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Fekih-Romdhane F, Maktouf H, Cheour M. Aggressive behaviour in antipsychotic-naive first-episode schizophrenia patients, their unaffected siblings and healthy controls. Early Interv Psychiatry 2023; 17:299-310. [PMID: 35712845 DOI: 10.1111/eip.13329] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 04/17/2022] [Accepted: 05/29/2022] [Indexed: 12/26/2022]
Abstract
AIM While patients with schizophrenia are more likely to be victims rather than perpetrators of aggressive behaviour, prior research has shown increased rates of aggressive behaviours in these patients that appear very early in the course of illness. We aimed to assess aggression in antipsychotic-naive first-episode schizophrenia patients, their healthy siblings, and controls; and to investigate correlates of aggression in the patients group. METHODS Patients (N = 55), siblings (N = 55) and healthy controls (N = 71) were evaluated on Buss and Perry Aggression Questionnaire (AQ), Life History of Aggression (LHA), Barratt Impulsiveness Scale, and Levenson Self-Report Psychopathy Scale. Age, gender and substance use were regarded as covariates, and differences between the three groups were evaluated using analysis of covariance. Hierarchical regression was performed to determine which variables were associated with aggression level in the patients group. RESULTS The Tukey multiple comparison test showed that both patients (p < .001) and siblings (p = .023) scored higher on the LHA Aggression than controls. Siblings scored higher than controls (p = .010) for the Anger subscale of the AQ. Patients scored significantly higher than controls in the three impulsiveness dimensions; whereas siblings scored higher than controls in the motor (p = .023) and non-planning (p = .004) dimensions. Multivariate analyses showed that, after controlling for confounders, only attentional impulsiveness (β = .446, p = .0244) and psychopathy traits (β = .359, p = .010) helped predict AQ total scores among patients. CONCLUSION Aggression and some of its risk factors including impulsiveness are likely to be trait variables that might provide important vulnerability markers for people at heightened risk of developing psychosis.
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Affiliation(s)
- Feten Fekih-Romdhane
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
- The Tunisian Center of Early Intervention in Psychosis, Department of Psychiatry "Ibn Omrane", Razi Hospital, Manouba, Tunisia
| | - Hela Maktouf
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
- The Tunisian Center of Early Intervention in Psychosis, Department of Psychiatry "Ibn Omrane", Razi Hospital, Manouba, Tunisia
| | - Majda Cheour
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
- The Tunisian Center of Early Intervention in Psychosis, Department of Psychiatry "Ibn Omrane", Razi Hospital, Manouba, Tunisia
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2
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Hochstrasser L, Studerus E, Riecher-Rössler A, Schimmelmann BG, Lambert M, Lang UE, Borgwardt S, Stieglitz RD, Huber CG. Latent state-trait structure of BPRS subscales in clinical high-risk state and first episode psychosis. Sci Rep 2022; 12:6652. [PMID: 35459763 PMCID: PMC9033870 DOI: 10.1038/s41598-022-10207-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 03/21/2022] [Indexed: 11/08/2022] Open
Abstract
To investigate the longitudinal latent state-trait structure of the different dimensions of psychosis symptoms in clinical high-risk state (CHRS) and first episode psychosis (FEP) individuals over a one year time-span. This paper examines if the symptom clusters Positive Symptoms, Negative Symptoms, Affectivity, Resistance, Activation, and Excitement according to the Brief Psychiatric Rating Scale (BPRS) differ in their trait and state characters in 196 CHRS and 131 FEP individuals. Statistical analysis was performed using latent state-trait analysis. On average, trait differences accounted for 72.2% of Positive Symptoms, 81.1% of Negative Symptoms, 57.0% of Affectivity, and 69.2% of Activation, whereas 15.0% of the variance of Resistance and 13.2% of the variance of Excitement were explained by trait differences. Explorative analyses showed a trait components' increase of 0.408 in Positive Symptoms from baseline up to the 9th month and an increase of 0.521 in Affectivity from baseline up to the 6th month. Negative Symptoms had the highest trait component levels of all subscales between baseline and 6 months. The finding that an increasing proportion of psychosis symptoms is persisting over time underlines the importance of early intervention programs in individuals with psychotic disorders.
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Affiliation(s)
- Lisa Hochstrasser
- University Psychiatric Clinics Basel, University of Basel, Wilhelm Klein-Str. 27, 4012, Basel, Switzerland.
| | - Erich Studerus
- Department of Clinical Psychology and Psychiatry, University of Basel, Faculty of Psychology, Missionsstr. 60/62, 4055, Basel, Switzerland
| | - Anita Riecher-Rössler
- University Psychiatric Clinics Basel, University of Basel, Wilhelm Klein-Str. 27, 4012, Basel, Switzerland
| | - Benno G Schimmelmann
- University Hospital of Child and Adolescent Psychiatry, University of Bern, Effingerstr. 12, 3011, Bern, Switzerland
- Klinik für Kinder- und Jugendpsychiatrie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Martin Lambert
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Undine E Lang
- University Psychiatric Clinics Basel, University of Basel, Wilhelm Klein-Str. 27, 4012, Basel, Switzerland
| | - Stefan Borgwardt
- University Psychiatric Clinics Basel, University of Basel, Wilhelm Klein-Str. 27, 4012, Basel, Switzerland
| | - Rolf-Dieter Stieglitz
- University Psychiatric Clinics Basel, University of Basel, Wilhelm Klein-Str. 27, 4012, Basel, Switzerland
- Department of Clinical Psychology and Psychiatry, University of Basel, Faculty of Psychology, Missionsstr. 60/62, 4055, Basel, Switzerland
| | - Christian G Huber
- University Psychiatric Clinics Basel, University of Basel, Wilhelm Klein-Str. 27, 4012, Basel, Switzerland
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3
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Murru A, Verdolini N, Anmella G, Pacchiarotti I, Samalin L, Aedo A, Undurraga J, Goikolea JM, Amann BL, Carvalho AF, Vieta E. A 12-month prospective study on the time to hospitalization and clinical management of a cohort of bipolar type I and schizoaffective bipolar patients. Eur Psychiatry 2019; 61:1-8. [DOI: 10.1016/j.eurpsy.2019.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 05/15/2019] [Accepted: 06/06/2019] [Indexed: 01/09/2023] Open
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4
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Schoretsanitis G, Stegmayer K, Razavi N, Federspiel A, Müller TJ, Horn H, Wiest R, Strik W, Walther S. Inferior frontal gyrus gray matter volume is associated with aggressive behavior in schizophrenia spectrum disorders. Psychiatry Res Neuroimaging 2019; 290:14-21. [PMID: 31254799 DOI: 10.1016/j.pscychresns.2019.06.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Revised: 06/19/2019] [Accepted: 06/21/2019] [Indexed: 12/19/2022]
Abstract
We aimed to assess potential gray matter (GM) alterations for aggressive patterns of behavior in a sample of in- and outpatients with schizophrenia spectrum disorders. Eighty-four patients previously participating in brain volumetric studies were included. Aggression was assessed using the Modified Overt Aggression Scales (MOAS) based upon review of clinical records of the hospital register. Multiple regression analyses for total MOAS and each MOAS subscale separately were conducted correcting for age, sex, history of addiction, chlorpromazine equivalents, illness duration, and total intracranial volume. Significant effects were reported in two cases; the total MOAS scores and MOAS verbal aggression scores were associated with GM volume in left inferior frontal gyrus. From the demographic/clinical characteristics, only the number of episodes correlated with the subscales and the total MOAS scores. Our results highlight the role of GM volume in left inferior frontal gyri in patients with history of aggression. This evidence ties in well with previous data reporting involvement of these regions in response control and semantic networks.
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Affiliation(s)
- Georgios Schoretsanitis
- University of Bern, University Hospital of Psychiatry, Bern, Switzerland; Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA; Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, NY, USA.
| | | | - Nadja Razavi
- University of Bern, University Hospital of Psychiatry, Bern, Switzerland
| | - Andrea Federspiel
- University of Bern, University Hospital of Psychiatry, Bern, Switzerland
| | - Thomas J Müller
- University of Bern, University Hospital of Psychiatry, Bern, Switzerland; Privatklinik Meiringen, Meiringen, Switzerland
| | - Helge Horn
- Institute of Psychiatry and Psychotherapy Bern, Switzerland; University of Bern, University Hospital of Psychiatry, Bern, Switzerland
| | - Roland Wiest
- Institute of Neuroradiology, Inselspital, Bern, Switzerland
| | - Werner Strik
- University of Bern, University Hospital of Psychiatry, Bern, Switzerland
| | - Sebastian Walther
- University of Bern, University Hospital of Psychiatry, Bern, Switzerland
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5
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Arnold BD, Moeller J, Hochstrasser L, Schneeberger AR, Borgwardt S, Lang UE, Huber CG. Compulsory Admission to Psychiatric Wards-Who Is Admitted, and Who Appeals Against Admission? Front Psychiatry 2019; 10:544. [PMID: 31447710 PMCID: PMC6695555 DOI: 10.3389/fpsyt.2019.00544] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 07/15/2019] [Indexed: 12/03/2022] Open
Abstract
Background: When persons with a mental illness present a danger to themselves or others, involuntary hospital admission can be used to initiate an immediate inpatient treatment. Often, the patients have the right to appeal against compulsory admission. These processes are implemented in most mental health-care systems, but regulations and legal framework differ widely. In the Swiss canton of Basel-Stadt, a new regulation was implemented in January 2013. While the current literature holds some evidence for factors associated with involuntary admission, knowledge on who uses the right to appeal against admission is sparse. Aims: The study aims to examine if specific sociodemographic and clinical characteristics are associated with involuntary admission and with an appeal against the compulsory admission order. Method: Routine clinical data of all inpatient cases admitted during the period from January 2013 to December 2015 at the Psychiatric University Hospital Basel were extracted. Generalized estimating equation (GEE) analyses were used to examine the association of sociodemographic and clinical characteristics with "involuntary admission" and "appeal against compulsory admission order." Results: Of the 8,917 cases included in the present study, 942 (10.6%) were admitted involuntarily. Of these, 250 (26.5%) lodged an appeal against the compulsory admission order. Compared with cases admitted on a voluntary legal status, cases admitted involuntarily were older and were admitted more often during the nighttime or weekend. Moreover, involuntarily admitted cases had more often a principal diagnosis of a schizophrenia spectrum disorder. Patients from cases where an appeal was lodged were more often female, had more often Swiss nationality, and were more often diagnosed with schizophrenia spectrum disorder. Conclusion: Despite legal changes, the frequency of involuntary admissions in the observed catchment area seems to be relatively stable across the last 20 years. The percentage of appeals has decreased from 2000 to 2015, and only comparably few patients make use of the possibility to appeal. Better knowledge of the regulations, higher social functioning, and lower insight into illness might be associated with a higher probability of lodging an appeal. Future research should examine if specific patient groups are in need of additional assistance to exert their rights to appeal.
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Affiliation(s)
- Benjamin D Arnold
- Klinik für Erwachsene, Universitäre Psychiatrische Kliniken Basel (UPK), Universität Basel, Basel, Switzerland
| | - Julian Moeller
- Klinik für Erwachsene, Universitäre Psychiatrische Kliniken Basel (UPK), Universität Basel, Basel, Switzerland.,Department of Psychology, Division of Clinical Psychology and Epidemiology, University of Basel, Basel, Switzerland
| | - Lisa Hochstrasser
- Klinik für Erwachsene, Universitäre Psychiatrische Kliniken Basel (UPK), Universität Basel, Basel, Switzerland
| | - Andres R Schneeberger
- Psychiatrische Dienste Graubünden (PDGR), Chur, Switzerland.,Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine (AECOM), Bronx, NY, United States.,Psychiatrische Universitätsklinik (PUK), Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Universität Zürich, Zurich, Switzerland
| | - Stefan Borgwardt
- Klinik für Erwachsene, Universitäre Psychiatrische Kliniken Basel (UPK), Universität Basel, Basel, Switzerland
| | - Undine E Lang
- Klinik für Erwachsene, Universitäre Psychiatrische Kliniken Basel (UPK), Universität Basel, Basel, Switzerland
| | - Christian G Huber
- Klinik für Erwachsene, Universitäre Psychiatrische Kliniken Basel (UPK), Universität Basel, Basel, Switzerland
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6
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Voxel-Based Morphometry Correlates of an Agitated-Aggressive Syndrome in the At-Risk Mental State for Psychosis and First Episode Psychosis. Sci Rep 2018; 8:16516. [PMID: 30409978 PMCID: PMC6224526 DOI: 10.1038/s41598-018-33770-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 10/06/2018] [Indexed: 12/29/2022] Open
Abstract
There are mixed reports on structural neuroimaging correlates of aggression in schizophrenia with weak evidence due to cohort overlaps and lack of replications. To our knowledge, no study examined volumetric neuroimaging correlates of aggression in early stages of psychosis. An agitated-aggressive syndrome is present in at-risk mental state (ARMS) and in first-episode psychosis (FEP) - it is unclear whether this syndrome is associated with structural brain abnormalities in early stages of psychosis. Using three-dimensional magnetic resonance imaging and a whole brain voxel-based morphometry approach, we examined 56 ARMS patients, 55 FEP patients and 25 healthy controls. We operationalized aggression using the Excited Component of the Brief Psychiatric Rating Scale (BPRS-EC) and dichotomized our patient group by median split into "BPRS-EC high" (n = 49) and "BPRS-EC low" groups (n = 62). The "BPRS-EC high" group had significantly smaller left lingual gyrus volume than HC. This finding was not present in the "BPRS-EC low" group. In addition, grey matter volume in the left lingual gyrus showed a negative linear correlation with BPRS-EC over all subjects (ρ = -0.318; p = 0.0001) and in the patient group (ρ = -0.202; p = 0.033). These findings provide first hints on structural brain abnormalities associated with an agitated-aggressive syndrome in ARMS and FEP patients.
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7
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The association of psychopathology with concurrent level of functioning and subjective well-being in persons with schizophrenia spectrum disorders. Eur Arch Psychiatry Clin Neurosci 2018; 268:455-459. [PMID: 28357563 DOI: 10.1007/s00406-017-0780-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 03/06/2017] [Indexed: 10/19/2022]
Abstract
The objective is to investigate the relationship between psychopathology measured by the positive and negative syndrome scale (PANSS) and concurrent global assessment of functioning (GAF) and subjective well-being under neuroleptics (SWN) in patients with schizophrenia spectrum disorder (SSD) regarding severity of illness and disease phase. We analyzed a sample of 202 SSD patients consisting of first episode psychosis (FEP) and multiple episode psychosis (MEP) patients followed up to 12 months using linear mixed models. All PANSS syndromes except excitement were associated with GAF scores (positive syndrome: p < 0.001, d = 1.21; negative syndrome: p = 0.029, d = 0.015; disorganized syndrome: p < 0.001, d = 0.37; anxiety/depression syndrome: p < 0.001, d = 0.49), and positive symptoms had an increasing impact on global functioning with higher severity of illness (mildly ill: p = 0.039, d = 0.22; moderately ill: p < 0.001, d = 0.28; severely ill: p < 0.001, d = 0.69). SWN was associated with positive (p = 0.002, d = 0.22) and anxiety/depression (p < 0.001, d = 0.38) syndromes. Subgroup analyses showed differing patterns depending on illness severity and phase. Over all our results show different patterns of associations of psychopathology and concurrent functioning and subjective well-being. These findings contribute knowledge on the possible role of specific psychopathological syndromes for the functioning and well-being of our patients and may enable tailored treatments depending on severity and phase of illness.
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8
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Das S, Sengupta S, Pathak K, Sah D, Mehta S, Avinash PR, Baruah A, Deuri SK, Sarmah A, Gogoi V, Kalita KN, Hazarika J. Aggression as an independent entity even in psychosis - The role of cortisol. Psychiatry Res 2018; 259:405-411. [PMID: 29120850 DOI: 10.1016/j.psychres.2017.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 10/17/2017] [Accepted: 11/01/2017] [Indexed: 02/04/2023]
Abstract
Aggression is a common entity in psychiatric disorders, particularly psychotic disorders. Glucocorticoid hypofunction has been linked to abnormal forms of aggressive behavior in various studies in a 'possibly causal' role. We hypothesise that aggression, even among those having psychosis is associated with glucocorticoid alterations similar to those who are aggressive but not psychotic. To our knowledge, this is the first study attempting to look at the cortisol functioning in relation to both aggression and psychosis. The present study included 80 participants divided into four groups depending upon presence or absence of aggression and psychosis. Morning cortisol, afternoon cortisol and their variability were measured using ELISA. The groups were compared on measures of aggression, psychosis, morning cortisol, afternoon cortisol and their variability using standard statistical instruments. The present study found lower levels of morning cortisol, afternoon cortisol and cortisol variability among the aggressive group (vs. non aggressive group) and among the diseased group (vs. non diseased group). The differences were most marked for cortisol variability which was related to both aggression and psychosis independently. There were statistically significant correlation between cortisol variability and aggression, which was retained even after controlling for psychosis. There was no significant correlation of cortisol variability with psychosis severity (after controlling for aggression score) or with age, gender or duration of psychosis. We conclude that aggression, even among patients with psychosis, is an independent entity characterized by lower levels of morning cortisol and cortisol variability. The etio-pathology may lie in some altered neuro-immune parameters executed by cortisol and psychosis as trigger.
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Affiliation(s)
- Sourav Das
- Somnos Sleep Clinic, Kolkata, WB, India.
| | - Soumik Sengupta
- Dept. of Psychiatry, LGB Regional Institute of Mental Health, Tezpur, Assam, India
| | - Kangkan Pathak
- Dept. of Psychiatry, LGB Regional Institute of Mental Health, Tezpur, Assam, India
| | - Divyashree Sah
- Dept. of Psychology, Kumaon University, Nainital, UK, India
| | - Sumit Mehta
- Dept. of Psychiatry, LGB Regional Institute of Mental Health, Tezpur, Assam, India
| | - Priya Ranjan Avinash
- Dept. of Psychiatry, LGB Regional Institute of Mental Health, Tezpur, Assam, India
| | - Aparajeeta Baruah
- Dept. of Psychiatry, LGB Regional Institute of Mental Health, Tezpur, Assam, India
| | | | - Anil Sarmah
- Dept. of Pathology, LGB Regional Institute of Mental Health, Tezpur, Assam, India
| | - Vijay Gogoi
- Dept. of Psychiatry, LGB Regional Institute of Mental Health, Tezpur, Assam, India
| | - Kamal Narayan Kalita
- Dept. of Psychiatry, LGB Regional Institute of Mental Health, Tezpur, Assam, India
| | - Jyoti Hazarika
- Dept. of Microbiology, LGB Regional Institute of Mental Health, Tezpur, Assam, India
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9
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Widmayer S, Sowislo JF, Jungfer HA, Borgwardt S, Lang UE, Stieglitz RD, Huber CG. Structural Magnetic Resonance Imaging Correlates of Aggression in Psychosis: A Systematic Review and Effect Size Analysis. Front Psychiatry 2018; 9:217. [PMID: 29930519 PMCID: PMC6000417 DOI: 10.3389/fpsyt.2018.00217] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 05/07/2018] [Indexed: 12/12/2022] Open
Abstract
Background: Aggression in psychoses is of high clinical importance, and volumetric MRI techniques have been used to explore its structural brain correlates. Methods: We conducted a systematic review searching EMBASE, ScienceDirect, and PsycINFO through September 2017 using thesauri representing aggression, psychosis, and brain imaging. We calculated effect sizes for each study and mean Hedge's g for whole brain (WB) volume. Methodological quality was established using the PRISMA checklist (PROSPERO: CRD42014014461). Results: Our sample consisted of 12 studies with 470 patients and 155 healthy controls (HC). After subtracting subjects due to cohort overlaps, 314 patients and 96 HC remained. Qualitative analyses showed lower volumes of WB, prefrontal regions, temporal lobe, hippocampus, thalamus and cerebellum, and higher volumes of lateral ventricles, amygdala, and putamen in violent vs. non-violent people with schizophrenia. In quantitative analyses, violent persons with schizophrenia exhibited a significantly lower WB volume than HC (p = 0.004), and also lower than non-violent persons with schizophrenia (p = 0.007). Conclusions: We reviewed evidence for differences in brain volume correlates of aggression in persons with schizophrenia. Our results point toward a reduced whole brain volume in violent as opposed to non-violent persons with schizophrenia. However, considerable sample overlap in the literature, lack of reporting of potential confounding variables, and missing research on affective psychoses limit our explanatory power. To permit stronger conclusions, further studies evaluating structural correlates of aggression in psychotic disorders are needed.
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Affiliation(s)
- Sonja Widmayer
- Erwachsenen-Psychiatrische Klinik, Universitäre Psychiatrische Kliniken Basel, Basel, Switzerland
| | - Julia F Sowislo
- Erwachsenen-Psychiatrische Klinik, Universitäre Psychiatrische Kliniken Basel, Basel, Switzerland
| | - Hermann A Jungfer
- Erwachsenen-Psychiatrische Klinik, Universitäre Psychiatrische Kliniken Basel, Basel, Switzerland.,Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.,Asklepios Klinik Nord-Ochsenzoll, Hamburg, Germany
| | - Stefan Borgwardt
- Erwachsenen-Psychiatrische Klinik, Universitäre Psychiatrische Kliniken Basel, Basel, Switzerland
| | - Undine E Lang
- Erwachsenen-Psychiatrische Klinik, Universitäre Psychiatrische Kliniken Basel, Basel, Switzerland
| | - Rolf D Stieglitz
- Erwachsenen-Psychiatrische Klinik, Universitäre Psychiatrische Kliniken Basel, Basel, Switzerland.,Fakultät für Psychologie, Universität Basel, Basel, Switzerland
| | - Christian G Huber
- Erwachsenen-Psychiatrische Klinik, Universitäre Psychiatrische Kliniken Basel, Basel, Switzerland
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10
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Widmayer S, Borgwardt S, Lang UE, Stieglitz RD, Huber CG. Functional Neuroimaging Correlates of Aggression in Psychosis: A Systematic Review With Recommendations for Future Research. Front Psychiatry 2018; 9:777. [PMID: 30804823 PMCID: PMC6370727 DOI: 10.3389/fpsyt.2018.00777] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 12/24/2018] [Indexed: 12/19/2022] Open
Abstract
Background and methods: Aggression in psychosis is clinically important. We systematically compiled the evidence on functional correlates of aggression in psychosis searching PubMed, EMBASE, ScienceDirect, and PsycINFO until September 2017. We included studies reporting functional brain imaging correlates of aggression comparing: (1) affective or non-affective psychosis groups with a history of violence or with aggression operationalized using questionnaires, (2) affective or non-affective psychosis groups with a history of violence or with aggression operationalized using questionnaires to controls, (3) affective or non-affective psychosis groups with a history of violence or with aggression operationalized using questionnaires to controls with diagnoses other than affective or non-affective psychoses. We applied no language restriction and required patients to have a DSM or ICD diagnosis of affective or non-affective psychosis. Results: Our sample consisted of 12 studies with 334 patients and 113 controls. During n-back tasks, violent (VS) as opposed to non-violent persons with schizophrenia (NVS) hypoactivated their inferior parietal lobe. When anticipating shock, VS vs. NVS hyperactivated their medial prefrontal gyrus, cuneus, middle temporal gyrus, and middle occipital gyrus. When viewing negative emotional pictures, VS vs. NVS hyperactivated the middle frontal gyrus, inferior frontal gyrus, anterior cingulate, lingual gyrus, precentral gyrus, globus pallidus, mid-cingulate, and precuneus. Limitations: Due to the small number of available studies, sample overlap, and insufficient reporting of relevant moderators we could not conduct a meta-analysis. Conclusions: We found non-systematic functional correlates of aggression in schizophrenia. Only few studies using varied paradigms and often overlapping samples have been conducted. There have been no attempts to replicate any of the observed findings in the published literature. Focusing on future directions, we recommend that authors adhere to clear definitions of aggression, measurements of psychopathology, comorbidities, and medication. In particular, replication studies would allow for a better synthesis of the findings. PROSPERO Registration Number: CRD42016048579.
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Affiliation(s)
- Sonja Widmayer
- Department of Psychiatry, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Stefan Borgwardt
- Department of Psychiatry, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Undine E Lang
- Department of Psychiatry, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Rolf-Dieter Stieglitz
- Department of Psychiatry, University Hospital Basel, University of Basel, Basel, Switzerland.,Psychological Faculty, University of Basel, Basel, Switzerland
| | - Christian G Huber
- Department of Psychiatry, University Hospital Basel, University of Basel, Basel, Switzerland
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11
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Li H, Zhang Q, Li N, Wang F, Xiang H, Zhang Z, Su Y, Huang Y, Zhang S, Zhao G, Zhou R, Mao L, Lin Z, Cai W, Fang Y, Xie B, Zhao M, Hong W. Plasma levels of Th17-related cytokines and complement C3 correlated with aggressive behavior in patients with schizophrenia. Psychiatry Res 2016; 246:700-706. [PMID: 27829509 DOI: 10.1016/j.psychres.2016.10.061] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 10/13/2016] [Accepted: 10/20/2016] [Indexed: 12/18/2022]
Abstract
Increasing evidence indicates that immune inflammatory processes, especially autoimmune reaction, should be considered in the pathophysiology of schizophrenia and aggressive behavior. The present study aimed to explore the correlation between immune factors (C3 and Th17-related cytokines) and aggressive behavior in schizophrenia patients. Forty schizophrenia patients and forty age- and gender-matched healthy controls participated in the study. Blood samples were assessed by ELISA upon enrollment. Positive and negative syndrome scale (PANSS) and modified overt aggression scale (MOAS) were used to estimate the severity and aggressive symptoms of schizophrenia patients. Plasma levels of IL-17, IL-23, and TGF-β1 in schizophrenia patients were significantly higher than those in healthy controls [(37.63±17.82) vs. (29.34±10.38)pg/ml, p=0.02; (101.40±135.26) vs. (13.09±5.94) pg/ml, p=0.01; (2864.57±2163.61) vs. (1839.69±1797.73)pg/ml, p=0.04], whereas C3 levels were significantly lower in schizophrenia patients [( 120,479.67± 65,612.50) vs. ( 208,060.21± 217,008.21)ng/ml, p=0.02]. IL-17, IL-23, and TGF-β1 levels were positively related to total scores of MOAS (p=0.02, p=0.02 and p=0.03, respectively) and PANSS (p=0.04, p=0.04 and p=0.02, respectively), whereas C3 levels were negatively related to total PANSS scores (p=0.03). IL-17 and IL-23 levels were positively correlated with PANSS excited component scores (p=0.04 and p=0.01, respectively). Our findings suggested that the Th17-related cytokine levels were positively related to the severity of schizophrenia and aggressive behavior, whereas C3 levels were negatively related to the severity of schizophrenia. This study demonstrated that elevated levels of Th17-related cytokines and decreased levels of C3 could be potential biomarkers for schizophrenia and aggressive behavior.
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Affiliation(s)
- Haozhe Li
- Shanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Service Platform, Institute of Forensic Science, Ministry of Justice, PR China, Shanghai, China; Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qinting Zhang
- Shanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Service Platform, Institute of Forensic Science, Ministry of Justice, PR China, Shanghai, China; Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Ningning Li
- Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fan Wang
- Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hui Xiang
- Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zongfeng Zhang
- Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yousong Su
- Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yueqi Huang
- Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shengyu Zhang
- Shanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Service Platform, Institute of Forensic Science, Ministry of Justice, PR China, Shanghai, China
| | - Guoqing Zhao
- Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Rubai Zhou
- Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ling Mao
- XuHui District Mental Health Center of Shanghai, Shanghai, China
| | - Zhiguang Lin
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Weixiong Cai
- Shanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Service Platform, Institute of Forensic Science, Ministry of Justice, PR China, Shanghai, China
| | - Yiru Fang
- Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bin Xie
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Min Zhao
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wu Hong
- Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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12
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Huber CG, Hochstrasser L, Meister K, Schimmelmann BG, Lambert M. Evidence for an agitated-aggressive syndrome in early-onset psychosis correlated with antisocial personality disorder, forensic history, and substance use disorder. Schizophr Res 2016; 175:198-203. [PMID: 27117676 DOI: 10.1016/j.schres.2016.04.027] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 04/12/2016] [Accepted: 04/18/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Agitation, aggression, and violence are increased in psychotic disorders. Additionally, an earlier age at onset may be associated with aggressive behavior. However, the relationship of age at onset, an agitated-aggressive syndrome as measured with the Positive And Negative Syndrome Scale for Schizophrenia - Excited Component (PANSS-EC), and its potential correlates in first-episode psychosis (FEP) has not been studied. METHOD This study assessed the association between age at onset, an agitated-aggressive syndrome, and its potential correlates in a prospective sample of 52 FEP patients with early-onset and adult-onset followed up for 12months. RESULTS Twenty-six patients conformed to the criteria of early-onset psychosis. Early age at onset was associated with antisocial personality disorder (p=0.004; φc=0.39), a history of legal involvement (p=0.005; φc=0.39), and higher rates of lifetime substance use disorder (SUD; p=0.002; φc=0.42). Early-onset patients had significantly higher PANSS-EC scores over the course of observation (F(1,44.4)=5.39; p=0.025; d=0.656), but no significant group differences emerged for the remaining PANSS subscores. PANSS-EC scores were correlated positively with antisocial personality disorder and forensic history at 6weeks, 3months, 6months, and 12months, and with lifetime substance use disorder at 3months and 6months. CONCLUSIONS Patients with early onset psychosis may have increased levels of agitation/aggressiveness, and, more likely, antisocial personality disorder, forensic history, and lifetime substance use disorder. These variables were linked to suicidality, aggressiveness, and involuntary treatment.
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Affiliation(s)
- Christian G Huber
- Universitäre Psychiatrische Kliniken Basel, Wilhelm Klein-Str. 27, 4012 Basel, Switzerland.
| | - Lisa Hochstrasser
- Universitäre Psychiatrische Kliniken Basel, Wilhelm Klein-Str. 27, 4012 Basel, Switzerland
| | - Klara Meister
- Universitätsklinikum Hamburg-Eppendorf, Klinik für Psychiatrie und Psychotherapie, Martinistr. 52, 20246 Hamburg, Germany
| | - Benno G Schimmelmann
- University Hospital of Child and Adolescent Psychiatry, University of Bern, Effingerstr. 12, 3011 Bern, Switzerland; Universitätsklinikum Hamburg-Eppendorf, Klinik für Kinder- und Jugendpsychiatrie, Martinistr. 52, 20246 Hamburg, Germany
| | - Martin Lambert
- Universitätsklinikum Hamburg-Eppendorf, Klinik für Psychiatrie und Psychotherapie, Martinistr. 52, 20246 Hamburg, Germany
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13
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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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14
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Carney R, Cotter J, Bradshaw T, Firth J, Yung AR. Cardiometabolic risk factors in young people at ultra-high risk for psychosis: A systematic review and meta-analysis. Schizophr Res 2016; 170:290-300. [PMID: 26794596 DOI: 10.1016/j.schres.2016.01.010] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 12/09/2015] [Accepted: 01/04/2016] [Indexed: 01/30/2023]
Abstract
BACKGROUND The physical health of people with schizophrenia is poor, and associated with increased morbidity and mortality. Unhealthy lifestyles and side-effects of antipsychotic medication contribute to cardiometabolic dysfunction. Yet it is unclear when this unhealthy profile starts. We aimed to see if people at ultra-high risk for psychosis (UHR) have increased rates of cardiometabolic risk factors. METHOD An electronic search of MEDLINE, PsycINFO, Embase and the Cochrane Central Register of Controlled Trials was conducted on 1st May 2015 using terms associated with the ultra-high risk state and health. Eligible studies were peer-reviewed English language research articles with populations that met at-risk diagnostic criteria and reported cardiometabolic risk factors. A meta-analysis was conducted on smoking data, the cardiometabolic risk factor that yielded the most studies. RESULTS Forty-seven eligible studies were identified. UHR samples had low levels of physical activity, and high rates of smoking and alcohol abuse compared with controls. No differences were found for body mass index. An overall pooled rate of smoking for UHR participants was 33% (95% CI=0.24-0.42) and significantly more UHR individuals smoked compared with controls with a pooled odds ratio of 2.3 (P<0.05; 95% CI=-1.48-3.48). CONCLUSIONS UHR samples display cardiometabolic risk factors which are largely modifiable. The UHR phase is an important opportunity for early intervention services to improve physical health.
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Affiliation(s)
- Rebekah Carney
- Institute of Brain, Behaviour and Mental Health, University of Manchester, M13 9PL, UK.
| | - Jack Cotter
- Institute of Brain, Behaviour and Mental Health, University of Manchester, M13 9PL, UK
| | - Tim Bradshaw
- School of Nursing, Midwifery and Social Work, University of Manchester, M13 9PL, UK
| | - Joseph Firth
- Institute of Brain, Behaviour and Mental Health, University of Manchester, M13 9PL, UK
| | - Alison R Yung
- Institute of Brain, Behaviour and Mental Health, University of Manchester, M13 9PL, UK
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15
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Ventriglio A, Gentile A, Bonfitto I, Stella E, Mari M, Steardo L, Bellomo A. Suicide in the Early Stage of Schizophrenia. Front Psychiatry 2016; 7:116. [PMID: 27445872 PMCID: PMC4921745 DOI: 10.3389/fpsyt.2016.00116] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 06/13/2016] [Indexed: 12/11/2022] Open
Abstract
Suicide is a relevant leading cause of death among patients affected by schizophrenia. Even if suicidal ideation may be present in different stages of disease, some differences have been described between the risk of suicide in patients experiencing first episode of psychosis and those with long-term schizophrenia. It is particularly higher during the first year of illness and reaches a steady decline over the following years. Suicidal ideation and attempts may also be common among subjects with subthreshold psychotic experiences. Factors associated with the risk of suicide in the early phase of schizophrenia are previous suicidal attempts and social aspects: the lack of social support and stable relationships, social drift after the first episode, and social impairment. Also, several psychotic symptoms (suspiciousness, paranoid delusions, mental disintegration and agitation, negative symptoms, depression and hopelessness, and command hallucinations) and substance abuse are associated with higher risk of suicide. It has been described that perfectionism and good levels of insight among individuals who have recently developed psychotic symptoms are significantly associated with higher numbers of suicidal attempts. Moreover, recent evidences show that prefrontal cortex-based circuit dysfunction may be related to suicide in the early stage of schizophrenia. This narrative review summarizes available evidences on suicide in the early stage of schizophrenia and deals with issues to be further studied and discussed.
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Affiliation(s)
- Antonio Ventriglio
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy; Department of Mental Health, Regione Marche, ASUR, Area Vasta 2, Jesi, Italy
| | | | - Iris Bonfitto
- Department of Clinical and Experimental Medicine, University of Foggia , Foggia , Italy
| | - Eleonora Stella
- Department of Clinical and Experimental Medicine, University of Foggia , Foggia , Italy
| | - Massimo Mari
- Department of Mental Health, Regione Marche, ASUR, Area Vasta 2 , Jesi , Italy
| | - Luca Steardo
- Department of Psychiatry, University of Naples SUN , Naples , Italy
| | - Antonello Bellomo
- Department of Clinical and Experimental Medicine, University of Foggia , Foggia , Italy
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