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Ou J, Dong H, Dai S, Hou Y, Wang Y, Lu X, Xun G, Xia K, Zhao J, Shen Y. Development and validation of a risk score model for predicting autism based on pre- and perinatal factors. Front Psychiatry 2024; 15:1291356. [PMID: 38435974 PMCID: PMC10904522 DOI: 10.3389/fpsyt.2024.1291356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 01/30/2024] [Indexed: 03/05/2024] Open
Abstract
Background The use of pre- and perinatal risk factors as predictive factors may lower the age limit for reliable autism prediction. The objective of this study was to develop a clinical model based on these risk factors to predict autism. Methods A stepwise logistic regression analysis was conducted to explore the relationships between 28 candidate risk factors and autism risk among 615 Han Chinese children with autism and 615 unrelated typically developing children. The significant factors were subsequently used to create a clinical risk score model. A chi-square automatic interaction detector (CHAID) decision tree was used to validate the selected predictors included in the model. The predictive performance of the model was evaluated by an independent cohort. Results Five factors (pregnancy influenza-like illness, pregnancy stressors, maternal allergic/autoimmune disease, cesarean section, and hypoxia) were found to be significantly associated with autism risk. A receiver operating characteristic (ROC) curve indicated that the risk score model had good discrimination ability for autism, with an area under the curve (AUC) of 0.711 (95% CI=0.679-0.744); in the external validation cohort, the model showed slightly worse but overall similar predictive performance. Further subgroup analysis indicated that a higher risk score was associated with more behavioral problems. The risk score also exhibited robustness in a subgroup analysis of patients with mild autism. Conclusion This risk score model could lower the age limit for autism prediction with good discrimination performance, and it has unique advantages in clinical application.
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Affiliation(s)
- Jianjun Ou
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Huixi Dong
- Mental Health Center of Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Si Dai
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Yanting Hou
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Ying Wang
- Mental Health Center of Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xiaozi Lu
- Qingdao Mental Health Center, Qingdao, Shandong, China
| | - Guanglei Xun
- Shandong Mental Health Center, Jinan, Shandong, China
| | - Kun Xia
- Center for Medical Genetics and School of Life Sciences, Central South University, Changsha, Hunan, China
| | - Jingping Zhao
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Yidong Shen
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
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Rich-Edwards JW, Stuart JJ, Becene IA, Largier LF, Rexrode KM, Cantonwine DE, Carpenter MO, McElrath TF, Gray KJ. Validation of parental recall questionnaire to classify preterm delivery subtypes: Spontaneous preterm labour, preterm premature rupture of membranes and clinician-initiated preterm delivery. Paediatr Perinat Epidemiol 2023; 37:710-718. [PMID: 37770068 PMCID: PMC10840943 DOI: 10.1111/ppe.13009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 07/24/2023] [Accepted: 09/14/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND Preterm delivery (PTD) includes three main presenting subtypes: spontaneous preterm labour (sPTL), preterm premature rupture of membranes (pPROM) and clinician-initiated preterm delivery (ciPTD). PTD subtype data are rarely available from birth registries and are onerous to derive from medical records. OBJECTIVES To develop and test the validity of a questionnaire to classify PTD subtype based on birthing parent recall of labour and delivery events. METHODS The questionnaire was sent in 2022 to 581 patients with PTD history documented in the LIFECODES study, a hospital-based birth cohort in Boston, Massachusetts. Eighty-two respondents reported 94 PTDs that could be linked to medical records. Data on PTD subtype were extracted from medical records as the reference standard. RESULTS Medical records indicated 47 spontaneous (24 sPTL, 23 pPROM) and 47 ciPTD deliveries occurring a median eight years earlier. The sensitivity and specificity of the recall questionnaire were 88% (95% confidence interval: 68, 97%) and 89% (79, 95%) for sPTL; 96% (78, 100%) and 94% (86, 98%) for pPROM; and 83% (69, 92%) and 100% (92, 100%) for ciPTD, respectively. Greater time since pregnancy did not degrade the sensitivity or specificity of the parental recall questionnaire. CONCLUSIONS Although derived from a modest sample, the moderate-to-high sensitivity and specificity of the parental recall questionnaire to classify sPTL, pPROM and ciPTD demonstrates its potential for large studies of PTD and for correction of misclassification bias. Future studies are required to test the questionnaire in a variety of populations.
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Affiliation(s)
- Janet W Rich-Edwards
- Division of Women's Health, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Jennifer J Stuart
- Division of Women's Health, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Iris A Becene
- Division of Women's Health, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Louise F Largier
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kathryn M Rexrode
- Division of Women's Health, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - David E Cantonwine
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Thomas F McElrath
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kathryn J Gray
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Sagué-Vilavella M, Amoretti S, Garriga M, Mezquida G, Williams E, Serra-Navarro M, Forte MF, Varo C, Montejo L, Palacios-Garran R, Madero S, Sparacino G, Anmella G, Fico G, Giménez-Palomo A, Pons-Cabrera MT, Salgado-Pineda P, Montoro Salvatierra I, Sánchez Gistau V, Pomarol-Clotet E, Ramos-Quiroga JA, Undurraga J, Reinares M, Martínez-Arán A, Pacchiarotti I, Valli I, Bernardo M, Garcia-Rizo C, Vieta E, Verdolini N. Shaped before birth: Obstetric complications identify a more severe clinical phenotype among patients presenting a first affective or non-affective episode of psychosis. J Psychiatr Res 2022; 151:461-468. [PMID: 35609362 DOI: 10.1016/j.jpsychires.2022.05.005] [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: 01/04/2022] [Revised: 04/08/2022] [Accepted: 05/09/2022] [Indexed: 10/18/2022]
Abstract
Obstetric complications (OCs) may contribute to the heterogeneity that characterizes psychiatric illness, particularly the phenotypic presentation of first episode psychoses (FEP). Our aim was to examine the relationship between OCs and socio-demographic, clinical, functioning and neuropsychological characteristics in affective and non-affective FEP. We performed a cross-sectional,study where we recruited participants with FEP between 2011 and 2021, and retrospectively assessed OCs using the Lewis-Murray scale. OCs were used as a dichotomous variable and further stratified into three subtypes: complications of pregnancy, abnormal fetal growth and development, and difficulties in delivery. We performed a logistic stepwise forward regression analysis to examine variables associated with the presence of OCs. Of the 104 participants (67 affective FEP and 37 non-affective FEP), 31.7% (n = 33) had experienced OCs. Subjects with OCs showed a more gradual emergence of prodromal symptoms as well as higher negative and total Positive and Negative Syndrome Scale (PANSS) scores. In the multivariate analysis, the presence of OCs was independently associated with a younger age at first episode of any type (OR = 0.904, p = 0.003) and slower emergence of prodromal symptoms (OR = 0.274, p = 0.011). When considering specific types of OCs, those related with fetal growth were associated with worse neuropsychological performance, while OCs at delivery were related to earlier onset of illness and more severe symptoms. In conclusion, OCs signaled a specific FEP phenotype characterized by earlier and more protracted onset of illness as well as more burdensome symptoms, independently of FEP type (i.e., affective vs non-affective). These results indicate a potential target of early intervention in FEP.
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Affiliation(s)
- Maria Sagué-Vilavella
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Silvia Amoretti
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain; Department of Psychiatry, Hospital Universitari Vall d'Hebron, Group of Psychiatry, Mental Health and Addictions, Psychiatric Genetics Unit, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - Marina Garriga
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain
| | - Gisela Mezquida
- Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain; Barcelona Clinic Schizophrenia Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Evelyn Williams
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Maria Serra-Navarro
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Maria Florencia Forte
- Barcelona Clinic Schizophrenia Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Cristina Varo
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Laura Montejo
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain
| | - Roberto Palacios-Garran
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; University Hospital Santa Maria, University of Lleida, Lleida, Spain
| | - Santiago Madero
- Barcelona Clinic Schizophrenia Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Giulio Sparacino
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Gerard Anmella
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Giovanna Fico
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Anna Giménez-Palomo
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Maria Teresa Pons-Cabrera
- Addictive Behaviours Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, Barcelona, Catalonia, Spain
| | - Pilar Salgado-Pineda
- Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain; FIDMAG Germanes Hospitalàries Research Foundation, c/ Dr. Pujades 38, 08830, Sant Boi de Llobregat, Barcelona, Spain
| | - Irene Montoro Salvatierra
- Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain; Hospital Universitari Institut Pere Mata, Institut d'Investigació Sanitària Pere Virgili (IISPV), Universitat Rovira i Virgili, CIBERSAM, Reus, Tarragona, Spain
| | - Vanessa Sánchez Gistau
- Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain; Hospital Universitari Institut Pere Mata, Institut d'Investigació Sanitària Pere Virgili (IISPV), Universitat Rovira i Virgili, CIBERSAM, Reus, Tarragona, Spain
| | - Edith Pomarol-Clotet
- Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain; FIDMAG Germanes Hospitalàries Research Foundation, c/ Dr. Pujades 38, 08830, Sant Boi de Llobregat, Barcelona, Spain
| | - Josep Antoni Ramos-Quiroga
- Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain; Department of Psychiatry, Hospital Universitari Vall d'Hebron, Group of Psychiatry, Mental Health and Addictions, Psychiatric Genetics Unit, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain; Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Juan Undurraga
- Department of Neurology and Psychiatry, Faculty of Medicine, Clinica Alemana Universidad del Desarrollo, Santiago, Chile; Early Intervention Program, Instituto Psiquiátrico Dr. J. Horwitz Barak, Santiago, Chile
| | - María Reinares
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Anabel Martínez-Arán
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain
| | - Isabella Pacchiarotti
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain
| | - Isabel Valli
- Department of Child and Adolescent Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic Barcelona, IDIBAPS, CIBERSAM, Universitat de Barcelona, Barcelona, Spain
| | - Miguel Bernardo
- Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain; Barcelona Clinic Schizophrenia Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Clemente Garcia-Rizo
- Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain; Barcelona Clinic Schizophrenia Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain.
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain.
| | - Norma Verdolini
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain
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4
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Vassos E, Kou J, Tosato S, Maxwell J, Dennison CA, Legge SE, Walters JTR, Owen MJ, O’Donovan MC, Breen G, Lewis CM, Sullivan PF, Hultman C, Ruggeri M, Walshe M, Bramon E, Bergen SE, Murray RM. Lack of Support for the Genes by Early Environment Interaction Hypothesis in the Pathogenesis of Schizophrenia. Schizophr Bull 2022; 48:20-26. [PMID: 33987677 PMCID: PMC8781344 DOI: 10.1093/schbul/sbab052] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Ursini et al reported recently that the liability of schizophrenia explained by a polygenic risk score (PRS) derived from the variants most associated with schizophrenia was increased 5-fold in individuals who experienced complications during pregnancy or birth. Follow-up gene expression analysis showed that the genes mapping to the most associated genetic variants are highly expressed in placental tissues. If confirmed, these findings will have major implications in our understanding of the joint effect of genes and environment in the pathogenesis of schizophrenia. We examined the interplay between PRS and obstetric complications (OCs) in 5 independent samples (effective N = 2110). OCs were assessed with the full or modified Lewis-Murray scale, or with birth weight < 2.5 kg as a proxy. In a large cohort we tested whether the pathways from placenta-relevant variants in the original report were associated with case-control status. Unlike in the original study, we did not find significant effect of PRS on the presence of OCs in cases, nor a substantial difference in the association of PRS with case-control status in samples stratified by the presence of OCs. Furthermore, none of the PRS by OCs interactions were significant, nor were any of the biological pathways, examined in the Swedish cohort. Our study could not support the hypothesis of a mediating effect of placenta biology in the pathway from genes to schizophrenia. Methodology differences, in particular the different scales measuring OCs, as well as power constraints for interaction analyses in both studies, may explain this discrepancy.
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Affiliation(s)
- Evangelos Vassos
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
- NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Trust, London, UK
| | - Jiaqi Kou
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Sarah Tosato
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Jessye Maxwell
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
- NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Trust, London, UK
| | - Charlotte A Dennison
- Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, Cardiff, UK
| | - Sophie E Legge
- Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, Cardiff, UK
| | - James T R Walters
- Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, Cardiff, UK
| | - Michael J Owen
- Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, Cardiff, UK
| | - Michael C O’Donovan
- Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, Cardiff, UK
| | - Gerome Breen
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
- NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Trust, London, UK
| | - Cathryn M Lewis
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
- NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Trust, London, UK
| | - Patrick F Sullivan
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Center for Psychiatric Genomics, Department of Genetics and Psychiatry, University of North Carolina, Chapel Hill, NC
| | - Christina Hultman
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Mirella Ruggeri
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Muriel Walshe
- Division of Psychiatry, University College London, London, UK
| | - Elvira Bramon
- Division of Psychiatry, University College London, London, UK
| | - Sarah E Bergen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Robin M Murray
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
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5
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Tosato S, Bonetto C, Vassos E, Lasalvia A, De Santi K, Gelmetti M, Cristofalo D, Richards A, Ruggeri M. Obstetric Complications and Polygenic Risk Score: Which Role in Predicting a Severe Short-Term Outcome in Psychosis? Genes (Basel) 2021; 12:1895. [PMID: 34946845 PMCID: PMC8702213 DOI: 10.3390/genes12121895] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 11/17/2021] [Accepted: 11/25/2021] [Indexed: 11/17/2022] Open
Abstract
Understanding and improving the outcomes of psychosis remains a major challenge for clinical research. Obstetric complications (OCs) as a risk factor for schizophrenia (SZ) have been investigated as a potential predictor of outcomes in relation to illness severity and poorer treatment outcome, but there are less reports on first episode psychosis (FEP) patients. We test whether OCs, collected in a cohort of FEP patients, can predict illness course and psychopathology severity after 2 years from the onset. Moreover, we explore whether the SZ-polygenic risk score (PRS) would predict the illness course and whether the interaction between OCS and PRS shows a significant effect. A cohort of 264 FEP patients were assessed with standardized instruments. OCs were recorded using the Lewis-Murray scale in interviews with the patients' mothers: 30% of them reported at least one OC. Patients with at least one OC were more likely to have a non-remitting course of illness compared to those without OCs (35.3% vs. 16.3%, p = 0.014). No association between SZ-PRS and course of illness nor evidence for a gene-environment interaction was found. In our sample, poor short-term outcomes were associated with OCs, while SZ-PRS was not a prognostic indicator of poor outcomes.
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Affiliation(s)
- Sarah Tosato
- Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, 37134 Verona, Italy; (C.B.); (A.L.); (M.G.); (D.C.); (M.R.)
| | - Chiara Bonetto
- Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, 37134 Verona, Italy; (C.B.); (A.L.); (M.G.); (D.C.); (M.R.)
| | - Evangelos Vassos
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London SE5 8AF, UK;
- The National Institute for Health Research, Maudsley Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London, London SE5 8AF, UK
| | - Antonio Lasalvia
- Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, 37134 Verona, Italy; (C.B.); (A.L.); (M.G.); (D.C.); (M.R.)
| | - Katia De Santi
- Unit of Psychiatry, Azienda Ospedaliera Universitaria Integrata, 37134 Verona, Italy;
| | - Margherita Gelmetti
- Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, 37134 Verona, Italy; (C.B.); (A.L.); (M.G.); (D.C.); (M.R.)
| | - Doriana Cristofalo
- Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, 37134 Verona, Italy; (C.B.); (A.L.); (M.G.); (D.C.); (M.R.)
| | - Alexander Richards
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff CF24 4HQ, UK;
| | - Mirella Ruggeri
- Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, 37134 Verona, Italy; (C.B.); (A.L.); (M.G.); (D.C.); (M.R.)
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6
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Maj M, van Os J, De Hert M, Gaebel W, Galderisi S, Green MF, Guloksuz S, Harvey PD, Jones PB, Malaspina D, McGorry P, Miettunen J, Murray RM, Nuechterlein KH, Peralta V, Thornicroft G, van Winkel R, Ventura J. The clinical characterization of the patient with primary psychosis aimed at personalization of management. World Psychiatry 2021; 20:4-33. [PMID: 33432763 PMCID: PMC7801854 DOI: 10.1002/wps.20809] [Citation(s) in RCA: 138] [Impact Index Per Article: 46.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The current management of patients with primary psychosis worldwide is often remarkably stereotyped. In almost all cases an antipsychotic medica-tion is prescribed, with second-generation antipsychotics usually preferred to first-generation ones. Cognitive behavioral therapy is rarely used in the vast majority of countries, although there is evidence to support its efficacy. Psychosocial interventions are often provided, especially in chronic cases, but those applied are frequently not validated by research. Evidence-based family interventions and supported employment programs are seldom implemented in ordinary practice. Although the notion that patients with primary psychosis are at increased risk for cardiovascular diseases and diabetes mellitus is widely shared, it is not frequent that appropriate measures be implemented to address this problem. The view that the management of the patient with primary psychosis should be personalized is endorsed by the vast majority of clinicians, but this personalization is lacking or inadequate in most clinical contexts. Although many mental health services would declare themselves "recovery-oriented", it is not common that a focus on empowerment, identity, meaning and resilience is ensured in ordinary practice. The present paper aims to address this situation. It describes systematically the salient domains that should be considered in the characterization of the individual patient with primary psychosis aimed at personalization of management. These include positive and negative symptom dimensions, other psychopathological components, onset and course, neurocognition and social cognition, neurodevelopmental indicators; social functioning, quality of life and unmet needs; clinical staging, antecedent and concomitant psychiatric conditions, physical comorbidities, family history, history of obstetric complications, early and recent environmental exposures, protective factors and resilience, and internalized stigma. For each domain, simple assessment instruments are identified that could be considered for use in clinical practice and included in standardized decision tools. A management of primary psychosis is encouraged which takes into account all the available treatment modalities whose efficacy is supported by research evidence, selects and modulates them in the individual patient on the basis of the clinical characterization, addresses the patient's needs in terms of employment, housing, self-care, social relationships and education, and offers a focus on identity, meaning and resilience.
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Affiliation(s)
- Mario Maj
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Jim van Os
- Department of Psychiatry, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, The Netherlands
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Marc De Hert
- University Psychiatric Centre KU Leuven, Kortenberg, Belgium
- Antwerp Health Law and Ethics Chair, University of Antwerp, Antwerp, Belgium
| | - Wolfgang Gaebel
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University Düsseldorf, LVR-Klinikum Düsseldorf, and WHO Collaborating Center on Quality Assurance and Empowerment in Mental Health, Düsseldorf, Germany
| | - Silvana Galderisi
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Michael F Green
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
- Department of Veterans Affairs, Desert Pacific Mental Illness Research, Education, and Clinical Center, Los Angeles, CA, USA
| | - Sinan Guloksuz
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Philip D Harvey
- Division of Psychology, Department of Psychiatry, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Peter B Jones
- Department of Psychiatry, University of Cambridge and Cambridgeshire & Peterborough NHS Foundation Trust, Cambridge, UK
| | - Dolores Malaspina
- Department of Psychiatry and Neuroscience, Ichan Medical School at Mount Sinai, New York, NY, USA
| | - Patrick McGorry
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Jouko Miettunen
- Centre for Life Course Health Research, University of Oulu, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Robin M Murray
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Keith H Nuechterlein
- Semel Institute for Neuroscience and Human Behavior, Geffen School of Medicine, and Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA
| | - Victor Peralta
- Mental Health Department, Servicio Navarro de Salud, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
| | - Graham Thornicroft
- Centre for Global Mental Health and Centre for Implementation Science, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Ruud van Winkel
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
- Antwerp Health Law and Ethics Chair, University of Antwerp, Antwerp, Belgium
- University Psychiatric Center KU Leuven, Leuven, Belgium
| | - Joseph Ventura
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
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Bokslag A, Fons AB, Zeverijn LJ, Teunissen PW, de Groot CJM. Maternal recall of a history of early-onset preeclampsia, late-onset preeclampsia, or gestational hypertension: a validation study. Hypertens Pregnancy 2020; 39:444-450. [PMID: 32981372 DOI: 10.1080/10641955.2020.1818090] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Objective: This study assessed women's ability to recall different types of hypertensive disorders of pregnancy because of its disproportionate cardiovascular risk later in life. Methods: Participants were 5-10 years post-partum with a history of early-onset-, late-onset preeclampsia, or gestational hypertension. Recall was assessed by questionnaire and compared to medical records. Results: Questionnaire-based recall of early-onset preeclampsia had high sensitivity and specificity, late-onset preeclampsia poor sensitivity and high specificity and gestational hypertension had very poor sensitivity and high specificity. Conclusion: Early-onset preeclampsia can accurately be assessed using a simple questionnaire. Recall of late-onset preeclampsia and gestational hypertension was not accurate.
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Affiliation(s)
- Anouk Bokslag
- Department of Obstetrics and Gynaecology, Amsterdam UMC, Vrije Universiteit Amsterdam , Amsterdam, The Netherlands
| | - Anne B Fons
- Department of Obstetrics and Gynaecology, Amsterdam UMC, Vrije Universiteit Amsterdam , Amsterdam, The Netherlands
| | - Laurien J Zeverijn
- Department of Obstetrics and Gynaecology, Amsterdam UMC, Vrije Universiteit Amsterdam , Amsterdam, The Netherlands
| | - Pim W Teunissen
- Department of Obstetrics and Gynaecology, Amsterdam UMC, Vrije Universiteit Amsterdam , Amsterdam, The Netherlands.,School of Health Professions Education (SHE), Maastricht University , Maastricht, The Netherlands
| | - Christianne J M de Groot
- Department of Obstetrics and Gynaecology, Amsterdam UMC, Vrije Universiteit Amsterdam , Amsterdam, The Netherlands
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8
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Fernandez-Egea E, Walker R, Ziauddeen H, Cardinal RN, Bullmore ET. Birth weight, family history of diabetes and diabetes onset in schizophrenia. BMJ Open Diabetes Res Care 2020; 8:8/1/e001036. [PMID: 32049635 PMCID: PMC7039608 DOI: 10.1136/bmjdrc-2019-001036] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 01/02/2020] [Accepted: 01/07/2020] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION The prevalence of diabetes in schizophrenia is twice that in the general population, but there are few reliable predictors of which individuals will develop glucose dysregulation. OBJECTIVE To test if abnormal birth weight (either too low or too high) and parental diabetes, both variables that can be ascertained in the clinic, can predict diabetes onset in patients with schizophrenia. RESEARCH DESIGN AND METHODS Electronic records of a cohort of 190 clozapine-treated patients (37% treated for more than 20 years) and Cox regression survival analysis (with any type of glucose dysregulation as the event) to account for differences in length of treatment before the event and age at clozapine treatment initiation. RESULTS Age at clozapine initiation (Exp(B)=1.098; p<0.001), family history of diabetes (Exp(B)=2.299; p=0.049) and birth weight2 (Exp(B)=0.999; p=0.013) were significant predictors of glucose dysregulation onset, while gender was not (Exp(B)=0.1.350; p=0.517). Among individuals with 10 years of follow-up, 80% of those with both abnormal birth weight and a family history of diabetes developed diabetes compared with 56% with only abnormal birth weight, 40% with only a family history of diabetes and 20% in those with neither. CONCLUSIONS Since 48% of cases had at least one risk factor and 6% had both risk factors, there is a substantial proportion of patients for whom preventive strategies could be implemented.
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Affiliation(s)
- Emilio Fernandez-Egea
- Department of Psychiatry, Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Ryan Walker
- Department of Psychiatry, Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
| | - Hisham Ziauddeen
- Department of Psychiatry, Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
- Wellcome Trust-MRC Institute of Metabolic Science, Cambridge, UK
| | - Rudolf N Cardinal
- Department of Psychiatry, Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Edward T Bullmore
- Department of Psychiatry, Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
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9
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Pugliese V, Bruni A, Carbone EA, Calabrò G, Cerminara G, Sampogna G, Luciano M, Steardo L, Fiorillo A, Garcia CS, De Fazio P. Maternal stress, prenatal medical illnesses and obstetric complications: Risk factors for schizophrenia spectrum disorder, bipolar disorder and major depressive disorder. Psychiatry Res 2019; 271:23-30. [PMID: 30458317 DOI: 10.1016/j.psychres.2018.11.023] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 09/18/2018] [Accepted: 11/12/2018] [Indexed: 12/17/2022]
Abstract
Maternal stress and medical illnesses during early life are well-documented environmental indicators of an increased risk of schizophrenia. Few studies, conversely, have confirmed an association with major affective disorders. The present study examined the impact of maternal stress, medical illnesses and obstetric complications on the development of severe mental disorder in 240 patients with a diagnosis of schizophrenia spectrum disorder, bipolar disorder, or major depressive disorder and matched with 85 controls. Mothers of participants were asked about stressful events during pregnancy using the Social Readjustment Scale; information on prenatal/perinatal illnesses were acquired from medical records. Schizophrenia spectrum disorder was positively associated with maternal stress (OR = 2.16), infections (OR = 7.67), inadequate weight gain (OR = 9.52) during pregnancy, and peripartum asphyxia (OR = 4.00). An increased risk of bipolar disorder was associated with head circumference < 32 cm at birth (OR = 5.40) and inversely with inadequate weight gain (OR = 0.29). Major depressive disorder diagnosis was inversely related to inadequate weight gain (OR = 0.22). These results support a role for maternal stress, medical illnesses and obstetric complications as risk factors for subsequent severe mental illness in adulthood. Further research is needed, especially with regard to affective disorders.
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Affiliation(s)
- Valentina Pugliese
- Department of Psychiatry, University "Magna Graecia"of Catanzaro, Via T. Campanella 115, Catanzaro 88100, Italy
| | - Antonella Bruni
- Department of Psychiatry, University "Magna Graecia"of Catanzaro, Via T. Campanella 115, Catanzaro 88100, Italy
| | - Elvira Anna Carbone
- Department of Psychiatry, University "Magna Graecia"of Catanzaro, Via T. Campanella 115, Catanzaro 88100, Italy
| | - Giuseppina Calabrò
- Department of Psychiatry, University "Magna Graecia"of Catanzaro, Via T. Campanella 115, Catanzaro 88100, Italy
| | - Gregorio Cerminara
- Department of Psychiatry, University "Magna Graecia"of Catanzaro, Via T. Campanella 115, Catanzaro 88100, Italy
| | - Gaia Sampogna
- Department of Psychiatry, University "Luigi Vanvitelli" of Campania, Largo Madonna delle Grazie, Naples 80138, Italy
| | - Mario Luciano
- Department of Psychiatry, University "Luigi Vanvitelli" of Campania, Largo Madonna delle Grazie, Naples 80138, Italy
| | - Luca Steardo
- Department of Psychiatry, University "Luigi Vanvitelli" of Campania, Largo Madonna delle Grazie, Naples 80138, Italy
| | - Andrea Fiorillo
- Department of Psychiatry, University "Luigi Vanvitelli" of Campania, Largo Madonna delle Grazie, Naples 80138, Italy
| | - Cristina Segura Garcia
- Department of Psychiatry, University "Magna Graecia"of Catanzaro, Via T. Campanella 115, Catanzaro 88100, Italy
| | - Pasquale De Fazio
- Department of Psychiatry, University "Magna Graecia"of Catanzaro, Via T. Campanella 115, Catanzaro 88100, Italy.
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10
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Abstract
Summary
Pregnancy, childbirth and motherhood are new situations for women and require adjustment. Women suffering from schizophrenia require special attention due to the course of the disease. Physiological changes that occur in the body during pregnancy may be unacceptable for women suffering from schizophrenia. They may delusively deny the existence of the pregnancy, lead an unhealthy lifestyle (stimulants, poor diet, lack of gynaecological check-ups), which in turn causes an increased risk of complications. In the research conducted so far, it has been proven that three kinds of complications are associated with schizophrenia: complications concerning pregnancy itself (bleeding, diabetes, Rh-incompatibility, pre-eclampsia), intrauterine growth restriction (low birth weight, congenital malformations, small head circumference) and complications regarding labour (uterine atony, asphyxia, emergency Caesarean section). The course of the labour itself in this specific group of patients has not yet been sufficiently examined. It has also been proven that perinatal complications are one of the factors determining an increased risk of schizophrenia.
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Abstract
Schizophrenia is a complex mental disorder with genetic and environmental components. Obstetric complications (OCs) are one of the most common environmental risk factors described. However, despite being different in timing and outcome, OCs are usually described as a homogeneous entity. In the present study, we evaluate the presence of different patterns of OCs evaluated with the Lewis-Murray Scale in chronic schizophrenia patients (n = 101) and their association with a crude marker of the intrauterine environment such as weight at birth.OCs related with abnormal fetal growth (p < 0.001) and OCs during gestation (p = 0.003) were associated with lower birth weight. However, difficulties in delivery, complications in pregnancy, and OCs all together (as a set) were not associated with weight at birth.Our results infer that OCs cannot be taken as a homogeneous group. Different patterns of OCs result in different birth weights, which is associated with specific metabolic, cognitive, and brain structure outcomes.
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12
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Issues affecting reliable and valid assessment of early life stressors in psychosis. Schizophr Res 2018; 192:465-466. [PMID: 28427931 DOI: 10.1016/j.schres.2017.04.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 04/09/2017] [Indexed: 11/23/2022]
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13
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Fraguas D, Díaz-Caneja CM, Corripio I, González-Pinto A, Lobo A, Bioque M, Cuesta MJ, Sanjuán J, Rodríguez-Toscano E, Arias B, Sarró S, Cabrera B, Bulbena A, Vieta E, Castro-Fornieles J, Arango C, Bernardo M, Parellada M. Gene-environment interaction as a predictor of early adjustment in first episode psychosis. Schizophr Res 2017; 189:196-203. [PMID: 28262436 DOI: 10.1016/j.schres.2017.02.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 02/14/2017] [Accepted: 02/16/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND This study aims to explore the gene-environment interaction hypothesis applied to pre-symptomatic neurodevelopmental phenotypes of first episode psychosis (FEP), that is, genetic factors might increase vulnerability to the effects of environmental adverse conditions occurring at later stages of development. METHODS We constructed a schematic 'two-hit' model, with Val/Val homozygosity for the catechol-O-methyltransferase (COMT) Val158Met polymorphism as the 'first hit' and history of obstetric complications and parental socioeconomic status as 'second hits'. Early adjustment, measured using the Premorbid Adjustment Scale, was considered the main outcome. The study population comprised 221 adolescents and adults with FEP and 191 sex- and age-matched controls. RESULTS The interaction between the Val/Val COMT genotype and a positive history of obstetric complications plus low parental socioeconomic status was significantly associated with poorer early adjustment. These results were observed both in FEP individuals and in controls, and remained significant after controlling for age, sex, and diagnosis. CONCLUSIONS Individuals carrying Val/Val seem to be more sensitive to the synergistic effect of environmental factors acting early in neurodevelopment, which leads to vulnerability phenotypes such as impaired early adjustment.
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Affiliation(s)
- David Fraguas
- Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, CIBERSAM, IiSGM, School of Medicine, Universidad Complutense, Madrid, Spain.
| | - Covadonga M Díaz-Caneja
- Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, CIBERSAM, IiSGM, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Iluminada Corripio
- Department of Psychiatry, Institut d'Investigació Biomèdica-Sant Pau (IIB-SANT PAU), Hospital de la Santa Creu i Sant Pau, Barcelona; Universitat Autònoma de Barcelona (UAB), CIBERSAM, Barcelona, Spain
| | - Ana González-Pinto
- BIOARABA Health Research Institute. OSI Araba. University Hospital. University of the Basque Country, CIBERSAM, Vitoria, Spain
| | - Antonio Lobo
- Instituto de Investigación Sanitaria de Aragón (IIS Aragón), University of Zaragoza, CIBERSAM, Spain
| | - Miquel Bioque
- Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clinic of Barcelona, CIBERSAM, Spain
| | - Manuel J Cuesta
- Department of Psychiatry, Complejo Hospitalario de Navarra, IdiSNA, Pamplona, Spain
| | - Julio Sanjuán
- Department of Psychiatry, Hospital Clinic, University of Valencia, INCLIVA, CIBERSAM, Valencia, Spain
| | - Elisa Rodríguez-Toscano
- Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, CIBERSAM, IiSGM, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Bárbara Arias
- Departament de Biologia Evolutiva, Ecologia i Ciències Ambientals, Facultat de Biologia, Universitat de Barcelona, IBUB, CIBERSAM, Barcelona, Spain
| | - Salvador Sarró
- FIDMAG Hermanas Hospitalarias, CIBERSAM, Barcelona, Spain
| | - Bibiana Cabrera
- Barcelona Clínic Schizophrenia Unit, Neuroscience Institute, Hospital Clínic de Barcelona, CIBERSAM, Barcelona, Spain
| | - Antoni Bulbena
- Institut de Neuropsiquiatria i Addiccions, Hospital del Mar, Barcelona, Spain; IMIM (Hospital del Mar Medical Research Institute), Barcelona; Department of Psychiatry and Forensic Medicine, Autonomous University of Barcelona UAB, Bellaterra, Spain
| | - Eduard Vieta
- Bipolar Disorder Unit, Institute of Neuroscience, Hospital Clinic, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Spain
| | - Josefina Castro-Fornieles
- Department of Child and Adolescent Psychiatry and Psychology, SGR489, Institute of Neuroscience, Hospital Clínic of Barcelona, IDIBAPS, CIBERSAM, Department of Psychiatry and Clinical Psychobiology, University of Barcelona, Barcelona, Spain
| | - Celso Arango
- Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, CIBERSAM, IiSGM, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Miquel Bernardo
- Barcelona Clínic Schizophrenia Unit, Neurosciences Institute, Hospital Clínic, Barcelona, Spain; Department of Medicine, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - Mara Parellada
- Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, CIBERSAM, IiSGM, School of Medicine, Universidad Complutense, Madrid, Spain
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14
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Tanz LJ, Stuart JJ, Williams PL, Rimm EB, Missmer SA, Rexrode KM, Mukamal KJ, Rich-Edwards JW. Preterm Delivery and Maternal Cardiovascular Disease in Young and Middle-Aged Adult Women. Circulation 2017; 135:578-589. [PMID: 28153993 DOI: 10.1161/circulationaha.116.025954] [Citation(s) in RCA: 133] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 12/21/2016] [Indexed: 01/26/2023]
Abstract
BACKGROUND Preterm delivery has been shown to be associated with increased risk of cardiovascular disease (CVD), but it is unknown whether this risk remains after adjustment for prepregnancy lifestyle and CVD risk factors. METHODS We examined the association between history of having delivered an infant preterm (<37 weeks) and CVD in 70 182 parous women in the Nurses' Health Study II. Multivariable Cox proportional-hazards models were used to estimate hazards ratios (HRs) and 95% confidence intervals (CIs) for CVD events (myocardial infarction and stroke, n=949); we also adjusted for intermediates to determine the proportion of the association between preterm and CVD accounted for by postpartum development of CVD risk factors. RESULTS After adjusting for age, race, parental education, and prepregnancy lifestyle and CVD risk factors, preterm delivery in the first pregnancy was associated with an increased risk of CVD (HR, 1.42; 95% CI, 1.16-1.72) in comparison with women with a term delivery (≥37 weeks) in the first pregnancy. When preterm delivery was split into moderate preterm (≥32 to <37 weeks) and very preterm (<32 weeks), the HRs were 1.22 (95% CI, 0.96-1.54) and 2.01 (95% CI, 1.47-2.75), respectively. The increased rate of CVD in the very preterm group persisted even among women whose first pregnancy was not complicated by hypertensive disorders of pregnancy (HR, 2.01; 95% CI, 1.38-2.93). In comparison with women with at least 2 pregnancies, all of which were delivered at term, women with a preterm first birth and at least 1 later preterm birth had a HR of CVD of 1.65 (95% CI, 1.20-2.28). The association between moderate preterm first birth and CVD was accounted for in part by the development of postpartum chronic hypertension, hypercholesterolemia, type 2 diabetes mellitus, and changes in body mass index (proportion accounted for, 14.5%; 95% CI, 4.0-41.1), as was the very-preterm-CVD relationship (13.1%; 95% CI, 9.0-18.7). CONCLUSIONS Preterm delivery is independently predictive of CVD and may be useful for CVD prevention efforts. Because only a modest proportion of the preterm-CVD association was accounted for by development of conventional CVD risk factors, further research may identify additional pathways.
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Affiliation(s)
- Lauren J Tanz
- From Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (L.J.T., J.J.S., P.L.W., E.B.R., S.A.M., J.W.R.-E.); Connors Center for Women's Health and Gender Biology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (L.J.T., J.J.S., J.W.R.-E.); Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA (P.L.W.); Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA (E.B.R., K.J.M.); Division of Adolescent and Young Adult Medicine, Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, MA (S.A.M.); Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA (E.B.R., S.A.M., J.W.R.-E.); Department of Obstetrics, Gynecology, and Reproductive Biology, College of Human Medicine, Michigan State University, Grand Rapids (S.A.M.); Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (K.M.R.); and Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, MA (K.J.M.).
| | - Jennifer J Stuart
- From Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (L.J.T., J.J.S., P.L.W., E.B.R., S.A.M., J.W.R.-E.); Connors Center for Women's Health and Gender Biology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (L.J.T., J.J.S., J.W.R.-E.); Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA (P.L.W.); Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA (E.B.R., K.J.M.); Division of Adolescent and Young Adult Medicine, Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, MA (S.A.M.); Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA (E.B.R., S.A.M., J.W.R.-E.); Department of Obstetrics, Gynecology, and Reproductive Biology, College of Human Medicine, Michigan State University, Grand Rapids (S.A.M.); Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (K.M.R.); and Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, MA (K.J.M.)
| | - Paige L Williams
- From Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (L.J.T., J.J.S., P.L.W., E.B.R., S.A.M., J.W.R.-E.); Connors Center for Women's Health and Gender Biology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (L.J.T., J.J.S., J.W.R.-E.); Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA (P.L.W.); Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA (E.B.R., K.J.M.); Division of Adolescent and Young Adult Medicine, Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, MA (S.A.M.); Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA (E.B.R., S.A.M., J.W.R.-E.); Department of Obstetrics, Gynecology, and Reproductive Biology, College of Human Medicine, Michigan State University, Grand Rapids (S.A.M.); Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (K.M.R.); and Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, MA (K.J.M.)
| | - Eric B Rimm
- From Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (L.J.T., J.J.S., P.L.W., E.B.R., S.A.M., J.W.R.-E.); Connors Center for Women's Health and Gender Biology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (L.J.T., J.J.S., J.W.R.-E.); Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA (P.L.W.); Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA (E.B.R., K.J.M.); Division of Adolescent and Young Adult Medicine, Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, MA (S.A.M.); Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA (E.B.R., S.A.M., J.W.R.-E.); Department of Obstetrics, Gynecology, and Reproductive Biology, College of Human Medicine, Michigan State University, Grand Rapids (S.A.M.); Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (K.M.R.); and Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, MA (K.J.M.)
| | - Stacey A Missmer
- From Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (L.J.T., J.J.S., P.L.W., E.B.R., S.A.M., J.W.R.-E.); Connors Center for Women's Health and Gender Biology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (L.J.T., J.J.S., J.W.R.-E.); Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA (P.L.W.); Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA (E.B.R., K.J.M.); Division of Adolescent and Young Adult Medicine, Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, MA (S.A.M.); Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA (E.B.R., S.A.M., J.W.R.-E.); Department of Obstetrics, Gynecology, and Reproductive Biology, College of Human Medicine, Michigan State University, Grand Rapids (S.A.M.); Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (K.M.R.); and Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, MA (K.J.M.)
| | - Kathryn M Rexrode
- From Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (L.J.T., J.J.S., P.L.W., E.B.R., S.A.M., J.W.R.-E.); Connors Center for Women's Health and Gender Biology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (L.J.T., J.J.S., J.W.R.-E.); Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA (P.L.W.); Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA (E.B.R., K.J.M.); Division of Adolescent and Young Adult Medicine, Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, MA (S.A.M.); Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA (E.B.R., S.A.M., J.W.R.-E.); Department of Obstetrics, Gynecology, and Reproductive Biology, College of Human Medicine, Michigan State University, Grand Rapids (S.A.M.); Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (K.M.R.); and Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, MA (K.J.M.)
| | - Kenneth J Mukamal
- From Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (L.J.T., J.J.S., P.L.W., E.B.R., S.A.M., J.W.R.-E.); Connors Center for Women's Health and Gender Biology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (L.J.T., J.J.S., J.W.R.-E.); Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA (P.L.W.); Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA (E.B.R., K.J.M.); Division of Adolescent and Young Adult Medicine, Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, MA (S.A.M.); Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA (E.B.R., S.A.M., J.W.R.-E.); Department of Obstetrics, Gynecology, and Reproductive Biology, College of Human Medicine, Michigan State University, Grand Rapids (S.A.M.); Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (K.M.R.); and Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, MA (K.J.M.)
| | - Janet W Rich-Edwards
- From Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (L.J.T., J.J.S., P.L.W., E.B.R., S.A.M., J.W.R.-E.); Connors Center for Women's Health and Gender Biology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (L.J.T., J.J.S., J.W.R.-E.); Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA (P.L.W.); Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA (E.B.R., K.J.M.); Division of Adolescent and Young Adult Medicine, Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, MA (S.A.M.); Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA (E.B.R., S.A.M., J.W.R.-E.); Department of Obstetrics, Gynecology, and Reproductive Biology, College of Human Medicine, Michigan State University, Grand Rapids (S.A.M.); Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (K.M.R.); and Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, MA (K.J.M.)
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Okewole AO, Ogunwale A, Mosanya TJ, Ojo BM. A 12 year chart review of childhood and adolescent onset psychosis at a Nigerian tertiary mental health facility. J Child Adolesc Ment Health 2016; 28:189-197. [PMID: 27998263 DOI: 10.2989/17280583.2016.1245194] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To review the profile of children and adolescents presenting with psychosis at a specialist mental health facility, and to compare childhood with adolescent onset psychosis. METHOD Hospital records of all children and adolescents over a 12-year period (1999-2010) were perused to identify those falling under the categories of psychotic disorders. Clinical, socio-demographic, obstetric, and developmental information was extracted. RESULTS Mean age of the children ((n = 409)) was 15.9 years, with 8.1% aged 12 years or less. The most frequent diagnoses were schizophrenia (40.8%), brief psychotic disorder (25.9%), mood disorder with psychosis (15.2%), and organic psychosis (7.8%). Family history of mental illness was reported among 22.5%. Subjects with childhood onset were significantly less likely than those with adolescent onset to have a family history of mental illness (p = 0.016), more likely to report maternal illness during pregnancy (p = 0.005) and illness during infancy (p = 0.010), and more likely to have a diagnosis of psychotic disorder due to another general medical condition (p < 0.001). CONCLUSION The study suggests that antenatal/obstetric factors and illness during infancy may be particularly relevant in psychosis of childhood onset. Family history of mental illness may however be of greater relevance in adolescent onset psychosis.
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McDonald EG, Dayan N, Pelletier R, Eisenberg MJ, Pilote L. Premature cardiovascular disease following a history of hypertensive disorder of pregnancy. Int J Cardiol 2016; 219:9-13. [PMID: 27257849 DOI: 10.1016/j.ijcard.2016.05.053] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 05/12/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Following an episode of hypertensive disorder of pregnancy (HDP) women have an increased risk of cardiovascular disease over their lifetime. At the time of acute coronary syndrome we compared clinical information between women with and without a history of hypertension in pregnancy to gain further insight into the pathophysiology of cardiovascular disease in this population. METHODS GENESIS-PRAXY (GENdEr and Sex determInantS of cardiovascular disease: from bench to beyond-PRemature Acute Coronary SYdrome) is a prospective multicenter study, with recruitment between January 2009 and April 2013, including 242 parous women with premature acute coronary syndrome. RESULTS The median age was 50years (IQR 6) and HDP was common; 43 (17.8%) women had prior gestational hypertension, 33 (13.6%) preeclampsia and 166 (68.6%) a prior normotensive pregnancy. Women with a history of HDP commonly had chronic hypertension and diabetes and those presenting with ST-elevation myocardial infarction were more likely to have a history of preeclampsia (aOR 3.12, 95% CI 1.22-8.01) than were women with prior normotensive pregnancies. Neither gestational hypertension (aOR 1.40, 95% CI 0.60-3.26) nor preeclampsia (aOR 0.63, 95% CI 0.23-1.74) was associated with a higher composite risk of three-vessel, left main or proximal left anterior descending coronary disease. CONCLUSION In this study of women with premature cardiovascular disease, ST-elevation myocardial infarction was associated with a history of preeclampsia possibly because of persistent endothelial dysfunction. High-risk coronary lesions on angiography did not appear to have an association with preeclampsia or gestational hypertension despite a high burden of traditional risk factors.
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Affiliation(s)
- Emily G McDonald
- Division of General Internal Medicine, Department of Medicine, McGill University Health Centre, Montreal, Canada.
| | - Natalie Dayan
- Division of General Internal Medicine, Department of Medicine, McGill University Health Centre, Montreal, Canada
| | - Roxanne Pelletier
- Division of Clinical Epidemiology, McGill University Health Centre, Montréal, Québec
| | - Mark J Eisenberg
- Division of Cardiology, Department of Medicine, McGill University, Canada
| | - Louise Pilote
- Division of General Internal Medicine, Department of Medicine, McGill University Health Centre, Montreal, Canada
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Ayhan Y, McFarland R, Pletnikov MV. Animal models of gene-environment interaction in schizophrenia: A dimensional perspective. Prog Neurobiol 2015; 136:1-27. [PMID: 26510407 DOI: 10.1016/j.pneurobio.2015.10.002] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 09/07/2015] [Accepted: 10/22/2015] [Indexed: 12/12/2022]
Abstract
Schizophrenia has long been considered as a disorder with multifactorial origins. Recent discoveries have advanced our understanding of the genetic architecture of the disease. However, even with the increase of identified risk variants, heritability estimates suggest an important contribution of non-genetic factors. Various environmental risk factors have been proposed to play a role in the etiopathogenesis of schizophrenia. These include season of birth, maternal infections, obstetric complications, adverse events at early childhood, and drug abuse. Despite the progress in identification of genetic and environmental risk factors, we still have a limited understanding of the mechanisms whereby gene-environment interactions (G × E) operate in schizophrenia and psychoses at large. In this review we provide a critical analysis of current animal models of G × E relevant to psychotic disorders and propose that dimensional perspective will advance our understanding of the complex mechanisms of these disorders.
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Affiliation(s)
- Yavuz Ayhan
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, USA; Hacettepe University Faculty of Medicine, Department of Psychiatry, Turkey
| | - Ross McFarland
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, USA; Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, USA
| | - Mikhail V Pletnikov
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, USA; Solomon H Snyder Department of Neuroscience, Johns Hopkins University School of Medicine, USA; Department of Molecular and Comparative Pathobiology, Johns Hopkins University School of Medicine, USA; Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, USA.
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18
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Córdova-Palomera A, Fatjó-Vilas M, Falcón C, Bargalló N, Alemany S, Crespo-Facorro B, Nenadic I, Fañanás L. Birth Weight and Adult IQ, but Not Anxious-Depressive Psychopathology, Are Associated with Cortical Surface Area: A Study in Twins. PLoS One 2015; 10:e0129616. [PMID: 26086820 PMCID: PMC4472844 DOI: 10.1371/journal.pone.0129616] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 05/11/2015] [Indexed: 11/18/2022] Open
Abstract
Background Previous research suggests that low birth weight (BW) induces reduced brain cortical surface area (SA) which would persist until at least early adulthood. Moreover, low BW has been linked to psychiatric disorders such as depression and psychological distress, and to altered neurocognitive profiles. Aims We present novel findings obtained by analysing high-resolution structural MRI scans of 48 twins; specifically, we aimed: i) to test the BW-SA association in a middle-aged adult sample; and ii) to assess whether either depression/anxiety disorders or intellectual quotient (IQ) influence the BW-SA link, using a monozygotic (MZ) twin design to separate environmental and genetic effects. Results Both lower BW and decreased IQ were associated with smaller total and regional cortical SA in adulthood. Within a twin pair, lower BW was related to smaller total cortical and regional SA. In contrast, MZ twin differences in SA were not related to differences in either IQ or depression/anxiety disorders. Conclusion The present study supports findings indicating that i) BW has a long-lasting effect on cortical SA, where some familial and environmental influences alter both foetal growth and brain morphology; ii) uniquely environmental factors affecting BW also alter SA; iii) higher IQ correlates with larger SA; and iv) these effects are not modified by internalizing psychopathology.
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Affiliation(s)
- Aldo Córdova-Palomera
- Unidad de Antropología, Departamento de Biología Animal, Facultad de Biología and Instituto de Biomedicina (IBUB), Universitat de Barcelona, Av. Diagonal, 643, 08028, Barcelona, Spain
- Centro de Investigaciones Biomédicas en Red de Salud Mental (CIBERSAM), C/Doctor Esquerdo, 46, 28007, Madrid, Spain
| | - Mar Fatjó-Vilas
- Unidad de Antropología, Departamento de Biología Animal, Facultad de Biología and Instituto de Biomedicina (IBUB), Universitat de Barcelona, Av. Diagonal, 643, 08028, Barcelona, Spain
- Centro de Investigaciones Biomédicas en Red de Salud Mental (CIBERSAM), C/Doctor Esquerdo, 46, 28007, Madrid, Spain
| | - Carles Falcón
- Medical Image Core Facility, the Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); C/Rosselló, 149–153, 08036, Barcelona, Spain
- Centro de Investigación Biomédica en Red en Bioingeniería, Biomedicina y Nanomedicina (CIBER-BBN), C/ Poeta Mariano Esquillor, s/n., 50018, Zaragoza, Spain
| | - Nuria Bargalló
- Centro de Investigaciones Biomédicas en Red de Salud Mental (CIBERSAM), C/Doctor Esquerdo, 46, 28007, Madrid, Spain
- Medical Image Core Facility, the Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); C/Rosselló, 149–153, 08036, Barcelona, Spain
- Centro de Diagnóstico por Imagen, Hospital Clínico, C/Villarroel, 170, 08036, Barcelona, Spain
| | - Silvia Alemany
- Unidad de Antropología, Departamento de Biología Animal, Facultad de Biología and Instituto de Biomedicina (IBUB), Universitat de Barcelona, Av. Diagonal, 643, 08028, Barcelona, Spain
- Centro de Investigaciones Biomédicas en Red de Salud Mental (CIBERSAM), C/Doctor Esquerdo, 46, 28007, Madrid, Spain
| | - Benedicto Crespo-Facorro
- Centro de Investigaciones Biomédicas en Red de Salud Mental (CIBERSAM), C/Doctor Esquerdo, 46, 28007, Madrid, Spain
- University Hospital Marqués de Valdecilla, Department of Psychiatry, School of Medicine, University of Cantabria, Av. Valdecilla, s/n, 39008, Santander, Cantabria, Spain
- IFIMAV, Instituto de Formación e Investigación Marqués de Valdecilla, Av. Valdecilla, s/n, 39008, Santander, Cantabria, Spain
| | - Igor Nenadic
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Friedrich Schiller University Jena, Philosophenweg 3, 07743, Jena, Germany
| | - Lourdes Fañanás
- Unidad de Antropología, Departamento de Biología Animal, Facultad de Biología and Instituto de Biomedicina (IBUB), Universitat de Barcelona, Av. Diagonal, 643, 08028, Barcelona, Spain
- Centro de Investigaciones Biomédicas en Red de Salud Mental (CIBERSAM), C/Doctor Esquerdo, 46, 28007, Madrid, Spain
- * E-mail:
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Carter EB, Stuart JJ, Farland LV, Rich-Edwards JW, Zera CA, McElrath TF, Seely EW. Pregnancy Complications as Markers for Subsequent Maternal Cardiovascular Disease: Validation of a Maternal Recall Questionnaire. J Womens Health (Larchmt) 2015; 24:702-12. [PMID: 26061196 DOI: 10.1089/jwh.2014.4953] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND We designed and tested the validity of a questionnaire to characterize maternal recall of pregnancy complications associated with increased future cardiovascular disease risk, based on the 2011 American Heart Association (AHA) guidelines. METHODS A maternal recall questionnaire of pregnancy history was administered to 971 patients who had participated in a previous cohort study of 1,608 pregnant women. Medical records from the study pregnancy served as the gold standard. Prevalence, sensitivity (sens), specificity (spec), positive predictive value (PPV), negative predictive value (NPV), and/or Spearman's correlation coefficients (r) were calculated for each question. RESULTS A total of 526 (54%) individuals recontacted responded. Respondents were more likely to be older, white, educated, and nulliparous and were less likely to deliver low-birthweight infants in the study pregnancy than were individuals who did not respond. Mean length of recall was 4.35 years (standard deviation [SD] 0.46) postpartum. Maternal recall was most accurate for gestational diabetes (sens: 92%, spec: 98%, PPV: 79%, NPV: 99%), infant birthweight (r=0.95), and gestation length (r=0.85). Maternal recall was modest for preeclampsia (sens: 79%, spec: 97%, PPV: 68%, NPV: 98%) and pregnancy-associated hypertension, including preeclampsia or gestational hypertension (sens: 60%, spec: 95%, PPV: 64%, NPV: 94%). CONCLUSIONS This validation study demonstrated that the majority of women could accurately recall a history of gestational diabetes, infant birthweight, and gestational age at delivery, 4 years postpartum on average. Recall of preeclampsia and pregnancy-associated hypertension overall was modest. Maternal report of these pregnancy conditions may help clinicians identify women at increased risk for cardiovascular disease.
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Affiliation(s)
- Ebony Boyce Carter
- 1 Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Barnes-Jewish Hospital, Washington University School of Medicine , St. Louis, Missouri
| | - Jennifer J Stuart
- 2 Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- 3 Connors Center for Women's Health and Gender Biology, Division of Women's Health, Brigham and Women's Hospital , Boston, Massachusetts
| | - Leslie V Farland
- 2 Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Janet W Rich-Edwards
- 2 Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- 3 Connors Center for Women's Health and Gender Biology, Division of Women's Health, Brigham and Women's Hospital , Boston, Massachusetts
| | - Chloe A Zera
- 4 Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Brigham and Women's Hospital , Boston, Massachusetts
| | - Thomas F McElrath
- 4 Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Brigham and Women's Hospital , Boston, Massachusetts
| | - Ellen W Seely
- 5 Department of Medicine, Division of Endocrinology, Brigham and Women's Hospital , Boston, Massachusetts
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Opler M, Charap J, Greig A, Stein V, Polito S, Malaspina D. Environmental Risk Factors and Schizophrenia. INTERNATIONAL JOURNAL OF MENTAL HEALTH 2014. [DOI: 10.2753/imh0020-7411420102] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Mark Opler
- a Institute for Social and Psychiatric Initiatives (InSPIRES), Departments of Psychiatry and Environmental Medicine, New York University School of Medicine, New York, NY
| | - Joseph Charap
- b Departments of Psychiatry and Environmental Medicine, New York University School of Medicine, New York, NY
| | - Astrea Greig
- b Departments of Psychiatry and Environmental Medicine, New York University School of Medicine, New York, NY
| | - Victoria Stein
- b Departments of Psychiatry and Environmental Medicine, New York University School of Medicine, New York, NY
| | - Stephanie Polito
- b Departments of Psychiatry and Environmental Medicine, New York University School of Medicine, New York, NY
| | - Dolores Malaspina
- b Departments of Psychiatry and Environmental Medicine, New York University School of Medicine, New York, NY
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Córdova-Palomera A, Alemany S, Falcón C, Bargalló N, Goldberg X, Crespo-Facorro B, Nenadic I, Fañanás L. Cortical thickness correlates of psychotic experiences: examining the effect of season of birth using a genetically informative design. J Psychiatr Res 2014; 56:144-9. [PMID: 24923523 DOI: 10.1016/j.jpsychires.2014.05.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Revised: 05/13/2014] [Accepted: 05/14/2014] [Indexed: 12/22/2022]
Abstract
Season of birth has been shown to influence risk for several neuropsychiatric diseases. Furthermore, it has been suggested that season of birth modifies a number of brain morphological traits. Since cortical thickness alterations have been reported across some levels of the psychosis-spectrum, this study was aimed at i) assessing the scarcely explored relationship between cortical thickness and severity of subclinical psychotic experiences (PEs) in healthy subjects, and ii) evaluating the potential impact of season of birth in the preceding thickness-PEs relationship. As both PEs and brain cortical features are heritable, the current work used monozygotic twins to separately evaluate familial and unique environmental factors. High-resolution structural MRI scans of 48 twins (24 monozygotic pairs) were analyzed to estimate cortical thickness using FreeSurfer. They were then examined in relation to PEs, accounting for the effects of birth season; putative differential relationships between PEs and cortical thickness depending on season of birth were also tested. Current results support previous findings indicative of cortical thickening in healthy individuals with high psychometrically assessed psychosis scores, probably in line with theories of compensatory aspects of brain features in non-clinical populations. Additionally, they suggest distinct patterns of cortical thickness-PEs relationships depending on birth seasonality. Familial factors underlying the presence of PEs may drive these effects.
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Affiliation(s)
- A Córdova-Palomera
- Unidad de Antropología, Departamento de Biología Animal, Facultad de Biología and Instituto de Biomedicina (IBUB), Universitat de Barcelona, Av. Diagonal, 643, 08028 Barcelona, Spain; Centro de Investigaciones Biomédicas en Red de Salud Mental (CIBERSAM), C/Doctor Esquerdo, 46, 28007 Madrid, Spain
| | - S Alemany
- Unidad de Antropología, Departamento de Biología Animal, Facultad de Biología and Instituto de Biomedicina (IBUB), Universitat de Barcelona, Av. Diagonal, 643, 08028 Barcelona, Spain; Centro de Investigaciones Biomédicas en Red de Salud Mental (CIBERSAM), C/Doctor Esquerdo, 46, 28007 Madrid, Spain
| | - C Falcón
- Medical Image Core Facility, the Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), C/Rosselló, 149-153, 08036 Barcelona, Spain; Centro de Investigación Biomédica en Red en Bioingeniería, Biomedicina y Nanomedicina (CIBER-BBN), C/Poeta Mariano Esquillor, s/n, 50018 Zaragoza, Spain
| | - N Bargalló
- Centro de Investigaciones Biomédicas en Red de Salud Mental (CIBERSAM), C/Doctor Esquerdo, 46, 28007 Madrid, Spain; Medical Image Core Facility, the Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), C/Rosselló, 149-153, 08036 Barcelona, Spain; Centro de Diagnóstico por Imagen, Hospital Clínico, C/Villarroel, 170, 08036 Barcelona, Spain
| | - X Goldberg
- Unidad de Antropología, Departamento de Biología Animal, Facultad de Biología and Instituto de Biomedicina (IBUB), Universitat de Barcelona, Av. Diagonal, 643, 08028 Barcelona, Spain; Centro de Investigaciones Biomédicas en Red de Salud Mental (CIBERSAM), C/Doctor Esquerdo, 46, 28007 Madrid, Spain
| | - B Crespo-Facorro
- Centro de Investigaciones Biomédicas en Red de Salud Mental (CIBERSAM), C/Doctor Esquerdo, 46, 28007 Madrid, Spain; University Hospital Marqués de Valdecilla, Department of Psychiatry, School of Medicine, University of Cantabria, Av. Valdecilla, s/n, 39008 Santander, Cantabria, Spain; IFIMAV, Instituto de Formación e Investigación Marqués de Valdecilla, Av. Valdecilla, s/n, 39008 Santander, Cantabria, Spain
| | - I Nenadic
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Friedrich Schiller University Jena, Philosophenweg 3, 07743 Jena, Germany
| | - L Fañanás
- Unidad de Antropología, Departamento de Biología Animal, Facultad de Biología and Instituto de Biomedicina (IBUB), Universitat de Barcelona, Av. Diagonal, 643, 08028 Barcelona, Spain; Centro de Investigaciones Biomédicas en Red de Salud Mental (CIBERSAM), C/Doctor Esquerdo, 46, 28007 Madrid, Spain.
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Córdova-Palomera A, Goldberg X, Alemany S, Nenadic I, Gastó C, Fañanás L. Letter to the editor: low birth weight and adult depression: eliciting their association. Psychol Med 2014; 44:1117-1119. [PMID: 24229470 DOI: 10.1017/s0033291713002754] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- A Córdova-Palomera
- Unitat d'Antropologia, Departament de Biologia Animal, Facultat de Biologia and Institut de Biomedicina (IBUB), Universitat de Barcelona, Barcelona, Spain
| | - X Goldberg
- Unitat d'Antropologia, Departament de Biologia Animal, Facultat de Biologia and Institut de Biomedicina (IBUB), Universitat de Barcelona, Barcelona, Spain
| | - S Alemany
- Unitat d'Antropologia, Departament de Biologia Animal, Facultat de Biologia and Institut de Biomedicina (IBUB), Universitat de Barcelona, Barcelona, Spain
| | - I Nenadic
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany
| | - C Gastó
- Centro de Investigaciones Biomédicas en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - L Fañanás
- Unitat d'Antropologia, Departament de Biologia Animal, Facultat de Biologia and Institut de Biomedicina (IBUB), Universitat de Barcelona, Barcelona, Spain
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Obstetric complications in early psychosis: relation with family history of psychosis. Psychiatry Res 2012; 200:708-14. [PMID: 22868179 DOI: 10.1016/j.psychres.2012.07.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2011] [Revised: 07/12/2012] [Accepted: 07/15/2012] [Indexed: 10/28/2022]
Abstract
The people classified as being at ultra-high risk (UHR) of developing psychosis are expected to share many risk factors for psychosis with the patients diagnosed with schizophrenia, including an enhanced incidence of obstetric complications (OCs). This study set out to investigate the incidence and correlates of OCs in a sample of patients accessing an early intervention center. Patients' mothers were asked whether they had suffered from any somatic complication during pregnancy from a list of OCs with potential direct relevance to the physical wellbeing of the offspring. Out of 86 patients diagnosed with first-episode psychosis, 20 (23%) cases were positive for the occurrence of severe OCs, as reported by their mothers during an interview; out of 83 UHR patients, 21 (25%) cases were positive for OCs. OCs were more common in individuals with a family history of psychosis than in those without such a history. OCs might interact with genetic vulnerability to increase the risk of psychosis. Lack of comparison to healthy controls is a limitation that decreases the value of these findings.
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Stuart JJ, Bairey Merz CN, Berga SL, Miller VM, Ouyang P, Shufelt CL, Steiner M, Wenger NK, Rich-Edwards JW. Maternal recall of hypertensive disorders in pregnancy: a systematic review. J Womens Health (Larchmt) 2012; 22:37-47. [PMID: 23215903 DOI: 10.1089/jwh.2012.3740] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Hypertensive disorders in pregnancy are risk markers for future maternal coronary heart disease (CHD). Clinical assessment of a woman's history of pregnancy complications relies on self-report, but the predictive value of maternal recall is unclear. A systematic review was conducted to comprehensively review and critically assess the available literature on maternal recall of hypertensive disorders in pregnancy. METHODS The PubMed, EMBASE, and Web of Science databases were searched through August 2012. We included original research articles comparing maternal recall of hypertensive disorders in pregnancy with medical records. RESULTS Ten studies met eligibility criteria for qualitative analysis and were independently reviewed by two investigators. Recall periods ranged from 48 hours to 30 years. Length of recall did not appear to uniformly affect recall quality. Sensitivity was generally lower and less consistent for gestational hypertension than for preeclampsia. Specificity was >90% for all hypertensive disorders. Determinants of recall accuracy included maternal education and parity. CONCLUSIONS Although maternal recall of hypertensive disorders of pregnancy is specific, low sensitivity and predictive values may limit the clinical utility of asking mothers to recall their history of hypertensive pregnancy complications. Future research on maternal recall of pregnancy complications should be designed to yield predictive values and test recall of disorder subtypes, recurrent complications, and changing recall over time in the same population. The utility of gestation length and offspring birth weight for clinical identification of women whose pregnancy history puts them at increased CHD risk should also be explored.
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Affiliation(s)
- Jennifer J Stuart
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA.
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Bersani G, Clemente R, Gherardelli S, Bersani FS, Manuali G. Obstetric complications and neurological soft signs in male patients with schizophrenia. Acta Neuropsychiatr 2012; 24:344-8. [PMID: 25287176 DOI: 10.1111/j.1601-5215.2011.00636.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Bersani G, Clemente R, Gherardelli S, Bersani FS, Manuali G. Obstetric complications and neurological soft signs in male patients with schizophrenia.Objective: The study investigated the relationship between neurological soft signs (NSS) and obstetric complications (OCs) in patients with schizophrenia.Methods: Sixty-three male patients with schizophrenia were divided into two subgroups, based on the OCs presence or absence, which were compared in relation to NSS prevalence. After that, a Person's correlation test was performed to explore the correlation between NSS and OCs severity.Results: The subgroup with OCs showed more NSS, but there were not significant correlations between NSS and OCs severity.Conclusions: It seems that any OC, without distinction in typology and severity, could unspecifically impair the neurodevelopment and inducing NSS expression. Our findings confirm the hypothesis that neurodevelopment alterations, such as those probably induced by OCs, can contribute to a premorbid brain dysfunctional state expressed by NSS.
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Affiliation(s)
- Giuseppe Bersani
- Department of Medical - Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy
| | - Roberta Clemente
- Department of Medical - Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy
| | - Simona Gherardelli
- Department of Medical - Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy
| | - Francesco Saverio Bersani
- Department of Medical - Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy
| | - Giorgiana Manuali
- Department of Medical - Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy
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