1
|
Ortiz-Valladares M, Gonzalez-Perez O, Pedraza-Medina R. Bridging the gap: Prenatal nutrition, myelination, and schizophrenia etiopathogenesis. Neuroscience 2024; 558:58-69. [PMID: 39159841 DOI: 10.1016/j.neuroscience.2024.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Revised: 08/02/2024] [Accepted: 08/13/2024] [Indexed: 08/21/2024]
Abstract
Schizophrenia (SZ) is a complex mental illness characterized by disturbances in thinking, emotionality, and behavior, significantly impacting the quality of life for individuals affected and those around them. The etiology of SZ involves intricate interactions between genetic and environmental factors, although the precise mechanisms remain incompletely understood. Genetic predisposition, neurotransmitter dysregulation (particularly involving dopamine and serotonin), and structural brain abnormalities, including impaired prefrontal cortex function, have been implicated in SZ development. However, increasing evidence reveals the role of environmental factors, such as nutrition, during critical periods like pregnancy and lactation. Epidemiological studies suggest that early malnutrition significantly increases the risk of SZ symptoms manifesting in late adolescence, a crucial period coinciding with peak myelination and brain maturation. Prenatal undernutrition may disrupt myelin formation, rendering individuals more susceptible to SZ pathology. This review explores the potential relationship between prenatal undernutrition, myelin alterations, and susceptibility to SZ. By delineating the etiopathogenesis, examining genetic and environmental factors associated with SZ, and reviewing the relationship between SZ and myelination disorders, alongside the impact of malnutrition on myelination, we aim to examine how malnutrition might be linked to SZ by altering myelination processes, which contribute to increasing the understanding of SZ etiology and help identify targets for intervention and management.
Collapse
Affiliation(s)
| | - Oscar Gonzalez-Perez
- Laboratory of Neuroscience, School of Psychology, University of Colima, Colima 28040. México
| | - Ricardo Pedraza-Medina
- Medical Science Postgraduate Program, School of Medicine, University of Colima, Colima 28040. México
| |
Collapse
|
2
|
Yu SC, Hwang TJ, Liu CM, Chan HY, Kuo CJ, Yang TT, Wang JP, Liu CC, Hsieh MH, Lin YT, Chien YL, Kuo PH, Shih YW, Yu SL, Chen HY, Chen WJ. Patients with first-episode psychosis in northern Taiwan: neurocognitive performance and niacin response profile in comparison with schizophrenia patients of different familial loadings and relationship with clinical features. BMC Psychiatry 2024; 24:155. [PMID: 38389072 PMCID: PMC10885443 DOI: 10.1186/s12888-024-05598-2] [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] [Received: 11/08/2023] [Accepted: 02/08/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Examining patients with first-episode psychosis (FEP) provides opportunities to better understand the mechanism underlying these illnesses. By incorporating quantitative measures in FEP patients, we aimed to (1) determine the baseline distribution of clinical features; (2) examine the impairment magnitude of the quantitative measures by comparing with external controls and then the counterparts of schizophrenia patients of different familial loadings; and (3) evaluate whether these quantitative measures were associated with the baseline clinical features. METHODS Patients with FEP were recruited from one medical center, two regional psychiatric centers, and two private clinics in northern Taiwan with clinical features rated using the Positive and Negative Syndrome Scale (PANSS) and Personal and Social Performance (PSP) scale. Quantitative measurements included the Continuous Performance Test (CPT), Wisconsin Card Sorting Test (WCST), niacin response abnormality (NRA), and minor physical anomalies and craniofacial features (MPAs). To evaluate the relative performance of the quantitative measures in our FEP patients, four external comparison groups from previous studies were used, including three independent healthy controls for the CPT, WCST, and NRA, respectively, and one group of treatment-resistant schizophrenia patients for the MPAs. Additionally, patients from simplex families and patients from multiplex families were used to assess the magnitude of FEP patients' impairment on the CPT, WCST, and NRA. RESULTS Among the 80 patients with FEP recruited in this study (58% female, mean age = 25.6 years, mean duration of untreated psychosis = 132 days), the clinical severity was mild to moderate (mean PANSS score = 67.3; mean PSP score = 61.8). Patients exhibited both neurocognitive and niacin response impairments (mean Z-scores: -1.24 for NRA, - 1.06 for undegraded d', - 0.70 for degraded d', - 0.32 for categories achieved, and 0.44 for perseverative errors) but did not show MPAs indicative of treatment resistance. Among these quantitative measures, three of the four neurocognitive indices were correlated with the baseline clinical features, whereas NRA did not show such correlation. CONCLUSIONS This FEP study of Taiwanese patients revealed the presence of neurocognitive performance and niacin response and their different relationships with clinical features, rendering this sample useful for future follow-up and incorporation of multiomics investigation.
Collapse
Affiliation(s)
- Shun-Chun Yu
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
- Centers for Genomic and Precision Medicine, National Taiwan University, Taipei, Taiwan
| | - Tzung-Jeng Hwang
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
- Neurobiology and Cognitive Science Center, National Taiwan University, Taipei, Taiwan
| | - Chih-Min Liu
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | | | - Chian-Jue Kuo
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
| | - Tsung-Tsair Yang
- Department of Social Psychology, Shih Hsin University, Taipei, Taiwan
| | | | - Chen-Chung Liu
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Ming H Hsieh
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Yi-Ting Lin
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Yi-Ling Chien
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Po-Hsiu Kuo
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Ya-Wen Shih
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Sung-Liang Yu
- Department of Clinical Laboratory Sciences and Medical Biotechnology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Hsuan-Yu Chen
- Institute of Statistical Science, Academia Sinica, Taipei, Taiwan
| | - Wei J Chen
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
- Centers for Genomic and Precision Medicine, National Taiwan University, Taipei, Taiwan.
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan.
- Center for Neuropsychiatric Research, National Health Research Institutes, Zhunan, Miaoli County, Taiwan.
| |
Collapse
|
3
|
Remberk B, Niwiński P, Brzóska-Konkol E, Borowska A, Papasz-Siemieniuk A, Brągoszewska J, Bażyńska AK, Szostakiewicz Ł, Herman A. Ectodermal disturbance in development shared by anorexia and schizophrenia may reflect neurodevelopmental abnormalities. Brain Behav 2021; 11:e2281. [PMID: 34510800 PMCID: PMC8553323 DOI: 10.1002/brb3.2281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 05/25/2021] [Accepted: 06/27/2021] [Indexed: 12/25/2022] Open
Abstract
Minor physical abnormalities (MPA) are subtle dysmorphic features of bodily structures that have little or no impact on function. Most MPA develop during the first gestational trimester and are considered as important indicators of neuroectodermal deficiencies emerging during early brain development. A higher frequency of MPA was confirmed in schizophrenia patients and their relatives, when compared to controls. These findings are consistent with the neurodevelopmental model of schizophrenia. A neurodevelopmental component amongst other risk factors has also been recently proposed for anorexia nervosa (AN). The current study aimed to assess MPA frequency in adolescent inpatients with either schizophrenia spectrum disorders (SSD) or AN as compared to healthy controls (HC). The Waldrop Scale was used for assessing MPA. The mean MPA total score and mean head subscore was significantly higher in both test groups than in HC. There were no statistically significant differences between SSD and AN groups. The MPA profile (not frequency) was similar in all three groups. This finding is consistent both with widely acknowledged neurodevelopmental schizophrenia hypothesis as well as with more recent neurodevelopmental model of AN. Nevertheless, the findings should not be overgeneralized and further studies are warranted.
Collapse
Affiliation(s)
| | - Piotr Niwiński
- Psychological and Pedagogical Counselling Centre no 7, Warsaw, Poland
| | | | - Anna Borowska
- Institute of Psychiatry and Neurology, Warsaw, Poland
| | | | | | | | | | - Anna Herman
- Medical University of Warsaw, Warsaw, Poland
| |
Collapse
|
4
|
Sreeraj VS, Puzhakkal JC, Holla B, Nadella RK, Sheth S, Balachander S, Ithal D, Ali F, Viswanath B, Muralidharan K, Venkatasubramanian G, John JP, Benegal V, Murthy P, Varghese M, Reddy YJ, Jain S. Cross-diagnostic evaluation of minor physical anomalies in psychiatric disorders. J Psychiatr Res 2021; 142:54-62. [PMID: 34325233 DOI: 10.1016/j.jpsychires.2021.07.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 07/11/2021] [Accepted: 07/16/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Minor physical anomalies (MPA) are markers of impaired neurodevelopment during the prenatal stage. Assessing MPA across psychiatric disorders may help understand their shared nature. In addition, MPA in family members would indicate a shared liability and endophenotype potential. We examined familial aggregation of MPA and their role as transdiagnostic and disorder-specific markers of 5 major psychiatric/neuropsychiatric conditions (schizophrenia, bipolar disorder, substance dependence, obsessive-compulsive disorder, and Alzheimer's dementia). METHODS Modified Waldrop's MPA scale was applied on 1321 individuals from 439 transdiagnostic multiplex families and 125 healthy population controls (HC). Stage of fetal development (morphogenetic/phenogenetic)- and anatomical location (craniofacial/peripheral)-based sub-scores were calculated. Familiality and endophenotypic potential of MPA were analyzed with serial negative binomial mixed-effect regression. Cross-diagnostic differences and the effect of family history density (FHD) of each diagnosis on MPA were assessed. Mixed-effects Cox models estimated the influence of MPA on age-at-onset of illness (AAO). RESULTS MPA were found to be heritable in families with psychiatric disorders, with a familiality of 0.52. MPA were higher in psychotic disorders after controlling for effects of sex and intrafamilial correlation. Morphogenetic variant MPA was noted to be lower in dementia in comparison to HC. FHD of schizophrenia and bipolar disorder predicted higher, and that of dementia and substance dependence predicted lower MPA. MPA brought forward the AAO [HR:1.07 (1.03-1.11)], and this was more apparent in psychotic disorders. CONCLUSION MPA are transmissible in families, are specifically related to the risk of developing psychoses, and predict an earlier age at onset. Neurodevelopmentally informed classification of MPA has the potential to enhance the etiopathogenic and translational understanding of psychiatric disorders.
Collapse
Affiliation(s)
- Vanteemar S Sreeraj
- Department of Psychiatry, National Institute for Mental Health and Neurosciences (NIMHANS), Bangalore, India.
| | - Joan C Puzhakkal
- Department of Psychiatry, National Institute for Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Bharath Holla
- Department of Psychiatry, National Institute for Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Ravi Kumar Nadella
- Department of Psychiatry, National Institute for Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Sweta Sheth
- Department of Psychiatry, National Institute for Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Srinivas Balachander
- Department of Psychiatry, National Institute for Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Dhruva Ithal
- Department of Psychiatry, National Institute for Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Furkhan Ali
- Department of Psychiatry, National Institute for Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Biju Viswanath
- Department of Psychiatry, National Institute for Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Kesavan Muralidharan
- Department of Psychiatry, National Institute for Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Ganesan Venkatasubramanian
- Department of Psychiatry, National Institute for Mental Health and Neurosciences (NIMHANS), Bangalore, India.
| | - John P John
- Department of Psychiatry, National Institute for Mental Health and Neurosciences (NIMHANS), Bangalore, India.
| | - Vivek Benegal
- Department of Psychiatry, National Institute for Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Pratima Murthy
- Department of Psychiatry, National Institute for Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Mathew Varghese
- Department of Psychiatry, National Institute for Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Yc Janardhan Reddy
- Department of Psychiatry, National Institute for Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Sanjeev Jain
- Department of Psychiatry, National Institute for Mental Health and Neurosciences (NIMHANS), Bangalore, India.
| | | |
Collapse
|
5
|
Mobile RZ, Roussenq AC, de Araujo MR, Sbalqueiro R, Maciel JVB, de Lima AAS. The characteristics of palate and upper dental arch can be an anatomical marker for men with schizophrenia? Case-control study: Palate can be a marker for schizophrenia? SPECIAL CARE IN DENTISTRY 2020; 40:412-417. [PMID: 32620039 DOI: 10.1111/scd.12488] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 05/25/2020] [Accepted: 05/29/2020] [Indexed: 12/01/2022]
Abstract
AIMS The aim of this study was to compare individuals with and without schizophrenia through the characteristics of the palate, such as width, length, depth, palate shape, and upper dental arch shape. METHODS AND RESULTS The sample was divided into one case group (n = 45) and two control groups (n = 90; 45 individuals each group). Groups were paired by variables: sex, age, and malocclusion type. All analyses were performed on upper dental arch plaster models. All individuals were male and the mean age was 28.56 (SD: 7.82) years. The frequency of the malocclusion type observed was 54.1% (Class I), 22.2% (Class II), and 23.7% (Class III). Statistically significant difference was observed between the case and control groups for the variables palate shape (P = .004) and upper dental arch shape (P = .003). The case group had a higher frequency of the deep or grooved palate shape (57.8%) and parabolic dental arch shape (48.9%). There was no statistically significant difference for the palate width, length, and depth (P > .05). CONCLUSIONS There was an evidence that the deep or grooved palate shape and parabolic dental arch shape are morphological characteristics of the palate in men with schizophrenia.
Collapse
Affiliation(s)
- Rafael Zancan Mobile
- Department of Stomatology, Universidade Federal do Paraná (UFPR), Curitiba, Brazil
| | - Ana Clelia Roussenq
- Department of Stomatology, Universidade Federal do Paraná (UFPR), Curitiba, Brazil
| | | | - Ricardo Sbalqueiro
- Department of Psychiatry, Associação San Julian Amigos e Colaboradores, Parana, Brazil
| | | | | |
Collapse
|
6
|
Franco RPAV, Mobile RZ, Filla CDFS, Sbalqueiro R, de Lima AAS, Silva RF, Paranhos LR, Tanaka OM, Turkina A, Franco A. Morphology of the palate, palatal rugae pattern, and dental arch form in patients with schizophrenia. SPECIAL CARE IN DENTISTRY 2019; 39:464-470. [PMID: 31329315 DOI: 10.1111/scd.12408] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 06/19/2019] [Accepted: 07/08/2019] [Indexed: 11/28/2022]
Abstract
AIMS This study aimed to investigate the morphology of the palate, palatal rugae pattern, and dental arch form in patients with schizophrenia. METHODS AND RESULTS An observational case-control study was designed following the STROBE statement and checklist. The sample consisted of 132 patients (39 diagnosed with schizophrenia and 93 controls). Dental casts of the patients were classified based on the pattern of their palatal rugae, their dental arch form, and the area of their palate. The palatal rugae in patients with schizophrenia had a more random distribution and shape compared to the control group (P = .027). Oval dental arches were the most prevalent in both groups (P = .473). The palate area was slightly larger in the control group (3.2318 ± 0.549 mm2 ) compared with the group of patients with schizophrenia (3.060 ± 0.470 mm2 ) (P = .090). CONCLUSION Palatal rugae pattern may feature as a potential minor physical anomaly for schizophrenia. Additional studies with alternative sampling and classification systems are necessary to understand this finding and its applications in practice.
Collapse
Affiliation(s)
| | | | | | - Ricardo Sbalqueiro
- Department of Psychiatry, Associação San Juan Amigos e Colaboradores, Curitiba, Brazil
| | | | | | - Luiz Renato Paranhos
- Department of Preventive and Community Dentistry, School of Dentistry, Federal University of Uberlândia, Uberlândia, Brazil
| | - Orlando Motohiro Tanaka
- Department of Dentistry - Orthodontics, School of Life Sciences, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| | - Anna Turkina
- Department of Therapeutic Dentistry, Institute of Dentistry, I. M. Sechenov First Moscow Medical State University, Moscow, Russian Federation
| | - Ademir Franco
- Department of Therapeutic Dentistry, Institute of Dentistry, I. M. Sechenov First Moscow Medical State University, Moscow, Russian Federation
| |
Collapse
|
7
|
Narla ST, Decker B, Sarder P, Stachowiak EK, Stachowiak MK. Induced Pluripotent Stem Cells Reveal Common Neurodevelopmental Genome Deprograming in Schizophrenia. Results Probl Cell Differ 2018; 66:137-162. [PMID: 30209658 DOI: 10.1007/978-3-319-93485-3_6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Schizophrenia is a neurodevelopmental disorder characterized by complex aberrations in the structure, wiring, and chemistry of multiple neuronal systems. The abnormal developmental trajectory of the brain is established during gestation, long before clinical manifestation of the disease. Over 200 genes and even greater numbers of single nucleotide polymorphisms and copy number variations have been linked with schizophrenia. How does altered function of such a variety of genes lead to schizophrenia? We propose that the protein products of these altered genes converge on a common neurodevelopmental pathway responsible for the development of brain neural circuit and neurotransmitter systems. The results of a multichanneled investigation using induced pluripotent stem cell (iPSCs)- and embryonic stem cell (ESCs)-derived neuronal committed cells (NCCs) indicate an early (preneuronal) developmental-genomic etiology of schizophrenia and that the dysregulated developmental gene networks are common to genetically unrelated cases of schizophrenia. The results support a "watershed" mechanism in which mutations within diverse signaling pathways affect the common pan-ontogenic mechanism, integrative nuclear (n)FGFR1 signaling (INFS). Dysregulation of INFS in schizophrenia NCCs deconstructs coordinated gene networks and leads to formation of new networks by the dysregulated genes. This genome deprograming affects critical gene programs and pathways for neural development and functions. Studies show that the genomic deprograming reflect an altered nFGFR1-genome interactions and deregulation of miRNA genes by nFGFR1. In addition, changes in chromatin topology imposed by nFGFR1 may play a role in coordinate gene dysregulation in schizophrenia.
Collapse
Affiliation(s)
- Sridhar T Narla
- Department of Pathology and Anatomical Sciences, Molecular and Structural Neurobiology and Gene Therapy Program, State University of New York, Buffalo, NY, USA
| | - Brandon Decker
- Department of Pathology and Anatomical Sciences, Molecular and Structural Neurobiology and Gene Therapy Program, State University of New York, Buffalo, NY, USA
| | - Pinaki Sarder
- Department of Pathology and Anatomical Sciences, Molecular and Structural Neurobiology and Gene Therapy Program, State University of New York, Buffalo, NY, USA.,Department of Biomedical Engineering, State University of New York, Buffalo, NY, USA
| | - Ewa K Stachowiak
- Department of Pathology and Anatomical Sciences, Molecular and Structural Neurobiology and Gene Therapy Program, State University of New York, Buffalo, NY, USA.,Western New York Stem Cells Culture and Analysis Center, State University of New York, Buffalo, NY, USA
| | - Michal K Stachowiak
- Department of Pathology and Anatomical Sciences, Molecular and Structural Neurobiology and Gene Therapy Program, State University of New York, Buffalo, NY, USA. .,Department of Biomedical Engineering, State University of New York, Buffalo, NY, USA. .,Western New York Stem Cells Culture and Analysis Center, State University of New York, Buffalo, NY, USA.
| |
Collapse
|
8
|
Dell’Osso B, Carlotta Palazzo M, Carlo Altamura A. Neurodevelopmental and Neurodegenerative Alterations in the Pathophysiology of Schizophrenia: Focus on Neuro-Immuno-Inflammation. NEURODEGENER DIS 2018. [DOI: 10.1007/978-3-319-72938-1_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
9
|
Stachowiak EK, Benson CA, Narla ST, Dimitri A, Chuye LEB, Dhiman S, Harikrishnan K, Elahi S, Freedman D, Brennand KJ, Sarder P, Stachowiak MK. Cerebral organoids reveal early cortical maldevelopment in schizophrenia-computational anatomy and genomics, role of FGFR1. Transl Psychiatry 2017; 7:6. [PMID: 30446636 PMCID: PMC5802550 DOI: 10.1038/s41398-017-0054-x] [Citation(s) in RCA: 106] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 08/17/2017] [Accepted: 09/23/2017] [Indexed: 12/15/2022] Open
Abstract
Studies of induced pluripotent stem cells (iPSCs) from schizophrenia patients and control individuals revealed that the disorder is programmed at the preneuronal stage, involves a common dysregulated mRNA transcriptome, and identified Integrative Nuclear FGFR1 Signaling a common dysregulated mechanism. We used human embryonic stem cell (hESC) and iPSC-derived cerebral organoids from four controls and three schizophrenia patients to model the first trimester of in utero brain development. The schizophrenia organoids revealed an abnormal scattering of proliferating Ki67+ neural progenitor cells (NPCs) from the ventricular zone (VZ), throughout the intermediate (IZ) and cortical (CZ) zones. TBR1 pioneer neurons and reelin, which guides cortico-petal migration, were restricted from the schizophrenia cortex. The maturing neurons were abundantly developed in the subcortical regions, but were depleted from the schizophrenia cortex. The decreased intracortical connectivity was denoted by changes in the orientation and morphology of calretinin interneurons. In schizophrenia organoids, nuclear (n)FGFR1 was abundantly expressed by developing subcortical cells, but was depleted from the neuronal committed cells (NCCs) of the CZ. Transfection of dominant negative and constitutively active nFGFR1 caused widespread disruption of the neuro-ontogenic gene networks in hESC-derived NPCs and NCCs. The fgfr1 gene was the most prominent FGFR gene expressed in NPCs and NCCs, and blocking with PD173074 reproduced both the loss of nFGFR1 and cortical neuronal maturation in hESC cerebral organoids. We report for the first time, progression of the cortical malformation in schizophrenia and link it to altered FGFR1 signaling. Targeting INFS may offer a preventive treatment of schizophrenia.
Collapse
Affiliation(s)
- E. K. Stachowiak
- 0000 0004 1936 9887grid.273335.3Department of Pathology and Anatomical Sciences, State University of New York at Buffalo, Buffalo, NY USA
| | - C. A. Benson
- 0000 0004 1936 9887grid.273335.3Department of Pathology and Anatomical Sciences, State University of New York at Buffalo, Buffalo, NY USA
| | - S. T. Narla
- 0000 0004 1936 9887grid.273335.3Department of Pathology and Anatomical Sciences, State University of New York at Buffalo, Buffalo, NY USA
| | - A. Dimitri
- 0000 0004 1936 9887grid.273335.3Department of Pathology and Anatomical Sciences, State University of New York at Buffalo, Buffalo, NY USA ,0000 0004 0388 0154grid.264268.cDepartment of Biology, State University of New York at Fredonia, Fredonia, NY USA
| | - L. E. Bayona Chuye
- 0000 0004 1936 9887grid.273335.3Department of Pathology and Anatomical Sciences, State University of New York at Buffalo, Buffalo, NY USA
| | - S. Dhiman
- 0000 0004 1936 9887grid.273335.3Department of Pathology and Anatomical Sciences, State University of New York at Buffalo, Buffalo, NY USA ,0000 0004 1936 9887grid.273335.3Department of Biomedical Engineering, State University of New York at Buffalo, Buffalo, NY USA
| | - K. Harikrishnan
- 0000 0004 1936 9887grid.273335.3Department of Pathology and Anatomical Sciences, State University of New York at Buffalo, Buffalo, NY USA ,0000 0004 1936 9887grid.273335.3Department of Biomedical Engineering, State University of New York at Buffalo, Buffalo, NY USA
| | - S. Elahi
- 0000 0004 1936 9887grid.273335.3Department of Pathology and Anatomical Sciences, State University of New York at Buffalo, Buffalo, NY USA
| | - D. Freedman
- 0000 0004 1936 9887grid.273335.3Department of Pathology and Anatomical Sciences, State University of New York at Buffalo, Buffalo, NY USA
| | - K. J. Brennand
- Icahn School of Medicine at Mount Sinai, Departments of Psychiatry and Neuroscience, New York, NY USA
| | - P. Sarder
- 0000 0004 1936 9887grid.273335.3Department of Pathology and Anatomical Sciences, State University of New York at Buffalo, Buffalo, NY USA ,0000 0004 1936 9887grid.273335.3Department of Biomedical Engineering, State University of New York at Buffalo, Buffalo, NY USA
| | - M. K. Stachowiak
- 0000 0004 1936 9887grid.273335.3Department of Pathology and Anatomical Sciences, State University of New York at Buffalo, Buffalo, NY USA ,0000 0004 1936 9887grid.273335.3Department of Biomedical Engineering, State University of New York at Buffalo, Buffalo, NY USA
| |
Collapse
|
10
|
Narla ST, Lee YW, Benson C, Sarder P, Brennand K, Stachowiak E, Stachowiak M. Common developmental genome deprogramming in schizophrenia - Role of Integrative Nuclear FGFR1 Signaling (INFS). Schizophr Res 2017; 185:17-32. [PMID: 28094170 PMCID: PMC5507209 DOI: 10.1016/j.schres.2016.12.012] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 12/06/2016] [Accepted: 12/12/2016] [Indexed: 12/16/2022]
Abstract
The watershed-hypothesis of schizophrenia asserts that over 200 different mutations dysregulate distinct pathways that converge on an unspecified common mechanism(s) that controls disease ontogeny. Consistent with this hypothesis, our RNA-sequencing of neuron committed cells (NCCs) differentiated from established iPSCs of 4 schizophrenia patients and 4 control subjects uncovered a dysregulated transcriptome of 1349 mRNAs common to all patients. Data reveals a global dysregulation of developmental genome, deconstruction of coordinated mRNA networks, and the formation of aberrant, new coordinated mRNA networks indicating a concerted action of the responsible factor(s). Sequencing of miRNA transcriptomes demonstrated an overexpression of 16 miRNAs and deconstruction of interactive miRNA-mRNA networks in schizophrenia NCCs. ChiPseq revealed that the nuclear (n) form of FGFR1, a pan-ontogenic regulator, is overexpressed in schizophrenia NCCs and overtargets dysregulated mRNA and miRNA genes. The nFGFR1 targeted 54% of all human gene promoters and 84.4% of schizophrenia dysregulated genes. The upregulated genes reside within major developmental pathways that control neurogenesis and neuron formation, whereas downregulated genes are involved in oligodendrogenesis. Our results indicate (i) an early (preneuronal) genomic etiology of schizophrenia, (ii) dysregulated genes and new coordinated gene networks are common to unrelated cases of schizophrenia, (iii) gene dysregulations are accompanied by increased nFGFR1-genome interactions, and (iv) modeling of increased nFGFR1 by an overexpression of a nFGFR1 lead to up or downregulation of selected genes as observed in schizophrenia NCCs. Together our results designate nFGFR1 signaling as a potential common dysregulated mechanism in investigated patients and potential therapeutic target in schizophrenia.
Collapse
Affiliation(s)
- S. T. Narla
- Department of Pathology and Anatomical Sciences, State University of New York at Buffalo, Buffalo, NY, USA,Western New York Stem Cell Culture and Analysis Center, State University of New York at Buffalo, Buffalo, NY, USA
| | - Y-W. Lee
- Department of Pathology and Anatomical Sciences, State University of New York at Buffalo, Buffalo, NY, USA
| | - C.A. Benson
- Department of Pathology and Anatomical Sciences, State University of New York at Buffalo, Buffalo, NY, USA,Western New York Stem Cell Culture and Analysis Center, State University of New York at Buffalo, Buffalo, NY, USA
| | - P. Sarder
- Department of Pathology and Anatomical Sciences, State University of New York at Buffalo, Buffalo, NY, USA
| | - K. Brennand
- Icahn School of Medicine at Mount Sinai, Departments of Psychiatry and Neuroscience, New York, NY, USA
| | - E.K. Stachowiak
- Department of Pathology and Anatomical Sciences, State University of New York at Buffalo, Buffalo, NY, USA,Western New York Stem Cell Culture and Analysis Center, State University of New York at Buffalo, Buffalo, NY, USA
| | - M.K. Stachowiak
- Department of Pathology and Anatomical Sciences, State University of New York at Buffalo, Buffalo, NY, USA,Western New York Stem Cell Culture and Analysis Center, State University of New York at Buffalo, Buffalo, NY, USA,Correspondence should be addressed to Michal K. Stachowiak Department of Pathology and Anatomical Sciences, SUNY, 3435 Main Street, 206A Farber Hall, Buffalo, N.Y. 14214, tel. (716) 829 3540
| |
Collapse
|
11
|
Minor physical anomalies in bipolar I and bipolar II disorders - Results with the Méhes Scale. Psychiatry Res 2017; 249:120-124. [PMID: 28092791 DOI: 10.1016/j.psychres.2017.01.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 01/03/2017] [Accepted: 01/03/2017] [Indexed: 11/21/2022]
Abstract
Minor physical anomalies (MPAs) are external markers of abnormal brain development, so the more common appearence of these signs among bipolar I and bipolar II patients can confirm the possibility of a neurodevelopmental deficit in these illnesses. The aim of the present study was to investigate the rate and topological profile of minor physical anomalies in patients with bipolar I and - first in literature - with bipolar II disorders compared to matched healthy control subjects. Using a list of 57 minor physical anomalies (the Méhes Scale), 30 bipolar I and 30 bipolar II patients, while as a comparison 30 matched healthy control subjects were examined. Significant differences were detected between the three groups comparing the total number of minor physical anomalies, minor malformations and phenogenetic variants and in the cases of the ear and the mouth regions. The individual analyses of the 57 minor physical anomalies by simultaneous comparison of the three groups showed, that in the cases of furrowed tongue and high arched palate were significant differences between the three groups. The results can promote the concept, that a neurodevelopmental deficit may play a role in the etiology of both bipolar I and bipolar II disorders.
Collapse
|
12
|
Papiol S, Fatjó-Vilas M, Schulze TG. Neurological soft signs in patients with schizophrenia: current knowledge and future perspectives in the post-genomics era. ACTA ACUST UNITED AC 2016. [DOI: 10.3402/tdp.v4.30071] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
|
13
|
Tsai IN, Lin JJ, Lu MK, Tan HP, Jang FL, Gan ST, Lin SH. Improving risk assessment and familial aggregation of age at onset in schizophrenia using minor physical anomalies and craniofacial measures. Medicine (Baltimore) 2016; 95:e4406. [PMID: 27472737 PMCID: PMC5265874 DOI: 10.1097/md.0000000000004406] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Age at onset is the most important feature of schizophrenia that could indicate its origin. Minor physical anomalies (MPAs) characterize potential marker indices of disturbances in early neurodevelopment. However, the association between MPAs and age at onset of schizophrenia is still unclear. We aimed to compare risk assessment and familial aggregation in patients with early-onset schizophrenia (EOS) and adult-onset schizophrenia (AOS) with MPAs and craniofacial measures.We estimated the risk assessment of MPAs among patients with EOS (n = 68), patients with AOS (n = 183), nonpsychotic relatives (n = 147), and healthy controls (n = 241) using 3 data-mining algorithms. In addition, we assessed the magnitude of familial aggregation of MPAs with respect to the age at onset of schizophrenia.The performance of EOS was superior to that of AOS, with discrimination accuracies of 89% and 76%, respectively. Combined MPA scores as the risk assessment were significantly higher in all schizophrenia subgroups and the nonpsychotic relatives of EOS patients than in the healthy controls. The recurrence risk ratio for familial aggregation of the MPA scores of EOS families (odds ratio 9.27) was substantially higher than that of AOS families (odds ratio 2.47).The results highlight that EOS improves risk assessment and has a severe magnitude of familial aggregation of MPAs. These findings indicate that EOS might result from a stronger genetic susceptibility to neurodevelopmental deficits.
Collapse
Affiliation(s)
- I-Ning Tsai
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University
| | - Jin-Jia Lin
- Department of Psychiatry, Chimei Medical Center
| | - Ming-Kun Lu
- Department of Health, Jianan Mental Hospital
- Department of Applied Life Science and Health, Chia Nan University of Pharmacy and Science
| | - Hung-Pin Tan
- Department of Psychiatry, Kaohsiung Veterans General Hospital Tainan Branch
- Department of Acupressure Technology, Chung Hwa University of Medical Technology
- Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University
| | | | - Shu-Ting Gan
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University
| | - Sheng-Hsiang Lin
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University
- Biostatistics Consulting Center, National Cheng Kung University Hospital, Tainan, Taiwan
- Correspondence: Sheng-Hsiang Lin, Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, 138, Shengli Road, Tainan, Taiwan (e-mail: )
| |
Collapse
|
14
|
Dyshniku F, Murray ME, Fazio RL, Lykins AD, Cantor JM. Minor Physical Anomalies as a Window into the Prenatal Origins of Pedophilia. ARCHIVES OF SEXUAL BEHAVIOR 2015; 44:2151-2159. [PMID: 26058490 DOI: 10.1007/s10508-015-0564-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 04/30/2015] [Accepted: 05/04/2015] [Indexed: 06/04/2023]
Abstract
Evidence is steadily accumulating to support a neurodevelopmental basis for pedophilia. This includes increased incidence of non-right-handedness, which is a result primarily of prenatal neural development and solidified very early in life. Minor physical anomalies (MPAs; superficial deviations from typical morphological development, such as un-detached earlobes) also develop only prenatally, suggesting them as another potential marker of atypical physiological development during the prenatal period among pedophiles. This study administered the Waldrop Physical Anomaly Scale to assess the prevalence of MPAs in a clinical sample of men referred for assessment following a sexual assault, or another illegal or clinically significant sexual behavior. Significant associations emerged between MPA indices and indicators of pedophilia, including penile responses to depictions of children, number of child victims, and possession of child pornography. Moreover, greater sexual attraction to children was associated with an elevated craniofacial-to-peripheral anomalies ratio. The overall sample demonstrated a greater number of MPAs relative to prior samples of individuals with schizophrenia as well as to healthy controls.
Collapse
Affiliation(s)
- Fiona Dyshniku
- Department of Psychology, University of Windsor, Windsor, ON, Canada
| | - Michelle E Murray
- Sexual Behaviours Clinic, Centre for Addiction and Mental Health, 250 College St., Toronto, ON, M5T 1R8, Canada
| | - Rachel L Fazio
- Sexual Behaviours Clinic, Centre for Addiction and Mental Health, 250 College St., Toronto, ON, M5T 1R8, Canada.
| | - Amy D Lykins
- School of Behavioural, Cognitive, and Social Sciences, University of New England, Armidale, NSW, Australia
| | - James M Cantor
- Sexual Behaviours Clinic, Centre for Addiction and Mental Health, 250 College St., Toronto, ON, M5T 1R8, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
15
|
Lin AS, Chang SS, Lin SH, Peng YC, Hwu HG, Chen WJ. Minor physical anomalies and craniofacial measures in patients with treatment-resistant schizophrenia. Psychol Med 2015; 45:1839-1850. [PMID: 25515974 DOI: 10.1017/s0033291714002931] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Schizophrenia patients have higher rates of minor physical anomalies (MPAs) than controls, particularly in the craniofacial region; this difference lends support to the neurodevelopmental model of schizophrenia. Whether MPAs are associated with treatment response in schizophrenia remains unknown. The aim of this case-control study was to investigate whether more MPAs and specific quantitative craniofacial features in patients with schizophrenia are associated with operationally defined treatment resistance. METHOD A comprehensive scale, consisting of both qualitatively measured MPAs and quantitative measurements of the head and face, was applied in 108 patients with treatment-resistant schizophrenia (TRS) and in 104 non-TRS patients. Treatment resistance was determined according to the criteria proposed by Conley & Kelly (2001; Biological Psychiatry 50, 898-911). RESULTS Our results revealed that patients with TRS had higher MPA scores in the mouth region than non-TRS patients, and the two groups also differed in four quantitative measurements (facial width, lower facial height, facial height, and length of the philtrum), after controlling for multiple comparisons using the false discovery rate. Among these dysmorphological measurements, three MPA item types (mouth MPA score, facial width, and lower facial height) and earlier disease onset were further demonstrated to have good discriminant validity in distinguishing TRS from non-TRS patients in a multivariable logistic regression analysis, with an area under the curve of 0.84 and a generalized R 2 of 0.32. CONCLUSIONS These findings suggest that certain MPAs and craniofacial features may serve as useful markers for identifying TRS at early stages of the illness.
Collapse
Affiliation(s)
- A-S Lin
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University,17 Xu-Zhou Road,Taipei 100,Taiwan
| | - S-S Chang
- Hong Kong Jockey Club Centre for Suicide Research and Prevention, University of Hong Kong,Hong Kong Special Administrative Region,People's Republic of China
| | - S-H Lin
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University,Tainan,Taiwan
| | - Y-C Peng
- Department of General Psychiatry,Bali Psychiatric Center, Ministry of Health and Welfare,New Taipei City,Taiwan
| | - H-G Hwu
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University,17 Xu-Zhou Road,Taipei 100,Taiwan
| | - W J Chen
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University,17 Xu-Zhou Road,Taipei 100,Taiwan
| |
Collapse
|
16
|
Neurodevelopment Alterations, Neurodegeneration, and Immunoinflammatory Patterns in the Pathophysiology of Schizophrenia. NEURODEGENER DIS 2014. [DOI: 10.1007/978-1-4471-6380-0_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
17
|
Folsom TD, Fatemi SH. The involvement of Reelin in neurodevelopmental disorders. Neuropharmacology 2013; 68:122-35. [PMID: 22981949 PMCID: PMC3632377 DOI: 10.1016/j.neuropharm.2012.08.015] [Citation(s) in RCA: 189] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Revised: 08/14/2012] [Accepted: 08/16/2012] [Indexed: 12/21/2022]
Abstract
Reelin is a glycoprotein that serves important roles both during development (regulation of neuronal migration and brain lamination) and in adulthood (maintenance of synaptic function). A number of neuropsychiatric disorders including autism, schizophrenia, bipolar disorder, major depression, Alzheimer's disease and lissencephaly share a common feature of abnormal Reelin expression in the brain. Altered Reelin expression has been hypothesized to impair neuronal connectivity and synaptic plasticity, leading ultimately to the cognitive deficits present in these disorders. The mechanisms for abnormal Reelin expression in some of these disorders are currently unknown although possible explanations include early developmental insults, mutations, hypermethylation of the promoter for the Reelin gene (RELN), miRNA silencing of Reelin mRNA, FMRP underexpression and Reelin processing abnormalities. Increasing Reelin expression through pharmacological therapies may help ameliorate symptoms resulting from Reelin deficits. This article is part of the Special Issue entitled 'Neurodevelopmental Disorders'.
Collapse
Affiliation(s)
- Timothy D. Folsom
- Department of Psychiatry, Division of Neuroscience Research, University of Minnesota Medical School, 420 Delaware St SE, MMC 392, Minneapolis, MN 55455, USA
| | - S. Hossein Fatemi
- Department of Psychiatry, Division of Neuroscience Research, University of Minnesota Medical School, 420 Delaware St SE, MMC 392, Minneapolis, MN 55455, USA
- Department of Pharmacology, University of Minnesota Medical School, 420 Delaware St SE, MMC 392, Minneapolis, MN 55455, USA
- Department of Neuroscience, University of Minnesota Medical School, 420 Delaware St SE, MMC 392, Minneapolis, MN 55455, USA
| |
Collapse
|
18
|
Altamura AC, Pozzoli S, Fiorentini A, Dell'osso B. Neurodevelopment and inflammatory patterns in schizophrenia in relation to pathophysiology. Prog Neuropsychopharmacol Biol Psychiatry 2013; 42:63-70. [PMID: 23021973 DOI: 10.1016/j.pnpbp.2012.08.015] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Revised: 08/23/2012] [Accepted: 08/25/2012] [Indexed: 11/18/2022]
Abstract
As for other major psychoses, the etiology of schizophrenia still remains poorly understood, involving genetic and epigenetic mechanisms, as well as environmental contributions. In addition, immune alterations have been widely reported in schizophrenic patients, involving both the unspecific and specific pathways of the immune system, and suggesting that infectious/autoimmune processes play an important role in the etiopathogenesis of the disorder. Cytokines, in particular, are supposed to play a critical role in infectious and inflammatory processes, mediating the cross-talk between the brain and the immune system. In this perspective, even though mixed results have been reported, it seems that schizophrenia is associated with an imbalance in inflammatory cytokines. Alterations in the inflammatory and immune systems, moreover, seem to be already present in the early stages of schizophrenia and connected to the neurodevelopmental hypothesis of the disorder, identifying its roots in brain development abnormalities that do not manifest themselves until adolescence or early adulthood. At the same time, neuropathological and longitudinal studies in schizophrenia also support a neurodegenerative hypothesis and, more recently, a novel mixed hypothesis, integrating neurodevelopmental and neurodegenerative models, has been put forward. The present review aims to provide an updated overview of the connections between the immune and inflammatory alterations and the aforementioned hypotheses in schizophrenia.
Collapse
Affiliation(s)
- A Carlo Altamura
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milano, Italy.
| | | | | | | |
Collapse
|
19
|
Mhalla A, Boussaïd N, Gassab L, Gaha L, Mechri A. [Minor neurological and physical anomalies in patients with first-episode psychosis]. Encephale 2012; 39:149-54. [PMID: 23095597 DOI: 10.1016/j.encep.2012.06.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Accepted: 06/27/2012] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Over the last several decades, there has been an increasing number of neuroanatomical, neuroimaging, neurophysiological, and neuropsychological studies in search of structural, functional, and cognitive correlates of brain insult(s) that could ultimately lead to unravelling the pathophysiology of schizophrenia. A direct, easily administered, and inexpensive way of investigating brain dysfunction in schizophrenia is the study of neurological soft signs and minor physical anomalies, two putative indices of developmental abnormality. The study of these neurodevelopmental markers in the first-episode psychosis allows the detection of the neurodevelopmental abnormalities at the onset of psychosis. AIMS OF THE STUDY The objectives of our study were to determinate the prevalence, the scores, and the nature of neurological soft signs (NSS) and minor physical anomalies (MPA) in patients with first-episode psychosis and to explore the correlations between these neurodevelopmental markers and the demographic, clinical and therapeutic features. METHOD A cross-sectional study was carried-out on 61 patients (mean age: 28.9±9.4years; 86.9% were males), hospitalized for first-episode psychosis (DSM-IV-TR diagnosis of schizophrenia, schizophreniform disorder, brief psychotic disorder, delusional disorder, and psychotic disorder not otherwise specified). The evaluation procedure consisted of a retrospective assessment of the premorbid functioning by the Premorbid Functioning Scale (PAS) and the following clinical scales: Positive and Negative Symptoms Scale (PANSS), Clinical Global Impression (CGI) and Global Assessment of Functioning (GAF), the NSS scale of Krebs et al. (23 items exploring motor coordination, motor integrative function, sensory integration, involuntary movements or posture, quality of lateralization) and the MPA scale of Gourion et al. (41 items, exploring anomalies of face, eyes, ears, mouth, hands and feet). RESULTS The prevalence of NSS was 83.6% (cut-off point=9.5), with a mean total score of 15.3±6.7. The highest score was for the motor coordination. The prevalence of MPA was 62.7% (cut-off point=5), with a mean total score of 5.8±3.2. The most common MPA were the fine hair (50.8%), adherent earlobes (49.2%) and clinodactyly (31.1%). Correlations were found between the NSS total score and the Poor Premorbid Functioning (r=0.32, P=0.04), the PANSS total score (r=0.36, P=0.005), and the negative (r=0.45, P<0.001) and disorganization sub-scores (r=0.41, P=0.001), the CGI-severity of (r=0.30, P=0.02), the impairment functioning in the GAF (r=-0.26, P=0.04) and with extrapyramidal symptoms (r=0.52, P<0.001). However, no correlation was found between the NSS total scores, age, gender, the PANSS positive sub-score, the daily dosage of antipsychotics, the CGI-improvement score and the MPA total score. There was no correlation between MPA total score and demographic, clinical and therapeutic features of patients. Moreover, there was no correlation between the NSS or MPA scores and the short-term evolution (6months to 1year) towards schizophrenia. CONCLUSION These results confirm the data in the literature relating high NSS and MPA scores in patients with a first-episode psychosis. The NSS appear to characterize severe psychotic disorders with more negative and disorganization symptoms and poor social functioning and may be a prognostic indicator.
Collapse
Affiliation(s)
- A Mhalla
- Service de psychiatrie, CHU de Monastir, rue 1(er)-Juin, 5000 Monastir, Tunisie
| | | | | | | | | |
Collapse
|
20
|
Gamliel M, Ebstein R, Yirmiya N, Mankuta D. Minor Fetal Sonographic Findings in Autism Spectrum Disorder. Obstet Gynecol Surv 2012; 67:176-86. [DOI: 10.1097/ogx.0b013e31824bb5d6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
|
21
|
Minor physical anomalies in patients with bipolar I disorder and normal controls. J Affect Disord 2011; 135:193-200. [PMID: 21846578 DOI: 10.1016/j.jad.2011.07.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Revised: 07/19/2011] [Accepted: 07/19/2011] [Indexed: 02/02/2023]
Abstract
BACKGROUND The neurodevelopmental hypothesis is well established in schizophrenia but has received modest empirical support in bipolar disorder. In schizophrenia it is partly based on the higher prevalence of minor physical anomalies (MPAs), established by many well controlled studies. No studies with comparable designs have been performed in bipolar disorder. The present study aims to establish the rate and topographic distribution of MPAs in bipolar I patients. METHODS The subjects were 61 patients (25 men, 36 women) with bipolar I disorder and 103 normal subjects (49 men, 54 women) who were examined for MPAs using a modified version of the Waldrop Physical Anomaly Scale. RESULTS The bipolar I patients showed significantly higher regional MPA scores in 3 distinct regions - mouth, feet and head, as well as in the overall scores for the craniofacial complex, the periphery and the total MPA score. Differences were statistically significant for 3 anomalies - high/steepled palate, big gap between I and II toes and furrowed tongue that made significant contribution to the prediction of the patient-control status in a discriminant analysis model. CONCLUSIONS Our data suggest that aberrant processes of neurodevelopment may contribute to the etiology of bipolar I disorder. The field is open for further research using modern instruments and designs in order to identify potential biological markers for bipolar disorder.
Collapse
|
22
|
Brown AS. The environment and susceptibility to schizophrenia. Prog Neurobiol 2011; 93:23-58. [PMID: 20955757 PMCID: PMC3521525 DOI: 10.1016/j.pneurobio.2010.09.003] [Citation(s) in RCA: 451] [Impact Index Per Article: 34.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2010] [Revised: 09/22/2010] [Accepted: 09/30/2010] [Indexed: 02/07/2023]
Abstract
In the present article the putative role of environmental factors in schizophrenia is reviewed and synthesized. Accumulating evidence from recent studies suggests that environmental exposures may play a more significant role in the etiopathogenesis of this disorder than previously thought. This expanding knowledge base is largely a consequence of refinements in the methodology of epidemiologic studies, including birth cohort investigations, and in preclinical research that has been inspired by the evolving literature on animal models of environmental exposures. This paper is divided into four sections. In the first, the descriptive epidemiology of schizophrenia is reviewed. This includes general studies on incidence, prevalence, and differences in these measures by urban-rural, neighborhood, migrant, and season of birth status, as well as time trends. In the second section, we discuss the contribution of environmental risk factors acting during fetal and perinatal life; these include infections [e.g. rubella, influenza, Toxoplasma gondii (T. gondii), herpes simplex virus type 2 (HSV-2)], nutritional deficiencies (e.g., famine, folic acid, iron, vitamin D), paternal age, fetal/neonatal hypoxic and other obstetric insults and complications, maternal stress and other exposures [e.g. lead, rhesus (Rh) incompatibility, maternal stress]. Other putative neurodevelopmental determinants, including cannabis, socioeconomic status, trauma, and infections during childhood and adolescence are also covered. In the third section, these findings are synthesized and their implications for prevention and uncovering biological mechanisms, including oxidative stress, apoptosis, and inflammation, are discussed. Animal models, including maternal immune activation, have yielded evidence suggesting that these exposures cause brain and behavioral phenotypes that are analogous to findings observed in patients with schizophrenia. In the final section, future studies including new, larger, and more rigorous epidemiologic investigations, and research on translational and clinical neuroscience, gene-environment interactions, epigenetics, developmental trajectories and windows of vulnerability, are elaborated upon. These studies are aimed at confirming observed risk factors, identifying new environmental exposures, elucidating developmental mechanisms, and shedding further light on genes and exposures that may not be identified in the absence of these integrated approaches. The study of environmental factors in schizophrenia may have important implications for the identification of causes and prevention of this disorder, and offers the potential to complement, and refine, existing efforts on explanatory neurodevelopmental models.
Collapse
Affiliation(s)
- Alan S Brown
- Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York State Psychiatric Institute, New York, NY 10032, USA.
| |
Collapse
|
23
|
Stain HJ, Clark S, O'Donnell M, Schall U. Young rural people at risk for schizophrenia: time for mental health services to translate research evidence into best practice of care. Aust N Z J Psychiatry 2010; 44:872-82. [PMID: 20932200 DOI: 10.3109/00048674.2010.493857] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Early intervention into prodromal schizophrenia has shown promise, but controversy continues regarding the ethical acceptability of identifying a group of 'ultra high risk' individuals of whom only 30 to 50% will develop a psychotic disorder. With well developed early intervention services this group faces the possibility of being labelled as 'pre-psychotic', a condition for which the well known stigma associated with the diagnosis of schizophrenia or bipolar disorder is likely to be associated. In addition, the use of potent antipsychotic and other medications (albeit usually at lower doses than those used for those with manifest psychosis) mandates consideration of the risks associated with their use and neurological and metabolic side effects. The potential for iatrogenic morbidity in the 'false positive' group must be weighed against the need of the 'true positives' identified through screening and assessment. Current evidence for the concept of 'at-risk mental state' was reviewed within a neurodevelopmental framework, including emerging data on the effectiveness of early intervention for the purpose of providing recommendations for community mental health services. The review suggests that different treatment strategies may be appropriate depending on the clinical stage of the condition as long as the benefits of intervention outweigh its risk burden. It further suggests that the severity of psychoses and the evidence of its early onset in utero and its acceleration in adolescence positions 'ultra high risk' intervention as a core model for early intervention for young people by teasing apart the symptomatic components of the 'prepsychotic state' and ensuring the population is reaching targeted mental health services for screening. The model is not restricted to the delivery of intervention for 'pre-psychotic' young people but is applicable for targeted programmes for a number of clinical groups considered at 'ultra high risk'. However, only further research in naturalistic populations embedded in clinical practice and ideally conducted in partnership of mental health services with academic research institutions will help clarify potential risks of early identification and intervention and assist in updating and making more explicit the clinical guidelines services will use in approaching those in the 'ultra high risk' group.
Collapse
Affiliation(s)
- Helen J Stain
- Centre for Rural and Remote Mental Health, University of Newcastle, Orange, New South Wales, Australia.
| | | | | | | |
Collapse
|
24
|
Murphy BP. Beyond the first episode: candidate factors for a risk prediction model of schizophrenia. Int Rev Psychiatry 2010; 22:202-23. [PMID: 20504060 DOI: 10.3109/09540261003661833] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Many early psychosis services are financially compromised and cannot offer a full tenure of care to all patients. To maintain viability of services it is important that those with schizophrenia are identified early to maximize long-term outcomes, as are those with better prognoses who can be discharged early. The duration of untreated psychosis remains the mainstay in determining those who will benefit from extended care, yet its ability to inform on prognosis is modest in both the short and medium term. There are a number of known or putative genetic and environmental risk factors that have the potential to improve prognostication, though a multivariate risk prediction model combining them with clinical characteristics has yet to be developed. Candidate risk factors for such a model are presented, with an emphasis on environmental risk factors. More work is needed to corroborate many putative factors and to determine which of the established factors are salient and which are merely proxy measures. Future research should help clarify how gene-environment and environment-environment interactions occur and whether risk factors are dose-dependent, or if they act additively or synergistically, or are redundant in the presence (or absence) of other factors.
Collapse
Affiliation(s)
- Brendan P Murphy
- Recovery and Prevention of Psychosis Service, Southern Health, Melbourne, Victoria, Australia.
| |
Collapse
|
25
|
Hennessy RJ, Baldwin PA, Browne DJ, Kinsella A, Waddington JL. Frontonasal dysmorphology in bipolar disorder by 3D laser surface imaging and geometric morphometrics: comparisons with schizophrenia. Schizophr Res 2010; 122:63-71. [PMID: 20554158 PMCID: PMC2941027 DOI: 10.1016/j.schres.2010.05.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2010] [Revised: 04/22/2010] [Accepted: 05/05/2010] [Indexed: 11/22/2022]
Abstract
Any developmental relationship between bipolar disorder and schizophrenia engenders continuing debate. As the brain and face emerge in embryological intimacy, brain dysmorphogenesis is accompanied by facial dysmorphogenesis. 3D laser surface imaging was used to capture the facial surface of 13 male and 14 female patients with bipolar disorder in comparison with 61 male and 75 female control subjects and with 37 male and 32 female patients with schizophrenia. Surface images were analysed using geometric morphometrics and 3D visualisations to identify domains of facial shape that distinguish bipolar patients from controls and bipolar patients from those with schizophrenia. Both male and female bipolar patients evidenced significant facial dysmorphology: common to male and female patients was overall facial widening, increased width of nose, narrowing of mouth and upward displacement of the chin; dysmorphology differed between male and female patients for nose length, lip thickness and tragion height. There were few morphological differences in comparison with schizophrenia patients. That dysmorphology of the frontonasal prominences and related facial regions in bipolar disorder is more similar to than different from that found in schizophrenia indicates some common dysmorphogenesis. Bipolar disorder and schizophrenia might reflect similar insult(s) acting over slightly differing time-frames or slightly differing insult(s) acting over a similar time-frame.
Collapse
Affiliation(s)
- Robin J. Hennessy
- Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland, St. Stephen's Green, Dublin 2, Ireland
| | - Patrizia A. Baldwin
- Cavan-Monaghan Mental Health Service, St. Davnet's Hospital, Monaghan, Ireland
| | - David J. Browne
- Cavan-Monaghan Mental Health Service, St. Davnet's Hospital, Monaghan, Ireland
| | - Anthony Kinsella
- Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland, St. Stephen's Green, Dublin 2, Ireland
| | - John L. Waddington
- Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland, St. Stephen's Green, Dublin 2, Ireland,Cavan-Monaghan Mental Health Service, St. Davnet's Hospital, Monaghan, Ireland,Corresponding author. Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland, St. Stephen's Green, Dublin 2, Ireland. Tel.: + 353 1 402 2129; fax: + 353 1 402 2453.
| |
Collapse
|
26
|
Blanchard JJ, Aghevli M, Wilson A, Sargeant M. Developmental instability in social anhedonia: an examination of minor physical anomalies and clinical characteristics. Schizophr Res 2010; 118:162-7. [PMID: 19944570 PMCID: PMC2856752 DOI: 10.1016/j.schres.2009.10.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2009] [Revised: 10/22/2009] [Accepted: 10/28/2009] [Indexed: 11/24/2022]
Abstract
Developmental instability (DI) refers to the inability of the developing brain to buffer the effects of genetic and environmental insults. This concept has been invoked to better understand how fetal brain development goes awry in schizophrenia and related spectrum disorders. This study examined one marker of DI, minor physical anomalies (MPAs), and its association with a putative indicator of schizotypy, the trait of social anhedonia. MPAs and clinical symptoms were assessed within a community sample of psychometrically identified individuals high in social anhedonia and a matched group of healthy controls. Results indicated that, compared to the controls, MPAs were elevated in the social anhedonia group. Additionally, within the social anhedonia group, MPAs were significantly correlated with clinical ratings of schizoid personality disorder characteristics and also showed strong associations with schizotypal personality disorder ratings. These findings indicate a relationship between developmental anomalies and negative schizotypy and suggest that, when combined with psychometrically identified risk, the presence of MPAs may further elevate the probability of clinical manifestations of schizophrenia-spectrum characteristics.
Collapse
Affiliation(s)
- Jack J Blanchard
- Department of Psychology, University of Maryland at College Park, MD 20742, United States.
| | | | | | | |
Collapse
|
27
|
Meyer U, Feldon J. Epidemiology-driven neurodevelopmental animal models of schizophrenia. Prog Neurobiol 2010; 90:285-326. [DOI: 10.1016/j.pneurobio.2009.10.018] [Citation(s) in RCA: 261] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2009] [Revised: 09/30/2009] [Accepted: 10/14/2009] [Indexed: 12/17/2022]
|
28
|
Abstract
While multiple theories have been put forth regarding the origin of schizophrenia, by far the vast majority of evidence points to the neurodevelopmental model in which developmental insults as early as late first or early second trimester lead to the activation of pathologic neural circuits during adolescence or young adulthood leading to the emergence of positive or negative symptoms. In this report, we examine the evidence from brain pathology (enlargement of the cerebroventricular system, changes in gray and white matters, and abnormal laminar organization), genetics (changes in the normal expression of proteins that are involved in early migration of neurons and glia, cell proliferation, axonal outgrowth, synaptogenesis, and apoptosis), environmental factors (increased frequency of obstetric complications and increased rates of schizophrenic births due to prenatal viral or bacterial infections), and gene-environmental interactions (a disproportionate number of schizophrenia candidate genes are regulated by hypoxia, microdeletions and microduplications, the overrepresentation of pathogen-related genes among schizophrenia candidate genes) in support of the neurodevelopmental model. We relate the neurodevelopmental model to a number of findings about schizophrenia. Finally, we also examine alternate explanations of the origin of schizophrenia including the neurodegenerative model.
Collapse
|
29
|
Brown JS. Effects of bisphenol-A and other endocrine disruptors compared with abnormalities of schizophrenia: an endocrine-disruption theory of schizophrenia. Schizophr Bull 2009; 35:256-78. [PMID: 18245062 PMCID: PMC2643957 DOI: 10.1093/schbul/sbm147] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
In recent years, numerous substances have been identified as so-called "endocrine disruptors" because exposure to them results in disruption of normal endocrine function with possible adverse health outcomes. The pathologic and behavioral abnormalities attributed to exposure to endocrine disruptors like bisphenol-A (BPA) have been studied in animals. Mental conditions ranging from cognitive impairment to autism have been linked to BPA exposure by more than one investigation. Concurrent with these developments in BPA research, schizophrenia research has continued to find evidence of possible endocrine or neuroendocrine involvement in the disease. Sufficient information now exists for a comparison of the neurotoxicological and behavioral pathology associated with exposure to BPA and other endocrine disruptors to the abnormalities observed in schizophrenia. This review summarizes these findings and proposes a theory of endocrine disruption, like that observed from BPA exposure, as a pathway of schizophrenia pathogenesis. The review shows similarities exist between the effects of exposure to BPA and other related chemicals with schizophrenia. These similarities can be observed in 11 broad categories of abnormality: physical development, brain anatomy, cellular anatomy, hormone function, neurotransmitters and receptors, proteins and factors, processes and substances, immunology, sexual development, social behaviors or physiological responses, and other behaviors. Some of these similarities are sexually dimorphic and support theories that sexual dimorphisms may be important to schizophrenia pathogenesis. Research recommendations for further elaboration of the theory are proposed.
Collapse
Affiliation(s)
- James S Brown
- Department of Psychiatry, VCU School of Medicine, Richmond, VA, USA.
| |
Collapse
|
30
|
Tényi T, Trixler M, Csábi G. Minor physical anomalies in affective disorders. A review of the literature. J Affect Disord 2009; 112:11-8. [PMID: 18508129 DOI: 10.1016/j.jad.2008.04.025] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2008] [Revised: 04/28/2008] [Accepted: 04/28/2008] [Indexed: 11/30/2022]
Abstract
BACKGROUND The increased frequency of MPAs may be external markers of abnormal brain development in affective disorders. METHODS A MEDLINE, psychInfo and Web of Science search was evaluated to collect all publications on the prevalence of minor physical anomalies in bipolar affective disorder and unipolar major depression. AIMS As reports on the prevalence of MPAs in affective disorders were controversial, were based on highly different number of patients and were evaluated by the use of scales with different sensitivities, we considered as important to review the current state of knowledge and to recommend directions to further research. RESULTS 14 publications on 12 studies were found after a careful literature search. 5 studies have dealt with the prevalence of MPAs in bipolar affective disorder, 3 have reported on examinations among patients with unipolar major depression, while 5 publications on 3 studies combined patients with bipolar affective disorder, schizoaffective disorder and unipolar major depression. 1 study was published on the prevalence of MPAs among mood disorders, without the differentiation of the data of patients with bipolar affective disorder and unipolar major depression. LIMITATIONS Few studies with relatively small size were published, there is no data on the distinction between bipolar I and bipolar II disorders. CONCLUSION The reviewed data suggest a higher probability of the role of an aberrant neurodevelopment in bipolar affective disorder and a smaller in unipolar major depression.
Collapse
Affiliation(s)
- Tamás Tényi
- Department of Psychiatry and Psychotherapy, University of Pécs, Hungary.
| | | | | |
Collapse
|
31
|
Fatemi SH, Folsom TD, Reutiman TJ, Sidwell RW. Viral regulation of aquaporin 4, connexin 43, microcephalin and nucleolin. Schizophr Res 2008; 98:163-77. [PMID: 17997079 PMCID: PMC2259220 DOI: 10.1016/j.schres.2007.09.031] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2007] [Revised: 09/18/2007] [Accepted: 09/24/2007] [Indexed: 12/21/2022]
Abstract
The current study investigated whether human influenza viral infection in midpregnancy leads to alterations in proteins involved in brain development. Human influenza viral infection was administered to E9 pregnant Balb/c mice. Brains of control and virally-exposed littermates were subjected to microarray analysis, SDS-PAGE and western blotting at three postnatal stages. Microarray analysis of virally-exposed mouse brains showed significant, two-fold change in expression of multiple genes in both neocortex and cerebellum when compared to sham-infected controls. Levels of mRNA and protein levels of four selected genes were examined in brains of exposed mice. Nucleolin mRNA was significantly decreased in day 0 and day 35 neocortex and significantly increased in day 35 cerebellum. Protein levels were significantly upregulated at days 35 and 56 in neocortex and at day 56 in cerebellum. Connexin 43 protein levels were significantly decreased at day 56 in neocortex. Aquaporin 4 mRNA was significantly decreased in day 0 neocortex. Aquaporin 4 protein levels decreased in neocortex significantly at day 35. Finally, microcephalin mRNA was significantly decreased in day 56 neocortex and protein levels were significantly decreased at 56 cerebellum. These data suggest that influenza viral infection in midpregnancy in mice leads to long-term changes in brain markers for enhanced ribosome genesis (nucleolin), increased production of immature neurons (microcephalin), and abnormal glial-neuronal communication and neuron migration (connexin 43 and aquaporin 4).
Collapse
Affiliation(s)
- S. Hossein Fatemi
- Department of Psychiatry, Division of Neuroscience Research, University of Minnesota Medical School, 420 Delaware Ave SE, MMC 392, Minneapolis, MN USA 55455; emails: , ,
| | - Timothy D. Folsom
- Department of Psychiatry, Division of Neuroscience Research, University of Minnesota Medical School, 420 Delaware Ave SE, MMC 392, Minneapolis, MN USA 55455; emails: , ,
| | - Teri J. Reutiman
- Department of Psychiatry, Division of Neuroscience Research, University of Minnesota Medical School, 420 Delaware Ave SE, MMC 392, Minneapolis, MN USA 55455; emails: , ,
| | - Robert W. Sidwell
- Director, Institute for Antiviral Research, Department of Animal, Dairy and Veterinary Sciences, Utah State University, 4815 Old Main Hill, UMC 5600, Logan, UT USA 84322-4815;
| |
Collapse
|
32
|
Siegmann AE. A classification of sociomedical health indicators: perspectives for health administrators and health planners. INTERNATIONAL JOURNAL OF HEALTH SERVICES : PLANNING, ADMINISTRATION, EVALUATION 1976; 6:521-38. [PMID: 955757 PMCID: PMC3004532 DOI: 10.2190/my7u-4bgm-9qfy-n0tn] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The conceptualization and operationalization of measures of health status are considered. Health indicators are conceived as a subset of social indicators, and therefore, as any social indicator, they are viewed as derivative from social issues. The interrelationships of different frames of reference for defining and measuring health that have accompained three distinct health problem patterns in the United States are viewed from a developmental perspective. Mortality and morbidity rates, the traditional health indicators, by themselves no longer serve to assess health status in developed nations. Their deficiencies as indicators serve as background for a classification schema for sociomedical health status indicators that relates health definition frames of reference, measures of health status, and health problems. The role of a group of health indicators-sociomedical heath indicators-in the current formulation of health status measures is assessed.
Collapse
|