1
|
Executive Functions and Psychopathology Dimensions in Deficit and Non-Deficit Schizophrenia. J Clin Med 2023; 12:jcm12051998. [PMID: 36902784 PMCID: PMC10003976 DOI: 10.3390/jcm12051998] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/24/2023] [Accepted: 02/27/2023] [Indexed: 03/06/2023] Open
Abstract
This study: (a) compared executive functions between deficit (DS) and non-deficit schizophrenia (NDS) patients and healthy controls (HC), controlling premorbid IQ and level of education; (b) compared executive functions in DS and NDS patients, controlling premorbid IQ and psychopathological symptoms; and (c) estimated relationships between clinical factors, psychopathological symptoms, and executive functions using structural equation modelling. Participants were 29 DS patients, 44 NDS patients, and 39 HC. Executive functions were measured with the Mazes Subtest, Spatial Span Subtest, Letter Number Span Test, Color Trail Test, and Berg Card Sorting Test. Psychopathological symptoms were evaluated with the Positive and Negative Syndrome Scale, Brief Negative Symptom Scale, and Self-evaluation of Negative Symptoms. Compared to HC, both clinical groups performed poorer on cognitive flexibility, DS patients on verbal working memory, and NDS patients on planning. DS and NDS patients did not differ in executive functions, except planning, after controlling premorbid IQ and negative psychopathological symptoms. In DS patients, exacerbation had an effect on verbal working memory and cognitive planning; in NDS patients, positive symptoms had an effect on cognitive flexibility. Both DS and NDS patients presented deficits, affecting the former to a greater extent. Nonetheless, clinical variables appeared to significantly affect these deficits.
Collapse
|
2
|
Galderisi S. Negative symptoms of schizophrenia: Trying to answer unanswered research questions. Psychiatry Res 2023; 320:115043. [PMID: 36623425 DOI: 10.1016/j.psychres.2022.115043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/26/2022] [Accepted: 12/27/2022] [Indexed: 12/29/2022]
Abstract
My research has focused on unmet needs in caring for people with schizophrenia. In particular, I focused on negative symptoms, a complex psychopathological dimension of the disorder, with a significant impact on the disease outcome, and not effectively addressed by existing treatments. In the present commentary, I summarize the trajectory of my research activity. I start with the description of my initial attempts to define the role of the dorsolateral prefrontal cortex in the pathogenesis of broadly defined negative symptoms. Then, I report on the evidence that led me to realize that no progress in research on schizophrenia negative symptoms could occur without considering the heterogeneity and complexity of the construct. Finally, I illustrate my attempts to succeed in this direction and the most pressing unsolved issues in this research field.
Collapse
Affiliation(s)
- Silvana Galderisi
- Professor of Psychiatry, University of Campania Luigi Vanvitelli, Naples, Italy.
| |
Collapse
|
3
|
Takahashi T, Sasabayashi D, Takayanagi Y, Furuichi A, Kobayashi H, Yuasa Y, Noguchi K, Suzuki M. Gross anatomical features of the insular cortex in schizophrenia and schizotypal personality disorder: Potential relationships with vulnerability, illness stages, and clinical subtypes. Front Psychiatry 2022; 13:1050712. [PMID: 36465304 PMCID: PMC9715601 DOI: 10.3389/fpsyt.2022.1050712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 11/07/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction Patients with schizophrenia have a higher number of insular gyri; however, it currently remains unclear whether the brain characteristics of patients with schizotypal personality disorder (SPD), a mild form of schizophrenia, are similar. It is also unknown whether insular gross anatomical features are associated with the illness stages and clinical subtypes of schizophrenia. Materials and methods This magnetic resonance imaging study examined gross anatomical variations in the insular cortex of 133 patients with schizophrenia, 47 with SPD, and 88 healthy controls. The relationships between the insular gross anatomy and schizophrenia subgroups (71 first-episode and 58 chronic groups, 38 deficit and 37 non-deficit subtype groups) were also investigated. Results The number of insular gyri was higher in the schizophrenia and SPD patients than in the controls, where the patients were characterized by well-developed accessory, middle short, and posterior long insular gyri. The insular gross anatomy did not significantly differ between the first-episode and chronic schizophrenia subgroups; however, the relationship between the developed accessory gyrus and more severe positive symptoms was specific to the first-episode group. The prevalence of a right middle short gyrus was higher in the deficit schizophrenia group than in the non-deficit group. Discussion These findings suggest that schizophrenia and SPD patients may share an altered insular gross morphology as a vulnerability factor associated with early neurodevelopmental anomalies, which may also contribute to positive symptomatology in the early illness stages and clinical subtypes of schizophrenia.
Collapse
Affiliation(s)
- Tsutomu Takahashi
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan
- Research Center for Idling Brain Science, University of Toyama, Toyama, Japan
| | - Daiki Sasabayashi
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan
- Research Center for Idling Brain Science, University of Toyama, Toyama, Japan
| | - Yoichiro Takayanagi
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan
- Arisawabashi Hospital, Toyama, Japan
| | - Atsushi Furuichi
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan
- Research Center for Idling Brain Science, University of Toyama, Toyama, Japan
| | - Haruko Kobayashi
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan
- Research Center for Idling Brain Science, University of Toyama, Toyama, Japan
| | - Yusuke Yuasa
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan
- Research Center for Idling Brain Science, University of Toyama, Toyama, Japan
| | - Kyo Noguchi
- Department of Radiology, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan
| | - Michio Suzuki
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan
- Research Center for Idling Brain Science, University of Toyama, Toyama, Japan
| |
Collapse
|
4
|
Phahladira L, Asmal L, Lückhoff HK, du Plessis S, Scheffler F, Smit R, Chiliza B, Emsley R. The trajectories and correlates of two negative symptom subdomains in first-episode schizophrenia. Schizophr Res 2022; 243:17-23. [PMID: 35228035 DOI: 10.1016/j.schres.2022.02.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 02/10/2022] [Accepted: 02/12/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND Recent studies suggest a two-factor structure for negative symptoms as assessed by the Positive and Negative Syndrome Scale (PANSS) in schizophrenia, namely experiential and expressive subdomains. Little is known about their clinical correlates and treatment trajectories. OBJECTIVES We sought to replicate the two factor-analysis derived subdomains for PANSS negative symptoms in schizophrenia and to assess their independent demographic, premorbid and treatment-related characteristics. METHODS This was a longitudinal study of 106 minimally treated participants with a first episode of a schizophrenia spectrum disorder who received treatment with flupenthixol decanoate 2-weekly injections over two years. Factor analysis was used to characterize the PANSS negative symptom subdomains and linear mixed-effect models for continuous repeated measures were constructed to assess the temporal relations between the negative symptom subdomains and premorbid and treatment related variables. RESULTS Factor analysis confirmed a two-factor solution for experiential and expressive subdomains of negative symptoms, although they were strongly correlated. The treatment response trajectories for the two subdomains did not differ significantly, and neither subdomain was significantly associated with our premorbid variables. We found significant main effects for disorganised symptoms and extrapyramidal symptoms on the expressive subdomain, and for disorganised symptoms and depressive symptoms on the experiential subdomain. Post-hoc testing indicated that reductions in HDL-cholesterol levels were associated with less improvement in both expressive and experiential subdomain scores. CONCLUSION The two negative symptom subdomains are closely related, have similar premorbid correlates and respond similarly to antipsychotic treatment. Depression affects the experiential subdomain, whereas extrapyramidal symptoms affect the expressive subdomain.
Collapse
Affiliation(s)
| | - Laila Asmal
- Department of Psychiatry, Stellenbosch University, South Africa
| | | | | | - Freda Scheffler
- Department of Psychiatry, Stellenbosch University, South Africa
| | - Retha Smit
- Department of Psychiatry, Stellenbosch University, South Africa
| | - Bonginkosi Chiliza
- Department of Psychiatry, Nelson R Mandela School of Medicine, University of Kwazulu-Natal, South Africa
| | - Robin Emsley
- Department of Psychiatry, Stellenbosch University, South Africa
| |
Collapse
|
5
|
Schlag F, Allegrini AG, Buitelaar J, Verhoef E, van Donkelaar M, Plomin R, Rimfeld K, Fisher SE, St Pourcain B. Polygenic risk for mental disorder reveals distinct association profiles across social behaviour in the general population. Mol Psychiatry 2022; 27:1588-1598. [PMID: 35228676 PMCID: PMC9095485 DOI: 10.1038/s41380-021-01419-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 11/26/2021] [Accepted: 12/01/2021] [Indexed: 12/16/2022]
Abstract
Many mental health conditions present a spectrum of social difficulties that overlaps with social behaviour in the general population including shared but little characterised genetic links. Here, we systematically investigate heterogeneity in shared genetic liabilities with attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorders (ASD), bipolar disorder (BP), major depression (MD) and schizophrenia across a spectrum of different social symptoms. Longitudinally assessed low-prosociality and peer-problem scores in two UK population-based cohorts (4-17 years; parent- and teacher-reports; Avon Longitudinal Study of Parents and Children(ALSPAC): N ≤ 6,174; Twins Early Development Study(TEDS): N ≤ 7,112) were regressed on polygenic risk scores for disorder, as informed by genome-wide summary statistics from large consortia, using negative binomial regression models. Across ALSPAC and TEDS, we replicated univariate polygenic associations between social behaviour and risk for ADHD, MD and schizophrenia. Modelling variation in univariate genetic effects jointly using random-effect meta-regression revealed evidence for polygenic links between social behaviour and ADHD, ASD, MD, and schizophrenia risk, but not BP. Differences in age, reporter and social trait captured 45-88% in univariate effect variation. Cross-disorder adjusted analyses demonstrated that age-related heterogeneity in univariate effects is shared across mental health conditions, while reporter- and social trait-specific heterogeneity captures disorder-specific profiles. In particular, ADHD, MD, and ASD polygenic risk were more strongly linked to peer problems than low prosociality, while schizophrenia was associated with low prosociality only. The identified association profiles suggest differences in the social genetic architecture across mental disorders when investigating polygenic overlap with population-based social symptoms spanning 13 years of child and adolescent development.
Collapse
Affiliation(s)
- Fenja Schlag
- Language and Genetics Department, Max Planck Institute for Psycholinguistics, Wundtlaan 1, 6525 XD, Nijmegen, The Netherlands
| | - Andrea G Allegrini
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, Memory Ln, Camberwell, London, SE5 8AF, London, UK
- Psychology and Language Sciences, University College London, 26 Bedford Way, Bloomsbury, London, WC1H 0AP, London, UK
| | - Jan Buitelaar
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Kapittelweg 29, 6525 EN, Nijmegen, The Netherlands
- Karakter Child and Adolescent Psychiatry University Centre, Reinier Postlaan 12, 6525 GC, Nijmegen, The Netherlands
- Department of Cognitive Neuroscience, Radboud University Medical Center, Geert Grooteplein 21, 6525 EZ, Nijmegen, The Netherlands
| | - Ellen Verhoef
- Language and Genetics Department, Max Planck Institute for Psycholinguistics, Wundtlaan 1, 6525 XD, Nijmegen, The Netherlands
| | - Marjolein van Donkelaar
- Language and Genetics Department, Max Planck Institute for Psycholinguistics, Wundtlaan 1, 6525 XD, Nijmegen, The Netherlands
| | - Robert Plomin
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, Memory Ln, Camberwell, London, SE5 8AF, London, UK
| | - Kaili Rimfeld
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, Memory Ln, Camberwell, London, SE5 8AF, London, UK
| | - Simon E Fisher
- Language and Genetics Department, Max Planck Institute for Psycholinguistics, Wundtlaan 1, 6525 XD, Nijmegen, The Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Kapittelweg 29, 6525 EN, Nijmegen, The Netherlands
| | - Beate St Pourcain
- Language and Genetics Department, Max Planck Institute for Psycholinguistics, Wundtlaan 1, 6525 XD, Nijmegen, The Netherlands.
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Kapittelweg 29, 6525 EN, Nijmegen, The Netherlands.
- MRC Integrative Epidemiology Unit, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK.
- Population Health Sciences, University of Bristol, 5 Tyndall Avenue, Bristol, BS8 1UD, UK.
| |
Collapse
|
6
|
The association of matrix metalloproteinase 9 (MMP9) with hippocampal volume in schizophrenia: a preliminary MRI study. Neuropsychopharmacology 2022; 47:524-530. [PMID: 33833403 PMCID: PMC8674225 DOI: 10.1038/s41386-021-00997-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 02/13/2021] [Accepted: 03/05/2021] [Indexed: 02/02/2023]
Abstract
Matrix metalloproteinases 9 (MMP9) are enzymes involved in regulating neuroplasticity in the hippocampus. This, combined with evidence for disrupted hippocampal structure and function in schizophrenia, has prompted our current investigation into the relationship between MMP9 and hippocampal volumes in schizophrenia. 34 healthy individuals (mean age = 32.50, male = 21, female = 13) and 30 subjects with schizophrenia (mean age = 33.07, male = 19, female = 11) underwent a blood draw and T1-weighted magnetic resonance imaging. The hippocampus was automatically segmented utilizing FreeSurfer. MMP9 plasma levels were measured with ELISA. ANCOVAs were conducted to compare MMP9 plasma levels (corrected for age and sex) and hippocampal volumes between groups (corrected for age, sex, total intracranial volume). Spearman correlations were utilized to investigate the relationship between symptoms, medication, duration of illness, number of episodes, and MMP9 plasma levels in patients. Last, we explored the correlation between MMP9 levels and hippocampal volumes in patients and healthy individuals separately. Patients displayed higher MMP9 plasma levels than healthy individuals (F(1, 60) = 21.19, p < 0.0001). MMP9 levels correlated with negative symptoms in patients (R = 0.39, p = 0.035), but not with medication, duration of illness, or the number of episodes. Further, patients had smaller left (F(1,59) = 9.12, p = 0.0040) and right (F(1,59) = 6.49, p = 0.013) hippocampal volumes. Finally, left (R = -0.39, p = 0.034) and right (R = -0.37, p = 0.046) hippocampal volumes correlated negatively with MMP9 plasma levels in patients. We observe higher MMP9 plasma levels in SCZ, associated with lower hippocampal volumes, suggesting involvement of MMP9 in the pathology of SCZ. Future studies are needed to investigate how MMP9 influences the pathology of SCZ over the lifespan, whether the observed associations are specific for schizophrenia, and if a therapeutic modulation of MMP9 promotes neuroprotective effects in SCZ.
Collapse
|
7
|
Collo G, Mucci A, Giordano GM, Merlo Pich E, Galderisi S. Negative Symptoms of Schizophrenia and Dopaminergic Transmission: Translational Models and Perspectives Opened by iPSC Techniques. Front Neurosci 2020; 14:632. [PMID: 32625059 PMCID: PMC7315891 DOI: 10.3389/fnins.2020.00632] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 05/22/2020] [Indexed: 12/18/2022] Open
Abstract
Negative symptoms (NS) represent a heterogeneous dimension of schizophrenia (SCZ), associated with a poor functional outcome. A dysregulated dopamine (DA) system, including a reduced D1 receptor activation in the prefrontal cortex, DA hypoactivity in the caudate and alterations in D3 receptor activity, seems to contribute to the pathogenesis of NS. However, failure to take into account the NS heterogeneity has slowed down progress in research on their neurobiological correlates and discoveries of new effective treatments. A better neurobiological characterization of NS is needed, and this requires objective quantification of their features that can be applied in translational models, such as animal models and human inducible pluripotent stem cells (iPSC). In this review we summarize the evidence for dopaminergic alterations relevant to NS in translational animal models focusing on dysfunctional motivation, a core aspect of NS. Among others, experiments on mutant rodents with an overexpression of DA D2 or D3 receptors and the dopamine deficient mice are discussed. In the second part we summarize the findings from recent studies using iPSC to model the pathogenesis of SCZ. By retaining the genetic background of risk genetic variants, iPSC offer the possibility to study the effect of de novo mutations or inherited polymorphisms from subgroups of patients and their response to drugs, adding an important tool for personalized psychiatry. Given the key role of DA in NS, we focus on findings of iPSC-derived DA neurons. Since implementation of iPSC-derived neurons to study the neurobiology of SCZ is a relatively recent acquisition, the available data are limited. We highlight some methodological aspects of relevance in the interpretation of in vitro testing results, including limitations and strengths, offering a critical viewpoint for the implementation of future pharmacological studies aimed to the discovery and characterization of novel treatments for NS.
Collapse
Affiliation(s)
- Ginetta Collo
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Armida Mucci
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Giulia M. Giordano
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Emilio Merlo Pich
- Research & Development, Alfasigma Schweiz, Zofingen, Switzerland
- Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Silvana Galderisi
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Naples, Italy
| |
Collapse
|
8
|
The Influence of Premorbid Adjustment and Autistic Traits on Social Cognitive Dysfunction in Schizophrenia. J Int Neuropsychol Soc 2020; 26:276-285. [PMID: 31507263 DOI: 10.1017/s1355617719000961] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Premorbid dysfunction during childhood and adolescence is well documented in patients with schizophrenia. Literature pointed out multiple premorbid trajectories leading to different patients' cognitive status, symptomatology, and global functioning after disease onset. This study aimed at identifying groups of premorbid trajectories and disentangling between group differences in clinical and cognitive measures, focusing on theory of mind (ToM) and autistic traits (ATs). METHODS Ninety-seven patients with schizophrenia were recruited and assessed for cognitive and ToM abilities, psychopathology, and ATs. A two-step cluster analysis identified three different groups of patients based on premorbid adjustment during childhood, adolescence, and late adolescence (i.e., stable-good, stable-poor, and "deteriorating"). RESULTS Compared to 66 healthy controls, results showed a widespread impairment in cognitive and ToM abilities among all groups of patients, except for affective ToM and executive functions in the stable-good group. Moreover, the stable-poor group exhibited more pronounced ATs and a more severe ToM impairment, compared to the other two groups of patients. CONCLUSIONS Our findings highlight the existence of a group of patients with poor premorbid adjustment since childhood, more pronounced ATs and a severe ToM impairment affecting those basic mentalizing skills that are usually preserved in schizophrenia. Results might have intriguing implications in identifying underpinning endophenotypes and implementing cutting-edge rehabilitation programs.
Collapse
|
9
|
Hall MH, Holton KM, Öngür D, Montrose D, Keshavan MS. Longitudinal trajectory of early functional recovery in patients with first episode psychosis. Schizophr Res 2019; 209:234-244. [PMID: 30826261 PMCID: PMC7003957 DOI: 10.1016/j.schres.2019.02.003] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 01/11/2019] [Accepted: 02/05/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND There is a large variability in the recovery trajectory and outcome of first episode of psychosis [FEP] patients. To date, individuals' outcome trajectories at early stage of illness and potential risk factors associated with a poor outcome trajectory are largely unknown. This study aims to apply three separate predictors (positive symptoms, negative symptoms, and soft neurological signs) to identify homogeneous function outcome trajectories in patients with FEP using objective data-driven methods, and to explore the potential risk /protective factors associated with each trajectory. METHODS A total of 369 first episode patients (93% antipsychotic naive) were included in the baseline assessments and followed-up at 4-8 weeks, 6 months, and 1 year. K means cluster modeling for longitudinal data (kml3d) was used to identify distinct, homogeneous clusters of functional outcome trajectories. Patients with at least 3 assessments were included in the trajectory analyses (N = 129). The Scale for the Assessment of Negative Symptoms (SANS), Scale for the Assessment of Positive Symptoms (SAPS), and Neurological examination abnormalities (NEA) were used as predictors against Global Assessment of Functioning Scale (GAF). RESULTS In each of the three predictor models, four distinct functional outcome trajectories emerged: "Poor", "Intermediate", High" and "Catch-up". Individuals with male gender; ethnic minority status; low premorbid adjustment; low executive function/IQ, low SES, personality disorder, substance use history may be risk factors for poor recovery. CONCLUSIONS Functioning recovery in individuals with FEP is heterogeneous, although distinct recovery profiles are apparent. Data-driven trajectory analysis can facilitate better characterization of individual longitudinal patterns of functioning recovery.
Collapse
Affiliation(s)
- Mei-Hua Hall
- Psychotic Disorders Division, McLean Hospital HMS, Boston, MA, USA.
| | | | - Dost Öngür
- Psychotic Disorders Division, McLean Hospital HMS, Boston, MA, USA
| | - Debra Montrose
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Department of Psychiatry, Pittsburgh, PA, USA
| | - Matcheri S Keshavan
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Department of Psychiatry, Pittsburgh, PA, USA; Beth Israel Deaconess Medical Center and Massachusetts Mental Health Center, HMS, Boston, MA, USA
| |
Collapse
|
10
|
Gao J, Tang X, Kang J, Xie C, Yu M, Sha W, Wang X, Zhang X, Zhang X, Yi H. Correlation between neurocognitive impairment and DNA methylation of MMP-9 gene in patients with deficit schizophrenia. Schizophr Res 2019; 204:455-457. [PMID: 30337154 DOI: 10.1016/j.schres.2018.10.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 09/17/2018] [Accepted: 10/06/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Ju Gao
- Department of Geriatric Psychiatry, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu 210029, China; Centers for Disease Control of Mental Disorders, Shanghai, Changning Mental Health Center, Shanghai 200335, China
| | - Xiaowei Tang
- Department of Geriatric Psychiatry, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu 210029, China; Department of Psychiatry, Wutaishan Hospital of Yangzhou, Yangzhou, Jiangsu 225003, China
| | - Ju Kang
- Centers for Disease Control of Mental Disorders, Shanghai, Changning Mental Health Center, Shanghai 200335, China
| | - Chunming Xie
- Department of Neurology, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Miao Yu
- Department of Geriatric Psychiatry, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Weiwei Sha
- Department of Psychiatry, Wutaishan Hospital of Yangzhou, Yangzhou, Jiangsu 225003, China
| | - Xiang Wang
- Medical Psychological Institute of the Second Xiangya Hospital, Changsha, Hunan 410011, China
| | - Xiaobin Zhang
- Department of Psychiatry, Wutaishan Hospital of Yangzhou, Yangzhou, Jiangsu 225003, China
| | - Xiangrong Zhang
- Department of Geriatric Psychiatry, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu 210029, China.
| | - Hongwei Yi
- Department of Pharmacology, School of Medicine, Southeast University, Nanjing, Jiangsu 210009, China.
| |
Collapse
|
11
|
Bucci P, Galderisi S, Mucci A, Rossi A, Rocca P, Bertolino A, Aguglia E, Amore M, Andriola I, Bellomo A, Biondi M, Cuomo A, dell'Osso L, Favaro A, Gambi F, Giordano GM, Girardi P, Marchesi C, Monteleone P, Montemagni C, Niolu C, Oldani L, Pacitti F, Pinna F, Roncone R, Vita A, Zeppegno P, Maj M. Premorbid academic and social functioning in patients with schizophrenia and its associations with negative symptoms and cognition. Acta Psychiatr Scand 2018; 138:253-266. [PMID: 29984409 DOI: 10.1111/acps.12938] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/14/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The study aimed to explore premorbid academic and social functioning in patients with schizophrenia, and its associations with the severity of negative symptoms and neurocognitive impairment. METHOD Premorbid adjustment (PA) in patients with schizophrenia was compared to early adjustment in unaffected first-degree relatives and healthy controls. Its associations with psychopathology, cognition, and real-life functioning were investigated. The associations of PA with primary negative symptoms and their two factors were explored. RESULTS We found an impairment of academic and social PA in patients (P ≤ 0.000001) and an impairment of academic aspects of early adjustment in relatives (P ≤ 0.01). Patients with poor PA showed greater severity of negative symptoms (limited to avolition after excluding the effect of depression/parkinsonism), working memory, social cognition, and real-life functioning (P ≤ 0.01 to ≤0.000001). Worse academic and social PA were associated with greater severity of psychopathology, cognitive impairment, and real-life functioning impairment (P ≤ 0.000001). Regression analyses showed that worse PA in the academic domain was mainly associated to the impairment of working memory, whereas worse PA in the social domain to avolition (P ≤ 0.000001). CONCLUSION Our findings suggest that poor early adjustment may represent a marker of vulnerability to schizophrenia and highlight the need for preventive/early interventions based on psychosocial and/or cognitive programs.
Collapse
Affiliation(s)
- P Bucci
- Department of Psychiatry, University of Campania L. Vanvitelli, Naples, Italy
| | - S Galderisi
- Department of Psychiatry, University of Campania L. Vanvitelli, Naples, Italy
| | - A Mucci
- Department of Psychiatry, University of Campania L. Vanvitelli, Naples, Italy
| | - A Rossi
- Section of Psychiatry, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - P Rocca
- Section of Psychiatry, Department of Neuroscience, University of Turin, Turin, Italy
| | - A Bertolino
- Department of Neurological and Psychiatric Sciences, University of Bari, Bari, Italy
| | - E Aguglia
- Department of Clinical and Molecular Biomedicine, Psychiatry Unit, University of Catania, Catania, Italy
| | - M Amore
- Section of Psychiatry, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health, University of Genoa, Genoa, Italy
| | - I Andriola
- Department of Neurological and Psychiatric Sciences, University of Bari, Bari, Italy
| | - A Bellomo
- Psychiatry Unit, Department of Medical Sciences, University of Foggia, Foggia, Italy
| | - M Biondi
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - A Cuomo
- Department of Molecular Medicine and Clinical Department of Mental Health, University of Siena, Siena, Italy
| | - L dell'Osso
- Section of Psychiatry, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - A Favaro
- Department of Neurosciences, Psychiatric Clinic, University of Padua, Padua, Italy
| | - F Gambi
- Chair of Psychiatry, Department of Neuroscience and Imaging, G. d'Annunzio University, Chieti, Italy
| | - G M Giordano
- Department of Psychiatry, University of Campania L. Vanvitelli, Naples, Italy
| | - P Girardi
- Department of Neurosciences, Mental Health and Sensory Organs, S. Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - C Marchesi
- Department of Neuroscience, Psychiatry Unit, University of Parma, Parma, Italy
| | - P Monteleone
- Chair of Psychiatry, Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - C Montemagni
- Section of Psychiatry, Department of Neuroscience, University of Turin, Turin, Italy
| | - C Niolu
- Chair of Psychiatry, Department of Systems Medicine, Tor Vergata University of Rome, Rome, Italy
| | - L Oldani
- Department of Psychiatry, University of Milan, Milan, Italy
| | - F Pacitti
- Section of Psychiatry, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - F Pinna
- Section of Psychiatry, Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy
| | - R Roncone
- Unit of Psychiatry, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - A Vita
- Psychiatric Unit, School of Medicine, University of Brescia, Brescia, Italy.,Department of Mental Health, Spedali Civili Hospital, Brescia, Italy
| | - P Zeppegno
- Psychiatric Unit, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - M Maj
- Department of Psychiatry, University of Campania L. Vanvitelli, Naples, Italy
| | | |
Collapse
|
12
|
Galderisi S, Mucci A, Buchanan RW, Arango C. Negative symptoms of schizophrenia: new developments and unanswered research questions. Lancet Psychiatry 2018; 5:664-677. [PMID: 29602739 DOI: 10.1016/s2215-0366(18)30050-6] [Citation(s) in RCA: 256] [Impact Index Per Article: 42.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 10/03/2017] [Accepted: 12/13/2017] [Indexed: 01/05/2023]
Abstract
Negative symptoms of schizophrenia are associated with poor functional outcome and place a substantial burden on people with this disorder, their families, and health-care systems. We summarise the evolution of the conceptualisation of negative symptoms, the most important findings, and the remaining open questions. Several studies have shown that negative symptoms might be primary to schizophrenia or secondary to other factors, and that they cluster in the domains of avolition-apathy and expressive deficit. Failure to take this heterogeneity into account might hinder progress in research on neurobiological substrates and discoveries of treatments for primary or enduring negative symptoms. Improvement in recognition and routine assessment of negative symptoms is instrumental for correct management of secondary negative symptoms that are amenable to treatment. If substantial progress is to be made in the understanding and treatment of negative symptoms, then advances in concepts and assessment should be integrated into the design of future studies of these symptoms.
Collapse
Affiliation(s)
- Silvana Galderisi
- Department of Psychiatry, University of Campania Luigi Vanvitelli, Naples, Italy.
| | - Armida Mucci
- Department of Psychiatry, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Robert W Buchanan
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Celso Arango
- Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, Centro de Investigación en Red de Salud Mental, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| |
Collapse
|
13
|
Crespi BJ. The Paradox of Copy Number Variants in ASD and Schizophrenia: False Facts or False Hypotheses? REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2018. [DOI: 10.1007/s40489-018-0132-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
|
14
|
Bora E, Binnur Akdede B, Alptekin K. Neurocognitive impairment in deficit and non-deficit schizophrenia: a meta-analysis. Psychol Med 2017; 47:2401-2413. [PMID: 28468693 DOI: 10.1017/s0033291717000952] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Most studies suggested that patients with deficit schizophrenia have more severe impairment compared with patients with non-deficit schizophrenia. However, it is not clear whether deficit and non-deficit schizophrenia are associated with differential neurocognitive profiles. METHODS The aim of this meta-analytic review was to compare cognitive performances of deficit and non-deficit patients with each other and with healthy controls. In the current meta-analysis, differences in cognitive abilities between 897 deficit and 1636 non-deficit patients with schizophrenia were examined. Cognitive performances of 899 healthy controls were also compared with 350 patients with deficit and 592 non-deficit schizophrenia. RESULTS Both deficit (d = 1.04-1.53) and non-deficit (d = 0.68-1.19) schizophrenia were associated with significant deficits in all cognitive domains. Deficit patients underperformed non-deficit patients in all cognitive domains (d = 0.24-0.84) and individual tasks (d = 0.39-0.93). The relationship between deficit syndrome and impairment in olfaction, social cognition, verbal fluency, and speed-based cognitive tasks were relatively stronger. CONCLUSIONS Our findings suggest that there is consistent evidence for a significant relationship between deficit syndrome and more severe cognitive impairment in schizophrenia.
Collapse
Affiliation(s)
- E Bora
- Department of Psychiatry,Dokuz Eylul University School of Medicine,Izmir,Turkey
| | - B Binnur Akdede
- Department of Psychiatry,Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health,Carlton South, Victoria 3053,Australia
| | - K Alptekin
- Department of Psychiatry,Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health,Carlton South, Victoria 3053,Australia
| |
Collapse
|
15
|
Yu M, Dai Z, Tang X, Wang X, Zhang X, Sha W, Yao S, Shu N, Wang X, Yang J, Zhang X, Zhang X, He Y, Zhang Z. Convergence and Divergence of Brain Network Dysfunction in Deficit and Non-deficit Schizophrenia. Schizophr Bull 2017; 43:1315-1328. [PMID: 29036672 PMCID: PMC5737538 DOI: 10.1093/schbul/sbx014] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Deficit schizophrenia (DS), characterized by primary and enduring negative symptoms, has been considered as a pathophysiologically distinct schizophrenic subgroup. Neuroimaging characteristics of DS, especially functional brain network architecture, remain largely unknown. Resting-state functional magnetic resonance imaging and graph theory approaches were employed to investigate the topological organization of whole-brain functional networks of 114 male participants including 33 DS, 41 non-deficit schizophrenia (NDS) and 40 healthy controls (HCs). At the whole-brain level, both the NDS and DS group exhibited lower local efficiency (Eloc) than the HC group, implying the reduction of local specialization of brain information processing (reduced functional segregation). The DS, but not NDS group, exhibited enhanced parallel information transfer (enhanced functional integration) as determined by smaller characteristic path length (Lp) and higher global efficiency (Eglob). The Lp and Eglob presented significant correlations with Brief Psychiatric Rating Scale (BPRS) total score in the DS group. At the nodal level, both the NDS and DS groups showed higher functional connectivity in the inferior frontal gyrus and hippocampus, and lower connectivity in the visual areas and striatum than the controls. The DS group exhibited higher nodal connectivity in the right inferior temporal gyrus than the NDS and HC group. The diminished expression of Scale for the Assessment of Negative Symptoms (SANS) subfactors negatively correlated with nodal connectivity of right putamen, while asociality/amotivation positively correlated with right hippocampus across whole patients. We highlighted the convergence and divergence of brain functional network dysfunctions in patients with DS and NDS, which provides crucial insights into pathophysiological mechanisms of the 2 schizophrenic subtypes.
Collapse
Affiliation(s)
- Miao Yu
- Department of Neuropsychiatry, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Zhengjia Dai
- Department of Psychology, Sun Yat-sen University, Guangzhou, China,State Key Laboratory of Cognitive Neuroscience and Learning & IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
| | - Xiaowei Tang
- Department of Psychiatry, Wutaishan Hospital of Yangzhou, Yangzhou, China
| | - Xiang Wang
- Medical Psychological Institute of the Second Xiangya Hospital, Central South University, Changsha, China
| | - Xiaobin Zhang
- Department of Psychiatry, Wutaishan Hospital of Yangzhou, Yangzhou, China
| | - Weiwei Sha
- Department of Psychiatry, Wutaishan Hospital of Yangzhou, Yangzhou, China
| | - Shuqiao Yao
- Medical Psychological Institute of the Second Xiangya Hospital, Central South University, Changsha, China
| | - Ni Shu
- State Key Laboratory of Cognitive Neuroscience and Learning & IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
| | - Xindi Wang
- State Key Laboratory of Cognitive Neuroscience and Learning & IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
| | - Jiaying Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Southeast University, Nanjing, China
| | - Xiangyang Zhang
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX
| | - Xiangrong Zhang
- Department of Neuropsychiatry, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China,Department of Geriatric Psychiatry, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, China,To whom correspondence should be addressed; Department of Neuropsychiatry, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, No.87 DingJiaQiao Road, Nanjing 210009, China; tel: 0086-25-822906586, fax:0086-25-83719457, e-mail:
| | - Yong He
- State Key Laboratory of Cognitive Neuroscience and Learning & IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
| | - Zhijun Zhang
- Department of Neuropsychiatry, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China,Beijing Institute for Brain Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
16
|
Takahashi T, Takayanagi Y, Nishikawa Y, Nakamura M, Komori Y, Furuichi A, Kido M, Sasabayashi D, Noguchi K, Suzuki M. Brain neurodevelopmental markers related to the deficit subtype of schizophrenia. Psychiatry Res Neuroimaging 2017; 266:10-18. [PMID: 28549318 DOI: 10.1016/j.pscychresns.2017.05.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 03/29/2017] [Accepted: 05/19/2017] [Indexed: 02/02/2023]
Abstract
Deficit schizophrenia is a homogeneous subtype characterized by a trait-like feature of primary and prominent negative symptoms, but the etiologic factors related to this specific subtype remain largely unknown. This magnetic resonance imaging study aimed to examine gross brain morphology that probably reflects early neurodevelopment in 38 patients with deficit schizophrenia, 37 patients with non-deficit schizophrenia, and 59 healthy controls. Potential brain neurodevelopmental markers investigated in this study were the adhesio interthalamica (AI), cavum septi pellucidi (CSP), and surface morphology (i.e., olfactory sulcus depth, sulcogyral pattern, and number of orbital sulci) of the orbitofrontal cortex (OFC). The subtype classification of schizophrenia patients was based on the score of Proxy for the Deficit Syndrome. The deficit schizophrenia group had a significantly shorter AI compared with the non-deficit group and controls. The deficit group, but not the non-deficit group, was also characterized by an altered distribution of the OFC sulcogyral pattern, as well as fewer posterior orbital sulcus compared with controls. Other neurodevelopmental markers did not differentiate the deficit and non-deficit subgroups. These results suggest that the deficit subtype of schizophrenia and its clinical manifestation may be at least partly related to prominent neurodevelopmental pathology.
Collapse
Affiliation(s)
- Tsutomu Takahashi
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan.
| | - Yoichiro Takayanagi
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan
| | - Yumiko Nishikawa
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan
| | - Mihoko Nakamura
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan
| | - Yuko Komori
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan
| | - Atsushi Furuichi
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan
| | - Mikio Kido
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan
| | - Daiki Sasabayashi
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan
| | - Kyo Noguchi
- Department of Radiology, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan
| | - Michio Suzuki
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan
| |
Collapse
|
17
|
Mucci A, Merlotti E, Üçok A, Aleman A, Galderisi S. Primary and persistent negative symptoms: Concepts, assessments and neurobiological bases. Schizophr Res 2017; 186:19-28. [PMID: 27242069 DOI: 10.1016/j.schres.2016.05.014] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 05/10/2016] [Accepted: 05/17/2016] [Indexed: 02/01/2023]
Abstract
Primary and persistent negative symptoms (PPNS) represent an unmet need in the care of people with schizophrenia. They have an unfavourable impact on real-life functioning and do not respond to available treatments. Underlying etiopathogenetic mechanisms of PPNS are still unknown. The presence of primary and enduring negative symptoms characterizes deficit schizophrenia (DS), proposed as a separate disease entity with respect to non-deficit schizophrenia (NDS). More recently, to reduce the heterogeneity of negative symptoms by using criteria easily applicable in the context of clinical trials, the concept of persistent negative symptoms (PNS) was developed. Both PNS and DS constructs include enduring negative symptoms (at least 6months for PNS and 12months for DS) that do not respond to available treatments. PNS exclude secondary negative symptoms based on a cross-sectional evaluation of severity thresholds on commonly used rating scales for positive symptoms, depression and extrapyramidal side effects; the DS diagnosis, instead, excludes all potential sources of secondary negative symptoms based on a clinical longitudinal assessment. In this paper we review the evolution of concepts and assessment modalities relevant to PPNS, data on prevalence of DS and PNS, as well as studies on clinical, neuropsychological, brain imaging electrophysiological and psychosocial functioning aspects of DS and PNS.
Collapse
Affiliation(s)
- Armida Mucci
- Department of Psychiatry, University of Naples SUN, Naples, Italy.
| | | | - Alp Üçok
- Department of Psychiatry, Psychotic Disorders Research Program, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - André Aleman
- University of Groningen, University Medical Center Groningen, Department of Neuroscience and Department of Psychology, Groningen, The Netherlands
| | | |
Collapse
|
18
|
Abstract
We previously proposed that people with schizophrenia who have primary, enduring negative symptoms have a disease-deficit schizophrenia (DS)-that is separate from that affecting people with schizophrenia without these features. Additional evidence consistent with the separate disease hypothesis has accumulated in recent years. White matter changes may be widespread in deficit compared to nondeficit patients and may relate to problems in early brain migration. These 2 patient groups also appear to differ on metabolic measures prior to antipsychotic treatment. Studies of reward and defeatist beliefs provide the basis for future treatment trials. The 2 factors or groups within negative symptoms broadly defined (both primary and secondary) have also been found in DS, and recent evidence suggests these 2 symptom groups have different correlates and reflect the existence of 2 groups with in DS. Negative symptoms are found in disorders other than schizophrenia, and excess summer birth, a deficit risk factor, has been found in a non-patient group with deficit-like features. It may be useful in future research to determine whether findings in DS extend to patients with other neuropsychiatric disorders who also have negative symptoms.
Collapse
Affiliation(s)
- Brian Kirkpatrick
- Department of Psychiatry and Behavioral Sciences, University of Nevada Reno School of Medicine, Reno, NV
| | - Armida Mucci
- Department of Psychiatry, University of Naples SUN, Naples, Italy
| | - Silvana Galderisi
- Department of Psychiatry, University of Campania Luigi Vanvitelli (SUN); University Hospital SUN, Naples, Italy
| |
Collapse
|
19
|
Exploring functioning in schizophrenia: Predictors of functional capacity and real-world behaviour. Psychiatry Res 2017; 251:118-124. [PMID: 28199909 DOI: 10.1016/j.psychres.2017.02.019] [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] [Received: 10/19/2016] [Revised: 01/19/2017] [Accepted: 02/08/2017] [Indexed: 02/06/2023]
Abstract
Impairment in daily functioning still represents a major treatment issue in schizophrenia and a more in-depth knowledge of underlying constructs is crucial for interventions to translate into better outcomes. This study aims to model factors influencing both functional capacity and real-life behaviour in a sample of outpatients with chronic schizophrenia, through a comprehensive assessment including evaluations of psychopathology, cognitive and social cognitive abilities, premorbid adjustment, family environment and early childhood experiences. No significant correlation was observed between functional capacity and real-life behaviour. Functional capacity was significantly predicted by IQ, while real-life behaviour was significantly predicted by empathy, affect recognition and symptoms. Functional capacity seems mainly related to neurocognition, whereas real-life behaviour appears more complex, requiring the integration of different factors including symptoms, with a major role of empathy. Results thus support a divergence between the two constructs of functioning and their underlying components and highlight the need to target both dimensions through individualized sequential rehabilitation programs in order to optimize functional outcome.
Collapse
|
20
|
Abstract
PURPOSE OF REVIEW To provide a review on studies published in the last year relevant to the categorization and assessment of negative symptoms. RECENT FINDINGS Recent research supported the validity of the 'deficit/non-deficit schizophrenia' categorization. Few studies confirmed the validity of the category 'persistent negative symptoms', whereas no recent study explored the validity of the category 'predominant negative symptoms'. The two-factor structure of the negative dimension is supported by studies reporting different correlates for the two subdomains: diminished expression and avolition/apathy. The need to further split avolition/apathy in two distinct components, that is anhedonia and amotivation, is confirmed in recent papers. Additional approaches to the assessment of negative symptoms have been proposed, including the self-assessment of negative symptoms, and the evaluation of negative symptoms in daily life and their assessment by means of computerized analyses. SUMMARY Negative symptoms represent an unmet need in the care of schizophrenia, as they are associated to poor response to available treatments and to poor functional outcome. Their accurate categorization and assessment represent a major challenge for research on neurobiological substrates and new treatment strategies.
Collapse
|