1
|
Cuesta MJ, Lecumberri P, Moreno-Izco L, López-Ilundain JM, Ribeiro M, Cabada T, Lorente-Omeñaca R, de Erausquin G, García-Martí G, Sanjuan J, Sánchez-Torres AM, Gómez M, Peralta V. Motor abnormalities and basal ganglia in first-episode psychosis (FEP). Psychol Med 2021; 51:1625-1636. [PMID: 32114994 DOI: 10.1017/s0033291720000343] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Motor abnormalities (MAs) are the primary manifestations of schizophrenia. However, the extent to which MAs are related to alterations of subcortical structures remains understudied. METHODS We aimed to investigate the associations of MAs and basal ganglia abnormalities in first-episode psychosis (FEP) and healthy controls. Magnetic resonance imaging was performed on 48 right-handed FEP and 23 age-, gender-, handedness-, and educational attainment-matched controls, to obtain basal ganglia shape analysis, diffusion tensor imaging techniques (fractional anisotropy and mean diffusivity), and relaxometry (R2*) to estimate iron load. A comprehensive motor battery was applied including the assessment of parkinsonism, catatonic signs, and neurological soft signs (NSS). A fully automated model-based segmentation algorithm on 1.5T MRI anatomical images and accurate corregistration of diffusion and T2* volumes and R2* was used. RESULTS FEP patients showed significant local atrophic changes in left globus pallidus nucleus regarding controls. Hypertrophic changes in left-side caudate were associated with higher scores in sensory integration, and in right accumbens with tremor subscale. FEP patients showed lower fractional anisotropy measures than controls but no significant differences regarding mean diffusivity and iron load of basal ganglia. However, iron load in left basal ganglia and right accumbens correlated significantly with higher extrapyramidal and motor coordination signs in FEP patients. CONCLUSIONS Taken together, iron load in left basal ganglia may have a role in the emergence of extrapyramidal signs and NSS of FEP patients and in consequence in the pathophysiology of psychosis.
Collapse
Affiliation(s)
- Manuel J Cuesta
- Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Pablo Lecumberri
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
- Movalsys S. L., NavarraBiomed, Pamplona, Spain
| | - Lucia Moreno-Izco
- Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Jose M López-Ilundain
- Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - María Ribeiro
- Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Teresa Cabada
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
- Department of Neuroradiology, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Ruth Lorente-Omeñaca
- Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Gabriel de Erausquin
- Zachry Foundation, The Glenn Biggs Institute of Alzheimer's & Neurodegenerative Disorders, UT Heath San Antonio, Texas, USA
| | - Gracian García-Martí
- Radiology Department, CIBERSAM, Valencia, España, Quirón Salud Hospital, Valencia, España
| | - Julio Sanjuan
- Research Institute of Clinic University Hospital of Valencia (INCLIVA), Valencia, Spain
- CIBERSAM, Biomedical Research Network on Mental Health Area, Madrid, Spain
- Department of Psychiatric, University of Valencia School of Medicine, Valencia, Spain
| | - Ana M Sánchez-Torres
- Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Marisol Gómez
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
- Movalsys S. L., NavarraBiomed, Pamplona, Spain
- Department of Statistics, Computer Science and Mathematics, Universidad Pública de Navarra (UPNA), Pamplona, Spain
| | - Victor Peralta
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
- Mental Health Department, Servicio Navarro de Salud, Pamplona, Spain
| |
Collapse
|
2
|
Szatmári S, Ajtay A, Oberfrank F, Dobi B, Bereczki D. The prevalence of psychiatric symptoms before the diagnosis of Parkinson's disease in a nationwide cohort: A comparison to patients with cerebral infarction. PLoS One 2020; 15:e0236728. [PMID: 32750069 PMCID: PMC7402492 DOI: 10.1371/journal.pone.0236728] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 07/11/2020] [Indexed: 11/23/2022] Open
Abstract
Objectives Psychiatric symptoms (PS) can be non-motor features in Parkinson’s disease (PD) which are common even in the prodromal, untreated phase of the disease. Some PS, especially depression and anxiety recently became known predictive markers for PD. Our objective was to explore retrospectively the prevalence of PS before the diagnosis of PD. Methods In the framework of the Hungarian Brain Research Program we created a database from medical and medication reports submitted for reimbursement purposes to the National Health Insurance Fund in Hungary, a country with 10 million inhabitants and a single payer health insurance system. We used record linkage to evaluate the prevalence of PS before the diagnosis of PD and compared that with patients with ischemic cerebrovascular lesion (ICL) in the period between 2004–2016 using ICD-10 codes of G20 for PD, I63-64 for ICL and F00-F99 for PS. We included only those patients who got their PD, ICL and psychiatric diagnosis at least twice. Results There were 79 795 patients with PD and 676 874 patients with ICL. Of the PD patients 16% whereas of those with ischemic cerebrovascular lesion 9.7% had a psychiatric diagnosis before the first appearance of PD or ICL (p<0.001) established in psychiatric care at least twice. The higher rate of PS in PD compared to ICL remained significant after controlling for age and gender in logistic regression analysis. The difference between PD and ICL was significant for Mood disorders (F30-F39), Organic, including symptomatic, mental disorders (F00-F09), Neurotic, stress-related and somatoform disorders (F40-F48) and Schizophrenia, schizotypal and delusional disorders (F20-F29) diagnosis categories (p<0.001, for all). Discussion The higher rate of psychiatric morbidity in the premotor phase of PD may reflect neurotransmitter changes in the early phase of PD.
Collapse
Affiliation(s)
- Szabolcs Szatmári
- János Szentágothai Doctoral School of Neurosciences, Semmelweis University, Budapest, Hungary
- Department of Neurology, Semmelweis University, Budapest, Hungary
- MTA-SE Neuroepidemiological Research Group, Budapest, Hungary
| | - András Ajtay
- Department of Neurology, Semmelweis University, Budapest, Hungary
- MTA-SE Neuroepidemiological Research Group, Budapest, Hungary
| | | | - Balázs Dobi
- MTA-SE Neuroepidemiological Research Group, Budapest, Hungary
- Department of Probability Theory and Statistics, Eötvös Loránd University, Budapest, Hungary
| | - Dániel Bereczki
- Department of Neurology, Semmelweis University, Budapest, Hungary
- MTA-SE Neuroepidemiological Research Group, Budapest, Hungary
- * E-mail:
| |
Collapse
|
3
|
Osborne KJ, Walther S, Shankman SA, Mittal VA. Psychomotor Slowing in Schizophrenia: Implications for Endophenotype and Biomarker Development. Biomark Neuropsychiatry 2020; 2:100016. [PMID: 33738459 PMCID: PMC7963400 DOI: 10.1016/j.bionps.2020.100016] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Motor abnormalities (e.g., dyskinesia, psychomotor slowing, neurological soft signs) are core features of schizophrenia that occur independent of drug treatment and are associated with the genetic vulnerability and pathophysiology for the illness. Among this list, psychomotor slowing in particular is one of the most consistently observed and robust findings in the field. Critically, psychomotor slowing may serve as a uniquely promising endophenotype and/or biomarker for schizophrenia considering it is frequently observed in those with genetic vulnerability for the illness, predicts transition in subjects at high-risk for the disorder, and is associated with symptoms and recovery in patients. The purpose of the present review is to provide an overview of the history of psychomotor slowing in psychosis, discuss its possible neural underpinnings, and review the current literature supporting slowing as a putative endophenotype and/or biomarker for the illness. This review summarizes substantial evidence from a diverse array of methodologies and research designs that supports the notion that psychomotor slowing not only reflects genetic vulnerability, but is also sensitive to disease processes and the pathophysiology of the illness. Furthermore, there are unique deficits across the cognitive (prefix "psycho") and motor execution (root word "motor") aspects of slowing, with cognitive processes such as planning and response selection being particularly affected. These findings suggest that psychomotor slowing may serve as a promising endophenotype and biomarker for schizophrenia that may prove useful for identifying individuals at greatest risk and tracking the course of the illness and recovery.
Collapse
Affiliation(s)
- K. Juston Osborne
- Northwestern University, Department of Psychology, Evanston, IL, USA
| | - Sebastian Walther
- University of Bern, University Hospital of Psychiatry, Translational Research Center, Bern, Switzerland
| | - Stewart A. Shankman
- Northwestern University, Department of Psychology, Evanston, IL, USA
- Northwestern University, Department of Psychiatry, Chicago, IL, USA
| | - Vijay A. Mittal
- Northwestern University, Department of Psychology, Evanston, IL, USA
- Northwestern University, Department of Psychiatry, Chicago, IL, USA
- Northwestern University, Department of Psychiatry, Institute for Policy Research, Department of Medical Social Sciences, Institute for Innovations in Developmental Sciences (DevSci), Evanston, Chicago, IL, USA
| |
Collapse
|
4
|
Rudå D, Einarsson G, Matthiassen JB, Correll CU, Jensen KG, Klauber DG, Richard CJ, Andersen ASS, Krøigaard S, Møllegaard Jepsen JR, Fagerlund B, Winge K, Clemmesen LKH, Pagsberg AK, Paulsen RR, Fink-Jensen A. Measuring movements in adolescents with psychosis using the Microsoft Kinect sensor: a pilot study exploring a new tool for assessing aspects of antipsychotic-induced parkinsonism. Child Adolesc Ment Health 2020; 25:79-94. [PMID: 32307841 DOI: 10.1111/camh.12360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/10/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND The assessment of motor disturbances in antipsychotic-treated adolescent patients is often limited to the use of observer-based rating scales with interobserver variability. The objectives of this pilot study were to measure movement patterns associated with antipsychotic-induced parkinsonism in young patients with psychosis and initiating/treated with antipsychotics, using a computer application connected with the Microsoft Kinect sensor (Motorgame). METHOD All participants were assessed by neurological examination, clinical side effect rating scales (Udvalg for Kliniske Undersøgelser Side Effect Rating Scale, Barnes Akathisia Rating Scale, Simpson Angus Scale (SAS), and Abnormal Involuntary Movement Scale), and the Motorgame. Furthermore, speed of information processing and motor speed with subtests from the Brief Assessment of Cognition in Schizophrenia test battery was assessed. RESULTS We included 21 adolescents with first-episode psychosis (62% treated with antipsychotics; males 38%; mean age 16 ± 1.4 years) and 69 healthy controls (males 36%; mean age 16 ± 1.5 years). Prolonged time of motor performance (TOMP) in the Motorgame was associated with higher SAS scores for arm dropping (p = .009). A consistent practice effect was detected (p < .001). We found no significant associations between TOMP and age, height, body weight, sex, antipsychotic dosage, or information processing speed. CONCLUSIONS We found an uncorrected significant association between prolonged TOMP and shoulder bradykinesia. The Motorgame was found useful in assessing parkinsonian symptoms in early-onset psychosis and accepted by participants. Future studies of larger cohorts, including patients with high scores in clinical motor side effect scales, are required to establish solid validity of the novel test.
Collapse
Affiliation(s)
- Ditte Rudå
- Centre for Child and Adolescent Mental Health, Mental Health Services, Capital Region of Denmark, Glostrup, Denmark.,Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
| | - Gudmundur Einarsson
- Section for Image Analysis and Computer Graphics, DTU Compute, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Jannik Boll Matthiassen
- Section for Image Analysis and Computer Graphics, DTU Compute, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Christoph U Correll
- Hofstra North Shore Long Island Jewish School of Medicine, The Zucker Hillside Hospital, New York, NY, USA.,Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| | - Karsten Gjessing Jensen
- Centre for Child and Adolescent Mental Health, Mental Health Services, Capital Region of Denmark, Glostrup, Denmark.,Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
| | - Dea Gowers Klauber
- Centre for Child and Adolescent Mental Health, Mental Health Services, Capital Region of Denmark, Glostrup, Denmark.,Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
| | - Clara Josefine Richard
- Centre for Child and Adolescent Mental Health, Mental Health Services, Capital Region of Denmark, Glostrup, Denmark.,Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
| | - Anne Sofie Schott Andersen
- Centre for Child and Adolescent Mental Health, Mental Health Services, Capital Region of Denmark, Glostrup, Denmark.,Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
| | - Sabrina Krøigaard
- Centre for Child and Adolescent Mental Health, Mental Health Services, Capital Region of Denmark, Glostrup, Denmark.,Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
| | - Jens Richardt Møllegaard Jepsen
- Centre for Child and Adolescent Mental Health, Mental Health Services, Capital Region of Denmark, Glostrup, Denmark.,Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark.,Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research, Mental Health Services, Copenhagen, Denmark
| | - Birgitte Fagerlund
- Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research, Mental Health Services, Copenhagen, Denmark.,Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Kristian Winge
- Department of Neurology, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Line K H Clemmesen
- Section for Image Analysis and Computer Graphics, DTU Compute, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Anne Katrine Pagsberg
- Centre for Child and Adolescent Mental Health, Mental Health Services, Capital Region of Denmark, Glostrup, Denmark.,Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
| | - Rasmus R Paulsen
- Section for Image Analysis and Computer Graphics, DTU Compute, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Anders Fink-Jensen
- Psychiatric Centre Copenhagen, University Hospital Copenhagen, Copenhagen, Denmark.,Laboratory of Neuropsychiatry, Department of Neuroscience and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
5
|
Kent JS, Disner SG, Van Voorhis AC, Urošević S, Caligiuri MP, Sponheim SR. Exploring the Relationship of Transdiagnostic Mood and Psychosis Symptom Domains with Motor Dysfunction. Neuropsychobiology 2020; 79:301-312. [PMID: 31851987 PMCID: PMC8500525 DOI: 10.1159/000503928] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 10/05/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND A number of motor abnormalities have been reported in psychotic disorders, including dyskinesia and psychomotor slowing. There is also evidence for many of the same motor abnormalities in biological first-degree relatives and accruing evidence for motor abnormalities in bipolar disorder. In addition to motor dysfunction, there are also shared symptom domains amongst these populations. OBJECTIVES We explored the associations of (1) current and lifetime psychosis and mood symptom domains and (2) domains of psychosis proneness with various domains of motor function in a transdiagnostic sample (n = 149). METHOD Individuals with schizophrenia, schizoaffective disorder, or bipolar disorder, biological first-degree relatives of individuals with a psychotic disorder, and controls completed measures of psychomotor speed and movement fluidity, and neural activity related to motor preparation (stimulus-locked lateralized readiness potential, S-LRP) and execution (response-locked LRP) was assessed using EEG. All participants completed the Brief Psychiatric Rating Scale; patients were additionally assessed for lifetime psychosis and mood episode symptoms, and relatives and controls completed the Chapman psychosis proneness scales. RESULTS Multiple regression revealed levels of current negative symptoms and mania were significantly positively associated with psychomotor slowing even after accounting for current antipsychotic medication dosage and duration of illness. S-LRP onset latency was significantly positively associated with magical ideation. CONCLUSION Domains of motor function are associated with various mood and psychosis symptom domains in a transdiagnostic sample, which may provide insight into brain abnormalities relevant to the expression of symptoms across disorders.
Collapse
Affiliation(s)
- Jerillyn S. Kent
- University of Minnesota, Department of Psychiatry, Minneapolis, MN, USA,Jerillyn S. Kent, University of Minnesota, Department of Psychiatry, 2450 Riverside Ave, Minneapolis, MN 55454 USA, 612-625-1472
| | - Seth G. Disner
- University of Minnesota, Department of Psychiatry, Minneapolis, MN, USA,Minneapolis VA Health Care System, Minneapolis, MN, USA
| | | | - Snežana Urošević
- University of Minnesota, Department of Psychiatry, Minneapolis, MN, USA,Minneapolis VA Health Care System, Minneapolis, MN, USA
| | - Michael P. Caligiuri
- University of California San Diego, Department of Psychiatry, San Diego, CA, USA
| | - Scott R. Sponheim
- University of Minnesota, Department of Psychiatry, Minneapolis, MN, USA,Minneapolis VA Health Care System, Minneapolis, MN, USA,University of Minnesota, Department of Psychology, Minneapolis, MN, USA
| |
Collapse
|
6
|
The sinister face of heme oxygenase-1 in brain aging and disease. Prog Neurobiol 2019; 172:40-70. [DOI: 10.1016/j.pneurobio.2018.06.008] [Citation(s) in RCA: 103] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 06/19/2018] [Accepted: 06/30/2018] [Indexed: 11/23/2022]
|
7
|
Drepper C, Geißler J, Pastura G, Yilmaz R, Berg D, Romanos M, Gerlach M. Transcranial sonography in psychiatry as a potential tool in diagnosis and research. World J Biol Psychiatry 2018; 19:484-496. [PMID: 28971725 DOI: 10.1080/15622975.2017.1386325] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES During the last two decades transcranial sonography (TCS) of the brain parenchyma evolved from a pure research tool to a clinical relevant neuroimaging method especially in Parkinson's disease and related movement disorders. The aim of this systematic review is to update and summarise the published TCS findings in psychiatric disorders and critically address the question whether TCS may be a valuable tool for the diagnosis or differential diagnosis of psychiatric disorders similarly to the field of movement disorders. METHODS This paper provides detailed information about the perspectives and limitations of TCS, including guidelines for the scanning procedures, assessment of midbrain structures and discusses the potential causes of the ultrasound abnormalities in psychiatric disorders. RESULTS Changes in the echogenicity of subcortical brain structures were detected in different disorders, such as obsessive-compulsive disorder, autism spectrum disorder, schizophrenia, panic disorder, attention-deficit/hyperactivity (ADHD), bipolar disorder and depressive disorder. Although the physical properties of brain tissue underlying the echogenic features in TCS are largely unknown, no alternative technique provides the same insight into the specific central nervous structural characteristics. CONCLUSIONS Urgent research questions to further clarify the underlying pathophysiological and structural alterations are further outlined to bring this promising technique to the clinic.
Collapse
Affiliation(s)
- Carsten Drepper
- a Center of Mental Health, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy , University Hospital of Würzburg , Würzburg , Germany
| | - Julia Geißler
- a Center of Mental Health, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy , University Hospital of Würzburg , Würzburg , Germany
| | - Giuseppe Pastura
- b Department of Pediatrics , The Federal University of Rio de Janeiro , Rio de Janeiro , Brazil
| | - Rezzak Yilmaz
- c Department of Neurology , Christian-Albrecht-University , Kiel , Germany
| | - Daniela Berg
- c Department of Neurology , Christian-Albrecht-University , Kiel , Germany.,d Department of Neurodegeneration , University of Tübingen , Tübingen , Germany
| | - Marcel Romanos
- a Center of Mental Health, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy , University Hospital of Würzburg , Würzburg , Germany
| | - Manfred Gerlach
- a Center of Mental Health, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy , University Hospital of Würzburg , Würzburg , Germany
| |
Collapse
|
8
|
Parkinsonian motor impairment predicts personality domains related to genetic risk and treatment outcomes in schizophrenia. NPJ SCHIZOPHRENIA 2017; 3:16036. [PMID: 28127577 PMCID: PMC5226082 DOI: 10.1038/npjschz.2016.36] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Revised: 08/19/2016] [Accepted: 09/23/2016] [Indexed: 12/27/2022]
Abstract
Identifying endophenotypes of schizophrenia is of critical importance and has profound implications on clinical practice. Here we propose an innovative approach to clarify the mechanims through which temperament and character deviance relates to risk for schizophrenia and predict long-term treatment outcomes. We recruited 61 antipsychotic naïve subjects with chronic schizophrenia, 99 unaffected relatives, and 68 healthy controls from rural communities in the Central Andes. Diagnosis was ascertained with the Schedules of Clinical Assessment in Neuropsychiatry; parkinsonian motor impairment was measured with the Unified Parkinson’s Disease Rating Scale; mesencephalic parenchyma was evaluated with transcranial ultrasound; and personality traits were assessed using the Temperament and Character Inventory. Ten-year outcome data was available for ~40% of the index cases. Patients with schizophrenia had higher harm avoidance and self-transcendence (ST), and lower reward dependence (RD), cooperativeness (CO), and self-directedness (SD). Unaffected relatives had higher ST and lower CO and SD. Parkinsonism reliably predicted RD, CO, and SD after correcting for age and sex. The average duration of untreated psychosis (DUP) was over 5 years. Further, SD was anticorrelated with DUP and antipsychotic dosing at follow-up. Baseline DUP was related to antipsychotic dose-years. Further, ‘explosive/borderline’, ‘methodical/obsessive’, and ‘disorganized/schizotypal’ personality profiles were associated with increased risk of schizophrenia. Parkinsonism predicts core personality features and treatment outcomes in schizophrenia. Our study suggests that RD, CO, and SD are endophenotypes of the disease that may, in part, be mediated by dopaminergic function. Further, SD is an important determinant of treatment course and outcome.
Collapse
|
9
|
Parkinsonian axial signs in schizophrenia. Parkinsonism Relat Disord 2016; 36:89-92. [PMID: 28038867 DOI: 10.1016/j.parkreldis.2016.12.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 12/15/2016] [Accepted: 12/21/2016] [Indexed: 11/23/2022]
Abstract
INTRODUCTION We have recently demonstrated evidence of nigro-striatal denervation, disease progression and response to levodopa in a subgroup of patients with schizophrenia who developed parkinsonism. OBJECTIVE In the present study, we investigated whether axial parkinsonian signs might be an early manifestation of parkinsonism in schizophrenia not necessarily related to chronic administration of antipsychotic drugs (AP) drugs. METHODS From a baseline cohort of 299 schizophrenic patients who did not satisfy the diagnostic criteria for parkinsonism (presence of at least two of the following appendicular signs: bradykinesia, tremor, rigidity), we identified a group of patients who manifested two out of three axial parkinsonian signs (abnormality of trunk posture, hypomimia and short-step gait). Accordingly, we obtained two sub-groups of patients with schizophrenia, with (Schiz-Axial, N = 26), and without parkinsonian axial signs (Schiz-NO-Axial, N = 273). Clinical and demographical variables were compared between groups. The motor section of the Unified Parkinson's disease rating scale (UPDRS) was employed to measure motor disability. RESULTS Schiz-Axial patients were significantly older (p = 0.007) and had longer disease duration (p = 0.04) compared to Schiz-NO-Axial. The two groups did not differ for variables related to AP treatment. Total UPDRS motor score (p < 0.0001) as well as limb (p < 0.0001) and axial (p < 0.0001) UPDRS sub-scores were increased in Schiz-Axial patients compared to Schiz-NO-Axial. CONCLUSIONS Our findings provide evidence that axial parkinsonian signs might be an early manifestation of parkinsonism in schizophrenia associated to older age and longer disease duration.
Collapse
|
10
|
Molina JL, González Alemán G, Florenzano N, Padilla E, Calvó M, Guerrero G, Kamis D, Stratton L, Toranzo J, Molina Rangeon B, Hernández Cuervo H, Bourdieu M, Sedó M, Strejilevich S, Cloninger CR, Escobar JI, de Erausquin GA. Prediction of Neurocognitive Deficits by Parkinsonian Motor Impairment in Schizophrenia: A Study in Neuroleptic-Naïve Subjects, Unaffected First-Degree Relatives and Healthy Controls From an Indigenous Population. Schizophr Bull 2016; 42:1486-1495. [PMID: 26994395 PMCID: PMC5049519 DOI: 10.1093/schbul/sbw023] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Neurocognitive deficits are among the most debilitating and pervasive symptoms of schizophrenia, and are present also in unaffected first-degree relatives. Also, multiple reports reveal parkisonian motor deficits in untreated subjects with schizophrenia and in first-degree relatives of affected subjects. Yet, the relation between motor and cognitive impairment and its value as a classifier of endophenotypes has not been studied. AIMS To test the efficacy of midbrain hyperechogenicity (MHE) and parkinsonian motor impairment (PKM) as predictors of neurocognitive impairment in subjects with or at risk for schizophrenia, that could be used to segregate them from first-degree relatives and healthy controls. METHOD Seventy-six subjects with chronic schizophrenia never exposed to antipsychotic medication, 106 unaffected first-degree relatives, and 62 healthy controls were blindly assessed for cognitive and motor function, and transcranial ultrasound. RESULTS Executive function, fluid intelligence, motor planning, and hand coordination showed group differences. PKM and MHE were significantly higher in untreated schizophrenia and unaffected relatives. Unaffected relatives showed milder impairment, but were different from controls. CONCLUSIONS PKM and MHE predict cognitive impairment in neuroleptic-naive patients with schizophrenia and their unaffected first-degree relatives and may be used to segregate them from first-degree relatives and healthy controls.
Collapse
Affiliation(s)
- Juan L. Molina
- Roskamp Laboratory of Brain Development, Modulation and Repair, Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL
| | | | - Néstor Florenzano
- Unidad de Neurociencias, Dr. J.J. Naón, Facultad de Medicina, Universidad de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - Eduardo Padilla
- Hospital Neuropsiquiátrico Dr. Néstor Sequeiros, San Salvador de Jujuy, Argentina
| | - María Calvó
- Hospital Neuropsiquiátrico Dr. Néstor Sequeiros, San Salvador de Jujuy, Argentina
| | - Gonzalo Guerrero
- Hospital Neuropsiquiátrico Dr. Néstor Sequeiros, San Salvador de Jujuy, Argentina
| | - Danielle Kamis
- Roskamp Laboratory of Brain Development, Modulation and Repair, Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL
| | - Lee Stratton
- Roskamp Laboratory of Brain Development, Modulation and Repair, Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL
| | | | | | - Helena Hernández Cuervo
- Roskamp Laboratory of Brain Development, Modulation and Repair, Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL
| | | | | | | | - Claude Robert Cloninger
- Departments of Psychiatry and Genetics, Washington University School of Medicine, St Louis, MO
| | - Javier I. Escobar
- Department of Psychiatry, Rutgers University-Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Gabriel A. de Erausquin
- Roskamp Laboratory of Brain Development, Modulation and Repair, Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL;,Division of Neurosciences and Department of Psychiatry and Neurology, UTRGV School of Medicine, Harlingen, TX,*To whom correspondence should be addressed; Division of Neurosciences and Department of Psychiatry and Neurology, UTRGV School of Medicine, 2102 Treasure Hills Blvd., Harlingen, TX 78550, US; tel: 956-296-1546, fax: 956-665-2450, e-mail:
| |
Collapse
|
11
|
Schmitt A, Rujescu D, Gawlik M, Hasan A, Hashimoto K, Iceta S, Jarema M, Kambeitz J, Kasper S, Keeser D, Kornhuber J, Koutsouleris N, Lanzenberger R, Malchow B, Saoud M, Spies M, Stöber G, Thibaut F, Riederer P, Falkai P. Consensus paper of the WFSBP Task Force on Biological Markers: Criteria for biomarkers and endophenotypes of schizophrenia part II: Cognition, neuroimaging and genetics. World J Biol Psychiatry 2016; 17:406-28. [PMID: 27311987 DOI: 10.1080/15622975.2016.1183043] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVES Schizophrenia is a group of severe psychiatric disorders with high heritability but only low odds ratios of risk genes. Despite progress in the identification of pathophysiological processes, valid biomarkers of the disease are still lacking. METHODS This comprehensive review summarises recent efforts to identify genetic underpinnings, clinical and cognitive endophenotypes and symptom dimensions of schizophrenia and presents findings from neuroimaging studies with structural, functional and spectroscopy magnetic resonance imaging and positron emission tomography. The potential of findings to be biomarkers of schizophrenia is discussed. RESULTS Recent findings have not resulted in clear biomarkers for schizophrenia. However, we identified several biomarkers that are potential candidates for future research. Among them, copy number variations and links between genetic polymorphisms derived from genome-wide analysis studies, clinical or cognitive phenotypes, multimodal neuroimaging findings including positron emission tomography and magnetic resonance imaging, and the application of multivariate pattern analyses are promising. CONCLUSIONS Future studies should address the effects of treatment and stage of the disease more precisely and apply combinations of biomarker candidates. Although biomarkers for schizophrenia await validation, knowledge on candidate genomic and neuroimaging biomarkers is growing rapidly and research on this topic has the potential to identify psychiatric endophenotypes and in the future increase insight on individual treatment response in schizophrenia.
Collapse
Affiliation(s)
- Andrea Schmitt
- a Department of Psychiatry and Psychotherapy , LMU Munich , Germany ;,b Laboratory of Neuroscience (LIM27), Institute of Psychiatry , University of Sao Paulo , Sao Paulo , Brazil
| | - Dan Rujescu
- c Department of Psychiatry, Psychotherapy and Psychosomatics , University of Halle , Germany
| | - Micha Gawlik
- d Department of Psychiatry, Psychotherapy and Psychosomatics , University of Würzburg , Germany
| | - Alkomiet Hasan
- a Department of Psychiatry and Psychotherapy , LMU Munich , Germany
| | - Kenji Hashimoto
- e Division of Clinical Neuroscience , Chiba University Center for Forensic Mental Health , Chiba , Japan
| | - Sylvain Iceta
- f INSERM, U1028; CNRS, UMR5292; Lyon Neuroscience Research Center, PsyR2 Team , Lyon , F-69000 , France ; Hospices Civils De Lyon, France
| | - Marek Jarema
- g Department of Psychiatry , Institute of Psychiatry and Neurology , Warsaw , Poland
| | - Joseph Kambeitz
- a Department of Psychiatry and Psychotherapy , LMU Munich , Germany
| | - Siegfried Kasper
- h Department of Psychiatry and Psychotherapy , Medical University of Vienna , Austria
| | - Daniel Keeser
- a Department of Psychiatry and Psychotherapy , LMU Munich , Germany
| | - Johannes Kornhuber
- i Department of Psychiatry and Psychotherapy , Friedrich-Alexander-University Erlangen-Nuremberg , Erlangen , Germany
| | | | - Rupert Lanzenberger
- h Department of Psychiatry and Psychotherapy , Medical University of Vienna , Austria
| | - Berend Malchow
- a Department of Psychiatry and Psychotherapy , LMU Munich , Germany
| | - Mohamed Saoud
- f INSERM, U1028; CNRS, UMR5292; Lyon Neuroscience Research Center, PsyR2 Team , Lyon , F-69000 , France ; Hospices Civils De Lyon, France
| | - Marie Spies
- h Department of Psychiatry and Psychotherapy , Medical University of Vienna , Austria
| | - Gerald Stöber
- d Department of Psychiatry, Psychotherapy and Psychosomatics , University of Würzburg , Germany
| | - Florence Thibaut
- j Department of Psychiatry , University Hospital Cochin (Site Tarnier), University of Paris-Descartes, INSERM U 894 Centre Psychiatry and Neurosciences , Paris , France
| | - Peter Riederer
- k Center of Psychic Health; Clinic and Policlinic for Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Wuerzburg , Germany
| | - Peter Falkai
- a Department of Psychiatry and Psychotherapy , LMU Munich , Germany
| | | |
Collapse
|
12
|
Balda M, Calvó M, Padilla E, Guerrero G, Molina J, Florenzano NV, Kamis D, Escobar JI, Cloninger CR, de Erausquin G. Detection, Assessment, and Management of Schizophrenia in an Andean Population of South America: Parkinsonism Testing and Transcranial Ultrasound as Preventive Tools. FOCUS: JOURNAL OF LIFE LONG LEARNING IN PSYCHIATRY 2015; 13:432-440. [PMID: 26516317 DOI: 10.1176/appi.focus.20150018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Schizophrenia is a debilitating psychiatric illness that is among the world's top 10 causes of long-term disability, affecting people who are just entering the peak of social, economic, and intellectual productivity. Such functional loss is particularly relevant in indigenous communities, which rely on change in functional status (rather than on the presence of symptoms) to identify mental illness. Particularly among the indigenous communities of Latin America, the gap between mental health need and availability of resources to reduce the burden has been judged "a case of outrageous exclusion." For more than a decade, as part of the Investigation of Movement Abnormalities and Genetic of Schizophrenia study, the authors have been studying vulnerability markers (genetic, motor, imaging, and neuropsychological differences) for schizophrenia in a remote, indigenous population in rural northern Argentina. In this article, the authors discuss the implementation of a task-shifting paradigm resulting in more proficient identification and referral of individuals with untreated psychosis and a severalfold reduction in the duration of untreated psychosis, with very high retention rates (70%) and treatment adherence during a decade in a rural environment. The authors also propose to use transcranial ultrasound screening and testing for parkinsonism at illness onset before introduction of neuroleptics as potentially useful markers in determining illness severity, negative symptomatology, and tolerance to antipsychotic treatment/refractoriness.
Collapse
Affiliation(s)
- Mara Balda
- Department of Psychiatry and Behavioral Sciences, University of Miami, Miami, FL, and Roskamp Laboratory for Brain Development, Modulation and Repair, Morsani College of Medicine, University of South Florida, Tampa
| | - Maria Calvó
- Fundación de Lucha contra los Trastornos Neurológicos y Psiquiátricos en Minorías (FULTRA), Buenos Aires, Argentina
| | - Eduardo Padilla
- Ministerio de Salud, Hospital Neuropsiquiátrico Néstor Sequeiros, Provinicia de Jujuy, Argentina
| | - Gonzalo Guerrero
- FULTRA, Buenos Aires, Argentina; and Hospital Neuropsiquiátrico Néstor Sequeiros, Provinicia de Jujuy, Argentina
| | - Juan Molina
- Roskamp Laboratory for Brain Development, Modulation and Repair, Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa
| | | | - Danielle Kamis
- Roskamp Laboratory for Brain Development, Modulation and Repair, Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa
| | - Javier I Escobar
- Department of Global Health and Department of Psychiatry and Family Medicine, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ
| | - C Robert Cloninger
- Sansone Family Center for Well-Being and Center for Psychobiology of Personality, Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
| | - Gabriel de Erausquin
- Roskamp Laboratory for Brain Development, Modulation and Repair, Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa
| |
Collapse
|