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Mueser KT, Sussman RF, DeTore NR, Eberlin ES, McGurk SR. The impact of early intervention for first episode psychosis on cognitive functioning. Schizophr Res 2023; 260:132-139. [PMID: 37657279 PMCID: PMC10592046 DOI: 10.1016/j.schres.2023.07.021] [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: 01/19/2023] [Revised: 05/17/2023] [Accepted: 07/23/2023] [Indexed: 09/03/2023]
Abstract
IMPORTANCE Impaired cognitive functioning is a core characteristic of schizophrenia, present from the onset of the illness and relatively stable thereafter. Despite evidence supporting the impact of early intervention services (EIS) on improving symptoms and functioning in first episode psychosis (FEP), controlled research has not examined its impact on cognitive functioning. OBJECTIVE To evaluate the longitudinal course of cognitive functioning in FEP patients participating in a large, controlled study comparing EIS with usual services. METHODS A total of 404 persons ages 15-40 years old with non-affective FEP participated in the Recovery After Initial Schizophrenia-Early Treatment Program. A cluster randomized controlled trial was conducted with 34 community mental health treatment centers across the U.S. randomized to provide either an EIS program (NAVIGATE) or usual Community Care (CC) to FEP patients for 2 years. Cognitive functioning was assessed with the Brief Assessment of Cognition in Schizophrenia (BACS) at baseline and 1- and 2-years later. RESULTS Older participants (≥20 years old) in both treatment groups improved on all BACS tests. Younger participants (15-19) in NAVIGATE improved significantly more on Digit Sequencing (working memory) than those in CC, whereas both groups improved on most of the other BACS tests. Improvements in cognitive functioning occurred mostly over the first year and were correlated with reductions in symptom severity. DISCUSSION EIS do not improve cognitive functioning more than usual care for older FEP patients but may improve working memory in younger FEP patients. Interventions targeting cognition may be required to enhance cognitive functioning in most FEP patients.
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Affiliation(s)
- Kim T Mueser
- Center for Psychiatric Rehabilitation, Boston University, Boston, MA, USA; Department of Occupational Therapy, Boston University, Boston, MA, USA.
| | - Rachel F Sussman
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Nicole R DeTore
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | | | - Susan R McGurk
- Center for Psychiatric Rehabilitation, Boston University, Boston, MA, USA; Department of Occupational Therapy, Boston University, Boston, MA, USA
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2
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Relapse of first-episode schizophrenia patients and neurocognitive impairment: The role of dopaminergic and anticholinergic burden. Schizophr Res 2022; 248:331-340. [PMID: 36155307 DOI: 10.1016/j.schres.2022.09.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 08/11/2022] [Accepted: 09/05/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND The prevention of relapse may be a key factor to diminish the cognitive impairment of first-episode schizophrenia (FES) patients. We aimed to ascertain the effects of relapse, and dopaminergic and anticholinergic treatment burdens on cognitive functioning in the follow-up. METHODS Ninety-nine FES patients participated in this study. Cognitive assessments were performed at baseline and after 3 years of follow-up or, in those patients who relapsed, after >2 months of stabilization of the new acute psychotic episode. The primary outcomes were final cognitive dimensions. RESULTS Repeated measures MANOVA analyses showed improvements in the whole sample on the end-point assessments in processing speed and social cognition. However, only impairment in social cognition showed a significant interaction with relapse by time in this sample. Relapse in FES patients was significantly associated with poor performance on end-point assessments of working memory, social cognition and global cognitive score. Anticholinergic burden, but not dopaminergic burden, was associated with verbal memory impairment. These significant associations resulted after controlling for baseline cognitive functioning, relapse and dopaminergic burden. CONCLUSIONS The relationship between relapse and cognitive impairment in recovered FES patients seems to be particularly complex at the short-term follow-up of these patients. While relapse was associated with working memory, social cognition impairments and global cognitive score, anticholinergic burden might play an additional worsening effect on verbal memory. Thus, tailoring or changing antipsychotics and other drugs to reduce their anticholinergic burden may be a potential modifiable factor to diminish cognitive impairment at this stage of the illness.
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Huang BJ, Pu CC, Miao Q, Ma K, Cheng Z, Shi C, Yu X. Neurocognitive trajectories and their clinical implications in first-episode schizophrenia after one year of antipsychotic treatment. Schizophr Res 2022; 241:292-297. [PMID: 35217357 DOI: 10.1016/j.schres.2022.02.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 01/03/2022] [Accepted: 02/13/2022] [Indexed: 01/10/2023]
Abstract
Neurocognitive impairment is a core feature of schizophrenia, and patients with first-episode schizophrenia (FES) are optimal candidates for cognitive remediation, but we do not know enough about the incidence, severity and longitudinal changes in neurocognitive impairment in those with FES. This study aimed to assess the neurocognitive trajectories of patients with FES and to compare the clinical and functional outcomes among those with different trajectories. A total of 562 untreated patients with FES completed a neurocognitive test battery and psychopathological and functional assessment. A total of 373 patients attended the follow-up. Group-based trajectory modelling (GBTM) was applied to identify neurocognitive trajectories. Analysis of variance and chi-square tests were conducted to compare demographic characteristics, multiple neurocognitive domains, and clinical and functional outcomes among the different subgroups. We identified three neurocognitive subgroups: preserved (n = 133), mildly to moderately impaired (n = 187) and severely impaired (n = 53). Neurocognitive function in the two impaired subgroups improved within a year but failed to reach the normal level. The processing speed followed trajectories similar to those of overall cognition. The three subgroups did not significantly differ in antipsychotic usage or clinical remission rate. The severely impaired subgroup had poorer functional outcomes than the preserved subgroup, but the mildly to moderately impaired subgroup did not. Patients with FES followed distinct neurocognitive trajectories during the first year of treatment. Patients with severe neurocognitive impairment have poorer functional outcomes, which require and are more likely to benefit from cognitive remediation. Processing speeding is a potential indicator for screening overall cognition.
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Affiliation(s)
- Bing-Jie Huang
- Peking University Sixth Hospital, Beijing, China; Peking University Institute of Mental Health, Beijing, China; NHC Key Laboratory of Mental Health (Peking University), Beijing, China; National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Cheng-Cheng Pu
- Peking University Sixth Hospital, Beijing, China; Peking University Institute of Mental Health, Beijing, China; NHC Key Laboratory of Mental Health (Peking University), Beijing, China; National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Qi Miao
- Peking University Sixth Hospital, Beijing, China; Shandong Mental Health Center, Shandong University, Jinan, Shandong, 250014, China
| | - Ke Ma
- Peking University Sixth Hospital, Beijing, China; Department of Clinical Psychology, Beingjing Chaoyang Hospital of Capital Medical University, China
| | - Zhang Cheng
- Peking University Sixth Hospital, Beijing, China; Peking University Institute of Mental Health, Beijing, China; NHC Key Laboratory of Mental Health (Peking University), Beijing, China; National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Chuan Shi
- Peking University Sixth Hospital, Beijing, China; Peking University Institute of Mental Health, Beijing, China; NHC Key Laboratory of Mental Health (Peking University), Beijing, China; National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Xin Yu
- Peking University Sixth Hospital, Beijing, China; Peking University Institute of Mental Health, Beijing, China; NHC Key Laboratory of Mental Health (Peking University), Beijing, China; National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China.
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Murillo-García N, Setién-Suero E, Pardo-de-Santayana G, Murillo-García M, Pelayo-Terán JM, Crespo-Facorro B, Ayesa-Arriola R. Entire duration of active psychosis and neurocognitive performance in first-episode non-affective psychosis. Early Interv Psychiatry 2021; 15:1266-1275. [PMID: 33244853 DOI: 10.1111/eip.13077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 08/27/2020] [Accepted: 11/15/2020] [Indexed: 11/28/2022]
Abstract
AIM To explore if the entire duration of active psychosis (DAP) is related to neurocognitive performance at baseline and at 3-year follow-up in patients with first episode psychosis (FEP). METHODS DAP was estimated for 481 FEP patients. A neuropsychological battery was administered to measure neurocognitive specific domains, and a global indicator of neurocognitive impairment (global deficits score, GDS) was calculated. According to the DAP quartiles, four subgroups were formed, and these were compared. In addition, a logistic regression analysis was carried out to predict neurocognitive impairment at 3-year follow-up. RESULTS FEP patients with the longest DAP (more than 18.36 months) presented a more severe global neurocognitive impairment evidenced in their GDS, both at baseline (F = 5.53; p˂ .01) and at 3-year follow-up (F = 4.16; p˂ .01). Moreover, a subgroup of participants with DAP between 7.40 and 18.36 months showed a specific attentional decline over the 3-year follow-up (F = 3.089; p˂ .05).The logistic regression model showed that sex (Wald = 7.29, p < .010), premorbid adjustment (Wald = 7.24, p < .010), attention (Wald = 12.10, p < .001), verbal memory (Wald = 16.29, p < .001) and visual memory (Wald = 9.41, p < .010) were significant predictors of neurocognitive impairment 3 years after the FEP. The variables composing the DAP were not significant predictors in this model. CONCLUSIONS DAP seems to be related to global neurocognitive impairment in FEP patients. These findings contribute in several ways to our understanding of the effects of active psychosis on the brain, and provide the basis for future research.
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Affiliation(s)
- Nancy Murillo-García
- IDIVAL, Valdecilla Biomedical Research Institute, Santander, Spain.,Department of Molecular Biology, School of Medicine, University Hospital Marqués de Valdecilla, University of Cantabria, Santander, Spain
| | | | | | - Marisol Murillo-García
- International Education Program, Framingham State University, Framingham, Massachusetts, USA
| | - José María Pelayo-Terán
- CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Madrid, Spain.,Servicio de Salud de Castilla y León, Unidad de Calidad Asistencial y Seguridad del Paciente, Ponferrada, ES, Spain
| | - Benedicto Crespo-Facorro
- CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Madrid, Spain.,Hospital Universitario Virgen del Rocío, Department of Psychiatry, Universidad de Sevilla, Sevilla, Spain
| | - Rosa Ayesa-Arriola
- IDIVAL, Valdecilla Biomedical Research Institute, Santander, Spain.,CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Madrid, Spain
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Kilciksiz CM, Keefe R, Benoit J, Öngür D, Torous J. Verbal memory measurement towards digital perspectives in first-episode psychosis: A review. Schizophr Res Cogn 2020; 21:100177. [PMID: 32322540 PMCID: PMC7163058 DOI: 10.1016/j.scog.2020.100177] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 03/20/2020] [Accepted: 03/21/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Even in the early phases of psychotic spectrum illnesses such as schizophrenia, patients can experience cognitive decline or deficits prior to the onset of psychotic symptoms such as delusions and hallucinations. In this systematic review, we assessed which verbal memory assessments are most widely used in first-episode psychosis and may be applied via digital technologies (smartphone applications, etc.) for use in early detection. METHODS In November 2019, we searched for studies measuring verbal memory in first episode psychosis or schizophrenia over the past 10 years on PubMed and PsycINFO. We screened abstracts of these studies and excluded review studies. Full-texts of included studies were used to identify the verbal memory measurement tests, follow-up frequencies, and sample sizes. RESULTS We screened 233 reports and found that 120 original research studies measured verbal memory in first episode psychosis over the past 10 years. Four of these studies specified using a computer, 24 (20%) used a paper-pen format, 1(1%) used both, and 91 (76%) studies did not specify their administration tools or suggest there were offered in digital formats. Thirty-five (30%) studies had follow-up measurements of verbal memory, while 85 (70%) had only a single verbal memory measurement. DISCUSSION While many scales are commonly used to measure verbal memory in first episode psychosis, they are not often administered via digital technology. There is an emerging opportunity to administer these and other tests via digital technologies for expanding access to early detection of cognitive decline in clinical high risk and first-episode psychosis.
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Affiliation(s)
- Can Mişel Kilciksiz
- Digital Psychiatry Division, Psychosis Research Program, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America
| | - Richard Keefe
- Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States of America
| | - James Benoit
- Digital Psychiatry Division, Psychosis Research Program, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America
| | - Dost Öngür
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America
- Psychotic Disorders Division, McLean Hospital, Belmont, MA, United States of America
| | - John Torous
- Digital Psychiatry Division, Psychosis Research Program, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America
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Vázquez-Bourgon J, Ayesa-Arriola R, Fatjó-Vilas M, Roiz-Santiañez R, Fañanás L, Crespo-Facorro B. Effect of DISC1 Polymorphisms on the Long-term Course of Neurocognitive Deficits in Non-affective Psychosis. Eur Psychiatry 2020; 30:861-7. [DOI: 10.1016/j.eurpsy.2015.07.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 07/10/2015] [Accepted: 07/13/2015] [Indexed: 12/12/2022] Open
Abstract
AbstractNeurocognitive deficits are core symptoms of schizophrenia that determine a poorer outcome. High variability in the progression of neuropsychological deficits in schizophrenia has been described. It is still unknown whether genetic variations can affect the course of cognitive deficits. Variations in the Disrupted in Schizophrenia 1 (DISC1) gene have previously been associated with neurocognitive deficits. This study investigated the association between 3 DISC1 polymorphisms (rs6675281 (Leu607Phe), rs1000731, and rs821616 (Ser704Cys)) and long-term (3 years) cognitive performance. One-hundred-thirty-three Caucasian drug-naive patients experiencing a first episode of non-affective psychosis were genotyped. Cognitive function was assessed at baseline and after 3 years of initiating treatment. Other clinical and socio-demographic variables were recorded to eliminate potential confounding effects. Patients carrying the A allele of rs1000731 exhibited a significant improvement in Working Memory and Attention domains, and the homozygosity of the A allele of rs821616 showed a significant improvement in Motor Dexterity performance over 3 years of follow-up. In conclusion, DISC1 gene variations may affect the course of cognitive deficits found in patients suffering from the first episode of non-affective psychosis.
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Ayesa-Arriola R, Setién-Suero E, Neergaard KD, Belzunces ÀA, Contreras F, van Haren NEM, Crespo-Facorro B. Premorbid IQ subgroups in first episode non affective psychosis patients: Long-term sex differences in function and neurocognition. Schizophr Res 2018; 197:370-377. [PMID: 29275855 DOI: 10.1016/j.schres.2017.12.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 12/07/2017] [Accepted: 12/13/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Low IQ has been associated with schizophrenia, even to the point of being posited as a possible causal factor for psychosis. However, individuals with normal and high IQ also develop psychotic illnesses. The aim of this study was to characterize premorbid IQ subgroups at first episode of psychosis (FEP). METHODS The study sample comes from a large epidemiological, 3-year longitudinal, intervention program on psychosis containing individuals living in a catchment area in Spain. Estimated premorbid IQ (epIQ) scores were used to build low (<90), normal (90-110) and high (>110) epIQ subgroups in samples of FEP patients (N=292) and healthy controls (N=199). The epIQ subgroups were compared in sociodemographic, neuropsychological, clinical and premorbid characteristics. Long-term functional and cognitive outcome, with a focus on sex differences, were also explored. RESULTS Low-epIQ was more frequently found in FEP patients (28.8%) than in healthy controls (14.6%). Low-epIQ patients were more likely to have worse premorbid adjustment, belong to low socioeconomic status families, have less years of education, and to be single, unemployed, and younger. They presented more severe impairments in processing speed, executive and global cognitive function. Female patients with low-epIQ showed better baseline function and more stable outcome than males. CONCLUSIONS Our results indicate that low premorbid IQ is a morbid manifestation, easily detected in a subgroup of FEP patients that predicts poorer outcome particularly in males. This perspective provides important information for the tailoring of subgroup-specific early intervention programs for psychosis.
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Affiliation(s)
- Rosa Ayesa-Arriola
- Department of Psychiatry, Marqués de Valdecilla University Hospital, IDIVAL, School of Medicine, University of Cantabria, Santander, Spain; Centro Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.
| | - Esther Setién-Suero
- Department of Psychiatry, Marqués de Valdecilla University Hospital, IDIVAL, School of Medicine, University of Cantabria, Santander, Spain
| | - Karl David Neergaard
- Department of Chinese and Bilingual Studies, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Àuria Albacete Belzunces
- Psychiatry Department, Bellvitge University Hospital - Institut d'Investigació Biomèdica de Bellvitge, Barcelona, Spain; Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
| | - Fernando Contreras
- Centro Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; Psychiatry Department, Bellvitge University Hospital - Institut d'Investigació Biomèdica de Bellvitge, Barcelona, Spain; Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
| | - Neeltje E M van Haren
- Brain Centre Rudolf Magnus, Department of Psychiatry, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Benedicto Crespo-Facorro
- Department of Psychiatry, Marqués de Valdecilla University Hospital, IDIVAL, School of Medicine, University of Cantabria, Santander, Spain; Centro Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
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Hidese S, Ota M, Sasayama D, Matsuo J, Ishida I, Hiraishi M, Teraishi T, Hattori K, Kunugi H. Manual dexterity and brain structure in patients with schizophrenia: A whole-brain magnetic resonance imaging study. Psychiatry Res Neuroimaging 2018; 276:9-14. [PMID: 29702462 DOI: 10.1016/j.pscychresns.2018.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 02/08/2018] [Accepted: 04/13/2018] [Indexed: 11/17/2022]
Abstract
The Purdue Pegboard Test (PPT) is a motor coordination task used to assess manual dexterity. Although several brain regions are thought to be involved in PPT performance, the relationship of the task with decreased insular volume has not been investigated. The PPT was administered to 83 subjects diagnosed with schizophrenia (mean ± standard deviation age: 38.6 ± 11.2 years; 47 males, 36 females) and 130 healthy controls (42.1 ± 15.2 years; 67 males, 63 females). All subjects were Japanese and right-handed. Gray matter volume was analyzed using voxel-based morphometry in statistical parametric mapping, while white matter measures were analyzed using diffusion tensor imaging in tract-based spatial statistics. For the patients with schizophrenia, the left-hand scores positively correlated with the right insular and bilateral operculum volumes, while the summation score (sum of left-, right-, and both-hands scores) positively correlated with the right insular volume, and the summation and assembly (number of assemblies completed) scores correlated with the diffuse white matter fractional anisotropy, axial diffusivity, and radial diffusivity values. In contrast, no significant correlations were found for the controls. These results suggested that decreased insular volume and white matter measures contributed to the impairments in manual dexterity observed in subjects with schizophrenia.
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Affiliation(s)
- Shinsuke Hidese
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP), 4-1-1, Ogawa-Higashi, Kodaira, Tokyo 187-8502, Japan; Department of NCNP Brain Physiology and Pathology, Division of Cognitive and Behavioral Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Miho Ota
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP), 4-1-1, Ogawa-Higashi, Kodaira, Tokyo 187-8502, Japan
| | - Daimei Sasayama
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP), 4-1-1, Ogawa-Higashi, Kodaira, Tokyo 187-8502, Japan
| | - Junko Matsuo
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP), 4-1-1, Ogawa-Higashi, Kodaira, Tokyo 187-8502, Japan
| | - Ikki Ishida
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP), 4-1-1, Ogawa-Higashi, Kodaira, Tokyo 187-8502, Japan
| | - Moeko Hiraishi
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP), 4-1-1, Ogawa-Higashi, Kodaira, Tokyo 187-8502, Japan
| | - Toshiya Teraishi
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP), 4-1-1, Ogawa-Higashi, Kodaira, Tokyo 187-8502, Japan
| | - Kotaro Hattori
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP), 4-1-1, Ogawa-Higashi, Kodaira, Tokyo 187-8502, Japan
| | - Hiroshi Kunugi
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP), 4-1-1, Ogawa-Higashi, Kodaira, Tokyo 187-8502, Japan; Department of NCNP Brain Physiology and Pathology, Division of Cognitive and Behavioral Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo 113-8519, Japan.
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Stratifying empiric risk of schizophrenia among first degree relatives using multiple predictors in two independent Indian samples. Asian J Psychiatr 2016; 24:79-84. [PMID: 27931915 PMCID: PMC5454026 DOI: 10.1016/j.ajp.2016.08.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 08/12/2016] [Accepted: 08/17/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND Schizophrenia (SZ) has an estimated heritability of 64-88%, with the higher values based on twin studies. Conventionally, family history of psychosis is the best individual-level predictor of risk, but reliable risk estimates are unavailable for Indian populations. Genetic, environmental, and epigenetic factors are equally important and should be considered when predicting risk in 'at risk' individuals. OBJECTIVE To estimate risk based on an Indian schizophrenia participant's family history combined with selected demographic factors. METHODS To incorporate variables in addition to family history, and to stratify risk, we constructed a regression equation that included demographic variables in addition to family history. The equation was tested in two independent Indian samples: (i) an initial sample of SZ participants (N=128) with one sibling or offspring; (ii) a second, independent sample consisting of multiply affected families (N=138 families, with two or more sibs/offspring affected with SZ). RESULTS The overall estimated risk was 4.31±0.27 (mean±standard deviation). There were 19 (14.8%) individuals in the high risk group, 75 (58.6%) in the moderate risk and 34 (26.6%) in the above average risk (in Sample A). In the validation sample, risks were distributed as: high (45%), moderate (38%) and above average (17%). Consistent risk estimates were obtained from both samples using the regression equation. CONCLUSIONS Familial risk can be combined with demographic factors to estimate risk for SZ in India. If replicated, the proposed stratification of risk may be easier and more realistic for family members.
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Ayesa-Arriola R, Rodríguez-Sánchez JM, Suero ES, Reeves LE, Tabarés-Seisdedos R, Crespo-Facorro B. Diagnosis and neurocognitive profiles in first-episode non-affective psychosis patients. Eur Arch Psychiatry Clin Neurosci 2016; 266:619-28. [PMID: 26769121 DOI: 10.1007/s00406-015-0667-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 12/17/2015] [Indexed: 11/28/2022]
Abstract
This study explored whether there are distinguishable neurocognitive profiles in diagnostic subgroups of first-episode non-affective psychosis (FEP) patients. Four hundred and eighty-seven individuals with diagnoses of non-affective psychosis disorders were evaluated 6 months after first contact with psychiatric services. Individuals with schizophrenia (n = 257), schizophreniform (n = 141), brief psychotic disorder (n = 54), and psychosis not otherwise specified (n = 35) were compared on baseline neuropsychological variables using analyses of variance and covariance with potential clinical, premorbid, and sociodemographic confounders. The brief psychotic disorder subgroup was the least impaired on global cognitive function, in particular when compared to the schizophrenia subgroup, and specifically on executive function, processing speed, and motor dexterity domains. However, with the exception of the processing speed domain, profile differences could be explained by sex, age, psychotic and negative symptoms, years of education, and premorbid IQ. These results suggest processing speed as a diagnostic marker for brief psychotic disorder in FEP patients. Further, there are quantitative and qualitative differences across the schizophrenia spectrum disorders subgroups, indicating different profiles with varying degrees of deficit.
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Affiliation(s)
- Rosa Ayesa-Arriola
- Department of Psychiatry, IDIVAL, School of Medicine, Marqués de Valdecilla University Hospital, University of Cantabria, Avda. Valdecilla s/n, 39008, Santander, Spain. .,CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Madrid, Spain.
| | - José Manuel Rodríguez-Sánchez
- Department of Psychiatry, IDIVAL, School of Medicine, Marqués de Valdecilla University Hospital, University of Cantabria, Avda. Valdecilla s/n, 39008, Santander, Spain.,CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Madrid, Spain
| | - Esther Setién Suero
- Department of Psychiatry, IDIVAL, School of Medicine, Marqués de Valdecilla University Hospital, University of Cantabria, Avda. Valdecilla s/n, 39008, Santander, Spain
| | - Lauren E Reeves
- Department of Psychology, Temple University, Philadelphia, PA, USA
| | - Rafael Tabarés-Seisdedos
- CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Madrid, Spain.,Teaching Unit of Psychiatry and Psychological Medicine, Department of Medicine, University of Valencia, Valencia, Spain
| | - Benedicto Crespo-Facorro
- Department of Psychiatry, IDIVAL, School of Medicine, Marqués de Valdecilla University Hospital, University of Cantabria, Avda. Valdecilla s/n, 39008, Santander, Spain.,CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Madrid, Spain
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11
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Gu CZ, He HL, Duan HF, Su ZH, Chen H, Gan JL. Predictors of neurocognitive impairment at 2years after a first-episode major depressive disorder. Compr Psychiatry 2016; 68:24-33. [PMID: 27234179 DOI: 10.1016/j.comppsych.2016.03.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 03/26/2016] [Accepted: 03/28/2016] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Neurocognitive impairment is a contributor to major depressive disorder (MDD). However, MDD patients show great variability in the level and course of deficits. The present longitudinal study was to identify predictors of neurocognitive impairment in first-episode MDD patients. METHODS Neurocognitive performance was analyzed in a cohort of 100 patients at 2years after a first-episode MDD. Subgroups, deficit type vs. non-deficit type, were compared on baseline clinical, neuropsychological, premorbid and sociodemographic characteristics. The analysis was performed using the multivariate logistic regression to obtain a model for neurocognitive impairment determination. The predicted probabilities of multivariate logistic regression were analyzed using receiver operating characteristic (ROC) curve. RESULTS Fifty-two percent of MDD participants presented general neurocognitive impairment. The regression analyses demonstrated that clinical and sociodemographic characteristics were not predictive variables. A model composed of processing speed, executive function, and attention, dexterity correctly classified 85.8% of the MDD patients with deficit type. ROC curve indicated that the changes of these three cognitions could identify MDD with deficit type from MDD with non-deficit type. In addition, ROC curve also indicated that processing speed and executive function could identify MDD from CN subjects. Finally, processing speed performance was negatively correlated with Hamilton Depression Scale scores in both MDD with deficit and non-deficit type. CONCLUSION The present study provides novel insights on frequency and neurocognitive profile of subtypes of patients showing impairment. Our results suggest that processing speed impairment is a trait dimension of the disorder related to specific cognitive dysfunctions and the severity of depression.
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Affiliation(s)
- Chuan-Zheng Gu
- The Third Psychiatric Department, Jining Psychiatric Hospital, Jining, 272051, Shandong Province, People's Republic of China; The Third Psychiatric Department, The Second Affiliated Hospital of Jining Medical University, Jining, 272051, Shandong Province, People's Republic of China.
| | - Hui-Li He
- The Third Psychiatric Department, Jining Psychiatric Hospital, Jining, 272051, Shandong Province, People's Republic of China; The Third Psychiatric Department, The Second Affiliated Hospital of Jining Medical University, Jining, 272051, Shandong Province, People's Republic of China
| | - Hui-Feng Duan
- Department of Psychiatry, Mental Diseases Prevention and Treatment Institute of PLA, PLA 91st Central Hospital, Jiaozuo, 454003, Shandong Province, People's Republic of China
| | - Zhong-Hua Su
- Department of Geriatric Psychiatry, Jining Psychiatric Hospital, Jining, 272051, Shandong Province, People's Republic of China; Department of Geriatric Psychiatry, The Second Affiliated Hospital of Jining Medical University, Jining, 272051, Shandong Province, People's Republic of China
| | - Hong Chen
- Department of Geriatric Psychiatry, Jining Psychiatric Hospital, Jining, 272051, Shandong Province, People's Republic of China; Department of Geriatric Psychiatry, The Second Affiliated Hospital of Jining Medical University, Jining, 272051, Shandong Province, People's Republic of China
| | - Jing-Li Gan
- Department of Psychiatry, Mental Diseases Prevention and Treatment Institute of PLA, PLA 91st Central Hospital, Jiaozuo, 454003, Shandong Province, People's Republic of China.
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12
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Reser MP, Allott KA, Killackey E, Farhall J, Cotton SM. Exploring cognitive heterogeneity in first-episode psychosis: What cluster analysis can reveal. Psychiatry Res 2015; 229:819-27. [PMID: 26272022 DOI: 10.1016/j.psychres.2015.07.084] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 07/25/2015] [Accepted: 07/30/2015] [Indexed: 01/19/2023]
Abstract
Variable outcomes in first-episode psychosis (FEP) are partly attributable to heterogeneity in cognitive functioning. To aid identification of those likely to have poorer or better outcomes, we examined whether purported cognitive profiles identified through use of cluster analysis in chronic schizophrenia were evident in FEP. We also aimed to assess whether there was a relationship between cognitive profile and factors independent of the solution, providing external validation that the cognitive profiles represented distinct subgroups. Ward's method hierarchical cluster analysis, verified by a k-means cluster solution, was performed using data obtained from a cognitive test battery administered to 128 participants aged 15-25 years. Four cognitive profiles were identified. A continuity element was evident; participants in cluster four were more cognitively impaired compared to participants in cluster three, who appeared more cognitively intact. Clusters one and two were distinguishable across measures of attention and working memory and visual recognition memory, most likely reflecting sample specific patterns of deficit. Participants in cluster four had significantly lower premorbid and current IQ and higher negative symptoms compared to participants in cluster three. The distinct levels and patterns of cognition found in chronic schizophrenia cohorts are also evident across diagnostic categories in FEP.
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Affiliation(s)
- Maree P Reser
- Department of Psychology and Counselling, La Trobe University, Melbourne, Victoria 3086, Australia
| | - Kelly A Allott
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, Victoria 3053, Australia; Centre for Youth Mental Health, The University of Melbourne, Victoria 3010, Australia
| | - Eóin Killackey
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, Victoria 3053, Australia; Centre for Youth Mental Health, The University of Melbourne, Victoria 3010, Australia
| | - John Farhall
- Department of Psychology and Counselling, La Trobe University, Melbourne, Victoria 3086, Australia
| | - Susan M Cotton
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, Victoria 3053, Australia; Centre for Youth Mental Health, The University of Melbourne, Victoria 3010, Australia.
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13
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Roiz-Santiáñez R, Ortiz-García de la Foz V, Ayesa-Arriola R, Tordesillas-Gutiérrez D, Jorge R, Varela-Gómez N, Suárez-Pinilla P, Córdova-Palomera A, Navasa-Melado JM, Crespo-Facorro B. No progression of the alterations in the cortical thickness of individuals with schizophrenia-spectrum disorder: a three-year longitudinal magnetic resonance imaging study of first-episode patients. Psychol Med 2015; 45:2861-2871. [PMID: 26004991 DOI: 10.1017/s0033291715000811] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Cortical thickness measurement offers an index of brain development processes. In healthy individuals, cortical thickness is reduced with increasing age and is related to cognitive decline. Cortical thinning has been reported in schizophrenia. Whether cortical thickness changes differently over time in patients and its impact on outcome remain unanswered. METHOD Data were examined from 109 patients and 76 healthy controls drawn from the Santander Longitudinal Study of first-episode schizophrenia for whom adequate structural magnetic resonance imaging (MRI) data were available (n = 555 scans). Clinical and cognitive assessments and MRIs were acquired at three regular time points during a 3-year follow-up period. We investigated likely progressive cortical thickness changes in schizophrenia during the first 3 years after initiating antipsychotic treatment. The effects of cortical thickness changes on cognitive and clinical variables were also examined along with the impact of potential confounding factors. RESULTS There were significant diagnoses × scan time interaction main effects for total cortical thickness (F 1,309.1 = 4.60, p = 0.033) and frontal cortical thickness (F 1,310.6 = 5.30, p = 0.022), reflecting a lesser thinning over time in patients. Clinical and cognitive outcome was not associated with progressive cortical changes during the early years of the illness. CONCLUSIONS Cortical thickness abnormalities do not unswervingly progress, at least throughout the first years of the illness. Previous studies have suggested that modifiable factors may partly account for cortical thickness abnormalities. Therefore, the importance of implementing practical actions that may modify those factors and improve them over the course of the illness should be highlighted.
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Affiliation(s)
- R Roiz-Santiáñez
- Department of Psychiatry,University Hospital Marqués de Valdecilla,School of Medicine,University of Cantabria-IDIVAL,Santander,Spain
| | - V Ortiz-García de la Foz
- Department of Psychiatry,University Hospital Marqués de Valdecilla,School of Medicine,University of Cantabria-IDIVAL,Santander,Spain
| | - R Ayesa-Arriola
- Department of Psychiatry,University Hospital Marqués de Valdecilla,School of Medicine,University of Cantabria-IDIVAL,Santander,Spain
| | | | - R Jorge
- Department of Psychiatry and Behavioral Sciences,Baylor College of Medicine,Houston,TX,USA
| | - N Varela-Gómez
- Department of Psychiatry,University Hospital Marqués de Valdecilla,School of Medicine,University of Cantabria-IDIVAL,Santander,Spain
| | - P Suárez-Pinilla
- Department of Psychiatry,University Hospital Marqués de Valdecilla,School of Medicine,University of Cantabria-IDIVAL,Santander,Spain
| | - A Córdova-Palomera
- Cibersam (Centro Investigación Biomédica en Red Salud Mental),Madrid,Spain
| | - J M Navasa-Melado
- Department of Neuroradiology,University Hospital Marqués de Valdecilla-IDIVAL,Santander,Spain
| | - B Crespo-Facorro
- Department of Psychiatry,University Hospital Marqués de Valdecilla,School of Medicine,University of Cantabria-IDIVAL,Santander,Spain
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Varela-Gomez N, Mata I, Perez-Iglesias R, Rodriguez-Sanchez JM, Ayesa R, Fatjo-Vilas M, Crespo-Facorro B. Dysbindin gene variability is associated with cognitive abnormalities in first-episode non-affective psychosis. Cogn Neuropsychiatry 2015; 20:144-56. [PMID: 25530342 DOI: 10.1080/13546805.2014.991780] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Dystrobrevin-binding protein 1 gene (dysbindin or DTNBP1) has been associated with schizophrenia and cognitive performance. Its expression in areas implicated in cognition such as the dorsolateral prefrontal cortex, as well as its role in dopaminergic and glutamatergic system, has been replicated by several studies. The main aim of this study was to examine the association between DTNBP1 variability and cognitive performance in a sample of 238 patients with a first episode of a non-affective psychosis. METHODS Patients, and a comparison sample of 47 healthy subjects, completed an extensive neuropsychological battery. Five single nucleotide polymorphisms (SNPs) within DTNBP1 (rs2619528, rs2619538, rs3213207, rs2619539 and rs760761) and three haplotypes (GACAC, GAGAC and GTGAC) were analysed. RESULTS In the group of patients, we found a significant association between two of the DTNBP1 SNPs and one of the haplotypes (rs2619539, rs3213207 and GACAC) and a measure of premorbid IQ [Wechsler Adult Intelligence Scale-3rd Edition (WAIS-III) Vocabulary subtest]. Moreover, one of these SNPs, rs2619539, was also associated with our measure of working memory (WAIS-III Backward digits subtest) and two haplotypes, GAGAC and GTGAC, with our measure of verbal memory (Rey Auditory Verbal Learning Test), of visual memory (Rey Complex Figure Test) in the case of GAGAC, and of speed of processing (WAIS-III Digit Symbol-coding) in the case of GTGAC. CONCLUSIONS Our findings add further evidence suggesting an association between dysbindin gene variability and cognitive abnormalities in schizophrenia, providing preliminary evidence of this association since the time of illness onset among minimally medicated patients.
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Affiliation(s)
- Noemí Varela-Gomez
- a Department of Psychiatry, School of Medicine, University Hospital Marques de Valdecilla, IFIMAV , University of Cantabria , Santander , Spain
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15
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Duan HF, Gan JL, Yang JM, Cheng ZX, Gao CY, Shi ZJ, Zhu XQ, Liang XJ, Zhao LM. A longitudinal study on intrinsic connectivity of hippocampus associated with positive symptom in first-episode schizophrenia. Behav Brain Res 2015; 283:78-86. [PMID: 25619684 DOI: 10.1016/j.bbr.2015.01.022] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 01/10/2015] [Accepted: 01/14/2015] [Indexed: 11/16/2022]
Abstract
Hippocampal pathology has been considered to underlie clinical, functional and cognitive impairments in schizophrenia. While longitudinal magnetic resonance imaging (MRI) studies have demonstrated progressive gray matter reduction of the hippocampus during the early phases of schizophrenia (SCZ), very little is known about whether functional connectivity (FC) between the hippocampus and other brain regions also exhibit progressive changes. In this study, resting state functional MRI (fMRI) was used to examine changes in hippocampal connectivity at baseline and follow-up scans comparing 68 patients with first episode SCZ and 62 matched controls. At baseline and follow-up, in the bilateral hippocampal network, SCZ mainly showed decreased FC with bilateral cerebellum posterior lobe, frontal gyrus temporal gyrus, precuneus, and cingulate cortex compared to controls. Furthermore, in the bilateral hippocampus, there was a significant interaction effect of group and time for FC with cerebellum posterior lobe, temporal gyrus, frontal gyrus, and posterior cingulate cortex. Interestingly, longitudinal changes of bilateral hippocampal connectivity with right middle frontal gyrus negatively correlated with positive symptom scores in SCZ. These results provide novel evidence for the progressive changes of FC between hippocampus and other brain regions in SCZ. It further suggests that longitudinal changes of bilateral hippocampal connectivity with right middle frontal gyrus can contribute to the formation and emergence of positive symptom of SCZ.
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Affiliation(s)
- Hui-Feng Duan
- Department of Psychiatry, Mental Diseases Prevention and Treatment Institute of PLA, PLA 91st Central Hospital, Jiaozuo 454003, Henan Province, PR China
| | - Jing-Li Gan
- Department of Psychiatry, Mental Diseases Prevention and Treatment Institute of PLA, PLA 91st Central Hospital, Jiaozuo 454003, Henan Province, PR China.
| | - Jia-Ming Yang
- Center for Medical Imaging, PLA 91st Central Hospital, Jiaozuo 454003, Henan Province, PR China
| | - Zheng-Xiang Cheng
- Department of Psychiatry, Mental Diseases Prevention and Treatment Institute of PLA, PLA 91st Central Hospital, Jiaozuo 454003, Henan Province, PR China
| | - Cun-You Gao
- Department of Psychiatry, Mental Diseases Prevention and Treatment Institute of PLA, PLA 91st Central Hospital, Jiaozuo 454003, Henan Province, PR China
| | - Zhen-Juan Shi
- Department of Psychiatry, Mental Diseases Prevention and Treatment Institute of PLA, PLA 91st Central Hospital, Jiaozuo 454003, Henan Province, PR China
| | - Xi-Quan Zhu
- Department of Psychiatry, Mental Diseases Prevention and Treatment Institute of PLA, PLA 91st Central Hospital, Jiaozuo 454003, Henan Province, PR China
| | - Xue-Jun Liang
- Department of Psychiatry, Mental Diseases Prevention and Treatment Institute of PLA, PLA 91st Central Hospital, Jiaozuo 454003, Henan Province, PR China
| | - Lan-Min Zhao
- Department of Psychiatry, Mental Diseases Prevention and Treatment Institute of PLA, PLA 91st Central Hospital, Jiaozuo 454003, Henan Province, PR China
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Schubert KO, Clark SR, Baune BT. The use of clinical and biological characteristics to predict outcome following First Episode Psychosis. Aust N Z J Psychiatry 2015; 49:24-35. [PMID: 25430911 DOI: 10.1177/0004867414560650] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Psychotic illnesses such as schizophrenia and other non-affective psychoses are heterogeneous in disease course and functional outcomes. We review evidence from investigations in clinical psychiatry, neuroimaging, neurocognition, and blood biomarker research suggesting that distinct bio-psycho-social patterns exist at the onset and during the early phase of a First Episode Psychosis (FEP), which can describe the risk of individual illness progression and functional trajectories. METHOD A selective literature review was performed on articles drawn from Medline searches for relevant key words. A simulation model was constructed from data derived from two recent publications, selected as examples of studies that investigated multivariate predictors of long-term outcome following FEP. RESULTS We illustrate how illness trajectories following FEP could be described based on multimodal sociodemographic, clinical, psychological, and neurobiological information. A clinical modeling simulation shows thatrisk trajectories for achieving long-term favorable or unfavorable outcomes can differ significantly depending on baseline characteristics in combination with MRI and functional measurements within 6 months of disease onset. CONCLUSIONS Multimodal trajectory modeling may be useful to describe longitudinal outcomes following FEP. Richlongitudinal data on predictors and outcomes, and better integration of multimodal (sociodemographic, clinical, psychological, biological) data, are required to operationalize this approach. This technique may improve our understanding of course of illness and help to provide a more personalized approach to the assessment and treatment of people presenting with FEP.
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Affiliation(s)
- K Oliver Schubert
- Discipline of Psychiatry, School of Medicine, University of Adelaide, Australia
| | - Scott R Clark
- Discipline of Psychiatry, School of Medicine, University of Adelaide, Australia
| | - Bernhard T Baune
- Discipline of Psychiatry, School of Medicine, University of Adelaide, Australia
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Roiz-Santiáñez R, Ayesa-Arriola R, Tordesillas-Gutiérrez D, Ortiz-García de la Foz V, Pérez-Iglesias R, Pazos A, Sánchez E, Crespo-Facorro B. Three-year longitudinal population-based volumetric MRI study in first-episode schizophrenia spectrum patients. Psychol Med 2014; 44:1591-1604. [PMID: 24067252 DOI: 10.1017/s0033291713002365] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Schizophrenia is a chronic brain disorder associated with structural brain abnormalities already present at the onset of the illness. Whether these brain abnormalities might progress over time is still under debate. METHOD The aim of this study was to investigate likely progressive brain volume changes in schizophrenia during the first 3 years after initiating antipsychotic treatment. The study included 109 patients with a schizophrenia spectrum disorder and a control group of 76 healthy subjects. Subjects received detailed clinical and cognitive assessment and structural magnetic resonance imaging (MRI) at regular time points during a 3-year follow-up period. The effects of brain changes on cognitive and clinical variables were examined along with the impact of potential confounding factors. RESULTS Overall, patients and healthy controls exhibited a similar pattern of brain volume changes. However, patients showed a significant lower progressive decrease in the volume of the caudate nucleus than control subjects (F 1,307.2 = 2.12, p = 0.035), with healthy subjects showing a greater reduction than patients during the follow-up period. Clinical and cognitive outcomes were not associated with progressive brain volume changes during the early years of the illness. CONCLUSIONS Brain volume abnormalities that have been consistently observed at the onset of non-affective psychosis may not inevitably progress, at least over the first years of the illness. Taking together with clinical and cognitive longitudinal data, our findings, showing a lack of brain deterioration in a substantial number of individuals, suggest a less pessimistic and more reassuring perception of the illness.
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Affiliation(s)
- R Roiz-Santiáñez
- Marqués de Valdecilla University Hospital, IFIMAV, Santander, Spain
| | - R Ayesa-Arriola
- Marqués de Valdecilla University Hospital, IFIMAV, Santander, Spain
| | | | | | - R Pérez-Iglesias
- Marqués de Valdecilla University Hospital, IFIMAV, Santander, Spain
| | - A Pazos
- Marqués de Valdecilla University Hospital, IFIMAV, Santander, Spain
| | - E Sánchez
- Department of Neuroradiology, Marqués de Valdecilla University Hospital, Santander, Spain
| | - B Crespo-Facorro
- Marqués de Valdecilla University Hospital, IFIMAV, Santander, Spain
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18
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Ayesa-Arriola R, Roiz-Santiáñez R, Pérez-Iglesias R, Ferro A, Sainz J, Crespo-Facorro B. Neuroanatomical Differences between First-Episode Psychosis Patients with and without Neurocognitive Deficit: A 3-Year Longitudinal Study. Front Psychiatry 2013; 4:134. [PMID: 24146655 PMCID: PMC3797976 DOI: 10.3389/fpsyt.2013.00134] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Accepted: 10/01/2013] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The course of cognitive function in first-episode psychosis (FEP) patients suggests that some individuals are normal or near normal whereas some cases present a marked decline. The goal of the present longitudinal study was to identify neuroanatomical differences between deficit and non-deficit patients. METHODS Fifty nine FEP patients with neuroimage and neurocognitive information were studied at baseline and 3 year after illness onset. A global cognitive function score was used to classify deficit and non-deficit patients at baseline. Analysis of covariances and repeated-measures analysis were performed to evaluate differences in brain volumes. Age, premorbid IQ, and intracranial volume were used as covariates. We examined only volumes of whole brain, whole brain gray and white matter, cortical CSF and lateral ventricles, lobular volumes of gray and white matter, and subcortical (caudate nucleus and thalamus) regions. RESULTS At illness onset 50.8% of patients presented global cognitive deficit. There were no significant differences between neuropsychological subgroups in any of the brain regions studied at baseline [all F(1, 54) ≤ 3.42; all p ≥ 0.07] and follow-up [all F(1, 54) ≤ 3.43; all p ≥ 0.07] time points. There was a significant time by group interaction for the parietal tissue volume [F(1, 54) = 4.97, p = 0.030] and the total gray matter volume [F(1, 54) = 4.31, p = 0.042], with the deficit group showing a greater volume decrease. CONCLUSION Our results did not confirm the presence of significant morphometric differences in the brain regions evaluated between cognitively impaired and cognitively preserved schizophrenia patients at the early stages of the illness. However, there were significant time by group interactions for the parietal tissue volume and the total gray matter volume during the 3-year follow-up period, which might indicate that cognitive deficit in schizophrenia would be associated with progressive brain volume loss.
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Affiliation(s)
- Rosa Ayesa-Arriola
- Department of Psychiatry, School of Medicine, University of Cantabria, University Hospital Marqués de Valdecilla, IFIMAV, Santander, Spain
- CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Madrid, Spain
| | - Roberto Roiz-Santiáñez
- Department of Psychiatry, School of Medicine, University of Cantabria, University Hospital Marqués de Valdecilla, IFIMAV, Santander, Spain
- CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Madrid, Spain
| | - Rocío Pérez-Iglesias
- Department of Psychiatry, School of Medicine, University of Cantabria, University Hospital Marqués de Valdecilla, IFIMAV, Santander, Spain
- CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Madrid, Spain
- Psychosis Studies Department, Institute of Psychiatry, London, UK
| | - Adele Ferro
- Department of Experimental Clinical Medicine, Inter-University Center for Behavioural Neurosciences (ICBN), University of Udine, Udine, Italy
| | - Jesús Sainz
- CSIC, Spanish National Research Council, Institute of Biomedicine and Biotechnology of Cantabria, University of Cantabria, Santander, Spain
| | - Benedicto Crespo-Facorro
- Department of Psychiatry, School of Medicine, University of Cantabria, University Hospital Marqués de Valdecilla, IFIMAV, Santander, Spain
- CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Madrid, Spain
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