1
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Cohen-Laroque J, Grangier I, Perez N, Kirschner M, Kaiser S, Sabé M. Positive and negative symptoms in methamphetamine-induced psychosis compared to schizophrenia: A systematic review and meta-analysis. Schizophr Res 2024; 267:182-190. [PMID: 38554698 DOI: 10.1016/j.schres.2024.03.037] [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: 04/26/2023] [Revised: 03/06/2024] [Accepted: 03/24/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND The clinical profiles of methamphetamine-induced psychosis (MIP) and schizophrenia are largely overlapping making differentiation challenging. In this systematic review and meta-analysis, we aim to compare the positive and negative symptoms of MIP and schizophrenia to better understand the differences between them. STUDY DESIGN In accordance with our pre-registered protocol (CRD42021286619), we conducted a search of English-language studies up to December 16th, 2022, in PubMed, EMBASE, and PsycINFO, including stable outpatients with MIP and schizophrenia. We used the Newcastle-Ottawa Scale to measure the quality of cross-sectional, case-control, and cohort studies. STUDY RESULTS Of the 2052 articles retrieved, we included 12 studies (6 cross-sectional, 3 case-control, and 2 cohort studies) in our meta-analysis, involving 624 individuals with MIP and 524 individuals with schizophrenia. Our analysis found no significant difference in positive symptoms between the two groups (SMD, -0.01; 95%CI, -0.13 to +0.11; p = 1). However, individuals with MIP showed significantly less negative symptoms compared to those with schizophrenia (SMD, -0.35; 95CI%, -0.54 to -0.16; p = 0.01; I2 = 54 %). Our sensitivity analysis, which included only studies with a low risk of bias, did not change the results. However, our meta-analysis is limited by its cross-sectional approach, which limits the interpretation of causal associations. Furthermore, differences in population, inclusion criteria, methodology, and drug exposure impact our findings. CONCLUSIONS Negative symptoms are less prominent in individuals with MIP. While both groups do not differ regarding positive symptoms, raises the possibility of shared and partly different underlying neurobiological mechanisms related to MIP and schizophrenia.
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Affiliation(s)
| | - Inès Grangier
- Faculty of Medicine, University of Geneva, Geneva, Switzerland.
| | - Natacha Perez
- Faculty of Medicine, University of Geneva, Geneva, Switzerland; Division of Adult Psychiatry, Department of Psychiatry, Geneva University Hospitals, Switzerland
| | - Matthias Kirschner
- Faculty of Medicine, University of Geneva, Geneva, Switzerland; Division of Adult Psychiatry, Department of Psychiatry, Geneva University Hospitals, Switzerland
| | - Stefan Kaiser
- Faculty of Medicine, University of Geneva, Geneva, Switzerland; Division of Adult Psychiatry, Department of Psychiatry, Geneva University Hospitals, Switzerland
| | - Michel Sabé
- Faculty of Medicine, University of Geneva, Geneva, Switzerland; Division of Adult Psychiatry, Department of Psychiatry, Geneva University Hospitals, Switzerland.
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2
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Zeng K, Yu X, Wei Z, Wu Y, Wang J, Liu R, Li Y, Wang X. Single-nucleus transcriptome profiling of prefrontal cortex induced by chronic methamphetamine treatment. Gen Psychiatr 2023; 36:e101057. [PMID: 37936947 PMCID: PMC10626793 DOI: 10.1136/gpsych-2023-101057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 10/01/2023] [Indexed: 11/09/2023] Open
Abstract
Background Methamphetamine (METH) addiction causes a huge burden on society. The prefrontal cortex (PFC), associated with emotion and cognitive behaviours, is also involved in addiction neurocircuitry. Although bulk RNA sequencing has shown METH-induced gene alterations in the mouse PFC, the impact on different cell types remains unknown. Aims To clarify the effects of METH treatment on different cell types of the PFC and the potential pathways involved in METH-related disorders. Methods We performed single-nucleus RNA sequencing (snRNA-seq) to examine the transcriptomes of 20 465 nuclei isolated from the PFC of chronic METH-treated and control mice. Main cell types and differentially expressed genes (DEGs) were identified and confirmed by RNA fluorescence in situ hybridization(FISH). Results Six main cell types were identified depending on the single-cell nucleus sequencing; of particular interest were the mature oligodendrocytes in the PFC. The DEGs of mature oligodendrocytes were enriched in the myelin sheath, adenosine triphosphate (ATP) metabolic process, mitochondrial function and components, and so on. The messenger RNA levels of Aldoc and Atp5l (FISH) and the protein level of the mitochondrial membrane pore subunit TOM40 (immunofluorescence) decreased in the mature oligodendrocytes. Fast blue staining and transmission electron microscopy image indicated myelin damage, and the myelin thickness decreased in METH brains. Conclusions snRNA-seq reveals altered transcriptomes of different cell types in mouse PFC induced by chronic METH treatment, underscoring potential relationships with psychiatric disorders.
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Affiliation(s)
- Kuan Zeng
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, Hubei, China
- Research Center for Psychological and Health Sciences, China University of Geosciences, Wuhan, Hubei, China
| | - Xuan Yu
- Department of Pathophysiology, School of Basic Medicine, Key Laboratory of Education Ministry/Hubei Province of China for Neurological Disorders, Huazhong University of Science and Technology Tongji Medical College, Wuhan, Hubei, China
| | - Zhen Wei
- Department of Pathophysiology, School of Basic Medicine, Key Laboratory of Education Ministry/Hubei Province of China for Neurological Disorders, Huazhong University of Science and Technology Tongji Medical College, Wuhan, Hubei, China
- Department of Pathology, Maternal and Child Hospital of Hubei Province, Huazhong University of Science and Technology Tongji Medical College, Wuhan, Hubei, China
| | - Yong Wu
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, Hubei, China
- Research Center for Psychological and Health Sciences, China University of Geosciences, Wuhan, Hubei, China
| | - Jianzhi Wang
- Department of Pathophysiology, School of Basic Medicine, Key Laboratory of Education Ministry/Hubei Province of China for Neurological Disorders, Huazhong University of Science and Technology Tongji Medical College, Wuhan, Hubei, China
- Co-innovation Center of Neuroregeneration, Nantong University, Nantong, Jiangsu, China
| | - Rong Liu
- Department of Pathophysiology, School of Basic Medicine, Key Laboratory of Education Ministry/Hubei Province of China for Neurological Disorders, Huazhong University of Science and Technology Tongji Medical College, Wuhan, Hubei, China
| | - Yi Li
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, Hubei, China
- Research Center for Psychological and Health Sciences, China University of Geosciences, Wuhan, Hubei, China
| | - Xiaochuan Wang
- Department of Pathophysiology, School of Basic Medicine, Key Laboratory of Education Ministry/Hubei Province of China for Neurological Disorders, Huazhong University of Science and Technology Tongji Medical College, Wuhan, Hubei, China
- Co-innovation Center of Neuroregeneration, Nantong University, Nantong, Jiangsu, China
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3
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Jia X, Wang J, Jiang W, Kong Z, Deng H, Lai W, Ye C, Guan F, Li P, Zhao M, Yang M. Common gray matter loss in the frontal cortex in patients with methamphetamine-associated psychosis and schizophrenia. Neuroimage Clin 2022; 36:103259. [PMID: 36510408 PMCID: PMC9668661 DOI: 10.1016/j.nicl.2022.103259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 10/08/2022] [Accepted: 11/02/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND HYPOTHESIS Methamphetamine (MA)-associated psychosis has become a public concern. However, its mechanism is not clear. Investigating similarities and differences between MA-associated psychosis and schizophrenia in brain alterations would be informative for neuropathology. STUDY DESIGN This study compared gray matter volumes of the brain across four participant groups: healthy controls (HC, n = 53), MA users without psychosis (MA, n = 22), patients with MA-associated psychosis (MAP, n = 34) and patients with schizophrenia (SCZ, n = 33). Clinical predictors of brain alterations, as well as association of brain alterations with psychotic symptoms and attention impairment were further investigated. STUDY RESULTS Compared with the HC, the MAP and the SCZ showed similar gray matter reductions in the frontal cortex, particularly in prefrontal areas. Moreover, a stepwise extension of gray matter reductions was exhibited across the MA - MAP - SCZ. Duration of abstinence was associated with regional volumetric recovery in the MAP, while this amendment in brain morphometry was not accompanied with symptom's remission. Illness duration of psychosis was among the predictive factors of regional gray matter reductions in both psychotic groups. Volume reductions were found to be associated with attention impairment in the SCZ, while this association was reversed in the MAP in frontal cortex. CONCLUSIONS This study suggested MA-associated psychosis and schizophrenia had common neuropathology in cognitive-related frontal cortices. A continuum of neuropathology between MA use and schizophrenia was tentatively implicated. Illness progressions and glial repairments could both play roles in neuropathological changes in MA-associated psychosis.
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Affiliation(s)
- Xiaojian Jia
- Shenzhen Kangning Hospital, Shenzhen Mental Health Center, Shenzhen Clinical Research Center for Mental Disorders, Shenzhen 518020, China
| | - Jianhong Wang
- Shenzhen Kangning Hospital, Shenzhen Mental Health Center, Shenzhen Clinical Research Center for Mental Disorders, Shenzhen 518020, China
| | - Wentao Jiang
- Shenzhen Kangning Hospital, Shenzhen Mental Health Center, Shenzhen Clinical Research Center for Mental Disorders, Shenzhen 518020, China
| | - Zhi Kong
- Shenzhen Kangning Hospital, Shenzhen Mental Health Center, Shenzhen Clinical Research Center for Mental Disorders, Shenzhen 518020, China
| | - Huan Deng
- School of International Education, Beijing University of Chemical Technology, Beijing 100029, China
| | - Wentao Lai
- Shenzhen Kangning Hospital, Shenzhen Mental Health Center, Shenzhen Clinical Research Center for Mental Disorders, Shenzhen 518020, China
| | - Caihong Ye
- Shenzhen Kangning Hospital, Shenzhen Mental Health Center, Shenzhen Clinical Research Center for Mental Disorders, Shenzhen 518020, China
| | - Fen Guan
- Shenzhen Kangning Hospital, Shenzhen Mental Health Center, Shenzhen Clinical Research Center for Mental Disorders, Shenzhen 518020, China
| | - Peng Li
- Peking University Sixth Hospital, Peking University, Beijing 100191, China
| | - Min Zhao
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Mei Yang
- Shenzhen Kangning Hospital, Shenzhen Mental Health Center, Shenzhen Clinical Research Center for Mental Disorders, Shenzhen 518020, China.
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4
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Effects of acute exercise on craving and cortical hemodynamics under drug-cue exposure in MA-dependent individuals. Neurosci Lett 2022; 781:136672. [DOI: 10.1016/j.neulet.2022.136672] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 04/27/2022] [Accepted: 04/28/2022] [Indexed: 11/18/2022]
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5
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Gicas KM, Parmar PK, Fabiano GF, Mashhadi F. Substance-induced psychosis and cognitive functioning: A systematic review. Psychiatry Res 2022; 308:114361. [PMID: 34979380 DOI: 10.1016/j.psychres.2021.114361] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 12/21/2021] [Accepted: 12/22/2021] [Indexed: 11/15/2022]
Abstract
Longitudinal studies of substance-induced psychosis (SIP) suggest that approximately 11-46% of persons will progress to schizophrenia with differential risk of progression depending on the type of substance used. The findings suggest SIP may be a distinct variant of a psychotic disorder, yet SIP is understudied and the disease expression is not well characterized, particularly the cognitive phenotype. There is some evidence for cognitive dysfunction in SIP, but a synthesis of this literature has not been undertaken. We systematically reviewed all empirical research (up to December 31, 2020) that examined cognition in SIP using clinical neuropsychological measures. The cognitive outcomes are summarized by type of SIP (methamphetamine, other stimulants, alcohol, cannabis, undifferentiated). There was evidence for global and domain-specific cognitive dysfunction in SIP compared to controls and non-psychotic persons who use substances. Impairments were of similar magnitude compared to persons with schizophrenia. Delineation of a specific cognitive profile in SIP was precluded by lack of literature with comparable study designs and outcomes. Variation in visual-based cognition may be a distinct feature of SIP, but this requires further investigation. More rigorously controlled studies of cognition in SIP are needed to inform differential diagnosis and identify the unique clinical needs of this population.
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6
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Bu L, Qi L, Yan W, Yan Q, Tang Z, Li F, Liu X, Diao C, Li K, Dong G. Acute kick-boxing exercise alters effective connectivity in the brain of females with methamphetamine dependencies. Neurosci Lett 2020; 720:134780. [PMID: 31978497 DOI: 10.1016/j.neulet.2020.134780] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 01/17/2020] [Accepted: 01/20/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Methamphetamine (METH) dependence, especially among women, is a serious global health problem. Kick-boxing exercise can be used to reduce cue-induced craving and develop a healthy lifestyle for female with METH dependencies. This study aimed to assess acute kick-boxing related changes in effective connectivity (EC) in the brain of females with METH dependencies by using functional near-infrared spectroscopy (fNIRS) signals. METHODS The fNIRS signals were continuously recorded from the left and right prefrontal cortices (LPFC/RPFC) and left and right motor cortices (LMC/RMC) of 30 female subjects with methamphetamine dependencies (METH group) and 30 age-matched controls (control group) during resting and kick-boxing exercise (training) periods. EC was calculated in the frequency range of 0.01-0.08 Hz. RESULTS In both resting and training state, the EC levels of METH group were significantly lower than the control group (p < 0.05). The EC levels of control group showed more significantly increased connection types than that of the METH group. CONCLUSION Acute kick-boxing exercise altered EC in the brain of females with METH dependencies. Furthermore, the efficiency of the information flow between different brain regions in the control group was significantly higher than that in the METH group. This study provides a novel and portable assessment technique for METH rehabilitation in females on the basis of fNIRS signals.
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Affiliation(s)
- Lingguo Bu
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, 639798, Singapore; Key Laboratory of High Efficiency and Clean Mechanical Manufacture, School of Mechanical Engineering, Shandong University, Jinan, 250061, China
| | - Liping Qi
- School of Biomedical Engineering, Dalian University of Technology, Dalian, 116024, China
| | - Wu Yan
- Shandong Sport University, Jinan, 250102, China
| | - Qian Yan
- Shandong Sport University, Jinan, 250102, China
| | - Zekun Tang
- Shandong Sport University, Jinan, 250102, China
| | - Furong Li
- Female Compulsory Isolation Drug Rehabilitation Center of Shandong Province, Zibo, 255311, China
| | - Xin Liu
- Drug Rehabilitation Administration of Shandong Province, Jinan, 250014, China
| | - Chunfeng Diao
- Drug Rehabilitation Administration of Shandong Province, Jinan, 250014, China
| | - Kefeng Li
- Shandong Sport University, Jinan, 250102, China.
| | - Guijun Dong
- Shandong Sport University, Jinan, 250102, China.
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7
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Yeh JY, Shyu YC, Lee SY, Yuan SS, Yang CJ, Yang KC, Lee TL, Sun CC, Wang LJ. Comorbidity of Narcolepsy and Psychotic Disorders: A Nationwide Population-Based Study in Taiwan. Front Psychiatry 2020; 11:205. [PMID: 32269533 PMCID: PMC7109289 DOI: 10.3389/fpsyt.2020.00205] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 03/02/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Narcolepsy is a chronic sleep disorder that is likely to have neuropsychiatric comorbidities. Psychotic disorders are characterized by delusion, hallucination, and reality impairments. This study investigates the relationship between narcolepsy and psychotic disorders. DESIGN AND METHODS This study involves patients who were diagnosed with narcolepsy between January 2002 and December 2011 (n = 258) and age- and gender-matched controls (n = 2580) from Taiwan's National Health Insurance database. Both the patients and the controls were monitored from January 1, 2002 to December 31, 2011 to identify any occurrence of a psychotic disorder. Drugs that have been approved for treating narcolepsy: immediate-release methylphenidate (IR-MPH), osmotic controlled-release formulations of methylphenidate (OROS-MPH), and modafinil, were analyzed. A multivariate logistic regression model was used to evaluate the potential comorbidity of narcolepsy with psychotic disorders. RESULTS During the study period, 8.1% of the narcoleptic patients exhibited comorbidity with a psychotic disorder, whereas only 1.5% of the control subjects (1.5%) had psychotic disorders (aOR, 4.07; 95% CI, 2.21-7.47). Of the narcolepsy patients, 41.5, 5.4, and 13.2% were treated with MPH-IR, MPH-OROS, and modafinil, accordingly. Pharmacotherapy for narcolepsy did not significantly affect the risk of exhibiting a psychotic disorder. CONCLUSIONS This nationwide study revealed that narcolepsy and psychotic disorders commonly co-occur. Pharmacotherapy for narcolepsy was not associated with the risk of psychotic disorders. Our findings serve as a reminder that clinicians must consider the comorbidity of narcolepsy and psychosis.
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Affiliation(s)
- Jia-Yin Yeh
- Department of Child and Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yu-Chiau Shyu
- Community Medicine Research Center, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan.,Institute of Molecular Biology, Academia Sinica, Taipei, Taiwan.,Department of Nursing, Department of Nutrition and Health Sciences, Research Center for Food and Cosmetic Safety, and Research Center for Chinese Herbal Medicine, College of Human Ecology, Chang Gung University of Science and Technology, Taoyuan, Taiwan
| | - Sheng-Yu Lee
- Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,Department of Psychiatry, College of Medicine and Hospital, National Cheng Kung University, Tainan, Taiwan
| | - Shin-Sheng Yuan
- Institute of Statistical Science, Academia Sinica, Taipei, Taiwan
| | - Chun-Ju Yang
- Community Medicine Research Center, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan.,Institute of Biopharmaceutical Sciences, National Yang-Ming University, Taipei, Taiwan
| | - Kang-Chung Yang
- Community Medicine Research Center, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan.,Institute of Biopharmaceutical Sciences, National Yang-Ming University, Taipei, Taiwan
| | - Tung-Liang Lee
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Chi-Chin Sun
- Department of Ophthalmology, Keelung, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Liang-Jen Wang
- Department of Child and Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
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8
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Bu L, Wu Y, Yan Q, Tang L, Liu X, Diao C, Li K, Dong G. Effects of physical training on brain functional connectivity of methamphetamine dependencies as assessed using functional near-infrared spectroscopy. Neurosci Lett 2019; 715:134605. [PMID: 31698028 DOI: 10.1016/j.neulet.2019.134605] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 10/28/2019] [Accepted: 10/29/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVE This study aims to assess the effects of physical training based on the functional near-infrared spectroscopy (fNIRS) and heart rate signals. METHODS The oxygenated hemoglobin concentration (Delta [HbO2]) signals were recorded from the left prefrontal cortex (LPFC), right prefrontal cortex (RPFC), left motor cortex (LMC) and right motor cortex (RMC) of 23 subjects with methamphetamine (METH) dependencies at resting, spinning training and strength training states. The wavelet phase coherence (WPCO) values were calculated in four frequency intervals: I, 0.6-2; II, 0.145-0.6; III, 0.052-0.145; and IV, 0.021-0.052 Hz. During the spinning training and strength training states, heart rate signals were recorded at 1, 2, 3, 4, 5, 6, 7, 8, 9 and 10 min, respectively. RESULTS After physical training, the brain regions of LPFC, RPFC and LMC showed different degrees of activation in the subjects with METH dependencies (p < 0.05). The WPCO values between the brain regions significantly altered after spinning training and strength training (p < 0.05) in frequency intervals I, II, III and IV. CONCLUSIONS The altered WPCO values indicated physical training could affect brain functional connectivity (FC) to a certain extent in the subjects with METH dependencies. These findings provide a method for the assessment of the effects of physical training in FC and will contribute to the development of drug rehabilitation methods in subjects with METH dependencies.
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Affiliation(s)
- Lingguo Bu
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, 639798, Singapore; Key Laboratory of High Efficiency and Clean Mechanical Manufacture, School of Mechanical Engineering, Shandong University, Jinan, 250061, PR China
| | - Yan Wu
- Shandong Sport University, Jinan, 250102, PR China
| | - Qian Yan
- Shandong Sport University, Jinan, 250102, PR China
| | - Lei Tang
- Luzhong Compulsory Isolation Drug Rehabilitation Center of Shandong Province, Zibo, 255311, PR China
| | - Xin Liu
- Drug Rehabilitation Administration of Shandong Province, Jinan, 250014, PR China
| | - Chunfeng Diao
- Drug Rehabilitation Administration of Shandong Province, Jinan, 250014, PR China
| | - Kefeng Li
- Shandong Sport University, Jinan, 250102, PR China.
| | - Guijun Dong
- Shandong Sport University, Jinan, 250102, PR China.
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9
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Wang LJ, Chen CK, Lin SK, Chen YC, Xu K, Huang MC. Cognitive profile of ketamine-dependent patients compared with methamphetamine-dependent patients and healthy controls. Psychopharmacology (Berl) 2018; 235:2113-2121. [PMID: 29713787 DOI: 10.1007/s00213-018-4910-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 04/17/2018] [Indexed: 01/22/2023]
Abstract
BACKGROUND Ketamine has emerged as a major substance of abuse worldwide and has been listed with methamphetamine (METH) as two of the most widely available illicit substances in Taiwan. Only a few studies have examined the long-term consequences of chronic and heavy ketamine abuse. We compared the cognitive function of ketamine-dependent patients with that of METH-dependent patients and healthy controls. METHODS We recruited 165 participants (58 ketamine-dependent and 49 METH-dependent patients who sought treatment and 58 healthy controls) and evaluated them by using a cognitive test battery, the Brief Assessment of Cognition in Schizophrenia, with scores being estimated in reference to normative data in general population. RESULTS The ketamine-dependent patients had significantly poorer performance than did the controls in many cognitive tests, including verbal memory, motor speed, verbal fluency, and attention and processing speed, and the battery as a whole. METH-dependent patients exhibited poorer function in motor speed, verbal fluency, and attention and processing speed. The ketamine group performed poorer than did METH group in the domains of verbal memory, working memory, and attention and processing speed and the composite battery scores. A previous experience of ketamine-induced psychotomimetic symptoms, using higher doses of ketamine, and longer abstinence appeared to be associated with performance in some tests; however, the significance disappeared after multiple comparison correction. CONCLUSIONS The ketamine-dependent patients had impaired cognitive function, and METH-dependent patients exhibited intermediate performance between ketamine-dependent patients and healthy controls. Given the growing population of ketamine abusers, public education on the cognitive consequences should be provided.
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Affiliation(s)
- Liang-Jen Wang
- Department of Child and Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Department of Psychiatry, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Chih-Ken Chen
- Department of Psychiatry, Chang Gung Memorial Hospital, Keelung, Taiwan.,Chang Gung University School of Medicine, Taoyuan, Taiwan
| | - Shih-Ku Lin
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan.,Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, 309, Song-De Road, Taipei, Taiwan
| | - Yi-Chih Chen
- Department of Psychiatry, Chang Gung Memorial Hospital, Keelung, Taiwan.,Chang Gung University School of Medicine, Taoyuan, Taiwan
| | - Ke Xu
- Department of Psychiatry, Yale School of Medicine, New Heaven, CT, USA
| | - Ming-Chyi Huang
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan. .,Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, 309, Song-De Road, Taipei, Taiwan.
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10
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Yamamuro K, Kimoto S, Iida J, Kishimoto N, Tanaka S, Toritsuka M, Ikawa D, Yamashita Y, Ota T, Makinodan M, Yoshino H, Kishimoto T. Distinct patterns of blood oxygenation in the prefrontal cortex in clinical phenotypes of schizophrenia and bipolar disorder. J Affect Disord 2018. [PMID: 29522943 DOI: 10.1016/j.jad.2018.02.065] [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] [Indexed: 01/28/2023]
Abstract
BACKGROUND Schizophrenia (SZ) and bipolar disorder (BD) are characterized by different clinical symptoms, and have previously been considered as categorically separate. However, several lines of evidence controversially suggest that these two disorders may run on a continuum. While it is therefore important to evaluate the subtle differences between SZ and BD, few studies have investigated the difference of brain functioning between the two by focusing on the common symptoms of cognitive functioning and impulsivity, rather than positive/negative and mood symptoms. Recent developments in near-infrared spectroscopy (NIRS) technology have enabled noninvasive assessment of brain function in people with psychiatric disorders. METHODS Near-infrared spectroscopy (NIRS) using 24-channels was conducted during the verbal fluency task (VFT) and Stroop color-word task (SCWT) in 38 patients diagnosed with SZ, 34 patients with BD, and 26 age- and sex-matched healthy controls. RESULTS Oxyhemoglobin changes in the prefrontal cortex (PFC) were significantly lower particularly in the SZ compared to control group during the VFT. On the other hand, these were significantly lower particularly in the BD and SZ group to control group during the SCWT. Regression analysis showed that hemodynamic changes were significantly correlated with verbal memory and impulsivity in both disorders. CONCLUSION These findings suggest that different hemodynamic responses in the prefrontal cortex might reflect cognitive functioning and impulsivity, providing a greater insight into SZ and BD pathophysiology.
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Affiliation(s)
- Kazuhiko Yamamuro
- Department of Psychiatry, Nara Medical University School of Medicine, Kashihara, Japan.
| | - Sohei Kimoto
- Department of Psychiatry, Nara Medical University School of Medicine, Kashihara, Japan
| | - Junzo Iida
- Faculty of Nursing, Nara Medical University School of Medicine, Kashihara, Japan
| | - Naoko Kishimoto
- Department of Psychiatry, Nara Medical University School of Medicine, Kashihara, Japan
| | - Shohei Tanaka
- Department of Psychiatry, Nara Medical University School of Medicine, Kashihara, Japan
| | - Michihiro Toritsuka
- Department of Psychiatry, Nara Medical University School of Medicine, Kashihara, Japan
| | - Daisuke Ikawa
- Department of Psychiatry, Nara Medical University School of Medicine, Kashihara, Japan
| | - Yasunori Yamashita
- Department of Psychiatry, Nara Medical University School of Medicine, Kashihara, Japan
| | - Toyosaku Ota
- Department of Psychiatry, Nara Medical University School of Medicine, Kashihara, Japan
| | - Manabu Makinodan
- Department of Psychiatry, Nara Medical University School of Medicine, Kashihara, Japan
| | - Hiroki Yoshino
- Department of Psychiatry, Nara Medical University School of Medicine, Kashihara, Japan
| | - Toshifumi Kishimoto
- Department of Psychiatry, Nara Medical University School of Medicine, Kashihara, Japan
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11
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Shared and differential cortical functional abnormalities associated with inhibitory control in patients with schizophrenia and bipolar disorder. Sci Rep 2018; 8:4686. [PMID: 29549335 PMCID: PMC5856811 DOI: 10.1038/s41598-018-22929-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 03/05/2018] [Indexed: 01/06/2023] Open
Abstract
Schizophrenia (SZ) and bipolar I disorder (BD-I) share genetic risk factors and cognitive impairments, but these conditions may exhibit differences in cortical functioning associated with inhibitory control. We measured hemodynamic responses during a stop-signal task using near-infrared spectroscopy (NIRS) in 20 patients with SZ, 21 patients with BD-I and 18 healthy controls (HCs). We used stop-signal reaction time (SSRT) to estimate behavioural inhibition. Compared with HCs, patients with either SZ or BD-I exhibited significantly reduced activation in the bilateral inferior, middle and superior frontal gyri. Furthermore, patients with BD-I showed inactivation of the right superior temporal gyri compared with patients with SZ or HCs. Patients with SZ or BD-I demonstrated significant negative correlations between SSRT and hemodynamic responses of the right inferior frontal gyrus. Moreover, patients with SZ exhibited correlations in the middle and superior frontal gyri. Our findings suggest that right inferior frontal abnormalities mediate behavioural inhibition impairments in individuals with SZ or BD-I. Differential patterns of orbitofrontal or superior temporal functional abnormalities may reflect important differences in psychopathological features between these disorders.
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Wearne TA, Cornish JL. A Comparison of Methamphetamine-Induced Psychosis and Schizophrenia: A Review of Positive, Negative, and Cognitive Symptomatology. Front Psychiatry 2018; 9:491. [PMID: 30364176 PMCID: PMC6191498 DOI: 10.3389/fpsyt.2018.00491] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 09/19/2018] [Indexed: 01/12/2023] Open
Abstract
Methamphetamine is a potent psychostimulant that can induce psychosis among recreational and chronic users, with some users developing a persistent psychotic syndrome that shows similarities to schizophrenia. This review provides a comprehensive critique of research that has directly compared schizophrenia with acute and chronic METH psychosis, with particular focus on psychiatric and neurocognitive symptomatology. We conclude that while there is considerable overlap in the behavioral and cognitive symptoms between METH psychosis and schizophrenia, there appears to be some evidence that suggests there are divergent aspects to each condition, particularly with acute METH psychosis. Schizophrenia appears to be associated with pronounced thought disorder, negative symptoms more generally and cognitive deficits mediated by the parietal cortex, such as difficulties with selective visual attention, while visual and tactile hallucinations appear to be more prevalent in acute METH-induced psychosis. As such, acute METH psychosis may represent a distinct psychotic disorder to schizophrenia and could be clinically distinguished from a primary psychotic disorder based on the aforementioned behavioral and cognitive sequelae. Preliminary evidence, on the other hand, suggests that chronic METH psychosis may be clinically similar to that of primary psychotic disorders, particularly with respect to positive and cognitive symptomatology, although negative symptoms appear to be more pronounced in schizophrenia. Limitations of the literature and avenues for future research are also discussed.
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Affiliation(s)
- Travis A Wearne
- Department of Psychology, Macquarie University, Sydney, NSW, Australia.,School of Psychology, University of New South Wales, Sydney, NSW, Australia
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13
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Noda T, Nakagome K, Setoyama S, Matsushima E. Working memory and prefrontal/temporal hemodynamic responses during post-task period in patients with schizophrenia: A multi-channel near-infrared spectroscopy study. J Psychiatr Res 2017; 95:288-298. [PMID: 28934615 DOI: 10.1016/j.jpsychires.2017.09.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 08/29/2017] [Accepted: 09/01/2017] [Indexed: 11/30/2022]
Abstract
The relationship between cognitive impairments and social dysfunction in schizophrenia is widely accepted. Neuroimaging studies in patients with schizophrenia have demonstrated abnormal function in the prefrontal region during various neurocognitive tasks. However, studies exploring the neural basis of these cognitive impairments are still limited. Multi-channel near-infrared spectroscopy (NIRS) is a non-invasive functional neuroimaging technique used to detect the spatiotemporal characteristics of brain activity. Previous NIRS studies indicated oxy-hemoglobin (oxy-Hb) increase in patients with schizophrenia during the verbal fluency task (VFT), but to a lesser extent than in healthy participants. Furthermore, aberrant re-increase in the prefrontal region was observed during the post-task period. We hypothesized that prefrontal/temporal oxy-Hb aberrant re-increase during the post-task period was associated with cognitive impairment because oxy-Hb aberrant re-increase represent inadequate suppression of neural activity in the post-task period. We recruited 30 patients with schizophrenia and 30 healthy participants in this study. All participants underwent 52-channel NIRS measurement using the VFT. The patients with schizophrenia showed oxy-Hb aberrant re-increase in prefrontal and temporal regions during the post-task period. Although there was no significant relationship between changes in the oxy-Hb during the task and the scores of the Brief Assessment of Cognition in Schizophrenia (BACS), a significant negative correlation was observed between the oxy-Hb during the post-task period and BACS working memory z-scores (in DLPFC and temporal regions). These results suggest that oxy-Hb re-increase during the post-task period in prefrontal and temporal regions is associated with WM deficits in patients with schizophrenia and NIRS may be a potential biomarker of working memory in chronic schizophrenia.
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Affiliation(s)
- Takamasa Noda
- Section of Liaison Psychiatry & Palliative Medicine Division of Comprehensive Patient Care, Graduate School of Medical & Dental Sciences, Tokyo Medical & Dental University, 1-5-45, Yushima, Bunkyo, Tokyo 113-8519, Japan; Department of Psychiatry, National Center of Neurology and Psychiatry Hospital, 4-1-1, Ogawahigashi, Kodaira, Tokyo 187-8551, Japan; Clinical Optic Imaging Section, Department of Clinical Neuroimaging, Integrative Brain Imaging Center, National Center of Neurology and Psychiatry, 4-1-1, Ogawahigashi, Kodaira, Tokyo 187-8551, Japan.
| | - Kazuyuki Nakagome
- National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1, Ogawahigashi, Kodaira, Tokyo 187-8553, Japan
| | - Shiori Setoyama
- Department of Psychiatry, National Center of Neurology and Psychiatry Hospital, 4-1-1, Ogawahigashi, Kodaira, Tokyo 187-8551, Japan
| | - Eisuke Matsushima
- Section of Liaison Psychiatry & Palliative Medicine Division of Comprehensive Patient Care, Graduate School of Medical & Dental Sciences, Tokyo Medical & Dental University, 1-5-45, Yushima, Bunkyo, Tokyo 113-8519, Japan
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Kumar V, Shivakumar V, Chhabra H, Bose A, Venkatasubramanian G, Gangadhar BN. Functional near infra-red spectroscopy (fNIRS) in schizophrenia: A review. Asian J Psychiatr 2017; 27:18-31. [PMID: 28558892 DOI: 10.1016/j.ajp.2017.02.009] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 02/02/2017] [Accepted: 02/12/2017] [Indexed: 01/14/2023]
Abstract
The research on the alterations in functional connectivity in schizophrenia has been facilitated by development of an array of functional neuroimaging techniques. Functional Near Infra Red Spectroscopy (fNIRS) is a novel diffuse optical neuromonitring method with its own advantages and limitations. The advantages of fNIRS have made it to be frequently used as a research tool by medical community in different settings. In fNIRS the property of haemoglobin to absorb near infrared light is used to measure brain activity. It provides the indirect measurement of the neuronal activity in the areas of interest. The advantage of fNIRS being less restrictive has made it to be used more commonly in the research of psychiatric disorders in general, schizophrenia in particular. The fNIRS studies on patients with schizophrenia have shown haemodynamic hypo activation primarily in the prefrontal cortex during various cognitive tasks. In this review, initially we have briefly explained the basic principles of fNIRS followed by detailed review of fNIRS findings in patients with schizophrenia.
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Affiliation(s)
- Vijay Kumar
- The Schizophrenia Clinic, Department of Psychiatry & Translational Psychiatry Laboratory, Neurobiology Research Centre, National Institute of Mental Health and Neurosciences, Bangalore, India.
| | - Venkataram Shivakumar
- The Schizophrenia Clinic, Department of Psychiatry & Translational Psychiatry Laboratory, Neurobiology Research Centre, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Harleen Chhabra
- The Schizophrenia Clinic, Department of Psychiatry & Translational Psychiatry Laboratory, Neurobiology Research Centre, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Anushree Bose
- The Schizophrenia Clinic, Department of Psychiatry & Translational Psychiatry Laboratory, Neurobiology Research Centre, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Ganesan Venkatasubramanian
- The Schizophrenia Clinic, Department of Psychiatry & Translational Psychiatry Laboratory, Neurobiology Research Centre, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Bangalore N Gangadhar
- The Schizophrenia Clinic, Department of Psychiatry & Translational Psychiatry Laboratory, Neurobiology Research Centre, National Institute of Mental Health and Neurosciences, Bangalore, India
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Nakanishi Y, Ota T, Iida J, Yamamuro K, Kishimoto N, Okazaki K, Kishimoto T. Differential therapeutic effects of atomoxetine and methylphenidate in childhood attention deficit/hyperactivity disorder as measured by near-infrared spectroscopy. Child Adolesc Psychiatry Ment Health 2017; 11:26. [PMID: 28507595 PMCID: PMC5429516 DOI: 10.1186/s13034-017-0163-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Accepted: 05/06/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The stimulant methylphenidate (MPH) and the nonstimulant atomoxetine (ATX) are the most commonly-prescribed pharmacological treatments for attention deficit/hyperactivity disorder (ADHD). However, the drug-specific mechanism of action on brain function in ADHD patients is not well known. This study examined differences in prefrontal hemodynamic activity between MPH and ATX in children with ADHD as measured by near-infrared spectroscopy (NIRS) using the Stroop color-word task. METHODS Thirty children with ADHD participated in the present study. We used 24-channel NIRS (ETG-4000) to measure the relative concentrations of oxyhemoglobin in the frontal lobes of participants in the drug-naïve condition and those who had received MPH (n = 16) or ATX (n = 14) for 12 weeks. Measurements were conducted every 0.1 s during the Stroop color-word task. We used the ADHD RS-IV-J (Home Version) to evaluate ADHD symptoms. RESULTS Treatment with either MPH or ATX significantly reduced ADHD symptoms, as measured by the ADHD RS-IV-J, and improved performance on the Stroop color-word task in terms of number of correct words. We found significantly higher levels of oxyhemoglobin changes in the prefrontal cortex of participants in the ATX condition compared with the values seen at baseline (pre-ATX). In contrast, we found no oxyhemoglobin changes between pre- and post-treatment with MPH. CONCLUSIONS The present study suggests that MPH and ATX have differential effects on prefrontal hemodynamic activity in children with ADHD.
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Affiliation(s)
- Yoko Nakanishi
- 0000 0004 0372 782Xgrid.410814.8Department of Psychiatry, Nara Medical University School of Medicine, 840 Shijo-cho Kashihara, Nara, 634-8522 Japan
| | - Toyosaku Ota
- 0000 0004 0372 782Xgrid.410814.8Department of Psychiatry, Nara Medical University School of Medicine, 840 Shijo-cho Kashihara, Nara, 634-8522 Japan
| | - Junzo Iida
- 0000 0004 0372 782Xgrid.410814.8Faculty of Nursing, Nara Medical University School of Medicine, 840 Shijo-cho Kashihara, Nara, 634-8522 Japan
| | - Kazuhiko Yamamuro
- 0000 0004 0372 782Xgrid.410814.8Department of Psychiatry, Nara Medical University School of Medicine, 840 Shijo-cho Kashihara, Nara, 634-8522 Japan
| | - Naoko Kishimoto
- 0000 0004 0372 782Xgrid.410814.8Department of Psychiatry, Nara Medical University School of Medicine, 840 Shijo-cho Kashihara, Nara, 634-8522 Japan
| | - Kosuke Okazaki
- 0000 0004 0372 782Xgrid.410814.8Department of Psychiatry, Nara Medical University School of Medicine, 840 Shijo-cho Kashihara, Nara, 634-8522 Japan
| | - Toshifumi Kishimoto
- 0000 0004 0372 782Xgrid.410814.8Department of Psychiatry, Nara Medical University School of Medicine, 840 Shijo-cho Kashihara, Nara, 634-8522 Japan
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Pu S, Nakagome K, Itakura M, Iwata M, Nagata I, Kaneko K. Association of fronto-temporal function with cognitive ability in schizophrenia. Sci Rep 2017; 7:42858. [PMID: 28205609 PMCID: PMC5311872 DOI: 10.1038/srep42858] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 01/18/2017] [Indexed: 01/13/2023] Open
Abstract
Deficits in neuropsychological performance are common in schizophrenia, but their relationship with the fronto-temporal functional abnormalities associated with this condition remains unclear. We explored the relationship between neuropsychological performance as measured using the Brief Assessment of Cognition in Schizophrenia (BACS) and the Social Cognition Screening Questionnaire theory of mind (ToM) subscale and fronto-temporal function in 23 patients with schizophrenia and 23 age- and gender-matched healthy controls (HCs), using 52-channel near-infrared spectroscopy (NIRS). Regional hemodynamic changes were significantly smaller in the schizophrenia group than in the HCs group in the ventro-lateral prefrontal cortex and the anterior part of the temporal cortex (VLPFC/aTC) and dorso-lateral prefrontal cortex and frontopolar cortex (DLPFC/FPC) regions. To dissect the effect of variance in BACS cognitive domains from the relationship between ToM function and fronto-temporal function, we performed additional partial correlation analyses between ToM and NIRS data, using BACS composite score as a control variable. The correlation between ToM and NIRS data remained significant only in the DLPFC/FPC region. This finding is important to models of recovery, as it suggests that intervention programs focusing on enhancing fronto-temporal function may have a greater impact on social and occupational outcomes than traditional rehabilitation programs focusing on neuropsychological performance.
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Affiliation(s)
- Shenghong Pu
- Division of Neuropsychiatry, Department of Brain and Neuroscience, Tottori University Faculty of Medicine: 36-1 Nishi-cho, Yonago, Tottori 683-8504, Japan
| | - Kazuyuki Nakagome
- National Center of Neurology and Psychiatry: 4-1-1 Ogawa-Higashi, Kodaira, Tokyo 187-8551 Japan
| | - Masashi Itakura
- Division of Neuropsychiatry, Department of Brain and Neuroscience, Tottori University Faculty of Medicine: 36-1 Nishi-cho, Yonago, Tottori 683-8504, Japan
| | - Masaaki Iwata
- Division of Neuropsychiatry, Department of Brain and Neuroscience, Tottori University Faculty of Medicine: 36-1 Nishi-cho, Yonago, Tottori 683-8504, Japan
| | - Izumi Nagata
- Division of Neuropsychiatry, Department of Brain and Neuroscience, Tottori University Faculty of Medicine: 36-1 Nishi-cho, Yonago, Tottori 683-8504, Japan
| | - Koichi Kaneko
- Division of Neuropsychiatry, Department of Brain and Neuroscience, Tottori University Faculty of Medicine: 36-1 Nishi-cho, Yonago, Tottori 683-8504, Japan
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Abstract
PURPOSE OF REVIEW The study reviews publications on the use of methamphetamine and amphetamine in relation to psychotic symptoms, substance-induced psychosis, and primary psychosis published between July 2014 and December 2015. The databases MEDLINE, Embase, and PsycINFO were searched using the terms 'amphetamine psychosis' and 'methamphetamine psychosis' for the time period 1 July 2014 to 31 December 2015. RECENT FINDINGS There were 37 studies published on the subject during this time period. Risk factors for psychotic symptoms, substance-induced psychosis, and primary psychosis included patterns of drug use, but results also pointed to the importance of nondrug-related vulnerability. Cognitive impairment is associated with both amphetamine use and psychosis, and the impairment among those with amphetamine-induced psychosis resembles that of schizophrenia. At the neuronal level, GABAergic mechanisms may offer some understanding about the association between stimulant use and psychosis. Several different types of antipsychotic medication are effective for treating agitation and psychosis, but drugs with high DRD2 blockade should be used with caution. Some novel treatments are described, but are not sufficiently repeated to be recommended. SUMMARY During the past 18 months, studies have been published that cover risk factors, neuronal mechanisms, and treatment. These recent results do not differ from previous understandings, but the role of cognition and GABAergic dysfunction should be further investigated, and knowledge about resilience factors is still scarce. Also, a clearer evidence base for medical treatment of psychosis with concurrent amphetamine use is warranted. VIDEO ABSTRACT.
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