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Majuri T, Haapea M, Nordström T, Säynäjäkangas V, Moilanen K, Tolonen J, Ala-Mursula L, Miettunen J, Jääskeläinen E. Effect of onset age on the long-term outcome of early-onset psychoses and other mental disorders: a register-based Northern Finland Birth Cohort 1986 study. Eur Child Adolesc Psychiatry 2024; 33:1741-1753. [PMID: 37568059 PMCID: PMC11211101 DOI: 10.1007/s00787-023-02279-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 08/03/2023] [Indexed: 08/13/2023]
Abstract
Psychiatric illnesses can affect the social transitions of adolescence and young adulthood, such as completing education and entering working life and relationships. However, associations between earlier onset age and long-term outcomes among those with early-onset psychoses (EOP) are unclear, as are the long-term outcomes of EOP compared to non-psychotic disorders. We used national register data of the Northern Finland Birth Cohort 1986 to detect persons with EOP and other early-onset psychiatric disorders. The long-term clinical and work-family outcomes of persons with onset age before 18 years (n = 41 psychoses, n = 495 non-psychoses) or between 18-22 years (n = 61 psychoses, n = 377 non-psychoses) were compared. Individuals with the onset of psychosis between 18-22 years had significantly more unfavourable long-term outcomes when compared to those with psychosis onset before 18 years. Persons with psychosis onset before the age of 18 years had similar outcomes to those with non-psychotic psychiatric disorder onset before 18 years regarding educational level, marital status, having children, and substance use disorders. Individuals with EOP were more often on a disability pension compared to those with other early-onset mental disorders. Adjusting for sex, educational level and substance use only slightly diluted these results. Unexpectedly, later onset age of EOP was associated with worse outcomes. Those with psychosis onset between 18-22 years of age are in a critical period, which underlines the importance of investing on interventions in this age group. Further studies on the effect of the onset age on later outcomes in EOP are needed.
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Affiliation(s)
- Tuomas Majuri
- Research Unit of Population Health, Faculty of Medicine, University of Oulu, P.O.BOX 5000, 90014, Oulu, Finland.
| | - Marianne Haapea
- Research Unit of Population Health, Faculty of Medicine, University of Oulu, P.O.BOX 5000, 90014, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
- Department of Psychiatry, Oulu University Hospital, Oulu, Finland
| | - Tanja Nordström
- Research Unit of Population Health, Faculty of Medicine, University of Oulu, P.O.BOX 5000, 90014, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
- Infrastructure for Population Studies, Northern Finland Birth Cohorts, University of Oulu, Arctic Biobank, Oulu, Finland
| | - Veera Säynäjäkangas
- Research Unit of Population Health, Faculty of Medicine, University of Oulu, P.O.BOX 5000, 90014, Oulu, Finland
| | | | - Jonna Tolonen
- Research Unit of Population Health, Faculty of Medicine, University of Oulu, P.O.BOX 5000, 90014, Oulu, Finland
| | - Leena Ala-Mursula
- Research Unit of Population Health, Faculty of Medicine, University of Oulu, P.O.BOX 5000, 90014, Oulu, Finland
| | - Jouko Miettunen
- Research Unit of Population Health, Faculty of Medicine, University of Oulu, P.O.BOX 5000, 90014, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Erika Jääskeläinen
- Research Unit of Population Health, Faculty of Medicine, University of Oulu, P.O.BOX 5000, 90014, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
- Department of Psychiatry, Oulu University Hospital, Oulu, Finland
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Dondé C, Dubertret C, Fond G, Andre M, Berna F, Boyer L, Capdevielle D, Chereau I, Coulon N, Dorey JM, Leignier S, Llorca PM, Misdrahi D, Passerieux C, Pignon B, Rey R, Schorr B, Schürhoff F, Urbach M, Polosan M, Mallet J. History of learning disorders is associated with worse cognitive and functional outcomes in schizophrenia: results from the multicentric FACE-SZ cross-sectional dataset. Eur Arch Psychiatry Clin Neurosci 2023; 273:1773-1783. [PMID: 36583738 DOI: 10.1007/s00406-022-01544-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 12/19/2022] [Indexed: 12/31/2022]
Abstract
Schizophrenia is associated with early neurodevelopmental disorders, including most frequently learning disorders (LD), among them dyslexia and dyspraxia. Despite the demonstrated links between schizophrenia and LD, specific clinical patterns of the schizophrenia with a history of LD subgroup remain unknown. The aim of the present study was to investigate cognitive impairment, symptoms and functional outcome associated with a history of LD in a large cross-sectional, multicentric, sample of schizophrenia subjects. 492 community-dwelling subjects with schizophrenia (75.6% male, mean age 30.8 years) were consecutively included in the network of the FondaMental Expert Centers for Schizophrenia in France and received a thorough clinical assessment. The 51 (10.4%) subjects identified with a history of LD had significantly impaired general cognitive ability (Wechsler Adult Intelligence Scale Full Scale Total IQ: Cohen's d = 0.50, p = 0.001), processing speed (d = 0.19), verbal comprehension (d = 0.29), working memory (d = 0.31), cognitive inhibition and flexibility (d = 0.26), central executive functioning (d = 0.26), phonemic verbal fluency (d = 0.22) and premorbid intellectual ability (d = 0.48), as well as with a worse functional outcome (Global Assessment of Functioning, d = 0.21), independently of age, sex, education level, symptoms, treatments, and addiction comorbidities. These results indicate that a history of LD is associated with later cognitive impairment and functional outcome in schizophrenia. This suggests that history of LD is a relevant clinical marker to discriminate subgroups of patients with schizophrenia with different profiles in a precision psychiatry framework.
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Affiliation(s)
- Clément Dondé
- Fondation Fondamental, Créteil, France.
- Univ. Grenoble Alpes, Inserm, U1216, Adult Psychiatry Department CHU Grenoble Alpes, Grenoble Institut Neurosciences, 38000, Grenoble, France.
- Psychiatry Department, CH Alpes-Isère, 38000, Saint-Egrève, France.
| | - Caroline Dubertret
- Fondation Fondamental, Créteil, France
- Institute of Psychiatry and Neuroscience of Paris, Université de Paris, INSERM UMR1266, Paris, France
- Department of Psychiatry, AP-HP, Louis Mourier Hospital, Colombes, France
| | - Guillaume Fond
- Fondation Fondamental, Créteil, France
- School of Medicine - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of Life Center, AP-HM, Aix-Marseille Univ., 27 Boulevard Jean Moulin, 13005, Marseille, France
| | - Myrtille Andre
- Fondation Fondamental, Créteil, France
- Service Universitaire de Psychiatrie Adulte, Hôpital la Colombière, CHRU Montpellier, Université Montpellier 1, Inserm 1061, Montpellier, France
| | - Fabrice Berna
- Fondation Fondamental, Créteil, France
- Fédération de Médecine Translationnelle de Strasbourg, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, INSERM U1114, Strasbourg, France
| | - Laurent Boyer
- Fondation Fondamental, Créteil, France
- School of Medicine - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of Life Center, AP-HM, Aix-Marseille Univ., 27 Boulevard Jean Moulin, 13005, Marseille, France
| | - Delphine Capdevielle
- Fondation Fondamental, Créteil, France
- Service Universitaire de Psychiatrie Adulte, Hôpital la Colombière, CHRU Montpellier, Université Montpellier 1, Inserm 1061, Montpellier, France
| | - Isabelle Chereau
- Fondation Fondamental, Créteil, France
- University Clermont Auvergne, CMP-B CHU, CNRS, Clermont Auvergne INP, Institut Pascal, 63000, Clermont-Ferrand, France
| | - Nathalie Coulon
- Fondation Fondamental, Créteil, France
- Centre Expert Schizophrénie, Centre Référent de Réhabilitation Psychosociale et de Remédiation Cognitive (C3R), CH Alpes Isère, Saint-Egrève, France
| | - Jean-Michel Dorey
- Fondation Fondamental, Créteil, France
- INSERM U1028, CNRS UMR5292, Centre de Recherche en Neurosciences de Lyon, Université Claude Bernard Lyon 1, Equipe PSYR2, Centre Hospitalier Le Vinatier, Pole Est, 95 Bd Pinel, BP 30039, 69678, Bron Cedex, France
| | - Sylvain Leignier
- Fondation Fondamental, Créteil, France
- Centre Expert Schizophrénie, Centre Référent de Réhabilitation Psychosociale et de Remédiation Cognitive (C3R), CH Alpes Isère, Saint-Egrève, France
| | - Pierre-Michel Llorca
- Fondation Fondamental, Créteil, France
- University Clermont Auvergne, CMP-B CHU, CNRS, Clermont Auvergne INP, Institut Pascal, 63000, Clermont-Ferrand, France
| | - David Misdrahi
- Department of Psychiatry, AP-HP, Louis Mourier Hospital, Colombes, France
- Department of Adult Psychiatry, Charles Perrens Hospital, Bordeaux, France
- Aquitaine Institute for Cognitive and Integrative Neuroscience, UMR 5287-INCIA, University of Bordeaux, CNRS, Bordeaux, France
| | - Christine Passerieux
- Fondation Fondamental, Créteil, France
- Department of Adult Psychiatry and Addictology, Versailles Hospital, Centre Hospitalier de Versailles, 177 Rue de Versailles, 78157, Le Chesnay, France
- DisAP-DevPsy-CESP, INSERM UMR1018, University of Paris-Saclay, University of Versailles Saint-Quentin-En-Yvelines 94807, Villejuif, France
| | - Baptiste Pignon
- Fondation Fondamental, Créteil, France
- UMR_S955, UPEC, Créteil, France Inserm, U955, Equipe 15 Psychiatrie Génétique, Créteil, France AP-HP, Hôpital H. Mondor-A. Chenevier, Pôle de Psychiatrie, Créteil, France Fondation FondaMental, Fondation de Cooperation Scientifique, Université Paris-Est, Créteil, France
| | - Romain Rey
- Fondation Fondamental, Créteil, France
- INSERM U1028, CNRS UMR5292, Centre de Recherche en Neurosciences de Lyon, Université Claude Bernard Lyon 1, Equipe PSYR2, Centre Hospitalier Le Vinatier, Pole Est, 95 Bd Pinel, BP 30039, 69678, Bron Cedex, France
| | - Benoît Schorr
- Fondation Fondamental, Créteil, France
- Fédération de Médecine Translationnelle de Strasbourg, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, INSERM U1114, Strasbourg, France
| | - Franck Schürhoff
- Fondation Fondamental, Créteil, France
- UMR_S955, UPEC, Créteil, France Inserm, U955, Equipe 15 Psychiatrie Génétique, Créteil, France AP-HP, Hôpital H. Mondor-A. Chenevier, Pôle de Psychiatrie, Créteil, France Fondation FondaMental, Fondation de Cooperation Scientifique, Université Paris-Est, Créteil, France
| | - Mathieu Urbach
- Fondation Fondamental, Créteil, France
- Department of Adult Psychiatry and Addictology, Versailles Hospital, Centre Hospitalier de Versailles, 177 Rue de Versailles, 78157, Le Chesnay, France
| | - Mircea Polosan
- Fondation Fondamental, Créteil, France
- Univ. Grenoble Alpes, Inserm, U1216, Adult Psychiatry Department CHU Grenoble Alpes, Grenoble Institut Neurosciences, 38000, Grenoble, France
- Psychiatry Department, CH Alpes-Isère, 38000, Saint-Egrève, France
| | - Jasmina Mallet
- Fondation Fondamental, Créteil, France
- Institute of Psychiatry and Neuroscience of Paris, Université de Paris, INSERM UMR1266, Paris, France
- Department of Psychiatry, AP-HP, Louis Mourier Hospital, Colombes, France
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Ventura J, Subotnik KL, Han S, Hellemann GS, Green MF, Nuechterlein KH. The relationship between sex and functional outcome in first-episode schizophrenia: the role of premorbid adjustment and insight. Psychol Med 2023; 53:6878-6887. [PMID: 38314778 PMCID: PMC10600815 DOI: 10.1017/s0033291723000442] [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: 05/31/2022] [Revised: 01/23/2023] [Accepted: 02/08/2023] [Indexed: 02/07/2024]
Abstract
BACKGROUND Studies that examined sex differences in first-episode patients consistently show that males compared to females have poor premorbid adjustment, earlier age of onset, worse clinical characteristics, and poorer outcomes. However, little is known about potential mediators that could explain these sex differences. METHODS Our sample consisted of 137 individuals with first episode schizophrenia (males, n = 105; 77%) with a mean age of 22.1(s.d. = 4.1) years and mean education of 12.5(s.d. = 1.7) years. At entry, patients were within 2 years of their first psychotic episode onset. Baseline assessments were conducted for premorbid adjustment, symptoms, cognitive functioning, insight, and at 6-months for role and social functioning. RESULTS Males as compared to females had poorer premorbid adjustment across several key developmental periods (p < 0.01), an earlier age of onset [M = 20.3(3.3) v. 22.8(5.6), p = 0.002], more negative symptoms (p = 0.044), poorer insight (p = 0.031), and poorer baseline and 6-month role (p = 0.002) and social functioning (p = 0.034). Several of these variables in which males showed impairment were significant predictors of 6-month role and social functioning. Premorbid adjustment and insight mediated the relationship between sex and role and social functioning at 6-months, but not negative symptoms. DISCUSSION Males compared to females were at lower levels across several key premorbid and clinical domains which are strongly associated with functional outcome supporting the hypothesis that males might have a more disabling form of schizophrenia. The relationship between sex with role and social functioning was mediated through premorbid adjustment and insight suggesting pathways for understanding why females might have a less disabling form of schizophrenia.
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Affiliation(s)
- Joseph Ventura
- UCLA Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, University of California, Los Angeles, California, USA
| | - Kenneth L. Subotnik
- UCLA Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, University of California, Los Angeles, California, USA
| | - Sam Han
- Graduate School of Education and Psychology, Pepperdine University, Malibu, California, USA
| | - Gerhard S. Hellemann
- School of Public Health, Biostatistics Department, University of Alabama, Tuscaloosa, Alabama, USA
| | - Michael F. Green
- UCLA Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, University of California, Los Angeles, California, USA
- VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Keith H. Nuechterlein
- UCLA Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, University of California, Los Angeles, California, USA
- UCLA Department of Psychology, University of California, Los Angeles, California, USA
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Kappes JR, Huber DA, Kirchebner J, Sonnweber M, Günther MP, Lau S. Self-Harm Among Forensic Psychiatric Inpatients With Schizophrenia Spectrum Disorders: An Explorative Analysis. INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2023; 67:352-372. [PMID: 34861802 DOI: 10.1177/0306624x211062139] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The burden of self-injury among offenders undergoing inpatient treatment in forensic psychiatry is substantial. This exploratory study aims to add to the previously sparse literature on the correlates of self-injury in inpatient forensic patients with schizophrenia spectrum disorders (SSD). Employing a sample of 356 inpatients with SSD treated in a Swiss forensic psychiatry hospital, patient data on 512 potential predictor variables were retrospectively collected via file analysis. The dataset was examined using supervised machine learning to distinguish between patients who had engaged in self-injurious behavior during forensic hospitalization and those who had not. Based on a combination of ten variables, including psychiatric history, criminal history, psychopathology, and pharmacotherapy, the final machine learning model was able to discriminate between self-injury and no self-injury with a balanced accuracy of 68% and a predictive power of AUC = 71%. Results suggest that forensic psychiatric patients with SSD who self-injured were younger both at the time of onset and at the time of first entry into the federal criminal record. They exhibited more severe psychopathological symptoms at the time of admission, including higher levels of depression and anxiety and greater difficulty with abstract reasoning. Of all the predictors identified, symptoms of depression and anxiety may be the most promising treatment targets for the prevention of self-injury in inpatient forensic patients with SSD due to their modifiability and should be further substantiated in future studies.
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Affiliation(s)
| | | | | | | | | | - Steffen Lau
- Psychiatric University Hospital Zurich, Switzerland
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Abstract
OBJECTIVE Schizophrenia (SCZ) is a debilitating disease with a complex genetic cause in which age at onset may reflect genetic vulnerability. Though there has been some association between genetic polymorphisms and age of onset, there has been little exploration of the role of epigenetic processes. We sought to explore the influence of DNA methylation, a key epigenetic mechanism, and its association with the age of onset of illness. METHODS One hundred thirty-eight participants aged 18-75 years and previously diagnosed with SCZ spectrum disorders by the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders (SCID DSM-5) were recruited. Venous blood was collected and genome-wide DNA methylation was quantified using the Illumina Infinium HumanMethylation450 BeadChip array. Individual CpG sites and regions of differential methylation were explored by the age of onset; covariates included age, sex, as well as white blood cell composition. RESULTS Binary grouping (early vs. late onset) revealed four intergenic CpG sites on chromosome 2 that were above the expected P-value threshold, with hypermethylation of the CpG site cg10392614 most strongly associated with early-onset SCZ. The four most strongly associated CpG sites, including cg 10392614, were intergenic. Continuous analysis revealed the top CpG site to be cg11723066 , which is linked to the JAM3 gene, with hypomethylation associated with earlier onset; however, results were below the expected P-value threshold. CONCLUSION Studies on DNA methylation in the first-episode psychosis population may help further our understanding of the role of epigenetics in the age of onset of SCZ.
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Mandal PK, Gaur S, Roy RG, Samkaria A, Ingole R, Goel A. Schizophrenia, Bipolar and Major Depressive Disorders: Overview of Clinical Features, Neurotransmitter Alterations, Pharmacological Interventions, and Impact of Oxidative Stress in the Disease Process. ACS Chem Neurosci 2022; 13:2784-2802. [PMID: 36125113 DOI: 10.1021/acschemneuro.2c00420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Psychiatric disorders are one of the leading causes of disability worldwide and affect the quality of life of both individuals and the society. The current understanding of these disorders points toward receptor dysfunction and neurotransmitter imbalances in the brain. Treatment protocols are hence oriented toward normalizing these imbalances and ameliorating the symptoms. However, recent literature has indicated the possible role of depleted levels of antioxidants like glutathione (GSH) as well as an alteration in the levels of the pro-oxidant, iron in the pathogenesis of major psychiatric diseases, viz., schizophrenia (Sz), bipolar disorder (BD), and major depressive disorder (MDD). This review aims to highlight the involvement of oxidative stress (OS) in these psychiatric disorders. An overview of the clinical features, neurotransmitter abnormalities, and pharmacological treatments concerning these psychiatric disorders has also been presented. Furthermore, it attempts to synthesize literature from existing magnetic resonance spectroscopy (MRS) and quantitative susceptibility mapping (QSM) studies for these disorders, assessing GSH and iron, respectively. This manuscript is a sincere attempt to stimulate research discussion to advance the knowledge base for further understanding of the pathoetiology of Sz, BD, and MDD.
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Affiliation(s)
- Pravat K Mandal
- Neuroimaging and Neurospectroscopy (NINS) Laboratory, National Brain Research Centre, Manesar, Haryana 122050, India.,The Florey Institute of Neuroscience and Mental Health, Melbourne School of Medicine Campus, Melbourne 3052, Australia
| | - Shradha Gaur
- Neuroimaging and Neurospectroscopy (NINS) Laboratory, National Brain Research Centre, Manesar, Haryana 122050, India
| | - Rimil Guha Roy
- Neuroimaging and Neurospectroscopy (NINS) Laboratory, National Brain Research Centre, Manesar, Haryana 122050, India
| | - Avantika Samkaria
- Neuroimaging and Neurospectroscopy (NINS) Laboratory, National Brain Research Centre, Manesar, Haryana 122050, India
| | | | - Anshika Goel
- Neuroimaging and Neurospectroscopy (NINS) Laboratory, National Brain Research Centre, Manesar, Haryana 122050, India
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Rad F, Stancu M, Andrei LE, Linca FI, Mariana Buică A, Leti MM, Dobrescu I, Mihailescu I, Efrim-Budisteanu M. Diagnosis stability and outcome of psychotic episodes in a Romanian group of children and adolescents. Medicine (Baltimore) 2022; 101:e30288. [PMID: 36042658 PMCID: PMC9410679 DOI: 10.1097/md.0000000000030288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Studies on early onset schizophrenia are limited because of their low prevalence but the reported results stated that early onset is associated with a poorer outcome. The present research analyzed the stability rate of the psychotic-related disorders from childhood to adult life. The study was based on an observational, retrospective, descriptive analysis study. The subjects were selected from patients admitted to the pediatric psychiatry ward of "Alexandru Obregia" Psychiatry Hospital between 2009 and 2018 for a psychosis-related disorder, who were 18 years or older at the moment of data collection and who also had admissions into the adult's psychiatry wards of the hospital. Of the 115 subjects, 93, representing 80.87% of the total, maintained a diagnosis of psychotic spectrum disorder into adulthood. The diagnosis was maintained in 82.4% of cases with onset before 13 years old and 80.6% of cases with onset after the age of 13 years of age. Of the 42 subjects who presented affective symptoms during childhood, 71.43% also presented affective symptoms into adulthood. These findings indicate an important stability rate of psychosis from childhood and adulthood and come in accordance with the theory of overlap between psychotic and affective disorders. The results underline the importance of an accurate diagnosis of early and very early onset schizophrenia (VEOS), the need for early and multimodal intervention, but also the need for long-term management of these patients and continuing research regarding psychotic-related disorders in children and adolescents.
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Affiliation(s)
- Florina Rad
- “Prof. Dr. Alexandru Obregia” Clinical Hospital of Psychiatry, Bucharest, Romania
| | - Mihaela Stancu
- “Mina Minovici” National Institute of Legal Medicine, Bucharest, Romania
| | | | | | - Alexandra Mariana Buică
- “Grigore Alexandrescu” Clinical Emergency Pediatrics Hospital, Bucharest, Romania
- *Correspondence: Alexandra Mariana Buică, “Grigore Alexandrescu” Clinical Emergency Pediatrics Hospital, 010555, Bucharest, Romania (e-mail: )
| | - Maria-Madalina Leti
- “Prof. Dr. Alexandru Obregia” Clinical Hospital of Psychiatry, Bucharest, Romania
| | - Iuliana Dobrescu
- “Prof. Dr. Alexandru Obregia” Clinical Hospital of Psychiatry, Bucharest, Romania
| | - Ilinca Mihailescu
- “Prof. Dr. Alexandru Obregia” Clinical Hospital of Psychiatry, Bucharest, Romania
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Iasevoli F, Razzino E, Altavilla B, Avagliano C, Barone A, Ciccarelli M, D'Ambrosio L, Matrone M, Milandri F, Notar Francesco D, Fornaro M, de Bartolomeis A. Relationships between early age at onset of psychotic symptoms and treatment resistant schizophrenia. Early Interv Psychiatry 2022; 16:352-362. [PMID: 33998142 PMCID: PMC9291026 DOI: 10.1111/eip.13174] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 04/21/2021] [Accepted: 05/05/2021] [Indexed: 11/30/2022]
Abstract
AIM Early age at schizophrenia onset (EOS) has been associated with a worse clinical course, although previous studies reported substantial heterogeneity. Despite the relevance of the subject, the relationship between the age of onset and treatment resistant schizophrenia (TRS) is less clear. METHODS We screened 197 non-affective psychotic patients. Of these, 99 suffered from schizophrenia and were putative TRS and were included in a prospective 4-to-8-week trial to assess their response to antipsychotics. According to status (TRS/nonTRS) and age-at-onset (early: ≤18 years, EOS; adult: >18 years, adult onset schizophrenia [AOS]) patients were subdivided in EOS-TRS, EOS-nonTRS, AOS-TRS, AOS-nonTRS. Multiple clinical variables were measured and compared by analysis of covariance (ANCOVA), using age as a covariate. Two-way analysis of variance (ANOVA) was used to assess whether significant differences were attributable to TRS status or age-at-onset. RESULTS The rate of TRS patients was significantly higher in EOS compared to AOS. At the ANCOVA, EOS-TRS had significantly worse clinical, cognitive, and psychosocial outcomes compared to the other groups. Overall, EOS-TRS were more impaired than EOS-nonTRS, while significant differences with AOS-TRS were less consistent, albeit appreciable. Two-way ANOVA demonstrated that, in the majority of the investigated variables, the significant differences among groups were attributable to the TRS status effect rather than to age-at-onset or combined effects. CONCLUSIONS These results suggest that refractoriness to antipsychotics may be strongly linked to the early onset of psychotic symptoms, possibly as a result of common neurobiology.
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Affiliation(s)
- Felice Iasevoli
- Section of Psychiatry - Unit on Treatment Resistant Psychosis, and Laboratory of Molecular and Translational Psychiatry, Department of Neuroscience, University School of Medicine Federico II, Naples, Italy
| | - Eugenio Razzino
- Section of Psychiatry - Unit on Treatment Resistant Psychosis, and Laboratory of Molecular and Translational Psychiatry, Department of Neuroscience, University School of Medicine Federico II, Naples, Italy
| | - Benedetta Altavilla
- Section of Psychiatry - Unit on Treatment Resistant Psychosis, and Laboratory of Molecular and Translational Psychiatry, Department of Neuroscience, University School of Medicine Federico II, Naples, Italy
| | - Camilla Avagliano
- Section of Psychiatry - Unit on Treatment Resistant Psychosis, and Laboratory of Molecular and Translational Psychiatry, Department of Neuroscience, University School of Medicine Federico II, Naples, Italy
| | - Annarita Barone
- Section of Psychiatry - Unit on Treatment Resistant Psychosis, and Laboratory of Molecular and Translational Psychiatry, Department of Neuroscience, University School of Medicine Federico II, Naples, Italy
| | - Mariateresa Ciccarelli
- Section of Psychiatry - Unit on Treatment Resistant Psychosis, and Laboratory of Molecular and Translational Psychiatry, Department of Neuroscience, University School of Medicine Federico II, Naples, Italy
| | - Luigi D'Ambrosio
- Section of Psychiatry - Unit on Treatment Resistant Psychosis, and Laboratory of Molecular and Translational Psychiatry, Department of Neuroscience, University School of Medicine Federico II, Naples, Italy
| | - Marta Matrone
- Section of Psychiatry - Unit on Treatment Resistant Psychosis, and Laboratory of Molecular and Translational Psychiatry, Department of Neuroscience, University School of Medicine Federico II, Naples, Italy
| | - Federica Milandri
- Section of Psychiatry - Unit on Treatment Resistant Psychosis, and Laboratory of Molecular and Translational Psychiatry, Department of Neuroscience, University School of Medicine Federico II, Naples, Italy
| | - Danilo Notar Francesco
- Section of Psychiatry - Unit on Treatment Resistant Psychosis, and Laboratory of Molecular and Translational Psychiatry, Department of Neuroscience, University School of Medicine Federico II, Naples, Italy
| | - Michele Fornaro
- Section of Psychiatry - Unit on Treatment Resistant Psychosis, and Laboratory of Molecular and Translational Psychiatry, Department of Neuroscience, University School of Medicine Federico II, Naples, Italy
| | - Andrea de Bartolomeis
- Section of Psychiatry - Unit on Treatment Resistant Psychosis, and Laboratory of Molecular and Translational Psychiatry, Department of Neuroscience, University School of Medicine Federico II, Naples, Italy
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Jeong JH, Kim SW, Lee BJ, Kim JJ, Yu JC, Won SH, Lee SH, Kim SH, Kang SH, Kim E, Chung YC, Lee KY. The factor structure and clinical utility of clinician-rated dimensions of psychosis symptom severity in patients with recent-onset psychosis: Results of a 1-year longitudinal follow-up prospective cohort study. Psychiatry Res 2022; 310:114420. [PMID: 35152067 DOI: 10.1016/j.psychres.2022.114420] [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: 04/06/2021] [Revised: 01/22/2022] [Accepted: 01/26/2022] [Indexed: 11/25/2022]
Abstract
The classic subtype classification of schizophrenia has been removed, and DSM-5 now includes the Clinician-Rated Dimensions of Psychosis Symptom Severity (CRDPSS). In the present study, a factor analysis of the CRDPSS was performed, and we assessed whether patient classification using the derived factor structure helps predict the clinical course. The participants were 390 patients with recent-onset psychosis enrolled in the Korean Early Psychosis Cohort Study (KEPS). Two factors were identified: psychotic (including delusions, hallucinations, disorganization, and abnormal psychomotor behavior) and negative-cognitive (including negative symptoms and impaired cognition). Patients were grouped based on the factor structure and changes in clinical course were monitored over 1 year. The negative-cognitive group demonstrated longer duration of untreated psychosis, earlier onset, and a higher rate of psychiatric comorbidities. Baseline Positive and Negative Syndrome Scale (PANSS) total and Clinical Global Impression-Severity (CGI-S) scores were higher in psychotic group, but group differences were not observed after 2 months. Conversely, the PANSS negative scale score was significantly higher in negative-cognitive group throughout follow-up, and CGI-S score was reversed at 12 months. The findings indicate that the factor structure derived herein for the CRDPSS could be helpful for predicting the clinical course of recent-onset psychosis patients.
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Affiliation(s)
- Jae Hoon Jeong
- Department of Psychiatry, Eulji University School of Medicine, Daejeon, Republic of Korea
| | - Sung-Wan Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Bong Ju Lee
- Department of Psychiatry, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Jung Jin Kim
- Department of Psychiatry, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Republic of Korea
| | - Je-Chun Yu
- Department of Psychiatry, Eulji University School of Medicine, Daejeon, Republic of Korea; Department of Psychiatry, Eulji University Hospital, Daejeon, Republic of Korea
| | - Seung-Hee Won
- Department of Psychiatry, Kyungpook National University School of Medicine, Daegu, Republic of Korea
| | - Seung-Hwan Lee
- Department of Psychiatry, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Republic of Korea
| | - Seung-Hyun Kim
- Department of Psychiatry, Korea University College of Medicine, Guro Hospital, Seoul, Republic of Korea
| | - Shi Hyun Kang
- Department of Social Psychiatry and Rehabilitation, National Center for Mental Health, Seoul, Republic of Korea
| | - Euitae Kim
- Department of Psychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Young-Chul Chung
- Department of Psychiatry, Jeonbuk National University Medical School, Jeonju, Republic of Korea; Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea.
| | - Kyu Young Lee
- Department of Psychiatry, Eulji University School of Medicine, Daejeon, Republic of Korea; Department of Psychiatry, Nowon Eulji University Hospital, Seoul, Republic of Korea.
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10
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Matrone M, Kotzalidis GD, Romano A, Bozzao A, Cuomo I, Valente F, Gabaglio C, Lombardozzi G, Trovini G, Amici E, Perrini F, De Persis S, Iasevoli F, De Filippis S, de Bartolomeis A. Treatment-resistant schizophrenia: Addressing white matter integrity, intracortical glutamate levels, clinical and cognitive profiles between early- and adult-onset patients. Prog Neuropsychopharmacol Biol Psychiatry 2022; 114:110493. [PMID: 34883221 DOI: 10.1016/j.pnpbp.2021.110493] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 11/05/2021] [Accepted: 11/29/2021] [Indexed: 01/30/2023]
Abstract
BACKGROUND Treatment-resistance in schizophrenia is 30-40%. Its neurobiology remains unclear; to explore it, we conducted a combined spectrometry/tractography/cognitive battery and psychopathological rating study on patients with treatment-resistant schizophrenia (TRS), dividing the sample into early-onset (N = 21) and adult-onset TRS (N = 20). Previous studies did not differentiate between early- (onset 13-18 years) and adult-onset (>18 years at formal diagnosis of schizophrenia) TRS. METHODS We evaluated cross-sectionally 41 TRS patients (26 male and 15 female) and 20 matched healthy controls (HCs) with psychopathological and cognitive testing prior to participating in brain imaging scanning using magnetic resonance spectroscopy and diffusion tensor imaging to determine the relationship between their symptoms and their glutamate levels and white matter integrity. RESULTS TRS patients scored lower than HCs on all cognitive domains; early-onset patients performed better than adult-onset patients only on the Symbol Coding domain. TRS correlated with symptom severity, especially negative symptoms. Glutamate levels and glutamate/creatine were increased in anterior cingulate cortex. Diffusion tensor imaging showed low fractional anisotropy in TRS patients in specific white matter tracts compared to HCs (bilateral anterior thalamic radiation, cortico-spinal tract, forceps minor, inferior fronto-occipital fasciculus, inferior longitudinal fasciculus, superior longitudinal fasciculus, and right uncinate fasciculus). CONCLUSIONS We identified specific magnetic resonance spectroscopy and diffusion tensor imaging alterations in TRS patients. Adult-onset TRS differed little from early-onset TRS on most measures; this points to alterations being present since the outset of schizophrenia and may constitute a biological signature of treatment-resistance.
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Affiliation(s)
- Marta Matrone
- Section of Psychiatry Laboratory of Molecular and Translational Psychiatry, Unit of Treatment Resistant Psychosis, Department of Neuroscience, Reproductive Science, and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; Clinica Neuropsichiatrica Villa von Siebenthal, Department of Neuropsychiatry, Via della Madonnina 1, 00045 Genzano di Roma, RM, Italy
| | - Georgios D Kotzalidis
- NESMOS (Neurosciences, Mental Health, and Sensory Organs) Department, Sapienza University of Rome, Faculty of Medicine and Psychology, Via di Grottarossa 1035-1039, 00189 Rome, Italy.
| | - Andrea Romano
- NESMOS (Neurosciences, Mental Health, and Sensory Organs) Department, Sapienza University of Rome, Faculty of Medicine and Psychology, Via di Grottarossa 1035-1039, 00189 Rome, Italy.
| | - Alessandro Bozzao
- NESMOS (Neurosciences, Mental Health, and Sensory Organs) Department, Sapienza University of Rome, Faculty of Medicine and Psychology, Via di Grottarossa 1035-1039, 00189 Rome, Italy.
| | - Ilaria Cuomo
- UOC SM I Distretto ASL ROMA 1, C.C. Regina Cœli, Via della Lungara 29, 00165 Rome, Italy.
| | - Francesca Valente
- Clinica Neuropsichiatrica Villa von Siebenthal, Department of Neuropsychiatry, Via della Madonnina 1, 00045 Genzano di Roma, RM, Italy; Department of Human Neurosciences, Institute of Child and Adolescent Neuropsychiatry, Sapienza University of Rome, Italy.
| | - Chiara Gabaglio
- Clinica Neuropsichiatrica Villa von Siebenthal, Department of Neuropsychiatry, Via della Madonnina 1, 00045 Genzano di Roma, RM, Italy
| | - Ginevra Lombardozzi
- Clinica Neuropsichiatrica Villa von Siebenthal, Department of Neuropsychiatry, Via della Madonnina 1, 00045 Genzano di Roma, RM, Italy
| | - Giada Trovini
- Clinica Neuropsichiatrica Villa von Siebenthal, Department of Neuropsychiatry, Via della Madonnina 1, 00045 Genzano di Roma, RM, Italy
| | - Emanuela Amici
- Clinica Neuropsichiatrica Villa von Siebenthal, Department of Neuropsychiatry, Via della Madonnina 1, 00045 Genzano di Roma, RM, Italy
| | - Filippo Perrini
- Clinica Neuropsichiatrica Villa von Siebenthal, Department of Neuropsychiatry, Via della Madonnina 1, 00045 Genzano di Roma, RM, Italy; UOC SMREE Distretto ASL ROMA 6, TSMREE, Via S. Biagio, 12, 00049, Velletri, Rome, Italy.
| | - Simone De Persis
- UOSD Attività Terapeutiche Riabilitative per i Disturbi da uso di Sostanze e nuove Dipendenze, ASL Rieti, Via Salaria per Roma 36, 02100 Rieti, Italy.
| | - Felice Iasevoli
- Section of Psychiatry Laboratory of Molecular and Translational Psychiatry, Unit of Treatment Resistant Psychosis, Department of Neuroscience, Reproductive Science, and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy.
| | - Sergio De Filippis
- Clinica Neuropsichiatrica Villa von Siebenthal, Department of Neuropsychiatry, Via della Madonnina 1, 00045 Genzano di Roma, RM, Italy
| | - Andrea de Bartolomeis
- Section of Psychiatry Laboratory of Molecular and Translational Psychiatry, Unit of Treatment Resistant Psychosis, Department of Neuroscience, Reproductive Science, and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy.
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11
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Safety and effectiveness of lurasidone in adolescents with schizophrenia: results of a 2-year, open-label extension study. CNS Spectr 2022; 27:118-128. [PMID: 33077012 DOI: 10.1017/s1092852920001893] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Minimal long-term benefit: Risk data are available regarding antipsychotic treatments for schizophrenia in pediatric populations. This study evaluated the long-term safety, tolerability, and effectiveness of lurasidone in adolescents with schizophrenia. METHODS Patients aged from 13 to 17 who completed 6 weeks of double-blind (DB), placebo-controlled treatment with lurasidone were enrolled in a 2-year, open-label (OL), flexible dose (20-80 mg/day) lurasidone treatment study. Safety was assessed via spontaneous reporting, rating scales, body weight measurement, metabolic, and prolactin testing. Effectiveness measures included the Positive and Negative Syndrome Scale (PANSS) total score. RESULTS About 271 patients completed 6 weeks of DB treatment and entered the 2-year OL extension study. Altogether, 42.4% discontinued prematurely, 10.7% due to adverse events. During OL treatment, the most common adverse events were headache (24.0%); anxiety (12.9%), schizophrenia, and nausea (12.5%); sedation/somnolence (12.2%); and nasopharyngitis (8.9%). Minimal changes were observed on metabolic parameters and prolactin. Mean change from DB baseline in weight at week 52 and week 104 was +3.3 kg and + 4.9 kg, respectively, compared to an expected weight gain of +3.4 kg and + 5.7 kg, respectively, based on the sex- and age-matched US Center for Disease Control normative data. Continued improvement was observed in PANSS total score, with mean change from OL baseline of -15.6 at week 52 and -18.4 at week 104. CONCLUSION In adolescents with schizophrenia, long-term lurasidone treatment was associated with minimal effects on body weight, lipids, glycemic indices, and prolactin. Continued improvement in symptoms of schizophrenia was observed over 2 years of lurasidone treatment.
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12
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Rotstein A, Shadmi E, Roe D, Gelkopf M, Levine SZ. Gender differences in quality of life and the course of schizophrenia: national study. BJPsych Open 2022; 8:e35. [PMID: 35101158 PMCID: PMC8867859 DOI: 10.1192/bjo.2022.3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Evidence from various sources suggests that females with schizophrenia tend to report lower quality of life than males with schizophrenia despite having a less severe course of the disorder. However, studies have not examined this directly. AIMS To examine gender differences in the association between quality of life and the risk of subsequent psychiatric hospital admissions in a national sample with schizophrenia. METHOD The sample consisted of 989 (60.90%) males and 635 (39.10%) females with an ICD-10 diagnosis of schizophrenia. Quality of life was assessed and scored using the Manchester Short Assessment of Quality of Life. The course of schizophrenia was assessed from the number of psychiatric hospital admissions. Participants completed the quality of life assessment and were then followed up for 18-months for subsequent psychiatric admissions. Hazard ratios (HR) from Cox proportional hazards regression models were estimated unadjusted and adjusted for covariates (age at schizophrenia onset and birth year). Analyses were computed for males and females separately, as well as for the entire cohort. RESULTS A subsample of 93 males and 55 females was admitted to a psychiatric hospital during follow-up. Higher quality of life scores were significantly (P < 0.05) associated with a reduced risk of subsequent admissions among males (unadjusted: HR = 0.96, 95% CI 0.93-0.99; adjusted HR = 0.96, 95% CI 0.93-0.99) but not among females (unadjusted: HR = 0.97, 95% CI 0.93-1.02; adjusted HR = 0.97, 95% CI 0.93-1.02). CONCLUSIONS Quality of life in schizophrenia is a gender-specific construct and should be considered as such in clinical practice and future research.
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Affiliation(s)
- Anat Rotstein
- Department of Community Mental Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Israel
| | - Efrat Shadmi
- Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Sciences, University of Haifa, Israel
| | - David Roe
- Department of Community Mental Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Israel
| | - Marc Gelkopf
- Department of Community Mental Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Israel
| | - Stephen Z Levine
- Department of Community Mental Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Israel
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13
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Cheng X, Zhang H, Zhang J, Xu P, Jin P, Fang H, Chu K, Ke X. Comparison of clinical characteristics and treatment efficacy in childhood-onset schizophrenia and adolescent-onset schizophrenia in mainland China: A retrospective study. Early Interv Psychiatry 2021; 15:1721-1729. [PMID: 33465837 DOI: 10.1111/eip.13121] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 12/18/2020] [Accepted: 01/04/2021] [Indexed: 12/23/2022]
Abstract
AIM The comparative study of childhood-onset schizophrenia (COS) and adolescent-onset schizophrenia (AOS) is scarce. This study aimed to examine the differences in clinical presentations and treatment efficacy between COS and AOS and further analyse the factors affecting the efficacy of early-onset schizophrenia (EOS). METHODS A total of 582 electronic medical records of inpatients with EOS (216 COS and 366 AOS inpatients) between 2012 and 2019 were retrospectively analysed. The positive and negative syndrome scale (PANSS) was used to assess psychotic symptoms. Logistic regression analysis was performed to analyse the predictors of efficacy. RESULTS The mean age of onset of EOS was 12.87 ± 2.19 years. The importance of better diagnosing COS appeared in a longer illness course, more frequently insidious onset, less frequent delusions, more severe negative symptoms and bizarre behaviours than AOS. Besides, COS had more frequent visual hallucinations and impulsive behaviours than AOS. After hospitalization, the improvement rate of psychotic symptoms in COS and AOS were 38.3% and 47.8%, respectively. The difference of efficacy between the two groups was statistically significant. Days of hospitalization, age of onset, presence of flat affect, PANSS total and negative score at admission were predictors of treatment efficacy in EOS individuals. CONCLUSIONS COS inpatients suffer more obvious negative symptoms, bizarre behaviours, visual hallucinations and impulsive behaviours and worse efficacy than AOS inpatients. The severity of negative symptoms and age of onset seem the most noteworthy predictors of efficacy. These findings highlight the importance of early detection and early intervention.
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Affiliation(s)
- Xin Cheng
- The Child Mental Health Research Center, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Huihui Zhang
- The Child Mental Health Research Center, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Jiuping Zhang
- The Child Mental Health Research Center, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Ping Xu
- Department of Psychiatry, Nanjing Lishui Psychiatric Hospital, Nanjing, China
| | - Peiying Jin
- The Child Mental Health Research Center, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Hui Fang
- The Child Mental Health Research Center, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Kangkang Chu
- The Child Mental Health Research Center, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Xiaoyan Ke
- The Child Mental Health Research Center, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
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14
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Relationship between cognition and age at onset of first-episode psychosis: comparative study between adolescents, young adults, and adults. Eur Child Adolesc Psychiatry 2021; 32:639-649. [PMID: 34714406 DOI: 10.1007/s00787-021-01901-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 10/24/2021] [Indexed: 12/13/2022]
Abstract
Psychotic disorders typically manifest from late adolescence to early adulthood, and an earlier onset might be associated with greater symptom severity and a worse long-term prognosis. This study aimed to compare the cognitive characteristics of patients with first-episode psychosis (FEP) by their age at onset. We included 298 patients diagnosed with FEP and classified them as having an early onset (EOS), youth onset (YOS), or adult onset (AOS) based on age limits of ≤ 18 years (N = 61), 19-24 years (N = 121), and ≥ 25 years (N = 116), respectively. Socio-demographic and clinical variables included age at baseline, gender, socio-economic status, antipsychotic medication, DSM-IV diagnoses assessed by clinical semi-structured interview, psychotic symptom severity, and age at onset. Neuropsychological assessment included six cognitive domains: premorbid intelligence, working memory, processing speed, verbal memory, sustained attention, and executive functioning. The EOS group had lower scores than the YOS or AOS groups in global cognition, executive functioning, and sustained attention. Although the scores in the YOS group were intermediate to those in the EOS and AOS groups for most cognitive factors, no statistically significant differences were detected between the YOS and AOS groups. Age at onset results in specific patterns of cognitive interference. Of note, impairment appears to be greater with EOS samples than with either YOS or AOS samples. A longitudinal study with a larger sample size is needed to confirm our findings.
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15
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Luckhoff HK, Asmal L, Scheffler F, du Plessis S, Buckle C, Chiliza B, Kilian S, Smit R, Phahladira L, Emsley R. Gender role endorsement in first-episode schizophrenia spectrum disorders. Psychiatry Res 2021; 299:113867. [PMID: 33751988 DOI: 10.1016/j.psychres.2021.113867] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 03/07/2021] [Indexed: 01/30/2023]
Abstract
Sex (a biological distinction) and gender (a social construct) are inter-related, but semi-independent measures. The aim of our research was to compare gender role endorsement between first-episode schizophrenia spectrum disorder patients (n=77) and matched controls (n=64). The Bem Sex Role Inventory (BSRI) was used to assess masculinity and femininity scores as separate linear measures. This well-known research instrument also allowed us to examine gender as a categorical measure based on sex-specific cut-off scores calculated for controls as our normative reference sample using a median-split technique. First, we found that both masculinity and femininity scores differed between patients and controls. The distribution of gender as a categorical measure also differed between the two groups. Post-hoc testing with correction for multiple comparisons identified masculinity scores in particular as being lower in both male and female patients compared to controls of the corresponding sex. In conclusion, lower masculinity scores reported for chronic schizophrenia also affects first-episode patients with minimal prior treatment exposure irrespective of their biological sex. Future studies would do well to examine the associations of sex and gender with clinical and treatment outcomes from the perspective of the neurodevelopmental model of schizophrenia as a proposed "disorder of the self".
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Affiliation(s)
- H K Luckhoff
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - L Asmal
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - F Scheffler
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - S du Plessis
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - C Buckle
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - B Chiliza
- Department of Psychiatry, Nelson R Mandela School of Medicine, University of Kwazulu-Natal, Durban, South Africa
| | - S Kilian
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - R Smit
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - L Phahladira
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - R Emsley
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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16
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Chen E, Bazargan-Hejazi S, Ani C, Hindman D, Pan D, Ebrahim G, Shirazi A, Banta JE. Schizophrenia hospitalization in the US 2005-2014: Examination of trends in demographics, length of stay, and cost. Medicine (Baltimore) 2021; 100:e25206. [PMID: 33847618 PMCID: PMC8052007 DOI: 10.1097/md.0000000000025206] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 02/25/2021] [Indexed: 01/04/2023] Open
Abstract
Primarily we aimed to examine the crude and standardized schizophrenia hospitalization trend from 2005 to 2014. We hypothesized that there will be a statistically significant linear trend in hospitalization rates for schizophrenia from 2005 to 2014. Secondarily we also examined trends in hospitalization by race/ethnicity, age, gender, as well as trends in hospitalization Length of Stay (LOS) and inflation adjusted cost.In this observational study, we used Nationwide Inpatient Sample data and International Classification of Diseases, Eleventh Revisions codes for Schizophrenia, which revealed 6,122,284 cases for this study. Outcomes included crude and standardized hospitalization rates, race/ethnicity, age, cost, and LOS. The analysis included descriptive statistics, indirect standardization, Rao-Scott Chi-Square test, t-test, and adjusted linear regression trend.Hospitalizations were most prevalent for individuals ages 45-64 (38.8%), African Americans were overrepresented (25.8% of hospitalizations), and the gender distribution was nearly equivalent. Mean LOS was 9.08 days (95% confidence interval 8.71-9.45). Medicare was the primary payer for most hospitalizations (55.4%), with most of the costs ranging from $10,000-$49,999 (57.1%). The crude hospitalization rates ranged from 790-1142/100,000 admissions, while the US 2010 census standardized rates were 380-552/100,000 from 2005-2014. Linear regression trend analysis showed no significant difference in trend for race/ethnicity, age, nor gender (P > .001). The hospitalizations' overall rates increased while LOS significantly decreased, while hospitalization costs and Charlson's co-morbidity index increased (P < .001).From 2005-2014, the overall US hospitalization rates significantly increased. Over this period, observed disparities in hospitalizations for middle-aged and African Americans were unchanged, and LOS has gone down while costs have gone up. Further studies addressing the important disparities in race/ethnicity and age and reducing costs of acute hospitalization are needed.
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Affiliation(s)
- Ethan Chen
- Charles Drew University of Medicine and Science and David Geffen School of Medicine at University of California at Los Angeles (UCLA)
| | - Shahrzad Bazargan-Hejazi
- Department of Psychiatry; Charles Drew University of Medicine and Science & David Geffen School of Medicine at University of California at Los Angeles (UCLA)
| | - Chizobam Ani
- Department of Internal Medicine, Charles Drew University of Medicine and. Science & University
| | - David Hindman
- Department of Psychiatry; Charles Drew University of Medicine and Science & David Geffen School of Medicine at University of California at Los Angeles (UCLA)
- Department of Psychiatry; Charles Drew University of Medicine and Science
| | - Deyu Pan
- Charles Drew University of Medicine and Science
| | - Gul Ebrahim
- Department of Psychiatry; Charles Drew University of Medicine and Science
| | - Anaheed Shirazi
- Department of Psychiatry, University of California at San Diego
| | - Jim E. Banta
- Health Policy and Leadership, School of Public Health, Loma Linda University, Los Angeles CA
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17
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Galitzer H, Anagnostopoulou N, Alba A, Gaete J, Dima D, Kyriakopoulos M. Functional outcomes and patient satisfaction following inpatient treatment for childhood-onset schizophrenia spectrum disorders vs non-psychotic disorders in children in the United Kingdom. Early Interv Psychiatry 2021; 15:412-419. [PMID: 32431095 DOI: 10.1111/eip.12973] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 03/11/2020] [Accepted: 04/28/2020] [Indexed: 11/28/2022]
Abstract
AIM The aim of this study was to compare clinical characteristics and treatment outcomes between children with Childhood-onset schizophrenia spectrum disorders (COSS) and children with other severe non-psychotic psychiatric conditions (non-COSS), all admitted to a national mental health inpatient children's unit. METHODS We conducted a retrospective study of all children discharged from a national children's inpatient unit in the United Kingdom, between 2009 and 2018. We compared functional and treatment outcomes and satisfaction with treatment in COSS with non-COSS in the whole sample and separately for male and female patients. RESULTS A total of 211 children (55% boys) were included in the sample. The mean age on admission was 129.7 months (10.8 years; age range, 6-12).Twenty cases were diagnosed with COSS (9.5%). In the whole sample, COSS patients had significantly lower Children's Global Assessment Scale (CGAS) scores on admission compared to non-COSS (P = .006). There was a trend towards children with COSS as a group having a longer admission (M = 194.6 days, SD = 125.4) compared to non-COSS (M = 135.8 days, SD = 86.2), (P = .053). Females with COSS seemed to have more significant differences compared to females with non-COSS, in particular, longer admissions (P = .016) and worse CGAS scores at discharge (P = .04), whilst in males, these differences seemed to be attenuated. CONCLUSIONS Children with COSS have lower functioning at the point of inpatient admission and possibly longer admissions, but similar satisfaction with treatment at discharge from hospital compared with non-COSS. Females with COSS may have worse functional outcomes compared to non-COSS at discharge.
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Affiliation(s)
- Hayley Galitzer
- National and Specialist Acorn Lodge Inpatient Children's Unit, Child and Adolescent Mental Health Clinical Academic Group, South London and the Maudsley NHS Foundation Trust, London, UK
| | - Nefeli Anagnostopoulou
- National and Specialist Acorn Lodge Inpatient Children's Unit, Child and Adolescent Mental Health Clinical Academic Group, South London and the Maudsley NHS Foundation Trust, London, UK
| | - Anca Alba
- National and Specialist Acorn Lodge Inpatient Children's Unit, Child and Adolescent Mental Health Clinical Academic Group, South London and the Maudsley NHS Foundation Trust, London, UK
| | - Jorge Gaete
- National and Specialist Acorn Lodge Inpatient Children's Unit, Child and Adolescent Mental Health Clinical Academic Group, South London and the Maudsley NHS Foundation Trust, London, UK.,Faculty of Education, Universidad de los Andes, Santiago, Chile.,Millennium Nucleus to Improve the Mental Health of Adolescents and Youths, Santiago, Chile
| | - Danai Dima
- Department of Psychology, School of Arts and Social Sciences, City, University of London, London, UK.,Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Marinos Kyriakopoulos
- National and Specialist Acorn Lodge Inpatient Children's Unit, Child and Adolescent Mental Health Clinical Academic Group, South London and the Maudsley NHS Foundation Trust, London, UK.,Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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18
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Risk of dementia and death in very-late-onset schizophrenia-like psychosis: A national cohort study. Schizophr Res 2020; 223:220-226. [PMID: 32807646 DOI: 10.1016/j.schres.2020.07.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 07/07/2020] [Accepted: 07/23/2020] [Indexed: 01/21/2023]
Abstract
Knowledge is limited regarding the risks of death and dementia in very-late onset schizophrenia-like psychosis (VLOS). This study aims to scrutinize the associations between VLOS with the risks of death and dementia. Based on a prospective Israeli cohort study with national coverage, 94,120 persons without dementia or schizophrenia diagnoses aged 60 to 90 in 2012 were followed-up for the risks of dementia or death from 2013 to 2017. VLOS was classified as present from the age of the first ICD-9 diagnosis during follow-up, otherwise as absent. Hazard ratios (HR) with confidence intervals (95% CI) were computed with survival models to quantify the associations between VLOS and the risks of death and dementia, without and with adjustment for confounding. Nine sensitivity analyses were computed to examine the robustness of the results. The group with VLOS, compared to the group without, had higher death (n = 61, 18.5% vs. n = 7028, 7.5%, respectively) and dementia (n = 64, 19.5% vs. n = 5962, 6.4%, respectively) rates. In the primary analysis, the group with VLOS compared to the group without had increased risks of death (unadjusted HR = 3.10, 95% CI = 2.36, 4.06, P < .001; adjusted HR = 2.89, 95% CI = 2.15, 3.89; P < .001) and dementia (unadjusted HR = 3.81, 95% CI = 2.90, 4.99, P < .001; adjusted HR = 2.67, 95% CI = 1.82, 3.91; P < .001). The results remained statistically significant (P < .05) in all sensitivity analyses, including among persons without antipsychotic medication. The results may support notions of increased dementia risk and accelerated aging in VLOS, or that VLOS is a prodromal state of dementia.
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Taylor CL, Munk-Olsen T, Howard LM, Vigod SN. Schizophrenia around the time of pregnancy: leveraging population-based health data and electronic health record data to fill knowledge gaps. BJPsych Open 2020; 6:e97. [PMID: 32854798 PMCID: PMC7488329 DOI: 10.1192/bjo.2020.78] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Research in schizophrenia and pregnancy has traditionally been conducted in small samples. More recently, secondary analysis of routine healthcare data has facilitated access to data on large numbers of women with schizophrenia. AIMS To discuss four scientific advances using data from Canada, Denmark and the UK from population-level health registers and clinical data sources. METHOD Narrative review of research from these three countries to illustrate key advances in the area of schizophrenia and pregnancy. RESULTS Health administrative and clinical data from electronic medical records have been used to identify population-level and clinical cohorts of women with schizophrenia, and follow them longitudinally along with their children. These data have demonstrated that fertility rates in women with schizophrenia have increased over time and have enabled documentation of the course of illness in relation with pregnancy, showing the early postpartum as the time of highest risk. As a result of large sample sizes, we have been able to understand the prevalence of and risk factors for rare outcomes that would be difficult to study in clinical research. Advanced pharmaco-epidemiological methods have been used to address confounding in studies of antipsychotic medications in pregnancy, to provide data about the benefits and risks of treatment for women and their care providers. CONCLUSIONS Use of these data has advanced the field of research in schizophrenia and pregnancy. Future developments in use of electronic health records include access to richer data sources and use of modern technical advances such as machine learning and supporting team science.
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Affiliation(s)
| | - Trine Munk-Olsen
- Department of Economics and Business Economics, Aarhus University, Denmark
| | - Louise M Howard
- Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, UK
| | - Simone N Vigod
- Women's College Research Institute, Women's College Hospital, Canada
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20
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Dazzan P, Lappin JM, Heslin M, Donoghue K, Lomas B, Reininghaus U, Onyejiaka A, Croudace T, Jones PB, Murray RM, Fearon P, Doody GA, Morgan C. Symptom remission at 12-weeks strongly predicts long-term recovery from the first episode of psychosis. Psychol Med 2020; 50:1452-1462. [PMID: 31364523 PMCID: PMC7385193 DOI: 10.1017/s0033291719001399] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 04/18/2019] [Accepted: 05/28/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND To determine the baseline individual characteristics that predicted symptom recovery and functional recovery at 10-years following the first episode of psychosis. METHODS AESOP-10 is a 10-year follow up of an epidemiological, naturalistic population-based cohort of individuals recruited at the time of their first episode of psychosis in two areas in the UK (South East London and Nottingham). Detailed information on demographic, clinical, and social factors was examined to identify which factors predicted symptom and functional remission and recovery over 10-year follow-up. The study included 557 individuals with a first episode psychosis. The main study outcomes were symptom recovery and functional recovery at 10-year follow-up. RESULTS At 10 years, 46.2% (n = 140 of 303) of patients achieved symptom recovery and 40.9% (n = 117) achieved functional recovery. The strongest predictor of symptom recovery at 10 years was symptom remission at 12 weeks (adj OR 4.47; CI 2.60-7.67); followed by a diagnosis of depression with psychotic symptoms (adj OR 2.68; CI 1.02-7.05). Symptom remission at 12 weeks was also a strong predictor of functional recovery at 10 years (adj OR 2.75; CI 1.23-6.11), together with being from Nottingham study centre (adj OR 3.23; CI 1.25-8.30) and having a diagnosis of mania (adj OR 8.17; CI 1.61-41.42). CONCLUSIONS Symptom remission at 12 weeks is an important predictor of both symptom and functional recovery at 10 years, with implications for illness management. The concepts of clinical and functional recovery overlap but should be considered separately.
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Affiliation(s)
- Paola Dazzan
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- National Institute for Health Research Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
| | - Julia M. Lappin
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Margaret Heslin
- National Institute for Health Research Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
- Department of Health Service & Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Kim Donoghue
- Department of Addictions, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Ben Lomas
- Department of Psychiatry, University of Nottingham, Nottingham, UK
| | - Uli Reininghaus
- Department of Health Service & Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University
| | - Adanna Onyejiaka
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Tim Croudace
- School of Nursing & Health Sciences, University of Dundee, Dundee, UK
| | - Peter B. Jones
- University of Cambridge, and Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Robin M. Murray
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- National Institute for Health Research Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
| | - Paul Fearon
- Discipline of Psychiatry, School of Medicine, Trinity College, Dublin, Ireland
| | - Gillian A. Doody
- Department of Psychiatry, University of Nottingham, Nottingham, UK
| | - Craig Morgan
- National Institute for Health Research Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
- Department of Health Service & Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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21
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Vernal DL, Boldsen SK, Lauritsen MB, Correll CU, Nielsen RE. Long-term outcome of early-onset compared to adult-onset schizophrenia: A nationwide Danish register study. Schizophr Res 2020; 220:123-129. [PMID: 32299717 DOI: 10.1016/j.schres.2020.03.045] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 01/09/2020] [Accepted: 03/21/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Early-onset schizophrenia (EOS) may have worse outcomes than adult-onset schizophrenia (AOS), but data are scarce. We compared outcomes of EOS vs. AOS. METHODS Longitudinal, register-based study of patients diagnosed with schizophrenia in Denmark between 1996 and 2012, with follow-up until 12/2014. Co-primary outcomes were psychiatric inpatient days during the initial two years after schizophrenia diagnosis and mean number of annual inpatient days for the remaining follow-up. RESULTS Altogether, 16,337 patients with schizophrenia were included (EOS = 1223, AOS = 15,114, mean follow-up = 9.5 ± 5.0 years). EOS were hospitalized longer during the first two years than AOS (180.9 ± 171.0 vs 163.4 ± 183.1 days, p < 0.005; IRR = 1.27, 95% CI = 1.19-1.35, p < 0.001), but duration and annual rates thereafter did not differ (EOS = 26.8 ± 57.1 days, AOS = 26.6 ± 56.2 days, p = 0.95; IRR = 1.07, 95% CI = 0.94-1.23, p = 0.30). Fewer EOS patients were never psychiatrically hospitalized (EOS = 17.2%, AOS = 20.1%, p < 0.001), but with no difference in re-admissions in patients diagnosed during hospitalization (EOS = 77.1% vs AOS = 78.1%, p = 0.56). More EOS patients were admitted involuntarily (41% vs. 36%, p < 0.02). AOS patients had more often comorbid substance use disorders during follow-up than EOS (EOS = 21.7%, AOS = 34.2%, p < 0.001). Substance use disorders and out-of-home placement were significantly associated with more inpatient days during both short- and long-term follow-up. CONCLUSION Although EOS was associated with more inpatient days in the first two years after diagnosis, results do not seem to support a generally poorer long-term outcome of EOS compared to AOS. Longer initial hospitalization may be driven by different treatment patterns in child and adolescent vs. adult psychiatry. These data suggest that patient characteristics other than age of onset significantly affect outcomes.
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Affiliation(s)
- Ditte Lammers Vernal
- Aalborg University Hospital, Research Unit for Child and Adolescent Psychiatry, North Denmark Region, Denmark.
| | - Søren Kjærgaard Boldsen
- Aalborg University Hospital, Research Unit for Child and Adolescent Psychiatry, North Denmark Region, Denmark.
| | - Marlene Briciet Lauritsen
- Aalborg University Hospital, Research Unit for Child and Adolescent Psychiatry, North Denmark Region, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
| | - Christoph U Correll
- The Zucker Hillside Hospital, Department of Psychiatry, Northwell Health, NY 11004, USA; Hofstra Northwell School of Medicine, Hofstra University, Hempstead, NY, USA; The Feinstein Institute for Medical Research, Manhasset, NY, USA; Charité Universitätsmedizin, Department of Child and Adolescent Psychiatry, Berlin, Germany.
| | - René Ernst Nielsen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Aalborg University Hospital, Department of Psychiatry, Unit for Psychiatric Research, Aalborg, Denmark.
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22
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Age of onset group characteristics in forensic patients with schizophrenia. Eur Psychiatry 2020; 29:149-52. [DOI: 10.1016/j.eurpsy.2012.11.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Revised: 11/14/2012] [Accepted: 11/23/2012] [Indexed: 11/30/2022] Open
Abstract
AbstractThis study aims to empirically identify age of onset groups and their clinical and background characteristics in forensic patients with schizophrenia. Hospital charts were reviewed of all 138 forensic patients with schizophrenia admitted to Geha Psychiatric Hospital that serves a catchment area of approximately 500,000 people, from 2000 to 2009 inclusive. Admixture analysis empirically identified early- (M = 19.99, SD = 3.31) and late-onset groups (M = 36.13, SD = 9.25). Early-onset was associated with more suicide attempts, violence before the age of 15, and early conduct problems, whereas late-onset was associated with a greater likelihood of violence after the age of 18 and marriage (P < 0.01). The current findings provide clinicians with a unique direction for risk assessment and indicate differences in violence between early- and late-onset schizophrenia, particularly co-occurrence of harmful behavioral phenotypes.
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23
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Armando M, Klauser P, Anagnostopoulos D, Hebebrand J, Moreno C, Revet A, Raynaud JP. Clinical high risk for psychosis model in children and adolescents: a joint position statement of ESCAP Clinical Division and Research Academy. Eur Child Adolesc Psychiatry 2020; 29:413-416. [PMID: 32146537 DOI: 10.1007/s00787-020-01499-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Marco Armando
- Department of Psychiatry, Developmental Imaging and Psychopathology Lab, University of Geneva, Geneva, Switzerland.
| | - Paul Klauser
- Service of Child and Adolescent Psychiatry, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
- Center for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | | | - Johannes Hebebrand
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, LVR Klinikum Essen, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Carmen Moreno
- Child and Adolescent Psychiatry Department, Hospital General, Universitario Gregorio Marañón, Madrid, Spain
| | - Alexis Revet
- Service Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, CHU de Toulouse, Toulouse, France
- UMR 1027, Inserm, Université Toulouse III, Toulouse, France
| | - Jean-Philippe Raynaud
- Service Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, CHU de Toulouse, Toulouse, France
- UMR 1027, Inserm, Université Toulouse III, Toulouse, France
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Zakharyan R, Ghazaryan H, Kocourkova L, Chavushyan A, Mkrtchyan A, Zizkova V, Arakelyan A, Petrek M. Association of Genetic Variants of Dopamine and Serotonin In Schizophrenia. Arch Med Res 2020; 51:13-20. [PMID: 32086104 DOI: 10.1016/j.arcmed.2019.12.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 11/29/2019] [Accepted: 12/16/2019] [Indexed: 01/03/2023]
Abstract
BACKGROUND Several studies indicated that antipsychotic treatment response and side effect manifestation can be different due to inter-individual variability in genetic variations. AIM OF THE STUDY Here we perform a case-control study to explore a potential association between schizophrenia and variants within the antipsychotic drug molecular targets (DRD1, DRD2, DRD3, HTR2A, HTR6) and metabolizing enzymes (CYP2D6, COMT) genes in Armenian population including also analysis of their possible relationship with disease clinical symptoms. METHODS A total of 18 SNPs was studied in patients with schizophrenia (n = 78) and healthy control subjects (n = 77) using MassARRAY genotyping. RESULTS We found that two studied genetic variants, namely DRD2 rs4436578*C and HTR2A rs6314*A are underrepresented in the group of patients compared to healthy subjects. After the correction for multiple testing, the rs4436578*C variant remained significant while the rs6314*A reported borderline significance. No significant differences in minor allele frequencies for other studied variants were identified. Also, a relationship between the genotypes and age of onset as well as disease duration has been detected. CONCLUSIONS The DRD2 rs4436578*C genetic variant might have protective role against schizophrenia, at least in Armenians.
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Affiliation(s)
- Roksana Zakharyan
- Institute of Molecular Biology NAS RA, Yerevan, Armenia; Russian-Armenian, University, Yerevan, Armenia.
| | - Hovsep Ghazaryan
- Andranik Chavushyan, Institute of Molecular Biology NAS RA, Yerevan, Armenia
| | - Lenka Kocourkova
- Department of Pathological Physiology, Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic
| | - Andranik Chavushyan
- Andranik Chavushyan, Institute of Molecular Biology NAS RA, Yerevan, Armenia
| | - Artur Mkrtchyan
- Department of Psychiatry, National Institute of Health, MH RA, Yerevan, Armenia
| | - Veronika Zizkova
- Department of Pathological Physiology, Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic
| | - Arsen Arakelyan
- Institute of Molecular Biology NAS RA, Yerevan, Armenia; Russian-Armenian, University, Yerevan, Armenia
| | - Martin Petrek
- Department of Pathological Physiology, Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic
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25
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Arango C, Ng-Mak D, Finn E, Byrne A, Loebel A. Lurasidone compared to other atypical antipsychotic monotherapies for adolescent schizophrenia: a systematic literature review and network meta-analysis. Eur Child Adolesc Psychiatry 2020; 29:1195-1205. [PMID: 31758359 PMCID: PMC7497364 DOI: 10.1007/s00787-019-01425-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Accepted: 10/12/2019] [Indexed: 02/07/2023]
Abstract
This network meta-analysis assessed the efficacy and tolerability of lurasidone versus other oral atypical antipsychotic monotherapies in adolescent schizophrenia. A systematic literature review identified 13 randomized controlled trials of antipsychotics in adolescents with schizophrenia-spectrum disorders. A Bayesian network meta-analysis compared lurasidone to aripiprazole, asenapine, clozapine, olanzapine, paliperidone extended-release (ER), quetiapine, risperidone, and ziprasidone. Outcomes included Positive and Negative Syndrome Scale (PANSS), Clinical Global Impressions-Severity (CGI-S), weight gain, all-cause discontinuation, extrapyramidal symptoms (EPS), and akathisia. Results were reported as median differences for continuous outcomes and odds ratios (ORs) for binary outcomes, along with 95% credible intervals (95% CrI). Lurasidone was significantly more efficacious than placebo on the PANSS (- 7.95, 95% CrI - 11.76 to - 4.16) and CGI-S (- 0.44, 95% CrI - 0.67 to - 0.22) scores. Lurasidone was associated with similar weight gain to placebo and statistically significantly less weight gain versus olanzapine (- 3.62 kg, 95% CrI - 4.84 kg to - 2.41 kg), quetiapine (- 2.13 kg, 95% CrI - 3.20 kg to - 1.08 kg), risperidone (- 1.16 kg, 95% CrI - 2.14 kg to - 0.17 kg), asenapine (- 0.98 kg, 95% CrI - 1.71 kg to - 0.24 kg), and paliperidone ER (- 0.85 kg, 95% CrI - 1.57 kg to - 0.14 kg). The odds of all-cause discontinuation were significantly lower for lurasidone than aripiprazole (OR = 0.28, 95% CrI 0.10-0.76) and paliperidone ER (OR = 0.25, 95% CrI 0.08-0.81) and comparable to other antipsychotics. Rates of EPS and akathisia were similar for lurasidone and other atypical antipsychotics. In this network meta-analysis of atypical antipsychotics in adolescent schizophrenia, lurasidone was associated with similar efficacy, less weight gain, and lower risk of all-cause discontinuation compared to other oral atypical antipsychotics.
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Affiliation(s)
- Celso Arango
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón. IiSGM, School of Medicine, Universidad Complutense, CIBERSAM. Av. Séneca 2, 28040 Madrid, Spain
| | - Daisy Ng-Mak
- Sunovion Pharmaceuticals Inc, 84 Waterford Drive, Marlborough, MA, 01752, USA.
| | - Elaine Finn
- IQVIA, 210 Pentonville Rd, London, N1 9JY UK
| | - Aidan Byrne
- IQVIA, 210 Pentonville Rd, London, N1 9JY UK
| | - Antony Loebel
- Sunovion Pharmaceuticals Inc, One Bridge Plaza North, Suite 510, Fort Lee, NJ 07024 USA
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Risk Model Assessment in Early-Onset and Adult-Onset Schizophrenia Using Neurological Soft Signs. J Clin Med 2019; 8:jcm8091443. [PMID: 31514416 PMCID: PMC6781040 DOI: 10.3390/jcm8091443] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 08/25/2019] [Accepted: 09/09/2019] [Indexed: 11/17/2022] Open
Abstract
Age at onset is one of the most important clinical features of schizophrenia that could indicate greater genetic loadings. Neurological soft signs (NSS) are considered as a potential endophenotype for schizophrenia. However, the association between NSS and different age-onset schizophrenia still remains unclear. We aimed to compare risk model in patients with early-onset schizophrenia (EOS) and adult-onset schizophrenia (AOS) with NSS. This study included 262 schizophrenia patients, 177 unaffected first-degree relatives and 243 healthy controls. We estimated the discriminant abilities of NSS models for early-onset schizophrenia (onset age < 20) and adult-onset schizophrenia (onset age ≥ 20) using three data mining methods: artificial neural networks (ANN), decision trees (DT) and logistic regression (LR). We then assessed the magnitude of NSS performance in EOS and AOS families. For the four NSS subscales, the NSS performance were greater in EOS and AOS families compared with healthy individuals. More interestingly, there were significant differences found between patients' families and control group in the four subscales of NSS. These findings support the potential for neurodevelopmental markers to be used as schizophrenia vulnerability indicators. The NSS models had higher discriminant abilities for EOS than for AOS. NSS were more accurate in distinguishing EOS patients from healthy controls compared to AOS patients. Our results support the neurodevelopmental hypothesis that EOS has poorer performance of NSS than AOS. Hence, poorer NSS performance may be imply trait-related NSS feature in EOS.
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27
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Karlsson H, Dal H, Gardner RM, Torrey EF, Dalman C. Birth month and later diagnosis of schizophrenia. A population-based cohort study in Sweden. J Psychiatr Res 2019; 116:1-6. [PMID: 31170611 DOI: 10.1016/j.jpsychires.2019.05.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 05/10/2019] [Accepted: 05/27/2019] [Indexed: 10/26/2022]
Abstract
The objective of the present study was to examine if the monthly variation in births of individuals diagnosed with schizophrenia currently differs from that of unaffected individuals in Sweden. In an extensive linkage of Swedish national and regional population registers we here investigate the birth pattern of the population born 1940-97 (5,995,499 individuals) which included 30,684 individuals diagnosed with schizophrenia in the National Patient Register by December 31, 2016. Among 2,409,862 individuals born since 1973 we investigated potential confounding by co-variates associated with pregnancy and birth. We also compared the monthly birth pattern of 22,570 affected individuals to that of their 41,528 unaffected full siblings. We observe a significant birth excess of individuals with schizophrenia in December, HR 1.07 95%CI (1.01-1.13). Patients born in December received a registered diagnosis of schizophrenia at a slightly younger age than those born during other months. A number of co-variates were associated not only with schizophrenia but also varied across birth months. Inclusion of these in the models however had virtually no influence on the risk for schizophrenia associated with December birth. In comparisons between full siblings, the association between December birth and later diagnosis of schizophrenia remained, albeit slightly attenuated, HR 1.06 (0.99-1.12). Risk for schizophrenia associated with birth in December in Sweden during the study period does not appear to be fully explained by our investigated co-variates or factors shared between family members and may thus represent monthly/seasonal variation in environmental factors involved in the etiology of schizophrenia.
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Affiliation(s)
- Hakan Karlsson
- Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden.
| | - Henrik Dal
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Renee M Gardner
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | | | - Christina Dalman
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
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28
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Pyle M, Broome MR, Joyce E, MacLennan G, Norrie J, Freeman D, Fowler D, Haddad PM, Shiers D, Hollis C, Smith J, Liew A, Byrne RE, French P, Peters S, Hudson J, Davies L, Emsley R, Yung A, Birchwood M, Longden E, Morrison AP. Study protocol for a randomised controlled trial of CBT vs antipsychotics vs both in 14-18-year-olds: Managing Adolescent first episode Psychosis: a feasibility study (MAPS). Trials 2019; 20:395. [PMID: 31272477 PMCID: PMC6611021 DOI: 10.1186/s13063-019-3506-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 06/10/2019] [Indexed: 01/03/2023] Open
Abstract
Background Adolescent-onset psychosis is associated with more severe symptoms and poorer outcomes than adult-onset psychosis. The National Institute for Clinical Excellence (NICE) recommend that adolescents with first episode psychosis (FEP) should be offered a combination of antipsychotic medication (APs), cognitive behavioural therapy (CBT) and family intervention (FI). The evidence for APs in treating psychosis is limited in adolescents compared to adults. Nevertheless, it indicates that APs can reduce overall symptoms in adolescents but may cause more severe side effects, including cardiovascular and metabolic effects, than in adults. CBT and FI can improve outcomes in adults, but there are no studies of psychological interventions (PI) in patients under 18 years old. Given this limited evidence base, NICE made a specific research recommendation for determining the clinical and cost effectiveness of APs versus PI versus both treatments for adolescent FEP. Methods/design The current study aimed to establish the feasibility and acceptability of conducting such a trial by recruiting 14–18-year-olds with a first episode of psychosis into a feasibility prospective randomised open blinded evaluation (PROBE) design, three-arm, randomised controlled trial of APs alone versus PI alone versus a combination of both treatments. We aimed to recruit 90 participants from Early Intervention and Child and Adolescent Mental Health Teams in seven UK sites. APs were prescribed by participants’ usual psychiatrists. PI comprised standardised cognitive behavioural therapy and family intervention sessions. Discussion This is the first study to compare APs to PI in an adolescent population with FEP. Recruitment finished on 31 October 2018. The study faced difficulties with recruitment across most sites due to factors including clinician and service-user treatment preferences. Trial registration Current controlled trial with ISRCTN, ISRCTN80567433. Registered on 27 February 2017. Electronic supplementary material The online version of this article (10.1186/s13063-019-3506-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Melissa Pyle
- The Psychosis Research Unit, Department of Psychology, Greater Manchester Mental Health NHS Foundation Trust, Prestwich, M25 3BL, UK.,Division of Psychology and Mental Health, University of Manchester, Zochonis Building, Manchester, M13 9PL, UK
| | - Matthew R Broome
- Institute for Mental Health, School of Psychology, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK. .,Department of Psychiatry, Medical Sciences Division, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK. .,Centre for Human Brain Health, School of Psychology, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK. .,Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, OX4 7JX, UK.
| | - Emmeline Joyce
- The Psychosis Research Unit, Department of Psychology, Greater Manchester Mental Health NHS Foundation Trust, Prestwich, M25 3BL, UK
| | - Graeme MacLennan
- Centre for Healthcare Randomised Trials, Health Services Research Unit, University of Aberdeen, 3rd Floor Health Sciences Building, Aberdeen, AB25 2ZD, UK
| | - John Norrie
- Edinburgh Clinical Trials Unit, Centre for Population Health Sciences, Usher Institute, Nine Edinburgh BioQuarter, 9 Little France Road, Edinburgh, EH16 4UX, UK
| | - Daniel Freeman
- Department of Psychiatry, Medical Sciences Division, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK.,Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, OX4 7JX, UK
| | - David Fowler
- School of Psychology, Pevensey Building, University of Sussex, Falmer, BN1 9QH, UK
| | - Peter M Haddad
- The Psychosis Research Unit, Department of Psychology, Greater Manchester Mental Health NHS Foundation Trust, Prestwich, M25 3BL, UK.,Department of Psychiatry, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - David Shiers
- The Psychosis Research Unit, Department of Psychology, Greater Manchester Mental Health NHS Foundation Trust, Prestwich, M25 3BL, UK.,Division of Psychology and Mental Health, University of Manchester, Zochonis Building, Manchester, M13 9PL, UK
| | - Chris Hollis
- NIHR MindTech MedTech Co-operative, Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham, Innovation Park, Triumph Road, Nottingham, NG7 2TU, UK
| | - Jo Smith
- School of Allied Health and Community, Bredon Building, University of Worcester, Worcester, WR2 6AJ, UK
| | - Ashley Liew
- Institute for Mental Health, School of Psychology, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.,Centre for Educational Development, Appraisal and Research, University of Warwick, Coventry, CV4 7AL, UK.,Forward Thinking Birmingham, Birmingham Women's and Children's NHS Foundation Trust, Finch Road, Lozells, B19 1HS, UK
| | - Rory E Byrne
- The Psychosis Research Unit, Department of Psychology, Greater Manchester Mental Health NHS Foundation Trust, Prestwich, M25 3BL, UK.,Division of Psychology and Mental Health, University of Manchester, Zochonis Building, Manchester, M13 9PL, UK
| | - Paul French
- The Psychosis Research Unit, Department of Psychology, Greater Manchester Mental Health NHS Foundation Trust, Prestwich, M25 3BL, UK.,Institute of Psychology, Health and Society, University of Liverpool, Waterhouse Building, Liverpool, L69 3BX, UK
| | - Sarah Peters
- Division of Psychology and Mental Health, University of Manchester, Zochonis Building, Manchester, M13 9PL, UK
| | - Jemma Hudson
- Centre for Healthcare Randomised Trials, Health Services Research Unit, University of Aberdeen, 3rd Floor Health Sciences Building, Aberdeen, AB25 2ZD, UK
| | - Linda Davies
- Division of Population Health, Health Services Research & Primary Care, University of Manchester, Jean MacFarlane Building, Manchester, M13 9PL, UK
| | - Richard Emsley
- Department of Biostatistics & Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, Denmark Hill, London, SE5 8AZ, UK
| | - Alison Yung
- The Psychosis Research Unit, Department of Psychology, Greater Manchester Mental Health NHS Foundation Trust, Prestwich, M25 3BL, UK.,Division of Psychology and Mental Health, University of Manchester, Zochonis Building, Manchester, M13 9PL, UK.,Centre for Youth Mental Health, Faculty of Medicine, University of Melbourne, 35 Poplar Rd, Parkville, Melbourne, VIC, 3052, Australia
| | - Max Birchwood
- Warwick Medical School-Mental Health and Wellbeing, University of Warwick, Coventry, CV4 7AL, UK
| | - Eleanor Longden
- The Psychosis Research Unit, Department of Psychology, Greater Manchester Mental Health NHS Foundation Trust, Prestwich, M25 3BL, UK.,Division of Psychology and Mental Health, University of Manchester, Zochonis Building, Manchester, M13 9PL, UK
| | - Anthony P Morrison
- The Psychosis Research Unit, Department of Psychology, Greater Manchester Mental Health NHS Foundation Trust, Prestwich, M25 3BL, UK.,Division of Psychology and Mental Health, University of Manchester, Zochonis Building, Manchester, M13 9PL, UK
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Rabinovitz S, Goldman K, Rosca P, Barda J, Levine SZ. The role of substance use and adult sexual assault severity in the course of schizophrenia: An epidemiological catchment study of sexual assault victims. Schizophr Res 2019; 208:406-413. [PMID: 30654922 DOI: 10.1016/j.schres.2019.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 01/05/2019] [Accepted: 01/05/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Childhood trauma increases the risk of schizophrenia, yet the role of adult sexual assault in the course of schizophrenia is unknown. This study aims to examine the associations between substance use and sexual assault severity characteristics with the course of schizophrenia among adult sexual assault victims using an epidemiologic study design. METHODS Sexual assault data on all individuals received from 2000 to 2010 (N = 2147) at the Center for Care of Sexual Assault Victims at Wolfson Medical Center, the largest medical center for sexual assault victims in the country, were merged with the Israel National Psychiatric Case Registry, that consisted of lifetime psychiatric hospitalizations of schizophrenia (birth to 6 years post-assault). The associations between substance use and adult sexual assault severity characteristics with hospitalizations were quantified using recurrent events Cox modeling. RESULTS Schizophrenia with sexual assault survivors occurred in 117 persons. Cox modeling showed that recurrent psychiatric hospitalizations were associated with younger age, sexual assault at older age, previous diagnosis of psychosis, and drug use shortly before or during the assault. Other assault characteristics (number of assailants, means of subdual, penetration type, perpetrator violence, physical injury of the victim) and immediacy of seeking help had a null association with the course of psychiatric hospitalization. These results replicated in two sensitivity analyses. CONCLUSIONS Substance use among victims of sexual assault was associated with an exacerbated course of schizophrenia, pointing to a possibly modifiable risk factor that should be targeted in prevention, assessment, treatment formulation and implementation.
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Affiliation(s)
- Sharon Rabinovitz
- School of Criminology and The Unit for Excellence in Research & Study of Addiction (ERSA), The Center for Rehabilitation Research, University of Haifa, Haifa, Israel.
| | - Keren Goldman
- School of Criminology and The Unit for Excellence in Research & Study of Addiction (ERSA), The Center for Rehabilitation Research, University of Haifa, Haifa, Israel; Department for the Treatment of Substance Abuse, Ministry of Health, Jerusalem, Israel
| | - Paula Rosca
- Department for the Treatment of Substance Abuse, Ministry of Health, Jerusalem, Israel; The Hebrew University Hadassah Medical School, Jerusalem, Israel
| | - Julia Barda
- Department of Obstetrics and Gynecology, The Center for Care of Sexual Assault Victims, Wolfson Medical Center, Holon, Israel
| | - Stephen Z Levine
- Department of Community Mental Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
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30
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Grover S, Sahoo S, Nehra R. A comparative study of childhood/adolescent and adult onset schizophrenia: does the neurocognitive and psychosocial outcome differ? Asian J Psychiatr 2019; 43:160-169. [PMID: 31176081 DOI: 10.1016/j.ajp.2019.05.031] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 04/21/2019] [Accepted: 05/17/2019] [Indexed: 01/31/2023]
Abstract
AIMS & OBJECTIVES The present study aimed to evaluate the neurocognitive functioning and psychosocial outcome (in terms of social functioning, disability and internalized stigma) in patients with schizophrenia with childhood/adolescent onset (age of onset ≤18 years) and adult onset (>18years) schizophrenia and to evaluate the effect of neurocognitive impairment on the outcome variables in patients with youth and adult onset schizophrenia. METHODOLOGY 34 patients with youth onset schizophrenia (Group-I) and 56 patients with adult onset schizophrenia (Group-II), who were currently in clinical remission were assessed on a comprehensive neurocognitive battery,Positive and Negative syndrome Scale (PANSS), Global Assessment of Functioning Scale (GAF), Indian Disability Evaluation and Assessment Scale (IDEAS),Social and Occupational Functioning Assessment Scale (SOFS) and Internalised Stigma of Mental Illness Scale (ISMIS). RESULTS On neurocognitive domains (after adjusting for co-variates) significant differences were noted between the two groups in terms of processing speed (TMT-A; I > II; p-value -0.009), verbal fluency (COWA;I < II;p-value-0.001) and cognitive flexibility (TMT-B; I > II; p -0.031). Compared to patients with adult onset schizophrenia, patients with childhood & adolescent onset schizophrenia had significantly higher PANSS negative score, higher disability in all domains of IDEAS, poorer socio-occupational functioning, low global functioning and reported more stigma in the domains of alienation and discrimination.In patients with childhood & adolescent onset schizophrenia, higher deficits in the processing speed and verbal fluency were associated with significantly lower socio-occupational functioning and higher disability; higher executive dysfunction was associated with higher internalized stigma. Among patients with adult onset schizophrenia, higher disability was related to executive dysfunction only and higher stigma was associated with poor cognitive processing, selective attention and poor executive functioning. CONCLUSIONS The present study suggests that compared to adult onset schizophrenia, patients with childhood & adolescent onset schizophrenia have more deficits in neurocognition, have higher level of disability, poorer socio-occupational functioning and have higher level of self-stigma.
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Affiliation(s)
- Sandeep Grover
- Department of Psychiatry, PGIMER, 160012, Chandigarh, India.
| | | | - Ritu Nehra
- Department of Psychiatry, PGIMER, 160012, Chandigarh, India
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31
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Qin J, Sui J, Ni H, Wang S, Zhang F, Zhou Z, Tian L. The Shared and Distinct White Matter Networks Between Drug-Naive Patients With Obsessive-Compulsive Disorder and Schizophrenia. Front Neurosci 2019; 13:96. [PMID: 30846924 PMCID: PMC6393388 DOI: 10.3389/fnins.2019.00096] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Accepted: 01/28/2019] [Indexed: 12/17/2022] Open
Abstract
Background: Obsessive-compulsive disorder (OCD) and schizophrenia (SZ) as two severe mental disorders share many clinical symptoms, and have a tight association on the psychopathological level. However, the neurobiological substrates between these two diseases remain unclear. To the best of our knowledge, no study has directly compared OCD with SZ from the perspective of white matter (WM) networks. Methods: Graph theory and network-based statistic methods were applied to diffusion MRI to investigate and compare the WM topological characteristics among 29 drug-naive OCDs, 29 drug-naive SZs, and 65 demographically-matched healthy controls (NC). Results: Compared to NCs, OCDs showed the alterations of nodal efficiency and strength in orbitofrontal (OFG) and middle frontal gyrus (MFG), while SZs exhibited widely-distributed abnormalities involving the OFG, MFG, fusiform gyrus, heschl gyrus, calcarine, lingual gyrus, putamen, and thalamus, and most of these regions also showed a significant difference from OCDs. Moreover, SZs had significantly fewer connections in striatum and visual/auditory cortices than OCDs. The right putamen consistently showed significant differences between both disorders on nodal characteristics and structural connectivity. Conclusions: SZ and OCD present different level of anatomical impairment and some distinct topological patterns, and the former has more serious and more widespread disruptions. The significant differences between both disorders are observed in many regions involving the frontal, temporal, occipital, and subcortical regions. Particularly, putamen may serve as a potential imaging marker to distinguish these two disorders and may be the key difference in their pathological changes.
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Affiliation(s)
- Jiaolong Qin
- The Key Laboratory of Intelligent Perception and Systems for High-Dimensional Information of Ministry of Education, School of Computer Science and Engineering, Nanjing University of Science and Technology, Nanjing, China
- National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences, Beijing, China
- Brainnetome Center, Institute of Automation, Chinese Academy of Sciences, Beijing, China
| | - Jing Sui
- National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences, Beijing, China
- Brainnetome Center, Institute of Automation, Chinese Academy of Sciences, Beijing, China
- Chinese Academy of Sciences Center for Excellence in Brain Science, Institute of Automation, Beijing, China
| | - Huangjing Ni
- Smart Health Big Data Analysis and Location Services Engineering Lab of Jiangsu Province, Nanjing University of Posts and Telecommunications, Nanjing, China
| | - Shuai Wang
- The Affiliated Wuxi Mental Health Center of Nanjing Medical University, Wuxi, China
- Wuxi Tongren International Rehabilitation Hospital, Wuxi, China
| | - Fuquan Zhang
- The Affiliated Wuxi Mental Health Center of Nanjing Medical University, Wuxi, China
- Wuxi Tongren International Rehabilitation Hospital, Wuxi, China
| | - Zhenhe Zhou
- The Affiliated Wuxi Mental Health Center of Nanjing Medical University, Wuxi, China
- Wuxi Tongren International Rehabilitation Hospital, Wuxi, China
| | - Lin Tian
- The Affiliated Wuxi Mental Health Center of Nanjing Medical University, Wuxi, China
- Wuxi Tongren International Rehabilitation Hospital, Wuxi, China
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32
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Cao B, Wang DF, Yan LL, McIntyre RS, Rosenblat JD, Musial N, Liu YQ, Xie Q, Wang JY, Lu QB. Parental characteristics and the risk of schizophrenia in a Chinese population: a case-control study. Nord J Psychiatry 2019; 73:90-95. [PMID: 30900499 DOI: 10.1080/08039488.2018.1529196] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Genetic studies have provided convergent results indicating that schizophrenia is a polygenic disorder with a heritability estimate of ∼60-80%. The propensity for schizophrenia is ∼10 times higher in individuals with first-degree relatives with schizophrenia when compared to the general population. AIM To identify associations between parental characteristics and the risk of schizophrenia in a Chinese population. METHODS Participants with a diagnosis of schizophrenia were recruited along with healthy controls (HCs) matched for age and gender from Weifang, China. Logistic regression models and generalized linear models were used to explore the associations between parental characteristics with the risk and age at onset of schizophrenia. In total, 414 cases and 639 HCs were recruited for the study. RESULTS We observed an inverse association between levels of paternal and maternal education and risk of schizophrenia after controlling for potential confounders (Paternal: OR = 1.525, 95% CI: 1.080-2.153, p = .017; Maternal: OR = 1.984, 95% CI: 1.346-2.924, p = .001). Younger paternal and maternal childbearing age were associated with a higher risk of diagnosis of schizophrenia. We furtherly observed that individuals with earlier age at onset of schizophrenia had fewer siblings (p = .007) and had higher rates of parental marital disharmony (p = .033). CONCLUSION Our results indicate that parental years of education and age of childbearing are associated with an increased risk of schizophrenia in a Chinese population. Age of onset of schizophrenia was positively associated with a greater number of siblings and negatively associated with parental marital disharmony.
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Affiliation(s)
- Bing Cao
- a Department of Laboratorial Science and Technology, School of Public Health , Peking University , Beijing , China
| | | | - Lai-Lai Yan
- a Department of Laboratorial Science and Technology, School of Public Health , Peking University , Beijing , China.,c Beijing Key Laboratory of Toxicological Research and Risk Assessment for Food Safety , Beijing , China.,d Peking University Medical and Health Analysis Center , Peking University , Beijing , China
| | - Roger S McIntyre
- e Mood Disorders Psychopharmacology Unit, Toronto Western Hospital , University Health Network , Toronto , Canada.,f The Brain and Cognition Discovery Foundation , Toronto , Canada
| | - Joshua D Rosenblat
- e Mood Disorders Psychopharmacology Unit, Toronto Western Hospital , University Health Network , Toronto , Canada
| | - Natalie Musial
- e Mood Disorders Psychopharmacology Unit, Toronto Western Hospital , University Health Network , Toronto , Canada
| | - Ya-Qiong Liu
- a Department of Laboratorial Science and Technology, School of Public Health , Peking University , Beijing , China
| | - Qing Xie
- a Department of Laboratorial Science and Technology, School of Public Health , Peking University , Beijing , China
| | - Jing-Yu Wang
- a Department of Laboratorial Science and Technology, School of Public Health , Peking University , Beijing , China.,c Beijing Key Laboratory of Toxicological Research and Risk Assessment for Food Safety , Beijing , China.,d Peking University Medical and Health Analysis Center , Peking University , Beijing , China
| | - Qing-Bin Lu
- a Department of Laboratorial Science and Technology, School of Public Health , Peking University , Beijing , China.,c Beijing Key Laboratory of Toxicological Research and Risk Assessment for Food Safety , Beijing , China
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De Crescenzo F, Postorino V, Siracusano M, Riccioni A, Armando M, Curatolo P, Mazzone L. Autistic Symptoms in Schizophrenia Spectrum Disorders: A Systematic Review and Meta-Analysis. Front Psychiatry 2019; 10:78. [PMID: 30846948 PMCID: PMC6393379 DOI: 10.3389/fpsyt.2019.00078] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 02/04/2019] [Indexed: 12/27/2022] Open
Abstract
Background: Recent studies have examined the association between autism spectrum disorder and schizophrenia spectrum disorders, describing a number of cognitive features common to both conditions (e.g., weak central coherence, difficulties in set-shifting, impairment in theory of mind). Several studies have reported high levels of autistic symptoms in population with schizophrenia spectrum disorders. Our study systematically reviews and quantitatively synthetizes the current evidence on the presence of autistic symptoms in individuals with schizophrenia spectrum disorders. Methods: A comprehensive literature search of the PubMed/MEDLINE, Cochrane Library, CINHAL, and Embase databases was performed from the date of their inceptions until March 2018. The primary outcome measure was the Autism Spectrum Quotient (AQ). As secondary outcome measures, we analyzed the AQ subscales. Data were extracted and analyzed by using a conservative model and expressed by standardized mean difference (SMD). Results: Thirteen studies comprising a total of 1,958 individuals were included in the analysis. Results showed that individuals with schizophrenia spectrum disorders have higher levels of autistic symptoms compared to healthy controls [SMD: 1.39, 95% confidence interval (CI): 1.11 to 1.68] and lower levels of autistic symptoms compared to individuals with autism (SMD: -1.27, 95% CI: -1.77 to -0.76). Conclusions: Current findings support that individuals with schizophrenia spectrum disorders have higher autistic symptoms than healthy controls. Therefore, further studies are needed in order to shed light on the association between these two conditions.
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Affiliation(s)
- Franco De Crescenzo
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom.,Pediatric University Hospital-Department, Bambino Gesù Children's Hospital, Rome, Italy.,Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Valentina Postorino
- Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, JFK, Aurora, CO, United States.,Brain and Body Integration - Mental Health Clinic, Denver, CO, United States
| | - Martina Siracusano
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.,Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Assia Riccioni
- Child Neurology and Psychiatry Unit, System Medicine Department, University of Rome Tor Vergata, Rome, Italy
| | - Marco Armando
- Developmental Imaging and Psychopathology Lab, Department of Psychiatry, School of Medicine, University of Geneva, Geneva, Switzerland
| | - Paolo Curatolo
- Child Neurology and Psychiatry Unit, System Medicine Department, University of Rome Tor Vergata, Rome, Italy
| | - Luigi Mazzone
- Child Neurology and Psychiatry Unit, System Medicine Department, University of Rome Tor Vergata, Rome, Italy
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34
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Barlati S, Deste G, Gregorelli M, Vita A. Autistic traits in a sample of adult patients with schizophrenia: prevalence and correlates. Psychol Med 2019; 49:140-148. [PMID: 29554995 DOI: 10.1017/s0033291718000600] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Schizophrenia and autism spectrum disorder (ASD) are currently conceptualized as distinct disorders. However, the relationship between these two disorders has been revisited in recent years due to evidence that they share phenotypic and genotypic expressions. This study aimed to identify ASD traits in patients with schizophrenia, and to define their demographic, psychopathological, cognitive and functional correlates. METHOD Seventy-five schizophrenia patients (20 females, mean age 42 ± 12) were evaluated with the Autism Diagnostic Observation Schedule (ADOS) and the Autism Diagnostic Interview-Revised (ADI-R). Participants were also assessed with clinical, neuropsychological, and psychosocial functioning measures. RESULTS Of the 75 patients, 47 were negative to all the autism scales administered (ADOS-TOT-NEG), 21 patients were positive to the ADOS Language sub-domain (ADOS-L-POS), 21 patients were positive to the ADOS Reciprocal Social Interaction (RSI) sub-domain (ADOS-RSI-POS), 14 patients were positive to the ADOS Total scale (ADOS-TOT-POS), and nine patients were positive to the ADI-R scale (ADI-R-POS). Demographic (duration of illness), psychopathological (negative symptoms and general psychopathology), and cognitive (working memory and processing speed) differences emerged between schizophrenic patients with and without ASD traits, while no differences in psychosocial functioning were detected. Results of this study indicate the existence, in a sample of patients with a diagnosis of schizophrenia, of a distinct group of subjects with ASD features, characterized by specific symptomatological and cognitive profile. CONCLUSIONS These findings may contribute to better characterize patients with schizophrenia in order to develop new procedures and therapeutic tools in a more personalized perspective.
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Affiliation(s)
- S Barlati
- Department of Mental Health,ASST Spedali Civili of Brescia,Italy
| | - G Deste
- Department of Mental Health,ASST Spedali Civili of Brescia,Italy
| | - M Gregorelli
- Center Diagnosis Care and Autism Research (CDRA),ULSS 9 Scaligera,Verona Italy; "Luna" Association Onlus,Brescia,Italy
| | - A Vita
- Department of Mental Health,ASST Spedali Civili of Brescia,Italy
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35
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Hoffmann A, Ziller M, Spengler D. Childhood-Onset Schizophrenia: Insights from Induced Pluripotent Stem Cells. Int J Mol Sci 2018; 19:E3829. [PMID: 30513688 PMCID: PMC6321410 DOI: 10.3390/ijms19123829] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 11/21/2018] [Accepted: 11/27/2018] [Indexed: 01/25/2023] Open
Abstract
Childhood-onset schizophrenia (COS) is a rare psychiatric disorder characterized by earlier onset, more severe course, and poorer outcome relative to adult-onset schizophrenia (AOS). Even though, clinical, neuroimaging, and genetic studies support that COS is continuous to AOS. Early neurodevelopmental deviations in COS are thought to be significantly mediated through poorly understood genetic risk factors that may also predispose to long-term outcome. In this review, we discuss findings from induced pluripotent stem cells (iPSCs) that allow the generation of disease-relevant cell types from early brain development. Because iPSCs capture each donor's genotype, case/control studies can uncover molecular and cellular underpinnings of COS. Indeed, recent studies identified alterations in neural progenitor and neuronal cell function, comprising dendrites, synapses, electrical activity, glutamate signaling, and miRNA expression. Interestingly, transcriptional signatures of iPSC-derived cells from patients with COS showed concordance with postmortem brain samples from SCZ, indicating that changes in vitro may recapitulate changes from the diseased brain. Considering this progress, we discuss also current caveats from the field of iPSC-based disease modeling and how to proceed from basic studies to improved diagnosis and treatment of COS.
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Affiliation(s)
- Anke Hoffmann
- Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, 80804 Munich, Germany.
| | - Michael Ziller
- Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, 80804 Munich, Germany.
| | - Dietmar Spengler
- Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, 80804 Munich, Germany.
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36
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Sinclair-McBride K, Morelli N, Tembulkar S, Graber K, Gonzalez-Heydrich J, D'Angelo EJ. Young children with psychotic symptoms and risk for suicidal thoughts and behaviors: a research note. BMC Res Notes 2018; 11:568. [PMID: 30097053 PMCID: PMC6086075 DOI: 10.1186/s13104-018-3680-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 08/03/2018] [Indexed: 11/24/2022] Open
Abstract
Objective Suicidal thoughts and behaviors (STBs) are prevalent among youth with psychotic disorders (PD) relative to the general population. Recent research now suggests that STBs may present during the prodromal phase of the disease, or the clinical high risk (CHR) state. While this knowledge is important for the development of suicide prevention strategies in adolescent and adult populations, it remains unclear whether risk for suicide extends to children with or at risk for psychosis. The current study is an extension of previous work assessing STBs in youth across the psychosis continuum. We examine STBs in 37 CHR and PD children ages 7–13 years old, and further explore the prodromal symptom correlates of STB severity among CHR children. Results CHR and PD children endorsed STBs with a frequency and severity similar to what is observed in older CHR and PD populations. A number of children had never previously vocalized their suicidal plans or intent. Among CHR children, Social Anhedonia and Odd Behavior or Appearance were significantly correlated with STB severity. These findings underscore the importance of screening for STBs even in young children presenting with psychotic symptoms.
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Affiliation(s)
- Keneisha Sinclair-McBride
- Department of Psychiatry, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA.,Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA
| | - Nicholas Morelli
- Department of Psychiatry, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Sahil Tembulkar
- Department of Pediatrics, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305, USA
| | - Kelsey Graber
- Department of Psychiatry, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Joseph Gonzalez-Heydrich
- Department of Psychiatry, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA.,Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA
| | - Eugene J D'Angelo
- Department of Psychiatry, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA. .,Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA.
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37
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Hayes D, Kyriakopoulos M. Dilemmas in the treatment of early-onset first-episode psychosis. Ther Adv Psychopharmacol 2018; 8:231-239. [PMID: 30065814 PMCID: PMC6058451 DOI: 10.1177/2045125318765725] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 02/26/2018] [Indexed: 12/20/2022] Open
Abstract
Early-onset first-episode psychosis (EOP) is a severe mental disorder that can pose a number of challenges to clinicians, young people and their families. Its assessment and differentiation from other neurodevelopmental and mental health conditions may at times be difficult, its treatment may not always lead to optimal outcomes and can be associated with significant side effects, and its long-term course and prognosis seem to be less favourable compared with the adult-onset disorder. In this paper, we discuss some dilemmas associated with the evaluation and management of EOP and propose approaches that can be used in the clinical decision-making process. A detailed and well-informed assessment of psychotic symptoms and comorbidities, a systematic approach to treatment with minimum possible medication doses and close monitoring of its effectiveness and adverse effects, and multidimensional interventions taking into consideration risks and expectations associated with EOP, are paramount in the achievement of the most favourable outcomes for affected children and young people.
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Affiliation(s)
- Daniel Hayes
- National and Specialist Bethlem Adolescent Unit, Bethlem Royal Hospital, Child and Adolescent Mental Health Clinical Academic Group, South London and the Maudsley NHS Foundation Trust, Monks Orchard Road, Beckenham, Kent BR3 3BX, UK
| | - Marinos Kyriakopoulos
- National and Specialist Acorn Lodge Inpatient Children's Unit, South London and the Maudsley NHS Foundation Trust, London, UK
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38
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Vernal DL, Stenstrøm AD, Staal N, Christensen AMR, Ebbesen C, Pagsberg AK, Correll CU, Nielsen RE, Lauritsen MB. Validation study of the early onset schizophrenia diagnosis in the Danish Psychiatric Central Research Register. Eur Child Adolesc Psychiatry 2018; 27:965-975. [PMID: 29299680 DOI: 10.1007/s00787-017-1102-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 12/21/2017] [Indexed: 12/23/2022]
Abstract
The objective of this study is to assess (1) the concordance and validity of schizophrenia register diagnoses among children and adolescents (early onset schizophrenia = EOS) in the Danish Psychiatric Central Research Register (DPCRR), and (2) the validity of clinical record schizophrenia diagnoses. Psychiatric records from 200 patients with a first-time diagnosis of schizophrenia (F20.x) at age < 18 years between 1994 and 2009 in the DPCRR were rated by experienced clinicians according to ICD-10 criteria, using a predefined checklist. We retrieved 178 records, representing 19.6% of all patients diagnosed with EOS from 1994 to 2009. Mean age was 15.2 years and 56.2% were males. The register-based and clinical diagnoses matched in 158 cases (88.8%). Raters' diagnoses confirmed the DPCRR schizophrenia diagnoses in 134 cases, rendering a diagnostic validity of 75.3% of DPCRR schizophrenia, while 149 cases were confirmed as being in the schizophrenia spectrum (83.7%). When removing records with registration errors, 83.5% of cases were confirmed as schizophrenia and 91.8% as being in the schizophrenia spectrum. Interrater reliability was substantial with Cohen's kappa > 0.78-0.83 depending on classification. Compared to diagnoses made in outpatient settings, EOS diagnoses during hospitalizations were more likely to be valid and had fewer registration errors. Diagnosed in inpatient settings, EOS diagnoses are reliable and valid for register-based research. Schizophrenia diagnosed in children and adolescents in outpatient settings were found to have a high number of false-positives, both due to registration errors and diagnostic practice. Utilizing this knowledge, it is possible to reduce the number of false-positives in register-based research of EOS.
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Affiliation(s)
- Ditte Lammers Vernal
- Research Unit for Child and Adolescent Psychiatry, Aalborg University Hospital, Moelleparkvej 10, 9000, Aalborg, North Denmark Region, Denmark.
| | - Anne Dorte Stenstrøm
- Department of Child and Adolescent Psychiatry, University Clinic Odense, University of Southern Denmark, Odense, Denmark
- Child and Adolescent Psychiatry Research Unit, University Clinic Odense, University of Southern Denmark, Odense, Denmark
- Faculty of Health Science, University of Southern Denmark, Odense, Denmark
| | - Nina Staal
- Child and Adolescent Mental Health Center, Mental Health Services, Glostrup, Capital Region of Denmark, Denmark
| | | | - Christine Ebbesen
- Center for Child Adolescent Psychiatry, Aarhus University Hospital, Risskov, Central Denmark Region, Denmark
| | - Anne Katrine Pagsberg
- Child and Adolescent Mental Health Center, Mental Health Services, Glostrup, Capital Region of Denmark, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Christoph U Correll
- The Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Glen Oaks, NY, USA
- Hofstra Northwell School of Medicine, Hempstead, NY, USA
- The Feinstein Institute for Medical Research, Manhasset, NY, USA
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| | - René Ernst Nielsen
- Unit for Psychiatric Research, Department of Psychiatry, Aalborg University Hospital, Aalborg, Denmark
- Institute of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Marlene Briciet Lauritsen
- Research Unit for Child and Adolescent Psychiatry, Aalborg University Hospital, Moelleparkvej 10, 9000, Aalborg, North Denmark Region, Denmark
- Institute of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Quality of life disparities between persons with schizophrenia and their professional caregivers: Network analysis in a National Cohort. Schizophr Res 2018; 197:109-115. [PMID: 29325726 DOI: 10.1016/j.schres.2017.12.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Revised: 09/28/2017] [Accepted: 12/26/2017] [Indexed: 01/25/2023]
Abstract
BACKGROUND Disparities between mental health patients and their professional caregivers in quality of life appraisals have been identified, however, the structure that such disparities assume is unknown. AIMS To examine the network structure of quality of life appraisals and disparities using network analysis. METHODS Participants were 1639 persons with schizophrenia using psychiatric rehabilitation services and their primary professional caregivers (N=582). Quality of life for persons with schizophrenia was measured based on an abbreviated version of the Manchester Short Assessment of Quality of Life. Appraisals were made self-reported and by professional caregivers. Disparities scores between the aforementioned were computed. Network analysis was performed on all quality of life appraisals. Sensitivity analyses were conducted. RESULTS The self-appraised network significantly (p<0.05) differed by network strength compared to the caregiver-appraised network. Self-appraised network communities (clusters of quality of life items) were health conditions and socioeconomic system, whereas caregiver-appraised network communities were social activities, and combined socioeconomic and health conditions. Strength centrality was highest for self-appraised social status and for caregiver-appraised residential status (Z=1.63, Z=1.12, respectively). The disparity scores network clustered into two communities: social relations and combined financial and health conditions. The most central appraisal disparities were in social status. CONCLUSIONS Quality of life differed when self-appraised by persons with schizophrenia compared to when appraised by their professional caregivers, yet the salient role of social relations was shared. The latter may be an initial focus of discussion by persons with schizophrenia and their caregivers.
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Rotstein A, Roe D, Gelkopf M, Levine SZ. Age of onset and quality of life among males and females with schizophrenia: A national study. Eur Psychiatry 2018; 53:100-106. [DOI: 10.1016/j.eurpsy.2018.06.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Revised: 06/12/2018] [Accepted: 06/13/2018] [Indexed: 01/26/2023] Open
Abstract
AbstractBackground:Age of onset is considered central to understanding the course of schizophrenia, yet little is known regarding its association with quality of life in general, and specifically among males and females.Aims:To examine the association between the age of schizophrenia onset and quality of life, in general, and among males and females, using data from a national sample and competing statistical models.Methods:Participants with a diagnosis of schizophrenia (N = 1624) completed the Manchester Short Assessment of Quality of Life (MSA-QoL) and were rated on a parallel measure by their professional caregivers (N = 578). Multiple regression analysis models were computed for self-appraised quality of life, and mixed models with random intercepts were used for caregivers. Six competing models were tested for parsimony for each rating source. Three models without adjustment and three models adjusted for confounding variables. Sensitivity analyses were conducted for males and females separately.Results:Age of onset was statistically significantly (P <.05) negatively associated with self-appraised and caregiver-appraised quality of life on aggregate and among females. Among males, a significant (P <.01) quadratic effect of onset age on self-appraised quality of life demonstrated a negative association up to onset age of 36.67 years, after which the association was positive.ConclusionsAn earlier age of onset is associated with a better quality of life in schizophrenia which is tentatively explained by social decline. Specific trends in psychiatric symptom severity may account for this association among females while social advantages may account for the particular results found among males.
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Immonen J, Jääskeläinen E, Korpela H, Miettunen J. Age at onset and the outcomes of schizophrenia: A systematic review and meta-analysis. Early Interv Psychiatry 2017; 11:453-460. [PMID: 28449199 PMCID: PMC5724698 DOI: 10.1111/eip.12412] [Citation(s) in RCA: 166] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 10/25/2016] [Indexed: 12/03/2022]
Abstract
The aim of this study was to analyse the effect of age at onset on the long-term clinical, social and global outcomes of schizophrenia through a systematic review and a meta-analysis. Original studies were searched from Web of Science, PsycINFO, Pubmed and Scopus, as well as manually. Naturalistic studies with at least a 2-year follow-up were included. Of the 3509 search results, 81 articles fulfilled the inclusion criteria. The meta-analysis was performed in Stata as a random-effect analysis with correlation coefficients between age at onset and the outcomes (categorized into remission, relapse, hospitalization, positive symptoms, negative symptoms, total symptoms, general clinical outcome, employment, social/occupational functioning and global outcome). There was a statistically significant (P < .05) correlation between younger age at onset and more hospitalizations (number of studies, n = 9; correlation, r = 0.17; 95% confidence interval, CI 0.09-0.25), more negative symptoms (n = 7; r = 0.14; 95% CI 0.01-0.27), more relapses (n = 3; r = 0.11; 95% CI 0.02-0.20), poorer social/occupational functioning (n = 12; r = 0.15; 95% CI 0.05-0.25) and poorer global outcome (n = 13; r = 0.14; 95% CI 0.07-0.22). Other relationships were not significant. This was the first systematic review of the effects of age at onset on the long-term outcomes of schizophrenia. The results show that age at onset has a small, but significant impact on some of the outcomes of schizophrenia.
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Affiliation(s)
- Johanna Immonen
- Center for Life Course Health ResearchUniversity of OuluOuluFinland
- Medical Research Center OuluOulu University Hospital and University of OuluOuluFinland
| | - Erika Jääskeläinen
- Center for Life Course Health ResearchUniversity of OuluOuluFinland
- Medical Research Center OuluOulu University Hospital and University of OuluOuluFinland
- Oulu Occupational HealthOuluFinland
| | - Hanna Korpela
- Center for Life Course Health ResearchUniversity of OuluOuluFinland
- Medical Research Center OuluOulu University Hospital and University of OuluOuluFinland
| | - Jouko Miettunen
- Center for Life Course Health ResearchUniversity of OuluOuluFinland
- Medical Research Center OuluOulu University Hospital and University of OuluOuluFinland
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Association of MSI2 Gene Polymorphism with Age-at-Onset of Schizophrenia in a Chinese Population. Neurosci Bull 2017; 33:731-733. [PMID: 28866849 DOI: 10.1007/s12264-017-0176-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 07/08/2017] [Indexed: 10/18/2022] Open
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Abstract
BACKGROUND The genesis of schizophrenia is multifactorial, including biological and environmental risk factors. We tested for an interactive effect between early-onset schizophrenia (EOS) and social class of origins (socioeconomic status (SES)). Data were further analyzed for a possible connection to type of schizophrenic symptoms. Sampling/Methods: Data for the study are taken from the medical records of 642 patients from a large state hospital in the northeastern United States. Clinical assessments were divided into positive and negative symptomatology through application of the Scale for the Assessment of Negative Symptoms (SANS), the Scale for the Assessment of Positive Symptoms (SAPS) and the Positive and Negative Syndrome Scale (PANSS). Detailed information about age of onset and SES of origin was obtained through Social Service Assessment interviews. RESULTS We uncovered a significant impact of EOS among the poor that elevates risk for negative symptomatology. CONCLUSION Poor SES alone does not increase the likelihood of EOS, but it magnifies the deleterious effect of EOS on negative symptoms. Future research on these variables may inform the relative contribution of each.
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Affiliation(s)
- Bernard J Gallagher
- Department of Sociology and Criminology, Villanova University, Villanova, PA, USA
| | - Brian J Jones
- Department of Sociology and Criminology, Villanova University, Villanova, PA, USA
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Hilker R, Helenius D, Fagerlund B, Skytthe A, Christensen K, Werge TM, Nordentoft M, Glenthøj B. Is an Early Age at Illness Onset in Schizophrenia Associated With Increased Genetic Susceptibility? Analysis of Data From the Nationwide Danish Twin Register. EBioMedicine 2017; 18:320-326. [PMID: 28427946 PMCID: PMC5405190 DOI: 10.1016/j.ebiom.2017.04.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 03/28/2017] [Accepted: 04/03/2017] [Indexed: 12/01/2022] Open
Abstract
Background Early age at illness onset has been viewed as an important liability marker for schizophrenia, which may be associated with an increased genetic vulnerability. A twin approach can be valuable, because it allows for the investigation of specific illness markers in individuals with a shared genetic background. Methods We linked nationwide registers to identify a cohort of twin pairs born in Denmark from 1951 to 2000 (N = 31,524 pairs), where one or both twins had a diagnosis in the schizophrenia spectrum. We defined two groups consisting of; N = 788 twin pairs (affected with schizophrenia spectrum) and a subsample of N = 448 (affected with schizophrenia). Survival analysis was applied to investigate the effect of age at illness onset. Findings We found that early age at illness onset compared to later onset in the first diagnosed twin can be considered a major risk factor for developing schizophrenia in the second twin. Additionally, we found that the stronger genetic component in MZ twins compared to DZ twins is manifested in the proximity of assigned diagnosis within pairs. Discussion Early onset schizophrenia could be linked to a more severe genetic predisposition, indicating that age might be perceived as a clinical marker for genetic vulnerability for the illness. Early age at schizophrenia onset in one twin increases risk of illness in the second twin 4.7 times compared to a later onset. A stronger genetic predisposition may be needed to affect early schizophrenia onset in females compared to males. Genetic factors seem to play an important role in the proximity of assigned diagnosis within twin pairs.
The main aim of this study is to examine if early age at schizophrenia onset can be viewed as a clinical marker for increased genetic vulnerability in the illness. By linking the Danish Twin Register to other nationwide health registers we obtain accurate data regarding psychiatric diagnostic outcome in a complete twin population (> 31,000 twin pairs). Our study shows how an early age at illness onset in the first diagnosed twin in a pair is a major risk factor for developing schizophrenia in the second twin, underlining the importance of genetic factors in illness vulnerability.
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Affiliation(s)
- Rikke Hilker
- Lundbeck Foundation Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Denmark; Center for Neuropsychiatric Schizophrenia Research, Mental Health Center Glostrup, Mental Health Services, Capital Region of Denmark, University of Copenhagen, DK-2600, Glostrup, Denmark; Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Denmark.
| | - Dorte Helenius
- Mental Health Center Sct. Hans, Mental Health Services, Capital Region Denmark, DK-4000, Roskilde, Denmark; iPSYCH, Lundbeck Foundation Initiative for Integrative Psychiatric Research, Denmark
| | - Birgitte Fagerlund
- Lundbeck Foundation Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Denmark; Center for Neuropsychiatric Schizophrenia Research, Mental Health Center Glostrup, Mental Health Services, Capital Region of Denmark, University of Copenhagen, DK-2600, Glostrup, Denmark
| | - Axel Skytthe
- The Danish Twin Register, University of Southern Denmark, DK-5000, Odense C, Denmark
| | - Kaare Christensen
- The Danish Twin Register, University of Southern Denmark, DK-5000, Odense C, Denmark
| | - Thomas M Werge
- Lundbeck Foundation Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Denmark; Mental Health Center Sct. Hans, Mental Health Services, Capital Region Denmark, DK-4000, Roskilde, Denmark; iPSYCH, Lundbeck Foundation Initiative for Integrative Psychiatric Research, Denmark
| | - Merete Nordentoft
- Lundbeck Foundation Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Denmark; Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Denmark; iPSYCH, Lundbeck Foundation Initiative for Integrative Psychiatric Research, Denmark; Mental Health Center Copenhagen, Mental Health Services, Capital Region Denmark, DK-2200, Copenhagen, Denmark
| | - Birte Glenthøj
- Lundbeck Foundation Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Denmark; Center for Neuropsychiatric Schizophrenia Research, Mental Health Center Glostrup, Mental Health Services, Capital Region of Denmark, University of Copenhagen, DK-2600, Glostrup, Denmark; Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Denmark
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Choi S, Cho HK, Lee MK. Demographic Characteristics, Medication Profile and Treatment Outcome of Patients with Very Early-Onset Schizophrenia in One Hospital. Soa Chongsonyon Chongsin Uihak 2017. [DOI: 10.5765/jkacap.2017.28.2.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- SungKu Choi
- Division of Medical Services, National Center for Mental Health, Seoul, Korea
| | - Hye-Kyung Cho
- Division of Medical Services, National Center for Mental Health, Seoul, Korea
| | - Min-Koo Lee
- Department of Information and Statistics, Chungnam National University, Daejeon, Korea
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Mané A, Bergé D, Penzol MJ, Parellada M, Bioque M, Lobo A, González-Pinto A, Corripio I, Cabrera B, Sánchez-Torres AM, Saiz-Ruiz J, Bernardo M. Cannabis use, COMT, BDNF and age at first-episode psychosis. Psychiatry Res 2017; 250:38-43. [PMID: 28142064 DOI: 10.1016/j.psychres.2017.01.045] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 11/21/2016] [Accepted: 01/18/2017] [Indexed: 01/06/2023]
Abstract
Although an interaction between COMT Val158Met and BDNF Val66Met polymorphisms with cannabis use has been proposed with respect to the risk of psychosis emergence, findings remain inconclusive. The aim of the present study was to evaluate the different possible associations between these polymorphisms and early cannabis use and the age at the first episode of psychosis. The relationship between age at psychosis onset and COMT Val158Met and BDNF Val66Met polymorphisms with early cannabis use as well as those factors associated with early cannabis use were investigated. Among 260 Caucasian first-episode psychosis patients, early cannabis use and the presence of the met-allele from the BDNF Val66Met polymorphism were significantly associated with age at psychosis onset. Furthermore, early cannabis use was significantly associated with male gender in the logistic regression analysis. These findings provide evidence of the important role of early cannabis use and the Val66Met BDNF polymorphism on age at psychosis onset and they point out to sex-specific differences in cannabis use patterns.
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Affiliation(s)
- Anna Mané
- Hospital del Mar, Medical Research Institute (IMIM), Department of Neurosciences and Psychiatry, Barcelona, Spain; Centro de Investigación en Red de Salud Mental (CIBERSAM), Spain.
| | - Daniel Bergé
- Hospital del Mar, Medical Research Institute (IMIM), Department of Neurosciences and Psychiatry, Barcelona, Spain; Centro de Investigación en Red de Salud Mental (CIBERSAM), Spain
| | - Maria Jose Penzol
- Centro de Investigación en Red de Salud Mental (CIBERSAM), Spain; Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, IiSGM, Madrid, Spain
| | - Mara Parellada
- Centro de Investigación en Red de Salud Mental (CIBERSAM), Spain; Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, IiSGM, Madrid, Spain; School of Medicine, Universidad Complutense, Madrid, Spain
| | - Miquel Bioque
- Centro de Investigación en Red de Salud Mental (CIBERSAM), Spain; Barcelona Clinic Schizophrenia Unit, Hospital Clinic Barcelona, Spain
| | - Antonio Lobo
- Centro de Investigación en Red de Salud Mental (CIBERSAM), Spain; Department of Psychiatry, Zaragoza University: IIS Aragón, Zaragoza, Spain
| | - Ana González-Pinto
- Centro de Investigación en Red de Salud Mental (CIBERSAM), Spain; Department of Psychiatry, University Hospital of Alava-Santiago, University of the Basque Country, Vitoria, Spain
| | - Iluminada Corripio
- Centro de Investigación en Red de Salud Mental (CIBERSAM), Spain; Universitat Autònoma de Barcelona (UAB), Barcelona, Spain; Department of Psychiatry, Institut d'Investigació Biomèdica-Sant Pau (IIB-SANT PAU), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Bibiana Cabrera
- Centro de Investigación en Red de Salud Mental (CIBERSAM), Spain; Barcelona Clinic Schizophrenia Unit, Hospital Clinic Barcelona, Spain
| | - Ana Maria Sánchez-Torres
- Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain; IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Jerónimo Saiz-Ruiz
- Centro de Investigación en Red de Salud Mental (CIBERSAM), Spain; IRYCIS, Department of Psychiatry, Hospital Ramon y Cajal, Universidad de Alcala, Madrid, Spain
| | - Miguel Bernardo
- Centro de Investigación en Red de Salud Mental (CIBERSAM), Spain; Barcelona Clinic Schizophrenia Unit, Hospital Clinic Barcelona, Spain
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- Centro de Investigación en Red de Salud Mental (CIBERSAM), Spain
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Sigrúnarson V, Gråwe RW, Lydersen S, Morken G. Predictors of long term use of psychiatric services of patients with recent-onset schizophrenia: 12 years follow-up. BMC Psychiatry 2017; 17:18. [PMID: 28088223 PMCID: PMC5237502 DOI: 10.1186/s12888-016-1186-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Accepted: 12/30/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The aim of study was to investigate predictors of long term use of psychiatric services of patients with recent-onset schizophrenia. METHODS A cohort of 50 clinically stable patients with recent-onset schizophrenia was included in a randomized controlled trial comparing early integrated treatment with treatment as usual. Recent onset was defined as emergence of psychotic symptoms for the first time during the preceding 2 years. The follow up period was from the date of randomization and until 12 years after termination of treatment trial, 14 years forward. RESULTS Score on Brief psychiatric rating scale both at baseline and after 2 years of treatment, suicide attempts during 2 years of treatment and being an inpatient during 2 years of treatment were significant predictors of long term use of services. CONCLUSION High score on Brief psychiatric rating scale, suicide attempts and being admitted as inpatient early in the course of schizophrenia are possible predictors of long term use of services. TRIAL REGISTRATION ClinicalTrials.gov NCT00184509 . Registered 15 September 2005.
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Affiliation(s)
- Víðir Sigrúnarson
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway ,Department of Psychiatry, St. Olav`s University Hospital, Trondheim, Norway
| | - Rolf W. Gråwe
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway ,Department of Research and Development, Drug and Alcohol Treatment Health Trust in Central Norway, Trondheim, Norway
| | - Stian Lydersen
- Regional Centre for Child and Youth Mental Health and Child Welfare – Central Norway, Norwegian University of Science and Technology, Trondheim, Norway
| | - Gunnar Morken
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway. .,Department of Psychiatry, St. Olav`s University Hospital, Trondheim, Norway. .,Department of Research and Development, Division of Mental Health, St. Olavs University Hospital, P O Box 3250, Sluppen, 7006, Trondheim, Norway.
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Lappin JM, Heslin M, Jones PB, Doody GA, Reininghaus UA, Demjaha A, Croudace T, Jamieson-Craig T, Donoghue K, Lomas B, Fearon P, Murray RM, Dazzan P, Morgan C. Outcomes following first-episode psychosis – Why we should intervene early in all ages, not only in youth. Aust N Z J Psychiatry 2016; 50:1055-1063. [PMID: 27756771 PMCID: PMC5316960 DOI: 10.1177/0004867416673454] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare baseline demographics and 10-year outcomes of a first-episode psychosis patient incidence cohort in order to establish whether current youth-focussed age-based criteria for early intervention services are justified by patient needs. The patients in this cohort were treated prior to the establishment of early intervention services. The study aimed to test the hypothesis that those who develop psychosis at a younger age have worse outcomes than those who develop psychosis at an older age. METHODS Data on first-episode psychosis patients from the ÆSOP-10 longitudinal follow-up study were used to compare baseline characteristics, and 10-year clinical, functional and service use outcomes between those patients who would and would not have met age-based criteria for early intervention services, in Australia or in the United Kingdom. RESULTS In total, 58% men and 71% women with first-episode psychosis were too old to meet current Australian-early intervention age-entry criteria (χ2 = 9.1, p = 0.003), while 21% men and 34% women were too old for UK-early intervention age-entry criteria (χ2 = 11.1, p = 0.001). The 10-year clinical and functional outcomes did not differ significantly between groups by either Australian- or UK-early intervention age-entry criteria. Service use was significantly greater among the patients young enough to meet early intervention age-criteria (Australia: incidence rate ratio = 1.35 [1.19, 1.52], p < 0.001; United Kingdom: incidence rate ratio = 1.65 [1.41, 1.93], p < 0.001). CONCLUSION Current early intervention services are gender- and age-inequitable. Large numbers of patients with first-episode psychosis will not receive early intervention care under current service provision. Illness outcomes at 10-years were no worse in first-episode psychosis patients who presented within the age range for whom early intervention has been prioritised, though these patients had greater service use. These data provide a rationale to consider extension of early intervention to all, rather than just to youth.
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Affiliation(s)
- Julia M Lappin
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia,Julia M Lappin, School of Psychiatry, Black Dog Institute, Hospital Road, Randwick, NSW 2031, Australia.
| | - Margaret Heslin
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Peter B Jones
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Gillian A Doody
- Department of Psychiatry, The University of Nottingham, Nottingham, UK
| | - Ulrich A Reininghaus
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Arsime Demjaha
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Timothy Croudace
- School of Nursing and Health Sciences University of Dundee, Dundee, UK
| | - Thomas Jamieson-Craig
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Kim Donoghue
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Ben Lomas
- Nottingham University Hospitals NHS Trust, The University of Nottingham, Nottingham, UK
| | - Paul Fearon
- Department of Psychiatry, Trinity College Dublin, Dublin, Ireland
| | - Robin M Murray
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Paola Dazzan
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Craig Morgan
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
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Levine SZ, Levav I, Pugachova I, Yoffe R, Becher Y. Transgenerational effects of genocide exposure on the risk and course of schizophrenia: A population-based study. Schizophr Res 2016; 176:540-545. [PMID: 27401532 DOI: 10.1016/j.schres.2016.06.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 06/09/2016] [Accepted: 06/17/2016] [Indexed: 01/21/2023]
Abstract
BACKGROUND Hypotheses about the sequel of parental genocide exposures on the offspring's risk and course of schizophrenia remain untested. AIMS To test hypotheses related to the transgenerational transmission of parental genocide exposure on the risk and course of schizophrenia. METHODS Data were extracted from the National Population Register on all offspring (N=51.233; born: 1948-1989) whose parents were born (1922 to 1945) in Nazi- dominated European nations. Both parents either immigrated before (indirect exposure: n=1627, 3.2%) or after (direct exposure: n=49.606, 96.8%) the Nazi era. Offspring subgroups were identified from the initial timing of parental exposure (e.g., likely in utero, combined in utero and postnatal, or postnatal). Schizophrenia disorders were ascertained (1950-2014) from the National Psychiatric Case Registry. Cox models were computed to compare the offspring groups with respect to the risk and the adverse course of schizophrenia, adjusting for confounders. RESULTS The offspring rates on the risk and course of schizophrenia did not differ by parental affiliation to the direct and indirect exposure groups. Cox models showed that offspring subgroups with maternal Holocaust exposures in utero only (HR=1.74, 1.13, 2.66) and combined in utero and postnatal (HR=1.48, 1.05, 2.10); as well as paternal Holocaust exposures combined in utero and postnatal (HR=1.48, 1.08, 2.05), and early postnatal (aged 1-2; HR=1.49, 1.10, 2.00) had a significantly (P<0.05) higher psychiatric re-hospitalization rate than the indirect group. CONCLUSIONS Transgenerational genocide exposure was unrelated to the risk of schizophrenia in the offspring, but was related to a course of deterioration during selected critical periods of early life.
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Affiliation(s)
- Stephen Z Levine
- Department of Community Mental Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa 3498838, Israel.
| | - Itzhak Levav
- Department of Community Mental Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa 3498838, Israel
| | - Inna Pugachova
- Department of Information and Evaluation, Ministry of Health, Jerusalem 9101002, Israel
| | - Rinat Yoffe
- Department of Information and Evaluation, Ministry of Health, Jerusalem 9101002, Israel
| | - Yifat Becher
- Department of Information and Evaluation, Ministry of Health, Jerusalem 9101002, Israel
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Tsai IN, Lin JJ, Lu MK, Tan HP, Jang FL, Gan ST, Lin SH. Improving risk assessment and familial aggregation of age at onset in schizophrenia using minor physical anomalies and craniofacial measures. Medicine (Baltimore) 2016; 95:e4406. [PMID: 27472737 PMCID: PMC5265874 DOI: 10.1097/md.0000000000004406] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Age at onset is the most important feature of schizophrenia that could indicate its origin. Minor physical anomalies (MPAs) characterize potential marker indices of disturbances in early neurodevelopment. However, the association between MPAs and age at onset of schizophrenia is still unclear. We aimed to compare risk assessment and familial aggregation in patients with early-onset schizophrenia (EOS) and adult-onset schizophrenia (AOS) with MPAs and craniofacial measures.We estimated the risk assessment of MPAs among patients with EOS (n = 68), patients with AOS (n = 183), nonpsychotic relatives (n = 147), and healthy controls (n = 241) using 3 data-mining algorithms. In addition, we assessed the magnitude of familial aggregation of MPAs with respect to the age at onset of schizophrenia.The performance of EOS was superior to that of AOS, with discrimination accuracies of 89% and 76%, respectively. Combined MPA scores as the risk assessment were significantly higher in all schizophrenia subgroups and the nonpsychotic relatives of EOS patients than in the healthy controls. The recurrence risk ratio for familial aggregation of the MPA scores of EOS families (odds ratio 9.27) was substantially higher than that of AOS families (odds ratio 2.47).The results highlight that EOS improves risk assessment and has a severe magnitude of familial aggregation of MPAs. These findings indicate that EOS might result from a stronger genetic susceptibility to neurodevelopmental deficits.
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Affiliation(s)
- I-Ning Tsai
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University
| | - Jin-Jia Lin
- Department of Psychiatry, Chimei Medical Center
| | - Ming-Kun Lu
- Department of Health, Jianan Mental Hospital
- Department of Applied Life Science and Health, Chia Nan University of Pharmacy and Science
| | - Hung-Pin Tan
- Department of Psychiatry, Kaohsiung Veterans General Hospital Tainan Branch
- Department of Acupressure Technology, Chung Hwa University of Medical Technology
- Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University
| | | | - Shu-Ting Gan
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University
| | - Sheng-Hsiang Lin
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University
- Biostatistics Consulting Center, National Cheng Kung University Hospital, Tainan, Taiwan
- Correspondence: Sheng-Hsiang Lin, Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, 138, Shengli Road, Tainan, Taiwan (e-mail: )
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