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Oliver D, Chesney E, Cullen AE, Davies C, Englund A, Gifford G, Kerins S, Lalousis PA, Logeswaran Y, Merritt K, Zahid U, Crossley NA, McCutcheon RA, McGuire P, Fusar-Poli P. Exploring causal mechanisms of psychosis risk. Neurosci Biobehav Rev 2024; 162:105699. [PMID: 38710421 DOI: 10.1016/j.neubiorev.2024.105699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 02/17/2024] [Accepted: 04/28/2024] [Indexed: 05/08/2024]
Abstract
Robust epidemiological evidence of risk and protective factors for psychosis is essential to inform preventive interventions. Previous evidence syntheses have classified these risk and protective factors according to their strength of association with psychosis. In this critical review we appraise the distinct and overlapping mechanisms of 25 key environmental risk factors for psychosis, and link these to mechanistic pathways that may contribute to neurochemical alterations hypothesised to underlie psychotic symptoms. We then discuss the implications of our findings for future research, specifically considering interactions between factors, exploring universal and subgroup-specific factors, improving understanding of temporality and risk dynamics, standardising operationalisation and measurement of risk and protective factors, and developing preventive interventions targeting risk and protective factors.
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Affiliation(s)
- Dominic Oliver
- Department of Psychiatry, University of Oxford, Oxford, UK; NIHR Oxford Health Biomedical Research Centre, Oxford, UK; OPEN Early Detection Service, Oxford Health NHS Foundation Trust, Oxford, UK; Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
| | - Edward Chesney
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 4 Windsor Walk, London SE5 8AF, UK
| | - Alexis E Cullen
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Department of Clinical Neuroscience, Karolinska Institutet, Sweden
| | - Cathy Davies
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Amir Englund
- Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 4 Windsor Walk, London SE5 8AF, UK
| | - George Gifford
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Sarah Kerins
- Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Paris Alexandros Lalousis
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University Munich, Munich, Germany
| | - Yanakan Logeswaran
- Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Department of Biostatistics & Health Informatics, King's College London, London, UK
| | - Kate Merritt
- Division of Psychiatry, Institute of Mental Health, UCL, London, UK
| | - Uzma Zahid
- Department of Psychology, King's College London, London, UK
| | - Nicolas A Crossley
- Department of Psychiatry, University of Oxford, Oxford, UK; Department of Psychiatry, School of Medicine, Pontificia Universidad Católica de Chile, Chile
| | - Robert A McCutcheon
- Department of Psychiatry, University of Oxford, Oxford, UK; Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Oxford Health NHS Foundation Trust, Oxford, UK
| | - Philip McGuire
- Department of Psychiatry, University of Oxford, Oxford, UK; NIHR Oxford Health Biomedical Research Centre, Oxford, UK; OPEN Early Detection Service, Oxford Health NHS Foundation Trust, Oxford, UK
| | - Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University Munich, Munich, Germany; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy; OASIS Service, South London and Maudsley NHS Foundation Trust, London SE11 5DL, UK
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2
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Jeste DV, Malaspina D, Bagot K, Barch DM, Cole S, Dickerson F, Dilmore A, Ford CL, Karcher NR, Luby J, Rajji T, Pinto-Tomas AA, Young LJ. Review of Major Social Determinants of Health in Schizophrenia-Spectrum Psychotic Disorders: III. Biology. Schizophr Bull 2023; 49:867-880. [PMID: 37023360 PMCID: PMC10318888 DOI: 10.1093/schbul/sbad031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
BACKGROUND Social determinants of health (SDoHs) are nonmedical factors that significantly impact health and longevity. We found no published reviews on the biology of SDoHs in schizophrenia-spectrum psychotic disorders (SSPD). STUDY DESIGN We present an overview of pathophysiological mechanisms and neurobiological processes plausibly involved in the effects of major SDoHs on clinical outcomes in SSPD. STUDY RESULTS This review of the biology of SDoHs focuses on early-life adversities, poverty, social disconnection, discrimination including racism, migration, disadvantaged neighborhoods, and food insecurity. These factors interact with psychological and biological factors to increase the risk and worsen the course and prognosis of schizophrenia. Published studies on the topic are limited by cross-sectional design, variable clinical and biomarker assessments, heterogeneous methods, and a lack of control for confounding variables. Drawing on preclinical and clinical studies, we propose a biological framework to consider the likely pathogenesis. Putative systemic pathophysiological processes include epigenetics, allostatic load, accelerated aging with inflammation (inflammaging), and the microbiome. These processes affect neural structures, brain function, neurochemistry, and neuroplasticity, impacting the development of psychosis, quality of life, cognitive impairment, physical comorbidities, and premature mortality. Our model provides a framework for research that could lead to developing specific strategies for prevention and treatment of the risk factors and biological processes, thereby improving the quality of life and increasing the longevity of people with SSPD. CONCLUSIONS Biology of SDoHs in SSPD is an exciting area of research that points to innovative multidisciplinary team science for improving the course and prognosis of these serious psychiatric disorders.
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Affiliation(s)
- Dilip V Jeste
- Department of Psychiatry, University of California, San Diego (Retired), CA, USA
| | - Dolores Malaspina
- Departments of Psychiatry, Neuroscience and Genetics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kara Bagot
- Department of Psychiatry, Addiction Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Deanna M Barch
- Departments of Psychological and Brain Sciences, Psychiatry, and Radiology, Washington University in St. Louis, St. Louis, MO, USA
| | - Steve Cole
- Departments of Psychiatry and Biobehavioral Sciences, and Medicine, University of California, Los Angeles, CA, USA
| | - Faith Dickerson
- Department of Psychology, Sheppard Pratt, Baltimore, MD, USA
| | - Amanda Dilmore
- Department of Pediatrics, University of California, San Diego, CA, USA
| | - Charles L Ford
- Center for Translational Social Neuroscience, Department of Psychiatry, Emory University, Atlanta, GA, USA
| | - Nicole R Karcher
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, USA
| | - Joan Luby
- Department of Psychiatry (Child), Washington University in St. Louis, St. Louis, MO, USA
| | - Tarek Rajji
- Adult Neurodevelopment and Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Adrián A Pinto-Tomas
- Biochemistry Department, School of Medicine, Universidad de Costa Rica, San José, Costa Rica
| | - Larry J Young
- Center for Translational Social Neuroscience, Department of Psychiatry, Emory University, Atlanta, GA, USA
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3
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Mawson ER, Morris BJ. A consideration of the increased risk of schizophrenia due to prenatal maternal stress, and the possible role of microglia. Prog Neuropsychopharmacol Biol Psychiatry 2023; 125:110773. [PMID: 37116354 DOI: 10.1016/j.pnpbp.2023.110773] [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: 04/07/2023] [Accepted: 04/18/2023] [Indexed: 04/30/2023]
Abstract
Schizophrenia is caused by interaction of a combination of genetic and environmental factors. Of the latter, prenatal exposure to maternal stress is reportedly associated with elevated disease risk. The main orchestrators of inflammatory processes within the brain are microglia, and aberrant microglial activation/function has been proposed to contribute to the aetiology of schizophrenia. Here, we evaluate the epidemiological and preclinical evidence connecting prenatal stress to schizophrenia risk, and consider the possible mediating role of microglia in the prenatal stress-schizophrenia relationship. Epidemiological findings are rather consistent in supporting the association, albeit they are mitigated by effects of sex and gestational timing, while the evidence for microglial activation is more variable. Rodent models of prenatal stress generally report lasting effects on offspring neurobiology. However, many uncertainties remain as to the mechanisms underlying the influence of maternal stress on the developing foetal brain. Future studies should aim to characterise the exact processes mediating this aspect of schizophrenia risk, as well as focussing on how prenatal stress may interact with other risk factors.
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Affiliation(s)
- Eleanor R Mawson
- School of Psychology and Neuroscience, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow G12 8QQ, UK
| | - Brian J Morris
- School of Psychology and Neuroscience, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow G12 8QQ, UK.
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Matuszewska A, Kowalski K, Jawień P, Tomkalski T, Gaweł-Dąbrowska D, Merwid-Ląd A, Szeląg E, Błaszczak K, Wiatrak B, Danielewski M, Piasny J, Szeląg A. The Hypothalamic-Pituitary-Gonadal Axis in Men with Schizophrenia. Int J Mol Sci 2023; 24:ijms24076492. [PMID: 37047464 PMCID: PMC10094807 DOI: 10.3390/ijms24076492] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 03/18/2023] [Accepted: 03/26/2023] [Indexed: 04/03/2023] Open
Abstract
Schizophrenia is a severe mental disorder with a chronic, progressive course. The etiology of this condition is linked to the interactions of multiple genes and environmental factors. The earlier age of onset of schizophrenia, the higher frequency of negative symptoms in the clinical presentation, and the poorer response to antipsychotic treatment in men compared to women suggests the involvement of sex hormones in these processes. This article aims to draw attention to the possible relationship between testosterone and some clinical features in male schizophrenic patients and discuss the complex nature of these phenomena based on data from the literature. PubMed, Web of Science, and Google Scholar databases were searched to select the papers without limiting the time of the publications. Hormone levels in the body are regulated by many organs and systems, and take place through the neuroendocrine, hormonal, neural, and metabolic pathways. Sex hormones play an important role in the development and function of the organism. Besides their impact on secondary sex characteristics, they influence brain development and function, mood, and cognition. In men with schizophrenia, altered testosterone levels were noted. In many cases, evidence from available single studies gave contradictory results. However, it seems that the testosterone level in men affected by schizophrenia may differ depending on the phase of the disease, types of clinical symptoms, and administered therapy. The etiology of testosterone level disturbances may be very complex. Besides the impact of the illness (schizophrenia), stress, and antipsychotic drug-induced hyperprolactinemia, testosterone levels may be influenced by, i.a., obesity, substances of abuse (e.g., ethanol), or liver damage.
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DeVylder J, Anglin D, Munson MR, Nishida A, Oh H, Marsh J, Narita Z, Bareis N, Fedina L. Ethnoracial Variation in Risk for Psychotic Experiences. Schizophr Bull 2023; 49:385-396. [PMID: 36398917 PMCID: PMC10016402 DOI: 10.1093/schbul/sbac171] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND & HYPOTHESIS Psychotic disorders are inequitably distributed by race in the United States, although it is not known whether this is due to assessment biases or inequitable distributions of risk factors. Psychotic experiences are subclinical hallucinations and delusions used to study the etiology of psychosis, which are based on self-report and therefore not subject to potential clinician biases. In this study, we test whether the prevalence of psychotic experiences (PE) varies by race and if this variance is explained by socioenvironmental risk factors. STUDY DESIGN Data on demographics, PE, and socioenvironmental risk factors were collected through the National Survey of Poly-victimization and Mental Health, a national probability sample of US young adults. Logistic regression analyses were used to determine whether PE prevalence varied by race/ethnicity and, if so, whether this was attenuated with inclusion of indicators of income, education, urban/rural living, discrimination, and trauma exposure. STUDY RESULTS Black and Hispanic respondents reported PE at significantly greater rates than White or "other" ethnoracial groups, with hallucinations more commonly reported by Hispanic respondents. PE were significantly associated with police violence exposure, discrimination, adverse childhood experiences, and educational attainment. These factors statistically explained ethnoracial differences in the likelihood of overall PE occurrence and of nearly all PE subtypes. CONCLUSIONS Previously observed racial differences in psychosis extend beyond clinical schizophrenia, and therefore, are unlikely to be explained entirely by clinician biases. Instead, racial disparities in PE appear to be driven by features of structural racism, trauma, and discrimination.
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Affiliation(s)
- Jordan DeVylder
- Graduate School of Social Service, Fordham University, New York, USA
- Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Deidre Anglin
- Department of Psychology, The City College of New York, New York, USA
| | | | - Atsushi Nishida
- Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Hans Oh
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, USA
| | - Jonathan Marsh
- Graduate School of Social Service, Fordham University, New York, USA
| | - Zui Narita
- Department of Behavioral Medicine, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Natalie Bareis
- Department of Psychiatry, Columbia University and the New York State Psychiatric Institute, New York, NY, USA
| | - Lisa Fedina
- University of Michigan School of Social Work, Ann Arbor, MI, USA
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Environmental Risk Factors and Cognitive Outcomes in Psychosis: Pre-, Perinatal, and Early Life Adversity. Curr Top Behav Neurosci 2023; 63:205-240. [PMID: 35915384 PMCID: PMC9892366 DOI: 10.1007/7854_2022_378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Risk for psychosis begins to accumulate as early as the fetal period through exposure to obstetric complications like fetal hypoxia, maternal stress, and prenatal infection. Stressors in the postnatal period, such as childhood trauma, peer victimization, and neighborhood-level adversity, further increase susceptibility for psychosis. Cognitive difficulties are among the first symptoms to emerge in individuals who go on to develop a psychotic disorder. We review the relationship between pre-, perinatal, and early childhood adversities and cognitive outcomes in individuals with psychosis. Current evidence shows that the aforementioned environmental risk factors may be linked to lower overall intelligence and executive dysfunction, beginning in the premorbid period and persisting into adulthood in individuals with psychosis. It is likely that early life stress contributes to cognitive difficulties in psychosis through dysregulation of the body's response to stress, causing changes such as increased cortisol levels and chronic immune activation, which can negatively impact neurodevelopment. Intersectional aspects of identity (e.g., sex/gender, race/ethnicity), as well as gene-environment interactions, likely inform the developmental cascade to cognitive difficulties throughout the course of psychotic disorders and are reviewed below. Prospective studies of birth cohorts will serve to further clarify the relationship between early-life environmental risk factors and cognitive outcomes in the developmental course of psychotic disorders. Specific methodological recommendations are provided for future research.
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Dabbah-Assadi F, Handel R, Shamir A. What we know about the role of corticosteroids in psychiatric disorders; evidence from animal and clinical studies. J Psychiatr Res 2022; 155:363-370. [PMID: 36182765 DOI: 10.1016/j.jpsychires.2022.09.032] [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: 03/06/2022] [Revised: 08/01/2022] [Accepted: 09/16/2022] [Indexed: 11/24/2022]
Abstract
Corticosteroids, often known as steroids, are anti-inflammatory medicine prescribed for various conditions. There is accumulating evidence of immune dysregulation in major psychiatric disorders. Significant changes in concentrations of inflammatory biomarkers (i.e., IL-6 and TNF-a) have been previously reported in individuals with schizophrenia, autistic individuals, and depressive patients. Thus, systemic corticosteroids can be used as an adjuvant treatment to reduce inflammation in major psychiatric disorders. However, despite their well-known potent anti-inflammatory and immunosuppressant properties, this treatment is often associated with increased severity of several psychiatric symptoms and relapse. This article reviews the available literature on psychiatric and cognitive changes during corticosteroid therapy. Specifically, we will provide data on the good and the bad of corticosteroid therapy in autism, schizophrenia, mood disorders, and PTSD. This review will summarize the vital role of corticosteroid therapy in social and cognitive behavior.
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Affiliation(s)
- Fadwa Dabbah-Assadi
- Psychobiology Research Laboratory, Mazor Mental Health Center, Akko, Israel; The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Ran Handel
- Faculty of Medicine in the Galilee, Bar-Ilan University, Zefat, Israel
| | - Alon Shamir
- Psychobiology Research Laboratory, Mazor Mental Health Center, Akko, Israel; The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.
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8
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Amoretti S, Rabelo-da-Ponte FD, Garriga M, Forte MF, Penadés R, Vieta E, Parellada E, Ramos-Quiroga JA, Gama CS, Verdolini N, Bitanihirwe B, Garcia-Rizo C. Obstetric complications and cognition in schizophrenia: a systematic review and meta-analysis. Psychol Med 2022; 52:2874-2884. [PMID: 35979824 DOI: 10.1017/s0033291722002409] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Schizophrenia (SZ) is a complex brain disorder linked to cognitive and neurostructural abnormalities that involves genetic and environmental factors with obstetric complications (OCs) at birth conferring a high risk for the disease. Indeed, current research in the general population describes the deleterious effect of OCs on cognitive performance in adulthood. With this rationale, we aim to review the relationship between OCs and cognition in SZ and related psychotic disorders. METHODS A systematic review and meta-analysis describing cognitive function and OCs in patients with SZ and related disorders were conducted. PubMed, EmBase, SCOPUS, and the Cochrane Library were systematically searched to identify eligible studies up to January 2022. We calculated the effect sizes (Hedges' g) of cognitive domains within each study and quantified the proportion of between-study variability using the I2 statistic. Homogeneity was assessed using the Q-statistic (X2). The study was registered on PROSPERO (CRD42018094238). RESULTS A total of 4124 studies were retrieved, with 10 studies meeting inclusion criteria for the systematic review and eight for meta-analysis. SZ subjects with OCs showed poor verbal memory [Hedges' g = -0.89 (95% CI -1.41 to -0.37), p < 0.001] and working memory performance [Hedges' g = -1.47 (95% CI -2.89 to -0.06), p = 0.01] in a random-effect model compared to those without OCs. CONCLUSIONS OCs appear to have a moderate impact on specific cognitive such as working memory and verbal memory. Our findings suggest that OCs are associated with brain development and might underlie the cognitive abnormalities described at onset of psychosis.
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Affiliation(s)
- Silvia Amoretti
- Psychiatric Genetics Unit, Vall d'Hebron Research Institute (VHIR), Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain
| | - Francisco Diego Rabelo-da-Ponte
- Molecular Psychiatry Laboratory, Hospital de Clínicas de Porto Alegre, Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Marina Garriga
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Maria Florencia Forte
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
- Barcelona Clínic Schizophrenia Unit, Neuroscience Institute, Hospital Clínic of Barcelona, Barcelona, Catalonia, Spain
- Department of Medicine, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CIBERSAM, Barcelona, Catalonia, Spain
| | - Rafael Penadés
- Barcelona Clínic Schizophrenia Unit, Neuroscience Institute, Hospital Clínic of Barcelona, Barcelona, Catalonia, Spain
- Department of Medicine, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CIBERSAM, Barcelona, Catalonia, Spain
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Eduard Parellada
- Barcelona Clínic Schizophrenia Unit, Neuroscience Institute, Hospital Clínic of Barcelona, Barcelona, Catalonia, Spain
- Department of Medicine, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CIBERSAM, Barcelona, Catalonia, Spain
| | - Josep Antoni Ramos-Quiroga
- Psychiatric Genetics Unit, Vall d'Hebron Research Institute (VHIR), Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain
- Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - Clarissa S Gama
- Molecular Psychiatry Laboratory, Hospital de Clínicas de Porto Alegre, Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Norma Verdolini
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Byron Bitanihirwe
- Centre for Global Health, Trinity College, Dublin, Ireland
- Department of Psychology, Trinity College, Dublin, Ireland
- School of Medicine, Trinity College, Dublin, Ireland
| | - Clemente Garcia-Rizo
- Barcelona Clínic Schizophrenia Unit, Neuroscience Institute, Hospital Clínic of Barcelona, Barcelona, Catalonia, Spain
- Department of Medicine, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CIBERSAM, Barcelona, Catalonia, Spain
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Bridgwater M, Bachman P, Tervo-Clemmens B, Haas G, Hayes R, Luna B, Salisbury DF, Jalbrzikowski M. Developmental influences on symptom expression in antipsychotic-naïve first-episode psychosis. Psychol Med 2022; 52:1698-1709. [PMID: 33019960 PMCID: PMC8021611 DOI: 10.1017/s0033291720003463] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The neurodevelopmental model of psychosis was established over 30 years ago; however, the developmental influence on psychotic symptom expression - how age affects clinical presentation in first-episode psychosis - has not been thoroughly investigated. METHODS Using generalized additive modeling, which allows for linear and non-linear functional forms of age-related change, we leveraged symptom data from a large sample of antipsychotic-naïve individuals with first-episode psychosis (N = 340, 12-40 years, 1-12 visits), collected at the University of Pittsburgh from 1990 to 2017. We examined relationships between age and severity of perceptual and non-perceptual positive symptoms and negative symptoms. We tested for age-associated effects on change in positive or negative symptom severity following baseline assessment and explored the time-varying relationship between perceptual and non-perceptual positive symptoms across adolescent development. RESULTS Perceptual positive symptom severity significantly decreased with increasing age (F = 7.0, p = 0.0007; q = 0.003) while non-perceptual positive symptom severity increased with age (F = 4.1, p = 0.01, q = 0.02). Anhedonia severity increased with increasing age (F = 6.7, p = 0.00035; q = 0.0003), while flat affect decreased in severity with increased age (F = 9.8, p = 0.002; q = 0.006). Findings remained significant when parental SES, IQ, and illness duration were included as covariates. There were no developmental effects on change in positive or negative symptom severity (all p > 0.25). Beginning at age 18, there was a statistically significant association between severity of non-perceptual and perceptual symptoms. This relationship increased in strength throughout adulthood. CONCLUSIONS These findings suggest that as maturation proceeds, perceptual symptoms attenuate while non-perceptual symptoms are enhanced. Findings underscore how pathological brain-behavior relationships vary as a function of development.
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Affiliation(s)
- Miranda Bridgwater
- Department of Psychology, University of Maryland, Baltimore County, Maryland, USA
| | - Peter Bachman
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | - Gretchen Haas
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
- VISN4 MIRECC at VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Rebecca Hayes
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Beatriz Luna
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Dean F Salisbury
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Maria Jalbrzikowski
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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10
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Sagué-Vilavella M, Amoretti S, Garriga M, Mezquida G, Williams E, Serra-Navarro M, Forte MF, Varo C, Montejo L, Palacios-Garran R, Madero S, Sparacino G, Anmella G, Fico G, Giménez-Palomo A, Pons-Cabrera MT, Salgado-Pineda P, Montoro Salvatierra I, Sánchez Gistau V, Pomarol-Clotet E, Ramos-Quiroga JA, Undurraga J, Reinares M, Martínez-Arán A, Pacchiarotti I, Valli I, Bernardo M, Garcia-Rizo C, Vieta E, Verdolini N. Shaped before birth: Obstetric complications identify a more severe clinical phenotype among patients presenting a first affective or non-affective episode of psychosis. J Psychiatr Res 2022; 151:461-468. [PMID: 35609362 DOI: 10.1016/j.jpsychires.2022.05.005] [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: 01/04/2022] [Revised: 04/08/2022] [Accepted: 05/09/2022] [Indexed: 10/18/2022]
Abstract
Obstetric complications (OCs) may contribute to the heterogeneity that characterizes psychiatric illness, particularly the phenotypic presentation of first episode psychoses (FEP). Our aim was to examine the relationship between OCs and socio-demographic, clinical, functioning and neuropsychological characteristics in affective and non-affective FEP. We performed a cross-sectional,study where we recruited participants with FEP between 2011 and 2021, and retrospectively assessed OCs using the Lewis-Murray scale. OCs were used as a dichotomous variable and further stratified into three subtypes: complications of pregnancy, abnormal fetal growth and development, and difficulties in delivery. We performed a logistic stepwise forward regression analysis to examine variables associated with the presence of OCs. Of the 104 participants (67 affective FEP and 37 non-affective FEP), 31.7% (n = 33) had experienced OCs. Subjects with OCs showed a more gradual emergence of prodromal symptoms as well as higher negative and total Positive and Negative Syndrome Scale (PANSS) scores. In the multivariate analysis, the presence of OCs was independently associated with a younger age at first episode of any type (OR = 0.904, p = 0.003) and slower emergence of prodromal symptoms (OR = 0.274, p = 0.011). When considering specific types of OCs, those related with fetal growth were associated with worse neuropsychological performance, while OCs at delivery were related to earlier onset of illness and more severe symptoms. In conclusion, OCs signaled a specific FEP phenotype characterized by earlier and more protracted onset of illness as well as more burdensome symptoms, independently of FEP type (i.e., affective vs non-affective). These results indicate a potential target of early intervention in FEP.
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Affiliation(s)
- Maria Sagué-Vilavella
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Silvia Amoretti
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain; Department of Psychiatry, Hospital Universitari Vall d'Hebron, Group of Psychiatry, Mental Health and Addictions, Psychiatric Genetics Unit, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - Marina Garriga
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain
| | - Gisela Mezquida
- Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain; Barcelona Clinic Schizophrenia Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Evelyn Williams
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Maria Serra-Navarro
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Maria Florencia Forte
- Barcelona Clinic Schizophrenia Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Cristina Varo
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Laura Montejo
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain
| | - Roberto Palacios-Garran
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; University Hospital Santa Maria, University of Lleida, Lleida, Spain
| | - Santiago Madero
- Barcelona Clinic Schizophrenia Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Giulio Sparacino
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Gerard Anmella
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Giovanna Fico
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Anna Giménez-Palomo
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Maria Teresa Pons-Cabrera
- Addictive Behaviours Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, Barcelona, Catalonia, Spain
| | - Pilar Salgado-Pineda
- Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain; FIDMAG Germanes Hospitalàries Research Foundation, c/ Dr. Pujades 38, 08830, Sant Boi de Llobregat, Barcelona, Spain
| | - Irene Montoro Salvatierra
- Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain; Hospital Universitari Institut Pere Mata, Institut d'Investigació Sanitària Pere Virgili (IISPV), Universitat Rovira i Virgili, CIBERSAM, Reus, Tarragona, Spain
| | - Vanessa Sánchez Gistau
- Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain; Hospital Universitari Institut Pere Mata, Institut d'Investigació Sanitària Pere Virgili (IISPV), Universitat Rovira i Virgili, CIBERSAM, Reus, Tarragona, Spain
| | - Edith Pomarol-Clotet
- Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain; FIDMAG Germanes Hospitalàries Research Foundation, c/ Dr. Pujades 38, 08830, Sant Boi de Llobregat, Barcelona, Spain
| | - Josep Antoni Ramos-Quiroga
- Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain; Department of Psychiatry, Hospital Universitari Vall d'Hebron, Group of Psychiatry, Mental Health and Addictions, Psychiatric Genetics Unit, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain; Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Juan Undurraga
- Department of Neurology and Psychiatry, Faculty of Medicine, Clinica Alemana Universidad del Desarrollo, Santiago, Chile; Early Intervention Program, Instituto Psiquiátrico Dr. J. Horwitz Barak, Santiago, Chile
| | - María Reinares
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Anabel Martínez-Arán
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain
| | - Isabella Pacchiarotti
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain
| | - Isabel Valli
- Department of Child and Adolescent Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic Barcelona, IDIBAPS, CIBERSAM, Universitat de Barcelona, Barcelona, Spain
| | - Miguel Bernardo
- Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain; Barcelona Clinic Schizophrenia Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Clemente Garcia-Rizo
- Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain; Barcelona Clinic Schizophrenia Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain.
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain.
| | - Norma Verdolini
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain
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11
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Impact of stress on inhibitory neuronal circuits, our tribute to Bruce McEwen. Neurobiol Stress 2022; 19:100460. [PMID: 35734023 PMCID: PMC9207718 DOI: 10.1016/j.ynstr.2022.100460] [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: 02/15/2022] [Revised: 04/22/2022] [Accepted: 05/10/2022] [Indexed: 12/03/2022] Open
Abstract
This manuscript is dedicated to the memory of Bruce S. McEwen, to commemorate the impact he had on how we understand stress and neuronal plasticity, and the profound influence he exerted on our scientific careers. The focus of this review is the impact of stressors on inhibitory circuits, particularly those of the limbic system, but we also consider other regions affected by these adverse experiences. We revise the effects of acute and chronic stress during different stages of development and lifespan, taking into account the influence of the sex of the animals. We review first the influence of stress on the physiology of inhibitory neurons and on the expression of molecules related directly to GABAergic neurotransmission, and then focus on specific interneuron subpopulations, particularly on parvalbumin and somatostatin expressing cells. Then we analyze the effects of stress on molecules and structures related to the plasticity of inhibitory neurons: the polysialylated form of the neural cell adhesion molecule and perineuronal nets. Finally, we review the potential of antidepressants or environmental manipulations to revert the effects of stress on inhibitory circuits.
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Garcia-Rizo C, Cabrera B, Bioque M, Mezquida G, Lobo A, Gonzalez-Pinto A, Diaz-Caneja CM, Corripio I, Vieta E, Baeza I, Garcia-Portilla MP, Gutierrez-Fraile M, Rodriguez-Jimenez R, Garriga M, Fernandez-Egea E, Bernardo M. The effect of early life events on glucose levels in first-episode psychosis. Front Endocrinol (Lausanne) 2022; 13:983792. [PMID: 36545332 PMCID: PMC9762519 DOI: 10.3389/fendo.2022.983792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 10/10/2022] [Indexed: 12/12/2022] Open
Abstract
First episode of psychosis (FEP) patients display a wide variety of metabolic disturbances at onset, which might underlie these patients' increased morbidity and early mortality. Glycemic abnormalities have been previously related to pharmacological agents; however, recent research highlights the impact of early life events. Birth weight (BW), an indirect marker of the fetal environment, has been related to glucose abnormalities in the general population over time. We aim to evaluate if BW correlates with glucose values in a sample of FEP patients treated with different antipsychotics. Two hundred and thirty-six patients were included and evaluated for clinical and metabolic variables at baseline and at 2, 6, 12, and 24 months of follow-up. Pearson correlations and linear mixed model analysis were conducted to analyze the data. Antipsychotic treatment was grouped due to its metabolic risk profile. In our sample of FEP patients, BW was negatively correlated with glucose values at 24 months of follow-up [r=-0.167, p=0.037]. BW showed a trend towards significance in the association with glucose values over the 24-month period (F=3.22; p=0.073) despite other confounders such as age, time, sex, body mass index, antipsychotic type, and chlorpromazine dosage. This finding suggests that BW is involved in the evolution of glucose values over time in a cohort of patients with an FEP, independently of the type of pharmacological agent used in treatment. Our results highlight the importance of early life events in the later metabolic outcome of patients.
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Affiliation(s)
- Clemente Garcia-Rizo
- Barcelona Clínic Schizophrenia Unit, Institute of Neuroscience, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Institut d’investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- *Correspondence: Clemente Garcia-Rizo,
| | - Bibiana Cabrera
- Barcelona Clínic Schizophrenia Unit, Institute of Neuroscience, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Miquel Bioque
- Barcelona Clínic Schizophrenia Unit, Institute of Neuroscience, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Institut d’investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Gisela Mezquida
- Barcelona Clínic Schizophrenia Unit, Institute of Neuroscience, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Institut d’investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Antonio Lobo
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Department of Medicine and Psychiatry, University of Zaragoza, Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain
| | - Ana Gonzalez-Pinto
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Hospital Universitario de Alava, Servicio de Psiquiatría, BIOARABA, University of the Basque Country, Vitoria, Spain
| | - Covadonga M. Diaz-Caneja
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Iluminada Corripio
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Eduard Vieta
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Institut d’investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Bipolar and Depressive Disorders Unit, Hospital Clinic, Institute of Neuroscience, University of Barcelona, Barcelona, Spain
| | - Inmaculada Baeza
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Institut d’investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Child and Adolescent Psychiatry and Psychology Department, Hospital Clinic of Barcelona, Institute of Neurosciences, University of Barcelona, Barcelona, Spain
| | - Maria Paz Garcia-Portilla
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Department of Psychiatry, University of Oviedo, Oviedo, Spain. Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Miguel Gutierrez-Fraile
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Department of Psychiatry, Araba University Hospital, University of the Basque Country (UPV/EHU), Vitoria, Spain
- Neurosciences Department, Araba University Hospital, University of the Basque Country (UPV/EHU), Vitoria, Spain
| | - Roberto Rodriguez-Jimenez
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Instituto de Investigacion Sanitaria, Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Marina Garriga
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Institut d’investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Bipolar and Depressive Disorders Unit, Hospital Clinic, Institute of Neuroscience, University of Barcelona, Barcelona, Spain
| | - Emilio Fernandez-Egea
- Department of Psychiatry, University of Cambridge, Addenbrooke’s Hospital, Cambridge, United Kingdom
- Cambridgeshire and Peterborough NHS Foundation Trust, Huntingdon, United Kingdom
| | - Miguel Bernardo
- Barcelona Clínic Schizophrenia Unit, Institute of Neuroscience, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Institut d’investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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Anglin DM, Ereshefsky S, Klaunig MJ, Bridgwater MA, Niendam TA, Ellman LM, DeVylder J, Thayer G, Bolden K, Musket CW, Grattan RE, Lincoln SH, Schiffman J, Lipner E, Bachman P, Corcoran CM, Mota NB, van der Ven E. From Womb to Neighborhood: A Racial Analysis of Social Determinants of Psychosis in the United States. Am J Psychiatry 2021; 178:599-610. [PMID: 33934608 PMCID: PMC8655820 DOI: 10.1176/appi.ajp.2020.20071091] [Citation(s) in RCA: 120] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The authors examine U.S.-based evidence that connects characteristics of the social environment with outcomes across the psychosis continuum, from psychotic experiences to schizophrenia. The notion that inequitable social and economic systems of society significantly influence psychosis risk through proxies, such as racial minority and immigrant statuses, has been studied more extensively in European countries. While there are existing international reviews of social determinants of psychosis, none to the authors' knowledge focus on factors in the U.S. context specifically-an omission that leaves domestic treatment development and prevention efforts incomplete and underinformed. In this review, the authors first describe how a legacy of structural racism in the United States has shaped the social gradient, highlighting consequential racial inequities in environmental conditions. The authors offer a hypothesized model linking structural racism with psychosis risk through interwoven intermediary factors based on existing theoretical models and a review of the literature. Neighborhood factors, cumulative trauma and stress, and prenatal and perinatal complications were three key areas selected for review because they reflect social and environmental conditions that may affect psychosis risk through a common pathway shaped by structural racism. The authors describe evidence showing that Black and Latino people in the United States suffer disproportionately from risk factors within these three key areas, in large part as a result of racial discrimination and social disadvantage. This broad focus on individual and community factors is intended to provide a consolidated space to review this growing body of research and to guide continued inquiries into social determinants of psychosis in U.S. contexts.
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Affiliation(s)
- Deidre M Anglin
- Department of Psychology, City College of New York, City University of New York, New York (Anglin, Thayer); Graduate Center, City University of New York (Anglin); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento (Ereshefsky, Niendam, Bolden, Grattan); Department of Psychology, University of Maryland, Baltimore County (Klaunig, Bridgwater, Schiffman); Department of Psychology, Temple University, Philadelphia (Ellman, Lipner); Graduate School of Social Service, Fordham University, New York (DeVylder); Department of Psychology (Musket) and Department of Psychiatry (Bachman), University of Pittsburgh, Pittsburgh; ISN Innovations, Institute for Social Neuroscience, Ivanhoe, Australia (Grattan); Department of Psychological Sciences, Case Western Reserve University, Cleveland (Lincoln); Department of Psychological Science, University of California, Irvine (Schiffman); Department of Psychiatry, Icahn School of Medicine, New York, and James J. Peters VA Medical Center, Bronx, N.Y. (Corcoran); Brain Institute, Federal University of Rio Grande do Norte, Natal, Brazil (Mota); Mailman School of Public Health, Columbia University, New York (van der Ven); School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands (van der Ven); Department of Clinical, Neuro, and Developmental Psychology, Vrije Universiteit (VU) Amsterdam, Amsterdam (van der Ven)
| | - Sabrina Ereshefsky
- Department of Psychology, City College of New York, City University of New York, New York (Anglin, Thayer); Graduate Center, City University of New York (Anglin); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento (Ereshefsky, Niendam, Bolden, Grattan); Department of Psychology, University of Maryland, Baltimore County (Klaunig, Bridgwater, Schiffman); Department of Psychology, Temple University, Philadelphia (Ellman, Lipner); Graduate School of Social Service, Fordham University, New York (DeVylder); Department of Psychology (Musket) and Department of Psychiatry (Bachman), University of Pittsburgh, Pittsburgh; ISN Innovations, Institute for Social Neuroscience, Ivanhoe, Australia (Grattan); Department of Psychological Sciences, Case Western Reserve University, Cleveland (Lincoln); Department of Psychological Science, University of California, Irvine (Schiffman); Department of Psychiatry, Icahn School of Medicine, New York, and James J. Peters VA Medical Center, Bronx, N.Y. (Corcoran); Brain Institute, Federal University of Rio Grande do Norte, Natal, Brazil (Mota); Mailman School of Public Health, Columbia University, New York (van der Ven); School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands (van der Ven); Department of Clinical, Neuro, and Developmental Psychology, Vrije Universiteit (VU) Amsterdam, Amsterdam (van der Ven)
| | - Mallory J Klaunig
- Department of Psychology, City College of New York, City University of New York, New York (Anglin, Thayer); Graduate Center, City University of New York (Anglin); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento (Ereshefsky, Niendam, Bolden, Grattan); Department of Psychology, University of Maryland, Baltimore County (Klaunig, Bridgwater, Schiffman); Department of Psychology, Temple University, Philadelphia (Ellman, Lipner); Graduate School of Social Service, Fordham University, New York (DeVylder); Department of Psychology (Musket) and Department of Psychiatry (Bachman), University of Pittsburgh, Pittsburgh; ISN Innovations, Institute for Social Neuroscience, Ivanhoe, Australia (Grattan); Department of Psychological Sciences, Case Western Reserve University, Cleveland (Lincoln); Department of Psychological Science, University of California, Irvine (Schiffman); Department of Psychiatry, Icahn School of Medicine, New York, and James J. Peters VA Medical Center, Bronx, N.Y. (Corcoran); Brain Institute, Federal University of Rio Grande do Norte, Natal, Brazil (Mota); Mailman School of Public Health, Columbia University, New York (van der Ven); School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands (van der Ven); Department of Clinical, Neuro, and Developmental Psychology, Vrije Universiteit (VU) Amsterdam, Amsterdam (van der Ven)
| | - Miranda A Bridgwater
- Department of Psychology, City College of New York, City University of New York, New York (Anglin, Thayer); Graduate Center, City University of New York (Anglin); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento (Ereshefsky, Niendam, Bolden, Grattan); Department of Psychology, University of Maryland, Baltimore County (Klaunig, Bridgwater, Schiffman); Department of Psychology, Temple University, Philadelphia (Ellman, Lipner); Graduate School of Social Service, Fordham University, New York (DeVylder); Department of Psychology (Musket) and Department of Psychiatry (Bachman), University of Pittsburgh, Pittsburgh; ISN Innovations, Institute for Social Neuroscience, Ivanhoe, Australia (Grattan); Department of Psychological Sciences, Case Western Reserve University, Cleveland (Lincoln); Department of Psychological Science, University of California, Irvine (Schiffman); Department of Psychiatry, Icahn School of Medicine, New York, and James J. Peters VA Medical Center, Bronx, N.Y. (Corcoran); Brain Institute, Federal University of Rio Grande do Norte, Natal, Brazil (Mota); Mailman School of Public Health, Columbia University, New York (van der Ven); School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands (van der Ven); Department of Clinical, Neuro, and Developmental Psychology, Vrije Universiteit (VU) Amsterdam, Amsterdam (van der Ven)
| | - Tara A Niendam
- Department of Psychology, City College of New York, City University of New York, New York (Anglin, Thayer); Graduate Center, City University of New York (Anglin); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento (Ereshefsky, Niendam, Bolden, Grattan); Department of Psychology, University of Maryland, Baltimore County (Klaunig, Bridgwater, Schiffman); Department of Psychology, Temple University, Philadelphia (Ellman, Lipner); Graduate School of Social Service, Fordham University, New York (DeVylder); Department of Psychology (Musket) and Department of Psychiatry (Bachman), University of Pittsburgh, Pittsburgh; ISN Innovations, Institute for Social Neuroscience, Ivanhoe, Australia (Grattan); Department of Psychological Sciences, Case Western Reserve University, Cleveland (Lincoln); Department of Psychological Science, University of California, Irvine (Schiffman); Department of Psychiatry, Icahn School of Medicine, New York, and James J. Peters VA Medical Center, Bronx, N.Y. (Corcoran); Brain Institute, Federal University of Rio Grande do Norte, Natal, Brazil (Mota); Mailman School of Public Health, Columbia University, New York (van der Ven); School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands (van der Ven); Department of Clinical, Neuro, and Developmental Psychology, Vrije Universiteit (VU) Amsterdam, Amsterdam (van der Ven)
| | - Lauren M Ellman
- Department of Psychology, City College of New York, City University of New York, New York (Anglin, Thayer); Graduate Center, City University of New York (Anglin); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento (Ereshefsky, Niendam, Bolden, Grattan); Department of Psychology, University of Maryland, Baltimore County (Klaunig, Bridgwater, Schiffman); Department of Psychology, Temple University, Philadelphia (Ellman, Lipner); Graduate School of Social Service, Fordham University, New York (DeVylder); Department of Psychology (Musket) and Department of Psychiatry (Bachman), University of Pittsburgh, Pittsburgh; ISN Innovations, Institute for Social Neuroscience, Ivanhoe, Australia (Grattan); Department of Psychological Sciences, Case Western Reserve University, Cleveland (Lincoln); Department of Psychological Science, University of California, Irvine (Schiffman); Department of Psychiatry, Icahn School of Medicine, New York, and James J. Peters VA Medical Center, Bronx, N.Y. (Corcoran); Brain Institute, Federal University of Rio Grande do Norte, Natal, Brazil (Mota); Mailman School of Public Health, Columbia University, New York (van der Ven); School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands (van der Ven); Department of Clinical, Neuro, and Developmental Psychology, Vrije Universiteit (VU) Amsterdam, Amsterdam (van der Ven)
| | - Jordan DeVylder
- Department of Psychology, City College of New York, City University of New York, New York (Anglin, Thayer); Graduate Center, City University of New York (Anglin); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento (Ereshefsky, Niendam, Bolden, Grattan); Department of Psychology, University of Maryland, Baltimore County (Klaunig, Bridgwater, Schiffman); Department of Psychology, Temple University, Philadelphia (Ellman, Lipner); Graduate School of Social Service, Fordham University, New York (DeVylder); Department of Psychology (Musket) and Department of Psychiatry (Bachman), University of Pittsburgh, Pittsburgh; ISN Innovations, Institute for Social Neuroscience, Ivanhoe, Australia (Grattan); Department of Psychological Sciences, Case Western Reserve University, Cleveland (Lincoln); Department of Psychological Science, University of California, Irvine (Schiffman); Department of Psychiatry, Icahn School of Medicine, New York, and James J. Peters VA Medical Center, Bronx, N.Y. (Corcoran); Brain Institute, Federal University of Rio Grande do Norte, Natal, Brazil (Mota); Mailman School of Public Health, Columbia University, New York (van der Ven); School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands (van der Ven); Department of Clinical, Neuro, and Developmental Psychology, Vrije Universiteit (VU) Amsterdam, Amsterdam (van der Ven)
| | - Griffin Thayer
- Department of Psychology, City College of New York, City University of New York, New York (Anglin, Thayer); Graduate Center, City University of New York (Anglin); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento (Ereshefsky, Niendam, Bolden, Grattan); Department of Psychology, University of Maryland, Baltimore County (Klaunig, Bridgwater, Schiffman); Department of Psychology, Temple University, Philadelphia (Ellman, Lipner); Graduate School of Social Service, Fordham University, New York (DeVylder); Department of Psychology (Musket) and Department of Psychiatry (Bachman), University of Pittsburgh, Pittsburgh; ISN Innovations, Institute for Social Neuroscience, Ivanhoe, Australia (Grattan); Department of Psychological Sciences, Case Western Reserve University, Cleveland (Lincoln); Department of Psychological Science, University of California, Irvine (Schiffman); Department of Psychiatry, Icahn School of Medicine, New York, and James J. Peters VA Medical Center, Bronx, N.Y. (Corcoran); Brain Institute, Federal University of Rio Grande do Norte, Natal, Brazil (Mota); Mailman School of Public Health, Columbia University, New York (van der Ven); School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands (van der Ven); Department of Clinical, Neuro, and Developmental Psychology, Vrije Universiteit (VU) Amsterdam, Amsterdam (van der Ven)
| | - Khalima Bolden
- Department of Psychology, City College of New York, City University of New York, New York (Anglin, Thayer); Graduate Center, City University of New York (Anglin); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento (Ereshefsky, Niendam, Bolden, Grattan); Department of Psychology, University of Maryland, Baltimore County (Klaunig, Bridgwater, Schiffman); Department of Psychology, Temple University, Philadelphia (Ellman, Lipner); Graduate School of Social Service, Fordham University, New York (DeVylder); Department of Psychology (Musket) and Department of Psychiatry (Bachman), University of Pittsburgh, Pittsburgh; ISN Innovations, Institute for Social Neuroscience, Ivanhoe, Australia (Grattan); Department of Psychological Sciences, Case Western Reserve University, Cleveland (Lincoln); Department of Psychological Science, University of California, Irvine (Schiffman); Department of Psychiatry, Icahn School of Medicine, New York, and James J. Peters VA Medical Center, Bronx, N.Y. (Corcoran); Brain Institute, Federal University of Rio Grande do Norte, Natal, Brazil (Mota); Mailman School of Public Health, Columbia University, New York (van der Ven); School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands (van der Ven); Department of Clinical, Neuro, and Developmental Psychology, Vrije Universiteit (VU) Amsterdam, Amsterdam (van der Ven)
| | - Christie W Musket
- Department of Psychology, City College of New York, City University of New York, New York (Anglin, Thayer); Graduate Center, City University of New York (Anglin); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento (Ereshefsky, Niendam, Bolden, Grattan); Department of Psychology, University of Maryland, Baltimore County (Klaunig, Bridgwater, Schiffman); Department of Psychology, Temple University, Philadelphia (Ellman, Lipner); Graduate School of Social Service, Fordham University, New York (DeVylder); Department of Psychology (Musket) and Department of Psychiatry (Bachman), University of Pittsburgh, Pittsburgh; ISN Innovations, Institute for Social Neuroscience, Ivanhoe, Australia (Grattan); Department of Psychological Sciences, Case Western Reserve University, Cleveland (Lincoln); Department of Psychological Science, University of California, Irvine (Schiffman); Department of Psychiatry, Icahn School of Medicine, New York, and James J. Peters VA Medical Center, Bronx, N.Y. (Corcoran); Brain Institute, Federal University of Rio Grande do Norte, Natal, Brazil (Mota); Mailman School of Public Health, Columbia University, New York (van der Ven); School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands (van der Ven); Department of Clinical, Neuro, and Developmental Psychology, Vrije Universiteit (VU) Amsterdam, Amsterdam (van der Ven)
| | - Rebecca E Grattan
- Department of Psychology, City College of New York, City University of New York, New York (Anglin, Thayer); Graduate Center, City University of New York (Anglin); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento (Ereshefsky, Niendam, Bolden, Grattan); Department of Psychology, University of Maryland, Baltimore County (Klaunig, Bridgwater, Schiffman); Department of Psychology, Temple University, Philadelphia (Ellman, Lipner); Graduate School of Social Service, Fordham University, New York (DeVylder); Department of Psychology (Musket) and Department of Psychiatry (Bachman), University of Pittsburgh, Pittsburgh; ISN Innovations, Institute for Social Neuroscience, Ivanhoe, Australia (Grattan); Department of Psychological Sciences, Case Western Reserve University, Cleveland (Lincoln); Department of Psychological Science, University of California, Irvine (Schiffman); Department of Psychiatry, Icahn School of Medicine, New York, and James J. Peters VA Medical Center, Bronx, N.Y. (Corcoran); Brain Institute, Federal University of Rio Grande do Norte, Natal, Brazil (Mota); Mailman School of Public Health, Columbia University, New York (van der Ven); School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands (van der Ven); Department of Clinical, Neuro, and Developmental Psychology, Vrije Universiteit (VU) Amsterdam, Amsterdam (van der Ven)
| | - Sarah Hope Lincoln
- Department of Psychology, City College of New York, City University of New York, New York (Anglin, Thayer); Graduate Center, City University of New York (Anglin); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento (Ereshefsky, Niendam, Bolden, Grattan); Department of Psychology, University of Maryland, Baltimore County (Klaunig, Bridgwater, Schiffman); Department of Psychology, Temple University, Philadelphia (Ellman, Lipner); Graduate School of Social Service, Fordham University, New York (DeVylder); Department of Psychology (Musket) and Department of Psychiatry (Bachman), University of Pittsburgh, Pittsburgh; ISN Innovations, Institute for Social Neuroscience, Ivanhoe, Australia (Grattan); Department of Psychological Sciences, Case Western Reserve University, Cleveland (Lincoln); Department of Psychological Science, University of California, Irvine (Schiffman); Department of Psychiatry, Icahn School of Medicine, New York, and James J. Peters VA Medical Center, Bronx, N.Y. (Corcoran); Brain Institute, Federal University of Rio Grande do Norte, Natal, Brazil (Mota); Mailman School of Public Health, Columbia University, New York (van der Ven); School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands (van der Ven); Department of Clinical, Neuro, and Developmental Psychology, Vrije Universiteit (VU) Amsterdam, Amsterdam (van der Ven)
| | - Jason Schiffman
- Department of Psychology, City College of New York, City University of New York, New York (Anglin, Thayer); Graduate Center, City University of New York (Anglin); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento (Ereshefsky, Niendam, Bolden, Grattan); Department of Psychology, University of Maryland, Baltimore County (Klaunig, Bridgwater, Schiffman); Department of Psychology, Temple University, Philadelphia (Ellman, Lipner); Graduate School of Social Service, Fordham University, New York (DeVylder); Department of Psychology (Musket) and Department of Psychiatry (Bachman), University of Pittsburgh, Pittsburgh; ISN Innovations, Institute for Social Neuroscience, Ivanhoe, Australia (Grattan); Department of Psychological Sciences, Case Western Reserve University, Cleveland (Lincoln); Department of Psychological Science, University of California, Irvine (Schiffman); Department of Psychiatry, Icahn School of Medicine, New York, and James J. Peters VA Medical Center, Bronx, N.Y. (Corcoran); Brain Institute, Federal University of Rio Grande do Norte, Natal, Brazil (Mota); Mailman School of Public Health, Columbia University, New York (van der Ven); School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands (van der Ven); Department of Clinical, Neuro, and Developmental Psychology, Vrije Universiteit (VU) Amsterdam, Amsterdam (van der Ven)
| | - Emily Lipner
- Department of Psychology, City College of New York, City University of New York, New York (Anglin, Thayer); Graduate Center, City University of New York (Anglin); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento (Ereshefsky, Niendam, Bolden, Grattan); Department of Psychology, University of Maryland, Baltimore County (Klaunig, Bridgwater, Schiffman); Department of Psychology, Temple University, Philadelphia (Ellman, Lipner); Graduate School of Social Service, Fordham University, New York (DeVylder); Department of Psychology (Musket) and Department of Psychiatry (Bachman), University of Pittsburgh, Pittsburgh; ISN Innovations, Institute for Social Neuroscience, Ivanhoe, Australia (Grattan); Department of Psychological Sciences, Case Western Reserve University, Cleveland (Lincoln); Department of Psychological Science, University of California, Irvine (Schiffman); Department of Psychiatry, Icahn School of Medicine, New York, and James J. Peters VA Medical Center, Bronx, N.Y. (Corcoran); Brain Institute, Federal University of Rio Grande do Norte, Natal, Brazil (Mota); Mailman School of Public Health, Columbia University, New York (van der Ven); School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands (van der Ven); Department of Clinical, Neuro, and Developmental Psychology, Vrije Universiteit (VU) Amsterdam, Amsterdam (van der Ven)
| | - Peter Bachman
- Department of Psychology, City College of New York, City University of New York, New York (Anglin, Thayer); Graduate Center, City University of New York (Anglin); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento (Ereshefsky, Niendam, Bolden, Grattan); Department of Psychology, University of Maryland, Baltimore County (Klaunig, Bridgwater, Schiffman); Department of Psychology, Temple University, Philadelphia (Ellman, Lipner); Graduate School of Social Service, Fordham University, New York (DeVylder); Department of Psychology (Musket) and Department of Psychiatry (Bachman), University of Pittsburgh, Pittsburgh; ISN Innovations, Institute for Social Neuroscience, Ivanhoe, Australia (Grattan); Department of Psychological Sciences, Case Western Reserve University, Cleveland (Lincoln); Department of Psychological Science, University of California, Irvine (Schiffman); Department of Psychiatry, Icahn School of Medicine, New York, and James J. Peters VA Medical Center, Bronx, N.Y. (Corcoran); Brain Institute, Federal University of Rio Grande do Norte, Natal, Brazil (Mota); Mailman School of Public Health, Columbia University, New York (van der Ven); School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands (van der Ven); Department of Clinical, Neuro, and Developmental Psychology, Vrije Universiteit (VU) Amsterdam, Amsterdam (van der Ven)
| | - Cheryl M Corcoran
- Department of Psychology, City College of New York, City University of New York, New York (Anglin, Thayer); Graduate Center, City University of New York (Anglin); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento (Ereshefsky, Niendam, Bolden, Grattan); Department of Psychology, University of Maryland, Baltimore County (Klaunig, Bridgwater, Schiffman); Department of Psychology, Temple University, Philadelphia (Ellman, Lipner); Graduate School of Social Service, Fordham University, New York (DeVylder); Department of Psychology (Musket) and Department of Psychiatry (Bachman), University of Pittsburgh, Pittsburgh; ISN Innovations, Institute for Social Neuroscience, Ivanhoe, Australia (Grattan); Department of Psychological Sciences, Case Western Reserve University, Cleveland (Lincoln); Department of Psychological Science, University of California, Irvine (Schiffman); Department of Psychiatry, Icahn School of Medicine, New York, and James J. Peters VA Medical Center, Bronx, N.Y. (Corcoran); Brain Institute, Federal University of Rio Grande do Norte, Natal, Brazil (Mota); Mailman School of Public Health, Columbia University, New York (van der Ven); School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands (van der Ven); Department of Clinical, Neuro, and Developmental Psychology, Vrije Universiteit (VU) Amsterdam, Amsterdam (van der Ven)
| | - Natália B Mota
- Department of Psychology, City College of New York, City University of New York, New York (Anglin, Thayer); Graduate Center, City University of New York (Anglin); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento (Ereshefsky, Niendam, Bolden, Grattan); Department of Psychology, University of Maryland, Baltimore County (Klaunig, Bridgwater, Schiffman); Department of Psychology, Temple University, Philadelphia (Ellman, Lipner); Graduate School of Social Service, Fordham University, New York (DeVylder); Department of Psychology (Musket) and Department of Psychiatry (Bachman), University of Pittsburgh, Pittsburgh; ISN Innovations, Institute for Social Neuroscience, Ivanhoe, Australia (Grattan); Department of Psychological Sciences, Case Western Reserve University, Cleveland (Lincoln); Department of Psychological Science, University of California, Irvine (Schiffman); Department of Psychiatry, Icahn School of Medicine, New York, and James J. Peters VA Medical Center, Bronx, N.Y. (Corcoran); Brain Institute, Federal University of Rio Grande do Norte, Natal, Brazil (Mota); Mailman School of Public Health, Columbia University, New York (van der Ven); School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands (van der Ven); Department of Clinical, Neuro, and Developmental Psychology, Vrije Universiteit (VU) Amsterdam, Amsterdam (van der Ven)
| | - Els van der Ven
- Department of Psychology, City College of New York, City University of New York, New York (Anglin, Thayer); Graduate Center, City University of New York (Anglin); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento (Ereshefsky, Niendam, Bolden, Grattan); Department of Psychology, University of Maryland, Baltimore County (Klaunig, Bridgwater, Schiffman); Department of Psychology, Temple University, Philadelphia (Ellman, Lipner); Graduate School of Social Service, Fordham University, New York (DeVylder); Department of Psychology (Musket) and Department of Psychiatry (Bachman), University of Pittsburgh, Pittsburgh; ISN Innovations, Institute for Social Neuroscience, Ivanhoe, Australia (Grattan); Department of Psychological Sciences, Case Western Reserve University, Cleveland (Lincoln); Department of Psychological Science, University of California, Irvine (Schiffman); Department of Psychiatry, Icahn School of Medicine, New York, and James J. Peters VA Medical Center, Bronx, N.Y. (Corcoran); Brain Institute, Federal University of Rio Grande do Norte, Natal, Brazil (Mota); Mailman School of Public Health, Columbia University, New York (van der Ven); School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands (van der Ven); Department of Clinical, Neuro, and Developmental Psychology, Vrije Universiteit (VU) Amsterdam, Amsterdam (van der Ven)
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14
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Abstract
Introduction: Most medical diagnoses present somewhat differently in men and women, more so at specific periods of life. Treatment effects may also differ. This is true for schizophrenia, where premorbid effects are experienced earlier in life in boys than in girls, and where symptoms and outcomes differ.Areas covered: This review does not cover all the differences that have been reported between men and women but, instead, focuses on the ones that carry important implications for clinical care: effective antipsychotic doses, medication side effects, symptom fluctuation due to hormonal levels, comorbidities, and women's requirements for prenatal, obstetric, postpartum, and parenting support.Expert opinion: Of consequence to schizophrenia, sex-biased genes, epigenetic modifications, and sex steroids all impact the structure and function of the brain. Furthermore, life experiences and social roles exert major sex-specific influences. The co-morbidities that accompany schizophrenia also affect men and women to different degrees. This review offers several examples of sex-specific intervention and concludes that gold standard treatment must look beyond symptoms and address all the physiologic, psychologic, and social role needs of men and women suffering from this psychiatric disorder.
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Affiliation(s)
- Mary V Seeman
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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15
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Paquin V, Lapierre M, Veru F, King S. Early Environmental Upheaval and the Risk for Schizophrenia. Annu Rev Clin Psychol 2021; 17:285-311. [PMID: 33544627 DOI: 10.1146/annurev-clinpsy-081219-103805] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Why does prenatal exposure to wars, natural disasters, urbanicity, or winter increase the risk for schizophrenia? Research from the last two decades has provided rich insight about the underlying chains of causation at play during environmental upheaval, from conception to early infancy. In this review, we appraise the evidence linking schizophrenia spectrum disorder to prenatal maternal stress, obstetric complications, early infections, and maternal nutrition and other lifestyle factors. We discuss putative mechanisms, including the maternal stress system, perinatal hypoxia, and maternal-offspring immune activation. We propose that gene-environment interactions, timing during development, and sex differentiate the neuropsychiatric outcomes. Future research should pursue the translation of animal studies to humans and the longitudinal associations between early exposures, intermediate phenotypes, and psychiatric disorders. Finally, to paint a comprehensive model of risk and to harness targets for prevention, we argue that risk factors should be situated within the individual's personal ecosystem.
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Affiliation(s)
- Vincent Paquin
- Department of Psychiatry, McGill University, Montréal, Québec H3A 1A1, Canada; .,Douglas Research Centre, Montréal, Québec H4H 1R3, Canada
| | - Mylène Lapierre
- Douglas Research Centre, Montréal, Québec H4H 1R3, Canada.,Department of Psychology, Université de Montréal, Montréal, Québec H2V 2S9, Canada
| | - Franz Veru
- Department of Psychiatry, McGill University, Montréal, Québec H3A 1A1, Canada; .,Douglas Research Centre, Montréal, Québec H4H 1R3, Canada
| | - Suzanne King
- Department of Psychiatry, McGill University, Montréal, Québec H3A 1A1, Canada; .,Douglas Research Centre, Montréal, Québec H4H 1R3, Canada.,Department of Psychology, Université de Montréal, Montréal, Québec H2V 2S9, Canada
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16
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Becoming Stressed: Does the Age Matter? Reviewing the Neurobiological and Socio-Affective Effects of Stress throughout the Lifespan. Int J Mol Sci 2020; 21:ijms21165819. [PMID: 32823723 PMCID: PMC7460954 DOI: 10.3390/ijms21165819] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 08/10/2020] [Accepted: 08/11/2020] [Indexed: 12/25/2022] Open
Abstract
Social and affective relations occur at every stage of our lives. Impairments in the quality of this “social world” can be exceptionally detrimental and lead to psychopathology or pathological behavior, including schizophrenia, autism spectrum disorder, affective disorders, social phobia or violence, among other things. Exposure to highly stressful or traumatic events, depending on the stage of life in which stress exposure occurs, could severely affect limbic structures, including the amygdala, and lead to alterations in social and affective behaviors. This review summarizes recent findings from stress research and provides an overview of its age-dependent effects on the structure and function of the amygdala, which includes molecular and cellular changes, and how they can trigger deviant social and affective behaviors. It is important to highlight that discoveries in this field may represent a breakthrough both for medical science and for society, as they may help in the development of new therapeutic approaches and prevention strategies in neuropsychiatric disorders and pathological behaviors.
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17
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MacKinley ML, Sabesan P, Palaniyappan L. Deviant cortical sulcation related to schizophrenia and cognitive deficits in the second trimester. Transl Neurosci 2020; 11:236-240. [PMID: 33312722 PMCID: PMC7705986 DOI: 10.1515/tnsci-2020-0111] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 06/05/2020] [Accepted: 06/16/2020] [Indexed: 12/14/2022] Open
Abstract
Objectives Aberrant cortical development, inferred from cortical folding, is linked to the risk of schizophrenia. Cortical folds develop in a time-locked fashion during fetal growth. We leveraged this temporal specificity of sulcation to investigate the timing of the prenatal insult linked to schizophrenia and the cognitive impairment seen in this illness. Methods Anatomical MRI scans from 68 patients with schizophrenia and 72 controls were used to evaluate the sulcal depth of five major invariable primary sulci representing lobar development (calcarine sulcus, superior temporal sulcus, superior frontal sulcus, intraparietal sulcus and inferior frontal sulcus) with formation representing the distinct developmental periods. Results A repeated-measure ANOVA with five sulci and two hemispheres as the within-subject factors and gender, age and intracranial volume as covariates revealed a significant effect of diagnosis (F[1,134] = 14.8, p = 0.0002). Control subjects had deeper bilateral superior temporal, right inferior frontal and left calcarine sulci. A deeper superior frontal sulcus predicted better cognitive scores among patients. Conclusion Our results suggest that the gestational disruption underlying schizophrenia is likely to predate, if not coincide with the appearance of calcarine sulcus (early second trimester). Nevertheless, the burden of cognitive deficits may relate specifically to the aberrant superior frontal development apparent in late second trimester.
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Affiliation(s)
- Michael Lloyd MacKinley
- Robarts Research Institute & The Brain and Mind Institute, University of Western Ontario, Room-A2/636, Prevention and Early Intervention Program for Psychoses, Victoria Hospital, 800, Commissioners Road, London, Ontario, Canada.,Schulich School of Medicine and Dentistry, Department of Neuroscience, University of Western Ontario, London, Ontario, Canada
| | - Priyadharshini Sabesan
- Department of Psychiatry, University of Western Ontario, London, Ontario, Canada.,Lawson Health Research Institute, London, Ontario, Canada
| | - Lena Palaniyappan
- Robarts Research Institute & The Brain and Mind Institute, University of Western Ontario, Room-A2/636, Prevention and Early Intervention Program for Psychoses, Victoria Hospital, 800, Commissioners Road, London, Ontario, Canada.,Department of Psychiatry, University of Western Ontario, London, Ontario, Canada.,Lawson Health Research Institute, London, Ontario, Canada
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18
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Davies C, Segre G, Estradé A, Radua J, De Micheli A, Provenzani U, Oliver D, Salazar de Pablo G, Ramella-Cravaro V, Besozzi M, Dazzan P, Miele M, Caputo G, Spallarossa C, Crossland G, Ilyas A, Spada G, Politi P, Murray RM, McGuire P, Fusar-Poli P. Prenatal and perinatal risk and protective factors for psychosis: a systematic review and meta-analysis. Lancet Psychiatry 2020; 7:399-410. [PMID: 32220288 DOI: 10.1016/s2215-0366(20)30057-2] [Citation(s) in RCA: 163] [Impact Index Per Article: 40.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 01/24/2020] [Accepted: 02/04/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Prenatal and perinatal insults are implicated in the aetiopathogenesis of psychotic disorders but the consistency and magnitude of their associations with psychosis have not been updated for nearly two decades. The aim of this systematic review and meta-analysis was to provide a comprehensive and up-to-date synthesis of the evidence on the association between prenatal or perinatal risk and protective factors and psychotic disorders. METHODS In this systematic review and meta-analysis, we searched the Web of Science database for articles published up to July 20, 2019. We identified cohort and case-control studies examining the association (odds ratio [OR]) between prenatal and perinatal factors and any International Classification of Diseases (ICD) or Diagnostic and Statistical Manual of Mental Disorders (DSM) non-organic psychotic disorder with a healthy comparison group. Other inclusion criteria were enough data available to do the analyses, and non-overlapping datasets. We excluded reviews, meta-analyses, abstracts or conference proceedings, and articles with overlapping datasets. Data were extracted according to EQUATOR and PRISMA guidelines. Extracted variables included first author, publication year, study type, sample size, type of psychotic diagnosis (non-affective psychoses or schizophrenia-spectrum disorders, affective psychoses) and diagnostic instrument (DSM or ICD and version), the risk or protective factor, and measure of association (primary outcome). We did random-effects pairwise meta-analyses, Q statistics, I2 index, sensitivity analyses, meta-regressions, and assessed study quality and publication bias. The study protocol was registered at PROSPERO, CRD42017079261. FINDINGS 152 studies relating to 98 risk or protective factors were eligible for analysis. Significant risk factors were: maternal age younger than 20 years (OR 1·17) and 30-34 years (OR 1·05); paternal age younger than 20 years (OR 1·31) and older than 35 years (OR 1·28); any maternal (OR 4·60) or paternal (OR 2·73) psychopathology; maternal psychosis (OR 7·61) and affective disorder (OR 2·26); three or more pregnancies (OR 1·30); herpes simplex 2 (OR 1·35); maternal infections not otherwise specified (NOS; OR 1·27); suboptimal number of antenatal visits (OR 1·83); winter (OR 1·05) and winter to spring (OR 1·05) season of birth in the northern hemisphere; maternal stress NOS (OR 2·40); famine (OR 1·61); any famine or nutritional deficits in pregnancy (OR 1·40); maternal hypertension (OR 1·40); hypoxia (OR 1·63); ruptured (OR 1·86) and premature rupture (OR 2·29) of membranes; polyhydramnios (OR 3·05); definite obstetric complications NOS (OR 1·83); birthweights of less than 2000 g (OR 1·84), less than 2500 g (OR 1·53), or 2500-2999 g (OR 1·23); birth length less than 49 cm (OR 1·17); small for gestational age (OR 1·40); premature birth (OR 1·35), and congenital malformations (OR 2·35). Significant protective factors were maternal ages 20-24 years (OR 0·93) and 25-29 years (OR 0·92), nulliparity (OR 0·91), and birthweights 3500-3999 g (OR 0·90) or more than 4000 g (OR 0·86). The results were corrected for publication biases; sensitivity and meta-regression analyses confirmed the robustness of these findings for most factors. INTERPRETATION Several prenatal and perinatal factors are associated with the later onset of psychosis. The updated knowledge emerging from this study could refine understanding of psychosis pathogenesis, enhance multivariable risk prediction, and inform preventive strategies. FUNDING None.
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Affiliation(s)
- Cathy Davies
- Early Psychosis: Interventions and Clinical-detection (EPIC) Laboratory, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Giulia Segre
- Early Psychosis: Interventions and Clinical-detection (EPIC) Laboratory, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Andrés Estradé
- Early Psychosis: Interventions and Clinical-detection (EPIC) Laboratory, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Department of Clinical and Health Psychology, Universidad Católica, Montevideo, Uruguay
| | - Joaquim Radua
- Early Psychosis: Interventions and Clinical-detection (EPIC) Laboratory, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Imaging of Mood and Anxiety-Related Disorders (IMARD) group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CIBERSAM, Barcelona, Spain; Department of Clinical Neuroscience, Centre for Psychiatric Research and Education, Karolinska Institutet, Stockholm, Sweden
| | - Andrea De Micheli
- Early Psychosis: Interventions and Clinical-detection (EPIC) Laboratory, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; National Institute for Health Research Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | - Umberto Provenzani
- Early Psychosis: Interventions and Clinical-detection (EPIC) Laboratory, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Dominic Oliver
- Early Psychosis: Interventions and Clinical-detection (EPIC) Laboratory, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Gonzalo Salazar de Pablo
- Early Psychosis: Interventions and Clinical-detection (EPIC) Laboratory, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Institute of Psychiatry and Mental Health, Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, Universidad Complutense, CIBERSAM, Madrid, Spain
| | - Valentina Ramella-Cravaro
- Early Psychosis: Interventions and Clinical-detection (EPIC) Laboratory, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Maria Besozzi
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Paola Dazzan
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Maddalena Miele
- Perinatal Mental Health Service, St Mary's Hospital, Imperial College London and Central North West London NHS Foundation Trust, London, UK
| | - Gianluigi Caputo
- Early Psychosis: Interventions and Clinical-detection (EPIC) Laboratory, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Cecilia Spallarossa
- Early Psychosis: Interventions and Clinical-detection (EPIC) Laboratory, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Georgia Crossland
- Early Psychosis: Interventions and Clinical-detection (EPIC) Laboratory, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Athif Ilyas
- Early Psychosis: Interventions and Clinical-detection (EPIC) Laboratory, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Giulia Spada
- Early Psychosis: Interventions and Clinical-detection (EPIC) Laboratory, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Pierluigi Politi
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Robin M Murray
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Philip McGuire
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; National Institute for Health Research Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK; Outreach And Support in South London (OASIS) Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-detection (EPIC) Laboratory, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; National Institute for Health Research Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK; Outreach And Support in South London (OASIS) Service, South London and Maudsley NHS Foundation Trust, London, UK; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
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Mittal VA, Walker EF. Advances in the neurobiology of stress and psychosis. Schizophr Res 2019; 213:1-5. [PMID: 31575430 DOI: 10.1016/j.schres.2019.08.030] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 08/27/2019] [Indexed: 02/06/2023]
Affiliation(s)
- Vijay A Mittal
- Department of Psychology, Northwestern University, 2029 Sheridan Road, Swift 202, Evanston, IL 60208, USA.
| | - Elaine F Walker
- Department of Psychology, Emory University, 36 Eagle Row, Atlanta, GA, USA 30322.
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20
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Lipner E, Murphy SK, Ellman LM. Prenatal Maternal Stress and the Cascade of Risk to Schizophrenia Spectrum Disorders in Offspring. Curr Psychiatry Rep 2019; 21:99. [PMID: 31522269 PMCID: PMC7043262 DOI: 10.1007/s11920-019-1085-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE OF REVIEW Disruptions in fetal development (via genetic and environmental pathways) have been consistently associated with risk for schizophrenia in a variety of studies. Although multiple obstetric complications (OCs) have been linked to schizophrenia, this review will discuss emerging evidence supporting the role of prenatal maternal stress (PNMS) in the etiology of schizophrenia spectrum disorders (SSD). In addition, findings linking PNMS to intermediate phenotypes of the disorder, such as OCs and premorbid cognitive, behavioral, and motor deficits, will be reviewed. Maternal immune and endocrine dysregulation will also be explored as potential mechanisms by which PNMS confers risk for SSD. RECENT FINDINGS PNMS has been linked to offspring SSD; however, findings are mixed due to inconsistent and retrospective assessments of PNMS and lack of specificity about SSD outcomes. PNMS is also associated with various intermediate phenotypes of SSD (e.g., prenatal infection/inflammation, decreased fetal growth, hypoxia-related OCs). Recent studies continue to elucidate the impact of PNMS while considering the moderating roles of fetal sex and stress timing, but it is still unclear which aspects of PNMS (e.g., type, timing) confer risk for SSD specifically. PNMS increases risk for SSD, but only in a small portion of fetuses exposed to PNMS. Fetal sex, genetics, and other environmental factors, as well as additional pre- and postnatal insults, likely contribute to the PNMS-SSD association. Longitudinal birth cohort studies are needed to prospectively illuminate the mechanisms that account for the variability in outcomes following PNMS.
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Affiliation(s)
- Emily Lipner
- Department of Psychology, Temple University, Weiss Hall, 1701 N. 13th Street, Philadelphia, PA, 19106, USA
| | - Shannon K Murphy
- Department of Psychology, Temple University, Weiss Hall, 1701 N. 13th Street, Philadelphia, PA, 19106, USA
| | - Lauren M Ellman
- Department of Psychology, Temple University, Weiss Hall, 1701 N. 13th Street, Philadelphia, PA, 19106, USA.
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