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Silverberg NB, Lee-Wong MF, Silverberg JI. VINDICATE-P: A Mnemonic for the Many Comorbidities of Atopic Dermatitis. Dermatol Clin 2024; 42:559-567. [PMID: 39278709 DOI: 10.1016/j.det.2024.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/18/2024]
Abstract
Patients with atopic dermatitis (AD) are at increased risk of atopic and non-atopic comorbidities. In fact, the Hanifin and Rajka criteria include allergic and infectious comorbidities as a minor criterion. Despite the well-recognized list of comorbidities, the past 15 years greatly expanded the list of recognized comorbidities of AD. This narrative review focuses on comorbidities of AD using a mnemonic, VINDICATE-P: vascular/cardiovascular, infectious, neoplastic and neurologic, degenerative, iatrogenic, congenital, atopic and autoimmune, traumatic, endocrine/metabolic, and psychiatric. The comorbidities of AD vary by age. More research is needed into the mechanisms of comorbidities and optimal screening strategies in AD patients.
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Affiliation(s)
- Nanette B Silverberg
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, 5 East 98th Street, 5th Floor, New York, NY 10028, USA.
| | - Mary F Lee-Wong
- Division of Adult Allergy and Immunology, Maimonides Medical Center, 4813 9th Avenue, 5th Floor, Brooklyn, NY 11219, USA
| | - Jonathan I Silverberg
- Department of Dermatology, George Washington University School of Medicine and Health Sciences, 2150 Pennsylvania Avenue Northwest, Suite 2B-430, Washington, DC 20037, USA
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2
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Taylor JH, Bermudez-Gomez J, Zhou M, Gómez O, Ganz-Leary C, Palacios-Ordonez C, Huque ZM, Barzilay R, Goldsmith DR, Gur RE. Immune and oxidative stress biomarkers in pediatric psychosis and psychosis-risk: Meta-analyses and systematic review. Brain Behav Immun 2024; 117:1-11. [PMID: 38141839 DOI: 10.1016/j.bbi.2023.12.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 10/08/2023] [Accepted: 12/18/2023] [Indexed: 12/25/2023] Open
Abstract
OBJECTIVE While genetic and cohort studies suggest immune and reduction/oxidation (redox) alterations occur in psychosis, less is known about potential alterations in children and adolescents. METHODS We conducted a systematic review to identify immune and redox biomarker studies in children and adolescents (mean age ≤ 18 years old) across the psychosis spectrum: from psychotic like experiences, which are common in children, to threshold psychotic disorders like schizophrenia. We conducted meta-analyses when at least three studies measured the same biomarker. RESULTS The systematic review includes 38 pediatric psychosis studies. The meta-analyses found that youth with threshold psychotic disorders had higher neutrophil/lymphocyte ratio (Hedge's g = 0.40, 95 % CI 0.17 - 0.64), tumor necrosis factor (Hedge's g = 0.38, 95 % CI 0.06 - 0.69), C-reactive protein (Hedge's g = 0.38, 95 % CI 0.05 - 0.70), interleukin-6 (Hedge's g = 0.35; 95 % CI 0.11 - 0.64), and total white blood cell count (Hedge's g = 0.29, 95 % CI 0.12 - 0.46) compared to youth without psychosis. Other immune and oxidative stress meta-analytic findings were very heterogeneous. CONCLUSION Results from several studies are consistent with the hypothesis that signals often classified as "proinflammatory" are elevated in threshold pediatric psychotic disorders. Data are less clear for immune markers in subthreshold psychosis and redox markers across the subthreshold and threshold psychosis spectrum. Immune and redox biomarker intervention studies are lacking, and research investigating interventions targeting the immune system in threshold pediatric psychosis is especially warranted.
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Affiliation(s)
- Jerome Henry Taylor
- Children's Hospital of Philadelphia (CHOP), Philadelphia, PA, USA; University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA; Lifespan Brain Institute of CHOP and Penn Medicine, Philadelphia, PA, USA.
| | - Julieta Bermudez-Gomez
- National Institute of Psychiatry Ramon de la Fuente Muñiz, Mexico City, Mexico; Statiscripts, LLC, USA
| | - Marina Zhou
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Oscar Gómez
- Statiscripts, LLC, USA; Faculty of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Casey Ganz-Leary
- Children's Hospital of Philadelphia (CHOP), Philadelphia, PA, USA; University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA; Lifespan Brain Institute of CHOP and Penn Medicine, Philadelphia, PA, USA
| | - Cesar Palacios-Ordonez
- Statiscripts, LLC, USA; Monterrey Institute of Technology and Higher Education, Monterrey, Mexico
| | - Zeeshan M Huque
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA; Lifespan Brain Institute of CHOP and Penn Medicine, Philadelphia, PA, USA; Temple University, Philadelphia, PA, USA
| | - Ran Barzilay
- Children's Hospital of Philadelphia (CHOP), Philadelphia, PA, USA; University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA; Lifespan Brain Institute of CHOP and Penn Medicine, Philadelphia, PA, USA
| | | | - Raquel E Gur
- Children's Hospital of Philadelphia (CHOP), Philadelphia, PA, USA; University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA; Lifespan Brain Institute of CHOP and Penn Medicine, Philadelphia, PA, USA
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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: 7] [Impact Index Per Article: 7.0] [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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BARLOW R, PAYYAZHI G, HOGAN S, GRINDLAY D, CHOI D, VERMA M, PASUNURU K, TAYLOR R, BEWLEY A, MOHANDAS P. Suicide and Suicidality in Children and Adolescents with Chronic Skin Disorders: A Systematic Review. Acta Derm Venereol 2023; 103:adv00851. [PMID: 36629476 PMCID: PMC9885289 DOI: 10.2340/actadv.v102.1502] [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: 01/13/2022] [Accepted: 08/11/2022] [Indexed: 01/14/2023] Open
Abstract
Suicide in young children is rare; the incidence increases towards the end of adolescence. Skin disorders confer a high prevalence of psychiatric and psycho-logical comorbidities. However, published research on suicidal behaviour in adolescents and children with skin disorders is sparse. The aim of this study was to identify the prevalence of suicidal behaviour in children and adolescents under 18 years of age with chronic skin disorders and associated contributing risk factors. MEDLINE, PsycINFO, EMBASE, CINAHL and Cochrane databases were searched from inception to October 2020 for suicide or suicide attempts in patients under 18 years old with chronic skin disorders. The study protocol was logged on PROSPERO (CRD42020083528). Returned texts were reviewed independently by 2 authors. Bias was assessed according to Joanna Briggs Institute criteria. Five studies met the inclusion criteria; 4 cross-sectional surveys and 1 retrospective matched-cohort study. A total of 31,641 patients with acne, atopic dermatitis, body dysmorphic disorder or psoriasis were identified. Prevalence of suicidal ideation was 0.45% (psoriasis) to 67% (body dysmorphic disorder). The prevalence of suicidal attempts ranged from 0.08% (psoriasis) to 21.9% (acne). Patients with acne or atopic dermatitis had significantly increased odds ratio for suicidal attempts. Meta-analysis could not be performed owing to the heterogeneity and sparsity of data. Suicidal risk in skin disorders amongst adolescents and children under the age of 18 years old is broad and complex. The suicidal risk remained after adjusting for depression, suggestive of an alternative mechanism.
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Wan J, Shin DB, Syed MN, Abuabara K, Lemeshow AR, Gelfand JM. Atopic dermatitis and risk of major neuropsychiatric disorders in children: A population-based cohort study. J Eur Acad Dermatol Venereol 2023; 37:114-122. [PMID: 36018560 PMCID: PMC9929490 DOI: 10.1111/jdv.18564] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 08/18/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Paediatric atopic dermatitis (AD) has been linked to neuropsychiatric comorbidities such as depression, anxiety and attention-deficit/hyperactivity disorder (ADHD). However, longitudinal data are limited, and the effect of AD severity on neuropsychiatric outcomes requires further characterization. OBJECTIVES To determine the risk of several major neuropsychiatric conditions in children with AD. METHODS We analysed UK health records data in a population-based cohort study. Each patient <18 years old with AD was matched to up to five unaffected patients on age, practice and index date. Treatments served as proxies for AD severity, which was analysed in a time-updated manner. Outcomes were incident anxiety, depression, bipolar disorder, schizophrenia, ADHD, autism, obsessive-compulsive disorder (OCD), suicidal ideation or attempt, and completed suicide. RESULTS A total of 409,431 children with AD (93.2% mild, 5.5% moderate, 1.3% severe) were compared to 1,809,029 children without AD. In Cox regression models adjusted for age, sex, socioeconomic status and other atopic comorbidities, no statistically significant relationships were observed between AD and incident anxiety (HR 1.01, 95% CI 0.99-1.03), ADHD (1.02, 0.97-1.06), autism (1.02, 0.98-1.06), bipolar disorder (1.08, 0.85-1.36), suicidal ideation/attempt (0.98, 0.95-1.01) or completed suicide (0.85, 0.64-1.14). Children with AD were less likely to develop depression (0.93, 0.91-0.95) or schizophrenia (0.72, 0.54-0.95) but more likely to develop OCD (1.26, 1.16-1.37). However, there was substantial variation by AD severity and age in both the direction and magnitude of effect for many of the neuropsychiatric conditions examined. CONCLUSIONS The was no substantial impact of AD on the overall risk of many neuropsychiatric conditions in children, but disease severity and age may be important modifying factors. Additional research is needed to further dissect the complex relationship between paediatric AD and neuropsychiatric comorbidities.
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Affiliation(s)
- Joy Wan
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Daniel B Shin
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Maha N Syed
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Katrina Abuabara
- Department of Dermatology, University of California San Francisco, San Francisco, California, USA
| | | | - Joel M Gelfand
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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6
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Ren T, Chen J, Yu Y, He H, Zhang J, Li F, Svendsen K, Obel C, Wang H, Li J. The association of asthma, atopic dermatitis, and allergic rhinitis with peripartum mental disorders. Clin Transl Allergy 2021; 11:e12082. [PMID: 34962724 PMCID: PMC8805685 DOI: 10.1002/clt2.12082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 10/24/2021] [Accepted: 11/17/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Atopic diseases are characterized by dysregulated inflammatory response, which may incur the onset of peripartum mental disorders, but the impact remains unknown. This study examined whether and to what extent the history of atopic diseases is associated with newly onset peripartum mental disorders. METHODS Using population-based registries, we identified all primiparous women who gave birth to live singletons in Denmark during 1978-2016 (n = 937,422). The exposure was hospital contact due to the three major types of atopic diseases-asthma, atopic dermatitis, and allergic rhinitis-before conception. The primary outcome was any hospital contact for mental disorder during pregnancy and 1-year postpartum, which was further classified into affective disorders, neurotic, stress-related and somatoform disorders, and substance abuse. The follow-up started from the date of conception and ended at the date of the first diagnosis of mental disorders, 1-year postpartum, death, emigration, or December 31, 2016, whichever came first. Cox regression was used, adjusted for calendar year, age at childbirth, education, residence, and Charlson comorbidity index. RESULTS A total of 24,016 (2.6%) women received diagnosis of at least one of the three atopic diseases before conception (asthma, 1.7%; atopic dermatitis, 0.6%; and allergic rhinitis, 0.8%). Exposure to asthma, atopic dermatitis, or allergic rhinitis was associated with a 37% increased overall risk of peripartum mental disorders (hazard ratio [HR], 1.37; 95% confidence interval [CI], 1.27-1.49). Higher risks were observed among women with more frequent hospital contacts for atopic disease (HR, 1.80; 95% CI, 1.37-2.35; ≥5 times), and with recent hospital contacts for atopic disease (HR, 1.74; 95% CI, 1.48-2.06; within 2 years before conception). Specific associations were observed between asthma and neurotic, stress-related and somatoform disorders (HR, 1.40; 95% CI, 1.21-1.62), and between atopic dermatitis and substance abuse (HR, 1.62; 95% CI, 1.12-2.34). CONCLUSIONS History of asthma, atopic dermatitis, and allergic rhinitis before conception was associated with increased risks of peripartum mental disorders. Women who have atopic diseases before pregnancy may benefit from systematic mental health monitoring.
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Affiliation(s)
- Tai Ren
- Ministry of Education - Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Clinical Medicine and Epidemiology, Aarhus University, Aarhus, Denmark
| | - Jiawen Chen
- Department of Dermatology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yongfu Yu
- Department of Biostatistics, Key Laboratory of Public Health Safety, School of Public Health, Fudan University, Shanghai, China
| | - Hua He
- Department of Developmental and Behavioural Paediatric & Child Primary Care, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jun Zhang
- Ministry of Education - Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fei Li
- Ministry of Education - Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Developmental and Behavioural Paediatric & Child Primary Care, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | | | - Carsten Obel
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Hui Wang
- Ministry of Education - Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiong Li
- Ministry of Education - Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Clinical Medicine and Epidemiology, Aarhus University, Aarhus, Denmark
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Marazziti D, Buccianelli B, Palermo S, Parra E, Arone A, Beatino MF, Massa L, Carpita B, Barberi FM, Mucci F, Dell’Osso L. The Microbiota/Microbiome and the Gut-Brain Axis: How Much Do They Matter in Psychiatry? Life (Basel) 2021; 11:life11080760. [PMID: 34440503 PMCID: PMC8401073 DOI: 10.3390/life11080760] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 07/19/2021] [Accepted: 07/19/2021] [Indexed: 02/07/2023] Open
Abstract
The functioning of the central nervous system (CNS) is the result of the constant integration of bidirectional messages between the brain and peripheral organs, together with their connections with the environment. Despite the anatomical separation, gut microbiota, i.e., the microorganisms colonising the gastrointestinal tract, is highly related to the CNS through the so-called "gut-brain axis". The aim of this paper was to review and comment on the current literature on the role of the intestinal microbiota and the gut-brain axis in some common neuropsychiatric conditions. The recent literature indicates that the gut microbiota may affect brain functions through endocrine and metabolic pathways, antibody production and the enteric network while supporting its possible role in the onset and maintenance of several neuropsychiatric disorders, neurodevelopment and neurodegenerative disorders. Alterations in the gut microbiota composition were observed in mood disorders and autism spectrum disorders and, apparently to a lesser extent, even in obsessive-compulsive disorder (OCD) and related conditions, as well as in schizophrenia. Therefore, gut microbiota might represent an interesting field of research for a better understanding of the pathophysiology of common neuropsychiatric disorders and possibly as a target for the development of innovative treatments that some authors have already labelled "psychobiotics".
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Affiliation(s)
- Donatella Marazziti
- Department of Clinical and Experimental Medicine Section of Psychiatry, University of Pisa, 56100 Pisa, Italy; (B.B.); (S.P.); (E.P.); (A.A.); (M.F.B.); (L.M.); (B.C.); (F.M.B.); (L.D.)
- Unicamillus—Saint Camillus International University of Medical and Health Sciences, 00131 Rome, Italy
- Correspondence:
| | - Beatrice Buccianelli
- Department of Clinical and Experimental Medicine Section of Psychiatry, University of Pisa, 56100 Pisa, Italy; (B.B.); (S.P.); (E.P.); (A.A.); (M.F.B.); (L.M.); (B.C.); (F.M.B.); (L.D.)
| | - Stefania Palermo
- Department of Clinical and Experimental Medicine Section of Psychiatry, University of Pisa, 56100 Pisa, Italy; (B.B.); (S.P.); (E.P.); (A.A.); (M.F.B.); (L.M.); (B.C.); (F.M.B.); (L.D.)
| | - Elisabetta Parra
- Department of Clinical and Experimental Medicine Section of Psychiatry, University of Pisa, 56100 Pisa, Italy; (B.B.); (S.P.); (E.P.); (A.A.); (M.F.B.); (L.M.); (B.C.); (F.M.B.); (L.D.)
| | - Alessandro Arone
- Department of Clinical and Experimental Medicine Section of Psychiatry, University of Pisa, 56100 Pisa, Italy; (B.B.); (S.P.); (E.P.); (A.A.); (M.F.B.); (L.M.); (B.C.); (F.M.B.); (L.D.)
| | - Maria Francesca Beatino
- Department of Clinical and Experimental Medicine Section of Psychiatry, University of Pisa, 56100 Pisa, Italy; (B.B.); (S.P.); (E.P.); (A.A.); (M.F.B.); (L.M.); (B.C.); (F.M.B.); (L.D.)
| | - Lucia Massa
- Department of Clinical and Experimental Medicine Section of Psychiatry, University of Pisa, 56100 Pisa, Italy; (B.B.); (S.P.); (E.P.); (A.A.); (M.F.B.); (L.M.); (B.C.); (F.M.B.); (L.D.)
| | - Barbara Carpita
- Department of Clinical and Experimental Medicine Section of Psychiatry, University of Pisa, 56100 Pisa, Italy; (B.B.); (S.P.); (E.P.); (A.A.); (M.F.B.); (L.M.); (B.C.); (F.M.B.); (L.D.)
| | - Filippo M. Barberi
- Department of Clinical and Experimental Medicine Section of Psychiatry, University of Pisa, 56100 Pisa, Italy; (B.B.); (S.P.); (E.P.); (A.A.); (M.F.B.); (L.M.); (B.C.); (F.M.B.); (L.D.)
| | - Federico Mucci
- Dipartimento di Biochimica e Biologia Molecolare, University of Siena, 53100 Siena, Italy;
| | - Liliana Dell’Osso
- Department of Clinical and Experimental Medicine Section of Psychiatry, University of Pisa, 56100 Pisa, Italy; (B.B.); (S.P.); (E.P.); (A.A.); (M.F.B.); (L.M.); (B.C.); (F.M.B.); (L.D.)
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Chaplin AB, Jones PB, Khandaker GM. Association between common early-childhood infection and subsequent depressive symptoms and psychotic experiences in adolescence: a population-based longitudinal birth cohort study. Psychol Med 2020; 52:1-11. [PMID: 33183379 PMCID: PMC9386436 DOI: 10.1017/s0033291720004080] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 09/09/2020] [Accepted: 10/14/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Childhood infections are associated with adult psychosis and depression, but studies of psychotic experiences (PEs) and depressive symptoms in childhood, adolescence, and early-adulthood are scarce. Previous studies have typically examined severe infections, but studies of common infections are also scarce. METHODS Using data from the Avon Longitudinal Study of Parents and Children (ALSPAC) birth cohort, we examined associations of the number of infections in childhood from age 1.5 to 7.5 years with depressive symptom scores at age 10, 13, 14, 17, 18, and 19 years, and with PEs at 12 and 18 years. We performed additional analysis using infection burden ('low' = 0-4 infections, 'medium' = 5-6, 'high' = 7-9, or 'very high' = 10-22 infections) as the exposure. RESULTS The risk set comprised 11 786 individuals with childhood infection data. Number of childhood infections was associated with depressive symptoms from age 10 (adjusted beta = 0.14; standard error (s.e.) = 0.04; p = <0.01) to 17 years (adjusted beta = 0.17; s.e. = 0.08; p = 0.04), and with PEs at age 12 (suspected/definite PEs: adjusted odds ratio (OR) = 1.18; 95% confidence interval (CI) = 1.09-1.27). These effect sizes were larger when the exposure was defined as very high infection burden (depressive symptoms age 17: adjusted beta = 0.79; s.e. = 0.29; p = 0.01; suspected/definite PEs at age 12: adjusted OR = 1.60; 95% CI = 1.25-2.05). Childhood infections were not associated with depressive/psychotic outcomes at age 18 or 19. CONCLUSIONS Common early-childhood infections are associated with depressive symptoms up to mid-adolescence and with PEs subsequently in childhood, but not with these outcomes in early-adulthood. These findings require replication including larger samples with outcomes in adulthood.
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Affiliation(s)
- Anna B. Chaplin
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Peter B. Jones
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Golam M. Khandaker
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
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Ouabbou S, He Y, Butler K, Tsuang M. Inflammation in Mental Disorders: Is the Microbiota the Missing Link? Neurosci Bull 2020; 36:1071-1084. [PMID: 32592144 PMCID: PMC7475155 DOI: 10.1007/s12264-020-00535-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 03/18/2020] [Indexed: 01/15/2023] Open
Abstract
Research suggests that inflammation is important in the pathophysiology of mental disorders. In addition, a growing body of evidence has led to the concept of the microbiota-gut-brain axis. To understand the potential interactions, we begin by exploring the liaison between the immune system and mental disorders, then we describe the evidence that the microbiota impact the immune response in the developing brain. Next, we review the literature that has documented microbiome alterations in major mental disorders. We end with a summary of therapeutic applications, ranging from psycho-biotics to immunomodulatory drugs that could affect the microbiota-gut-brain axis, and potential treatments to alleviate the adverse effects of antipsychotics. We conclude that there is promising evidence to support the position that the microbiota plays an important role in the immunological pathophysiology of mental disorders with an emphasis on psychotic disorders and mood disorders. However, more research is needed to elucidate the mechanisms.
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Affiliation(s)
- Sophie Ouabbou
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, and Hunan Key Laboratory of Psychiatry and Mental Health, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China
- Human Microbiome Research Program, Faculty of Medicine, University of Helsinki, 00290, Helsinki, Finland
- Cellular and Molecular Biology Research Centre, University of Costa Rica, San José, 11501, Costa Rica
| | - Ying He
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, and Hunan Key Laboratory of Psychiatry and Mental Health, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China.
- Center for Behavioral Genomics, Department of Psychiatry, Institute for Genomic Medicine, University of California San Diego, La Jolla, CA, 92093, USA.
| | - Keith Butler
- Center for Behavioral Genomics, Department of Psychiatry, Institute for Genomic Medicine, University of California San Diego, La Jolla, CA, 92093, USA
| | - Ming Tsuang
- Center for Behavioral Genomics, Department of Psychiatry, Institute for Genomic Medicine, University of California San Diego, La Jolla, CA, 92093, USA
- Harvard Institute of Psychiatric Epidemiology and Genetics, Harvard School of Public Health, Boston, MA, 02115, USA
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10
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Taylor JH, Calkins ME, Gur RE. Markers of Psychosis Risk in the General Population. Biol Psychiatry 2020; 88:337-348. [PMID: 32220500 DOI: 10.1016/j.biopsych.2020.02.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 12/17/2019] [Accepted: 02/05/2020] [Indexed: 12/17/2022]
Abstract
The categorical approach to defining schizophrenia spectrum disorders requires meeting established criteria. To advance early identification and intervention in young people, the field has progressed to studying help-seeking individuals who are at clinical high risk based on subthreshold psychosis spectrum symptoms, and criteria have been articulated for qualifying individuals as at risk. A broader dimensional examination of psychosis has been applied to population-based studies on non-help seekers. This review highlights the ascertainment and assessment approaches to such population-based studies. Most studies are cross-sectional and rely on questionnaires with limited overlap of tools. However, several consistent findings emerge on symptoms, neurocognitive deficits, and neuroimaging parameters and other biomarkers associated with emergence and persistence of psychotic features. The findings are consistent with the literature on abnormalities associated with schizophrenia, including the presence of neurocognitive deficits; abnormalities in brain structure, function, and connectivity that are related to distress; impairment; and functional outcome. These findings support the validity of studying psychosis experiences during development in a way that can chart the emergence of psychosis in the context of general psychopathology. Such studies are necessary for establishing developmental trajectories that characterize this emergence and for identifying risk and resilience biomarkers moderating or modulating the full range of schizophrenia-related manifestations. More community-based studies are needed, with better standardization and harmonization of measures and incorporating longitudinal follow-up, to establish mechanistic links between cellular-molecular aberrations and specific manifestations of psychosis as envisioned by the precision medicine agenda.
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Affiliation(s)
- Jerome H Taylor
- Lifespan Brain Institute, Penn Medicine and Children's Hospital of Philadelphia, Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, and Department of Psychiatry, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Monica E Calkins
- Lifespan Brain Institute, Penn Medicine and Children's Hospital of Philadelphia, Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, and Department of Psychiatry, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Raquel E Gur
- Lifespan Brain Institute, Penn Medicine and Children's Hospital of Philadelphia, Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, and Department of Psychiatry, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania.
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11
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McPhie ML, Bridgman AC, Kirchhof MG. A Review of Skin Disease in Schizophrenia. Dermatology 2020; 237:248-261. [PMID: 32759610 DOI: 10.1159/000508868] [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: 03/30/2020] [Accepted: 05/22/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Schizophrenia is a debilitating neuropsychiatric condition that affects 0.5% of the North American population. Skin disease in schizophrenia has not been well described. Identifying skin diseases that are commonly comorbid with schizophrenia may help clinicians address the burden of skin disease in patients with schizophrenia. SUMMARY We conducted a nonsystematic review of the literature to identify skin diseases that may be associated with schizophrenia. We searched MEDLINE, EMBASE, and PsycINFO for articles published in English from December 2000 through April 2020 using the key words "skin disease" or "dermatological" or "dermatology" and "schizophrenia." Based on our results, we further refined the search terms to include more specific skin diseases. Schizophrenia appears to be associated with a number of skin diseases, including inflammatory dermatoses, autoimmune diseases, and certain genodermatoses. Limitations include being a nonsystematic review and the relative paucity of more rigorous clinical research using longitudinal study designs.
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Affiliation(s)
- Meghan L McPhie
- School of Medicine, Queen's University, Kingston, Ontario, Canada
| | | | - Mark G Kirchhof
- Division of Dermatology, Department of Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, Ontario, Canada,
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12
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Sala R, Amet L, Blagojevic-Stokic N, Shattock P, Whiteley P. Bridging the Gap Between Physical Health and Autism Spectrum Disorder. Neuropsychiatr Dis Treat 2020; 16:1605-1618. [PMID: 32636630 PMCID: PMC7335278 DOI: 10.2147/ndt.s251394] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 05/05/2020] [Indexed: 12/12/2022] Open
Abstract
Autism spectrum disorder (ASD) is a highly complex and heterogeneous developmental disorder that affects how individuals communicate with other people and relate to the world around them. Research and clinical focus on the behavioural and cognitive manifestations of ASD, whilst important, have obscured the recognition that ASD is also commonly associated with a range of physical and mental health conditions. Many physical conditions appear with greater frequency in individuals with ASD compared to non-ASD populations. These can contribute to a worsening of social communication and behaviour, lower quality of life, higher morbidity and premature mortality. We highlight some of the key physical comorbidities affecting the immune and the gastrointestinal systems, metabolism and brain function in ASD. We discuss how healthcare professionals working with individuals with ASD and parents/carers have a duty to recognise their needs in order to improve their overall health and wellbeing, deliver equality in their healthcare experiences and reduce the likelihood of morbidity and early mortality associated with the condition.
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Affiliation(s)
- Regina Sala
- Centre for Psychiatry, Wolfson Institute, Barts & The London School of Medicine & Dentistry Queen Mary University of London, London, UK
| | | | | | - Paul Shattock
- Education & Services for People with Autism, Sunderland, UK
| | - Paul Whiteley
- Education & Services for People with Autism Research, Sunderland, UK
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13
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Holland JF, Khandaker GM, Dauvermann MR, Morris D, Zammit S, Donohoe G. Effects of early life adversity on immune function and cognitive performance: results from the ALSPAC cohort. Soc Psychiatry Psychiatr Epidemiol 2020; 55:723-733. [PMID: 31897578 DOI: 10.1007/s00127-019-01813-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 11/28/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Early life adversity (ELA) is a significant risk factor for mental health disorders. One hypothesised mechanism by which this occurs is via an effect on immune response. In this analysis of epidemiological data, we tested whether ELA was associated with cognitive performance, and if so, whether these effects were influenced by immune function. METHODS We investigated the longitudinal relationship between ELA, inflammatory markers, and cognition in data from Avon Longitudinal Study of Parents And Children (ALSPAC; n ~ 5000). ELA was defined in terms of physical/emotional abuse, harsh parenting, or domestic violence before 5 years. Social cognition was measured in terms of theory of mind, and general cognitive ability was measured using IQ. Inflammatory markers included serum C-reactive protein and interleukin-6 levels. RESULTS A significant association was observed between IQ and harsh parenting, whereby children who were physically disciplined had lower IQ scores (accounting for relevant social factors). Both immune markers were associated with variation in cognition, however, neither accounted for the effects of ELA on cognition. DISCUSSION This study highlights the impact of ELA on cognition. In the absence of evidence that these effects are explained by inflammation, other mechanisms by which the effects of ELA are mediated are discussed.
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Affiliation(s)
- Jessica F Holland
- Cognitive Genetics and Cognitive Therapy Group, The Centre for Neuroimaging, Cognition and Genomics (NICOG), School of Psychology and Discipline of Biochemistry, National University of Ireland Galway, Galway, Ireland
| | - Golam M Khandaker
- Department of Psychiatry, University of Cambridge, Cambridge Biomedical Campus, Herschel Smith Building for Brain & Mind Sciences, Cambridge, UK.,Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Maria R Dauvermann
- Cognitive Genetics and Cognitive Therapy Group, The Centre for Neuroimaging, Cognition and Genomics (NICOG), School of Psychology and Discipline of Biochemistry, National University of Ireland Galway, Galway, Ireland
| | - Derek Morris
- Cognitive Genetics and Cognitive Therapy Group, The Centre for Neuroimaging, Cognition and Genomics (NICOG), School of Psychology and Discipline of Biochemistry, National University of Ireland Galway, Galway, Ireland
| | - Stanley Zammit
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK.,National Institute for Health Research (NIHR) Biomedical Research Centre, University of Bristol, Bristol, UK
| | - Gary Donohoe
- Cognitive Genetics and Cognitive Therapy Group, The Centre for Neuroimaging, Cognition and Genomics (NICOG), School of Psychology and Discipline of Biochemistry, National University of Ireland Galway, Galway, Ireland.
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14
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Mazza MG, Lucchi S, Rossetti A, Clerici M. Neutrophil-lymphocyte ratio, monocyte-lymphocyte ratio and platelet-lymphocyte ratio in non-affective psychosis: A meta-analysis and systematic review. World J Biol Psychiatry 2020; 21:326-338. [PMID: 30806142 DOI: 10.1080/15622975.2019.1583371] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Objectives: Neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR) and monocyte/lymphocyte ratio (MLR) are inexpensive and reproducible biomarkers of inflammation. This is the first meta-analysis exploring the role of NLR, MLR and PLR in non-affective psychosis.Methods: Eight studies have been identified from the main electronic databases. Meta-analyses based on random-effects models have been carried out generating pooled standardised mean differences (SMDs) between non-affective psychotic patients and healthy controls (HCs).Results: Subjects with non-affective psychosis had a significant higher NLR and MLR as compared with HC (respectively SMD = 0.715; P < 0.001; I2=57.565% and SMD = 0.417; P = 0.001; I2=65.754%), confirmed by heterogeneity-based sensitivity analysis. Subgroup analyses showed no differences in effect size across different study characteristics, including drug treatment status, diagnosis, and setting. Meta-regression showed that age influenced the relationship between non-affective psychosis and MLR. A trend of significance, not confirmed by heterogeneity-based sensitivity analysis, was observed in PLR with patients showing higher PLR than HC.Conclusions: Our meta-analysis supports the hypothesis that an inflammatory activation occurs in non-affective psychosis and inflammatory ratios, especially NLR and MLR, may be useful to detect this activation.
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Affiliation(s)
- Mario Gennaro Mazza
- Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
| | - Sara Lucchi
- Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
| | - Aurora Rossetti
- Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
| | - Massimo Clerici
- Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
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15
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Oh H, Smith L, Koyanagi A. Health Conditions and Psychotic Experiences: Cross-Sectional Findings From the American Life Panel. Front Psychiatry 2020; 11:612084. [PMID: 33519553 PMCID: PMC7839662 DOI: 10.3389/fpsyt.2020.612084] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 12/14/2020] [Indexed: 11/13/2022] Open
Abstract
Background: People with psychotic disorders have poor health, but studies have shown that people who have a milder and more prevalent form of psychosis (psychotic experiences) are also at risk for health problems. More research is needed to examine a broad range of health conditions to discover new relations with psychotic experiences. Methods: We analyzed cross-sectional data from the American Life Panel, a nationally representative sample of the United States adult population. Using multivariable logistic regression, we examined the associations between health conditions (categories of conditions, specific conditions, count of conditions) and lifetime psychotic experiences. Results: Approximately 71% of the weighted sample reported at least one health condition, and around 18% reported a lifetime psychotic experience. Using multivariable logistic regression, we found that several health conditions were associated with psychotic experiences, including pain due to other causes, neck pain, other injury, any gastrointestinal/kidney problem, liver diseases/cirrhosis, any nervous/sensory problem, migraine, nerve problem causing numbness/pain, any other disorder, specifically sleep disorder, chronic fatigue syndrome, and chronic pain. Further, the count of specific health conditions and the count of categories were associated with greater odds of psychotic experiences. Conclusion: We found that numerous health conditions were associated with psychotic experiences.
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Affiliation(s)
- Hans Oh
- Suzanne Dworak Peck School of Social Work, University of Southern California, Los Angeles, CA, United States
| | - Lee Smith
- The Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, United Kingdom
| | - Ai Koyanagi
- Research and Development Unit, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Parc Sanitari Sant Joan de Déu, Barcelona, Spain.,Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain
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16
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Benros ME, Mortensen PB. Role of Infection, Autoimmunity, Atopic Disorders, and the Immune System in Schizophrenia: Evidence from Epidemiological and Genetic Studies. Curr Top Behav Neurosci 2020; 44:141-159. [PMID: 30895532 DOI: 10.1007/7854_2019_93] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
An immunologic component to schizophrenia has been increasingly recognized, where infections and chronic inflammatory diseases as atopic disorders and autoimmune diseases could be involved in the pathogenesis of schizophrenia. Psychotic symptoms can be directly triggered by infections reaching the CNS, or be secondary to systemic inflammation indirectly affecting the brain through immune components, such as brain-reactive antibodies and cytokines. Large-scale epidemiological studies have consistently displayed that infections, autoimmune diseases, and atopic disorders are associated with increased risk of schizophrenia and that schizophrenia is associated with increased levels of immune markers at diagnosis. However, since there is also an increased risk of immune-related diseases after the diagnosis with schizophrenia and in family members of individuals with schizophrenia, parts of the association could also be due to heritable factors. Shared genetic factor might account for some of this increased prevalence of immune-related diseases among individuals with schizophrenia, and indeed the most pronounced genetic association with schizophrenia lies within the HLA region, which is one of the most important regions for the immune system. However, genetic studies have shown that the common genetic variants associated with schizophrenia do not seem to increase the susceptibility for acquiring infections. Nonetheless, shared genes with the susceptibility for acquiring infections not captured by the polygenic risk score for schizophrenia could still influence the association.
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Affiliation(s)
- Michael E Benros
- Mental Health Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark.
- National Centre for Register Based Research, Aarhus University, Aarhus, Denmark.
| | - Preben B Mortensen
- National Centre for Register Based Research, Aarhus University, Aarhus, Denmark
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17
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Xie QW, Dai X, Tang X, Chan CHY, Chan CLW. Risk of Mental Disorders in Children and Adolescents With Atopic Dermatitis: A Systematic Review and Meta-Analysis. Front Psychol 2019; 10:1773. [PMID: 31447731 PMCID: PMC6691144 DOI: 10.3389/fpsyg.2019.01773] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 07/16/2019] [Indexed: 12/30/2022] Open
Abstract
Assessing the psychological effects on children and adolescents of suffering atopic dermatitis (AD) is essential, when planning successful management. This study aimed to systematically review the literature regarding risk of mental disorders in children and adolescents with, or without, AD; and to explore confounders. We identified potentially relevant studies from EMBASE, MEDLINE, PsycINFO, ERIC, the British Nursing Index, the Family and Society Studies Worldwide, the Social Work Abstracts, and the Sociological Abstracts from inception to Sep 30, 2018. Investigators independently screened titles and abstracts, and then full-texts. Investigators independently extracted data from included studies. Meta-analyses using random-effects models were performed, reporting odds ratios (ORs; 95% CIs). Thirty-seven studies (n = 2,068,911 children/ adolescents) were included. Meta-analysis of 35 studies found that children and adolescents with AD had significantly higher risk of total mental disorders than those without AD (OR = 1.652; 95% CI, 1.463-1.864). There was no significant difference in risks for ADHD (OR = 1.563; 95% CI, 1.382-1.769); sleep disorders (OR = 2.100; 95% CI, 1.322-3.336); anxiety (OR = 1.339; 95% CI, 1.062-1.687); depression (OR = 1.402 95% CI, 1.256-1.565); conduct disorder (OR = 1.494 95% CI, 1.230-1.815); or ASD (OR = 2.574; 95% CI, 1.469-4.510; Q b = 8.344, p = 0.138). Race/ethnicity of child, target of comparison, type of studies, representativeness of the sample, measures of AD and mental disorders were significant moderators for total mental disorders. Integrated, holistic, multidisciplinary management of pediatric AD is significantly important, which emphasizes the well-being of the whole person.
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Affiliation(s)
- Qian-Wen Xie
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong
| | - Xiaolu Dai
- Department of Social Work and Social Administration, Changsha Social Work College, Changsha, China
| | - Xinfeng Tang
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong
| | - Celia H. Y. Chan
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong
| | - Cecilia L. W. Chan
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong
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18
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Begemann MJ, Linszen MM, de Boer JN, Hovenga WD, Gangadin SS, Schutte MJ, Sommer IE. Atopy Increases Risk of Psychotic Experiences: A Large Population-Based Study. Front Psychiatry 2019; 10:453. [PMID: 31354535 PMCID: PMC6637312 DOI: 10.3389/fpsyt.2019.00453] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 06/07/2019] [Indexed: 01/10/2023] Open
Abstract
Introduction: Building upon the comorbidity between atopy and schizophrenia, we conducted a large cross-sectional, observational population-based study to examine if such associations also exist between atopic disorders (eczema, allergic rhinitis, and asthma) and nonclinical psychotic experiences. Methods: We examined psychotic experiences in a Dutch population sample through an online survey (≥14 years of age). Participants filled out the Questionnaire for Psychotic Experiences, together with questions screening for atopic disorders (eczema, allergic rhinitis, and asthma). Prevalence rates were calculated; binary logistic regression was used to determine odds ratios (ORs) (age, gender, and years of education as covariates). Results: We included 6,479 participants. Individuals diagnosed with one or more atopic disorders had an increased risk of psychotic experiences as compared with controls (OR = 1.26). Analysis of individual symptoms revealed an OR of 1.27 for hallucinations, whereas delusions only showed a trend. With each additional atopic disorder, the risk of psychotic experiences increased. This was also observed for hallucinations alone but not for delusions alone. Atopy was associated with hallucinations across all modalities (OR ranging from 1.19 to 1.40). These results did not appear to be driven specifically by any one of the atopic disorders. Conclusion: In the largest population sample of adolescents and adults to date, we found that atopic disorders (asthma, eczema, and allergic rhinitis) increase the risk of psychotic experiences, in a dose-response fashion. These results provide further support for the role of immunological components in the predisposition for psychosis and can serve as a base for further research.
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Affiliation(s)
- Marieke J.H. Begemann
- Cognitive Neurosciences, Department of Biomedical Sciences of Cells & Systems, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Department of Psychiatry, University Medical Center Utrecht, Utrecht, Netherlands
| | - Mascha M.J. Linszen
- Cognitive Neurosciences, Department of Biomedical Sciences of Cells & Systems, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Department of Psychiatry, University Medical Center Utrecht, Utrecht, Netherlands
| | - Janna N. de Boer
- Department of Psychiatry, University Medical Center Utrecht, Utrecht, Netherlands
| | - Wytske D. Hovenga
- Department of Psychiatry, University Medical Center Utrecht, Utrecht, Netherlands
| | - Shiral S. Gangadin
- Cognitive Neurosciences, Department of Biomedical Sciences of Cells & Systems, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Department of Psychiatry, University Medical Center Utrecht, Utrecht, Netherlands
| | - Maya J.L. Schutte
- Cognitive Neurosciences, Department of Biomedical Sciences of Cells & Systems, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Department of Psychiatry, University Medical Center Utrecht, Utrecht, Netherlands
| | - Iris E.C. Sommer
- Cognitive Neurosciences, Department of Biomedical Sciences of Cells & Systems, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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Trovão N, Prata J, VonDoellinger O, Santos S, Barbosa M, Coelho R. Peripheral Biomarkers for First-Episode Psychosis-Opportunities from the Neuroinflammatory Hypothesis of Schizophrenia. Psychiatry Investig 2019; 16:177-184. [PMID: 30836740 PMCID: PMC6444098 DOI: 10.30773/pi.2018.12.19.1] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 12/19/2018] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE Schizophrenia is a disabling disorder of unknown aetiology, lacking definite diagnostic method and cure. A reliable biological marker of schizophrenia is highly demanded, for which traceable immune mediators in blood could be promising candidates. We aimed to gather the best findings of neuroinflammatory markers for first-episode psychosis (FEP). METHODS We performed an extensive narrative review of online literature on inflammation-related markers found in human FEP patients only. RESULTS Changes to cytokine levels have been increasingly reported in schizophrenia. The peripheral levels of IL-1 (or its receptor antagonist), soluble IL-2 receptor, IL-4, IL-6, IL-8, and TNF-α have been frequently reported as increased in FEP, in a suggestive continuum from high-risk stages for psychosis. Microglia and astrocytes establish the link between this immune signalling and the synthesis of noxious tryptophan catabolism products, that cause structural damage and directly hamper normal neurotransmission. Amongst these, only 3-hydroxykynurenine has been consistently described in the blood of FEP patients. CONCLUSION Peripheral molecules stemming from brain inflammation might provide insightful biomarkers of schizophrenia, as early as FEP or even prodromal phases, although more time- and clinically-adjusted studies are essential for their validation.
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Affiliation(s)
- Nuno Trovão
- Department of Psychiatry, Vila Nova de Gaia/ Espinho Hospital Center, Vila Nova de Gaia, Portugal.,Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal.,Department of Psychiatry, Faculty of Medicine of University of Porto, Porto, Portugal
| | - Joana Prata
- Department of Psychiatry, Vila Nova de Gaia/ Espinho Hospital Center, Vila Nova de Gaia, Portugal.,Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal.,Department of Psychiatry, Faculty of Medicine of University of Porto, Porto, Portugal
| | - Orlando VonDoellinger
- Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal.,Department of Psychiatry, Tâmega e Sousa Hospital Center, Penafiel, Portugal
| | - Susana Santos
- Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal.,Instituto de Engenharia Biomédica, University of Porto, Porto, Portugal
| | - Mário Barbosa
- Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal.,Instituto de Engenharia Biomédica, University of Porto, Porto, Portugal.,Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto, Portugal
| | - Rui Coelho
- Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal.,Department of Psychiatry, Faculty of Medicine of University of Porto, Porto, Portugal
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20
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Microglial Activation and Psychotic Disorders: Evidence from Pre-clinical and Clinical Studies. Curr Top Behav Neurosci 2019; 44:161-205. [PMID: 30828767 DOI: 10.1007/7854_2018_81] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Clinical and pre-clinical studies have demonstrated an important role of neuroinflammation in the etiology of schizophrenia. While the underlying mechanisms remain poorly understood, there are some studies demonstrating an association between maternal immune activation and behavioral changes in adult offspring and identifying early life infection as a trigger for schizophrenia; in addition, inflammatory markers were found to be increased in the schizophrenic post-mortem brain. During maternal immune activation, pro-inflammatory mediators such as cytokines, chemokines, antibodies, and acute-phase proteins are released in the maternal bloodstream, thus increasing the permeability of the placental barrier and the fetal blood-brain barrier, allowing the inflammatory mediators to enter the fetal brain. In the central nervous system (CNS), these pro-inflammatory mediators are able to activate microglial cells that can release pro-inflammatory cytokines such as tumor necrosis factor alpha (TNF-α), interleukin (IL)-1β, and IL-6. As a consequence, circulating immune cells may infiltrate the brain, increasing cytokine levels and releasing antibodies that aggravate the neuroinflammation. Neuroinflammation may affect processes that are pivotal for normal brain maturation such as myelination, synaptic pruning, and neuronal remodeling. Microglial cell activation and pro-inflammatory mediators have been extensively studied in schizophrenic post-mortem brain samples. Some results of these investigations demonstrated an increase in microglial activation markers, cytokines, and chemokines in post-mortem brain samples from individuals with schizophrenia. In contrast, there are studies that have demonstrated low levels of microglial activation makers in the schizophrenic post-mortem brain. Thus, based on the important role of neuroinflammation as a trigger in the development of schizophrenia, this chapter aims (1) to enumerate evidence of neuroinflammation and microglial activation from pre-clinical schizophrenia models, (2) to show links between schizophrenia and neuroinflammation in clinical studies, and (3) to identify mechanisms by which microglial activation may influence in the development of schizophrenia.
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21
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Agnafors S, Norman Kjellström A, Torgerson J, Rusner M. Somatic comorbidity in children and adolescents with psychiatric disorders. Eur Child Adolesc Psychiatry 2019; 28:1517-1525. [PMID: 30895480 PMCID: PMC6800882 DOI: 10.1007/s00787-019-01313-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 03/09/2019] [Indexed: 12/11/2022]
Abstract
In the adult population, psychiatric disorders are associated with somatic illness. Explanatory life style factors have been found, but also a failure to recognize somatic illness in this group. Another factor is side effects from long-term use of antipsychotic drugs. Given the psychiatric-somatic comorbidity in the adult population, it is of interest to investigate whether an association exists already during childhood. The aim of the present study was to investigate the frequency of somatic illness in children and adolescents with a psychiatric diagnose. Data were obtained from the regional health care database Vega, Sweden. Psychiatric and somatic diagnoses obtained during 2011-2013 for individuals aged 3-18 years were extracted. Descriptive statistics were used to examine difference in somatic morbidity between children with and without psychiatric diagnoses. Logistic regression was used in age-stratified models to test the association between psychiatric and somatic diagnoses. Anxiety and behavioral disorders were associated with all somatic conditions investigated at nearly all ages. The same applied to substance use, investigated at age 9-18 years. Affective disorders were associated with all somatic conditions at age 12-18 years. Psychotic conditions were associated with asthma, bowel disorders and myalgia in adolescents. Children with psychiatric disorders are at remarkably high risk for concurrent somatic illness. The associations span across many types of conditions and across all ages. The results support the need for awareness of somatic morbidity in child and adolescent psychiatric clinical settings, and the need for coordinated health care for children with comorbid states.
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Affiliation(s)
- Sara Agnafors
- Division of Children's and Women's Health, Department of Clinical and Experimental Medicine, Linköping University, 581 83, Linköping, Sweden. .,Department of Research, Södra Älvsborgs Hospital, Borås, Sweden.
| | - Anna Norman Kjellström
- Department of Data Management and Analysis, Head Office, Region Västra Götaland, Skövde, Sweden
| | - Jarl Torgerson
- Department of Psychosis, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Marie Rusner
- Department of Research, Södra Älvsborgs Hospital, Borås, Sweden ,Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
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Scott KM, Saha S, Lim CC, Aguilar-Gaxiola S, Al-Hamzawi A, Alonso J, Benjet C, Bromet EJ, Bruffaerts R, Caldas-de-Almeida JM, de Girolamo G, de Jonge P, Degenhardt L, Florescu S, Gureje O, Haro JM, Hu C, Karam EG, Kovess-Masfety V, Lee S, Lepine JP, Mneimneh Z, Navarro-Mateu F, Piazza M, Posada-Villa J, Sampson NA, Stagnaro JC, Kessler RC, McGrath JJ. Psychotic experiences and general medical conditions: a cross-national analysis based on 28 002 respondents from 16 countries in the WHO World Mental Health Surveys. Psychol Med 2018; 48:2730-2739. [PMID: 29478433 PMCID: PMC6109618 DOI: 10.1017/s0033291718000363] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Previous work has identified associations between psychotic experiences (PEs) and general medical conditions (GMCs), but their temporal direction remains unclear as does the extent to which they are independent of comorbid mental disorders. METHODS In total, 28 002 adults in 16 countries from the WHO World Mental Health (WMH) Surveys were assessed for PEs, GMCs and 21 Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) mental disorders. Discrete-time survival analyses were used to estimate the associations between PEs and GMCs with various adjustments. RESULTS After adjustment for comorbid mental disorders, temporally prior PEs were significantly associated with subsequent onset of 8/12 GMCs (arthritis, back or neck pain, frequent or severe headache, other chronic pain, heart disease, high blood pressure, diabetes and peptic ulcer) with odds ratios (ORs) ranging from 1.3 [95% confidence interval (CI) 1.1-1.5] to 1.9 (95% CI 1.4-2.4). In contrast, only three GMCs (frequent or severe headache, other chronic pain and asthma) were significantly associated with subsequent onset of PEs after adjustment for comorbid GMCs and mental disorders, with ORs ranging from 1.5 (95% CI 1.2-1.9) to 1.7 (95% CI 1.2-2.4). CONCLUSIONS PEs were associated with the subsequent onset of a wide range of GMCs, independent of comorbid mental disorders. There were also associations between some medical conditions (particularly those involving chronic pain) and subsequent PEs. Although these findings will need to be confirmed in prospective studies, clinicians should be aware that psychotic symptoms may be risk markers for a wide range of adverse health outcomes. Whether PEs are causal risk factors will require further research.
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Affiliation(s)
- Kate M. Scott
- Department of Psychological Medicine, University of Otago, Dunedin, New Zealand
| | - Sukanta Saha
- Queensland Centre for Mental Health Research and Queensland Brain Institute, The University of Queensland, St. Lucia, Queensland, Australia
| | - Carmen C.W. Lim
- Queensland Centre for Mental Health Research and Queensland Brain Institute, The University of Queensland, St. Lucia, Queensland, Australia
| | - Sergio Aguilar-Gaxiola
- Center for Reducing Health Disparities, UC Davis Health System, Sacramento, California, USA
| | - Ali Al-Hamzawi
- College of Medicine, Al-Qadisiya University, Diwaniya governorate, Iraq
| | - Jordi Alonso
- Health Services Research Unit, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain; Pompeu Fabra University (UPF), Barcelona, Spain; and CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Corina Benjet
- Department of Epidemiologic and Psychosocial Research, National Institute of Psychiatry Ramón de la Fuente, Mexico City, Mexico
| | - Evelyn J. Bromet
- Department of Psychiatry, Stony Brook University School of Medicine, Stony Brook, New York, USA
| | - Ronny Bruffaerts
- Universitair Psychiatrisch Centrum - Katholieke Universiteit Leuven (UPC-KUL), Campus Gasthuisberg, Leuven, Belgium
| | - José Miguel Caldas-de-Almeida
- Lisbon Institute of Global Mental Health and Chronic Diseases Research Center (CEDOC), NOVA Medical School | Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Giovanni de Girolamo
- Unit of Epidemiological and Evaluation Psychiatry, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS)-St. John of God Clinical Research Centre, Via Pilastroni 4, Brescia, Italy
| | - Peter de Jonge
- Developmental Psychology, Department of Psychology, Rijksuniversiteit Groningen, Groningen, NL; Interdisciplinary Center Psychopathology and Emotion Regulation, Department of Psychiatry, University Medical Center Groningen, Groningen, NL
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Silvia Florescu
- National School of Public Health, Management and Development, Bucharest, Romania
| | - Oye Gureje
- Department of Psychiatry, University College Hospital, Ibadan, Nigeria
| | - Josep M. Haro
- Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Sant Boi de Llobregat, Barcelona, Spain
| | - Chiyi Hu
- Shenzhen Institute of Mental Health & Shenzhen Kangning Hospital, Shenzhen, China
| | - Elie G. Karam
- Department of Psychiatry and Clinical Psychology, Faculty of Medicine, Balamand University, Beirut, Lebanon; Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Beirut, Lebanon; Institute for Development Research Advocacy and Applied Care (IDRAAC), Beirut, Lebanon
| | - Viviane Kovess-Masfety
- Ecole des Hautes Etudes en Santé Publique (EHESP), EA 4057, Paris Descartes University, Paris, France
| | - Sing Lee
- Department of Psychiatry, Chinese University of Hong Kong, Tai Po, Hong Kong
| | - Jean-Pierre Lepine
- Hôpital Lariboisière- Fernand Widal, Assistance Publique Hôpitaux de Paris; Universités Paris Descartes-Paris Diderot; INSERM UMR-S 1144, Paris, France
| | - Zeina Mneimneh
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Fernando Navarro-Mateu
- UDIF-SM, Subdirección General de Planificación, Innovación y Cronicidad, Servicio Murciano de Salud. IMIB-Arrixaca. CIBERESP-Murcia, Murcia, Spain
| | - Marina Piazza
- Universidad Cayetano Heredia, Lima, Peru; National Institute of Health, Lima, Peru
| | - José Posada-Villa
- Colegio Mayor de Cundinamarca University, Faculty of Social Sciences, Bogota, Colombia
| | - Nancy A. Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Juan Carlos Stagnaro
- Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, Universidad de Buenos Aires, Argentina
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - John J. McGrath
- Queensland Centre for Mental Health Research, and Queensland Brain Institute, University of Queensland, St. Lucia, Queensland, Australia; and National Centre for Register-based Research, Aarhus BSS, Aarhus University, Aarhus, Denmark
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Paller A, Jaworski JC, Simpson EL, Boguniewicz M, Russell JJ, Block JK, Tofte S, Dunn JD, Feldman SR, Clark AR, Schwartz G, Eichenfield LF. Major Comorbidities of Atopic Dermatitis: Beyond Allergic Disorders. Am J Clin Dermatol 2018; 19:821-838. [PMID: 30168085 DOI: 10.1007/s40257-018-0383-4] [Citation(s) in RCA: 149] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The consequences of atopic dermatitis reach beyond the skin and past childhood. Patients with atopic dermatitis are at risk of developing allergic comorbidities, but less is known about the associations between atopic dermatitis and non-allergic conditions. Understanding these non-allergic comorbidities has the potential to improve patient outcomes and to help mitigate the cost and burdens associated with these conditions. Atopic dermatitis is associated with cutaneous bacterial infections, more severe forms/courses of cutaneous viral infections, and extra-cutaneous infections. Atopic dermatitis is also associated with several mental health comorbidities particularly attention-deficit hyperactivity disorder, anxiety, and depression. Data are largely inconsistent for specific cancers, but atopic dermatitis appears to protect against malignancy overall; severe long-term atopic dermatitis is associated with adult lymphomas. Atopic dermatitis may also be associated with obesity, cardiovascular disease, and autoimmune disease, particularly alopecia areata and gastrointestinal immune-mediated disorders. Although the causative mechanisms underlying these associations are poorly understood, treating physicians should be aware of associations in seeking to alleviate the burden for patients with atopic dermatitis.
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24
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Khandaker GM, Stochl J, Zammit S, Goodyer I, Lewis G, Jones PB. Childhood inflammatory markers and intelligence as predictors of subsequent persistent depressive symptoms: a longitudinal cohort study. Psychol Med 2018; 48:1514-1522. [PMID: 29140226 PMCID: PMC6088526 DOI: 10.1017/s0033291717003038] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 07/04/2017] [Accepted: 07/05/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND To identify developmental sub-groups of depressive symptoms during the second decade of life, a critical period of brain development, using data from a prospective birth cohort. To test whether childhood intelligence and inflammatory markers are associated with subsequent persistent depressive symptoms. METHODS IQ, a proxy for neurodevelopment, was measured at age 8 years. Interleukin 6 (IL-6) and C-reactive protein, typical inflammatory markers, were measured at age 9 years. Depressive symptoms were measured six times between 10 and 19 years using the short mood and feelings questionnaire (SMFQ), which were coded as binary variable and then used in latent class analysis to identify developmental sub-groups of depressive symptoms. RESULTS Longitudinal SMFQ data from 9156 participants yielded three distinct population sub-groups of depressive symptoms: no symptoms (81.2%); adolescent-onset symptoms (13.2%); persistent symptoms (5.6%). Lower IQ and higher IL-6 levels in childhood were independently associated with subsequent persistent depressive symptoms in a linear, dose-response fashion, but not with adolescent-onset symptoms. Compared with the group with no symptoms the adjusted odds ratio for persistent depressive symptoms per s.d. increase in IQ was 0.80 (95% CI, 0.68-0.95); that for IL-6 was 1.20 (95% CI, 1.03-1.39). Evidence for an association with IL-6 remained after controlling for initial severity of depressive symptoms at 10 years. There was no evidence that IL-6 moderated or mediated the IQ-persistent depressive symptom relationship. CONCLUSIONS The results indicate potentially important roles for two distinct biological processes, neurodevelopment and inflammation, in the aetiology of persistent depressive symptoms in young people.
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Affiliation(s)
- G. M. Khandaker
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - J. Stochl
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Department of Kinanthropology, Charles University, Prague, Czech Republic
| | - S. Zammit
- Centre for Mental Health, Addiction and Suicide Research, School of Social and Community Medicine, University of Bristol, Bristol, UK
- Institute of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - I. Goodyer
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - G. Lewis
- Division of Psychiatry, University College London, London, UK
| | - P. B. Jones
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
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25
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Shores DR, Everett AD. Children as Biomarker Orphans: Progress in the Field of Pediatric Biomarkers. J Pediatr 2018; 193:14-20.e31. [PMID: 29031860 PMCID: PMC5794519 DOI: 10.1016/j.jpeds.2017.08.077] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 08/04/2017] [Accepted: 08/30/2017] [Indexed: 12/20/2022]
Affiliation(s)
- Darla R Shores
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD.
| | - Allen D Everett
- Division of Cardiology, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD
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26
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Li Q, Zhou J, Cao X, Liu Q, Li Q, Li W, Wang X. Clonal Characteristics of T-Cell Receptor Repertoires in Violent and Non-violent Patients With Schizophrenia. Front Psychiatry 2018; 9:403. [PMID: 30233426 PMCID: PMC6127418 DOI: 10.3389/fpsyt.2018.00403] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 08/09/2018] [Indexed: 01/28/2023] Open
Abstract
Background: Activated or impaired T-cell function in inflammatory and degenerative process can contribute to the risk and progression of schizophrenia. This study used immune repertoire sequencing to investigate the T-cell receptor beta variable chain (TRBV) presence in blood mononuclear cells in the violent or non-violent schizophrenic patients. Methods: Ten violent and 10 non-violent schizophrenic patients and 8 matched healthy controls were enrolled. The Brief Psychiatric Rating Scale (BPRS) was used to evaluate patients' psychiatric symptoms. The level of aggression was assessed using the Modified Overt Aggression Scale (MOAS). The complementarity-determining region 3 (CDR3) of TRBV was detected using multiplex-PCR and high-throughput sequencing. Results: The TCR repertoire diversity were no significant differences in the Shannon-Wiener or inverse Simpson diversity index between three groups. Principal component analysis (PCA) of TRBV composition and abundance showed that principal component 1 and principal component 2 can explain 28.88 and 13.24% of total variation, respectively. Schizophrenic patients (violent and non-violent) had significantly different V gene distribution compared to healthy controls. In particular, TRBV2 occurred at a significantly higher frequency in the violent schizophrenia group than in the non-violent schizophrenia and healthy control groups, and TRBV7-2 occurred at a significantly higher frequency in the non-violent schizophrenia group than in the violent schizophrenia and healthy control groups. Conclusions: The results suggest that violent and non-violent schizophrenic patients carry abnormal T-cell receptor repertoires, and these data provide a useful clue to explore the etiology of violent behavior in schizophrenia.
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Affiliation(s)
- Qiguang Li
- Department of Psychiatry and Mental Health Institute of the Second Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center on Mental Disorders and National Technology Institute on Mental Disorders, Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, China
| | - Jiansong Zhou
- Department of Psychiatry and Mental Health Institute of the Second Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center on Mental Disorders and National Technology Institute on Mental Disorders, Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, China
| | - Xia Cao
- Department of Health Management Center, Third Xiangya Hospital, Central South University, Changsha, China
| | - Qiang Liu
- Department of Surgery, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
| | - Qi Li
- Department of Psychiatry, State Key Laboratory for Cognitive and Brain Sciences, HKU-SIRI, University of Hong Kong, Hong Kong, China
| | - Wen Li
- Department of Psychiatry and Mental Health Institute of the Second Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center on Mental Disorders and National Technology Institute on Mental Disorders, Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, China
| | - Xiaoping Wang
- Department of Psychiatry and Mental Health Institute of the Second Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center on Mental Disorders and National Technology Institute on Mental Disorders, Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, China
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27
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Orsolini L, Sarchione F, Vellante F, Fornaro M, Matarazzo I, Martinotti G, Valchera A, Di Nicola M, Carano A, Di Giannantonio M, Perna G, Olivieri L, De Berardis D. Protein-C Reactive as Biomarker Predictor of Schizophrenia Phases of Illness? A Systematic Review. Curr Neuropharmacol 2018; 16:583-606. [PMID: 29357805 PMCID: PMC5997872 DOI: 10.2174/1570159x16666180119144538] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Revised: 11/07/2017] [Accepted: 11/21/2017] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Schizophrenia is a complex illness in which genetic, environmental, and epigenetic components have been implicated. However, recently, psychiatric disorders appear to be related to a chronic inflammatory state, at the level of specific cerebral areas which have been found as well impaired and responsible for schizophrenia symptomatology. Hence, a role of inflammatory mediators and cytokines has been as well defined. Accordingly, the role of an acute inflammatory phase protein, the C-reactive protein (CRP) has been recently investigated. OBJECTIVE The objective of the present study is to evaluate how PCR may represent a biomarker in schizophrenia, i.e. correlated with illness phases and/or clinical manifestation and/or psychopathological severity. METHODS A systematic review was here carried out by searching the following keywords ((C-reactive protein AND ((schizophrenia) OR (psychotic disorder))) for the topics 'PCR' and 'Schizophrenia', by using MESH terms. RESULTS An immune dysfunction and inflammation have been described amongst schizophrenic patients. Findings reported elevated CRP levels in schizophrenia, mainly correlated with the severity of illness and during the recrudescent phase. CRP levels are higher when catatonic features, negative symptomatology and aggressiveness are associated. CRP levels appeared not to be related to suicidal behaviour and ideation. CONCLUSION CRP and its blood levels have been reported higher amongst schizophrenic patients, by suggesting a role of inflammation in the pathogenesis of schizophrenia. Further studies are needed to better understand if CRP may be considered a biomarker in schizophrenia.
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Affiliation(s)
- Laura Orsolini
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, College Lane Campus, Hatfield, HertsAL10 9AB, UK
- Polyedra Research, Teramo, Italy
| | - Fabiola Sarchione
- Department of Neurosciences and Imaging, Chair of Psychiatry, University “G. D’Annunzio”, Chieti, Italy
| | - Federica Vellante
- Department of Neurosciences and Imaging, Chair of Psychiatry, University “G. D’Annunzio”, Chieti, Italy
| | - Michele Fornaro
- Department of Neuroscience, Reproductive Science and Odontostomatology, School of Medicine ‘Federico II’ Naples, Naples, Italy
| | - Ilaria Matarazzo
- Department of Neurosciences and Imaging, Chair of Psychiatry, University “G. D’Annunzio”, Chieti, Italy
| | - Giovanni Martinotti
- Department of Neurosciences and Imaging, Chair of Psychiatry, University “G. D’Annunzio”, Chieti, Italy
| | - Alessandro Valchera
- Polyedra Research, Teramo, Italy
- Villa S. Giuseppe Hospital, Hermanas Hospitalarias, Ascoli Piceno, Italy
| | - Marco Di Nicola
- Institute of Psychiatry and Psychology, Fondazione Policlinico Universitario “A. Gemelli”, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alessandro Carano
- NHS, Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, Hospital “Madonna Del Soccorso”, San Benedetto del Tronto, Ascoli Piceno, Italy
| | - Massimo Di Giannantonio
- Department of Neurosciences and Imaging, Chair of Psychiatry, University “G. D’Annunzio”, Chieti, Italy
| | - Giampaolo Perna
- Hermanas Hospitalarias, FoRiPsi, Department of Clinical Neurosciences, Villa San Benedetto Menni, Albese con Cassano, Como, Italy
- Department of Psychiatry and Behavioral Sciences, Leonard Miller School of Medicine, University of Miami, Florida, USA
| | - Luigi Olivieri
- NHS, Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, Hospital “G. Mazzini”, ASL 4 Teramo, Italy
| | - Domenico De Berardis
- NHS, Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, Hospital “G. Mazzini”, ASL 4 Teramo, Italy
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28
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Khandaker GM, Dantzer R, Jones PB. Immunopsychiatry: important facts. Psychol Med 2017; 47:2229-2237. [PMID: 28418288 PMCID: PMC5817424 DOI: 10.1017/s0033291717000745] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 02/28/2017] [Accepted: 03/01/2017] [Indexed: 12/11/2022]
Abstract
Accumulating evidence indicate a role for the immune system particularly inflammation and autoimmunity in the aetiology of major psychiatric disorders such as depression and schizophrenia. In this paper, we discuss some of the key advances in immunopsychiatry in order to highlight to psychiatrists and other health professionals how an increased understanding of this field might enhance our knowledge of illness mechanism and approaches to treatment. We present a brief overview of clinical research that link inflammation and autoimmunity with depression and psychosis, including potential role of inflammation in treatment response, current evidence for the effectiveness of immune-modulating treatment for depression and psychosis, and possible role of inflammation in common physical comorbidities for these disorders such as coronary heart disease and diabetes mellitus. Gaining a better understanding of the role of immune system could be paradigm changing for psychiatry. We need collaborations between clinicians and scientists to deliver high-quality translational research in order to fully realise the clinical potential of this exciting and rapidly expanding field.
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Affiliation(s)
- G. M. Khandaker
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - R. Dantzer
- Department of Symptom Research, University of Texas MD Anderson Cancer Centre, Houston, TX, USA
| | - P. B. Jones
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
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29
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Laugesen K, Byrjalsen A, Frøslev T, Olsen MS, Sørensen HT. Use of glucocorticoids during pregnancy and risk of attention-deficit/hyperactivity disorder in offspring: a nationwide Danish cohort study. BMJ Open 2017; 7:e016825. [PMID: 28947451 PMCID: PMC5623520 DOI: 10.1136/bmjopen-2017-016825] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE Prenatal exposure to excess endogenous glucocorticoid (GC) has been linked to attention-deficit/hyperactivity disorder (ADHD). We investigated whether prenatal exposure to exogenous GC is associated with ADHD. DESIGN Nationwide cohort study. SETTING A cohort of 875 996 singletons born alive between 1996 and 2009 in Denmark. Data were obtained from national registries. EXPOSURES We identified children exposed prenatally to GCs, children unexposed prenatally and born to maternal former users, and children unexposed and born to maternal never users. MAIN OUTCOME MEASURES We compared ADHD risk in children prenatally exposed to GCs and in children of former GC users with risk in unexposed children of never users. We computed cumulative incidence at 10 years of age and adjusted HRs (aHRs). In addition, we compared exposed children with unexposed siblings in a sibling design. RESULTS We identified 875 996 children, among whom 5319 were prenatally exposed to systemic GCs and 36 780 to local/inhaled GCs. Cumulative incidences of ADHD at 10 years of age were 2.65% in prenatally exposed children and 2.03% in unexposed children of never users. At the general population level, prenatal exposure was associated with ADHD compared with unexposed, with aHR of 1.43(95% CI 1.24 to 1.65) for systemic exposure and 1.23 (95% CI 1.15 to 1.31) for local/inhaled exposure. However, our former user analysis (aHR of 1.25 (95% CI 1.20 to 1.29)) and sibling design (aHR of 1.03 (95% CI 0.87 to 1.20)) indicated that these findings were due to confounding. CONCLUSION This study provides no evidence of a causal association between prenatal exposure to GCs and risk of ADHD.
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Affiliation(s)
- Kristina Laugesen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Anna Byrjalsen
- Department of Clinical Genetics, Rigshospitalet, Copenhagen, Denmark
| | - Trine Frøslev
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Morten S Olsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
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30
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Calaprice D, Tona J, Parker-Athill EC, Murphy TK. A Survey of Pediatric Acute-Onset Neuropsychiatric Syndrome Characteristics and Course. J Child Adolesc Psychopharmacol 2017; 27:607-618. [PMID: 28140619 DOI: 10.1089/cap.2016.0105] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To date, studies in the area of pediatric acute-onset neuropsychiatric syndrome (PANS; including pediatric autoimmune neuropsychiatric disorder associated with streptococcal infection [PANDAS] and pediatric infection-triggered neuropsychiatric disorder [PITAND]) have been relatively small and hence unable to comprehensively address questions of disease heterogeneity (e.g., by age, gender), comorbidities, and progression. In this study, we investigated an internet survey sample to more fully characterize the phenotypic traits; medical, family, and developmental history; functional challenges; and clinical course associated with PANS. METHODS Six hundred and ninety-eight patients with clinical diagnoses of PANS were included in this study. Participants, who included parents and legal guardians (for minors) or the PANS patients themselves (for those ages 18 and older), were asked to complete a 146-question survey designed to ascertain medical, developmental, and family history; PANS symptomatology; medical and nonmedical interventions for PANS; PANS course; PANS outcomes; and access to PANS care. RESULTS Our results agree with previous findings concerning the core symptoms of PANS as well as its male predominance (65% in this survey) and infection-triggered onset, thus validating the study population. Infection was implicated as the primary inciting factor in 65% of patients; 54% of patients reported an association with group A streptococcus specifically. The results of this survey also revealed new findings, including a surprisingly strong impact of gender and pubertal status on symptom course and chronicity, a high rate of medical comorbidity suggesting generalized immune dysfunction, a profound impact of PANS episodes on functional status, and a role for early resolution of infection through antibiotic treatment in disease course. CONCLUSIONS This study serves as the first survey of its size to provide insight into the global clinical picture and range of phenotypes of PANS patients. Significant results included the impact of gender and pubertal status on phenotype, affirmation of the role of the immune system in PANS pathology, and the role of timely resolution of infection in clinical outcomes. Understanding how PANS presents in a broad population-based sample, within the limitations of a self-selected and administered online survey, is an important step toward improving diagnosis, creating more targeted treatment options, educating the clinical and research community, and generating hypotheses for future prospective research.
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Affiliation(s)
| | - Janice Tona
- 2 Department of Rehabilitation Science, University at Buffalo , Buffalo, New York
| | | | - Tanya K Murphy
- 3 Department of Pediatrics, University of South Florida , St. Petersburg, Florida.,4 Department of Psychiatry, University of South Florida , St. Petersburg, Florida
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31
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Lasebikan VO, Azegbeobor J. Medical Co-morbidities Among Patients with Severe Mental Illnesses in a Community Health Facility in Nigeria. Community Ment Health J 2017; 53:736-746. [PMID: 27888379 DOI: 10.1007/s10597-016-0063-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 11/22/2016] [Indexed: 01/05/2023]
Abstract
To examine prevalence of medical comorbidity (MCM) in schizophrenia (n = 1310) and in bipolar disorder (n = 1307) and the association of high burden of MCM (≥3 MCM) with duration of untreated illness, number of episodes, functioning, poly-medication and lifetime hospitalization for the mental disorder. Participants were recruited from a private psychiatric facility in Ibadan, Nigeria between 2004 and 2013 and enquiry made about the lifetime occurrence of 20 common chronic diseases including common tropical diseases. Psychiatric diagnosis was made using the Structured Clinical Interview for DSM IV Axis I disorder (SCID). Except for nutritional anemia, dermatitis and intestinal Helminthiasis, patients with schizophrenia were not at higher odds of reporting MCM than those with bipolar disorder. DUI ≥2 years, episodes of illness ≥3, being on multiple neuroleptics and history of previous hospitalization were significantly associated with high burden of MCM in schizophrenia and episodes of illness ≥3, reduced functioning and history of previous hospitalization with bipolar disorder. Schizophrenia and bipolar disorder are associated with high rates of medical comorbidity. Treatment of this medical comorbidity is essential in order to improve the outcomes for patients with bipolar disorder and schizophrenia.
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Affiliation(s)
- Victor Olufolahan Lasebikan
- Consultation Liaison Unit, Department of Psychiatry, University College Hospital, PMB 5116, Ibadan, Nigeria.
| | - Joachim Azegbeobor
- Department of Psychiatry, University College Hospital, Ibadan, PMB 5116, Ibadan, Nigeria
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Schiavone S, Trabace L. Inflammation, Stress Response, and Redox Dysregulation Biomarkers: Clinical Outcomes and Pharmacological Implications for Psychosis. Front Psychiatry 2017; 8:203. [PMID: 29118723 PMCID: PMC5660996 DOI: 10.3389/fpsyt.2017.00203] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 09/27/2017] [Indexed: 12/31/2022] Open
Abstract
In recent years, several studies claiming the finding of a specific biomarker for the identification of the "high-risk state" to develop psychosis, first psychotic episode, as well as the prediction of the individual response to antipsychotics have been published. Together with genetic reports, numerous publications in this field have been focused on inflammation and stress response blood biomarkers, as well as on indicators of redox dysregulation. In this review, we focus on human studies found in PubMed from January 1st 2010 to January 31st 2017, describing the clinical use of these biomarkers to detect the "premorbid" psychotic state and early phases of the disease. Their pharmacological implications in predicting and monitoring the individual response to antipsychotic medication is also discussed.
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Affiliation(s)
- Stefania Schiavone
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Luigia Trabace
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
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Hayes JF, Khandaker GM, Anderson J, Mackay D, Zammit S, Lewis G, Smith DJ, Osborn DPJ. Childhood interleukin-6, C-reactive protein and atopic disorders as risk factors for hypomanic symptoms in young adulthood: a longitudinal birth cohort study. Psychol Med 2017; 47:23-33. [PMID: 27476619 PMCID: PMC5197925 DOI: 10.1017/s0033291716001574] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 05/16/2016] [Accepted: 06/15/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND There are no existing longitudinal studies of inflammatory markers and atopic disorders in childhood and risk of hypomanic symptoms in adulthood. This study examined if childhood: (1) serum interleukin-6 (IL-6) and C-reactive protein (CRP); and (2) asthma and/or eczema are associated with features of hypomania in young adulthood. METHOD Participants in the Avon Longitudinal Study of Parents and Children, a prospective general population UK birth cohort, had non-fasting blood samples for IL-6 and CRP measurement at the age of 9 years (n = 4645), and parents answered a question about doctor-diagnosed atopic illness before the age of 10 years (n = 7809). These participants completed the Hypomania Checklist at age 22 years (n = 3361). RESULTS After adjusting for age, sex, ethnicity, socio-economic status, past psychological and behavioural problems, body mass index and maternal postnatal depression, participants in the top third of IL-6 values at 9 years, compared with the bottom third, had an increased risk of hypomanic symptoms by age 22 years [adjusted odds ratio 1.77, 95% confidence interval (CI) 1.10-2.85, p < 0.001]. Higher IL-6 levels in childhood were associated with adult hypomania features in a dose-response fashion. After further adjustment for depression at the age of 18 years this association remained (adjusted odds ratio 1.70, 95% CI 1.03-2.81, p = 0.038). There was no evidence of an association of hypomanic symptoms with CRP levels, asthma or eczema in childhood. CONCLUSIONS Higher levels of systemic inflammatory marker IL-6 in childhood were associated with hypomanic symptoms in young adulthood, suggesting that inflammation may play a role in the pathophysiology of mania. Inflammatory pathways may be suitable targets for the prevention and intervention for bipolar disorder.
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Affiliation(s)
| | - G. M. Khandaker
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - J. Anderson
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - D. Mackay
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - S. Zammit
- Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, UK
- Centre for Academic Mental Health, School of Social & Community Medicine, University of Bristol, Bristol, UK
| | - G. Lewis
- Division of Psychiatry, UCL, London, UK
| | - D. J. Smith
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
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Metcalf SA, Jones PB, Nordstrom T, Timonen M, Mäki P, Miettunen J, Jääskeläinen E, Järvelin MR, Stochl J, Murray GK, Veijola J, Khandaker GM. Serum C-reactive protein in adolescence and risk of schizophrenia in adulthood: A prospective birth cohort study. Brain Behav Immun 2017; 59:253-259. [PMID: 27622678 PMCID: PMC5176002 DOI: 10.1016/j.bbi.2016.09.008] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Revised: 08/31/2016] [Accepted: 09/09/2016] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE Meta-analyses of cross-sectional studies confirm an increase in circulating inflammatory markers during acute psychosis. Longitudinal studies are scarce but are needed to understand whether elevated inflammatory markers are a cause or consequence of illness. We report a longitudinal study of serum C-reactive protein (CRP) in adolescence and subsequent risk of schizophrenia and related psychoses in adulthood in the Northern Finland Birth Cohort 1986. METHOD Serum high-sensitivity CRP was measured at age 15/16 years in 6362 participants. ICD-10 diagnoses of schizophrenia and related psychoses were obtained from centralised hospital inpatient and outpatient registers up to age 27 years. Logistic regression calculated odds ratios (ORs) for psychotic outcomes associated with baseline CRP levels analysed as both continuous and categorical variables using American Heart Association criteria. Age, sex, body mass index, maternal education, smoking, and alcohol use were included as potential confounders. RESULTS By age 27years, 88 cases of non-affective psychosis (1.38%), of which 22 were schizophrenia (0.35%), were identified. Adolescent CRP was associated with subsequent schizophrenia. The adjusted OR for schizophrenia by age 27yearsfor each standard deviation (SD) increase in CRP levels at age 15/16yearswas 1.25 (95% CI, 1.07-1.46), which was consistent with a linear, dose-response relationship (P-value for quadratic term 0.23). Using CRP as a categorical variable, those with high (>3mg/L) compared with low (<1mg/L) CRP levels at baseline were more likely to develop schizophrenia; adjusted OR 4.25 (95% CI, 1.30-13.93). There was some indication that higher CRP was associated with earlier onset of schizophrenia (rs=-0.40; P=0.07). CONCLUSIONS A longitudinal association between adolescent CRP levels and adult schizophrenia diagnosis indicates a potentially important role of inflammation in the pathogenesis of the illness, although the findings, based on a small number of cases, need to be interpreted with caution and require replication in other samples.
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Affiliation(s)
| | - Peter B Jones
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Tanja Nordstrom
- Center for Life-Course Health Research, University of Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Finland
| | - Markku Timonen
- Center for Life-Course Health Research, University of Oulu, Finland
| | - Pirjo Mäki
- Center for Life-Course Health Research, University of Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Finland; Department of Psychiatry, Research Unit of Clinical Neuroscience, University of Oulu, Finland; Department of Psychiatry, Oulu University Hospital, Finland; Department of Psychiatry, Länsi-Pohja Healthcare District, Finland; Department of Psychiatry, The Middle Ostrobothnia Central Hospital, Kiuru, Finland; Mental Health Services, Joint Municipal Authority of Wellbeing in Raahe District, Finland; Mental Health Services, Basic Health Care District of Kallio, Finland; Visala Hospital, The Northern Ostrobothnia Hospital District, Finland
| | - Jouko Miettunen
- Center for Life-Course Health Research, University of Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Finland
| | - Erika Jääskeläinen
- Center for Life-Course Health Research, University of Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Finland
| | - Marjo-Riitta Järvelin
- Center for Life-Course Health Research, University of Oulu, Finland; Department of Epidemiology and Biostatistics, MRC-PHE Centre for Environment & Health, School of Public Health, Imperial College London, UK; Biocenter Oulu, P.O. Box 5000, Aapistie 5A, FI-90014, University of Oulu, Finland; Unit of Primary Care, Oulu University Hospital, Kajaanintie 50, P.O. Box 20, FI-90220 Oulu 90029 OYS, Finland
| | - Jan Stochl
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Graham K Murray
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Juha Veijola
- Center for Life-Course Health Research, University of Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Finland
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Ajdacic-Gross V, Aleksandrowicz A, Rodgers S, Mutsch M, Tesic A, Müller M, Kawohl W, Rössler W, Seifritz E, Castelao E, Strippoli MPF, Vandeleur C, von Känel R, Paolicelli R, Landolt MA, Witthauer C, Lieb R, Preisig M. Infectious, atopic and inflammatory diseases, childhood adversities and familial aggregation are independently associated with the risk for mental disorders: Results from a large Swiss epidemiological study. World J Psychiatry 2016; 6:419-430. [PMID: 28078206 PMCID: PMC5183994 DOI: 10.5498/wjp.v6.i4.419] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 09/08/2016] [Accepted: 10/09/2016] [Indexed: 02/05/2023] Open
Abstract
AIM To examine the associations between mental disorders and infectious, atopic, inflammatory diseases while adjusting for other risk factors.
METHODS We used data from PsyCoLaus, a large Swiss Population Cohort Study (n = 3720; age range 35-66). Lifetime diagnoses of mental disorders were grouped into the following categories: Neurodevelopmental, anxiety (early and late onset), mood and substance disorders. They were regressed on infectious, atopic and other inflammatory diseases adjusting for sex, educational level, familial aggregation, childhood adversities and traumatic experiences in childhood. A multivariate logistic regression was applied to each group of disorders. In a complementary analysis interactions with sex were introduced via nested effects.
RESULTS Associations with infectious, atopic and other chronic inflammatory diseases were observable together with consistent effects of childhood adversities and familial aggregation, and less consistent effects of trauma in each group of mental disorders. Streptococcal infections were associated with neurodevelopmental disorders (men), and measles/mumps/rubella-infections with early and late anxiety disorders (women). Gastric inflammatory diseases took effect in mood disorders (both sexes) and in early disorders (men). Similarly, irritable bowel syndrome was prominent in a sex-specific way in mood disorders in women, and, moreover, was associated with early and late anxiety disorders. Atopic diseases were associated with late anxiety disorders. Acne (associations with mood disorders in men) and psoriasis (associations with early anxiety disorders in men and mood disorders in women) contributed sex-specific results. Urinary tract infections were associated with mood disorders and, in addition, in a sex-specific way with late anxiety disorders (men), and neurodevelopmental and early anxiety disorders (women).
CONCLUSION Infectious, atopic and inflammatory diseases are important risk factors for all groups of mental disorders. The sexual dimorphism of the associations is pronounced.
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Fernandes BS, Steiner J, Molendijk ML, Dodd S, Nardin P, Gonçalves CA, Jacka F, Köhler CA, Karmakar C, Carvalho AF, Berk M. C-reactive protein concentrations across the mood spectrum in bipolar disorder: a systematic review and meta-analysis. Lancet Psychiatry 2016; 3:1147-1156. [PMID: 27838212 DOI: 10.1016/s2215-0366(16)30370-4] [Citation(s) in RCA: 151] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 10/19/2016] [Accepted: 10/19/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND Inflammatory processes and neural-immune interactions have been implicated in the pathogenesis of psychiatric conditions, but studies in bipolar disorder are inconclusive so far. We aimed to investigate whether peripheral concentrations of C-reactive protein (CRP), an acute-phase response protein of inflammatory activity, are increased in bipolar disorder across the mood spectrum. METHODS In this systematic review and meta-analysis, we searched MEDLINE, the Cochrane Library, Scopus, and Web of Knowledge from database inception to Aug 14, 2016, for studies that measured serum and plasma CRP concentrations in adult patients with bipolar disorder (as defined by DSM-IV-TR) and healthy controls. We extracted data from published reports. We did three between-group meta-analyses comparing CRP concentrations in patients in mania, depression, or euthymia, with those in healthy controls (cross-sectional studies), and two within-group meta-analyses comparing changes in CRP concentrations before and after treatment of an index manic or depressive episode (longitudinal studies). We used Hedges' adjusted g to calculate effect sizes and pooled results using random-effect models. We also did meta-regression analyses by mood state to investigate possible moderators of CRP concentrations. FINDINGS We identified 27 studies representing 2161 patients with bipolar disorder and 81 932 healthy controls. Compared with healthy individuals, CRP concentrations were moderately increased in people with bipolar disorder during depression (g 0·67, 95% CI 0·23 to 1·11; p=0·003) and euthymia (0·65, 0·40 to 0·90; p<0·0001) and more substantially increased during mania (0·87, 0·58 to 1·15; p<0·0001). The extent of the increases in CRP concentrations in mania and depression was not related to symptom severity (p=0·256 for mania and p=0·626 for depression). CRP concentrations were moderately decreased after resolution of an index manic episode (-0·36, -0·66 to -0·05; p=0·022) and slightly decreased after resolution of an index depressive episode (-0·18, -0·30 to -0·07; p=0·002). INTERPRETATION CRP concentrations are increased in bipolar disorder regardless of mood state, but are higher during mania than in depression and euthymia, suggesting an increased inflammatory burden in mania. FUNDING None.
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Affiliation(s)
- Brisa S Fernandes
- IMPACT Strategic Research Centre, Deakin University School of Medicine, and Barwon Health, Geelong, VIC, Australia; Laboratory of Calcium Binding Proteins in the Central Nervous System, Department of Biochemistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
| | - Johann Steiner
- Department of Psychiatry, University of Magdeburg, Magdeburg, Germany
| | - Marc L Molendijk
- Institute of Psychology, Department of Clinical Psychology, Leiden University Medical Center, Leiden, Netherlands; Leiden Institute for Brain and Cognition, Leiden University Medical Center, Leiden, Netherlands
| | - Seetal Dodd
- IMPACT Strategic Research Centre, Deakin University School of Medicine, and Barwon Health, Geelong, VIC, Australia
| | - Patricia Nardin
- Laboratory of Calcium Binding Proteins in the Central Nervous System, Department of Biochemistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Carlos-Alberto Gonçalves
- Laboratory of Calcium Binding Proteins in the Central Nervous System, Department of Biochemistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Felice Jacka
- IMPACT Strategic Research Centre, Deakin University School of Medicine, and Barwon Health, Geelong, VIC, Australia
| | - Cristiano A Köhler
- Translational Psychiatry Research Group and Department of Clinical Medicine, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil
| | - Chandan Karmakar
- Center for Pattern Recognition and Data Analytics, School of Information Technology, Deakin University, Geelong, VIC, Australia
| | - André F Carvalho
- Translational Psychiatry Research Group and Department of Clinical Medicine, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil
| | - Michael Berk
- IMPACT Strategic Research Centre, Deakin University School of Medicine, and Barwon Health, Geelong, VIC, Australia; Florey Institute for Neuroscience and Mental Health, Department of Psychiatry and Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
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Debnath M, Berk M. Functional Implications of the IL-23/IL-17 Immune Axis in Schizophrenia. Mol Neurobiol 2016; 54:8170-8178. [PMID: 27900676 DOI: 10.1007/s12035-016-0309-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 11/17/2016] [Indexed: 12/14/2022]
Abstract
The aetiology of schizophrenia seems to stem from complex interactions amongst environmental, genetic, metabolic, immunologic and oxidative components. Chronic low-grade inflammation has been persistently linked to schizophrenia, and this has primarily been based on the findings derived from Th1/Th2 cytokine balance. While the IL-23/IL-17 axis plays crucial role in the pathogenesis of several immune-mediated disorders, it has remained relatively unexplored in neuropsychiatric disorders. Altered levels of cytokines related to IL-23/IL-17 axis have been observed in schizophrenia patients in a few studies. In addition, other indirect factors known to confer schizophrenia risk like complement activation and altered gut microbiota are shown to modulate the IL-23/IL-17 axis. These preliminary observations provide crucial clues about the functional implications of IL-23/IL-17 axis in schizophrenia. In this review, an attempt has been made to highlight the biology of IL-23/IL-17 axis and its relevance to schizophrenia risk and pathogenesis. Given the pathogenic potential of the IL-23/IL-17 axis, therapeutic targeting of this axis may be a promising approach to benefit patients suffering from this devastating disorder.
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Affiliation(s)
- Monojit Debnath
- Department of Human Genetics, National Institute of Mental Health and Neurosciences, Hosur Road, Bangalore, 560029, India.
| | - Michael Berk
- School of Medicine, IMPACT Strategic Research Centre, Deakin University, Geelong, VIC, Australia.,Department of Psychiatry, the Florey Institute of Neuroscience and Mental Health, and Orygen Youth Health Research Centre, University of Melbourne, Parkville, Australia
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Koppes SA, Brans R, Ljubojevic Hadzavdic S, Frings-Dresen MHW, Rustemeyer T, Kezic S. Stratum Corneum Tape Stripping: Monitoring of Inflammatory Mediators in Atopic Dermatitis Patients Using Topical Therapy. Int Arch Allergy Immunol 2016; 170:187-93. [PMID: 27584583 DOI: 10.1159/000448400] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 07/13/2016] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE The aim of this study was to explore the tape strip sampling technique in the assessment of stratum corneum levels of inflammatory mediators in a clinical trial setting. METHODS Thirty-eight inflammatory mediators were analyzed by a multiplex-assay in the stratum corneum, collected by adhesive tapes before and after 6 weeks of therapy, in mild and moderate atopic dermatitis (AD) patients (n = 90). Treatment was a ceramide- and magnesium-containing emollient. RESULTS Twenty-four mediators could quantitatively be determined. The Th2 mediators interleukin (IL)-4, IL-13, CCL2 (monocyte chemotactic protein-1), CCL22 (macrophage-derived chemokine), and CCL17 [thymus and activation-regulated chemokine (TARC)] were significantly decreased after therapy as well as IL-1β, IL-2, IL-8 (CXCL8), IL-10, acute-phase protein serum amyloid A, C-reactive protein, and vascular adhesion molecule-1. The decrease of CCL17 and IL-8 was correlated with the decrease in disease severity in a subgroup of moderate AD individuals. CONCLUSION Stratum corneum tape stripping offers a minimally invasive approach for studying local levels of immunomodulatory molecules in the skin. CCL17 (TARC) and IL-8 were found to be the most promising biomarkers of AD and might be useful for investigating the course of skin diseases and the effect of local therapy.
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Affiliation(s)
- Sjors A Koppes
- Coronel Institute of Occupational Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Watkins CC, Andrews SR. Clinical studies of neuroinflammatory mechanisms in schizophrenia. Schizophr Res 2016; 176:14-22. [PMID: 26235751 DOI: 10.1016/j.schres.2015.07.018] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Revised: 06/08/2015] [Accepted: 07/08/2015] [Indexed: 12/27/2022]
Abstract
Schizophrenia is a pervasive neurodevelopmental disorder that appears to result from genetic and environmental factors. Although the dopamine hypothesis is the driving theory behind the majority of translation research in schizophrenia, emerging evidence suggests that aberrant immune mechanisms in the peripheral and central nervous system influence the etiology of schizophrenia and the pathophysiology of psychotic symptoms that define the illness. The initial interest in inflammatory processes comes from epidemiological data and historical observations, dating back several decades. A growing body of research on developmental exposure to infection, stress-induced inflammatory response, glial cell signaling, structural and functional brain changes and therapeutic trials demonstrates the impact that inflammation has on the onset and progression of schizophrenia. Research in animal models of psychosis has helped to advance clinical and basic science investigations of the immune mechanisms disrupted in schizophrenia. However, they are limited by the inability to recapitulate the human experience of hallucinations, delusions and thought disorder that define psychosis. To date, translational studies of inflammatory mechanisms in human subjects have not been reviewed in great detail. Here, we critically review clinical studies that focus on inflammatory mechanisms in schizophrenia. Understanding the neuroinflammatory mechanisms involved in schizophrenia may be essential in identifying potential therapeutic targets to minimize the morbidity and mortality of schizophrenia by interrupting disease development.
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Affiliation(s)
- Crystal C Watkins
- Memory Center in Neuropsychiatry, Sheppard Pratt Health Systems, Baltimore, MD, United States; Department of Psychiatry, The Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287, United States.
| | - Sarah Ramsay Andrews
- Department of Psychiatry, The Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287, United States
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Hong W, Zhao M, Li H, Peng F, Wang F, Li N, Xiang H, Su Y, Huang Y, Zhang S, Zhao G, Zhou R, Mao L, Lin Z, Fang Y, Zhang Q, Xie B. Higher Plasma S100B Concentrations in Schizophrenia Patients, and Dependently Associated with Inflammatory Markers. Sci Rep 2016; 6:27584. [PMID: 27279465 PMCID: PMC4899785 DOI: 10.1038/srep27584] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 05/16/2016] [Indexed: 02/07/2023] Open
Abstract
Glial damage and immune dysfunction are involved in pathogenesis of schizophrenia. However, interaction between glial damage and immune dysfunction in schizophrenia is undefined. This study aims to compare plasma S100 calcium binding protein (S100B) levels between schizophrenia patients and healthy participants, and to determine if immune markers are independently related with concentration of S100B in schizophrenia patients. Forty-one schizophrenia patients and thirty-three healthy volunteers were enrolled. Enzyme-linked immunosorbent assay (ELISA) was used to assess the concentrations of plasma S100B and inflammatory markers. We found that concentrations of S100B were elevated in schizophrenia patients than healthy participants (p < 0.05), and were negatively related with the severity of symptoms (p = 0.046). Receiver operating characteristic (ROC) curve analysis showed that different S100B levels between schizophrenia and healthy participants can be used as a clinical diagnostic factor (predictive value: 0.666, p = 0.015). Multiple linear regression analysis found that length of illness (Beta = −0.161), plasma levels of inflammatory regulation factors (including TGF-β1, logIL-23 and logIL-10) (Beta = 0.119, 0.475, 0.514) were independently associated with concentrations of S100B (Adjusted R2 = 0.897, p < 0.001). Therefore, our results suggest the possible function of S100B in pathogenesis of schizophrenia, and implicate the important role of autoimmune response and balance to glial dysfunction in patients with schizophrenia.
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Affiliation(s)
- Wu Hong
- Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
| | - Min Zhao
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
| | - Haozhe Li
- Shanghai Key Laboratory of Forensic Medicine, Institute of Forensic Science, Ministry of Justice, Shanghai, 200063, China.,Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
| | - Fanglan Peng
- Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
| | - Fan Wang
- Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
| | - Ningning Li
- Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
| | - Hui Xiang
- Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
| | - Yousong Su
- Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
| | - Yueqi Huang
- Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
| | - Shengyu Zhang
- Shanghai Key Laboratory of Forensic Medicine, Institute of Forensic Science, Ministry of Justice, Shanghai, 200063, China
| | - Guoqin Zhao
- Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
| | - Rubai Zhou
- Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
| | - Ling Mao
- Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China.,XuHui District Mental Health Center of Shanghai, Shanghai, 200232, China
| | - Zhiguang Lin
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
| | - Yiru Fang
- Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
| | - Qinting Zhang
- Shanghai Key Laboratory of Forensic Medicine, Institute of Forensic Science, Ministry of Justice, Shanghai, 200063, China.,Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
| | - Bin Xie
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
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Khandaker GM, Dantzer R. Is there a role for immune-to-brain communication in schizophrenia? Psychopharmacology (Berl) 2016. [PMID: 26037944 DOI: 10.1007/s00213-015-75-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Schizophrenia is characterised by hallucinations, delusions, depression-like so-called negative symptoms, cognitive dysfunction, impaired neurodevelopment and neurodegeneration. Epidemiological and genetic studies strongly indicate a role of inflammation and immunity in the pathogenesis of symptoms of schizophrenia. Evidence accrued over the last two decades has demonstrated that there are a number of pathways through which systemic inflammation can exert profound influence on the brain leading to changes in mood, cognition and behaviour. The peripheral immune system-to-brain communication pathways have been studied extensively in the context of depression where inflammatory cytokines are thought to play a key role. In this review, we highlight novel evidence suggesting an important role of peripheral immune-to-brain communication pathways in schizophrenia. We discuss recent population-based longitudinal studies that report an association between elevated levels of circulating inflammatory cytokines and subsequent risk of psychosis. We discuss emerging evidence indicating potentially important role of blood-brain barrier endothelial cells in peripheral immune-to-brain communication, which may be also relevant for schizophrenia. Drawing on clinical and preclinical studies, we discuss whether immune-mediated mechanisms could help to explain some of the clinical and pathophysiological features of schizophrenia. We discuss implication of these findings for approaches to diagnosis, treatment and research in future. Finally, pointing towards links with early-life adversity, we consider whether persistent low-grade activation of the innate immune response, as a result of impaired foetal or childhood development, could be a common mechanism underlying the high comorbidity between certain neuropsychiatric and physical illnesses, such as schizophrenia, depression, heart disease and type-two diabetes.
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Affiliation(s)
- Golam M Khandaker
- Department of Psychiatry, University of Cambridge, Box 189, Cambridge Biomedical Campus, Cambridge, CB2 2QQ, UK.
| | - Robert Dantzer
- Department of Symptom Research, Division of Internal Medicine, MD Anderson Cancer Center, Houston, TX, USA
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Khandaker GM, Dantzer R. Is there a role for immune-to-brain communication in schizophrenia? Psychopharmacology (Berl) 2016; 233:1559-73. [PMID: 26037944 PMCID: PMC4671307 DOI: 10.1007/s00213-015-3975-1] [Citation(s) in RCA: 104] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 05/22/2015] [Indexed: 02/06/2023]
Abstract
Schizophrenia is characterised by hallucinations, delusions, depression-like so-called negative symptoms, cognitive dysfunction, impaired neurodevelopment and neurodegeneration. Epidemiological and genetic studies strongly indicate a role of inflammation and immunity in the pathogenesis of symptoms of schizophrenia. Evidence accrued over the last two decades has demonstrated that there are a number of pathways through which systemic inflammation can exert profound influence on the brain leading to changes in mood, cognition and behaviour. The peripheral immune system-to-brain communication pathways have been studied extensively in the context of depression where inflammatory cytokines are thought to play a key role. In this review, we highlight novel evidence suggesting an important role of peripheral immune-to-brain communication pathways in schizophrenia. We discuss recent population-based longitudinal studies that report an association between elevated levels of circulating inflammatory cytokines and subsequent risk of psychosis. We discuss emerging evidence indicating potentially important role of blood-brain barrier endothelial cells in peripheral immune-to-brain communication, which may be also relevant for schizophrenia. Drawing on clinical and preclinical studies, we discuss whether immune-mediated mechanisms could help to explain some of the clinical and pathophysiological features of schizophrenia. We discuss implication of these findings for approaches to diagnosis, treatment and research in future. Finally, pointing towards links with early-life adversity, we consider whether persistent low-grade activation of the innate immune response, as a result of impaired foetal or childhood development, could be a common mechanism underlying the high comorbidity between certain neuropsychiatric and physical illnesses, such as schizophrenia, depression, heart disease and type-two diabetes.
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Affiliation(s)
- Golam M Khandaker
- Department of Psychiatry, University of Cambridge, Box 189, Cambridge Biomedical Campus, Cambridge, CB2 2QQ, UK.
| | - Robert Dantzer
- Department of Symptom Research, Division of Internal Medicine, MD Anderson Cancer Center, Houston, TX, USA
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Liao TC, Lien YT, Wang S, Huang SL, Chen CY. Comorbidity of Atopic Disorders with Autism Spectrum Disorder and Attention Deficit/Hyperactivity Disorder. J Pediatr 2016; 171:248-55. [PMID: 26846570 DOI: 10.1016/j.jpeds.2015.12.063] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 12/04/2015] [Accepted: 12/22/2015] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To assess the relationship between allergic manifestations in early life and the occurrence of newly diagnosed autism spectrum disorder (ASD) and attention deficit/hyperactivity disorder (ADHD) throughout childhood. STUDY DESIGN We collected a population-based longitudinal cohort comprising children enrolled in Taiwan's National Health Insurance Program during 2000-2010. We first identified 387,262 children who had a diagnosis of atopic dermatitis (AD) before age 2 years, with 1:1 individualized matching to children without AD. Cox regression analyses were performed to estimate the early-onset and cumulative effects of allergic manifestations on ASD and ADHD. RESULTS An estimated 0.5% of AD-exposed children received a diagnosis of ASD, and 3.7% were diagnosed with ADHD, significantly higher than the respective rates of 0.4% and 2.9% found in their nonexposed peers. Having AD before age 2 years was associated with an increased hazard ratio (HR) for ASD by 10% and that for ADHD by 16%; such increases were particularly prominent among those with earlier-onset or more severe AD. HRs were especially higher for children with persistent AD and emerging atopic respiratory diseases in childhood (eg, for ASD, adjusted HR, 1.75 and 2.13, respectively; P < .001). CONCLUSION The observed increased risks of ASD and ADHD associated with AD in infancy suggest that a disordered immunologic response may exert effects on neurodevelopment and have implications for research into etiology and treatment strategies.
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Affiliation(s)
- Tzu-Chu Liao
- Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
| | - Yi-Ting Lien
- Institute of Public Health, National Yang-Ming University, Taipei, Taiwan; Center of Neuropsychiatric Research, National Health Research Institutes, Zhunan, Taiwan
| | - Sabrina Wang
- Institute of Anatomy and Cell Biology, National Yang-Ming University, Taipei, Taiwan
| | - Song-Lih Huang
- Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
| | - Chuan-Yu Chen
- Institute of Public Health, National Yang-Ming University, Taipei, Taiwan; Center of Neuropsychiatric Research, National Health Research Institutes, Zhunan, Taiwan.
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Aggression as an independent entity even in psychosis- the role of inflammatory cytokines. J Neuroimmunol 2016; 292:45-51. [DOI: 10.1016/j.jneuroim.2016.01.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 12/01/2015] [Accepted: 01/14/2016] [Indexed: 11/18/2022]
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The Avon Longitudinal Study of Parents and Children (ALSPAC) birth cohort as a resource for studying psychopathology in childhood and adolescence: a summary of findings for depression and psychosis. Soc Psychiatry Psychiatr Epidemiol 2015; 50:1017-27. [PMID: 26002411 DOI: 10.1007/s00127-015-1072-8] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 05/13/2015] [Indexed: 12/16/2022]
Abstract
PURPOSE The purpose of this study is to highlight the Avon Longitudinal Study of Parents and Children (ALSPAC) as a resource to study psychopathology. To demonstrate this, we review the studies related to depression and psychosis in childhood and adolescence and discuss the results in relation to the aetiology of depression and psychotic experiences (PEs) and possible underlying mechanisms. METHODS We examined the list of publications from ALSPAC and then classified them as examining (a) the course and risk factors of maternal and paternal depression, (b) the effects of maternal and paternal depression on child development, (c) risk factors for depression in childhood and adolescence, (d) the frequency, clinical relevance and risk factors of PEs, and (e) shared risk factors for depression and PEs. RESULTS There was evidence that environmental stressors and the way these are interpreted contribute to risk of depression and evidence that biological factors related to puberty are also likely to play a role. With regards to PEs, the findings further support the existence of 'a continuum of psychosis' while they also suggest that PEs might be of limited clinical utility in predicting psychotic disorder during adolescence and early adulthood. Finally, most risk factors examined were found to be shared between depression and PEs. CONCLUSIONS The ALSPAC birth cohort has provided important insights for our understanding of the aetiological mechanisms underlying depression and PEs. Future research could aim to incorporate measures of automatic psychological mechanisms to provide insights into the brain mechanisms that underlie these clinical phenomena.
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Fuller Torrey E, Simmons W, Yolken RH. Is childhood cat ownership a risk factor for schizophrenia later in life? Schizophr Res 2015; 165:1-2. [PMID: 25892720 DOI: 10.1016/j.schres.2015.03.036] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 02/26/2015] [Accepted: 03/02/2015] [Indexed: 11/17/2022]
Abstract
Two previous studies suggested that childhood cat ownership is a possible risk factor for later developing schizophrenia or other serious mental illness. We therefore used an earlier, large NAMI questionnaire to try and replicate this finding. The results were the same, suggesting that cat ownership in childhood is significantly more common in families in which the child later becomes seriously mentally ill. If true, an explanatory mechanism may be Toxoplasma gondii. We urge our colleagues to try and replicate these findings to clarify whether childhood cat ownership is truly a risk factor for later schizophrenia.
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Affiliation(s)
| | | | - Robert H Yolken
- Stanley Laboratory of Developmental Neurovirology, Johns Hopkins University, School of Medicine, United States
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Khandaker GM, Cousins L, Deakin J, Lennox BR, Yolken R, Jones PB. Inflammation and immunity in schizophrenia: implications for pathophysiology and treatment. Lancet Psychiatry 2015; 2:258-270. [PMID: 26359903 PMCID: PMC4595998 DOI: 10.1016/s2215-0366(14)00122-9] [Citation(s) in RCA: 565] [Impact Index Per Article: 62.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 10/03/2014] [Indexed: 12/16/2022]
Abstract
Complex interactions between the immune system and the brain might have important aetiological and therapeutic implications for neuropsychiatric brain disorders. A possible association between schizophrenia and the immune system was postulated over a century ago, and is supported by epidemiological and genetic studies pointing to links with infection and inflammation. Contrary to the traditional view that the brain is an immunologically privileged site shielded behind the blood-brain barrier, studies in the past 20 years have noted complex interactions between the immune system, systemic inflammation, and the brain, which can lead to changes in mood, cognition, and behaviour. In this Review, we describe some of the important areas of research regarding innate and adaptive immune response in schizophrenia and related psychotic disorders that, we think, will be of interest to psychiatric clinicians and researchers. We discuss potential mechanisms and therapeutic implications of these findings, including studies of anti-inflammatory drugs in schizophrenia, describe areas for development, and offer testable hypotheses for future investigations.
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Affiliation(s)
- Golam M Khandaker
- Department of Psychiatry, University of Cambridge, Cambridge, UK; National Institute for Health Research Cambridge Biomedical Research Centre, Cambridge, UK; Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Lesley Cousins
- Department of Psychiatry, University of Cambridge, Cambridge, UK; National Institute for Health Research Cambridge Biomedical Research Centre, Cambridge, UK; Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Julia Deakin
- Department of Psychiatry, University of Cambridge, Cambridge, UK; National Institute for Health Research Cambridge Biomedical Research Centre, Cambridge, UK; Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | | | - Robert Yolken
- Stanley Division of Developmental Neurovirology, Johns Hopkins University, Baltimore, MD, USA
| | - Peter B Jones
- Department of Psychiatry, University of Cambridge, Cambridge, UK; National Institute for Health Research Cambridge Biomedical Research Centre, Cambridge, UK; Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
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Immune System Related Markers: Changes in childhood Neuropsychiatry Disorders Cause and Consequence. ACTA ACUST UNITED AC 2015. [DOI: 10.1007/978-3-319-13602-8_9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Khandaker GM, Stochl J, Zammit S, Lewis G, Jones PB. A population-based longitudinal study of childhood neurodevelopmental disorders, IQ and subsequent risk of psychotic experiences in adolescence. Psychol Med 2014; 44:3229-38. [PMID: 25066026 PMCID: PMC4180723 DOI: 10.1017/s0033291714000750] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Schizophrenia has a neurodevelopmental component to its origin, and may share overlapping pathogenic mechanisms with childhood neurodevelopmental disorders (NDs). Nevertheless, longitudinal studies of psychotic outcomes among individuals with NDs are limited. We report a population-based prospective study of six common childhood NDs, subsequent neurocognitive performance and the risk of psychotic experiences (PEs) in early adolescence. METHOD PEs were assessed by semi-structured interviews at age 13 years. IQ and working memory were measured between ages 9 and 11 years. The presence of six NDs (autism spectrum, dyslexia, dyspraxia, dysgraphia, dysorthographia, dyscalculia) was determined from parent-completed questionnaires at age 9 years. Linear regression calculated the mean difference in cognitive scores between children with and without NDs. Associations between NDs and PEs were expressed as odds ratios (ORs) with 95% confidence intervals (CIs); effects of cognitive deficits were examined. Potential confounders included age, gender, father's social class, ethnicity and maternal education. RESULTS Out of 8220 children, 487 (5.9%) were reported to have NDs at age 9 years. Children with, compared with those without, NDs performed worse on all cognitive measures; the adjusted mean difference in total IQ was 6.84 (95% CI 5.00-8.69). The association between total IQ and NDs was linear (p < 0.0001). The risk of PEs was higher in those with, compared with those without, NDs; the adjusted OR for definite PEs was 1.76 (95% CI 1.11-2.79). IQ (but not working memory) deficit partly explained this association. CONCLUSIONS Higher risk of PEs in early adolescence among individuals with childhood ND is consistent with the neurodevelopmental hypothesis of schizophrenia.
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Affiliation(s)
- Golam M. Khandaker
- Department of Psychiatry, University of Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
- Centre for Mental Health, Addiction and Suicide Research, School of Social and Community Medicine, University of Bristol, UK
| | - Jan Stochl
- Department of Psychiatry, University of Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Stanley Zammit
- Centre for Mental Health, Addiction and Suicide Research, School of Social and Community Medicine, University of Bristol, UK
- Institute of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, UK
| | - Glyn Lewis
- Centre for Mental Health, Addiction and Suicide Research, School of Social and Community Medicine, University of Bristol, UK
- Mental Health Sciences Unit, University College London, London, UK
| | - Peter B Jones
- Department of Psychiatry, University of Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
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