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Lu J. Effect of psychological nursing interventions on effectiveness and quality of life in schizophrenia patients receiving modified electroconvulsive therapy. World J Clin Cases 2024; 12:2751-2757. [PMID: 38899291 PMCID: PMC11185346 DOI: 10.12998/wjcc.v12.i16.2751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 04/05/2024] [Accepted: 04/11/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Schizophrenia is a common and severe mental disorder characterized by severe thought disturbances, hallucinations, delusions, and emotional instability. For some patients, conventional treatment methods may not effectively alleviate symptoms, necessitating the use of alternative therapeutic approaches. Modified electroconvulsive therapy (MECT) is an effective treatment modality for schizophrenia, inducing anti-depressive and antipsychotic effects through the stimulation of brain electrical activity. AIM To explore the impact of psychological nursing intervention (PNI) before and after MECT on the efficacy and quality of life of patients with schizophrenia. METHODS Eighty patients with schizophrenia who received MECT treatment from 2021 to 2023 were randomly divided into two groups: The intervention group (n = 40) and the control group (n = 40). The intervention group received PNI before and after MECT, while the control group received routine nursing care. The efficacy of MECT was evaluated by the Positive and Negative Syndrome Scale (PANSS) and the Clinical Global Impression Scale (CGI) before and after the treatment. The quality of life was assessed by the Short Form 36 Health Survey (SF-36) after the treatment. RESUITS The intervention group had significantly lower scores of PANSS and CGI than the control group after the treatment (P < 0.05). The intervention group also had significantly higher scores of SF-36 than the control group in all domains except physical functioning (P < 0.05). CONCLUSION PNI before and after MECT can improve the efficacy and quality of life of patients with schizophrenia. It is suggested that nurses should provide individualized and comprehensive psychological care for patients undergoing MECT to enhance their recovery and well-being.
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Affiliation(s)
- Jing Lu
- Department of Psychiatry, Third People's Hospital of Shangrao City, Shangrao 334000, Jiangxi Province, China
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Ragazzi TCC, Shuhama R, da Silva PHR, Corsi-Zuelli F, Loureiro CM, da Roza DL, Leoni RF, Menezes PR, Del-Ben CM. Neurocognition and brain functional connectivity in a non-clinical population-based sample with psychotic experiences. Schizophr Res 2024; 267:156-164. [PMID: 38547718 DOI: 10.1016/j.schres.2024.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 01/17/2024] [Accepted: 03/17/2024] [Indexed: 05/21/2024]
Abstract
We characterized the neurocognitive profile of communed-based individuals and unaffected siblings of patients with psychosis from Brazil reporting psychotic experiences (PEs). We also analyzed associations between PEs and the intra and inter-functional connectivity (FC) in the Default Mode Network (DMN), the Fronto-Parietal Network (FPN) and the Salience Network (SN) measured by functional magnetic resonance imaging. The combined sample of communed-based individuals and unaffected siblings of patients with psychosis comprised 417 (neurocognition) and 85 (FC) volunteers who were divided as having low (<75th percentile) and high (≥75th percentile) PEs (positive, negative, and depressive dimensions) assessed by the Community Assessment of Psychic Experiences. The neurocognitive profile and the estimated current brief intellectual quotient (IQ) were assessed using the digit symbol (processing speed), arithmetic (working memory), block design (visual learning) and information (verbal learning) subtests of Wechsler Adult Intelligence Scale-third edition. Logistic regression models were performed for neurocognitive analysis. For neuroimaging, we used the CONN toolbox to assess FC between the specified regions, and ROI-to-ROI analysis. In the combined sample, high PEs (all dimensions) were related to lower processing speed performance. High negative PEs were related to poor visual learning performance and lower IQ, while high depressive PEs were associated with poor working memory performance. Those with high negative PEs presented FPN hypoconnectivity between the right and left lateral prefrontal cortex. There were no associations between PEs and the DMN and SN FC. Brazilian individuals with high PEs showed neurocognitive impairments like those living in wealthier countries. Hypoconnectivity in the FPN in a community sample with high PEs is coherent with the hypothesis of functional dysconnectivity in schizophrenia.
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Affiliation(s)
- Taciana Cristina Carvalho Ragazzi
- Department of Neuroscience and Behaviour, Ribeirão Preto Medical School, University of São Paulo, Brazil, 3900, Bandeirantes Avenue, Monte Alegre, 14040-900 Ribeirão Preto, São Paulo, Brazil.
| | - Rosana Shuhama
- Department of Neuroscience and Behaviour, Ribeirão Preto Medical School, University of São Paulo, Brazil, 3900, Bandeirantes Avenue, Monte Alegre, 14040-900 Ribeirão Preto, São Paulo, Brazil.
| | - Pedro Henrique Rodrigues da Silva
- Department of Physics, InBrain Laboratory, Faculty of Philosophy Sciences and Letters of Ribeirão Preto-University of Sao Paulo, Brazil, 3900, Bandeirantes Avenue, Monte Alegre, 14040-901 Ribeirão Preto, São Paulo, Brazil.
| | - Fabiana Corsi-Zuelli
- Department of Neuroscience and Behaviour, Ribeirão Preto Medical School, University of São Paulo, Brazil, 3900, Bandeirantes Avenue, Monte Alegre, 14040-900 Ribeirão Preto, São Paulo, Brazil.
| | - Camila Marcelino Loureiro
- Department of Neuroscience and Behaviour, Ribeirão Preto Medical School, University of São Paulo, Brazil, 3900, Bandeirantes Avenue, Monte Alegre, 14040-900 Ribeirão Preto, São Paulo, Brazil.
| | - Daiane Leite da Roza
- Department of Neuroscience and Behaviour, Ribeirão Preto Medical School, University of São Paulo, Brazil, 3900, Bandeirantes Avenue, Monte Alegre, 14040-900 Ribeirão Preto, São Paulo, Brazil; Department of Epidemiology, School of Public Health, University of São Paulo, São Paulo, SP, Brazil.
| | - Renata Ferranti Leoni
- Department of Physics, InBrain Laboratory, Faculty of Philosophy Sciences and Letters of Ribeirão Preto-University of Sao Paulo, Brazil, 3900, Bandeirantes Avenue, Monte Alegre, 14040-901 Ribeirão Preto, São Paulo, Brazil.
| | - Paulo Rossi Menezes
- Department of Preventive Medicine, Faculty of Medicine, University of São Paulo, Brazil, Population Mental Health Research Centre, Brazil, 455, Dr. Arnaldo Avenue, Cerqueira César, 01246903 São Paulo, São Paulo, Brazil.
| | - Cristina Marta Del-Ben
- Department of Neuroscience and Behaviour, Ribeirão Preto Medical School, University of São Paulo, Brazil, 3900, Bandeirantes Avenue, Monte Alegre, 14040-900 Ribeirão Preto, São Paulo, Brazil.
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Chui MKK, Schneider K, Miclau K, LaHue SC, Furman D, Leutwyler H, Newman JC. Associations of Systemic Inflammation and Senescent Cell Biomarkers with Clinical Outcomes in Older Adults with Schizophrenia. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.03.06.24303857. [PMID: 38496401 PMCID: PMC10942530 DOI: 10.1101/2024.03.06.24303857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Individuals with schizophrenia suffer from higher morbidity and mortality throughout life partly due to acceleration of aging-related diseases and conditions. Systemic inflammation is a hallmark of aging and is also observed in schizophrenia. An improved understanding of how inflammation and accelerated aging contribute to long-term health outcomes in schizophrenia could provide more effective treatments to preserve long-term cognitive and physical function. In this pilot cross-sectional study, 24 older adults (≥55 years old) with schizophrenia were assessed on symptoms (Positive and Negative Syndrome Scale), neurocognition (Matrics Consensus Cognitive Battery), mobility (Timed Get Up and Go), and general health (SF-12). Serum levels of 112 different cytokines were measured, from which we derived estimated senescence-associated secretory phenotype (SASP) scores for each participant. Two-tailed Pearson's bivariate correlations were computed to test the associations between schizophrenia clinical outcomes with individual cytokines, and SASP. Higher levels of eotaxin, IL-1α, IL-1β, and IFNα are associated with both worse PANSS negative and depressive symptoms scores. IL-1α and IL-1β negatively associated with general physical health whereas eotaxin negatively associated with mobility and global cognition. Overall, we found that specific inflammatory cytokines, but not composite measurements of SASP, are associated with clinical outcomes in older adults with schizophrenia.
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Affiliation(s)
- M K Kirsten Chui
- Buck Institute for Research on Aging, Novato CA, USA
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
| | | | - Katherine Miclau
- School of Medicine, University of California San Francisco, San Francisco CA, USA
| | - Sara C LaHue
- Buck Institute for Research on Aging, Novato CA, USA
- Department of Neurology, School of Medicine, University of California, San Francisco, CA, USA
| | - David Furman
- Buck Artificial Intelligence Platform, the Buck Institute for Research on Aging, Novato, CA, USA
- Stanford 1000 Immunomes Project, Stanford University School of Medicine, Stanford, CA, USA
- Instituto de Investigaciones en Medicina Traslacional (IIMT), Universidad Austral, CONICET, Pilar, Argentina
| | - Heather Leutwyler
- Department of Physiological Nursing, School of Nursing, University of California San Francisco, San Francisco CA, USA
| | - John C Newman
- Buck Institute for Research on Aging, Novato CA, USA
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
- Division of Geriatrics, School of Medicine, University of California San Francisco, San Francisco CA, USA
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Ma CC, Lin YY, Chung YA, Park SY, Huang CCY, Chang WC, Chang HA. The two-back task leads to activity in the left dorsolateral prefrontal cortex in schizophrenia patients with predominant negative symptoms: a fNIRS study and its implication for tDCS. Exp Brain Res 2024; 242:585-597. [PMID: 38227007 DOI: 10.1007/s00221-023-06769-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 12/16/2023] [Indexed: 01/17/2024]
Abstract
Transcranial direct current stimulation (tDCS) over left dorsolateral prefrontal cortex (DLPFC) has shown some potential as an adjunctive intervention for ameliorating negative symptoms of schizophrenia, but its efficacy requires optimization. Recently, 'functional targeting' of stimulation holds promise for advancing tDCS efficacy by coupling tDCS with a cognitive task where the target brain regions are activated by that task and further specifically polarized by tDCS.The study used 48-channel functional near infra-red spectroscopy (fNIRS) aiming to determine a cognitive task that can effectively induce a cortical activation of the left DLPFC in schizophrenia patients with predominant negative symptoms before running a tDCS trial. Sixty schizophrenia patients with predominant negative symptoms completed measures of clinical and psychosocial functioning characteristics and assessments across cognitive domains. Hemodynamic changes during n-back working memory tasks with different cognitive loads (1-back and 2-back) and verbal fluency test (VFT) were measured using fNIRS. For n-back tasks, greater signal changes were found when the task required elevated cognitive load. One sample t-test revealed that only 2-back task elicited significant activation in left DLPFC (t = 4.23, FDR-corrected p = 0.0007). During VFT, patients failed to show significant task-related activity in left DLPFC (one sample t-test, t = -0.25, FDR-corrected p > 0.05). Our study implies that 2-back task can effectively activate left DLPFC in schizophrenia patients with predominant negative symptoms. This neurophysiologically-validated task is considered highly potential to be executed in conjunction with high-definition tDCS for "functional targeting" of the left DLPFC to treat negative symptoms in a double-blind randomized sham-control trial, registered on ClinicalTrials.gov Registry (ID: NCT05582980).
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Affiliation(s)
- Chin-Chao Ma
- Department of Psychiatry, Tri-Service General Hospital, Beitou Branch, National Defense Medical Center, No. 325, Cheng-Kung Road, Sec. 2, Nei-Hu District, Taipei, Taiwan
| | - Yen-Yue Lin
- Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- Department of Emergency Medicine, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan
- Department of Life Sciences, National Central University, Taoyuan, Taiwan
| | - Yong-An Chung
- Department of Nuclear Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Sonya Youngju Park
- Department of Nuclear Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | | | - Wei-Chou Chang
- Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Hsin-An Chang
- Department of Psychiatry, Tri-Service General Hospital, Beitou Branch, National Defense Medical Center, No. 325, Cheng-Kung Road, Sec. 2, Nei-Hu District, Taipei, Taiwan.
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Zhou C, Tang X, Yu M, Zhang H, Zhang X, Gao J, Zhang X, Chen J. Convergent and divergent genes expression profiles associated with brain-wide functional connectome dysfunction in deficit and non-deficit schizophrenia. Transl Psychiatry 2024; 14:124. [PMID: 38413564 PMCID: PMC10899251 DOI: 10.1038/s41398-024-02827-w] [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: 07/19/2023] [Revised: 02/07/2024] [Accepted: 02/13/2024] [Indexed: 02/29/2024] Open
Abstract
Deficit schizophrenia (DS) is a subtype of schizophrenia characterized by the primary and persistent negative symptoms. Previous studies have identified differences in brain functions between DS and non-deficit schizophrenia (NDS) patients. However, the genetic regulation features underlying these abnormal changes are still unknown. This study aimed to detect the altered patterns of functional connectivity (FC) in DS and NDS and investigate the gene expression profiles underlying these abnormal FC. The study recruited 82 DS patients, 96 NDS patients, and 124 healthy controls (CN). Voxel-based unbiased brain-wide association study was performed to reveal altered patterns of FC in DS and NDS patients. Machine learning techniques were used to access the utility of altered FC for diseases diagnosis. Weighted gene co-expression network analysis (WGCNA) was employed to explore the associations between altered FC and gene expression of 6 donated brains. Enrichment analysis was conducted to identify the genetic profiles, and the spatio-temporal expression patterns of the key genes were further explored. Comparing to CN, 23 and 20 brain regions with altered FC were identified in DS and NDS patients. The altered FC among these regions showed significant correlations with the SDS scores and exhibited high efficiency in disease classification. WGCNA revealed associations between DS/NDS-related gene expression and altered FC. Additionally, 22 overlapped genes, including 12 positive regulation genes and 10 negative regulation genes, were found between NDS and DS. Enrichment analyses demonstrated relationships between identified genes and significant pathways related to cellular response, neuro regulation, receptor binding, and channel activity. Spatial and temporal gene expression profiles of SCN1B showed the lowest expression at the initiation of embryonic development, while DPYSL3 exhibited rapid increased in the fetal. The present study revealed different altered patterns of FC in DS and NDS patients and highlighted the potential value of FC in disease classification. The associations between gene expression and neuroimaging provided insights into specific and common genetic regulation underlying these brain functional changes in DS and NDS, suggesting a potential genetic-imaging pathogenesis of schizophrenia.
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Affiliation(s)
- Chao Zhou
- Department of Geriatric Psychiatry, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xiaowei Tang
- Department of Psychiatry, Affiliated WuTaiShan Hospital of Medical College of Yangzhou University, Yangzhou, Jiangsu, China
| | - Miao Yu
- Department of Neurology, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Hongying Zhang
- Department of Radiology, Subei People's Hospital of Jiangsu Province, Yangzhou University, Yangzhou, Jiangsu, China
| | - Xiaobin Zhang
- Institute of Mental Health, Suzhou Psychiatric Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Ju Gao
- Institute of Mental Health, Suzhou Psychiatric Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Xiangrong Zhang
- Department of Geriatric Psychiatry, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, Jiangsu, China.
| | - Jiu Chen
- Department of Radiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China.
- Institute of Medical Imaging and Artificial Intelligence, Nanjing University, Nanjing, Jiangsu, China.
- Medical Imaging Center, the Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China.
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Stogios N, Humber B, Agarwal SM, Hahn M. Antipsychotic-Induced Weight Gain in Severe Mental Illness: Risk Factors and Special Considerations. Curr Psychiatry Rep 2023; 25:707-721. [PMID: 37755655 DOI: 10.1007/s11920-023-01458-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/12/2023] [Indexed: 09/28/2023]
Abstract
PURPOSE OF REVIEW Weight gain is a disconcerting issue experienced by patients treated with antipsychotics (APs). This review summarizes current knowledge on the prevalence, etiology, and risk factors for antipsychotic-induced weight gain (AIWG), and evidence for interventions, including special considerations. RECENT FINDINGS Predisposing risk factors for AIWG include lack of prior AP exposure, sex, and age. AP dose and duration of exposure are additional treatment-related factors that may contribute to this issue. Among current approaches to target AIWG, metformin has the most evidence to support its use, and this is increasingly reflected in clinical guidelines. While lifestyle approaches are recommended, cost-effectiveness and scalability represent limitations. More research is needed to identify newer treatment options and inform clinical recommendations for AIWG. Concerns around scope of practice in psychiatry to address AIWG and related comorbidities will require enhanced training opportunities and interdisciplinary collaborations, as well as updated position statements/practice guidelines emphasizing prevention.
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Affiliation(s)
- Nicolette Stogios
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), 1051 Queen Street West, Toronto, ON, M6J 1H3, Canada
- Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Bailey Humber
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), 1051 Queen Street West, Toronto, ON, M6J 1H3, Canada
- Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Sri Mahavir Agarwal
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), 1051 Queen Street West, Toronto, ON, M6J 1H3, Canada
- Institute of Medical Science, University of Toronto, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Banting and Best Diabetes Centre (BBDC), University of Toronto, Toronto, Canada
| | - Margaret Hahn
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), 1051 Queen Street West, Toronto, ON, M6J 1H3, Canada.
- Institute of Medical Science, University of Toronto, Toronto, Canada.
- Department of Psychiatry, University of Toronto, Toronto, Canada.
- Banting and Best Diabetes Centre (BBDC), University of Toronto, Toronto, Canada.
- Department of Pharmacology, University of Toronto, Toronto, Canada.
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Kinoshita T, Takekita Y, Hiraoka S, Tamura F, Iwama Y. Long-term safety and efficacy of sublingual asenapine for the treatment of schizophrenia: A phase III extension study with follow-up for 52 weeks (P06125)-Secondary publication. Neuropsychopharmacol Rep 2023; 43:328-337. [PMID: 37232002 PMCID: PMC10496045 DOI: 10.1002/npr2.12342] [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] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 04/06/2023] [Accepted: 04/10/2023] [Indexed: 05/27/2023] Open
Abstract
After completion of a 6-week double-blind trial of asenapine sublingual tablets (10 or 20 mg/day) versus placebo in Asian patients with acute exacerbation of schizophrenia, including Japanese patients, this open-label study evaluated the safety and efficacy of a 52-week treatment with asenapine at flexible doses. In 201 subjects, including 44 who had received placebo (P/A group) and 157 who had received asenapine (A/A group) in the feeder trial, adverse events occurred at rates of 90.9% and 85.4% and serious adverse events at rates of 11.4% and 20.4%, respectively. One patient in the P/A group died. No clinically significant abnormal measurements of body weight, body mass index, or glycated hemoglobin, fasting plasma glucose, insulin, and prolactin levels were observed. The sustained efficacy rate, as evaluated by the Positive and Negative Syndrome Scale total score and other measures, remained at approximately 50% between 6 and 12 months of treatment. These results suggest that long-term treatment with asenapine is well tolerated and provides sustained efficacy.
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Mullapudi T, Debnath M, Govindaraj R, Raj P, Banerjee M, Varambally S. Effects of a six-month yoga intervention on the immune-inflammatory pathway in antipsychotic-stabilized schizophrenia patients: A randomized controlled trial. Asian J Psychiatr 2023; 86:103636. [PMID: 37290243 DOI: 10.1016/j.ajp.2023.103636] [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: 02/13/2023] [Revised: 05/20/2023] [Accepted: 05/21/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND Schizophrenia is a complex neuropsychiatric disorder for which several etiopathological theories have been proposed, one of the prominent ones being immune dysfunction. Recent studies on yoga as an add-on therapy have shown improvement in negative symptoms, cognition, and quality of life in schizophrenia patients. However, the biological mechanism/s of action of yoga in schizophrenia are not clear. The current study was aimed at exploring the effects of long-term (6 months) add-on yoga therapy on the immune inflammatory pathway in schizophrenia patients. METHODS Sixty schizophrenia patients were randomized to add-on yoga therapy (YT=30) and treatment-as-usual (TAU=30) groups of which 21 patients in YT and 20 in TAU group completed the study. Blood samples and clinical assessments were obtained at baseline and at the end of 6 months. The plasma levels of nine cytokines (IL-2, IL-4, IL-5, IL-10, IL-12(p70), IL-13, GM-CSF, IFN-γ, and TNF-α) were quantified using multiplex suspension array. The clinical assessments included SAPS, SANS, BPRS, PSS, CGI, SOFS and WHOQUOL-BREF. RESULTS Patients in the yoga group showed significant reductions in plasma TNF-α (Z = 2.99, p = 0.003) and IL-5 levels (Z = 2.20, p = 0.03) and greater clinical improvements in SAPS, SANS, PSS, and SOFS scores as compared to TAU group. Further, plasma TNF-α levels exhibited a positive correlation with negative symptoms (rs =0.45, p = 0.02) and socio-occupational functioning (rs =0.61, p = 0.002) in the YT group. CONCLUSIONS The findings of the study suggest that improvements in schizophrenia psychopathology with yoga interventions are associated with immuno-modulatory effects.
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Affiliation(s)
- Thrinath Mullapudi
- Department of Human Genetics, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India.
| | - Monojit Debnath
- Department of Human Genetics, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India.
| | - Ramajayam Govindaraj
- Department of Neurophysiology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India.
| | - Praveen Raj
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India.
| | - Moinak Banerjee
- Human Molecular Genetics Lab, Rajiv Gandhi Centre for Biotechnology (RGCB), Trivandrum, Kerala, India.
| | - Shivarama Varambally
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India; Department of Integrative Medicine, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India.
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Abstract
Schizophrenia is a disabling condition impacting approximately 1% of the worldwide population. Symptoms include positive symptoms (eg, hallucinations, delusions), negative symptoms (eg, avolition, anhedonia), and cognitive impairment. There are likely many different environmental and pathophysiologic etiologies involving distinct neurotransmitters and neurocircuits. Pharmacologic treatment at present consists of dopamine receptor antagonists, which are reasonably effective at treating positive symptoms, but less effective at treating cognitive and negative symptoms. Nondopaminergic medications targeting alternative receptors are under investigation. Supportive psychosocial treatments can work in tandem with antipsychotic medications and optimize patient care.
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Affiliation(s)
- Justin Faden
- Lewis Katz School of Medicine at Temple University, 100 East Lehigh Avenue, Suite 305B, Philadelphia, PA 19125, USA.
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Choudhary A, Peles D, Nayak R, Mizrahi L, Stern S. Current progress in understanding schizophrenia using genomics and pluripotent stem cells: A meta-analytical overview. Schizophr Res 2022:S0920-9964(22)00406-6. [PMID: 36443183 DOI: 10.1016/j.schres.2022.11.001] [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: 06/23/2022] [Revised: 10/16/2022] [Accepted: 11/01/2022] [Indexed: 11/27/2022]
Abstract
Schizophrenia (SCZ) is a complex, heritable and polygenic neuropsychiatric disease, which disables the patients as well as decreases their life expectancy and quality of life. Common and rare variants studies on SCZ subjects have provided >100 genomic loci that hold importance in the context of SCZ pathophysiology. Transcriptomic studies from clinical samples have informed about the differentially expressed genes (DEGs) and non-coding RNAs in SCZ patients. Despite these advancements, no causative genes for SCZ were found and hence SCZ is difficult to recapitulate in animal models. In the last decade, induced Pluripotent Stem Cells (iPSCs)-based models have helped in understanding the neural phenotypes of SCZ by studying patient iPSC-derived 2D neuronal cultures and 3D brain organoids. Here, we have aimed to provide a simplistic overview of the current progress and advancements after synthesizing the enormous literature on SCZ genetics and SCZ iPSC-based models. Although further understanding of SCZ genetics and pathophysiological mechanisms using these technological advancements is required, the recent approaches have allowed to delineate important cellular mechanisms and biological pathways affected in SCZ.
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Affiliation(s)
- Ashwani Choudhary
- Sagol Department of Neurobiology, Faculty of Natural Sciences, University of Haifa, Haifa 3498838, Israel
| | - David Peles
- Sagol Department of Neurobiology, Faculty of Natural Sciences, University of Haifa, Haifa 3498838, Israel
| | - Ritu Nayak
- Sagol Department of Neurobiology, Faculty of Natural Sciences, University of Haifa, Haifa 3498838, Israel
| | - Liron Mizrahi
- Sagol Department of Neurobiology, Faculty of Natural Sciences, University of Haifa, Haifa 3498838, Israel
| | - Shani Stern
- Sagol Department of Neurobiology, Faculty of Natural Sciences, University of Haifa, Haifa 3498838, Israel.
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Castro-de-Araujo LFS, Rodrigues EDS, Machado DB, Henriques CMP, Verotti MP, Gonçalves AQ, Duarte-Salles T, Kanaan RA, Barreto ML, Lewis G, Barbosa JR. Multimorbidity worsened anxiety and depression symptoms during the COVID-19 pandemic in Brazil. J Affect Disord 2022; 314:86-93. [PMID: 35810830 PMCID: PMC9259509 DOI: 10.1016/j.jad.2022.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 05/16/2022] [Accepted: 07/03/2022] [Indexed: 11/24/2022]
Abstract
Multimorbidity is a global health issue impacting the quality of life of all ages. Multimorbidity with a mental disorder is little studied and is likely to have been affected by the COVID-19 pandemic. We used a survey of 14,007 respondents living in Brazil to investigate whether people who already had at least one chronic medical condition had more depression and anxiety symptoms during social distancing in 2020. Generalized linear models and structural equation modelling were used to estimate the effects. A 19 % and 15 % increase in depressive symptoms were found in females and males, respectively, for each unit of increase in the observed value of reported chronic disease. Older subjects presented fewer symptoms of depression and anxiety. There was a 16 % increase in anxiety symptoms in females for each unit increase in the reported chronic disease variable and a 14 % increase in males. Younger subjects were more affected by anxiety symptoms in a dose-response fashion. High income was significantly related to fewer depressive and anxiety symptoms in both males and females. Physical activity was significantly associated with fewer anxiety and depression symptoms. Structural equation modelling confirmed these results and provided further insight into the hypothesised paths.
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Affiliation(s)
- Luis Fernando Silva Castro-de-Araujo
- Center of Data and Knowledge Integration for Health (CIDACS), Fiocruz, Salvador, Brazil; Dept of Psychiatry, The University of Melbourne, Austin Health, Victoria, Australia.
| | - Elisângela da Silva Rodrigues
- Center of Data and Knowledge Integration for Health (CIDACS), Fiocruz, Salvador, Brazil; Federal University of Ceará, Campus Jardins de Anita, Itapajé, Ceará, Brazil.
| | - Daiane Borges Machado
- Center of Data and Knowledge Integration for Health (CIDACS), Fiocruz, Salvador, Brazil; Harvard Medical School, Department Global Health and Social Medicine, United States of America.
| | | | | | - Alessandra Queiroga Gonçalves
- Unitat de Suport a la Recerca Terres de l'Ebre, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Tortosa, Catalunya, Spain; Unitat Docent de Medicina de Família i Comunitària Tortosa-Terres de L'Ebre, Institut Català de la Salut, Tortosa, Catalunya, Spain.
| | - Talita Duarte-Salles
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain.
| | - Richard A Kanaan
- Dept of Psychiatry, The University of Melbourne, Austin Health, Victoria, Australia
| | - Mauricio Lima Barreto
- Center of Data and Knowledge Integration for Health (CIDACS), Fiocruz, Salvador, Brazil
| | - Glyn Lewis
- Division of Psychiatry, UCL, London, United Kingdom of Great Britain and Northern Ireland
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12
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Nestoros JN, Vallianatou NG. Infra-Low Frequency Neurofeedback rapidly ameliorates schizophrenia symptoms: A case report of the first session. Front Hum Neurosci 2022; 16:923695. [PMID: 36211131 PMCID: PMC9532604 DOI: 10.3389/fnhum.2022.923695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 07/27/2022] [Indexed: 11/13/2022] Open
Abstract
A 38-year-old army officer started therapy in 2020 with a four-year history of auditory hallucinations and delusions of reference, persecution and grandeur, symptoms that were resistant to traditional antipsychotic medications. He follows an integrative psychotherapy program that aims to reduce his anxiety, continues his antipsychotic medications, and has Infra-Low Frequency Neurofeedback. After his initial assessment he had a 40 min session of Infra-Low Frequency Neurofeedback before any other kind of intervention. Before and immediately after the session he completed the SCL-90 scale and the Visual Analog Scale covering 20 aspects of his psychological and physical state as well as his schizophrenic symptoms. This first Neurofeedback session had dramatic effects on his psychotic symptoms, levels of anxiety and psychosomatic condition, before his first psychotherapy session and/or any changes in his antipsychotic medication. The above results have great importance due to the severity and chronicity of schizophrenia. Informed consent was obtained from the participant for the publication of this case report (including all data and images).
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Automatic language analysis identifies and predicts schizophrenia in first-episode of psychosis. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2022; 8:53. [PMID: 35853943 PMCID: PMC9261086 DOI: 10.1038/s41537-022-00259-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 04/18/2022] [Indexed: 12/22/2022]
Abstract
Automated language analysis of speech has been shown to distinguish healthy control (HC) vs chronic schizophrenia (SZ) groups, yet the predictive power on first-episode psychosis patients (FEP) and the generalization to non-English speakers remain unclear. We performed a cross-sectional and longitudinal (18 months) automated language analysis in 133 Spanish-speaking subjects from three groups: healthy control or HC (n = 49), FEP (n = 40), and chronic SZ (n = 44). Interviews were manually transcribed, and the analysis included 30 language features (4 verbal fluency; 20 verbal productivity; 6 semantic coherence). Our cross-sectional analysis showed that using the top ten ranked and decorrelated language features, an automated HC vs SZ classification achieved 85.9% accuracy. In our longitudinal analysis, 28 FEP patients were diagnosed with SZ at the end of the study. Here, combining demographics, PANSS, and language information, the prediction accuracy reached 77.5% mainly driven by semantic coherence information. Overall, we showed that language features from Spanish-speaking clinical interviews can distinguish HC vs chronic SZ, and predict SZ diagnosis in FEP patients.
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Managing Bipolar Disease Complicated with Psychosis in Conjunction with Polypharmacy, Parkinson’s Disease, and Multiple Comorbidities. Case Rep Psychiatry 2022; 2022:3813929. [PMID: 35571149 PMCID: PMC9098339 DOI: 10.1155/2022/3813929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 04/08/2022] [Accepted: 04/11/2022] [Indexed: 11/18/2022] Open
Abstract
The lifelong prevalence of bipolar disorder in adults, including subsyndromal forms, has increased over the years in the United States. By contrast, neurodegenerative diseases such as Parkinson’s disease have demonstrated an age-related rise in prevalence. As the global population manages to live longer thanks to sociomedical developments, it is expected to observe a rise in the occurrence of comorbid neuropsychiatric disorders. Herein, we present the case and management regimen of a 51-year-old female patient with multiple comorbidities and in the presence of polypharmacy. She was diagnosed with Parkinson’s disease and bipolar disorder type I alongside multiple comorbidities; her polypharmacy and medical history presented a significant clinical challenge in managing her condition. This case report focuses on the pharmacologic management of neuropsychiatric disorders titrated to this patient’s particular needs, which were complicated by psychosis and comorbidities.
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AMPA receptors in schizophrenia: A systematic review of postmortem studies on receptor subunit expression and binding. Schizophr Res 2022; 243:98-109. [PMID: 35247795 DOI: 10.1016/j.schres.2022.02.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 12/04/2021] [Accepted: 02/26/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND While altered expression of α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) type receptor has been reported in postmortem studies of schizophrenia, these findings are inconsistent. Therefore, we aimed to systematically review postmortem studies that investigated AMPA receptor expressions in schizophrenia. METHODS A systematic literature search was conducted for postmortem studies that measured AMPA receptor subunit expressions or receptor bindings in schizophrenia compared to healthy individuals on February 3, 2021, using Medline and Embase. RESULTS A total of 39 relevant articles were identified from 1360 initial reports. The dorsolateral prefrontal cortex (DLPFC) was the most investigated region (15 studies), followed by the medial temporal lobe (8 studies). For the DLPFC, 4/15 studies (26.7%) showed increased AMPA receptor binding or subunit expression in patients with schizophrenia compared to that in controls, especially in GRIA1 and GRIA4, 2/15 studies (13.3%) reported a decrease, particularly in GRIA2, and 8/15 studies (56.7%) found no significant differences. A decreased expression or receptor binding was observed in 6/8 studies (75.0%) in the subregions of the hippocampus in patients with schizophrenia compared to that in controls, whereas the other two studies found no significant differences. CONCLUSION Published data have reported decreased subunit expression or receptor binding in the hippocampus in schizophrenia. These findings were inconsistent in other brain regions, which might be due to the heterogeneity of this population, various study design, physiological changes after death, and limited number of studies. Future in vivo studies are warranted to examine AMPA receptor expressions in human brains, together with their comprehensive clinical characterization.
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Lan YL, Ping LY, Su LW, Chen CC. The Impact of Health Promotion Activities on the Physiological, Psychological, and Social Functions of Inpatients With Chronic Mental Illness. Psychiatry Investig 2022; 19:171-177. [PMID: 35196827 PMCID: PMC8958207 DOI: 10.30773/pi.2021.0128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 11/07/2021] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE To explore the impact of the participation of patients with chronic mental illness in health promotion activities on their physical, psychological, and social functions. METHODS This study included inpatient with chronic mental illness from a hospital in Eastern Taiwan. According to the experimental research design, the selected subjects were randomly divided into a health promotion group and a control group, with 60 people in each group. The health promotion team conducts health promotion activities twice a week, each for approximately 50 minutes, over the course of eight weeks (16 times in total). The measurement instrument adopts the Adult Mental Health Scale (AMHS) scale. Five experts and scholars in related fields are invited to conduct expert validity. RESULTS Using independent sample t-tests to analyze the changes in the two groups after 8 weeks, the physical, psychological and social problems of the health promotion group were significantly improved compared with the control group. CONCLUSION Health promotion activities can alleviate the physical illness, anxiety, irritability, depression, and social distress of chronic hospitalized mental patients, and can also increase their positive and optimistic mood. It can provide chronic mental health care institutions to plan patients' physical activities or exercises.
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Affiliation(s)
- Yu Li Lan
- Department of Health Administration, Tzu Chi University of Science and Technology, Taiwan, R.O.C
| | - Lieh Yung Ping
- Department of Psychiatry, Taipei Veterans General Hospital Yuli Branch, Taiwan, R.O.C
| | - Li Wen Su
- Department of Rehabilitation, Taipei Veterans General Hospital Yuli Branch, Taiwan, R.O.C
| | - Chien Chih Chen
- Department of Future Studies and LOHAS Industry, Fo Guang University, Taiwan, R.O.C
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17
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Duque-Yemail JD, Avila JC. Switching Clozapine to Cariprazine in Three Patients with Persistent Symptoms of Schizophrenia: A Case Series. Neuropsychiatr Dis Treat 2022; 18:1433-1440. [PMID: 35859803 PMCID: PMC9289754 DOI: 10.2147/ndt.s367922] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 07/05/2022] [Indexed: 11/23/2022] Open
Abstract
Despite many available treatments for schizophrenia, several unmet needs persist in treating individuals with this disorder, and the response rate to first-line antipsychotics remains relatively low. Clozapine has shown efficacy in treating schizophrenia patients who failed to respond to previous antipsychotics. However, side effects and the need for routine blood tests have limited its use as a first-line treatment. Cariprazine is a D2/D3 partial agonist antipsychotic with a mechanism of action that differs from other antipsychotics due to its higher affinity for D3 receptors. Several trials have demonstrated the efficacy of cariprazine on positive and negative symptoms of schizophrenia and have shown that it is a well-tolerated treatment. In this series, we present 3 cases of patients diagnosed with schizophrenia who were initially under treatment with clozapine. Despite some initial improvement, the patients showed persisting positive and negative symptoms or developed limiting side effects while in treatment with clozapine. Cariprazine treatment was titrated concurrently with clozapine tapering until its discontinuation. Significant improvement in both positive and negative symptoms was observed up to 14 months after starting cariprazine, and resolution of side effects was reported in all cases. Our case series supports cariprazine as an effective treatment for positive and negative symptoms in patients who failed to adequately respond or poorly tolerated treatment with clozapine, as well as a potential treatment in dual disorders, specifically psychotic disorders and cocaine use disorder.
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Affiliation(s)
- Juan D Duque-Yemail
- Psychiatry Resident, Department of Mental Health, Vall d'Hebron University Hospital, Barcelona, Spain
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18
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Ivanova E, Panayotova T, Grechenliev I, Peshev B, Kolchakova P, Milanova V. A Complex Combination Therapy for a Complex Disease-Neuroimaging Evidence for the Effect of Music Therapy in Schizophrenia. Front Psychiatry 2022; 13:795344. [PMID: 35370834 PMCID: PMC8964524 DOI: 10.3389/fpsyt.2022.795344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 01/31/2022] [Indexed: 11/29/2022] Open
Abstract
Schizophrenia is a disease characterized by clinical polymorphism: a combination of diverse syndromes defined by differences in structure, course and outcome. The etiology and pathogenesis of this mental disorder is still not completely understood, in spite of the achievements in the fields of neuroscience, genetics, neuroimaging and others. Different treatment strategies have been developed for patients with schizophrenia, but the search for new pharmacological agents continues with the mission of achieving a more effective control over the disease manifestations (positive and negative symptoms), improvement of the patients' social functioning and quality of life. The accumulated clinical experience has revealed that drug treatment and the inclusion in various rehabilitation programs and social skills training shows promising results in these patients. In recent years a plethora of evidence has been compiled regarding the role of music therapy as a possible alternative in the combination treatment of patients with mental disorders, schizophrenia included. Thus, the purpose of this review is to present the reader with a more detailed and science-based account of the beneficial effect of music therapy on the general wellbeing of patients diagnosed with schizophrenia. To fulfill our goal, we will focus mainly on the evidence provided by modern neuroimaging research.
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Affiliation(s)
- Elena Ivanova
- Psychiatric Clinic, Alexandrovska University Hospital, Sofia, Bulgaria.,Department of Psychiatry and Medical Psychology, Medical University, Sofia, Bulgaria
| | | | - Ivan Grechenliev
- Psychiatric Clinic, Alexandrovska University Hospital, Sofia, Bulgaria
| | - Bogomil Peshev
- Psychiatric Clinic, Alexandrovska University Hospital, Sofia, Bulgaria
| | | | - Vihra Milanova
- Psychiatric Clinic, Alexandrovska University Hospital, Sofia, Bulgaria
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Pérez-Aldana BE, Martínez-Magaña JJ, Mayén-Lobo YG, Dávila-Ortiz de Montellano DJ, Aviña-Cervantes CL, Ortega-Vázquez A, Genis-Mendoza AD, Sarmiento E, Soto-Reyes E, Juárez-Rojop IE, Tovilla-Zarate CA, González-Castro TB, Nicolini H, López-López M, Monroy-Jaramillo N. Clozapine Long-Term Treatment Might Reduce Epigenetic Age Through Hypomethylation of Longevity Regulatory Pathways Genes. Front Psychiatry 2022; 13:870656. [PMID: 35664466 PMCID: PMC9157596 DOI: 10.3389/fpsyt.2022.870656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 03/29/2022] [Indexed: 11/13/2022] Open
Abstract
Long-term studies have shown significantly lower mortality rates in patients with continuous clozapine (CLZ) treatment than other antipsychotics. We aimed to evaluate epigenetic age and DNA methylome differences between CLZ-treated patients and those without psychopharmacological treatment. The DNA methylome was analyzed using the Infinium MethylationEPIC BeadChip in 31 CLZ-treated patients with psychotic disorders and 56 patients with psychiatric disorders naive to psychopharmacological treatment. Delta age (Δage) was calculated as the difference between predicted epigenetic age and chronological age. CLZ-treated patients were stratified by sex, age, and years of treatment. Differential methylation sites between both groups were determined using linear regression models. The Δage in CLZ-treated patients was on average lower compared with drug-naive patients for the three clocks analyzed; however, after data-stratification, this difference remained only in male patients. Additional differences were observed in Hannum and Horvath clocks when comparing chronological age and years of CLZ treatment. We identified 44,716 differentially methylated sites, of which 87.7% were hypomethylated in CLZ-treated patients, and enriched in the longevity pathway genes. Moreover, by protein-protein interaction, AMPK and insulin signaling pathways were found enriched. CLZ could promote a lower Δage in individuals with long-term treatment and modify the DNA methylome of the longevity-regulating pathways genes.
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Affiliation(s)
| | - José Jaime Martínez-Magaña
- Laboratorio de Genómica de Enfermedades Psiquiátricas y Neurodegenerativas, Instituto Nacional de Medicina Genómica, Mexico City, Mexico
| | - Yerye Gibrán Mayén-Lobo
- Departamento de Sistemas Biológicos, Universidad Autónoma Metropolitana, Mexico City, Mexico
| | | | - Carlos Luis Aviña-Cervantes
- Departamento de Psiquiatría, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico
| | - Alberto Ortega-Vázquez
- Departamento de Sistemas Biológicos, Universidad Autónoma Metropolitana, Mexico City, Mexico
| | - Alma Delia Genis-Mendoza
- Laboratorio de Genómica de Enfermedades Psiquiátricas y Neurodegenerativas, Instituto Nacional de Medicina Genómica, Mexico City, Mexico
| | - Emmanuel Sarmiento
- Dirección General, Hospital Psiquiátrico Infantil Juan N Navarro, Mexico City, Mexico
| | - Ernesto Soto-Reyes
- Departamento de Ciencias Naturales, Universidad Autónoma Metropolitana, Unidad Cuajimalpa, Mexico City, Mexico
| | - Isela Esther Juárez-Rojop
- División Académica de Ciencias de la Salud, Universidad Juárez Autónoma de Tabasco, Villahermosa, Mexico
| | | | - Thelma Beatriz González-Castro
- División Académica Multidisciplinaria de Jalpa de Méndez, Universidad Juárez Autónoma de Tabasco, Jalpa de Méndez, Mexico
| | - Humberto Nicolini
- Laboratorio de Genómica de Enfermedades Psiquiátricas y Neurodegenerativas, Instituto Nacional de Medicina Genómica, Mexico City, Mexico.,Grupo de Estudios Médicos y Familiares Carracci, Mexico City, Mexico
| | - Marisol López-López
- Departamento de Sistemas Biológicos, Universidad Autónoma Metropolitana, Mexico City, Mexico
| | - Nancy Monroy-Jaramillo
- Departamento de Genética, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico
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20
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Kadakia A, Brady BL, Dembek C, Williams GR, Kent JM. The incidence and economic burden of extrapyramidal symptoms in patients with schizophrenia treated with second generation antipsychotics in a Medicaid population. J Med Econ 2022; 25:87-98. [PMID: 34913797 DOI: 10.1080/13696998.2021.2019501] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Extrapyramidal symptoms (EPS) are common side-effects of second-generation antipsychotics (SGA), that can negatively impact patient quality-of-life, and are associated with increased morbidity and mortality. This study examined the incidence and burden of EPS in patients with schizophrenia initiating SGAs. METHODS Patients with schizophrenia initiating SGAs were identified in the MarketScan Multi-state Medicaid database from 1 January 2012 to 31 December 2018. Incidence of EPS (identified via ICD-9/ICD-10 diagnoses and medications) was assessed during the 12-months following SGA initiation. Cohorts with and without EPS were defined. Multivariate models were used to examine all-cause and schizophrenia-related hospitalizations and total costs in the 12 months following the first EPS claim (EPS) or randomly assigned index date (Non-EPS) while controlling for multiple baseline covariates. Logistic regression was used for hospitalization and two-part models were used for skewed cost data. RESULTS A total of 11,642 patients with schizophrenia filled a prescription for an SGA; of which, 2,468 (21.2%) experienced EPS in the first year. The age- and gender-matched EPS group and non-EPS group included 2,295 and 5,607 patients, respectively. Multivariate analyses confirmed that EPS patients had 25% higher odds of all-cause (OR = 1.25; 95% CI = 1.11-1.40) and 75% increased odds of schizophrenia-related (OR = 1.75; 95% CI = 1.53-2.00) inpatient admissions compared to non-EPS patients. Multivariate adjustment of post-period costs between groups also found significant differences in both all-cause (EPS: $27,408 vs. non-EPS: $22,489, p < 0.001) and schizophrenia-related (EPS:$12,833 vs. non-EPS:$8,077, p < 0.0001) costs between the EPS and non-EPS cohorts. CONCLUSIONS Over one-fifth of patients initiating treatment with atypical antipsychotics in this study developed EPS in the 12 months following SGA initiation. Extrapyramidal side-effects associated with atypical antipsychotics increase the risk of hospitalization and contribute to higher healthcare costs. For patients with schizophrenia, treatment options that minimize the risk of EPS may reduce the economic burden associated with the disease.
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21
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Wang Y, Amdanee N, Zhang X. Exosomes in schizophrenia: Pathophysiological mechanisms, biomarkers, and therapeutic targets. Eur Psychiatry 2022; 65:e61. [PMID: 36082534 PMCID: PMC9532215 DOI: 10.1192/j.eurpsy.2022.2319] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
While schizophrenia (SCZ) is a devastating psychiatric disorder that detrimentally affects a significant portion of the worldwide population, its diagnosis is traditionally based on a relatively subjective assessment of current symptoms and medical history, devoid of an objective diagnostic modality. Antipsychotic medications are commonly used in the treatment of SCZ; however, some patients have low remission rates or forsake treatment due to the associated multiple side effects, resulting in recurrent episodes of the disease and poor prognosis. These situations imply that the diagnosis, treatment, and prognosis of SCZ need to be improved to increase the odds of a better outcome. Mounting studies have found that extracellular vesicles (EVs) play essential roles in the central nervous system. They are implicated in several mechanisms closely associated with SCZ such as cellular communication and synaptic plasticity. They can additionally exhibit neuroprotective and therapeutic effects. Since they possess distinct constituents, are readily available, easily detectable, and dependent on the internal environment, they can potentially serve as reliable biomarkers for disease diagnosis. Moreover, their biological configuration along with their ability to increase the bioavailability of their constituents and modulate intricate intracellular reactions in target cells, propel EVs as new targets for treatment. This review paper summarizes relevant research pertaining to the roles of EVs in SCZ, with the aim of improving insights into SCZ pathogenesis and evaluating EVs as potential biomarkers in the diagnosis and treatment of SCZ.
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22
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Franscescon F, Souza TP, Müller TE, Michelotti P, Canzian J, Stefanello FV, Rosemberg DB. Taurine prevents MK-801-induced shoal dispersion and altered cortisol responses in zebrafish. Prog Neuropsychopharmacol Biol Psychiatry 2021; 111:110399. [PMID: 34246730 DOI: 10.1016/j.pnpbp.2021.110399] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 06/22/2021] [Accepted: 07/05/2021] [Indexed: 11/28/2022]
Abstract
Schizophrenia is a chronic neuropsychiatric disorder characterized by a shortened lifespan and significant impaired social and vocational functioning. Schizophrenic patients can present hypothalamic-pituitary-adrenal (HPA) axis dysfunctions and cortisol dysregulation, which play an important role on the etiology onset, exacerbation, and relapsing of symptoms. Based on its intrinsic neuroprotective properties, taurine is considered a promising substance with beneficial role on various brain disorders, including schizophrenia. Here, we evaluated the effects of taurine on shoaling behavior and whole-body cortisol levels in zebrafish treated with dizocilpine (MK-801), which elicits schizophrenia-like phenotypes in animal models. Briefly, zebrafish shoals (4 fish per shoal) were exposed to dechlorinated water or taurine (42, 150, or 400 mg/L) for 60 min. Then, saline (PBS, pH 7.4 or 2.0 mg/kg MK-801) were intraperitoneally injected and zebrafish behavior was recorded 15 min later. In general, MK-801 disrupted shoaling behavior and reduced whole-body cortisol levels in zebrafish. All taurine pretreatments prevented MK-801-induced increase in shoal area, while 400 mg/L taurine prevented the MK-801-induced alterations in neuroendocrine responses. Moreover, all taurine-pretreated groups showed increased geotaxis, supporting a modulatory role in the overall dispersion pattern of the shoal. Collectively, our novel findings show a potential protective effect of taurine on MK-801-induced shoal dispersion and altered neuroendocrine responses, fostering the use of zebrafish models to assess schizophrenia-like phenotypes.
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Affiliation(s)
- Francini Franscescon
- Laboratory of Experimental Neuropsychobiology, Department of Biochemistry and Molecular Biology, Natural and Exact Sciences Center, Federal University of Santa Maria, 1000 Roraima Avenue, Santa Maria, RS 97105-900, Brazil; Graduate Program in Biological Sciences: Toxicological Biochemistry, Federal University of Santa Maria. 1000 Roraima Avenue, Santa Maria, RS 97105-900, Brazil.
| | - Thiele P Souza
- Laboratory of Experimental Neuropsychobiology, Department of Biochemistry and Molecular Biology, Natural and Exact Sciences Center, Federal University of Santa Maria, 1000 Roraima Avenue, Santa Maria, RS 97105-900, Brazil; Graduate Program in Biological Sciences: Toxicological Biochemistry, Federal University of Santa Maria. 1000 Roraima Avenue, Santa Maria, RS 97105-900, Brazil
| | - Talise E Müller
- Laboratory of Experimental Neuropsychobiology, Department of Biochemistry and Molecular Biology, Natural and Exact Sciences Center, Federal University of Santa Maria, 1000 Roraima Avenue, Santa Maria, RS 97105-900, Brazil; Graduate Program in Biological Sciences: Toxicological Biochemistry, Federal University of Santa Maria. 1000 Roraima Avenue, Santa Maria, RS 97105-900, Brazil
| | - Paula Michelotti
- Graduate Program in Biological Sciences: Toxicological Biochemistry, Federal University of Santa Maria. 1000 Roraima Avenue, Santa Maria, RS 97105-900, Brazil
| | - Julia Canzian
- Laboratory of Experimental Neuropsychobiology, Department of Biochemistry and Molecular Biology, Natural and Exact Sciences Center, Federal University of Santa Maria, 1000 Roraima Avenue, Santa Maria, RS 97105-900, Brazil; Graduate Program in Biological Sciences: Toxicological Biochemistry, Federal University of Santa Maria. 1000 Roraima Avenue, Santa Maria, RS 97105-900, Brazil
| | - Flavia V Stefanello
- Laboratory of Experimental Neuropsychobiology, Department of Biochemistry and Molecular Biology, Natural and Exact Sciences Center, Federal University of Santa Maria, 1000 Roraima Avenue, Santa Maria, RS 97105-900, Brazil; Graduate Program in Biological Sciences: Toxicological Biochemistry, Federal University of Santa Maria. 1000 Roraima Avenue, Santa Maria, RS 97105-900, Brazil
| | - Denis B Rosemberg
- Laboratory of Experimental Neuropsychobiology, Department of Biochemistry and Molecular Biology, Natural and Exact Sciences Center, Federal University of Santa Maria, 1000 Roraima Avenue, Santa Maria, RS 97105-900, Brazil; Graduate Program in Biological Sciences: Toxicological Biochemistry, Federal University of Santa Maria. 1000 Roraima Avenue, Santa Maria, RS 97105-900, Brazil; The International Zebrafish Neuroscience Research Consortium (ZNRC), 309 Palmer Court, Slidell, LA 70458, USA.
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23
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Zhang L, Zhang X, Fang X, Zhou C, Wen L, Pan X, Zhang F, Chen J. Eye movement characteristics in male patients with deficit and non-deficit schizophrenia and their relationships with psychiatric symptoms and cognitive function. BMC Neurosci 2021; 22:70. [PMID: 34819034 PMCID: PMC8613938 DOI: 10.1186/s12868-021-00673-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 11/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The cognitive impairment pattern of deficit schizophrenia (DS) is centered on an impaired attention function. Previous studies have suggested that the exploratory eye movement (EEM) tests reflect attention deficits in patients with schizophrenia. However, no study has investigated the characteristics of eye movement in DS in the Chinese Han population. This study aimed to investigate the pattern of eye movement characteristics in DS patients and to examine whether eye movement characteristic is associated with serious negative symptoms and cognitive decline in this schizophrenia subtype. METHODS A total of 86 male patients [37 DS and 49 non-deficit schizophrenia (NDS)] and 80 healthy controls (HC) participated in this study. Clinical symptoms were assessed using the Scale for the Assessment of Positive Symptoms (SAPS) and Scale for the Assessment of Negative Symptoms (SANS). Cognitive function was assessed using the Mattis Dementia Rating Scale (MDRS-2). Eye movement data of subjects were collected using an eye movement tracking analyzer. RESULTS There were significant differences in the overall eye movement data and cognitive test scores among the three groups (all P < 0.001). Both DS and NDS schizophrenia subgroups showed more severe eye movement and cognitive impairment compared with the control group. The number of eye fixations (NEF), total of eye scanning length (TESL), and cognitive function in DS patients were significantly lower than those in NDS patients. The discriminant analysis (D score) was higher than that of the control group (P < 0.001). In the DS group, the inattention factor of SANS was negatively correlated with the attention factor (r = - 0.545, P = 0.001) and structure factor of cognitive (r = - 0.389, P = 0.023), the affective flattening factor of SANS was negatively correlated with TESL (r = - 0.353, P = 0.041) and initiation/retention factor of cognitive (r = - 0.376,P = 0.028). TESL was found to positively correlate with the MDRS-2 total score (r = 0.427, P = 0.012), attention factor (r = 0.354, P = 0.040), and memory factor (r = 0.349, P = 0.043) in the DS group, whereas the mean of eye scanning length (MESL) positively correlated with cognitive impairments in the NDS group. The negative symptoms showed no significant correlation with cognition in the NDS group. CONCLUSIONS Total of eye scanning length may be a characteristic eye movement symptom in DS patients, which is associated with serious negative symptoms and cognitive impairment in this schizophrenia subtype.
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Affiliation(s)
- Lin Zhang
- Department of Geriatric Psychiatry, The Affiliated Nanjing Brain Hospital of Nanjing Medical University, No. 264 Guangzhou Road, Nanjing, 210029, Jiangsu, China.,Department of Psychiatry, The Second People's Hospital of Jiangning District, No. 50 ChenLing Road, Nanjing, 210003, Jiangsu, China
| | - Xiangrong Zhang
- Department of Geriatric Psychiatry, The Affiliated Nanjing Brain Hospital of Nanjing Medical University, No. 264 Guangzhou Road, Nanjing, 210029, Jiangsu, China.
| | - Xinyu Fang
- Department of Geriatric Psychiatry, The Affiliated Nanjing Brain Hospital of Nanjing Medical University, No. 264 Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - Chao Zhou
- Department of Geriatric Psychiatry, The Affiliated Nanjing Brain Hospital of Nanjing Medical University, No. 264 Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - Lu Wen
- Department of Psychiatry, The Second People's Hospital of Jiangning District, No. 50 ChenLing Road, Nanjing, 210003, Jiangsu, China
| | - Xinming Pan
- Department of Psychiatry, The Second People's Hospital of Jiangning District, No. 50 ChenLing Road, Nanjing, 210003, Jiangsu, China
| | - Fuquan Zhang
- Institute of Neuropsychiatry, The Affiliated Brain Hospital of Nanjing Medical University, No. 264 Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - Jiu Chen
- Institute of Neuropsychiatry, The Affiliated Brain Hospital of Nanjing Medical University, No. 264 Guangzhou Road, Nanjing, 210029, Jiangsu, China
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Wang Y, Huang X, Fan H, An H, Ma T, Zhang Q, Zhao W, Yun Y, Yang W, Zhang X, Wang Z, Yang F. High-Dose Betahistine Improves Cognitive Function in Patients With Schizophrenia: A Randomized Double-Blind Placebo-Controlled Trial. Front Psychiatry 2021; 12:762656. [PMID: 34790138 PMCID: PMC8591287 DOI: 10.3389/fpsyt.2021.762656] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 10/12/2021] [Indexed: 11/19/2022] Open
Abstract
Background: There is currently no effective treatment for cognitive impairment associated with schizophrenia (CIAS). Recent studies have shown that increased histamine levels in the brain may help to improve CIAS symptoms. Betahistine is an H1-receptor agonist and H3-receptor antagonist. This study evaluated the effect of high-dose betahistine on cognitive function as well as its safety in Chinese Han patients with schizophrenia. Methods: This randomized double-blind, placebo-controlled trial enrolled 89 patients with schizophrenia who were randomly administered betahistine (72 mg/d) or placebo for 12 weeks. At baseline and at 4, 8, and 12 weeks after commencing the intervention, we measured changes in cognitive function and clinical symptoms using the MATRICS Consensus Cognitive Battery (MCCB) and Positive and Negative Syndrome Scale (PANSS), respectively. Furthermore, we used the Treatment Emergent Symptom Scale (TESS) to assess the adverse effects of the patients' medications. Results: Compared to the placebo group, the betahistine group showed significant improvements in the MCCB composite score after 12 weeks of treatment (p = 0.003) as well as improvements in MCCB verbal learning (p = 0.02) and visual learning (p = 0.001) domain scores. However, there were no significant improvements in the PANSS total scores or subscores (p > 0.05). Generally, high-dose betahistine treatment was considered safe in patients with schizophrenia. Conclusions: Additional use of high-dose betahistine can effectively improve cognitive function but not psychiatric symptoms in patients with schizophrenia. Betahistine (72 mg/d) is well tolerated by Chinese Han patients with schizophrenia. Trial Registration: chictr.org.cn, identifier: ChiCTR1900021078. http://www.chictr.org.cn/edit.aspx?pid=35484&htm=4.
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Affiliation(s)
- Yongqian Wang
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, China
| | - Xufeng Huang
- Illawarra Health and Medical Research Institute, School of Medicine, University of Wollongong, Wollongong, NSW, Australia
| | - Hongzhen Fan
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, China
| | - Huimei An
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, China
| | - Ting Ma
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, China
| | - Qi Zhang
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, China
| | - Wenxuan Zhao
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, China
| | - Yajun Yun
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, China
| | - Wenshuang Yang
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, China
| | - Xiaolu Zhang
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, China
| | - Zhiren Wang
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, China
| | - Fude Yang
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, China
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25
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Applications of innovative technologies to the delivery of antipsychotics. Drug Discov Today 2021; 27:401-421. [PMID: 34601123 DOI: 10.1016/j.drudis.2021.09.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 07/27/2021] [Accepted: 09/25/2021] [Indexed: 12/24/2022]
Abstract
Psychosis is a high-incidence pathology associated with a profound alteration in the perception of reality. The limitations of drugs available on the market have stimulated the search for alternative solutions to achieve effective antipsychotic therapies. In this review, we evaluate innovative formulations of antipsychotic drugs developed through the application of modern pharmaceutical technologies, including classes of micro and nanocarriers, such as lipid formulations, polymeric nanoparticles (NPs), solid dispersions, and cyclodextrins (CDs). We also consider alternative routes of administration to the oral and parenteral ones currently used. Improved solubility, stability of preparations, and pharmacokinetic (PK) and pharmacodynamic (PD) parameters confirm the potential of these new formulations in the treatment of psychotic disorders.
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Fitzgerald A, Fitzgerald RD, Seidl A, Oczenski W, Shaheen FAM. Development, Implementation, Evaluation, and Long-Term Outcome of a Program to Increase Student Interest in Anesthesia and Intensive Care Training. EXP CLIN TRANSPLANT 2021; 19:1094-1098. [PMID: 34387154 DOI: 10.6002/ect.2021.0136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES The increasing need for anesthetists has been coupled with a rising number of open training positions. Thus, there is an increased need to attract future anesthetists among students and graduates from medical universities. Using results from a questionnaire, we designed an information and training program to increase interest in anesthesia and intensive care. MATERIALS AND METHODS With the use of semistructured interviews, medical students were questioned about factors influencing their decision for a speciality. We used the results to design an information and practice program for students and young doctors. This program was held 12 times at different anesthesia departments in different hospitals. Evaluation was obtained through a feedback questionnaire at the end of each sessions and with another questionnaire 2 to 4 years after the program. RESULTS Feedback showed positive responses concerning utility for practical work, actuality, and relevance for daily practical work. There was a 22.7% response from participants for the follow-up questionnaire. Of these, 87% stated that interest in anesthesia was increased by the program, and 74% underwent practical training in an anesthesia department. Seventeen participants started a speciality training for anesthesia and intensive care medicine. CONCLUSIONS The design of this practice-oriented program was effective in eliciting, spreading, and increasing interest and attracting students to a medical specialty.
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Affiliation(s)
- Annelies Fitzgerald
- From the Karl Landsteiner Institute for Human Factors & Human Resources, Kirchstetten, Austria
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Higher Dietary Inflammation in Patients with Schizophrenia: A Case-Control Study in Korea. Nutrients 2021; 13:nu13062033. [PMID: 34199231 PMCID: PMC8231973 DOI: 10.3390/nu13062033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/07/2021] [Accepted: 06/09/2021] [Indexed: 11/16/2022] Open
Abstract
Inflammation is a risk factor for the onset and progression of schizophrenia, and dietary factors are related to chronic inflammation. We investigated whether the dietary inflammatory index (DII) is associated with schizophrenia in the Korean population. Of the 256 subjects who responded to the questionnaire, 184 subjects (117 controls; 67 individuals with schizophrenia) were included in this case-control study. A semi-quantitative food frequency questionnaire was used to evaluate the dietary intakes of the study participants. The energy-adjusted DII (E-DII) was used to assess the inflammatory potential of the participants' diets. Dietary intakes of vitamin C, niacin, and folate were significantly reduced in the patients with schizophrenia. The patients with schizophrenia had higher E-DII scores than the controls (p = 0.011). E-DII was positively associated with schizophrenia (odds ratio = 1.254, p = 0.010). The additional analysis confirmed that E-DII was significantly associated with schizophrenia, especially in the third tertile group of E-DII scores (odds ratio = 2.731, p = 0.016). Our findings suggest that patients with schizophrenia have more pro-inflammatory diets.
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Abstract
PURPOSE OF REVIEW To provide an update of recent studies describing the effects of transcranial direct current stimulation (tDCS) on patients with schizophrenia, with particular focus on auditory verbal hallucinations (AVH), cognitive deficits, and negative symptoms. RECENT FINDINGS As a low-cost, easy-to-use neuromodulation technique, tDCS may have clinical implications for those suffering from treatment-persistent AVH, negative symptoms, and cognitive symptoms in schizophrenia. Over the past decade, tDCS has shown no effects for negative symptoms, except when used at a high frequency of sessions, and inconclusive results for AVH and cognitive symptoms. The treatment has little to no adverse effects. SUMMARY The studies reviewed here support the need for further investigation and empirical data regarding the use of tDCS. The underlying mechanisms of tDCS as well as the most effective stimulation parameters must be better understood. Findings support the need for increased duration and frequency of tDCS sessions. One of the next steps is the investigation of effects of concomitant nonpharmacological treatments with tDCS.
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Kuo YC, Chang DY, Liao YH. Twelve-Weeks of Bench-Step Exercise Training Ameliorates Cardiopulmonary Fitness and Mood State in Patients with Schizophrenia: A Pilot Study. ACTA ACUST UNITED AC 2021; 57:medicina57020149. [PMID: 33562247 PMCID: PMC7915556 DOI: 10.3390/medicina57020149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/04/2021] [Accepted: 02/04/2021] [Indexed: 11/17/2022]
Abstract
Background and objectives: Unhealthy, physically inactive lifestyles increase the risk of future cardiovascular events and impaired physical fitness in individuals with schizophrenia. Insufficient literature exists to provide fundamental information about appropriate exercise training modality for this population. This pilot study preliminarily investigated the effects of a 12-week moderate-intensity bench-step exercise training (BSET) program on cardiopulmonary fitness, mood state, and cognition in patients with schizophrenia. Methods: Twenty-eight patients with schizophrenia completed this study. The participants were allocated into either bench-step exercise-training (BSET; N = 14) or control (CTRL; N = 14) groups according to their preferences. The BSET group received a 12-week bench-step intervention, whereas the CTRL group did not participate in any training. The Beck Depression Inventory-II (BDI-II), 6-min walk test (6MWD), and Symbol Digit Modalities Test (SDMT) were assessed at baseline (PRE) and at the end of the intervention (POST) to determine mood state, endurance fitness, and attention, respectively. Results: After a 12-week BSET intervention, the 6MWD was significantly increased in the BSET (p = 0.007) but not in the CTRL (p > 0.05). The participants with BSET intervention showed a significant decrease in BDI-II at the end of the intervention (p = 0.03). However, SDMT scores were not different in both BSET and CTRL (p > 0.05). Conclusions: This study demonstrated that the 12-week intervention of moderate-intensity bench-step exercise training (frequency: 1 session/week; each session of 30 min; step cadence: 96 beats/min) might effectively enhance cardiopulmonary fitness and mood state in patients with schizophrenia. However, attention did not change after the bench-step exercise intervention.
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Affiliation(s)
| | | | - Yi-Hung Liao
- Correspondence: ; Tel.: +86-2-2822-7101 (ext. 7707)
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30
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Li SM, Lee KH, Lu SJ, Peng WS. Contemporary psychotherapeutic approaches to patients with schizophrenia in Taiwan. TAIWANESE JOURNAL OF PSYCHIATRY 2021. [DOI: 10.4103/tpsy.tpsy_21_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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31
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Park SC, Kim GM, Kato TA, Chong MY, Lin SK, Yang SY, Avasthi A, Grover S, Kallivayalil RA, Xiang YT, Chee KY, Tanra AJ, Tan CH, Sim K, Sartorius N, Shinfuku N, Park YC, Inada T. Dyskinesia is most centrally situated in an estimated network of extrapyramidal syndrome in Asian patients with schizophrenia: findings from research on Asian psychotropic prescription patterns for antipsychotics. Nord J Psychiatry 2021; 75:9-17. [PMID: 32580668 DOI: 10.1080/08039488.2020.1777462] [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] [Indexed: 10/24/2022]
Abstract
BACKGROUND Network analysis provides a new viewpoint that explicates intertwined and interrelated symptoms into dynamic causal architectures of symptom clusters. This is a process called 'symptomics' and is concurrently applied to various areas of symptomatology. AIMS Using the data from Research on Asian Psychotropic Prescription Patterns for Antipsychotics (REAP-AP), we aimed to estimate a network model of extrapyramidal syndrome in patients with schizophrenia. METHODS Using data from REAP-AP, extrapyramidal symptoms of 1046 Asian patients with schizophrenia were evaluated using the nine items of the Drug-Induced Extrapyramidal Symptoms Scale (DIEPSS). The estimated network of the ordered-categorical DIEPSS items consisted of nodes (symptoms) and edges (interconnections). A community detection algorithm was also used to identify distinctive symptom clusters, and correlation stability coefficients were used to evaluate the centrality stability. RESULTS An interpretable level of node strength centrality was ensured with a correlation coefficient. An estimated network of extrapyramidal syndrome showed that 26 (72.2%) of all possible 35 edges were estimated to be greater than zero. Dyskinesia was most centrally situated within the estimated network. In addition, earlier antipsychotic-induced extrapyramidal symptoms were divided into three distinctive clusters - extrapyramidal syndrome without parkinsonism, postural instability and gait difficulty-dominant parkinsonism, and tremor-dominant parkinsonism. CONCLUSIONS Our findings showed that dyskinesia is the most central domain in an estimated network structure of extrapyramidal syndrome in Asian patients with schizophrenia. These findings are consistent with the speculation that acute dystonia, akathisia, and parkinsonism could be the risk factors of tardive dyskinesia.
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Affiliation(s)
- Seon-Cheol Park
- Department of Psychiatry, Inje University Haeundae Paik Hospital, Busan, Republic of Korea
| | - Gyung-Mee Kim
- Department of Psychiatry, Inje University Haeundae Paik Hospital, Busan, Republic of Korea
| | - Takahiro A Kato
- Department of Neuropsychiatry, Graduate School of Medicine, Kyushu University, Fukuoka, Japan
| | - Mian-Yoon Chong
- Chang Gung Memorial Hospital, Chiayi, Taiwan.,School of Medicine, Chang Gung University, Kwei-Shan, Taiwan
| | - Shih-Ku Lin
- Department of Psychiatry, Taipei City Hospital, Songde Branch, Taipei, Taiwan
| | - Shu-Yu Yang
- Department of Pharmacy, Tapei City Hospital, Songde Branch, Tapei, Taiwan
| | - Ajit Avasthi
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sandeep Grover
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | | | - Yu-Tao Xiang
- Center for Cognition and Brain Sciences, University of Macau, Macao SAR, China
| | - Kok Yoon Chee
- Tunku Abdul Rahman Institute of Neuroscience, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia
| | | | - Chay Hoon Tan
- Department of Pharmacology, National University Hospital, Singapore, Singapore
| | - Kang Sim
- West Region, Institute of Mental Health and Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Norman Sartorius
- Association for the Improvement of Mental Health Programmes, Geneva, Switzerland
| | - Naotaka Shinfuku
- Department of Social Welfare, School of Human Sciences, Seinan Gakuin University, Fukuoka, Japan
| | - Yong Chon Park
- Department of Neuropsychiatry, Hanyang University Guri Hospital, Guri, Republic of Korea
| | - Toshiya Inada
- Department of Psychiatry and Psychobiology, Nagoya University, Graduate School of Medicine, Nagoya, Japan
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Single-Session Dance/Movement Therapy for People with Acute Schizophrenia: Development of a Treatment Protocol. AMERICAN JOURNAL OF DANCE THERAPY 2020. [DOI: 10.1007/s10465-020-09341-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Jia R, Liang D, Yu J, Lu G, Wang Z, Wu Z, Huang H, Chen C. The effectiveness of adjunct music therapy for patients with schizophrenia: A meta-analysis. Psychiatry Res 2020; 293:113464. [PMID: 33002835 DOI: 10.1016/j.psychres.2020.113464] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 09/04/2020] [Indexed: 01/01/2023]
Abstract
To evaluate the efficacy of adjunct music therapy on patients with schizophrenia, we conducted a meta-analysis of currently available randomized controlled trials and controlled clinical trials. Eight electronic databases (CNKI, PubMed, EMBASE, Cochrane Library, PsycINFO, Web of Science, Psychology and behavioural Sciences Collection, and Medline) were systematically searched from inception to January 2020. Standard mean difference (SMD) with 95% confidence interval (CI) values were used to evaluate the effects of music therapy. Finally, we selected eighteen studies comprising 1,212 participants comparing with control conditions. The meta-analysis demonstrated that adjunct music therapy significantly improved total symptoms (SMD = -0.48, 95%CI: -0.74 to -0.22), negative symptoms (SMD=-0.56, 95%CI: -0.72 to -0.40), depression symptoms (SMD = -0.35, 95% CI: -0.54 to -0.17), and quality of life (SMD = 0.35, 95%CI: 0.07 to 0.62) in people with schizophrenia compared with the control group. In addition, the meta-analysis indicated no publication bias for total symptoms, negative symptoms, and positive symptoms. The sensitivity analysis showed that the result was reliable. But the quality of evidence is still low, more well-designed studies with larger sample size and high quality are needed to confirm the efficiency of adjunct music therapy in treating schizophrenia.
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Affiliation(s)
- Ruiying Jia
- Institute of Nursing and Health, College of Nursing and Health, Henan University, Jinming Avenue, Kaifeng, Henan, 475004, China
| | - Dandan Liang
- Institute of Nursing and Health, College of Nursing and Health, Henan University, Jinming Avenue, Kaifeng, Henan, 475004, China
| | - Jingfen Yu
- Institute of Nursing and Health, College of Nursing and Health, Henan University, Jinming Avenue, Kaifeng, Henan, 475004, China
| | - Guangli Lu
- School of Business, Henan University, Jinming Avenue, Kaifeng, Henan, 475004, China.
| | - Zihui Wang
- Institute of Nursing and Health, College of Nursing and Health, Henan University, Jinming Avenue, Kaifeng, Henan, 475004, China
| | - Zhen Wu
- Institute of Nursing and Health, College of Nursing and Health, Henan University, Jinming Avenue, Kaifeng, Henan, 475004, China
| | - Haitao Huang
- Institute of Nursing and Health, College of Nursing and Health, Henan University, Jinming Avenue, Kaifeng, Henan, 475004, China
| | - Chaoran Chen
- Institute of Nursing and Health, College of Nursing and Health, Henan University, Jinming Avenue, Kaifeng, Henan, 475004, China
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Preda A, Shapiro BB. A safety evaluation of aripiprazole in the treatment of schizophrenia. Expert Opin Drug Saf 2020; 19:1529-1538. [DOI: 10.1080/14740338.2020.1832990] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Adrian Preda
- Department of Psychiatry and Human Behavior, UC Irvine Medical Center, Orange, CA, USA
| | - Bryan B. Shapiro
- Department of Psychiatry and Human Behavior, UC Irvine Medical Center, Orange, CA, USA
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35
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Wang Y, Wei Y, Edmiston EK, Womer FY, Zhang X, Duan J, Zhu Y, Zhang R, Yin Z, Zhang Y, Jiang X, Wei S, Liu Z, Zhang Y, Tang Y, Wang F. Altered structural connectivity and cytokine levels in Schizophrenia and Genetic high-risk individuals: Associations with disease states and vulnerability. Schizophr Res 2020; 223:158-165. [PMID: 32684357 DOI: 10.1016/j.schres.2020.05.044] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 03/26/2020] [Accepted: 05/17/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Alterations of white matter (WM) integrity have been observed in both schizophrenia (SZ) and individuals at genetic high risk for SZ (GHR-SZ); however, the molecular mechanisms underlying WM disruption remain unclear. Cytokines are chemical messengers of the immune system that are closely related to inflammation and neurogenesis in the brain. This study aimed to identify abnormalities in WM integrity, cytokine levels, and their association in SZ and GHR-SZ. METHODS A total of 355 participants (126 with SZ, 99 GHR-SZ, and 130 healthy controls [HCs]) were recruited. All participants underwent diffusion tensor imaging and blood samples were obtained from 113 participants within 24 h of imaging. RESULTS In SZ, there was decreased fractional anisotropy(FA) in the genu and body of the corpus callosum (GCC/BCC), anterior corona radiata, anterior and posterior limbs of the internal capsule (ALIC/PLIC), superior fronto-occipital fasciculus, external capsule, and fornix, and elevated IL-6 levels. In both SZ and GHR-SZ, decreased FA in the splenium of the corpus callosum (SCC), posterior corona radiate (PCR), and posterior thalamic radiation (PTR) was observed, and elevated leptin levels were present. Additionally, the IL-6 levels were negatively correlated with FA in the GCC and ALIC in SZ, and leptin levels were negatively correlated with the SCC, PCR, and PTR in SZ and GHR-SZ. CONCLUSIONS Abnormal WM integrity in SZ may reflect the state of disease and is associated with increased IL-6 levels. In addition, these leptin-associated WM integrity abnormalities in both SZ and GHR-SZ may reflect a genetic vulnerability to SZ.
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Affiliation(s)
- Yang Wang
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, PR China; Brain Function Research Section, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, PR China
| | - Yange Wei
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, PR China; Brain Function Research Section, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, PR China
| | - E Kale Edmiston
- Department of Psychiatry, University of Pittsburgh Medical Center, USA
| | - Fay Y Womer
- Department of Psychiatry, Washington University School of Medicine, St. Louis, USA
| | - Xizhe Zhang
- School of Computer Science and Engineering, Northeastern University, Shenyang, Liaoning, PR China
| | - Jia Duan
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, PR China; Brain Function Research Section, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, PR China
| | - Yue Zhu
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, PR China; Brain Function Research Section, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, PR China
| | - Ran Zhang
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, PR China; Brain Function Research Section, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, PR China
| | - Zhiyang Yin
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, PR China; Brain Function Research Section, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, PR China
| | - Yifan Zhang
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, PR China; Brain Function Research Section, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, PR China
| | - Xiaowei Jiang
- Brain Function Research Section, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, PR China; Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, PR China
| | - Shengnan Wei
- Brain Function Research Section, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, PR China; Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, PR China
| | - Zhuang Liu
- School of Public Health, China Medical University, Shenyang, Liaoning, PR China
| | - Yanbo Zhang
- Department of Psychiatry, College of Medicine, University of Saskatchewan, Canada
| | - Yanqing Tang
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, PR China; Brain Function Research Section, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, PR China.
| | - Fei Wang
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, PR China; Brain Function Research Section, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, PR China; Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, PR China; Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.
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Huerta-Ramos E, Labad J, Cobo J, Núñez C, Creus M, García-Parés G, Cuadras D, Franco J, Miquel E, Reyes JC, Marcó-García S, Usall J. Effects of raloxifene on cognition in postmenopausal women with schizophrenia: a 24-week double-blind, randomized, parallel, placebo-controlled trial. Eur Arch Psychiatry Clin Neurosci 2020; 270:729-737. [PMID: 31728631 DOI: 10.1007/s00406-019-01079-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 10/24/2019] [Indexed: 12/13/2022]
Abstract
We assessed the utility of raloxifene (60 mg/day) as an adjuvant treatment for cognitive symptoms in postmenopausal women with schizophrenia in a 24-week, double-blind, randomized, placebo-controlled study. Patients were recruited from the inpatient and outpatient services of Parc Sanitari Sant Joan de Déu, Hospital Universitari Institut Pere Mata, and Corporació Sanitària Parc Taulí. Seventy eight postmenopausal women with schizophrenia were randomized to either adjunctive raloxifene or placebo. Sixty-eight began the clinical trial (37 women on raloxifene adjunct) and 31 on placebo adjunct. The outcome measures were: memory, attention and executive function. Assessment was conducted at baseline and at week 24. Between groups homogeneity was tested with the Student's t test for continuous variables and/or the Mann-Whitney U test for ordinal variables and the χ2 test or Fisher's exact test for categorical variables. The differences between the two groups in neuropsychological test scores were compared using the Student's t test. The sample was homogenous with respect to age, formal education, illness duration and previous pharmacological treatment. The addition of raloxifene to antipsychotic treatment as usual showed no differences in cognitive function. The daily use of 60 mg raloxifene as an adjuvant treatment in postmenopausal women with schizophrenia has no appreciable effect.ClinicalTrials.gov Identifier: NCT01573637.
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Affiliation(s)
- Elena Huerta-Ramos
- Parc Sanitari Sant Joan de Déu, C/Antoni Pujadas, 42. Sant Boi de Llobregat, 08830, Barcelona, Spain. .,Fundació Sant Joan de Déu, Barcelona, Spain. .,Instituto de Salud Carlos III, Centro de Investigación en Red de Salud Mental (CIBERSAM), Madrid, Spain. .,Institut de Recerca Sant Joan de Déu, Barcelona, Spain.
| | - Javier Labad
- Corporació Sanitària Parc Taulí, Barcelona, Spain
| | - Jesus Cobo
- Corporació Sanitària Parc Taulí, Barcelona, Spain
| | - Christian Núñez
- Parc Sanitari Sant Joan de Déu, C/Antoni Pujadas, 42. Sant Boi de Llobregat, 08830, Barcelona, Spain.,Fundació Sant Joan de Déu, Barcelona, Spain.,Institut de Recerca Sant Joan de Déu, Barcelona, Spain
| | | | | | - Daniel Cuadras
- Parc Sanitari Sant Joan de Déu, C/Antoni Pujadas, 42. Sant Boi de Llobregat, 08830, Barcelona, Spain.,Fundació Sant Joan de Déu, Barcelona, Spain.,Institut de Recerca Sant Joan de Déu, Barcelona, Spain
| | | | - Eva Miquel
- Parc Sanitari Sant Joan de Déu, C/Antoni Pujadas, 42. Sant Boi de Llobregat, 08830, Barcelona, Spain
| | | | - Silvia Marcó-García
- Parc Sanitari Sant Joan de Déu, C/Antoni Pujadas, 42. Sant Boi de Llobregat, 08830, Barcelona, Spain.,Fundació Sant Joan de Déu, Barcelona, Spain.,Institut de Recerca Sant Joan de Déu, Barcelona, Spain
| | | | - Judith Usall
- Parc Sanitari Sant Joan de Déu, C/Antoni Pujadas, 42. Sant Boi de Llobregat, 08830, Barcelona, Spain.,Fundació Sant Joan de Déu, Barcelona, Spain.,Instituto de Salud Carlos III, Centro de Investigación en Red de Salud Mental (CIBERSAM), Madrid, Spain.,Institut de Recerca Sant Joan de Déu, Barcelona, Spain
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Szoke A, Pignon B, Boster S, Jamain S, Schürhoff F. Schizophrenia: Developmental Variability Interacts with Risk Factors to Cause the Disorder: Nonspecific Variability-Enhancing Factors Combine with Specific Risk Factors to Cause Schizophrenia. Bioessays 2020; 42:e2000038. [PMID: 32864753 DOI: 10.1002/bies.202000038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 08/10/2020] [Indexed: 12/31/2022]
Abstract
A new etiological model is proposed for schizophrenia that combines variability-enhancing nonspecific factors acting during development with more specific risk factors. This model is better suited than the current etiological models of schizophrenia, based on the risk factors paradigm, for predicting and/or explaining several important findings about schizophrenia: high co-morbidity rates, low specificity of many risk factors, and persistence in the population of the associated genetic polymorphisms. Compared with similar models, e.g., de-canalization, common psychopathology factor, sexual-selection, or differential sensitivity to the environment, this proposal is more general and integrative. Recently developed research methods have proven the existence of genetic and environmental factors that enhance developmental variability. Applying such methods to newly collected or already available data can allow for testing the hypotheses upon which this model is built. If validated, this model may change the understanding of the etiology of schizophrenia, the research models, and preventionbrk paradigms.
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Affiliation(s)
- Andrei Szoke
- INSERM, U955, Translational NeuroPsychiatry Lab, Créteil, 94000, France.,AP-HP, DHU IMPACT, Pôle de Psychiatrie, Hôpitaux Universitaires Henri-Mondor, Créteil, 94000, France.,Fondation FondaMental, Créteil, 94000, France.,UPEC, Faculté de Médecine, Université Paris-Est Créteil, Créteil, 94000, France
| | - Baptiste Pignon
- INSERM, U955, Translational NeuroPsychiatry Lab, Créteil, 94000, France.,AP-HP, DHU IMPACT, Pôle de Psychiatrie, Hôpitaux Universitaires Henri-Mondor, Créteil, 94000, France.,Fondation FondaMental, Créteil, 94000, France.,UPEC, Faculté de Médecine, Université Paris-Est Créteil, Créteil, 94000, France
| | | | - Stéphane Jamain
- INSERM, U955, Translational NeuroPsychiatry Lab, Créteil, 94000, France.,UPEC, Faculté de Médecine, Université Paris-Est Créteil, Créteil, 94000, France
| | - Franck Schürhoff
- INSERM, U955, Translational NeuroPsychiatry Lab, Créteil, 94000, France.,AP-HP, DHU IMPACT, Pôle de Psychiatrie, Hôpitaux Universitaires Henri-Mondor, Créteil, 94000, France.,Fondation FondaMental, Créteil, 94000, France.,UPEC, Faculté de Médecine, Université Paris-Est Créteil, Créteil, 94000, France
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38
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Clementz BA, Trotti RL, Pearlson GD, Keshavan MS, Gershon ES, Keedy SK, Ivleva EI, McDowell JE, Tamminga CA. Testing Psychosis Phenotypes From Bipolar-Schizophrenia Network for Intermediate Phenotypes for Clinical Application: Biotype Characteristics and Targets. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2020; 5:808-818. [PMID: 32600898 DOI: 10.1016/j.bpsc.2020.03.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 03/30/2020] [Accepted: 03/31/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Psychiatry aspires to the molecular understanding of its disorders and, with that knowledge, to precision medicine. Research supporting such goals in the dimension of psychosis has been compromised, in part, by using phenomenology alone to estimate disease entities. To this end, we are proponents of a deep phenotyping approach in psychosis, using computational strategies to discover the most informative phenotypic fingerprint as a promising strategy to uncover mechanisms in psychosis. METHODS Doing this, the Bipolar-Schizophrenia Network for Intermediate Phenotypes (B-SNIP) has used biomarkers to identify distinct subtypes of psychosis with replicable biomarker characteristics. While we have presented these entities as relevant, their potential utility in clinical practice has not yet been demonstrated. RESULTS Here we carried out an analysis of clinical features that characterize biotypes. We found that biotypes have unique and defining clinical characteristics that could be used as initial screens in the clinical and research settings. Differences in these clinical features appear to be consistent with biotype biomarker profiles, indicating a link between biological features and clinical presentation. Clinical features associated with biotypes differ from those associated with DSM diagnoses, indicating that biotypes and DSM syndromes are not redundant and are likely to yield different treatment predictions. We highlight 3 predictions based on biotype that are derived from individual biomarker features and cannot be obtained from DSM psychosis syndromes. CONCLUSIONS In the future, biotypes may prove to be useful for targeting distinct molecular, circuit, cognitive, and psychosocial therapies for improved functional outcomes.
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Affiliation(s)
- Brett A Clementz
- Departments of Psychology and Neuroscience, Bio-Imaging Research Center, University of Georgia, Athens, Georgia
| | - Rebekah L Trotti
- Departments of Psychology and Neuroscience, Bio-Imaging Research Center, University of Georgia, Athens, Georgia
| | - Godfrey D Pearlson
- Olin Neuropsychiatry Research Center, Institute of Living at Hartford Hospital, Hartford, Connecticut; Department of Psychiatry, Yale University, New Haven, Connecticut
| | - Matcheri S Keshavan
- Department of Psychiatry, Beth Israel Deaconess, Harvard Medical School, Boston, Massachusetts
| | - Elliot S Gershon
- Department of Psychiatry, University of Chicago, Chicago, Illinois
| | - Sarah K Keedy
- Department of Psychiatry, University of Chicago, Chicago, Illinois
| | - Elena I Ivleva
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jennifer E McDowell
- Departments of Psychology and Neuroscience, Bio-Imaging Research Center, University of Georgia, Athens, Georgia
| | - Carol A Tamminga
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas.
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39
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Delfin C, Reckless GE, Bolstad I, Groote I, Andreassen OA, Jensen J. Exploring the Effects of an Acute Dose of Antipsychotic Medication on Motivation-mediated BOLD Activity Using fMRI and a Perceptual Decision-making Task. Neuroscience 2020; 440:146-159. [PMID: 32473275 DOI: 10.1016/j.neuroscience.2020.05.035] [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: 01/29/2020] [Revised: 05/09/2020] [Accepted: 05/20/2020] [Indexed: 10/24/2022]
Abstract
The left inferior frontal gyrus and the bilateral ventral striatum are thought to be involved in motivation-mediated decision-making. Antipsychotics may influence this relationship, and atypical antipsychotics improve secondary negative symptoms in schizophrenia, such as loss of motivation, although the acute effects of pharmacological medication on motivation are not fully understood. In this single-blinded, randomized controlled trial, 49 healthy volunteers were randomized into three groups to receive a single dose of haloperidol, aripiprazole or placebo. Between 4.0 and 5.6 h later, participant's brain blood-oxygen-level dependent (BOLD) activity was recorded using functional magnetic resonance imaging (fMRI) while completing a perceptual decision-making fMRI task consisting of one neutral and one motivated condition. Response bias, reflecting the participant's willingness to say that the target stimulus is present, was calculated using signal detection theory. Concurrent with widespread changes in BOLD signal in the motivated vs. neutral condition, a less conservative, mathematically optimal response bias was observed in the motivated condition across the whole sample. Within-group differences in BOLD signal in the left inferior frontal gyrus and bilateral ventral striatum were observed between conditions in the aripiprazole and haloperidol groups, but not in the placebo group. No robust between-group differences in brain activity in the left inferior frontal gyrus or the bilateral ventral striatum were found. Overall, we found no robust evidence for an effect of either aripiprazole or haloperidol on motivationally mediated behavior. An interesting pattern of correlations possibly related to pharmacologically induced alterations in the dopamine system was observed, although findings remain inconclusive and must be replicated in larger samples.
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Affiliation(s)
- Carl Delfin
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, Norway; Centre for Ethics, Law and Mental Health, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Sweden; Research Department, Regional Forensic Psychiatric Clinic Växjö, Sweden.
| | - Greg E Reckless
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, Norway; Institute of Clinical Medicine, University of Oslo, Norway
| | - Ingeborg Bolstad
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, Norway; Institute of Clinical Medicine, University of Oslo, Norway
| | - Inge Groote
- Computational Radiology & Artificial Intelligence, Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Ole A Andreassen
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, Norway; Institute of Clinical Medicine, University of Oslo, Norway
| | - Jimmy Jensen
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, Norway; Centre for Psychology, Kristianstad University, Kristianstad, Sweden
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40
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Garcia-Rosa S, Carvalho BS, Guest PC, Steiner J, Martins-de-Souza D. Blood plasma proteomic modulation induced by olanzapine and risperidone in schizophrenia patients. J Proteomics 2020; 224:103813. [DOI: 10.1016/j.jprot.2020.103813] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 04/27/2020] [Accepted: 05/05/2020] [Indexed: 12/29/2022]
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41
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Nasib LG, Sommer IE, Winter-van Rossum I, de Vries J, Gangadin SS, Oomen PP, Judge G, Blom RE, Luykx JJ, van Beveren NJM, Veen ND, Kroken RA, Johnsen EL. Prednisolone versus placebo addition in the treatment of patients with recent-onset psychotic disorder: a trial design. Trials 2020; 21:492. [PMID: 32513294 PMCID: PMC7278136 DOI: 10.1186/s13063-020-04365-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 05/05/2020] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND The symptom severity of a substantial group of schizophrenia patients (30-40%) does not improve through pharmacotherapy with antipsychotic medication, indicating a clear need for new treatment options to improve schizophrenia outcome. Meta-analyses, genetic studies, randomized controlled trials, and post-mortem studies suggest that immune dysregulation plays a role in the pathophysiology of schizophrenia. Some anti-inflammatory drugs have shown beneficial effects on the symptom severity of schizophrenia patients. Corticosteroids are effective in various chronic inflammatory and autoimmune disorders. Prednisolone, a potent glucocorticosteroid, has minor mineral-corticosteroid potencies and can adequately pass the blood-brain barrier and its side effects and safety profile are well known. Therefore, the effect of prednisolone can be studied as a proof of concept for immune modulation as a treatment for schizophrenia. METHODS/DESIGN In total, 90 subjects aged 18-70 years and diagnosed with schizophrenia, schizoaffective disorder, or schizophreniform disorder (Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) 295.x) or psychosis not otherwise specified (NOS; 298.9) will be included. The time interval between the onset of psychosis and study entry should not exceed 7 years. Patients will be randomized 1:1 to either prednisolone or placebo daily for a period of 6 weeks in addition to a stable dose of antipsychotic medication. Study medication will be initiated at 40 mg for 3 days, after which it will be tapered down within 6 weeks after initiation, following inflammatory bowel diseases treatment guidelines. Primary outcome is change in symptom severity, expressed as change in total score on the Positive and Negative Symptom Scale (PANSS) from baseline to end of treatment. Cognitive functioning (measured through the Brief Assessment of Cognition in Schizophrenia (BACS)) and change in Global Assessment Functioning (GAF) and depressive symptoms as measured with the Calgary Depression Scale for Schizophrenia (CDS) will be assessed, in addition to various immunological biomarkers. Secondary outcomes are a 4- and 6-month follow-up assessment of PANSS, BACS, and GAF scores and immunological biomarkers. Additionally, a subgroup of patients will be included in the magnetic resonance imaging (MRI) part of the study where MR spectroscopy and structural, functional, and diffusion MRI will be conducted. DISCUSSION It is expected that prednisolone addition to current antipsychotic medication use will reduce symptom severity and will improve cognition when compared to placebo. TRIAL REGISTRATION ClinicalTrials.gov, NCT02949232 and NCT03340909. Registered 31 October 2016 and 14 November 2017. EudraCT-number 2014-000520-14 and 2017-000163-32.
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Affiliation(s)
- Lyliana G Nasib
- Department of Psychiatry, UMC Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
| | - Iris E Sommer
- Cognitive Neurosciences, Department of Biomedical Sciences of Cells & Systems, University Medical Center Groningen, Groningen, The Netherlands.,Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
| | - Inge Winter-van Rossum
- Department of Psychiatry, UMC Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | | | - Shiral S Gangadin
- Department of Psychiatry, UMC Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Cognitive Neurosciences, Department of Biomedical Sciences of Cells & Systems, University Medical Center Groningen, Groningen, The Netherlands
| | - Priscilla P Oomen
- Department of Psychiatry, UMC Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Cognitive Neurosciences, Department of Biomedical Sciences of Cells & Systems, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Renske E Blom
- Department of Psychiatry, UMC Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Jurjen J Luykx
- Department of Psychiatry, UMC Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Department of Translational Neuroscience, UMC Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Department of Psychiatry, ZNA Hospitals, Antwerp, Belgium.,Department of Psychiatry, SymforaMeander Hospital, Amersfoort, The Netherlands
| | - Nico J M van Beveren
- Antes Center for Mental Health Care, Rotterdam, The Netherlands.,Department of Psychiatry, Erasmus MC, Rotterdam, The Netherlands.,Department of Neuroscience, Erasmus MC, Rotterdam, The Netherlands
| | | | - Rune A Kroken
- Norment, Division of Psychiatry, Haukeland University Hospital, Jonas Lies vei 65, 5021, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Pb 7800, 5020, Bergen, Norway
| | - Erik L Johnsen
- Norment, Division of Psychiatry, Haukeland University Hospital, Jonas Lies vei 65, 5021, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Pb 7800, 5020, Bergen, Norway
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42
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Maffioletti E, Valsecchi P, Minelli A, Magri C, Bonvicini C, Barlati S, Sacchetti E, Vita A, Gennarelli M. Association study betweenHTR2Ars6313 polymorphism and early response to risperidone and olanzapine in schizophrenia patients. Drug Dev Res 2020; 81:754-761. [DOI: 10.1002/ddr.21686] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 04/16/2020] [Accepted: 05/01/2020] [Indexed: 12/17/2022]
Affiliation(s)
| | - Paolo Valsecchi
- Department of Mental Health and Addiction ServicesASST Spedali Civili Brescia Italy
- Department of Clinical and Experimental SciencesUniversity of Brescia Brescia Italy
| | - Alessandra Minelli
- Department of Molecular and Translational MedicineUniversity of Brescia Brescia Italy
| | - Chiara Magri
- Department of Molecular and Translational MedicineUniversity of Brescia Brescia Italy
| | - Cristian Bonvicini
- Genetics UnitIRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli Brescia Italy
| | - Stefano Barlati
- Department of Mental Health and Addiction ServicesASST Spedali Civili Brescia Italy
- Department of Clinical and Experimental SciencesUniversity of Brescia Brescia Italy
| | - Emilio Sacchetti
- Department of Mental Health and Addiction ServicesASST Spedali Civili Brescia Italy
- Department of Clinical and Experimental SciencesUniversity of Brescia Brescia Italy
| | - Antonio Vita
- Department of Mental Health and Addiction ServicesASST Spedali Civili Brescia Italy
- Department of Clinical and Experimental SciencesUniversity of Brescia Brescia Italy
| | - Massimo Gennarelli
- Department of Molecular and Translational MedicineUniversity of Brescia Brescia Italy
- Genetics UnitIRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli Brescia Italy
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43
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Kuharic DB, Kekin I, Hew J, Kuzman MR, Puljak L. Preventive treatments in patients at high risk of psychosis. Lancet Psychiatry 2020; 7:384-385. [PMID: 32353265 DOI: 10.1016/s2215-0366(20)30100-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 02/25/2020] [Accepted: 02/26/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Dina Bosnjak Kuharic
- Department for Diagnostics and Intensive Care and Department for First Episode Psychosis, University Psychiatric Hospital Vrapče, Zagreb 10090, Croatia.
| | - Ivana Kekin
- Department of Psychiatry, Zagreb University Hospital Centre, Zagreb, Croatia
| | - Joanne Hew
- Department of Acute Care Psychiatry, South London and Maudsley NHS Foundation Trust, London, UK
| | - Martina Rojnic Kuzman
- Department of Psychiatry, Zagreb University Hospital Centre, Zagreb, Croatia; Zagreb School of Medicine, University of Zagreb, Croatia
| | - Livia Puljak
- Center for Evidence-Based Medicine and Health Care, Catholic University of Croatia, Zagreb, Croatia
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44
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Begemann MJH, Thompson IA, Veling W, Gangadin SS, Geraets CNW, van 't Hag E, Müller-Kuperus SJ, Oomen PP, Voppel AE, van der Gaag M, Kikkert MJ, Van Os J, Smit HFE, Knegtering RH, Wiersma S, Stouten LH, Gijsman HJ, Wunderink L, Staring ABP, Veerman SRT, Mahabir AGS, Kurkamp J, Pijnenborg GHM, Veen ND, Marcelis M, Grootens KP, Faber G, van Beveren NJ, Been A, van den Brink T, Bak M, van Amelsvoort TAMJ, Ruissen A, Blanke C, Groen K, de Haan L, Sommer IEC. To continue or not to continue? Antipsychotic medication maintenance versus dose-reduction/discontinuation in first episode psychosis: HAMLETT, a pragmatic multicenter single-blind randomized controlled trial. Trials 2020; 21:147. [PMID: 32033579 PMCID: PMC7006112 DOI: 10.1186/s13063-019-3822-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 10/22/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Antipsychotic medication is effective for symptomatic treatment in schizophrenia-spectrum disorders. After symptom remission, continuation of antipsychotic treatment is associated with lower relapse rates and lower symptom severity compared to dose reduction/discontinuation. Therefore, most guidelines recommend continuation of treatment with antipsychotic medication for at least 1 year. Recently, however, these guidelines have been questioned as one study has shown that more patients achieved long-term functional remission in an early discontinuation condition-a finding that was not replicated in another recently published long-term study. METHODS/DESIGN The HAMLETT (Handling Antipsychotic Medication Long-term Evaluation of Targeted Treatment) study is a multicenter pragmatic single-blind randomized controlled trial in two parallel conditions (1:1) investigating the effects of continuation versus dose-reduction/discontinuation of antipsychotic medication after remission of a first episode of psychosis (FEP) on personal and social functioning, psychotic symptom severity, and health-related quality of life. In total 512 participants will be included, aged between 16 and 60 years, in symptomatic remission from a FEP for 3-6 months, and for whom psychosis was not associated with severe or life-threatening self-harm or violence. Recruitment will take place at 24 Dutch sites. Patients are randomized (1:1) to: continuation of antipsychotic medication until at least 1 year after remission (original dose allowing a maximum reduction of 25%, or another antipsychotic drug in similar dose range); or gradual dose reduction till eventual discontinuation of antipsychotics according to a tapering schedule. If signs of relapse occur in this arm, medication dose can be increased again. Measurements are conducted at baseline, at 3, and 6 months post-baseline, and yearly during a follow-up period of 4 years. DISCUSSION The HAMLETT study will offer evidence to guide patients and clinicians regarding questions concerning optimal treatment duration and when to taper off medication after remission of a FEP. Moreover, it may provide patient characteristics associated with safe dose reduction with a minimal risk of relapse. TRIAL STATUS Protocol version 1.3, October 2018. The study is active and currently recruiting patients (since September 2017), with the first 200 participants by the end of 2019. We anticipate completing recruitment in 2022 and final assessments (including follow-up 3.5 years after phase one) in 2026. TRIAL REGISTRATION European Clinical Trials Database, EudraCT number 2017-002406-12. Registered 7 June 2017.
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Affiliation(s)
- Marieke J H Begemann
- Department of Biomedical Sciences of Cells & Systems, Cognitive Neurosciences, University of Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands.
| | - Ilse A Thompson
- Department of Biomedical Sciences of Cells & Systems, Cognitive Neurosciences, University of Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands
| | - Wim Veling
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Shiral S Gangadin
- Department of Biomedical Sciences of Cells & Systems, Cognitive Neurosciences, University of Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Chris N W Geraets
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Erna van 't Hag
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Sanne J Müller-Kuperus
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Priscilla P Oomen
- Department of Biomedical Sciences of Cells & Systems, Cognitive Neurosciences, University of Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands
| | - Alban E Voppel
- Department of Biomedical Sciences of Cells & Systems, Cognitive Neurosciences, University of Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands
| | - Mark van der Gaag
- Parnassia Psychiatric Institute, The Hague, The Netherlands
- Department of Clinical Psychology, VU University, Amsterdam, The Netherlands
| | - Martijn J Kikkert
- Department of Research, Arkin Mental Health Care, Amsterdam, The Netherlands
| | - Jim Van Os
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, EURON, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - H Filip E Smit
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
- Centre of Economic Evaluation, Trimbos Institute (Netherlands Institute of Mental Health), Utrecht, The Netherlands
| | - Rikus H Knegtering
- Lentis Research, Lentis Psychiatric Institute, Groningen, The Netherlands
- Rob Giel Research Center, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Sybren Wiersma
- Early Intervention Psychosis Team, GGZ inGeest Specialized Mental Health Care, Hoofddorp, The Netherlands
| | - Luyken H Stouten
- Centre for Early Psychosis, Parnassia Psychiatric Institute, The Hague, The Netherlands
| | - Harm J Gijsman
- Program for Psychosis & Severe Mental Illness, Pro Persona Mental Health, Wolfheze, The Netherlands
| | - Lex Wunderink
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Education and Research, Friesland Mental Health Care Services, Leeuwarden, The Netherlands
| | - Anton B P Staring
- Department ABC, Altrecht Psychiatric Institute, Utrecht, The Netherlands
| | - Selene R T Veerman
- Community Mental Health, Mental Health Service Noord-Holland Noord, Alkmaar, The Netherlands
| | | | - Jörg Kurkamp
- Center for Youth with Psychosis, Mediant ABC Twente, Enschede, The Netherlands
| | | | - Natalie D Veen
- GGZ Delfland, Delfland Institute for Mental Health Care, Delft, The Netherlands
| | - Machteld Marcelis
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, EURON, Maastricht University Medical Center, Maastricht, The Netherlands
- Institute for Mental Health Care Eindhoven (GGzE), Eindhoven, The Netherlands
| | - Koen P Grootens
- Reinier van Arkel Institute for Mental Health Care, 's Hertogenbosch, The Netherlands
- Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Gunnar Faber
- Yulius, Mental Health Institute, Dordrecht, The Netherlands
| | - Nico J van Beveren
- Antes Center for Mental Health Care, Rotterdam, The Netherlands
- Department of Neuroscience, Erasmus MC, Rotterdam, The Netherlands
- Department of Psychiatry, Erasmus MC, Rotterdam, The Netherlands
| | - Agaath Been
- Center for Developmental Disorders, Dimence Institute for Mental Health, Deventer, The Netherlands
| | | | - Maarten Bak
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, EURON, Maastricht University Medical Center, Maastricht, The Netherlands
- Mondriaan Mental Health Care, Heerlen, The Netherlands
| | - Therese A M J van Amelsvoort
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, EURON, Maastricht University Medical Center, Maastricht, The Netherlands
- Mondriaan Mental Health Care, Heerlen, The Netherlands
| | | | - Christine Blanke
- Anoiksis, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Karin Groen
- MIND Ypsilon, Organization of Relatives and Carers of People with a Vulnerability to Psychosis, The Hague, The Netherlands
| | - Lieuwe de Haan
- Department of Early Psychosis, Amsterdam UMC, Academic Medical Center, Amsterdam, The Netherlands
| | - Iris E C Sommer
- Department of Biomedical Sciences of Cells & Systems, Cognitive Neurosciences, University of Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands
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45
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Martins-de-Souza D, Guest PC, Steiner J. A proteomic signature associated to atypical antipsychotic response in schizophrenia patients: a pilot study. Eur Arch Psychiatry Clin Neurosci 2020; 270:127-134. [PMID: 30937516 DOI: 10.1007/s00406-019-01002-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 03/21/2019] [Indexed: 12/14/2022]
Abstract
A major hurdle faced by most schizophrenia patients is the poor efficacy of current antipsychotic medications. This stems from a poor understanding of the underlying pathophysiology and the lack of biomarkers for the prediction of a positive medication response. By employing state-of-the-art proteomic analysis of blood plasma from 58 patients who were either drug-naive or drug-free at the time of sample collection, we identified potential biomarkers that were predictive of a positive response after 6 weeks of treatment with antipsychotics. Complement and coagulation cascades were the most over-represented biological pathways among these proteins, consistent with the importance of these processes in schizophrenia. Although preliminary, these findings are novel and may drive future efforts in the development of predictive tests for medication efficacy and thereby have a positive influence on disease outcome.
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Affiliation(s)
- Daniel Martins-de-Souza
- Laboratory of Neuroproteomics, Department of Biochemistry and Tissue Biology, Institute of Biology, University of Campinas (UNICAMP), RuaMonteiroLobato, 255, Campinas, SP, 13083-862, Brazil. .,Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBION), Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), São Paulo, Brazil. .,UNICAMP Neurobiology Center, Campinas, Brazil.
| | - Paul C Guest
- Laboratory of Neuroproteomics, Department of Biochemistry and Tissue Biology, Institute of Biology, University of Campinas (UNICAMP), RuaMonteiroLobato, 255, Campinas, SP, 13083-862, Brazil
| | - Johann Steiner
- Laboratory of Translational Psychiatry, University of Magdeburg, Magdeburg, Germany.,Department of Psychiatry and Psychotherapy, University of Magdeburg, Magdeburg, Germany.,Center for Behavioral Brain Sciences (CBBS), Magdeburg, Germany
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46
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Predicting relapse with residual symptoms in schizophrenia: A secondary analysis of the PROACTIVE trial. Schizophr Res 2020; 215:173-180. [PMID: 31672387 DOI: 10.1016/j.schres.2019.10.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 10/04/2019] [Accepted: 10/12/2019] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Little attention has been paid to the contribution of individual residual symptom to predict relapse in patients with schizophrenia receiving oral or long-acting injectable (LAI) antipsychotics. METHOD We used the data from the Preventing Relapse on Oral Antipsychotics Compared to Injectables - Evaluating Efficacy (PROACTIVE) study, in which 305 outpatients with schizophrenia were randomly allocated to either biweekly LAI-risperidone (LAI-R) or daily oral second-generation antipsychotics (SGA) and assessed for up to 30 months. Baseline individual symptoms that could predict subsequent relapse were identified, using a Cox proportional hazards model. Moreover, among those who relapsed during the study (n = 73), individual symptoms were compared between baseline and biweekly ratings 8 to 2 weeks before relapse, using the linear mixed model. RESULTS A greater score in grandiosity at baseline was significantly associated with subsequent relapse (adjusted HR = 1.24, p = 0.006). When the two treatment groups were separately analyzed, more severe grandiosity (adjusted HR = 1.43, p = 0.003) and less severe hallucinatory behavior (adjusted HR = 0.70, p = 0.013) at baseline were significantly associated with relapse in the oral SGA group, but none was identified in the LAI-R group. Emotional withdrawal was significantly worse 8 and 2 weeks before relapse compared to the baseline (p = 0.032 and p = 0.043, respectively). DISCUSSION More severe grandiosity and less hallucination may have led to more frequent relapses in patients with schizophrenia receiving oral antipsychotics, which was not a case in those receiving LAI-R. The exploratory analysis indicates an increase in emotional withdrawal before relapse may be a useful marker for earlier interventions to possibly avert relapse.
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47
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One-Year Outcome and Adherence to Pharmacological Guidelines in First-Episode Schizophrenia: Results From a Consecutive Cohort Study. J Clin Psychopharmacol 2020; 40:534-540. [PMID: 33136922 PMCID: PMC7643791 DOI: 10.1097/jcp.0000000000001303] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
BACKGROUND Remission in schizophrenia is difficult to achieve. Antipsychotic drugs are critical in the treatment of schizophrenia. International guidelines for the pharmacological treatment of schizophrenia recommend a 3-step algorithm with clozapine being the third-line antipsychotic agent. This study investigated the 1-year outcome and the application of the guidelines for the pharmacological treatment of nonremitted first-episode schizophrenia (FES) patients during the first year of follow-up. METHODS A sample of 78 FES patients from the Norwegian TIPS (Early Treatment and Intervention in Psychosis) 2 study was assessed at the end of the first year of follow-up. The symptom remission criteria were those defined by the Remission in Schizophrenia Working Group. The adherence to the pharmacological guidelines was assessed by reading the medical files and by a digital search of the words "clozapine," "klozapin," and "Leponex" in the hospital electronic data system. RESULTS The majority (n = 53, 67.9%) of the patients included were nonremitted at the 1-year follow-up. The majority of the nonremitted patients received either none (7.5%), one (56.6%), or 2 types (15.1%) of antipsychotic drugs during the first year of follow-up. Only 2 (3.8%) received treatment with clozapine, and 3 (5.7%) in total were offered it. CONCLUSIONS For our FES sample, there was a low 1-year remission rate and a poor adherence to the pharmacological guidelines. Higher adherence to treatment guidelines with a more intensified antipsychotic treatment, which in some cases will include clozapine, will enhance the quality of treatment and may enhance the rates of remission for schizophrenia.
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Van der Poorten T, De Hert M. The sublingual use of atropine in the treatment of clozapine-induced sialorrhea: A systematic review. Clin Case Rep 2019; 7:2108-2113. [PMID: 31788260 PMCID: PMC6878073 DOI: 10.1002/ccr3.2431] [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: 02/04/2019] [Revised: 07/29/2019] [Accepted: 08/06/2019] [Indexed: 12/31/2022] Open
Abstract
Clozapine is considered the golden standard in the treatment of therapy-resistant schizophrenia; however, it associated with bothersome side effects such as sialorrhea. Current evidence suggests that the sublingual use of atropine seems to be safe and effective and could be considered as a first-line treatment of clozapine-induced sialorrhea.
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Affiliation(s)
| | - Marc De Hert
- Department Of NeurosciencesKU LeuvenKortenbergBelgium
- University of AntwerpAntwerpBelgium
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49
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Ruiz-Iriondo M, Salaberría K, Polo-López R, Iruin Á, Echeburúa E. Improving clinical symptoms, functioning, and quality of life in chronic schizophrenia with an integrated psychological therapy (IPT) plus emotional management training (EMT): A controlled clinical trial. Psychother Res 2019; 30:1026-1038. [PMID: 31651213 DOI: 10.1080/10503307.2019.1683634] [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] [Indexed: 10/25/2022] Open
Abstract
Objective: This paper describes the results of testing a multi-component psychological therapy that includes integrated psychological therapy (IPT), together with an adaptation of emotional management therapy (EMT), versus treatment as usual (TAU), delivered in a community mental health setting for individual with chronic schizophrenia. We investigated the effectiveness of a psychological intervention on clinical symptoms, cognitive and social functioning, as well as the feasibility of treatment and its acceptance. Method: 77 outpatients were recruited, 42 in the experimental group, who were treated with IPT + EMT, and 35 participants in control condition (TAU), both during 8 months. The subjects of both groups were assessed pre and postreatment. Results: Treatment attendance was 98% in experimental group and none of patients required hospital admission during therapy, meanwhile 11 patients from the TAU group withdrew and 3 were hospitalized during therapy. After therapy, patients in the experimental group compared to TAU, reduced clinical symptoms and improved cognitive functioning and quality of life. Conclusion: Psychological therapy seems to be a feasible intervention even in the chronic stages of the disease.
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Affiliation(s)
- Maria Ruiz-Iriondo
- Mental Health and Psychiatric Assistance, Neuroscience Department, Biodonostia Health Research Institute, Gipuzkoa, Spain.,Department of Personality, Assessment and Psychological Treatment (UPV/EHU), Psychology School, Gipuzkoa, Spain
| | - Karmele Salaberría
- Mental Health and Psychiatric Assistance, Neuroscience Department, Biodonostia Health Research Institute, Gipuzkoa, Spain.,Department of Personality, Assessment and Psychological Treatment (UPV/EHU), Psychology School, Gipuzkoa, Spain
| | - Rocio Polo-López
- Mental Health and Psychiatric Assistance, Neuroscience Department, Biodonostia Health Research Institute, Gipuzkoa, Spain
| | - Álvaro Iruin
- Mental Health and Psychiatric Assistance, Neuroscience Department, Biodonostia Health Research Institute, Gipuzkoa, Spain.,Guipúzcoa Mental Health Network, Basque Health Service-Osakidetza, Gipuzkoa, Spain
| | - Enrique Echeburúa
- Mental Health and Psychiatric Assistance, Neuroscience Department, Biodonostia Health Research Institute, Gipuzkoa, Spain.,Department of Personality, Assessment and Psychological Treatment (UPV/EHU), Psychology School, Gipuzkoa, Spain
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Hahn B, Shrieves ME, Yuille MB, Buchanan RW, Wells AK. Nicotine effects on cognitive remediation training outcome in people with schizophrenia: A pilot study. Psychiatry Res 2019; 280:112498. [PMID: 31437659 PMCID: PMC6756954 DOI: 10.1016/j.psychres.2019.112498] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 07/16/2019] [Accepted: 07/28/2019] [Indexed: 10/26/2022]
Abstract
Cognitive remediation training can alleviate cognitive impairment associated with schizophrenia, but the impact is limited by small effect sizes. The present study aimed at augmenting training effects by administering nicotine prior to training sessions. Twenty-five people with schizophrenia were enrolled in a 10-week, 5 days/week, computerized cognitive training regimen. Participants were randomized to two treatment groups: nicotine or placebo. Every Monday and Thursday, the nicotine group received a nicotine lozenge before the training, and the placebo group a placebo lozenge. Outcome measurements were conducted on a no-lozenge day in weeks 0, 4, 7, and 10, and at 4-week follow-up. The MATRICS Consensus Cognitive Battery composite score improved over time, but there was no group difference in this effect. A significant group difference emerged over time in the reasoning/problem solving sub-domain: the placebo group improved but not the nicotine group, suggesting that nicotine exposure negatively impacted training benefits on executive control processes. There were no effects on psychiatric symptoms. However, significant improvements were seen across groups on the Quality of Life Scale and the Cognitive Assessment Interview, measuring real-life functional outcome. In conclusion, the present study failed to find evidence that nicotine exposure during cognitive remediation training may potentiate training benefits.
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Affiliation(s)
- Britta Hahn
- Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland School of Medicine, P.O. Box 21247, Baltimore, MD 21228, USA.
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