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Fuentes-Claramonte P, Estradé A, Solanes A, Ramella-Cravaro V, Garcia-Leon MA, de Diego-Adeliño J, Molins C, Fung E, Valentí M, Anmella G, Pomarol-Clotet E, Oliver D, Vieta E, Radua J, Fusar-Poli P. Biomarkers for Psychosis: Are We There Yet? Umbrella Review of 1478 Biomarkers. SCHIZOPHRENIA BULLETIN OPEN 2024; 5:sgae018. [PMID: 39228676 PMCID: PMC11369642 DOI: 10.1093/schizbullopen/sgae018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 09/05/2024]
Abstract
Background and Hypothesis This umbrella review aims to comprehensively synthesize the evidence of association between peripheral, electrophysiological, neuroimaging, neuropathological, and other biomarkers and diagnosis of psychotic disorders. Study Design We selected systematic reviews and meta-analyses of observational studies on diagnostic biomarkers for psychotic disorders, published until February 1, 2018. Data extraction was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Evidence of association between biomarkers and psychotic disorders was classified as convincing, highly suggestive, suggestive, weak, or non-significant, using a standardized classification. Quality analyses used the Assessment of Multiple Systematic Reviews (AMSTAR) tool. Study Results The umbrella review included 110 meta-analyses or systematic reviews corresponding to 3892 individual studies, 1478 biomarkers, and 392 210 participants. No factor showed a convincing level of evidence. Highly suggestive evidence was observed for transglutaminase autoantibodies levels (odds ratio [OR] = 7.32; 95% CI: 3.36, 15.94), mismatch negativity in auditory event-related potentials (standardized mean difference [SMD] = 0.73; 95% CI: 0.5, 0.96), P300 component latency (SMD = -0.6; 95% CI: -0.83, -0.38), ventricle-brain ratio (SMD = 0.61; 95% CI: 0.5, 0.71), and minor physical anomalies (SMD = 0.99; 95% CI: 0.64, 1.34). Suggestive evidence was observed for folate, malondialdehyde, brain-derived neurotrophic factor, homocysteine, P50 sensory gating (P50 S2/S1 ratio), frontal N-acetyl-aspartate, and high-frequency heart rate variability. Among the remaining biomarkers, weak evidence was found for 626 and a non-significant association for 833 factors. Conclusions While several biomarkers present highly suggestive or suggestive evidence of association with psychotic disorders, methodological biases, and underpowered studies call for future higher-quality research.
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Affiliation(s)
- Paola Fuentes-Claramonte
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain
- Biomedical Research Networking Centre Consortium on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Barcelona, Spain
| | - Andrés Estradé
- Department of Psychosis Studies, Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Institute of Psychiatry Psychology and Neuroscience, King’s College London, London, UK
| | - Aleix Solanes
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB), Barcelona, Spain
- Department of Psychiatry and Forensic Medicine, Barcelona Autonomous University (UAB), Barcelona, Spain
| | - Valentina Ramella-Cravaro
- Department of Psychosis Studies, Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Institute of Psychiatry Psychology and Neuroscience, King’s College London, London, UK
| | - Maria Angeles Garcia-Leon
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain
- Biomedical Research Networking Centre Consortium on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Barcelona, Spain
| | - Javier de Diego-Adeliño
- Biomedical Research Networking Centre Consortium on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Barcelona, Spain
- Department of Psychiatry and Forensic Medicine, Barcelona Autonomous University (UAB), Barcelona, Spain
- Sant Pau Mental Health Research Group, Institut de Recerca Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Conrad Molins
- Psychiatric Service, Hospital Universitari Santa Maria, Lleida, Catalonia, Spain
| | - Eric Fung
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain
| | - Marc Valentí
- Biomedical Research Networking Centre Consortium on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB), Barcelona, Spain
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Gerard Anmella
- Biomedical Research Networking Centre Consortium on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB), Barcelona, Spain
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Edith Pomarol-Clotet
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain
- Biomedical Research Networking Centre Consortium on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Barcelona, Spain
| | - Dominic Oliver
- Department of Psychosis Studies, Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Institute of Psychiatry Psychology and Neuroscience, King’s College London, London, UK
- Department of Psychiatry, University of Oxford, Oxford OX3 7JX, UK
- NIHR Oxford Health Biomedical Research Centre, Oxford OX3 7JX, UK
- OPEN Early Detection Service, Oxford Health NHS Foundation Trust, Oxford OX3 7JX, UK
| | - Eduard Vieta
- Biomedical Research Networking Centre Consortium on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB), Barcelona, Spain
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Joaquim Radua
- Biomedical Research Networking Centre Consortium on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Barcelona, Spain
- Department of Psychosis Studies, Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Institute of Psychiatry Psychology and Neuroscience, King’s College London, London, UK
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB), Barcelona, Spain
- Department of Clinical Neuroscience, Center for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
| | - Paolo Fusar-Poli
- Department of Psychosis Studies, Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Institute of Psychiatry Psychology and Neuroscience, King’s College London, London, UK
- OASIS Service, South London and the Maudsley NHS Foundation Trust, London, UK
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
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Ramesh A, Nayak T, Beestrum M, Quer G, Pandit JA. Heart Rate Variability in Psychiatric Disorders: A Systematic Review. Neuropsychiatr Dis Treat 2023; 19:2217-2239. [PMID: 37881808 PMCID: PMC10596135 DOI: 10.2147/ndt.s429592] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 10/11/2023] [Indexed: 10/27/2023] Open
Abstract
Introduction Heart rate variability (HRV) is a measure of the fluctuation in time interval between consecutive heart beats. Decreased heart rate variability has been shown to have associations with autonomic dysfunction in psychiatric conditions such as depression, substance abuse, anxiety, and schizophrenia, although its use as a prognostic tool remains highly debated. This study aims to review the current literature on heart rate variability as a diagnostic and prognostic tool in psychiatric populations. Methods A literature search was conducted using the MEDLINE, EMBASE, Cochrane, and PsycINFO libraries to identify full-text studies involving adult psychiatric populations that reported HRV measurements. From 1647 originally identified, 31 studies were narrowed down through an abstract and full-text screen. Studies were excluded if they enrolled adolescents or children, used animal models, enrolled patients with another primary diagnosis other than psychiatric as outlined by the diagnostic and statistical manual of mental disorders (DSM) V, or if they assessed HRV in the context of treatment rather than diagnosis. Study quality assessment was conducted using a modified Downs and Blacks quality assessment tool for observational rather than interventional studies. Data were reported in four tables: 1) summarizing study characteristics, 2) methods of HRV detection, 3) key findings and statistics, and 4) quality assessment. Results There is significant variability between studies in their methodology of recording as well as reporting HRV, which makes it difficult to meaningfully interpret data that is clinically applicable due to the presence of significant bias in existing studies. The presence of an association between HRV and the severity of various psychiatric disorders, however, remains promising. Conclusion Future studies should be done to further explore how HRV parameters may be used to enhance the diagnosis and prognosis of several psychiatric disorders.
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Affiliation(s)
- Ashvita Ramesh
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Tanvi Nayak
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Molly Beestrum
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Giorgio Quer
- Scripps Research Translational Institute, La Jolla, CA, USA
| | - Jay A Pandit
- Scripps Research Translational Institute, La Jolla, CA, USA
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3
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Datta A, Choudhary S, Soni S, Misra R, Singh K. Altered Heart Rate Variability During Rest in Schizophrenia: A State Marker. Cureus 2023; 15:e44145. [PMID: 37753044 PMCID: PMC10518643 DOI: 10.7759/cureus.44145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Autonomic nervous system (ANS) imbalance has been reported in a number of psychiatric disorders such as depression, schizophrenia, panic disorder, etc. Autonomic dysfunction in schizophrenia has been associated with the symptoms and manifestation of psychosis. Heart rate variability (HRV) as a tool has been widely used to assess ANS activity and the effect of disease on the sympathovagal balance. Therefore, in the present study, HRV derived from electrocardiogram (ECG) lead II at rest was investigated in order to understand the changes in frequency domain measures in patients with schizophrenia and their first-degree relatives compared to healthy controls. METHODS Twenty-five patients with schizophrenia, 24 first-degree relatives of patients, and 24 healthy controls (Diagnostic and Statistical Manual of Mental Disorders (DSM)-5; 18-45 years) were included in the study. HRV of the subjects was measured after five minutes of rest. ECG lead II was recorded for five minutes and HRV was analysed in the frequency domain: low frequency (LF), high frequency (HF), total power, and LF/HF ratio. HRV parameters and heart rate were statistically analysed for group comparisons using general linear model multivariate analysis. RESULTS Patients had significantly higher minimum heart rate and lower HF (normalized units (nu)) compared to their first-degree relatives. A trend was observed in HF (nu) with the lowest in patients followed by healthy controls and first-degree relatives and LF/HF ratio was the highest in patients followed by healthy controls and first-degree relatives, although not statistically significant. No significant difference was found between first-degree relatives and healthy controls. CONCLUSION The alteration of HRV in schizophrenia could be attributed to reduction in vagal tone and sympathetic dominance, which in turn could serve as state markers of schizophrenia.
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Affiliation(s)
- Anjum Datta
- Physiology, Subharti Medical College and Associated Chhatrapati Shivaji Subharti Hospital, Meerut, IND
| | - Sandeep Choudhary
- Psychiatry, Subharti Medical College and Associated Chhatrapati Shivaji Subharti Hospital, Meerut, IND
| | - Sunaina Soni
- Physiology, Subharti Medical College and Associated Chhatrapati Shivaji Subharti Hospital, Meerut, IND
| | - Rajesh Misra
- Physiology, Subharti Medical College and Associated Chhatrapati Shivaji Subharti Hospital, Meerut, IND
| | - Kiran Singh
- Physiology, Subharti Medical College and Associated Chhatrapati Shivaji Subharti Hospital, Meerut, IND
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Nordholm D, Jensen MA, Kristiansen J, Glenthøj LB, Kristensen TD, Wenneberg C, Hjorthøj C, Garde AH, Nordentoft M. A longitudinal study on physiological stress in individuals at ultra high-risk of psychosis. Schizophr Res 2023; 254:218-226. [PMID: 36996675 DOI: 10.1016/j.schres.2023.03.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 01/19/2023] [Accepted: 03/03/2023] [Indexed: 04/01/2023]
Abstract
INTRODUCTION Individuals at ultra high-risk (UHR) of psychosis exhibit significantly higher stress levels than healthy controls (HC). This study investigates how physiological stress measures differ between HC and UHR individuals and how physiological stress is associated with attenuated psychotic symptoms and changes over time in UHR individuals. Additionally, it examines how the use of medication affects physiological levels of stress. METHOD The study included 72 UHR individuals and 36 HC. UHR were included according to the comprehensive assessment of at-risk mental state (CAARMS); a total-CAARMS score measured the attenuated psychotic symptoms and was calculated from the four psychosis subscales. HC and UHR were examined at baseline, and 47 UHR individuals were followed up after six months. Physiological stress measures were salivary cortisol, alpha-amylase (SAA) and heart-rate variability (HRV). Saliva was collected at four-time points during the day. RESULTS There was no significant difference regarding cortisol (awakening response) or SAA measures between HC and UHR individuals. The use of antipsychotics and antidepressants was associated with low HRV in UHR individuals. In an exploratory analysis of 19 UHR individuals, we found an association between the change in total-CAARMS (six months total-CAARMS minus baseline total CAARMS) and the change in HRV during sleep (six months HRV minus baseline HRV). CONCLUSION Our findings indicate that the use of antipsychotics and antidepressants could be associated with lower HRV in UHR individuals. There might be potential to investigate how HRV develops during the course of illness in UHR individuals.
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Affiliation(s)
- Dorte Nordholm
- Copenhagen Research Center for Mental Health-CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Denmark.
| | | | - Jesper Kristiansen
- The National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Louise Birkedal Glenthøj
- Copenhagen Research Center for Mental Health-CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Denmark
| | - Tina Dam Kristensen
- Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, and Center for Neuropsychiatric Schizophrenia Research, CNSR, Mental Health Centre Glostrup, University of Copenhagen, Glostrup, Denmark
| | - Christina Wenneberg
- Copenhagen Research Center for Mental Health-CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Denmark; Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, and Center for Neuropsychiatric Schizophrenia Research, CNSR, Mental Health Centre Glostrup, University of Copenhagen, Glostrup, Denmark
| | - Carsten Hjorthøj
- Copenhagen Research Center for Mental Health-CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Denmark; University of Copenhagen, Department of Public Health, Section of Epidemiology, Copenhagen, Denmark
| | - Anne Helene Garde
- The National Research Centre for the Working Environment, Copenhagen, Denmark; University of Copenhagen, Department of Public Health, Copenhagen, Denmark
| | - Merete Nordentoft
- Copenhagen Research Center for Mental Health-CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Denmark
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5
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Bahlinger K, Lincoln TM, Clamor A. Recovery After Stress-Autonomic and Subjective Arousal in Individuals With Psychosis Compared to Healthy Controls. Schizophr Bull 2022; 48:1373-1383. [PMID: 35998116 PMCID: PMC9673261 DOI: 10.1093/schbul/sbac097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND HYPOTHESIS Heightened stress levels in individuals with psychosis (PSY) are associated with psychotic symptom occurrence and may be partially attributed to well-established deficits in resting-state heart rate variability (HRV) and emotion regulation. In healthy participants, resting-state HRV and self-reported emotion regulation skills have been linked to recovery after a stressor; however, it is unclear whether stress recovery is altered in PSY. Thus, we compared the autonomic and subjective recovery of PSY to healthy controls (HC) and investigated the predictive value of resting-state HRV and emotion regulation skills. STUDY DESIGN We assessed resting-state HRV and self-reported emotion regulation one week prior to a combined physical and cognitive stress induction. After the stress exposure, we assessed the autonomic (decrease in heart rate [HR], increase in HRV) and subjective (decrease in subjective stress and negative affect) recovery in PSY (n = 50) and HC (n = 50) over 60 min. STUDY RESULTS Repeated-measures ANOVA revealed the expected interaction of time × group for subjective stress but not negative affect or autonomic stress. Resting-state HRV predicted recovery of HR, and emotion regulation skills predicted recovery of HRV but not of the other parameters. CONCLUSIONS Although subjective stress recovery was delayed in PSY, the absence of autonomic recovery deficits suggests that a prolonged stress response may not contribute to heightened stress levels to the expected extent. Improving resting-state HRV and emotion regulation may support autonomic recovery, but further investigation is required to test the impact of such improvements on psychotic symptoms.
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Affiliation(s)
- Katrin Bahlinger
- Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Human Movement Sciences, Universität Hamburg, Hamburg, Germany
| | - Tania M Lincoln
- Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Human Movement Sciences, Universität Hamburg, Hamburg, Germany
| | - Annika Clamor
- Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Human Movement Sciences, Universität Hamburg, Hamburg, Germany
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6
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Osaka K, Matsumoto K, Akiyama T, Tanioka R, Betriana F, Zhao Y, Kai Y, Miyagawa M, Tanioka T, Locsin RC. Investigation of Methods to Create Future Multimodal Emotional Data for Robot Interactions in Patients with Schizophrenia: A Case Study. Healthcare (Basel) 2022; 10:healthcare10050848. [PMID: 35627984 PMCID: PMC9140390 DOI: 10.3390/healthcare10050848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 04/28/2022] [Accepted: 05/01/2022] [Indexed: 11/16/2022] Open
Abstract
Rapid progress in humanoid robot investigations offers possibilities for improving the competencies of people with social disorders, although this improvement of humanoid robots remains unexplored for schizophrenic people. Methods for creating future multimodal emotional data for robot interactions were studied in this case study of a 40-year-old male patient with disorganized schizophrenia without comorbidities. The qualitative data included heart rate variability (HRV), video-audio recordings, and field notes. HRV, Haar cascade classifier (HCC), and Empath API© were evaluated during conversations between the patient and robot. Two expert nurses and one psychiatrist evaluated facial expressions. The research hypothesis questioned whether HRV, HCC, and Empath API© are useful for creating future multimodal emotional data about robot–patient interactions. The HRV analysis showed persistent sympathetic dominance, matching the human–robot conversational situation. The result of HCC was in agreement with that of human observation, in the case of rough consensus. In the case of observed results disagreed upon by experts, the HCC result was also different. However, emotional assessments by experts using Empath API© were also found to be inconsistent. We believe that with further investigation, a clearer identification of methods for multimodal emotional data for robot interactions can be achieved for patients with schizophrenia.
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Affiliation(s)
- Kyoko Osaka
- Department of Psychiatric Nursing, Nursing Course of Kochi Medical School, Kochi University, Kochi 783-8505, Japan
- Correspondence:
| | - Kazuyuki Matsumoto
- Graduate School of Engineering, Tokushima University, Tokushima 770-8506, Japan;
| | - Toshiya Akiyama
- Graduate School of Health Sciences, Tokushima University, Tokushima 770-8509, Japan; (T.A.); (R.T.); (F.B.)
| | - Ryuichi Tanioka
- Graduate School of Health Sciences, Tokushima University, Tokushima 770-8509, Japan; (T.A.); (R.T.); (F.B.)
| | - Feni Betriana
- Graduate School of Health Sciences, Tokushima University, Tokushima 770-8509, Japan; (T.A.); (R.T.); (F.B.)
| | - Yueren Zhao
- Department of Psychiatry, School of Medicine, Fujita Health University, Toyoake 470-1192, Japan;
| | - Yoshihiro Kai
- Department of Mechanical Engineering, Tokai University, Tokyo 259-1292, Japan;
| | - Misao Miyagawa
- Department of Nursing, Faculty of Health and Welfare, Tokushima Bunri University, Tokushima 770-8514, Japan;
| | - Tetsuya Tanioka
- Institute of Biomedical Sciences, Tokushima University, Tokushima 770-8509, Japan; (T.T.); or (R.C.L.)
| | - Rozzano C. Locsin
- Institute of Biomedical Sciences, Tokushima University, Tokushima 770-8509, Japan; (T.T.); or (R.C.L.)
- Christine E Lynn College of Nursing, Florida Atlantic University, Boca Raton, FL 33431, USA
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7
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Liu Y, Huang Y, Zhou J, Li G, Chen J, Xiang Z, Wu F, Wu K. Altered Heart Rate Variability in Patients With Schizophrenia During an Autonomic Nervous Test. Front Psychiatry 2021; 12:626991. [PMID: 33912081 PMCID: PMC8074969 DOI: 10.3389/fpsyt.2021.626991] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 02/26/2021] [Indexed: 01/12/2023] Open
Abstract
Reduced heart rate variability (HRV) and dysfunction of the autonomic nervous system (ANS) have been observed in schizophrenia patients. HRV parameters of schizophrenia patients in the resting state have been well-documented; however, these parameters of schizophrenia patients who experience continuous psychophysiological stress remain unclear. The objective of this study was to systematically explore the linear and nonlinear HRV parameters between schizophrenia patients and normal controls and to detect the adaptive capabilities of HRV of schizophrenia patients during the stimulation tests of autonomic nervous system. Forty-five schizophrenia patients and forty-five normal controls, matched for age, sex and body mass index, completed a 14 min ANS test. Thirteen linear and nonlinear HRV parameters of all subjects under the ANS test were computed and statistically analyzed between groups and between sessions. The STROBE checklist was adhered to in this study. All time-domain HRV features in the ANS test were significantly different between schizophrenia patients and normal controls (p < 0.01). The schizophrenia patients showed significantly low values in the Poincaré indices, which revealed significantly decreased heart rate fluctuation complexity compared with that of normal controls (p < 0.001). In addition, the normal controls, not schizophrenia patients, showed significant differences between the recovery and stress states in the parameters of low frequency, high frequency, and nonlinear dynamics. Schizophrenia patients showed autonomic dysfunction of the heart in a series of stimulation tests of the autonomic nervous system and could not regain normal physiological functions after stress cessation. Our findings revealed that the dynamic parameters of HRV in psychophysiological stress are sensitive and practical for a diagnosis of schizophrenia.
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Affiliation(s)
- Ya Liu
- Department of Biomedical Engineering, School of Material Science and Engineering, South China University of Technology, Guangzhou, China.,National Engineering Research Center for Tissue Restoration and Reconstruction, South China University of Technology, Guangzhou, China.,Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Yuanyuan Huang
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou Huiai Hospital, Guangzhou, China
| | - Jing Zhou
- Department of Biomedical Engineering, School of Material Science and Engineering, South China University of Technology, Guangzhou, China.,National Engineering Research Center for Tissue Restoration and Reconstruction, South China University of Technology, Guangzhou, China.,Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Guixiang Li
- Department of Scientific Research, Institute of Health Medicine, Guangdong Academy of Sciences, Guangzhou, China.,Guangdong Engineering Technology Research Center for Diagnosis and Rehabilitation of Dementia, Guangzhou, China
| | - Jun Chen
- Department of Scientific Research, Institute of Health Medicine, Guangdong Academy of Sciences, Guangzhou, China.,Guangdong Engineering Technology Research Center for Diagnosis and Rehabilitation of Dementia, Guangzhou, China
| | - Zhiming Xiang
- Department of Radiology, Panyu Central Hospital of Guangzhou, Guangzhou, China
| | - Fengchun Wu
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou Huiai Hospital, Guangzhou, China
| | - Kai Wu
- Department of Biomedical Engineering, School of Material Science and Engineering, South China University of Technology, Guangzhou, China.,National Engineering Research Center for Tissue Restoration and Reconstruction, South China University of Technology, Guangzhou, China.,Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China.,The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou Huiai Hospital, Guangzhou, China.,Guangdong Engineering Technology Research Center for Diagnosis and Rehabilitation of Dementia, Guangzhou, China.,Key Laboratory of Biomedical Engineering of Guangdong Province, South China University of Technology, Guangzhou, China.,Department of Nuclear Medicine and Radiology, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan
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8
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Heart rate variability as an index of emotion (dys)regulation in psychosis? Int J Psychophysiol 2020; 158:310-317. [DOI: 10.1016/j.ijpsycho.2020.08.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 07/21/2020] [Accepted: 08/23/2020] [Indexed: 01/11/2023]
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9
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Kocsis A, Gajwani R, Gross J, Gumley AI, Lawrie SM, Schwannauer M, Schultze-Lutter F, Grent-‘t-Jong T, Uhlhaas PJ. Altered Autonomic Function in Individuals at Clinical High Risk for Psychosis. Front Psychiatry 2020; 11:580503. [PMID: 33240132 PMCID: PMC7677235 DOI: 10.3389/fpsyt.2020.580503] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 09/11/2020] [Indexed: 11/22/2022] Open
Abstract
Introduction: Alterations in autonomic functioning in individuals diagnosed with schizophrenia are well-documented. Yet, it is currently unclear whether these dysfunctions extend into the clinical high-risk state. Thus, we investigated resting heart rate (RHR) and heart rate variability (HRV) indices in individuals at clinical high-risk for psychosis (CHR-P). Methods: We recruited 117 CHR-P participants, 38 participants with affective disorders and substance abuse (CHR-N) as well as a group of 49 healthy controls. CHR-P status was assessed with the Comprehensive Assessment of At-Risk Mental States (CAARMS) and the Schizophrenia Proneness Instrument, Adult Version (SPI-A). We obtained 5 min, eyes-open resting-state MEG data, which was used for the extraction of cardiac field-related inter-beat-interval data and from which heart-rate and heart-rate variability measures were computed. Results: Compared to both CHR-N and healthy controls, CHR-P participants were characterized by an increased RHR, which was not explained by differences in psychopathological comorbidity and medication status. Increased RHR correlated with the presence of subthreshold psychotic symptoms and associated distress. No differences between groups were found for heart-rate variability measures, however. Furthermore, there was an association between motor-performance and psychophysiological measures. Conclusion: The current study provides evidence of alterations in autonomic functioning as disclosed by increased RHR in CHR-P participants. Future studies are needed to further evaluate this characteristic feature of CHR-P individuals and its potential predictive value for psychosis development.
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Affiliation(s)
- Anna Kocsis
- Institute for Neuroscience and Psychology, University of Glasgow, Glasgow, United Kingdom
- Department of Experimental Psychology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Ruchika Gajwani
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Joachim Gross
- Institute for Neuroscience and Psychology, University of Glasgow, Glasgow, United Kingdom
| | - Andrew I. Gumley
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Stephen M. Lawrie
- Department of Psychiatry, University of Edinburgh, Edinburgh, United Kingdom
| | - Matthias Schwannauer
- Department of Clinical Psychology, University Edinburgh, Edinburgh, United Kingdom
| | - Frauke Schultze-Lutter
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
- Department of Psychology and Mental Health, Faculty of Psychology, Airlangga University, Surabaya, Indonesia
| | - Tineke Grent-‘t-Jong
- Institute for Neuroscience and Psychology, University of Glasgow, Glasgow, United Kingdom
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| | - Peter J. Uhlhaas
- Institute for Neuroscience and Psychology, University of Glasgow, Glasgow, United Kingdom
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
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10
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Bahlinger K, Lincoln TM, Krkovic K, Clamor A. Linking psychophysiological adaptation, emotion regulation, and subjective stress to the occurrence of paranoia in daily life. J Psychiatr Res 2020; 130:152-159. [PMID: 32823048 DOI: 10.1016/j.jpsychires.2020.07.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 07/12/2020] [Accepted: 07/17/2020] [Indexed: 12/22/2022]
Abstract
As stress is relevant to the formation of paranoia, maladaptive behavioral and physiological stress regulation is discussed as a crucial indicator of vulnerability. This is supported by research linking psychosis to the tendency to make less use of functional and more use of dysfunctional emotion regulation strategies (ER) and with a lower vagally-mediated heart rate variability (HRV). However, it remains unclear whether ER serves as a mediator between resting-state HRV on the one hand and subjective stress levels and paranoia on the other and whether this is specific to paranoia as compared to depression. We used an experience sampling method during seven days to repeatedly assess the experience of stress, usage of ER strategies, paranoia und depression (9/day) in a sample with subclinical positive symptoms (N = 32). Resting-state HRV was measured during a 5min interval in the laboratory. Data was analyzed by multi-level models. Higher resting-state HRV was predictive of lower stress-levels and of using more functional ER strategies (reappraisal, acceptance) in daily life, but did not predict the use of dysfunctional strategies (rumination, suppression) or paranoia. The association between resting-state HRV and stress was mediated by the usage of functional ER. Less functional and more dysfunctional ER were linked to higher levels of stress, paranoia and depression. Our study highlights that deficits in ER represent a link between psychophysiological and phenomenological aspects of paranoia but also of depression. This encourages to further investigate transdiagnostic prevention and therapy programs aiming to improve ER and to increase HRV.
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Affiliation(s)
- Katrin Bahlinger
- Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Human Movement Sciences, Universität Hamburg, Germany.
| | - Tania M Lincoln
- Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Human Movement Sciences, Universität Hamburg, Germany
| | - Katarina Krkovic
- Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Human Movement Sciences, Universität Hamburg, Germany
| | - Annika Clamor
- Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Human Movement Sciences, Universität Hamburg, Germany
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Martins D, Davies C, De Micheli A, Oliver D, Krawczun-Rygmaczewska A, Fusar-Poli P, Paloyelis Y. Intranasal oxytocin increases heart-rate variability in men at clinical high risk for psychosis: a proof-of-concept study. Transl Psychiatry 2020; 10:227. [PMID: 32655132 PMCID: PMC7354990 DOI: 10.1038/s41398-020-00890-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 06/08/2020] [Indexed: 12/24/2022] Open
Abstract
Autonomic nervous system (ANS) dysfunction (i.e., increased sympathetic and/or decreased parasympathetic activity) has been proposed to contribute to psychosis vulnerability. Yet, we still lack directed therapeutic strategies that improve ANS regulation in psychosis or at-risk states. The oxytocin system constitutes a potential therapeutic target, given its role in ANS regulation. However, whether intranasal oxytocin ameliorates autonomic regulation during emerging psychosis is currently unknown. We pooled together two datasets, one of 30 men at clinical high risk for psychosis (CHR-P), and another of 17 healthy men, who had participated in two double-blinded, placebo-controlled, randomised, crossover MRI studies with similar protocols. All participants self-administered 40 IU of intranasal oxytocin or placebo using a nasal spray. We recorded pulse plethysmography during a period of 8 min at about 1 h post dosing and estimated heart rate (HR) and high-frequency HR variability (HF-HRV), an index of cardio-parasympathetic activity. CHR-P and healthy men did not differ at resting HR or HF-HRV under placebo. We found a significant condition × treatment effect for HF-HRV, showing that intranasal oxytocin, compared with placebo, increased HF-HRV in CHR-P but not in healthy men. The main effects of treatment and condition were not significant. In this proof-of-concept study, we show that intranasal oxytocin increases cardio-parasympathetic activity in CHR-P men, highlighting its therapeutic potential to improve autonomic regulation in this clinical group. Our findings support the need for further research on the preventive and therapeutic potential of intranasal oxytocin during emerging psychosis, where we lack effective treatments.
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Affiliation(s)
- Daniel Martins
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Cathy Davies
- Early Psychosis: Interventions & Clinical detection (EPIC) lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF, UK
| | - Andrea De Micheli
- Early Psychosis: Interventions & Clinical detection (EPIC) lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF, UK
| | - Dominic Oliver
- Early Psychosis: Interventions & Clinical detection (EPIC) lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF, UK
| | - Alicja Krawczun-Rygmaczewska
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Paolo Fusar-Poli
- Early Psychosis: Interventions & Clinical detection (EPIC) lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF, UK
- OASIS Service, South London and the Maudsley NHS National Health Service Foundation Trust, London, UK
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
| | - Yannis Paloyelis
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK.
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Zhang Y, Zhou B, Qiu J, Zhang L, Zou Z. Heart rate variability changes in patients with panic disorder. J Affect Disord 2020; 267:297-306. [PMID: 32217230 DOI: 10.1016/j.jad.2020.01.132] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 11/19/2019] [Accepted: 01/21/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND This review aimed to evaluate whether patients with panic disorder (PD) exhibit different heart rate variability (HRV) compared to healthy controls and to determine whether HRV is different in patients with PD after treatment. METHODS Literature databases were searched for studies comparing resting-state HRV between drug-naïve patients with PD and healthy controls. Parameters from the short-term frequency-domain and long-term time domain were included. RESULTS In the low frequency (LF) analysis, no significant association was found between LF and PD (standardised mean difference [SMD] = -0.0443, 95% confidence interval [CI]: -0.1765 to 0.0879). In the high frequency (HF) analysis, no significant association was found between HF and PD (SMD = -0.1269, 95% CI: -0.2598 to 0.0059). In the LF/HF analysis, a significantly higher LF/HF ratio was found in cases than in controls, but the effect was moderate (SMD = 0.1390, 95% CI: 0.0180 to 0.2600). For the standard deviation of normal-to-normal intervals, a significantly lower value was observed in cases than in controls (SMD = -0.3133, 95% CI: -0.5459 to -0.0808). LIMITATIONS Limited sample size in the time-domain and treatment effect analyses. CONCLUSIONS Patients with PD had a higher short-term LF/HF ratio, indicating impaired sympathovagal balance. The LF/HF ratio findings were more consistent compared with LF and HF alone, making it a better parameter to interpret the LF and HF in conjunction. HRV may be a promising biomarker for predicting antidepressant response.
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Affiliation(s)
- Yuan Zhang
- Personalized Drug Therapy Key Laboratory of Sichuan Province, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, Sichuan, PR China
| | - Bo Zhou
- Psychosomatic department, Sichuan Academy of Medical Science & Sichuan Provincial People's Hospital, Chengdu 610072, PR China
| | - Jian Qiu
- Psychosomatic department, Sichuan Academy of Medical Science & Sichuan Provincial People's Hospital, Chengdu 610072, PR China
| | - Lijuan Zhang
- Personalized Drug Therapy Key Laboratory of Sichuan Province, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, Sichuan, PR China
| | - Zhili Zou
- Psychosomatic department, Sichuan Academy of Medical Science & Sichuan Provincial People's Hospital, Chengdu 610072, PR China.
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