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Salahuddin NH, Schütz A, Pitschel-Walz G, Mayer SF, Chaimani A, Siafis S, Priller J, Leucht S, Bighelli I. Psychological and psychosocial interventions for treatment-resistant schizophrenia: a systematic review and network meta-analysis. Lancet Psychiatry 2024; 11:545-553. [PMID: 38879276 DOI: 10.1016/s2215-0366(24)00136-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 04/12/2024] [Accepted: 04/16/2024] [Indexed: 08/13/2024]
Abstract
BACKGROUND Many patients with schizophrenia have symptoms that do not respond to antipsychotics. This condition is called treatment-resistant schizophrenia and has not received specific attention as opposed to general schizophrenia. Psychological and psychosocial interventions as an add-on treatment to pharmacotherapy could be useful, but their role and comparative efficacy to each other and to standard care in this population are not known. We investigated the efficacy, acceptability, and tolerability of psychological and psychosocial interventions for patients with treatment-resistant schizophrenia. METHODS In this systematic review and network meta-analysis (NMA), we searched for published and unpublished randomised controlled trials (RCTs) through a systematic database search in BIOSIS, CINAHL, Embase, LILACS, MEDLINE, PsychInfo, ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform for articles published from inception up to Jan 31, 2020. We also searched the Cochrane Schizophrenia Group registry for studies published from inception up to March 31, 2022, and PubMed and Cochrane CENTRAL for studies published from inception up to July 31, 2023. We included RCTs that included patients with treatment-resistant schizophrenia. The primary outcome was overall symptoms. We did random-effects pairwise meta-analyses and NMAs to calculate standardised mean differences (SMDs) or risk ratios with 95% CIs. No people with lived experience were involved throughout the research process. The study protocol was registered in PROSPERO, CRD42022358696. FINDINGS We identified 30 326 records, excluding 24 526 by title and abstract screening. 5762 full-text articles were assessed for eligibility, of which 5540 were excluded for not meeting the eligibility criteria, and 222 reports corresponding to 60 studies were included in the qualitative synthesis. Of these, 52 RCTs with 5034 participants (1654 [33·2%] females and 3325 [66·8%] males with sex indicated) comparing 20 psychological and psychosocial interventions provided data for the NMA. Mean age of participants was 38·05 years (range 23·10-48·50). We aimed to collect ethnicity data, but they were scarcely reported. According to the quality of evidence, cognitive behavioural therapy for psychosis (CBTp; SMD -0·22, 95% CI -0·35 to -0·09, 35 trials), virtual reality intervention (SMD -0·41, -0·79 to -0·02, four trials), integrated intervention (SMD -0·70, -1·18 to -0·22, three trials), and music therapy (SMD -1·27, -1·83 to -0·70, one study) were more efficacious than standard care in reducing overall symptoms. No indication of publication bias was identified. INTERPRETATION We provide robust findings that CBTp can reduce the overall symptoms of patients with treatment-resistant schizophrenia, and therefore clinicians can prioritise this intervention in their clinical practice. Other psychological and psychosocial interventions showed promising results but need further investigation. FUNDING DAAD-ASFE.
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Affiliation(s)
- Nurul Husna Salahuddin
- Department of Psychiatry and Psychotherapy, TUM School of Medicine and Health, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Alexandra Schütz
- Department of Psychiatry and Psychotherapy, TUM School of Medicine and Health, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Gabi Pitschel-Walz
- Institute of General Practice and Health Services Research, TUM School of Medicine and Health, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Susanna Franziska Mayer
- Department of Psychiatry and Psychotherapy, TUM School of Medicine and Health, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Anna Chaimani
- Université Paris Cité, Centre of Research in Epidemiology and Statistics (CRESS-U1153), Inserm, Paris, France
| | - Spyridon Siafis
- Department of Psychiatry and Psychotherapy, TUM School of Medicine and Health, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; German Centre for Mental Health (DZPG), Munich and Augsburg, Germany
| | - Josef Priller
- Department of Psychiatry and Psychotherapy, TUM School of Medicine and Health, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; German Centre for Mental Health (DZPG), Munich and Augsburg, Germany; Neuropsychiatry and Laboratory of Molecular Psychiatry, Charité-Universitätsmedizin Berlin and DZNE, Berlin, Germany; University of Edinburgh and UK DRI, Edinburgh, UK
| | - Stefan Leucht
- Department of Psychiatry and Psychotherapy, TUM School of Medicine and Health, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; German Centre for Mental Health (DZPG), Munich and Augsburg, Germany.
| | - Irene Bighelli
- Department of Psychiatry and Psychotherapy, TUM School of Medicine and Health, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; German Centre for Mental Health (DZPG), Munich and Augsburg, Germany
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Ganapathiraju MK, Triptish B, Deshpande S, Wesesky M, Wood J, Nimgaonkar VL. Schizophrenia interactome derived repurposable drugs and randomized control trials of two candidates. Biol Psychiatry 2024:S0006-3223(24)01426-4. [PMID: 38950808 DOI: 10.1016/j.biopsych.2024.06.022] [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: 01/19/2024] [Revised: 05/29/2024] [Accepted: 06/09/2024] [Indexed: 07/03/2024]
Abstract
There is a substantial unmet need for effective and patient-acceptable drugs to treat severe mental illnesses like schizophrenia. Computational analysis of genomic, transcriptomic, and pharmacologic data generated in the past two decades enables repurposing of drugs or compounds with acceptable safety profiles, namely those that are FDA-approved or reached late stages in clinical trials. We developed a rational approach to achieve this computationally for schizophrenia by studying drugs that target the proteins in its protein interaction network ('interactome'). This involved contrasting the transcriptomic modulations observed in the disorder and the drug; our analyses resulted in 12 candidate drugs, 9 of which had additional supportive evidence: their target networks were enriched for pathways relevant to schizophrenia etiology or for genes that had an association with diseases pathogenically similar to schizophrenia. To translate these computational results to the clinic, these shortlisted drugs must be tested empirically through randomized controlled trials (RCT), where their prior safety approvals obviate the need for time-consuming phase I and II studies. We selected two among the shortlisted candidates based on likely adherence and side effect profiles. We are testing them through adjunctive RCTs for patients with schizophrenia or schizoaffective disorder who experienced incomplete resolution of psychotic features with conventional treatment. The integrated computational analysis for identifying and ranking drugs for clinical trials can be iterated as additional data are obtained. Our approach could be expanded to enable disease subtype-specific drug discovery in future and should also be exploited for other psychiatric disorders.
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Affiliation(s)
- Madhavi K Ganapathiraju
- Department of Biomedical Informatics and Intelligent Systems Program, University of Pittsburgh, Pittsburgh, PA, USA; Carnegie Mellon University in Qatar, Doha, Qatar.
| | - Bhatia Triptish
- Dept. of Psychiatry, Centre of Excellence in Mental Health, ABVIMS- Dr Ram Manohar Lohia Hospital, New Delhi 110001, India
| | - Smita Deshpande
- Department of Psychiatry, St John's Medical College Hospital, Koramangala, Bengaluru, Karnataka 560034, India
| | - Maribeth Wesesky
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Joel Wood
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Vishwajit L Nimgaonkar
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA; Department of Human Genetics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA; Veterans Administration Pittsburgh Healthcare System, Pittsburgh, PA, USA.
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Camporesi S, Xin L, Golay P, Eap CB, Cleusix M, Cuenod M, Fournier M, Hashimoto K, Jenni R, Ramain J, Restellini R, Solida A, Conus P, Do KQ, Khadimallah I. Neurocognition and NMDAR co-agonists pathways in individuals with treatment resistant first-episode psychosis: a 3-year follow-up longitudinal study. Mol Psychiatry 2024:10.1038/s41380-024-02631-4. [PMID: 38849515 DOI: 10.1038/s41380-024-02631-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 05/15/2024] [Accepted: 05/28/2024] [Indexed: 06/09/2024]
Abstract
This study aims to determine whether 1) individuals with treatment-resistant schizophrenia display early cognitive impairment compared to treatment-responders and healthy controls and 2) N-methyl-D-aspartate-receptor hypofunction is an underlying mechanism of cognitive deficits in treatment-resistance. In this case‒control 3-year-follow-up longitudinal study, n = 697 patients with first-episode psychosis, aged 18 to 35, were screened for Treatment Response and Resistance in Psychosis criteria through an algorithm that assigns patients to responder, limited-response or treatment-resistant category (respectively resistant to 0, 1 or 2 antipsychotics). Assessments at baseline: MATRICS Consensus Cognitive Battery; N-methyl-D-aspartate-receptor co-agonists biomarkers in brain by MRS (prefrontal glutamate levels) and plasma (D-serine and glutamate pathways key markers). Patients were compared to age- and sex-matched healthy controls (n = 114). Results: patient mean age 23, 27% female. Treatment-resistant (n = 51) showed lower scores than responders (n = 183) in processing speed, attention/vigilance, working memory, verbal learning and visual learning. Limited responders (n = 59) displayed an intermediary phenotype. Treatment-resistant and limited responders were merged in one group for the subsequent D-serine and glutamate pathway analyses. This group showed D-serine pathway dysregulation, with lower levels of the enzymes serine racemase and serine-hydroxymethyltransferase 1, and higher levels of the glutamate-cysteine transporter 3 than in responders. Better cognition was associated with higher D-serine and lower glutamate-cysteine transporter 3 levels only in responders; this association was disrupted in the treatment resistant group. Treatment resistant patients and limited responders displayed early cognitive and persistent functioning impairment. The dysregulation of NMDAR co-agonist pathways provides underlying molecular mechanisms for cognitive deficits in treatment-resistant first-episode psychosis. If replicated, our findings would open ways to mechanistic biomarkers guiding response-based patient stratification and targeting cognitive improvement in clinical trials.
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Affiliation(s)
- Sara Camporesi
- Center for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
- Service of General Psychiatry, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
- Department of psychiatry and Emergency Department, Geneva University Hospital, Geneva, Switzerland
| | - Lijing Xin
- Center for Biomedical Imaging, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Philippe Golay
- Service of General Psychiatry, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Chin Bin Eap
- Center for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
- School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland
- Center for Research and Innovation in Clinical Pharmaceutical Sciences, University of Lausanne, Lausanne, Switzerland
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, University of Lausanne, Geneva, Switzerland
| | - Martine Cleusix
- Center for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Michel Cuenod
- Center for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Margot Fournier
- Center for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Kenji Hashimoto
- Division of Clinical Neuroscience, Chiba University Center for Forensic Mental Health, Chiba, Japan
| | - Raoul Jenni
- Center for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Julie Ramain
- Service of General Psychiatry, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
- Training and Research Institute in Mental Health (IFRSM), Neuchâtel Centre of Psychiatry, Neuchâtel, Switzerland
| | - Romeo Restellini
- Service of General Psychiatry, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
- Emergency medicine department, Geneva University Hospital, Geneva, Switzerland
| | - Alessandra Solida
- Service of General Psychiatry, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
- Psychiatry Department for Adults 2, Neuchâtel Centre of Psychiatry, Prefargier, Switzerland
| | - Philippe Conus
- Service of General Psychiatry, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Kim Q Do
- Center for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Ines Khadimallah
- Center for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland.
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Bern, Switzerland.
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Cilia BJ, Eratne D, Wannan C, Malpas C, Janelidze S, Hansson O, Everall I, Bousman C, Thomas N, Santillo AF, Velakoulis D, Pantelis C. Associations between structural brain changes and blood neurofilament light chain protein in treatment-resistant schizophrenia. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.04.07.24305362. [PMID: 38645076 PMCID: PMC11030485 DOI: 10.1101/2024.04.07.24305362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/23/2024]
Abstract
Background and Hypothesis Around 30% of people with schizophrenia are refractory to antipsychotic treatment (treatment-resistant schizophrenia; TRS). While abnormal structural neuroimaging findings, in particular volume and thickness reductions, are often observed in schizophrenia, it is anticipated that biomarkers of neuronal injury like neurofilament light chain protein (NfL) can improve our understanding of the pathological basis underlying schizophrenia. The current study aimed to determine whether people with TRS demonstrate different associations between plasma NfL levels and regional cortical thickness reductions compared with controls. Study Design Measurements of plasma NfL and cortical thickness were obtained from 39 individuals with TRS, and 43 healthy controls. T1-weighted magnetic resonance imaging sequences were obtained and processed via FreeSurfer. General linear mixed models adjusting for age and weight were estimated to determine whether the interaction between diagnostic group and plasma NfL level predicted lower cortical thickness across frontotemporal structures and the insula. Study Results Significant (false discovery rate corrected) cortical thinning of the left ( p = 0.001, η 2p = 0.104) and right ( p < 0.001, η 2 = 0.167) insula was associated with higher levels of plasma NfL in TRS, but not in healthy controls. Conclusions The association between regional thickness reduction of the insula bilaterally and plasma NfL may reflect a neurodegenerative process during the course of TRS. The findings of the present study suggest that some level of cortical degeneration localised to the bilateral insula may exist in people with TRS, which is not observed in the normal population.
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Kogure M, Kanahara N, Miyazawa A, Shiko Y, Otsuka I, Matsuyama K, Takase M, Kimura M, Kimura H, Ota K, Idemoto K, Tamura M, Oda Y, Yoshida T, Okazaki S, Yamasaki F, Nakata Y, Watanabe Y, Niitsu T, Hishimoto A, Iyo M. Association of SLC6A3 variants with treatment-resistant schizophrenia: a genetic association study of dopamine-related genes in schizophrenia. Front Psychiatry 2024; 14:1334335. [PMID: 38476817 PMCID: PMC10929739 DOI: 10.3389/fpsyt.2023.1334335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 12/21/2023] [Indexed: 03/14/2024] Open
Abstract
Background Most genetic analyses that have attempted to identify a locus or loci that can distinguish patients with treatment-resistant schizophrenia (TRS) from those who respond to treatment (non-TRS) have failed. However, evidence from multiple studies suggests that patients with schizophrenia who respond well to antipsychotic medication have a higher dopamine (DA) state in brain synaptic clefts whereas patients with TRS do not show enhanced DA synthesis/release pathways. Patients and methods To examine the contribution (if any) of genetics to TRS, we conducted a genetic association analysis of DA-related genes in schizophrenia patients (TRS, n = 435; non-TRS, n = 539) and healthy controls (HC: n = 489). Results The distributions of the genotypes of rs3756450 and the 40-bp variable number tandem repeat on SLC6A3 differed between the TRS and non-TRS groups. Regarding rs3756450, the TRS group showed a significantly higher ratio of the A allele, whereas the non-TRS group predominantly had the G allele. The analysis of the combination of COMT and SLC6A3 yielded a significantly higher ratio of the putative low-DA type (i.e., high COMT activity + high SLC6A3 activity) in the TRS group compared to the two other groups. Patients with the low-DA type accounted for the minority of the non-TRS group and exhibited milder psychopathology. Conclusion The overall results suggest that (i) SLC6A3 could be involved in responsiveness to antipsychotic medication and (ii) genetic variants modulating brain DA levels may be related to the classification of TRS and non-TRS.
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Affiliation(s)
- Masanobu Kogure
- Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Nobuhisa Kanahara
- Division of Medical Treatment and Rehabilitation, Center for Forensic Mental Health, Chiba University, Chiba, Japan
| | - Atsuhiro Miyazawa
- Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba, Japan
- Doujin-kai Kisarazu Hospital, Kisarazu, Japan
| | - Yuki Shiko
- Biostatistics Section, Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Ikuo Otsuka
- Department of Psychiatry, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Koichi Matsuyama
- Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba, Japan
- Douwa-kai Chiba Hospital, Funabashi, Japan
| | | | - Makoto Kimura
- Chiba Psychiatric Medical Center, Chiba, Japan
- Department of Psychiatry, Kameda Medical Center, Kamogawa, Japan
| | - Hiroshi Kimura
- Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba, Japan
- Gakuji-kai Kimura Hospital, Chiba, Japan
- Department of Psychiatry, School of Medicine, International University of Health and Welfare, Narita, Japan
| | - Kiyomitsu Ota
- Doujin-kai Kisarazu Hospital, Kisarazu, Japan
- Choshi-kokoro Clinic, Choshi, Japan
| | - Keita Idemoto
- Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba, Japan
- Doujin-kai Kisarazu Hospital, Kisarazu, Japan
| | - Masaki Tamura
- Doujin-kai Kisarazu Hospital, Kisarazu, Japan
- Department of Cognitive Behavioral Psychology, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yasunori Oda
- Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba, Japan
| | | | - Satoshi Okazaki
- Department of Psychiatry, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Fumiaki Yamasaki
- Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yusuke Nakata
- Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba, Japan
| | | | - Tomihisa Niitsu
- Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Akitoyo Hishimoto
- Department of Psychiatry, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masaomi Iyo
- Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba, Japan
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Hsu CW, Stahl D, Mouchlianitis E, Peters E, Vamvakas G, Keppens J, Watson M, Schmidt N, Jacobsen P, McGuire P, Shergill S, Kabir T, Hirani T, Yang Z, Yiend J. User-Centered Development of STOP (Successful Treatment for Paranoia): Material Development and Usability Testing for a Digital Therapeutic for Paranoia. JMIR Hum Factors 2023; 10:e45453. [PMID: 38064256 PMCID: PMC10746980 DOI: 10.2196/45453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 06/13/2023] [Accepted: 09/23/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Paranoia is a highly debilitating mental health condition. One novel intervention for paranoia is cognitive bias modification for paranoia (CBM-pa). CBM-pa comes from a class of interventions that focus on manipulating interpretation bias. Here, we aimed to develop and evaluate new therapy content for CBM-pa for later use in a self-administered digital therapeutic for paranoia called STOP ("Successful Treatment of Paranoia"). OBJECTIVE This study aimed to (1) take a user-centered approach with input from living experts, clinicians, and academics to create and evaluate paranoia-relevant item content to be used in STOP and (2) engage with living experts and the design team from a digital health care solutions company to cocreate and pilot-test the STOP mobile app prototype. METHODS We invited 18 people with living or lived experiences of paranoia to create text exemplars of personal, everyday emotionally ambiguous scenarios that could provoke paranoid thoughts. Researchers then adapted 240 suitable exemplars into corresponding intervention items in the format commonly used for CBM training and created 240 control items for the purpose of testing STOP. Each item included newly developed, visually enriching graphics content to increase the engagement and realism of the basic text scenarios. All items were then evaluated for their paranoia severity and readability by living experts (n=8) and clinicians (n=7) and for their item length by the research team. Items were evenly distributed into six 40-item sessions based on these evaluations. Finalized items were presented in the STOP mobile app, which was co-designed with a digital health care solutions company, living or lived experts, and the academic team; user acceptance was evaluated across 2 pilot tests involving living or lived experts. RESULTS All materials reached predefined acceptable thresholds on all rating criteria: paranoia severity (intervention items: ≥1; control items: ≤1, readability: ≥3, and length of the scenarios), and there was no systematic difference between the intervention and control group materials overall or between individual sessions within each group. For item graphics, we also found no systematic differences in users' ratings of complexity (P=.68), attractiveness (P=.15), and interest (P=.14) between intervention and control group materials. User acceptance testing of the mobile app found that it is easy to use and navigate, interactive, and helpful. CONCLUSIONS Material development for any new digital therapeutic requires an iterative and rigorous process of testing involving multiple contributing groups. Appropriate user-centered development can create user-friendly mobile health apps, which may improve face validity and have a greater chance of being engaging and acceptable to the target end users.
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Affiliation(s)
- Che-Wei Hsu
- Department of Psychological Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
- Department of Psychosis Studies, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom
| | - Daniel Stahl
- Department of Biostatistics and Health Informatics, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom
| | | | - Emmanuelle Peters
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom
- South London and Maudsley National Health Service Foundation Trust, London, United Kingdom
| | - George Vamvakas
- Department of Biostatistics and Health Informatics, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom
| | - Jeroen Keppens
- Department of Informatics, King's College London, London, United Kingdom
| | - Miles Watson
- Department of Psychosis Studies, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom
| | - Nora Schmidt
- Department of Psychosis Studies, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom
| | | | - Philip McGuire
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Sukhi Shergill
- Department of Psychosis Studies, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom
| | - Thomas Kabir
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Tia Hirani
- Department of Psychosis Studies, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom
| | - Ziyang Yang
- Department of Psychosis Studies, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom
| | - Jenny Yiend
- Department of Psychosis Studies, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom
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Donantueno C, Yger P, Cabestaing F, Jardri R. fMRI-based neurofeedback strategies and the way forward to treating phasic psychiatric symptoms. Front Neurosci 2023; 17:1275229. [PMID: 38125404 PMCID: PMC10731299 DOI: 10.3389/fnins.2023.1275229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 11/17/2023] [Indexed: 12/23/2023] Open
Abstract
Auditory verbal hallucinations (AVH) are the perfect illustration of phasic symptoms in psychiatric disorders. For some patients and in some situations, AVH cannot be relieved by standard therapeutic approaches. More advanced treatments are needed, among which neurofeedback, and more specifically fMRI-based neurofeedback, has been considered. This paper discusses the different possibilities to approach neurofeedback in the specific context of phasic symptoms, by highlighting the strengths and weaknesses of the available neurofeedback options. It concludes with the added value of the recently introduced information-based neurofeedback. Although requiring an online fMRI signal classifier, which can be quite complex to implement, this neurofeedback strategy opens a door toward an alternative treatment option for complex phasic symptomatology.
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Affiliation(s)
- Candela Donantueno
- University of Lille, INSERM U-1172, CHU Lille, Lille Neuroscience & Cognition Center, Plasticity & SubjectivitY Team, Fontan Hospital, Lille, France
| | - Pierre Yger
- University of Lille, INSERM U-1172, CHU Lille, Lille Neuroscience & Cognition Center, Plasticity & SubjectivitY Team, Fontan Hospital, Lille, France
| | | | - Renaud Jardri
- University of Lille, INSERM U-1172, CHU Lille, Lille Neuroscience & Cognition Center, Plasticity & SubjectivitY Team, Fontan Hospital, Lille, France
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Horiguchi J, Wake R, Murotani K, Seno H, Miyaoka T, Inoue K. A multicenter, double-blind, randomized, controlled study of patients with treatment-resistant schizophrenia treated with yokukansan for 12 weeks. PCN REPORTS : PSYCHIATRY AND CLINICAL NEUROSCIENCES 2023; 2:e155. [PMID: 38868736 PMCID: PMC11114414 DOI: 10.1002/pcn5.155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 10/06/2023] [Accepted: 10/26/2023] [Indexed: 06/14/2024]
Abstract
Aim We conducted a 12-week double-blind, placebo-controlled, multicenter study to evaluate the efficacy and safety of yokukansan in patients with schizophrenia. Methods Patients with schizophrenia resistant to antipsychotics whose Positive and Negative Syndrome Scale (PANSS) scores were stable within five points were enrolled and assigned to the yokukansan or placebo group. Fifty-three of the 61 consenting patients were allocated to the yokukansan (n = 27) and placebo (n = 26) groups. Results The changes in total and positive PANSS scores at 12 weeks were significantly greater in the yokukansan group than in the placebo group. There were no significant changes in other psychiatric symptom rating scores in either group. Adverse reactions were reported in six of 27 patients (22.2%) in the yokukansan group and five of 26 patients (19.2%) in the placebo group, all of which were nonserious. Conclusion Yokukansan is very safe and has clinical potential as a treatment for schizophrenia in combination with Western medicine.
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Affiliation(s)
- Jun Horiguchi
- Department of PsychiatryShimane University School of MedicineIzumoJapan
| | - Rei Wake
- Department of PsychiatryShimane University School of MedicineIzumoJapan
| | | | - Haruo Seno
- PsychiatryMatsue Aoba HospitalMatsueJapan
| | - Tsuyoshi Miyaoka
- Department of PsychiatryShimane University School of MedicineIzumoJapan
| | - Ken Inoue
- Research and Education Faculty, Medical Sciences Cluster, Health Service CenterKochi UniversityKochiJapan
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Tanaka R, Yamada K. Genomic and Reverse Translational Analysis Discloses a Role for Small GTPase RhoA Signaling in the Pathogenesis of Schizophrenia: Rho-Kinase as a Novel Drug Target. Int J Mol Sci 2023; 24:15623. [PMID: 37958606 PMCID: PMC10648424 DOI: 10.3390/ijms242115623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 10/18/2023] [Accepted: 10/24/2023] [Indexed: 11/15/2023] Open
Abstract
Schizophrenia is one of the most serious psychiatric disorders and is characterized by reductions in both brain volume and spine density in the frontal cortex. RhoA belongs to the RAS homolog (Rho) family and plays critical roles in neuronal development and structural plasticity via Rho-kinase. RhoA activity is regulated by GTPase-activating proteins (GAPs) and guanine nucleotide exchange factors (GEFs). Several variants in GAPs and GEFs associated with RhoA have been reported to be significantly associated with schizophrenia. Moreover, several mouse models carrying schizophrenia-associated gene variants involved in RhoA/Rho-kinase signaling have been developed. In this review, we summarize clinical evidence showing that variants in genes regulating RhoA activity are associated with schizophrenia. In the last half of the review, we discuss preclinical evidence indicating that RhoA/Rho-kinase is a potential therapeutic target of schizophrenia. In particular, Rho-kinase inhibitors exhibit anti-psychotic-like effects not only in Arhgap10 S490P/NHEJ mice, but also in pharmacologic models of schizophrenia (methamphetamine- and MK-801-treated mice). Accordingly, we propose that Rho-kinase inhibitors may have antipsychotic effects and reduce cognitive deficits in schizophrenia despite the presence or absence of genetic variants in small GTPase signaling pathways.
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Affiliation(s)
- Rinako Tanaka
- Department of Neuropsychopharmacology and Hospital Pharmacy, Graduate School of Medicine, Nagoya University, Nagoya 466-8560, Japan;
| | - Kiyofumi Yamada
- Department of Neuropsychopharmacology and Hospital Pharmacy, Graduate School of Medicine, Nagoya University, Nagoya 466-8560, Japan;
- International Center for Brain Science (ICBS), Fujita Health University, Toyoake 470-1192, Japan
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10
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Psychotic disorders as a framework for precision psychiatry. Nat Rev Neurol 2023; 19:221-234. [PMID: 36879033 DOI: 10.1038/s41582-023-00779-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2023] [Indexed: 03/08/2023]
Abstract
People with psychotic disorders can show marked interindividual variations in the onset of illness, responses to treatment and relapse, but they receive broadly similar clinical care. Precision psychiatry is an approach that aims to stratify people with a given disorder according to different clinical outcomes and tailor treatment to their individual needs. At present, interindividual differences in outcomes of psychotic disorders are difficult to predict on the basis of clinical assessment alone. Therefore, current research in psychosis seeks to build models that predict outcomes by integrating clinical information with a range of biological measures. Here, we review recent progress in the application of precision psychiatry to psychotic disorders and consider the challenges associated with implementing this approach in clinical practice.
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11
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Masumo Y, Kanahara N, Kogure M, Yamasaki F, Nakata Y, Iyo M. Dopamine supersensitivity psychosis and delay of clozapine treatment in patients with treatment-resistant schizophrenia. Int Clin Psychopharmacol 2023; 38:102-109. [PMID: 36719338 DOI: 10.1097/yic.0000000000000442] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Both the underutilization of clozapine and treatment resistance of patients to clozapine are serious problems worldwide. Identifying clinical markers predicting response to clozapine would help clinicians more effectively utilize clozapine treatment. The present study retrospectively assessed dopamine supersensitivity psychosis (DSP) in addition to other measures such as age at disease onset and delay of clozapine introduction for a total of 47 treatment-resistant schizophrenia (TRS) patients. The response to clozapine was judged with CGI-C at 1 and 2 years from clozapine introduction. Results revealed that the DSP group tended to have a longer delay between designation of TRS and introduction of clozapine and continued to have slightly more severe psychopathology after treatment with clozapine, showing only slight improvement. The logistic regression analysis showed that the age at disease onset was the only significant indicator, predicting responsiveness to clozapine: patients with an onset age <20 years had a significantly better response to clozapine than patients with an onset age ≥20 years. The present study suggests that DSP might be related to a longer delay in clozapine introduction and the persistence of refractory symptoms despite clozapine treatment, whereas early age of disease onset might be related to a better response to clozapine.
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Affiliation(s)
- Yuto Masumo
- Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba
- Department of Psychiatry, Naoki-kai Isogaya Hospital, Ichihara
| | - Nobuhisa Kanahara
- Division of Medical Treatment and Rehabilitation, Center for Forensic Mental Health, Chiba University, Chiba
- Shirayuri-kai Ichihara Tsuruoka Hospital, Ichihara, Japan
| | - Masanobu Kogure
- Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba
| | - Fumiaki Yamasaki
- Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba
| | - Yusuke Nakata
- Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba
| | - Masaomi Iyo
- Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba
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Abstract
PURPOSE Clozapine represents the criterion standard therapy for patients with treatment-resistant schizophrenia. Unfortunately, a significant percentage of such patients are also partial responders to clozapine. Consequently, several augmentation strategies have been proposed with various and sometimes controversial efficacy. Among these add-on treatments, lurasidone has been recently introduced and could represent a potential option, especially for the additional positive effect on cognitive symptoms. METHODS This case series aims to determine possible advantages of lurasidone augmentation in four patients treated with clozapine, who were diagnosed with treatment-resistant schizophrenia. Positive and Negative Syndrome Scales were used to evaluate psychopathology, the Udvalg for Kliniske Undersøgelser scale for tolerability and safety. FINDING All patients achieved a significant reduction of both positive and negative symptoms, with no significant adverse effects to be reported. IMPLICATIONS Our observation suggests that lurasidone can lead to clinically significant improvements in psychopathology with a good tolerability profile when added to clozapine.
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13
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Pérez-Rodríguez D, Penedo MA, Rivera-Baltanás T, Peña-Centeno T, Burkhardt S, Fischer A, Prieto-González JM, Olivares JM, López-Fernández H, Agís-Balboa RC. MiRNA Differences Related to Treatment-Resistant Schizophrenia. Int J Mol Sci 2023; 24:ijms24031891. [PMID: 36768211 PMCID: PMC9916039 DOI: 10.3390/ijms24031891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 01/09/2023] [Accepted: 01/12/2023] [Indexed: 01/21/2023] Open
Abstract
Schizophrenia (SZ) is a serious mental disorder that is typically treated with antipsychotic medication. Treatment-resistant schizophrenia (TRS) is the condition where symptoms remain after pharmacological intervention, resulting in long-lasting functional and social impairments. As the identification and treatment of a TRS patient requires previous failed treatments, early mechanisms of detection are needed in order to quicken the access to effective therapy, as well as improve treatment adherence. In this study, we aim to find a microRNA (miRNA) signature for TRS, as well as to shed some light on the molecular pathways potentially involved in this severe condition. To do this, we compared the blood miRNAs of schizophrenia patients that respond to medication and TRS patients, thus obtaining a 16-miRNA TRS profile. Then, we assessed the ability of this signature to separate responders and TRS patients using hierarchical clustering, observing that most of them are grouped correctly (~70% accuracy). We also conducted a network, pathway analysis, and bibliography search to spot molecular pathways potentially altered in TRS. We found that the response to stress seems to be a key factor in TRS and that proteins p53, SIRT1, MDM2, and TRIM28 could be the potential mediators of such responses. Finally, we suggest a molecular pathway potentially regulated by the miRNAs of the TRS profile.
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Affiliation(s)
- Daniel Pérez-Rodríguez
- NeuroEpigenetics Lab, Instituto de Investigación Sanitaria de Santiago (IDIS), Complejo Hospitalario Universitario de Santiago, 15706 Santiago de Compostela, Spain
- Translational Neuroscience Group, Galicia Sur Health Research Institute (IIS Galicia Sur), Área Sanitaria de Vigo-Hospital Álvaro Cunqueiro, SERGAS-UVIGO, CIBERSAM-ISCIII, 36213 Vigo, Spain
| | - Maria Aránzazu Penedo
- Translational Neuroscience Group, Galicia Sur Health Research Institute (IIS Galicia Sur), Área Sanitaria de Vigo-Hospital Álvaro Cunqueiro, SERGAS-UVIGO, CIBERSAM-ISCIII, 36213 Vigo, Spain
- Grupo de Neurofarmacología de Las Adicciones y Los Trastornos Degenerativos (NEUROFAN), Universidad CEU San Pablo, 28925 Madrid, Spain
| | - Tania Rivera-Baltanás
- Translational Neuroscience Group, Galicia Sur Health Research Institute (IIS Galicia Sur), Área Sanitaria de Vigo-Hospital Álvaro Cunqueiro, SERGAS-UVIGO, CIBERSAM-ISCIII, 36213 Vigo, Spain
| | - Tonatiuh Peña-Centeno
- Department for Epigenetics and Systems Medicine in Neurodegenerative Diseases, German Center for Neurodegenerative Diseases, 37075 Göttingen, Germany
| | - Susanne Burkhardt
- Department for Epigenetics and Systems Medicine in Neurodegenerative Diseases, German Center for Neurodegenerative Diseases, 37075 Göttingen, Germany
| | - Andre Fischer
- Department for Epigenetics and Systems Medicine in Neurodegenerative Diseases, German Center for Neurodegenerative Diseases, 37075 Göttingen, Germany
| | - José M. Prieto-González
- NeuroEpigenetics Lab, Instituto de Investigación Sanitaria de Santiago (IDIS), Complejo Hospitalario Universitario de Santiago, 15706 Santiago de Compostela, Spain
- Servicio de Neurología, Hospital Clínico Universitario de Santiago, 15706 Santiago de Compostela, Spain
- Grupo Trastornos del Movimiento, Instituto de Investigación Sanitaria de Santiago (IDIS), Complejo Hospitalario Universitario de Santiago, 15706 Santiago de Compostela, Spain
| | - José Manuel Olivares
- Translational Neuroscience Group, Galicia Sur Health Research Institute (IIS Galicia Sur), Área Sanitaria de Vigo-Hospital Álvaro Cunqueiro, SERGAS-UVIGO, CIBERSAM-ISCIII, 36213 Vigo, Spain
- Department of Psychiatry, Área Sanitaria de Vigo, 36312 Vigo, Spain
| | - Hugo López-Fernández
- SING Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, 36213 Vigo, Spain
- CINBIO, Department of Computer Science, ESEI-Escuela Superior de Ingeniería Informática, Universidade de Vigo, 32004 Ourense, Spain
- Correspondence: (H.L.-F.); (R.C.A.-B.)
| | - Roberto Carlos Agís-Balboa
- NeuroEpigenetics Lab, Instituto de Investigación Sanitaria de Santiago (IDIS), Complejo Hospitalario Universitario de Santiago, 15706 Santiago de Compostela, Spain
- Translational Neuroscience Group, Galicia Sur Health Research Institute (IIS Galicia Sur), Área Sanitaria de Vigo-Hospital Álvaro Cunqueiro, SERGAS-UVIGO, CIBERSAM-ISCIII, 36213 Vigo, Spain
- Servicio de Neurología, Hospital Clínico Universitario de Santiago, 15706 Santiago de Compostela, Spain
- Grupo Trastornos del Movimiento, Instituto de Investigación Sanitaria de Santiago (IDIS), Complejo Hospitalario Universitario de Santiago, 15706 Santiago de Compostela, Spain
- Correspondence: (H.L.-F.); (R.C.A.-B.)
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14
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Gault JM, Hosokawa P, Kramer D, Saks ER, Appelbaum PS, Thompson JA, Olincy A, Cascella N, Sawa A, Goodman W, Moukaddam N, Sheth SA, Anderson WS, Davis RA. Postsurgical morbidity and mortality favorably informs deep brain stimulation for new indications including schizophrenia and schizoaffective disorder. Front Surg 2023; 10:958452. [PMID: 37066004 PMCID: PMC10098000 DOI: 10.3389/fsurg.2023.958452] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 03/07/2023] [Indexed: 04/18/2023] Open
Abstract
Background Deep brain stimulation (DBS) shows promise for new indications like treatment-refractory schizophrenia in early clinical trials. In the first DBS clinical trial for treatment refractory schizophrenia, despite promising results in treating psychosis, one of the eight subjects experienced both a symptomatic hemorrhage and an infection requiring device removal. Now, ethical concerns about higher surgical risk in schizophrenia/schizoaffective disorder (SZ/SAD) are impacting clinical trial progress. However, insufficient cases preclude conclusions regarding DBS risk in SZ/SAD. Therefore, we directly compare adverse surgical outcomes for all surgical procedures between SZ/SAD and Parkinson's disease (PD) cases to infer relative surgical risk relevant to gauging DBS risks in subjects with SZ/SAD. Design In the primary analysis, we used browser-based statistical analysis software, TriNetX Live (trinetx.com TriNetX LLC, Cambridge, MA), for Measures of Association using the Z-test. Postsurgical morbidity and mortality after matching for ethnicity, over 39 risk factors, and 19 CPT 1003143 coded surgical procedures from over 35,000 electronic medical records, over 19 years, from 48 United States health care organizations (HCOs) through the TriNetX Research Network™. TriNetXis a global, federated, web-based health research network providing access and statistical analysis of aggregate counts of deidentified EMR data. Diagnoses were based on ICD-10 codes. In the final analysis, logistic regression was used to determine relative frequencies of outcomes among 21 diagnostic groups/cohorts being treated with or considered for DBS and 3 control cohorts. Results Postsurgical mortality was 1.01-4.11% lower in SZ/SAD compared to the matched PD cohort at 1 month and 1 year after any surgery, while morbidity was 1.91-2.73% higher and associated with postsurgical noncompliance with medical treatment. Hemorrhages and infections were not increased. Across the 21 cohorts compared, PD and SZ/SAD were among eight cohorts with fewer surgeries, nine cohorts with higher postsurgical morbidity, and fifteen cohorts within the control-group range for 1-month postsurgical mortality. Conclusions Given that the subjects with SZ or SAD, along with most other diagnostic groups examined, had lower postsurgical mortality than PD subjects, it is reasonable to apply existing ethical and clinical guidelines to identify appropriate surgical candidates for inclusion of these patient populations in DBS clinical trials.
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Affiliation(s)
- Judith M. Gault
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- Correspondence: Judith M. Gault
| | - Patrick Hosokawa
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Daniel Kramer
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Elyn R. Saks
- The Law School, University of Southern California, Los Angeles, CA, United States
| | - Paul S. Appelbaum
- Department of Psychiatry, Columbia University, New York, Ny, United States Of America
| | - John A. Thompson
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Ann Olincy
- VA Eastern Colorado Medical Center, Aurora, CO, United States
| | - Nicola Cascella
- Department of Psychiatry, Johns Hopkins University, Baltimore, MD, United States
| | - Akira Sawa
- Department of Psychiatry, Johns Hopkins University, Baltimore, MD, United States
| | - Wayne Goodman
- Department of Psychiatry, Baylor College of Medicine, Houston, TX, United States
| | - Nidal Moukaddam
- Department of Psychiatry, Baylor College of Medicine, Houston, TX, United States
| | - Sameer A. Sheth
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States
| | - William S. Anderson
- Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, United States
| | - Rachel A. Davis
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
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15
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Purohith AN, Chatorikar SA, Praharaj SK, Bhandary RP, Sharma PSVN. Efficacy and safety of maintenance electroconvulsive therapy (M-ECT) in treatment-resistant schizophrenia: A case series. Asian J Psychiatr 2022; 73:103132. [PMID: 35533602 DOI: 10.1016/j.ajp.2022.103132] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 04/05/2022] [Accepted: 04/20/2022] [Indexed: 11/02/2022]
Abstract
BACKGROUND Treatment-resistant schizophrenia (TRS) is a substantial burden to patients, caregivers, and the treating team. There is a lack of robust evidence to support the efficacy of various pharmacological and non-pharmacological measures to augment clozapine in this population. When used in conjunction with clozapine or other combination antipsychotic regimens, maintenance electroconvulsive therapy (M-ECT) can be a potential therapeutic option in preventing symptom exacerbation in TRS. However, there is limited evidence supporting the role of M-ECT in TRS. AIM To evaluate the efficacy and safety of maintenance electroconvulsive therapy in patients with TRS. METHODOLOGY Sociodemographic details, illness characteristics, details of M-ECT procedure, adverse events, and course of the illness were evaluated using a retrospective chart review at a tertiary care psychiatry centre in south India. Scores on Clinical Global Impression-Severity (CGI-S), Social and Occupational Functioning Assessment Scale (SOFAS), and Hindi Mental Status Examination were compared before and after the course of M-ECT. RESULTS Seven male and three female patients received M-ECT in the last eight years (range of 22-172 sessions). There was a reduction in hospitalizations for acute exacerbation and significant improvement in the patient's overall functioning without significant adverse effects. CONCLUSION Maintenance ECT can be a safe and effective treatment option for achieving symptom control in the long-term management of refractory schizophrenia. Controlled trials are needed in this area for further evidence.
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Affiliation(s)
- Abhiram Narasimhan Purohith
- Department of Psychiatry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India.
| | - Shalaka Anand Chatorikar
- Department of Psychiatry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India.
| | - Samir Kumar Praharaj
- Department of Psychiatry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India.
| | - Rajeshkrishna Panambur Bhandary
- Department of Psychiatry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India.
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16
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Adam Yaple Z, Tolomeo S, Yu R. Spatial and chronic differences in neural activity in medicated and unmedicated schizophrenia patients. Neuroimage Clin 2022; 35:103029. [PMID: 35569228 PMCID: PMC9112098 DOI: 10.1016/j.nicl.2022.103029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 04/10/2022] [Accepted: 04/28/2022] [Indexed: 11/07/2022]
Abstract
The medicated schizophrenia group yielded concordant activity among three right lateralized frontal clusters and a left lateralized parietal cluster. The unmedicated schizophrenia group yielded concordant activity among right lateralized frontal-parietal regions. A neural compensatory mechanism in schizophrenia.
A major caveat with investigations on schizophrenic patients is the difficulty to control for medication usage across samples as disease-related neural differences may be confounded by medication usage. Following a thorough literature search (632 records identified), we included 37 studies with a total of 740 medicated schizophrenia patients and 367 unmedicated schizophrenia patients. Here, we perform several meta-analyses to assess the neurofunctional differences between medicated and unmedicated schizophrenic patients across fMRI studies to determine systematic regions associated with medication usage. Several clusters identified by the meta-analysis on the medicated group include three right lateralized frontal clusters and a left lateralized parietal cluster, whereas the unmedicated group yielded concordant activity among right lateralized frontal-parietal regions. We further explored the prevalence of activity within these regions across illness duration and task type. These findings suggest a neural compensatory mechanism across these regions both spatially and chronically, offering new insight into the spatial and temporal dynamic neural differences among medicated and unmedicated schizophrenia patients.
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Affiliation(s)
| | - Serenella Tolomeo
- Social and Cognitive Computing Department, Institute of High Performance Computing, Agency for Science, Technology and Research, Singapore, Singapore
| | - Rongjun Yu
- Department of Management, Hong Kong Baptist University, Hong Kong, China; Department of Sport, Physical Education and Health, Hong Kong Baptist University, Hong Kong, China; Department of Physics, Hong Kong Baptist University, Hong Kong, China.
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17
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Shikuri Y, Tanoue H, Imai H, Nakamura H, Yamaguchi F, Goto T, Kido Y, Tajika A, Sawada H, Ishida Y, Yoshinaga N. Psychosocial interventions for community-dwelling individuals with schizophrenia: study protocol for a systematic review and meta-analysis. BMJ Open 2022; 12:e057286. [PMID: 35487709 PMCID: PMC9058762 DOI: 10.1136/bmjopen-2021-057286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Despite the recent global mental health movement of the transition from hospital-centred to integrated community-based services, comprehensive evidence of psychosocial interventions focusing on community-dwelling individuals with schizophrenia is still lacking. To overcome this gap in the current knowledge, we will conduct a systematic review and meta-analysis to assess the efficacy of all types of psychosocial interventions for community-dwelling (non-hospitalised) individuals with schizophrenia when compared with non-active control conditions (eg, treatment as usual). METHODS AND ANALYSIS This study protocol has been developed according to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines. By March 2022, the following sources will have been searched, without restrictions for language or publication period: Embase, PubMed, PsycINFO, CINAHL, the Cochrane Central Register of Controlled Trials, ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform. We will also try to identify other potentially eligible studies by searching the reference lists of included studies, other relevant systematic reviews and grey literature. All relevant randomised controlled trials from both high-income and low-income to middle-income countries will be allowed. Two independent reviewers will conduct the selection/screening of studies, data extraction and methodological quality assessment of included studies. The primary outcomes are quality of life and psychiatric hospital admission. Standard pairwise meta-analyses with a random-effects model will be conducted. Subgroup and sensitivity analyses will be performed to assess the robustness of the findings. Risk of bias will be assessed with the Revised Cochrane Risk-of-Bias Tool for Randomised Trials. The Grades of Recommendation Assessment, Development and Evaluation approach will be used to assess the quality of evidence. ETHICS AND DISSEMINATION Ethics approval is not required for this study. The study findings will be disseminated through conference presentations as well as peer-reviewed publications. PROSPERO REGISTRATION NUMBER CRD42021266187.
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Affiliation(s)
- Yuki Shikuri
- Graduate School of Nursing Science, University of Miyazaki, Miyazaki, Japan
| | - Hiroki Tanoue
- School of Nursing, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Hissei Imai
- Department of Health Promotion and Human Behavior, Graduate School of Medicine/School of Public Health, Kyoto University, Kyoto, Japan
| | - Hideki Nakamura
- Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chiba, Japan
| | - Fumitake Yamaguchi
- School of Nursing, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Taichi Goto
- Department of Pain and Translational Symptom Science, University of Maryland School of Nursing, Baltimore, Maryland, USA
| | - Yoshifumi Kido
- Faculty of Nursing, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Aran Tajika
- Department of Health Promotion and Human Behavior, Graduate School of Medicine/School of Public Health, Kyoto University, Kyoto, Japan
| | - Hirotake Sawada
- School of Nursing, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Yasushi Ishida
- Division of Psychiatry, Department of Clinical Neuroscience, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Naoki Yoshinaga
- School of Nursing, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
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18
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De Salles A, Lucena L, Paranhos T, Ferragut MA, de Oliveira-Souza R, Gorgulho A. Modern neurosurgical techniques for psychiatric disorders. PROGRESS IN BRAIN RESEARCH 2022; 270:33-59. [PMID: 35396030 DOI: 10.1016/bs.pbr.2022.01.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Psychosurgery refers to an ensemble of more or less invasive techniques designed to reduce the burden caused by psychiatric diseases in patients who have failed to respond to conventional therapy. While most surgeries are designed to correct apparent anatomical abnormalities, no discrete cerebral anatomical lesion is evident in most psychiatric diseases amenable to invasive interventions. Finding the optimal surgical targets in mental illness is troublesome. In general, contemporary psychosurgical procedures can be classified into one of two primary modalities: lesioning and stimulation procedures. The first group is divided into (a) thermocoagulation and (b) stereotactic radiosurgery or recently introduced transcranial magnetic resonance-guided focused ultrasound, whereas stimulation techniques mainly include deep brain stimulation (DBS), cortical stimulation, and the vagus nerve stimulation. The most studied psychiatric diseases amenable to psychosurgical interventions are severe treatment-resistant major depressive disorder, obsessive-compulsive disorder, Tourette syndrome, anorexia nervosa, schizophrenia, and substance use disorder. Furthermore, modern neuroimaging techniques spurred the interest of clinicians to identify cerebral regions amenable to be manipulated to control psychiatric symptoms. On this way, the concept of a multi-nodal network need to be embraced, enticing the collaboration of psychiatrists, psychologists, neurologists and neurosurgeons participating in multidisciplinary groups, conducting well-designed clinical trials.
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Affiliation(s)
- Antonio De Salles
- University of California Los Angeles (UCLA), Los Angeles, CA, United States; NeuroSapiens®, Brazil; Hospital Rede D'Or, São Luiz, SP, Brazil.
| | - Luan Lucena
- NeuroSapiens®, Brazil; Hospital Rede D'Or, São Luiz, SP, Brazil
| | - Thiago Paranhos
- Hospital Rede D'Or, São Luiz, SP, Brazil; Federal University of Rio De Janeiro (UFRJ), Rio de Janeiro, Brazil
| | | | - Ricardo de Oliveira-Souza
- D'Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil; Federal University of the State of Rio De Janeiro (UNIRIO), Rio de Janeiro, Brazil
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19
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Hu H, Jiang Y, Xia M, Tang Y, Zhang T, Cui H, Wang J, Xu L, Curtin A, Sheng J, Cao X, Guo Q, Jia Y, Li C, Wang Z, Luo C, Wang J. Functional reconfiguration of cerebellum-cerebral neural loop in schizophrenia following electroconvulsive therapy. Psychiatry Res Neuroimaging 2022; 320:111441. [PMID: 35085957 DOI: 10.1016/j.pscychresns.2022.111441] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 11/15/2021] [Accepted: 01/17/2022] [Indexed: 11/26/2022]
Abstract
Recent evidence highlights the role of the cerebellum-cerebral loop in the pathophysiology of schizophrenia (SZ). Electroconvulsive therapy (ECT) is clinically applied to augment the effect of antipsychotic drugs. The study aims to address whether the cerebellum-cerebral loop is involved in the mechanisms of ECT's augmentation effect. Forty-two SZ patients and 23 healthy controls (HC) were recruited and scanned using resting-state functional MRI (rs-fMRI). Twenty-one patients received modified ECT plus antipsychotics (MSZ group), and 21 patients took antipsychotics only (DSZ group). All patients were re-scanned four weeks later. Brain functional network was constructed according to the graph theory. The sub-network exhibited longitudinal changes after ECT or medications were constructed. For the MSZ group, a sub-network involving default-mode network and cerebellum showed significant longitudinal changes. For the DSZ group, a different sub-network involving the thalamus, frontal and occipital cortex was found to be altered in the follow-up scan. In addition, the changing FC of the left cerebellar crus2 region was correlated with the changing scores of the psychotic symptoms only in the MSZ group but not in the DSZ group. In conclusion, the cerebral-cerebellum loop is possibly involved in the antipsychotic mechanisms of ECT for schizophrenia.
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Affiliation(s)
- Hao Hu
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao tong University School of Medicine, Shanghai 200030, China
| | - Yuchao Jiang
- Key Laboratory for NeuroInformation of Ministry of Education, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu 610054, China
| | - Mengqing Xia
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao tong University School of Medicine, Shanghai 200030, China
| | - Yingying Tang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao tong University School of Medicine, Shanghai 200030, China
| | - Tianhong Zhang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao tong University School of Medicine, Shanghai 200030, China
| | - Huiru Cui
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao tong University School of Medicine, Shanghai 200030, China
| | - Junjie Wang
- Institute of Mental Health, Suzhou Psychiatric Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, Jiangsu, 215137, China
| | - Lihua Xu
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao tong University School of Medicine, Shanghai 200030, China
| | - Adrian Curtin
- School of Biomedical Engineering & Health Sciences, Drexel University, Philadelphia, PA 19104, United States; Med-X Institute, Shanghai Jiao Tong University, Shanghai 200300, China
| | - Jianhua Sheng
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao tong University School of Medicine, Shanghai 200030, China
| | - Xinyi Cao
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao tong University School of Medicine, Shanghai 200030, China
| | - Qian Guo
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao tong University School of Medicine, Shanghai 200030, China
| | - Yuping Jia
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao tong University School of Medicine, Shanghai 200030, China
| | - Chunbo Li
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao tong University School of Medicine, Shanghai 200030, China; CAS Center for Excellence in Brain Science and Intelligence Technology (CEBSIT), Chinese Academy of Science, Shanghai, China; Institute of Psychology and Behavioral Science, Shanghai Jiao Tong University, Shanghai, China
| | - Zhen Wang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao tong University School of Medicine, Shanghai 200030, China.
| | - Cheng Luo
- Key Laboratory for NeuroInformation of Ministry of Education, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu 610054, China.
| | - Jijun Wang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao tong University School of Medicine, Shanghai 200030, China; CAS Center for Excellence in Brain Science and Intelligence Technology (CEBSIT), Chinese Academy of Science, Shanghai, China; Institute of Psychology and Behavioral Science, Shanghai Jiao Tong University, Shanghai, China.
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Abstract
Schizophrenia, characterised by psychotic symptoms and in many cases social and occupational decline, remains an aetiological and therapeutic challenge. Contrary to popular belief, the disorder is modestly more common in men than in women. Nor is the outcome uniformly poor. A division of symptoms into positive, negative, and disorganisation syndromes is supported by factor analysis. Catatonic symptoms are not specific to schizophrenia and so-called first rank symptoms are no longer considered diagnostically important. Cognitive impairment is now recognised as a further clinical feature of the disorder. Lateral ventricular enlargement and brain volume reductions of around 2% are established findings. Brain functional changes occur in different subregions of the frontal cortex and might ultimately be understandable in terms of disturbed interaction among large-scale brain networks. Neurochemical disturbance, involving dopamine function and glutamatergic N-methyl-D-aspartate receptor function, is supported by indirect and direct evidence. The genetic contribution to schizophrenia is now recognised to be largely polygenic. Birth and early life factors also have an important aetiological role. The mainstay of treatment remains dopamine receptor-blocking drugs; a psychological intervention, cognitive behavioural therapy, has relatively small effects on symptoms. The idea that schizophrenia is better regarded as the extreme end of a continuum of psychotic symptoms is currently influential. Other areas of debate include cannabis and childhood adversity as causative factors, whether there is progressive brain change after onset, and the long-term success of early intervention initiatives.
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Affiliation(s)
- Sameer Jauhar
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College, London, UK
| | - Mandy Johnstone
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College, London, UK; National Psychosis Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Peter J McKenna
- FIDMAG Hermanas Hospitalarias Research Foundation, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain.
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21
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Corripio I, Roldán A, McKenna P, Sarró S, Alonso-Solís A, Salgado L, Álvarez E, Molet J, Pomarol-Clotet E, Portella M. Target selection for deep brain stimulation in treatment resistant schizophrenia. Prog Neuropsychopharmacol Biol Psychiatry 2022; 112:110436. [PMID: 34517055 DOI: 10.1016/j.pnpbp.2021.110436] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 08/28/2021] [Accepted: 09/07/2021] [Indexed: 11/19/2022]
Abstract
The use of deep brain stimulation (DBS) in treatment resistant patients with schizophrenia is of considerable current interest, but where to site the electrodes is challenging. This article reviews rationales for electrode placement in schizophrenia based on evidence for localized brain abnormality in the disorder and the targets that have been proposed and employed to date. The nucleus accumbens and the subgenual anterior cingulate cortex are of interest on the grounds that they are sites of potential pathologically increased brain activity in schizophrenia and so susceptible to the local inhibitory effects of DBS; both sites have been employed in trials of DBS in schizophrenia. Based on other lines of reasoning, the ventral tegmental area, the substantia nigra pars reticulata and the habenula have also been proposed and in some cases employed. The dorsolateral prefrontal cortex has not been suggested, probably reflecting evidence that it is underactive rather than overactive in schizophrenia. The hippocampus is also of theoretical interest but there is no clear functional imaging evidence that it shows overactivity in schizophrenia. On current evidence, the nucleus accumbens may represent the strongest candidate for DBS electrode placement in schizophrenia, with the substantia nigra pars reticulata also showing promise in a single case report; the ventral tegmental area is also of potential interest, though it remains untried.
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Affiliation(s)
- Iluminada Corripio
- Psychiatry Department, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB-Sant Pau), Universitat Autònoma de Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain
| | - Alexandra Roldán
- Psychiatry Department, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB-Sant Pau), Universitat Autònoma de Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain
| | - Peter McKenna
- FIDMAG Germanes Hospitalàries, Sant Boi de Llobregat, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain.
| | - Salvador Sarró
- FIDMAG Germanes Hospitalàries, Sant Boi de Llobregat, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain
| | - Anna Alonso-Solís
- Psychiatry Department, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB-Sant Pau), Universitat Autònoma de Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain
| | - Laura Salgado
- Neurosurgery Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Spain
| | - Enric Álvarez
- Psychiatry Department, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB-Sant Pau), Universitat Autònoma de Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain
| | - Joan Molet
- Neurosurgery Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Spain
| | - Edith Pomarol-Clotet
- FIDMAG Germanes Hospitalàries, Sant Boi de Llobregat, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain
| | - Maria Portella
- Psychiatry Department, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB-Sant Pau), Universitat Autònoma de Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain
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22
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Jongkind A, Hendriks M, Grootens K, Beekman ATF, van Meijel B. Evaluation of a collaborative care program for patients with treatment-resistant schizophrenia: Protocol for a multiple case-study. (Preprint). JMIR Res Protoc 2021; 11:e35336. [PMID: 35700002 PMCID: PMC9237776 DOI: 10.2196/35336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 03/11/2022] [Accepted: 04/22/2022] [Indexed: 12/15/2022] Open
Abstract
Background Approximately one-third of all patients with schizophrenia are treatment resistant. Worldwide, undertreatment with clozapine and other effective treatment options exist for people with treatment-resistant schizophrenia (TRS). In this respect, it appears that regular health care models do not optimally fit this patient group. The Collaborative Care (CC) model has proven to be effective for patients with severe mental illness, both in primary care and in specialized mental health care facilities. The key principles of the CC model are that both patients and informal caregivers are part of the treatment team, that a structured treatment plan is put in place with planned evaluations by the team, and that the treatment approach is multidisciplinary in nature and uses evidence-based interventions. We developed a tailored CC program for patients with TRS. Objective In this paper, we provide an overview of the research design for a potential study that seeks to gain insight into both the process of implementation and the preliminary effects of the CC program for patients with TRS. Moreover, we aim to gain insight into the experiences of professionals, patients, and informal caregivers with the program. Methods This study will be underpinned by a multiple case study design (N=20) that uses a mixed methods approach. These case studies will focus on an Early Psychosis Intervention Team and 2 Flexible Assertive Community treatment teams in the Netherlands. Data will be collected from patient records as well as through questionnaires, individual interviews, and focus groups. Patient recruitment commenced from October 2020. Results Recruitment of participants commenced from October 2020, with the aim of enrolling 20 patients over 2 years. Data collection will be completed by the end of 2023, and the results will be published once all data are available for reporting. Conclusions The research design, framed within the process of developing and testing innovative interventions, is discussed in line with the aims of the study. The limitations in clinical practice and specific consequences of this study are explained. International Registered Report Identifier (IRRID) DERR1-10.2196/35336
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Affiliation(s)
- Amy Jongkind
- Reinier van Arkel, 's-Hertogenbosch, Netherlands
- Amsterdam University Medical Center (VUmc), Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | | | - Koen Grootens
- Reinier van Arkel, 's-Hertogenbosch, Netherlands
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands
| | - Aartjan T F Beekman
- Amsterdam University Medical Center (VUmc), Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Berno van Meijel
- Amsterdam University Medical Center (VUmc), Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
- Inholland University of Applied Sciences, Department of Health, Sports & Welfare, Cluster Nursing, Amsterdam, Netherlands
- Parnassia Psychiatric Institute, Parnassia Academy, The Hague, Netherlands
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23
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A preliminary genetic association study of GAD1 and GABAB receptor genes in patients with treatment-resistant schizophrenia. Mol Biol Rep 2021; 49:2015-2024. [PMID: 34845648 DOI: 10.1007/s11033-021-07019-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 11/24/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND GABAergic system dysfunction has been implicated in the etiology of schizophrenia and of cognitive impairments in particular. Patients with treatment-resistant schizophrenia (TRS) generally suffer from profound cognitive impairments in addition to severe positive symptoms, suggesting that GABA system dysfunction could be involved more closely in patients with TRS. METHODS AND RESULTS In the present study, exome sequencing was conducted on fourteen TRS patients, whereby four SNPs were identified on GAD1, GABBR1 and GABBR2 genes. An association study for five SNPs including these 4 SNPs and rs3749034 on GAD1 as then performed among 357 patients with TRS, 682 non-TRS patients and 508 healthy controls (HC). The results revealed no significant differences in allelic and/or genetic distributions for any of the five SNPs. However, several subanalyses in comparisons between schizophrenia and HC groups, as well as between the three groups, showed nominal-level significance for rs3749034 on GAD1 and rs10985765/rs3750344 on GABBR2. In particular, in comparisons of female subjects, rigorous analysis for rs3749034 showed a statistical difference between the schizophrenia and HC groups and between the TRS and HC groups. CONCLUSIONS Several positive results in subanalyses suggested that genetic vulnerability in the GABA system to schizophrenia or TRS could be affected by sex or sampling area, and overall, that rs3749034 on GAD1 and rs10985765 on GABBR2 could be related to TRS. In the present study, only a few SNPs were examined; it is possible that other important genetic variants in other regions of GABA-related genes were not captured in this preliminary study.
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Millgate E, Kravariti E, Egerton A, Howes OD, Murray RM, Kassoumeri L, Donocik J, Lewis S, Drake R, Lawrie S, Murphy A, Collier T, Lees J, Stockton-Powdrell C, Walters J, Deakin B, MacCabe J. Cross-sectional study comparing cognitive function in treatment responsive versus treatment non-responsive schizophrenia: evidence from the STRATA study. BMJ Open 2021; 11:e054160. [PMID: 34824121 PMCID: PMC8627394 DOI: 10.1136/bmjopen-2021-054160] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 10/04/2021] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND 70%-84% of individuals with antipsychotic treatment resistance show non-response from the first episode. Emerging cross-sectional evidence comparing cognitive profiles in treatment resistant schizophrenia to treatment-responsive schizophrenia has indicated that verbal memory and language functions may be more impaired in treatment resistance. We sought to confirm this finding by comparing cognitive performance between antipsychotic non-responders (NR) and responders (R) using a brief cognitive battery for schizophrenia, with a primary focus on verbal tasks compared against other measures of cognition. DESIGN Cross-sectional. SETTING This cross-sectional study recruited antipsychotic treatment R and antipsychotic NR across four UK sites. Cognitive performance was assessed using the Brief Assessment of Cognition in Schizophrenia (BACS). PARTICIPANTS One hundred and six participants aged 18-65 years with a diagnosis of schizophrenia or schizophreniform disorder were recruited according to their treatment response, with 52 NR and 54 R cases. OUTCOMES Composite and subscale scores of cognitive performance on the BACS. Group (R vs NR) differences in cognitive scores were investigated using univariable and multivariable linear regressions adjusted for age, gender and illness duration. RESULTS Univariable regression models observed no significant differences between R and NR groups on any measure of the BACS, including verbal memory (ß=-1.99, 95% CI -6.63 to 2.66, p=0.398) and verbal fluency (ß=1.23, 95% CI -2.46 to 4.91, p=0.510). This pattern of findings was consistent in multivariable models. CONCLUSIONS The lack of group difference in cognition in our sample is likely due to a lack of clinical distinction between our groups. Future investigations should aim to use machine learning methods using longitudinal first episode samples to identify responder subtypes within schizophrenia, and how cognitive factors may interact within this. TRAIL REGISTRATION NUMBER REC: 15/LO/0038.
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Affiliation(s)
- Edward Millgate
- Department of Psychosis Studies, King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
| | - Eugenia Kravariti
- Department of Psychosis Studies, King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
- NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
| | - Alice Egerton
- Department of Psychosis Studies, King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
- NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
| | - Oliver D Howes
- Department of Psychosis Studies, King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
- NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
| | - Robin M Murray
- Department of Psychosis Studies, King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
- NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
| | - Laura Kassoumeri
- Department of Psychosis Studies, King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
- NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
| | - Jacek Donocik
- Department of Psychosis Studies, King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
| | - Shôn Lewis
- Division of Psychology and Mental Health, The University of Manchester, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Richard Drake
- Division of Psychology and Mental Health, The University of Manchester, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Stephen Lawrie
- Psychiatry, The University of Edinburgh Division of Psychiatry, Edinburgh, UK
| | - Anna Murphy
- Division of Psychology and Mental Health, The University of Manchester, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Tracy Collier
- Department of Psychosis Studies, King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
| | - Jane Lees
- Division of Psychology and Mental Health, The University of Manchester, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | | | - James Walters
- MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Bill Deakin
- Division of Psychology and Mental Health, The University of Manchester, Manchester, UK
| | - James MacCabe
- Department of Psychosis Studies, King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
- NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
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Jakobsen MI, Storebø OJ, Austin SF, Nielsen J, Simonsen E. Patients' and psychiatrists' perspectives on clozapine treatment-a scoping review protocol. BMJ Open 2021; 11:e054308. [PMID: 34620673 PMCID: PMC8499327 DOI: 10.1136/bmjopen-2021-054308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 09/20/2021] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION The atypical antipsychotic clozapine has shown superior efficacy compared with other antipsychotics and is the gold standard for treating otherwise treatment resistant schizophrenia. However, multiple studies have found that clozapine is underutilised in most parts of the world. A few reviews of literature addressing barriers to clozapine prescribing have been conducted. While there is some variation in the literature included in these reviews, a common feature of the studies included is that they primarily focus on clinical staff's attitudes and perceived barriers for prescribing. Studies of patient perspectives are only sparsely included. A preliminary literature search revealed though, that additional literature on the subject exists, including literature on patient perspectives. It is therefore difficult to conclude if the formerly synthesised literature is representative of current evidence or if the topic has been adequately investigated to inform clinical practice. A scoping review is warranted in order to map and synthesise primary literature on patients' and psychiatrists' perspectives on clozapine treatment, and to identify gaps for future research. METHODS AND ANALYSIS The electronic databases Cochrane Library, CINAHL, Web of Science, Psychinfo, MEDLINE and EMBASE will be searched for relevant publications, supplied with searches of Google scholar, The Networked Digital Library of Theses and Dissertations and OpenGrey. Citation tracking of selected studies will furthermore be undertaken. Two researchers will independently screen and extract data. Data will be collated to provide a descriptive summary of the literature, along with a qualitative content analysis of key findings. Identified gaps in research will be accompanied by recommendations for future investigations. ETHICS AND DISSEMINATION Findings will be disseminated through a peer-reviewed journal and conference presentations. The scoping review does not require ethics approval.
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Affiliation(s)
- Michelle Iris Jakobsen
- Department of Clinical Medicine, University of Copenhagen, Faculty of Health and Medical Sciences, Kobenhavn, Denmark
- Early Psychosis Intervention Center, Psychiatric Services Region Zealand East, Roskilde, Denmark
| | - Ole Jakob Storebø
- Department of Psychology, University of Southern Denmark, Faculty of Health Sciences, Odense, Denmark
- Psychiatric Research Unit, Psychiatric Services Region Zealand, Slagelse, Denmark
| | - Stephen Fitzgerald Austin
- Early Psychosis Intervention Center, Psychiatric Services Region Zealand East, Roskilde, Denmark
- Psychiatric Research Unit, Psychiatric Services Region Zealand, Slagelse, Denmark
| | - Jimmi Nielsen
- Department of Clinical Medicine, University of Copenhagen, Faculty of Health and Medical Sciences, Kobenhavn, Denmark
- Psychiatric Centre Glostrup, Unit for Complicated Schizophrenia, Mental Health Services in the Capital Region of Denmark, Kobenhavn, Denmark
| | - Erik Simonsen
- Department of Clinical Medicine, University of Copenhagen, Faculty of Health and Medical Sciences, Kobenhavn, Denmark
- Psychiatric Research Unit, Psychiatric Services Region Zealand, Slagelse, Denmark
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Shan X, Zhang H, Dong Z, Chen J, Liu F, Zhao J, Zhang H, Guo W. Increased subcortical region volume induced by electroconvulsive therapy in patients with schizophrenia. Eur Arch Psychiatry Clin Neurosci 2021; 271:1285-1295. [PMID: 34275006 DOI: 10.1007/s00406-021-01303-6] [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: 03/09/2021] [Accepted: 07/04/2021] [Indexed: 02/08/2023]
Abstract
Electroconvulsive therapy (ECT) has been widely used to treat patients with schizophrenia. However, the underlying mechanisms of ECT remain unknown. In the present study, the treatment effects of ECT on brain structure in patients with schizophrenia were explored. Seventy patients with schizophrenia were scanned using structural magnetic resonance imaging. Patients in the drug group were scanned at baseline (time 1) and follow-up (time 2, 6 weeks of treatment). Patients in the ECT group were scanned before ECT treatment (baseline, time 1) and 10-12 h after the last ECT treatment (time 2). Voxel-based morphometry was applied to analyze the imaging data. Patients in the ECT group showed significantly increased gray matter volume (GMV) in the bilateral hippocampus/amygdala and left superior temporal gyrus (STG)/middle temporal gyrus (MTG) after ECT combined with antipsychotic therapy at time 2. In contrast, patients in the drug group showed decreased GMV in widespread brain regions. Correlation analysis results showed significantly negative correlations between the increased GMV in the bilateral hippocampus/amygdala and PANSS scores at baseline in the ECT group. ECT may modulate brain structure in patients with schizophrenia. The GMV in distinct subcortical regions was related to the individual therapeutic response in patients with schizophrenia.
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Affiliation(s)
- Xiaoxiao Shan
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Haisan Zhang
- The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, 453002, Henan, China.,Xinxiang Key Laboratory of Multimodal Brain Imaging, Xinxiang, 453002, Henan, China
| | - Zhao Dong
- The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, 453002, Henan, China.,Zhumadian Psychiatric Hospital, Zhumadian, 463000, Henan, China
| | - Jindong Chen
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Feng Liu
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin, 300000, China
| | - Jingping Zhao
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Hongxing Zhang
- The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, 453002, Henan, China. .,Xinxiang Key Laboratory of Multimodal Brain Imaging, Xinxiang, 453002, Henan, China. .,School of Psychology, Xinxiang Medical University, Xinxiang, 453003, Henan, China.
| | - Wenbin Guo
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China. .,Department of Psychiatry, The Third People's Hospital of Foshan, Foshan, 528000, Guangdong, China.
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Iruretagoyena B, Castañeda CP, Mena C, Diaz C, Nachar R, Ramirez-Mahaluf JP, González-Valderrama A, Undurraga J, Maccabe JH, Crossley NA. Predictors of clozapine discontinuation at 2 years in treatment-resistant schizophrenia. Schizophr Res 2021; 235:102-108. [PMID: 34340062 DOI: 10.1016/j.schres.2021.07.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 06/20/2021] [Accepted: 07/19/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Little is known about predictors of clinical response to clozapine treatment in treatment-resistant psychosis. Most published cohorts are small, providing inconsistent results. We aimed to identify baseline clinical predictors of future clinical response in patients who initiate clozapine treatment, mainly focusing on the effect of age, duration of illness, baseline clinical symptoms and homelessness. METHODOLOGY Retrospective cohort of patients with treatment-resistant schizophrenia, aged between 15 and 60 years, that initiated clozapine between 2014 and 2017. Sociodemographic characteristics, years from illness diagnosis, and clinical presentation before the initiation of clozapine were collected and analyzed. All-cause discontinuation at two years follow-up was used as the primary measure of clozapine response. RESULTS 261 patients were included with a median age at illness diagnosis of 23 years old (IQR 19-29) and a median age at clozapine initiation of 25 (IQR: 21-33). 72.33% (183/253) continued clozapine after two years follow-up. Being homeless was associated to higher clozapine non-adherence, with an OR of 2.78 (95%CI 1.051-7.38) (p = 0.039, controlled by gender). Older age at clozapine initiation and longer delay from first schizophrenia diagnosis to clozapine initiation were also associated with higher clozapine non-adherence, with each year increasing the odds of discontinuation by 1.043 (95%CI 1.02-1.07; p = 0.001) and OR 1.092 (95%CI 1.01-1.18;p = 0.032) respectively. CONCLUSION Starting clozapine in younger patients or shortly after schizophrenia diagnosis were associated with better adherence.
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Affiliation(s)
- Barbara Iruretagoyena
- Department of Psychiatry, School of Medicine, Pontificia Universidad Católica de Chile, Chile; Department of Neurology and Psychiatry, Faculty of Medicine, Clínica Alemana Universidad del Desarrollo, Chile
| | - Carmen Paz Castañeda
- Early Intervention Program, Instituto Psiquiátrico Dr. J Horwitz Barak, Santiago, Chile
| | - Cristian Mena
- Early Intervention Program, Instituto Psiquiátrico Dr. J Horwitz Barak, Santiago, Chile
| | - Camila Diaz
- Early Intervention Program, Instituto Psiquiátrico Dr. J Horwitz Barak, Santiago, Chile
| | - Ruben Nachar
- Early Intervention Program, Instituto Psiquiátrico Dr. J Horwitz Barak, Santiago, Chile
| | | | - Alfonso González-Valderrama
- Early Intervention Program, Instituto Psiquiátrico Dr. J Horwitz Barak, Santiago, Chile; School of Medicine, Universidad Finis Terrae, Chile
| | - Juan Undurraga
- Early Intervention Program, Instituto Psiquiátrico Dr. J Horwitz Barak, Santiago, Chile; Department of Neurology and Psychiatry, Faculty of Medicine, Clínica Alemana Universidad del Desarrollo, Chile
| | - James H Maccabe
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - Nicolas A Crossley
- Department of Psychiatry, School of Medicine, Pontificia Universidad Católica de Chile, Chile.
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Ismail MA, Midin M. Shared Decision-Making and Role Preference Among Patients With Schizophrenia in Malaysia: A Cross-Sectional Study. Front Psychiatry 2021; 12:680800. [PMID: 34381387 PMCID: PMC8350437 DOI: 10.3389/fpsyt.2021.680800] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 06/25/2021] [Indexed: 01/19/2023] Open
Abstract
Introduction: Shared decision-making (SDM) is recognized as a promising strategy for improving collaboration between clinicians and their patients in achieving recovery. In Malaysia, SDM among people with schizophrenia is still lacking both in practice and in research. This study aimed to determine the level of SDM and role preference and their associated factors among patients with schizophrenia in Malaysia. Methods: A cross-sectional study was conducted on 86 outpatient attendees with schizophrenia at a teaching hospital in Kuala Lumpur, Malaysia. The nine-item Shared Decision Making Questionnaire and Control Preference Scale were used to assess perceived SDM experience and role preference, respectively. Linear and logistic regression models were used to analyze the factors associated with SDM and role preference, respectively. Factors with a p <0.25 from the simple regression analyses were controlled as the covariates in the multiple regression analyses. Results: The study respondents were predominantly female, single, and unemployed, with a mean age of 44 years. Only 35% of the participants reported having high SDM experiences, even though the majority (56%) preferred autonomous role preference. Among the participants who preferred autonomous roles, only 40% experienced high SDM. High SDM was found to be significantly associated with being younger (B = -0.33, 95% CI = -0.67 to -0.003) and being non-clozapine users (B = 19.90, 95% CI = 9.39-30.41), while autonomous role preference was significantly associated with a lower level of insight [adjusted odds ratio (AOR) = 0.84, 95% CI = 0.72-0.99] and being on oral antipsychotic drugs only (AOR = 2.94, 95% CI = 1.10-7.82). Conclusion: The practice of SDM is still lacking in the treatment of patients with schizophrenia in Malaysia, even though many of them preferred to be involved in the decision-making pertaining to their treatment. This study indicates the need for clinicians to improve their patients' involvement in the treatment process. More research is needed on how SDM can be implemented in patients with schizophrenia, especially in Asian population settings.
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Affiliation(s)
| | - Marhani Midin
- Psychiatry Department, Universiti Kebangsaan Malaysia Medical Center (UKMMC), Kuala Lumpur, Malaysia
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Griffiths K, Millgate E, Egerton A, MacCabe JH. Demographic and clinical variables associated with response to clozapine in schizophrenia: a systematic review and meta-analysis. Psychol Med 2021; 51:376-386. [PMID: 33602358 DOI: 10.1017/s0033291721000246] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Clozapine is the only licensed pharmacotherapy for treatment-resistant schizophrenia. However, response to clozapine is variable. Understanding the demographic and clinical features associated with response to clozapine may be useful for patient stratification for clinical trials or for identifying patients for earlier initiation of clozapine. We systematically reviewed the literature to investigate clinical and demographic factors associated with variation in clozapine response in treatment-resistant patients with schizophrenia spectrum disorders. Subsequently, we performed a random-effects meta-analysis to evaluate differences in duration of illness, age at clozapine initiation, age of illness onset, body weight and years of education between clozapine responders and non-responders. Thirty-one articles were eligible for qualitative review and 17 of these were quantitatively reviewed. Shorter duration of illness, later illness onset, younger age at clozapine initiation, fewer hospitalisations and fewer antipsychotic trials prior to clozapine initiation showed a trend to be significantly associated with a better response to clozapine. Meta-analysis of seven studies, totalling 313 subjects, found that clozapine responders had a significantly shorter duration of illness compared to clozapine non-responders [g = 0.31; 95% confidence interval (CI) 0.06-0.56; p = 0.01]. The results imply that a delay in clozapine treatment may result in a poorer response and that a focus on prompt treatment with clozapine is warranted.
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Affiliation(s)
- Kira Griffiths
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Edward Millgate
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Alice Egerton
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - James H MacCabe
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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30
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Beaudoin M, Potvin S, Machalani A, Dellazizzo L, Bourguignon L, Phraxayavong K, Dumais A. The therapeutic processes of avatar therapy: A content analysis of the dialogue between treatment-resistant patients with schizophrenia and their avatar. Clin Psychol Psychother 2021; 28:500-518. [PMID: 33484042 DOI: 10.1002/cpp.2556] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 12/21/2020] [Accepted: 01/05/2021] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Because the therapeutic processes of Avatar Therapy remain equivocal, the current study aims to further extend our previous findings by analysing the evolution of the avatars' and patients' speech and changes in patient responses as sessions progressed. DESIGN Eighteen patients with treatment-resistant schizophrenia were selected from two clinical trials on Avatar Therapy. Three coders analysed both the avatars' and patients' discourse during immersive therapy sessions using content analysis methods. RESULTS Our analyses enabled the categorization of the avatar discourse into confrontational techniques (e.g., provocation) and positive techniques (e.g., reinforcement). Patients responded to these utterances using coping mechanism or by expressing emotions, beliefs, self-perceptions or aspirations. Through identification of mutual changes in the interaction between the patient and their avatar, a shift was observed over the sessions from confrontation to a constructive dialogue. Assertiveness, emotional responses and prevention strategies seemed to be central to the therapeutic process, and these usually occur in response to positive techniques. CONCLUSION Investigating AT's therapeutic process may help to identify components to achieve positive outcomes and can enable the development of more effective treatments. Further studies should explore the association between these themes and therapeutic response to help predict which patients will better respond to Avatar Therapy.
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Affiliation(s)
- Mélissa Beaudoin
- Department of Psychiatry and Addictology, Université de Montréal, Montreal, Canada
- Faculty of Medicine, McGill University, Montreal, Canada
- Research Center, University Institute in Mental Health of Montreal, Montreal, Canada
| | - Stéphane Potvin
- Department of Psychiatry and Addictology, Université de Montréal, Montreal, Canada
- Research Center, University Institute in Mental Health of Montreal, Montreal, Canada
| | - Alexandra Machalani
- Faculty of Medicine, McGill University, Montreal, Canada
- Université du Québec à Trois-Rivières, Trois-Rivières, Canada
| | - Laura Dellazizzo
- Department of Psychiatry and Addictology, Université de Montréal, Montreal, Canada
- Research Center, University Institute in Mental Health of Montreal, Montreal, Canada
| | - Lysandre Bourguignon
- Department of Psychiatry and Addictology, Université de Montréal, Montreal, Canada
- Research Center, University Institute in Mental Health of Montreal, Montreal, Canada
| | | | - Alexandre Dumais
- Department of Psychiatry and Addictology, Université de Montréal, Montreal, Canada
- Research Center, University Institute in Mental Health of Montreal, Montreal, Canada
- Institut national de psychiatrie légale Philippe-Pinel, Montreal, Canada
- Services et Recherches Psychiatriques AD, Montreal, Canada
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31
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Cognitive performance in early, treatment-resistant psychosis patients: Could cognitive control play a role in persistent symptoms? Psychiatry Res 2021; 295:113607. [PMID: 33285345 DOI: 10.1016/j.psychres.2020.113607] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 11/24/2020] [Indexed: 12/26/2022]
Abstract
Approximately one third of psychosis patients fail to respond to conventional antipsychotic medication, which exerts its effect via striatal dopamine receptor antagonism. The present study aimed to investigate impaired cognitive control as a potential contributor to persistent positive symptoms in treatment resistant (TR) patients. 52 medicated First Episode Psychosis (FEP) patients (17 TR and 35 non-TR (NTR)) took part in a longitudinal study in which they performed a series of cognitive tasks and a clinical assessment at two timepoints, 12 months apart. Cognitive performance at baseline was compared to that of 39 healthy controls (HC). Across both timepoints, TR patients were significantly more impaired than NTR patients in a task of cognitive control, while performance on tasks of phonological and semantic fluency, working memory and general intelligence did not differ between patient groups. No significant associations were found between cognitive performance and psychotic symptomatology, and no significant performance changes were observed from the first to second timepoint in any of the cognitive tasks within patient groups. The results suggest that compared with NTR patients, TR patients have an exacerbated deficit specific to cognitive control, which is established early in psychotic illness and stabilises in the years following a first episode.
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32
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Nakata Y, Kanahara N, Kimura A, Niitsu T, Komatsu H, Oda Y, Ishikawa M, Hasegawa T, Kamata Y, Yamauchi A, Inazumi K, Kimura H, Iyo M. Autistic traits and cognitive profiles of treatment-resistant schizophrenia. Schizophr Res Cogn 2020; 22:100186. [PMID: 32760657 PMCID: PMC7390750 DOI: 10.1016/j.scog.2020.100186] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 07/10/2020] [Accepted: 07/10/2020] [Indexed: 12/27/2022]
Abstract
The complex pathophysiology of treatment-resistant schizophrenia (TRS) includes severe positive symptoms but also other symptom domains. The overlapping psychological profiles of schizophrenia and autistic spectrum disorder (ASD) are not established. We compared TRS patients (n = 30) with schizophrenia patients in remission (RemSZ, n = 28) and ASD patients (n = 28), focusing on both neurodevelopmental aspects and general and social cognitive impairments. The TRS group performed the worst on general neurocognition (measured by the MATRICS Consensus Cognitive Battery) and social cognition (measured by the theory of mind and emotional expression). The RemSZ group performed the best among the three groups. Regarding autistic traits, all measurements by the Autism-Spectrum Quotient/Autism Screening Questionnaire/Pervasive Developmental Disorder Assessment Rating Scale showed that (1) the ASD patients had the highest autistic traits (2) the TRS patients' scores were less severe than the ASD group's, but (3) the overall trends placed the TRS group between the ASD and the RemSZ group. These findings indicate that TRS patients and remitted patients could have distinctive neurodevelopmental and cognitive profiles. Further, the degrees of social cognitive dysfunction and autistic traits in TRS patients could be close to those of ASD patients, suggesting similarities between TRS and ASD.
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Affiliation(s)
- Yusuke Nakata
- Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Nobuhisa Kanahara
- Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba, Japan
- Division of Medical Treatment and Rehabilitation, Center for Forensic Mental Health, Chiba University, Chiba, Japan
- Corresponding author at: Division of Medical Treatment and Rehabilitation, Chiba University Center for Forensic Mental Health, 1-8-1 Inohana, Chuou-ku, Chiba-shi, Chiba 260-8670, Japan.
| | - Atsushi Kimura
- Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Tomihisa Niitsu
- Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Hideki Komatsu
- Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yasunori Oda
- Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Masatomo Ishikawa
- Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Tadashi Hasegawa
- Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba, Japan
- Palliative Care Center, Chiba University Hospital, Chiba, Japan
| | - Yu Kamata
- Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Atsushi Yamauchi
- Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba, Japan
- Department of Psychiatry, Chiba Rosai Hospital, Ichihara, Japan
| | - Kazuhiko Inazumi
- Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Hiroshi Kimura
- Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba, Japan
- Department of Psychiatry, Gakuji-kai Kimura Hospital, Chiba, Japan
| | - Masaomi Iyo
- Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba, Japan
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Tanoue H, Yoshinaga N, Hayashi Y, Ishikawa R, Ishigaki T, Ishida Y. Clinical effectiveness of metacognitive training as a transdiagnostic program in routine clinical settings: A prospective, multicenter, single-group study. Jpn J Nurs Sci 2020; 18:e12389. [PMID: 33174673 DOI: 10.1111/jjns.12389] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 08/27/2020] [Accepted: 09/16/2020] [Indexed: 11/29/2022]
Abstract
AIM To evaluate the clinical effectiveness of metacognitive training (MCT) as a transdiagnostic program, on a diverse population with mental disorders in routine Japanese day-care settings. METHODS This study employed a prospective, multicenter, single-group pre-post design. Participants diagnosed with various mental disorders received 10 MCT group sessions. We set transdiagnostic outcomes to assess quality of life, global functioning, cognitive insight, and depressive symptoms. At the end of the MCT, we also evaluated participants' satisfaction with treatment. Assessments were conducted at baseline (Pre), Week 5 (Mid), Week 10 (Post), and Week 14 (follow-up: FU). RESULTS Thirty-four participants enrolled in the study and received MCT (schizophrenia = 22, non-schizophrenia = 12). Intent-to-treat analyses revealed significant improvements in quality of life/global functioning during the intervention period, and further improvements were observed during the follow-up (all p < .05). The Pre-FU treatment effect sizes for quality of life and global functioning were small (Hedge's g = 0.44 and 0.47, respectively). Significant improvements were also found in depressive symptoms during both the intervention and follow-up periods (all p < .05), but not in cognitive insight. Overall, participants were highly satisfied with the MCT content and format. Scores on almost all outcomes (except for depression) at each assessment point were not significantly different between the schizophrenic and non-schizophrenic sub-groups. CONCLUSIONS Despite several limitations, mainly due to small sample size and having no control conditions, our results suggest that MCT for a diverse population with mental disorders is a potentially effective approach in improving quality of life/global functioning and other clinical outcomes in routine day-care settings.
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Affiliation(s)
- Hiroki Tanoue
- School of Nursing, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan.,Graduate School of Medicine and Veterinary Medicine, University of Miyazaki, Miyazaki, Japan
| | - Naoki Yoshinaga
- School of Nursing, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Yuta Hayashi
- Graduate School of Medicine and Veterinary Medicine, University of Miyazaki, Miyazaki, Japan.,Department of Nursing, Graduate School of Health Sciences, Kobe University, Kobe, Japan
| | - Ryotaro Ishikawa
- Department of Clinical Psychology, Taisho University, Tokyo, Japan
| | - Takuma Ishigaki
- Graduate School of Arts and Sciences, The University of Tokyo, Tokyo, Japan
| | - Yasushi Ishida
- Division of Psychiatry, Department of Clinical Neuroscience, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
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Mesenchymal stem cells derived extracellular vesicles improve behavioral and biochemical deficits in a phencyclidine model of schizophrenia. Transl Psychiatry 2020; 10:305. [PMID: 32873780 PMCID: PMC7463024 DOI: 10.1038/s41398-020-00988-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 06/24/2020] [Accepted: 07/03/2020] [Indexed: 02/07/2023] Open
Abstract
Schizophrenia is a debilitating psychiatric disorder with a significant number of patients not adequately responding to treatment. Phencyclidine (PCP) is used as a validated model for schizophrenia, shown to reliably induce positive, negative and cognitive-like behaviors in rodents. It was previously shown in our lab that behavioral phenotypes of PCP-treated mice can be alleviated after intracranial transplantation of mesenchymal stem cells (MSC). Here, we assessed the feasibility of intranasal delivery of MSCs-derived-extracellular vesicles (EVs) to alleviate schizophrenia-like behaviors in a PCP model of schizophrenia. As MSCs-derived EVs were already shown to concentrate at the site of lesion in the brain, we determined that in PCP induced injury the EVs migrate to the prefrontal cortex (PFC) of treated mice, a most involved area of the brain in schizophrenia. We show that intranasal delivery of MSC-EVs improve social interaction and disruption in prepulse inhibition (PPI) seen in PCP-treated mice. In addition, immunohistochemical studies demonstrate that the EVs preserve the number of parvalbumin-positive GABAergic interneurons in the PFC of treated mice. Finally, MSCs-EVs reduced glutamate levels in the CSF of PCP-treated mice, which might explain the reduction of toxicity. In conclusion, we show that MSCs-EVs improve the core schizophrenia-like behavior and biochemical markers of schizophrenia and might be used as a novel treatment for this incurable disorder.
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35
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Scott M, Rossell SL, Meyer D, Toh WL, Thomas N. Childhood trauma, attachment and negative schemas in relation to negative auditory verbal hallucination (AVH) content. Psychiatry Res 2020; 290:112997. [PMID: 32470717 DOI: 10.1016/j.psychres.2020.112997] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 04/07/2020] [Accepted: 04/08/2020] [Indexed: 11/30/2022]
Abstract
Auditory verbal hallucinations (AVHs, or hearing voices) are particularly characterized by negative content such as criticism and threats. The extent of negative content is a major predictor of distress, yet there is limited research on what contributes to the content of AVHs. The current study aimed to assess the relationships between childhood trauma, attachment styles (anxious and avoidant) and negative self schemas as plausible mechanisms underlying negative AVH content. Structural equation modelling was used to test a theoretical model, including these constructs, in a transdiagnostic sample of 140 people with AVHs. Findings indicated that collectively, emotional trauma during childhood, insecure anxious attachment and negative self schemas predicted the proportion of negative AVH content experienced by voice hearers. Whereby, trauma predicted attachment, which predicted schemas and in turn negative AVH content. This study marks an important step towards understanding the underlying mechanisms involved in negative AVHs. The results highlight the importance of recognising early experiences of trauma, adult attachment styles and self schemas in developing formulations and effective treatments for negative and distressing AVHs. Psychological interventions that target these underlying mechanisms of negative AVHs may lead to a reduction in negative content, thereby reducing voice related distress.
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Affiliation(s)
- Monique Scott
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia
| | - Susan L Rossell
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia; Psychiatry, St Vincent's Hospital Melbourne, Australia
| | - Denny Meyer
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia
| | - Wei Lin Toh
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia
| | - Neil Thomas
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia; Alfred Health, Melbourne, Australia.
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36
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Kumar V, Manchegowda S, Jacob A, Rao NP. Glutamate metabolites in treatment resistant schizophrenia: A meta-analysis and systematic review of 1H-MRS studies. Psychiatry Res Neuroimaging 2020; 300:111080. [PMID: 32279055 DOI: 10.1016/j.pscychresns.2020.111080] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 03/17/2020] [Accepted: 03/20/2020] [Indexed: 10/24/2022]
Abstract
Nearly a third to half of schizophrenia patients are non-responsive to first-line antipsychotics and are labelled treatment resistant schizophrenia (TRS). Neurochemical abnormalities in TRS may not be dopaminergic but possibly glutamate (Glu) related. Studies that have examined glutamatergic abnormalities using proton magnetic resonance spectroscopy (1H-MRS) in TRS, have showed inconsistent results. Hence, we conducted a meta-analysis of 1H-MRS studies comparing levels of Glu-and its metabolites in the brains of TRS and non-treatment resistant schizophrenia (nTRS) patients. Four eligible studies were included in the analysis. Summary effect size for the group difference between TRS (n = 101, including Ultra-TRS) and nTRS (n = 61) in Glu-levels in the anterior cingulate cortex (ACC) as measured with Hedges's g was 0.21 (95% CI: -0.42 to 0.85; p = 0.5) suggesting absence of significant difference. However, on leave one out analysis, one iteration showed significant difference in Glu-levels between the groups (Hedges's g = 0.46; p = 0.02) with higher Glu-levels in TRS implying significant effect of a single study on the effect size. The higher ACC Glu-in TRS was not associated with symptom severity or antipsychotic administration, indicating a possible trait abnormality. The limited number of datasets comparing Glu-metabolites in other brain regions are narratively described. Our analysis is limited by the significant heterogeneity between studies. Further longitudinal, prospective studies are needed to confirm higher Glu-metabolite levels in ACC in TRS and explore this potential trait abnormality.
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Affiliation(s)
- Vijay Kumar
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Shayanth Manchegowda
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Arpitha Jacob
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Naren P Rao
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India.
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37
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Neuromodulation in Schizophrenia: Relevance of Neuroimaging. Curr Behav Neurosci Rep 2020. [DOI: 10.1007/s40473-020-00209-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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38
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Abstract
During recent years, the role of non-pharmacological interventions in the management of psychotic symptoms, including delusions, has received increased recognition. However, a few factors such as the client's cognitive impairments and poor insight into the illness may create challenges for the therapist in conducting these interventions. Present paper discusses some of these issues and the steps a therapist can take to deal with them.
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Affiliation(s)
- Devvarta Kumar
- Department of Clinical Psychology, National Institute of Mental Health and Neurosciences, Bangalore, India
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39
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Takase M, Kimura H, Kanahara N, Nakata Y, Iyo M. Plasma monoamines change under dopamine supersensitivity psychosis in patients with schizophrenia: A comparison with first-episode psychosis. J Psychopharmacol 2020; 34:540-547. [PMID: 31961236 DOI: 10.1177/0269881119900982] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Patients with first-episode psychosis respond well to initial antipsychotic treatment, but among patients experiencing a relapse of psychosis, the response rate falls to approximately 30%. The mechanism of this discrepancy has not been clarified, but the development of dopamine supersensitivity psychosis with the underlying up-regulation of post-synaptic dopamine D2 receptors could be involved in this lesser response. It is uncertain whether elevated dopamine synthesis and release occurs in patients with dopamine supersensitivity psychosis, in contrast to those with first-episode psychosis. PATIENTS AND METHODS We examined a first-episode psychosis group (n=6) and a chronic schizophrenia group, i.e. patients experiencing relapse (n=23) including those who relapsed due to dopamine supersensitivity psychosis (n=18). Following the initiation of treatment, we measured the patients' blood concentrations of homovanillic acid and 3-methoxy-4-hydroxyphenylglycol at two weeks and four weeks after the baseline measurements. RESULTS The first-episode psychosis group tended to show decreased homovanillic acid, accompanied by an improvement of symptoms. The chronic schizophrenia group showed no alteration of homovanillic acid or 3-methoxy-4-hydroxyphenylglycol over the treatment period. These results were the same in the dopamine supersensitivity psychosis patients alone. CONCLUSIONS Our findings suggest that unlike first-episode psychosis, the release of dopamine from presynaptic neurons did not increase in relapse episodes in the patients with dopamine supersensitivity psychosis. This indirectly indicates that the development of supersensitivity of post-synapse dopamine D2 receptor is involved in relapse in dopamine supersensitivity psychosis patients.
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Affiliation(s)
- Masayuki Takase
- Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Hisoshi Kimura
- Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba, Japan.,Department of Psychiatry, Gakuji-kai Kimura Hospital, Chiba, Japan
| | - Nobuhisa Kanahara
- Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba, Japan.,Center for Forensic Mental Health, Chiba University, Chiba, Japan
| | - Yusuke Nakata
- Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Masaomi Iyo
- Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba, Japan
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40
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Indicated association between polygenic risk score and treatment-resistance in a naturalistic sample of patients with schizophrenia spectrum disorders. Schizophr Res 2020; 218:55-62. [PMID: 32171635 DOI: 10.1016/j.schres.2020.03.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 03/02/2020] [Accepted: 03/05/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND One third of people diagnosed with schizophrenia fail to respond adequately to antipsychotic medication, resulting in persisting disabling symptoms, higher rates of hospitalization and higher costs for society. In an effort to better understand the mechanisms behind resistance to antipsychotic treatment in schizophrenia, we investigated its potential relationship to the genetic architecture of the disorder. METHODS Patients diagnosed with a schizophrenia spectrum disorder (N = 321) were classified as either being treatment-resistant (N = 108) or non-treatment-resistant (N = 213) to antipsychotic medication using defined consensus criteria. A schizophrenia polygenic risk score based on genome-wide association studies (GWAS) was calculated for each patient and binary logistic regression was performed to investigate the association between polygenetic risk and treatment resistance. We adjusted for principal components, batch number, age and sex. Additional analyses were performed to investigate associations with demographic and clinical variables. RESULTS High levels of polygenic risk score for schizophrenia significantly predicted treatment resistance (p = 0.003). The positive predictive value of the model was 61.5% and the negative predictive value was 71.7%. The association was significant for one (p = 0.01) out of five tested SNP significance thresholds. Season of birth was able to predict treatment-resistance in the regression model (p = 0.05). CONCLUSIONS The study indicates that treatment-resistance to antipsychotic medication is associated with higher polygenetic risk of schizophrenia, suggesting a link between antipsychotics mechanism of action and the genetic underpinnings of the disorder.
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Corripio I, Roldán A, Sarró S, McKenna PJ, Alonso-Solís A, Rabella M, Díaz A, Puigdemont D, Pérez-Solà V, Álvarez E, Arévalo A, Padilla PP, Ruiz-Idiago JM, Rodríguez R, Molet J, Pomarol-Clotet E, Portella MJ. Deep brain stimulation in treatment resistant schizophrenia: A pilot randomized cross-over clinical trial. EBioMedicine 2020; 51:102568. [PMID: 31927311 PMCID: PMC6953640 DOI: 10.1016/j.ebiom.2019.11.029] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 11/18/2019] [Indexed: 01/11/2023] Open
Abstract
Background Up to 30% of patients with schizophrenia are resistant to antipsychotic drug treatment, with 60% of such cases also failing to respond to clozapine. Deep brain stimulation (DBS) has been used in treatment resistant patients with other psychiatric disorders, but there is a lack of trials in schizophrenia, partly due to uncertainties over where to site the electrodes. This trial aimed to examine the effectiveness of nucleus accumbens (NAcc) and subgenual anterior cingulate cortex (subgenual ACC) targeted DBS; the primary outcome measure was PANSS total score, as assessed fortnightly. Methods Eight patients with schizophrenia, who met criteria for treatment resistance and were also resistant to/intolerant of clozapine, were randomly assigned using central allocation to receive DBS in the NAcc or subgenual ACC. An open stabilization phase lasting at least six months was followed by a randomized double-blind crossover phase lasting 24 weeks in those who met symptomatic improvement criteria. The primary end-point was a 25% improvement in PANSS total score. (ClinicalTrials.gov Identifier: NCT02377505; trial completed). Findings One implanted patient did not receive DBS due to complications of surgery. Of the remaining 7 patients, 2/3 with NAcc and 2/4 with subgenual ACC electrode placements met the symptomatic improvement criteria (58% and 86%, and 37% and 68% improvement in PANSS total score, respectively). Three of these patients entered the crossover phase and all showed worsening when the stimulation was discontinued. The fourth patient worsened after the current was switched off accidentally without her or the investigators’ knowledge. Physical adverse events were uncommon, but two patients developed persistent psychiatric adverse effects (negative symptoms/apathy and mood instability, respectively). Interpretation These preliminary findings point to the possibility of DBS having therapeutic effects in patients with schizophrenia who do not respond to any other treatment. Larger trials with careful attention to blinding will be necessary to establish the extent of the benefits and whether these can be achieved without psychiatric side-effects.
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Affiliation(s)
- Iluminada Corripio
- Psychiatry Department, Institut d'Investigació Biomèdica-Sant Pau (IIB-SANT PAU), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Alexandra Roldán
- Psychiatry Department, Institut d'Investigació Biomèdica-Sant Pau (IIB-SANT PAU), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Salvador Sarró
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; FIDMAG Germanes Hospitalàries Research Foundation, C/. Dr. Antoni Pujadas 38, 08830 Sant Boi de Llobregat, Barcelona, Spain; Psychiatry Department, Benito Menni CASM Hermanas Hospitalarias, Sant Boi de Llobregat, Spain
| | - Peter J McKenna
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; FIDMAG Germanes Hospitalàries Research Foundation, C/. Dr. Antoni Pujadas 38, 08830 Sant Boi de Llobregat, Barcelona, Spain.
| | - Anna Alonso-Solís
- Psychiatry Department, Institut d'Investigació Biomèdica-Sant Pau (IIB-SANT PAU), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Mireia Rabella
- Psychiatry Department, Institut d'Investigació Biomèdica-Sant Pau (IIB-SANT PAU), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Anna Díaz
- Psychiatry Department, Institut d'Investigació Biomèdica-Sant Pau (IIB-SANT PAU), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Dolors Puigdemont
- Psychiatry Department, Institut d'Investigació Biomèdica-Sant Pau (IIB-SANT PAU), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Víctor Pérez-Solà
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; Psychiatry Department, Institut de Neuropsiquiatria i Addicions, Hospital del Mar, Barcelona, Spain; IMIM (Hospital del Mar Medical Research Institute), Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Enric Álvarez
- Psychiatry Department, Institut d'Investigació Biomèdica-Sant Pau (IIB-SANT PAU), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Antonio Arévalo
- FIDMAG Germanes Hospitalàries Research Foundation, C/. Dr. Antoni Pujadas 38, 08830 Sant Boi de Llobregat, Barcelona, Spain; Psychiatry Department, Hospital Sagrat Cor Hermanas Hospitalarias, Barcelona, Spain
| | - Pedro P Padilla
- FIDMAG Germanes Hospitalàries Research Foundation, C/. Dr. Antoni Pujadas 38, 08830 Sant Boi de Llobregat, Barcelona, Spain; Psychiatry Department, Centro Neuropsiquiátrico Nuestra Señora del Carmen Hermanas Hospitalarias, Zaragoza, Spain
| | - Jesus M Ruiz-Idiago
- FIDMAG Germanes Hospitalàries Research Foundation, C/. Dr. Antoni Pujadas 38, 08830 Sant Boi de Llobregat, Barcelona, Spain; Unitat Polivalent Barcelona Nord Hospital, Hospital Mare de Déu de la Mercè Hermanas Hospitalarias, Barcelona, Spain
| | - Rodrigo Rodríguez
- Neurosurgery Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Joan Molet
- Neurosurgery Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Edith Pomarol-Clotet
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; FIDMAG Germanes Hospitalàries Research Foundation, C/. Dr. Antoni Pujadas 38, 08830 Sant Boi de Llobregat, Barcelona, Spain
| | - Maria J Portella
- Psychiatry Department, Institut d'Investigació Biomèdica-Sant Pau (IIB-SANT PAU), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
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42
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Abstract
PURPOSE/BACKGROUND In addition to clozapine, other atypical antipsychotic drugs pharmacologically similar to clozapine, for example, olanzapine, risperidone, and melperone, are also effective in a similar proportion of treatment-resistant schizophrenia (TRS) patients, ~40%. The major goal of this study was to compare 2 doses of lurasidone, another atypical antipsychotic drug, and time to improvement in psychopathology and cognition during a 6-month trial in TRS patients. METHODS/PROCEDURES The diagnosis of TRS was based on clinical history and lack of improvement in psychopathology during a 6-week open trial of lurasidone 80 mg/d (phase 1). This was followed by a randomized, double-blind, 24-week trial of lurasidone, comparing 80- and 240-mg/d doses (phase 2). FINDINGS/RESULTS Significant non-dose-related improvement in the Positive and Negative Syndrome Scale-Total and subscales and in 2 of 7 cognitive domains, speed of processing and executive function, were noted. Twenty-eight (41.8%) of 67 patients in the combined sample improved ≥20% in the Positive and Negative Syndrome Scale-Total. Of the 28 responders, 19 (67.9%) first reached ≥20% improvement between weeks 6 and 24 during phase 2, including some who had previously failed to respond to clozapine. IMPLICATIONS/CONCLUSIONS Improvement with lurasidone is comparable with those previously reported for clozapine, melperone, olanzapine, and risperidone in TRS patients. In addition, this study demonstrated that 80 mg/d lurasidone, an effective and tolerable dose for non-TRS patients, was also effective in TRS patients but required longer duration of treatment. Direct comparison of lurasidone with clozapine in TRS patients is indicated.
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43
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Shan X, Liao R, Ou Y, Ding Y, Liu F, Chen J, Zhao J, Guo W, He Y. Metacognitive Training Modulates Default-Mode Network Homogeneity During 8-Week Olanzapine Treatment in Patients With Schizophrenia. Front Psychiatry 2020; 11:234. [PMID: 32292360 PMCID: PMC7118222 DOI: 10.3389/fpsyt.2020.00234] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 03/10/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Previous studies have revealed the efficacy of metacognitive training for schizophrenia. However, the underlying mechanisms of metacognitive training on brain function alterations, including the default-mode network (DMN), remain unknown. The present study explored treatment effects of metacognitive training on functional connectivity of the brain regions in the DMN. METHODS Forty-one patients with schizophrenia and 20 healthy controls were scanned using resting-state functional magnetic resonance imaging. Patients were randomly assigned to drug plus psychotherapy (DPP) and drug therapy (DT) groups. The DPP group received olanzapine and metacognitive training, and the DT group received only olanzapine for 8 weeks. Network homogeneity (NH) was applied to analyze the imaging data, and pattern classification techniques were applied to test whether abnormal NH deficits at baseline might be used to discriminate patients from healthy controls. Abnormal NH in predicting treatment response was also examined in each patient group. RESULTS Compared with healthy controls, patients at baseline showed decreased NH in the bilateral ventral medial prefrontal cortex (MPFC), right posterior cingulate cortex (PCC)/precuneus, and bilateral precuneus and increased NH in the right cerebellum Crus II and bilateral superior MPFC. NH values in the right PCC/precuneus increased in the DPP group after 8 weeks of treatment, whereas no substantial difference in NH value was observed in the DT group. Support vector machine analyses showed that the accuracy, sensitivity, and specificity for distinguishing patients from healthy controls were more than 0.7 in the NH values of the right PCC/precuneus, bilateral ventral MPFC, bilateral superior MPFC, and bilateral precuneus regions. Support vector regression analyses showed that high NH levels at baseline in the bilateral superior MPFC could predict symptomatic improvement of positive and negative syndrome scale (PANSS) after 8 weeks of DPP treatment. No correlations were found between alterations in the NH values and changes in the PANSS scores/cognition parameters in the patients. CONCLUSION This study provides evidence that metacognitive training is related to the modulation of DMN homogeneity in schizophrenia.
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Affiliation(s)
- Xiaoxiao Shan
- Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China.,National Clinical Research Center on Mental Disorders, Changsha, China
| | - Rongyuan Liao
- The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Yangpan Ou
- Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China.,National Clinical Research Center on Mental Disorders, Changsha, China
| | - Yudan Ding
- Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China.,National Clinical Research Center on Mental Disorders, Changsha, China
| | - Feng Liu
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Jindong Chen
- Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China.,National Clinical Research Center on Mental Disorders, Changsha, China
| | - Jingping Zhao
- Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China.,National Clinical Research Center on Mental Disorders, Changsha, China
| | - Wenbin Guo
- Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China.,National Clinical Research Center on Mental Disorders, Changsha, China
| | - Yiqun He
- The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
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44
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Cassetta BD, Menon M, Carrion PB, Pearce H, DeGraaf A, Leonova O, White RF, Stowe RM, Honer WG, Woodward TS, Torres IJ. Preliminary examination of the validity of the NIH toolbox cognition battery in treatment-resistant psychosis. Clin Neuropsychol 2019; 34:981-1003. [PMID: 31782350 DOI: 10.1080/13854046.2019.1694072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: Prior research has suggested that treatment-resistant psychosis (TRP) may be a categorically distinct subtype from treatment-responsive psychotic disorders. However, relatively few studies have investigated the cognitive profile of individuals with TRP. Moreover, no prior studies have investigated the effectiveness of using the NIH Toolbox Cognition Battery (NTCB) for assessing cognition among psychiatric inpatients despite its promising efficiency and practicality in such settings. The current study aimed to investigate the validity of the NTCB and the associated cognitive profile of inpatients with TRP.Methods: Participants (N = 38) were administered the NTCB and a neuropsychological test battery. The Positive and Negative Syndrome Scale and the Routine Assessment of Patient Progress measured psychosis symptomatology and daily functioning, respectively.Results: Results showed deficits relative to normative values in fluid cognitive abilities using the NTCB, as predicted. There was strong convergent validity and adequate divergent validity between the NTCB subtests and corresponding neuropsychological measures, though no NTCB subtest correlated with performance on the Wisconsin Card Sorting Task. NTCB performance correlated with positive and disorganized symptoms of psychosis as well as daily functioning.Conclusions: Taken together, the NTCB appears to be a relatively strong tool for cognitive screening among psychiatric inpatients and may be used to identify which patients might benefit from further neuropsychological evaluation.
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Affiliation(s)
- Briana D Cassetta
- Department of Psychology, University of Calgary, Calgary, AB, Canada.,Vancouver Coastal Health, Vancouver, BC, Canada
| | - Mahesh Menon
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.,BC Psychosis Program, Vancouver, BC, Canada
| | - Prescilla B Carrion
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Hadley Pearce
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Ashley DeGraaf
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Olga Leonova
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Randall F White
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.,BC Psychosis Program, Vancouver, BC, Canada
| | - Robert M Stowe
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.,Department of Neurology, University of British Columbia, Vancouver, BC, Canada
| | - William G Honer
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.,BC Psychosis Program, Vancouver, BC, Canada
| | - Todd S Woodward
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.,British Columbia Mental Health and Substance Use Services, Vancouver, BC, Canada
| | - Ivan J Torres
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.,British Columbia Mental Health and Substance Use Services, Vancouver, BC, Canada
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45
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Ruso-Julve F, Pombero A, Pilar-Cuéllar F, García-Díaz N, Garcia-Lopez R, Juncal-Ruiz M, Castro E, Díaz Á, Vazquez-Bourgón J, García-Blanco A, Garro-Martinez E, Pisonero H, Estirado A, Ayesa-Arriola R, López-Giménez J, Mayor F, Valdizán E, Meana J, Gonzalez-Maeso J, Martínez S, Vaqué JP, Crespo-Facorro B. Dopaminergic control of ADAMTS2 expression through cAMP/CREB and ERK: molecular effects of antipsychotics. Transl Psychiatry 2019; 9:306. [PMID: 31740729 PMCID: PMC6861307 DOI: 10.1038/s41398-019-0647-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 10/08/2019] [Accepted: 10/20/2019] [Indexed: 02/07/2023] Open
Abstract
A better understanding of the molecular mechanisms that participate in the development and clinical manifestations of schizophrenia can lead to improve our ability to diagnose and treat this disease. Previous data strongly associated the levels of deregulated ADAMTS2 expression in peripheral blood mononuclear cells (PBMCs) from patients at first episode of psychosis (up) as well as in clinical responders to treatment with antipsychotic drugs (down). In this current work, we performed an independent validation of such data and studied the mechanisms implicated in the control of ADAMTS2 gene expression. Using a new cohort of drug-naïve schizophrenia patients with clinical follow-up, we confirmed that the expression of ADAMTS2 was highly upregulated in PBMCs at the onset (drug-naïve patients) and downregulated, in clinical responders, after treatment with antipsychotics. Mechanistically, ADAMTS2 expression was activated by dopaminergic signalling (D1-class receptors) and downstream by cAMP/CREB and mitogen-activated protein kinase (MAPK)/ERK signalling. Incubation with antipsychotic drugs and selective PKA and MEK inhibitors abrogated D1-mediated activation of ADAMTS2 in neuronal-like cells. Thus, D1 receptors signalling towards CREB activation might participate in the onset and clinical responses to therapy in schizophrenia patients, by controlling ADAMTS2 expression and activity. The unbiased investigation of molecular mechanisms triggered by antipsychotic drugs may provide a new landscape of novel targets potentially associated with clinical efficacy.
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Affiliation(s)
- Fulgencio Ruso-Julve
- Department of Psychiatry, University Hospital Marqués de Valdecilla-IDIVAL, Santander, 39011, Cantabria, Spain
- Department of Molecular Biology, School of Medicine, University of Cantabria, Santander, 39011, Cantabria, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, 28029, Spain
| | - Ana Pombero
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, 28029, Spain
- Instituto de Neurociencias, UMH-CSIC, Alicante, 3550, Spain
| | - Fuencisla Pilar-Cuéllar
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, 28029, Spain
- Instituto de Biomedicina y Biotecnología de Cantabria, IBBTEC (Universidad de Cantabria, CSIC, SODERCAN), 39011, Santander, Cantabria, Spain
- Department of Physiology and Pharmacology, School of Medicine, University of Cantabria, Santander, 39011, Cantabria, Spain
| | - Nuria García-Díaz
- Department of Molecular Biology, School of Medicine, University of Cantabria, Santander, 39011, Cantabria, Spain
- Infection, Immunity and Digestive Pathology Group, University Hospital Marqués de Valdecilla-IDIVAL, Santander, 39011, Cantabria, Spain
| | - Raquel Garcia-Lopez
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, 28029, Spain
- Instituto de Neurociencias, UMH-CSIC, Alicante, 3550, Spain
| | - María Juncal-Ruiz
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, 28029, Spain
- Department of Psychiatry, Sierrallana Hospital, Torrelavega, 39300, Cantabria, Spain
| | - Elena Castro
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, 28029, Spain
- Instituto de Biomedicina y Biotecnología de Cantabria, IBBTEC (Universidad de Cantabria, CSIC, SODERCAN), 39011, Santander, Cantabria, Spain
- Department of Physiology and Pharmacology, School of Medicine, University of Cantabria, Santander, 39011, Cantabria, Spain
| | - Álvaro Díaz
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, 28029, Spain
- Instituto de Biomedicina y Biotecnología de Cantabria, IBBTEC (Universidad de Cantabria, CSIC, SODERCAN), 39011, Santander, Cantabria, Spain
- Department of Physiology and Pharmacology, School of Medicine, University of Cantabria, Santander, 39011, Cantabria, Spain
| | - Javier Vazquez-Bourgón
- Department of Psychiatry, University Hospital Marqués de Valdecilla-IDIVAL, Santander, 39011, Cantabria, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, 28029, Spain
| | - Agustín García-Blanco
- Department of Molecular Biology, School of Medicine, University of Cantabria, Santander, 39011, Cantabria, Spain
- Infection, Immunity and Digestive Pathology Group, University Hospital Marqués de Valdecilla-IDIVAL, Santander, 39011, Cantabria, Spain
| | - Emilio Garro-Martinez
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, 28029, Spain
- Instituto de Biomedicina y Biotecnología de Cantabria, IBBTEC (Universidad de Cantabria, CSIC, SODERCAN), 39011, Santander, Cantabria, Spain
- Department of Physiology and Pharmacology, School of Medicine, University of Cantabria, Santander, 39011, Cantabria, Spain
| | - Helena Pisonero
- Department of Molecular Biology, School of Medicine, University of Cantabria, Santander, 39011, Cantabria, Spain
- Infection, Immunity and Digestive Pathology Group, University Hospital Marqués de Valdecilla-IDIVAL, Santander, 39011, Cantabria, Spain
| | - Alicia Estirado
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, 28029, Spain
- Instituto de Neurociencias, UMH-CSIC, Alicante, 3550, Spain
| | - Rosa Ayesa-Arriola
- Department of Psychiatry, University Hospital Marqués de Valdecilla-IDIVAL, Santander, 39011, Cantabria, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, 28029, Spain
| | - Juan López-Giménez
- Institute of Parasitology and Biomedicine "López-Neyra" (IPBLN-CSIC), Armilla, 18016, Granada, Spain
| | - Federico Mayor
- Department of Molecular Biology, Centro de Biología Molecular "Severo Ochoa" (UAM-CSIC), Universidad Autónoma de Madrid, Madrid, 28049, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, 28029, Spain
| | - Elsa Valdizán
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, 28029, Spain
- Instituto de Biomedicina y Biotecnología de Cantabria, IBBTEC (Universidad de Cantabria, CSIC, SODERCAN), 39011, Santander, Cantabria, Spain
- Department of Physiology and Pharmacology, School of Medicine, University of Cantabria, Santander, 39011, Cantabria, Spain
| | - Javier Meana
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, 28029, Spain
- Department of Pharmacology, University of the Basque Country UPV/EHU, Leioa, 48940, Bizkaia, Spain
| | - Javier Gonzalez-Maeso
- Department of Physiology and Biophysics, Virginia Commonwealth University School of Medicine, P.O. Box 980551, Molecular Medicine Research Building 5-038, Richmond, 23298, Virginia, USA
| | - Salvador Martínez
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, 28029, Spain
- Instituto de Neurociencias, UMH-CSIC, Alicante, 3550, Spain
| | - José Pedro Vaqué
- Department of Molecular Biology, School of Medicine, University of Cantabria, Santander, 39011, Cantabria, Spain.
- Infection, Immunity and Digestive Pathology Group, University Hospital Marqués de Valdecilla-IDIVAL, Santander, 39011, Cantabria, Spain.
| | - Benedicto Crespo-Facorro
- Department of Psychiatry, University Hospital Marqués de Valdecilla-IDIVAL, Santander, 39011, Cantabria, Spain.
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, 28029, Spain.
- Department of Psychiatry, School of Medicine, University Hospital Virgen del Rocio-IBiS, Sevilla, 41013, Spain.
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46
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Nucifora FC, Woznica E, Lee BJ, Cascella N, Sawa A. Treatment resistant schizophrenia: Clinical, biological, and therapeutic perspectives. Neurobiol Dis 2019; 131:104257. [PMID: 30170114 PMCID: PMC6395548 DOI: 10.1016/j.nbd.2018.08.016] [Citation(s) in RCA: 122] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 08/07/2018] [Accepted: 08/26/2018] [Indexed: 12/16/2022] Open
Abstract
Treatment resistant schizophrenia (TRS) refers to the significant proportion of schizophrenia patients who continue to have symptoms and poor outcomes despite treatment. While many definitions of TRS include failure of two different antipsychotics as a minimum criterion, the wide variability in inclusion criteria has challenged the consistency and reproducibility of results from studies of TRS. We begin by reviewing the clinical, neuroimaging, and neurobiological characteristics of TRS. We further review the current treatment strategies available, addressing clozapine, the first-line pharmacological agent for TRS, as well as pharmacological and non-pharmacological augmentation of clozapine including medication combinations, electroconvulsive therapy, repetitive transcranial magnetic stimulation, deep brain stimulation, and psychotherapies. We conclude by highlighting the most recent consensus for defining TRS proposed by the Treatment Response and Resistance in Psychosis Working Group, and provide our overview of future perspectives and directions that could help advance the field of TRS research, including the concept of TRS as a potential subtype of schizophrenia.
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Affiliation(s)
- Frederick C Nucifora
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Hospital, 600 N. Wolfe St., Baltimore, MD 21287, USA.
| | - Edgar Woznica
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Hospital, 600 N. Wolfe St., Baltimore, MD 21287, USA
| | - Brian J Lee
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Hospital, 600 N. Wolfe St., Baltimore, MD 21287, USA
| | - Nicola Cascella
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Hospital, 600 N. Wolfe St., Baltimore, MD 21287, USA
| | - Akira Sawa
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Hospital, 600 N. Wolfe St., Baltimore, MD 21287, USA
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47
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Fekadu A, Medhin G, Lund C, DeSilva M, Selamu M, Alem A, Asher L, Birhane R, Patel V, Hailemariam M, Shibre T, Thornicroft G, Prince M, Hanlon C. The psychosis treatment gap and its consequences in rural Ethiopia. BMC Psychiatry 2019; 19:325. [PMID: 31664977 PMCID: PMC6819476 DOI: 10.1186/s12888-019-2281-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 09/10/2019] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND The "treatment gap" (TG) for mental disorders, widely advocated by the WHO in low-and middle-income countries, is an important indicator of the extent to which a health system fails to meet the care needs of people with mental disorder at the population level. While there is limited research on the TG in these countries, there is even a greater paucity of studies looking at TG beyond a unidimensional understanding. This study explores several dimensions of the TG construct for people with psychosis in Sodo, a rural district in Ethiopia, and its implications for building a more holistic capacity for mental health services. METHOD The study was a cross-sectional survey of 300 adult participants with psychosis identified through community-based case detection and confirmed through subsequent structured clinical evaluations. The Butajira Treatment Gap Questionnaire (TGQ), a new customised tool with 83 items developed by the Ethiopia research team, was administered to evaluate several TG dimensions (access, adequacy and effectiveness of treatment, and impact/consequence of the treatment gap) across a range of provider types corresponding with the WHO pyramid service framework. RESULTS Lifetime and current access gap for biomedical care were 41.8 and 59.9% respectively while the corresponding figures for faith and traditional healing (FTH) were 15.1 and 45.2%. Of those who had received biomedical care for their current episode, 71.7% did not receive minimally adequate care. Support from the community and non-governmental organisations (NGOs) were negligible. Those with education (Adj. OR: 2.1; 95% CI: 1.2, 3.8) and history of use of FTH (Adj. OR: 3.2; 95% CI: 1.9-5.4) were more likely to use biomedical care. Inadequate biomedical care was associated with increased lifetime risk of adverse experiences, such as history of restraint, homelessness, accidents and assaults. CONCLUSION This is the first study of its kind. Viewing TG not as a unidimensional, but as a complex, multi-dimensional construct, offers a more realistic and holistic understanding of health beliefs, help-seeking behaviors, and need for care. The reconceptualized multidimensional TG construct could assist mental health services capacity building advocacy and policy efforts and allow community and NGOs play a larger role in supporting mental healthcare.
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Affiliation(s)
- Abebaw Fekadu
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University, Addis Ababa, Ethiopia. .,Global Health & Infection Department, Brighton and Sussex Medical School, Brighton, UK. .,College of Health Sciences, School of Medicine, Department of Psychiatry, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Girmay Medhin
- 0000 0001 1250 5688grid.7123.7Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Crick Lund
- 0000 0004 1937 1151grid.7836.aAlan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, Addis Ababa University, University of Cape Town, Cape Town, South Africa ,0000 0001 2322 6764grid.13097.3cCentre for Global Mental Health, Health Service and Population Research Department, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Mary DeSilva
- 0000 0004 0427 7672grid.52788.30The Wellcome Trust, London, UK
| | - Medhin Selamu
- 0000 0001 1250 5688grid.7123.7College of Health Sciences, School of Medicine, Department of Psychiatry, Addis Ababa University, Addis Ababa, Ethiopia
| | - Atalay Alem
- 0000 0001 1250 5688grid.7123.7College of Health Sciences, School of Medicine, Department of Psychiatry, Addis Ababa University, Addis Ababa, Ethiopia
| | - Laura Asher
- 0000 0004 1936 8868grid.4563.4Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Rahel Birhane
- 0000 0001 1250 5688grid.7123.7College of Health Sciences, School of Medicine, Department of Psychiatry, Addis Ababa University, Addis Ababa, Ethiopia
| | - Vikram Patel
- 000000041936754Xgrid.38142.3cDepartment of Global Health & Social Medicine, Harvard Medical School, Boston, USA
| | - Maji Hailemariam
- 0000 0001 1250 5688grid.7123.7College of Health Sciences, School of Medicine, Department of Psychiatry, Addis Ababa University, Addis Ababa, Ethiopia
| | - Teshome Shibre
- 0000 0004 1936 8200grid.55602.34Department of Psychiatry, Dalhousie University, Horizon Zone 3, Fredericton, NB Canada
| | - Graham Thornicroft
- 0000 0001 2322 6764grid.13097.3cCentre for Global Mental Health, Health Service and Population Research Department, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Martin Prince
- 0000 0001 2322 6764grid.13097.3cCentre for Global Mental Health, Health Service and Population Research Department, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Charlotte Hanlon
- 0000 0001 1250 5688grid.7123.7College of Health Sciences, School of Medicine, Department of Psychiatry, Addis Ababa University, Addis Ababa, Ethiopia ,0000 0001 2322 6764grid.13097.3cCentre for Global Mental Health, Health Service and Population Research Department, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
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48
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Thomas S, Höfler M, Schäfer I, Trautmann S. Childhood maltreatment and treatment outcome in psychotic disorders: a systematic review and meta-analysis. Acta Psychiatr Scand 2019; 140:295-312. [PMID: 31357235 DOI: 10.1111/acps.13077] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/24/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Childhood maltreatment (CM) plays an important role in the aetiology and course of psychotic disorders and is associated with characteristics that could be relevant for treatment. We aimed to conduct a systematic review and meta-analysis on the association between CM and treatment outcome in psychotic disorders. METHODS Treatment outcome was defined as change in psychotic symptoms or in social or occupational functioning between first and last reported measurement in the course of a pharmacological and/or psychological treatment. RESULTS Twelve treatment results from seven studies (636 patients, average treatment duration: 59.2 weeks) were included. CM was related to poorer treatment outcomes in psychotic disorders (OR = 1.51, 95% CI = [1.08, 2.10]). There is evidence that this association might increase with illness duration and increasing age and might be stronger in schizophrenia samples. CONCLUSIONS Childhood maltreatment is highly understudied with regard to treatment outcome in psychotic disorders. The need for more studies is emphasized by the fact that this meta-analysis reveals evidence for a poorer treatment response in patients with CM. If this association is confirmed, the identification of patients with CM and the consideration of associated clinical and biological conditions could contribute to improve treatment outcome in psychotic disorders.
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Affiliation(s)
- S Thomas
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - M Höfler
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - I Schäfer
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Center for Interdisciplinary Addiction Research, University of Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - S Trautmann
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany.,Department of Psychology, Medical School Hamburg, Hamburg, Germany
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Chan NK, Kim J, Shah P, Brown EE, Plitman E, Carravaggio F, Iwata Y, Gerretsen P, Graff-Guerrero A. Resting-state functional connectivity in treatment response and resistance in schizophrenia: A systematic review. Schizophr Res 2019; 211:10-20. [PMID: 31331784 DOI: 10.1016/j.schres.2019.07.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 06/23/2019] [Accepted: 07/11/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND Treatment-resistant schizophrenia (TRS) and treatment-responsive schizophrenia may exhibit distinct pathophysiology. Several functional magnetic resonance imaging (fMRI) studies have used resting-state functional connectivity analyses (rs-FC) in TRS patients to identify markers of treatment resistance. However, to date, existing findings have not been systematically evaluated. METHODS A systematic literature search using Embase, MEDLINE, PsycINFO, ProQuest, PUBMED, and Scopus was performed. The query sought fMRI articles investigating rs-FC in treatment response or resistance in patients with schizophrenia. Only studies that examined treatment response, operationalized as the explicit categorization of patients by their response to antipsychotic medication, were considered eligible. Pairwise comparisons between patient groups and controls were extracted from each study. RESULTS The search query identified 159 records. Ten studies met inclusion criteria. Five studies examined not TRS (NTRS), and 8 studies examined TRS. Differences in rs-FC analysis methodology precluded direct comparisons between studies. However, disruptions in areas involved in visual and auditory information processing were implicated in both patients with TRS and NTRS. Changes in connectivity with sensorimotor network areas tended to appear in the context of TRS but not NTRS. Moreover, there was some indication that this connectivity could be affected by clozapine. CONCLUSIONS Functional connectivity may provide clinically meaningful biomarkers of treatment response and resistance in schizophrenia. Studies generally identified similar areas of disruption, though methodological differences largely precluded direct comparison between disruption effects. Implementing data sharing as standard practice will allow future reviews and meta-analyses to identify rs-FC correlates of TRS.
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Affiliation(s)
- Nathan K Chan
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Julia Kim
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Parita Shah
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Eric E Brown
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Geriatric Mental Health Division, CAMH, University of Toronto, Toronto, Ontario, Canada; Campbell Family Mental Health Research Institute, CAMH, University of Toronto, Toronto, Ontario, Canada
| | - Eric Plitman
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Fernando Carravaggio
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Yusuke Iwata
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Philip Gerretsen
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Geriatric Mental Health Division, CAMH, University of Toronto, Toronto, Ontario, Canada; Campbell Family Mental Health Research Institute, CAMH, University of Toronto, Toronto, Ontario, Canada
| | - Ariel Graff-Guerrero
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Geriatric Mental Health Division, CAMH, University of Toronto, Toronto, Ontario, Canada; Campbell Family Mental Health Research Institute, CAMH, University of Toronto, Toronto, Ontario, Canada.
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50
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Yabuki Y, Wu L, Fukunaga K. Cognitive enhancer ST101 improves schizophrenia-like behaviors in neonatal ventral hippocampus-lesioned rats in association with improved CaMKII/PKC pathway. J Pharmacol Sci 2019; 140:263-272. [PMID: 31474557 DOI: 10.1016/j.jphs.2019.07.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 07/20/2019] [Accepted: 07/24/2019] [Indexed: 12/31/2022] Open
Abstract
Atypical antipsychotics improve positive and negative symptoms but are not effective for treating cognitive impairments in patients with schizophrenia. We previously reported that cognitive impairments in neonatal ventral hippocampus (NVH)-lesioned rats show resistance to atypical antipsychotics risperidone and are associated with reduced calcium/calmodulin-dependent protein kinase II (CaMKII) and protein kinase C (PKC) signaling in memory-related regions. The cognitive enhancer ST101 (spiro[imi-dazo[1,2-a]pyridine-3,2-indan]-2(3H)-one) stimulates CaMKII activity in the hippocampus and medial prefrontal cortex (mPFC). We thus tested ST101 on cognitive impairments in NVH-lesioned rats. Chronic ST101 administration (0.1 and/or 0.5 mg/kg, p.o.) significantly improved deficits in prepulse inhibition (PPI), social interaction, and cognitive function in NVH-lesioned rats. ST101 administration (0.5 mg/kg, p.o.) significantly restored the decreased CaMKII autophosphorylation (Thr-286) in the mPFC and hippocampal CA1 regions of NVH-lesioned rats when assessed by immunohistochemistry. Chronic ST101 administration (0.1 mg/kg, p.o.) improved the decline in phosphorylation levels of CaMKII (Thr-286), PKCα (Ser-657), α-amino-3-hydroxy-5-methyl-4-isoxazol- propionic acid (AMPA)-type glutamate receptor subunit 1 (GluA1: Ser-831), and N-methyl-d-aspartate (NMDA) receptor subunit 1 (GluN1: Ser-896) in the mPFC and hippocampal CA1 regions. Taken together, these results suggest that ST101 improves schizophrenia-like behaviors and cognitive impairment by enhancing CaMKII/PKCα signaling in the mPFC and hippocampus in NVH-lesioned rats.
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Affiliation(s)
- Yasushi Yabuki
- Department of Pharmacology, Graduate School of Pharmaceutical Sciences, Tohoku University, Sendai, Japan
| | - Lei Wu
- Department of Pharmacology, Graduate School of Pharmaceutical Sciences, Tohoku University, Sendai, Japan
| | - Kohji Fukunaga
- Department of Pharmacology, Graduate School of Pharmaceutical Sciences, Tohoku University, Sendai, Japan.
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