1
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Wang HR, Liu ZQ, Nakua H, Hegarty CE, Thies MB, Patel PK, Schleifer CH, Boeck TP, McKinney RA, Currin D, Leathem L, DeRosse P, Bearden CE, Misic B, Karlsgodt KH. Decoding Early Psychoses: Unraveling Stable Microstructural Features Associated with Psychopathology Across Independent Cohorts. Biol Psychiatry 2024:S0006-3223(24)01391-X. [PMID: 38908657 DOI: 10.1016/j.biopsych.2024.06.011] [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: 01/04/2024] [Revised: 05/14/2024] [Accepted: 06/11/2024] [Indexed: 06/24/2024]
Abstract
BACKGROUND Early Psychosis patients (EP, within 3 years after psychosis onset) show significant variability, making outcome predictions challenging. Currently, little evidence exists for stable relationships between neural microstructural properties and symptom profiles across EP diagnoses, limiting the development of early interventions. METHODS A data-driven approach, Partial Least Squares (PLS) correlation, was used across two independent datasets to examine multivariate relationships between white matter (WM) properties and symptomatology, to identify stable and generalizable signatures in EP. The primary cohort included EP patients from the Human Connectome Project-Early Psychosis (n=124). The replication cohort included EP patients from the Feinstein Institute for Medical Research (n=78). Both samples included individuals with schizophrenia, schizoaffective disorder, and psychotic mood disorders. RESULTS In both cohorts, a significant latent component (LC) corresponded to a symptom profile combining negative symptoms, primarily diminished expression, with specific somatic symptoms. Both LCs captured comprehensive features of WM disruption, primarily a combination of subcortical and frontal association fibers. Strikingly, the PLS model trained on the primary cohort accurately predicted microstructural features and symptoms in the replication cohort. Findings were not driven by diagnosis, medication, or substance use. CONCLUSIONS This data-driven transdiagnostic approach revealed a stable and replicable neurobiological signature of microstructural WM alterations in EP, across diagnoses and datasets, showing a strong covariance of these alterations with a unique profile of negative and somatic symptoms. This finding suggests the clinical utility of applying data-driven approaches to reveal symptom domains that share neurobiological underpinnings.
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Affiliation(s)
- Haley R Wang
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States; Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, United States
| | - Zhen-Qi Liu
- Montréal Neurological Institute, McGill University, Montréal, QC, Canada
| | - Hajer Nakua
- Centre for Addiction and Mental Health, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Catherine E Hegarty
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Melanie Blair Thies
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Pooja K Patel
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, United States; Desert Pacific Mental Illness Research, Education, and Clinical Center Greater Los Angeles VA Healthcare System, Los Angeles, CA, United States
| | - Charles H Schleifer
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, United States; David Geffen School of Medicine, University of California, Los Angeles, CA, United States
| | - Thomas P Boeck
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Rachel A McKinney
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Danielle Currin
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Logan Leathem
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Pamela DeRosse
- Department of Psychology, Stony Brook University, Stony Brook, NY, United States
| | - Carrie E Bearden
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, United States; Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Bratislav Misic
- Montréal Neurological Institute, McGill University, Montréal, QC, Canada
| | - Katherine H Karlsgodt
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States; Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, United States.
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Kane JM, Schoretsanitis G, Rubio JM, Correll CU. Clozapine in treatment-resistant schizophrenia: Reflections from the Hallmark US clinical trial and beyond. Schizophr Res 2024; 268:9-13. [PMID: 38290942 DOI: 10.1016/j.schres.2024.01.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 01/22/2024] [Accepted: 01/23/2024] [Indexed: 02/01/2024]
Affiliation(s)
- John M Kane
- The Zucker Hillside Hospital, Department of Psychiatry, Northwell Health, Glen Oaks, NY, USA; The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Department of Psychiatry and Molecular Medicine, Hempstead, NY, USA; The Feinstein Institute for Medical Research, Center for Psychiatric Neuroscience, Manhasset, NY, USA
| | - Georgios Schoretsanitis
- The Zucker Hillside Hospital, Department of Psychiatry, Northwell Health, Glen Oaks, NY, USA; The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Department of Psychiatry and Molecular Medicine, Hempstead, NY, USA; The Feinstein Institute for Medical Research, Center for Psychiatric Neuroscience, Manhasset, NY, USA; Department of Psychiatry, Psychotherapy and Psychosomatics, Hospital of Psychiatry, University of Zurich, Zurich, Switzerland.
| | - Jose M Rubio
- The Zucker Hillside Hospital, Department of Psychiatry, Northwell Health, Glen Oaks, NY, USA; The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Department of Psychiatry and Molecular Medicine, Hempstead, NY, USA; The Feinstein Institute for Medical Research, Center for Psychiatric Neuroscience, Manhasset, NY, USA
| | - Christoph U Correll
- The Zucker Hillside Hospital, Department of Psychiatry, Northwell Health, Glen Oaks, NY, USA; The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Department of Psychiatry and Molecular Medicine, Hempstead, NY, USA; The Feinstein Institute for Medical Research, Center for Psychiatric Neuroscience, Manhasset, NY, USA; Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany; German Center for Mental Health (DZPG), partner site Berlin, Germany
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3
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Wang HR, Liu ZQ, Nakua H, Hegarty CE, Thies MB, Patel PK, Schleifer CH, Boeck TP, McKinney RA, Currin D, Leathem L, DeRosse P, Bearden CE, Misic B, Karlsgodt KH. Decoding Early Psychoses: Unraveling Stable Microstructural Features Associated with Psychopathology Across Independent Cohorts. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.05.10.593636. [PMID: 38766080 PMCID: PMC11100779 DOI: 10.1101/2024.05.10.593636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
Background Early Psychosis patients (EP, within 3 years after psychosis onset) show significant variability, making outcome predictions challenging. Currently, little evidence exists for stable relationships between neural microstructural properties and symptom profiles across EP diagnoses, limiting the development of early interventions. Methods A data-driven approach, Partial Least Squares (PLS) correlation, was used across two independent datasets to examine multivariate relationships between white matter (WM) properties and symptomatology, to identify stable and generalizable signatures in EP. The primary cohort included EP patients from the Human Connectome Project-Early Psychosis (n=124). The replication cohort included EP patients from the Feinstein Institute for Medical Research (n=78). Both samples included individuals with schizophrenia, schizoaffective disorder, and psychotic mood disorders. Results In both cohorts, a significant latent component (LC) corresponded to a symptom profile combining negative symptoms, primarily diminished expression, with specific somatic symptoms. Both LCs captured comprehensive features of WM disruption, primarily a combination of subcortical and frontal association fibers. Strikingly, the PLS model trained on the primary cohort accurately predicted microstructural features and symptoms in the replication cohort. Findings were not driven by diagnosis, medication, or substance use. Conclusions This data-driven transdiagnostic approach revealed a stable and replicable neurobiological signature of microstructural WM alterations in EP, across diagnoses and datasets, showing a strong covariance of these alterations with a unique profile of negative and somatic symptoms. This finding suggests the clinical utility of applying data-driven approaches to reveal symptom domains that share neurobiological underpinnings.
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Cuesta MJ, Gil-Berrozpe GJ, Sánchez-Torres AM, Moreno-Izco L, García de Jalón E, Peralta V. 20-Year trajectories of six psychopathological dimensions in patients with first-episode psychosis: Could they be predicted? Psychiatry Res 2024; 331:115614. [PMID: 38039651 DOI: 10.1016/j.psychres.2023.115614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 11/14/2023] [Accepted: 11/17/2023] [Indexed: 12/03/2023]
Abstract
Patients with first-episode psychoses (FEP) exhibit heterogeneity in clinical manifestations and outcomes. This study investigated the long-term trajectories of six key psychopathological dimensions (reality-distortion, negative, disorganization, catatonia, mania and depression) in patients diagnosed with FEP. A total of 243 patients were followed up for 20 years and the trajectories of the dimensions were analysed using growth mixture modelling. These dimensions showed varied course patterns, ranging from two to five trajectories. Additionally, the study examined the predictive value of different factors in differentiating between the long-term trajectories. The exposome risk score showed that familial load, distal and intermediate risk factors, acute psychosocial stressors and acute onset were significant predictors for differentiating between long-term psychopathological trajectories. In contrast, polygenic risk score, duration of untreated psychosis and duration of untreated illness demonstrated little or no predictive value. The findings highlight the importance of conducting a multidimensional assessment not only at FEP but also during follow-up to customize the effectiveness of interventions. Furthermore, the results emphasize the relevance of assessing premorbid predictors from the onset of illness. This may enable the identification of FEP patients at high-risk of poor long-term outcomes who would benefit from targeted prevention programs on specific psychopathological dimensions.
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Affiliation(s)
- Manuel J Cuesta
- Department of Psychiatry, Complejo Hospitalario de Navarra (Pamplona, Spain); Navarra Institute for Health Research (IdiSNA) (Pamplona, Spain).
| | - Gustavo J Gil-Berrozpe
- Department of Psychiatry, Complejo Hospitalario de Navarra (Pamplona, Spain); Navarra Institute for Health Research (IdiSNA) (Pamplona, Spain)
| | - Ana M Sánchez-Torres
- Navarra Institute for Health Research (IdiSNA) (Pamplona, Spain); Departament of Health Sciences, Universidad Pública de Navarra (UPNA), Pamplona, Spain
| | - Lucía Moreno-Izco
- Department of Psychiatry, Complejo Hospitalario de Navarra (Pamplona, Spain); Navarra Institute for Health Research (IdiSNA) (Pamplona, Spain)
| | - Elena García de Jalón
- Navarra Institute for Health Research (IdiSNA) (Pamplona, Spain); Mental Health Department, Servicio Navarro de Salud - Osasunbidea (Pamplona, Spain)
| | - Victor Peralta
- Navarra Institute for Health Research (IdiSNA) (Pamplona, Spain); Mental Health Department, Servicio Navarro de Salud - Osasunbidea (Pamplona, Spain)
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Leucht S, Dombi ZB, Szabó P, Barabássy Á, Levine SZ. Single trajectory treatment response for predominant negative symptoms: Post-hoc analysis of a clinical trial with cariprazine and risperidone. Schizophr Res 2023; 261:24-30. [PMID: 37688910 DOI: 10.1016/j.schres.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 09/02/2023] [Accepted: 09/04/2023] [Indexed: 09/11/2023]
Abstract
Examining the heterogeneity of negative symptoms of schizophrenia contributes to the identification of available treatment targets. Generally, prior evidence classified three to four symptom treatment response trajectory groups over the course of positive symptoms, yet, no evidence exists regarding the heterogeneity of medium-term response to predominant negative symptoms. The current post-hoc analysis aims to identify the heterogeneity in negative symptom treatment response trajectories among patients with predominant negative symptoms who received either cariprazine or risperidone for 26 weeks. Treatment response was analyzed based on the: the Positive and Negative Syndrome Scale Factor Score for Negative Symptoms (PANSS-FSNS), and the Clinical Global Impression Severity (CGIS) and Improvement (CGII) scales. To identify subgroups of patients with a similar course of treatment response, group-based trajectory modelling was utilized. Results demonstrated that in comparison with competing models, a single trajectory best described the treatment response of patients with predominant negative symptoms. The results indicate that patients with predominant negative symptoms with over ten years of schizophrenia respond rapidly to adequate treatment and follow a course of steady improvement.
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Affiliation(s)
- Stefan Leucht
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | | | - Péter Szabó
- Medical Division, Gedeon Richter Plc., Budapest, Hungary
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Starzer M, Hansen HG, Hjorthøj C, Albert N, Nordentoft M, Madsen T. 20-year trajectories of positive and negative symptoms after the first psychotic episode in patients with schizophrenia spectrum disorder: results from the OPUS study. World Psychiatry 2023; 22:424-432. [PMID: 37713547 PMCID: PMC10503930 DOI: 10.1002/wps.21121] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/17/2023] Open
Abstract
This study aimed to identify the 20-year trajectories of positive and negative symptoms after the first psychotic episode in a sample of patients with an ICD-10 diagnosis of schizophrenia spectrum disorder, and to investigate the baseline characteristics and long-term outcomes associated with these trajectories. A total of 373 participants in the OPUS trial were included in the study. Symptoms were assessed at baseline and after 1, 2, 5, 10 and 20 years using the Scales for the Assessment of Positive and Negative Symptoms. We used latent class growth mixture modelling to identify trajectories, and multinominal regression analyses to investigate predictors of membership to identified trajectories. Five trajectories of positive symptoms were identified: early continuous remission (50.9% of the sample), stable improvement (18.0%), intermittent symptoms (10.2%), relapse with moderate symptoms (11.9%), and continuous severe symptoms (9.1%). Substance use disorder (odds ratio, OR: 2.83, 95% CI: 1.09-7.38, p=0.033), longer duration of untreated psychosis (OR: 1.02, 95% CI: 1.00-1.03, p=0.007) and higher level of negative symptoms (OR: 1.60, 95% CI: 1.07-2.39, p=0.021) were predictors of the relapse with moderate symptoms trajectory, while only longer duration of untreated psychosis (OR: 1.01, 95% CI: 1.00-1.02, p=0.030) predicted membership to the continuous severe symptoms trajectory. Two trajectories of negative symptoms were identified: symptom remission (51.0%) and continuous symptoms (49.0%). Predictors of the continuous symptoms trajectory were male sex (OR: 3.03, 95% CI: 1.48-6.02, p=0.002) and longer duration of untreated psychosis (OR: 1.01, 95% CI: 1.00-1.02, p=0.034). Trajectories displaying continuous positive and negative symptoms were linked to lower neurocognition, as measured by the Brief Assessment of Cognition in Schizophrenia (BACS) (z-score: -0.78, CI: -1.39 to -0.17, for continuous positive symptoms; z-score: -0.33, CI: -0.53 to -0.13, for continuous negative symptoms). The same trajectories were also linked to higher use of antipsychotic medication at 20-year follow-up (continuous positive symptoms: 78%; continuous negative symptoms: 67%). These findings suggest that the majority of patients with first-episode schizophrenia spectrum disorder have a trajectory with early stable remission of positive symptoms. Long duration of untreated psychosis and comorbid substance abuse are modifiable predictors of poor trajectories for positive symptoms in these patients. In about half of patients, negative symptoms do not improve over time. These symptoms, in addition to being associated with poor social and neurocognitive functioning, may prevent patients from seeking help.
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Affiliation(s)
- Marie Starzer
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Helene Gjervig Hansen
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Carsten Hjorthøj
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen, Denmark
| | - Nikolai Albert
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
- Mental Health Centre Amager, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Merete Nordentoft
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Trine Madsen
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen, Denmark
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Chen EYH, Wong SMY, Hui CLM, Suen YN, Chan SKW. The emergence of primary negative symptoms: relevance of timing? Br J Psychiatry 2023:1-2. [PMID: 37184101 DOI: 10.1192/bjp.2023.51] [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] [Indexed: 05/16/2023]
Abstract
Negative symptoms are an important symptom dimension in schizophrenia that are often least responsive to antipsychotic medications. We revisit the current practice of identifying 'primary' negative symptoms and suggest that its concept would benefit from a further elaboration of their timing of emergence in relation to the dynamic neurobiological changes to enhance their utility in clinical decision-making and research.
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Affiliation(s)
- Eric Yu Hai Chen
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong
| | - Stephanie Ming Yin Wong
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Christy Lai Ming Hui
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Yi Nam Suen
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Sherry Kit Wa Chan
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong
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Suen YN, Pang SWT, Cheung C, Wong TY, Hui LMC, Lee HME, Chang WC, Chen YHE, Chan SKW. Impact of early negative symptom patterns on the long-term outcomes of patients with first-episode schizophrenia-spectrum disorders: A 12-year follow up study. Psychiatry Res 2023; 323:115180. [PMID: 36989910 DOI: 10.1016/j.psychres.2023.115180] [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: 12/09/2022] [Revised: 03/18/2023] [Accepted: 03/23/2023] [Indexed: 03/31/2023]
Abstract
Given the strong prognostic value of early negative symptoms (NS), understanding their associations with long-term outcomes of schizophrenia is essential. The study examined early NS patterns in trajectory, severity and variability and their association with 12-year outcomes. NS in the first 36 months after onset and the symptomatology, cognitive function, and functioning at 12 years were examined in 330 patients with first-episode schizophrenia spectrum disorders. The relationships and pathways between the outcomes at 12 years and the trajectory, severity, and variability of early NS were examined. We found that the prediction of trajectory of early NS to long-term outcomes was limited, whereas variability was negatively associated with the patient's long-term executive function, and severity was positively associated with long-term symptomatology and negatively associated with long-term functioning. Path modelling revealed that the severity and variability of early NS influenced patients' long-term functioning via cognitive function and/or clinical symptom pathways. Our findings support the notion that severity of early NS influences the prognosis of schizophrenia and the closer examination revealed that the severity and variability of early NS are differentially associated with long-term clinical symptoms, executive function, and functional outcomes via distinct pathways.
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Affiliation(s)
- Yi Nam Suen
- Department of Psychiatry, University of Hong Kong, Hong Kong SAR, China
| | | | - Charlton Cheung
- Department of Psychiatry, University of Hong Kong, Hong Kong SAR, China
| | - Ting Yat Wong
- Department of Psychiatry, University of Pennsylvania, United States of America
| | | | - Ho Ming Edwin Lee
- Department of Psychiatry, University of Hong Kong, Hong Kong SAR, China
| | - Wing Chung Chang
- Department of Psychiatry, University of Hong Kong, Hong Kong SAR, China; State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Hong Kong SAR, China
| | - Yu Hai Eric Chen
- Department of Psychiatry, University of Hong Kong, Hong Kong SAR, China; State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Hong Kong SAR, China
| | - Sherry Kit Wa Chan
- Department of Psychiatry, University of Hong Kong, Hong Kong SAR, China; State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Hong Kong SAR, China.
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Canal-Rivero M, Ruiz-Veguilla M, Ortiz-García de la Foz V, López-Díaz A, Garrido-Torres N, Ayesa-Arriola R, Vazquez-Bourgon J, Mayoral-van Son J, Brambilla P, Kircher T, Romero-García R, Crespo-Facorro B. Longitudinal trajectories in negative symptoms and changes in brain cortical thickness: 10-year follow-up study. Br J Psychiatry 2023:1-10. [PMID: 36805840 DOI: 10.1192/bjp.2022.192] [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] [Indexed: 02/23/2023]
Abstract
BACKGROUND Understanding the evolution of negative symptoms in first-episode psychosis (FEP) requires long-term longitudinal study designs that capture the progression of this condition and the associated brain changes. AIMS To explore the factors underlying negative symptoms and their association with long-term abnormal brain trajectories. METHOD We followed up 357 people with FEP over a 10-year period. Factor analyses were conducted to explore negative symptom dimensionality. Latent growth mixture modelling (LGMM) was used to identify the latent classes. Analysis of variance (ANOVA) was conducted to investigate developmental trajectories of cortical thickness. Finally, the resulting ANOVA maps were correlated with a wide set of regional molecular profiles derived from public databases. RESULTS Three trajectories (stable, decreasing and increasing) were found in each of the three factors (expressivity, experiential and attention) identified by the factor analyses. Patients with an increasing trajectory in the expressivity factor showed cortical thinning in caudal middle frontal, pars triangularis, rostral middle frontal and superior frontal regions from the third to the tenth year after the onset of the psychotic disorder. The F-statistic map of cortical thickness expressivity differences was associated with a receptor density map derived from positron emission tomography data. CONCLUSIONS Stable and decreasing were the most common trajectories. Additionally, cortical thickness abnormalities found at relatively late stages of FEP onset could be exploited as a biomarker of poor symptom outcome in the expressivity dimension. Finally, the brain areas with less density of receptors spatially overlap areas that discriminate the trajectories of the expressivity dimension.
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Affiliation(s)
- Manuel Canal-Rivero
- Mental Health Service, Hospital Universitario Virgen del Rocío, Seville, Spain; Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III (CIBERSAM), Madrid, Spain; and Instituto de Biomedicina de Sevilla (IBiS)/HUVR/CSIC/Universidad de Sevilla, Seville, Spain
| | - Miguel Ruiz-Veguilla
- Mental Health Service, Hospital Universitario Virgen del Rocío, Seville, Spain; Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III (CIBERSAM), Madrid, Spain; Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain; and Department of Psychiatry, Universidad de Sevilla, Seville, Spain
| | - Victor Ortiz-García de la Foz
- Department of Psychiatry, Marqués de Valdecilla University Hospital, Santander, Spain; Instituto de Investigación Sanitaria (IDIVAL), Santander, Spain; and School of Medicine, University of Cantabria, Santander, Spain
| | - Alvaro López-Díaz
- Hospital Universitario Virgen Macarena, Seville, Spain; and Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III (CIBERSAM), Madrid, Spain
| | - Nathalia Garrido-Torres
- Mental Health Service, Hospital Universitario Virgen del Rocío, Seville, Spain; Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III (CIBERSAM), Madrid, Spain; and Instituto de Biomedicina de Sevilla (IBiS)/HUVR/CSIC/Universidad de Sevilla, Seville, Spain
| | - Rosa Ayesa-Arriola
- Department of Psychiatry, Marqués de Valdecilla University Hospital, Santander, Spain; Instituto de Investigación Sanitaria (IDIVAL), Santander, Spain; and School of Medicine, University of Cantabria, Santander, Spain
| | - Javier Vazquez-Bourgon
- Department of Psychiatry, Marqués de Valdecilla University Hospital, Santander, Spain; Instituto de Investigación Sanitaria (IDIVAL), Santander, Spain; and School of Medicine, University of Cantabria, Santander, Spain
| | - Jacqueline Mayoral-van Son
- Mental Health Service, Hospital Universitario Virgen del Rocío, Seville, Spain; and Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III (CIBERSAM), Madrid, Spain
| | - Paolo Brambilla
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy; and Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Tilo Kircher
- Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany
| | - Rafael Romero-García
- Instituto de Biomedicina de Sevilla (IBiS)/HUVR/CSIC/Universidad de Sevilla, Seville, Spain; Department of Medical Physiology and Biophysics, University of Seville, Seville, Spain; Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III (CIBERSAM), Madrid, Spain; and Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Benedicto Crespo-Facorro
- Mental Health Service, Hospital Universitario Virgen del Rocío, Seville, Spain; Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III (CIBERSAM), Madrid, Spain; Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain; and Department of Psychiatry, Universidad de Sevilla, Seville, Spain
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10
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James SH, Berglund A, Chang WC, Strauss GP. Discrepancies between ideal and actual affect in schizophrenia: Implications for understanding negative symptoms. J Psychiatr Res 2022; 155:313-319. [PMID: 36174366 DOI: 10.1016/j.jpsychires.2022.09.024] [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: 06/08/2022] [Revised: 08/29/2022] [Accepted: 09/16/2022] [Indexed: 11/26/2022]
Abstract
Anhedonia is a core symptom of schizophrenia (SZ). However, psychological mechanisms underlying anhedonia are unclear, making it difficult to develop personalized psychosocial treatments. The current study explored the novel hypothesis that anhedonia is driven by discrepancies between ideal and actual affect (i.e., how positive or negative someone wants to feel compared to how they do feel), which impact the frequency of recreational, goal-directed, and social behaviors. Participants included 32 outpatients with SZ and 29 healthy controls (CN) who completed the Affect Valuation Index and measures of negative symptom severity. Results indicated that individuals with SZ displayed greater positive and negative emotion discrepancy scores than CN, suggesting that they strongly desire to feel more positive and less negative in the future than they actually do. Additionally, greater ideal relative to actual positive and negative affect was associated with greater severity of anhedonia, avolition, and asociality. The discrepancy between ideal and actual affective states may be demotivating, leading individuals with SZ to develop dysfunctional beliefs after repeated experiences of failing to achieve their desired emotional goal state. These findings suggest that ideal affect may be a novel psychological mechanism underlying negative symptoms that could be targeted in psychosocial treatments.
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Affiliation(s)
- Sydney H James
- Department of Psychology, University of Georgia, Athens, GA, USA
| | - Alysia Berglund
- Department of Psychology, University of Georgia, Athens, GA, USA
| | - Wing Chung Chang
- Department of Psychiatry, University of Hong Kong, Pok Fu Lam, Hong Kong; State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Pok Fu Lam, Hong Kong
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11
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Unrau J, Percie du Sert O, Joober R, Malla A, Lepage M, Raucher-Chéné D. Subtyping negative symptoms in first-episode psychosis: Contrasting persistent negative symptoms with a data-driven approach. Schizophr Res 2022; 248:219-227. [PMID: 36108466 DOI: 10.1016/j.schres.2022.09.010] [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: 01/28/2022] [Revised: 08/04/2022] [Accepted: 09/04/2022] [Indexed: 10/14/2022]
Abstract
Persistent negative symptoms (PNS) are linked to poor functional outcomes and may be primary or caused by secondary factors. Although several studies have examined PNS in first-episode psychosis (FEP), a comparison with a data-driven approach is lacking. Here, we compared clinically defined PNS subgroups with class trajectories identified through latent growth modeling (LGM). Patients admitted to an early intervention service (N = 392) were classified as PNS (n = 105), secondary PNS (sPNS; n = 74), or non-PNS (n = 213) based on longitudinal data collected six to twelve months after admission. LGM was used to stratify patients based on similar negative symptom course over the same time period. Using multiple linear regression, we assessed the utility of both approaches in predicting Social and Occupational Functioning Assessment Scale (SOFAS) scores at two-year follow-up. Three negative symptom trajectories were identified: low and remitting (LR; n = 158), moderate and improving (MI; n = 163) and delayed partial response (DR; n = 71). Most non-PNS patients followed the LR trajectory, while patients with PNS or sPNS were generally divided between MI and DR. Both PNS classification and trajectory membership were significant predictors of two-year functional outcomes; the DR and MI trajectories predicted greater increases in SOFAS scores (DR: b = -19.14; MI: b = -11.54) than either sPNS (b = -9.19) or PNS (b = -6.46). These findings demonstrate that combining PNS and symptom-based stratification can predict functional outcomes more accurately than either taxonomy alone. Such a combined approach could yield significant advances in developing more targeted interventions for patients at risk for poor functional outcomes.
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Affiliation(s)
- Joshua Unrau
- Douglas Mental Health University Institute, Montreal, Canada; Department of Psychology, McGill University, Montreal, Canada
| | - Olivier Percie du Sert
- Douglas Mental Health University Institute, Montreal, Canada; Department of Psychiatry, McGill University, Montreal, Canada
| | - Ridha Joober
- Douglas Mental Health University Institute, Montreal, Canada; Department of Psychiatry, McGill University, Montreal, Canada
| | - Ashok Malla
- Douglas Mental Health University Institute, Montreal, Canada; Department of Psychiatry, McGill University, Montreal, Canada
| | - Martin Lepage
- Douglas Mental Health University Institute, Montreal, Canada; Department of Psychology, McGill University, Montreal, Canada; Department of Psychiatry, McGill University, Montreal, Canada.
| | - Delphine Raucher-Chéné
- Douglas Mental Health University Institute, Montreal, Canada; Department of Psychiatry, McGill University, Montreal, Canada; University of Reims Champagne-Ardenne, Cognition, Health, and Society Laboratory (EA 6291), Reims, France; Academic Department of Psychiatry, University Hospital of Reims, EPSM Marne, Reims, France
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12
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Wong SMY, Suen YN, Wong CWC, Chan SKW, Hui CLM, Chang WC, Lee EHM, Cheng CPW, Ho GCL, Lo GG, Leung EYL, Yeung PKMA, Chen S, Honer WG, Mak HKF, Sham PC, McKenna PJ, Pomarol-Clotet E, Veronese M, Howes OD, Chen EYH. Striatal dopamine synthesis capacity and its association with negative symptoms upon resolution of positive symptoms in first-episode schizophrenia and delusional disorder. Psychopharmacology (Berl) 2022; 239:2133-2141. [PMID: 35211769 DOI: 10.1007/s00213-022-06088-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 02/10/2022] [Indexed: 12/21/2022]
Abstract
RATIONALE How striatal dopamine synthesis capacity (DSC) contributes to the pathogenesis of negative symptoms in first-episode schizophrenia (SZ) and delusional disorder (DD) has seldom been explored. As negative symptoms during active psychotic episodes can be complicated by secondary influences, such as positive symptoms, longitudinal investigations may help to clarify the relationship between striatal DSC and negative symptoms and differentiate between primary and secondary negative symptoms. OBJECTIVE A longitudinal study was conducted to examine whether baseline striatal DSC would be related to negative symptoms at 3 months in first-episode SZ and DD patients. METHODS Twenty-three first-episode age- and gender-matched patients (11 DD and 12 SZ) were consecutively recruited through an early intervention service for psychosis in Hong Kong. Among them, 19 (82.6%) patients (9 DD and 10 SZ) were followed up at 3 months. All patients received an 18F-DOPA PET/MR scan at baseline. RESULTS Baseline striatal DSC (Kocc;30-60) was inversely associated with negative symptoms at 3 months in first-episode SZ patients (rs = - 0.80, p = 0.010). This association remained in SZ patients even when controlling for baseline negative, positive, and depressive symptoms, as well as cumulative antipsychotic dosage (β = - 0.69, p = 0.012). Such associations were not observed in first-episode DD patients. Meanwhile, the severity of negative symptoms at 3 months was associated with more positive symptoms in DD patients (rs = 0.74, p = 0.010) and not in SZ patients. CONCLUSIONS These findings highlight the role of striatal DSC in negative symptoms upon resolution of active psychotic episodes among first-episode SZ patients. Baseline striatal dopamine activity may inform future symptom expression with important treatment implications.
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Affiliation(s)
- Stephanie M Y Wong
- Department of Psychiatry, The University of Hong Kong, 2/F New Clinical Building, Queen Mary Hospital, Pokfulam Road, Pokfulam, Hong Kong, China
| | - Y N Suen
- Department of Psychiatry, The University of Hong Kong, 2/F New Clinical Building, Queen Mary Hospital, Pokfulam Road, Pokfulam, Hong Kong, China
| | - Charlotte W C Wong
- Department of Psychiatry, The University of Hong Kong, 2/F New Clinical Building, Queen Mary Hospital, Pokfulam Road, Pokfulam, Hong Kong, China
| | - Sherry K W Chan
- Department of Psychiatry, The University of Hong Kong, 2/F New Clinical Building, Queen Mary Hospital, Pokfulam Road, Pokfulam, Hong Kong, China.,The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Pokfulam, Hong Kong, China
| | - Christy L M Hui
- Department of Psychiatry, The University of Hong Kong, 2/F New Clinical Building, Queen Mary Hospital, Pokfulam Road, Pokfulam, Hong Kong, China
| | - W C Chang
- Department of Psychiatry, The University of Hong Kong, 2/F New Clinical Building, Queen Mary Hospital, Pokfulam Road, Pokfulam, Hong Kong, China.,The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Pokfulam, Hong Kong, China
| | - Edwin H M Lee
- Department of Psychiatry, The University of Hong Kong, 2/F New Clinical Building, Queen Mary Hospital, Pokfulam Road, Pokfulam, Hong Kong, China
| | - Calvin P W Cheng
- Department of Psychiatry, The University of Hong Kong, 2/F New Clinical Building, Queen Mary Hospital, Pokfulam Road, Pokfulam, Hong Kong, China
| | - Garrett C L Ho
- Hong Kong Sanatorium & Hospital, Happy Valley, Pokfulam, Hong Kong, China
| | - Gladys Goh Lo
- Hong Kong Sanatorium & Hospital, Happy Valley, Pokfulam, Hong Kong, China
| | - Eric Y L Leung
- Hong Kong Sanatorium & Hospital, Happy Valley, Pokfulam, Hong Kong, China
| | - Paul K M Au Yeung
- Hong Kong Sanatorium & Hospital, Happy Valley, Pokfulam, Hong Kong, China
| | - Sirong Chen
- Hong Kong Sanatorium & Hospital, Happy Valley, Pokfulam, Hong Kong, China
| | - William G Honer
- Department of Psychiatry, The University of British Columbia, Vancouver, BC, Canada.,British Columbia Institute of Mental Health and Substance Use Services, Vancouver, Canada
| | - Henry K F Mak
- Department of Diagnostic Radiology, The University of Hong Kong, Pokfulam, Hong Kong, China
| | - P C Sham
- Department of Psychiatry, The University of Hong Kong, 2/F New Clinical Building, Queen Mary Hospital, Pokfulam Road, Pokfulam, Hong Kong, China.,The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Pokfulam, Hong Kong, China
| | - Peter J McKenna
- FIDMAG Hermanas Hospitalarias Research Foundation, Barcelona, Spain
| | | | - Mattia Veronese
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Oliver D Howes
- Psychosis Studies Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,Institute of Clinical Sciences (ICS), Faculty of Medicine, Imperial College London, London, UK.,MRC London Institute of Medical Sciences, Hammersmith Hospital, London, UK
| | - Eric Y H Chen
- Department of Psychiatry, The University of Hong Kong, 2/F New Clinical Building, Queen Mary Hospital, Pokfulam Road, Pokfulam, Hong Kong, China. .,The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Pokfulam, Hong Kong, China.
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13
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Wong TY, Chan SKW, Cheung C, Lai Ming Hui C, Suen YN, Chang WC, Lee EHM, Chen EYH. Dynamic Patterns of Symptoms and Functioning in Predicting Deliberate Self-harm in Patients with First-Episode Schizophrenia-Spectrum Disorders Over 3 Years. Schizophr Bull 2022; 48:1043-1052. [PMID: 35689554 PMCID: PMC9434452 DOI: 10.1093/schbul/sbac057] [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] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Patients with schizophrenia have a significant risk of self-harm. We aimed to explore the dynamic relationship between symptomatology, functioning and deliberate self-harm (DSH) and evaluate the feasibility of developing a self-harm risk prediction tool for patients with first-episode schizophrenia (FES). METHODS Patients with FES (n = 1234) were followed up for 36 months. Symptomatology, functioning, treatment adherence and self-harm information were obtained monthly over the follow-up period. A time-varying vector autoregressive (VAR) model was used to study the contribution of clinical variables to self-harm over the 36th month. Random forest models for self-harm were established to classify the individuals with self-harm and predict future self-harm events. RESULTS Over a 36-month period, 187 patients with FES had one or more self-harm events. The depressive symptoms contributed the most to self-harm prediction during the first year, while the importance of positive psychotic symptoms increased from the second year onwards. The random forest model with all static information and symptom instability achieved a good area under the receiver operating characteristic curve (AUROC = 0.77 ± 0.023) for identifying patients with DSH. With a sliding window analysis, the averaged AUROC of predicting a self-event was 0.65 ± 0.102 (ranging from 0.54 to 0.78) with the best model being 6-month predicted future 6-month self-harm for month 11-23 (AUROC = 0.7). CONCLUSIONS Results highlight the importance of the dynamic relationship of depressive and positive psychotic symptoms with self-harm and the possibility of self-harm prediction in FES with longitudinal clinical data.
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Affiliation(s)
| | - Sherry Kit Wa Chan
- To whom correspondence should be addressed; Room 219, New Clinical Building, Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong SAR; tel: (852) 2255 4488, fax: (852) 2255 1345, e-mail:
| | - Charlton Cheung
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR
| | - Christy Lai Ming Hui
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR
| | - Yi Nam Suen
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR
| | - Wing Chung Chang
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR,The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong SAR
| | - Edwin Ho Ming Lee
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR
| | - Eric Yu Hai Chen
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR,The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong SAR
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14
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Giulia LB, Anne B. The stability of multidimensional subclinical apathy during a pandemic and its relations to psycho-behavioral factors. Sci Rep 2022; 12:2931. [PMID: 35190558 PMCID: PMC8860996 DOI: 10.1038/s41598-022-06777-5] [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: 11/11/2021] [Accepted: 02/04/2022] [Indexed: 11/09/2022] Open
Abstract
Apathy is a clinical symptom prevalent in many neuropsychiatric pathologies. Subclinical apathy is found in 35% of the general population. Despite high prevalence and negative consequences, underlying mechanisms are poorly understood, perhaps because the concept of apathy is one-dimensional. The current investigation aims to address the incidence of multidimensional apathetic trait in three distinct forms in a student population, to specify its determinants and to evaluate its stability during a global pandemic. Two online surveys, conducted 1 year apart on two separate cohorts of university students, with qualitative measures and validated scales. The final analysis included, respectively, 2789 and 1678 students. The three forms of apathetic trait were present, with the same debilitating consequences as apathetic symptom but independent determinants. Executive apathy was predicted by depressive symptoms, emotional apathy by motivational deficit and initiative apathy comprised a mixed executive-emotional form and a pure deficit of action initiation. The three forms of subclinical apathy remained similar in the context of increased depressive symptoms due to a global pandemic. This study confirmed the presence and independence of three forms of subclinical apathy in healthy students, which remained similar even in the light of increased depressive scores. These results shed light on cognitive and neuronal mechanisms underlying multidimensional apathy, allowing new, targeted treatments.
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15
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Humensky JL, Nossel I, Bello I, Malinovsky I, Radigan M, Gu G, Wang R, Wall MM, Jones N, Dixon LB. Rates of Inpatient and Emergency Room Use Before and After Discharge Among Medicaid Enrollees in OnTrackNY. Psychiatr Serv 2021; 72:1328-1331. [PMID: 34106739 PMCID: PMC8570971 DOI: 10.1176/appi.ps.202000791] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study examined hospital and emergency room (ER) use among Medicaid enrollees before and after discharge from OnTrackNY, a coordinated specialty care program for recent-onset psychosis. METHODS Medicaid claims data were linked to program data. Inpatient hospitalization, inpatient days, and ER visits were assessed in the 6 months prior to OnTrackNY enrollment and 6 months prior to and after discharge. The sample consisted of 138 participants with continuous Medicaid enrollment during the study. RESULTS Inpatient visits significantly declined from the pre-OnTrackNY enrollment period to the predischarge period (β=-1.23, standard error [SE]=0.22, p<0.001), did not significantly change in the first 6 months after discharge (β=0.19, SE=0.26, p=0.48), and remained significantly lower than before OnTrackNY enrollment (β=-1.05, SE=0.20, p<0.001). Similar patterns were observed for inpatient days and ER use. CONCLUSIONS ER and hospital use declined during OnTrackNY participation and did not significantly change in the first 6 months after discharge.
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Affiliation(s)
- Jennifer L Humensky
- Division of Behavioral Health Services and Policy Research (Humensky, Nossel, Bello, Malinovsky, Dixon) and Division of Mental Health Data Science (Wall), New York State Psychiatric Institute, New York City; Department of Psychiatry, Columbia University Irving Medical Center, New York City (Humensky, Nossel, Bello, Malinovsky, Wall, Dixon); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Radigan, Gu, Wang); Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa (Jones). Benjamin G. Druss, M.D., M.P.H., served as decision editor on the manuscript
| | - Ilana Nossel
- Division of Behavioral Health Services and Policy Research (Humensky, Nossel, Bello, Malinovsky, Dixon) and Division of Mental Health Data Science (Wall), New York State Psychiatric Institute, New York City; Department of Psychiatry, Columbia University Irving Medical Center, New York City (Humensky, Nossel, Bello, Malinovsky, Wall, Dixon); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Radigan, Gu, Wang); Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa (Jones). Benjamin G. Druss, M.D., M.P.H., served as decision editor on the manuscript
| | - Iruma Bello
- Division of Behavioral Health Services and Policy Research (Humensky, Nossel, Bello, Malinovsky, Dixon) and Division of Mental Health Data Science (Wall), New York State Psychiatric Institute, New York City; Department of Psychiatry, Columbia University Irving Medical Center, New York City (Humensky, Nossel, Bello, Malinovsky, Wall, Dixon); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Radigan, Gu, Wang); Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa (Jones). Benjamin G. Druss, M.D., M.P.H., served as decision editor on the manuscript
| | - Igor Malinovsky
- Division of Behavioral Health Services and Policy Research (Humensky, Nossel, Bello, Malinovsky, Dixon) and Division of Mental Health Data Science (Wall), New York State Psychiatric Institute, New York City; Department of Psychiatry, Columbia University Irving Medical Center, New York City (Humensky, Nossel, Bello, Malinovsky, Wall, Dixon); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Radigan, Gu, Wang); Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa (Jones). Benjamin G. Druss, M.D., M.P.H., served as decision editor on the manuscript
| | - Marleen Radigan
- Division of Behavioral Health Services and Policy Research (Humensky, Nossel, Bello, Malinovsky, Dixon) and Division of Mental Health Data Science (Wall), New York State Psychiatric Institute, New York City; Department of Psychiatry, Columbia University Irving Medical Center, New York City (Humensky, Nossel, Bello, Malinovsky, Wall, Dixon); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Radigan, Gu, Wang); Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa (Jones). Benjamin G. Druss, M.D., M.P.H., served as decision editor on the manuscript
| | - Gyojeong Gu
- Division of Behavioral Health Services and Policy Research (Humensky, Nossel, Bello, Malinovsky, Dixon) and Division of Mental Health Data Science (Wall), New York State Psychiatric Institute, New York City; Department of Psychiatry, Columbia University Irving Medical Center, New York City (Humensky, Nossel, Bello, Malinovsky, Wall, Dixon); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Radigan, Gu, Wang); Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa (Jones). Benjamin G. Druss, M.D., M.P.H., served as decision editor on the manuscript
| | - Rui Wang
- Division of Behavioral Health Services and Policy Research (Humensky, Nossel, Bello, Malinovsky, Dixon) and Division of Mental Health Data Science (Wall), New York State Psychiatric Institute, New York City; Department of Psychiatry, Columbia University Irving Medical Center, New York City (Humensky, Nossel, Bello, Malinovsky, Wall, Dixon); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Radigan, Gu, Wang); Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa (Jones). Benjamin G. Druss, M.D., M.P.H., served as decision editor on the manuscript
| | - Melanie M Wall
- Division of Behavioral Health Services and Policy Research (Humensky, Nossel, Bello, Malinovsky, Dixon) and Division of Mental Health Data Science (Wall), New York State Psychiatric Institute, New York City; Department of Psychiatry, Columbia University Irving Medical Center, New York City (Humensky, Nossel, Bello, Malinovsky, Wall, Dixon); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Radigan, Gu, Wang); Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa (Jones). Benjamin G. Druss, M.D., M.P.H., served as decision editor on the manuscript
| | - Nev Jones
- Division of Behavioral Health Services and Policy Research (Humensky, Nossel, Bello, Malinovsky, Dixon) and Division of Mental Health Data Science (Wall), New York State Psychiatric Institute, New York City; Department of Psychiatry, Columbia University Irving Medical Center, New York City (Humensky, Nossel, Bello, Malinovsky, Wall, Dixon); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Radigan, Gu, Wang); Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa (Jones). Benjamin G. Druss, M.D., M.P.H., served as decision editor on the manuscript
| | - Lisa B Dixon
- Division of Behavioral Health Services and Policy Research (Humensky, Nossel, Bello, Malinovsky, Dixon) and Division of Mental Health Data Science (Wall), New York State Psychiatric Institute, New York City; Department of Psychiatry, Columbia University Irving Medical Center, New York City (Humensky, Nossel, Bello, Malinovsky, Wall, Dixon); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Radigan, Gu, Wang); Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa (Jones). Benjamin G. Druss, M.D., M.P.H., served as decision editor on the manuscript
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16
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Martin EA, Jonas KG, Lian W, Foti D, Donaldson KR, Bromet EJ, Kotov R. Predicting Long-Term Outcomes in First-Admission Psychosis: Does the Hierarchical Taxonomy of Psychopathology Aid DSM in Prognostication? Schizophr Bull 2021; 47:1331-1341. [PMID: 33890112 PMCID: PMC8379532 DOI: 10.1093/schbul/sbab043] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
The Hierarchical Taxonomy of Psychopathology (HiTOP) is an empirical, dimensional model of psychological symptoms and functioning. Its goals are to augment the use and address the limitations of traditional diagnoses, such as arbitrary thresholds of severity, within-disorder heterogeneity, and low reliability. HiTOP has made inroads to addressing these problems, but its prognostic validity is uncertain. The present study sought to test the prediction of long-term outcomes in psychotic disorders was improved when the HiTOP dimensional approach was considered along with traditional (ie, DSM) diagnoses. We analyzed data from the Suffolk County Mental Health Project (N = 316), an epidemiologic study of a first-admission psychosis cohort followed for 20 years. We compared 5 diagnostic groups (schizophrenia/schizoaffective, bipolar disorder with psychosis, major depressive disorder with psychosis, substance-induced psychosis, and other psychoses) and 5 dimensions derived from the HiTOP thought disorder spectrum (reality distortion, disorganization, inexpressivity, avolition, and functional impairment). Both nosologies predicted a significant amount of variance in most outcomes. However, except for cognitive functioning, HiTOP showed consistently greater predictive power across outcomes-it explained 1.7-fold more variance than diagnoses in psychiatric and physical health outcomes, 2.1-fold more variance in community functioning, and 3.4-fold more variance in neural responses. Even when controlling for diagnosis, HiTOP dimensions incrementally predicted almost all outcomes. These findings support a shift away from the exclusive use of categorical diagnoses and toward the incorporation of HiTOP dimensions for better prognostication and linkage with neurobiology.
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Affiliation(s)
- Elizabeth A Martin
- Department of Psychological Science, University of California, Irvine, Irvine, CA
| | | | - Wenxuan Lian
- Department of Materials Science and Engineering and Department of Applied Math and Statistics, Stony Brook University, Stony Brook, NY
| | - Dan Foti
- Department of Psychological Sciences, Purdue University, West Lafayette, IN
| | | | - Evelyn J Bromet
- Department of Psychiatry, Stony Brook University, Stony Brook, NY
| | - Roman Kotov
- Department of Psychiatry, Stony Brook University, Stony Brook, NY
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17
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A systematic review and narrative synthesis of data-driven studies in schizophrenia symptoms and cognitive deficits. Transl Psychiatry 2020; 10:244. [PMID: 32694510 PMCID: PMC7374614 DOI: 10.1038/s41398-020-00919-x] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 06/24/2020] [Accepted: 07/03/2020] [Indexed: 12/30/2022] Open
Abstract
To tackle the phenotypic heterogeneity of schizophrenia, data-driven methods are often applied to identify subtypes of its symptoms and cognitive deficits. However, a systematic review on this topic is lacking. The objective of this review was to summarize the evidence obtained from longitudinal and cross-sectional data-driven studies in positive and negative symptoms and cognitive deficits in patients with schizophrenia spectrum disorders, their unaffected siblings and healthy controls or individuals from general population. Additionally, we aimed to highlight methodological gaps across studies and point out future directions to optimize the translatability of evidence from data-driven studies. A systematic review was performed through searching PsycINFO, PubMed, PsycTESTS, PsycARTICLES, SCOPUS, EMBASE and Web of Science electronic databases. Both longitudinal and cross-sectional studies published from 2008 to 2019, which reported at least two statistically derived clusters or trajectories were included. Two reviewers independently screened and extracted the data. In this review, 53 studies (19 longitudinal and 34 cross-sectional) that conducted among 17,822 patients, 8729 unaffected siblings and 5520 controls or general population were included. Most longitudinal studies found four trajectories that characterized by stability, progressive deterioration, relapsing and progressive amelioration of symptoms and cognitive function. Cross-sectional studies commonly identified three clusters with low, intermediate (mixed) and high psychotic symptoms and cognitive profiles. Moreover, identified subgroups were predicted by numerous genetic, sociodemographic and clinical factors. Our findings indicate that schizophrenia symptoms and cognitive deficits are heterogeneous, although methodological limitations across studies are observed. Identified clusters and trajectories along with their predictors may be used to base the implementation of personalized treatment and develop a risk prediction model for high-risk individuals with prodromal symptoms.
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