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Association between subjective distress and symptom domains in patients with treatment-resistant schizophrenia receiving clozapine. Schizophr Res 2022; 240:228-230. [PMID: 35086033 DOI: 10.1016/j.schres.2022.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 12/28/2021] [Accepted: 01/01/2022] [Indexed: 11/21/2022]
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Schoorl J, Barbu MC, Shen X, Harris MR, Adams MJ, Whalley HC, Lawrie SM. Grey and white matter associations of psychotic-like experiences in a general population sample (UK Biobank). Transl Psychiatry 2021; 11:21. [PMID: 33414383 PMCID: PMC7791107 DOI: 10.1038/s41398-020-01131-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 11/10/2020] [Accepted: 11/23/2020] [Indexed: 01/29/2023] Open
Abstract
There has been a substantial amount of research reporting the neuroanatomical associations of psychotic symptoms in people with schizophrenia. Comparatively little attention has been paid to the neuroimaging correlates of subclinical psychotic symptoms, so-called "psychotic-like experiences" (PLEs), within large healthy populations. PLEs are relatively common in the general population (7-13%), can be distressing and negatively affect health. This study therefore examined gray and white matter associations of four different PLEs (auditory or visual PLEs, and delusional ideas about conspiracies or communications) in subjects of the UK Biobank study with neuroimaging data (N = 21,390, mean age = 63 years). We tested for associations between any PLE (N = 768) and individual PLEs with gray and white matter brain structures, controlling for sex, age, intracranial volume, scanning site, and position in the scanner. Individuals that reported having experienced auditory hallucinations (N = 272) were found to have smaller volumes of the caudate, putamen, and accumbens (β = -0.115-0.134, pcorrected = 0.048-0.036), and reduced temporal lobe volume (β = -0.017, pcorrected = 0.047) compared to those that did not. People who indicated that they had ever believed in unreal conspiracies (N = 111) had a larger volume of the left amygdala (β = 0.023, pcorrected = 0.038). Individuals that reported a history of visual PLEs (N = 435) were found to have reduced white matter microstructure of the forceps major (β = -0.029, pcorrected = 0.009), an effect that was more marked in participants who reported PLEs as distressing. These associations were not accounted for by diagnoses of psychotic or depressive illness, nor the known risk factors for psychotic symptoms of childhood adversity or cannabis use. These findings suggest altered regional gray matter volumes and white matter microstructure in association with PLEs in the general population. They further suggest that these alterations may appear more frequently with the presentation of different psychotic symptoms in the absence of clinically diagnosed psychotic disorders.
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Affiliation(s)
- Julie Schoorl
- Division of Psychiatry, Kennedy Tower, Royal Edinburgh Hospital, Edinburgh, EH10 5HF, UK
| | - Miruna C Barbu
- Division of Psychiatry, Kennedy Tower, Royal Edinburgh Hospital, Edinburgh, EH10 5HF, UK
| | - Xueyi Shen
- Division of Psychiatry, Kennedy Tower, Royal Edinburgh Hospital, Edinburgh, EH10 5HF, UK
| | - Mat R Harris
- Division of Psychiatry, Kennedy Tower, Royal Edinburgh Hospital, Edinburgh, EH10 5HF, UK
| | - Mark J Adams
- Division of Psychiatry, Kennedy Tower, Royal Edinburgh Hospital, Edinburgh, EH10 5HF, UK
| | - Heather C Whalley
- Division of Psychiatry, Kennedy Tower, Royal Edinburgh Hospital, Edinburgh, EH10 5HF, UK
| | - Stephen M Lawrie
- Division of Psychiatry, Kennedy Tower, Royal Edinburgh Hospital, Edinburgh, EH10 5HF, UK.
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Nomura N, Kitagawa K, So R, Misawa F, Kodama M, Takeuchi H, Bies R, Straubinger T, Banker C, Mizuno Y, Mimura M, Uchida H. Comprehensive assessment of exposure to clozapine in association with side effects among patients with treatment-resistant schizophrenia: a population pharmacokinetic study. Ther Adv Psychopharmacol 2021; 11:20451253211016189. [PMID: 34046160 PMCID: PMC8138292 DOI: 10.1177/20451253211016189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 04/20/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND There have been scarce data on the distribution of clozapine concentrations in comparison with the recommended range (350-600 ng/ml) or their relationship with side effects among patients with treatment-resistant schizophrenia. Furthermore, no studies have assessed the association between side effects and overall exposure to the drug by calculating the 24-h area-under-curve (AUC). METHODS In- and outpatients with schizophrenia or schizoaffective disorder (ICD-10) who were receiving a stable dose of clozapine for ⩾2 weeks were included. Side effects were assessed using the Glasgow antipsychotic side-effects scale for clozapine (GASS-C). Using two collected plasma samples, plasma clozapine and norclozapine concentrations at peak and trough and their 24-h AUC were estimated using population pharmacokinetic models. RESULTS A total of 108 patients completed the study (mean ± SD age, 43.0 ± 10.1 years; clozapine dose, 357.5 ± 136.9 mg/day); 33 patients (30.6%) showed estimated trough concentrations of clozapine within the recommended range (350-600 ng/ml) whereas the concentrations were higher and lower than this range among 37 (43.5%) and 28 (25.9%) patients (%), respectively. There were no significant correlations between estimated peak or trough concentrations or 24-h AUC of both clozapine or norclozapine, and GASS-C total or individual scores. No significant differences were found between GASS-C total or individual item scores between the patients with estimated trough concentrations of clozapine of >600 ng/ml and the other subjects. CONCLUSION The results suggest that clozapine or norclozapine concentrations are not linked directly to the extent of side effects experienced in clozapine-treated patients with treatment-resistant schizophrenia while the cross-sectional study design limits the interpretation of any causal relationships. These findings indicate that side effects associated with clozapine may occur at any dose or concentration.
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Affiliation(s)
- Nobuyuki Nomura
- Department of Neuropsychiatry, Yamanashi Prefectural Kita Hospital, Yamanashi, Japan
| | - Kohei Kitagawa
- Department of Neuropsychiatry, Okayama Psychiatric Medical Center, 3-16, Shikatahonmachi, Kita-ku, Okayama-shi, Okayama, 700-0915, Japan
| | - Ryuhei So
- Department of Neuropsychiatry, Okayama Psychiatric Medical Center, 3-16, Shikatahonmachi, Kita-ku, Okayama-shi, Okayama, 700-0915, Japan
| | - Fuminari Misawa
- Department of Neuropsychiatry, Yamanashi Prefectural Kita Hospital, Yamanashi, Japan
| | - Masafumi Kodama
- Department of Neuropsychiatry, Okayama Psychiatric Medical Center, Okayama, Japan
| | - Hiroyoshi Takeuchi
- Department of Neuropsychiatry, Yamanashi Prefectural Kita Hospital, Yamanashi, Japan
| | - Robert Bies
- Department of Pharmaceutical Sciences, University at Buffalo, New York, USA
| | - Thomas Straubinger
- Department of Pharmaceutical Sciences, University at Buffalo, New York, USA
| | - Christopher Banker
- Department of Pharmaceutical Sciences, University at Buffalo, New York, USA
| | - Yuya Mizuno
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Masaru Mimura
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Hiroyuki Uchida
- Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
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