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Onyeama F, Melegkovits E, Yu N, Parvez A, Rodrigues A, Billings J, Kelleher I, Cannon M, Bloomfield MAP. A systematic review and meta-analysis of the traumatogenic phenotype hypothesis of psychosis. BJPsych Open 2024; 10:e146. [PMID: 39118412 DOI: 10.1192/bjo.2024.52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND Developmental trauma increases psychosis risk and is associated with poor prognosis. It has been proposed that psychosis in survivors of developmental trauma gives rise to a distinct 'traumatogenic' phenotype. AIMS Given the implications for personalised treatment, we sought to explore the traumatogenic psychosis phenotype hypothesis in a systematic review and meta-analysis of studies comparing psychotic presentations between adults with and without developmental trauma histories. METHOD We registered the systematic review on PROSPERO (CRD42019131245) and systematically searched EMBASE, Medline and PsycINFO. The outcomes of interests were quantitative and qualitative comparisons in psychotic symptom expression (positive, negative, cognitive) and other domains of psychopathology, including affect regulation, sleep, depression and anxiety, between adults with and without experience of developmental trauma. RESULTS Of 34 studies included (N = 13 150), 11 were meta-analysed (n = 2842). A significant relationship was found between developmental trauma and increased symptom severity for positive (Hedge's g = 0.27; 95% CI 0.10-0.44; P = 0.002), but not negative symptoms (Hedge's g = 0.13; 95% CI -0.04 to 0.30; P = 0.14). Developmental trauma was associated with greater neurocognitive, specifically executive, deficits, as well as poorer affect, dissociation and social cognition. Furthermore, psychotic symptom content thematically related to traumatic memories in survivors of developmental trauma. CONCLUSIONS Our findings that developmental trauma is associated with more severe positive and affective symptoms, and qualitative differences in symptom expression, support the notion that there may be a traumatogenic psychosis phenotype. However, underdiagnosis of post-traumatic stress disorder may also explain some of these findings. More research is needed to explore this further.
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Affiliation(s)
- Franca Onyeama
- Division of Psychiatry, University College London, UK; and Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, Institute of Mental Health, Faculty of Brain Sciences, Division of Psychiatry, University College London, UK
| | - Eirini Melegkovits
- Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, Institute of Mental Health, Faculty of Brain Sciences, Division of Psychiatry, University College London, UK
| | - Nicole Yu
- Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, Institute of Mental Health, Faculty of Brain Sciences, Division of Psychiatry, University College London, UK
| | - Ameerah Parvez
- Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, Institute of Mental Health, Faculty of Brain Sciences, Division of Psychiatry, University College London, UK; and UCL Medical School, University College London, UK
| | - Artur Rodrigues
- Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, Institute of Mental Health, Faculty of Brain Sciences, Division of Psychiatry, University College London, UK; and Department of Biology, Faculdade de Ciências da Universidade do Porto, Portugal
| | - Jo Billings
- Division of Psychiatry, University College London, UK
| | - Ian Kelleher
- School of Medicine and Medical Sciences, University College Dublin, Ireland; Department of Psychiatry, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Ireland; and Lucena Clinic, St John of God Community Mental Health Services, Dublin, Ireland
| | - Mary Cannon
- Department of Psychiatry, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
| | - Michael A P Bloomfield
- Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, Institute of Mental Health, Faculty of Brain Sciences, Division of Psychiatry, University College London, UK; Traumatic Stress Clinic, St Pancras Hospital, Camden and Islington NHS Foundation Trust, London, UK; National Institute for Health Research, University College London Hospitals Biomedical Research Centre, London, UK; and National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
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Kudinova AY, Kulak MJ, Daniels TE, Angeles WLDL, de la Monte S, Mathis KJ, Beck QM, Laumann LE, Tyrka AR. Increased plasminogen activator inhibitor-1 (PAI-1) and its associations with metabolic risk in healthy young adults with early life stress. Psychoneuroendocrinology 2024; 166:107071. [PMID: 38754340 PMCID: PMC11188775 DOI: 10.1016/j.psyneuen.2024.107071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 05/01/2024] [Accepted: 05/05/2024] [Indexed: 05/18/2024]
Abstract
OBJECTIVES We aimed to characterize the interplay between early life stress (ELS), metabolic syndrome (MetS), and plasminogen activator inhibitor-1 (PAI-1), a major inhibitor of the fibrinolytic system implicated in cardiometabolic diseases. We also examined the understudied intersection of ELS, physical activity and PAI-1. METHODS Healthy young adults ages 18-40 (N=200; 68% female) were recruited from the community. Participants with ELS (N=118) experienced childhood maltreatment, and the majority (n=92) also experienced childhood parental loss. Control participants (N=82) had no history of childhood maltreatment or parental loss. Participants had no current cardiometabolic or thrombotic conditions. Fasting plasma samples were assessed for markers of metabolic risk and total PAI-1 using the Bio-Plex Pro Human Diabetes Panel (Bio-Rad Laboratories). A composite metabolic risk z-score (MetS risk) was computed from the mean standardized z-scores of waist-to-height ratio, systolic and diastolic blood pressure, triglycerides, total cholesterol, LDL and HLD cholesterol, fasting plasma glucose, and hemoglobin A1c. RESULTS We found that a history of ELS was linked to both higher PAI-1 levels and a higher MetS risk score. ELS was associated with a higher MetS Z-score in adulthood via increased circulating PAI-1 levels (Average Causal Mediation Effect [ACME]= 0.07, p = 0.036). ELS was also linked to increased PAI-1 levels via greater MetS z-scores (ACME = 0.02, p < 0.001). There was a significant interaction effect of ELS and exercise on PAI-1 levels (p = 0.03), such that engaging in higher levels of daily exercise was linked to lower PAI-1 levels in individuals with ELS. CONCLUSION Healthy young adults with ELS have elevated PAI-1 levels and metabolic risk scores. Among individuals with ELS, exercise is linked to lower PAI-1 levels, suggesting a potential direction for early intervention.
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Affiliation(s)
- Anastacia Y Kudinova
- Department of Pediatrics, Hasbro Children's Hospital and Bradley Hospital, RI, USA; Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Meghan J Kulak
- Warren Alpert Medical School, Brown University, Providence, RI, USA; Initiative on Stress, Trauma, and Resilience (STAR), Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI, USA.
| | - Teresa E Daniels
- Initiative on Stress, Trauma, and Resilience (STAR), Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI, USA; Mood Disorders Research Program and Laboratory for Clinical and Translational Neuroscience, Butler Hospital, Providence, RI, USA
| | - William Lewis-de Los Angeles
- Department of Pediatrics, Hasbro Children's Hospital and Bradley Hospital, RI, USA; Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Suzanne de la Monte
- Department of Pathology, Alpert Medical School of Brown University, Providence, RI, USA; fProvidence VA Medical Center, Providence, RI, USA; Rhode Island Hospital, Providence, RI, USA
| | - Karen Jennings Mathis
- Initiative on Stress, Trauma, and Resilience (STAR), Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI, USA; The Miriam Hospital, Center for Behavioral and Preventive Medicine, USA
| | - Quincy M Beck
- Initiative on Stress, Trauma, and Resilience (STAR), Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI, USA; Mood Disorders Research Program and Laboratory for Clinical and Translational Neuroscience, Butler Hospital, Providence, RI, USA
| | - Laura E Laumann
- Initiative on Stress, Trauma, and Resilience (STAR), Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI, USA; Mood Disorders Research Program and Laboratory for Clinical and Translational Neuroscience, Butler Hospital, Providence, RI, USA
| | - Audrey R Tyrka
- Initiative on Stress, Trauma, and Resilience (STAR), Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI, USA; Mood Disorders Research Program and Laboratory for Clinical and Translational Neuroscience, Butler Hospital, Providence, RI, USA
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Armio RL, Laurikainen H, Ilonen T, Walta M, Sormunen E, Tolvanen A, Salokangas RKR, Koutsouleris N, Tuominen L, Hietala J. Longitudinal study on hippocampal subfields and glucose metabolism in early psychosis. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2024; 10:66. [PMID: 39085221 PMCID: PMC11291638 DOI: 10.1038/s41537-024-00475-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 05/11/2024] [Indexed: 08/02/2024]
Abstract
Altered hippocampal morphology and metabolic pathology, but also hippocampal circuit dysfunction, are established phenomena seen in psychotic disorders. Thus, we tested whether hippocampal subfield volume deficits link with deviations in glucose metabolism commonly seen in early psychosis, and whether the glucose parameters or subfield volumes change during follow-up period using one-year longitudinal study design of 78 first-episode psychosis patients (FEP), 48 clinical high-risk patients (CHR) and 83 controls (CTR). We also tested whether hippocampal morphology and glucose metabolism relate to clinical outcome. Hippocampus subfields were segmented with Freesurfer from 3T MRI images and parameters of glucose metabolism were determined in fasting plasma samples. Hippocampal subfield volumes were consistently lower in FEPs, and findings were more robust in non-affective psychoses, with strongest decreases in CA1, molecular layer and hippocampal tail, and in hippocampal tail of CHRs, compared to CTRs. These morphometric differences remained stable at one-year follow-up. Both non-diabetic CHRs and FEPs had worse glucose parameters compared to CTRs at baseline. We found that, insulin levels and insulin resistance increased during the follow-up period only in CHR, effect being largest in the CHRs converting to psychosis, independent of exposure to antipsychotics. The worsening of insulin resistance was associated with deterioration of function and symptoms in CHR. The smaller volume of hippocampal tail was associated with higher plasma insulin and insulin resistance in FEPs, at the one-year follow-up. Our longitudinal study supports the view that temporospatial hippocampal subfield volume deficits are stable near the onset of first psychosis, being more robust in non-affective psychoses, but less prominent in the CHR group. Specific subfield defects were related to worsening glucose metabolism during the progression of psychosis, suggesting that hippocampus is part of the circuits regulating aberrant glucose metabolism in early psychosis. Worsening of glucose metabolism in CHR group was associated with worse clinical outcome measures indicating a need for heightened clinical attention to metabolic problems already in CHR.
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Grants
- Turun Yliopistollisen Keskussairaalan Koulutus- ja Tutkimussäätiö (TYKS-säätiö)
- Alfred Kordelinin Säätiö (Alfred Kordelin Foundation)
- Finnish Cultural Foundation | Varsinais-Suomen Rahasto (Varsinais-Suomi Regional Fund)
- Suomalainen Lääkäriseura Duodecim (Finnish Medical Society Duodecim)
- Turun Yliopisto (University of Turku)
- This work was supported by funding for the VAMI-project (Turku University Hospital, state research funding, no. P3848), partly supported by EU FP7 grants (PRONIA, grant a # 602152 and METSY grant #602478). Dr. Armio received personal funding from Doctoral Programme in Clinical Research at the University of Turku, grants from State Research Funding, Turunmaa Duodecim Society, Finnish Psychiatry Research Foundation, Finnish University Society of Turku (Valto Takala Foundation), Tyks-foundation, The Finnish Medical Foundation (Maija and Matti Vaskio fund), University of Turku, The Alfred Kordelin Foundation, Finnish Cultural Foundation (Terttu Enckell fund and Ritva Helminen fund) and The Alfred Kordelin foundation. Further, Dr. Tuominen received personal grant from Sigrid Juselius and Orion research foundation and NARSAD Young Investigator Grant from the Brain & Behavior Research Foundation.
- This work was supported by funding for the VAMI-project (Turku University Hospital, state research funding, no. P3848), partly supported by EU FP7 grants (PRONIA, grant a # 602152 and METSY grant #602478). Dr. Tuominen received personal grant from Sigrid Juselius and Orion research foundation and NARSAD Young Investigator Grant from the Brain & Behavior Research Foundation.
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Affiliation(s)
- Reetta-Liina Armio
- PET Centre, Turku University Hospital, 20520, Turku, Finland.
- Department of Psychiatry, University of Turku, 20700, Turku, Finland.
- Department of Psychiatry, Turku University Hospital, 20520, Turku, Finland.
| | - Heikki Laurikainen
- PET Centre, Turku University Hospital, 20520, Turku, Finland
- Department of Psychiatry, University of Turku, 20700, Turku, Finland
- Department of Psychiatry, Turku University Hospital, 20520, Turku, Finland
| | - Tuula Ilonen
- Department of Psychiatry, University of Turku, 20700, Turku, Finland
| | - Maija Walta
- PET Centre, Turku University Hospital, 20520, Turku, Finland
- Department of Psychiatry, University of Turku, 20700, Turku, Finland
- Department of Psychiatry, Turku University Hospital, 20520, Turku, Finland
| | - Elina Sormunen
- PET Centre, Turku University Hospital, 20520, Turku, Finland
- Department of Psychiatry, University of Turku, 20700, Turku, Finland
- Department of Psychiatry, Turku University Hospital, 20520, Turku, Finland
| | - Arvi Tolvanen
- Department of Psychiatry, University of Turku, 20700, Turku, Finland
| | | | - Nikolaos Koutsouleris
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, D-80336, Munich, Germany
| | - Lauri Tuominen
- Department of Psychiatry, Turku University Hospital, 20520, Turku, Finland
- The Royal's Institute of Mental Health Research, University of Ottawa, Ottawa, ON, Canada
- Department of Psychiatry, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Jarmo Hietala
- PET Centre, Turku University Hospital, 20520, Turku, Finland
- Department of Psychiatry, University of Turku, 20700, Turku, Finland
- Department of Psychiatry, Turku University Hospital, 20520, Turku, Finland
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Chiappelli J, Savransky A, Ma Y, Gao S, Kvarta MD, Kochunov P, Slavich GM, Hong LE. Impact of lifetime stressor exposure on neuroenergetics in schizophrenia spectrum disorders. Schizophr Res 2024; 269:58-63. [PMID: 38733800 PMCID: PMC11180558 DOI: 10.1016/j.schres.2024.04.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 03/22/2024] [Accepted: 04/28/2024] [Indexed: 05/13/2024]
Abstract
N-acetylasparate and lactate are two prominent brain metabolites closely related to mitochondrial functioning. Prior research revealing lower levels of NAA and higher levels of lactate in the cerebral cortex of patients with schizophrenia suggest possible abnormalities in the energy supply pathway necessary for brain function. Given that stress and adversity are a strong risk factor for a variety of mental health problems, including psychotic disorders, we investigated the hypothesis that stress contributes to abnormal neuroenergetics in patients with schizophrenia. To test this hypothesis, we used the Stress and Adversity Inventory (STRAIN) to comprehensively assess the lifetime stressor exposure profiles of 35 patients with schizophrenia spectrum disorders and 33 healthy controls who were also assessed with proton magnetic resonance spectroscopy at the anterior cingulate cortex using 3 Tesla scanner. Consistent with the hypothesis, greater lifetime stressor exposure was significantly associated with lower levels of N-acetylasparate (β = -0.36, p = .005) and higher levels of lactate (β = 0.43, p = .001). Moreover, these results were driven by patients, as these associations were significant for the patient but not control group. Though preliminary, these findings suggest a possible role for stress processes in the pathophysiology of abnormal neuroenergetics in schizophrenia.
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Affiliation(s)
- Joshua Chiappelli
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA.
| | - Anya Savransky
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Yizhou Ma
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Si Gao
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Mark D Kvarta
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Peter Kochunov
- Faillace Department of Psychiatry and Behavioral Sciences at McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - George M Slavich
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - L Elliot Hong
- Faillace Department of Psychiatry and Behavioral Sciences at McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
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5
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Gilgoff R, Mengelkoch S, Elbers J, Kotz K, Radin A, Pasumarthi I, Murthy R, Sindher S, Harris NB, Slavich GM. The Stress Phenotyping Framework: A multidisciplinary biobehavioral approach for assessing and therapeutically targeting maladaptive stress physiology. Stress 2024; 27:2327333. [PMID: 38711299 PMCID: PMC11219250 DOI: 10.1080/10253890.2024.2327333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 03/02/2024] [Indexed: 05/08/2024] Open
Abstract
Although dysregulated stress biology is becoming increasingly recognized as a key driver of lifelong disparities in chronic disease, we presently have no validated biomarkers of toxic stress physiology; no biological, behavioral, or cognitive treatments specifically focused on normalizing toxic stress processes; and no agreed-upon guidelines for treating stress in the clinic or evaluating the efficacy of interventions that seek to reduce toxic stress and improve human functioning. We address these critical issues by (a) systematically describing key systems and mechanisms that are dysregulated by stress; (b) summarizing indicators, biomarkers, and instruments for assessing stress response systems; and (c) highlighting therapeutic approaches that can be used to normalize stress-related biopsychosocial functioning. We also present a novel multidisciplinary Stress Phenotyping Framework that can bring stress researchers and clinicians one step closer to realizing the goal of using precision medicine-based approaches to prevent and treat stress-associated health problems.
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Affiliation(s)
- Rachel Gilgoff
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University, Palo Alto, CA, USA
| | - Summer Mengelkoch
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Jorina Elbers
- Trauma recovery Program, HeartMath Institute, Boulder Creek, CA, USA
| | | | | | - Isha Pasumarthi
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University, Palo Alto, CA, USA
| | - Reanna Murthy
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University, Palo Alto, CA, USA
| | - Sayantani Sindher
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University, Palo Alto, CA, USA
| | | | - George M. Slavich
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
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Miyakoshi T, Ishikawa S, Okubo R, Hashimoto N, Sato N, Kusumi I, Ito YM. Risk factors for abnormal glucose metabolism during antipsychotic treatment: A prospective cohort study. J Psychiatr Res 2023; 168:149-156. [PMID: 37913741 DOI: 10.1016/j.jpsychires.2023.10.055] [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: 07/11/2023] [Revised: 09/05/2023] [Accepted: 10/25/2023] [Indexed: 11/03/2023]
Abstract
Antipsychotic medications increase the risk of abnormal glucose metabolism. However, in clinical practice, it is difficult to predict this risk because it is affected by medication-related and background factors. This study aimed to identify the risk factors for abnormal glucose metabolism during antipsychotic treatment. We conducted a multicenter, prospective, cohort study in patients with schizophrenia, schizoaffective disorder, or bipolar disorder. Of these patients, those with prediabetes or possible diabetes were excluded. Finally, 706 patients were included in the analysis. The hazard ratio (HR) for each factor was calculated for events of progression to hyperglycemia using time-dependent Cox regression analysis stratified according to facility type and adjusted for available background and drug-related factors. Treatments with olanzapine (HR = 2.06, 95% confidence interval [CI] = 1.05-4.05), clozapine (HR = 4.25, 95% CI = 1.56-11.60), and chlorpromazine (HR = 4.48, 95% CI = 1.21-16.57), overweight and obesity (HR = 1.57, 95% CI = 1.02-2.41), and hypertriglyceridemia (HR = 1.72, 95% CI = 1.02-2.88) were associated with a significantly higher occurrence of hyperglycemic progression. The number and daily dose of antipsychotics were not associated with their occurrence. Our study demonstrated that more careful monitoring is necessary during olanzapine, clozapine, and chlorpromazine treatment because of the higher occurrence of abnormalities in glucose metabolism. Furthermore, patients with obesity or hypertriglyceridemia warrant monitoring for the occurrence of abnormal glucose metabolism, regardless of the type of antipsychotic medication.
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Affiliation(s)
- Takashi Miyakoshi
- Department of Health Data Science, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
| | - Shuhei Ishikawa
- Department of Psychiatry, Hokkaido University Hospital, Sapporo, Japan.
| | - Ryo Okubo
- Department of Psychiatry and Neurology, National Hospital Organization Obihiro Hospital, Obihiro, Japan.
| | - Naoki Hashimoto
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
| | - Norihiro Sato
- Clinical Research & Medical Innovation Center, Promotion Unit, Institute of Health Science Innovation for Medical Care, Hokkaido University Hospital, Sapporo, Japan.
| | - Ichiro Kusumi
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
| | - Yoichi M Ito
- Data Science Center, Promotion Unit, Institute of Health Science Innovation for Medical Care, Hokkaido University Hospital, Sapporo, Japan.
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Maternal childhood trauma is associated with offspring body size during the first year of life. Sci Rep 2022; 12:19619. [PMID: 36380091 PMCID: PMC9666509 DOI: 10.1038/s41598-022-23740-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 11/04/2022] [Indexed: 11/16/2022] Open
Abstract
Maternal childhood trauma (MCT) is an important factor affecting offspring size at birth. Whether the effect of MCT persists during the subsequent development remains unclear. We present the results of a semi-longitudinal investigation examining the physical growth of infants born to mothers with high (HCT) and low (LCT) childhood trauma during the first year of life. One hundred healthy mother-infant dyads were included based on following criteria: exclusive breastfeeding, birth on term with appropriate weight for gestational age. MCT was assessed using the Early Life Stress Questionnaire. The weight, length, and head circumference of the infant were taken at birth, 5 and 12 months postpartum. Separate MANCOVA models were run for infant size at each age. We found an association between MCT and infant size at 5 and 12 months. The children of mothers with HCT had higher weight and greater head circumference than the children of mothers with LCT. These results suggest that MCT might contribute to developmental programming of offspring growth during the first year of life. From an evolutionary perspective, the larger size of HCT mother's offspring might represent an adaptation to potentially harsh environmental conditions. This effect might be mediated by epigenetic changes to DNA and altered breast milk composition.
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8
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Goh KK, Chen CYA, Wu TH, Chen CH, Lu ML. Crosstalk between Schizophrenia and Metabolic Syndrome: The Role of Oxytocinergic Dysfunction. Int J Mol Sci 2022; 23:ijms23137092. [PMID: 35806096 PMCID: PMC9266532 DOI: 10.3390/ijms23137092] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 06/23/2022] [Accepted: 06/23/2022] [Indexed: 02/01/2023] Open
Abstract
The high prevalence of metabolic syndrome in persons with schizophrenia has spurred investigational efforts to study the mechanism beneath its pathophysiology. Early psychosis dysfunction is present across multiple organ systems. On this account, schizophrenia may be a multisystem disorder in which one organ system is predominantly affected and where other organ systems are also concurrently involved. Growing evidence of the overlapping neurobiological profiles of metabolic risk factors and psychiatric symptoms, such as an association with cognitive dysfunction, altered autonomic nervous system regulation, desynchrony in the resting-state default mode network, and shared genetic liability, suggest that metabolic syndrome and schizophrenia are connected via common pathways that are central to schizophrenia pathogenesis, which may be underpinned by oxytocin system dysfunction. Oxytocin, a hormone that involves in the mechanisms of food intake and metabolic homeostasis, may partly explain this piece of the puzzle in the mechanism underlying this association. Given its prosocial and anorexigenic properties, oxytocin has been administered intranasally to investigate its therapeutic potential in schizophrenia and obesity. Although the pathophysiology and mechanisms of oxytocinergic dysfunction in metabolic syndrome and schizophrenia are both complex and it is still too early to draw a conclusion upon, oxytocinergic dysfunction may yield a new mechanistic insight into schizophrenia pathogenesis and treatment.
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Affiliation(s)
- Kah Kheng Goh
- Department of Psychiatry, Wan-Fang Hospital, Taipei Medical University, Taipei 116, Taiwan; (K.K.G.); (C.Y.-A.C.); (C.-H.C.)
- Psychiatric Research Center, Wan-Fang Hospital, Taipei Medical University, Taipei 116, Taiwan;
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
| | - Cynthia Yi-An Chen
- Department of Psychiatry, Wan-Fang Hospital, Taipei Medical University, Taipei 116, Taiwan; (K.K.G.); (C.Y.-A.C.); (C.-H.C.)
- Psychiatric Research Center, Wan-Fang Hospital, Taipei Medical University, Taipei 116, Taiwan;
| | - Tzu-Hua Wu
- Psychiatric Research Center, Wan-Fang Hospital, Taipei Medical University, Taipei 116, Taiwan;
- Department of Clinical Pharmacy, School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei 110, Taiwan
| | - Chun-Hsin Chen
- Department of Psychiatry, Wan-Fang Hospital, Taipei Medical University, Taipei 116, Taiwan; (K.K.G.); (C.Y.-A.C.); (C.-H.C.)
- Psychiatric Research Center, Wan-Fang Hospital, Taipei Medical University, Taipei 116, Taiwan;
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
| | - Mong-Liang Lu
- Department of Psychiatry, Wan-Fang Hospital, Taipei Medical University, Taipei 116, Taiwan; (K.K.G.); (C.Y.-A.C.); (C.-H.C.)
- Psychiatric Research Center, Wan-Fang Hospital, Taipei Medical University, Taipei 116, Taiwan;
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
- Correspondence:
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9
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Garcia-Rizo C, Cabrera B, Bioque M, Mezquida G, Lobo A, Gonzalez-Pinto A, Diaz-Caneja CM, Corripio I, Vieta E, Baeza I, Garcia-Portilla MP, Gutierrez-Fraile M, Rodriguez-Jimenez R, Garriga M, Fernandez-Egea E, Bernardo M. The effect of early life events on glucose levels in first-episode psychosis. Front Endocrinol (Lausanne) 2022; 13:983792. [PMID: 36545332 PMCID: PMC9762519 DOI: 10.3389/fendo.2022.983792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 10/10/2022] [Indexed: 12/12/2022] Open
Abstract
First episode of psychosis (FEP) patients display a wide variety of metabolic disturbances at onset, which might underlie these patients' increased morbidity and early mortality. Glycemic abnormalities have been previously related to pharmacological agents; however, recent research highlights the impact of early life events. Birth weight (BW), an indirect marker of the fetal environment, has been related to glucose abnormalities in the general population over time. We aim to evaluate if BW correlates with glucose values in a sample of FEP patients treated with different antipsychotics. Two hundred and thirty-six patients were included and evaluated for clinical and metabolic variables at baseline and at 2, 6, 12, and 24 months of follow-up. Pearson correlations and linear mixed model analysis were conducted to analyze the data. Antipsychotic treatment was grouped due to its metabolic risk profile. In our sample of FEP patients, BW was negatively correlated with glucose values at 24 months of follow-up [r=-0.167, p=0.037]. BW showed a trend towards significance in the association with glucose values over the 24-month period (F=3.22; p=0.073) despite other confounders such as age, time, sex, body mass index, antipsychotic type, and chlorpromazine dosage. This finding suggests that BW is involved in the evolution of glucose values over time in a cohort of patients with an FEP, independently of the type of pharmacological agent used in treatment. Our results highlight the importance of early life events in the later metabolic outcome of patients.
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Affiliation(s)
- Clemente Garcia-Rizo
- Barcelona Clínic Schizophrenia Unit, Institute of Neuroscience, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Institut d’investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- *Correspondence: Clemente Garcia-Rizo,
| | - Bibiana Cabrera
- Barcelona Clínic Schizophrenia Unit, Institute of Neuroscience, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Miquel Bioque
- Barcelona Clínic Schizophrenia Unit, Institute of Neuroscience, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Institut d’investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Gisela Mezquida
- Barcelona Clínic Schizophrenia Unit, Institute of Neuroscience, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Institut d’investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Antonio Lobo
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Department of Medicine and Psychiatry, University of Zaragoza, Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain
| | - Ana Gonzalez-Pinto
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Hospital Universitario de Alava, Servicio de Psiquiatría, BIOARABA, University of the Basque Country, Vitoria, Spain
| | - Covadonga M. Diaz-Caneja
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Iluminada Corripio
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Eduard Vieta
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Institut d’investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Bipolar and Depressive Disorders Unit, Hospital Clinic, Institute of Neuroscience, University of Barcelona, Barcelona, Spain
| | - Inmaculada Baeza
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Institut d’investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Child and Adolescent Psychiatry and Psychology Department, Hospital Clinic of Barcelona, Institute of Neurosciences, University of Barcelona, Barcelona, Spain
| | - Maria Paz Garcia-Portilla
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Department of Psychiatry, University of Oviedo, Oviedo, Spain. Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Miguel Gutierrez-Fraile
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Department of Psychiatry, Araba University Hospital, University of the Basque Country (UPV/EHU), Vitoria, Spain
- Neurosciences Department, Araba University Hospital, University of the Basque Country (UPV/EHU), Vitoria, Spain
| | - Roberto Rodriguez-Jimenez
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Instituto de Investigacion Sanitaria, Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Marina Garriga
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Institut d’investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Bipolar and Depressive Disorders Unit, Hospital Clinic, Institute of Neuroscience, University of Barcelona, Barcelona, Spain
| | - Emilio Fernandez-Egea
- Department of Psychiatry, University of Cambridge, Addenbrooke’s Hospital, Cambridge, United Kingdom
- Cambridgeshire and Peterborough NHS Foundation Trust, Huntingdon, United Kingdom
| | - Miguel Bernardo
- Barcelona Clínic Schizophrenia Unit, Institute of Neuroscience, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Institut d’investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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10
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Reynolds GP. The Etiology of Metabolic Disturbances in Schizophrenia: Drugs, Genes, and Environment. Int J Neuropsychopharmacol 2021; 24:854-855. [PMID: 34252192 PMCID: PMC8538903 DOI: 10.1093/ijnp/pyab047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 07/10/2021] [Indexed: 12/29/2022] Open
Affiliation(s)
- Gavin P Reynolds
- Biomolecular Sciences Research Centre, Sheffield Hallam University, Howard Street, Sheffield, UK,Correspondence: Gavin P. Reynolds, PhD, Biomolecular Sciences Research Centre, Sheffield Hallam University, Howard Street, Sheffield S1 1WB, UK ()
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11
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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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12
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Bentele UU, Meier M, Benz ABE, Denk BF, Dimitroff SJ, Pruessner JC, Unternaehrer E. The impact of maternal care and blood glucose availability on the cortisol stress response in fasted women. J Neural Transm (Vienna) 2021; 128:1287-1300. [PMID: 33978833 PMCID: PMC8423636 DOI: 10.1007/s00702-021-02350-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 05/03/2021] [Indexed: 01/05/2023]
Abstract
Individuals with a history of low maternal care (MC) frequently present a blunted, yet sometimes also show an increased cortisol stress response. Fasted individuals with low blood glucose levels who are exposed to acute stress typically show an attenuated response pattern in this endocrine marker. Despite well-documented metabolic dysregulations after low MC, a possible interaction of both factors has not been investigated yet. Here, we examined the effects of MC and blood glucose concentration on various aspects of the stress response. Fasted women (N = 122, meanage = 22.12, sdage = 2.56) who experienced either very high, high, or low MC (based on the Parental Bonding Instrument) were randomly assigned to consume grape juice (condition sugar), or water (condition water) prior to being exposed to the Trier-Social-Stress-Test for groups. Salivary cortisol and alpha amylase, blood glucose, and mood ratings were assessed repeatedly. Using multilevel mixed models, we replicated the boosting effect of glucose on the cortisol stress response. While we found neither an effect of MC, nor an interaction between MC and blood glucose availability on the cortisol stress response, we observed an effect of MC on the amylase stress response. We discuss the results in the light of links between various stress/energy systems that possibly mediate health-related MC effects.
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Affiliation(s)
- Ulrike U Bentele
- Department of Psychology, Division of Neuropsychology, University of Constance, Constance, Germany
| | - Maria Meier
- Department of Psychology, Division of Neuropsychology, University of Constance, Constance, Germany.
| | - Annika B E Benz
- Department of Psychology, Division of Neuropsychology, University of Constance, Constance, Germany
| | - Bernadette F Denk
- Department of Psychology, Division of Neuropsychology, University of Constance, Constance, Germany.,Centre for the Advanced Study of Collective Behaviour, University of Constance, Constance, Germany
| | - Stephanie J Dimitroff
- Department of Psychology, Division of Neuropsychology, University of Constance, Constance, Germany
| | - Jens C Pruessner
- Department of Psychology, Division of Neuropsychology, University of Constance, Constance, Germany.,Centre for the Advanced Study of Collective Behaviour, University of Constance, Constance, Germany
| | - Eva Unternaehrer
- Department of Psychology, Division of Neuropsychology, University of Constance, Constance, Germany.,Child- and Adolescent Research Department, Psychiatric University Hospitals Basel (UPK), University of Basel, Basel, Switzerland
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13
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Lunding SH, Simonsen C, Aas M, Rødevand L, Werner MCF, Laskemoen JF, Hjell G, Ringen PA, Lagerberg TV, Melle I, Andreassen OA, Ueland T, Steen NE. Childhood trauma and cardiometabolic risk in severe mental disorders: The mediating role of cognitive control. Eur Psychiatry 2021; 64:e24. [PMID: 33775258 PMCID: PMC8084596 DOI: 10.1192/j.eurpsy.2021.14] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background Cardiometabolic risk is increased in severe mental disorders (SMDs), and there appears to be a relationship between childhood trauma and cardiometabolic risk, possibly related to adverse health behavior. The current study examined the association between childhood trauma and serum lipids and adiposity in SMDs and the potential mediating role of cognitive and personality characteristics. Methods Participants with schizophrenia and bipolar spectrum disorders (N = 819) were included, cardiometabolic risk factors (serum lipids, body mass index, and waist circumference) were measured, and history of childhood trauma was assessed by the Childhood Trauma Questionnaire. Cognitive and personality characteristics were available in subsamples, with assessments of cognitive control, impulsiveness, self-esteem, and affective lability. Linear regressions and mediation analyses with Hayes’ PROCESS were performed, adjusting for age, sex, antipsychotic agent propensity of metabolic side-effect, and diagnostic group. Results Experience of three or more subtypes of childhood trauma was positively associated with waist circumference in patients with SMDs (p = 0.014). There were no other significant associations between trauma variables and lipid or adiposity measures in the total sample. Cognitive control was a significant mediator between experience of one or two subtypes of childhood trauma and waist circumference. Conclusions The results indicate childhood trauma as a predisposing factor for increased waist circumference in individuals with SMDs. Poorer cognitive control, suggestive of adverse health behavior, might be a mediating factor of the association, and the findings indicate the potential importance of increased focus on these factors in prevention and treatment regimens targeting cardiometabolic health.
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Affiliation(s)
- Synve Hoffart Lunding
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Carmen Simonsen
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Early Intervention in Psychosis Advisory Unit for South East Norway, Oslo University Hospital, Oslo, Norway
| | - Monica Aas
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Linn Rødevand
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Maren Caroline Frogner Werner
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Jannicke Fjæra Laskemoen
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Gabriela Hjell
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Psychiatry, Ostfold Hospital, Graalum, Norway
| | - Petter Andreas Ringen
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Trine Vik Lagerberg
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ingrid Melle
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ole A Andreassen
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Torill Ueland
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Psychology, University of Oslo, Oslo, Norway
| | - Nils Eiel Steen
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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14
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Veru-Lesmes F, Guay S, Shah JL, Schmitz N, Giguère CÉ, Joober R, Iyer SN, Malla AK. Adipose tissue dysregulation at the onset of psychosis: Adipokines and social determinants of health. Psychoneuroendocrinology 2021; 123:104915. [PMID: 33130407 DOI: 10.1016/j.psyneuen.2020.104915] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 09/25/2020] [Accepted: 10/04/2020] [Indexed: 12/11/2022]
Abstract
Recent evidence suggests that patients with psychotic disorders have metabolic disturbances (e.g., insulin resistance, dyslipidemia) at the onset of the disease and before antipsychotic exposure. Such disturbances are strongly associated with adipose tissue dysregulation. Measuring adipokines, the molecular mediators of adipose function, could provide a picture of the state of metabolic regulation at the onset of psychosis. The present study explores adipokine changes in a population of first-episode psychosis (FEP) patients with minimal prior exposure to antipsychotics. The effects of social determinants of health (childhood trauma and minority status) associated with both metabolic and psychotic disorders were studied as potential determinants of this phenomenon. Data was collected through the Signature project, a biobank of clinical, socio-demographic, and biological markers. Adipokines (leptin, adiponectin, resistin and chemerin) were measured in serum of FEP patients with minimal exposure to antipsychotics (N = 48) and controls (N = 39). Data were analyzed with univariate (t-tests) and multivariate (linear regression) statistical methods. Patients, compared to controls, had significantly higher levels of adiponectin and resistin, and significantly lower levels of leptin and chemerin. These results persisted after controlling for sex, waist-to-height ratio, childhood trauma, and visible minority status. Adiponectin and chemerin retained their effects after further controlling for tobacco and depression. Resistin increased with childhood trauma scores; chemerin was higher in visible minority patients. Adipose tissue dysfunction is present in FEP patients, before exposure to antipsychotics. Social determinants of health contribute to adipose (and metabolic) dysregulation in FEP, but may not be the main determinants of this relationship.
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Affiliation(s)
- Franz Veru-Lesmes
- Department of Psychiatry, McGill University, Montreal, Canada; Douglas Mental Health University Institute, Montreal, Canada; Prevention and Early Intervention Program for Psychosis, Montreal, Canada.
| | - Stéphane Guay
- Institut Universitaire en Santé Mentale de Montréal, Canada.
| | - Jai L Shah
- Department of Psychiatry, McGill University, Montreal, Canada; Douglas Mental Health University Institute, Montreal, Canada; Prevention and Early Intervention Program for Psychosis, Montreal, Canada
| | - Norbert Schmitz
- Department of Psychiatry, McGill University, Montreal, Canada; Douglas Mental Health University Institute, Montreal, Canada; Prevention and Early Intervention Program for Psychosis, Montreal, Canada
| | | | - Ridha Joober
- Department of Psychiatry, McGill University, Montreal, Canada; Douglas Mental Health University Institute, Montreal, Canada; Prevention and Early Intervention Program for Psychosis, Montreal, Canada
| | - Srividya N Iyer
- Department of Psychiatry, McGill University, Montreal, Canada; Douglas Mental Health University Institute, Montreal, Canada; Prevention and Early Intervention Program for Psychosis, Montreal, Canada
| | - Ashok K Malla
- Department of Psychiatry, McGill University, Montreal, Canada; Douglas Mental Health University Institute, Montreal, Canada; Prevention and Early Intervention Program for Psychosis, Montreal, Canada
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15
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Metabolic Dysregulation and Psychosocial Stress in Patients with Schizophrenia Spectrum Disorders: A Case-Control Study. J Clin Med 2020; 9:jcm9123822. [PMID: 33255883 PMCID: PMC7760156 DOI: 10.3390/jcm9123822] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 11/18/2020] [Accepted: 11/23/2020] [Indexed: 12/12/2022] Open
Abstract
Patients with schizophrenia spectrum disorders have a reduced life expectancy, which is largely the consequence of a high co-occurrence of cardiovascular diseases. To date, several intrinsic and environmental factors underlying this phenomenon have been found. However, the association with psychosocial stress has not been extensively addressed. In this study, we tested the relationship between a history of adverse childhood experiences (ACEs), lifetime stressors, perceived stress and metabolic parameters in patients with schizophrenia spectrum disorders and in healthy controls. The participants included 85 inpatients with schizophrenia spectrum disorders and 56 healthy controls. Serum levels of glucose, insulin, low- and high-density lipoproteins (LDL and HDL), triglycerides, total cholesterol and high-sensitivity C-reactive protein (hsCRP) were determined. After adjustment for potential confounding factors, patients had significantly higher levels of glucose (F = 4.856, p = 0.030), triglycerides (F = 4.720, p = 0.032) and hsCRP (F = 7.499, p = 0.007) as well as significantly lower levels of HDL (F = 5.300, p = 0.023) compared to healthy controls. There were also significant effects of interactions between diagnosis and a history of ACEs on the levels of insulin (F = 4.497, p = 0.036) and homeostatic model assessment of insulin resistance (HOMA-IR) (F = 3.987, p = 0.048). More specifically, the levels of insulin and HOMA-IR were significantly higher in the subgroup of patients with schizophrenia spectrum disorders and a positive history of ACEs compared to other subgroups of participants. No significant associations between lifetime stressors and perceived stress with metabolic parameters were found. Our findings indicate that a history of ACEs might be associated with insulin resistance in patients with schizophrenia spectrum disorders. Therapeutic strategies targeting early-life stress should be considered with early interventions that aim to manage cardiometabolic comorbidity in patients with schizophrenia spectrum disorders.
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16
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Lis M, Stańczykiewicz B, Liśkiewicz P, Misiak B. Impaired hormonal regulation of appetite in schizophrenia: A narrative review dissecting intrinsic mechanisms and the effects of antipsychotics. Psychoneuroendocrinology 2020; 119:104744. [PMID: 32534330 DOI: 10.1016/j.psyneuen.2020.104744] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 05/25/2020] [Accepted: 05/30/2020] [Indexed: 12/14/2022]
Abstract
Cardiometabolic diseases are the main contributor of reduced life expectancy in patients with schizophrenia. It is now widely accepted that antipsychotic treatment plays an important role in the development of obesity and its consequences. However, some intrinsic mechanisms need to be taken into consideration. One of these mechanisms might be related to impaired hormonal regulation of appetite in this group of patients. In this narrative review, we aimed to dissect impairments of appetite-regulating hormones attributable to intrinsic mechanisms and those related to medication effects. Early hormonal alterations that might be associated with intrinsic mechanisms include low levels of leptin and glucagon-like peptide-1 (GLP-1) together with elevated insulin levels in first-episode psychosis (FEP) patients. However, evidence regarding low GLP-1 levels in FEP patients is based on one large study. In turn, multiple-episode schizophrenia patients show elevated levels of insulin, leptin and orexin A together with decreased levels of adiponectin. In addition, patients receiving olanzapine may present with low ghrelin levels. Post mortem studies have also demonstrated reduced number of neuropeptide Y neurons in the prefrontal cortex of patients with schizophrenia. Treatment with certain second-generation antipsychotics may also point to these alterations. Although our understanding of hormonal regulation of appetite in schizophrenia has largely been improved, several limitations and directions for future studies need to be addressed. This is of particular importance since several novel pharmacological interventions for obesity and diabetes have already been developed and translation of these developments to the treatment of cardiometabolic comorbidities in schizophrenia patients is needed.
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Affiliation(s)
- Michał Lis
- Clinical Department of Internal Diseases, Endocrinology and Diabetology, The Central Clinical Hospital of the Ministry of the Interior in Warsaw, Wołoska 137 Street, 02-507 Warsaw, Poland
| | - Bartłomiej Stańczykiewicz
- Department of Nervous System Diseases, Wroclaw Medical University, Bartla 5 Street, 51-618, Wroclaw, Poland
| | - Paweł Liśkiewicz
- Department of Psychiatry, Pomeranian Medical University, Broniewskiego 26 Street, 71-460, Szczecin, Poland
| | - Błażej Misiak
- Department of Genetics, Wroclaw Medical University, Marcinkowskiego 1 Street, 50-368 Wroclaw, Poland.
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17
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Garcia-Rizo C, Bitanihirwe BKY. Implications of early life stress on fetal metabolic programming of schizophrenia: A focus on epiphenomena underlying morbidity and early mortality. Prog Neuropsychopharmacol Biol Psychiatry 2020; 101:109910. [PMID: 32142745 DOI: 10.1016/j.pnpbp.2020.109910] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 02/16/2020] [Accepted: 03/03/2020] [Indexed: 12/19/2022]
Abstract
The fetal origin of adult disease hypothesis postulates that a stressful in utero environment can have deleterious consequences on fetal programming, potentially leading to chronic disease in later life. Factors known to impact fetal programming include the timing, intensity, duration and nature of the external stressor during pregnancy. As such, dynamic modulation of fetal programming is heavily involved in shaping health throughout the life course, possibly by influencing metabolic parameters including insulin action, hypothalamic-pituitary-adrenal activity and immune function. The ability of prenatal insults to program adult disease is likely to occur as a result of reduced functional capacity in key organs-a "thrifty" phenotype-where more resources are re-allocated to preserve critical organs such as the brain. Notably, it has been postulated that the manifestation of neuropsychiatric disorders in individuals priorly exposed to prenatal stress may arise from the interaction between hereditary factors and the intrauterine environment, which together precipitate disease onset by disrupting the trajectory of normal brain development. In this review we discuss the evidence linking prenatal programming to neuropsychiatric disorders, mainly schizophrenia, via a "Thrifty psychiatric phenotype" concept. We start by outlining the conception of the thrifty psychiatric phenotype. Next, we discuss the convergence of potential mechanistic pathways through which prenatal insults may trigger epigenetic changes that contribute to the increased morbidity and early mortality observed in neuropsychiatric disorders. Finally, we touch on the public health importance of fetal programming for these disorders. We conclude by providing a brief outlook on the future of this evolving field of research.
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Affiliation(s)
- Clemente Garcia-Rizo
- Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clinic, Barcelona, Spain; Institute of Biomedical Research Agusti Pi iSunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; Department of Medicine, University of Barcelona, Barcelona, Spain.
| | - Byron K Y Bitanihirwe
- Centre for Global Health, Trinity College Dublin, Dublin, Ireland; Department of Psychology, Trinity College Dublin, Dublin, Ireland; School of Medicine, Trinity College Dublin, Dublin, Ireland
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