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Cullen AE, Labad J, Oliver D, Al-Diwani A, Minichino A, Fusar-Poli P. The Translational Future of Stress Neurobiology and Psychosis Vulnerability: A Review of the Evidence. Curr Neuropharmacol 2024; 22:350-377. [PMID: 36946486 PMCID: PMC10845079 DOI: 10.2174/1570159x21666230322145049] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 12/17/2022] [Accepted: 12/27/2022] [Indexed: 03/23/2023] Open
Abstract
Psychosocial stress is a well-established risk factor for psychosis, yet the neurobiological mechanisms underlying this relationship have yet to be fully elucidated. Much of the research in this field has investigated hypothalamic-pituitary-adrenal (HPA) axis function and immuno-inflammatory processes among individuals with established psychotic disorders. However, as such studies are limited in their ability to provide knowledge that can be used to develop preventative interventions, it is important to shift the focus to individuals with increased vulnerability for psychosis (i.e., high-risk groups). In the present article, we provide an overview of the current methods for identifying individuals at high-risk for psychosis and review the psychosocial stressors that have been most consistently associated with psychosis risk. We then describe a network of interacting physiological systems that are hypothesised to mediate the relationship between psychosocial stress and the manifestation of psychotic illness and critically review evidence that abnormalities within these systems characterise highrisk populations. We found that studies of high-risk groups have yielded highly variable findings, likely due to (i) the heterogeneity both within and across high-risk samples, (ii) the diversity of psychosocial stressors implicated in psychosis, and (iii) that most studies examine single markers of isolated neurobiological systems. We propose that to move the field forward, we require well-designed, largescale translational studies that integrate multi-domain, putative stress-related biomarkers to determine their prognostic value in high-risk samples. We advocate that such investigations are highly warranted, given that psychosocial stress is undoubtedly a relevant risk factor for psychotic disorders.
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Affiliation(s)
- Alexis E. Cullen
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, United Kingdom
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Solna, Sweden
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, United Kingdom
| | - Javier Labad
- CIBERSAM, Sabadell, Barcelona, Spain
- Department of Mental Health and Addictions, Consorci Sanitari del Maresme, Mataró, Spain
| | - Dominic Oliver
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, United Kingdom
- Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom
| | - Adam Al-Diwani
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, United Kingdom
| | - Amedeo Minichino
- Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom
| | - Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
- OASIS Service, South London and Maudsley NHS Foundation Trust, London, United Kingdom
- National Institute of Health Research Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
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Couturier A, Chaumette B, Kebir O, Iftimovici A, Krebs E, He Q, Jiao C, Krebs MO, Scoriels L, Frajerman A. The impact of BDNF on the cognitive functions of ultra-high risk patients: An exploratory study. Schizophr Res 2023; 262:211-213. [PMID: 36481244 DOI: 10.1016/j.schres.2022.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 10/31/2022] [Accepted: 11/12/2022] [Indexed: 12/12/2022]
Affiliation(s)
- Alexandre Couturier
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, F-75014 Paris, France; AP-HP, GHU AP-HP Nord, DMU ESPRIT, service de Psychiatrie et Addictologie, Hôpital Louis Mourier, Colombes, France
| | - Boris Chaumette
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, F-75014 Paris, France; GHU Paris Psychiatrie et Neurosciences, F-75674 Paris, France; Department of Psychiatry, McGill University, Montréal, QC H3A 0G4, Canada.
| | - Oussama Kebir
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, F-75014 Paris, France; GHU Paris Psychiatrie et Neurosciences, F-75674 Paris, France
| | - Anton Iftimovici
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, F-75014 Paris, France; GHU Paris Psychiatrie et Neurosciences, F-75674 Paris, France
| | - Emma Krebs
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, F-75014 Paris, France
| | - Qin He
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, F-75014 Paris, France
| | - Chuan Jiao
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, F-75014 Paris, France
| | - Marie-Odile Krebs
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, F-75014 Paris, France; GHU Paris Psychiatrie et Neurosciences, F-75674 Paris, France
| | - Linda Scoriels
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, F-75014 Paris, France; GHU Paris Psychiatrie et Neurosciences, F-75674 Paris, France
| | - Ariel Frajerman
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, F-75014 Paris, France; MOODS Team, INSERM, CESP, Université Paris-Saclay, Faculté de Médecine Paris-Saclay, Le Kremlin Bicêtre F-94275, France; Service Hospitalo-Universitaire de Psychiatrie de Bicêtre, Mood Center Paris Saclay, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Saclay, Hôpital de Bicêtre, F-94275, France
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Andreou C, Eickhoff S, Heide M, de Bock R, Obleser J, Borgwardt S. Predictors of transition in patients with clinical high risk for psychosis: an umbrella review. Transl Psychiatry 2023; 13:286. [PMID: 37640731 PMCID: PMC10462748 DOI: 10.1038/s41398-023-02586-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 08/03/2023] [Accepted: 08/14/2023] [Indexed: 08/31/2023] Open
Abstract
Diagnosis of a clinical high-risk (CHR) state enables timely treatment of individuals at risk for a psychotic disorder, thereby contributing to improving illness outcomes. However, only a minority of patients diagnosed with CHR will make the transition to overt psychosis. To identify patients most likely to benefit from early intervention, several studies have investigated characteristics that distinguish CHR patients who will later develop a psychotic disorder from those who will not. We aimed to summarize evidence from systematic reviews and meta-analyses on predictors of transition to psychosis in CHR patients, among characteristics and biomarkers assessed at baseline. A systematic search was conducted in Pubmed, Scopus, PsychInfo and Cochrane databases to identify reviews and meta-analyses of studies that investigated specific baseline predictors or biomarkers for transition to psychosis in CHR patients using a cross-sectional or longitudinal design. Non-peer-reviewed publications, gray literature, narrative reviews and publications not written in English were excluded from analyses. We provide a narrative synthesis of results from all included reviews and meta-analyses. For each included publication, we indicate the number of studies cited in each domain and its quality rating. A total of 40 publications (21 systematic reviews and 19 meta-analyses) that reviewed a total of 272 original studies qualified for inclusion. Baseline predictors most consistently associated with later transition included clinical characteristics such as attenuated psychotic and negative symptoms and functioning, verbal memory deficits and the electrophysiological marker of mismatch negativity. Few predictors reached a level of evidence sufficient to inform clinical practice, reflecting generalizability issues in a field characterized by studies with small, heterogeneous samples and relatively few transition events. Sample pooling and harmonization of methods across sites and projects are necessary to overcome these limitations.
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Affiliation(s)
- Christina Andreou
- Translational Psychiatry, Department of Psychiatry and Psychotherapy, University of Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
- Center of Brain, Behavior, and Metabolism (CBBM), University of Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
| | - Sofia Eickhoff
- Translational Psychiatry, Department of Psychiatry and Psychotherapy, University of Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
| | - Marco Heide
- Translational Psychiatry, Department of Psychiatry and Psychotherapy, University of Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
| | - Renate de Bock
- University Psychiatric Clinics Basel, Wilhelm Klein-Strasse 27, 4002, Basel, Switzerland
| | - Jonas Obleser
- Center of Brain, Behavior, and Metabolism (CBBM), University of Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
- Department of Psychology, University of Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
| | - Stefan Borgwardt
- Translational Psychiatry, Department of Psychiatry and Psychotherapy, University of Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany.
- Center of Brain, Behavior, and Metabolism (CBBM), University of Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany.
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Frajerman A, Chaumette B, Farabos D, Despres G, Simonard C, Lamazière A, Krebs MO, Kebir O. Membrane Lipids in Ultra-High-Risk Patients: Potential Predictive Biomarkers of Conversion to Psychosis. Nutrients 2023; 15:2215. [PMID: 37432345 DOI: 10.3390/nu15092215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/01/2023] [Accepted: 05/04/2023] [Indexed: 07/12/2023] Open
Abstract
Alterations in membrane lipids are reported in schizophrenia. However, no conclusion can be drawn regarding the extended and predictive value of these alterations in persons at ultra-high risk of psychosis (UHR). Recent studies suggested that sterols' impact on psychiatric disorders was underestimated. Here, we simultaneously explored sterols, fatty acids (FA), and phospholipids (PL) in UHR persons for the first time. We analysed erythrocyte membrane lipids in 61 UHR persons, including 29 who later converted to psychosis (UHR-C) and 32 who did not (UHC-NC). We used gas chromatography for FA and liquid chromatography tandem with mass spectrometry for sterols and phospholipids. Among UHR individuals, elevated baseline membrane linoleic acid level was associated with conversion to psychosis (26.1% vs. 60.5%, p = 0.02). Combining sterols, FA, and PL membrane composition improved the prediction of psychosis onset (AUC = 0.73). This is the first report showing that membrane sterol participates, with other membrane lipids, in modulating the risk of psychosis. It suggests that membrane lipids could be used as biomarkers for personalised medicine in UHR patients.
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Affiliation(s)
- Ariel Frajerman
- Institute of Psychiatry and Neuroscience of Paris (IPNP), Université de Paris, INSERM U1266, F-75014 Paris, France
| | - Boris Chaumette
- Institute of Psychiatry and Neuroscience of Paris (IPNP), Université de Paris, INSERM U1266, F-75014 Paris, France
- GHU Paris Psychiatrie et Neurosciences, F-75674 Paris, France
- Department of Psychiatry, McGill University, Montréal, QC H3A 0G4, Canada
| | - Dominique Farabos
- INSERM UMR S 938, Département METOMICS, Centre de Recherche Saint-Antoine, Sorbonne Université, AP-HP, F-75012 Paris, France
| | - Gaétan Despres
- INSERM UMR S 938, Département METOMICS, Centre de Recherche Saint-Antoine, Sorbonne Université, AP-HP, F-75012 Paris, France
| | - Christelle Simonard
- INSERM UMR S 938, Département METOMICS, Centre de Recherche Saint-Antoine, Sorbonne Université, AP-HP, F-75012 Paris, France
| | - Antonin Lamazière
- INSERM UMR S 938, Département METOMICS, Centre de Recherche Saint-Antoine, Sorbonne Université, AP-HP, F-75012 Paris, France
| | - Marie-Odile Krebs
- Institute of Psychiatry and Neuroscience of Paris (IPNP), Université de Paris, INSERM U1266, F-75014 Paris, France
- GHU Paris Psychiatrie et Neurosciences, F-75674 Paris, France
| | - Oussama Kebir
- Institute of Psychiatry and Neuroscience of Paris (IPNP), Université de Paris, INSERM U1266, F-75014 Paris, France
- GHU Paris Psychiatrie et Neurosciences, F-75674 Paris, France
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Almstrup FB, Nordentoft M, Jensen MA, Kristiansen J, Kristensen TD, Wenneberg C, Garde AH, Glenthøj LB, Nordholm D. Associations between saliva alpha-amylase, heart rate variability, saliva cortisol and cognitive performance in individuals at ultra high-risk for psychosis. Schizophr Res 2023; 255:165-172. [PMID: 37001391 DOI: 10.1016/j.schres.2023.03.041] [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: 07/11/2022] [Revised: 02/24/2023] [Accepted: 03/18/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND Cognitive impairments are present in individuals at ultra-high risk (UHR) of psychosis and UHR individuals exhibit a hyperactive and dysfunctional HPA-axis. Increasing stress levels could potentially lead to cognitive impairments and no previous studies have examined the association between physiological stress biomarkers and cognition in UHR individuals. This study aims to examine the association between saliva alpha amylase (SAA), heart rate variability (HRV), saliva cortisol, and cognition in UHR individuals. METHOD We included 72 UHR individuals, aged 18-40, fulfilling criteria of the comprehensive assessment of at-risk mental state (CAARMS). Cognitive tests indexed the 7 core domains as stated by Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS). Physiological stress levels were observed for one day: saliva was collected at awakening, 30 min and 60 min after awakening and at bedtime. HRV was measured during sleep and before awakening. We used generalized linear model and controlled for multiple testing using false discovery rate (FDR). RESULTS Higher levels of SAA were significantly associated with lower cognitive performance in the domains of verbal and visual learning and memory, sustained attention, working memory and global neurocognition looking at unadjusted data. Controlling for FDR visual memory, sustained attention and global neurocognition remained significant associated with SAA. We discovered no associations between cortisol and cognition. CONCLUSION Visual learning and memory, sustained attention and global neurocognition remained significantly associated with SAA. This finding supports our hypothesis that an association between abnormal stress biomarkers and impaired cognition might be present in UHR individuals.
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Affiliation(s)
- Frederik Beske Almstrup
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Denmark.
| | - Merete Nordentoft
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Denmark
| | | | - Jesper Kristiansen
- The National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Tina Dam Kristensen
- Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, Center for Neuropsychiatric Schizophrenia Research, CNSR, Mental Health Centre Glostrup, University of Copenhagen, Glostrup, Denmark
| | - Christina Wenneberg
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Denmark; Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, Center for Neuropsychiatric Schizophrenia Research, CNSR, Mental Health Centre Glostrup, University of Copenhagen, Glostrup, Denmark
| | - Anne Helene Garde
- The National Research Centre for the Working Environment, Copenhagen, Denmark; University of Copenhagen, Department of Public Health, Copenhagen, Denmark
| | - Louise Birkedal Glenthøj
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Denmark; Department of Psychology, University of Copenhagen, Denmark
| | - Dorte Nordholm
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Denmark
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Aymerich C, Pedruzo B, Pacho M, Laborda M, Herrero J, Pillinger T, McCutcheon RA, Alonso-Alconada D, Bordenave M, Martínez-Querol M, Arnaiz A, Labad J, Fusar-Poli P, González-Torres MÁ, Catalan A. Prolactin and morning cortisol concentrations in antipsychotic naïve first episode psychosis: A systematic review and meta-analysis. Psychoneuroendocrinology 2023; 150:106049. [PMID: 36758330 DOI: 10.1016/j.psyneuen.2023.106049] [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: 11/03/2022] [Revised: 01/02/2023] [Accepted: 02/02/2023] [Indexed: 02/05/2023]
Abstract
IMPORTANCE Alterations in prolactin and cortisol levels have been reported in antipsychotic naïve patients with first episode psychosis (FEP). However, it has been studied in very small samples, and inter-group variability has never been studied before. OBJECTIVE To provide estimates of standardized mean differences (SMD) and inter-group variability for prolactin, cortisol awakening response (CAR) and morning cortisol concentrations in antipsychotic naïve FEP (AN-FEP) patients and healthy controls (HC). DATA SOURCES BIOSIS, KCI, MEDLINE, Russian Science Citation Index, SciELO, Cochrane, PsycINFO, Web of Science were searched from inception to February 28, 2022. STUDY SELECTION Peer-reviewed cohort studies that reported on prolactin or cortisol blood concentrations in AN- FEP patients and HC were included. DATA EXTRACTION AND SYNTHESIS Study characteristics, means and standard deviations (SD) were extracted from each article. Inter group differences in magnitude of effect were estimated using Hedges g. Inter-group variability was estimated with the coefficient of variation ratio (CVR). In both cases estimates were pooled using random-effects meta-analysis. Differences by study-level characteristics were estimated using meta-regression. PRISMA guideline was followed (No. CRD42022303555). MAIN OUTCOMES AND MEASURES Prolactin, CAR and morning cortisol blood concentrations in AN-FEP group in relation to HC group. RESULTS Fourteen studies for prolactin (N = 761 for AN-FEP group, N = 687 for HC group) and twelve studies for morning cortisol (N = 434 for AN-FEP group, N = 528 for HC group) were included. No studies were found in CAR in AN-FEP patients. Mean SMD for prolactin blood concentration was 0.88 (95% CI 0.57, 1.20) for male and 0.56 (95% CI 0.26, 0.87) for female. As a group, AN-FEP presented greater inter-group variability for prolactin levels than HC (CVR=1.28, 95% CI 1.02, 1.62). SMD for morning cortisol concentrations was non-significant: 0.34 (95% CI -0.01, 0.69) and no inter-group variability significant differences were detected: CVR= 1.05 (95% CI 0.91, 1.20). Meta-regression analyses for age and quality were non-significant. Funnel plots did not suggest a publication bias. CONCLUSIONS AND RELEVANCE Increased prolactin levels were found in AN-FEP patients. A greater inter-group variability in the AN-FEP group suggests the existence of patient subgroups with different prolactin levels. No significant abnormalities were found in morning cortisol levels. Further research is needed to clarify whether prolactin concentrations could be used as an illness biomarker.
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Affiliation(s)
- Claudia Aymerich
- Psychiatry Department, Basurto University Hospital, Basque Health Service (Osakidetza), Bilbao, Spain. Biocruces Bizkaia Health Research Institute, Barakaldo, Spain.
| | - Borja Pedruzo
- Psychiatry Department, Basurto University Hospital, Basque Health Service (Osakidetza), Bilbao, Spain
| | - Malein Pacho
- Psychiatry Department, Basurto University Hospital, Basque Health Service (Osakidetza), Bilbao, Spain
| | - María Laborda
- Psychiatry Department, Basurto University Hospital, Basque Health Service (Osakidetza), Bilbao, Spain
| | - Jon Herrero
- Psychiatry Department, Basurto University Hospital, Basque Health Service (Osakidetza), Bilbao, Spain
| | - Toby Pillinger
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; MRC London Institute of Medical Sciences, Faculty of Medicine, Imperial College London, Hammersmith Hospital Campus, London, UK
| | - Robert A McCutcheon
- Department of Psychiatry, University of Oxford, UK. Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Psychiatric Imaging Group, Medical Research Council, London Institute of Medical Sciences, Hammersmith Hospital, London, UK; Institute of Clinical Sciences, Faculty of Medicine, Imperial College London, London, UK
| | - Daniel Alonso-Alconada
- Department of Cell Biology and Histology, School of Medicine and Nursing, University of the Basque Country (UPV/EHU), Leioa, Spain
| | - Marta Bordenave
- Psychiatry Department, Basurto University Hospital, Basque Health Service (Osakidetza), Bilbao, Spain
| | | | - Ainara Arnaiz
- Erandio Mental Health Center, Basque Health Service (Osakidetza), Erandio, Spain. Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
| | - Javier Labad
- Mental Health Networking Biomedical Research Centre (CIBERSAM), Spain. Salut Mental Taulí, Parc Taulí University Hospital, I3PT, Autonomous University of Barcelona, Sabadell, Barcelona, Spain
| | - Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Section of Psychiatry, Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy; OASIS service, South London and Maudsley NHS Foundation Trust, London, UK; National Institute for Health Research, Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | - Miguel Ángel González-Torres
- Psychiatry Department. Biocruces Bizkaia Health Research Institute, OSI Bilbao-Basurto. School of Medicine and Nursing, University of the Basque Country (UPV/EHU), Leioa, Spain; Centro de Investigación en Red de Salud Mental. (CIBERSAM), Instituto de Salud Carlos III, Plaza de Cruces 12, 48903 Barakaldo, Biscay, Spain
| | - Ana Catalan
- Psychiatry Department. Biocruces Bizkaia Health Research Institute, OSI Bilbao-Basurto. School of Medicine and Nursing, University of the Basque Country (UPV/EHU), Leioa, Spain; Centro de Investigación en Red de Salud Mental. (CIBERSAM), Instituto de Salud Carlos III, Plaza de Cruces 12, 48903 Barakaldo, Biscay, Spain
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Nordholm D, Jensen MA, Kristiansen J, Glenthøj LB, Kristensen TD, Wenneberg C, Hjorthøj C, Garde AH, Nordentoft M. A longitudinal study on physiological stress in individuals at ultra high-risk of psychosis. Schizophr Res 2023; 254:218-226. [PMID: 36996675 DOI: 10.1016/j.schres.2023.03.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 01/19/2023] [Accepted: 03/03/2023] [Indexed: 04/01/2023]
Abstract
INTRODUCTION Individuals at ultra high-risk (UHR) of psychosis exhibit significantly higher stress levels than healthy controls (HC). This study investigates how physiological stress measures differ between HC and UHR individuals and how physiological stress is associated with attenuated psychotic symptoms and changes over time in UHR individuals. Additionally, it examines how the use of medication affects physiological levels of stress. METHOD The study included 72 UHR individuals and 36 HC. UHR were included according to the comprehensive assessment of at-risk mental state (CAARMS); a total-CAARMS score measured the attenuated psychotic symptoms and was calculated from the four psychosis subscales. HC and UHR were examined at baseline, and 47 UHR individuals were followed up after six months. Physiological stress measures were salivary cortisol, alpha-amylase (SAA) and heart-rate variability (HRV). Saliva was collected at four-time points during the day. RESULTS There was no significant difference regarding cortisol (awakening response) or SAA measures between HC and UHR individuals. The use of antipsychotics and antidepressants was associated with low HRV in UHR individuals. In an exploratory analysis of 19 UHR individuals, we found an association between the change in total-CAARMS (six months total-CAARMS minus baseline total CAARMS) and the change in HRV during sleep (six months HRV minus baseline HRV). CONCLUSION Our findings indicate that the use of antipsychotics and antidepressants could be associated with lower HRV in UHR individuals. There might be potential to investigate how HRV develops during the course of illness in UHR individuals.
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Affiliation(s)
- Dorte Nordholm
- Copenhagen Research Center for Mental Health-CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Denmark.
| | | | - Jesper Kristiansen
- The National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Louise Birkedal Glenthøj
- Copenhagen Research Center for Mental Health-CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Denmark
| | - Tina Dam Kristensen
- Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, and Center for Neuropsychiatric Schizophrenia Research, CNSR, Mental Health Centre Glostrup, University of Copenhagen, Glostrup, Denmark
| | - Christina Wenneberg
- Copenhagen Research Center for Mental Health-CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Denmark; Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, and Center for Neuropsychiatric Schizophrenia Research, CNSR, Mental Health Centre Glostrup, University of Copenhagen, Glostrup, Denmark
| | - Carsten Hjorthøj
- Copenhagen Research Center for Mental Health-CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Denmark; University of Copenhagen, Department of Public Health, Section of Epidemiology, Copenhagen, Denmark
| | - Anne Helene Garde
- The National Research Centre for the Working Environment, Copenhagen, Denmark; University of Copenhagen, Department of Public Health, Copenhagen, Denmark
| | - Merete Nordentoft
- Copenhagen Research Center for Mental Health-CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Denmark
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8
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Vaessen T, Reininghaus U, van Aubel E, Beijer-Klippel A, Steinhart H, Myin-Germeys I, Waltz J. Neural correlates of daily-life affective stress reactivity in early psychosis: A study combining functional MRI and experience sampling methodology. Schizophr Res 2023; 255:93-101. [PMID: 36989675 DOI: 10.1016/j.schres.2023.03.038] [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: 04/08/2022] [Revised: 08/01/2022] [Accepted: 03/18/2023] [Indexed: 03/31/2023]
Abstract
Affective reactivity to daily stressors are increased in individuals in the early stages of psychosis. Studies in psychosis patients and healthy individuals at increased psychosis risk show altered neural reactivity to stress in limbic (i.e., hippocampus [HC] and amygdala), prelimbic (i.e., ventromedial prefrontal cortex [vmPFC] and ventral anterior cingulate cortex [vACC]), and salience areas (i.e., Anterior Insula [AI]). We investigated whether a similar pattern of neural reactivity is present in early psychosis individuals and if brain activity in these regions is associated with daily-life stress reactivity. Twenty-nine early psychosis individuals (11 at-risk mental state and 18 first-episode psychosis) completed the Montreal Imaging Stress Task in conjunction with functional MRI. The study was part of a large-scale randomized controlled trial on the efficacy of an acceptance and commitment therapy-based ecological momentary intervention for early psychosis. All participants also provided experience sampling methodology (ESM) data on momentary affect and stressful activities in their everyday environment. Multilevel regression models were used to estimate if daily-life stress reactivity was moderated by activity in (pre)limbic and salience areas. Task-induced stress was associated with increased activation of the right AI and decreased activation in the vmPFC, vACC, and HC. Task-induced changes in vmPFC and vACC activity were associated with affective stress reactivity, whereas changes in HC and amygdala activity were associated with higher overall stress ratings. These preliminary results suggest region-specific roles in affective and psychotic daily-life stress reactivity in early psychosis. The observed pattern suggests that chronic stress plays a role in neural stress reactivity.
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Affiliation(s)
- Thomas Vaessen
- Center for Contextual Psychiatry, KU Leuven, Kapucijnenvoer 33, P.O. Box 7001, 3000 Leuven, Belgium; Department of Psychology, Health, & Technology, University of Twente, P.O. Box 217, 7500AE Enschede, the Netherlands.
| | - Ulrich Reininghaus
- Department Public Mental Health, Central Institute of Mental Health, J 5, 68159 Mannheim, Germany
| | - Evelyne van Aubel
- Center for Contextual Psychiatry, KU Leuven, Kapucijnenvoer 33, P.O. Box 7001, 3000 Leuven, Belgium
| | - Annelie Beijer-Klippel
- Center for Contextual Psychiatry, KU Leuven, Kapucijnenvoer 33, P.O. Box 7001, 3000 Leuven, Belgium; Department of Lifespan Psychology, Open University, P.O. Box 2960, 6401DL Heerlen, the Netherlands
| | - Henrietta Steinhart
- Center for Contextual Psychiatry, KU Leuven, Kapucijnenvoer 33, P.O. Box 7001, 3000 Leuven, Belgium
| | - Inez Myin-Germeys
- Center for Contextual Psychiatry, KU Leuven, Kapucijnenvoer 33, P.O. Box 7001, 3000 Leuven, Belgium
| | - James Waltz
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, P.O. Box 21247, Baltimore, MD 21228, USA
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9
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van den Heuvel LL, Smit AM, Stalder T, Kirschbaum C, Seedat S, Emsley R. Hair cortisol levels in schizophrenia and metabolic syndrome. Early Interv Psychiatry 2022; 16:902-911. [PMID: 34978366 DOI: 10.1111/eip.13238] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 08/16/2021] [Accepted: 10/19/2021] [Indexed: 11/28/2022]
Abstract
AIM Individuals with schizophrenia demonstrate higher rates of metabolic syndrome (MetS) than the general population. Hair cortisol concentrations (HCC) reflect longer-term cortisol secretion and can provide additional insights into the role of the hypothalamic pituitary adrenal (HPA) axis in schizophrenia and co-occurring MetS. METHODS In a case-control study of 16 patients with schizophrenia (11 first episode psychosis [FEP] and 5 chronic) and 21 controls hair samples, representing a 3-month retrospective window of cortisol, were collected and analysed utilizing liquid chromatography tandem mass spectrometry. We investigated whether schizophrenia and MetS co-occurrence were associated with HCC utilizing multivariate regression models. We also explored the longitudinal trajectory of HCC in FEP patients by conducting a mixed models analysis. RESULTS At baseline HCC were significantly lower (Cohen's d = 0.88) in patients with schizophrenia than in controls (p = .014). HCC increased from baseline to month-12 in FEP patients compared to controls, demonstrating a trend towards significance (p = .097). MetS was not associated with HCC at baseline, but HCC increased significantly from baseline to month-12 in relation to MetS (p = .037). CONCLUSIONS In a subgroup of schizophrenia patients, psychosis may be associated with a blunted HPA axis with lower long-term cortisol output. MetS was associated with an increase in HCC and elevated cortisol levels observed in schizophrenia may be related to increased rates of MetS in schizophrenia patients.
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Affiliation(s)
- Leigh Luella van den Heuvel
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa.,South African Medical Research Council, Stellenbosch University Genomics of Brain Disorders Research Unit, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Anna Margaretha Smit
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Tobias Stalder
- Clinical Psychology, University of Siegen, Siegen, Germany
| | - Clemens Kirschbaum
- Biological Psychology, Dresden University of Technology, Dresden, Germany
| | - Soraya Seedat
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa.,South African Medical Research Council, Stellenbosch University Genomics of Brain Disorders Research Unit, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Robin Emsley
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa.,South African Medical Research Council, Stellenbosch University Genomics of Brain Disorders Research Unit, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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10
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Bob P, Touskova TP, Pec O, Raboch J, Boutros N, Lysaker P. Psychosocial Stress, Epileptic-Like Symptoms and Psychotic Experiences. Front Psychol 2022; 13:804628. [PMID: 35496146 PMCID: PMC9048482 DOI: 10.3389/fpsyg.2022.804628] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 03/17/2022] [Indexed: 12/19/2022] Open
Abstract
Background Current research suggests that stressful life experiences and situations create a substantive effect in the development of the initial manifestations of psychotic disorders and may influence temporo-limbic epileptic-like activity manifesting as cognitive and affective seizure-like symptoms in non-epileptic conditions. Methods The current study assessed trauma history, hair cortisol levels, epileptic-like manifestations and other psychopathological symptoms in 56 drug naive adult young women experiencing their initial occurrence of psychosis. Results Hair cortisol levels among patients experiencing their initial episode of psychosis, were significantly correlated with stress symptoms measured by Trauma Symptom Checklist-40 (r = − 0.48, p < 0.01), and complex partial seizure-like symptoms measured by the Complex Partial Seizure-Like Symptoms Inventory (r = − 0.33, p < 0.05) and LSCL-33 (r = − 0.33, p < 0.05). Hair cortisol levels were not found to be significantly correlated with symptoms of anxiety and depression measured by Beck depression Inventory and Zung Anxiety Scale. Conclusion These findings suggest a significant relationship between epileptic-like symptoms and stress responses demonstrated by patients in their first psychotic episode. These findings may suggest the potential for research to explore usefulness of anticonvulsant treatment in patients who do not respond to usual psychotropic medication.
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Affiliation(s)
- Petr Bob
- Center for Neuropsychiatric Research of Traumatic Stress, Department of Psychiatry and UHSL, First Faculty of Medicine, and Department of Psychiatry, Faculty of Medicine Pilsen, Charles University in Prague, Prague, Czechia
- *Correspondence: Petr Bob,
| | - Tereza Petraskova Touskova
- Center for Neuropsychiatric Research of Traumatic Stress, Department of Psychiatry and UHSL, First Faculty of Medicine, and Department of Psychiatry, Faculty of Medicine Pilsen, Charles University in Prague, Prague, Czechia
| | - Ondrej Pec
- Center for Neuropsychiatric Research of Traumatic Stress, Department of Psychiatry and UHSL, First Faculty of Medicine, and Department of Psychiatry, Faculty of Medicine Pilsen, Charles University in Prague, Prague, Czechia
| | - Jiri Raboch
- Center for Neuropsychiatric Research of Traumatic Stress, Department of Psychiatry and UHSL, First Faculty of Medicine, and Department of Psychiatry, Faculty of Medicine Pilsen, Charles University in Prague, Prague, Czechia
| | - Nash Boutros
- Rush University Medical Center, Chicago, IL, United States
| | - Paul Lysaker
- Roudebush VA Medical Center and the Indiana University School of Medicine, Indianapolis, IN, United States
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11
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Cortisol Levels in Childhood Associated With Emergence of Attenuated Psychotic Symptoms in Early Adulthood. Biol Psychiatry 2022; 91:226-235. [PMID: 34715990 PMCID: PMC7612877 DOI: 10.1016/j.biopsych.2021.08.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 08/08/2021] [Accepted: 08/11/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND In individuals at clinical high-risk for psychosis, elevated cortisol levels predict subsequent onset of psychotic disorder. However, it is unclear whether cortisol alterations are evident at an earlier clinical stage and promote progression of psychosis expression. This study aimed to address this issue by investigating whether cortisol levels in childhood were associated with the emergence of attenuated psychotic symptoms in early adulthood. In exploratory analyses, we examined whether cortisol and psychosocial stress measures interacted in predicting attenuated psychotic symptoms. METHODS A sample of children (N = 109) enriched for psychosis risk factors were recruited at age 9-12 years and assessed at age 11-14 years (T1) and 17-21 years (T2). Measures of psychopathology, psychosocial stressors, and salivary cortisol were obtained at T1. Attenuated psychotic symptoms were assessed at T2 using the Prodromal Questionnaire. RESULTS Diurnal cortisol (β = 0.915, 95% CI: 0.062-1.769) and daily stressors (β = 0.379, 95% CI: 0.034-0.723) at T1 were independently associated with total Prodromal Questionnaire scores at T2 after accounting for demographic factors and T1 psychopathology. Exploratory analyses indicated a significant interaction between T1 diurnal cortisol and daily stressors (β = 0.743, 95% CI: 0.081-1.405), with the highest predicted T2 total Prodromal Questionnaire scores occurring when both diurnal cortisol and daily stressors were increased. CONCLUSIONS Our findings suggest that daily stressors and elevations in diurnal cortisol in late childhood/early adolescence increases risk for developing attenuated psychotic symptoms. These findings emphasize the importance of assessing environmental and biological risk factors for psychosis during neurodevelopmentally vulnerable time periods.
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12
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Li Z, Zhang T, Xu L, Wei Y, Cui H, Tang Y, Liu X, Qian Z, Zhang H, Liu P, Li C, Wang J. Plasma metabolic alterations and potential biomarkers in individuals at clinical high risk for psychosis. Schizophr Res 2022; 239:19-28. [PMID: 34800912 DOI: 10.1016/j.schres.2021.11.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 10/21/2021] [Accepted: 11/08/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND Early identification and treatment of clinical high-risk for psychosis (CHRP) are critical to prevent the onset of psychosis, but there is no objective biomarker for CHR-P diagnosis. METHODS Ninety medication naïve CHR-P subjects and eighty-six healthy controls (HCs) were recruited. The metabolic profiles of plasma samples were acquired using an untargeted metabolomics approach based on ultra-high-performance liquid chromatography equipped with quadrupole time-of-flight mass spectrometry. The obtained data were further mapped on the Kyoto Encyclopedia of Genes and Genomes for pathway analysis, and an ensemble learning method was applied to identify diagnostic biomarkers. Bayesian linear regression model was then used to explore predicative biomarkers of conversion to psychosis. Receiver-operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic or predicative value of potential biomarkers. RESULTS A total of one hundred and four differential metabolites and forty-eight differential pathways were identified. A panel of five metabolites was found that could effectively discriminate CHR-P from HCs with area under the ROC curve of 1 in the training set (70% of the samples) and 0.997 in the testing set (30% of the samples). The biosynthesis of unsaturated fatty acids pathway perturbed most significantly in CHR-P subjects. Twenty-three CHR-P subjects converted to psychotic disorders during two-year follow-up, and increased 1-stearoyl-2-arachidonoyl-sn-glycerol in plasma was potentially associated with the higher risk of conversion to psychosis. CONCLUSIONS These findings demonstrate the alterations of plasma metabolic profiles in CHR-P population, which may deliver valuable biomarkers for early identification and outcome prediction of CHR-P.
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Affiliation(s)
- Zhixing Li
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai 200030, PR China
| | - Tianhong Zhang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai 200030, PR China.
| | - Lihua Xu
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai 200030, PR China
| | - Yanyan Wei
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai 200030, PR China
| | - Huiru Cui
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai 200030, PR China
| | - Yingying Tang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai 200030, PR China
| | - Xiaohua Liu
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai 200030, PR China
| | - Zhenying Qian
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai 200030, PR China
| | - Hu Zhang
- School of Pharmacy, Brain Health Research Centre, Brain Research New Zealand, University of Otago, Dunedin, New Zealand
| | - Ping Liu
- Department of Anatomy, School of Biomedical Sciences, Brain Health Research Centre, Brain Research New Zealand, University of Otago, Dunedin, New Zealand.
| | - Chunbo Li
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai 200030, PR China
| | - Jijun Wang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai 200030, PR China; CAS Center for Excellence in Brain Science and Intelligence Technology (CEBSIT), Chinese Academy of Science, Shanghai 200031, PR China; Institute of Psychology and Behavioral Science, Shanghai Jiao Tong University, Shanghai 200030, PR China.
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13
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Cortisol as a Biomarker of Mental Disorder Severity. J Clin Med 2021; 10:jcm10215204. [PMID: 34768724 PMCID: PMC8584322 DOI: 10.3390/jcm10215204] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 10/28/2021] [Accepted: 11/04/2021] [Indexed: 01/19/2023] Open
Abstract
Cortisol—the most important steroid hormone with a significant effect on body metabolism—strongly affects peripheral tissues and the central nervous system. Fluctuations in cortisol secretion often accompany psychiatric disorders, and normalization of its levels correlates with improvement in the patient’s health. This indicates that cortisol may be useful as a biological marker that can help determine the likelihood of mental illness, its impending onset, and the severity of symptoms, which is especially important in the face of the increasing prevalence of mental disorders, including those associated with social isolation and anxiety during the COVID-19 pandemic. This publication reviews recent reports on cortisol levels in healthy participants and shows the current state of knowledge on changes in the levels of this hormone in people at risk for depression, bipolar disorder, and psychosis. It shows how people with psychiatric disorders react to stressful situations and how the applied therapies affect cortisol secretion. The influence of antidepressants and antipsychotics on cortisol levels in healthy people and those with mental disorders is also described. Finally, it reviews publications on the patterns of cortisol secretion in patients in remission.
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14
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Motavalli R, Majidi T, Pourlak T, Abediazar S, Shoja MM, Zununi Vahed S, Etemadi J. The clinical significance of the glucocorticoid receptors: Genetics and epigenetics. J Steroid Biochem Mol Biol 2021; 213:105952. [PMID: 34274458 DOI: 10.1016/j.jsbmb.2021.105952] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 07/04/2021] [Accepted: 07/11/2021] [Indexed: 12/14/2022]
Abstract
The impacts of glucocorticoids (GCs) are mainly mediated by a nuclear receptor (GR) existing in almost every tissue. The GR regulates a wide range of physiological functions, including inflammation, cell metabolism, and differentiation playing a major role in cellular responses to GCs and stress. Therefore, the dysregulation or disruption of GR can cause deficiencies in the adaptation to stress and the preservation of homeostasis. The number of GR polymorphisms associated with different diseases has been mounting per year. Tackling these clinical complications obliges a comprehensive understanding of the molecular network action of GCs at the level of the GR structure and its signaling pathways. Beyond genetic variation in the GR gene, epigenetic changes can enhance our understanding of causal factors involved in the development of diseases and identifying biomarkers. In this review, we highlight the relationships of GC receptor gene polymorphisms and epigenetics with different diseases.
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Affiliation(s)
- Roza Motavalli
- Kidney Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Taraneh Majidi
- Kidney Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Tala Pourlak
- Department of Pathology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sima Abediazar
- Kidney Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammadali M Shoja
- Clinical Academy of Teaching and Learning, Ross University School of Medicine, Miramar, FL, USA
| | | | - Jalal Etemadi
- Kidney Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
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15
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Mikulska J, Juszczyk G, Gawrońska-Grzywacz M, Herbet M. HPA Axis in the Pathomechanism of Depression and Schizophrenia: New Therapeutic Strategies Based on Its Participation. Brain Sci 2021; 11:brainsci11101298. [PMID: 34679364 PMCID: PMC8533829 DOI: 10.3390/brainsci11101298] [Citation(s) in RCA: 103] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 09/24/2021] [Accepted: 09/24/2021] [Indexed: 12/27/2022] Open
Abstract
The hypothalamic-pituitary-adrenal (HPA) axis is involved in the pathophysiology of many neuropsychiatric disorders. Increased HPA axis activity can be observed during chronic stress, which plays a key role in the pathophysiology of depression. Overactivity of the HPA axis occurs in major depressive disorder (MDD), leading to cognitive dysfunction and reduced mood. There is also a correlation between the HPA axis activation and gut microbiota, which has a significant impact on the development of MDD. It is believed that the gut microbiota can influence the HPA axis function through the activity of cytokines, prostaglandins, or bacterial antigens of various microbial species. The activity of the HPA axis in schizophrenia varies and depends mainly on the severity of the disease. This review summarizes the involvement of the HPA axis in the pathogenesis of neuropsychiatric disorders, focusing on major depression and schizophrenia, and highlights a possible correlation between these conditions. Although many effective antidepressants are available, a large proportion of patients do not respond to initial treatment. This review also discusses new therapeutic strategies that affect the HPA axis, such as glucocorticoid receptor (GR) antagonists, vasopressin V1B receptor antagonists and non-psychoactive CB1 receptor agonists in depression and/or schizophrenia.
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16
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Rukavishnikov GV, Kasyanov ED, Zhilyaeva TV, Mazo GE. [Schizophrenia and cardiometabolic disorders]. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 121:132-138. [PMID: 34283543 DOI: 10.17116/jnevro2021121061132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of this review is to analyze the basic biological mechanisms of comorbidity of schizophrenia and metabolic, cardiovascular diseases, which are not directly associated with external risk factors. The study of the general pathophysiological mechanisms of schizophrenia and metabolic disorders can provide a significant basis not only for the fundamentally novel therapeutic, preventive and diagnostic measures, but also for a better understanding of the etiopathogenesis of these diseases. It seems likely that schizophrenia represents a heterogeneous group with a varying genetic basis for both mental symptoms and neuroendocrine, inflammatory processes that form concomitant somatic disorders. Thus, the new integrated approaches to the study of this problem with the latest methods of genetic and molecular research are relevant.
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Affiliation(s)
- G V Rukavishnikov
- Bekhterev National Medical Research Center for Psychiatry and Neurology, St. Petersburg, Russia
| | - E D Kasyanov
- Bekhterev National Medical Research Center for Psychiatry and Neurology, St. Petersburg, Russia
| | - T V Zhilyaeva
- Privolzhsky Research Medical University, Nizhny Novgorod, Russia
| | - G E Mazo
- Bekhterev National Medical Research Center for Psychiatry and Neurology, St. Petersburg, Russia
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17
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Busch JR, Wang X, Lynnerup N, Jacobsen C, Jørgensen MB, Linnet K, Johansen SS, Banner J. Hair cortisol concentrations in decedents with severe mental illness – An autopsy-based cohort study. FORENSIC SCIENCE INTERNATIONAL: REPORTS 2021. [DOI: 10.1016/j.fsir.2021.100173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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18
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Misiak B, Pruessner M, Samochowiec J, Wiśniewski M, Reginia A, Stańczykiewicz B. A meta-analysis of blood and salivary cortisol levels in first-episode psychosis and high-risk individuals. Front Neuroendocrinol 2021; 62:100930. [PMID: 34171354 DOI: 10.1016/j.yfrne.2021.100930] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 06/10/2021] [Accepted: 06/19/2021] [Indexed: 11/18/2022]
Abstract
Dysregulated cortisol responses and glucose metabolism have been reported in psychosis. We performed a random-effects meta-analysis of cortisol responses in first-episode psychosis (FEP) and psychosis risk states, taking into consideration glucose metabolism. A total of 47 studies were included. Unstimulated blood cortisol levels were significantly higher (g = 0.48, 95 %CI: 0.25-0.70, p < 0.001) in FEP, but not in psychosis risk states (g = 0.39, 95 %CI: -0.42-1.21, p = 0.342), compared to controls. Cortisol awakening response (CAR) was attenuated in FEP (g = -0.40, 95 %CI: -0.68 - -0.12, p = 0.006), but not in psychosis risk states (p = 0.433). Glucose and insulin levels were positively correlated with unstimulated blood cortisol levels in FEP. Our meta-analysis supports previous findings of elevated blood cortisol levels and attenuated CAR in FEP. Future research should focus on identifying the common denominators for alterations in stress hormones and glucose metabolism.
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Affiliation(s)
- Błażej Misiak
- Department of Psychiatry, Division of Consultation Psychiatry and Neuroscience, Wroclaw Medical University, Pasteura 10 Street, 50-367 Wroclaw, Poland.
| | - Marita Pruessner
- Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, Canada; Department of Clinical Psychology, University of Konstanz, Konstanz, Germany
| | - Jerzy Samochowiec
- Department of Psychiatry, Pomeranian Medical University, Broniewskiego 26 Street, 71-457 Szczecin, Poland
| | | | - Artur Reginia
- Department of Psychiatry, Pomeranian Medical University, Broniewskiego 26 Street, 71-457 Szczecin, Poland
| | - Bartłomiej Stańczykiewicz
- Department of Nervous System Diseases, Wroclaw Medical University, Bartla 5 Street, 51-618 Wroclaw, Poland
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19
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The Impact of the FKBP5 Gene Polymorphisms on the Relationship between Traumatic Life Events and Psychotic-Like Experiences in Non-Clinical Adults. Brain Sci 2021; 11:brainsci11050561. [PMID: 33925151 PMCID: PMC8144983 DOI: 10.3390/brainsci11050561] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 04/24/2021] [Indexed: 01/30/2023] Open
Abstract
Common variations of the FKBP5 gene are implicated in psychotic disorders, by modulating the hypothalamic–pituitary–adrenal axis reactivity to stress. It has been demonstrated that some of them might moderate the effects of childhood trauma on psychosis proneness. However, these associations have not been investigated with respect to traumatic life events (TLEs). Therefore, we aimed to explore whether the FKBP5 polymorphisms moderate the effects of TLEs on the level of psychotic-like experiences (PLEs). A total of 535 non-clinical adults were approached for participation, and genotyping of six FKBP5 polymorphisms (rs3800373, rs9470080, rs4713902, rs737054, rs1360780 and rs9296158) was performed. The Prodromal Questionnaire-16 (PQ-16) and the Traumatic Events Checklist (TEC) were administered to assess PLEs and TLEs, respectively. Among the rs1360780 CC homozygotes, a history of physical abuse was associated with significantly higher PQ-16 scores. This difference was not significant in the rs1360780 T allele carriers. Similarly, a history of physical abuse was associated with significantly higher PQ-16 scores in the rs9296158 GG homozygotes but not in the rs9296158 A allele carriers. Finally, emotional neglect was related to significantly higher PQ-16 scores in the rs737054 T allele carriers but not in the rs737054 CC homozygotes. The present study indicates that variation in the FKBP5 gene might moderate the effects of lifetime traumatic events on psychosis proneness.
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20
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Nordholm D, Hjorthøj C, Mondelli V, Krakauer K, Randers L, Dazzan P, Nordentoft M. Are attenuated positive symptoms and cortisol levels associated? Schizophr Res 2021; 228:621-623. [PMID: 33248883 DOI: 10.1016/j.schres.2020.11.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 06/22/2020] [Accepted: 11/15/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Dorte Nordholm
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Kildegårdsvej 28, opg. 15, Hellerup, Denmark; Lundbeck Foundation Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Mental Health Centre Glostrup, University of Copenhagen, Denmark; Research Collaboration at Psychiatric Centre North Zealand, Dyrehavevej 48, Hillerød, Denmark.
| | - Carsten Hjorthøj
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Kildegårdsvej 28, opg. 15, Hellerup, Denmark; University of Copenhagen, Department of Public Health, Section of Epidemiology, Denmark
| | - Valeria Mondelli
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, London, United Kingdom; National Institute for Health Research (NIHR), Biomedical Research Centre for Mental Health at South London and Maudsley, NHS Foundation Trust and Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - Kristine Krakauer
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Kildegårdsvej 28, opg. 15, Hellerup, Denmark; Lundbeck Foundation Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Mental Health Centre Glostrup, University of Copenhagen, Denmark
| | - Lasse Randers
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Kildegårdsvej 28, opg. 15, Hellerup, Denmark; Lundbeck Foundation Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Mental Health Centre Glostrup, University of Copenhagen, Denmark
| | - Paola Dazzan
- National Institute for Health Research (NIHR), Biomedical Research Centre for Mental Health at South London and Maudsley, NHS Foundation Trust and Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom; Institute of Psychiatry, Psychology and Neuroscience, Department of Psychosis Studies, King's College London, United Kingdom
| | - Merete Nordentoft
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Kildegårdsvej 28, opg. 15, Hellerup, Denmark
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21
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Hair cortisol concentrations in mental disorders: A systematic review. Physiol Behav 2021; 229:113244. [DOI: 10.1016/j.physbeh.2020.113244] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 10/26/2020] [Accepted: 11/06/2020] [Indexed: 12/11/2022]
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22
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Umeoka EHL, van Leeuwen JMC, Vinkers CH, Joëls M. The Role of Stress in Bipolar Disorder. Curr Top Behav Neurosci 2021; 48:21-39. [PMID: 32748285 DOI: 10.1007/7854_2020_151] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Stress is a major risk factor for bipolar disorder. Even though we do not completely understand how stress increases the risk for the onset and poorer course of bipolar disorder, knowledge of stress physiology is rapidly evolving. Following stress, stress hormones - including (nor)adrenaline and corticosteroid - reach the brain and change neuronal function in a time-, region-, and receptor-dependent manner. Stress has direct consequences for a range of cognitive functions which are time-dependent. Directly after stress, emotional processing is increased at the cost of higher brain functions. In the aftermath of stress, the reverse is seen, i.e., increased executive function and contextualization of information. In bipolar disorder, basal corticosteroid levels (under non-stressed conditions) are generally found to be increased with blunted responses in response to experimental stress. Moreover, patients who have bipolar disorder generally show impaired brain function, including reward processing. There is some evidence for a causal role of (dysfunction of) the stress system in the etiology of bipolar disorder and their effects on brain system functionality. However, longitudinal studies investigating the functionality of the stress systems in conjunction with detailed information on the development and course of bipolar disorder are vital to understand in detail how stress increases the risk for bipolar disorder.
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Affiliation(s)
- Eduardo H L Umeoka
- Faculty of Medicine, University Center Unicerrado, Goiatuba, GO, Brazil.
| | - Judith M C van Leeuwen
- Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Christiaan H Vinkers
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, Amsterdam Neuroscience, Amsterdam, The Netherlands
- Amsterdam UMC, Department of Anatomy and Neurosciences, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Marian Joëls
- Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
- University Medical Center Groningen, Groningen, The Netherlands
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23
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Progression from being at-risk to psychosis: next steps. NPJ SCHIZOPHRENIA 2020; 6:27. [PMID: 33020486 PMCID: PMC7536226 DOI: 10.1038/s41537-020-00117-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 08/06/2020] [Indexed: 12/15/2022]
Abstract
Over the past 20 years there has been a great deal of research into those considered to be at risk for developing psychosis. Much has been learned and studies have been encouraging. The aim of this paper is to offer an update of the current status of research on risk for psychosis, and what the next steps might be in examining the progression from CHR to psychosis. Advances have been made in accurate prediction, yet there are some methodological issues in ascertainment, diagnosis, the use of data-driven selection methods and lack of external validation. Although there have been several high-quality treatment trials the heterogeneity of this clinical high-risk population has to be addressed so that their treatment needs can be properly met. Recommendations for the future include more collaborative research programmes, and ensuring they are accessible and harmonized with respect to criteria and outcomes so that the field can continue to move forward with the development of large collaborative consortiums as well as increased funding for multisite projects.
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24
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Martland N, Martland R, Cullen AE, Bhattacharyya S. Are adult stressful life events associated with psychotic relapse? A systematic review of 23 studies. Psychol Med 2020; 50:2302-2316. [PMID: 33054892 DOI: 10.1017/s0033291720003554] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Relapse rates among individuals with psychotic disorders are high. In addition to the financial burden placed on clinical services, relapse is associated with worse long-term prognosis and poorer quality of life. Robust evidence indicates that stressful life events commonly precede the onset of the first psychotic episode; however, the extent to which they are associated with relapse remains unclear. The aim of this systematic review is to summarize available research investigating the association between recent stressful life events and psychotic relapse or relapse of bipolar disorder if the diagnosis included psychotic symptoms. PsycINFO, Medline and EMBASE were searched for cross-sectional, retrospective and prospective studies published between 01/01/1970 and 08/01/2020 that investigated the association between adult stressful life events and relapse of psychosis. Study quality was assessed using the Effective Public Health Practice Project guidelines. Twenty-three studies met eligibility criteria (prospective studies: 14; retrospective studies: 6; cross-sectional: 3) providing data on 2046 participants in total (sample size range: 14-240 participants). Relapse was defined as a return of psychotic symptoms (n = 20), a return of symptoms requiring hospitalization (n = 2) and a return of symptoms or hospitalization (n = 1). Adult stressful life events were defined as life events occurring after the onset of psychosis. Stressful life events included but were not limited to adult trauma, bereavement, financial problems and conflict. Eighteen studies found a significant positive association between adult stressful life events and psychotic relapse and five studies found a non-significant association. We conclude that adult stressful life events, occurring after psychosis onset, appear to be associated with psychotic relapse.
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Affiliation(s)
- Natasha Martland
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, London, UK
| | - Rebecca Martland
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, London, UK
| | - Alexis E Cullen
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, London, UK
| | - Sagnik Bhattacharyya
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, Denmark Hill, London, SE5 8AZ, UK
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25
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Söder E, Krkovic K, Lincoln TM. The relevance of chronic stress for the acute stress reaction in people at elevated risk for psychosis. Psychoneuroendocrinology 2020; 119:104684. [PMID: 32512251 DOI: 10.1016/j.psyneuen.2020.104684] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 04/07/2020] [Accepted: 04/07/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Theoretical models and empirical evidence suggest that alterations of the acute stress reaction are a vulnerability indicator of psychosis. However, more studies are needed that use laboratory stressors and a multimodal assessment of the stress reaction. Furthermore, it needs to be clarified whether alterations of the acute stress reaction result from the chronic stress level. METHODS We recruited participants at familial (n = 32) and symptomatic risk (n = 43) for psychosis and a low-risk control group (n = 35). We assessed their chronic stress levels (self-report, hair cortisol concentrations) and self-reported (subjective, affective, paranoia) as well as physiological (heart rate, skin conductance level, cortisol) reactions to the Trier Social Stress Test. RESULTS The groups did not differ in their acute stress reaction but both at-risk groups showed higher levels of self-reported chronic stress. Chronic stress predicted changes in negative affect, paranoia and skin conductance level in the total sample. CONCLUSIONS We could not confirm that alterations of the acute stress reaction are an early vulnerability indicator of psychosis and conclude that they might develop at a later time-point on the trajectory to psychosis. The high chronic stress level of the at-risk groups might constitute an intermediate state that increases the likelihood of altered stress reactions in later risk stages. To test this, future work needs to investigate the temporal order between chronic stress levels, acute stress reactions and symptom development across the psychosis continuum.
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Affiliation(s)
- Eveline Söder
- Universität Hamburg, Clinical Psychology and Psychotherapy, Institute of Psychology, Von-Melle-Park 5, 20146 Hamburg, Germany.
| | - Katarina Krkovic
- Universität Hamburg, Clinical Psychology and Psychotherapy, Institute of Psychology, Von-Melle-Park 5, 20146 Hamburg, Germany
| | - Tania M Lincoln
- Universität Hamburg, Clinical Psychology and Psychotherapy, Institute of Psychology, Von-Melle-Park 5, 20146 Hamburg, Germany
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26
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Fusar-Poli P, Salazar de Pablo G, Correll CU, Meyer-Lindenberg A, Millan MJ, Borgwardt S, Galderisi S, Bechdolf A, Pfennig A, Kessing LV, van Amelsvoort T, Nieman DH, Domschke K, Krebs MO, Koutsouleris N, McGuire P, Do KQ, Arango C. Prevention of Psychosis: Advances in Detection, Prognosis, and Intervention. JAMA Psychiatry 2020; 77:755-765. [PMID: 32159746 DOI: 10.1001/jamapsychiatry.2019.4779] [Citation(s) in RCA: 255] [Impact Index Per Article: 63.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
IMPORTANCE Detection, prognosis, and indicated interventions in individuals at clinical high risk for psychosis (CHR-P) are key components of preventive psychiatry. OBJECTIVE To provide a comprehensive, evidence-based systematic appraisal of the advancements and limitations of detection, prognosis, and interventions for CHR-P individuals and to formulate updated recommendations. EVIDENCE REVIEW Web of Science, Cochrane Central Register of Reviews, and Ovid/PsychINFO were searched for articles published from January 1, 2013, to June 30, 2019, to identify meta-analyses conducted in CHR-P individuals. MEDLINE was used to search the reference lists of retrieved articles. Data obtained from each article included first author, year of publication, topic investigated, type of publication, study design and number, sample size of CHR-P population and comparison group, type of comparison group, age and sex of CHR-P individuals, type of prognostic assessment, interventions, quality assessment (using AMSTAR [Assessing the Methodological Quality of Systematic Reviews]), and key findings with their effect sizes. FINDINGS In total, 42 meta-analyses published in the past 6 years and encompassing 81 outcomes were included. For the detection component, CHR-P individuals were young (mean [SD] age, 20.6 [3.2] years), were more frequently male (58%), and predominantly presented with attenuated psychotic symptoms lasting for more than 1 year before their presentation at specialized services. CHR-P individuals accumulated several sociodemographic risk factors compared with control participants. Substance use (33% tobacco use and 27% cannabis use), comorbid mental disorders (41% with depressive disorders and 15% with anxiety disorders), suicidal ideation (66%), and self-harm (49%) were also frequently seen in CHR-P individuals. CHR-P individuals showed impairments in work (Cohen d = 0.57) or educational functioning (Cohen d = 0.21), social functioning (Cohen d = 1.25), and quality of life (Cohen d = 1.75). Several neurobiological and neurocognitive alterations were confirmed in this study. For the prognosis component, the prognostic accuracy of CHR-P instruments was good, provided they were used in clinical samples. Overall, risk of psychosis was 22% at 3 years, and the risk was the highest in the brief and limited intermittent psychotic symptoms subgroup (38%). Baseline severity of attenuated psychotic (Cohen d = 0.35) and negative symptoms (Cohen d = 0.39) as well as low functioning (Cohen d = 0.29) were associated with an increased risk of psychosis. Controlling risk enrichment and implementing sequential risk assessments can optimize prognostic accuracy. For the intervention component, no robust evidence yet exists to favor any indicated intervention over another (including needs-based interventions and control conditions) for preventing psychosis or ameliorating any other outcome in CHR-P individuals. However, because the uncertainty of this evidence is high, needs-based and psychological interventions should still be offered. CONCLUSIONS AND RELEVANCE This review confirmed recent substantial advancements in the detection and prognosis of CHR-P individuals while suggesting that effective indicated interventions need to be identified. This evidence suggests a need for specialized services to detect CHR-P individuals in primary and secondary care settings, to formulate a prognosis with validated psychometric instruments, and to offer needs-based and psychological interventions.
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Affiliation(s)
- Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Institute of Psychiatry, Psychology & Neuroscience, Department of Psychosis Studies, King's College London, London, United Kingdom.,OASIS Service, South London and Maudsley National Health Service (NHS) Foundation Trust, London, United Kingdom.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,Maudsley Biomedical Research Centre, National Institute for Health Research, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Gonzalo Salazar de Pablo
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Institute of Psychiatry, Psychology & Neuroscience, Department of Psychosis Studies, King's College London, London, United Kingdom.,Institute of Psychiatry and Mental Health, Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Centro de Investigación Biomédica en Red Salud Mental (CIBERSAM), Madrid, Spain
| | - Christoph U Correll
- The Zucker Hillside Hospital, Department of Psychiatry, Northwell Health, Glen Oaks, New York.,The Feinstein Institute for Medical Research, Center for Psychiatric Neuroscience, Manhasset, New York.,Charité Universitätsmedizin Berlin, Department of Child and Adolescent Psychiatry, Berlin, Germany.,Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Andreas Meyer-Lindenberg
- Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Mark J Millan
- Centre for Therapeutic Innovation in Neuropsychiatry, Institut de Recherche Servier, Croissy sur Seine, Paris, France
| | - Stefan Borgwardt
- Department of Psychiatry, University of Basel, Basel, Switzerland.,Department of Psychiatry, Psychosomatics and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Silvana Galderisi
- Department of Psychiatry, University of Campania L. Vanvitelli, Naples, Italy
| | - Andreas Bechdolf
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine with Early Intervention and Recognition Centre, Vivantes Klinikum Am Urban, Charité-Universitätsmedizin, Berlin, Germany.,Vivantes Klinikum im Friedrichshain, Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Charité-Universitätsmedizin, Berlin, Germany.,Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany.,Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia
| | - Andrea Pfennig
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Medical Faculty, Technische Universität Dresden, Dresden, Germany
| | - Lars Vedel Kessing
- Copenhagen Affective Disorder Research Center, Psychiatric Center Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Therese van Amelsvoort
- Department of Psychiatry and Neuropsychology, Maastricht University Medical Center School for Mental Health and Neuroscience, Maastricht, the Netherlands
| | - Dorien H Nieman
- Amsterdam University Medical Centers, Academic Medical Center, Department of Psychiatry, Amsterdam, the Netherlands
| | - Katharina Domschke
- Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Center for Basics in NeuroModulation (NeuroModul), Medical Faculty, University of Freiburg, Germany
| | - Marie-Odile Krebs
- INSERM, IPNP UMR S1266, Laboratoire de Physiopathologie des Maladies Psychiatriques, Université Paris Descartes, Université de Paris, CNRS, GDR3557-Institut de Psychiatrie, Paris, France.,Faculté de Médecine Paris Descartes, GHU Paris-Sainte-Anne, Service Hospitalo-Universitaire, Paris, France
| | - Nikolaos Koutsouleris
- University Hospital, Department of Psychiatry and Psychotherapy, Ludwig Maximilian University of Munich, Munich, Germany.,Institute of Psychiatry, Psychology & Neuroscience, Department of Psychosis Studies, King's College London, London, United Kingdom
| | - Philip McGuire
- Maudsley Biomedical Research Centre, National Institute for Health Research, South London and Maudsley NHS Foundation Trust, London, United Kingdom.,Institute of Psychiatry, Psychology & Neuroscience, Department of Psychosis Studies, King's College London, London, United Kingdom
| | - Kim Q Do
- Center for Psychiatric Neuroscience, Lausanne University Hospital, Lausanne-Prilly, Switzerland
| | - Celso Arango
- Institute of Psychiatry and Mental Health, Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Centro de Investigación Biomédica en Red Salud Mental (CIBERSAM), Madrid, Spain
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27
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Separation of hallucinations from other positive symptoms by prolactin response to 12.5 μg i.v. TRH (mini-TRH test). Schizophr Res 2020; 220:287-288. [PMID: 32253076 DOI: 10.1016/j.schres.2020.03.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 03/11/2020] [Accepted: 03/17/2020] [Indexed: 12/19/2022]
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28
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Carvalho AF, Solmi M, Sanches M, Machado MO, Stubbs B, Ajnakina O, Sherman C, Sun YR, Liu CS, Brunoni AR, Pigato G, Fernandes BS, Bortolato B, Husain MI, Dragioti E, Firth J, Cosco TD, Maes M, Berk M, Lanctôt KL, Vieta E, Pizzagalli DA, Smith L, Fusar-Poli P, Kurdyak PA, Fornaro M, Rehm J, Herrmann N. Evidence-based umbrella review of 162 peripheral biomarkers for major mental disorders. Transl Psychiatry 2020; 10:152. [PMID: 32424116 PMCID: PMC7235270 DOI: 10.1038/s41398-020-0835-5] [Citation(s) in RCA: 90] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 04/03/2020] [Accepted: 05/01/2020] [Indexed: 01/03/2023] Open
Abstract
The literature on non-genetic peripheral biomarkers for major mental disorders is broad, with conflicting results. An umbrella review of meta-analyses of non-genetic peripheral biomarkers for Alzheimer's disease, autism spectrum disorder, bipolar disorder (BD), major depressive disorder, and schizophrenia, including first-episode psychosis. We included meta-analyses that compared alterations in peripheral biomarkers between participants with mental disorders to controls (i.e., between-group meta-analyses) and that assessed biomarkers after treatment (i.e., within-group meta-analyses). Evidence for association was hierarchically graded using a priori defined criteria against several biases. The Assessment of Multiple Systematic Reviews (AMSTAR) instrument was used to investigate study quality. 1161 references were screened. 110 met inclusion criteria, relating to 359 meta-analytic estimates and 733,316 measurements, on 162 different biomarkers. Only two estimates met a priori defined criteria for convincing evidence (elevated awakening cortisol levels in euthymic BD participants relative to controls and decreased pyridoxal levels in participants with schizophrenia relative to controls). Of 42 estimates which met criteria for highly suggestive evidence only five biomarker aberrations occurred in more than one disorder. Only 15 meta-analyses had a power >0.8 to detect a small effect size, and most (81.9%) meta-analyses had high heterogeneity. Although some associations met criteria for either convincing or highly suggestive evidence, overall the vast literature of peripheral biomarkers for major mental disorders is affected by bias and is underpowered. No convincing evidence supported the existence of a trans-diagnostic biomarker. Adequately powered and methodologically sound future large collaborative studies are warranted.
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Affiliation(s)
- André F. Carvalho
- grid.17063.330000 0001 2157 2938Department of Psychiatry, University of Toronto, Toronto, ON Canada ,grid.155956.b0000 0000 8793 5925Centre for Addiction & Mental Health (CAMH), Toronto, ON Canada
| | - Marco Solmi
- grid.5608.b0000 0004 1757 3470Neuroscience Department, University of Padova, Padova, Italy ,grid.5608.b0000 0004 1757 3470Neuroscience Center, University of Padova, Padova, Italy ,grid.13097.3c0000 0001 2322 6764Early Psychosis: Interventions and Clinical-detection (EPIC) lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Marcos Sanches
- grid.155956.b0000 0000 8793 5925Centre for Addiction & Mental Health (CAMH), Toronto, ON Canada ,Krembil Centre for NeuroInformatics, Toronto, ON Canada
| | - Myrela O. Machado
- grid.417199.30000 0004 0474 0188Division of Dermatology, Women’s College Hospital, Toronto, ON Canada
| | - Brendon Stubbs
- grid.37640.360000 0000 9439 0839Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK ,grid.13097.3c0000 0001 2322 6764Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, De Crespigny Park, London, UK
| | - Olesya Ajnakina
- grid.13097.3c0000 0001 2322 6764Department of Biostatistics & Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Chelsea Sherman
- grid.17063.330000 0001 2157 2938Neuropsychopharmacology Research Group, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON Canada
| | - Yue Ran Sun
- grid.17063.330000 0001 2157 2938Neuropsychopharmacology Research Group, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON Canada
| | - Celina S. Liu
- grid.17063.330000 0001 2157 2938Neuropsychopharmacology Research Group, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON Canada
| | - Andre R. Brunoni
- grid.11899.380000 0004 1937 0722Service of Interdisciplinary Neuromodulation, Laboratory of Neurosciences (LIM-27) and National Institute of Biomarkers in Psychiatry (INBioN), Department and Institute of Psychiatry, University of São Paulo, São Paulo, SP Brazil ,grid.11899.380000 0004 1937 0722Department of Internal Medicine, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Giorgio Pigato
- grid.5608.b0000 0004 1757 3470Neuroscience Department, University of Padova, Padova, Italy ,grid.5608.b0000 0004 1757 3470Neuroscience Center, University of Padova, Padova, Italy
| | - Brisa S. Fernandes
- grid.267308.80000 0000 9206 2401Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center, Houston, TX USA
| | | | - Muhammad I. Husain
- grid.17063.330000 0001 2157 2938Department of Psychiatry, University of Toronto, Toronto, ON Canada ,grid.155956.b0000 0000 8793 5925Centre for Addiction & Mental Health (CAMH), Toronto, ON Canada
| | - Elena Dragioti
- grid.5640.70000 0001 2162 9922Pain and Rehabilitation Centre, and Department of Medical and Health Sciences, Linköping University, SE-581 85 Linköping, Sweden
| | - Joseph Firth
- grid.1029.a0000 0000 9939 5719NICM Health Research Institute, Western Sydney University, Westmead, Australia ,grid.5379.80000000121662407Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Theodore D. Cosco
- grid.61971.380000 0004 1936 7494Gerontology Research Center, Simon Fraser University, Vancouver, Canada ,grid.4991.50000 0004 1936 8948Oxford Institute of Population Ageing, University of Oxford, Oxford, UK
| | - Michael Maes
- grid.7922.e0000 0001 0244 7875Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand ,grid.1021.20000 0001 0526 7079IMPACT Strategic Research Center, Deakin University, Geelong, Australia
| | - Michael Berk
- grid.1021.20000 0001 0526 7079IMPACT Strategic Research Center, Deakin University, Geelong, Australia ,grid.488501.0Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, VIC Australia ,grid.1008.90000 0001 2179 088XCentre for Youth Mental Health, University of Melbourne, Melbourne, VIC Australia ,grid.1008.90000 0001 2179 088XFlorey Institute for Neuroscience and Mental Health, University of Melbourne, Melbourne, VIC Australia
| | - Krista L. Lanctôt
- grid.17063.330000 0001 2157 2938Department of Psychiatry, University of Toronto, Toronto, ON Canada ,grid.155956.b0000 0000 8793 5925Centre for Addiction & Mental Health (CAMH), Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Neuropsychopharmacology Research Group, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Sunnybrook Research Institute, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON Canada
| | - Eduard Vieta
- grid.418264.d0000 0004 1762 4012Psychiatry and Psychology Department of the Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia Spain
| | - Diego A. Pizzagalli
- grid.38142.3c000000041936754XDepartment of Psychiatry & McLean Hospital, Harvard Medical School, Belmont, MA 02478 USA
| | - Lee Smith
- grid.5115.00000 0001 2299 5510The Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, UK
| | - Paolo Fusar-Poli
- grid.13097.3c0000 0001 2322 6764Early Psychosis: Interventions and Clinical-detection (EPIC) lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK ,OASIS Service, South London and Maudsley National Health Service Foundation Trust, London, UK ,grid.8982.b0000 0004 1762 5736Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Paul A. Kurdyak
- grid.17063.330000 0001 2157 2938Department of Psychiatry, University of Toronto, Toronto, ON Canada ,grid.418647.80000 0000 8849 1617Canada Institute for Clinical Evaluative Sciences (ICES), Toronto, ON Canada ,grid.155956.b0000 0000 8793 5925Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Michele Fornaro
- grid.4691.a0000 0001 0790 385XDepartment of Neuroscience, Reproductive Science and Dentistry, Section of Psychiatr, University School of Medicine Federico II, Naples, Italy
| | - Jürgen Rehm
- grid.17063.330000 0001 2157 2938Department of Psychiatry, University of Toronto, Toronto, ON Canada ,grid.155956.b0000 0000 8793 5925Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Canada ,grid.155956.b0000 0000 8793 5925Campbell Family Mental Health Research Institute, CAMH, Toronto, Canada ,grid.17063.330000 0001 2157 2938Addiction Policy, Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada ,grid.4488.00000 0001 2111 7257Institute of Clinical Psychology and Psychotherapy & Center for Clinical Epidemiology and Longitudinal Studies, Technische Universität Dresden, Dresden, Germany ,grid.17063.330000 0001 2157 2938Institute of Medical Science, University of Toronto, Toronto, Canada ,grid.448878.f0000 0001 2288 8774Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Nathan Herrmann
- grid.17063.330000 0001 2157 2938Department of Psychiatry, University of Toronto, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Neuropsychopharmacology Research Group, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Sunnybrook Research Institute, Toronto, ON Canada
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Cullen AE, Addington J, Bearden CE, Stone WS, Seidman LJ, Cadenhead KS, Cannon TD, Cornblatt BA, Mathalon DH, McGlashan TH, Perkins DO, Tsuang MT, Woods SW, Walker EF. Stressor-Cortisol Concordance Among Individuals at Clinical High-Risk for Psychosis: Novel Findings from the NAPLS Cohort. Psychoneuroendocrinology 2020; 115:104649. [PMID: 32197198 PMCID: PMC7193890 DOI: 10.1016/j.psyneuen.2020.104649] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 02/19/2020] [Accepted: 03/04/2020] [Indexed: 01/02/2023]
Abstract
Whilst elevations in basal cortisol levels have been reported among individuals at-risk for psychosis, the extent to which this represents hyperresponsivity of the hypothalamic-pituitary-adrenal (HPA) axis to psychosocial stressors encountered in the natural environment is currently unclear. We aimed to examine stressor-cortisol concordance among youth at clinical high-risk (CHR) for psychosis in the North American Prodrome Longitudinal Study 2 (NAPLS 2) and the relationship with clinical outcome. At baseline, CHR (N = 457) and healthy (N = 205) individuals provided salivary cortisol samples and completed daily stressor, life event, and childhood trauma measures. CHR youth were categorised as remitted, symptomatic, progression of positive symptoms, or psychosis conversion at the two-year follow-up. Within-group regression models tested associations between psychosocial stressors and cortisol; standardised beta coefficients (Stβ) were subsequently derived to enable within-group pooling of effect sizes across stressor types. After adjustment for potential confounders, all CHR subgroups reported greater exposure to life events and daily stressors, and more distress in relation to these events, relative to controls. All CHR groups were also more likely to experience childhood trauma; only CHR converters, however, were characterised by elevated basal cortisol. Daily stressor distress was significantly associated with cortisol in controls (β = 0.60, 95% CI: 0.12-1.08) and CHR youth who converted to psychosis (β = 0.91, 95% CI: 0.05-1.78). In controls only, life event exposure was associated with cortisol (β = 0.45, 95% CI: 0.08-0.83). When pooled across stressors, stressor-cortisol concordance was substantially higher among CHR converters (Stβ = 0.26, 95% CI: 0.07 to 0.44) relative to CHR progressed (Stβ = 0.02, 95% CI: -0.11 to 0.15), symptomatic (Stβ = 0.01, 95% CI: -0.11 to 0.12), and remitted groups (Stβ = 0.00, 95% CI: -0.13 to 0.13); however, unexpectedly, healthy controls showed intermediate levels of concordance (Stβ = 0.15, 95% CI: 0.05 to 0.26). In conclusion, whilst all CHR subgroups showed increased psychosocial stress exposure and distress relative to controls, only those who later converted to psychosis were characterised by significantly elevated basal cortisol levels. Moreover, only CHR converters showed a higher magnitude of stressor-cortisol concordance compared to controls, although confidence intervals overlapped considerably between these two groups. These findings do not support the notion that all individuals at CHR for psychosis show HPA hyperresponsiveness to psychosocial stressors. Instead, CHR individuals vary in their response to stressor exposure/distress, perhaps driven by genetic or other vulnerability factors.
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Affiliation(s)
- Alexis E. Cullen
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom,Corresponding author at: Institute of Psychiatry, Psychology & Neuroscience (PO67), 16 De Crespigny Park, Denmark Hill, London, SE5 8AF, United Kingdom.
| | - Jean Addington
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Carrie E. Bearden
- Department of Psychiatry and Behavioural Sciences and Psychology, UCLA, Los Angeles, United States
| | - William S. Stone
- Harvard Medical School, Departments of Psychiatry at Massachusetts Mental Health Center Public Psychiatry Division, Beth Israel Deaconess Medical Center, Massachusetts, General Hospital, Boston, MA, United States
| | - Larry J. Seidman
- Harvard Medical School, Departments of Psychiatry at Massachusetts Mental Health Center Public Psychiatry Division, Beth Israel Deaconess Medical Center, Massachusetts, General Hospital, Boston, MA, United States
| | - Kristin S. Cadenhead
- Department of Psychiatry, University of California, San Diego, CA, United States
| | - Tyrone D. Cannon
- Department of Psychiatry, Yale University, New Haven, Connecticut, United States
| | - Barbara A. Cornblatt
- Department of Psychiatry, Zucker Hillside Hospital, Long Island, NY, United States
| | - Daniel H. Mathalon
- Department of Psychiatry, University of California, San Francisco Veterans Affairs Medical Center, San Francisco, CA, United States
| | | | - Diana O. Perkins
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, United States
| | - Ming T. Tsuang
- Department of Psychiatry, University of California, San Diego, CA, United States
| | - Scott W. Woods
- Department of Psychiatry, Yale University, New Haven, CT, United States
| | - Elaine F. Walker
- Department of Psychology, Emory University, Atlanta, GA, United States,Department of Psychiatry, Emory University, Atlanta, GA, United States,Corresponding author at: 487 PAIS Building, 36 Eagle Row, Emory University, Atlanta, GA, 30322, United States.
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Chaumette B, Kebir O, Dion PA, Rouleau GA, Krebs MO. Reliability and correlation of mixture cell correction in methylomic and transcriptomic blood data. BMC Res Notes 2020; 13:74. [PMID: 32051015 PMCID: PMC7017605 DOI: 10.1186/s13104-020-4936-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 02/03/2020] [Indexed: 12/15/2022] Open
Abstract
Objectives The number of DNA methylome and RNA transcriptome studies is growing, but investigators have to consider the cell type composition of tissues used. In blood samples, the data reflect the picture of a mixture of different cells. Specialized algorithms can address the cell-type heterogeneity issue. We tested if these corrections are correlated between two heterogeneous datasets. Results We used methylome and transcriptome datasets derived from a cohort of ten individuals whose blood was sampled at two different timepoints. We examined how the cell composition derived from these omics correlated with each other using “CIBERSORT” for the transcriptome and “estimateCellCounts function” in R for the methylome. The correlation coefficients between the two omic datasets ranged from 0.45 to 0.81 but correlations were minimal between two different timepoints. Our results suggest that a posteriori correction of a mixture of cells present in blood samples is reliable. Using an omic dataset to correct a second dataset for relative fractions of cells appears to be applicable, but only when the samples are simultaneously collected. This could be beneficial when there are difficulties to control the cell types in the second dataset, even when the sample size is limited.
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Affiliation(s)
- Boris Chaumette
- Department of Psychiatry, McGill University, Montreal, Canada. .,Université de Paris, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, 102-108 Rue de la Santé, 75014, Paris, France. .,GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte Anne, Paris, France. .,CNRS GDR 3557 Institut de Psychiatrie, Paris, France.
| | - Oussama Kebir
- Université de Paris, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, 102-108 Rue de la Santé, 75014, Paris, France.,GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte Anne, Paris, France.,CNRS GDR 3557 Institut de Psychiatrie, Paris, France
| | - Patrick A Dion
- Montreal Neurological Institute, Department of Neurology and Neurosurgery, McGill University, Montreal, Canada
| | - Guy A Rouleau
- Montreal Neurological Institute, Department of Neurology and Neurosurgery, McGill University, Montreal, Canada
| | - Marie-Odile Krebs
- Université de Paris, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, 102-108 Rue de la Santé, 75014, Paris, France.,GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte Anne, Paris, France.,CNRS GDR 3557 Institut de Psychiatrie, Paris, France
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Pan X, Kaminga AC, Wen SW, Wang Z, Wu X, Liu A. The 24-hour urinary cortisol in post-traumatic stress disorder: A meta-analysis. PLoS One 2020; 15:e0227560. [PMID: 31918435 PMCID: PMC6952249 DOI: 10.1371/journal.pone.0227560] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Accepted: 12/20/2019] [Indexed: 01/09/2023] Open
Abstract
Objective Previous studies found inconsistent results on the relationship between post-traumatic stress disorder (PTSD) and concentrations of 24-hour (24-h) urinary cortisol. This study performed a systematic review and meta-analysis to summarize previous findings on this relationship. Methods We searched in the databases of Web of Science, PubMed, Embase, and Psyc-ARTICLES for articles published before September 2018. We used the random-effects model with restricted maximum-likelihood estimator to synthesize the effect sizes by calculating the standardized mean difference (SMD) and assessing its significance. Results Six hundred and nineteen articles were identified from the preceding databases and 20 of them were included in the meta-analysis. Lower concentrations of 24-h urinary cortisol were observed in patients with PTSD when compared with the controls (SMD = -0.49, 95%CI [-0.91; -0.07], p = 0.02). Subgroup analysis revealed that the concentrations of 24-h urinary cortisol were lower in PTSD patients than in the controls for studies that included female participants or studies that included participants from the United States of America. Conclusions Overall, decreased levels of 24-h urinary cortisol were linked with the pathophysiology of PTSD. Nonetheless, more studies should be conducted to validate the molecular underpinnings of urine cortisol degeneration in PTSD.
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Affiliation(s)
- Xiongfeng Pan
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Atipatsa C Kaminga
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China.,Department of Mathematics and Statistics, Mzuzu University, Mzuzu, Malawi
| | - Shi Wu Wen
- Department of Obstetrics and Gynaecology, University of Ottawa, Ottawa, Ontario, Canada.,Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Zhipeng Wang
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Xiaoli Wu
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Aizhong Liu
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
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Merritt J, Tanguturi Y, Fuchs C, Cundiff AW. Medical Etiologies of Secondary Psychosis in Children and Adolescents. Child Adolesc Psychiatr Clin N Am 2020; 29:29-42. [PMID: 31708051 DOI: 10.1016/j.chc.2019.08.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This is an updated review of child and adolescent somatic disorders associated with psychosis/psychotic symptoms, organized into neurologic, infectious, genetic, inborn errors of metabolism, autoimmune, rheumatologic, endocrine, nutritional, metabolic, and iatrogenic categories. When possible clinical manifestations or types of psychotic symptoms and proposed neuropathogenesis causing the neuropsychiatric symptoms are included. In some cases, the psychiatric symptoms may be the first presentation of the disease. The authors hope that this review will aid child and adolescent psychiatrists in considering alternative etiologies of youth presenting with psychosis and encourage appropriate physical examination, history, and further work-up when suspected.
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Affiliation(s)
- Jessica Merritt
- Department of Child and Adolescent Psychiatry, Vanderbilt University Medical Center, 1500 21st Avenue South, Suite 2200, Nashville, TN 37212, USA
| | - Yasas Tanguturi
- Department of Psychiatry, Child and Adolescent Psychiatry, Vanderbilt University Medical Center, 1601 23rd Avenue South, Nashville, TN 37212, USA
| | - Catherine Fuchs
- Department of Child and Adolescent Psychiatry, Vanderbilt University Medical Center, 1500 21st Avenue South, Suite 2200, Nashville, TN 37212, USA
| | - Allyson Witters Cundiff
- Department of Child and Adolescent Psychiatry, Vanderbilt University Medical Center, 1500 21st Avenue South, Suite 2200, Nashville, TN 37212, USA.
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Cullen AE, Rai S, Vaghani MS, Mondelli V, McGuire P. Cortisol Responses to Naturally Occurring Psychosocial Stressors Across the Psychosis Spectrum: A Systematic Review and Meta-Analysis. Front Psychiatry 2020; 11:513. [PMID: 32595532 PMCID: PMC7300294 DOI: 10.3389/fpsyt.2020.00513] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 05/19/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Individuals with established psychosis and those at high-risk for the disorder have been found to show abnormalities within the hypothalamic-pituitary-adrenal (HPA) axis, including elevations in basal and diurnal cortisol, but a blunted cortisol awakening response. However, the extent to which these features are associated with psychosocial stressors encountered in the natural environment (which are known to be more commonly experienced by these groups, and more distressing) is currently unclear. We therefore conducted a systematic review and meta-analysis to investigate the concordance between naturally-occurring psychosocial stressors and cortisol levels in these populations. METHODS PubMed, PsycINFO, and EMBASE were searched up to November 2019 to identify studies examining the concordance between psychosocial stressors and cortisol in healthy controls and individuals on the psychosis spectrum (patients with established psychosis and/or high-risk individuals). An overall meta-analysis (including data for all stressor-cortisol pairings) was performed to determine the degree of concordance irrespective of group status, with meta-regression employed to test whether the degree of concordance differed in established psychosis and high-risk groups compared to controls. Planned stratified analyses were then performed to examine group differences (where established psychosis and high-risk groups were combined) within individual stressor-cortisol pairings. RESULTS Eighteen studies (16 datasets) were eligible for inclusion. The overall model, comprising 134 effect sizes, showed that stressors and cortisol measures were only weakly correlated [r=0.05 (95% CI: -0.00 to 0.10), p=0.059] and that neither established psychosis status (r=0.01, p=0.838) nor high-risk status (r=0.02, p=0.477) had a significant effect of the strength of correlation. In stratified analyses, significant differences between healthy controls and psychosis spectrum groups were observed for only one of the six stressor-cortisol pairings examined, where life event exposure and diurnal cortisol were positively correlated in controls [r=0.25 (95% CI: 0.01 to 0.46)], but negatively correlated in the psychosis spectrum group [r=-0.28 (95% CI: -0.49 to -0.04)]. CONCLUSIONS Overall, we observed poor concordance between naturally-occurring psychosocial stressors and cortisol irrespective of stressor type, cortisol measure, or group status. We consider a range of methodological factors that may have obscured the ability to detect "true" associations and provide recommendations for future studies in this field.
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Affiliation(s)
- Alexis E Cullen
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Sushma Rai
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Meghna S Vaghani
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Valeria Mondelli
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.,NIHR Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Philip McGuire
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.,NIHR Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, United Kingdom
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Iftimovici A, Kebir O, He Q, Jay TM, Rouleau GA, Krebs MO, Chaumette B. Stress, Cortisol and NR3C1 in At-Risk Individuals for Psychosis: A Mendelian Randomization Study. Front Psychiatry 2020; 11:680. [PMID: 32754072 PMCID: PMC7367416 DOI: 10.3389/fpsyt.2020.00680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 06/29/2020] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION The emergence of psychosis in at-risk individuals results from interactions between genetic vulnerability and environmental factors, possibly involving dysregulation of the hypothalamic-pituitary-adrenal axis. Hypercorticism was indeed described in schizophrenia and ultra-high-risk states, but its association with clinical outcome has yet to be demonstrated. The impact of stress through cortisol may vary depending on the expression level of genes related to the stress pathway. METHODS To test this hypothesis, we selected NR3C1, the gene encoding the glucocorticoid receptor, and modeled through logistic regression how its peripheral expression could explain some of the risk of psychosis, independently of peripheral cortisol levels, in a French longitudinal prospective cohort of 133 at-risk individuals, adjusted for sex, age, cannabis, and antipsychotic medication intake. We then performed a genome-wide association analysis, stratified by sex (55 females and 78 males), to identify NR3C1 expression quantitative trait loci to be used as instrumental variables in a Mendelian randomization framework. RESULTS NR3C1 expression was significantly associated with a higher risk of conversion to psychosis (OR = 2.03, p = 0.03), independently of any other factor. Cortisol was not associated with outcome nor correlated with NR3C1. In the female subgroup, rs6849528 was associated both with NR3C1 mRNA levels (p = 0.015, Effect-Size = 2.7) and conversion (OR = 8.24, p = 0.03). CONCLUSIONS For the same level of cortisol, NR3C1 expression increases psychotic risk, independently of sex, age, cannabis, and antipsychotic intake. In females, Mendelian randomization confirmed NR3C1's effect on outcome to be unbiased by any environmental confounder.
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Affiliation(s)
- Anton Iftimovici
- Institut de Psychiatrie et Neurosciences de Paris, INSERM UMR 1266, Laboratoire de Physiopathologie des Maladies Psychiatriques, Université de Paris, GDR3557-Institut de Psychiatrie, Paris, France.,NeuroSpin, Atomic Energy Commission, Gif-sur-Yvette, France
| | - Oussama Kebir
- Institut de Psychiatrie et Neurosciences de Paris, INSERM UMR 1266, Laboratoire de Physiopathologie des Maladies Psychiatriques, Université de Paris, GDR3557-Institut de Psychiatrie, Paris, France.,GHU Paris Psychiatrie et Neurosciences, Paris, France
| | - Qin He
- Institut de Psychiatrie et Neurosciences de Paris, INSERM UMR 1266, Laboratoire de Physiopathologie des Maladies Psychiatriques, Université de Paris, GDR3557-Institut de Psychiatrie, Paris, France
| | - Thérèse M Jay
- Institut de Psychiatrie et Neurosciences de Paris, INSERM UMR 1266, Laboratoire de Physiopathologie des Maladies Psychiatriques, Université de Paris, GDR3557-Institut de Psychiatrie, Paris, France
| | | | - Guy A Rouleau
- Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Marie-Odile Krebs
- Institut de Psychiatrie et Neurosciences de Paris, INSERM UMR 1266, Laboratoire de Physiopathologie des Maladies Psychiatriques, Université de Paris, GDR3557-Institut de Psychiatrie, Paris, France.,GHU Paris Psychiatrie et Neurosciences, Paris, France
| | - Boris Chaumette
- Institut de Psychiatrie et Neurosciences de Paris, INSERM UMR 1266, Laboratoire de Physiopathologie des Maladies Psychiatriques, Université de Paris, GDR3557-Institut de Psychiatrie, Paris, France.,GHU Paris Psychiatrie et Neurosciences, Paris, France.,Department of Psychiatry, McGill University, Montreal, QC, Canada
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Cherian K, Schatzberg AF, Keller J. HPA axis in psychotic major depression and schizophrenia spectrum disorders: Cortisol, clinical symptomatology, and cognition. Schizophr Res 2019; 213:72-79. [PMID: 31307859 DOI: 10.1016/j.schres.2019.07.003] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 06/30/2019] [Accepted: 07/02/2019] [Indexed: 01/09/2023]
Abstract
The Hypothalamic Pituitary Adrenal (HPA) axis has been implicated in the pathophysiology of a variety of mood and cognitive disorders. Neuroendocrine studies have demonstrated HPA axis overactivity in major depression, a relationship of HPA axis activity to cognitive performance, and a potential role of HPA axis genetic variation in cognition. In schizophrenia differential HPA activity has been found, including higher rates of non-suppression to dexamethasone challenge and higher salivary cortisol levels, which have been a premonitory risk factor for conversion to psychosis in adolescents at risk for developing schizophrenia. The present study investigated the simultaneous roles HPA axis activity and clinical symptomatology play in poor cognitive performance. Patients with major depression with psychosis (PMD) or schizophrenia spectrum disorder (SCZ) and healthy controls (HC) were studied. All participants underwent a diagnostic interview and psychiatric ratings, a comprehensive neuropsychological battery, and overnight hourly blood sampling for cortisol. Cognitive performance did not differ between the clinical groups, though they both performed more poorly than the HC's across a variety of cognitive domains. Across all subjects, cognitive performance was negatively correlated with higher cortisol, and PMD patients had higher evening cortisol levels than did SCZ and HCs. Cortisol and clinical symptoms, as well as age, sex, and antipsychotic use predicted cognitive performance. Diathesis stress models and their links to symptomatology, cognition, and HPA function are discussed.
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Affiliation(s)
- Kirsten Cherian
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, United States of America; Palo Alto University, United States of America
| | - Alan F Schatzberg
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, United States of America
| | - Jennifer Keller
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, United States of America.
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Millman ZB, Gold JM, Mittal VA, Schiffman J. The Critical Need for Help-Seeking Controls in Clinical High-Risk Research. Clin Psychol Sci 2019; 7:1171-1189. [PMID: 33614257 PMCID: PMC7891463 DOI: 10.1177/2167702619855660] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Despite rapidly growing knowledge of the clinical high-risk (CHR) state for psychosis, the vast majority of case-control studies have relied on healthy volunteers as a reference point for drawing inferences about the CHR construct. Researchers have long recognized that results generated from this design are limited by significant interpretive concerns, yet little attention has been given to how these concerns affect the growing field of CHR research. We argue that overreliance on healthy controls in CHR research threatens the validity of inferences concerning group differences, hinders advances in understanding the development of psychosis, and limits clinical progress. We suggest that the combined use of healthy and help-seeking (i.e., psychiatric) controls is a necessary step for the next generation of CHR research. We then evaluate methods for help-seeking control studies, identify the available CHR studies that have used such designs, discuss select findings in this literature, and offer recommendations for research.
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Affiliation(s)
| | - James M. Gold
- Maryland Psychiatric Research Center, University of Maryland School of Medicine
| | - Vijay A. Mittal
- Department of Psychology, Northwestern University
- Department of Psychiatry, Northwestern University
- Institute for Policy Research, Northwestern University
- Medical Social Sciences, Northwestern University
- Institute for Innovations in Developmental Sciences, Northwestern University
| | - Jason Schiffman
- Department of Psychology, University of Maryland, Baltimore County
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Pituitary volume in individuals at elevated risk for psychosis: A systematic review and meta-analysis. Schizophr Res 2019; 213:23-31. [PMID: 30600112 DOI: 10.1016/j.schres.2018.12.026] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 12/13/2018] [Accepted: 12/16/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Pituitary volume (PV) abnormalities, representing one of several markers of hypothalamic-pituitary-adrenal (HPA) axis dysregulation, have been observed in psychosis, with variable patterns across illness stages. Typically, enlargements characterise first-episode patients, with reductions observed in those with chronic illness relative to healthy controls. Findings in high-risk populations have been inconsistent, highlighting the need for an updated review of the evidence. METHODS We searched PubMed, PsycINFO, and EMBASE for studies examining PV in high-risk [clinical high-risk (CHR), family history of psychosis (FHx), schizotypal personality disorder (SPD), and psychotic-experiences (PEs)] and healthy individuals. Random effects models were used to examine group differences in PV (Hedges g) with stratified analyses and meta-regression employed to investigate the effect of high-risk category, transition status, age, sex, and antipsychotic medication. RESULTS Ten studies, yielding 11 effect sizes, were eligible for inclusion. Overall, high-risk individuals had significantly larger PV relative to healthy controls (g = 0.16 [95% CI: 0.01 to 0.32] p = 0.04), despite showing a reduction in whole brain volume (g = -0.17, [95% CI. -0.30 to -0.03] p = 0.020). Individual sub-group analyses for CHR and FHx groups showed no significant differences relative to controls; however, larger PV increases characterised those who later transitioned to psychosis (g = 0.55, [95% CI. 0.06 to 1.04] p = 0.028). Larger effect sizes were positively associated with the proportion of high-risk individuals receiving antipsychotic medication. CONCLUSIONS PV enlargements characterise high-risk individuals and are more pronounced among those who later develop psychosis. We provide recommendations for future studies.
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Romain K, Eriksson A, Onyon R, Kumar M. The psychosis risk timeline: can we improve our preventive strategies? Part 3: primary common pathways and preventive strategies. BJPSYCH ADVANCES 2019. [DOI: 10.1192/bja.2019.34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SUMMARYPsychosis is a recognised feature of several psychiatric disorders and it causes patients significant distress and morbidity. It is therefore important to keep knowledge of possible risk factors for psychosis up to date and to have an overview model on which further learning can be structured. This article concludes a three-part series. It gives a review of evidence regarding common pathways by which many risk factors come together to influence the development of psychosis and finalises our suggested overview model, a psychosis risk timeline. The three primary pathways considered are based on the major themes identified in this narrative review of recent literature and they focus on neurological, neurochemical and inflammatory changes. We link each back to the factors discussed in the first and second parts of this series that alter psychosis risk through different mechanisms and at different stages throughout life. We then consider and summarise key aspects of this complex topic with the aim of providing current and future clinicians with a model on which to build their knowledge and begin to access and understand current psychosis research and implications for future preventive work.LEARNING OBJECTIVESAfter reading this article you will be able to:
•give an overview of common pathways thought to link identified risk factors with psychosis development•understand neurochemical, neurostructural and inflammatory changes associated with psychosis•demonstrate increased knowledge of possible preventive strategies.DECLARATION OF INTERESTNone.
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Labad J. The role of cortisol and prolactin in the pathogenesis and clinical expression of psychotic disorders. Psychoneuroendocrinology 2019; 102:24-36. [PMID: 30503781 DOI: 10.1016/j.psyneuen.2018.11.028] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 11/19/2018] [Accepted: 11/21/2018] [Indexed: 02/03/2023]
Abstract
For many years, the study of the psychotic phenotpe and approach to treatment of schizophrenia has been focused on positive psychotic symptoms, although the functional outcome is more clearly associated with negative and cognitive symptoms. Recently, there has been a growing interest in identifying biomarkers associated with these symptoms at early stages of the illness, including the risk of psychosis in vulnerable individuals (at-risk mental states [ARMS]). In this paper, the role of cortisol and prolactin in the clinical expression of psychosis will be reviewed. In examination of the role of these hormones and the risk of developing a psychotic disorder in ARMS individuals, previous studies have suggested potential roles for both cortisol and prolactin. The study of cognitive abilities in recent-onset psychotic patients has suggested that affected cognitive domains differ depending upon the studied hormones: cortisol (processing speed, verbal and working memory) and prolactin (processing speed), with several studies suggesting that there are sex-differences in these associations. All of these results suggest that both cortisol and prolactin contribute to the pathogenesis and clinical expression of psychotic disorders.
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Affiliation(s)
- Javier Labad
- Department of Mental Health, Parc Taulí Hospital Universitari, Institut d'Investigació Sanitària Parc Taulí (I3PT), Translational Neuroscience Unit, Universitat Autònoma de Barcelona (UAB), CIBERSAM. Sabadell, Barcelona, Spain.
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Bazsó A, Szappanos Á, Rásonyi R, Nagy E, Farkas A, Várnai B, Patócs A, Kiss E, Poór G. Polymorphisms of human glucocorticoid receptor gene in systemic lupus erythematosus: a single-centre result. Clin Rheumatol 2019; 38:1979-1984. [PMID: 30850964 DOI: 10.1007/s10067-019-04478-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 02/06/2019] [Accepted: 02/11/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND SLE is a systemic autoimmune disorder with multiple organ manifestations. Despite of the innovations glucocorticoids (GC) have still remained the first-line therapy in SLE. Besides HSD11B enzymes, intracellular glucocorticoid receptors (GR) affect tissue-specific cortisol effect and the consequent signalisation pathway. SNPs of the glucocorticoid receptor gene (NR3C1) modulate individual sensitivity to glucocorticoids. Our aim was to determine the allele frequency of the three, clinically most important SNPs in a SLE patient population in comparison to healthy volunteers and to find association with particular manifestations of SLE. METHODS We analysed results of 104 SLE patients compared to 160 healthy subjects. All patients were genotyped for the functional GR polymorphisms BclI, N363S, and A3669G. The GR gene polymorphisms were determined using allele-specific PCR and Taqman allelic discrimination assays. RESULTS The BclI allele frequency was lower in the SLE group compared to the healthy control group. The central nervous system and especially psychiatric symptoms developed more frequently in the BclI carriers compared to none carriers. The prevalence of theA3669G polymorphism was the same in both groups, but showed a negative association with the psychiatric symptoms. CONCLUSION The increased and decreased sensitivity associated with GR BclI and A3669G polymorphisms could have a pathogenic significance in SLE especial with the central nervous system and psychiatric symptoms. Improving our knowledge on the importance of GR polymorphisms may reveal their pathophysiologic and therapeutic consequences.
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Affiliation(s)
- Anna Bazsó
- National Rheumatology and Physiotherapy Institute, Frankel Leo út 38-40,, Budapest, 1023, Hungary.
| | - Ágnes Szappanos
- National Rheumatology and Physiotherapy Institute, Frankel Leo út 38-40,, Budapest, 1023, Hungary
- HAS-SE Lendulet Hereditary Endocrine Tumours Research Group, Budapest, Hungary
| | - Rita Rásonyi
- National Rheumatology and Physiotherapy Institute, Frankel Leo út 38-40,, Budapest, 1023, Hungary
| | - Eszter Nagy
- National Rheumatology and Physiotherapy Institute, Frankel Leo út 38-40,, Budapest, 1023, Hungary
| | - Abigél Farkas
- 2nd Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Blanka Várnai
- 2nd Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Attila Patócs
- HAS-SE Lendulet Hereditary Endocrine Tumours Research Group, Budapest, Hungary
- Department of Laboratory Medicine, Semmelweis University, Budapest, Hungary
| | - Emese Kiss
- National Rheumatology and Physiotherapy Institute, Frankel Leo út 38-40,, Budapest, 1023, Hungary
- 3rd Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Gyula Poór
- National Rheumatology and Physiotherapy Institute, Frankel Leo út 38-40,, Budapest, 1023, Hungary
- 3rd Department of Medicine, Semmelweis University, Budapest, Hungary
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Ciufolini S, Gayer-Anderson C, Fisher HL, Marques TR, Taylor H, Di Forti M, Zunszain P, Morgan C, Murray RM, Pariante CM, Dazzan P, Mondelli V. Cortisol awakening response is decreased in patients with first-episode psychosis and increased in healthy controls with a history of severe childhood abuse. Schizophr Res 2019; 205:38-44. [PMID: 29776641 DOI: 10.1016/j.schres.2018.05.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 04/30/2018] [Accepted: 05/04/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Childhood abuse is highly prevalent in psychosis patients, but whether/how it affects hypothalamic-pituitary-adrenal (HPA) axis at the onset of psychosis remains unclear. We aimed to investigate the effects of severity of childhood abuse on HPA axis activity, in first-episode psychosis (FEP) and healthy controls. METHODS We recruited 169 FEP patients and 133 controls with different degrees of childhood physical and sexual abuse (i.e. no abuse exposure, non-severe abuse exposure, and severe abuse exposure). Saliva samples were collected to measure cortisol awakening response with respect to ground (CARg), increase (CARi) and diurnal (CDD) cortisol levels. Two-way ANOVA analyses were conducted to test the relationships between severity of childhood abuse and psychosis on cortisol levels in individuals with psychosis and healthy controls with and without childhood abuse history. RESULTS A statistically significant interaction between childhood abuse and psychosis on CARg was found (F(2,262) = 4.60, p = 0.011, ω2 = 0.42). Overall, controls showed a U-shaped relationship between abuse exposure and CARg, while patients showed an inverted U-shaped relationship. CARg values were markedly different between patients and controls with either no abuse history or exposure to severe childhood abuse. No significant differences were found when looking at CARi and CDD. CONCLUSIONS Our results show a divergent effect of severe childhood abuse on HPA axis activity in patients with first-episode psychosis and in controls. In the presence of exposure to severe childhood abuse, a blunted CARg and a less reactive HPA axis may represent one of the biological mechanisms involved in the development of psychosis.
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Affiliation(s)
- Simone Ciufolini
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, Department of Psychosis Studies, London, UK; National Institute for Health Research (NIHR), Mental Health Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, King's College London, UK
| | - Charlotte Gayer-Anderson
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, Department of Health Services & Population Research, London, UK
| | - Helen L Fisher
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, Social, Genetic & Developmental Psychiatry Centre, London, UK
| | - Tiago Reis Marques
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, Department of Psychosis Studies, London, UK
| | - Heather Taylor
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, Department of Psychosis Studies, London, UK
| | - Marta Di Forti
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, Social, Genetic & Developmental Psychiatry Centre, London, UK
| | - Patricia Zunszain
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, Department of Psychological Medicine, London, UK
| | - Craig Morgan
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, Department of Health Services & Population Research, London, UK
| | - Robin M Murray
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, Department of Psychosis Studies, London, UK
| | - Carmine M Pariante
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, Department of Psychological Medicine, London, UK; National Institute for Health Research (NIHR), Mental Health Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, King's College London, UK
| | - Paola Dazzan
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, Department of Psychosis Studies, London, UK; National Institute for Health Research (NIHR), Mental Health Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, King's College London, UK
| | - Valeria Mondelli
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, Department of Psychological Medicine, London, UK; National Institute for Health Research (NIHR), Mental Health Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, King's College London, UK.
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Pillinger T, D’Ambrosio E, McCutcheon R, Howes OD. Is psychosis a multisystem disorder? A meta-review of central nervous system, immune, cardiometabolic, and endocrine alterations in first-episode psychosis and perspective on potential models. Mol Psychiatry 2019; 24:776-794. [PMID: 29743584 PMCID: PMC6124651 DOI: 10.1038/s41380-018-0058-9] [Citation(s) in RCA: 106] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 02/01/2018] [Accepted: 02/21/2018] [Indexed: 01/02/2023]
Abstract
People with psychotic disorders show abnormalities in several organ systems in addition to the central nervous system (CNS); and this contributes to excess mortality. However, it is unclear how strong the evidence is for alterations in non-CNS systems at the onset of psychosis, how the alterations in non-CNS systems compare to those in the CNS, or how they relate to symptoms. Here, we consider these questions, and suggest potential models to account for findings. We conducted a systematic meta-review to summarize effect sizes for both CNS (focusing on brain structural, neurophysiological, and neurochemical parameters) and non-CNS dysfunction (focusing on immune, cardiometabolic, and hypothalamic-pituitary-adrenal (HPA) systems) in first-episode psychosis (FEP). Relevant meta-analyses were identified in a systematic search of Pubmed and the methodological quality of these was assessed using the AMSTAR checklist (A Measurement Tool to Assess Systematic Reviews). Case-control data were extracted from studies included in these meta-analyses. Random effects meta-analyses were re-run and effect size magnitudes for individual parameters were calculated, as were summary effect sizes for each CNS and non-CNS system. We also grouped studies to obtain overall effect sizes for non-CNS and CNS alterations. Robustness of data for non-CNS and CNS parameters was assessed using Rosenthal's fail-safe N. We next statistically compared summary effect size for overall CNSand overall non-CNS alterations, as well as for each organ system separately. We also examined how non-CNS alterations correlate CNS alterations, and with psychopathological symptoms. Case-control data were extracted for 165 studies comprising a total sample size of 13,440. For people with first episode psychosis compared with healthy controls, we observed alterations in immune parameters (summary effect size: g = 1.19), cardiometabolic parameters (g = 0.23); HPA parameters (g = 0.68); brain structure (g = 0.40); neurophysiology (g = 0.80); and neurochemistry (g = 0.43). Grouping non-CNS organ systems together provided an effect size for overall non-CNS alterations in patients compared with controls (g = 0.58), which was not significantly different from the overall CNS alterations effect size (g = 0.50). However, the summary effect size for immune alterations was significantly greater than that for brain structural (P < 0.001) and neurochemical alterations (P < 0.001), while the summary effect size for cardiometabolic alterations was significantly lower than neurochemical (P = 0.04), neurophysiological (P < 0.001), and brain structural alterations (P = 0.001). The summary effect size for HPA alterations was not significantly different from brain structural (P = 0.14), neurophysiological (P = 0.54), or neurochemical alterations (P = 0.22). These outcomes remained similar in antipsychotic naive sensitivity analyses. We found some, but limited and inconsistent, evidence that non-CNS alterations were associated with CNS changes and symptoms in first episode psychosis. Our findings indicate that there are robust alterations in non-CNS systems in psychosis, and that these are broadly similar in magnitude to a range of CNS alterations. We consider models that could account for these findings and discuss implications for future research and treatment.
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Affiliation(s)
- Toby Pillinger
- 0000 0001 2322 6764grid.13097.3cIoPPN, King’s College London, De Crespigny Park, London, SE5 8AF UK
| | - Enrico D’Ambrosio
- 0000 0001 2322 6764grid.13097.3cIoPPN, King’s College London, De Crespigny Park, London, SE5 8AF UK
| | - Robert McCutcheon
- 0000 0001 2322 6764grid.13097.3cIoPPN, King’s College London, De Crespigny Park, London, SE5 8AF UK
| | - Oliver D. Howes
- 0000 0001 2322 6764grid.13097.3cIoPPN, King’s College London, De Crespigny Park, London, SE5 8AF UK ,0000000122478951grid.14105.31MRC London Institute of Medical Sciences (LMS), Du Cane Road, London, W12 0NN UK ,0000 0001 2113 8111grid.7445.2Institute of Clinical Sciences (ICS), Faculty of Medicine, Imperial College London, Du Cane Road, London, W12 0NN UK
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Elevated allostatic load early in the course of schizophrenia. Transl Psychiatry 2018; 8:246. [PMID: 30420620 PMCID: PMC6232085 DOI: 10.1038/s41398-018-0299-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 06/17/2018] [Accepted: 07/14/2018] [Indexed: 12/19/2022] Open
Abstract
Stress plays a significant role in schizophrenia from disease onset to exacerbation of psychotic symptoms. Allostatic load (AL) is a measure of cumulative stress to the organism. This study is an extension of our previous work on AL and its relationship to brain structures. Here, we further determined whether elevated AL is a function of illness chronicity, or if it is already present early in the course of schizophrenia. AL was compared in schizophrenia patients early in the illness (within 5 years of disease onset), patients with chronic schizophrenia (more than 5 years of illness), and two groups of healthy controls that were age-and sex-matched to the two patient groups. This work is presented with an expanded sample and includes about two-thirds of the participants who were previously reported. We found that patients with early psychosis had significantly elevated AL score compared with their age-matched controls (p = 0.005). Chronic course patients also had elevated AL compared with age-matched controls (p = 0.003). Immune and stress hormone AL subcomponents were nominally higher in early-stage patients compared with controls (p = 0.005 and 0.04, respectively). Greater AL was also associated with more severe positive psychotic symptoms in early-stage patients (r = 0.54, p = 0.01). Elevated levels of allostatic load are already present in the early years of the schizophrenia illness, particularly in patients with more severe psychotic symptoms. AL may be a useful evaluation for the need of early intervention on psychosomatic comorbidity.
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Vaessen T, Kasanova Z, Hernaus D, Lataster J, Collip D, van Nierop M, Myin-Germeys I. Overall cortisol, diurnal slope, and stress reactivity in psychosis: An experience sampling approach. Psychoneuroendocrinology 2018; 96:61-68. [PMID: 29906787 DOI: 10.1016/j.psyneuen.2018.06.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 06/05/2018] [Accepted: 06/06/2018] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Results from experimental studies suggest that psychosis and psychosis liability are associated with increased cortisol levels and blunted cortisol reactivity, and that use of antipsychotics may reduce these aberrations. Here, we report on overall cortisol, diurnal slope, and cortisol stress reactivity in everyday life in psychosis and psychosis liability using the experience sampling method (ESM). METHODS Our sample consisted of individuals diagnosed with psychotic disorder currently on (MPD; n = 53) or off antipsychotic medication (NMPD; n = 20), first-degree relatives of psychotic patients (REL; n = 47), and healthy volunteers (HV; n = 67). Saliva samples were collected throughout the day on six consecutive days and analyzed for cortisol levels. Simultaneously, stressfulness of the current activity was assessed with ESM questionnaires. RESULTS We found no group differences in overall cortisol level between groups, but REL had a steeper diurnal slope than HV; in MPD a trend was found in the same direction. Regarding reactivity to stressful activities, results indicated attenuation of the cortisol response in both patient groups compared to HV. CONCLUSION These results do not confirm reports of increased cortisol levels in psychosis, but provide evidence of stress-related cortisol alterations in everyday life.
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Affiliation(s)
- Thomas Vaessen
- Department of Neurosciences, Psychiatry Research Group, Center for Contextual Psychiatry, KU Leuven, Belgium; Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands.
| | - Zuzana Kasanova
- Department of Neurosciences, Psychiatry Research Group, Center for Contextual Psychiatry, KU Leuven, Belgium
| | - Dennis Hernaus
- Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Johan Lataster
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands; Faculty of Psychology and Educational Sciences, Open University, Heerlen, The Netherlands
| | - Dina Collip
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Martine van Nierop
- Department of Neurosciences, Psychiatry Research Group, Center for Contextual Psychiatry, KU Leuven, Belgium
| | - Inez Myin-Germeys
- Department of Neurosciences, Psychiatry Research Group, Center for Contextual Psychiatry, KU Leuven, Belgium
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Khoury R, Nasrallah HA. Inflammatory biomarkers in individuals at clinical high risk for psychosis (CHR-P): State or trait? Schizophr Res 2018; 199:31-38. [PMID: 29703661 DOI: 10.1016/j.schres.2018.04.017] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Revised: 04/04/2018] [Accepted: 04/10/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Studies linking neuro-inflammation to psychotic episodes has been rapidly expanding. Assessments of changes in inflammatory biomarkers in prodromal patients who subsequently convert to psychosis may help in predicting those likely to transition to psychosis. METHODS We reviewed the literature for original studies that measured inflammatory biomarkers in individuals at clinical high risk for psychosis (CHR-P), and compared pro-inflammatory biomarker data between converters and non-converters to psychosis as well as in healthy controls. RESULTS Our search yielded 15 studies. Our findings suggest a possible role of plasma levels of Interleukins-1β, 7, 8, matrix metalloproteinase (MMP)-8, cortisol, albumin and salivary cortisol, measured at baseline, as predictors of psychotic transition. Both baseline C-reactive protein (CRP) and Interleukin-6 levels were not shown to discriminate between converters and non-converters to psychosis. The dearth of longitudinal biomarker measures, before and after treating the psychotic episodes, was a limitation for assessing inflammatory biomarkers as trait vs state marker properties of biomarkers. DISCUSSION Gaps of data in published studies prevent confirming whether inflammatory biomarkers are state or trait indicators of transition to psychosis in the CHR-P populations. Future investigations should be designed to longitudinally measure inflammatory biomarkers in order to navigate the extensive heterogeneity of the schizophrenia syndrome and its prodrome.
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Affiliation(s)
- Rita Khoury
- Department of Psychiatry and Behavioral Neuroscience, Saint Louis University School of Medicine, United States.
| | - Henry A Nasrallah
- Department of Psychiatry and Behavioral Neuroscience, Saint Louis University School of Medicine, United States
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Emotion regulation as a predictor of the endocrine, autonomic, affective, and symptomatic stress response and recovery. Psychoneuroendocrinology 2018; 94:112-120. [PMID: 29775874 DOI: 10.1016/j.psyneuen.2018.04.028] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Revised: 03/15/2018] [Accepted: 04/25/2018] [Indexed: 01/16/2023]
Abstract
Stress is associated with the development of mental disorders such as depression and psychosis. The ability to regulate emotions is likely to influence how individuals respond to and recover from acute stress, and may thus be relevant to symptom development. To test this, we investigated whether self-reported emotion regulation predicts the endocrine, autonomic, affective, and symptomatic response to and recovery from a stressor. Social-evaluative stress was induced by the Trier Social Stress Test (TSST) in N = 67 healthy individuals (53.7% female, Mage = 29.9). Self-reported habitual emotion regulation skills were assessed at baseline. We measured salivary cortisol, heart rate, negative affect, state depression and state paranoia at three time points: pre-TSST, post-TSST, and after a 10 min recovery phase. Repeated-measures ANOVA showed all indicators to significantly increase in response to the stressor (p < .001) and decrease during the recovery phase (p < .001), except for salivary cortisol, which showed a linear increase (p < .001). The habitual use of maladaptive emotion regulation (e.g., rumination, catastrophizing) significantly predicted an increased affective and reduced cortisol response. Adaptive emotion regulation (e.g., acceptance, reappraisal) was not predictive of the stress response for any of the indicators. Neither type of emotion regulation predicted response during the stress recovery phase. Individuals who habitually resort to maladaptive emotion regulation strategies show a stronger affective and a blunted endocrine stress response, which may make them vulnerable to mental health problems. However, further research is needed to identify the full scope of skills required for effective stress-regulation before this knowledge can be used to develop effective prevention programs.
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Clinical correlates of hypothalamic-pituitary-adrenal axis measures in individuals at risk for psychosis and with first-episode psychosis. Psychiatry Res 2018; 265:284-291. [PMID: 29775885 DOI: 10.1016/j.psychres.2018.05.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 04/21/2018] [Accepted: 05/05/2018] [Indexed: 01/05/2023]
Abstract
Hypothalamic-pituitary-adrenal (HPA) axis alterations in at-risk mental states (ARMS) resemble those observed in established psychosis but are less consistent. We aimed to explore HPA axis abnormalities in both first-episode psychosis (FEP) and ARMS patients, while controlling for psychopathological symptoms. We studied 21 ARMS, 34 FEP patients and 34 healthy subjects. Clinical assessment included psychopathological symptoms (positive, negative, disorganized, excited and depressive symptoms) and stress measures. Saliva cortisol levels were determined at awakening, 30' and 60' post-awakening, 10:00 h, 23:00 h and 10:00 h on the day after the administration of 0.25 mg of dexamethasone, which occurred at 23:00 h. Three HPA axis measures were calculated: cortisol awakening response (CAR), cortisol diurnal slope and cortisol suppression ratio of the dexamethasone suppression test (DST). There were no significant differences between groups in HPA axis measures. However, when exploring the relationship between HPA axis measures and psychopathological symptoms, in ARMS subjects (but not FEP patients), a flatter cortisol slope was associated with more prominent negative symptoms, whereas a blunted CAR was associated with excited symptoms. Although no significant differences in HPA axis measures were found between diagnostic groups, subtle abnormalities in the CAR or circadian cortisol rhythmicity might be important for the phenotype of ARMS individuals.
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Nordholm D, Rostrup E, Mondelli V, Randers L, Nielsen MØ, Wulff S, Nørbak-Emig H, Broberg BV, Krakauer K, Dazzan P, Zunszain PA, Nordentoft M, Glenthøj B. Multiple measures of HPA axis function in ultra high risk and first-episode schizophrenia patients. Psychoneuroendocrinology 2018; 92:72-80. [PMID: 29635174 DOI: 10.1016/j.psyneuen.2018.03.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 03/21/2018] [Accepted: 03/25/2018] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Abnormalities within hypothalamus-pituitary-adrenal (HPA) axis might interact with other neurobiological systems to enhance the risk of psychosis. Most of the neurodevelopmental and HPA axis changes occur in adolescence; this is also the period when prodromal and psychotic symptoms occur for the first time. More knowledge about how various stress components interact can advance understanding of the link between psychosis and the HPA axis. METHOD We examined 41 ultra high-risk (UHR) patients and 40 antipsychotic-naïve first-episode schizophrenia (FES) patients and compared them with 47 matched controls. The Perceived Stress Scale and the Recent Life Events Questionnaire were used to assess the stress levels. Day-time saliva samples were taken to measure cortisol. The pituitary gland volume was measured manually on the structural MRI using stereology. RESULTS Only the UHR patients, had a higher cortisol increase just after awakening (p = 0.009) compared to healthy controls. In UHR patients, we found a negative correlation between cortisol increase after awakening and symptom severity (p = 0.008). Pituitary gland volume and diurnal cortisol were not significantly different among the three groups. There was no correlation between pituitary gland volume, perceived stress/recent life events and any of the cortisol measures or symptoms. CONCLUSION Symptom severity during the very early phase of illness (UHR) seems to be associated with altered cortisol increase. Longitudinal studies in UHR patients would be useful to examine how stress levels affect the course of the illness.
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Affiliation(s)
- Dorte Nordholm
- Mental Health Centre Copenhagen, University of Copenhagen, Denmark; Lundbeck Foundation Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Mental Health Centre Glostrup, University of Copenhagen, Denmark.
| | - Egill Rostrup
- Functional Imaging Unit, Department of Clinical Physiology and Nuclear Medicine, Rigshospitalet - Glostrup Hospital, Copenhagen, Denmark
| | - Valeria Mondelli
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, London, United Kingdom; National Institute for Health Research (NIHR), Biomedical Research Centre for Mental Health at South London and Maudsley, NHS Foundation Trust and Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - Lasse Randers
- Mental Health Centre Copenhagen, University of Copenhagen, Denmark; Lundbeck Foundation Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Mental Health Centre Glostrup, University of Copenhagen, Denmark
| | - Mette Ø Nielsen
- Lundbeck Foundation Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Mental Health Centre Glostrup, University of Copenhagen, Denmark; Center for Neuropsychiatric Schizophrenia Research, Mental Health Centre Glostrup, University of Copenhagen, Denmark
| | - Sanne Wulff
- Lundbeck Foundation Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Mental Health Centre Glostrup, University of Copenhagen, Denmark; Center for Neuropsychiatric Schizophrenia Research, Mental Health Centre Glostrup, University of Copenhagen, Denmark
| | - Henrik Nørbak-Emig
- Lundbeck Foundation Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Mental Health Centre Glostrup, University of Copenhagen, Denmark; Center for Neuropsychiatric Schizophrenia Research, Mental Health Centre Glostrup, University of Copenhagen, Denmark
| | - Brian V Broberg
- Lundbeck Foundation Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Mental Health Centre Glostrup, University of Copenhagen, Denmark; Center for Neuropsychiatric Schizophrenia Research, Mental Health Centre Glostrup, University of Copenhagen, Denmark
| | - Kristine Krakauer
- Mental Health Centre Copenhagen, University of Copenhagen, Denmark; Lundbeck Foundation Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Mental Health Centre Glostrup, University of Copenhagen, Denmark
| | - Paola Dazzan
- National Institute for Health Research (NIHR), Biomedical Research Centre for Mental Health at South London and Maudsley, NHS Foundation Trust and Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom; Institute of Psychiatry, Psychology and Neuroscience, Department of Psychosis Studies, King's College London, United Kingdom
| | - Patricia A Zunszain
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, London, United Kingdom; National Institute for Health Research (NIHR), Biomedical Research Centre for Mental Health at South London and Maudsley, NHS Foundation Trust and Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | | | - Birte Glenthøj
- Lundbeck Foundation Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Mental Health Centre Glostrup, University of Copenhagen, Denmark; Center for Neuropsychiatric Schizophrenia Research, Mental Health Centre Glostrup, University of Copenhagen, Denmark
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Davison J, O'Gorman A, Brennan L, Cotter DR. A systematic review of metabolite biomarkers of schizophrenia. Schizophr Res 2018; 195:32-50. [PMID: 28947341 DOI: 10.1016/j.schres.2017.09.021] [Citation(s) in RCA: 95] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 09/01/2017] [Accepted: 09/14/2017] [Indexed: 12/23/2022]
Abstract
Current diagnosis of schizophrenia relies exclusively on the potentially subjective interpretation of clinical symptoms and social functioning as more objective biological measurement and medical diagnostic tests are not presently available. The use of metabolomics in the discovery of disease biomarkers has grown in recent years. Metabolomic methods could aid in the discovery of diagnostic biomarkers of schizophrenia. This systematic review focuses on biofluid metabolites associated with schizophrenia. A systematic search of Web of Science and Ovid Medline databases was conducted and 63 studies investigating metabolite biomarkers of schizophrenia were included. A review of these studies revealed several potential metabolite signatures of schizophrenia including reduced levels of essential polyunsaturated fatty acids (EPUFAs), vitamin E and creatinine; and elevated levels of lipid peroxidation metabolites and glutamate. Further research is needed to validate these biomarkers and would benefit from large cohort studies and more homogeneous and well-defined subject groups.
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Affiliation(s)
- Jennifer Davison
- RCSI Psychiatry, Royal College of Surgeons in Ireland, Education and Research Centre Beaumont Hospital, Dublin 9, Ireland; Institute of Food & Health, UCD School of Agriculture and Food Science, University College Dublin, Dublin 4, Ireland
| | - Aoife O'Gorman
- RCSI Psychiatry, Royal College of Surgeons in Ireland, Education and Research Centre Beaumont Hospital, Dublin 9, Ireland; Institute of Food & Health, UCD School of Agriculture and Food Science, University College Dublin, Dublin 4, Ireland
| | - Lorraine Brennan
- Institute of Food & Health, UCD School of Agriculture and Food Science, University College Dublin, Dublin 4, Ireland
| | - David R Cotter
- RCSI Psychiatry, Royal College of Surgeons in Ireland, Education and Research Centre Beaumont Hospital, Dublin 9, Ireland.
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Redman SL, Corcoran CM, Kimhy D, Malaspina D. Effects of early trauma on psychosis development in clinical high-risk individuals and stability of trauma assessment across studies: a review. ARCHIVES OF PSYCHOLOGY (CHICAGO, ILL.) 2017; 1:28. [PMID: 29400347 PMCID: PMC5791764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Early trauma (ET), though broadly and inconsistently defined, has been repeatedly linked to numerous psychological disturbances, including various developmental stages of psychotic disorders. The prodromal phase of psychosis highlights a unique and relevant population that provides insight into the critical periods of psychosis development. As such, a relatively recent research focus on individuals at clinical high risk (CHR) for psychosis reveals robust associations of early life trauma exposures with prodromal symptoms and function in these cohorts. While prevalence rates of ET in CHR cohorts remain consistently high, methodological measures of traumatic experiences vary across studies, presenting potential problems for reliability and validity of results. This review aims to 1) highlight the existing evidence identifying associations of ET, of multiple forms, with both symptom severity and transition rates to psychosis in CHR individuals, 2) present data on the variability among trauma assessments and its implications for conclusions about its relationship with clinical variables, 3) describe cognitive deficits common in CHR cohorts, including perceptual and neurocognitive impairments, and their neural correlates, that may modify the relationship of ET to symptoms, and 4) propose future directions for standardization of trauma assessment in CHR cohorts to better understand its clinical and cognitive correlates.
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Affiliation(s)
- Samantha L. Redman
- Corresponding Author: Samantha Redman, Icahn School of Medicine at Mount Sinai, Department of Psychiatry, 53 E 96 Street, New York, NY 10128, phone: 212-659-8756,
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