Eliminate schizophrenia

How pharmacology can aid in the diagnosis of mental disorders

The precise diagnosis of mental disorders constitutes a formidable problem. Mental disorders are currently diagnosed based on clinical symptoms, which are often subjective. Various drug classes, traditionally referred to as "antidepressants," "antipsychotics" and "mood stabilizers" are then used empirically to treat affected patients. The previous decade has witnessed an increasing extension of the use of drug classes beyond their traditional indications (e.g., "antidepressants" in the treatment of anxiety disorders). Therefore, we would like to initiate a discussion in the pharmacological and psychiatric research communities on an alternative classification of mental disorders: Instead of using the traditional categorical classification of mental disorders physicians should rather diagnose symptoms (e.g., anhedonia) without bias to a traditional categorization (e.g., depression). The appropriate most effective drugs are then selected based on these symptoms. Depending on the responsiveness of the patient towards a given drug X, the disease should be classified, e.g., as drug X-responsive disease. This approach will also help us elucidate the still poorly understood molecular mechanisms underlying mental disorders, i.e., drugs can also be viewed and used as molecular diagnostic tools. In several fields of medicine, drugs are already used as molecular diagnostic tools. Thus, there is already precedence for the concept proposed here for mental disorders.

The schizophrenia syndrome, circa 2024: What we know and how that informs its nature

With new data about different aspects of schizophrenia being continually generated, it becomes necessary to periodically revisit exactly what we know. Along with a need to review what we currently know about schizophrenia, there is an equal imperative to evaluate the construct itself. With these objectives, we undertook an iterative, multi-phase process involving fifty international experts in the field, with each step building on learnings from the prior one. This review assembles currently established findings about schizophrenia (construct, etiology, pathophysiology, clinical expression, treatment) and posits what they reveal about its nature. Schizophrenia is a heritable, complex, multi-dimensional syndrome with varying degrees of psychotic, negative, cognitive, mood, and motor manifestations. The illness exhibits a remitting and relapsing course, with varying degrees of recovery among affected individuals with most experiencing significant social and functional impairment. Genetic risk factors likely include thousands of common genetic variants that each have a small impact on an individual's risk and a plethora of rare gene variants that have a larger individual impact on risk. Their biological effects are concentrated in the brain and many of the same variants also increase the risk of other psychiatric disorders such as bipolar disorder, autism, and other neurodevelopmental conditions. Environmental risk factors include but are not limited to urban residence in childhood, migration, older paternal age at birth, cannabis use, childhood trauma, antenatal maternal infection, and perinatal hypoxia. Structural, functional, and neurochemical brain alterations implicate multiple regions and functional circuits. Dopamine D-2 receptor antagonists and partial agonists improve psychotic symptoms and reduce risk of relapse. Certain psychological and psychosocial interventions are beneficial. Early intervention can reduce treatment delay and improve outcomes. Schizophrenia is increasingly considered to be a heterogeneous syndrome and not a singular disease entity. There is no necessary or sufficient etiology, pathology, set of clinical features, or treatment that fully circumscribes this syndrome. A single, common pathophysiological pathway appears unlikely. The boundaries of schizophrenia remain fuzzy, suggesting the absence of a categorical fit and need to reconceptualize it as a broader, multi-dimensional and/or spectrum construct.

Psychomotor slowing in schizophrenia is associated with cortical thinning of primary motor cortex: A three cohort structural magnetic resonance imaging study

Psychomotor slowing (PS) is characterized by slowed movements and lower activity levels. PS is frequently observed in schizophrenia (SZ) and distressing because it impairs performance of everyday tasks and social activities. Studying brain topography contributing to PS in SZ can help to understand the underlying neurobiological mechanisms as well as help to develop more effective treatments that specifically target affected brain areas. Here, we conducted structural magnetic resonance imaging (sMRI) of three independent cohorts of right-handed SZ patients (SZ#1: n = 72, SZ#2: n = 37, SZ#3: n = 25) and age, gender and education matched healthy controls (HC) (HC#1: n = 40, HC#2: n = 37, HC#3: n = 38). PS severity in the three SZ cohorts was determined using the Positive and Negative Syndrome Scale (PANSS) item #G7 (motor retardation) and Trail-Making-Test B (TMT-B). FreeSurfer v7.2 was used for automated parcellation and segmentation of cortical and subcortical regions. SZ#1 patients showed reduced cortical thickness in right precentral gyrus (M1; p = 0.04; Benjamini-Hochberg [BH] corr.). In SZ#1, cortical thinning in right M1 was associated with PANSS item #G7 (p = 0.04; BH corr.) and TMT-B performance (p = 0.002; BH corr.). In SZ#1, we found a significant correlation between PANSS item #G7 and TMT-B (p = 0.005, ρ=0.326). In conclusion, PANSS G#7 and TMT-B might have a surrogate value for predicting PS in SZ. Cortical thinning of M1 rather than alterations of subcortical structures may point towards cortical pathomechanism underlying PS in SZ.

Differentiation value of miR-26b for major depressive disorder, schizophrenia, generalized anxiety disorder

Introduction

First episode and drug naive schizophrenia (SZ) patients comorbid with major depressive episode and generalized anxiety disorder (GAD) comorbid with major depressive disorder (MDD) are common in clinical practice, overlapping symptomatology during first presentation of MDD, SZ and GAD challenged the diagnostic process.

Materials and Methods

This study aimed to investigate the differentiation value of peripheral microRNA-26b expression in 52 patients of MDD, SZ, and GAD, respectively, and 52 controls. Quantitative real-time reverse transcription polymerase chain reaction was used to further verify aberrant miRNAs of previous identified in MDD and investigate expression level of these peripheral miRNAs in SZ and GAD.

Results

The expression levels of miR-26b and miR-4743 were significantly upregulated and of miR-4498, miR-4485, and miR-1972 had no significant difference. There were no significant differences of expression levels of miR-26b, miR-4498, miR-4485, and miR-1972 except miR-4743 between SZ patients and control group and of miR-26b, miR-1972, miR-4498, and miR-4485 between GAD group and the controls. The receiver operating characteristic (ROC) curve of miR-26b in MDD patients showed that its sensitivity and specificity for diagnosis were 0.540 and 0.830, respectively, with the area under curve (AUC) being 0.728; the ROC of miR-26b for SZ and MDD differentiation showed that its sensitivity and specificity were 0.580 and 0.710, respectively, with AUC being 0.631; the ROC of miR-26b for GAD and MDD differentiation suggested that sensitivity and specificity were 0.560 and 0.750, respectively, with AUC being 0.637.

Conclusion

MiR-26b might have potential value of differentiation biomarker for MDD, SZ, and GAD.

Schizophrenia: A Narrative Review of Etiopathogenetic, Diagnostic and Treatment Aspects

Although schizophrenia is currently conceptualized as being characterized as a syndrome that includes a collection of signs and symptoms, there is strong evidence of heterogeneous and complex underpinned etiological, etiopathogenetic, and psychopathological mechanisms, which are still under investigation. Therefore, the present viewpoint review is aimed at providing some insights into the recently investigated schizophrenia research fields in order to discuss the potential future research directions in schizophrenia research. The traditional schizophrenia construct and diagnosis were progressively revised and revisited, based on the recently emerging neurobiological, genetic, and epidemiological research. Moreover, innovative diagnostic and therapeutic approaches are pointed to build a new construct, allowing the development of better clinical and treatment outcomes and characterization for schizophrenic individuals, considering a more patient-centered, personalized, and tailored-based dimensional approach. Further translational studies are needed in order to integrate neurobiological, genetic, and environmental studies into clinical practice and to help clinicians and researchers to understand how to redesign a new schizophrenia construct.