials of anti-inflammatory therapies for psychiatric disorders.
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Affiliation(s)
- Jonah F Byrne
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland.
- SFI FutureNeuro Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland.
| | - Colm Healy
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - David Mongan
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Subash Raj Susai
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Stan Zammit
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Melanie Fӧcking
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland
- SFI FutureNeuro Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Mary Cannon
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland
- SFI FutureNeuro Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - David R Cotter
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland
- SFI FutureNeuro Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
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4
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Ozdamar Unal G, Hekimler Ozturk K, Inci HE. Increased NLRP3 inflammasome expression in peripheral blood mononuclear cells of patients with schizophrenia: a case-control study. Int J Psychiatry Clin Pract 2022:1-7. [PMID: 35938405 DOI: 10.1080/13651501.2022.2106245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
OBJECTIVE This study aimed to evaluate the gene expression of the P2X purinoceptor 7 (P2X7R)- nod-like receptor pyrin domain-containing protein 3 (NLRP3) signal pathway in peripheral blood mononuclear cells (PBMCs) between schizophrenia (SCZ) patients and healthy controls (HC) to reveal its relationship with clinical variables. METHODS Thirty-two SCZ patients and 41 healthy controls were included in this study. The Scale for the Assessment of Positive Symptoms (SAPS) and the Scale for the Assessment of Negative Symptoms (SANS), The Global Assessment of Functioning (GAF) scale and the Functioning Assessment Short Test (FAST) scales were applied. P2X7R, NLRP3, IL-1β and IL-18 gene expression levels were evaluated by real-time polymerase chain reaction in PBMCs. RESULTS NLRP3, P2RX7, IL-1β and IL-18 expression levels were significantly higher in PBMCs of SCZ patients than in HC subjects. Negative correlations were found between NLRP3 gene expression levels and GAF and FAST scales scores. There was a negative correlation between IL-18 expression levels and the GAF and FAST scales scores and a positive correlation with the SAPS scale scores. CONCLUSIONS Systemic inflammation is implicated in SCZ pathogenesis, according to our findings, which suggest that the NLRP3 pathway may be involved. The NLRP3 inflammasome may serve as a biomarker for SCZ, and its pharmacological regulation may be a promising treatment approach.Key pointsWe hypothesised that the NLRP3 pathway may contribute to the etiopathogenesis of schizophrenia.NLRP3, IL-1β and IL-18 mRNA levels were higher in patients with schizophrenia compared to healthy controls.Negative correlations were found between NLRP3 gene expression levels and GAF and FAST scales scores.There was a negative correlation between IL-18 expression levels and the GAF and FAST scales scores.The SAPS scale scores and IL-18 expression levels had a positive correlation.Given all these findings, it can be stated that NLRP3 inflammasome may play a role in the pathogenesis and symptoms of schizophrenia.
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Affiliation(s)
- Gulin Ozdamar Unal
- Department of Psychiatry, Suleyman Demirel University, Faculty of Medicine, Isparta, Turkey
| | - Kuyas Hekimler Ozturk
- Department of Medical Genetics, Suleyman Demirel University, Faculty of Medicine, Isparta, Turkey
| | - Huseyin Emre Inci
- Department of Psychiatry, Suleyman Demirel University, Faculty of Medicine, Isparta, Turkey
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5
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Fond G, Sunhary de Verville PL, Richieri R, Etchecopar-Etchart D, Korchia T, Faugere M, Godin O, Schürhoff F, Berna F, Aouizerate B, Capdevielle D, Chereau I, Clauss-Kobayashi J, Coulon N, Dorey JM, Dubertret C, Dubreucq J, Mallet J, Misdrahi D, Passerieux C, Pignon B, Rey R, Urbach M, Leboyer M. Redefining peripheral inflammation signature in schizophrenia based on the real-world FACE-SZ cohort. Prog Neuropsychopharmacol Biol Psychiatry 2021; 111:110335. [PMID: 33933539 DOI: 10.1016/j.pnpbp.2021.110335] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 04/16/2021] [Accepted: 04/21/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Peripheral inflammation is associated with impaired prognosis in schizophrenia (SZ). Highly sensitive C-reactive protein (hs-CRP) is the most used inflammatory biomarker in daily practice. However, no consensual cut-off has been determined to date to discriminate patients with peripheral inflammation from those without. AIMS To determine if patients with peripheral inflammation between 1 and 3 mg/L had poorer outcomes compared to those with undetectable CRP (<1 mg/L). METHOD Consecutive participants of the FACE-SZ cohort with a hs-CRP < 3 mg/L were included in 10 expert academic centers with a national geographical distribution between 2010 and 2018. Potential sources of inflammation, socio-demographics, illness characteristics, current illness severity, functioning and quality of life and were reported following the FACE-SZ standardized protocol. RESULTS 580 patients were included, of whom 226 (39%) were identified with low-grade inflammation defined by a hs-CRP between 1 and 3 mg/L. Overweight and lack of dental care were identified as potential sources of inflammation. After adjustment for these factors, patients with inflammation had more severe psychotic, depressive and aggressive symptomatology and impaired functioning compared to the patients with undetectable hs-CRP. No association with tobacco smoking or physical activity level has been found. CONCLUSIONS Patients with schizophrenia with hs-CRP level between 1 and 3 mg/L should be considered at risk for inflammation-associated disorders. Lowering weight and increasing dental care may be useful strategies to limit the sources of peripheral inflammation. Hs-CRP > 1 mg/L is a reliable marker to detect peripheral inflammation in patients with schizophrenia.
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Affiliation(s)
- G Fond
- Fondation FondaMental, Créteil, France; Aix-Marseille Univ, Faculté de Médecine - Secteur Timone, EA 3279, CEReSS -Centre d'Etude et de Recherche sur les Services de Santé et la Qualité de vie, 27 Boulevard Jean Moulin, 13005 Marseille, France.
| | | | - R Richieri
- Fondation FondaMental, Créteil, France; Aix-Marseille Univ, Faculté de Médecine - Secteur Timone, EA 3279, CEReSS -Centre d'Etude et de Recherche sur les Services de Santé et la Qualité de vie, 27 Boulevard Jean Moulin, 13005 Marseille, France
| | - D Etchecopar-Etchart
- Fondation FondaMental, Créteil, France; Aix-Marseille Univ, Faculté de Médecine - Secteur Timone, EA 3279, CEReSS -Centre d'Etude et de Recherche sur les Services de Santé et la Qualité de vie, 27 Boulevard Jean Moulin, 13005 Marseille, France
| | - T Korchia
- Fondation FondaMental, Créteil, France; Aix-Marseille Univ, Faculté de Médecine - Secteur Timone, EA 3279, CEReSS -Centre d'Etude et de Recherche sur les Services de Santé et la Qualité de vie, 27 Boulevard Jean Moulin, 13005 Marseille, France
| | - M Faugere
- Fondation FondaMental, Créteil, France; Aix-Marseille Univ, Faculté de Médecine - Secteur Timone, EA 3279, CEReSS -Centre d'Etude et de Recherche sur les Services de Santé et la Qualité de vie, 27 Boulevard Jean Moulin, 13005 Marseille, France
| | - O Godin
- Fondation FondaMental, Créteil, France
| | - F Schürhoff
- Fondation FondaMental, Créteil, France; Université Paris Est Creteil (UPEC), AP-HP, Hôpitaux Universitaires « H. Mondor », DMU IMPACT, INSERM, IMRB, Translational Neuropsychiatry, Fondation FondaMental, F-94010 Creteil, France
| | - F Berna
- Fondation FondaMental, Créteil, France; Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, INSERM U1114, Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France
| | - B Aouizerate
- Fondation FondaMental, Créteil, France; Centre Hospitalier Charles Perrens, Université de Bordeaux, F-33076 Bordeaux, France; INRA, NutriNeuro, University of Bordeaux, U1286, F-33076 Bordeaux, France
| | - D Capdevielle
- Fondation FondaMental, Créteil, France; Service Universitaire de Psychiatrie Adulte, Hôpital la Colombière, CHRU Montpellier, Université Montpellier 1, Inserm, 1061, Montpellier, France
| | - I Chereau
- Fondation FondaMental, Créteil, France; Université Clermont Auvergne, CMP-B, CHU, CNRS, Clermont Auvergne INP, Institut Pascal, F-63000 Clermont-Ferrand, France
| | - J Clauss-Kobayashi
- Fondation FondaMental, Créteil, France; Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, INSERM U1114, Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France
| | - N Coulon
- Fondation FondaMental, Créteil, France; Centre Référent de Réhabilitation Psychosociale, CH Alpes Isère, Grenoble, France
| | - J M Dorey
- Fondation FondaMental, Créteil, France; INSERM U1028, CNRS UMR5292, Centre de Recherche en Neurosciences de Lyon, Université Claude Bernard Lyon 1, Equipe PSYR2, Centre Hospitalier Le Vinatier, Pole Est, 95 bd Pinel, BP 30039, 69678 Bron Cedex, France
| | - C Dubertret
- Fondation FondaMental, Créteil, France; Université de Paris, AP-HP, Department of Psychiatry, Louis Mourier Hospital, Colombes, INSERM UMR 1266, Paris, France
| | - J Dubreucq
- Fondation FondaMental, Créteil, France; Centre Référent de Réhabilitation Psychosociale, CH Alpes Isère, Grenoble, France
| | - J Mallet
- Fondation FondaMental, Créteil, France; Université de Paris, AP-HP, Department of Psychiatry, Louis Mourier Hospital, Colombes, INSERM UMR 1266, Paris, France
| | - D Misdrahi
- Fondation FondaMental, Créteil, France; Centre Hospitalier Charles Perrens, Université de Bordeaux, F-33076 Bordeaux, France; CNRS UMR 5287, INCIA, France
| | - C Passerieux
- Fondation FondaMental, Créteil, France; Centre Hospitalier de Versailles, Service de psychiatrie et d'addictologie adulte, Le Chesnay, EA 4047 HANDIReSP, UFR des Sciences de la Santé Simone Veil, Université Versailles Saint-Quentin-en-Yvelines, Versailles, France
| | - B Pignon
- Fondation FondaMental, Créteil, France; Université Paris Est Creteil (UPEC), AP-HP, Hôpitaux Universitaires « H. Mondor », DMU IMPACT, INSERM, IMRB, Translational Neuropsychiatry, Fondation FondaMental, F-94010 Creteil, France
| | - R Rey
- Fondation FondaMental, Créteil, France; INSERM U1028, CNRS UMR5292, Centre de Recherche en Neurosciences de Lyon, Université Claude Bernard Lyon 1, Equipe PSYR2, Centre Hospitalier Le Vinatier, Pole Est, 95 bd Pinel, BP 30039, 69678 Bron Cedex, France
| | - M Urbach
- Fondation FondaMental, Créteil, France; Centre Hospitalier de Versailles, Service de psychiatrie et d'addictologie adulte, Le Chesnay, EA 4047 HANDIReSP, UFR des Sciences de la Santé Simone Veil, Université Versailles Saint-Quentin-en-Yvelines, Versailles, France
| | - M Leboyer
- Fondation FondaMental, Créteil, France; Université Paris Est Creteil (UPEC), AP-HP, Hôpitaux Universitaires « H. Mondor », DMU IMPACT, INSERM, IMRB, Translational Neuropsychiatry, Fondation FondaMental, F-94010 Creteil, France
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6
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Dubreucq J, Gabayet F, Godin O, Andre M, Aouizerate B, Capdevielle D, Chereau I, Clauss-Kobayashi J, Coulon N, D’Amato T, Dorey JM, Dubertret C, Faraldo M, Laouamri H, Leigner S, Lancon C, Leboyer M, Llorca PM, Mallet J, Misdrahi D, Passerieux C, Rey R, Pignon B, Schorr B, Urbach M, Schürhoff F, Szoke A, Fond G, Berna F. Overlap and Mutual Distinctions Between Clinical Recovery and Personal Recovery in People With Schizophrenia in a One-Year Study. Schizophr Bull 2021; 48:382-394. [PMID: 34718808 PMCID: PMC8886587 DOI: 10.1093/schbul/sbab114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Recovery is a multidimensional construct that can be defined either from a clinical perspective or from a consumer-focused one, as a self-broadening process aimed at living a meaningful life beyond mental illness. We aimed to longitudinally examine the overlap and mutual distinctions between clinical and personal recovery. Of 1239 people with schizophrenia consecutively recruited from the FondaMental Advanced Centers of Expertise for SZ network, the 507 present at one-year did not differ from those lost to follow-up. Clinical recovery was defined as the combination of clinical remission and functional remission. Personal recovery was defined as being in the rebuilding or in the growth stage of the Stages of Recovery Instrument (STORI). Full recovery was defined as the combination of clinical recovery and personal recovery. First, we examined the factors at baseline associated with each aspect of recovery. Then, we conducted multivariable models on the correlates of stable clinical recovery, stable personal recovery, and stable full recovery after one year. At baseline, clinical recovery and personal recovery were characterized by distinct patterns of outcome (i.e. better objective outcomes but no difference in subjective outcomes for clinical recovery, the opposite pattern for personal recovery, and better overall outcomes for full recovery). We found that clinical recovery and personal recovery predicted each other over time (baseline personal recovery for stable clinical recovery at one year; P = .026, OR = 4.94 [1.30-23.0]; baseline clinical recovery for stable personal recovery at one year; P = .016, OR = 3.64 [1.31-11.2]). In short, given the interaction but also the degree of difference between clinical recovery and personal recovery, psychosocial treatment should target, beyond clinical recovery, subjective aspects such as personal recovery and depression to reach full recovery.
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Affiliation(s)
- Julien Dubreucq
- Fondation FondaMental, Créteil, France,Centre Référent de Réhabilitation psychosociale et de Remédiation cognitive (C3R), CH Alpes Isère, Saint Egrève, France,To whom correspondence should be addressed to: Centre Référent de Réhabilitation psychosociale et de Remédiation Cognitive (C3R), CH Alpes Isère, 8 place du Conseil National de la Résistance, 38400 Saint Martin d’Hères, France; tel: (33 4) 56 58 88 00, e-mail:
| | - Franck Gabayet
- Fondation FondaMental, Créteil, France,Centre Référent de Réhabilitation psychosociale et de Remédiation cognitive (C3R), CH Alpes Isère, Saint Egrève, France
| | - Ophélia Godin
- Fondation FondaMental, Créteil, France,Univ Paris Est Créteil, INSERM U955, IMRB, Translational Neuro-Psychiatry, Créteil, France
| | - Myrtille Andre
- Fondation FondaMental, Créteil, France,IGF, University of Montpellier, CNRS, INSERM, Montpellier, France,Service Universitaire de Psychiatrie Adulte, Hôpital la Colombière, CHU Montpellier, France
| | - Bruno Aouizerate
- Fondation FondaMental, Créteil, France,Centre Hospitalier Charles Perrens, Université de Bordeaux, Bordeaux, France,INRA, NutriNeuro, University of Bordeaux, Bordeaux, France
| | - Delphine Capdevielle
- Fondation FondaMental, Créteil, France,IGF, University of Montpellier, CNRS, INSERM, Montpellier, France,Service Universitaire de Psychiatrie Adulte, Hôpital la Colombière, CHU Montpellier, France
| | - Isabelle Chereau
- Fondation FondaMental, Créteil, France,Université Clermont Auvergne, CMP-B CHU, CNRS, Clermont Auvergne INP, Institut Pascal, Clermont-Ferrand, France
| | - Julie Clauss-Kobayashi
- Fondation FondaMental, Créteil, France,Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, INSERM U1114, Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France
| | - Nathalie Coulon
- Fondation FondaMental, Créteil, France,Centre Référent de Réhabilitation psychosociale et de Remédiation cognitive (C3R), CH Alpes Isère, Saint Egrève, France
| | - Thierry D’Amato
- INSERM, U1028, CNRS, UMR5292, Lyon Neuroscience Research Center, PSYR2 team, Lyon, France,Centre Hospitalier le Vinatier, Centre Expert Dépression Résistante, Lyon, France
| | - Jean-Michel Dorey
- INSERM U1028, CNRS, UMR 5292, Lyon Neuroscience Research Center, EDUWELL Team, Lyon 2 University, Lyon, France,Centre Hospitalier le Vinatier, Pôle PsyPA, Lyon, France
| | - Caroline Dubertret
- Fondation FondaMental, Créteil, France,AP-HP, Groupe Hospitalo-Universitaire AP-HP Nord, Service de Psychiatrie et Addictologie. Hôpital Louis Mourier, Colombes, France,Université de Paris INSERM UMR1266, Institute of Psychiatry and Neuroscience of Paris, Paris, France
| | - Mégane Faraldo
- Fondation FondaMental, Créteil, France,Centre Référent de Réhabilitation psychosociale et de Remédiation cognitive (C3R), CH Alpes Isère, Saint Egrève, France
| | | | - Sylvain Leigner
- Fondation FondaMental, Créteil, France,Centre Référent de Réhabilitation psychosociale et de Remédiation cognitive (C3R), CH Alpes Isère, Saint Egrève, France
| | - Christophe Lancon
- Fondation FondaMental, Créteil, France,AP-HP, Groupe Hospitalo-Universitaire AP-HP Nord, Service de Psychiatrie et Addictologie. Hôpital Louis Mourier, Colombes, France,Université de Paris INSERM UMR1266, Institute of Psychiatry and Neuroscience of Paris, Paris, France
| | - Marion Leboyer
- Fondation FondaMental, Créteil, France,Univ Paris Est Créteil, INSERM U955, IMRB, Translational Neuro-Psychiatry, Créteil, France,AP-HP, Hôpitaux Universitaires Henri Mondor, Département Médico-Universitaire de Psychiatrie et d’Addictologie (DMU IMPACT), Fédération Hospitalo-Universitaire de Médecine de Précision en Psychiatrie (FHU ADAPT), Paris, France
| | - Pierre-Michel Llorca
- Fondation FondaMental, Créteil, France,Université Clermont Auvergne, CMP-B CHU, CNRS, Clermont Auvergne INP, Institut Pascal, Clermont-Ferrand, France
| | - Jasmina Mallet
- Fondation FondaMental, Créteil, France,AP-HP, Groupe Hospitalo-Universitaire AP-HP Nord, Service de Psychiatrie et Addictologie. Hôpital Louis Mourier, Colombes, France,Université de Paris INSERM UMR1266, Institute of Psychiatry and Neuroscience of Paris, Paris, France
| | - David Misdrahi
- Fondation FondaMental, Créteil, France,Pôle de psychiatrie Générale et Universitaire, Centre Hospitalier Charles Perrens, Université de Bordeaux, CNRS UMR 5287-INCIA, Bordeaux, France
| | - Christine Passerieux
- Fondation FondaMental, Créteil, France,Service Universitaire de Psychiatrie d’Adultes et d’Addictologie, Centre Hospitalier de Versailles, Le Chesnay, France,DisAP-DevPsy-CESP, INSERM UMR1018, Université Paris-Saclay, Université Versailles Saint-Quentin-En-Yvelines, Villejuif, France
| | - Romain Rey
- INSERM, U1028, CNRS, UMR5292, Lyon Neuroscience Research Center, PSYR2 team, Lyon, France,Centre Hospitalier le Vinatier, Centre Expert Dépression Résistante, Lyon, France
| | - Baptiste Pignon
- Fondation FondaMental, Créteil, France,Univ Paris Est Créteil, INSERM U955, IMRB, Translational Neuro-Psychiatry, Créteil, France,AP-HP, Hôpitaux Universitaires Henri Mondor, Département Médico-Universitaire de Psychiatrie et d’Addictologie (DMU IMPACT), Fédération Hospitalo-Universitaire de Médecine de Précision en Psychiatrie (FHU ADAPT), Paris, France
| | - Benoit Schorr
- Fondation FondaMental, Créteil, France,Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, INSERM U1114, Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France
| | - Mathieu Urbach
- Fondation FondaMental, Créteil, France,Service Universitaire de Psychiatrie d’Adultes et d’Addictologie, Centre Hospitalier de Versailles, Le Chesnay, France,DisAP-DevPsy-CESP, INSERM UMR1018, Université Paris-Saclay, Université Versailles Saint-Quentin-En-Yvelines, Villejuif, France
| | - Franck Schürhoff
- Fondation FondaMental, Créteil, France,Univ Paris Est Créteil, INSERM U955, IMRB, Translational Neuro-Psychiatry, Créteil, France,AP-HP, Hôpitaux Universitaires Henri Mondor, Département Médico-Universitaire de Psychiatrie et d’Addictologie (DMU IMPACT), Fédération Hospitalo-Universitaire de Médecine de Précision en Psychiatrie (FHU ADAPT), Paris, France
| | - Andrei Szoke
- Fondation FondaMental, Créteil, France,Univ Paris Est Créteil, INSERM U955, IMRB, Translational Neuro-Psychiatry, Créteil, France,AP-HP, Hôpitaux Universitaires Henri Mondor, Département Médico-Universitaire de Psychiatrie et d’Addictologie (DMU IMPACT), Fédération Hospitalo-Universitaire de Médecine de Précision en Psychiatrie (FHU ADAPT), Paris, France
| | | | - Guillaume Fond
- Fondation FondaMental, Créteil, France,AP-HM, Aix-Marseille Univ, School of medicine—La Timone Medical Campus, EA 3279: CEReSS—Health Service Research and Quality of Life Center, Marseille, France
| | - Fabrice Berna
- Fondation FondaMental, Créteil, France,Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, INSERM U1114, Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France
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7
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Fond G, Garosi A, Faugere M, Campion JY, Lancon C, Boyer L, Richieri R, Guedj E. Peripheral inflammation is associated with brain SPECT perfusion changes in schizophrenia. Eur J Nucl Med Mol Imaging 2021; 49:905-912. [PMID: 34405275 DOI: 10.1007/s00259-021-05529-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 08/09/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Peripheral inflammation is frequent in schizophrenia and could play a role in the pathophysiology, prognosis, and persistence of psychotic symptomatology under treatment. We seek to determine the relationship between peripheral inflammation and brain SPECT perfusion in stabilized antipsychotic-treated outpatients with schizophrenia, and to determine whether such perfusion changes are correlated with persistent symptoms. METHODS Highly sensitive C-reactive protein blood level (hs-CRP) and brain SPECT perfusion were assessed in 137 stabilized outpatients with schizophrenia. Whole-brain voxel-based associations were searched with SPM between SPECT perfusion and hs-CRP (correlation analysis to quantitative levels and between-group analysis according to a threshold of 3 mg/L). The identified clusters were secondarily correlated with clinical symptoms. RESULTS After adjustment for age, sex, educational level, illness duration, antidepressant use, chlorpromazine equivalent dose, tobacco smoking and obesity, a negative correlation was found between hs-CRP level and the perfusion of 4 brain areas: the right inferior frontal gyrus, the right middle/superior temporal gyrus, the left superior parietal lobe, and the right postcentral/transverse temporal gyrus (p-voxel < 0.001, k > 80, uncorrected). Increased perfusion of the left amygdala was found in patients with hs-CRP ≥ 3 mg/L compared to those with hs-CRP levels < 3 mg/L. A negative correlation was found between perfusion of the right inferior frontal gyrus and the persistence of positive, negative, and excitement symptoms under antipsychotic treatment. CONCLUSION In stabilized patients with schizophrenia, peripheral inflammation is associated with brain perfusion changes that are correlated with the persistence of psychotic symptomatology.
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Affiliation(s)
- Guillaume Fond
- EA 3279 - EA 3279: CEReSS, Health Service Research and Quality of Life Center, Aix Marseille Univ, 27 Boulevard Jean Moulin, Marseille, France.,Department of Medical Information and Public Health, APHM, Aix Marseille Univ, 27 Boulevard Jean Moulin, 13005, Marseille, France
| | - Alexandra Garosi
- Department of Psychiatry, APHM, La Conception University Hospital, 147 Boulevard Baille, 13005, Marseille, France
| | - Mélanie Faugere
- EA 3279 - EA 3279: CEReSS, Health Service Research and Quality of Life Center, Aix Marseille Univ, 27 Boulevard Jean Moulin, Marseille, France.,Department of Psychiatry, APHM, La Conception University Hospital, 147 Boulevard Baille, 13005, Marseille, France
| | - Jacques-Yves Campion
- Aix Marseille Univ, CNRS, Ecole Centrale Marseille, UMR 7249, Institut Fresnel, CERIMED, 27 Boulevard Jean Moulin, 13005, Marseille, France
| | - Christophe Lancon
- EA 3279 - EA 3279: CEReSS, Health Service Research and Quality of Life Center, Aix Marseille Univ, 27 Boulevard Jean Moulin, Marseille, France.,Department of Psychiatry, APHM, La Conception University Hospital, 147 Boulevard Baille, 13005, Marseille, France
| | - Laurent Boyer
- EA 3279 - EA 3279: CEReSS, Health Service Research and Quality of Life Center, Aix Marseille Univ, 27 Boulevard Jean Moulin, Marseille, France.,Department of Medical Information and Public Health, APHM, Aix Marseille Univ, 27 Boulevard Jean Moulin, 13005, Marseille, France
| | - Raphaelle Richieri
- Department of Psychiatry, APHM, La Conception University Hospital, 147 Boulevard Baille, 13005, Marseille, France.,Aix Marseille Univ, CNRS, Ecole Centrale Marseille, UMR 7249, Institut Fresnel, CERIMED, 27 Boulevard Jean Moulin, 13005, Marseille, France
| | - Eric Guedj
- Aix Marseille Univ, CNRS, Ecole Centrale Marseille, UMR 7249, Institut Fresnel, CERIMED, 27 Boulevard Jean Moulin, 13005, Marseille, France. .,Nuclear Medicine Department, APHM, La Timone University Hospital, 264 rue Saint Pierre, 13005, Marseille, France.
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Chen Y, Li W. Prevalence, Influencing Factors, and Cognitive Characteristics of Depressive Symptoms in Elderly Patients with Schizophrenia. Neuropsychiatr Dis Treat 2021; 17:3645-3654. [PMID: 34934317 PMCID: PMC8684420 DOI: 10.2147/ndt.s341297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 12/02/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To investigate the prevalence, influencing factors, and cognitive characteristics of depressive symptoms in elderly patients with chronic schizophrenia. PATIENTS AND METHODS A total of 241 elderly patients with chronic schizophrenia and 156 healthy controls were enrolled in this study. The Geriatric Depression Scale (GDS) was used to assess depressive symptoms; the Positive and Negative Syndrome Scale was used to assess psychotic symptoms; and both the Mini-Mental State Examination and Montreal Cognitive Assessment were used to assess overall cognitive function, while the Activity of Daily Living Scale was used to assess daily living ability. RESULTS The prevalence of depressive symptoms was 48.5% (117/241) in elderly patients with chronic schizophrenia, which was substantially higher than that of normal controls (17.3%, 27/156). Using a stepwise binary logistic regression analysis, we found that high education (p=0.006, odds ratio [OR]=1.122, 95% confidence interval [CI]:1.034-1.218) and hypertension (p=0.019, OR=0.519, 95% CI: 0.300-0.898) were influencing factors for the comorbidity of depressive symptoms. Compared with individuals without depressive symptoms, individuals with depressive symptoms usually display worse overall cognitive function and more severe impairment of activities of daily living, but fewer psychotic symptoms. Interestingly, the GDS score was negatively correlated with the course of the disease (r=-0.157, p=0.016), suggesting that patients who had recently been admitted to the hospital were more likely to develop depression. CONCLUSION Elderly patients with chronic schizophrenia are often associated with higher levels of depression. Therefore, their overall cognitive function is worse, and their activities of daily living are more seriously impaired. Therefore, these patients should be provided with appropriate psychological comfort, especially those who have recently been admitted to the hospital.
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Affiliation(s)
- Yaopian Chen
- Department of Sleep Medicine, Wenzhou Seventh People's Hospital, Wenzhou, People's Republic of China
| | - Wei Li
- Department of Geriatric Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.,Alzheimer's Disease and Related Disorders Center, Shanghai Jiao Tong University, Shanghai, People's Republic of China
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