1
|
Lee H, Han D, Rhee SJ, Lee J, Kim J, Lee Y, Kim EY, Park DY, Roh S, Baik M, Jung HY, Lee TY, Kim M, Kim H, Kim SH, Kwon JS, Ahn YM, Ha K. Identifying clinical and proteomic markers for early diagnosis and prognosis prediction of major psychiatric disorders. J Affect Disord 2025; 369:886-896. [PMID: 39426510 DOI: 10.1016/j.jad.2024.10.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/05/2024] [Accepted: 10/14/2024] [Indexed: 10/21/2024]
Abstract
BACKGROUND To clarify if blood proteins can predict disease progression among individuals at clinical high-risk of severe mental illness (CHR-SMI), we developed a statistical model incorporating clinical and blood protein markers to distinguish the transition group (who developed severe mental illness) (CHR-SMI-T) and from non-transition group (CHR-SMI-NT) at baseline. METHODS Ninety individuals (74 at CHR-SMI: 16 patients) were monitored for ≤4 years and were the focus of predictive models. Three predictive models (1 [100 clinical variables], 2 [158 peptides], and 3 [100 clinical variables +158 peptides]) were evaluated using area under the receiver operating characteristic (AUROC) values. Clinical and protein feature patterns were evaluated by linear mixed-effect analysis within the model at 12 and 24 months among patients who did (CHR-SMI-T) and did not transition (CHR-SMI-NT) and the entire group. RESULT Eighteen CHR-SMI individuals with major psychiatric disorders (first episode psychosis: 2; bipolar II disorder: 13; major depressive disorder; 3) developed disorders over an average of 17.7 months. The combined model showed the highest discriminatory performance (AUROC = 0.73). Cytosolic malate dehydrogenase and transgelin-2 levels were lower in the CHR-SMI-T than the CHR-SMI-NT group. Complement component C9, inter-alpha-trypsin inhibitor heavy chain H4, von Willebrand factor, and C-reactive protein were lower in the patient than the CHR-SMI-NT group. These differences were non-significant after FDR adjustment. LIMITATIONS Small sample, no control for medication use. CONCLUSION This exploratory study identified clinical and proteomic markers that might predict severe mental illness early onset, which could aid in early detection and intervention. Future studies with larger samples and controlled variables are needed to validate these findings.
Collapse
Affiliation(s)
- Hyunju Lee
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Dohyun Han
- Proteomics Core Facility, Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea; Transdisciplinary Department of Medicine & Advanced Technology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sang Jin Rhee
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Junhee Lee
- Department of Psychiatry, Seoul St. Mary's Hospital, Seoul, Republic of Korea
| | - Jayoun Kim
- Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Yunna Lee
- Department of Neuropsychiatry, Kosin University Gospel Hospital, Busan, Republic of Korea
| | - Eun Young Kim
- Mental Health Center, Seoul National University Health Care Center, Seoul, Republic of Korea; Department of Human Systems Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Dong Yeon Park
- Department of Psychiatry, National Center for Mental Health, Seoul, Republic of Korea
| | - Sungwon Roh
- Department of Neuropsychiatry, Hanyang University Hospital, Seoul, Republic of Korea
| | - Myungjae Baik
- Department of Psychiatry, Kyung Hee University Medical Center, Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | - Hee Yeon Jung
- Department of Psychiatry, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea; Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Tae Young Lee
- Department of Psychiatry, Kyungpook National University Hospital, Daegu, Republic of Korea; Department of Psychiatry, Kyungpook National University School of Medicine, Daegu, Republic of Korea
| | - Minah Kim
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyeyoon Kim
- Proteomics Core Facility, Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
| | - Se Hyun Kim
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jun Soo Kwon
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea; Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea; Institute of Human Behavioral Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
| | - Yong Min Ahn
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea; Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea; Institute of Human Behavioral Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea.
| | - Kyooseob Ha
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada; Department of Psychiatry, Lions Gate Hospital - Vancouver Coastal Health, British Columbia, Canada.
| |
Collapse
|
2
|
Flinkenflügel K, Meinert S, Hirtsiefer C, Grotegerd D, Gruber M, Goltermann J, Winter NR, Stein F, Brosch K, Leehr EJ, Böhnlein J, Dohm K, Bauer J, Redlich R, Hahn T, Repple J, Opel N, Nitsch R, Jamalabadi H, Straube B, Alexander N, Jansen A, Nenadić I, van den Heuvel MP, Kircher T, Dannlowski U. Associations between white matter microstructure and cognitive decline in major depressive disorder versus controls in Germany: a prospective case-control cohort study. Lancet Psychiatry 2024; 11:899-909. [PMID: 39419563 DOI: 10.1016/s2215-0366(24)00291-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Revised: 08/18/2024] [Accepted: 09/04/2024] [Indexed: 10/19/2024]
Abstract
BACKGROUND Cognitive deficits are a key source of disability in individuals with major depressive disorder (MDD) and worsen with disease progression. Despite their clinical relevance, the underlying mechanisms of cognitive deficits remain poorly elucidated, hampering effective treatment strategies. Emerging evidence suggests that alterations in white matter microstructure might contribute to cognitive dysfunction in MDD. We aimed to investigate the complex association between changes in white matter integrity, cognitive decline, and disease course in MDD in a comprehensive longitudinal dataset. METHODS In the naturalistic, observational, prospective, case-control Marburg-Münster Affective Disorders Cohort Study, individuals aged 18-65 years and of Caucasian ancestry were recruited from local psychiatric hospitals in Münster and Marburg, Germany, and newspaper advertisements. Individuals diagnosed with MDD and individuals without any history of psychiatric disorder (ie, healthy controls) were included in this subsample analysis. Participants had diffusion-weighted imaging, a battery of neuropsychological tests, and detailed clinical data collected at baseline and at 2 years of follow-up. We used linear mixed-effect models to compare changes in cognitive performance and white matter integrity between participants with MDD and healthy controls. Diffusion-weighted imaging analyses were conducted using tract-based spatial statistics. To correct for multiple comparisons, threshold free cluster enhancement (TFCE) was used to correct α-values at the family-wise error rate (FWE; ptfce-FWE). Effect sizes were estimated by conditional, partial R2 values (sr2) following the Nakagawa and Schielzeth method to quantify explained variance. The association between changes in cognitive performance and changes in white matter integrity was analysed. Finally, we examined whether the depressive disease course between assessments predicted cognitive performance at follow-up and whether white matter integrity mediated this association. People with lived experience were not involved in the research and writing process. FINDINGS 881 participants were selected for our study, of whom 418 (47%) had MDD (mean age 36·8 years [SD 13·4], 274 [66%] were female, and 144 [34%] were male) and 463 (53%) were healthy controls (mean age 35·6 years [13·5], 295 [64%] were female, and 168 [36%] were male). Baseline assessments were done between Sept 11, 2014, and June 3, 2019, and after a mean follow-up of 2·20 years (SD 0·19), follow-up assessments were done between Oct 6, 2016, and May 31, 2021. Participants with MDD had lower cognitive performance than did healthy controls (p<0·0001, sr2=0·056), regardless of timepoint. Analyses of diffusion-weighted imaging indicated a significant diagnosis × time interaction with a steeper decline in white matter integrity of the superior longitudinal fasciculus over time in participants with MDD than in healthy controls (ptfce-FWE=0·026, sr2=0·002). Furthermore, cognitive decline was robustly associated with the decline in white matter integrity over time across both groups (ptfce-FWE<0·0001, sr2=0·004). In participants with MDD, changes in white matter integrity (p=0·0040, β=0·071) and adverse depressive disease course (p=0·0022, β=-0·073) independently predicted lower cognitive performance at follow-up. INTERPRETATION Alterations of white matter integrity occurred over time to a greater extent in participants with MDD than in healthy controls, and decline in white matter integrity was associated with a decline in cognitive performance across groups. Our findings emphasise the crucial role of white matter microstructure and disease progression in depression-related cognitive dysfunction, making both priority targets for future treatment development. FUNDING German Research Foundation (DFG).
Collapse
Affiliation(s)
- Kira Flinkenflügel
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Susanne Meinert
- Institute for Translational Psychiatry, University of Münster, Münster, Germany; Institute for Translational Neuroscience, University of Münster, Münster, Germany.
| | | | - Dominik Grotegerd
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Marius Gruber
- Institute for Translational Psychiatry, University of Münster, Münster, Germany; Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Janik Goltermann
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Nils R Winter
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Frederike Stein
- Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany
| | - Katharina Brosch
- Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany; Institute of Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - Elisabeth J Leehr
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Joscha Böhnlein
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Katharina Dohm
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Jochen Bauer
- Department of Radiology, University of Münster, Münster, Germany
| | - Ronny Redlich
- Institute for Translational Psychiatry, University of Münster, Münster, Germany; Department of Psychology, University of Halle, Halle, Germany; German Center for Mental Health (DZPG), Halle-Jena-Magdeburg, Germany
| | - Tim Hahn
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Jonathan Repple
- Institute for Translational Psychiatry, University of Münster, Münster, Germany; Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Nils Opel
- Institute for Translational Psychiatry, University of Münster, Münster, Germany; German Center for Mental Health (DZPG), Halle-Jena-Magdeburg, Germany; Department of Psychiatry, Jena University Hospital/Friedrich-Schiller-University Jena, Jena, Germany
| | - Robert Nitsch
- Institute for Translational Neuroscience, University of Münster, Münster, Germany
| | - Hamidreza Jamalabadi
- Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany; Center for Mind, Brain and Behavior, University of Marburg, Marburg, Germany
| | - Benjamin Straube
- Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany; Center for Mind, Brain and Behavior, University of Marburg, Marburg, Germany
| | - Nina Alexander
- Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany; Center for Mind, Brain and Behavior, University of Marburg, Marburg, Germany
| | - Andreas Jansen
- Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany; Center for Mind, Brain and Behavior, University of Marburg, Marburg, Germany; Core-Facility Brainimaging, Faculty of Medicine, University of Marburg, Marburg, Germany
| | - Igor Nenadić
- Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany; Center for Mind, Brain and Behavior, University of Marburg, Marburg, Germany
| | - Martijn P van den Heuvel
- Connectome Laboratory, Department of Complex Trait Genetics, Center for Neurogenomics and Cognitive Research, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam, Netherlands; Department of Child Psychiatry, Amsterdam University Medical Center, Amsterdam Neuroscience, Amsterdam, Netherlands
| | - Tilo Kircher
- Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany; Center for Mind, Brain and Behavior, University of Marburg, Marburg, Germany
| | - Udo Dannlowski
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| |
Collapse
|
3
|
Carrión RE, Ku BS, Dorvil S, Auther AM, McLaughlin D, Addington J, Bearden CE, Cadenhead KS, Cannon TD, Keshavan M, Mathalon DH, Perkins DO, Stone WS, Tsuang MT, Walker EF, Woods SW, Cornblatt BA. Neurocognition in adolescents and young adults at clinical high risk for psychosis: Predictive stability for social and role functioning. Schizophr Res 2024; 271:129-137. [PMID: 39024961 DOI: 10.1016/j.schres.2024.06.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 06/25/2024] [Accepted: 06/28/2024] [Indexed: 07/20/2024]
Abstract
The prodromal phase of schizophrenia provides an optimal opportunity to mitigate the profound functional disability that is often associated with fully expressed psychosis. Considerable evidence supports the importance of neurocognition in the development of interpersonal (social) and academic (role) skills. Further findings from adolescents and young adults at clinical high risk for developing psychosis (CHRP) suggest that treatment for functioning might be most effective when targeting early and specific neurocognitive deficits. The current study addresses this critical intervention issue by examining the potential of neurocognitive deficits at intake for predicting social and role functioning over time in CHR-P youth. The study included 345 CHR-P participants from the second phase of the North American Prodrome Longitudinal Study (NAPLS2) with baseline neurocognition and 2-year follow-up data on social and role functioning. Slower baseline processing speed consistently predicted poor social functioning over time, while attention deficits predicted poor role functioning at baseline and follow-up. In addition, the impact of processing speed and attention impairments on social and role functioning, respectively, persisted even when adjusting the regression models for attenuated positive, negative, and disorganized symptoms, and transition status. The current study demonstrates for, arguably the first time, that processing speed and attention are strongly predictive of social and role functioning over time, respectively, above and beyond the impact of symptoms and those CHR-P individuals that develop psychosis over the course of the study. These findings imply that early neurocognition is a critical treatment target linked to the developmental trajectory of social and role functioning.
Collapse
Affiliation(s)
- Ricardo E Carrión
- Northwell Health, New Hyde Park, NY, United States; Institute of Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, NY, United States; Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States.
| | - Benson S Ku
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States
| | - Sarah Dorvil
- Department of Psychology, Queens College, New York, United States
| | - Andrea M Auther
- Northwell Health, New Hyde Park, NY, United States; Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
| | | | - Jean Addington
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Carrie E Bearden
- Semel Institute for Neuroscience and Human Behavior and Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States; Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Kristin S Cadenhead
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
| | - Tyrone D Cannon
- Department of Psychology, Yale University, School of Medicine, New Haven, CT, United States; Department of Psychiatry, Yale University, School of Medicine, New Haven, CT, United States
| | - Matcheri Keshavan
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center and Massachusetts General Hospital, Boston, MA, United States
| | - Daniel H Mathalon
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, United States; Department of Psychiatry, University of California, San Francisco, CA, United States
| | - Diana O Perkins
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - William S Stone
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center and Massachusetts General Hospital, Boston, MA, United States
| | - Ming T Tsuang
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center and Massachusetts General Hospital, Boston, MA, United States
| | - Elaine F Walker
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States.; Department of Psychology, Emory University, Atlanta, GA, United States
| | - Scott W Woods
- Department of Psychiatry, Yale University, School of Medicine, New Haven, CT, United States
| | - Barbara A Cornblatt
- Northwell Health, New Hyde Park, NY, United States; Institute of Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, NY, United States; Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States; Department of Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
| |
Collapse
|
4
|
Gifford G, Cullen AE, Vieira S, Searle A, McCutcheon RA, Modinos G, Stone WS, Hird E, Barnett J, van Hell HH, Catalan A, Millgate E, Taptiklis N, Cormack F, Slot ME, Dazzan P, Maat A, de Haan L, Facorro BC, Glenthøj B, Lawrie SM, McDonald C, Gruber O, van Amelsvoort T, Arango C, Kircher T, Nelson B, Galderisi S, Bressan RA, Kwon JS, Weiser M, Mizrahi R, Sachs G, Kirschner M, Reichenberg A, Kahn R, McGuire P. PsyCog: A computerised mini battery for assessing cognition in psychosis. Schizophr Res Cogn 2024; 37:100310. [PMID: 38572271 PMCID: PMC10987298 DOI: 10.1016/j.scog.2024.100310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 03/20/2024] [Accepted: 03/23/2024] [Indexed: 04/05/2024]
Abstract
Despite the functional impact of cognitive deficit in people with psychosis, objective cognitive assessment is not typically part of routine clinical care. This is partly due to the length of traditional assessments and the need for a highly trained administrator. Brief, automated computerised assessments could help to address this issue. We present data from an evaluation of PsyCog, a computerised, non-verbal, mini battery of cognitive tests. Healthy Control (HC) (N = 135), Clinical High Risk (CHR) (N = 233), and First Episode Psychosis (FEP) (N = 301) participants from a multi-centre prospective study were assessed at baseline, 6 months, and 12 months. PsyCog was used to assess cognitive performance at baseline and at up to two follow-up timepoints. Mean total testing time was 35.95 min (SD = 2.87). Relative to HCs, effect sizes of performance impairments were medium to large in FEP patients (composite score G = 1.21, subtest range = 0.52-0.88) and small to medium in CHR patients (composite score G = 0.59, subtest range = 0.18-0.49). Site effects were minimal, and test-retest reliability of the PsyCog composite was good (ICC = 0.82-0.89), though some practice effects and differences in data completion between groups were found. The present implementation of PsyCog shows it to be a useful tool for assessing cognitive function in people with psychosis. Computerised cognitive assessments have the potential to facilitate the evaluation of cognition in psychosis in both research and in clinical care, though caution should still be taken in terms of implementation and study design.
Collapse
Affiliation(s)
| | - Alexis E. Cullen
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, KCL, London, UK
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Sweden
| | - Sandra Vieira
- Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | | | | | - Gemma Modinos
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, KCL, London, UK
| | - William S. Stone
- Harvard Medical School Department of Psychiatry at the Beth Israel Deaconess Medical Center and the Massachusetts Mental Health Center, United States of America
| | - Emily Hird
- Institute of Cognitive Neuroscience, UCL, London, UK
| | - Jennifer Barnett
- Cambridge Cognition Ltd, Cambridge, UK
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Hendrika H. van Hell
- University Medical Center, Division of Neurosciences, Department of Psychiatry, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
| | - Ana Catalan
- Basurto University Hospital, Bilbo, Bizkaia, Spain
| | | | | | | | - Margot E. Slot
- University Medical Center, Division of Neurosciences, Department of Psychiatry, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
| | - Paola Dazzan
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, KCL, London, UK
| | - Arija Maat
- University Medical Center, Division of Neurosciences, Department of Psychiatry, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
| | - Lieuwe de Haan
- Amsterdam UMC, University of Amsterdam, Psychiatry, Department Early Psychosis, Meibergdreef 9, Amsterdam, the Netherlands
| | - Benedicto Crespo Facorro
- CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Sevilla, Spain
- University Hospital Virgen del Rocio, IBIS-CSIC, Department of Psychiatry, School of Medicine, University of Sevilla, Sevilla, Spain
| | - Birte Glenthøj
- Centre for Neuropsychiatric Schizophrenia Research (CNSR), Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Mental Health Centre Glostrup, University of Copenhagen, Glostrup, Denmark
- University of Copenhagen, Faculty of Health and Medical Sciences, Dept. of Clinical Medicine, Copenhagen, Denmark
| | - Stephen M. Lawrie
- Division of Psychiatry, University of Edinburgh, Royal Edinburgh Hospital, Edinburgh, UK
| | - Colm McDonald
- Centre for Neuroimaging & Cognitive Genomics (NICOG), Galway Neuroscience Centre, University of Galway, H91 TK33 Galway, Ireland
| | - Oliver Gruber
- Section for Experimental Psychopathology and Neuroimaging, Department of General Psychiatry, Heidelberg University, Heidelberg, Germany
| | - Thérèse van Amelsvoort
- Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, the Netherlands
| | - Celso Arango
- Servicio de Psiquiatría del Niño y del Adolescente, Hospital General Universitario Gregorio Marañon, Universidad Complutense Madrid, Spain, Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain
| | - Tilo Kircher
- Dept of Psychiatry, University of Marburg, Rudolf-Bultmann-Straße 8, D-35039 Marburg, Germany
| | - Barnaby Nelson
- Orygen, 35 Poplar Road, Parkville, Victoria, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Silvana Galderisi
- Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, Largo Madonna delle Grazie, 80138 Naples, Italy
| | - Rodrigo A. Bressan
- Department of Psychiatry, Interdisciplinary Lab for Clinical Neurosciences (LiNC), Universidade Federal de Sao Paulo (UNIFESP), Sao Paulo, Brazil
| | - Jun Soo Kwon
- Department of Psychiatry, Seoul National University College of Medicine, 101 Dahakno, Jongno-gu, Seoul, Republic of Korea
| | - Mark Weiser
- Department of Psychiatry, Sheba Medical Center, Tel Hashomer 52621, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Romina Mizrahi
- Department of Psychiatry, McGill University, Montreal, Canada
| | - Gabriele Sachs
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Matthias Kirschner
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland
- Division of Adult Psychiatry, Department of Psychiatry, University Hospitals of Geneva, Switzerland
| | - Abraham Reichenberg
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1230, New York, NY 10029-6574, United States of America
| | - PSYSCAN Consortium
- University of Oxford, Oxford, UK
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, KCL, London, UK
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Sweden
- Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Cambridge Cognition Ltd, Cambridge, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, KCL, London, UK
- Harvard Medical School Department of Psychiatry at the Beth Israel Deaconess Medical Center and the Massachusetts Mental Health Center, United States of America
- Institute of Cognitive Neuroscience, UCL, London, UK
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- University Medical Center, Division of Neurosciences, Department of Psychiatry, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
- Basurto University Hospital, Bilbo, Bizkaia, Spain
- Amsterdam UMC, University of Amsterdam, Psychiatry, Department Early Psychosis, Meibergdreef 9, Amsterdam, the Netherlands
- CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Sevilla, Spain
- University Hospital Virgen del Rocio, IBIS-CSIC, Department of Psychiatry, School of Medicine, University of Sevilla, Sevilla, Spain
- Centre for Neuropsychiatric Schizophrenia Research (CNSR), Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Mental Health Centre Glostrup, University of Copenhagen, Glostrup, Denmark
- University of Copenhagen, Faculty of Health and Medical Sciences, Dept. of Clinical Medicine, Copenhagen, Denmark
- Division of Psychiatry, University of Edinburgh, Royal Edinburgh Hospital, Edinburgh, UK
- Centre for Neuroimaging & Cognitive Genomics (NICOG), Galway Neuroscience Centre, University of Galway, H91 TK33 Galway, Ireland
- Section for Experimental Psychopathology and Neuroimaging, Department of General Psychiatry, Heidelberg University, Heidelberg, Germany
- Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, the Netherlands
- Servicio de Psiquiatría del Niño y del Adolescente, Hospital General Universitario Gregorio Marañon, Universidad Complutense Madrid, Spain, Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain
- Dept of Psychiatry, University of Marburg, Rudolf-Bultmann-Straße 8, D-35039 Marburg, Germany
- Orygen, 35 Poplar Road, Parkville, Victoria, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
- Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, Largo Madonna delle Grazie, 80138 Naples, Italy
- Department of Psychiatry, Interdisciplinary Lab for Clinical Neurosciences (LiNC), Universidade Federal de Sao Paulo (UNIFESP), Sao Paulo, Brazil
- Department of Psychiatry, Seoul National University College of Medicine, 101 Dahakno, Jongno-gu, Seoul, Republic of Korea
- Department of Psychiatry, Sheba Medical Center, Tel Hashomer 52621, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Psychiatry, McGill University, Montreal, Canada
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland
- Division of Adult Psychiatry, Department of Psychiatry, University Hospitals of Geneva, Switzerland
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1230, New York, NY 10029-6574, United States of America
| | - René Kahn
- University Medical Center, Division of Neurosciences, Department of Psychiatry, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1230, New York, NY 10029-6574, United States of America
| | | |
Collapse
|
5
|
Gifford G, Avila A, Kempton MJ, Fusar-Poli P, McCutcheon RA, Coutts F, Tognin S, Valmaggia L, de Haan L, van der Gaag M, Nelson B, Pantelis C, Riecher-Rössler A, Bressan R, Barrantes-Vidal N, Krebs MO, Glenthøj B, Ruhrmann S, Sachs G, Rutten BPF, van Os J, Eu-Gei High Risk Study, McGuire P. Do Cognitive Subtypes Exist in People at Clinical High Risk for Psychosis? Results From the EU-GEI Study. Schizophr Bull 2024:sbae133. [PMID: 39052918 DOI: 10.1093/schbul/sbae133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
BACKGROUND AND HYPOTHESIS Cognition has been associated with socio-occupational functioning in individuals at Clinical High Risk for Psychosis (CHR-P). The present study hypothesized that clustering CHR-P participants based on cognitive data could reveal clinically meaningful subtypes. STUDY DESIGN A cohort of 291 CHR-P subjects was recruited through the multicentre EU-GEI high-risk study. We explored whether an underlying cluster structure was present in the cognition data. Clustering of cognition data was performed using k-means clustering and density-based spatial clustering of applications with noise. Cognitive subtypes were validated by comparing differences in functioning, psychosis symptoms, transition outcome, and grey matter volume between clusters. Network analysis was used to further examine relationships between cognition scores and clinical symptoms. STUDY RESULTS No underlying cluster structure was found in the cognitive data. K-means clustering produced "spared" and "impaired" cognition clusters similar to those reported in previous studies. However, these clusters were not associated with differences in functioning, symptomatology, outcome, or grey matter volume. Network analysis identified cognition and symptoms/functioning measures that formed separate subnetworks of associations. CONCLUSIONS Stratifying patients according to cognitive performance has the potential to inform clinical care. However, we did not find evidence of cognitive clusters in this CHR-P sample. We suggest that care needs to be taken in inferring the existence of distinct cognitive subtypes from unsupervised learning studies. Future research in CHR-P samples could explore the existence of cognitive subtypes across a wider range of cognitive domains.
Collapse
Affiliation(s)
- George Gifford
- Department of Psychiatry, University of Oxford, Oxford, UK
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Alessia Avila
- Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
- Faculty of Medicine, Universidade Católica de Lisboa, Lisbon, Portugal
| | - Matthew J Kempton
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Paolo Fusar-Poli
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Outreach and Support in South-London (OASIS) Service, South London and Maudlsey (SLaM) NHS Foundation Trust, London, UK
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilian-University (LMU), Munich, Germany
| | | | - Fiona Coutts
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Stefania Tognin
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Lucia Valmaggia
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Lieuwe de Haan
- Department Early Psychosis, AMC, Academic Psychiatric Centre, Amsterdam, The Netherlands
| | - Mark van der Gaag
- Department of Clinical Psychology, Faculty of Behavioural and Movement Sciences, VU University, Amsterdam, The Netherlands
- EMGO+ Institute for Health and Care Research, VU University, Amsterdam, The Netherlands
- Parnassia Psychiatric Institute, Department of Psychosis Research, The Hague, The Netherlands
| | - Barnaby Nelson
- Orygen, Victoria, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Christos Pantelis
- Melbourne Neuropsychiatry Centre, University of Melbourne & Melbourne Health, Carlton South, Vic, Australia
| | | | - Rodrigo Bressan
- Department of Psychiatry, Interdisciplinary Lab for Clinical Neurosciences (LiNC), Universidade Federal de Sao Paulo (UNIFESP), Sao Paulo, Brazil
| | - Neus Barrantes-Vidal
- Departamento de Psicologia Clínica i de la Salut (Universitat Autònoma de Barcelona), Fundació Sanitària Sant Pere Claver (Spain), Spanish Mental Health Research Network (CIBERSAM), Barcelona, Spain
| | - Marie-Odile Krebs
- University Paris Descartes, Hôpital Sainte-Anne, C'JAAD, Service Hospitalo-Universitaire, Inserm U894, Institut de Psychiatrie (CNRS 3557), Paris, France
| | - Birte Glenthøj
- Centre for Neuropsychiatric Schizophrenia Research (CNSR) & Centre for Clinical Intervention and Neuropsychiatric SchizophreSnia Research (CINS), Mental Health Centre Glostrup, University of Copenhagen, Glostrup, Denmark
- Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Stephan Ruhrmann
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | - Gabriele Sachs
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Bart P F Rutten
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Jim van Os
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | - Philip McGuire
- Department of Psychiatry, University of Oxford, Oxford, UK
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| |
Collapse
|
6
|
Faris P, Pischedda D, Palesi F, D’Angelo E. New clues for the role of cerebellum in schizophrenia and the associated cognitive impairment. Front Cell Neurosci 2024; 18:1386583. [PMID: 38799988 PMCID: PMC11116653 DOI: 10.3389/fncel.2024.1386583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 04/26/2024] [Indexed: 05/29/2024] Open
Abstract
Schizophrenia (SZ) is a complex neuropsychiatric disorder associated with severe cognitive dysfunction. Although research has mainly focused on forebrain abnormalities, emerging results support the involvement of the cerebellum in SZ physiopathology, particularly in Cognitive Impairment Associated with SZ (CIAS). Besides its role in motor learning and control, the cerebellum is implicated in cognition and emotion. Recent research suggests that structural and functional changes in the cerebellum are linked to deficits in various cognitive domains including attention, working memory, and decision-making. Moreover, cerebellar dysfunction is related to altered cerebellar circuit activities and connectivity with brain regions associated with cognitive processing. This review delves into the role of the cerebellum in CIAS. We initially consider the major forebrain alterations in CIAS, addressing impairments in neurotransmitter systems, synaptic plasticity, and connectivity. We then focus on recent findings showing that several mechanisms are also altered in the cerebellum and that cerebellar communication with the forebrain is impaired. This evidence implicates the cerebellum as a key component of circuits underpinning CIAS physiopathology. Further studies addressing cerebellar involvement in SZ and CIAS are warranted and might open new perspectives toward understanding the physiopathology and effective treatment of these disorders.
Collapse
Affiliation(s)
- Pawan Faris
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Doris Pischedda
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Fulvia Palesi
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Egidio D’Angelo
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Digital Neuroscience Center, IRCCS Mondino Foundation, Pavia, Italy
| |
Collapse
|
7
|
Zhang T, Wei Y, Tang X, Cui H, Xu L, Hu Y, Tang Y, Hu Q, Liu H, Wang Z, Chen T, Li C, Wang J. Cognitive functions following initiation of antipsychotic medication in adolescents and adults at clinical high risk for psychosis: a naturalistic sub group analysis using the MATRICS consensus cognitive battery. Child Adolesc Psychiatry Ment Health 2024; 18:53. [PMID: 38704567 PMCID: PMC11070077 DOI: 10.1186/s13034-024-00743-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 04/24/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND The effects of antipsychotic (AP) medications on cognitive functions in individuals at clinical high-risk (CHR) of psychosis are poorly understood. This study compared the effects of AP treatment on cognitive improvement in CHR adolescents and adults. METHODS A total of 327 CHR participants, with an age range of 13 to 45 years, who underwent baseline neuropsychological assessments and a 1-year clinical follow-up were included. Participants with CHR were categorized into four groups based on their age: adolescents (aged < 18) and adults (aged ≥ 18), as well as their antipsychotic medication status (AP+ or AP-). Therefore, the four groups were defined as Adolescent-AP-, Adolescent-AP+, Adult-AP-, and Adult-AP+. RESULTS During the follow-up, 231 CHR patients received AP treatment, 94 converted to psychosis, and 161 completed the 1-year follow-up. The Adolescent-AP+ group had more positive symptoms, lower general functions, and cognitive impairments than the Adolescent-AP- group at baseline, but no significant differences were observed among adults. The Adolescent-AP+ group showed a significant increase in the risk of conversion to psychosis (p < 0.001) compared to the Adolescent-AP- group. The Adult-AP+ group showed a decreasing trend in the risk of conversion (p = 0.088) compared to the Adult-AP- group. The Adolescent-AP- group had greater improvement in general functions (p < 0.001), neuropsychological assessment battery mazes (p = 0.025), and brief visuospatial memory test-revised (p = 0.020), as well as a greater decrease in positive symptoms (p < 0.001) at follow-up compared to the Adolescent-AP+ group. No significant differences were observed among adults. CONCLUSIONS Early use of AP was not associated with a positive effect on cognitive function in CHR adolescents. Instead, the absence of AP treatment was associated with better cognitive recovery, suggesting that AP exposure might not be the preferred choice for cognitive recovery in CHR adolescents, but may be more reasonable for use in adults.
Collapse
Affiliation(s)
- TianHong Zhang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Jiaotong University School of Medicine, 600 Wanping Nan Road, 200030, Shanghai, China.
| | - YanYan Wei
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Jiaotong University School of Medicine, 600 Wanping Nan Road, 200030, Shanghai, China
| | - XiaoChen Tang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Jiaotong University School of Medicine, 600 Wanping Nan Road, 200030, Shanghai, China
| | - HuiRu Cui
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Jiaotong University School of Medicine, 600 Wanping Nan Road, 200030, Shanghai, China
| | - LiHua Xu
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Jiaotong University School of Medicine, 600 Wanping Nan Road, 200030, Shanghai, China
| | - YeGang Hu
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Jiaotong University School of Medicine, 600 Wanping Nan Road, 200030, Shanghai, China
| | - YingYing Tang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Jiaotong University School of Medicine, 600 Wanping Nan Road, 200030, Shanghai, China
| | - Qiang Hu
- Department of Psychiatry, ZhenJiang Mental Health Center, Zhenjiang, People's Republic of China
| | - HaiChun Liu
- Department of Automation, Shanghai Jiao Tong University, 200240, Shanghai, China
| | - ZiXuan Wang
- Shanghai Xinlianxin Psychological Counseling Center, Shanghai, China
| | - Tao Chen
- Big Data Research Lab, University of Waterloo, Waterloo, ON, Canada
- Labor and Worklife Program, Harvard University, Cambridge, MA, USA
| | - ChunBo Li
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Jiaotong University School of Medicine, 600 Wanping Nan Road, 200030, Shanghai, China
| | - JiJun Wang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Jiaotong University School of Medicine, 600 Wanping Nan Road, 200030, Shanghai, China.
- Center for Excellence in Brain Science and Intelligence Technology (CEBSIT), Chinese Academy of Science, Shanghai, People's Republic of China.
- Institute of Psychology and Behavioral Science, Shanghai Jiao Tong University, Shanghai, People's Republic of China.
| |
Collapse
|
8
|
Catalan A, McCutcheon RA, Aymerich C, Pedruzo B, Radua J, Rodríguez V, Salazar de Pablo G, Pacho M, Pérez JL, Solmi M, McGuire P, Giuliano AJ, Stone WS, Murray RM, Gonzalez-Torres MA, Fusar-Poli P. The magnitude and variability of neurocognitive performance in first-episode psychosis: a systematic review and meta-analysis of longitudinal studies. Transl Psychiatry 2024; 14:15. [PMID: 38191534 PMCID: PMC10774360 DOI: 10.1038/s41398-023-02718-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 12/05/2023] [Accepted: 12/14/2023] [Indexed: 01/10/2024] Open
Abstract
Neurocognitive deficits are a core feature of psychotic disorders, but it is unclear whether they affect all individuals uniformly. The aim of this systematic review and meta-analysis was to synthesize the evidence on the magnitude, progression, and variability of neurocognitive functioning in individuals with first-episode psychosis (FEP). A multistep literature search was conducted in several databases up to November 1, 2022. Original studies reporting on neurocognitive functioning in FEP were included. The researchers extracted the data and clustered the neurocognitive tasks according to the seven Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) domains and six additional domains. Random-effect model meta-analyses, assessment of publication biases and study quality, and meta-regressions were conducted. The primary effect size reported was Hedges g of (1) neurocognitive functioning in individuals at FEP measuring differences with healthy control (HC) individuals or (2) evolution of neurocognitive impairment across study follow-up intervals. Of 30,384 studies screened, 54 were included, comprising 3,925 FEP individuals and 1,285 HC individuals. Variability analyses indicated greater variability in FEP compared to HC at baseline and follow-up. We found better neurocognitive performance in the HC group at baseline and follow-up but no differences in longitudinal neurocognitive changes between groups. Across the 13 domains, individuals with FEP showed improvement from baseline in all studied domains, except for visual memory. Metaregressions showed some differences in several of the studied domains. The findings suggest that individuals with FEP have marked cognitive impairment, but there is greater variability in cognitive functioning in patients than in HC. This suggests that subgroups of individuals suffer severe disease-related cognitive impairments, whereas others may be much less affected. While these impairments seem stable in the medium term, certain indicators may suggest potential further decline in the long term for a specific subgroup of individuals, although more research is needed to clarify this. Overall, this study highlights the need for tailored neurocognitive interventions for individuals with FEP based on their specific deficits and progression.
Collapse
Affiliation(s)
- Ana Catalan
- Department of Neuroscience, University of the Basque Country UPV/EHU; Psychiatry Department. Basurto University Hospital; Biobizkaia Health Research Institute; Centro de Investigación en Red de Salud Mental. (CIBERSAM) Instituto de Salud Carlos III , OSI Bilbao-Basurto, Av. Montevideo 18, 48013, Bilbao, Spain.
- Early Psychosis Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
| | - Robert A McCutcheon
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Department of Psychiatry. University of Oxford, Warneford Hospital, Headington, OX3 7JX, UK
- Oxford Health NHS foundation trust, Oxford, UK
| | - Claudia Aymerich
- Department of Neuroscience, University of the Basque CountryUPV/EHU. Psychiatry Department. Basurto University Hospital. BiBiobizkaia Health Research Institute. Centro de Investigaciónen Red de Salud Mental. (CIBERSAM), Instituto de Salud Carlos III, Avenida de Montevideo 18, 48013, Bilbao, Spain
| | - Borja Pedruzo
- Psychiatry Department. Basurto University Hospital, OSI Bilbao-Basurto, Bizkaia, Spain
| | - Joaquim Radua
- Imaging of Mood- and Anxiety-Related Disorders (IMARD) Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Mental Health Research Networking Center (CIBERSAM), Instituto de Salud Carlos III, University of Barcelona, Barcelona, Spain
| | - Victoria Rodríguez
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Gonzalo Salazar de Pablo
- Early Psychosis Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Child and Adolescent Mental Health Services, South London and Maudsley NHS Foundation Trust, London, UK
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health. Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid, Spain
| | - Malein Pacho
- Psychiatry Department. Basurto University Hospital, OSI Bilbao-Basurto, Bizkaia, Spain
| | - Jose Luis Pérez
- Psychiatry Department. Basurto University Hospital, OSI Bilbao-Basurto, Bizkaia, Spain
| | - Marco Solmi
- Charité Universitätsmedizin Berlin, Department of Child and Adolescent Psychiatry, Berlin, Germany
- SCIENCES lab, Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
- On Track: The Champlain First Episode Psychosis Program, Department of Mental Health, The Ottawa Hospital, Ottawa, ON, Canada
- Ottawa Hospital Research Institute (OHRI) Clinical Epidemiology Program University of Ottawa, Ottawa, ON, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Philip McGuire
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Department of Psychiatry. University of Oxford, Warneford Hospital, Headington, OX3 7JX, UK
| | - Anthony J Giuliano
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - William S Stone
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Robin M Murray
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Miguel Angel Gonzalez-Torres
- Department of Neuroscience, University of the Basque Country UPV/EHU; Psychiatry Department. Basurto University Hospital; Biobizkaia Health Research Institute; Centro de Investigación en Red de Salud Mental. (CIBERSAM) Instituto de Salud Carlos III , OSI Bilbao-Basurto, Av. Montevideo 18, 48013, Bilbao, Spain
| | - Paolo Fusar-Poli
- Early Psychosis Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Department of Brain and Behavioral Sciences, University of Pavia, , Pavia, Italy
- Outreach and Support in South London (OASIS) service, South London and Maudsley NHS Foundation Trust, London, UK
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University Munich, Munich, Germany
| |
Collapse
|
9
|
Caballero N, Machiraju S, Diomino A, Kennedy L, Kadivar A, Cadenhead KS. Recent Updates on Predicting Conversion in Youth at Clinical High Risk for Psychosis. Curr Psychiatry Rep 2023; 25:683-698. [PMID: 37755654 PMCID: PMC10654175 DOI: 10.1007/s11920-023-01456-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/05/2023] [Indexed: 09/28/2023]
Abstract
PURPOSE OF REVIEW This review highlights recent advances in the prediction and treatment of psychotic conversion. Over the past 25 years, research into the prodromal phase of psychotic illness has expanded with the promise of early identification of individuals at clinical high risk (CHR) for psychosis who are likely to convert to psychosis. RECENT FINDINGS Meta-analyses highlight conversion rates between 20 and 30% within 2-3 years using existing clinical criteria while research into more specific risk factors, biomarkers, and refinement of psychosis risk calculators has exploded, improving our ability to predict psychotic conversion with greater accuracy. Recent studies highlight risk factors and biomarkers likely to contribute to earlier identification and provide insight into neurodevelopmental abnormalities, CHR subtypes, and interventions that can target specific risk profiles linked to neural mechanisms. Ongoing initiatives that assess longer-term (> 5-10 years) outcome of CHR participants can provide valuable information about predictors of later conversion and diagnostic outcomes while large-scale international biomarker studies provide hope for precision intervention that will alter the course of early psychosis globally.
Collapse
Affiliation(s)
- Noe Caballero
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr., La Jolla, CA, 92093-0810, USA
| | - Siddharth Machiraju
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr., La Jolla, CA, 92093-0810, USA
| | - Anthony Diomino
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr., La Jolla, CA, 92093-0810, USA
| | - Leda Kennedy
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr., La Jolla, CA, 92093-0810, USA
| | - Armita Kadivar
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr., La Jolla, CA, 92093-0810, USA
| | - Kristin S Cadenhead
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr., La Jolla, CA, 92093-0810, USA.
| |
Collapse
|
10
|
Słowiński P, White A, Lison S, Sullivan S, Emmens T, Self P, Wileman J, Karl A, Tsaneva-Atanasova K. The potential of digital behavioural tests as a diagnostic aid for psychosis. PLOS DIGITAL HEALTH 2023; 2:e0000339. [PMID: 37713385 PMCID: PMC10503702 DOI: 10.1371/journal.pdig.0000339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 07/29/2023] [Indexed: 09/17/2023]
Abstract
Timely interventions have a proven benefit for people experiencing psychotic illness. One bottleneck to accessing timely interventions is the referral process to the specialist team for early psychosis (STEP). Many general practitioners lack awareness or confidence in recognising psychotic symptoms or state. Additionally, referrals for people without apparent psychotic symptoms, although beneficial at a population level, lead to excessive workload for STEPs. There is a clear unmet need for accurate stratification of STEPs users and healthy cohorts. Here we propose a new approach to addressing this need via the application of digital behavioural tests. To demonstrate that digital behavioural tests can be used to discriminate between the STEPs users (SU; n = 32) and controls (n = 32, age and sex matched), we compared performance of five different classifiers applied to objective, quantitative and interpretable features derived from the 'mirror game' (MG) and trail making task (TMT). The MG is a movement coordination task shown to be a potential socio-motor biomarker of schizophrenia, while TMT is a neuropsychiatric test of cognitive function. All classifiers had AUC in the range of 0.84-0.92. The best of the five classifiers (linear discriminant classifier) achieved an outstanding performance, AUC = 0.92 (95%CI 0.75-1), Sensitivity = 0.75 (95%CI 0.5-1), Specificity = 1 (95%CI 0.75-1), evaluated on 25% hold-out and 1000 folds. Performance of all analysed classifiers is underpinned by the large effect sizes of the differences between the cohorts in terms of the features used for classification what ensures generalisability of the results. We also found that MG and TMT are unsuitable in isolation to successfully differentiate between SU with and without at-risk-mental-state or first episode psychosis with sufficient level of performance. Our findings show that standardised batteries of digital behavioural tests could benefit both clinical and research practice. Including digital behavioural tests into healthcare practice could allow precise phenotyping and stratification of the highly heterogenous population of people referred to STEPs resulting in quicker and more personalised diagnosis. Moreover, the high specificity of digital behavioural tests could facilitate the identification of more homogeneous clinical high-risk populations, benefiting research on prognostic instruments for psychosis. In summary, our study demonstrates that cheap off-the-shelf equipment (laptop computer and a leap motion sensor) can be used to record clinically relevant behavioural data that could be utilised in digital mental health applications.
Collapse
Affiliation(s)
- Piotr Słowiński
- Translational Research Exchange @ Exeter, Living Systems Institute, Department of Mathematics and Statistics, Faculty of Environment, Science and Economy, University of Exeter, United Kingdom
| | - Alexander White
- Department of Psychology, Faculty of Health and Life Sciences, University of Exeter, United Kingdom
| | - Sian Lison
- Research & Development Department, Devon Partnership NHS Trust, Exeter, United Kingdom
| | - Sarah Sullivan
- Faculty of Health Sciences, Bristol Medical School, University of Bristol, United Kingdom
| | - Tobit Emmens
- Research & Development Department, Devon Partnership NHS Trust, Exeter, United Kingdom
| | - Philip Self
- Research & Development Department, Devon Partnership NHS Trust, Exeter, United Kingdom
| | - Jane Wileman
- Specialist Team for Early Psychosis, Devon Partnership NHS Trust, Exeter, United Kingdom
| | - Anke Karl
- Department of Psychology, Faculty of Health and Life Sciences, University of Exeter, United Kingdom
| | - Krasimira Tsaneva-Atanasova
- Translational Research Exchange @ Exeter, Living Systems Institute, Department of Mathematics and Statistics, Faculty of Environment, Science and Economy, University of Exeter, United Kingdom
- EPSRC Hub for Quantitative Modelling in Healthcare University of Exeter, Exeter, United Kingdom
| |
Collapse
|
11
|
McCutcheon RA, Keefe RSE, McGuire PK. Cognitive impairment in schizophrenia: aetiology, pathophysiology, and treatment. Mol Psychiatry 2023; 28:1902-1918. [PMID: 36690793 PMCID: PMC10575791 DOI: 10.1038/s41380-023-01949-9] [Citation(s) in RCA: 126] [Impact Index Per Article: 126.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 01/03/2023] [Accepted: 01/06/2023] [Indexed: 01/25/2023]
Abstract
Cognitive deficits are a core feature of schizophrenia, account for much of the impaired functioning associated with the disorder and are not responsive to existing treatments. In this review, we first describe the clinical presentation and natural history of these deficits. We then consider aetiological factors, highlighting how a range of similar genetic and environmental factors are associated with both cognitive function and schizophrenia. We then review the pathophysiological mechanisms thought to underlie cognitive symptoms, including the role of dopamine, cholinergic signalling and the balance between GABAergic interneurons and glutamatergic pyramidal cells. Finally, we review the clinical management of cognitive impairments and candidate novel treatments.
Collapse
Affiliation(s)
- Robert A McCutcheon
- Department of Psychiatry, University of Oxford, Oxford, UK.
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, London, UK.
- Oxford health NHS Foundation Trust, Oxford health NHS Foundation Trust, Oxford, UK.
| | - Richard S E Keefe
- Departments of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Philip K McGuire
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford health NHS Foundation Trust, Oxford health NHS Foundation Trust, Oxford, UK
- NIHR Oxford Health Biomedical Research Centre, Oxford, UK
| |
Collapse
|
12
|
Pratt DN, Luther L, Kinney KS, Osborne KJ, Corlett PR, Powers AR, Woods SW, Gold JM, Schiffman J, Ellman LM, Strauss GP, Walker EF, Zinbarg R, Waltz JA, Silverstein SM, Mittal VA. Comparing a Computerized Digit Symbol Test to a Pen-and-Paper Classic. SCHIZOPHRENIA BULLETIN OPEN 2023; 4:sgad027. [PMID: 37868160 PMCID: PMC10590153 DOI: 10.1093/schizbullopen/sgad027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
Background and Hypothesis Processing speed dysfunction is a core feature of psychosis and predictive of conversion in individuals at clinical high risk (CHR) for psychosis. Although traditionally measured with pen-and-paper tasks, computerized digit symbol tasks are needed to meet the increasing demand for remote assessments. Therefore we: (1) assessed the relationship between traditional and computerized processing speed measurements; (2) compared effect sizes of impairment for progressive and persistent subgroups of CHR individuals on these tasks; and (3) explored causes contributing to task performance differences. Study Design Participants included 92 CHR individuals and 60 healthy controls who completed clinical interviews, the Brief Assessment of Cognition in Schizophrenia Symbol Coding test, the computerized TestMyBrain Digit Symbol Matching Test, a finger-tapping task, and a self-reported motor abilities measure. Correlations, Hedges' g, and linear models were utilized, respectively, to achieve the above aims. Study Results Task performance was strongly correlated (r = 0.505). A similar degree of impairment was seen between progressive (g = -0.541) and persistent (g = -0.417) groups on the paper version. The computerized task uniquely identified impairment for progressive individuals (g = -477), as the persistent group performed similarly to controls (g = -0.184). Motor abilities were related to the computerized version, but the paper version was more related to symptoms and psychosis risk level. Conclusions The paper symbol coding task measures impairment throughout the CHR state, while the computerized version only identifies impairment in those with worsening symptomatology. These results may be reflective of sensitivity differences, an artifact of existing subgroups, or evidence of mechanistic differences.
Collapse
Affiliation(s)
- Danielle N Pratt
- Department of Psychology, Northwestern University, Evanston, IL, USA
| | - Lauren Luther
- Department of Psychology, University of Georgia, Athens, GA, USA
| | - Kyle S Kinney
- Department of Psychology & Neuroscience, Temple University, Philadelphia, PA, USA
| | | | | | - Albert R Powers
- Department of Psychiatry, Yale University, New Haven, CT, USA
| | - Scott W Woods
- Department of Psychiatry, Yale University, New Haven, CT, USA
| | - James M Gold
- Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Jason Schiffman
- Department of Psychological Science, University of California, Irvine, Irvine, CA, USA
| | - Lauren M Ellman
- Department of Psychology & Neuroscience, Temple University, Philadelphia, PA, USA
| | - Gregory P Strauss
- Department of Psychology, University of Georgia, Athens, GA, USA
- Department of Neuroscience, University of Georgia, Athens, GA, USA
| | - Elaine F Walker
- Department of Psychology and Program in Neuroscience, Emory University, Atlanta, GA, USA
| | - Richard Zinbarg
- Department of Psychology, Northwestern University, Evanston, IL, USA
| | - James A Waltz
- Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Steven M Silverstein
- Departments of Psychiatry, Neuroscience and Ophthalmology, University of Rochester Medical Center, Rochester, NY, USA
| | - Vijay A Mittal
- Department of Psychology, Northwestern University, Evanston, IL, USA
- Institutes for Policy Research (IPR) and Innovations in Developmental Sciences (DevSci), Psychiatry, Medical Social Sciences, Northwestern University, Evanston, IL, USA
| |
Collapse
|