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Venkataraman S, Hazan H, Li F, Ferrara M, Harper A, Ma J, Shah J, Musket C, Levine N, Keshavan MS, Srihari V. Role of Early Psychosis Detection in the Relationship Between Personal Income and Duration of Untreated Psychosis. Psychiatr Serv 2024; 75:427-433. [PMID: 38204369 DOI: 10.1176/appi.ps.20230239] [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] [Indexed: 01/12/2024]
Abstract
OBJECTIVE Prolonged duration of untreated psychosis (DUP) predicts poor outcomes of first-episode psychosis (FEP) and is often linked to low socioeconomic status (SES). The authors sought to determine whether patients' personal income, used as a proxy for SES, predicts length of DUP and whether personal income influences the effect of an early psychosis detection campaign-called Mindmap-on DUP reduction. METHODS Data were drawn from a trial that compared the effectiveness of early detection in reducing DUP across the catchment area of an FEP service (N=147 participants) compared with an FEP service with no early detection (N=75 participants). Hierarchical regression was used to determine whether personal income predicted DUP when analyses controlled for effects of age, race, and exposure to early psychosis detection. A group × personal income interaction term was used to assess whether the DUP difference between the early detection and control groups differed by personal income. RESULTS Lower personal income was significantly associated with younger age, fewer years of education, Black race, and longer DUP. Personal income predicted DUP beyond the effects of age, race, and early psychosis detection. Although Mindmap significantly reduced DUP across all income levels, this effect was smaller for participants reporting lower personal income. CONCLUSIONS Patients' personal income may be an important indicator of disparity in access to specialty care clinics across a wide range of settings. Early detection efforts should measure and target personal income and other SES indicators to improve access for all individuals who may benefit from FEP services.
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Affiliation(s)
- Shruthi Venkataraman
- Department of Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal (Venkataraman); Department of Psychiatry, Program for Specialized Treatment Early in Psychosis, Yale University School of Medicine, New Haven (Hazan, Ferrara, Musket, Levine, Srihari); Yale Center for Analytical Sciences, Yale School of Public Health, New Haven (Li); Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy (Ferrara); Department of Psychiatry, McGill University, Montreal (Harper, Shah); Center for Brain Health, School of Brain and Behavioral Science, University of Texas at Dallas, Dallas (Ma); Department of Psychiatry, Veterans Affairs Connecticut Healthcare System, West Haven (Musket); Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, Boston (Keshavan)
| | - Hadar Hazan
- Department of Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal (Venkataraman); Department of Psychiatry, Program for Specialized Treatment Early in Psychosis, Yale University School of Medicine, New Haven (Hazan, Ferrara, Musket, Levine, Srihari); Yale Center for Analytical Sciences, Yale School of Public Health, New Haven (Li); Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy (Ferrara); Department of Psychiatry, McGill University, Montreal (Harper, Shah); Center for Brain Health, School of Brain and Behavioral Science, University of Texas at Dallas, Dallas (Ma); Department of Psychiatry, Veterans Affairs Connecticut Healthcare System, West Haven (Musket); Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, Boston (Keshavan)
| | - Fangyong Li
- Department of Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal (Venkataraman); Department of Psychiatry, Program for Specialized Treatment Early in Psychosis, Yale University School of Medicine, New Haven (Hazan, Ferrara, Musket, Levine, Srihari); Yale Center for Analytical Sciences, Yale School of Public Health, New Haven (Li); Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy (Ferrara); Department of Psychiatry, McGill University, Montreal (Harper, Shah); Center for Brain Health, School of Brain and Behavioral Science, University of Texas at Dallas, Dallas (Ma); Department of Psychiatry, Veterans Affairs Connecticut Healthcare System, West Haven (Musket); Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, Boston (Keshavan)
| | - Maria Ferrara
- Department of Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal (Venkataraman); Department of Psychiatry, Program for Specialized Treatment Early in Psychosis, Yale University School of Medicine, New Haven (Hazan, Ferrara, Musket, Levine, Srihari); Yale Center for Analytical Sciences, Yale School of Public Health, New Haven (Li); Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy (Ferrara); Department of Psychiatry, McGill University, Montreal (Harper, Shah); Center for Brain Health, School of Brain and Behavioral Science, University of Texas at Dallas, Dallas (Ma); Department of Psychiatry, Veterans Affairs Connecticut Healthcare System, West Haven (Musket); Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, Boston (Keshavan)
| | - Annie Harper
- Department of Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal (Venkataraman); Department of Psychiatry, Program for Specialized Treatment Early in Psychosis, Yale University School of Medicine, New Haven (Hazan, Ferrara, Musket, Levine, Srihari); Yale Center for Analytical Sciences, Yale School of Public Health, New Haven (Li); Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy (Ferrara); Department of Psychiatry, McGill University, Montreal (Harper, Shah); Center for Brain Health, School of Brain and Behavioral Science, University of Texas at Dallas, Dallas (Ma); Department of Psychiatry, Veterans Affairs Connecticut Healthcare System, West Haven (Musket); Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, Boston (Keshavan)
| | - Jessica Ma
- Department of Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal (Venkataraman); Department of Psychiatry, Program for Specialized Treatment Early in Psychosis, Yale University School of Medicine, New Haven (Hazan, Ferrara, Musket, Levine, Srihari); Yale Center for Analytical Sciences, Yale School of Public Health, New Haven (Li); Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy (Ferrara); Department of Psychiatry, McGill University, Montreal (Harper, Shah); Center for Brain Health, School of Brain and Behavioral Science, University of Texas at Dallas, Dallas (Ma); Department of Psychiatry, Veterans Affairs Connecticut Healthcare System, West Haven (Musket); Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, Boston (Keshavan)
| | - Jai Shah
- Department of Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal (Venkataraman); Department of Psychiatry, Program for Specialized Treatment Early in Psychosis, Yale University School of Medicine, New Haven (Hazan, Ferrara, Musket, Levine, Srihari); Yale Center for Analytical Sciences, Yale School of Public Health, New Haven (Li); Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy (Ferrara); Department of Psychiatry, McGill University, Montreal (Harper, Shah); Center for Brain Health, School of Brain and Behavioral Science, University of Texas at Dallas, Dallas (Ma); Department of Psychiatry, Veterans Affairs Connecticut Healthcare System, West Haven (Musket); Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, Boston (Keshavan)
| | - Christie Musket
- Department of Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal (Venkataraman); Department of Psychiatry, Program for Specialized Treatment Early in Psychosis, Yale University School of Medicine, New Haven (Hazan, Ferrara, Musket, Levine, Srihari); Yale Center for Analytical Sciences, Yale School of Public Health, New Haven (Li); Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy (Ferrara); Department of Psychiatry, McGill University, Montreal (Harper, Shah); Center for Brain Health, School of Brain and Behavioral Science, University of Texas at Dallas, Dallas (Ma); Department of Psychiatry, Veterans Affairs Connecticut Healthcare System, West Haven (Musket); Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, Boston (Keshavan)
| | - Nina Levine
- Department of Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal (Venkataraman); Department of Psychiatry, Program for Specialized Treatment Early in Psychosis, Yale University School of Medicine, New Haven (Hazan, Ferrara, Musket, Levine, Srihari); Yale Center for Analytical Sciences, Yale School of Public Health, New Haven (Li); Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy (Ferrara); Department of Psychiatry, McGill University, Montreal (Harper, Shah); Center for Brain Health, School of Brain and Behavioral Science, University of Texas at Dallas, Dallas (Ma); Department of Psychiatry, Veterans Affairs Connecticut Healthcare System, West Haven (Musket); Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, Boston (Keshavan)
| | - Matcheri S Keshavan
- Department of Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal (Venkataraman); Department of Psychiatry, Program for Specialized Treatment Early in Psychosis, Yale University School of Medicine, New Haven (Hazan, Ferrara, Musket, Levine, Srihari); Yale Center for Analytical Sciences, Yale School of Public Health, New Haven (Li); Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy (Ferrara); Department of Psychiatry, McGill University, Montreal (Harper, Shah); Center for Brain Health, School of Brain and Behavioral Science, University of Texas at Dallas, Dallas (Ma); Department of Psychiatry, Veterans Affairs Connecticut Healthcare System, West Haven (Musket); Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, Boston (Keshavan)
| | - Vinod Srihari
- Department of Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal (Venkataraman); Department of Psychiatry, Program for Specialized Treatment Early in Psychosis, Yale University School of Medicine, New Haven (Hazan, Ferrara, Musket, Levine, Srihari); Yale Center for Analytical Sciences, Yale School of Public Health, New Haven (Li); Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy (Ferrara); Department of Psychiatry, McGill University, Montreal (Harper, Shah); Center for Brain Health, School of Brain and Behavioral Science, University of Texas at Dallas, Dallas (Ma); Department of Psychiatry, Veterans Affairs Connecticut Healthcare System, West Haven (Musket); Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, Boston (Keshavan)
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Testud B, Delacour C, El Ahmadi AA, Brun G, Girard N, Duhamel G, Heesen C, Häußler V, Thaler C, Has Silemek AC, Stellmann JP. Brain grey matter perfusion in primary progressive multiple sclerosis: Mild decrease over years and regional associations with cognition and hand function. Eur J Neurol 2022; 29:1741-1752. [PMID: 35167161 DOI: 10.1111/ene.15289] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 02/11/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Extend and dynamic of neurodegeneration in progressive Multiple Sclerosis (MS) might be reflected by global and regional brain perfusion, an outcome at the intercept between structure and function. Here, we provide a first insight in the evolution of brain perfusion and its association with disability in primary progressive MS (PPMS) over several years. METHODS 77 persons with PPMS were followed over up to 5 years. Visits included a 3T MRI with pulsed Arterial spin labelling (ASL) perfusion, the Timed-25-Foot-Walk, 9-Hole-Peg-Test (NHPT), Symbol-Digit-Modalities-Test (SDMT) and Expanded Disability Status Scale (EDSS). We extracted regional cerebral blood flow surrogates and compared them to 11 controls. Analyses focused in cortical and deep gray matter, the change over time and associations with disability on regional and global level. RESULTS Baseline brain perfusion of patients and controls was comparable for the cortex (p=0.716) and deep grey matter (p=0.095). EDSS disability increased mildly (p=0.023) while brain perfusion decreased during follow up (p<0.001) and with disease duration (p=0.009). Lower global perfusion correlated with higher disability as indicated by EDSS, NHPT and Timed-25-Foot-Walk (p<0.001). The motor task NHPT showed associations with twenty gray matter regions. In contrast, better SDMT performance correlated with lower perfusion (p<0.001) in seven predominantly frontal regions indicating a functional maladaptation. CONCLUSION Decreasing perfusion indicates a putative association with MS disease mechanisms such as neurodegeneration, reduced metabolism, and loss of resilience. A low alteration rate limits its use in clinical practice, but regional association patterns might provide a snapshot of adaptive and maladaptive functional reorganization.
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Affiliation(s)
- Benoit Testud
- APHM La Timone, CEMEREM, Marseille, France.,Aix-Marseille Univ, CNRS, CRMBM, UMR 7339, Marseille, France.,APHM La Timone, Department of Neuroradiology, Marseille, France
| | - Clara Delacour
- APHM La Timone, Department of Neuroradiology, Marseille, France
| | | | - Gilles Brun
- APHM La Timone, Department of Neuroradiology, Marseille, France
| | - Nadine Girard
- Aix-Marseille Univ, CNRS, CRMBM, UMR 7339, Marseille, France.,APHM La Timone, Department of Neuroradiology, Marseille, France
| | - Guillaume Duhamel
- APHM La Timone, CEMEREM, Marseille, France.,Aix-Marseille Univ, CNRS, CRMBM, UMR 7339, Marseille, France
| | - Christoph Heesen
- Institute of Neuroimmunology and MS (INIMS), University Medical Centre Hamburg-Eppendorf, Germany.,Department of Neurology, University Medical Centre Hamburg-Eppendorf, Germany
| | - Vivien Häußler
- Institute of Neuroimmunology and MS (INIMS), University Medical Centre Hamburg-Eppendorf, Germany.,Department of Neurology, University Medical Centre Hamburg-Eppendorf, Germany
| | - Christian Thaler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Arzu Ceylan Has Silemek
- Institute of Neuroimmunology and MS (INIMS), University Medical Centre Hamburg-Eppendorf, Germany
| | - Jan-Patrick Stellmann
- APHM La Timone, CEMEREM, Marseille, France.,Aix-Marseille Univ, CNRS, CRMBM, UMR 7339, Marseille, France.,Institute of Neuroimmunology and MS (INIMS), University Medical Centre Hamburg-Eppendorf, Germany.,Department of Neurology, University Medical Centre Hamburg-Eppendorf, Germany
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Stevenson R, Samokhina E, Rossetti I, Morley JW, Buskila Y. Neuromodulation of Glial Function During Neurodegeneration. Front Cell Neurosci 2020; 14:278. [PMID: 32973460 PMCID: PMC7473408 DOI: 10.3389/fncel.2020.00278] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 08/05/2020] [Indexed: 12/12/2022] Open
Abstract
Glia, a non-excitable cell type once considered merely as the connective tissue between neurons, is nowadays acknowledged for its essential contribution to multiple physiological processes including learning, memory formation, excitability, synaptic plasticity, ion homeostasis, and energy metabolism. Moreover, as glia are key players in the brain immune system and provide structural and nutritional support for neurons, they are intimately involved in multiple neurological disorders. Recent advances have demonstrated that glial cells, specifically microglia and astroglia, are involved in several neurodegenerative diseases including Amyotrophic lateral sclerosis (ALS), Epilepsy, Parkinson's disease (PD), Alzheimer's disease (AD), and frontotemporal dementia (FTD). While there is compelling evidence for glial modulation of synaptic formation and regulation that affect neuronal signal processing and activity, in this manuscript we will review recent findings on neuronal activity that affect glial function, specifically during neurodegenerative disorders. We will discuss the nature of each glial malfunction, its specificity to each disorder, overall contribution to the disease progression and assess its potential as a future therapeutic target.
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Affiliation(s)
- Rebecca Stevenson
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
| | - Evgeniia Samokhina
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
| | - Ilaria Rossetti
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
| | - John W. Morley
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
| | - Yossi Buskila
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
- International Centre for Neuromorphic Systems, The MARCS Institute for Brain, Behaviour and Development, Penrith, NSW, Australia
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Sivakolundu DK, West KL, Zuppichini MD, Wilson A, Moog TM, Blinn AP, Newton BD, Wang Y, Stanley T, Guo X, Rypma B, Okuda DT. BOLD signal within and around white matter lesions distinguishes multiple sclerosis and non-specific white matter disease: a three-dimensional approach. J Neurol 2020; 267:2888-2896. [PMID: 32468116 DOI: 10.1007/s00415-020-09923-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 05/12/2020] [Accepted: 05/14/2020] [Indexed: 12/16/2022]
Abstract
Multiple sclerosis (MS) diagnostic criteria are based upon clinical presentation and presence of white matter hyperintensities on two-dimensional magnetic resonance imaging (MRI) views. Such criteria, however, are prone to false-positive interpretations due to the presence of similar MRI findings in non-specific white matter disease (NSWMD) states such as migraine and microvascular disease. The coexistence of age-related changes has also been recognized in MS patients, and this comorbidity further poses a diagnostic challenge. In this study, we investigated the physiologic profiles within and around MS and NSWMD lesions and their ability to distinguish the two disease states. MS and NSWMD lesions were identified using three-dimensional (3D) T2-FLAIR images and segmented using geodesic active contouring. A dual-echo functional MRI sequence permitted near-simultaneous measurement of blood-oxygen-level-dependent signal (BOLD) and cerebral blood flow (CBF). BOLD and CBF were calculated within lesions and in 3D concentric layers surrounding each lesion. BOLD slope, an indicator of lesion metabolic capacity, was calculated as the change in BOLD from a lesion through its surrounding perimeters. We observed sequential BOLD signal reductions from the lesion towards the perimeters for MS, while no such decreases were observed for NSWMD lesions. BOLD slope was significantly lower in MS compared to NSWM lesions, suggesting decreased metabolic activity in MS lesions. Furthermore, BOLD signal within and around lesions significantly distinguished MS and NSWMD lesions. These results suggest that this technique shows promise for clinical utility in distinguishing NSWMD or MS disease states and identifying NSWMD lesions occurring in MS patients.
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Affiliation(s)
- Dinesh K Sivakolundu
- School of Behavioral and Brain Sciences, University of Texas at Dallas, Dallas, TX, USA.,Department of Biological Sciences, University of Texas at Dallas, Dallas, TX, USA
| | - Kathryn L West
- School of Behavioral and Brain Sciences, University of Texas at Dallas, Dallas, TX, USA
| | - Mark D Zuppichini
- School of Behavioral and Brain Sciences, University of Texas at Dallas, Dallas, TX, USA
| | - Andrew Wilson
- Department of Computer Science, University of Texas at Dallas, Dallas, TX, USA
| | - Tatum M Moog
- Neuroinnovation Program, Multiple Sclerosis & Neuroimmunology Imaging Program, Department of Neurology & Neurotherapeutics, UT Southwestern Medical Center, Dallas, TX, USA
| | - Aiden P Blinn
- Neuroinnovation Program, Multiple Sclerosis & Neuroimmunology Imaging Program, Department of Neurology & Neurotherapeutics, UT Southwestern Medical Center, Dallas, TX, USA
| | - Braeden D Newton
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Yeqi Wang
- Department of Computer Science, University of Texas at Dallas, Dallas, TX, USA
| | - Thomas Stanley
- Department of Computer Science, University of Texas at Dallas, Dallas, TX, USA
| | - Xiaohu Guo
- Department of Computer Science, University of Texas at Dallas, Dallas, TX, USA
| | - Bart Rypma
- School of Behavioral and Brain Sciences, University of Texas at Dallas, Dallas, TX, USA.,Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA
| | - Darin T Okuda
- Neuroinnovation Program, Multiple Sclerosis & Neuroimmunology Imaging Program, Department of Neurology & Neurotherapeutics, UT Southwestern Medical Center, Dallas, TX, USA.
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