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Cho KIK, Zhang F, Penzel N, Seitz-Holland J, Tang Y, Zhang T, Xu L, Li H, Keshavan M, Whitfield-Gabrieli S, Niznikiewicz M, Stone WS, Wang J, Shenton ME, Pasternak O. Excessive interstitial free-water in cortical gray matter preceding accelerated volume changes in individuals at clinical high risk for psychosis. Mol Psychiatry 2024:10.1038/s41380-024-02597-3. [PMID: 38830974 DOI: 10.1038/s41380-024-02597-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 05/01/2024] [Accepted: 05/03/2024] [Indexed: 06/05/2024]
Abstract
Recent studies show that accelerated cortical gray matter (GM) volume reduction seen in anatomical MRI can help distinguish between individuals at clinical high risk (CHR) for psychosis who will develop psychosis and those who will not. This reduction is suggested to represent atypical developmental or degenerative changes accompanying an accumulation of microstructural changes, such as decreased spine density and dendritic arborization. Detecting the microstructural sources of these changes before they accumulate into volume loss is crucial. Our study aimed to detect these microstructural GM alterations using diffusion MRI (dMRI). We tested for baseline and longitudinal group differences in anatomical and dMRI data from 160 individuals at CHR and 96 healthy controls (HC) acquired in a single imaging site. Of the CHR individuals, 33 developed psychosis (CHR-P), while 127 did not (CHR-NP). Among all participants, longitudinal data was available for 45 HCs, 17 CHR-P, and 66 CHR-NP. Eight cortical lobes were examined for GM volume and GM microstructure. A novel dMRI measure, interstitial free water (iFW), was used to quantify GM microstructure by eliminating cerebrospinal fluid contribution. Additionally, we assessed whether these measures differentiated the CHR-P from the CHR-NP. In addition, for completeness, we also investigated changes in cortical thickness and in white matter (WM) microstructure. At baseline the CHR group had significantly higher iFW than HC in the prefrontal, temporal, parietal, and occipital lobes, while volume was reduced only in the temporal lobe. Neither iFW nor volume differentiated between the CHR-P and CHR-NP groups at baseline. However, in many brain areas, the CHR-P group demonstrated significantly accelerated changes (iFW increase and volume reduction) with time than the CHR-NP group. Cortical thickness provided similar results as volume, and there were no significant changes in WM microstructure. Our results demonstrate that microstructural GM changes in individuals at CHR have a wider extent than volumetric changes or microstructural WM changes, and they predate the acceleration of brain changes that occur around psychosis onset. Microstructural GM changes, as reflected by the increased iFW, are thus an early pathology at the prodromal stage of psychosis that may be useful for a better mechanistic understanding of psychosis development.
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Affiliation(s)
- Kang Ik K Cho
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Fan Zhang
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Nora Penzel
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Johanna Seitz-Holland
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Yingying Tang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Brain Science and Technology Research Center, Shanghai Jiao Tong University, Shanghai, China
| | - Tianhong Zhang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lihua Xu
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Brain Science and Technology Research Center, Shanghai Jiao Tong University, Shanghai, China
| | - Huijun Li
- Department of Psychology, Florida A&M University, Tallahassee, FL, USA
| | - Matcheri Keshavan
- The Massachusetts Mental Health Center, Public Psychiatry Division, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston, MA, USA
| | - Susan Whitfield-Gabrieli
- Department of Psychology, Northeastern University, Boston, MA, USA
- The McGovern Institute for Brain Research and the Poitras Center for Affective Disorders Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Margaret Niznikiewicz
- The Department of Psychiatry, Veterans Affairs Boston Healthcare System, Brockton Division, Brockton, MA, USA
| | - William S Stone
- The Massachusetts Mental Health Center, Public Psychiatry Division, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston, MA, USA
| | - Jijun Wang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
- Brain Science and Technology Research Center, Shanghai Jiao Tong University, Shanghai, China.
| | - Martha E Shenton
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ofer Pasternak
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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Leslie AC, Ward MP, Dobyns WB. Undifferentiated psychosis or schizophrenia associated with vermis-predominant cerebellar hypoplasia. Am J Med Genet A 2024; 194:e63416. [PMID: 37933701 DOI: 10.1002/ajmg.a.63416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 09/02/2023] [Accepted: 09/12/2023] [Indexed: 11/08/2023]
Abstract
Schizophrenia (SCZ) is a well-studied neuropsychiatric condition that has been shown to have a high degree of genetic heritability. Still, little data on the specific genetic risk variants associated with the disease exists. Classification of the SCZ phenotype into SCZ-related endophenotypes is a promising methodology to parse out and elucidate the specific genetic risk variants for each. Here, we present a series of 17 previously reported individuals and a new proband with similar SCZ-related neuropsychiatric characteristics and shared brain imaging findings. Unsurprisingly, these individuals shared classic psychiatric features of SCZ. Interestingly, we also identified shared neuropsychiatric features in this series of individuals that had not been highlighted previously. A consistently decreased IQ, memory impairment, sleep and speech disturbances, and attention deficits were commonly reported findings. The brain imaging findings among these individuals also consistently showed posterior vermis predominant cerebellar hypoplasia (CBLH-V). Most individuals' diagnoses were initially described as Dandy-Walker malformation; however, our independent review of imaging suggests a more consistent pattern of posterior vermis predominant cerebellar hypoplasia rather than true Dandy-Walker malformation. While the specific genetic risk variants for this endophenotype are yet to be described, the aim of this paper is to present the shared neuropsychiatric features and consistent, symmetrical brain image findings which suggest that this subset of individuals comprises an endophenotype of SCZ with a high genetic solve rate.
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Affiliation(s)
- Alison C Leslie
- University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Mitchell P Ward
- University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - William B Dobyns
- Department of Pediatrics, Division of Genetics and Metabolism, University of Minnesota, Minneapolis, Minnesota, USA
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Kang N, Chung S, Lee SH, Bang M. Cerebro-cerebellar gray matter abnormalities associated with cognitive impairment in patients with recent-onset and chronic schizophrenia. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2024; 10:11. [PMID: 38280893 PMCID: PMC10851702 DOI: 10.1038/s41537-024-00434-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 01/12/2024] [Indexed: 01/29/2024]
Abstract
Although the role of the cerebellum in schizophrenia has gained attention, its contribution to cognitive impairment remains unclear. We aimed to investigate volumetric alterations in the cerebro-cerebellar gray matter (GM) in patients with recent-onset schizophrenia (ROS) and chronic schizophrenia (CS) compared with healthy controls (HCs). Seventy-two ROS, 43 CS, and 127 HC participants were recruited, and high-resolution T1-weighted structural magnetic resonance images of the brain were acquired. We compared cerebellar GM volumes among the groups using voxel-based morphometry and examined the cerebro-cerebellar GM volumetric correlations in participants with schizophrenia. Exploratory correlation analysis investigated the functional relevance of cerebro-cerebellar GM volume alterations to cognitive function in the schizophrenia group. The ROS and CS participants demonstrated smaller cerebellar GM volumes, particularly in Crus I and II, than HCs. Extracted cerebellar GM volumes demonstrated significant positive correlations with the cerebral GM volume in the fronto-temporo-parietal association areas engaged in higher-order association. The exploratory analysis showed that smaller cerebellar GM in the posterior lobe regions was associated with poorer cognitive performance in participants with schizophrenia. Our study suggests that cerebellar pathogenesis is present in the early stages of schizophrenia and interconnected with structural abnormalities in the cerebral cortex. Integrating the cerebellum into the pathogenesis of schizophrenia will help advance our understanding of the disease and identify novel treatment targets concerning dysfunctional cerebro-cerebellar interactions.
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Affiliation(s)
- Naok Kang
- Department of Psychiatry, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
| | - Subin Chung
- CHA University School of Medicine, Pocheon, Republic of Korea
| | - Sang-Hyuk Lee
- Department of Psychiatry, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
| | - Minji Bang
- Department of Psychiatry, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea.
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Kim WS, Shen J, Tsogt U, Odkhuu S, Cheraghi S, Rami FZ, Chung YC. Altered thalamic volumes and functional connectivity in the recovered patients with psychosis. Psychiatry Res 2024; 331:115688. [PMID: 38141265 DOI: 10.1016/j.psychres.2023.115688] [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: 07/26/2023] [Revised: 12/20/2023] [Accepted: 12/20/2023] [Indexed: 12/25/2023]
Abstract
BACKGROUND Investigating neural correlates in recovered patients with psychosis is important in terms of identifying biological markers associated with recovery status or predicting a possible future relapse. We sought to examine thalamic nuclei volumes and thalamus-centered functional connectivity (FC) in recovered patients with psychosis who discontinued their medication. METHODS Thirty patients with psychosis who satisfied the criteria for full recovery and 50 healthy controls (HC) matched for age, sex, and education underwent magnetic resonance imaging and clinical evaluation. The recovered patients were divided into the maintained and relapsed subjects according to their clinical status on the follow-ups. Thalamic nuclei volumes and thalamus-centered FC were measured between the recovered patients and HC. Correlations between the thalamic nuclei or altered FC, and clinical symptoms and cognitive functioning were explored. RESULTS Modest cognitive impairments and reduced thalamic nuclei volumes were evident in the recovered patients. Moreover, we found altered thalamo-cortical connectivity and its associations with negative symptoms and cognitive functioning in the recovered patients compared with HC. CONCLUSION These findings suggest that there are still cognitive impairments, and aberrant neuronal changes in the recovered patients. The implication of differential FC patterns between the maintained and the relapsed patients remain to be further explored.
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Affiliation(s)
- Woo-Sung Kim
- Department of Psychiatry, Jeonbuk National University Hospital, Jeonju, Korea; Research Institute of Clinical Medicine of Jeonbuk National, University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
| | - Jie Shen
- Medical School, Department of Psychiatry, Jeonbuk National University, Jeonju, Korea; Research Institute of Clinical Medicine of Jeonbuk National, University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
| | - Uyanga Tsogt
- Medical School, Department of Psychiatry, Jeonbuk National University, Jeonju, Korea; Research Institute of Clinical Medicine of Jeonbuk National, University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
| | - Soyolsaikhan Odkhuu
- Medical School, Department of Psychiatry, Jeonbuk National University, Jeonju, Korea; Research Institute of Clinical Medicine of Jeonbuk National, University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
| | - Sahar Cheraghi
- Medical School, Department of Psychiatry, Jeonbuk National University, Jeonju, Korea; Research Institute of Clinical Medicine of Jeonbuk National, University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
| | - Fatima Zahra Rami
- Medical School, Department of Psychiatry, Jeonbuk National University, Jeonju, Korea; Research Institute of Clinical Medicine of Jeonbuk National, University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
| | - Young-Chul Chung
- Department of Psychiatry, Jeonbuk National University Hospital, Jeonju, Korea; Medical School, Department of Psychiatry, Jeonbuk National University, Jeonju, Korea; Research Institute of Clinical Medicine of Jeonbuk National, University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea.
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5
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Kang IC, Pasternak O, Zhang F, Penzel N, Seitz-Holland J, Tang Y, Zhang T, Xu L, Li H, Keshavan M, Whitfield-Gabrielli S, Niznikiewicz M, Stone W, Wang J, Shenton M. Microstructural Cortical Gray Matter Changes Preceding Accelerated Volume Changes in Individuals at Clinical High Risk for Psychosis. RESEARCH SQUARE 2023:rs.3.rs-3179575. [PMID: 37841868 PMCID: PMC10571628 DOI: 10.21203/rs.3.rs-3179575/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
Recent studies show that accelerated cortical gray matter (GM) volume reduction seen in anatomical MRI can help distinguish between individuals at clinical high risk (CHR) for psychosis who will develop psychosis and those who will not. This reduction is thought to result from an accumulation of microstructural changes, such as decreased spine density and dendritic arborization. Detecting the microstructural sources of these changes before they accumulate is crucial, as volume reduction likely indicates an underlying neurodegenerative process. Our study aimed to detect these microstructural GM alterations using diffusion MRI (dMRI). We tested for baseline and longitudinal group differences in anatomical and dMRI data from 160 individuals at CHR and 96 healthy controls (HC) acquired in a single imaging site. Eight cortical lobes were examined for GM volume and GM microstructure. A novel dMRI measure, interstitial free water (iFW), was used to quantify GM microstructure by eliminating cerebrospinal fluid contribution. Additionally, we assessed whether these measures differentiated the 33 individuals at CHR who developed psychosis (CHR-P) from the 127 individuals at CHR who did not (CHR-NP). At baseline the CHR group had significantly higher iFW than HC in the prefrontal, temporal, parietal, and occipital lobes, while volume was reduced only in the temporal lobe. Neither iFW nor volume differentiated between the CHR-P and CHR-NP groups at baseline. However, in most brain areas, the CHR-P group demonstrated significantly accelerated iFW increase and volume reduction with time than the CHR-NP group. Our results demonstrate that microstructural GM changes in individuals at CHR have a wider extent than volumetric changes and they predate the acceleration of brain changes that occur around psychosis onset. Microstructural GM changes are thus an early pathology at the prodromal stage of psychosis that may be useful for early detection and a better mechanistic understanding of psychosis development.
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Affiliation(s)
| | | | | | | | - Johanna Seitz-Holland
- Brigham and Women's Hospital and Massachusetts General Hospital, Harvard Medical School
| | - Yingying Tang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine
| | - Tianhong Zhang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai 200030, PR China
| | | | | | | | | | | | | | - Jijun Wang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine
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Cao P, Chen C, Si Q, Li Y, Ren F, Han C, Zhao J, Wang X, Xu G, Sui Y. Volumes of hippocampal subfields suggest a continuum between schizophrenia, major depressive disorder and bipolar disorder. Front Psychiatry 2023; 14:1191170. [PMID: 37547217 PMCID: PMC10400724 DOI: 10.3389/fpsyt.2023.1191170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 07/03/2023] [Indexed: 08/08/2023] Open
Abstract
Objective There is considerable debate as to whether the continuum of major psychiatric disorders exists and to what extent the boundaries extend. Converging evidence suggests that alterations in hippocampal volume are a common sign in psychiatric disorders; however, there is still no consensus on the nature and extent of hippocampal atrophy in schizophrenia (SZ), major depressive disorder (MDD) and bipolar disorder (BD). The aim of this study was to verify the continuum of SZ - BD - MDD at the level of hippocampal subfield volume and to compare the volume differences in hippocampal subfields in the continuum. Methods A total of 412 participants (204 SZ, 98 MDD, and 110 BD) underwent 3 T MRI scans, structured clinical interviews, and clinical scales. We segmented the hippocampal subfields with FreeSurfer 7.1.1 and compared subfields volumes across the three diagnostic groups by controlling for age, gender, education, and intracranial volumes. Results The results showed a gradual increase in hippocampal subfield volumes from SZ to MDD to BD. Significant volume differences in the total hippocampus and 13 of 26 hippocampal subfields, including CA1, CA3, CA4, GC-ML-DG, molecular layer and the whole hippocampus, bilaterally, and parasubiculum in the right hemisphere, were observed among diagnostic groups. Medication treatment had the most effect on subfields of MDD compared to SZ and BD. Subfield volumes were negatively correlated with illness duration of MDD. Positive correlations were found between subfield volumes and drug dose in SZ and MDD. There was no significant difference in laterality between diagnostic groups. Conclusion The pattern of hippocampal volume reduction in SZ, MDD and BD suggests that there may be a continuum of the three disorders at the hippocampal level. The hippocampus represents a phenotype that is distinct from traditional diagnostic strategies. Combined with illness duration and drug intervention, it may better reflect shared pathophysiology and mechanisms across psychiatric disorders.
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Affiliation(s)
- Peiyu Cao
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing Brain Hospital, Nanjing, China
| | - Congxin Chen
- Women’s Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China
| | - Qi Si
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing Brain Hospital, Nanjing, China
- Huai’an No. 3 People’s Hospital, Huai’an, China
| | - Yuting Li
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing Brain Hospital, Nanjing, China
| | - Fangfang Ren
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing Brain Hospital, Nanjing, China
| | - Chongyang Han
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing Brain Hospital, Nanjing, China
| | - Jingjing Zhao
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing Brain Hospital, Nanjing, China
| | - Xiying Wang
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing Brain Hospital, Nanjing, China
| | - Guoxin Xu
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing Brain Hospital, Nanjing, China
| | - Yuxiu Sui
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing Brain Hospital, Nanjing, China
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Demjaha A, Galderisi S, Glenthøj B, Arango C, Mucci A, Lawrence A, O'Daly O, Kempton M, Ciufolini S, Baandrup L, Ebdrup BH, Rodriguez-Jimenez R, Diaz-Marsa M, Díaz-Caneja CM, Winter van Rossum I, Kahn R, Dazzan P, McGuire P. Negative symptoms in First-Episode Schizophrenia related to morphometric alterations in orbitofrontal and superior temporal cortex: the OPTiMiSE study. Psychol Med 2023; 53:3471-3479. [PMID: 35197142 PMCID: PMC10277764 DOI: 10.1017/s0033291722000010] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 12/20/2021] [Accepted: 01/04/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Negative symptoms are one of the most incapacitating features of Schizophrenia but their pathophysiology remains unclear. They have been linked to alterations in grey matter in several brain regions, but findings have been inconsistent. This may reflect the investigation of relatively small patient samples, and the confounding effects of chronic illness and exposure to antipsychotic medication. We sought to address these issues by investigating concurrently grey matter volumes (GMV) and cortical thickness (CTh) in a large sample of antipsychotic-naïve or minimally treated patients with First-Episode Schizophrenia (FES). METHODS T1-weighted structural MRI brain scans were acquired from 180 antipsychotic-naïve or minimally treated patients recruited as part of the OPTiMiSE study. The sample was stratified into subgroups with (N = 88) or without (N = 92) Prominent Negative Symptoms (PMN), based on PANSS ratings at presentation. Regional GMV and CTh in the two groups were compared using Voxel-Based Morphometry (VBM) and FreeSurfer (FS). Between-group differences were corrected for multiple comparisons via Family-Wise Error (FWE) and Monte Carlo z-field simulation respectively at p < 0.05 (2-tailed). RESULTS The presence of PMN symptoms was associated with larger left inferior orbitofrontal volume (p = 0.03) and greater CTh in the left lateral orbitofrontal gyrus (p = 0.007), but reduced CTh in the left superior temporal gyrus (p = 0.009). CONCLUSIONS The findings highlight the role of orbitofrontal and temporal cortices in the pathogenesis of negative symptoms of Schizophrenia. As they were evident in generally untreated FEP patients, the results are unlikely to be related to effects of previous treatment or illness chronicity.
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Affiliation(s)
- Arsime Demjaha
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- National Institute for Health Research Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
| | - Silvana Galderisi
- Department of Psychiatry, University of Campania Luigi Vanvitelli, Caserta, Italy
| | - Birthe Glenthøj
- Faculty of Health and Medical Sciences, Department of Clinical Medicine, Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, Mental Health Center Glostrup, University of Copenhagen, Copenhagen, Denmark
| | - Celso Arango
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health. Hospital General Universitario Gregorio Marañón. IiSGM, CIBERSAM. School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Armida Mucci
- Department of Psychiatry, University of Campania Luigi Vanvitelli, Caserta, Italy
| | - Andrew Lawrence
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- National Institute for Health Research Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
| | - Owen O'Daly
- Department of Neuroimaging, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Matthew Kempton
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- National Institute for Health Research Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
| | - Simone Ciufolini
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- National Institute for Health Research Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
| | - Lone Baandrup
- Faculty of Health and Medical Sciences, Department of Clinical Medicine, Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, Mental Health Center Glostrup, University of Copenhagen, Copenhagen, Denmark
| | - Bjørn H. Ebdrup
- Faculty of Health and Medical Sciences, Department of Clinical Medicine, Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, Mental Health Center Glostrup, University of Copenhagen, Copenhagen, Denmark
| | - Roberto Rodriguez-Jimenez
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health. Hospital General Universitario Gregorio Marañón. IiSGM, CIBERSAM. School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Maria Diaz-Marsa
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health. Hospital General Universitario Gregorio Marañón. IiSGM, CIBERSAM. School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Covadonga Martinez Díaz-Caneja
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health. Hospital General Universitario Gregorio Marañón. IiSGM, CIBERSAM. School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | | | - Rene Kahn
- Department of Psychiatry, Brain Center Rudolf Magnus, Utrecht, Netherlands
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Paola Dazzan
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- National Institute for Health Research Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
| | - Philip McGuire
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- National Institute for Health Research Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
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Chen Y, Cao H, Liu S, Zhang B, Zhao G, Zhang Z, Li S, Li H, Yu X, Deng H. Brain Structure Measurements Predict Individualized Treatment Outcome of 12-Week Antipsychotic Monotherapies in First-episode Schizophrenia. Schizophr Bull 2023; 49:697-705. [PMID: 37010371 PMCID: PMC10154710 DOI: 10.1093/schbul/sbad043] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Abstract
BACKGROUND AND HYPOTHESIS Early prediction of treatment response to antipsychotics in schizophrenia remains a challenge in clinical practice. This study aimed to investigate if brain morphometries including gray matter volume and cortical thickness could serve as potential predictive biomarkers in first-episode schizophrenia. STUDY DESIGN Sixty-eight drug-naïve first-episode patients underwent baseline structural MRI scans and were subsequently randomized to receive a single antipsychotic throughout the first 12 weeks. Assessments for symptoms and social functioning were conducted by eight "core symptoms" selected from the Positive and Negative Syndrome Scale (PANSS-8) and the Personal and Social performance scale (PSP) multiple times during follow-ups. Treatment outcome was evaluated as subject-specific slope coefficients for PANSS-8 and PSP scores using linear mixed model. LASSO regression model were conducted to examine the performance of baseline gray matter volume and cortical thickness in prediction of individualized treatment outcome. STUDY RESULTS The study showed that individual brain morphometries at baseline, especially the orbitofrontal, temporal and parietal cortex, pallidum and amygdala, significantly predicted 12-week treatment outcome of PANSS-8 (r[predicted vs observed] = 0.49, P = .001) and PSP (r[predicted vs observed] = 0.40, P = .003) in first-episode schizophrenia. Moreover, the gray matter volume performed better than cortical thickness in the prediction the symptom changes (P = .034), while cortical thickness outperformed gray matter volume in the prediction of outcome of social functioning (P = .029). CONCLUSIONS These findings provide initial evidence that brain morphometry have potential to be used as prognostic predictors for antipsychotic response in patients, encouraging the future investigation of the translational value of these measures in precision psychiatry.
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Affiliation(s)
- Ying Chen
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
- Hope Recovery and Rehabilitation Center, West China Hospital of Sichuan University, Chengdu, China
| | - Hengyi Cao
- Center for Psychiatric Neuroscience, Feinstein Institutes for Medical Research, Manhasset, NY, USA
- Division of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, NY, USA
| | - Shanming Liu
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, China
| | - Bo Zhang
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, China
| | | | - Zhuoqiu Zhang
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, China
| | - Shuiying Li
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, China
| | - Haiming Li
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, China
| | - Xin Yu
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Hong Deng
- Hope Recovery and Rehabilitation Center, West China Hospital of Sichuan University, Chengdu, China
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, China
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9
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Iraji A, Faghiri A, Fu Z, Rachakonda S, Kochunov P, Belger A, Ford JM, McEwen S, Mathalon DH, Mueller BA, Pearlson GD, Potkin SG, Preda A, Turner JA, van Erp TGM, Calhoun VD. Multi-spatial-scale dynamic interactions between functional sources reveal sex-specific changes in schizophrenia. Netw Neurosci 2022; 6:357-381. [PMID: 35733435 PMCID: PMC9208002 DOI: 10.1162/netn_a_00196] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 04/12/2021] [Indexed: 11/04/2022] Open
Abstract
We introduce an extension of independent component analysis (ICA), called multiscale ICA, and design an approach to capture dynamic functional source interactions within and between multiple spatial scales. Multiscale ICA estimates functional sources at multiple spatial scales without imposing direct constraints on the size of functional sources, overcomes the limitation of using fixed anatomical locations, and eliminates the need for model-order selection in ICA analysis. We leveraged this approach to study sex-specific and sex-common connectivity patterns in schizophrenia. Results show dynamic reconfiguration and interaction within and between multi-spatial scales. Sex-specific differences occur (a) within the subcortical domain, (b) between the somatomotor and cerebellum domains, and (c) between the temporal domain and several others, including the subcortical, visual, and default mode domains. Most of the sex-specific differences belong to between-spatial-scale functional interactions and are associated with a dynamic state with strong functional interactions between the visual, somatomotor, and temporal domains and their anticorrelation patterns with the rest of the brain. We observed significant correlations between multi-spatial-scale functional interactions and symptom scores, highlighting the importance of multiscale analyses to identify potential biomarkers for schizophrenia. As such, we recommend such analyses as an important option for future functional connectivity studies.
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Affiliation(s)
- Armin Iraji
- Tri-Institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Georgia State University, Georgia Institute of Technology, and Emory University, Atlanta, GA, USA
- * Corresponding Authors: ;
| | - Ashkan Faghiri
- Tri-Institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Georgia State University, Georgia Institute of Technology, and Emory University, Atlanta, GA, USA
| | - Zening Fu
- Tri-Institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Georgia State University, Georgia Institute of Technology, and Emory University, Atlanta, GA, USA
| | - Srinivas Rachakonda
- Tri-Institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Georgia State University, Georgia Institute of Technology, and Emory University, Atlanta, GA, USA
| | - Peter Kochunov
- Maryland Psychiatric Research Center, Department of Psychiatry, School of Medicine, University of Maryland, Baltimore, MD, USA
| | - Aysenil Belger
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
| | - Judy M. Ford
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA
- San Francisco VA Medical Center, San Francisco, CA, USA
| | - Sarah McEwen
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | - Daniel H. Mathalon
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA
- San Francisco VA Medical Center, San Francisco, CA, USA
| | - Bryon A. Mueller
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA
| | - Godfrey D. Pearlson
- Departments of Psychiatry and Neuroscience, Yale University, School of Medicine, New Haven, CT, USA
| | - Steven G. Potkin
- Department of Psychiatry and Human Behavior, University of California Irvine, Irvine, CA, USA
| | - Adrian Preda
- Department of Psychiatry and Human Behavior, University of California Irvine, Irvine, CA, USA
| | - Jessica A. Turner
- Department of Psychology, Georgia State University, Atlanta, GA, USA
| | - Theodorus G. M. van Erp
- Clinical Translational Neuroscience Laboratory, Department of Psychiatry and Human Behavior, University of California Irvine, Irvine, CA, USA
| | - Vince D. Calhoun
- Tri-Institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Georgia State University, Georgia Institute of Technology, and Emory University, Atlanta, GA, USA
- * Corresponding Authors: ;
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10
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Zhang M, Hong X, Yang F, Fan H, Fan F, Song J, Wang Z, Tan Y, Tan S, Elliot Hong L. Structural brain imaging abnormalities correlate with positive symptom in schizophrenia. Neurosci Lett 2022; 782:136683. [PMID: 35595192 DOI: 10.1016/j.neulet.2022.136683] [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: 11/13/2020] [Revised: 03/04/2022] [Accepted: 05/13/2022] [Indexed: 10/18/2022]
Abstract
Accumulating evidence indicates neuroanatomical mechanisms underlying positive symptoms in schizophrenia; however, the exact structural determinants of positive symptoms remain unclear. This study aimed to investigate associations between positive symptoms and structural brain changes, including alterations in grey matter (GM) volume and cortical thickness, in patients with first-episode schizophrenia (FES). This study included 44 patients with FES and 48 healthy controls (HCs). Clinical symptoms of patients were evaluated and individual-level GM volume and cortical thickness were assessed. Patients with FES showed reduced GM volume in the right superior temporal gyrus (STG) and increased cortical thickness in the left inferior segment of the circular sulcus of the insula (S_circular_insula_inf) compared with HCs. Increased thickness of the left S_circular_insula_inf correlated positively with positive symptoms in patients with FES. Exploratory correlation analysis found that increased thickness of the left S_circular_insula_inf correlated positively with conceptual disorganization and excitement symptoms, and the right STG GM volume correlated negatively with hallucinations. This study suggests that GM abnormalities in the STG and altered cortical thickness of the S_circular_insula_inf, which were detected at the early stage of schizophrenia, may underlie positive symptoms in patients with FES.
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Affiliation(s)
- Meng Zhang
- Peking University HuiLongGuan Clinical Medical School, Beijing HuiLongGuan Hospital, Beijing 100096, China
| | - Xiang Hong
- Chongqing Three Gorges Central Hospital, Chongqing 404000, China
| | - Fude Yang
- Peking University HuiLongGuan Clinical Medical School, Beijing HuiLongGuan Hospital, Beijing 100096, China
| | - Hongzhen Fan
- Peking University HuiLongGuan Clinical Medical School, Beijing HuiLongGuan Hospital, Beijing 100096, China
| | - Fengmei Fan
- Peking University HuiLongGuan Clinical Medical School, Beijing HuiLongGuan Hospital, Beijing 100096, China
| | - Jiaqi Song
- Peking University HuiLongGuan Clinical Medical School, Beijing HuiLongGuan Hospital, Beijing 100096, China
| | - Zhiren Wang
- Peking University HuiLongGuan Clinical Medical School, Beijing HuiLongGuan Hospital, Beijing 100096, China
| | - Yunlong Tan
- Peking University HuiLongGuan Clinical Medical School, Beijing HuiLongGuan Hospital, Beijing 100096, China
| | - Shuping Tan
- Peking University HuiLongGuan Clinical Medical School, Beijing HuiLongGuan Hospital, Beijing 100096, China.
| | - L Elliot Hong
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21288, USA
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11
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He M, Fan J, Zhou R, Gao G, Li R, Zuo Y, Li B, Li Y, Sun T. NLRP3/Caspase-1-Mediated Pyroptosis of Astrocytes Induced by Antipsychotics Is Inhibited by a Histamine H1 Receptor-Selective Agonist. Front Aging Neurosci 2022; 14:847561. [PMID: 35615587 PMCID: PMC9125084 DOI: 10.3389/fnagi.2022.847561] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 04/15/2022] [Indexed: 11/13/2022] Open
Abstract
Emerging data indicate that antipsychotic treatment causes brain volume loss and astrocyte death, but the mechanisms remain elusive. Pyroptosis, inflammatory cell death characterized by the formation of inflammatory bodies, increased expression of nod-like receptor proteins (NLRPs) such as NLRP3, and activation of caspases and gasdermin D (GSDMD) are largely associated with innate immunity, inflammation, and cell injury/death. However, the main effect of antipsychotics on astrocyte pyroptotic signaling and the molecular mechanisms remain obscure. In the present study, 72-h treatment with olanzapine, quetiapine, risperidone, or haloperidol significantly decreased the viability of astrocytes. Twenty-four hour treatment with olanzapine, quetiapine, risperidone, or haloperidol dose-dependently increased the protein expression of astrocytic NLRP3, NLRP6, caspase-1, caspase-4, and GSDMD. Co-treatment with a histamine H1 receptor agonist, 2-(3-trifluoromethylphenyl) histamine (FMPH), dose-dependently reduced the increased expression of NLRP3, caspase-1 and GSDMD induced by olanzapine, quetiapine, risperidone, or haloperidol. Moreover, olanzapine, quetiapine, risperidone, or haloperidol treatment induced pore formation in the membranes of astrocytes, and these effects were inhibited by FMPH co-treatment. Taken together, antipsychotic treatment activated astrocyte pyroptotic signaling, and these effects may be related to antipsychotic-induced astrocyte death. H1 receptor activation is an effective treatment strategy to suppress antipsychotic-induced astrocyte pyroptosis and inflammation.
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Affiliation(s)
- Meng He
- School of Chemistry, Chemical Engineering and Life Sciences, Wuhan University of Technology, Wuhan, China
| | - Jun Fan
- School of Chemistry, Chemical Engineering and Life Sciences, Wuhan University of Technology, Wuhan, China
| | - Ruqin Zhou
- School of Chemistry, Chemical Engineering and Life Sciences, Wuhan University of Technology, Wuhan, China
| | - Guanbin Gao
- State Key Laboratory of Advanced Technology for Materials Synthesis and Processing, Wuhan University of Technology, Wuhan, China
| | - Ruoxi Li
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - YuFeng Zuo
- School of Chemistry, Chemical Engineering and Life Sciences, Wuhan University of Technology, Wuhan, China
| | - Benben Li
- School of Chemistry, Chemical Engineering and Life Sciences, Wuhan University of Technology, Wuhan, China
| | - Yanmei Li
- Hubei Provincial Key Laboratory for Applied Toxicology, Hubei Provincial Center for Disease Control and Prevention, Wuhan, China
- *Correspondence: Taolei Sun,
| | - Taolei Sun
- School of Chemistry, Chemical Engineering and Life Sciences, Wuhan University of Technology, Wuhan, China
- Yanmei Li,
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12
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Fountoulakis KN, Stahl SM. The effect of first- and second-generation antipsychotics on brain morphology in schizophrenia: A systematic review of longitudinal magnetic resonance studies with a randomized allocation to treatment arms. J Psychopharmacol 2022; 36:428-438. [PMID: 35395911 DOI: 10.1177/02698811221087645] [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: 11/16/2022]
Abstract
Schizophrenia manifests as loss of brain volume in specific areas in a progressive nature and an important question concerns whether long-term treatment with medications contributes to this. The aim of the current PRISMA systematic review was to search for prospective studies involving randomization to treatment. PROSPERO ID: CRD42020197874. The MEDLINE/PUBMED was searched and it returned 2638 articles; 3 were fulfilling the inclusion criteria. A fourth was published later; they included 359 subjects, of whom 86 were healthy controls, while the rest were first-episode patients, with 91 under olanzapine, 93 under haloperidol, 48 under risperidone, 5 under paliperidone, 6 under ziprasidone, and 30 under placebo. Probably one-third of patients were suffering from a psychotic disorder other than schizophrenia. The consideration of their results suggested that there is no significant difference between these medications concerning their effects on brain structure and also in comparison to healthy subjects. There does not seem to be any strong support to the opinion that medications that treat psychosis cause loss of brain volume in patients with schizophrenia. On the contrary, the data might imply the possible presence of a protective effect for D2, 5-HT2, and NE alpha-2 antagonists (previously called SGAs). However, the literature is limited and focused research in large study samples is essential to clarify the issue, since important numerical differences do exist. The possibility of the results and their heterogeneity to be artifacts secondary to a modification of magnetic resonance imaging (MRI) signal by antipsychotics should not be easily rejected until relevant data are available.
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Affiliation(s)
- Konstantinos N Fountoulakis
- 3rd Department of Psychiatry, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stephen M Stahl
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA.,Department of Psychiatry, Cambridge University, Cambridge, UK
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13
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Predictive MRI Biomarkers in MS—A Critical Review. Medicina (B Aires) 2022; 58:medicina58030377. [PMID: 35334554 PMCID: PMC8949449 DOI: 10.3390/medicina58030377] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 02/12/2022] [Accepted: 02/21/2022] [Indexed: 11/16/2022] Open
Abstract
Background and Objectives: In this critical review, we explore the potential use of MRI measurements as prognostic biomarkers in multiple sclerosis (MS) patients, for both conventional measurements and more novel techniques such as magnetization transfer, diffusion tensor, and proton spectroscopy MRI. Materials and Methods: All authors individually and comprehensively reviewed each of the aspects listed below in PubMed, Medline, and Google Scholar. Results: There are numerous MRI metrics that have been proven by clinical studies to hold important prognostic value for MS patients, most of which can be readily obtained from standard 1.5T MRI scans. Conclusions: While some of these parameters have passed the test of time and seem to be associated with a reliable predictive power, some are still better interpreted with caution. We hope this will serve as a reminder of how vast a resource we have on our hands in this versatile tool—it is up to us to make use of it.
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14
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Partridge O, Maguire T, Newman-Taylor K. How does attachment style affect psychosis? A systematic review of causal mechanisms and guide to future inquiry. Psychol Psychother 2022; 95:345-380. [PMID: 34687273 DOI: 10.1111/papt.12371] [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: 03/07/2021] [Revised: 07/19/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE The link between attachment and psychosis is now well established, but less is known about the causal mechanisms underlying this relationship. This systematic review synthesises the studies that examine mediating mechanisms in the attachment and psychosis relationship, in both clinical and non-clinical samples. METHOD We conducted a database search (PsychINFO, MEDLINE, Web of Science) to identify all eligible studies irrespective of publication status, the language of article or article date. We assessed methodological quality and completed a narrative synthesis given the heterogeneity of studies to date. RESULTS We identified 17 papers, comprising 3,672 participants. The relationship between attachment and psychosis is mediated by four variables or groups of variables. There is good evidence for the causal role of affective factors (affective dysregulation and affective disturbances) and cognitive factors (e.g., self-beliefs and self-esteem and beliefs about symptoms). Affective factors differed by attachment style. Tentative evidence was found for the role of duration of untreated psychosis and baseline negative symptoms. CONCLUSIONS Cognitive and affective factors mediate the relationship between attachment style and psychosis. Whilst cognitive factors are routinely targeted in recommended psychological interventions for psychosis, affective factors and attachment style are less commonly considered. Psychological therapies may be improved by calibrating cognitive and affective interventions by attachment style, which should be subjected to experimental and then field studies to assess the impact on clinical and recovery outcomes. PRACTITIONER POINTS The relationship between attachment and psychosis is now well established, and studies have started to examine mediating mechanisms. Affective and cognitive factors mediate the attachment-psychosis relationship. Affective factors differ by attachment style. There is limited evidence for the duration of untreated psychosis and negative psychotic symptoms as mediating mechanisms, and research replication is needed. Cognitive factors are routinely targeted in recommended psychological therapies for psychosis, but affective factors and attachment style are less commonly considered. Research should be conducted into the effectiveness of psychological therapies which calibrate cognitive and affective interventions, according to attachment style.
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Affiliation(s)
| | - Tess Maguire
- Department of Psychology, University of Southampton, UK
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15
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Wand T, Glover S, Paul D. What should be the future focus of mental health nursing? Exploring the perspectives of mental health nurses, consumers, and allied health staff. Int J Ment Health Nurs 2022; 31:179-188. [PMID: 34679235 DOI: 10.1111/inm.12947] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/26/2021] [Accepted: 10/08/2021] [Indexed: 12/11/2022]
Abstract
The landscape of mental health care and service delivery is changing, as is our understanding of the underlying causes for mental distress. It is now apparent that biogenic explanations have been overstated and instead experiences of trauma and adversity constitute the main contributor to people's experiences of mental health challenges. The shortcomings of treatments traditionally used in mental health care are also evident, and with a contemporary focus on person-centred care, the utility of diagnostic labels has been called into question. Taking all this into consideration, this study sought to explore, what should be the future focus of mental health nursing? Three separate focus groups were conducted. One with a sample of senior clinical mental health nurses, one with a sample of consumer representatives and another with allied health professionals. The common theme across all three focus groups was the centrality of the therapeutic role of mental health nurses (MHNs). Consumers and allied health participants, in particular, advocated for a de-emphasis on medications, psychiatric diagnoses, and custodial practices. The MHNs role in health promotion, working collaboratively with consumers, being hopeful, understanding the individual perspective, and appreciating the social determinants of mental health were all highlighted in framing the future focus of MHN practice.
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Affiliation(s)
- Timothy Wand
- Emergency Department, Royal Prince Alfred Hospital, University of Sydney and Sydney Local Health District, Sydney, New South Wales, Australia
| | - Suzanne Glover
- Northern Sydney Local Health District, Sydney, New South Wales, Australia
| | - Diane Paul
- Northern Sydney Local Health District, Sydney, New South Wales, Australia
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16
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Wang J, Ke P, Zang J, Wu F, Wu K. Discriminative Analysis of Schizophrenia Patients Using Topological Properties of Structural and Functional Brain Networks: A Multimodal Magnetic Resonance Imaging Study. Front Neurosci 2022; 15:785595. [PMID: 35087373 PMCID: PMC8787107 DOI: 10.3389/fnins.2021.785595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 12/01/2021] [Indexed: 12/12/2022] Open
Abstract
Interest in the application of machine learning (ML) techniques to multimodal magnetic resonance imaging (MRI) data for the diagnosis of schizophrenia (SZ) at the individual level is growing. However, a few studies have applied the features of structural and functional brain networks derived from multimodal MRI data to the discriminative analysis of SZ patients at different clinical stages. In this study, 205 normal controls (NCs), 61 first-episode drug-naive SZ (FESZ) patients, and 79 chronic SZ (CSZ) patients were recruited. We acquired their structural MRI, diffusion tensor imaging, and resting-state functional MRI data and constructed brain networks for each participant, including the gray matter network (GMN), white matter network (WMN), and functional brain network (FBN). We then calculated 3 nodal properties for each brain network, including degree centrality, nodal efficiency, and betweenness centrality. Two classifications (SZ vs. NC and FESZ vs. CSZ) were performed using five ML algorithms. We found that the SVM classifier with the input features of the combination of nodal properties of both the GMN and FBN achieved the best performance to discriminate SZ patients from NCs [accuracy, 81.2%; area under the receiver operating characteristic curve (AUC), 85.2%; p < 0.05]. Moreover, the SVM classifier with the input features of the combination of the nodal properties of both the GMN and WMN achieved the best performance to discriminate FESZ from CSZ patients (accuracy, 86.2%; AUC, 92.3%; p < 0.05). Furthermore, the brain areas in the subcortical/cerebellum network and the frontoparietal network showed significant importance in both classifications. Together, our findings provide new insights to understand the neuropathology of SZ and further highlight the potential advantages of multimodal network properties for identifying SZ patients at different clinical stages.
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Affiliation(s)
- Jing Wang
- School of Biomedical Engineering, Guangzhou Xinhua University, Guangzhou, China
| | - Pengfei Ke
- School of Biomedical Sciences and Engineering, South China University of Technology, Guangzhou, China
- National Engineering Research Center for Tissue Restoration and Reconstruction, South China University of Technology, Guangzhou, China
| | - Jinyu Zang
- School of Biomedical Sciences and Engineering, South China University of Technology, Guangzhou, China
- National Engineering Research Center for Tissue Restoration and Reconstruction, South China University of Technology, Guangzhou, China
| | - Fengchun Wu
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
- Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
- *Correspondence: Fengchun Wu,
| | - Kai Wu
- School of Biomedical Sciences and Engineering, South China University of Technology, Guangzhou, China
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
- Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
- Guangdong Engineering Technology Research Center for Diagnosis and Rehabilitation of Dementia, Guangzhou, China
- National Engineering Research Center for Tissue Restoration and Reconstruction, South China University of Technology, Guangzhou, China
- Key Laboratory of Biomedical Engineering of Guangdong Province, South China University of Technology, Guangzhou, China
- Institute for Healthcare Artificial Intelligence Application, Guangdong Second Provincial General Hospital, Guangzhou, China
- Department of Nuclear Medicine and Radiology, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan
- Kai Wu,
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17
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Jung HY, Jung S, Bang M, Choi TK, Park CI, Lee SH. White matter correlates of impulsivity in frontal lobe and their associations with treatment response in first-episode schizophrenia. Neurosci Lett 2021; 767:136309. [PMID: 34736723 DOI: 10.1016/j.neulet.2021.136309] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 10/19/2021] [Accepted: 10/22/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND It is known that increased impulsivity in schizophrenia patients causes poor treatment outcomes by increasing cost, stigma, hospitalization, treatment challenge, and physical harm. Dysfunction in the prefrontal cortex appears to be involved in the impulsivity associated with schizophrenia; nonetheless, there is a dearth of research on specific white matter alterations in the prefrontal cortex related to impulsivity. METHODS We enrolled in the present study 119 first-episode schizophrenia patients. We measured their symptom severity at baseline and after eight weeks of treatment, using the positive and negative syndrome scale. We performed neuroimaging analysis using the Tract-Based Spatial Statistics program and by specifying the prefrontal white matter as a region of interest. RESULTS In voxel-wise correlational analysis, we observed white matter regions showing significant positive correlations with poor impulse control scores, in both the right dorsolateral prefrontal cortex and the right frontal pole region. The fractional anisotropy values of these areas correlated positively with symptom severity at baseline. Moreover, after eight weeks, treatment non responders showed significantly higher fractional anisotropy values in the same areas. CONCLUSIONS The results of the present study suggest that white matter tracts in the right dorsolateral prefrontal cortex and the right frontal pole may underlie dysfunctional impulse control and could be potential predictive markers for short-term treatment in patients with first-episode schizophrenia.
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Affiliation(s)
- Hye-Yeon Jung
- Department of Psychiatry, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea; Department of Psychiatry, CHA Gumi Medical Center, CHA University, Gumi, Republic of Korea
| | - Sra Jung
- Department of Psychiatry, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea; Department of Psychiatry, CHA Gumi Medical Center, CHA University, Gumi, Republic of Korea
| | - Minji Bang
- Department of Psychiatry, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea; Department of Psychiatry, CHA Gumi Medical Center, CHA University, Gumi, Republic of Korea
| | - Tai Kiu Choi
- Department of Psychiatry, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea; Department of Psychiatry, CHA Gumi Medical Center, CHA University, Gumi, Republic of Korea
| | - Chun Il Park
- Department of Psychiatry, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea; Department of Psychiatry, CHA Gumi Medical Center, CHA University, Gumi, Republic of Korea.
| | - Sang-Hyuk Lee
- Department of Psychiatry, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea; Department of Psychiatry, CHA Gumi Medical Center, CHA University, Gumi, Republic of Korea.
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18
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Shan X, Zhang H, Dong Z, Chen J, Liu F, Zhao J, Zhang H, Guo W. Increased subcortical region volume induced by electroconvulsive therapy in patients with schizophrenia. Eur Arch Psychiatry Clin Neurosci 2021; 271:1285-1295. [PMID: 34275006 DOI: 10.1007/s00406-021-01303-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 07/04/2021] [Indexed: 02/08/2023]
Abstract
Electroconvulsive therapy (ECT) has been widely used to treat patients with schizophrenia. However, the underlying mechanisms of ECT remain unknown. In the present study, the treatment effects of ECT on brain structure in patients with schizophrenia were explored. Seventy patients with schizophrenia were scanned using structural magnetic resonance imaging. Patients in the drug group were scanned at baseline (time 1) and follow-up (time 2, 6 weeks of treatment). Patients in the ECT group were scanned before ECT treatment (baseline, time 1) and 10-12 h after the last ECT treatment (time 2). Voxel-based morphometry was applied to analyze the imaging data. Patients in the ECT group showed significantly increased gray matter volume (GMV) in the bilateral hippocampus/amygdala and left superior temporal gyrus (STG)/middle temporal gyrus (MTG) after ECT combined with antipsychotic therapy at time 2. In contrast, patients in the drug group showed decreased GMV in widespread brain regions. Correlation analysis results showed significantly negative correlations between the increased GMV in the bilateral hippocampus/amygdala and PANSS scores at baseline in the ECT group. ECT may modulate brain structure in patients with schizophrenia. The GMV in distinct subcortical regions was related to the individual therapeutic response in patients with schizophrenia.
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Affiliation(s)
- Xiaoxiao Shan
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Haisan Zhang
- The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, 453002, Henan, China.,Xinxiang Key Laboratory of Multimodal Brain Imaging, Xinxiang, 453002, Henan, China
| | - Zhao Dong
- The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, 453002, Henan, China.,Zhumadian Psychiatric Hospital, Zhumadian, 463000, Henan, China
| | - Jindong Chen
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Feng Liu
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin, 300000, China
| | - Jingping Zhao
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Hongxing Zhang
- The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, 453002, Henan, China. .,Xinxiang Key Laboratory of Multimodal Brain Imaging, Xinxiang, 453002, Henan, China. .,School of Psychology, Xinxiang Medical University, Xinxiang, 453003, Henan, China.
| | - Wenbin Guo
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China. .,Department of Psychiatry, The Third People's Hospital of Foshan, Foshan, 528000, Guangdong, China.
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19
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Iliuta FP, Manea MC, Budisteanu M, Andrei E, Linca F, Rad F, Cergan R, Ciobanu AM. Magnetic resonance imaging of brain anomalies in adult and pediatric schizophrenia patients: Experience of a Romanian tertiary hospital. Exp Ther Med 2021; 22:1098. [PMID: 34504552 PMCID: PMC8383773 DOI: 10.3892/etm.2021.10532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 06/29/2021] [Indexed: 11/27/2022] Open
Abstract
Schizophrenia is a severe mental illness with a significant impact on the life of both the patient and the patient's family. Magnetic resonance imaging has proven a useful tool for studying structural changes of the brain in schizophrenia. However, interpreting the published literature presents several challenges. Despite thorough research in recent years, which has included anatomopathological, imaging, electrophysiological, and genetic studies, the intimate pathophysiological mechanisms of this disease are not yet fully elucidated. The present study included patients with schizophrenia diagnosed in the psychiatric clinics from the ‘Prof. Dr. Alexandru Obregia’ Clinical Psychiatry Hospital between September 2019 and December 2020. Three Tesla magnetic resonance neuroimaging studies were performed. In a significant number of cases, the neuroimaging studies showed association of cerebral modifications such as enlargement of the Virchow spaces, lesions of the white matter with demyelinating appearance, and inflammatory sinus reactions. Cortical atrophy and hemosiderotic spots were present in a statistically significant proportion in the patient group with an age range of 29-61 years. MRI is indicated as a useful technique in the follow-up process of schizophrenia patients. However, whether the anomalies revealed in this disorder can be utilised as diagnostic biomarkers is still being debated.
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Affiliation(s)
- Floris Petru Iliuta
- Department of Psychiatry, 'Prof. Dr. Alexandru Obregia' Clinical Hospital of Psychiatry, 041914 Bucharest, Romania.,Department of Psychiatry and Psychology, Faculty of Dental Medicine, 'Carol Davila' University of Medicine and Pharmacy, 010221 Bucharest, Romania
| | - Mihnea Costin Manea
- Department of Psychiatry, 'Prof. Dr. Alexandru Obregia' Clinical Hospital of Psychiatry, 041914 Bucharest, Romania.,Department of Psychiatry and Psychology, Faculty of Dental Medicine, 'Carol Davila' University of Medicine and Pharmacy, 010221 Bucharest, Romania
| | - Magdalena Budisteanu
- Psychiatry Research Laboratory, 'Prof. Dr. Alexandru Obregia' Clinical Hospital of Psychiatry, 041914 Bucharest, Romania.,Laboratory of Medical Genetics, 'Victor Babes' National Institute of Pathology, 050096 Bucharest, Romania.,Department of Medical Genetics, Faculty of Medicine, 'Titu Maiorescu' University, 031593 Bucharest, Romania
| | - Emanuela Andrei
- Psychiatry Research Laboratory, 'Prof. Dr. Alexandru Obregia' Clinical Hospital of Psychiatry, 041914 Bucharest, Romania
| | - Florentina Linca
- Psychiatry Research Laboratory, 'Prof. Dr. Alexandru Obregia' Clinical Hospital of Psychiatry, 041914 Bucharest, Romania
| | - Florina Rad
- Department of Child and Adolescent Psychiatry, 'Prof. Dr. Alexandru Obregia' Clinical Hospital of Psychiatry, 041914 Bucharest, Romania.,Discipline of Child and Adolescent Psychiatry, Department of Neurosciences, 050474 Bucharest, Romania
| | - Romica Cergan
- Department of Anatomy, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania.,Department of Radiology and Imaging, Clinical Hospital of Orthopedics, Traumatology and Osteoarticular TB, 030167 Bucharest, Romania
| | - Adela Magdalena Ciobanu
- Department of Psychiatry, 'Prof. Dr. Alexandru Obregia' Clinical Hospital of Psychiatry, 041914 Bucharest, Romania.,Discipline of Psychiatry, Department of Neurosciences, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania
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20
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Morimoto C, Nakamura Y, Kuwabara H, Abe O, Kasai K, Yamasue H, Koike S. Unique Morphometric Features of the Cerebellum and Cerebellocerebral Structural Correlation Between Autism Spectrum Disorder and Schizophrenia. BIOLOGICAL PSYCHIATRY GLOBAL OPEN SCIENCE 2021; 1:219-228. [PMID: 36325298 PMCID: PMC9616290 DOI: 10.1016/j.bpsgos.2021.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 05/13/2021] [Accepted: 05/23/2021] [Indexed: 12/13/2022] Open
Abstract
Background Although cerebellar morphological involvement has been increasingly recognized in autism spectrum disorder (ASD) and schizophrenia (SZ), the extent to which there are morphological differences between them has not been definitively quantified. Furthermore, although previous studies have demonstrated increased anatomical cerebellocerebral correlations in both conditions, differences between their associations have not been well characterized. Methods We compared cerebellar volume between males with ASD (n = 31), males with SZ (n = 28), and typically developing males (n = 49). A total of 31 cerebellar subregions were investigated with the cerebellum segmented into their constituent lobules, in gray matter (GM) and white matter (WM) separately. Additionally, structural correlations with the contralateral cerebrum were analyzed for each cerebellar lobule. Results We found significantly larger WM volume in the bilateral lobules VI and Crus I in the ASD group than in other groups. While WM or GM volumes of these right lobules had positive associations with ASD symptoms, there was a negative association between GM volume of the right Crus I and SZ symptoms. We further observed, in the ASD group specifically, significant correlations between WM of the right lobule VI and WM of the left frontal pole (r = 0.67) and between GM of the right lobule VI and the left caudate (r = 0.60). Conclusions Our findings support evidence that cerebellar morphology is involved in ASD and SZ with different mechanisms. Furthermore, this study showed that these biological differences require consideration when determining diagnostic criteria and treatment for these disorders.
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Affiliation(s)
- Chie Morimoto
- Department of Neuropsychiatry, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Yuko Nakamura
- UTokyo Center for Integrative Science of Human Behaviour, Graduate School of Art and Sciences, University of Tokyo, Tokyo, Japan
| | - Hitoshi Kuwabara
- Department of Psychiatry, Hamamatsu University School of Medicine, Hamamatsu City, Japan
| | - Osamu Abe
- Department of Radiology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Kiyoto Kasai
- Department of Neuropsychiatry, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
- Center for Evolutionary Cognitive Science, Graduate School of Art and Sciences, University of Tokyo, Tokyo, Japan
- International Research Center for Neurointelligence, University of Tokyo Institutes for Advanced Study, University of Tokyo, Tokyo, Japan
- UTokyo Institute for Diversity and Adaptation of Human Mind, University of Tokyo, Tokyo, Japan
| | - Hidenori Yamasue
- Department of Psychiatry, Hamamatsu University School of Medicine, Hamamatsu City, Japan
| | - Shinsuke Koike
- UTokyo Center for Integrative Science of Human Behaviour, Graduate School of Art and Sciences, University of Tokyo, Tokyo, Japan
- Center for Evolutionary Cognitive Science, Graduate School of Art and Sciences, University of Tokyo, Tokyo, Japan
- International Research Center for Neurointelligence, University of Tokyo Institutes for Advanced Study, University of Tokyo, Tokyo, Japan
- UTokyo Institute for Diversity and Adaptation of Human Mind, University of Tokyo, Tokyo, Japan
- Address correspondence to Shinsuke Koike, M.D., Ph.D.
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21
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Grünwald LM, Duddy C, Byng R, Crellin N, Moncrieff J. The role of trust and hope in antipsychotic medication reviews between GPs and service users a realist review. BMC Psychiatry 2021; 21:390. [PMID: 34348680 PMCID: PMC8340528 DOI: 10.1186/s12888-021-03355-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 06/26/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Increasing number of service users diagnosed with schizophrenia and psychosis are being discharged from specialist secondary care services to primary care, many of whom are prescribed long-term antipsychotics. It is unclear if General Practitioners (GPs) have the confidence and experience to appropriately review and adjust doses of antipsychotic medication without secondary care support. AIM To explore barriers and facilitators of conducting antipsychotic medication reviews in primary care for individuals with no specialist mental health input. DESIGN & SETTING Realist review in general practice settings. METHOD A realist review has been conducted to synthesise evidence on antipsychotic medication reviews conducted in primary care with service users diagnosed with schizophrenia or psychosis. Following initial scoping searches and discussions with stakeholders, a systematic search and iterative secondary searches were conducted. Articles were systematically screened and analysed to develop a realist programme theory explaining the contexts (C) and mechanisms (M) which facilitate or prevent antipsychotic medication reviews (O) in primary care settings, and the potential outcomes of medication reviews. RESULTS Meaningful Antipsychotic medication reviews may not occur for individuals with only primary care medical input. Several, often mutually reinforcing, mechanisms have been identified as potential barriers to conducting such reviews, including low expectations of recovery for people with severe mental illness, a perceived lack of capability to understand and participate in medication reviews, linked with a lack of information shared in appointments between GPs and Service Users, perceived risk and uncertainty regarding antipsychotic medication and illness trajectory. CONCLUSIONS The review identified reciprocal and reinforcing stereotypes affecting both GPs and service users. Possible mechanisms to counteract these barriers are discussed, including realistic expectations of medication, and the need for increased information sharing and trust between GPs and service users.
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Affiliation(s)
- L M Grünwald
- Division of Psychiatry, University College London, 149 Tottenham Court Rd, Bloomsbury, London, W1T 7NF, UK.
- Comprehensive Clinical Trials Unit, 90 High Holborn, London, WC1V 6LJ, UK.
| | - C Duddy
- Nuffield Department of Primary Care Health Sciences, University of Oxford Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - R Byng
- Peninsula Medical School, University of Plymouth, Drake Circus, Plymouth, Devon, PL4 8AA, UK
| | - N Crellin
- Nuffield Trust, 59 New Cavendish Street, London, W1G 7LP, UK
| | - J Moncrieff
- Division of Psychiatry, University College London, 149 Tottenham Court Rd, Bloomsbury, London, W1T 7NF, UK
- Research and Development Department, North East London Foundation Trust, Maggie Lilley Suite, Goodmayes Hospital, Barley Lane, Ilford, Essex, IG3 8XJ, UK
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22
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Morimoto C, Uematsu A, Nakatani H, Takano Y, Iwashiro N, Abe O, Yamasue H, Kasai K, Koike S. Volumetric differences in gray and white matter of cerebellar Crus I/II across the different clinical stages of schizophrenia. Psychiatry Clin Neurosci 2021; 75:256-264. [PMID: 34081816 DOI: 10.1111/pcn.13277] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 05/20/2021] [Accepted: 05/24/2021] [Indexed: 12/15/2022]
Abstract
AIM Schizophrenia is considered to be a disorder of progressive structural brain abnormalities. Previous studies have indicated that the cerebellar Crus I/II plays a critical role in schizophrenia. We aimed to investigate how specific morphological features in the Crus I/II at different critical stages of the schizophrenia spectrum contribute to the disease. METHODS The study involved 73 participants on the schizophrenia spectrum (28 with ultra-high risk for psychosis [UHR], 17 with first-episode schizophrenia [FES], and 28 with chronic schizophrenia) and 79 healthy controls. We undertook a detailed investigation into differences in Crus I/II volume using a semiautomated segmentation method optimized for the cerebellum. We analyzed the effects of group and sex, as well as their interaction, on Crus I/II volume in gray matter (GM) and white matter (WM). RESULTS Significant group × sex interactions were found in WM volumes of the bilateral Crus I/II; the males with UHR demonstrated significantly larger WM volumes compared with the other male groups, whereas no significant group differences were found in the female groups. Additionally, WM and GM volumes of the Crus I/II had positive associations with symptom severity in the UHR group, whereas, in contrast, GM volumes in the FES group were negatively associated with symptom severity. CONCLUSIONS The present findings provide evidence that the morphology of Crus I/II is involved in schizophrenia in a sex- and disease stage-dependent manner. Additionally, alterations of WM volumes of Crus I/II may have potential as a biological marker of early detection and treatment for individuals with UHR.
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Affiliation(s)
- Chie Morimoto
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Akiko Uematsu
- Center for Evolutionary Cognitive Science, Graduate School of Art and Sciences, The University of Tokyo, Tokyo, Japan
| | - Hironori Nakatani
- Department of Information Media Technology, School of Information and Telecommunication Engineering, Tokai University, Tokyo, Japan
| | - Yosuke Takano
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Norichika Iwashiro
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Osamu Abe
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hidenori Yamasue
- Department of Psychiatry, Hamamatsu University School of Medicine, Hamamatsu City, Japan
| | - Kiyoto Kasai
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,International Research Center for Neurointelligence (WPI-IRCN), UTIAS, The University of Tokyo, Tokyo, Japan.,UTokyo Center for Integrative Science of Human Behaviour (CiSHuB), Tokyo, Japan.,University of Tokyo Institute for Diversity & Adaptation of Human Mind (UTIDAHM), Tokyo, Japan
| | - Shinsuke Koike
- Center for Evolutionary Cognitive Science, Graduate School of Art and Sciences, The University of Tokyo, Tokyo, Japan.,International Research Center for Neurointelligence (WPI-IRCN), UTIAS, The University of Tokyo, Tokyo, Japan.,UTokyo Center for Integrative Science of Human Behaviour (CiSHuB), Tokyo, Japan.,University of Tokyo Institute for Diversity & Adaptation of Human Mind (UTIDAHM), Tokyo, Japan
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23
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Svancer P, Spaniel F. Brain ventricular volume changes in schizophrenia. A narrative review. Neurosci Lett 2021; 759:136065. [PMID: 34146640 DOI: 10.1016/j.neulet.2021.136065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 05/15/2021] [Accepted: 06/14/2021] [Indexed: 11/18/2022]
Abstract
Brain ventricles are among the most studied structures in psychotic illness. In our mini-review we present available evidence on brain ventricle changes during the course of schizophrenia, from high-risk subjects and the first episode of schizophrenia to patients with chronic schizophrenia. We present current findings on the relationship between ventricle changes and level of psychopathology. The potential pathophysiological background of ventricle changes is also discussed. Understanding the dynamics of brain ventricle changes could resolve long-standing questions on the proportion of neurodegenerative and neurodevelopmental processes in the pathophysiology of schizophrenia.
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Affiliation(s)
- Patrik Svancer
- National Institute of Mental Health, Klecany, Czech Republic; Third Faculty of Medicine, Charles University, Prague, Czech Republic.
| | - Filip Spaniel
- National Institute of Mental Health, Klecany, Czech Republic; Third Faculty of Medicine, Charles University, Prague, Czech Republic
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24
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25
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Zhuo C, Li G, Lin X, Jiang D, Xu Y, Tian H, Wang W, Song X. Strategies to solve the reverse inference fallacy in future MRI studies of schizophrenia: a review. Brain Imaging Behav 2021; 15:1115-1133. [PMID: 32304018 PMCID: PMC8032587 DOI: 10.1007/s11682-020-00284-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Few advances in schizophrenia research have been translated into clinical practice, despite 60 years of serum biomarkers studies and 50 years of genetic studies. During the last 30 years, neuroimaging studies on schizophrenia have gradually increased, partly due to the beautiful prospect that the pathophysiology of schizophrenia could be explained entirely by the Human Connectome Project (HCP). However, the fallacy of reverse inference has been a critical problem of the HCP. For this reason, there is a dire need for new strategies or research "bridges" to further schizophrenia at the biological level. To understand the importance of research "bridges," it is vital to examine the strengths and weaknesses of the recent literature. Hence, in this review, our team has summarized the recent literature (1995-2018) about magnetic resonance imaging (MRI) of schizophrenia in terms of regional and global structural and functional alterations. We have also provided a new proposal that may supplement the HCP for studying schizophrenia. As postulated, despite the vast number of MRI studies in schizophrenia, the lack of homogeneity between the studies, along with the relatedness of schizophrenia with other neurological disorders, has hindered the study of schizophrenia. In addition, the reverse inference cannot be used to diagnose schizophrenia, further limiting the clinical impact of findings from medical imaging studies. We believe that multidisciplinary technologies may be used to develop research "bridges" to further investigate schizophrenia at the single neuron or neuron cluster levels. We have postulated about future strategies for overcoming the current limitations and establishing the research "bridges," with an emphasis on multimodality imaging, molecular imaging, neuron cluster signals, single transmitter biomarkers, and nanotechnology. These research "bridges" may help solve the reverse inference fallacy and improve our understanding of schizophrenia for future studies.
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Affiliation(s)
- Chuanjun Zhuo
- Department of Psychiatry, The First Affiliated Hospital of Zhengzhou University, 450000, Zhengzhou, China.
- Department of Psychiatry Pattern Recognition, Department of Genetics Laboratory of Schizophrenia, School of Mental Health, Jining Medical University, 272119, Jining, China.
- Department of Psychiatry, Wenzhou Seventh People's Hospital, 325000, Wenzhou, China.
- Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Taiyuan, China.
- MDT Center for Cognitive Impairment and Sleep Disorders, First Hospital of Shanxi Medical University, 030001, Taiyuan, China.
- Department of Psychiatric-Neuroimaging-Genetics and Co-Morbidity Laboratory (PNGC_Lab), Tianjin Anding Hospital, Tianjin Mental Health Center, Tianjin Medical University Mental Health Teaching Hospital, 300222, Tianjin, China.
- Biological Psychiatry of Co-collaboration Laboratory of China and Canada, Xiamen Xianyue Hospital, University of Alberta, Xiamen Xianyue Hospital, 361000, Xiamen, China.
- Department of Psychiatry, Tianjin Medical University, 300075, Tianjin, China.
- Psychiatric-Neuroimaging-Genetics-Comorbidity Laboratory (PNGC_Lab), Tianjin Anding Hospital, Department of Psychiatry, Tianjin Mental Health Centre, Mental Health Teaching Hospital of Tianjin Medical University, Shanxi Medical University, 300222, Tianjin, China.
| | - Gongying Li
- Department of Psychiatry Pattern Recognition, Department of Genetics Laboratory of Schizophrenia, School of Mental Health, Jining Medical University, 272119, Jining, China
| | - Xiaodong Lin
- Department of Psychiatry, Wenzhou Seventh People's Hospital, 325000, Wenzhou, China
| | - Deguo Jiang
- Department of Psychiatry, Wenzhou Seventh People's Hospital, 325000, Wenzhou, China
| | - Yong Xu
- Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Taiyuan, China
- MDT Center for Cognitive Impairment and Sleep Disorders, First Hospital of Shanxi Medical University, 030001, Taiyuan, China
| | - Hongjun Tian
- Department of Psychiatric-Neuroimaging-Genetics and Co-Morbidity Laboratory (PNGC_Lab), Tianjin Anding Hospital, Tianjin Mental Health Center, Tianjin Medical University Mental Health Teaching Hospital, 300222, Tianjin, China
| | - Wenqiang Wang
- Biological Psychiatry of Co-collaboration Laboratory of China and Canada, Xiamen Xianyue Hospital, University of Alberta, Xiamen Xianyue Hospital, 361000, Xiamen, China
| | - Xueqin Song
- Department of Psychiatry, The First Affiliated Hospital of Zhengzhou University, 450000, Zhengzhou, China
- Psychiatric-Neuroimaging-Genetics-Comorbidity Laboratory (PNGC_Lab), Tianjin Anding Hospital, Department of Psychiatry, Tianjin Mental Health Centre, Mental Health Teaching Hospital of Tianjin Medical University, Shanxi Medical University, 300222, Tianjin, China
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27
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Jung S, Kim JH, Kang NO, Sung G, Ko YG, Bang M, Park CI, Lee SH. Fusiform gyrus volume reduction associated with impaired facial expressed emotion recognition and emotional intensity recognition in patients with schizophrenia spectrum psychosis. Psychiatry Res Neuroimaging 2021; 307:111226. [PMID: 33249305 DOI: 10.1016/j.pscychresns.2020.111226] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 10/16/2020] [Accepted: 10/24/2020] [Indexed: 11/28/2022]
Abstract
Impaired social cue perception such as emotional recognition is a prominent feature in patients with schizophrenia, adversely affecting psychosocial outcomes and worsening clinical manifestations of the disease. However, few structural neuroimaging studies have investigated both facial emotion recognition and emotion intensity recognition in schizophrenia. Ninety patients with schizophrenia spectrum psychosis and fifty healthy controls underwent structural magnetic resonance imaging. The gray matter volumes of emotion recognition areas such as the bilateral caudal anterior cingulate cortex, rostral anterior cingulate cortex, fusiform gyrus, insula, amygdala, and hippocampus, were compared between patients and controls. Emotional recognition levels and symptom severities were examined. Group analysis showed that the gray matter volumes of the patients were significantly smaller in left hippocampus and fusiform gyrus compared with healthy controls. A correlation analysis revealed that larger left fusiform gyrus volume was associated with better facial emotion recognition and emotional intensity recognition in patients with schizophrenia spectrum psychosis. Additionally, left fusiform gyrus volumes showed a significant negative correlation with the negative symptom scores at baseline. These findings suggest that gray matter abnormalities in the left fusiform gyrus are associated with impaired social emotion recognition and severity of negative symptoms at baseline in patients with schizophrenia spectrum psychosis.
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Affiliation(s)
- Sra Jung
- Department of Psychiatry, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Ji-Hye Kim
- CHA University School of Medicine, Seongnam, Republic of Korea
| | - Na-Ok Kang
- Department of Psychiatry, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Gihye Sung
- Department of Psychiatry, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea; Department of Psychology, Korea University, Seoul, Republic of Korea
| | - Young-Gun Ko
- Department of Psychology, Korea University, Seoul, Republic of Korea
| | - Minji Bang
- Department of Psychiatry, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Chun Il Park
- Department of Psychiatry, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea.
| | - Sang-Hyuk Lee
- Department of Psychiatry, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea.
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28
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Eitel F, Schulz MA, Seiler M, Walter H, Ritter K. Promises and pitfalls of deep neural networks in neuroimaging-based psychiatric research. Exp Neurol 2021; 339:113608. [PMID: 33513353 DOI: 10.1016/j.expneurol.2021.113608] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 01/07/2021] [Accepted: 01/09/2021] [Indexed: 12/13/2022]
Abstract
By promising more accurate diagnostics and individual treatment recommendations, deep neural networks and in particular convolutional neural networks have advanced to a powerful tool in medical imaging. Here, we first give an introduction into methodological key concepts and resulting methodological promises including representation and transfer learning, as well as modelling domain-specific priors. After reviewing recent applications within neuroimaging-based psychiatric research, such as the diagnosis of psychiatric diseases, delineation of disease subtypes, normative modeling, and the development of neuroimaging biomarkers, we discuss current challenges. This includes for example the difficulty of training models on small, heterogeneous and biased data sets, the lack of validity of clinical labels, algorithmic bias, and the influence of confounding variables.
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Affiliation(s)
- Fabian Eitel
- Charité - Universitätsmedizin Berlin, Corporate Member Of Freie Universität Berlin, Humboldt-Universität zu Berlin; Department of Psychiatry and Psychotherapy, 10117 Berlin, Germany; Bernstein Center for Computational Neuroscience, 10117 Berlin, Germany
| | - Marc-André Schulz
- Charité - Universitätsmedizin Berlin, Corporate Member Of Freie Universität Berlin, Humboldt-Universität zu Berlin; Department of Psychiatry and Psychotherapy, 10117 Berlin, Germany; Bernstein Center for Computational Neuroscience, 10117 Berlin, Germany
| | - Moritz Seiler
- Charité - Universitätsmedizin Berlin, Corporate Member Of Freie Universität Berlin, Humboldt-Universität zu Berlin; Department of Psychiatry and Psychotherapy, 10117 Berlin, Germany; Bernstein Center for Computational Neuroscience, 10117 Berlin, Germany
| | - Henrik Walter
- Charité - Universitätsmedizin Berlin, Corporate Member Of Freie Universität Berlin, Humboldt-Universität zu Berlin; Department of Psychiatry and Psychotherapy, 10117 Berlin, Germany; Bernstein Center for Computational Neuroscience, 10117 Berlin, Germany
| | - Kerstin Ritter
- Charité - Universitätsmedizin Berlin, Corporate Member Of Freie Universität Berlin, Humboldt-Universität zu Berlin; Department of Psychiatry and Psychotherapy, 10117 Berlin, Germany; Bernstein Center for Computational Neuroscience, 10117 Berlin, Germany.
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29
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Yang C, Tang J, Liu N, Yao L, Xu M, Sun H, Tao B, Gong Q, Cao H, Zhang W, Lui S. The Effects of Antipsychotic Treatment on the Brain of Patients With First-Episode Schizophrenia: A Selective Review of Longitudinal MRI Studies. Front Psychiatry 2021; 12:593703. [PMID: 34248691 PMCID: PMC8264251 DOI: 10.3389/fpsyt.2021.593703] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 05/28/2021] [Indexed: 02/05/2023] Open
Abstract
A large number of neuroimaging studies have detected brain abnormalities in first-episode schizophrenia both before and after treatment, but it remains unclear how these abnormalities reflect the effects of antipsychotic treatment on the brain. To summarize the findings in this regard and provide potential directions for future work, we reviewed longitudinal structural and functional imaging studies in patients with first-episode schizophrenia before and after antipsychotic treatment. A total of 36 neuroimaging studies was included, involving 21 structural imaging studies and 15 functional imaging studies. Both anatomical and functional brain changes in patients after treatment were consistently observed in the frontal and temporal lobes, basal ganglia, limbic system and several key components within the default mode network (DMN). Alterations in these regions were affected by factors such as antipsychotic type, course of treatment, and duration of untreated psychosis (DUP). Over all we showed that: (a) The striatum and DMN were core target regions of treatment in schizophrenia, and their changes were related to different antipsychotics; (b) The gray matter of frontal and temporal lobes tended to reduce after long-term treatment; and (c) Longer DUP was accompanied with faster hippocampal atrophy after initial treatment, which was also associated with poorer outcome. These findings are in accordance with previous notions but should be interpreted with caution. Future studies are needed to clarify the effects of different antipsychotics in multiple conditions and to identify imaging or other biomarkers that may predict antipsychotic treatment response. With such progress, it may help choose effective pharmacological interventional strategies for individuals experiencing recent-onset schizophrenia.
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Affiliation(s)
- Chengmin Yang
- Huaxi MR Research Center, Department of Radiology, West China Hospital, Sichuan University, Chengdu, China.,Department of Radiology, West China Hospital, Sichuan University, Chengdu, China.,Functional and Molecular Imaging Key Laboratory of Sichuan Province, Psychoradiology Research Unit, Chinese Academy of Medical Sciences, West China Hospital, Sichuan University, Chengdu, China
| | - Jing Tang
- Huaxi MR Research Center, Department of Radiology, West China Hospital, Sichuan University, Chengdu, China.,Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Naici Liu
- Huaxi MR Research Center, Department of Radiology, West China Hospital, Sichuan University, Chengdu, China.,Department of Radiology, West China Hospital, Sichuan University, Chengdu, China.,Functional and Molecular Imaging Key Laboratory of Sichuan Province, Psychoradiology Research Unit, Chinese Academy of Medical Sciences, West China Hospital, Sichuan University, Chengdu, China
| | - Li Yao
- Huaxi MR Research Center, Department of Radiology, West China Hospital, Sichuan University, Chengdu, China.,Department of Radiology, West China Hospital, Sichuan University, Chengdu, China.,Functional and Molecular Imaging Key Laboratory of Sichuan Province, Psychoradiology Research Unit, Chinese Academy of Medical Sciences, West China Hospital, Sichuan University, Chengdu, China
| | - Mengyuan Xu
- Huaxi MR Research Center, Department of Radiology, West China Hospital, Sichuan University, Chengdu, China.,Department of Radiology, West China Hospital, Sichuan University, Chengdu, China.,Functional and Molecular Imaging Key Laboratory of Sichuan Province, Psychoradiology Research Unit, Chinese Academy of Medical Sciences, West China Hospital, Sichuan University, Chengdu, China
| | - Hui Sun
- Huaxi MR Research Center, Department of Radiology, West China Hospital, Sichuan University, Chengdu, China.,Department of Radiology, West China Hospital, Sichuan University, Chengdu, China.,Functional and Molecular Imaging Key Laboratory of Sichuan Province, Psychoradiology Research Unit, Chinese Academy of Medical Sciences, West China Hospital, Sichuan University, Chengdu, China
| | - Bo Tao
- Huaxi MR Research Center, Department of Radiology, West China Hospital, Sichuan University, Chengdu, China.,Department of Radiology, West China Hospital, Sichuan University, Chengdu, China.,Functional and Molecular Imaging Key Laboratory of Sichuan Province, Psychoradiology Research Unit, Chinese Academy of Medical Sciences, West China Hospital, Sichuan University, Chengdu, China
| | - Qiyong Gong
- Huaxi MR Research Center, Department of Radiology, West China Hospital, Sichuan University, Chengdu, China.,Department of Radiology, West China Hospital, Sichuan University, Chengdu, China.,Functional and Molecular Imaging Key Laboratory of Sichuan Province, Psychoradiology Research Unit, Chinese Academy of Medical Sciences, West China Hospital, Sichuan University, Chengdu, China
| | - Hengyi Cao
- Huaxi MR Research Center, Department of Radiology, West China Hospital, Sichuan University, Chengdu, China.,Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, NY, United States.,Division of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, NY, United States
| | - Wenjing Zhang
- Huaxi MR Research Center, Department of Radiology, West China Hospital, Sichuan University, Chengdu, China.,Department of Radiology, West China Hospital, Sichuan University, Chengdu, China.,Functional and Molecular Imaging Key Laboratory of Sichuan Province, Psychoradiology Research Unit, Chinese Academy of Medical Sciences, West China Hospital, Sichuan University, Chengdu, China
| | - Su Lui
- Huaxi MR Research Center, Department of Radiology, West China Hospital, Sichuan University, Chengdu, China.,Department of Radiology, West China Hospital, Sichuan University, Chengdu, China.,Functional and Molecular Imaging Key Laboratory of Sichuan Province, Psychoradiology Research Unit, Chinese Academy of Medical Sciences, West China Hospital, Sichuan University, Chengdu, China
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Yin P, Zhao C, Li Y, Liu X, Chen L, Hong N. Changes in Brain Structure, Function, and Network Properties in Patients With First-Episode Schizophrenia Treated With Antipsychotics. Front Psychiatry 2021; 12:735623. [PMID: 34916969 PMCID: PMC8668948 DOI: 10.3389/fpsyt.2021.735623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 11/09/2021] [Indexed: 01/10/2023] Open
Abstract
Purpose: Comprehensive and longitudinal brain analysis is of great significance for understanding the pathological changes of antipsychotic drug treatment in patients with schizophrenia. This study aimed to investigate the changes of structure, function, and network properties in patients with first-episode schizophrenia (FES) after antipsychotic therapy and their relationship with clinical symptoms. Materials and Methods: A total of 30 patients diagnosed with FES and 30 healthy subjects matched for sex and age were enrolled in our study. Patients at baseline were labeled as antipsychotic-naive first-episode schizophrenia (AN-FES), and patients after antipsychotic treatment were labeled as antipsychotic treatment first-episode schizophrenia (AT-FES). The severity of illness was measured by using the PANSS and CGI score. Structural and functional MRI data were also performed. Differences in GMV, ALFF, and ReHo between the FES group and healthy control group were tested using a voxel-wise two-sample t-test, and the comparison of AN-FES group and AT-FES group was evaluated by paired-sample t-test. Results: After the 1-year follow-up, the FES patients showed increased GMV in the right cerebellum, right inferior temporal gyrus, left middle frontal gyrus, parahippocampal gyrus, bilateral inferior parietal lobule, and reduced GMV in the left occipital lobe, gyrus rectus, right orbital frontal cortex. The patients also showed increased ALFF in the medial superior frontal gyrus and right precentral gyrus. For network properties, the patients showed reduced characteristic path length and increased global efficiency. The GMV of the right inferior parietal lobule was negatively correlated with the clinical symptoms. Conclusions: Our study showed that the antipsychotic treatment contributed to the structural alteration and functional improvement, and the GMV alteration may be associated with the improvement of clinical symptoms.
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Affiliation(s)
- Ping Yin
- Department of Radiology, Peking University People's Hospital, Beijing, China
| | - Chao Zhao
- Department of Interventional Radiology, The First Hospital of Shanxi Medical University, Taiyuan, China
| | - Yang Li
- Department of Radiology, Peking University People's Hospital, Beijing, China
| | - Xiaoyi Liu
- Department of Radiology, Peking University People's Hospital, Beijing, China
| | - Lei Chen
- Department of Radiology, Peking University People's Hospital, Beijing, China
| | - Nan Hong
- Department of Radiology, Peking University People's Hospital, Beijing, China
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31
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Lin X, Deng J, Dong G, Li S, Wu P, Sun H, Liu L, Shi J, Fan Y, Lu L, Li P. Effects of Chronic Pharmacological Treatment on Functional Brain Network Connectivity in Patients with Schizophrenia. Psychiatry Res 2021; 295:113338. [PMID: 32768152 DOI: 10.1016/j.psychres.2020.113338] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 07/19/2020] [Accepted: 07/26/2020] [Indexed: 12/19/2022]
Abstract
Schizophrenia is characterized by the dysfunction of various brain networks. Previous studies suggested that pharmacological treatments for schizophrenia induce functional changes in localized brain regions. However, the effects of antipsychotic treatments on brain networks associated with symptom improvement are still elusive. The elucidation of antipsychotic-induced functional brain changes is essential for the development of biologically informed treatment strategies. Forty-five healthy controls and 44 patients with schizophrenia underwent resting-state fMRI scans at baseline. The patients underwent a second scan after 6 weeks of antipsychotic treatment. At baseline, patients exhibited a significant decrease in functional connectivity of the cingulate gyrus in the default mode network compared to healthy controls, and this decrease was negatively correlated with symptom severity. Clinical improvements were observed after 6 weeks treatment, accompanied by an increase in functional connectivity of the cingulate gyrus in the default mode network and the inferior parietal lobule in the executive control network. The changes in functional connectivity of the inferior parietal lobule were significantly correlated with symptom improvement. These longitudinal neuroimaging findings suggest that schizophrenia might be an outcome of the disruption of the optimal balance of brain networks, and reestablishing this balance through antipsychotic treatment may result in clinical symptom improvement.
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Affiliation(s)
- Xiao Lin
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Key Laboratory of Mental Health, Ministry of Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing 100191, China
| | - Jiahui Deng
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Key Laboratory of Mental Health, Ministry of Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing 100191, China
| | - Guangheng Dong
- Center for Cognition and Brain Disorders, Hangzhou Normal University, Hangzhou 311121, China
| | - Suxia Li
- National Institute on Drug Dependence and Beijing Key Laboratory on Drug Dependence Research, Peking University, Beijing 100191, China
| | - Ping Wu
- National Institute on Drug Dependence and Beijing Key Laboratory on Drug Dependence Research, Peking University, Beijing 100191, China
| | - Hongqiang Sun
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Key Laboratory of Mental Health, Ministry of Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing 100191, China
| | - Lin Liu
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Key Laboratory of Mental Health, Ministry of Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing 100191, China
| | - Jie Shi
- National Institute on Drug Dependence and Beijing Key Laboratory on Drug Dependence Research, Peking University, Beijing 100191, China
| | - Yong Fan
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Lin Lu
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Key Laboratory of Mental Health, Ministry of Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing 100191, China; National Institute on Drug Dependence and Beijing Key Laboratory on Drug Dependence Research, Peking University, Beijing 100191, China.
| | - Peng Li
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Key Laboratory of Mental Health, Ministry of Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing 100191, China.
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32
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Morrison AP, Pyle M, Byrne R, Broome M, Freeman D, Johns L, James A, Husain N, Whale R, MacLennan G, Norrie J, Hudson J, Peters S, Davies L, Bowe S, Smith J, Shiers D, Joyce E, Jones W, Hollis C, Maughan D. Psychological intervention, antipsychotic medication or a combined treatment for adolescents with a first episode of psychosis: the MAPS feasibility three-arm RCT. Health Technol Assess 2021; 25:1-124. [PMID: 33496261 PMCID: PMC7869006 DOI: 10.3310/hta25040] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND When psychosis emerges in young people there is a risk of poorer outcomes, and access to evidence-based treatments is paramount. The current evidence base is limited. Antipsychotic medications show only a small benefit over placebo, but young people experience more side effects than adults. There is sparse evidence for psychological intervention. Research is needed to determine the clinical effectiveness and cost-effectiveness of psychological intervention versus antipsychotic medication versus a combined treatment for adolescents with psychosis. OBJECTIVES The objective of Managing Adolescent first-episode Psychosis: a feasibility Study (MAPS) was to determine the feasibility of conducting a definitive trial to answer the question of clinical effectiveness and cost-effectiveness of these three treatment options. DESIGN This was a prospective, randomised, open-blinded, evaluation feasibility trial with a single blind. Participants were allocated 1 : 1 : 1 to receive antipsychotic medication, psychological intervention or a combination of both. A thematic qualitative study explored the acceptability and feasibility of the trial. SETTING Early intervention in psychosis services and child and adolescent mental health services in Manchester, Oxford, Lancashire, Sussex, Birmingham, Norfolk and Suffolk, and Northumberland, Tyne and Wear. PARTICIPANTS People aged 14-18 years experiencing a first episode of psychosis either with an International Classification of Diseases, Tenth Revision, schizophrenia spectrum diagnosis or meeting the entry criteria for early intervention in psychosis who had not received antipsychotic medication or psychological intervention within the last 3 months. INTERVENTIONS Psychological intervention involved up to 26 hours of cognitive-behavioural therapy and six family intervention sessions over 6 months, with up to four booster sessions. Antipsychotic medication was prescribed by the participant's psychiatrist in line with usual practice. Combined treatment was a combination of psychological intervention and antipsychotic medication. MAIN OUTCOME MEASURES The primary outcome was feasibility (recruitment, treatment adherence and retention). We used a three-stage progression criterion to determine feasibility. Secondary outcomes were psychosis symptoms, recovery, anxiety and depression, social and educational/occupational functioning, drug and alcohol use, health economics, adverse/metabolic side effects and adverse/serious adverse events. RESULTS We recruited 61 out of 90 (67.8%; amber zone) potential participants (psychological intervention, n = 18; antipsychotic medication, n = 22; combined treatment, n = 21). Retention to follow-up was 51 out of 61 participants (83.6%; green zone). In the psychological intervention arm and the combined treatment arm, 32 out of 39 (82.1%) participants received six or more sessions of cognitive-behavioural therapy (green zone). In the combined treatment arm and the antipsychotic medication arm, 28 out of 43 (65.1%) participants received antipsychotic medication for 6 consecutive weeks (amber zone). There were no serious adverse events related to the trial and one related adverse event. Overall, the number of completed secondary outcome measures, including health economics, was small. LIMITATIONS Medication adherence was determined by clinician report, which can be biased. The response to secondary outcomes was low, including health economics. The small sample size obtained means that the study lacked statistical power and there will be considerable uncertainty regarding estimates of treatment effects. CONCLUSIONS It is feasible to conduct a trial comparing psychological intervention with antipsychotic medication and a combination treatment in young people with psychosis with some adaptations to the design, including adaptations to collection of health economic data to determine cost-effectiveness. FUTURE WORK An adequately powered definitive trial is required to provide robust evidence. TRIAL REGISTRATION Current Controlled Trials ISRCTN80567433. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 4. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Anthony P Morrison
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Melissa Pyle
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Rory Byrne
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Matthew Broome
- Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham, UK
- Department of Psychiatry, Medical Sciences Division, University of Oxford, Oxford, UK
- Centre for Human Brain Health, School of Psychology, University of Birmingham, Birmingham, UK
- Warneford Hospital, Oxford Health NHS Foundation Trust, Oxford, UK
| | - Daniel Freeman
- Department of Psychiatry, Medical Sciences Division, University of Oxford, Oxford, UK
- Warneford Hospital, Oxford Health NHS Foundation Trust, Oxford, UK
| | - Louise Johns
- Department of Psychiatry, Medical Sciences Division, University of Oxford, Oxford, UK
- Warneford Hospital, Oxford Health NHS Foundation Trust, Oxford, UK
| | - Anthony James
- Department of Psychiatry, Medical Sciences Division, University of Oxford, Oxford, UK
- Warneford Hospital, Oxford Health NHS Foundation Trust, Oxford, UK
| | - Nusrat Husain
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Early Intervention in Psychosis Service, Lancashire and South Cumbria NHS Foundation Trust, Chorley, UK
| | - Richard Whale
- Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Graeme MacLennan
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - John Norrie
- Clinical Trials Unit, University of Edinburgh, Edinburgh, UK
| | - Jemma Hudson
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Sarah Peters
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Linda Davies
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Samantha Bowe
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Jo Smith
- School of Allied Health and Community, University of Worcester, Worcester, UK
| | - David Shiers
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Emmeline Joyce
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Wendy Jones
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Chris Hollis
- National Institute for Health Research MindTech MedTech Co-operative, Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Daniel Maughan
- Warneford Hospital, Oxford Health NHS Foundation Trust, Oxford, UK
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33
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Murray RM. Listening to our critics; the care of people with psychosis. Psychol Med 2020; 50:2641-2642. [PMID: 33280631 DOI: 10.1017/s0033291720004341] [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] [Indexed: 11/06/2022]
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34
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Boz Z, Hu M, Yu Y, Huang XF. N-acetylcysteine prevents olanzapine-induced oxidative stress in mHypoA-59 hypothalamic neurons. Sci Rep 2020; 10:19185. [PMID: 33154380 PMCID: PMC7644715 DOI: 10.1038/s41598-020-75356-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 09/25/2020] [Indexed: 12/30/2022] Open
Abstract
Olanzapine is a second-generation antipsychotic (AP) drug commonly prescribed for the treatment of schizophrenia. Recently, olanzapine has been found to cause brain tissue volume loss in rodent and primate studies; however, the underlying mechanism remains unknown. Abnormal autophagy and oxidative stress have been implicated to have a role in AP-induced neurodegeneration, while N-acetylcysteine (NAC) is a potent antioxidant, shown to be beneficial in the treatment of schizophrenia. Here, we investigate the role of olanzapine and NAC on cell viability, oxidative stress, mitochondrial mass and mitophagy in hypothalamic cells. Firstly, cell viability was assessed in mHypoA-59 and mHypoA NPY/GFP cells using an MTS assay and flow cytometric analyses. Olanzapine treated mHypoA-59 cells were then assessed for mitophagy markers and oxidative stress; including quantification of lysosomes, autophagosomes, LC3B-II, p62, superoxide anion (O2–) and mitochondrial mass. NAC (10 mM) was used to reverse the effects of olanzapine (100 µM) on O2−, mitochondrial mass and LC3B-II. We found that olanzapine significantly impacted cell viability in mHypoA-59 hypothalamic cells in a dose and time-dependent manner. Olanzapine inhibited mitophagy, instigated oxidative stress and prompted mitochondrial abnormalities. NAC was able to mitigate olanzapine-induced effects. These findings suggest that high doses of olanzapine may cause neurotoxicity of hypothalamic neurons via increased production of reactive oxygen species (ROS), mitochondrial damage and mitophagy inhibition. This could in part explain data suggesting that APs may reduce brain volume.
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Affiliation(s)
- Zehra Boz
- Illawarra Health and Medical Research Institute and School of Medicine, University of Wollongong, Wollongong, NSW, 2522, Australia
| | - Minmin Hu
- Jiangsu Key Laboratory of Immunity and Metabolism, Xuzhou Medical University, Xuzhou, 221004, Jiangsu, China
| | - Yinghua Yu
- Illawarra Health and Medical Research Institute and School of Medicine, University of Wollongong, Wollongong, NSW, 2522, Australia.,Jiangsu Key Laboratory of Immunity and Metabolism, Xuzhou Medical University, Xuzhou, 221004, Jiangsu, China
| | - Xu-Feng Huang
- Illawarra Health and Medical Research Institute and School of Medicine, University of Wollongong, Wollongong, NSW, 2522, Australia.
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35
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Gaebel W, Stricker J, Riesbeck M. The long-term antipsychotic treatment of schizophrenia: A selective review of clinical guidelines and clinical case examples. Schizophr Res 2020; 225:4-14. [PMID: 31806527 DOI: 10.1016/j.schres.2019.10.049] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 10/21/2019] [Accepted: 10/24/2019] [Indexed: 01/25/2023]
Abstract
There is a long-lasting debate regarding the long-term antipsychotic treatment of schizophrenia. The most frequently advocated strategy is continued antipsychotic maintenance treatment (i.e., continuous treatment with a constant dose of antipsychotic medication after symptom remission). Yet, because of the potential side effects of continued antipsychotic medication, other treatment strategies such as targeted intermittent treatment (i.e., stepwise drug discontinuation and early drug intervention in case of prodromal symptoms or early warning signs) have been discussed. In this manuscript, we review recommendations regarding the long-term antipsychotic treatment of schizophrenia from six evidence-based clinical guidelines. In line with the current state of research, all six clinical guidelines recommend continued antipsychotic maintenance treatment. Recommendations regarding other aspects of long-term antipsychotic treatment (e.g., the dosage of antipsychotic medication for long-term treatment, the minimum duration of antipsychotic long-term treatment, and discontinuation strategies) are more vague and heterogeneous. Additionally, we provide clinical case examples to illustrate different course types of patients exposed to targeted intermittent treatment. Finally, we discuss gaps in current clinical guidelines and future research avenues in antipsychotic maintenance treatment.
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Affiliation(s)
- Wolfgang Gaebel
- Department of Psychiatry and Psychotherapy, Medical Faculty, LVR-Klinikum Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany; WHO Collaborating Centre for Quality Assurance and Empowerment in Mental Health, Düsseldorf, Germany.
| | - Johannes Stricker
- Department of Psychiatry and Psychotherapy, Medical Faculty, LVR-Klinikum Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany; WHO Collaborating Centre for Quality Assurance and Empowerment in Mental Health, Düsseldorf, Germany.
| | - Mathias Riesbeck
- Department of Psychiatry and Psychotherapy, Medical Faculty, LVR-Klinikum Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany.
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36
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Jung S, Kim JH, Sung G, Ko YG, Bang M, Park CI, Lee SH. Uncinate fasciculus white matter connectivity related to impaired social perception and cross-sectional and longitudinal symptoms in patients with schizophrenia spectrum psychosis. Neurosci Lett 2020; 737:135144. [PMID: 32534095 DOI: 10.1016/j.neulet.2020.135144] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/03/2020] [Accepted: 06/08/2020] [Indexed: 11/16/2022]
Abstract
Dysfunctional social-emotional perception in patients with schizophrenia can result in adverse clinical symptoms and poorer long-term outcomes. The white matter tracts that interact among a number of brain regions have an important role to play. However, few neuroimaging studies focus on the effects of white matter connectivity on social-emotional perception in schizophrenia and its impact on patients' clinical symptoms and long-term outcomes. Forty-one patients with schizophrenia spectrum psychosis and 42 healthy controls underwent structural magnetic resonance imaging. The white matter fractional anisotropy values of the emotion recognition areas, the bilateral anterior thalamic radiation, inferior longitudinal fasciculus, cingulum bundle, superior longitudinal fasciculus, and uncinate fasciculus were compared between patients with schizophrenia spectrum psychosis and healthy controls. Social-emotional perception levels and symptom severity at baseline and after 1 year were examined. A group analysis showed that white matter connectivity was significantly lower in the bilateral anterior thalamic radiation, cingulum bundle, right inferior longitudinal fasciculus, and uncinate fasciculus of patients with schizophrenia spectrum psychosis compared to the healthy controls. Contrastingly, a correlation analysis revealed that larger right uncinate fasciculus fractional anisotropy values were associated with lower social-emotional perception levels in patients with schizophrenia spectrum psychosis. Additionally, the white matter fractional anisotropy values of the right uncinate fasciculus showed a significant positive correlation with the severity of positive symptoms at baseline and with poor outcomes after 1 year. The findings of the present study suggest that impaired social-emotional perception in patients with schizophrenia spectrum psychosis is associated with larger white matter connectivity of the uncinate fasciculus, which is also associated with more severe symptoms at baseline and after 1-year. These results suggest that the uncinate fasciculus could affect the pathophysiology of schizophrenia.
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Affiliation(s)
- Sra Jung
- Department of Psychiatry, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Ji-Hye Kim
- CHA University School of Medicine, Seongnam, Republic of Korea
| | - Gihye Sung
- Department of Psychiatry, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea; Department of Psychology, Korea University, Seoul, Republic of Korea
| | - Young-Gun Ko
- Department of Psychology, Korea University, Seoul, Republic of Korea
| | - Minji Bang
- Department of Psychiatry, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Chun-Il Park
- Department of Psychiatry, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea.
| | - Sang-Hyuk Lee
- Department of Psychiatry, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea.
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37
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Cui X, Deng Q, Lang B, Su Q, Liu F, Zhang Z, Chen J, Zhao J, Guo W. Less reduced gray matter volume in the subregions of superior temporal gyrus predicts better treatment efficacy in drug-naive, first-episode schizophrenia. Brain Imaging Behav 2020; 15:1997-2004. [PMID: 33033986 DOI: 10.1007/s11682-020-00393-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2020] [Indexed: 11/26/2022]
Abstract
Decreased gray matter volume (GMV) in the superior temporal gyrus (STG) has been implicated in the neurophysiology of schizophrenia. However, it remains unclear whether volumetric reduction in the subregions of the STG can predict treatment efficacy for schizophrenia. Our cohort included 44 drug-naive, first-episode patients, 42 unaffected siblings and 44 healthy controls. Voxel-based morphometry and pattern classification were utilized to analyze the acquired imaging data as per the anatomical subdivision by a well-defined brainnetome atlas. The patients presented lower GMV values in left TE1.0/1.2 (TE, anterior temporal visual association area) than the siblings, and lower GMV values in the left/right TE1.0/1.2 and left A22r (rostral area 22) than the controls. A positive correlation is observed between the GMV values in the right A38l (lateral area 38) and baseline Positive and Negative Syndrome Scale (PANSS) total scores in the patients. Support vector regression (SVR) results exhibited a significant association between predicted (based on the GMV values in the right A38l) and actual symptomatic improvement based on the reduction ratio of the PANSS total scores (r = 0.498, p = 0.001). Our results suggest that normal structure in the right A38l of the STG may be an important factor indicative of the effects of antipsychotic drugs, which can be potentially used to monitor drug effects for first-episode patients at an early stage in clinical practice.
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Affiliation(s)
- Xilong Cui
- Department of Psychaitry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China
| | - Qijian Deng
- Department of Psychaitry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China
| | - Bing Lang
- Department of Psychaitry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China
| | - Qinji Su
- Mental Health Center, the Second Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, 530007, China
| | - Feng Liu
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Zhikun Zhang
- Mental Health Center, the Second Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, 530007, China
| | - Jindong Chen
- Department of Psychaitry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China
| | - Jingping Zhao
- Department of Psychaitry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China
| | - Wenbin Guo
- Department of Psychaitry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China.
- The Third People's Hospital of Foshan, Foshan, Guangdong, 528000, China.
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38
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Differentiating patients with schizophrenia from healthy controls by hippocampal subfields using radiomics. Schizophr Res 2020; 223:337-344. [PMID: 32988740 DOI: 10.1016/j.schres.2020.09.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 08/11/2020] [Accepted: 09/14/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Accurately diagnosing schizophrenia is still challenging due to the lack of validated biomarkers. Here, we aimed to investigate whether radiomic features in bilateral hippocampal subfields from magnetic resonance images (MRIs) can differentiate patients with schizophrenia from healthy controls (HCs). METHODS A total of 152 participants with MRI (86 schizophrenia and 66 HCs) were allocated to training (n = 106) and test (n = 46) sets. Radiomic features (n = 642) from the bilateral hippocampal subfields processed with automatic segmentation techniques were extracted from T1-weighted MRIs. After feature selection, various combinations of classifiers (logistic regression, extra-trees, AdaBoost, XGBoost, or support vector machine) and subsampling were trained. The performance of the classifier was validated in the test set by determining the area under the curve (AUC). Furthermore, the association between selected radiomic features and clinical symptoms in schizophrenia was assessed. RESULTS Thirty radiomic features were identified to differentiate participants with schizophrenia from HCs. In the training set, the AUC exhibited poor to good performance (range: 0.683-0.861). The best performing radiomics model in the test set was achieved by the mutual information feature selection and logistic regression with an AUC, accuracy, sensitivity, and specificity of 0.821 (95% confidence interval 0.681-0.961), 82.1%, 76.9%, and 70%, respectively. Greater maximum values in the left cornu ammonis 1-3 subfield were associated with a higher severity of positive symptoms and general psychopathology in participants with schizophrenia. CONCLUSION Radiomic features from hippocampal subfields may be useful biomarkers for identifying schizophrenia.
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Morrison AP, Pyle M, Gumley A, Schwannauer M, Turkington D, MacLennan G, Norrie J, Hudson J, Bowe S, French P, Hutton P, Byrne R, Syrett S, Dudley R, McLeod HJ, Griffiths H, Barnes TR, Davies L, Shields G, Buck D, Tully S, Kingdon D. Cognitive-behavioural therapy for clozapine-resistant schizophrenia: the FOCUS RCT. Health Technol Assess 2020; 23:1-144. [PMID: 30806619 DOI: 10.3310/hta23070] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Clozapine (clozaril, Mylan Products Ltd) is a first-choice treatment for people with schizophrenia who have a poor response to standard antipsychotic medication. However, a significant number of patients who trial clozapine have an inadequate response and experience persistent symptoms, called clozapine-resistant schizophrenia (CRS). There is little evidence regarding the clinical effectiveness of pharmacological or psychological interventions for this population. OBJECTIVES To evaluate the clinical effectiveness and cost-effectiveness of cognitive-behavioural therapy (CBT) for people with CRS and to identify factors predicting outcome. DESIGN The Focusing on Clozapine Unresponsive Symptoms (FOCUS) trial was a parallel-group, randomised, outcome-blinded evaluation trial. Randomisation was undertaken using permuted blocks of random size via a web-based platform. Data were analysed on an intention-to-treat (ITT) basis, using random-effects regression adjusted for site, age, sex and baseline symptoms. Cost-effectiveness analyses were carried out to determine whether or not CBT was associated with a greater number of quality-adjusted life-years (QALYs) and higher costs than treatment as usual (TAU). SETTING Secondary care mental health services in five cities in the UK. PARTICIPANTS People with CRS aged ≥ 16 years, with an International Classification of Diseases, Tenth Revision (ICD-10) schizophrenia spectrum diagnoses and who are experiencing psychotic symptoms. INTERVENTIONS Individual CBT included up to 30 hours of therapy delivered over 9 months. The comparator was TAU, which included care co-ordination from secondary care mental health services. MAIN OUTCOME MEASURES The primary outcome was the Positive and Negative Syndrome Scale (PANSS) total score at 21 months and the primary secondary outcome was PANSS total score at the end of treatment (9 months post randomisation). The health benefit measure for the economic evaluation was the QALY, estimated from the EuroQol-5 Dimensions, five-level version (EQ-5D-5L), health status measure. Service use was measured to estimate costs. RESULTS Participants were allocated to CBT (n = 242) or TAU (n = 245). There was no significant difference between groups on the prespecified primary outcome [PANSS total score at 21 months was 0.89 points lower in the CBT arm than in the TAU arm, 95% confidence interval (CI) -3.32 to 1.55 points; p = 0.475], although PANSS total score at the end of treatment (9 months) was significantly lower in the CBT arm (-2.40 points, 95% CI -4.79 to -0.02 points; p = 0.049). CBT was associated with a net cost of £5378 (95% CI -£13,010 to £23,766) and a net QALY gain of 0.052 (95% CI 0.003 to 0.103 QALYs) compared with TAU. The cost-effectiveness acceptability analysis indicated a low likelihood that CBT was cost-effective, in the primary and sensitivity analyses (probability < 50%). In the CBT arm, 107 participants reported at least one adverse event (AE), whereas 104 participants in the TAU arm reported at least one AE (odds ratio 1.09, 95% CI 0.81 to 1.46; p = 0.58). CONCLUSIONS Cognitive-behavioural therapy for CRS was not superior to TAU on the primary outcome of total PANSS symptoms at 21 months, but was superior on total PANSS symptoms at 9 months (end of treatment). CBT was not found to be cost-effective in comparison with TAU. There was no suggestion that the addition of CBT to TAU caused adverse effects. Future work could investigate whether or not specific therapeutic techniques of CBT have value for some CRS individuals, how to identify those who may benefit and how to ensure that effects on symptoms can be sustained. TRIAL REGISTRATION Current Controlled Trials ISRCTN99672552. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 7. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Anthony P Morrison
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Prestwich, UK.,Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Melissa Pyle
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Prestwich, UK.,Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Andrew Gumley
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Matthias Schwannauer
- Department of Clinical Psychology, Edinburgh Medical School, University of Edinburgh, Edinburgh, UK
| | - Douglas Turkington
- Academic Psychiatry, Northumberland, Tyne and Wear NHS Foundation Trust, Centre for Ageing and Vitality, Newcastle General Hospital, Newcastle upon Tyne, UK
| | - Graeme MacLennan
- Centre for Healthcare Randomised Trials, Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - John Norrie
- Clinical Trials Unit, Edinburgh Medical School, University of Edinburgh, Edinburgh, UK
| | - Jemma Hudson
- Centre for Healthcare Randomised Trials, Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Samantha Bowe
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Prestwich, UK
| | - Paul French
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Prestwich, UK.,Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Paul Hutton
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Rory Byrne
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Prestwich, UK.,Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Suzy Syrett
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Robert Dudley
- School of Psychology, Newcastle University, Newcastle upon Tyne, UK
| | - Hamish J McLeod
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Helen Griffiths
- Department of Clinical Psychology, Edinburgh Medical School, University of Edinburgh, Edinburgh, UK
| | | | - Linda Davies
- Division of Population Health, University of Manchester, Manchester, UK
| | - Gemma Shields
- Division of Population Health, University of Manchester, Manchester, UK
| | - Deborah Buck
- Division of Population Health, University of Manchester, Manchester, UK
| | - Sarah Tully
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Prestwich, UK.,Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - David Kingdon
- Department of Psychiatry, University of Southampton, Academic Centre, Southampton, UK
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Characteristics of gray matter alterations in never-treated and treated chronic schizophrenia patients. Transl Psychiatry 2020; 10:136. [PMID: 32398765 PMCID: PMC7217843 DOI: 10.1038/s41398-020-0828-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 04/15/2020] [Accepted: 04/22/2020] [Indexed: 02/05/2023] Open
Abstract
Though gray matter deficits have been consistently revealed in chronic treated schizophrenia, it is still not clear whether there are different brain alterations between chronic never treated and treated patients. To explore the different patterns of gray matter alterations among chronic never treated patients and those treated with monotherapy, we recruited 35 never-treated chronic schizophrenia patients with illness durations ranging from 5 to 48 years, 20 illness duration-matched risperidone monotherapy and 20 clozapine monotherapy patients, and 55 healthy controls. GM (surface area, cortical thickness, and cortical volume) measures were extracted and compared using ANCOVA across the four groups followed by post hoc tests. Relative to controls, both treated and never-treated chronic schizophrenia patients showed reduced GM mainly involving the bilateral medial and rostral middle frontal, left banks superior temporal sulcus, left fusiform, and left pericalcarine cortex and increased in the left cuneus. Compared with the untreated patient group, the two treated groups showed reductions mainly in the bilateral prefrontal, temporal, and left inferior parietal lobules. The clozapine monotherapy patients demonstrated more severe decreases in the bilateral prefrontal cortex and left cuneus and less severe decreases in the left ventral temporal lobe than risperidone monotherapy patients. These findings provide new insights into the long-term effects of antipsychotic treatment on gray matter alterations in schizophrenia patients. Furthermore, the characteristic findings of reductions in the inferior parietal lobule might be specific for long-term antipsychotic treatment, which could be a possible target for medication development in the future.
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41
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Cauley KA, Hu Y, Fielden SW. Aging and the Brain: A Quantitative Study of Clinical CT Images. AJNR Am J Neuroradiol 2020; 41:809-814. [PMID: 32327433 DOI: 10.3174/ajnr.a6510] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 01/30/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND PURPOSE Though CT is a highly calibrated imaging modality, head CT is typically interpreted qualitatively. Our aim was to initiate the establishment of a reference quantitative database for clinical head CT. MATERIALS AND METHODS An automated segmentation algorithm was developed and applied to 354 clinical head CT scans with radiographically normal findings (ages, 18-101 years; 203 women) to measure brain volume, brain parenchymal fraction, brain radiodensity, and brain parenchymal radiomass. Brain parenchymal fraction was modeled using quantile regression analysis. RESULTS Brain parenchymal fraction is highly correlated with age (R 2 = 0.908 for men and 0.950 for women), with 11% overall brain volume loss in the adult life span (1%/year from 20 to 50 years and 2%/year after 50 years of age). Third-order polynomial quantile regression curves for brain parenchymal fraction were rationalized and statistically validated. Total brain parenchymal radiodensity shows a decline as a function of age (14.9% for men, 14.7% for women; slopes not significantly different, P = .760). Age-related loss of brain radiomass (the product of volume and radiodensity) is approximately 20% for both sexes, significantly greater than the loss of brain volume (P < .001). CONCLUSIONS An automated segmentation algorithm has been developed and applied to clinical head CT images to initiate the development of a reference database for quantitative brain CT imaging. Such a database can be subject to quantile regression analysis to stratify patient brain CT scans by metrics such as brain parenchymal fraction, radiodensity, and radiomass, to aid in the identification of statistical outliers and lend quantitative assessment to image interpretation.
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Affiliation(s)
- K A Cauley
- From the Department of Radiology (K.A.C., S.W.F.), Geisinger Medical Center, Danville Pennsylvania
| | - Y Hu
- Department of Imaging Science and Innovation (Y.H.), Geisinger Medical Center, Danville Pennyslvania. Dr Cauley is currently affiliated with Virtual Radiologic, Eden Prairie, Minnesota
| | - S W Fielden
- From the Department of Radiology (K.A.C., S.W.F.), Geisinger Medical Center, Danville Pennsylvania
- Department of Imaging Science and Innovation (S.W.F.), Geisinger Health System, Lewisburg, Pannsylvania
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Schönfeldt-Lecuona C, Kregel T, Schmidt A, Kassubek J, Dreyhaupt J, Freudenmann RW, Connemann BJ, Gahr M, Pinkhardt EH. Retinal single-layer analysis with optical coherence tomography (OCT) in schizophrenia spectrum disorder. Schizophr Res 2020; 219:5-12. [PMID: 30981598 DOI: 10.1016/j.schres.2019.03.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 03/22/2019] [Accepted: 03/25/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND Volume reductions in brain structures of patients with schizophrenia spectrum disorder (SSD) have repeatedly been found in voxel-based morphometry MRI studies. Hence, an underlying neurodegenerative etiological component of SSD is currently being discussed. In recent years, the imaging method of optical coherence tomography (OCT) has shown its potential in evaluating structural changes in the retina in patients with confirmed neurodegenerative disorders, providing a window into the brain. METHODS Twenty-six patients with schizophrenia or schizoaffective disorder and 23 age- and sex-matched healthy controls were examined with the Heidelberg Spectralis OCT system to derive a single-layer analysis of both retinas. The segmentation of retinal layers was manually corrected to minimize artifacts and software imprecisions. RESULTS Compared to the control group, SSD patients showed reduced thickness and volume measurements for nearly all retinal layers, and these differences reached significance for macular volume, macular thickness, retinal nerve fiber layer (RNFL) and inner nucleiform layer (INL). Furthermore, a significant correlation between the duration of illness and the total volume of the RNFL was found. CONCLUSION Our OCT measurements demonstrate reduced single retinal layer thickness in patients with SSD. In the context of the MRI volume changes, our results provide further evidence that structural changes seen in the brain of patients are also observable in the retina, potentially allowing further insights into the different components of the nervous system that are altered in this highly etiologically complex disorder.
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Affiliation(s)
| | - Thomas Kregel
- Department of Psychiatry and Psychotherapy III, University Clinic Ulm, Germany
| | - Arno Schmidt
- Department of Psychiatry and Psychotherapy III, University Clinic Ulm, Germany
| | - Jan Kassubek
- Department of Neurology, University Clinic Ulm, Germany
| | - Jens Dreyhaupt
- Institute of Epidemiology and Medical Biometry, University of Ulm, Germany
| | | | | | - Maximilian Gahr
- Department of Psychiatry and Psychotherapy III, University Clinic Ulm, Germany
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Moilanen J, Huhtaniska S, Haapea M, Jääskeläinen E, Veijola J, Isohanni M, Koponen H, Miettunen J. Brain morphometry of individuals with schizophrenia with and without antipsychotic medication – The Northern Finland Birth Cohort 1966 Study. Eur Psychiatry 2020; 30:598-605. [DOI: 10.1016/j.eurpsy.2015.02.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 02/10/2015] [Accepted: 02/11/2015] [Indexed: 10/23/2022] Open
Abstract
AbstractBackgroundIn schizophrenia, brain morphometric changes may be associated with antipsychotic medication. Only limited data is available concerning individuals with schizophrenia without antipsychotic medication. We aimed to study the associations of: use versus no use of antipsychotic medication; length of continuous time without antipsychotic medication; cumulative dose of lifetime antipsychotic medication; and type of antipsychotic medication; with brain morphometry in schizophrenia after an average of 10 years of illness.MethodsData of 63 individuals with schizophrenia (mean duration of illness 10.4 years) from the Northern Finland Birth Cohort 1966 were gathered by interview and from hospital and outpatient records. Structural MRI data at age 34 years were acquired and grey matter volume maps with voxel-based morphometry were analyzed using FSL tools.ResultsOf the individuals studied, 15 (24%) had taken no antipsychotic medication during the previous year. Individuals with antipsychotic medication had lower total grey matter (TGM) volume compared with non-medicated subjects, although this association was not statistically significant (Cohen's d = –0.51, P = 0.078). Time without antipsychotic medication associated with increased TGM (P = 0.028). Longer time without antipsychotic medication associated with increased regional volume in right precentral gyrus and right middle frontal gyrus. There were no associations between cumulative dose of lifetime antipsychotic medication or type of antipsychotic medication and brain morphometry.ConclusionsUnlike some previous investigators, we found no association between cumulative dose of lifetime antipsychotic medication and brain morphological changes in this population-based sample. However, longer continuous time without antipsychotic medication preceding the MRI scan associated with increased gray matter volume.
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Turkheimer FE, Selvaggi P, Mehta MA, Veronese M, Zelaya F, Dazzan P, Vernon AC. Normalizing the Abnormal: Do Antipsychotic Drugs Push the Cortex Into an Unsustainable Metabolic Envelope? Schizophr Bull 2020; 46:484-495. [PMID: 31755955 PMCID: PMC7147598 DOI: 10.1093/schbul/sbz119] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The use of antipsychotic medication to manage psychosis, principally in those with a diagnosis of schizophrenia or bipolar disorder, is well established. Antipsychotics are effective in normalizing positive symptoms of psychosis in the short term (delusions, hallucinations and disordered thought). Their long-term use is, however, associated with side effects, including several types of movement (extrapyramidal syndrome, dyskinesia, akathisia), metabolic and cardiac disorders. Furthermore, higher lifetime antipsychotic dose-years may be associated with poorer cognitive performance and blunted affect, although the mechanisms driving the latter associations are not well understood. In this article, we propose a novel model of the long-term effects of antipsychotic administration focusing on the changes in brain metabolic homeostasis induced by the medication. We propose here that the brain metabolic normalization, that occurs in parallel to the normalization of psychotic symptoms following antipsychotic treatment, may not ultimately be sustainable by the cerebral tissue of some patients; these patients may be characterized by already reduced oxidative metabolic capacity and this may push the brain into an unsustainable metabolic envelope resulting in tissue remodeling. To support this perspective, we will review the existing data on the brain metabolic trajectories of patients with a diagnosis of schizophrenia as indexed using available neuroimaging tools before and after use of medication. We will also consider data from pre-clinical studies to provide mechanistic support for our model.
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Affiliation(s)
- Federico E Turkheimer
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- MRC Centre for Neurodevelopmental Disorders, King’s College London, London, UK
| | - Pierluigi Selvaggi
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Mitul A Mehta
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Mattia Veronese
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Fernando Zelaya
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Paola Dazzan
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Anthony C Vernon
- MRC Centre for Neurodevelopmental Disorders, King’s College London, London, UK
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
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45
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Derome M, Zöller D, Modinos G, Schaer M, Eliez S, Debbané M. Developmental trajectories of subcortical structures in relation to dimensional schizotypy expression along adolescence. Schizophr Res 2020; 218:76-84. [PMID: 32081537 DOI: 10.1016/j.schres.2020.02.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 02/09/2020] [Accepted: 02/09/2020] [Indexed: 12/31/2022]
Abstract
Morphological abnormalities of subcortical structures have been consistently reported along the schizophrenia clinical spectrum, and they may play an important role in the pathophysiology of psychosis. However, the question arises whether these subcortical features are consequences of medication and illness chronicity, or if they contribute to the vulnerability to develop schizophrenia spectrum disorders. If some of the subcortical abnormalities could be evidenced in community adolescents expressing higher schizotypal traits (psychometric schizotypy), they could potentially shed light on vulnerability markers. To date, very few studies have examined the link between psychometric schizotypy and volumes of subcortical regions, and none of them have used a longitudinal design. This study sets out to investigate developmental trajectories of subcortical volumes in 110 community adolescents (12 to 20 years old), for whom MRI-scans were acquired over a period of 5 years, reaching a total of 297 scans. Analyses were conducted using Freesurfer, and schizotypal traits were measured with the Schizotypal Personality Questionnaire (SPQ). Using mixed model regression analyses following a region-of-interest approach, we observed differential linear developmental trajectories in four subcortical structures when comparing higher versus lower scorers on the disorganized schizotypy dimension (bilateral hippocampus, left-lateral ventricle and left-pallidum) and the negative schizotypy dimension (bilateral pallidum, and right-thalamus). All results survived a threshold of p < .05 (FDR-corrected) while covarying for the effect of other psychological problems (externalized and internalized psychopathology). These results indicate that expression of higher levels of negative and disorganized schizotypy during adolescence was associated with neural markers linking schizotypy personality features to schizophrenia spectrum disorders.
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Affiliation(s)
- Mélodie Derome
- Developmental Clinical Psychology Research Unit, Faculty of Psychology and Educational Sciences, University of Geneva, Switzerland; Developmental Neuroimaging and Psychopathology Laboratory, Department of Psychiatry, University of Geneva, Switzerland.
| | - Daniela Zöller
- Developmental Neuroimaging and Psychopathology Laboratory, Department of Psychiatry, University of Geneva, Switzerland; Medical Image Processing Lab, Institute of Bioengineering, EPFL, Lausanne, Switzerland; Department of Radiology and Medical Informatics, University of Geneva, Geneva, Switzerland.
| | - Gemma Modinos
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK; Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK.
| | - Marie Schaer
- Developmental Neuroimaging and Psychopathology Laboratory, Department of Psychiatry, University of Geneva, Switzerland.
| | - Stephan Eliez
- Developmental Neuroimaging and Psychopathology Laboratory, Department of Psychiatry, University of Geneva, Switzerland; Department of Genetic Medicine and Development, School of Medicine, University of Geneva, Switzerland.
| | - Martin Debbané
- Developmental Clinical Psychology Research Unit, Faculty of Psychology and Educational Sciences, University of Geneva, Switzerland; Developmental Neuroimaging and Psychopathology Laboratory, Department of Psychiatry, University of Geneva, Switzerland; Research Department of Clinical, Educational & Health Psychology, University College London, United Kingdom.
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Li H, Ou Y, Liu F, Su Q, Zhang Z, Chen J, Zhu F, Zhao J, Guo W. Region-specific insular volumetric decreases in drug-naive, first-episode schizophrenia and their unaffected siblings. Am J Med Genet B Neuropsychiatr Genet 2020; 183:106-112. [PMID: 31626393 DOI: 10.1002/ajmg.b.32765] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 09/18/2019] [Accepted: 09/30/2019] [Indexed: 11/10/2022]
Abstract
Decreased insular volume may be one of the anatomical alterations caused by schizophrenia. The possibility of region-specific insular volumetric reduction as an endophenotype and/or a possible treatment predictor is a critical issue with great implications for the diagnosis and prognosis of the disease. The sample of the current study comprised 44 drug-naive and first-episode patients, 42 unaffected siblings, and 44 healthy controls. A computational anatomy toolbox (CAT12) was applied to analyze the structural images with a fine-grained, cross-validated brainnetome atlas. Correlation analysis and support vector regression (SVR) were used to determine the relationship between insular deficits and symptomatic severity among patients. The gray matter volume (GMV) values in the left hypergranular insula (G) exhibited the following pattern: patients < siblings < controls. GMV values in the right ventral agranular insula (vIa) and baseline Positive and Negative Syndrome Scale negative symptoms subscale scores among patients showed a positive correlation (r = 0.384, p = .010). Further SVR analysis exhibited a significantly positive correlation between GMV values in the right vIa and negative symptomatic improvement among patients (r = 0.537, p < .001). Results suggested the presence of region-specific insular volumetric decreases in first-episode schizophrenia. Thus, volumetric decrease in left G might be a potential endophenotype for schizophrenia, and GMV values in right vIa might be used to predict negative symptomatic improvement in schizophrenia.
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Affiliation(s)
- Huabing Li
- Department of Radiology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Yangpan Ou
- Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China.,National Clinical Research Center of Mental Disorders, Changsha, China
| | - Feng Liu
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Qinji Su
- Mental Health Center, the Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Zhikun Zhang
- Mental Health Center, the Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jindong Chen
- Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China.,National Clinical Research Center of Mental Disorders, Changsha, China
| | - Furong Zhu
- Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China.,National Clinical Research Center of Mental Disorders, Changsha, China
| | - Jingping Zhao
- Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China.,National Clinical Research Center of Mental Disorders, Changsha, China
| | - Wenbin Guo
- Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China.,National Clinical Research Center of Mental Disorders, Changsha, China
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Hammans C, Neugebauer K, Kumar V, Mevissen L, Sternkopf MA, Novakovic A, Wensing T, Habel U, Abel T, Nickl-Jockschat T. BDNF Serum Levels are Associated With White Matter Microstructure in Schizophrenia - A Pilot Study. Front Psychiatry 2020; 11:31. [PMID: 32153434 PMCID: PMC7046752 DOI: 10.3389/fpsyt.2020.00031] [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: 10/04/2019] [Accepted: 01/10/2020] [Indexed: 11/21/2022] Open
Abstract
Brain derived neurotrophic factor (BDNF) has been implicated in the pathophysiology of schizophrenia. As BDNF regulates axonal and dendritic growth, altered BDNF levels in schizophrenia patients might underlie changes in structural connectivity that have been identified by magnetic resonance imaging (MRI). We investigated a possible correlation between BDNF serum levels, fiber tract architecture, and regional grey matter volumes in 19 schizophrenia patients and a gender- and age-matched control group. Two patients had to be excluded due to abnormalities in their MRI scans. Serum samples were obtained to determine BDNF levels, and T1- as well as diffusion-weighted sequences were acquired. We, then, investigated correlations between BDNF serum levels with neuroimaging parameters, using Voxel-based Morphometry (VBM) and Tract-based Spatial Statistics (TBSS). We found a significant negative correlation between BDNF serum levels and FA values in the right inferior fronto-occipital fasciculus and the right superior longitudinal fasciculus. These regions also showed a decrease in AD values in schizophrenia patients. Grey matter volumes were reduced in patients but there was no correlation between regional grey matter volumes and BDNF. The right superior longitudinal fasciculus has been repeatedly identified to exhibit microstructural changes in schizophrenia patients. Our findings of a negative correlation between BDNF and FA values in patients might indicate that BDNF is upregulated to compensate decreased structural connectivity as it induces neural plasticity and shows increased levels in damaged tissue. These findings of our pilot study are encouraging leads for future research in larger samples.
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Affiliation(s)
- Christine Hammans
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, RWTH Aachen University, Aachen, Germany.,JARA - Translational Brain Medicine, Jülich-Aachen Research Alliance, Jülich, Germany
| | - Kristina Neugebauer
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, RWTH Aachen University, Aachen, Germany.,JARA - Translational Brain Medicine, Jülich-Aachen Research Alliance, Jülich, Germany
| | - Vinod Kumar
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, RWTH Aachen University, Aachen, Germany.,JARA - Translational Brain Medicine, Jülich-Aachen Research Alliance, Jülich, Germany.,Department of High-field Magnetic Resonance, Max-Planck-Institute for Biological Cybernetics, Tübingen, Germany
| | - Lea Mevissen
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, RWTH Aachen University, Aachen, Germany.,JARA - Translational Brain Medicine, Jülich-Aachen Research Alliance, Jülich, Germany
| | - Melanie A Sternkopf
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, RWTH Aachen University, Aachen, Germany.,JARA - Translational Brain Medicine, Jülich-Aachen Research Alliance, Jülich, Germany
| | - Ana Novakovic
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, RWTH Aachen University, Aachen, Germany.,JARA - Translational Brain Medicine, Jülich-Aachen Research Alliance, Jülich, Germany
| | - Tobias Wensing
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, RWTH Aachen University, Aachen, Germany.,JARA - Translational Brain Medicine, Jülich-Aachen Research Alliance, Jülich, Germany
| | - Ute Habel
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, RWTH Aachen University, Aachen, Germany.,Institute of Neuroscience and Medicine: JARA-Institute Brain Structure Function Relationship (INM 10), Research Center Jülich, Jülich, Germany
| | - Ted Abel
- Carver College of Medicine, Iowa Neuroscience Institute, University of Iowa, Iowa City, IA, United States
| | - Thomas Nickl-Jockschat
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, RWTH Aachen University, Aachen, Germany.,JARA - Translational Brain Medicine, Jülich-Aachen Research Alliance, Jülich, Germany.,Carver College of Medicine, Iowa Neuroscience Institute, University of Iowa, Iowa City, IA, United States.,Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City, IA, United States
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Birner A, Bengesser SA, Seiler S, Dalkner N, Queissner R, Platzer M, Fellendorf FT, Hamm C, Maget A, Pilz R, Lenger M, Reininghaus B, Pirpamer L, Ropele S, Hinteregger N, Magyar M, Deutschmann H, Enzinger C, Kapfhammer HP, Reininghaus EZ. Total gray matter volume is reduced in individuals with bipolar disorder currently treated with atypical antipsychotics. J Affect Disord 2020; 260:722-727. [PMID: 31563071 DOI: 10.1016/j.jad.2019.09.068] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 09/13/2019] [Accepted: 09/18/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND/AIMS Recent evidence indicates that the intake of atypical antipsychotics (AAP) is associated with gray matter abnormalities in patients with psychiatric disorders. We explored if patients with bipolar disorder (BD) who are medicated with AAP exhibit total gray matter volume (TGV) reduction compared to BD individuals not medicated with AAP and healthy controls (HC). METHODS In a cross-sectional design, 124 individuals with BD and 86 HC underwent 3T-MRI of the brain and clinical assessment as part of our BIPFAT-study. The TGV was estimated using Freesurfer. We used univariate covariance analysis (ANCOVA) to test for normalized TGV differences and controlled for covariates. RESULTS ANCOVA results indicated that 75 BD individuals taking AAP had significantly reduced normalized TGV as compared to 49 BD not taking AAP (F = 9.995, p = .002., Eta = 0.084) and 86 HC (F = 7.577, p = .007, Eta = 0.046). LIMITATIONS Our cross-sectional results are not suited to draw conclusions about causality. We have no clear information on treatment time and baseline volumes before drug treatment in the studied subjects. We cannot exclude that patients received different psychopharmacologic medications prior to the study point. We did not included dosages into the calculation. Many BD individuals received combinations of psychopharmacotherapy across drug classes. We did not have records displaying quantitative alcohol consumption and drug abuse in our sample. CONCLUSIONS Our data provide further evidence for the impact of AAP on brain structure in BD. Longitudinal studies are needed to investigate the causal directions of the proposed relationships.
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Affiliation(s)
- Armin Birner
- Department of Psychiatry and Psychotherapy, Medical University of Graz, Auenbruggerplatz 31, A-8036, Graz, Austria
| | - Susanne A Bengesser
- Department of Psychiatry and Psychotherapy, Medical University of Graz, Auenbruggerplatz 31, A-8036, Graz, Austria.
| | - Stephan Seiler
- Imaging of Dementia and Aging (IDeA), Laboratory Department of Neurology and Center for Neuroscience, University of California, Davis, USA
| | - Nina Dalkner
- Department of Psychiatry and Psychotherapy, Medical University of Graz, Auenbruggerplatz 31, A-8036, Graz, Austria
| | - Robert Queissner
- Department of Psychiatry and Psychotherapy, Medical University of Graz, Auenbruggerplatz 31, A-8036, Graz, Austria
| | - Martina Platzer
- Department of Psychiatry and Psychotherapy, Medical University of Graz, Auenbruggerplatz 31, A-8036, Graz, Austria
| | - Frederike T Fellendorf
- Department of Psychiatry and Psychotherapy, Medical University of Graz, Auenbruggerplatz 31, A-8036, Graz, Austria
| | - Carlo Hamm
- Department of Psychiatry and Psychotherapy, Medical University of Graz, Auenbruggerplatz 31, A-8036, Graz, Austria
| | - Alexander Maget
- Department of Psychiatry and Psychotherapy, Medical University of Graz, Auenbruggerplatz 31, A-8036, Graz, Austria
| | - Rene Pilz
- Department of Psychiatry and Psychotherapy, Medical University of Graz, Auenbruggerplatz 31, A-8036, Graz, Austria
| | - Melanie Lenger
- Department of Psychiatry and Psychotherapy, Medical University of Graz, Auenbruggerplatz 31, A-8036, Graz, Austria
| | - Bernd Reininghaus
- Department of Psychiatry and Psychotherapy, Medical University of Graz, Auenbruggerplatz 31, A-8036, Graz, Austria
| | - Lukas Pirpamer
- Department of Neurology, Medical University of Graz, Austria
| | - Stefan Ropele
- Department of Neurology, Medical University of Graz, Austria; Division of Neuroradiology, Department of Radiology, Medical University of Graz, Austria
| | - Nicole Hinteregger
- Division of Neuroradiology, Department of Radiology, Medical University of Graz, Austria
| | - Marton Magyar
- Division of Neuroradiology, Department of Radiology, Medical University of Graz, Austria
| | - Hannes Deutschmann
- Division of Neuroradiology, Department of Radiology, Medical University of Graz, Austria
| | - Christian Enzinger
- Department of Neurology, Medical University of Graz, Austria; Division of Neuroradiology, Department of Radiology, Medical University of Graz, Austria
| | - Hans-Peter Kapfhammer
- Department of Psychiatry and Psychotherapy, Medical University of Graz, Auenbruggerplatz 31, A-8036, Graz, Austria
| | - Eva Z Reininghaus
- Department of Psychiatry and Psychotherapy, Medical University of Graz, Auenbruggerplatz 31, A-8036, Graz, Austria
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Hui CLM, Wong AKH, Leung WWT, Lee EHM, Chan SKW, Chang WC, Chen EYH, Chan TCT, Swapna V, Tagata H, Tsujino N, Nemoto T, Mizuno M, Kang NI, Kim SW, Chung YC. Psychiatrists' opinion towards medication discontinuation in remitted first-episode psychosis: A multi-site study of the Asian Network for Early Psychosis. Early Interv Psychiatry 2019; 13:1329-1337. [PMID: 30485671 DOI: 10.1111/eip.12765] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 09/01/2018] [Accepted: 11/04/2018] [Indexed: 11/26/2022]
Abstract
AIM The study investigated psychiatrists' views towards the issue of medication discontinuation for patients in remission from first-episode psychosis in four countries (Hong Kong, Korea, Singapore and Japan) that are part of the Asian Network for Early Psychosis, focusing on whether the views of these countries differ with one another. METHODS A questionnaire was distributed to psychiatrists for completion. The questionnaire contained three sections: direct questions probing at views on medication discontinuation, case vignettes to assess applied decision-making and a checklist of criteria psychiatrists may view as necessary for the patient to satisfy before discontinuation. Total of 484 psychiatrists (97 from Hong Kong, 88 from Korea, 64 from Singapore and 233 from Japan) completed the questionnaire. RESULTS We found that (a) Asian psychiatrists believed that 1% to 19% of remitted patients can discontinue medication, an estimation that was lower than Western psychiatrists; (b) in agreement with clinical guidelines, Asian psychiatrists believed that patients should remain on medication for at least 1 to 2 years following the absence of psychotic symptoms; (c) "Absence of any relapsing episode following first episode" was considered the most important criterion when making a decision; and (d) there were significant differences in clinicians' perceptions across the four countries: for instance, Korean psychiatrists were more conservative with the duration of antipsychotics maintenance, while Singaporean psychiatrists were more open-minded towards clinical trials. CONCLUSIONS Culture and social norms appear to determine the relative importance of factors that psychiatrists might consider during the decision-making process, thereby producing variations in the views held in different countries.
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Affiliation(s)
- Christy L-M Hui
- Department of Psychiatry, University of Hong Kong, Hong Kong, SAR, China
| | - Andreas K-H Wong
- Department of Psychiatry, University of Hong Kong, Hong Kong, SAR, China
| | - Whitty W-T Leung
- Department of Psychiatry, University of Hong Kong, Hong Kong, SAR, China
| | - Edwin H-M Lee
- Department of Psychiatry, University of Hong Kong, Hong Kong, SAR, China
| | - Sherry K-W 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
| | - 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
| | - Eric Y-H 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
| | - Tommy C-T Chan
- Institute of Mental Health, Singapore.,Duke-NUS Medical School, Singapore
| | - Verma Swapna
- Institute of Mental Health, Singapore.,Duke-NUS Medical School, Singapore
| | - Hiromi Tagata
- Department of Neuropsychiatry, Toho University School of Medicine, Tokyo, Japan
| | - Naohisa Tsujino
- Department of Neuropsychiatry, Toho University School of Medicine, Tokyo, Japan
| | - Takahiro Nemoto
- Department of Neuropsychiatry, Toho University School of Medicine, Tokyo, Japan
| | - Masafumi Mizuno
- Department of Neuropsychiatry, Toho University School of Medicine, Tokyo, Japan
| | - Nam-In Kang
- Department of Psychiatry, Maeumsarang Hospital, Wanju, Korea
| | - Sung-Wan Kim
- Mindlink and Department of Psychiatry, Chonnam National University Medical School, Gwangju, Korea
| | - Young-Chul Chung
- Department of Psychiatry, Chonbuk National University Medical School, Jeonju, Korea.,Research Institute of Clinical Medicine of Chonbuk National University - Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea
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50
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Quidé Y, Wilhelmi C, Green MJ. Structural brain morphometry associated with theory of mind in bipolar disorder and schizophrenia. Psych J 2019; 9:234-246. [DOI: 10.1002/pchj.322] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 09/04/2019] [Accepted: 09/30/2019] [Indexed: 11/06/2022]
Affiliation(s)
- Yann Quidé
- School of Psychiatry University of New South Wales Sydney Australia
- Neuroscience Research Australia Randwick Australia
| | | | - Melissa J. Green
- School of Psychiatry University of New South Wales Sydney Australia
- Neuroscience Research Australia Randwick Australia
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