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Guimond S, Alftieh A, Devenyi GA, Mike L, Chakravarty MM, Shah JL, Parker DA, Sweeney JA, Pearlson G, Clementz BA, Tamminga CA, Keshavan M. Enlarged pituitary gland volume: a possible state rather than trait marker of psychotic disorders. Psychol Med 2024; 54:1835-1843. [PMID: 38357733 PMCID: PMC11132920 DOI: 10.1017/s003329172300380x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
BACKGROUND Enlarged pituitary gland volume could be a marker of psychotic disorders. However, previous studies report conflicting results. To better understand the role of the pituitary gland in psychosis, we examined a large transdiagnostic sample of individuals with psychotic disorders. METHODS The study included 751 participants (174 with schizophrenia, 114 with schizoaffective disorder, 167 with psychotic bipolar disorder, and 296 healthy controls) across six sites in the Bipolar-Schizophrenia Network on Intermediate Phenotypes consortium. Structural magnetic resonance images were obtained, and pituitary gland volumes were measured using the MAGeT brain algorithm. Linear mixed models examined between-group differences with controls and among patient subgroups based on diagnosis, as well as how pituitary volumes were associated with symptom severity, cognitive function, antipsychotic dose, and illness duration. RESULTS Mean pituitary gland volume did not significantly differ between patients and controls. No significant effect of diagnosis was observed. Larger pituitary gland volume was associated with greater symptom severity (F = 13.61, p = 0.0002), lower cognitive function (F = 4.76, p = 0.03), and higher antipsychotic dose (F = 5.20, p = 0.02). Illness duration was not significantly associated with pituitary gland volume. When all variables were considered, only symptom severity significantly predicted pituitary gland volume (F = 7.54, p = 0.006). CONCLUSIONS Although pituitary volumes were not increased in psychotic disorders, larger size may be a marker associated with more severe symptoms in the progression of psychosis. This finding helps clarify previous inconsistent reports and highlights the need for further research into pituitary gland-related factors in individuals with psychosis.
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Affiliation(s)
- Synthia Guimond
- Department of Psychiatry, The Royal’s Institute of Mental Health Research, University of Ottawa, Ottawa, ON, Canada
- Department of Psychoeducation and Psychology, Université du Québec en Outaouais, Gatineau, QC, Canada
- Department of Psychiatry, Massachusetts Mental Health Center and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Ahmad Alftieh
- Department of Psychiatry, The Royal’s Institute of Mental Health Research, University of Ottawa, Ottawa, ON, Canada
| | - Gabriel A. Devenyi
- Department of Psychiatry, McGill University, Montréal, QC, Canada
- Douglas Mental Health University Institute, Verdun, QC, Canada
| | - Luke Mike
- Department of Psychiatry, Massachusetts Mental Health Center and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - M. Mallar Chakravarty
- Department of Psychiatry, McGill University, Montréal, QC, Canada
- Douglas Mental Health University Institute, Verdun, QC, Canada
- Department of Biomedical Engineering, McGill University Montréal, QC, Canada
- Cerebral Imaging Centre, Douglas Mental Health University Institute, Verdun, QC, Canada
| | - Jai L. Shah
- Department of Psychiatry, McGill University, Montréal, QC, Canada
- Douglas Mental Health University Institute, Verdun, QC, Canada
| | - David A. Parker
- Department of Psychology, BioImaging Research Center, University of Georgia, Athens, GA, USA
- Department of and Neuroscience, BioImaging Research Center, University of Georgia, Athens, GA, USA
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, USA
| | - John A. Sweeney
- Department of Psychiatry, University of Cincinnati, Cincinnati, OH, USA
| | - Godfrey Pearlson
- Department of Psychiatry, Yale University, New Haven, CT, USA
- Department of Neuroscience, Yale University, New Haven, CT, USA
| | - Brett A. Clementz
- Department of Psychology, BioImaging Research Center, University of Georgia, Athens, GA, USA
- Department of and Neuroscience, BioImaging Research Center, University of Georgia, Athens, GA, USA
| | - Carol A. Tamminga
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA
| | - Matcheri Keshavan
- Department of Psychiatry, Massachusetts Mental Health Center and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Ruggeri A, Nerland S, Mørch-Johnsen L, Jørgensen KN, Barth C, Wortinger LA, Andreou D, Andreassen OA, Agartz I. Hypothalamic Subunit Volumes in Schizophrenia and Bipolar Spectrum Disorders. Schizophr Bull 2024; 50:533-544. [PMID: 38206841 PMCID: PMC11059784 DOI: 10.1093/schbul/sbad176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
BACKGROUND The hypothalamus is central to many hormonal and autonomous nervous system pathways. Emerging evidence indicates that these pathways may be disrupted in schizophrenia and bipolar disorder. Yet, few studies have examined the volumes of hypothalamic subunits in these patient groups. We compared hypothalamic subunit volumes in individuals with psychotic disorders to healthy controls. STUDY DESIGN We included 344 patients with schizophrenia spectrum disorders (SCZ), 340 patients with bipolar disorders (BPD), and 684 age- and-sex-matched healthy controls (CTR). Total hypothalamus and five hypothalamic subunit volumes were extracted from T1-weighted magnetic resonance imaging (MRI) using an automated Bayesian segmentation method. Regression models, corrected for age, age2, sex, and segmentation-based intracranial volume (sbTIV), were used to examine diagnostic group differences, interactions with sex, and associations with clinical symptoms, antipsychotic medication, antidepressants and mood stabilizers. STUDY RESULTS SCZ had larger volumes in the left inferior tubular subunit and smaller right anterior-inferior, right anterior-superior, and right posterior hypothalamic subunits compared to CTR. BPD did not differ significantly from CTR for any hypothalamic subunit volume, however, there was a significant sex-by-diagnosis interaction. Analyses stratified by sex showed smaller right hypothalamus and right posterior subunit volumes in male patients, but not female patients, relative to same-sex controls. There was a significant association between BPD currently taking antipsychotic medication and the left inferior tubular subunits volumes. CONCLUSIONS Our results show regional-specific alterations in hypothalamus subunit volumes in individuals with SCZ, with relevance to HPA-axis dysregulation, circadian rhythm disruption, and cognition impairment.
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Affiliation(s)
- Aurora Ruggeri
- Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
- Norwegian Centre for Mental Disorders Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Stener Nerland
- Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
- Norwegian Centre for Mental Disorders Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Lynn Mørch-Johnsen
- Norwegian Centre for Mental Disorders Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Psychiatry, Østfold Hospital, Grålum, Norway
- Department of Clinical Research, Østfold Hospital, Grålum, Norway
| | - Kjetil Nordbø Jørgensen
- Norwegian Centre for Mental Disorders Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Psychiatry, Telemark Hospital, Skien, Norway
| | - Claudia Barth
- Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
- Norwegian Centre for Mental Disorders Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Laura Anne Wortinger
- Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
- Norwegian Centre for Mental Disorders Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Dimitrios Andreou
- Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
- Norwegian Centre for Mental Disorders Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Stockholm Region, Stockholm, Sweden
| | - Ole A Andreassen
- Norwegian Centre for Mental Disorders Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Norwegian Centre for Mental Disorders Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Ingrid Agartz
- Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
- Norwegian Centre for Mental Disorders Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Stockholm Region, Stockholm, Sweden
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Xenaki LA, Dimitrakopoulos S, Selakovic M, Stefanis N. Stress, Environment and Early Psychosis. Curr Neuropharmacol 2024; 22:437-460. [PMID: 37592817 PMCID: PMC10845077 DOI: 10.2174/1570159x21666230817153631] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 01/02/2023] [Accepted: 01/04/2023] [Indexed: 08/19/2023] Open
Abstract
Existing literature provides extended evidence of the close relationship between stress dysregulation, environmental insults, and psychosis onset. Early stress can sensitize genetically vulnerable individuals to future stress, modifying their risk for developing psychotic phenomena. Neurobiological substrate of the aberrant stress response to hypothalamic-pituitary-adrenal axis dysregulation, disrupted inflammation processes, oxidative stress increase, gut dysbiosis, and altered brain signaling, provides mechanistic links between environmental risk factors and the development of psychotic symptoms. Early-life and later-life exposures may act directly, accumulatively, and repeatedly during critical neurodevelopmental time windows. Environmental hazards, such as pre- and perinatal complications, traumatic experiences, psychosocial stressors, and cannabis use might negatively intervene with brain developmental trajectories and disturb the balance of important stress systems, which act together with recent life events to push the individual over the threshold for the manifestation of psychosis. The current review presents the dynamic and complex relationship between stress, environment, and psychosis onset, attempting to provide an insight into potentially modifiable factors, enhancing resilience and possibly influencing individual psychosis liability.
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Affiliation(s)
- Lida-Alkisti Xenaki
- First Department of Psychiatry, School of Medicine, Eginition Hospital, National and Kapodistrian University of Athens, 72 Vas. Sophias Ave., Athens, 115 28, Greece
| | - Stefanos Dimitrakopoulos
- First Department of Psychiatry, School of Medicine, Eginition Hospital, National and Kapodistrian University of Athens, 72 Vas. Sophias Ave., Athens, 115 28, Greece
| | - Mirjana Selakovic
- First Department of Psychiatry, School of Medicine, Eginition Hospital, National and Kapodistrian University of Athens, 72 Vas. Sophias Ave., Athens, 115 28, Greece
| | - Nikos Stefanis
- First Department of Psychiatry, School of Medicine, Eginition Hospital, National and Kapodistrian University of Athens, 72 Vas. Sophias Ave., Athens, 115 28, Greece
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Leung KK, Wong YC, Shea KS, Chan SC, Chang WC, Mo YMF, Chan SMS. Altered neutrophil-to-lymphocyte ratio in patients with non-affective first episode psychosis and its relationship with symptom severity and cognitive impairment. Sci Rep 2023; 13:11453. [PMID: 37454218 PMCID: PMC10349799 DOI: 10.1038/s41598-023-37846-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 06/28/2023] [Indexed: 07/18/2023] Open
Abstract
Signatures of immune dysregulation as clinical biomarker for psychosis have remained unclear. We aimed to compare the Neutrophil-to-lymphocyte ratio (NLR) of patients with acute non-affective first-episode psychosis (FEP) with healthy controls after accounting for emotional states. We also explored the associations of NLR with symptom severity, onset profile and cognitive functions. The NLR was enumerated from complete blood count taken within a week of assessment. All FEP patients were rated on the Positive and Negative Syndrome Scale (PANSS) and the Clinician Global Impression-Severity (CGI-S) with verbal memory and executive functions assessed with the Cambridge Neuropsychological Test Automated Battery. Prevailing emotional state was measured with Beck Depression Inventory-II and Beck Anxiety Inventory. Out of seventy-nine consecutive FEP patients presenting to the study site, twenty-seven subjects were eligible and recruited. Twenty-seven age-/sex-matched controls were recruited. FEP patients had an NLR of 1.886 over the controls after accounting for scores on emotional states. The NLR of FEP patients was positively associated with CGI-S scores, PANSS positive symptom, disorganization and excitation scores. There was no significant correlation between NLR with the duration of untreated psychosis and cognitive performances. These findings support using NLR as a clinical biomarker in FEP, purporting further prospective study to measure NLR changes in the course of treatment.
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Affiliation(s)
- Kwan Keung Leung
- Department of Psychiatry, Tai Po Hospital, G30, Ground Floor, Multicentre, Tai Po Hospital, Tai Po, New Territories, Hong Kong, SAR, China
- Department of Psychiatry, Alice Ho Miu Ling Nethersole Hospital, Hong Kong, China
| | - Yip Chau Wong
- Department of Psychiatry, Tai Po Hospital, G30, Ground Floor, Multicentre, Tai Po Hospital, Tai Po, New Territories, Hong Kong, SAR, China
- Department of Psychiatry, Alice Ho Miu Ling Nethersole Hospital, Hong Kong, China
| | - Ka Sin Shea
- Department of Psychiatry, Tai Po Hospital, G30, Ground Floor, Multicentre, Tai Po Hospital, Tai Po, New Territories, Hong Kong, SAR, China
- Department of Psychiatry, Alice Ho Miu Ling Nethersole Hospital, Hong Kong, China
| | - Sheung Chun Chan
- Department of Psychiatry, Tai Po Hospital, G30, Ground Floor, Multicentre, Tai Po Hospital, Tai Po, New Territories, Hong Kong, SAR, China
- Department of Psychiatry, Alice Ho Miu Ling Nethersole Hospital, Hong Kong, China
| | - Wing Chung Chang
- Department of Psychiatry, Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Yi Man Flora Mo
- Department of Psychiatry, Tai Po Hospital, G30, Ground Floor, Multicentre, Tai Po Hospital, Tai Po, New Territories, Hong Kong, SAR, China
- Department of Psychiatry, Alice Ho Miu Ling Nethersole Hospital, Hong Kong, China
| | - Sau Man Sandra Chan
- Department of Psychiatry, Tai Po Hospital, G30, Ground Floor, Multicentre, Tai Po Hospital, Tai Po, New Territories, Hong Kong, SAR, China.
- Department of Psychiatry, Alice Ho Miu Ling Nethersole Hospital, Hong Kong, China.
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
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5
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Bhattacharyya S, Schoeler T, Di Forti M, Murray R, Cullen AE, Colizzi M. Stressful life events and relapse of psychosis: analysis of causal association in a 2-year prospective observational cohort of individuals with first-episode psychosis in the UK. Lancet Psychiatry 2023; 10:414-425. [PMID: 37146625 PMCID: PMC10728826 DOI: 10.1016/s2215-0366(23)00110-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 03/22/2023] [Accepted: 03/22/2023] [Indexed: 05/07/2023]
Abstract
BACKGROUND Despite accumulating evidence of an association between stressful life events and psychosis relapse, the extent to which this is a causal relationship remains unclear. We aimed to examine the association between exposure to, and number of, stressful life events after initial psychosis onset and psychosis relapse. METHODS In this 2-year prospective observational study, we recruited individuals with first-episode psychosis, aged 18-65 years, who presented to psychiatric services in south London, UK. Participants were assessed via interview, with additional data obtained from electronic clinical records. Stressful life events were recorded at psychosis onset and during the 2-year follow-up using a brief questionnaire that assesses 12 major life events. Psychosis relapse was defined as inpatient admission because of symptom exacerbation within 2 years from psychosis onset. We examined the time to first psychosis relapse and the number and length of relapses using survival and binomial regression analyses. We used fixed-effects regression and cross-lagged path analysis to examine the directionality of effects and control for unmeasured confounders. FINDINGS Between April 12, 2002, and July 26, 2013, 256 individuals with first-episode psychosis (100 [39%] female and 156 [61%] male; 16 [6%] Asian, 140 [55%] Black African or Caribbean, 86 [34%] White, and 14 [6%] mixed ethnicity) were recruited, with a mean age of onset of psychosis of 28·06 years (SD 8·03; range 17·21-56·03). 93 (36%) participants experienced at least one relapse during the 2-year follow-up. 253 individuals had all relevant data and were included in analyses. For people exposed to stressful life events after the onset of psychosis, the adjusted hazard (hazard ratio [HR] 2·60, 95% CI 1·63-4·16, p<0·0001), incidence (incidence rate ratio [IRR] 1·87, 1·24-2·80, p=0·0026), and length (IRR 2·53, 1·40-4·67, p=0·0011) of relapse were greater than for those who were unexposed. These relationships were dose dependent (HR 1·36; 1·09-1·69, p=0·0054; incidence IRR 1·26, 1·02-1·53, p=0·023; length IRR 1·52, 1·12-2·12, p=0·0028). Adjusted fixed-effects models showed a higher (odds ratio [OR] 3·82, 1·82-8·00, p=0·0004) and dose-dependent (OR 1·62, 1·18-2·21, p=0·0028) risk of relapse when stressful life events preceded relapse compared with the period when they did not. Cross-lagged path analysis confirmed an effect of stressful life events on the number of subsequent relapses (β=0·66, p=0·0055) that was dose dependent (β=0·29, p=0·029), but it did not show an effect of relapses on subsequent risk or number of stressful life events. INTERPRETATION These results provide converging evidence of a causal effect of stressful life events on the risk of relapse in psychosis. They suggest that there is a need to develop interventions at the individual and health-service level that could mitigate the harmful effects of stressful life events. FUNDING National Institute for Health Research, UK.
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Affiliation(s)
- Sagnik Bhattacharyya
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Tabea Schoeler
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Department of Computational Biology, University of Lausanne, Lausanne, Switzerland
| | - Marta Di Forti
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Robin Murray
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Alexis E Cullen
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Marco Colizzi
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Unit of Psychiatry, Department of Medicine (DAME), University of Udine, Udine, Italy
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6
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Almstrup FB, Nordentoft M, Jensen MA, Kristiansen J, Kristensen TD, Wenneberg C, Garde AH, Glenthøj LB, Nordholm D. Associations between saliva alpha-amylase, heart rate variability, saliva cortisol and cognitive performance in individuals at ultra high-risk for psychosis. Schizophr Res 2023; 255:165-172. [PMID: 37001391 DOI: 10.1016/j.schres.2023.03.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 02/24/2023] [Accepted: 03/18/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND Cognitive impairments are present in individuals at ultra-high risk (UHR) of psychosis and UHR individuals exhibit a hyperactive and dysfunctional HPA-axis. Increasing stress levels could potentially lead to cognitive impairments and no previous studies have examined the association between physiological stress biomarkers and cognition in UHR individuals. This study aims to examine the association between saliva alpha amylase (SAA), heart rate variability (HRV), saliva cortisol, and cognition in UHR individuals. METHOD We included 72 UHR individuals, aged 18-40, fulfilling criteria of the comprehensive assessment of at-risk mental state (CAARMS). Cognitive tests indexed the 7 core domains as stated by Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS). Physiological stress levels were observed for one day: saliva was collected at awakening, 30 min and 60 min after awakening and at bedtime. HRV was measured during sleep and before awakening. We used generalized linear model and controlled for multiple testing using false discovery rate (FDR). RESULTS Higher levels of SAA were significantly associated with lower cognitive performance in the domains of verbal and visual learning and memory, sustained attention, working memory and global neurocognition looking at unadjusted data. Controlling for FDR visual memory, sustained attention and global neurocognition remained significant associated with SAA. We discovered no associations between cortisol and cognition. CONCLUSION Visual learning and memory, sustained attention and global neurocognition remained significantly associated with SAA. This finding supports our hypothesis that an association between abnormal stress biomarkers and impaired cognition might be present in UHR individuals.
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Affiliation(s)
- Frederik Beske Almstrup
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Denmark.
| | - Merete Nordentoft
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Denmark
| | | | - Jesper Kristiansen
- The National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Tina Dam Kristensen
- Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, Center for Neuropsychiatric Schizophrenia Research, CNSR, Mental Health Centre Glostrup, University of Copenhagen, Glostrup, Denmark
| | - Christina Wenneberg
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Denmark; Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, Center for Neuropsychiatric Schizophrenia Research, CNSR, Mental Health Centre Glostrup, University of Copenhagen, Glostrup, Denmark
| | - Anne Helene Garde
- The National Research Centre for the Working Environment, Copenhagen, Denmark; University of Copenhagen, Department of Public Health, Copenhagen, Denmark
| | - Louise Birkedal Glenthøj
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Denmark; Department of Psychology, University of Copenhagen, Denmark
| | - Dorte Nordholm
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Denmark
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7
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Kogler L, Regenbogen C, Müller VI, Kohn N, Schneider F, Gur RC, Derntl B. Cognitive Stress Regulation in Schizophrenia Patients and Healthy Individuals: Brain and Behavior. J Clin Med 2023; 12:jcm12072749. [PMID: 37048832 PMCID: PMC10095473 DOI: 10.3390/jcm12072749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 03/30/2023] [Accepted: 04/01/2023] [Indexed: 04/14/2023] Open
Abstract
Stress is an important factor in the development, triggering, and maintenance of psychotic symptoms. Still, little is known about the neural correlates of cognitively regulating stressful events in schizophrenia. The current study aimed at investigating the cognitive down-regulation of negative, stressful reactions during a neuroimaging psychosocial stress paradigm (non-regulated stress versus cognitively regulated stress). In a randomized, repeated-measures within-subject design, we assessed subjective reactions and neural activation in schizophrenia patients (SZP) and matched healthy controls in a neuroimaging psychosocial stress paradigm. In general, SZP exhibited an increased anticipation of stress compared to controls (p = 0.020). During non-regulated stress, SZP showed increased negative affect (p = 0.033) and stronger activation of the left parietal operculum/posterior insula (p < 0.001) and right inferior frontal gyrus/anterior insula (p = 0.005) than controls. Contrarily, stress regulation compared to non-regulated stress led to increased subjective reactions in controls (p = 0.003) but less deactivation in SZP in the ventral anterior cingulate cortex (p = 0.027). Our data demonstrate stronger reactions to and anticipation of stress in patients and difficulties with cognitive stress regulation in both groups. Considering the strong association between mental health and stress, the investigation of cognitive regulation in individuals vulnerable to stress, including SZP, has crucial implications for improving stress intervention trainings.
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Affiliation(s)
- Lydia Kogler
- Department of Psychiatry and Psychotherapy, Tübingen Centre for Mental Health (TüCMH), Medical Faculty, University of Tübingen, Calwerstrasse 14, 72076 Tübingen, Germany
| | - Christina Regenbogen
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Veronika I Müller
- Institute of Neuroscience und Medicine, INM-7, Research Centre Jülich, 52425 Jülich, Germany
- Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany
| | - Nils Kohn
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Pauwelsstraße 30, 52074 Aachen, Germany
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Postbus 9101, 6500 HB Nijmegen, The Netherlands
| | - Frank Schneider
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Pauwelsstraße 30, 52074 Aachen, Germany
- Medical Faculty, Heinrich Heine University Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany
| | - Ruben C Gur
- Neuropsychiatry Division, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA
| | - Birgit Derntl
- Department of Psychiatry and Psychotherapy, Tübingen Centre for Mental Health (TüCMH), Medical Faculty, University of Tübingen, Calwerstrasse 14, 72076 Tübingen, Germany
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Pauwelsstraße 30, 52074 Aachen, Germany
- International Max Planck Research School for the Mechanisms of Mental Function and Dysfunction (IMPRS-MMFD), Otfried-Müller-Str. 27, 72076 Tübingen, Germany
- LEAD Graduate School and Network, University of Tübingen, Walter-Simon-Straße 12, 72074 Tübingen, Germany
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8
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Xie M, Zhao Z, Dai M, Wu Y, Huang Y, Liu Y, Tang Y, Xiao L, Wei W, Zhang G, Du X, Li C, Guo W, Ma X, Deng W, Wang Q, Li T. Associations between urban birth or childhood trauma and first-episode schizophrenia mediated by low IQ. SCHIZOPHRENIA 2022; 8:89. [PMID: 36309513 PMCID: PMC9617944 DOI: 10.1038/s41537-022-00289-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 09/17/2022] [Indexed: 11/09/2022]
Abstract
Exposure to urban birth, childhood trauma, and lower Intelligence Quotient (IQ) were the most well-established risk factors for schizophrenia in developed countries. In developing countries, whether urban birth is a risk factor for schizophrenia and how these factors are related to one another remain unclear. This study aimed to investigate whether IQ mediates the relationship between urban birth or childhood trauma and first-episode schizophrenia (FES) in China. Birthplace, childhood trauma questionnaire (CTQ), and IQ were collected from 144 patients with FES and 256 healthy controls (HCs). Hierarchical logistic regression analysis was conducted to investigate the associations between birthplace, childhood trauma, IQ, and FES. Furthermore, mediation analysis was used to explore the mediation of IQ in the relationship between birthplace or childhood trauma and FES. After adjusting for age, sex and educational attainment, the final model identified urban birth (odds ratio (OR) = 3.15, 95% CI = 1.54, 6.44) and childhood trauma (OR = 2.79, 95% CI = 1.92, 4.06) were associated an elevated risk for FES. The 52.94% total effect of birthplace on the risk of FES could be offset by IQ (indirect effect/direct effect). The association between childhood trauma and FES could be partly explained by IQ (22.5%). In total, the mediation model explained 70.5% of the total variance in FES. Our study provides evidence that urban birth and childhood trauma are associated with an increased risk of FES. Furthermore, IQ mediates the relationship between urban birth or childhood trauma and FES.
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Affiliation(s)
- Min Xie
- grid.412901.f0000 0004 1770 1022Mental Health Center, West China Hospital, Sichuan University, 610041 Chengdu, Sichuan China
| | - Zhengyang Zhao
- grid.412901.f0000 0004 1770 1022Mental Health Center, West China Hospital, Sichuan University, 610041 Chengdu, Sichuan China
| | - Minhan Dai
- grid.412901.f0000 0004 1770 1022Mental Health Center, West China Hospital, Sichuan University, 610041 Chengdu, Sichuan China
| | - Yulu Wu
- grid.412901.f0000 0004 1770 1022Mental Health Center, West China Hospital, Sichuan University, 610041 Chengdu, Sichuan China
| | - Yunqi Huang
- grid.412901.f0000 0004 1770 1022Mental Health Center, West China Hospital, Sichuan University, 610041 Chengdu, Sichuan China
| | - Yunjia Liu
- grid.412901.f0000 0004 1770 1022Mental Health Center, West China Hospital, Sichuan University, 610041 Chengdu, Sichuan China
| | - Yiguo Tang
- grid.412901.f0000 0004 1770 1022Mental Health Center, West China Hospital, Sichuan University, 610041 Chengdu, Sichuan China
| | - Liling Xiao
- grid.412901.f0000 0004 1770 1022Mental Health Center, West China Hospital, Sichuan University, 610041 Chengdu, Sichuan China
| | - Wei Wei
- grid.412901.f0000 0004 1770 1022Mental Health Center, West China Hospital, Sichuan University, 610041 Chengdu, Sichuan China
| | - Guangya Zhang
- grid.263761.70000 0001 0198 0694Department of Psychiatry, Suzhou Psychiatric Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Xiangdong Du
- grid.263761.70000 0001 0198 0694Department of Psychiatry, Suzhou Psychiatric Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Chuanwei Li
- grid.263761.70000 0001 0198 0694Department of Psychiatry, Suzhou Psychiatric Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Wanjun Guo
- grid.13402.340000 0004 1759 700XAffiliated Mental Health Centre & Hangzhou Seventh People’s Hospital, Zhejiang University School of Medicine, 310013 Hangzhou, Zhejiang China
| | - Xiaohong Ma
- grid.412901.f0000 0004 1770 1022Mental Health Center, West China Hospital, Sichuan University, 610041 Chengdu, Sichuan China
| | - Wei Deng
- grid.13402.340000 0004 1759 700XAffiliated Mental Health Centre & Hangzhou Seventh People’s Hospital, Zhejiang University School of Medicine, 310013 Hangzhou, Zhejiang China
| | - Qiang Wang
- grid.412901.f0000 0004 1770 1022Mental Health Center, West China Hospital, Sichuan University, 610041 Chengdu, Sichuan China
| | - Tao Li
- grid.13402.340000 0004 1759 700XAffiliated Mental Health Centre & Hangzhou Seventh People’s Hospital, Zhejiang University School of Medicine, 310013 Hangzhou, Zhejiang China
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9
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Shi X, Nie X, Wu J. The cortisol awakening response and the late positive potentials evoked by unpleasant emotional pictures in healthy adults. Stress 2022; 25:40-47. [PMID: 34882046 DOI: 10.1080/10253890.2021.2008902] [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] [Indexed: 10/19/2022] Open
Abstract
The cortisol awakening response (CAR) refers to a sharp rise in cortisol concentrations within the 45 min following morning awakening. Alterations in CAR have been associated with various internalizing symptoms and brain function. The current study aimed to investigate the association between CAR and neural activity in response to unpleasant emotional pictures. A total of 46 healthy adults (22.55 years ± 1.69) collected saliva samples at 0, 30, and 45 min post-awakening on two days to assess the CAR. In the afternoon after CAR measurement on the first day, electroencephalograms were recorded when the participants completed a passive viewing task. The results showed that a greater CAR was associated with a decreased late positive potential difference score between unpleasant and neutral stimuli. This finding indicates that a larger CAR may be associated with decreased attentional engagement to unpleasant emotional information in healthy adults.
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Affiliation(s)
- Xia Shi
- Department of Psychology, Tianjin University of Technology and Education, Tianjin, China
| | - Xin Nie
- Department of Psychology, Tianjin University of Technology and Education, Tianjin, China
| | - Jianhui Wu
- Center for Brain Disorder and Cognitive Sciences, Shenzhen University, Shenzhen, Guangdong, China
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10
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Cognitive Deficit in Schizophrenia: From Etiology to Novel Treatments. Int J Mol Sci 2021; 22:ijms22189905. [PMID: 34576069 PMCID: PMC8468549 DOI: 10.3390/ijms22189905] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 09/08/2021] [Accepted: 09/10/2021] [Indexed: 01/09/2023] Open
Abstract
Schizophrenia is a major mental illness characterized by positive and negative symptoms, and by cognitive deficit. Although cognitive impairment is disabling for patients, it has been largely neglected in the treatment of schizophrenia. There are several reasons for this lack of treatments for cognitive deficit, but the complexity of its etiology-in which neuroanatomic, biochemical and genetic factors concur-has contributed to the lack of effective treatments. In the last few years, there have been several attempts to develop novel drugs for the treatment of cognitive impairment in schizophrenia. Despite these efforts, little progress has been made. The latest findings point to the importance of developing personalized treatments for schizophrenia which enhance neuroplasticity, and of combining pharmacological treatments with non-pharmacological measures.
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11
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Vila-Badia R, Butjosa A, Del Cacho N, Serra-Arumí C, Esteban-Sanjusto M, Ochoa S, Usall J. Types, prevalence and gender differences of childhood trauma in first-episode psychosis. What is the evidence that childhood trauma is related to symptoms and functional outcomes in first episode psychosis? A systematic review. Schizophr Res 2021; 228:159-179. [PMID: 33434728 DOI: 10.1016/j.schres.2020.11.047] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 11/28/2020] [Accepted: 11/28/2020] [Indexed: 11/24/2022]
Abstract
This paper reviews and discusses the literature on childhood trauma (CT) in people with first-episode psychosis (FEP). The aim is to update the knowledge on the prevalence and the types of CT suffered by FEP people, to compare them with other samples, to study the impact of gender, and to examine the relationship between CT and symptoms and functional outcomes. We conducted a literature search (1995-2019), to identify reported data on any topic related to CT in FEP samples. The following terms were used in the search: CT or sexual abuse or physical abuse or neglect, and first-episode psychosis. We found 493 studies, of which 68 were included in the review. FEP presented a higher prevalence of CT than controls. Women suffer more sexual abuse. The effect of CT on the severity, the prognosis and the evolution of FEP is unclear. FEP have a high prevalence of CT. Its relationship with symptoms and functional outcomes indicates its importance within treatment. This suggests the importance of creating and implementing specific interventions and personalized therapies addressed to work through their past traumatic experiences to improve their quality of live and their prognosis.
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Affiliation(s)
- Regina Vila-Badia
- Parc Sanitari Sant Joan de Déu, Teaching, Research & Innovation Unit, Institut de Recerca Sant Joan de Déu, CIBERSAM, Sant Boi de Llobregat, Spain; Universitat de Barcelona, Barcelona, Spain.
| | - Anna Butjosa
- Hospital Infanto-juvenil Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, CIBERSAM, Barcelona, Spain
| | - Núria Del Cacho
- Parc Sanitari Sant Joan de Déu, Teaching, Research & Innovation Unit, Institut de Recerca Sant Joan de Déu, CIBERSAM, Sant Boi de Llobregat, Spain; Universitat de Barcelona, Barcelona, Spain
| | - Clara Serra-Arumí
- Parc Sanitari Sant Joan de Déu, Teaching, Research & Innovation Unit, Institut de Recerca Sant Joan de Déu, CIBERSAM, Sant Boi de Llobregat, Spain; Universitat de Barcelona, Barcelona, Spain
| | - Marina Esteban-Sanjusto
- Parc Sanitari Sant Joan de Déu, Teaching, Research & Innovation Unit, Institut de Recerca Sant Joan de Déu, CIBERSAM, Sant Boi de Llobregat, Spain
| | - Susana Ochoa
- Parc Sanitari Sant Joan de Déu, Teaching, Research & Innovation Unit, Institut de Recerca Sant Joan de Déu, CIBERSAM, Sant Boi de Llobregat, Spain
| | - Judith Usall
- Parc Sanitari Sant Joan de Déu, Teaching, Research & Innovation Unit, Institut de Recerca Sant Joan de Déu, CIBERSAM, Sant Boi de Llobregat, Spain
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12
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Cheng SL, Yang FC, Chu HT, Tsai CK, Ku SC, Tseng YT, Yeh TC, Liang CS. Incongruent Expression of Brain-Derived Neurotrophic Factor and Cortisol in Schizophrenia: Results from a Randomized Controlled Trial of Laughter Intervention. Psychiatry Investig 2020; 17:1191-1199. [PMID: 33301667 PMCID: PMC8560332 DOI: 10.30773/pi.2020.0269] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 09/20/2020] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Schizophrenia has been associated with dysfunction of the hypothalamic-pituitary-adrenal axis. Furthermore, alterations in neurotrophic factors might contribute to the pathogenesis of schizophrenia. We aimed to evaluate the effects of a simulated laughter intervention on the levels of cortisol and BDNF and to determine whether the effects associated with simulated laughter could be sustained after discontinuation of the intervention. METHODS In this randomized controlled study, patients with schizophrenia according to DSM-IV clinical criteria were randomly assigned to receive either 8-week-long simulated laughter intervention (n=32) or treatment-as-usual group (control group, n=27). The serum levels of BDNF and cortisol were measured at baseline, week 8, and four weeks after discontinuation (week 12) of the intervention program. RESULTS After an 8-week simulated laughter intervention, the laughter group had significantly higher levels of BDNF; however, four weeks after discontinuation of the intervention, the levels of BDNF significantly dropped. Interestingly, the levels of cortisol did not change significantly at week 8, but they were significantly elevated at week 12. The levels of BDNF and cortisol in the control group did not change significantly between week 0 and week 8. CONCLUSION These findings suggest that the simulated laughter intervention has an early effect on neurogenesis with a significant delayed effect on stress regulation in subjects with schizophrenia.
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Affiliation(s)
- Shu-Li Cheng
- Department of Nursing, Mackay Medical College, Taipei, Taiwan, ROC
| | - Fu-Chi Yang
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Hsuan-Te Chu
- Department of Psychiatry, Beitou Branch, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Chia-Kuang Tsai
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Shih-Chieh Ku
- Department of Psychiatry, Beitou Branch, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Yu-Ting Tseng
- Department of Psychiatry, Beitou Branch, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Ta-Chuan Yeh
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC.,Division of Psychiatry, Penghu Branch, Tri-Service General Hospital, Penghu, Taiwan, ROC
| | - Chih-Sung Liang
- Department of Psychiatry, Beitou Branch, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC.,Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan, ROC
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13
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Law R, Evans P, Thorn L, Hucklebridge F, Loveday C, Clow A. The cortisol awakening response predicts a same-day index of executive function in healthy young adults. Int J Psychophysiol 2020; 158:27-33. [DOI: 10.1016/j.ijpsycho.2020.08.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 07/25/2020] [Accepted: 08/01/2020] [Indexed: 12/29/2022]
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14
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Murray RM, Mondelli V, Stilo SA, Trotta A, Sideli L, Ajnakina O, Ferraro L, Vassos E, Iyegbe C, Schoeler T, Bhattacharyya S, Marques TR, Dazzan P, Lopez-Morinigo J, Colizzi M, O'Connor J, Falcone MA, Quattrone D, Rodriguez V, Tripoli G, La Barbera D, La Cascia C, Alameda L, Trotta G, Morgan C, Gaughran F, David A, Di Forti M. The influence of risk factors on the onset and outcome of psychosis: What we learned from the GAP study. Schizophr Res 2020; 225:63-68. [PMID: 32037203 DOI: 10.1016/j.schres.2020.01.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 01/06/2020] [Accepted: 01/09/2020] [Indexed: 01/05/2023]
Abstract
The GAP multidisciplinary study carried out in South London, recruited 410 first episode of psychosis patients and 370 controls; the aim was to elucidate the multiple genetic and environmental factors influencing the onset and outcome of psychosis. The study demonstrated the risk increasing effect of adversity in childhood (especially parental loss, abuse, and bullying) on onset of psychosis especially positive symptoms. Adverse life events more proximal to onset, being from an ethnic minority, and cannabis use also played important roles; indeed, one quarter of new cases of psychosis could be attributed to use of high potency cannabis. The "jumping to conclusions" bias appeared to mediate the effect of lower IQ on vulnerability to psychosis. We confirmed that environmental factors operate on the background of polygenic risk, and that genetic and environment act together to push individuals over the threshold for manifesting the clinical disorder. The study demonstrated how biological pathways involved in the stress response (HPA axis and immune system) provide important mechanisms linking social risk factors to the development of psychotic symptoms. Further evidence implicating an immune/inflammatory component to psychosis came from our finding of complement dysregulation in FEP. Patients also showed an upregulation of the antimicrobial alpha-defensins, as well as differences in expression patterns of genes involved in NF-κB signaling and Cytokine Production. Being of African origin not only increased risk of onset but also of a more difficult course of illness. The malign effect of childhood adversity predicted a poorer outcome as did continued use of high potency cannabis.
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Affiliation(s)
- R M Murray
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychosis Studies, King's College London, London, UK; Department of Experimental Biomedicine and Clinical Neuroscience, University of Palermo, Palermo, Italy.
| | - V Mondelli
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychosis Studies, King's College London, London, UK
| | - S A Stilo
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychosis Studies, King's College London, London, UK; Division of Psychology and Language Sciences, University College London, London, UK
| | - A Trotta
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychosis Studies, King's College London, London, UK
| | - L Sideli
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychosis Studies, King's College London, London, UK; Department of Experimental Biomedicine and Clinical Neuroscience, University of Palermo, Palermo, Italy
| | - O Ajnakina
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychosis Studies, King's College London, London, UK
| | - L Ferraro
- Department of Experimental Biomedicine and Clinical Neuroscience, University of Palermo, Palermo, Italy
| | - E Vassos
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychosis Studies, King's College London, London, UK
| | - C Iyegbe
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychosis Studies, King's College London, London, UK
| | - T Schoeler
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychosis Studies, King's College London, London, UK; Department of Psychiatry, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - S Bhattacharyya
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychosis Studies, King's College London, London, UK
| | - T R Marques
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychosis Studies, King's College London, London, UK
| | - P Dazzan
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychosis Studies, King's College London, London, UK
| | - J Lopez-Morinigo
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychosis Studies, King's College London, London, UK; Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain
| | - M Colizzi
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychosis Studies, King's College London, London, UK
| | - J O'Connor
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychosis Studies, King's College London, London, UK; Department of Neuropsychology, Royal Free London NHS Foundation Trust, Royal Free Hospital, London, UK
| | - M A Falcone
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychosis Studies, King's College London, London, UK
| | - D Quattrone
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychosis Studies, King's College London, London, UK
| | - V Rodriguez
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychosis Studies, King's College London, London, UK
| | - G Tripoli
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychosis Studies, King's College London, London, UK; Department of Experimental Biomedicine and Clinical Neuroscience, University of Palermo, Palermo, Italy
| | - D La Barbera
- Department of Experimental Biomedicine and Clinical Neuroscience, University of Palermo, Palermo, Italy
| | - C La Cascia
- Department of Experimental Biomedicine and Clinical Neuroscience, University of Palermo, Palermo, Italy
| | - L Alameda
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychosis Studies, King's College London, London, UK
| | - G Trotta
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychosis Studies, King's College London, London, UK; Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
| | - C Morgan
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychosis Studies, King's College London, London, UK
| | - F Gaughran
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychosis Studies, King's College London, London, UK
| | - A David
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychosis Studies, King's College London, London, UK; Institute of Mental Health, University College London, London, UK
| | - M Di Forti
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychosis Studies, King's College London, London, UK; Department of Experimental Biomedicine and Clinical Neuroscience, University of Palermo, Palermo, Italy
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15
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Kilciksiz CM, Keefe R, Benoit J, Öngür D, Torous J. Verbal memory measurement towards digital perspectives in first-episode psychosis: A review. Schizophr Res Cogn 2020; 21:100177. [PMID: 32322540 PMCID: PMC7163058 DOI: 10.1016/j.scog.2020.100177] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 03/20/2020] [Accepted: 03/21/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Even in the early phases of psychotic spectrum illnesses such as schizophrenia, patients can experience cognitive decline or deficits prior to the onset of psychotic symptoms such as delusions and hallucinations. In this systematic review, we assessed which verbal memory assessments are most widely used in first-episode psychosis and may be applied via digital technologies (smartphone applications, etc.) for use in early detection. METHODS In November 2019, we searched for studies measuring verbal memory in first episode psychosis or schizophrenia over the past 10 years on PubMed and PsycINFO. We screened abstracts of these studies and excluded review studies. Full-texts of included studies were used to identify the verbal memory measurement tests, follow-up frequencies, and sample sizes. RESULTS We screened 233 reports and found that 120 original research studies measured verbal memory in first episode psychosis over the past 10 years. Four of these studies specified using a computer, 24 (20%) used a paper-pen format, 1(1%) used both, and 91 (76%) studies did not specify their administration tools or suggest there were offered in digital formats. Thirty-five (30%) studies had follow-up measurements of verbal memory, while 85 (70%) had only a single verbal memory measurement. DISCUSSION While many scales are commonly used to measure verbal memory in first episode psychosis, they are not often administered via digital technology. There is an emerging opportunity to administer these and other tests via digital technologies for expanding access to early detection of cognitive decline in clinical high risk and first-episode psychosis.
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Affiliation(s)
- Can Mişel Kilciksiz
- Digital Psychiatry Division, Psychosis Research Program, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America
| | - Richard Keefe
- Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States of America
| | - James Benoit
- Digital Psychiatry Division, Psychosis Research Program, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America
| | - Dost Öngür
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America
- Psychotic Disorders Division, McLean Hospital, Belmont, MA, United States of America
| | - John Torous
- Digital Psychiatry Division, Psychosis Research Program, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America
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16
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Nieman DH, Chavez-Baldini U, Vulink NC, Smit DJA, van Wingen G, de Koning P, Sutterland AL, Mocking RJT, Bockting C, Verweij KJH, Lok A, Denys D. Protocol Across study: longitudinal transdiagnostic cognitive functioning, psychiatric symptoms, and biological parameters in patients with a psychiatric disorder. BMC Psychiatry 2020; 20:212. [PMID: 32393362 PMCID: PMC7216345 DOI: 10.1186/s12888-020-02624-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 04/26/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Patients with psychiatric disorders, such as major depressive disorder, schizophrenia or obsessive-compulsive disorder, often suffer from cognitive dysfunction. The nature of these dysfunctions and their relation with clinical symptoms and biological parameters is not yet clear. Traditionally, cognitive dysfunction is studied in patients with specific psychiatric disorders, disregarding the fact that cognitive deficits are shared across disorders. The Across study aims to investigate cognitive functioning and its relation with psychiatric symptoms and biological parameters transdiagnostically and longitudinally. METHODS The study recruits patients diagnosed with a variety of psychiatric disorders and has a longitudinal cohort design with an assessment at baseline and at one-year follow-up. The primary outcome measure is cognitive functioning. The secondary outcome measures include clinical symptoms, electroencephalographic, genetic and blood markers (e.g., fatty acids), and hair cortisol concentration levels. DISCUSSION The Across study provides an opportunity for a transdiagnostic, bottom-up, data-driven approach of investigating cognition in relation to symptoms and biological parameters longitudinally in patients with psychiatric disorders. The study may help to find new clusters of symptoms, biological markers, and cognitive dysfunctions that have better prognostic value than the current diagnostic categories. Furthermore, increased insight into the relationship among cognitive deficits, biological parameters, and psychiatric symptoms can lead to new treatment possibilities. TRIAL REGISTRATION Netherlands Trial Register (NTR): NL8170.
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Affiliation(s)
- Dorien H. Nieman
- grid.7177.60000000084992262Department of Psychiatry, Amsterdam University Medical Centers (location AMC), University of Amsterdam, Meibergdreef 5, 1105 AZ Amsterdam, Netherlands
| | - UnYoung Chavez-Baldini
- grid.7177.60000000084992262Department of Psychiatry, Amsterdam University Medical Centers (location AMC), University of Amsterdam, Meibergdreef 5, 1105 AZ Amsterdam, Netherlands
| | - Nienke C. Vulink
- grid.7177.60000000084992262Department of Psychiatry, Amsterdam University Medical Centers (location AMC), University of Amsterdam, Meibergdreef 5, 1105 AZ Amsterdam, Netherlands
| | - Dirk J. A. Smit
- grid.7177.60000000084992262Department of Psychiatry, Amsterdam University Medical Centers (location AMC), University of Amsterdam, Meibergdreef 5, 1105 AZ Amsterdam, Netherlands
| | - Guido van Wingen
- grid.7177.60000000084992262Department of Psychiatry, Amsterdam University Medical Centers (location AMC), University of Amsterdam, Meibergdreef 5, 1105 AZ Amsterdam, Netherlands
| | - Pelle de Koning
- grid.7177.60000000084992262Department of Psychiatry, Amsterdam University Medical Centers (location AMC), University of Amsterdam, Meibergdreef 5, 1105 AZ Amsterdam, Netherlands
| | - Arjen L. Sutterland
- grid.7177.60000000084992262Department of Psychiatry, Amsterdam University Medical Centers (location AMC), University of Amsterdam, Meibergdreef 5, 1105 AZ Amsterdam, Netherlands
| | - Roel J. T. Mocking
- grid.7177.60000000084992262Department of Psychiatry, Amsterdam University Medical Centers (location AMC), University of Amsterdam, Meibergdreef 5, 1105 AZ Amsterdam, Netherlands
| | - Claudi Bockting
- grid.7177.60000000084992262Department of Psychiatry, Amsterdam University Medical Centers (location AMC), University of Amsterdam, Meibergdreef 5, 1105 AZ Amsterdam, Netherlands
| | - Karin J. H. Verweij
- grid.7177.60000000084992262Department of Psychiatry, Amsterdam University Medical Centers (location AMC), University of Amsterdam, Meibergdreef 5, 1105 AZ Amsterdam, Netherlands
| | - Anja Lok
- grid.7177.60000000084992262Department of Psychiatry, Amsterdam University Medical Centers (location AMC), University of Amsterdam, Meibergdreef 5, 1105 AZ Amsterdam, Netherlands
| | - Damiaan Denys
- grid.7177.60000000084992262Department of Psychiatry, Amsterdam University Medical Centers (location AMC), University of Amsterdam, Meibergdreef 5, 1105 AZ Amsterdam, Netherlands
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17
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Law R, Clow A. Stress, the cortisol awakening response and cognitive function. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2020; 150:187-217. [PMID: 32204832 DOI: 10.1016/bs.irn.2020.01.001] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
There is evidence that stress-induced disruption of the circadian rhythm of cortisol secretion, has negative consequences for brain health. The cortisol awakening response (CAR) is the most prominent and dynamic aspect of this rhythm. It has complex regulatory mechanisms making it distinct from the rest of the cortisol circadian rhythm, and is frequently investigated as a biomarker of stress and potential intermediary between stress and impaired brain function. Despite this, the precise function of the CAR within the healthy cortisol circadian rhythm remains poorly understood. Cortisol is a powerful hormone known to influence cognition in multiple and complex ways. Studies of the CAR and cognitive function have used varied methodological approaches which have produced similarly varied findings. The present review considers the accumulating evidence linking stress, attenuation of the CAR and reduced cognitive function, and seeks to contextualize the many findings to study populations, cognitive measures, and CAR methodologies employed. Associations between the CAR and both memory and executive functions are discussed in relation to its potential role as a neuroendocrine time of day signal that synchronizes peripheral clocks throughout the brain to enable optimum function, and recommendations for future research are provided.
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Affiliation(s)
- Robin Law
- Psychology, School of Social Sciences, University of Westminster, London, England.
| | - Angela Clow
- Psychology, School of Social Sciences, University of Westminster, London, England
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18
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Montalvo I, González-Rodríguez A, Cabezas Á, Gutiérrez-Zotes A, Solé M, Algora MJ, Ortega L, Martorell L, Sánchez-Gistau V, Vilella E, Labad J. Glycated Haemoglobin Is Associated With Poorer Cognitive Performance in Patients With Recent-Onset Psychosis. Front Psychiatry 2020; 11:455. [PMID: 32528326 PMCID: PMC7262729 DOI: 10.3389/fpsyt.2020.00455] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 05/05/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Glucose abnormalities and cognitive alterations are present before the onset of schizophrenia. We aimed to study whether glucose metabolism parameters are associated with cognitive functioning in recent-onset psychosis (ROP) patients while adjusting for hypothalamic-pituitary adrenal (HPA) axis measures. METHODS Sixty ROP outpatients and 50 healthy subjects (HS) were studied. Cognitive function was assessed with the MATRICS Consensus Cognitive Battery. Glycated haemoglobin (HbA1c), glucose, insulin, and C-peptide levels were determined in plasma. The HOMA-insulin resistance index was calculated. Salivary samples were obtained at home on another day to assess the cortisol awakening response and cortisol levels during the day. Univariate analyses were conducted to explore the association between glucose metabolism parameters and cognitive tasks. For those parameters that were more clearly associated with the cognitive outcome, multiple linear regression analyses were conducted to adjust for covariates. Each cognitive task was considered the dependent variable. Covariates were age, sex, education level, diagnosis, antipsychotic and benzodiazepine treatment, body mass index (BMI), smoking, and HPA axis measures. Potential interactions between diagnosis and glucose parameters were tested. RESULTS There were no significant differences in HPA axis measures or glucose parameters, with the exception of C-peptide (that was higher in ROP patients), between groups. ROP patients had a lower performance than HS in all cognitive tasks (p < 0.01 for all tasks). Of all glucose metabolism parameters, HbA1c levels were more clearly associated with cognitive impairment in cognitive tasks dealing with executive functions and visual memory in both ROP patients and HS. Multivariate analyses found a significant negative association between HbA1c and cognitive functioning in five cognitive tasks dealing with executive functions, visual memory and attention/vigilance (a ROP diagnosis by HbA1c negative interaction was found in this latter cognitive domain, suggesting that HBA1c levels are associated with impaired attention only in ROP patients). CONCLUSIONS Our study found that HbA1c was negatively associated with cognitive functioning in both ROP patients and HS in tasks dealing with executive functions and visual memory. In ROP patients, HbA1c was also associated with impaired attention. These results were independent of BMI and measures of HPA axis activity.
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Affiliation(s)
- Itziar Montalvo
- Department of Mental Health, Parc Taulí Hospital Universitari, Institut d'Investigació Sanitària Parc Taulí (I3PT), Universitat Autònoma de Barcelona, CIBERSAM, Sabadell, Spain
| | - Alexandre González-Rodríguez
- Department of Mental Health, Parc Taulí Hospital Universitari, Institut d'Investigació Sanitària Parc Taulí (I3PT), Universitat Autònoma de Barcelona, CIBERSAM, Sabadell, Spain
| | - Ángel Cabezas
- Hospital Universitari Institut Pere Mata, Institut d'Investigació Sanitària Pere Virgili (IISPV), Universitat Rovira i Virgili, CIBERSAM, Reus, Spain
| | - Alfonso Gutiérrez-Zotes
- Hospital Universitari Institut Pere Mata, Institut d'Investigació Sanitària Pere Virgili (IISPV), Universitat Rovira i Virgili, CIBERSAM, Reus, Spain
| | - Montse Solé
- Hospital Universitari Institut Pere Mata, Institut d'Investigació Sanitària Pere Virgili (IISPV), Universitat Rovira i Virgili, CIBERSAM, Reus, Spain
| | - Maria José Algora
- Hospital Universitari Institut Pere Mata, Institut d'Investigació Sanitària Pere Virgili (IISPV), Universitat Rovira i Virgili, CIBERSAM, Reus, Spain
| | - Laura Ortega
- Nursing Department, Universitat Rovira i Vigili, Tarragona, Spain
| | - Lourdes Martorell
- Hospital Universitari Institut Pere Mata, Institut d'Investigació Sanitària Pere Virgili (IISPV), Universitat Rovira i Virgili, CIBERSAM, Reus, Spain
| | - Vanessa Sánchez-Gistau
- Hospital Universitari Institut Pere Mata, Institut d'Investigació Sanitària Pere Virgili (IISPV), Universitat Rovira i Virgili, CIBERSAM, Reus, Spain
| | - Elisabet Vilella
- Hospital Universitari Institut Pere Mata, Institut d'Investigació Sanitària Pere Virgili (IISPV), Universitat Rovira i Virgili, CIBERSAM, Reus, Spain
| | - Javier Labad
- Department of Mental Health, Parc Taulí Hospital Universitari, Institut d'Investigació Sanitària Parc Taulí (I3PT), Universitat Autònoma de Barcelona, CIBERSAM, Sabadell, Spain
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19
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Nonhuman primate models of hippocampal development and dysfunction. Proc Natl Acad Sci U S A 2019; 116:26210-26216. [PMID: 31871159 DOI: 10.1073/pnas.1902278116] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Nonhuman primates provide highly valuable animal models that have significantly advanced our understanding of numerous behavioral and biological phenomena in humans. Here, we reviewed a series of developmental neuropsychological studies that informed us on the timing of development of the hippocampus and of hippocampal-dependent cognitive functions in primates. Data indicate that, in primates, the emergence of adult-like proficiency on behavioral tasks sensitive to hippocampal dysfunction is a stepwise process and reflects the gradual maturation of different hippocampal circuits and their connections with other neural structures. Profound and persistent memory loss resulting from insult to the hippocampus in infancy was absent in early infancy but became evident later in childhood and persisted in adulthood, indicating very little sparing or recovery of function. Finally, the early hippocampal insult resulted in both adaptive and maladaptive neuroplasticity: i.e., sparing contextual memory, but affecting working memory processes as well as emotional reactivity and hypothalamic-pituitary-adrenal (HPA) axis functioning. The results provide significant information on the emergence of hippocampal-dependent functions in humans, on the time course of memory impairment in human cases with early hippocampal insult, and on the clinical implication of the hippocampus in developmental neuropsychiatric disorders.
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20
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Cherian K, Schatzberg AF, Keller J. HPA axis in psychotic major depression and schizophrenia spectrum disorders: Cortisol, clinical symptomatology, and cognition. Schizophr Res 2019; 213:72-79. [PMID: 31307859 DOI: 10.1016/j.schres.2019.07.003] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 06/30/2019] [Accepted: 07/02/2019] [Indexed: 01/09/2023]
Abstract
The Hypothalamic Pituitary Adrenal (HPA) axis has been implicated in the pathophysiology of a variety of mood and cognitive disorders. Neuroendocrine studies have demonstrated HPA axis overactivity in major depression, a relationship of HPA axis activity to cognitive performance, and a potential role of HPA axis genetic variation in cognition. In schizophrenia differential HPA activity has been found, including higher rates of non-suppression to dexamethasone challenge and higher salivary cortisol levels, which have been a premonitory risk factor for conversion to psychosis in adolescents at risk for developing schizophrenia. The present study investigated the simultaneous roles HPA axis activity and clinical symptomatology play in poor cognitive performance. Patients with major depression with psychosis (PMD) or schizophrenia spectrum disorder (SCZ) and healthy controls (HC) were studied. All participants underwent a diagnostic interview and psychiatric ratings, a comprehensive neuropsychological battery, and overnight hourly blood sampling for cortisol. Cognitive performance did not differ between the clinical groups, though they both performed more poorly than the HC's across a variety of cognitive domains. Across all subjects, cognitive performance was negatively correlated with higher cortisol, and PMD patients had higher evening cortisol levels than did SCZ and HCs. Cortisol and clinical symptoms, as well as age, sex, and antipsychotic use predicted cognitive performance. Diathesis stress models and their links to symptomatology, cognition, and HPA function are discussed.
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Affiliation(s)
- Kirsten Cherian
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, United States of America; Palo Alto University, United States of America
| | - Alan F Schatzberg
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, United States of America
| | - Jennifer Keller
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, United States of America.
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21
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Current evidence of childhood traumatic experiences in psychosis - focus on gender differences. Psychiatry Res 2019; 281:112507. [PMID: 31465988 DOI: 10.1016/j.psychres.2019.112507] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 08/01/2019] [Accepted: 08/04/2019] [Indexed: 02/07/2023]
Abstract
Childhood abuse is common among people with psychosis and it is associated with poor illness outcomes. Some forms of childhood abuse are more common in women, but the impact of gender and childhood abuse in psychosis has been little investigated and evidence has never been put into a congruent frame. Herein, we conducted a narrative review to assess the impact of gender and childhood abuse in psychosis. Research articles were identified (n = 44) using a comprehensive electronic search of PubMed, Web-of-Science, Scopus and Cochrane databases. Women appeared to be at greater risk of sexual abuse than men. Women with childhood abuse report more positive and mood symptoms, and more suicide attempts compared to men. In addition, women exposed to childhood abuse display an earlier age of onset compared to not exposed, but this association is not present in men. Conversely, men with childhood abuse show more negative symptoms, substance use and a poorer cognitive performance compared to women. It seems therefore confirmed that gender and childhood abuse may impact on the outcome of psychosis, since not all gender differences found in patients who had been abused in their childhood are accounted by the overall differences between men and women with psychosis.
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22
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Vargas T, Lam PH, Azis M, Osborne KJ, Lieberman A, Mittal VA. Childhood Trauma and Neurocognition in Adults With Psychotic Disorders: A Systematic Review and Meta-analysis. Schizophr Bull 2019; 45:1195-1208. [PMID: 30376115 PMCID: PMC6811825 DOI: 10.1093/schbul/sby150] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Characterizing the link between childhood trauma and adult neurocognitive function in psychosis is crucial for improving the fields understanding of how early environmental risk factors impact the presentation of the disorder. To date, the literature has been inconsistent: meta-analytic synthesis is lacking, and it is unclear whether specific cognitive functions are affected. METHODS A meta-analysis was performed on a total of 3315 subjects with a psychotic disorder. The links between childhood trauma, overall neurocognitive function, and four cognitive subdomains (working memory, executive function, verbal/visual memory, and attention/processing speed) were examined. Relevant sample characteristics and methodological moderators were tested. The strength of the association between trauma and overall neurocognition in individuals with psychotic disorders was also compared to that of healthy controls. RESULTS Among individuals with psychotic disorders, there was a significant association between overall cognition and childhood trauma, r = -.055; 95% CI = -0.09, -0.02, P = .002. There was also a modest, negative relationship between childhood trauma and working memory, r = -.091; 95% CI = -0.15, -0.03, P = .002. Moderators did not have a significant effect on these analyses. Further, the association between childhood trauma and neurocognition was significantly stronger in healthy controls compared to patients with a psychotic disorder. CONCLUSION A small negative association was found between overall cognition and childhood trauma in individuals with psychotic disorders. Results suggest the association is less strong for individuals with a psychotic disorder compared to healthy populations. Findings are informative for prominent etiological models of psychosis.
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Affiliation(s)
- Teresa Vargas
- Department of Psychology, Weinberg College of Arts and Sciences, Northwestern University, Evanston, IL,To whom correspondence should be addressed; Swift Hall 102, 2029 Sheridan Road, Evanston, IL 60201, US; tel: 847-467-3880, fax: 847-491-7859, e-mail:
| | - Phoebe H Lam
- Department of Psychology, Weinberg College of Arts and Sciences, Northwestern University, Evanston, IL,Institute for Policy Research, Northwestern University, Evanston, IL
| | - Matilda Azis
- Department of Psychology, Weinberg College of Arts and Sciences, Northwestern University, Evanston, IL
| | - K Juston Osborne
- Department of Psychology, Weinberg College of Arts and Sciences, Northwestern University, Evanston, IL
| | - Amy Lieberman
- Department of Psychology, Weinberg College of Arts and Sciences, Northwestern University, Evanston, IL
| | - Vijay A Mittal
- Department of Psychology, Weinberg College of Arts and Sciences, Northwestern University, Evanston, IL,Institute for Policy Research, Northwestern University, Evanston, IL,Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL,Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL,Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL
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23
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Wannan CMJ, Cropley VL, Chakravarty MM, Van Rheenen TE, Mancuso S, Bousman C, Everall I, McGorry PD, Pantelis C, Bartholomeusz CF. Hippocampal subfields and visuospatial associative memory across stages of schizophrenia-spectrum disorder. Psychol Med 2019; 49:2452-2462. [PMID: 30511607 DOI: 10.1017/s0033291718003458] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND While previous studies have identified relationships between hippocampal volumes and memory performance in schizophrenia, these relationships are not apparent in healthy individuals. Further, few studies have examined the role of hippocampal subfields in illness-related memory deficits, and no study has examined potential differences across varying illness stages. The current study aimed to investigate whether individuals with early and established psychosis exhibited differential relationships between visuospatial associative memory and hippocampal subfield volumes. METHODS Measurements of visuospatial associative memory performance and grey matter volume were obtained from 52 individuals with a chronic schizophrenia-spectrum disorder, 28 youth with recent-onset psychosis, 52 older healthy controls, and 28 younger healthy controls. RESULTS Both chronic and recent-onset patients had impaired visuospatial associative memory performance, however, only chronic patients showed hippocampal subfield volume loss. Both chronic and recent-onset patients demonstrated relationships between visuospatial associative memory performance and hippocampal subfield volumes in the CA4/dentate gyrus and the stratum that were not observed in older healthy controls. There were no group by volume interactions when chronic and recent-onset patients were compared. CONCLUSIONS The current study extends the findings of previous studies by identifying particular hippocampal subfields, including the hippocampal stratum layers and the dentate gyrus, that appear to be related to visuospatial associative memory ability in individuals with both chronic and first-episode psychosis.
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Affiliation(s)
- Cassandra M J Wannan
- Department of Psychiatry, Melbourne Neuropsychiatry Centre, The University of Melbourne and Melbourne Health, Carlton South, Victoria, Australia
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia
- The Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
- The Cooperative Research Centre for Mental Health, Melbourne, Australia
- North Western Mental Health, Melbourne Health, Parkville, VIC, Australia
| | - Vanessa L Cropley
- Department of Psychiatry, Melbourne Neuropsychiatry Centre, The University of Melbourne and Melbourne Health, Carlton South, Victoria, Australia
- Centre for Mental Health, Faculty of Health, Arts and Design, School of Health Sciences, Swinburne University, Melbourne, Australia
| | - M Mallar Chakravarty
- Cerebral Imaging Centre, Douglas Mental Health University Institute, Montreal, Canada
- Departments of Psychiatry and Biological and Biomedical Engineering, McGill University, Montreal, Canada
| | - Tamsyn E Van Rheenen
- Department of Psychiatry, Melbourne Neuropsychiatry Centre, The University of Melbourne and Melbourne Health, Carlton South, Victoria, Australia
- Centre for Mental Health, Faculty of Health, Arts and Design, School of Health Sciences, Swinburne University, Melbourne, Australia
| | - Sam Mancuso
- Department of Psychiatry, The University of Melbourne, Parkville, Victoria, Australia
| | - Chad Bousman
- Departments of Medical Genetics, Psychiatry, and Physiology & Pharmacology, University of Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, Calgary, AB, Canada
| | - Ian Everall
- The Cooperative Research Centre for Mental Health, Melbourne, Australia
- Department of Psychiatry, The University of Melbourne, Parkville, Victoria, Australia
- Department of Electrical and Electronic Engineering, Centre for Neural Engineering, University of Melbourne, South Carlton, Victoria, Australia
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK
- Florey Institute for Neuroscience & Mental Health, Parkville, VIC, Australia
| | - Patrick D McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia
| | - Christos Pantelis
- Department of Psychiatry, Melbourne Neuropsychiatry Centre, The University of Melbourne and Melbourne Health, Carlton South, Victoria, Australia
- The Cooperative Research Centre for Mental Health, Melbourne, Australia
- North Western Mental Health, Melbourne Health, Parkville, VIC, Australia
- Department of Psychiatry, The University of Melbourne, Parkville, Victoria, Australia
- Department of Electrical and Electronic Engineering, Centre for Neural Engineering, University of Melbourne, South Carlton, Victoria, Australia
- Florey Institute for Neuroscience & Mental Health, Parkville, VIC, Australia
| | - Cali F Bartholomeusz
- Department of Psychiatry, Melbourne Neuropsychiatry Centre, The University of Melbourne and Melbourne Health, Carlton South, Victoria, Australia
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia
- The Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
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24
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Comacchio C, Howard LM, Bonetto C, Lo Parrino R, Furlato K, Semrov E, Preti A, Mesiano L, Neri G, De Girolamo G, de Santi K, Miglietta E, Tosato S, Cristofalo D, Lasalvia A, Ruggeri M. The impact of gender and childhood abuse on age of psychosis onset, psychopathology and needs for care in psychosis patients. Schizophr Res 2019; 210:164-171. [PMID: 30642687 DOI: 10.1016/j.schres.2018.12.046] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 12/21/2018] [Accepted: 12/25/2018] [Indexed: 12/15/2022]
Abstract
Gender is associated with several features of psychotic disorders, including age of illness onset, symptomatology, a higher prevalence of history of childhood sexual abuse (CSA) and needs for care. Childhood sexual abuse is associated with adverse mental health consequences but as there is a gender difference in stress reactivity, there may be a differential impact of CSA on psychopathology, age of psychosis onset and needs for care in First Episode Psychosis (FEP) patients. We hypothesized that a history of abuse would be associated with lowering of age of onset, increased symptomatology and more unmet needs in women but not men. A total of 444 FEP patients have been recruited within the context of the GET UP trial. Symptomatology has been assessed using the PANSS scale, needs for care with the CAN scale and childhood abuse with the CECA-Q scale. Childhood sexual abuse was more frequent among female patients [22.6% in women vs 11.6% in men (OR = 0.45, p < 0.01)], whereas there was no gender difference in the prevalence of childhood physical abuse (29.0% in women vs 31.7% in men). Childhood abuse was associated with higher levels of negative symptoms in both men and women, with a reduced age of onset in women only and little increase in needs for care in both men and women. Our results seem to suggest that childhood sexual abuse in female FEP patients may be linked to a more severe form of psychosis whose presentation is characterized by earlier age of onset and higher levels of negative symptoms and we can also speculate that gender-specific protective factors in women, but not in men, may be outweighed by the consequences of childhood abuse.
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Affiliation(s)
- Carla Comacchio
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement, University of Verona, Italy.
| | - Louise M Howard
- Section of Women's Mental Health, Health Services and Population Research Department, King's College London, UK
| | - Chiara Bonetto
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement, University of Verona, Italy
| | | | - Karin Furlato
- Department of Mental Health, Azienda USL Bolzano, Italy
| | | | - Antonio Preti
- Detection and Intervention in Psychosis, Department of Mental Health, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Luca Mesiano
- Department of Neurosciences, University of Padova and Azienda Ospedaliera, Padua, Italy
| | - Giovanni Neri
- Department of Mental Health, Azienda ULSS Modena, Modena, Italy
| | | | - Katia de Santi
- UOC Psichiatria, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona, Verona, Italy
| | - Elisabetta Miglietta
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement, University of Verona, Italy
| | - Sarah Tosato
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement, University of Verona, Italy
| | - Doriana Cristofalo
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement, University of Verona, Italy
| | - Antonio Lasalvia
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement, University of Verona, Italy; UOC Psichiatria, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona, Verona, Italy
| | - Mirella Ruggeri
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement, University of Verona, Italy; UOC Psichiatria, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona, Verona, Italy
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25
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Hadwin JA, Lee E, Kumsta R, Cortese S, Kovshoff H. Cortisol awakening response in children and adolescents with autism spectrum disorder: a systematic review and meta-analysis. EVIDENCE-BASED MENTAL HEALTH 2019; 22:118-124. [PMID: 31253603 PMCID: PMC10270439 DOI: 10.1136/ebmental-2019-300098] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 06/10/2019] [Accepted: 06/17/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND The cortisol awakening response (CAR) is characterised by an increase in cortisol in the 30 to 60 min after waking. Research has found significant associations between an atypical CAR and symptoms of stress and anxiety in typically developing (TD) children and adolescents. A number of studies have explored the CAR in autism spectrum disorder (ASD), but no evidence synthesis is available to date. OBJECTIVE AND METHODS Based on a preregistered protocol (PROSPERO: CRD42017051187), we carried out a systematic review (SR) and meta-analysis (MA) of CAR studies to explore potential significant differences between children and adolescents with ASD and TD controls. Web of Science, PubMed and PsychInfo were searched until January 2019. A random-effects model was used to pool studies and we used the Newcastle-Ottawa scale (NOS) to assess study quality and risk of bias. FINDINGS The SR retrieved a total of nine studies, with mixed findings on the comparison of the CAR between children and adolescents with ASD and TD controls. The MA, based on four studies (ASD; n=117 and TD n=118), suggested no differences between the CAR in ASD and TD populations (SMD: -0.21, 95% CI -0.49 to 0.08). In terms of NOS items, no study specified Representativeness of the cases and Non-response rate. DISCUSSION AND CLINICAL IMPLICATIONS: Given the relatively few studies and lack of appropriately matched TD controls, additional research is needed to further understand and recommend the utility of the CAR as a reliable marker to differentiate ASD and TD.
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Affiliation(s)
| | - Emma Lee
- Psychology, University of Southampton, Southampton, UK
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26
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Labad J. The role of cortisol and prolactin in the pathogenesis and clinical expression of psychotic disorders. Psychoneuroendocrinology 2019; 102:24-36. [PMID: 30503781 DOI: 10.1016/j.psyneuen.2018.11.028] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 11/19/2018] [Accepted: 11/21/2018] [Indexed: 02/03/2023]
Abstract
For many years, the study of the psychotic phenotpe and approach to treatment of schizophrenia has been focused on positive psychotic symptoms, although the functional outcome is more clearly associated with negative and cognitive symptoms. Recently, there has been a growing interest in identifying biomarkers associated with these symptoms at early stages of the illness, including the risk of psychosis in vulnerable individuals (at-risk mental states [ARMS]). In this paper, the role of cortisol and prolactin in the clinical expression of psychosis will be reviewed. In examination of the role of these hormones and the risk of developing a psychotic disorder in ARMS individuals, previous studies have suggested potential roles for both cortisol and prolactin. The study of cognitive abilities in recent-onset psychotic patients has suggested that affected cognitive domains differ depending upon the studied hormones: cortisol (processing speed, verbal and working memory) and prolactin (processing speed), with several studies suggesting that there are sex-differences in these associations. All of these results suggest that both cortisol and prolactin contribute to the pathogenesis and clinical expression of psychotic disorders.
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Affiliation(s)
- Javier Labad
- Department of Mental Health, Parc Taulí Hospital Universitari, Institut d'Investigació Sanitària Parc Taulí (I3PT), Translational Neuroscience Unit, Universitat Autònoma de Barcelona (UAB), CIBERSAM. Sabadell, Barcelona, Spain.
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27
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Ciufolini S, Gayer-Anderson C, Fisher HL, Marques TR, Taylor H, Di Forti M, Zunszain P, Morgan C, Murray RM, Pariante CM, Dazzan P, Mondelli V. Cortisol awakening response is decreased in patients with first-episode psychosis and increased in healthy controls with a history of severe childhood abuse. Schizophr Res 2019; 205:38-44. [PMID: 29776641 DOI: 10.1016/j.schres.2018.05.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 04/30/2018] [Accepted: 05/04/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Childhood abuse is highly prevalent in psychosis patients, but whether/how it affects hypothalamic-pituitary-adrenal (HPA) axis at the onset of psychosis remains unclear. We aimed to investigate the effects of severity of childhood abuse on HPA axis activity, in first-episode psychosis (FEP) and healthy controls. METHODS We recruited 169 FEP patients and 133 controls with different degrees of childhood physical and sexual abuse (i.e. no abuse exposure, non-severe abuse exposure, and severe abuse exposure). Saliva samples were collected to measure cortisol awakening response with respect to ground (CARg), increase (CARi) and diurnal (CDD) cortisol levels. Two-way ANOVA analyses were conducted to test the relationships between severity of childhood abuse and psychosis on cortisol levels in individuals with psychosis and healthy controls with and without childhood abuse history. RESULTS A statistically significant interaction between childhood abuse and psychosis on CARg was found (F(2,262) = 4.60, p = 0.011, ω2 = 0.42). Overall, controls showed a U-shaped relationship between abuse exposure and CARg, while patients showed an inverted U-shaped relationship. CARg values were markedly different between patients and controls with either no abuse history or exposure to severe childhood abuse. No significant differences were found when looking at CARi and CDD. CONCLUSIONS Our results show a divergent effect of severe childhood abuse on HPA axis activity in patients with first-episode psychosis and in controls. In the presence of exposure to severe childhood abuse, a blunted CARg and a less reactive HPA axis may represent one of the biological mechanisms involved in the development of psychosis.
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Affiliation(s)
- Simone Ciufolini
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, Department of Psychosis Studies, London, UK; National Institute for Health Research (NIHR), Mental Health Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, King's College London, UK
| | - Charlotte Gayer-Anderson
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, Department of Health Services & Population Research, London, UK
| | - Helen L Fisher
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, Social, Genetic & Developmental Psychiatry Centre, London, UK
| | - Tiago Reis Marques
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, Department of Psychosis Studies, London, UK
| | - Heather Taylor
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, Department of Psychosis Studies, London, UK
| | - Marta Di Forti
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, Social, Genetic & Developmental Psychiatry Centre, London, UK
| | - Patricia Zunszain
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, Department of Psychological Medicine, London, UK
| | - Craig Morgan
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, Department of Health Services & Population Research, London, UK
| | - Robin M Murray
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, Department of Psychosis Studies, London, UK
| | - Carmine M Pariante
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, Department of Psychological Medicine, London, UK; National Institute for Health Research (NIHR), Mental Health Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, King's College London, UK
| | - Paola Dazzan
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, Department of Psychosis Studies, London, UK; National Institute for Health Research (NIHR), Mental Health Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, King's College London, UK
| | - Valeria Mondelli
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, Department of Psychological Medicine, London, UK; National Institute for Health Research (NIHR), Mental Health Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, King's College London, UK.
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Flores-Reséndiz C, Soto-Piña AE, Valdés-Ramos R, Benítez-Arciniega AD, Tlatempa-Sotelo P, Guadarrama-López AL, Martínez-Carrillo BE, Pulido-Alvarado CC. Association Between Cardiovascular Risk Factors and Stress Hormones With Cognitive Performance in Mexican Adolescents. J Pediatr Psychol 2019; 44:208-219. [PMID: 30272242 DOI: 10.1093/jpepsy/jsy074] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 08/25/2018] [Indexed: 11/13/2022] Open
Abstract
Objective The objective of this study was to determine whether cardiovascular disease (CVD) risk factors and stress hormones are associated with cognitive performance in Mexican adolescents. Methods This was a cross-sectional study including 139 Mexican adolescents 10-14 years old. Participants were divided into three categories: 0, 1-2, and ≥3 CVD risk factors. These factors included: high-density lipoprotein-cholesterol (HDL-C) <40 mg/dl; waist circumference (WC) ≥90th percentile for age and sex, systolic or diastolic blood pressure ≥90th percentile for age, sex, and height; and triacylglycerols (TGs) ≥110 mg/dl. Low-density lipoprotein-cholesterol (LDL-C), very low-density lipoprotein-cholesterol (VLDL-C), total cholesterol, cortisol, and plasma catecholamines were measured as well. Furthermore, attention, memory, and executive functions were evaluated using a validated test for Spanish-speaking individuals (Neuropsi). Results Adolescents in the three risk categories did not show significant differences in Neuropsi test performance tasks; however, they presented different lipid and plasma norepinephrine concentrations. TG and VLDL-C were inversely associated with memory (r = -0.19, **p < .01). Multivariate regression analysis showed consistently that TG/HDL-C ratio was inversely related to attention-memory general score (standardized β = -0.99, t = -2.30, p = .023), memory (standardized β = -0.83, t = -2.08, p = .039), and attention-executive functions (standardized β = -1.02, t = -2.42, p = .017). Plasma epinephrine levels presented an inverse and weak relation to the attention-executive functions score (standardized β = -0.18, t = -2.19, p = .030). Conclusions Cognitive performance is not completely dependent on the accumulation of risk factors, but instead on the combination of strong predictors of CVD like waist to height ratio, TG/HDL-C, and VLDL-C. Plasma norepinephrine and epinephrine have a stronger association with cognition and CVD risk than dopamine and cortisol.
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Beck AT, Himelstein R, Bredemeier K, Silverstein SM, Grant P. What accounts for poor functioning in people with schizophrenia: a re-evaluation of the contributions of neurocognitive v. attitudinal and motivational factors. Psychol Med 2018; 48:2776-2785. [PMID: 29501072 DOI: 10.1017/s0033291718000442] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Neurocognitive deficits are often seen as core features of schizophrenia, and as primary determinants of poor functioning. Yet, our clinical observations suggest that individuals who score within the impaired range on standardized tests can reliably perform better in complex real-world situations, especially when performance is embedded within a positive socio-affective context. METHODS We analyzed literature on the influence of non-neurocognitive factors on test performance in order to clarify their contributions. RESULTS We identified seven non-neurocognitive factors that significantly contribute to neurocognitive test performance: avolition, dysfunctional attitudes, effort, stress, negative emotions, asociality, and disorganized symptoms. We then proposed an alternative model based on dysfunctional (e.g. defeatist) attitudes and their consequences for motivation and sustained task engagement. We demonstrated that these factors account for substantial variance in negative symptoms, neurocognitive test performance, and functional outcomes. We then demonstrated that recovery-oriented cognitive therapy - which is derived from this alternative model and primarily targets dysfunctional beliefs - has been successful in the treatment of low functioning individuals with schizophrenia. CONCLUSION The contributions of neurocognitive impairments to poor real-world functioning in people with schizophrenia may be overstated in the literature, and may even be limited relative to non-neurocognitive factors. We offer suggestions for further research to more precisely quantify the contributions of attitudinal/motivation v. neurocognitive factors in schizophrenia.
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Affiliation(s)
- Aaron T Beck
- Department of Psychiatry,University of Pennsylvania,Philadelphia,Pennsylvania,USA
| | - Robyn Himelstein
- Department of Psychiatry,University of Pennsylvania,Philadelphia,Pennsylvania,USA
| | - Keith Bredemeier
- Center for Assessment Research and Translation,University of Delaware,Newark,Delaware,USA
| | - Steven M Silverstein
- Department of Psychiatry,Rutgers - Robert Wood Johnson Medical School,Piscataway Township,New Jersey,USA
| | - Paul Grant
- Department of Psychiatry,University of Pennsylvania,Philadelphia,Pennsylvania,USA
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Vaessen T, Kasanova Z, Hernaus D, Lataster J, Collip D, van Nierop M, Myin-Germeys I. Overall cortisol, diurnal slope, and stress reactivity in psychosis: An experience sampling approach. Psychoneuroendocrinology 2018; 96:61-68. [PMID: 29906787 DOI: 10.1016/j.psyneuen.2018.06.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 06/05/2018] [Accepted: 06/06/2018] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Results from experimental studies suggest that psychosis and psychosis liability are associated with increased cortisol levels and blunted cortisol reactivity, and that use of antipsychotics may reduce these aberrations. Here, we report on overall cortisol, diurnal slope, and cortisol stress reactivity in everyday life in psychosis and psychosis liability using the experience sampling method (ESM). METHODS Our sample consisted of individuals diagnosed with psychotic disorder currently on (MPD; n = 53) or off antipsychotic medication (NMPD; n = 20), first-degree relatives of psychotic patients (REL; n = 47), and healthy volunteers (HV; n = 67). Saliva samples were collected throughout the day on six consecutive days and analyzed for cortisol levels. Simultaneously, stressfulness of the current activity was assessed with ESM questionnaires. RESULTS We found no group differences in overall cortisol level between groups, but REL had a steeper diurnal slope than HV; in MPD a trend was found in the same direction. Regarding reactivity to stressful activities, results indicated attenuation of the cortisol response in both patient groups compared to HV. CONCLUSION These results do not confirm reports of increased cortisol levels in psychosis, but provide evidence of stress-related cortisol alterations in everyday life.
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Affiliation(s)
- Thomas Vaessen
- Department of Neurosciences, Psychiatry Research Group, Center for Contextual Psychiatry, KU Leuven, Belgium; Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands.
| | - Zuzana Kasanova
- Department of Neurosciences, Psychiatry Research Group, Center for Contextual Psychiatry, KU Leuven, Belgium
| | - Dennis Hernaus
- Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Johan Lataster
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands; Faculty of Psychology and Educational Sciences, Open University, Heerlen, The Netherlands
| | - Dina Collip
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Martine van Nierop
- Department of Neurosciences, Psychiatry Research Group, Center for Contextual Psychiatry, KU Leuven, Belgium
| | - Inez Myin-Germeys
- Department of Neurosciences, Psychiatry Research Group, Center for Contextual Psychiatry, KU Leuven, Belgium
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Soria V, González-Rodríguez A, Huerta-Ramos E, Usall J, Cobo J, Bioque M, Barbero JD, García-Rizo C, Tost M, Monreal JA, Labad J. Targeting hypothalamic-pituitary-adrenal axis hormones and sex steroids for improving cognition in major mood disorders and schizophrenia: a systematic review and narrative synthesis. Psychoneuroendocrinology 2018; 93:8-19. [PMID: 29680774 DOI: 10.1016/j.psyneuen.2018.04.012] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 03/24/2018] [Accepted: 04/11/2018] [Indexed: 01/05/2023]
Abstract
Cognitive deficits are a core feature of serious mental illnesses such as schizophrenia, major depressive disorder (MDD) and bipolar disorder (BD) and are a common cause of functional disability. There is limited efficacy of pharmacological interventions for improving the cognitive deficits in these disorders. As pro-cognitive pharmacological treatments are lacking, hormones or drugs that target the endocrine system may become potential candidates for 'repurposing' trials aiming to improve cognition. We aimed to study whether treatment with drugs targeting the hypothalamic-pituitary-adrenal (HPA) axis and sex steroids can improve cognition in patients with schizophrenia, MDD or BD. A systematic search was performed using PubMed (Medline), PsychInfo and clinicaltrials.gov, and a narrative synthesis was included. The systematic review identified 12 studies dealing with HPA-related drugs (mifepristone [n = 3], cortisol synthesis inhibitors [ketoconazole, n = 2], dehydroepiandrosterone [n = 5], fludrocortisone [n = 2]) and 14 studies dealing with sex steroids (oestradiol [n = 2], selective oestrogen receptor modulators [raloxifene, n = 7], pregnenolone [n = 5]). Positive trials were found for BD (mifepristone), MDD (dehydroepiandrosterone and fludrocortisone) and schizophrenia (dehydroepiandrosterone, raloxifene and pregnenolone). A replication of positive findings by at least two clinical trials was found for mifepristone in BD and raloxifene and pregnenolone in schizophrenia. The use of drugs targeting hormones related to the HPA axis and sex steroids is a promising field of research that might help to improve the cognitive outcome of patients with schizophrenia, bipolar disorder and major depressive disorder in the near future.
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Affiliation(s)
- Virginia Soria
- Department of Psychiatry, Bellvitge University Hospital, Universitat de Barcelona, Bellvitge Biomedical Research Institute (IDIBELL), Neurosciences Group, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, Spain
| | - Alexandre González-Rodríguez
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, Spain; Department of Mental Health, Parc Taulí Hospital Universitari, Universitat Autònoma de Barcelona, I3PT, Sabadell, Barcerlona, Spain
| | - Elena Huerta-Ramos
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, Spain; Research and Development Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
| | - Judith Usall
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, Spain; Research and Development Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
| | - Jesús Cobo
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, Spain; Department of Mental Health, Parc Taulí Hospital Universitari, Universitat Autònoma de Barcelona, I3PT, Sabadell, Barcerlona, Spain
| | - Miquel Bioque
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, Spain; Barcelona Clínic Schizophrenia Unit, Hospital Clínic de Barcelona, Universitat de Barcelona, Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Juan David Barbero
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, Spain; Department of Mental Health, Parc Taulí Hospital Universitari, Universitat Autònoma de Barcelona, I3PT, Sabadell, Barcerlona, Spain
| | - Clemente García-Rizo
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, Spain; Barcelona Clínic Schizophrenia Unit, Hospital Clínic de Barcelona, Universitat de Barcelona, Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Meritxell Tost
- Department of Mental Health, Parc Taulí Hospital Universitari, Universitat Autònoma de Barcelona, I3PT, Sabadell, Barcerlona, Spain
| | - José Antonio Monreal
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, Spain; Department of Mental Health, Parc Taulí Hospital Universitari, Universitat Autònoma de Barcelona, I3PT, Sabadell, Barcerlona, Spain
| | | | - Javier Labad
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, Spain; Department of Mental Health, Parc Taulí Hospital Universitari, Universitat Autònoma de Barcelona, I3PT, Sabadell, Barcerlona, Spain.
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Montalvo I, Nadal R, Armario A, Gutiérrez-Zotes A, Creus M, Cabezas Á, Solé M, Algora MJ, Sánchez-Gistau V, Vilella E, Labad J. Sex differences in the relationship between prolactin levels and impaired processing speed in early psychosis. Aust N Z J Psychiatry 2018; 52:585-595. [PMID: 29232966 DOI: 10.1177/0004867417744254] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Hyperprolactinaemia is commonly observed in people with psychotic disorders due to D2 receptor blockade by antipsychotic drugs, although it may also exist in drug-naïve patients with first-episode psychosis. Recent studies suggest that hyperprolactinaemia may have a negative impact on cognitive function in people with early psychosis. We aimed to explore whether there are sex differences in the association between prolactin levels and cognitive performance in early psychosis patients. METHODS We studied 60 young patients with early psychosis (aged 18-35 years, 35% females) and a sex- and age-matched control group of 50 healthy subjects. Cognitive assessment was performed with the MATRICS Consensus Cognitive Battery. Prolactin, total cortisol, follicular-stimulating hormone, luteal hormone and sex steroids (testosterone in men, oestradiol and progesterone in women) were measured in plasma. Salivary cortisol was measured at different sampling times (awakening response, 10:00 and 23:00). Psychopathological status was assessed, and antipsychotic treatment was registered. Multiple linear regression analyses were used to explore the relationship between prolactin and cognitive tasks while adjusting for covariates. RESULTS Prolactin levels were associated with impaired processing speed in men, and this association was independent of cortisol and testosterone. In women, prolactin levels were not associated with processing speed tasks, although we observed a negative effect of prolactin on verbal learning and spatial working memory in female healthy subjects. The male-dependent effect maintained its significance after adjusting for education status, antipsychotic treatment and negative symptoms. CONCLUSION Our study demonstrates that the previously reported association between high prolactin levels and impaired cognitive processes in early psychosis is restricted to men.
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Affiliation(s)
- Itziar Montalvo
- 1 Parc Taulí Hospital Universitari, I3PT, Universitat Autònoma de Barcelona, CIBERSAM, Sabadell, Spain
| | - Roser Nadal
- 2 Institut de Neurociències, Universitat Autònoma de Barcelona, CIBERSAM, Cerdanyola del Vallès, Spain
| | - Antonio Armario
- 2 Institut de Neurociències, Universitat Autònoma de Barcelona, CIBERSAM, Cerdanyola del Vallès, Spain
| | - Alfonso Gutiérrez-Zotes
- 3 Hospital Universitari Institut Pere Mata, IISPV, Universitat Rovira i Virgili, CIBERSAM, Reus, Spain
| | - Marta Creus
- 3 Hospital Universitari Institut Pere Mata, IISPV, Universitat Rovira i Virgili, CIBERSAM, Reus, Spain
| | - Ángel Cabezas
- 3 Hospital Universitari Institut Pere Mata, IISPV, Universitat Rovira i Virgili, CIBERSAM, Reus, Spain
| | - Montse Solé
- 3 Hospital Universitari Institut Pere Mata, IISPV, Universitat Rovira i Virgili, CIBERSAM, Reus, Spain
| | - Maria José Algora
- 3 Hospital Universitari Institut Pere Mata, IISPV, Universitat Rovira i Virgili, CIBERSAM, Reus, Spain
| | - Vanessa Sánchez-Gistau
- 3 Hospital Universitari Institut Pere Mata, IISPV, Universitat Rovira i Virgili, CIBERSAM, Reus, Spain
| | - Elisabet Vilella
- 3 Hospital Universitari Institut Pere Mata, IISPV, Universitat Rovira i Virgili, CIBERSAM, Reus, Spain
| | - Javier Labad
- 1 Parc Taulí Hospital Universitari, I3PT, Universitat Autònoma de Barcelona, CIBERSAM, Sabadell, Spain
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Naß J, Efferth T. Pharmacogenetics and Pharmacotherapy of Military Personnel Suffering from Post-traumatic Stress Disorder. Curr Neuropharmacol 2018; 15:831-860. [PMID: 27834145 PMCID: PMC5652029 DOI: 10.2174/1570159x15666161111113514] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 09/23/2016] [Accepted: 11/08/2016] [Indexed: 12/26/2022] Open
Abstract
Background: Posttraumatic stress disorder (PTSD) is a severe problem among soldiers with combating experience difficult to treat. The pathogenesis is still not fully understood at the psychological level. Therefore, genetic research became a focus of interest. The identification of single nucleotide polymorphisms (SNPs) may help to predict, which persons are at high risk to develop PTSD as a starting point to develop novel targeted drugs for treatment. Methods: We conducted a systematic review on SNPs in genes related to PTSD pathology and development of targeted pharmacological treatment options based on PubMed database searches. We focused on clinical trials with military personnel. Results: SNPs in 22 human genes have been linked to PTSD. These genes encode proteins acting as neurotransmitters and receptors, downstream signal transducers and metabolizing enzymes. Pharmacological inhibitors may serve as drug candidates for PTSD treatment, e.g. β2 adrenoreceptor antagonists, dopamine antagonists, partial dopamine D2 receptor agonists, dopamine β hydroxylase inhibitors, fatty acid amid hydrolase antagonists, glucocorticoid receptor agonists, tropomyosin receptor kinase B agonists, selective serotonin reuptake inhibitors, catechol-O-methyltransferase inhibitors, gamma-amino butyric acid receptor agonists, glutamate receptor inhibitors, monoaminoxidase B inhibitors, N-methyl-d-aspartate receptor antagonists. Conclusion: The combination of genetic and pharmacological research may lead to novel target-based drug developments with improved specificity and efficacy to treat PTSD. Specific SNPs may be identified as reliable biomarkers to assess individual disease risk. Focusing on soldiers suffering from PTSD will not only help to improve treatment options for this specific group, but for all PTSD patients and the general population.
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Affiliation(s)
- Janine Naß
- Department of Pharmaceutical Biology, Institute of Pharmacy and Biochemistry, Johannes Gutenberg University, Staudinger Weg 5, 55128 Mainz. Germany
| | - Thomas Efferth
- Department of Pharmaceutical Biology, Institute of Pharmacy and Biochemistry, Johannes Gutenberg University, Staudinger Weg 5, 55128 Mainz. Germany
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Shi X, Sun X, Yao Z, Yuan Y, Wu J, Clow A. The cortisol awakening response predicts response inhibition in the afternoon of the same day. Psychoneuroendocrinology 2018; 89:23-29. [PMID: 29306774 DOI: 10.1016/j.psyneuen.2017.12.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 12/20/2017] [Accepted: 12/20/2017] [Indexed: 12/21/2022]
Abstract
The cortisol awakening response (CAR) is the rapid increase of cortisol levels 30-45 min after awakening in the morning. Numerous studies have indicated the relationship between the CAR and cognition. However, little is known about daily variation in the CAR and cognitive function in healthy adults. The aim of the present study was to investigate whether the CAR predicted the response inhibition function on the same day in both behaviour and the dynamic time course of brain processing. The saliva samples of 47 healthy men were collected at three time points: immediately on awakening, 30 min and 45 min post-awakening in the morning. Participants performed a Go/NoGo task while electroencephalograms (EEG) were recorded in the afternoon of the same day. The results showed that a greater CAR was associated with a stronger N2. In the sub-group of CAR responders (n = 33) the CAR was negatively related to the false alarm rate of NoGo-trials. Our findings suggested that the CAR was predictive of the function of response inhibition in both the earlier cognitive step (i.e., conflict monitoring) and the behavioural performance of response inhibition on the same day in healthy men.
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Affiliation(s)
- Xia Shi
- CAS Key Laboratory of Behavioral Science, Institute of Psychology, Beijing, China; Department of Psychology, Tianjin University of Technology and Education, Tianjin, China; University of Chinese Academy of Sciences, Beijing, China
| | - Xiaofang Sun
- CAS Key Laboratory of Behavioral Science, Institute of Psychology, Beijing, China; University of Chinese Academy of Sciences, Beijing, China
| | - Zhuxi Yao
- CAS Key Laboratory of Behavioral Science, Institute of Psychology, Beijing, China; University of Chinese Academy of Sciences, Beijing, China; Shenzhen Key Laboratory of Affective and Social Cognitive Science, Shenzhen University, Shenzhen, Guangdong, China
| | - Yiran Yuan
- CAS Key Laboratory of Behavioral Science, Institute of Psychology, Beijing, China
| | - Jianhui Wu
- Shenzhen Key Laboratory of Affective and Social Cognitive Science, Shenzhen University, Shenzhen, Guangdong, China.
| | - Angela Clow
- Department of Psychology, University of Westminster, London, UK
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Allott KA, Yuen HP, Bartholomeusz CF, Rapado-Castro M, Phassouliotis C, Butselaar F, Wood SJ, Proffitt TM, Savage G, Phillips LJ, Bendall S, Markulev C, Reniers RLEP, Pantelis C, Baldwin L, McGorry PD, Garner B. Stress hormones and verbal memory in young people over the first 12 weeks of treatment for psychosis. Psychiatry Res 2018; 260:60-66. [PMID: 29175500 DOI: 10.1016/j.psychres.2017.11.044] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 11/15/2017] [Accepted: 11/16/2017] [Indexed: 12/24/2022]
Abstract
AIMS Memory impairment in psychosis may be mediated through detrimental effects of hypothalamic-pituitary-adrenal (HPA) axis function. This study prospectively investigated the relationship between cortisol, sulphate dehydroepiandrosterone (DHEA(S) and cortisol: DHEA(S) ratio and memory in 35 first-episode psychosis (FEP) patients during the first 12 weeks of treatment and 23 healthy controls (HC). METHODS Morning blood sampling and tests of attention, working memory and verbal memory occurred at baseline and 12-week follow-up. RESULTS FEP and HC groups did not significantly differ in levels of cortisol, DHEA(S) or their ratio at baseline or over 12-weeks. The FEP group performed significantly below HC on all cognitive measures at baseline and over 12-weeks. Cortisol levels were unrelated to cognition in both groups. At baseline, DHEA(S) was positively associated with attention in HCs, but negatively associated with attention in FEP participants. Change in DHEA(S) was negatively associated with change in memory over 12-weeks in both groups. At 12-weeks, there was a negative correlation between the cortisol: DHEA(S) ratio and attention in both groups. CONCLUSIONS These findings are mostly in contrast to findings in chronic schizophrenia. Investigation at different illness phases and over longer-follow-up periods is required to determine the complex relationship between HPA-axis and memory functioning in psychosis.
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Affiliation(s)
- Kelly A Allott
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, Victoria 3052, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia.
| | - Hok Pan Yuen
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, Victoria 3052, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Cali F Bartholomeusz
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, Victoria 3052, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia; Melbourne Neuropsychiatry Centre, The University of Melbourne, Parkville, Australia
| | - Marta Rapado-Castro
- Melbourne Neuropsychiatry Centre, The University of Melbourne, Parkville, Australia; Child and Adolescent Psychiatry Department, Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, CIBERSAM, Madrid, Spain
| | | | - Felicity Butselaar
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, Victoria 3052, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Stephen J Wood
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, Victoria 3052, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia; School of Psychology and Institute of Clinical Sciences, University of Birmingham, United Kingdom
| | - Tina-Marie Proffitt
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, Victoria 3052, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Greg Savage
- ARC Centre of Excellence in Cognition and its Disorders, Department of Psychology, Macquarie University, Sydney, Australia
| | - Lisa J Phillips
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, Australia
| | - Sarah Bendall
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, Victoria 3052, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Connie Markulev
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, Victoria 3052, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Renate L E P Reniers
- School of Psychology and Institute of Clinical Sciences, University of Birmingham, United Kingdom
| | - Christos Pantelis
- Melbourne Neuropsychiatry Centre, The University of Melbourne, Parkville, Australia
| | - Lara Baldwin
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, Victoria 3052, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Patrick D McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, Victoria 3052, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Belinda Garner
- Translational Research Institute, Institute of Health and Biomedical Innovation, School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Queensland, Australia
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Premkumar P, Bream D, Sapara A, Fannon D, Anilkumar AP, Kuipers E, Kumari V. Pituitary volume reduction in schizophrenia following cognitive behavioural therapy. Schizophr Res 2018; 192:416-422. [PMID: 28434719 PMCID: PMC5821679 DOI: 10.1016/j.schres.2017.04.035] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 04/14/2017] [Accepted: 04/16/2017] [Indexed: 11/18/2022]
Abstract
Cognitive behavioural therapy (CBT) for psychosis (CBTp) aims to lower the stress of psychotic symptoms. Given that the pituitary is involved in stress regulation, CBT-led stress reduction may be accompanied by a change in pituitary volume. This study aimed to determine whether CBTp reduces pituitary volume in schizophrenia. The relation between pre-therapy memory and CBTp-led pituitary volume change was also examined given that poor memory relates to a blunted cortisol awakening response, denoting impaired stress response, in schizophrenia. Pituitary volume was measured at baseline in 40 schizophrenia or schizoaffective disorder patients and 30 healthy participants before therapy. Pituitary volume was measured again 6-9months after patients had either received CBTp in addition to standard care (CBTp+SC, n=24), or continued with standard care alone (SC, n=16). CBTp+SC and SC groups were compared on pituitary volume change from baseline to follow-up. Pre-therapy memory performance (Hopkins Verbal Learning and Wechsler Memory Scale - Logical memory) was correlated with baseline-to-follow-up pituitary volume change. Pituitary volume reduced over time in CBTp+SC patients. Additionally, pre-therapy verbal learning correlated more strongly with longitudinal pituitary volume reduction in the CBTp+SC group than the SC group. To conclude, CBTp reduces pituitary volume in schizophrenia most likely by enhancing stress regulation and lowering the distress due to psychotic symptoms.
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Affiliation(s)
- Preethi Premkumar
- Department of Psychology, School of Social Sciences, Nottingham Trent University, Nottingham, UK.
| | - Danielle Bream
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Adegboyega Sapara
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Dominic Fannon
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - Elizabeth Kuipers
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK,NIHR Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation Trust, London, UK
| | - Veena Kumari
- Research & Development, Sovereign Health Group, San Clemente, CA, USA
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Mansueto G, van Nierop M, Schruers K, Alizadeh BZ, Bartels-Velthuis AA, van Beveren NJ, Bruggeman R, Cahn W, de Haan L, Delespaul P, Meijer CJ, Myin-Germeys I, Kahn RS, Schirmbeck F, Simons CJP, van Haren NEM, van Os J, van Winkel R. The role of cognitive functioning in the relationship between childhood trauma and a mixed phenotype of affective-anxious-psychotic symptoms in psychotic disorders. Schizophr Res 2018; 192:262-268. [PMID: 28416093 DOI: 10.1016/j.schres.2017.04.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 03/17/2017] [Accepted: 04/01/2017] [Indexed: 12/11/2022]
Abstract
Cognitive impairments in patients with psychotic disorder have been associated with poor functioning and increased symptom severity. Furthermore, childhood trauma (CT) exposure has been associated with worse cognitive functioning as well as co-occurrence of affective-anxious-psychosis symptoms or a 'mixed phenotype of psychopathology' (MP), which in turn is associated with greater symptom severity, and poor functioning. This study aims to evaluate if cognition could be associated with CT/MP. 532 patients with non-affective psychotic patients were assessed on CT, symptom profile, cognition, functioning, and symptom severity at baseline and 3 and 6-year follow-up. Four subgroups were made according to trauma exposure (CT- or CT+) and presence of a mixed phenotype (MP- or MP+): CT-/MP (n=272), CT-/MP+ (n=157), CT+/MP- (n=49), and CT+/MP+ (n=54). Mixed-effects multilevel regression, linear regression, and Tobit analyses were performed. Patients with both CT and MP showed lower verbal learning and memory than CT-/MP+ individuals (p<0.001). No other significant differences were found among the 4 subgroups. No cognitive decline was found at follow-up, neither in the CT+/MP- nor in CT-/MP- group. Lower cognition was not associated with increased symptom severity or poor functioning at follow-up, neither in the CT+/MP- nor in CT-/MP- group. Although cognitive impairments and CT may be related to clinical or functional features of psychotic disorder, and cognitive functioning could be affected by CT exposure, cognition does not discriminate subgroups of patients stratified by CT exposure and MP.
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Affiliation(s)
- Giovanni Mansueto
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Martine van Nierop
- KU Leuven, Department of Neuroscience, Research Group Psychiatry, Center for Contextual Psychiatry, Leuven, Belgium
| | - Koen Schruers
- Maastricht University Medical Center, Dept. of Psychiatry & Psychology, School for Mental Health & Neuroscience, Maastricht, The Netherlands
| | | | - Berhooz Z Alizadeh
- University of Groningen, University Medical Center Groningen, University Center for Psychiatry, Groningen, The Netherlands
| | - Agna A Bartels-Velthuis
- University of Groningen, University Medical Center Groningen, University Center for Psychiatry, Groningen, The Netherlands
| | - Nico J van Beveren
- Antes Center for Mental Health Care, Rotterdam, The Netherlands; Erasmus MC, Dept of Psychiatry, Dept. of Neuroscience, Rotterdam, The Netherlands
| | - Richard Bruggeman
- University of Groningen, University Medical Center Groningen, University Center for Psychiatry, Groningen, The Netherlands
| | - Wiepke Cahn
- University Medical Centre Utrecht, Dept. of Psychiatry, Brain Centre Rudolf Magnus, Utrecht, The Netherlands
| | - Lieuwe de Haan
- Academic Medical Centre, University of Amsterdam, Dept. of Psychiatry, Amsterdam, The Netherlands
| | - Philippe Delespaul
- Maastricht University Medical Center, Dept. of Psychiatry & Psychology, School for Mental Health & Neuroscience, Maastricht, The Netherlands
| | - Carin J Meijer
- Academic Medical Centre, University of Amsterdam, Dept. of Psychiatry, Amsterdam, The Netherlands
| | - Inez Myin-Germeys
- KU Leuven, Department of Neuroscience, Research Group Psychiatry, Center for Contextual Psychiatry, Leuven, Belgium
| | - Rene S Kahn
- University Medical Centre Utrecht, Dept. of Psychiatry, Brain Centre Rudolf Magnus, Utrecht, The Netherlands
| | - Frederike Schirmbeck
- Academic Medical Centre, University of Amsterdam, Dept. of Psychiatry, Amsterdam, The Netherlands
| | - Claudia J P Simons
- Maastricht University Medical Center, Dept. of Psychiatry & Psychology, School for Mental Health & Neuroscience, Maastricht, The Netherlands; GGzE, Institute for Mental Health Care Eindhoven and De Kempen, Eindhoven, The Netherlands
| | - Neeltje E M van Haren
- University Medical Centre Utrecht, Dept. of Psychiatry, Brain Centre Rudolf Magnus, Utrecht, The Netherlands
| | - Jim van Os
- Maastricht University Medical Center, Dept. of Psychiatry & Psychology, School for Mental Health & Neuroscience, Maastricht, The Netherlands; King's College London, King's Health Partners, Dept. of Psychosis Studies, Institute of Psychiatry, London, United Kingdom
| | - Ruud van Winkel
- KU Leuven, Department of Neuroscience, Research Group Psychiatry, Center for Contextual Psychiatry, Leuven, Belgium; KU Leuven, University Psychiatric Center KU Leuven, Leuvensesteenweg 517, 3070 Kortenberg, Belgium.
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38
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Fogelman N, Canli T. Early life stress and cortisol: A meta-analysis. Horm Behav 2018; 98:63-76. [PMID: 29289660 DOI: 10.1016/j.yhbeh.2017.12.014] [Citation(s) in RCA: 94] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 11/27/2017] [Accepted: 12/24/2017] [Indexed: 12/16/2022]
Abstract
Given the high prevalence of early life stress (ELS) and the potential physiological dysregulation such experiences can lead to, this meta-analysis tested the relationship between ELS and cortisol. Search terms related to ELS and cortisol were entered in to PsycINFO and PubMed. Effect sizes were extracted for four outcomes variables: cortisol awakening response (CAR), baseline cortisol (cortisol at one time point), non-stressed cortisol over time (cortisol captured at two or more time points), and cortisol reactivity to an acute stressor. The articles were additionally coded for potential confounding variables, population-related, ELS-related and cortisol-related moderators. There was no significant relationship between ELS and the CAR (g=0.19, p=0.268), ELS and baseline cortisol (g=-0.072, p=0.328), ELS and non-stressed cortisol over time (g=0.09, p=0.292) or ELS and cortisol reactivity (g=-0.089, p=0.363). However, there was a significant amount of heterogeneity amongst relationships. Within the ELS-CAR relationship, in those who had experienced ELS that was sexually, physically or emotionally abusive, the CAR was heightened. Within the ELS-Baseline relationship, if blood samples were collected the ELS was associated with a blunting effect of cortisol. The non-significant main effects challenge the commonly held belief in the literature that ELS affects cortisol later in life. However, the high degree of heterogeneity uncovered by this analysis and significant moderators suggest that the literature may benefit from consistent operationalizations of ELS and standardized methods of how cortisol is measured.
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Affiliation(s)
- Nia Fogelman
- Department of Psychology, Stony Brook University, Stony Brook, NY 11794, USA.
| | - Turhan Canli
- Department of Psychology, Department of Psychiatry, Stony Brook University, Stony Brook, NY 11794, USA
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Takahashi T, Higuchi Y, Komori Y, Nishiyama S, Takayanagi Y, Sasabayashi D, Kido M, Furuichi A, Nishikawa Y, Nakamura M, Noguchi K, Suzuki M. Pituitary Volume and Socio-Cognitive Functions in Individuals at Risk of Psychosis and Patients With Schizophrenia. Front Psychiatry 2018; 9:574. [PMID: 30473669 PMCID: PMC6237858 DOI: 10.3389/fpsyt.2018.00574] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 10/19/2018] [Indexed: 11/13/2022] Open
Abstract
Objectives: Increased pituitary volume, which probably reflects hypothalamic-pituitary-adrenal (HPA) hyperactivity, has been reported in patients with schizophrenia and individuals at risk of psychosis. On the basis of potential role of abnormal HPA axis function on cognitive impairments in psychosis, we aimed to examine possible relations between the pituitary volume and socio-cognitive impairments in these subjects. Methods: This magnetic resonance imaging study examined the pituitary gland volume in 38 subjects with at-risk mental state (ARMS) [of whom 4 (10.5%) exhibited the transition to schizophrenia], 63 patients with schizophrenia, and 61 healthy controls. Social and cognitive functions of the ARMS and schizophrenia groups were assessed using the Brief Assessment of Cognition in Schizophrenia (BACS), the Schizophrenia Cognition Rating Scale (SCoRS), and the Social and Occupational Functioning Assessment Scale (SOFAS). Results: Both the ARMS and schizophrenia groups had a significantly larger pituitary volume compared to controls. In the schizophrenia group, the pituitary volume was negatively associated with the BACS working memory score. No association was found between the pituitary volume and clinical variables (medication, symptom severity) in either clinical group. Conclusion: Our findings support the notion of common HPA hyperactivity in the ARMS and schizophrenia groups, but abnormal HPA axis function may contribute differently to cognitive deficits according to the illness stages of schizophrenia.
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Affiliation(s)
- Tsutomu Takahashi
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan
| | - Yuko Higuchi
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan
| | - Yuko Komori
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan
| | - Shimako Nishiyama
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan
| | - Yoichiro Takayanagi
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan
| | - Daiki Sasabayashi
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan
| | - Mikio Kido
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan
| | - Atsushi Furuichi
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan
| | - Yumiko Nishikawa
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan
| | - Mihoko Nakamura
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan
| | - Kyo Noguchi
- Department of Radiology, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan
| | - Michio Suzuki
- Department of Neuropsychiatry, University of Toyama Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan
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Quevedo K, Doty J, Roos L, Anker JJ. The cortisol awakening response and anterior cingulate cortex function in maltreated depressed versus non-maltreated depressed youth. Psychoneuroendocrinology 2017; 86:87-95. [PMID: 28926761 PMCID: PMC5896765 DOI: 10.1016/j.psyneuen.2017.09.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 07/15/2017] [Accepted: 09/01/2017] [Indexed: 02/06/2023]
Abstract
Symptomatology of depression among children who have (vs. have not) experienced maltreatment is greater in severity, more resistant to conventional treatment, and associated with elevated risk for suicide. Recent evidence implicates perturbations in stress regulatory systems and heightened negative self-appraisals as factors that increase the severity of psychopathology experienced by depressed maltreated (vs. non-maltreated) youth. Likely explanatory mechanisms for these differences are disturbances in the function of the hypothalamic-pituitary axis (HPA) and persistent negative self-referential biases supported by prefrontal cortex function including the dorsal anterior cingulate cortex (dACC). The cortisol awakening response (CAR) and dACC activity during a self-appraisal task were assessed in maltreated and non-maltreated depressed youth. Hierarchical linear models were employed to model the CAR. Maltreatment group, dACC activity during positive and negative self-appraisals as well as other key predictors, were included in the models. Post hoc analyses explored explanations for significant differences. Results indicated that maltreated depressed youth exhibited a higher CAR compared to non-maltreated youth. At low levels of dACC activity during processing of negative self-descriptors maltreated and non-maltreated depressed youth's CAR did not differ. However, at elevated levels of dACC activity during processing of negative self-descriptors maltreated depressed youth exhibited significantly higher CAR compared to non-maltreated depressed youth.
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Affiliation(s)
- Karina Quevedo
- University of Minnesota, Department of Psychiatry, Minneapolis, MN, United States.
| | - Jennifer Doty
- University of Minnesota, Department of Psychiatry, Minneapolis, MN, United States
| | - Leslie Roos
- University of Oregon, Department of Psychiatry, Minneapolis, MN, United States
| | - Justin J Anker
- University of Minnesota, Department of Psychiatry, Minneapolis, MN, United States
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Carrigan N, Barkus E, Ong A, Wei M. Do complaints of everyday cognitive failures in high schizotypy relate to emotional working memory deficits in the lab? Compr Psychiatry 2017; 78:115-129. [PMID: 28843155 DOI: 10.1016/j.comppsych.2017.06.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 06/16/2017] [Accepted: 06/27/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Individuals high on schizotypy complain of increased cognitive failures in everyday life. However, the neuropsychological performance of this group does not consistently indicate underlying ability deficits. It is possible that current neuropsychological tests lack ecological validity. Given the increased affective reactivity of high schizotypes, they may be more sensitive to emotional content interfering with cognitive ability. This study sought to explore whether an affective n-back working memory task would elicit impaired performance in schizotypy, echoing complaints concerning real world cognition. METHODS 127 healthy participants completed self-report measures of schizotypy and cognitive failures and an affective n-back working memory task. This task was varied across three levels of load (1- to 3-back) and four types of stimulus emotion (neutral, fearful, happy, sad). Differences between high (n=39) and low (n=48) schizotypy groups on performance outcomes of hits and false alarms were examined, with emotion and load as within-groups variables. RESULTS As expected, high schizotypes reported heightened vulnerability to cognitive failures. They also demonstrated a relative working memory impairment for emotional versus neutral stimuli, whereas low schizotypes did not. High schizotypes performed most poorly in response to fearful stimuli. For false alarms, there was an interaction between schizotypy, load, and emotion, such that high schizotypy was associated with deficits in response to fearful stimuli only at higher levels of task difficulty. Inclusion of self-reported cognitive failures did not account for this. CONCLUSION These findings suggest that the "gap" between subjective and objective cognition in schizotypy may reflect the heightened emotional demands associated with cognitive functioning in the real world, although other factors also seem to play a role. There is a need to improve the ecological validity of objective assessments, whilst also recognizing that self-reported cognitive failures tap into a range of factors difficult to assess in the lab, including emotion. Cognitive interventions for at-risk individuals will likely be more beneficial if they address emotional processing alongside other aspects of cognition.
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Affiliation(s)
| | - Emma Barkus
- School of Psychology, University of Wollongong, Australia
| | - Adriel Ong
- School of Psychology, University of Wollongong, Australia
| | - Maryann Wei
- School of Psychology, University of Wollongong, Australia
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Bridging Autism Spectrum Disorders and Schizophrenia through inflammation and biomarkers - pre-clinical and clinical investigations. J Neuroinflammation 2017; 14:179. [PMID: 28870209 PMCID: PMC5584030 DOI: 10.1186/s12974-017-0938-y] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 08/08/2017] [Indexed: 12/15/2022] Open
Abstract
In recent years, evidence supporting a link between inflammation and neuropsychiatric disorders has been mounting. Autism spectrum disorders (ASD) and schizophrenia share some clinical similarities which we hypothesize might reflect the same biological basis, namely, in terms of inflammation. However, the diagnosis of ASD and schizophrenia relies solely on clinical symptoms, and to date, there is no clinically useful biomarker to diagnose or monitor the course of such illnesses. The focus of this review is the central role that inflammation plays in ASD and schizophrenia. It spans from pre-clinical animal models to clinical research and excludes in vitro studies. Four major areas are covered: (1) microglia, the inflammatory brain resident myeloid cells, (2) biomarkers, including circulating cytokines, oxidative stress markers, and microRNA players, known to influence cellular processes at brain and immune levels, (3) effect of anti-psychotics on biomarkers and other predictors of response, and (4) impact of gender on response to immune activation, biomarkers, and response to anti-psychotic treatments.
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The emerging role of the FKBP5 gene polymorphisms in vulnerability-stress model of schizophrenia: further evidence from a Serbian population. Eur Arch Psychiatry Clin Neurosci 2017; 267:527-539. [PMID: 27552816 DOI: 10.1007/s00406-016-0720-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Accepted: 08/01/2016] [Indexed: 10/21/2022]
Abstract
Increased reactivity to stress is observed in patients with schizophrenia spectrum disorders and their healthy siblings in comparison with the general population. Additionally, higher levels of neuroticism, as a proposed psychological measure of stress sensitivity, increase the risk of schizophrenia. HPA axis dysregulation is one of the possible mechanisms related to the vulnerability-stress model of schizophrenia, and recent studies revealed a possible role of the functional genetic variants of FK506-binding protein 51 (FKBP5) gene which modulate activity of HPA axis. The purpose of the present study was to investigate impact of FKBP5 on schizophrenia in Serbian patients and to explore relationship between genetic variants and neuroticism by using the case-sibling-control design. In 158 subjects, we measured psychotic experiences, childhood trauma and neuroticism. Nine single-nucleotide polymorphisms (rs9295158, rs3800373, rs9740080, rs737054, rs6926133, rs9380529, rs9394314, rs2766533 and rs12200498) were genotyped. The genetic influence was modeled using logistic regression, and the relationship between genetic variants and neuroticism was assessed by linear mixed model. Our results revealed genetic main effect of FKBP5 risk alleles (A allele of rs9296158 and T allele of rs3800373) and AGTC "risk" haplotype combination (rs9296158, rs3800373, rs9470080 and rs737054, respectively) on schizophrenia, particularly when childhood trauma was set as a confounding factor. We confirmed strong relationship between neuroticism and psychotic experiences in patients and siblings and further showed relationship between higher levels of neuroticism and FKBP5 risk variants suggesting potential link between biological and psychosocial risk factors. Our data support previous findings that trauma exposure shapes FKBP5 impact on schizophrenia.
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Minichino A, Ando' A, Francesconi M, Salatino A, Delle Chiaie R, Cadenhead K. Investigating the link between drug-naive first episode psychoses (FEPs), weight gain abnormalities and brain structural damages: Relevance and implications for therapy. Prog Neuropsychopharmacol Biol Psychiatry 2017; 77:9-22. [PMID: 28363765 DOI: 10.1016/j.pnpbp.2017.03.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 03/08/2017] [Accepted: 03/20/2017] [Indexed: 02/08/2023]
Abstract
Evidence suggests that obesity and overweight may be associated with severe brain structural abnormalities and poor cognitive and functional outcomes in the general population. Despite these observations and the high prevalence of weight gain abnormalities in patients with psychosis spectrum disorders (PSDs), no studies have investigated the impact that these metabolic disturbances may have on brain structures and development in the earliest stages of PSDs. In the present review we shed light on the association between weight gain and brain structural abnormalities that may affect the course of illness in drug-naïve FEPs. Given the lack of studies directly investigating this issue, we firstly identified and critically evaluated the literature assessing weight gain abnormalities and gray or white matter (GM, WM) volumes (either globally or in specific regions of interest) in otherwise healthy obese/overweight adolescents and young adults. We then compared the results of this systematic review with those of two recent meta-analysis investigating GM and WM abnormalities in drug-naïve FEPs. Weight gain in otherwise healthy subjects was consistently associated with frontal and temporal GM atrophy and with reduced integrity of WM in the corpus callosum. Of relevance, all these brain regions are affected in drug-naïve FEPs, and their integrity is associated with clinical, cognitive and functional outcomes. The underlying mechanisms that may explain the association between weight gain, adiposity, and brain damage in both healthy subjects and drug-naïve FEPs are widely discussed. On the basis of this knowledge, we tried: a) to deduce an integrative model for the development of obesity in psychosis spectrum disorders; b) to identify the key vulnerability factors underlying the association between weight gain and psychosis; c) to provide information on new potential targets of intervention.
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Affiliation(s)
- Amedeo Minichino
- Department of Neurology and Psychiatry, Sapienza University of Rome, Italy; Department of Psychiatry, UCSD, La Jolla, CA, United States.
| | - Agata Ando'
- Department of Psychology, University of Turin, Italy
| | - Marta Francesconi
- Department of Neurology and Psychiatry, Sapienza University of Rome, Italy; Department of Psychiatry, UCSD, La Jolla, CA, United States
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Krkovic K, Moritz S, Lincoln TM. Neurocognitive deficits or stress overload: Why do individuals with schizophrenia show poor performance in neurocognitive tests? Schizophr Res 2017; 183:151-156. [PMID: 27838097 DOI: 10.1016/j.schres.2016.11.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 10/14/2016] [Accepted: 11/02/2016] [Indexed: 11/17/2022]
Abstract
Poor performance in neurocognitive tasks is consistently found across studies in all stages of schizophrenia spectrum disorders and is interpreted as an underlying, brain function-related, neurocognitive deficit. However, neurocognitive test performance in schizophrenia might be compromised by patients' increased stress level. We investigated group-differences in neurocognitive performance while accounting for psychophysiological (salivary cortisol, heart rate, skin conductance level) and self-reported stress. We included 35 patients with schizophrenia, 29 participants with attenuated psychotic symptoms, 26 first-degree relatives of individuals with schizophrenia and 28 healthy controls. Participants completed a neurocognitive test battery that assessed processing speed, task switching, attention, working memory, verbal episodic memory, and verbal comprehension. Multivariate analyses of covariance (MANCOVA) were calculated to test for main effects of group on neurocognitive performance thereby not accounting versus accounting for confounding effects of stress. As expected, patients with schizophrenia scored lower than the other groups in all neurocognitive domains. Participants with attenuated psychotic symptoms, first-degree relatives and healthy individuals did not differ from each other in their performance. After accounting for heart rate and self-reported stress, the multivariate effect of group on neurocognition remained significant, but was rendered non-significant for specific domains - working memory capacity, episodic memory, and long-term memory. The findings imply that stress is relevant to neurocognitive performance and this should be taken into account when interpreting the origin of performance deficits in schizophrenia patients.
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Affiliation(s)
- Katarina Krkovic
- Department of Clinical Psychology and Psychotherapy, University of Hamburg, Germany.
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany
| | - Tania M Lincoln
- Department of Clinical Psychology and Psychotherapy, University of Hamburg, Germany
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Misiak B, Krefft M, Bielawski T, Moustafa AA, Sąsiadek MM, Frydecka D. Toward a unified theory of childhood trauma and psychosis: A comprehensive review of epidemiological, clinical, neuropsychological and biological findings. Neurosci Biobehav Rev 2017; 75:393-406. [PMID: 28216171 DOI: 10.1016/j.neubiorev.2017.02.015] [Citation(s) in RCA: 119] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 02/09/2017] [Accepted: 02/14/2017] [Indexed: 01/05/2023]
Abstract
There is a growing body of research focused on the relationship between childhood trauma and the risk of developing psychosis. Numerous studies, including many large-scale population-based studies, controlling for possible mediating variables, provide persuasive evidence of a dose-response association and are indicative of a causal relationship. Existing evidence supports the specificity model, showing differential associations between particular adversities and clinical symptoms, with cumulative adversity causing less favorable clinical and functional outcomes in psychotic patients. To date, several psychological and biological models have been proposed to search for underlying developmental trajectories leading to the onset of psychosis, influencing psychopathological manifestation and negative functional outcomes due to a history of childhood trauma. In this article, we provide a unified review on the relationship between childhood trauma and psychosis by integrating results of epidemiological, clinical, neuropsychological and biological studies. The question whether psychosis with a positive history of childhood trauma should be considered as a new psychotic phenotype, requiring specific therapeutic interventions, warrants further investigation.
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Affiliation(s)
- Błażej Misiak
- Department of Genetics, 1 Marcinkowski Street, 50-368 Wroclaw, Poland.
| | - Maja Krefft
- Department of Psychiatry, 10 Pasteur Street, 50-367 Wroclaw, Poland
| | - Tomasz Bielawski
- Department of Psychiatry, 10 Pasteur Street, 50-367 Wroclaw, Poland
| | - Ahmed A Moustafa
- School of Social Sciences and Psychology, Marcs Institute of Brain and Behaviour, University of Western Sydney, Penrith, NSW, Australia
| | - Maria M Sąsiadek
- Department of Genetics, 1 Marcinkowski Street, 50-368 Wroclaw, Poland
| | - Dorota Frydecka
- Department of Psychiatry, 10 Pasteur Street, 50-367 Wroclaw, Poland
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Pruessner M, Cullen AE, Aas M, Walker EF. The neural diathesis-stress model of schizophrenia revisited: An update on recent findings considering illness stage and neurobiological and methodological complexities. Neurosci Biobehav Rev 2017; 73:191-218. [DOI: 10.1016/j.neubiorev.2016.12.013] [Citation(s) in RCA: 131] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 12/09/2016] [Accepted: 12/12/2016] [Indexed: 01/29/2023]
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Raper J, Wilson M, Sanchez M, Payne C, Bachevalier J. Increased anxiety-like behaviors, but blunted cortisol stress response after neonatal hippocampal lesions in monkeys. Psychoneuroendocrinology 2017; 76:57-66. [PMID: 27888771 PMCID: PMC5272817 DOI: 10.1016/j.psyneuen.2016.11.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 11/16/2016] [Accepted: 11/16/2016] [Indexed: 01/05/2023]
Abstract
The hippocampus is most notably known for its role in cognition and spatial memory; however it also plays an essential role in emotional behaviors and neuroendocrine responses. The current study investigated the long-term effects of neonatal hippocampal lesions (Neo-Hibo) on emotional and hypothalamic-pituitary-adrenal (HPA) axis functioning. During infancy, unlike controls, Neo-Hibo monkeys exhibited enhanced expression of emotional behaviors (e.g. freezing, anxiety-like, and self-directed behaviors) when exposed to a human intruder (HI task). Upon reaching adulthood, they exhibited reduced freezing and hostility, but increased anxiety-like and self-directed behaviors during the HI task. Neo-Hibo monkeys behaved as if they systematically over-rated the risk inherent in the HI task, which supports Gray and McNaughton's septo-hippocampal theory of anxiety. Also, in adulthood, the increased levels of anxiety-like behaviors in Neo-Hibo monkeys were associated with a blunted cortisol response to the HI task. Examination of basal HPA axis function revealed that Neo-Hibo monkeys exhibited the typical diurnal cortisol decline throughout the day, but had lower cortisol concentrations in the morning as compared to controls. Taken together these data suggest that an intact hippocampus during development plays a larger role beyond that of inhibitory/negative feedback regulation of the HPA axis stress-activation, and may be critical for HPA axis basal functioning as well as for the stress response. The behavioral and neuroendocrine changes demonstrated in the current study are reminiscent of those seen in human or nonhuman primates with adult-onset hippocampal damage, demonstrating little functional compensation following early hippocampal damage.
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Affiliation(s)
- Jessica Raper
- Department of Psychology, Emory University, 36 Eagle Row, Atlanta GA 30322, United States; Yerkes National Primate Research Center, 954 Gatewood Rd NE, Atlanta GA 30329, United States.
| | - Mark Wilson
- Yerkes National Primate Research Center, 954 Gatewood Rd NE, Atlanta GA 30329,Department of Psychiatry & Behavioral Sciences, Emory University, 101 Woodruff Circle, WMB suite 4000, Atlanta GA 30322
| | - Mar Sanchez
- Yerkes National Primate Research Center, 954 Gatewood Rd NE, Atlanta GA 30329,Department of Psychiatry & Behavioral Sciences, Emory University, 101 Woodruff Circle, WMB suite 4000, Atlanta GA 30322
| | - Christa Payne
- Yerkes National Primate Research Center, 954 Gatewood Rd NE, Atlanta GA 30329,Marcus Autism Center, Children's Healthcare of Atlanta, 1920 Braircliff Rd NE, Atlanta GA, 30329
| | - Jocelyne Bachevalier
- Department of Psychology, Emory University, 36 Eagle Row, Atlanta GA 30322,Yerkes National Primate Research Center, 954 Gatewood Rd NE, Atlanta GA 30329
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Labad J, Gutiérrez-Zotes A, Creus M, Montalvo I, Cabezas Á, Solé M, Ortega L, Algora MJ, Sánchez-Gistau V, Vilella E. Hypothalamic-pituitary-adrenal axis measures and cognitive abilities in early psychosis: Are there sex differences? Psychoneuroendocrinology 2016; 72:54-62. [PMID: 27344379 DOI: 10.1016/j.psyneuen.2016.06.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 06/05/2016] [Accepted: 06/06/2016] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Measures of hypothalamic-pituitary-adrenal (HPA) axis activity such as increased diurnal cortisol levels or a blunted cortisol awakening response (CAR) have been associated with cognitive impairments in people with psychotic disorders. We aimed to explore whether there are sex differences in the relationship between HPA axis measures and cognition in early psychosis (EP). METHODS 60 EP outpatients and 50 healthy subjects (HS) were assessed with the MATRICS Consensus Cognitive Battery. Saliva cortisol levels were determined at the neuropsychological assessment and on another day at 6 sampling times: awakening; 30' and 60' post-awakening; and 10:00h, 23:00h and 10:00h the day after the administration of 0.25mg of dexamethasone, which occurred at 23:00h. Three HPA axis measures were calculated: CAR, cortisol diurnal slope and cortisol suppression ratio of the dexamethasone suppression test (DST). Multiple linear regression analyses were conducted to explore the relationship between HPA axis measures and cognitive tasks while adjusting for covariates (education level, smoking, cannabis use, and cortisol levels at the cognitive assessment). Interactions between female sex, EP diagnosis and HPA axis measures were examined. RESULTS An increased CAR was associated with a poorer cognitive performance in EP women in processing speed and verbal memory. In contrast, a more flattened diurnal cortisol slope was associated with poorer functioning in the spatial working memory of EP women. DST suppression ratio was associated with better visual memory, without sex differences. CONCLUSIONS Our study suggests that there are sex differences in the relationship between HPA axis measures and cognitive abilities in EP.
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Affiliation(s)
- Javier Labad
- Corporació Sanitària Parc Taulí, I3PT, Universitat Autònoma de Barcelona. CIBERSAM, Sabadell, Spain.
| | - Alfonso Gutiérrez-Zotes
- Hospital Universitari Institut Pere Mata, IISPV, Universitat Rovira i Virgili. CIBERSAM, Reus, Spain
| | - Marta Creus
- Hospital Universitari Institut Pere Mata, IISPV, Universitat Rovira i Virgili. CIBERSAM, Reus, Spain
| | - Itziar Montalvo
- Corporació Sanitària Parc Taulí, I3PT, Universitat Autònoma de Barcelona. CIBERSAM, Sabadell, Spain
| | - Ángel Cabezas
- Hospital Universitari Institut Pere Mata, IISPV, Universitat Rovira i Virgili. CIBERSAM, Reus, Spain
| | - Montse Solé
- Hospital Universitari Institut Pere Mata, IISPV, Universitat Rovira i Virgili. CIBERSAM, Reus, Spain
| | - Laura Ortega
- Hospital Universitari Institut Pere Mata, IISPV, Universitat Rovira i Virgili. CIBERSAM, Reus, Spain
| | - Maria José Algora
- Hospital Universitari Institut Pere Mata, IISPV, Universitat Rovira i Virgili. CIBERSAM, Reus, Spain
| | - Vanessa Sánchez-Gistau
- Hospital Universitari Institut Pere Mata, IISPV, Universitat Rovira i Virgili. CIBERSAM, Reus, Spain
| | - Elisabet Vilella
- Hospital Universitari Institut Pere Mata, IISPV, Universitat Rovira i Virgili. CIBERSAM, Reus, Spain
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50
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Carol EE, Spencer RL, Mittal VA. Sex differences in morning cortisol in youth at ultra-high-risk for psychosis. Psychoneuroendocrinology 2016; 72:87-93. [PMID: 27388688 PMCID: PMC4996727 DOI: 10.1016/j.psyneuen.2016.06.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 06/14/2016] [Accepted: 06/20/2016] [Indexed: 12/23/2022]
Abstract
Research suggests abnormalities in hypothalamic-pituitary-adrenal (HPA) axis function play an important role in the pathophysiology of psychosis. However, there is limited research on the biological stress system in young people at ultra high risk (UHR) for psychosis. Morning cortisol levels are particularly relevant to study in this context, as these markers reflect HPA regulation. This is the first examination of sex differences in morning cortisol levels in UHR individuals. Twenty-eight UHR and 22 matched healthy control participants were assessed in respect to symptoms and had home-based collection of salivary cortisol over three time points in the morning. It was predicted that the UHR participants would exhibit lower morning cortisol levels and lower cortisol would be associated with greater symptomatology (i.e. higher positive, negative, and depressive symptoms). Additionally, sex differences in morning cortisol levels were explored based on recent evidence suggesting that sex differences may play an important role in the exacerbation of psychosis. While there were no group differences in morning salivary cortisol secretion, there was a sex by time interaction among UHR individuals, such that only UHR males exhibited flat cortisol levels across two hours after awakening, whereas UHR females had a pattern of cortisol secretion similar to healthy controls, even among medication-free individuals (F=6.34, p=0.004). Cortisol AUC (area under the curve) across the three time points had a trend association (medium effect size; r=0.34, p=0.08) with depressive, but not positive or negative, symptom severity. These results stress the importance of considering sex differences in the psychosis-risk period, as they improve understanding of pathogenic processes.
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Affiliation(s)
- Emily E Carol
- University of Colorado Boulder, Department of Psychology and Neuroscience, Boulder, CO, 80309, United States; University of Colorado Boulder, Center for Neuroscience, Boulder, CO, 80309, United States.
| | - Robert L Spencer
- University of Colorado Boulder, Department of Psychology and Neuroscience, Boulder, CO, 80309, United States; University of Colorado Boulder, Center for Neuroscience, Boulder, CO, 80309, United States
| | - Vijay A Mittal
- Northwestern University, Department for Psychology, Evanston, Illinois, 60208, United States; Northwestern University, Department for Psychiatry, Chicago, Illinois, 60611, United States
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