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Pawełczyk A, Łojek E, Żurner N, Gawłowska-Sawosz M, Gębski P, Pawełczyk T. The correlation between white matter integrity and pragmatic language processing in first episode schizophrenia. Brain Imaging Behav 2021; 15:1068-1084. [PMID: 32710335 PMCID: PMC8032571 DOI: 10.1007/s11682-020-00314-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Objective: Higher-order language disturbances could be the result of white matter tract abnormalities. The study explores the relationship between white matter and pragmatic skills in first-episode schizophrenia. Methods: Thirty-four first-episode patients with schizophrenia and 32 healthy subjects participated in a pragmatic language and Diffusion Tensor Imaging study, where fractional anisotropy of the arcuate fasciculus, corpus callosum and cingulum was correlated with the Polish version of the Right Hemisphere Language Battery. Results: The patients showed reduced fractional anisotropy in the right arcuate fasciculus, left anterior cingulum bundle and left forceps minor. Among the first episode patients, reduced understanding of written metaphors correlated with reduced fractional anisotropy of left forceps minor, and greater explanation of written and picture metaphors correlated with reduced fractional anisotropy of the left anterior cingulum. Conclusions: The white matter dysfunctions may underlie the pragmatic language impairment in schizophrenia. Our results shed further light on the functional neuroanatomical basis of pragmatic language use by patients with schizophrenia.
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Affiliation(s)
- Agnieszka Pawełczyk
- Department of Affective and Psychotic Disorders, Medical University of Łódź, Łódź, Poland.
| | | | - Natalia Żurner
- Adolescent Ward, Central Clinical Hospital of Medical University of Łódź, Łódź, Poland
| | | | - Piotr Gębski
- Scanlab Diagnostyka Medyczna Księży Młyn, Medical Examination Centre, Medical University of Łódź, Łódź, Poland
| | - Tomasz Pawełczyk
- Department of Affective and Psychotic Disorders, Medical University of Łódź, Łódź, Poland
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Prolonged P300 Latency in Antipsychotic-Free Subjects with At-Risk Mental States Who Later Developed Schizophrenia. J Pers Med 2021; 11:jpm11050327. [PMID: 33919276 PMCID: PMC8143351 DOI: 10.3390/jpm11050327] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 04/16/2021] [Accepted: 04/18/2021] [Indexed: 12/17/2022] Open
Abstract
We measured P300, an event-related potential, in subjects with at-risk mental states (ARMS) and aimed to determine whether P300 parameter can predict progression to overt schizophrenia. Thirty-three subjects with ARMS, 39 with schizophrenia, and 28 healthy controls participated in the study. All subjects were antipsychotic-free. Subjects with ARMS were followed-up for more than two years. Cognitive function was measured by the Brief assessment of Cognition in Schizophrenia (BACS) and Schizophrenia Cognition Rating Scale (SCoRS), while the modified Global Assessment of Functioning (mGAF) was used to assess global function. Patients with schizophrenia showed smaller P300 amplitudes and prolonged latency at Pz compared to those of healthy controls and subjects with ARMS. During the follow-up period, eight out of 33 subjects with ARMS developed overt psychosis (ARMS-P) while 25 did not (ARMS-NP). P300 latency of ARMS-P was significantly longer than that of ARMS-NP. At baseline, ARMS-P elicited worse cognitive functions, as measured by the BACS and SCoRS compared to ARMS-NP. We also detected a significant relationship between P300 amplitudes and mGAF scores in ARMS subjects. Our results suggest the usefulness of prolonged P300 latency and cognitive impairment as a predictive marker of later development of schizophrenia in vulnerable individuals.
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McCarthy NS, Badcock JC, Clark ML, Knowles EEM, Cadby G, Melton PE, Morgan VA, Blangero J, Moses EK, Glahn DC, Jablensky A. Assessment of Cognition and Personality as Potential Endophenotypes in the Western Australian Family Study of Schizophrenia. Schizophr Bull 2018; 44:908-921. [PMID: 29040798 PMCID: PMC6007328 DOI: 10.1093/schbul/sbx141] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Phenotypic heterogeneity is a major barrier to understanding the genetic architecture underlying schizophrenia. Incorporating endophenotypes is one way to reduce heterogeneity and facilitate more powerful genetic analysis. Candidate endophenotypes require systematic assessment against endophenotype criteria, and a ranking of their potential utility for genetic analysis. In this study we assess 20 cognitive and personality measures in a sample of 127 families with at least 2 cases of schizophrenia per family (n = 535) plus a set of 30 control families (n = 121) against 4 endophenotype criteria: (a) be associated with the illness but not be a part of its diagnosis, (b) be heritable, (c) co-segregate with the illness in families, and (d) be found in unaffected relatives at a higher rate than in the general population. The endophenotype ranking score (endophenotype ranking variable [ERV]) was used to rank candidate endophenotypes based on their heritability and genetic correlation with schizophrenia. Finally, we used factor analysis to explore latent factors underlying the cognitive and personality measures. Evidence for personality measures as endophenotypes was at least equivalent to that of the cognitive measures. Factor analysis indicated that personality and cognitive traits contribute to independent latent dimensions. The results suggest for this first time that a number of cognitive and personality measures are independent and informative endophenotypes. Use of these endophenotypes in genetic studies will likely improve power and facilitate novel aetiological insights.
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Affiliation(s)
- Nina S McCarthy
- Centre for Genetic Origins of Health and Disease, Faculty of Medicine, Dentistry & Health Sciences, The University of Western Australia and Faculty of Health Sciences, Curtin University, Perth, Australia
- Centre for Clinical Research in Neuropsychiatry, Division of Psychiatry, Medical School, University of Western Australia, Perth, Australia
- Cooperative Research Centre for Mental Health, Carlton South, Australia
| | - Johanna C Badcock
- Centre for Clinical Research in Neuropsychiatry, Division of Psychiatry, Medical School, University of Western Australia, Perth, Australia
- Cooperative Research Centre for Mental Health, Carlton South, Australia
| | - Melanie L Clark
- Centre for Clinical Research in Neuropsychiatry, Division of Psychiatry, Medical School, University of Western Australia, Perth, Australia
| | - Emma E M Knowles
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Gemma Cadby
- Centre for Genetic Origins of Health and Disease, Faculty of Medicine, Dentistry & Health Sciences, The University of Western Australia and Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Phillip E Melton
- Centre for Genetic Origins of Health and Disease, Faculty of Medicine, Dentistry & Health Sciences, The University of Western Australia and Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Vera A Morgan
- Centre for Clinical Research in Neuropsychiatry, Division of Psychiatry, Medical School, University of Western Australia, Perth, Australia
- Neuropsychiatric Epidemiology Research Unit, Division of Psychiatry, Medical School, University of Western Australia, Perth, Australia
| | - John Blangero
- South Texas Diabetes and Obesity Institute, The University of Texas Rio Grande Valley, Brownsville, TX
| | - Eric K Moses
- Centre for Genetic Origins of Health and Disease, Faculty of Medicine, Dentistry & Health Sciences, The University of Western Australia and Faculty of Health Sciences, Curtin University, Perth, Australia
| | - David C Glahn
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
- Olin Neuropsychiatric Research Center, Institute of Living, Hartford Hospital, Hartford, CT
| | - Assen Jablensky
- Centre for Clinical Research in Neuropsychiatry, Division of Psychiatry, Medical School, University of Western Australia, Perth, Australia
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Galderisi S, Rossi A, Rocca P, Bertolino A, Mucci A, Bucci P, Rucci P, Gibertoni D, Aguglia E, Amore M, Blasi G, Comparelli A, Di Giannantonio M, Goracci A, Marchesi C, Monteleone P, Montemagni C, Pinna F, Roncone R, Siracusano A, Stratta P, Torti MC, Vita A, Zeppegno P, Chieffi M, Maj M. Pathways to functional outcome in subjects with schizophrenia living in the community and their unaffected first-degree relatives. Schizophr Res 2016; 175:154-160. [PMID: 27209527 DOI: 10.1016/j.schres.2016.04.043] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 04/20/2016] [Accepted: 04/25/2016] [Indexed: 11/25/2022]
Abstract
RATIONALE Variables influencing real-life functioning have repeatedly been modeled in schizophrenia subjects but not systematically investigated in their unaffected first-degree relatives (SRs), in whom milder forms of deficits reported in schizophrenia have been observed, but confounders of clinical cohorts are not in play. Demonstrating that pathways to functional outcome are similar between patients and SRs would validate structural models developed in schizophrenia subjects. The present multicenter study aimed to explore whether variables associated with real-life functioning are similar in schizophrenia patients and their unaffected relatives. METHODS The study sample included 921 schizophrenia patients, 379 SRs and 780 healthy controls. Structural Equation Models (SEMs) were used in patients and SRs to test associations of psychopathological dimensions, neurocognition, social cognition, resilience, perceived stigma and functional capacity with real-life functioning domains, impaired in both patients and SRs. RESULTS Interpersonal Relationships and Work Skills were the only functional domains impaired in both patients and SRs. For both domains, functional impairment in patients was found to predict impairment in unaffected relatives, suggesting the involvement of similar illness-related vulnerability factors. In both groups variables significantly associated with Interpersonal Relationships included Social Cognition, Neurocognition, Avolition, Resilience, Disorganization, Perceived Stigma and Gender, and those significantly associated with Work Skills included Social Cognition, Neurocognition and Disorganization. CONCLUSIONS Pathways to functional outcome for Interpersonal relationships and Work skills are similar between schizophrenia patients and their unaffected first-degree relatives. These findings validate, in the absence of confounders of clinical cohorts, structural models of determinants of functional outcome in people with schizophrenia.
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Affiliation(s)
- Silvana Galderisi
- Department of Psychiatry, University of Naples SUN, Largo Madonna delle Grazie, 80138 Naples, Italy.
| | - Alessandro Rossi
- Department of Biotechnological and Applied Clinical Sciences, Section of Psychiatry, University of L'Aquila, L'Aquila, Italy
| | - Paola Rocca
- Department of Neuroscience, Section of Psychiatry, University of Turin, Turin, Italy
| | - Alessandro Bertolino
- Department of Neurological and Psychiatric Sciences, University of Bari, Bari, Italy
| | - Armida Mucci
- Department of Psychiatry, University of Naples SUN, Largo Madonna delle Grazie, 80138 Naples, Italy
| | - Paola Bucci
- Department of Psychiatry, University of Naples SUN, Largo Madonna delle Grazie, 80138 Naples, Italy
| | - Paola Rucci
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Dino Gibertoni
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Eugenio Aguglia
- Department of Clinical and Molecular Biomedicine, Psychiatry Unit, University of Catania, Catania, Italy
| | - Mario Amore
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy
| | - Giuseppe Blasi
- Department of Neurological and Psychiatric Sciences, University of Bari, Bari, Italy
| | - Anna Comparelli
- Department of Neurosciences, Mental Health and Sensory Organs, S. Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Massimo Di Giannantonio
- Department of Neuroscience and Imaging, Chair of Psychiatry, G. d'Annunzio University, Chieti, Italy
| | - Arianna Goracci
- Department of Molecular Medicine and Clinical Department of Mental Health, University of Siena, Siena, Italy
| | - Carlo Marchesi
- Department of Neuroscience, Psychiatry Unit, University of Parma, Parma, Italy
| | - Palmiero Monteleone
- Department of Medicine and Surgery, Chair of Psychiatry, University of Salerno, Salerno, Italy
| | - Cristiana Montemagni
- Department of Neuroscience, Section of Psychiatry, University of Turin, Turin, Italy
| | - Federica Pinna
- Department of Public Health, Clinical and Molecular Medicine, Section of Psychiatry, University of Cagliari, Cagliari, Italy
| | - Rita Roncone
- Department of Life, Health and Environmental Sciences, Unit of Psychiatry, University of L'Aquila, L'Aquila, Italy
| | - Alberto Siracusano
- Department of Systems Medicine, Chair of Psychiatry, Tor Vergata University of Rome, Rome, Italy
| | - Paolo Stratta
- Department of Biotechnological and Applied Clinical Sciences, Section of Psychiatry, University of L'Aquila, L'Aquila, Italy
| | - Maria Chiara Torti
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Antonio Vita
- Psychiatric Unit, School of Medicine, University of Brescia, and Department of Mental Health, Spedali Civili Hospital, Brescia, Italy
| | - Patrizia Zeppegno
- Department of Translational Medicine, Psychiatric Unit, University of Eastern Piedmont, Novara, Italy
| | - Marcello Chieffi
- Department of Psychiatry, University of Naples SUN, Largo Madonna delle Grazie, 80138 Naples, Italy
| | - Mario Maj
- Department of Psychiatry, University of Naples SUN, Largo Madonna delle Grazie, 80138 Naples, Italy
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Metzler S, Dvorsky D, Wyss C, Müller M, Gerstenberg M, Traber-Walker N, Walitza S, Theodoridou A, Rössler W, Heekeren K. Changes in neurocognitive functioning during transition to manifest disease: comparison of individuals at risk for schizophrenic and bipolar affective psychoses. Psychol Med 2015; 45:2123-2134. [PMID: 25640248 DOI: 10.1017/s0033291715000057] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Neurocognitive deficits are important aspects of schizophrenic disorder because they have a strong impact on social and vocational outcomes. Previously it was assumed that cognitive abilities progressively deteriorate with illness onset. However, recent research results have contradicted this with observations of continuous or even improved performance in individuals at risk for psychosis or manifest schizophrenia. The objective of our longitudinal study was to examine neurocognitive functioning in help-seeking individuals meeting basic symptoms or ultra-high-risk criteria for schizophrenic psychosis (HRSchiz) or risk criteria for affective psychosis (HRBip). The progression of cognitive functioning in individuals converting to psychosis was compared with that of at-risk individuals who did not convert during the follow-up period. METHOD Data were available from 86 study participants who completed neurocognitive and clinical assessments at baseline and, on average, 12.8 (s.d. = 1.5) months later. Neurocognitive measures were grouped according to their load in factor analysis to five cognitive domains: speed, attention, fluency, learning and memory, and working memory. RESULTS Neurocognitive functioning in HRSchiz and HRBip individuals generally improved over time. Subjects converting to manifest psychosis displayed a stable neurocognitive profile from baseline to follow-up. Compared with non-converters, they had already demonstrated a significantly lower level of performance during their baseline examinations. CONCLUSIONS Our data provide no evidence for a progressive cognitive decline in individuals at risk of psychosis. In line with the neurodevelopmental model, our findings suggest that cognitive deficits are already present very early, before or during the prodromal stage of the illness.
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Affiliation(s)
- S Metzler
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP),University Hospital of Psychiatry Zurich,Switzerland
| | - D Dvorsky
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP),University Hospital of Psychiatry Zurich,Switzerland
| | - C Wyss
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP),University Hospital of Psychiatry Zurich,Switzerland
| | - M Müller
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP),University Hospital of Psychiatry Zurich,Switzerland
| | - M Gerstenberg
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP),University Hospital of Psychiatry Zurich,Switzerland
| | - N Traber-Walker
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP),University Hospital of Psychiatry Zurich,Switzerland
| | - S Walitza
- Department of Child and Adolescent Psychiatry,University of Zurich,Switzerland
| | - A Theodoridou
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP),University Hospital of Psychiatry Zurich,Switzerland
| | - W Rössler
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP),University Hospital of Psychiatry Zurich,Switzerland
| | - K Heekeren
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP),University Hospital of Psychiatry Zurich,Switzerland
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Beck AK, Baker AL, Todd J. Smoking in schizophrenia: cognitive impact of nicotine and relationship to smoking motivators. SCHIZOPHRENIA RESEARCH-COGNITION 2015; 2:26-32. [PMID: 29379758 PMCID: PMC5779288 DOI: 10.1016/j.scog.2014.12.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 11/25/2014] [Accepted: 12/02/2014] [Indexed: 10/31/2022]
Abstract
Smoking prevalence in schizophrenia is significantly elevated relative to other clinical and to non-clinical groups. The cognitive self-medication hypothesis attributes this to the beneficial effects of nicotine on illness-related cognitive deficits. Significant effects of nicotine have been observed on visual spatial working memory (VSWM), sustained attention (Continuous Performance Test - Identical Pairs; CPT-IP) and prepulse inhibition (PPI). It remains unclear whether these neurophysiological and neurocognitive effects of nicotine influence self-reported smoking motivation. To explore the relationship between nicotine effects on cognition and self-reported smoking motivation in schizophrenia and non-psychiatric control smokers, the impact of smoking abstinence and reinstatement was examined across three cognitive indices (VSWM, CPT-IP, PPI) and compared to self-reported smoking motivation (Modified Reasons for Smoking Scale revised to include 'cognitive motivators'). Cognitive function was assessed after 'typical' smoking and overnight abstinence. Schizophrenia smokers (but not controls) demonstrated significantly less error on the VSWM task in the smoking relative to abstinent condition. Control (but not schizophrenia) smokers, showed evidence of CPT-IP improvement in the smoking relative to abstinent condition. The overall profile of smoking motivation was comparable between groups. However, significant relationships between subjective and objective indices of smoking related cognitive change were observed for controls. Differential effects of nicotine on cognition have been hypothesised to influence the pattern and persistence of smoking in schizophrenia. These preliminary findings indicate that evidence for such effects is apparent even in small samples - particularly for VSWM. This is the first study to show that neurocognitive effects of smoking may influence self-reported smoking motivation.
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Affiliation(s)
- Alison K Beck
- School of Psychology, University of Newcastle, Callaghan, 2280, NSW, Australia.,Schizophrenia Research Institute, 405 Liverpool St, Darlinghurst, 2010, NSW, Australia
| | - Amanda L Baker
- Schizophrenia Research Institute, 405 Liverpool St, Darlinghurst, 2010, NSW, Australia.,School of Medicine & Public Health, University of Newcastle, Callaghan, 2280, NSW, Australia
| | - Juanita Todd
- School of Psychology, University of Newcastle, Callaghan, 2280, NSW, Australia.,Schizophrenia Research Institute, 405 Liverpool St, Darlinghurst, 2010, NSW, Australia
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Mirzakhanian H, Singh F, Seeber K, Shafer KM, Cadenhead KS. A developmental look at the attentional system in the at risk and first episode of psychosis: age related changes in attention along the psychosis spectrum. Cogn Neuropsychiatry 2013; 18:26-43. [PMID: 22994363 PMCID: PMC3719179 DOI: 10.1080/13546805.2012.713770] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Neurodevelopmental processes of adolescence, when superimposed on a vulnerable brain, may produce additive effects reflecting the subthreshold psychotic symptoms, cognitive, and functional deterioration that are the hallmark of the early stages of schizophrenia. METHODS As part of a longitudinal study, we investigated Continuous Performance Task, Identical Pairs Version (CPT-IP) performance in a sample of 301 participants (at risk for psychosis: 109; first episode-FE: 90; and controls: 102). Performance across groups was compared using d' of fast and slow, spatial and verbal conditions over two time points. Age effects were investigated using a regression model. RESULTS Across all four CPT-IP conditions FE patients performed significantly worse than controls while AR individuals significantly differed from healthy subjects in the verbal condition. Age-related performance associations across groups significantly differed in the slow verbal condition because the FE sample did not show a significant association with increasing age like the AR and NC samples. CPT performance was stable over time. CONCLUSIONS Sustained attention in the putative prodrome of psychosis is not only impaired but associated with age. Research focusing on cognitive and neurobiological age-related changes can help to address fundamental questions about the nature of the disorder, including whether the underlying pathophysiology of early psychosis is static or deteriorating.
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Affiliation(s)
| | - Fiza Singh
- Department of Psychiatry, University of California San Diego,Veteran’s Affairs San Diego Healthcare System
| | | | | | - Kristin S. Cadenhead
- Department of Psychiatry, University of California San Diego,Veteran’s Affairs San Diego Healthcare System
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8
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Diwadkar VA, Goradia D, Hosanagar A, Mermon D, Montrose DM, Birmaher B, Axelson D, Rajarathinem R, Haddad L, Amirsadri A, Zajac-Benitez C, Rajan U, Keshavan MS. Working memory and attention deficits in adolescent offspring of schizophrenia or bipolar patients: comparing vulnerability markers. Prog Neuropsychopharmacol Biol Psychiatry 2011; 35:1349-54. [PMID: 21549798 PMCID: PMC3126676 DOI: 10.1016/j.pnpbp.2011.04.009] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2011] [Revised: 04/15/2011] [Accepted: 04/18/2011] [Indexed: 01/14/2023]
Abstract
BACKGROUND Working memory deficits abound in schizophrenia and attention deficits have been documented in schizophrenia and bipolar disorder. Adolescent offspring of patients may inherit vulnerabilities in brain circuits that subserve these cognitive domains. Here we assess impairments in offspring of schizophrenia (SCZ-Offspring) or bipolar (BP-Offspring) patients compared to controls (HC) with no family history of mood or psychotic disorders to the second degree. METHODS Three groups (n=100 subjects; range: 10-20 yrs) of HC, SCZ-Offspring and BP-Offspring gave informed consent. Working memory was assessed using a delayed spatial memory paradigm with two levels of delay (2s & 12s); sustained attention processing was assessed using the Continuous Performance Task-Identical Pairs version. RESULTS SCZ-Offspring (but not BP-Offspring) showed impairments in working memory (relative to HC) at the longer memory delay indicating a unique deficit. Both groups showed reduced sensitivity during attention but only BP-Offspring significantly differed from controls. CONCLUSIONS These results suggest unique (working memory/dorsal frontal cortex) and potentially overlapping (attention/fronto-striatal cortex) vulnerability pathways in adolescent offspring of patients with schizophrenia and bipolar disorder. Working memory and attention assessments in these offspring may assist in the clinical characterization of the adolescents vulnerable to SCZ or BP.
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Affiliation(s)
- Vaibhav A. Diwadkar
- Dept of Psychiatry & Behavioral Neuroscience, Wayne State University SOM,Dept of Psychiatry, University of Pittsburgh SOM,Address Correspondence to: Vaibhav A. Diwadkar, PhD, Division of Brain Research & Imaging Neuroscience, Dept of Psychiatry & Behavioral Neuroscience, Wayne State University SOM, UHC 9B, 4201 St. Antoine Blvd, Detroit MI 48301, U.S.A., Ph: 1.313.577.0164, Fax: 1.313.577.5900,
| | - Dhruman Goradia
- Dept of Psychiatry & Behavioral Neuroscience, Wayne State University SOM
| | | | - Diana Mermon
- Dept of Psychiatry, University of Pittsburgh SOM
| | | | | | | | - R. Rajarathinem
- Dept of Psychiatry & Behavioral Neuroscience, Wayne State University SOM
| | - Luay Haddad
- Dept of Psychiatry & Behavioral Neuroscience, Wayne State University SOM
| | - Ali Amirsadri
- Dept of Psychiatry & Behavioral Neuroscience, Wayne State University SOM
| | | | - Usha Rajan
- Dept of Psychiatry & Behavioral Neuroscience, Wayne State University SOM
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LAWRIE STEPHENM, OLABI BAYANNE, HALL JEREMY, McINTOSH ANDREWM. Do we have any solid evidence of clinical utility about the pathophysiology of schizophrenia? World Psychiatry 2011; 10:19-31. [PMID: 21379347 PMCID: PMC3048512 DOI: 10.1002/j.2051-5545.2011.tb00004.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
A diagnosis of schizophrenia, as in most of psychiatric practice, is made largely by eliciting symptoms with reference to subjective, albeit operationalized, criteria. This diagnosis then provides some rationale for management. Objective diagnostic and therapeutic tests are much more desirable, provided they are reliably measured and interpreted. Definite advances have been made in our understanding of schizophrenia in recent decades, but there has been little consideration of how this information could be used in clinical practice. We review here the potential utility of the strongest and best replicated risk factors for and manifestations of schizophrenia within clinical, epidemiological, cognitive, blood biomarker and neuroimaging domains. We place particular emphasis on the sensitivity, specificity and predictive power of pathophysiological indices for making a diagnosis, establishing an early diagnosis or predicting treatment response in schizophrenia. We conclude that a number of measures currently available have the potential to increase the rigour of clinical assessments in schizophrenia. We propose that the time has come to more fully evaluate these and other well replicated abnormalities as objective potential diagnostic and prognostic guides, and to steer future clinical, therapeutic and nosological research in this direction.
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Affiliation(s)
- STEPHEN M. LAWRIE
- Division of Psychiatry, School of Molecular and Clinical Medicine, Royal Edinburgh Hospital, Morningside, Edinburgh EH10 5HF, UK
| | - BAYANNE OLABI
- Division of Psychiatry, School of Molecular and Clinical Medicine, Royal Edinburgh Hospital, Morningside, Edinburgh EH10 5HF, UK
| | - JEREMY HALL
- Division of Psychiatry, School of Molecular and Clinical Medicine, Royal Edinburgh Hospital, Morningside, Edinburgh EH10 5HF, UK
| | - ANDREW M. McINTOSH
- Division of Psychiatry, School of Molecular and Clinical Medicine, Royal Edinburgh Hospital, Morningside, Edinburgh EH10 5HF, UK
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Daumann J, Wagner D, Heekeren K, Neukirch A, Thiel CM, Gouzoulis-Mayfrank E. Neuronal correlates of visual and auditory alertness in the DMT and ketamine model of psychosis. J Psychopharmacol 2010; 24:1515-24. [PMID: 19304859 DOI: 10.1177/0269881109103227] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Deficits in attentional functions belong to the core cognitive symptoms in schizophrenic patients. Alertness is a nonselective attention component that refers to a state of general readiness that improves stimulus processing and response initiation. The main goal of the present study was to investigate cerebral correlates of alertness in the human 5HT(2A) agonist and N-methyl-D-aspartic acid (NMDA) antagonist model of psychosis. Fourteen healthy volunteers participated in a randomized double-blind, cross-over event-related functional magnetic resonance imaging (fMRI) study with dimethyltryptamine (DMT) and S-ketamine. A target detection task with cued and uncued trials in both the visual and the auditory modality was used. Administration of DMT led to decreased blood oxygenation level-dependent response during performance of an alertness task, particularly in extrastriate regions during visual alerting and in temporal regions during auditory alerting. In general, the effects for the visual modality were more pronounced. In contrast, administration of S-ketamine led to increased cortical activation in the left insula and precentral gyrus in the auditory modality. The results of the present study might deliver more insight into potential differences and overlapping pathomechanisms in schizophrenia. These conclusions must remain preliminary and should be explored by further fMRI studies with schizophrenic patients performing modality-specific alertness tasks.
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Affiliation(s)
- J Daumann
- Department of Psychiatry and Psychotherapy, University of Cologne, Germany.
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11
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Chkonia E, Roinishvili M, Herzog MH, Brand A. First-order relatives of schizophrenic patients are not impaired in the Continuous Performance Test. J Clin Exp Neuropsychol 2009; 32:481-6. [DOI: 10.1080/13803390903201777] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Eka Chkonia
- a Department of Psychiatry , Tbilisi State Medical University , Tbilisi, Georgia
| | - Maya Roinishvili
- b Department of Behaviour and Cognitive Functions , Beritashvili Institute of Physiology , Tbilisi, Georgia
| | - Michael H. Herzog
- c Laboratory of Psychophysics, Brain Mind Institute, Ecole Polytechnique Fédérale de Lausanne (EPFL) , Lausanne, Switzerland
| | - Andreas Brand
- d Klinikum Bremen-Ost, Center for Psychiatry and Psychotherapy , Bremen, Germany
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Hill SK, Harris MSH, Herbener ES, Pavuluri M, Sweeney JA. Neurocognitive allied phenotypes for schizophrenia and bipolar disorder. Schizophr Bull 2008; 34:743-59. [PMID: 18448479 PMCID: PMC2632447 DOI: 10.1093/schbul/sbn027] [Citation(s) in RCA: 108] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Psychiatric disorders are genetically complex and represent the end product of multiple biological and social factors. Links between genes and disorder-related abnormalities can be effectively captured via assessment of phenotypes that are both associated with genetic effects and potentially contributory to behavioral abnormalities. Identifying intermediate or allied phenotypes as a strategy for clarifying genetic contributions to disorders has been successful in other areas of medicine and is a promising strategy for identifying susceptibility genes in complex psychiatric disorders. There is growing evidence that schizophrenia and bipolar disorder, rather than being wholly distinct disorders, share genetic risk at several loci. Further, there is growing evidence of similarity in the pattern of cognitive and neurobiological deficits in these groups, which may be the result of the effects of these common genetic factors. This review was undertaken to identify patterns of performance on neurocognitive and affective tasks across probands with schizophrenia and bipolar disorder as well as unaffected family members, which warrant further investigation as potential intermediate trait markers. Available evidence indicates that measures of attention regulation, working memory, episodic memory, and emotion processing offer potential for identifying shared and illness-specific allied neurocognitive phenotypes for schizophrenia and bipolar disorder. However, very few studies have evaluated neurocognitive dimensions in bipolar probands or their unaffected relatives, and much work in this area is needed.
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Affiliation(s)
- S. Kristian Hill
- To whom correspondence should be addressed; tel: 312 996-2107, fax: 312 413-8837, e-mail:
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13
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Maziade M, Gingras N, Rouleau N, Poulin S, Jomphe V, Paradis ME, Mérette C, Roy MA. Clinical diagnoses in young offspring from eastern Québec multigenerational families densely affected by schizophrenia or bipolar disorder. Acta Psychiatr Scand 2008; 117:118-26. [PMID: 18028250 PMCID: PMC2253694 DOI: 10.1111/j.1600-0447.2007.01125.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE The follow-up since 1989 of a large sample of multigenerational families of eastern Québec that are densely affected by schizophrenia (SZ) or bipolar disorder (BP) has permitted to look at the rates of DSM diagnoses in the young offspring of a SZ parent (HRSZ) and of a BP parent (HRBP) who had an extremely loaded family history. METHOD The sample (average age of 17.5, SD 4.5) consisted of 54 high-risk offspring (HR) having one parent affected by a DSM-IV SZ or BP. The parents descended from 21 multigenerational families that constitute a quasi-total sample of such kindred in eastern Québec. The HRs were administered a lifetime best estimate DSM-IV diagnosis. RESULTS We observed that the rates, the diversity of diagnoses, the high comorbidity, the severity and the age of onset of the clinical diagnoses tended to be similar with those already reported in the offspring of affected parents with a low familial loading. Although the sample size was small, HRSZ and HRBP also tended to show similarities in their clinical status. CONCLUSION Overall, taking into account methodological limitations, the observation early in life of some shared characteristics among HRSZ and HRBP in terms of non-psychotic diagnosis may be congruent with the accumulating evidence that several phenotypic features are shared in adulthood by the two major psychoses.
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Affiliation(s)
- M Maziade
- Centre de recherche Université Laval Robert-Giffard, QC, Canada.
| | - N Gingras
- Centre de recherche Université Laval Robert-GiffardQC, Canada
| | - N Rouleau
- Centre de recherche Université Laval Robert-GiffardQC, Canada,École de psychologie, Université Laval, QuébecQC, Canada
| | - S Poulin
- Centre de recherche Université Laval Robert-GiffardQC, Canada
| | - V Jomphe
- Centre de recherche Université Laval Robert-GiffardQC, Canada
| | - M-E Paradis
- Centre de recherche Université Laval Robert-GiffardQC, Canada
| | - C Mérette
- Centre de recherche Université Laval Robert-GiffardQC, Canada
| | - M-A Roy
- Centre de recherche Université Laval Robert-GiffardQC, Canada
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Wolitzky R, Goudsmit N, Goetz RR, Printz D, Gil R, Harkavy-Friedman J, Malaspina D. Etiological Heterogeneity and Intelligence Test Scores in Patients with Schizophrenia. J Clin Exp Neuropsychol 2007; 28:167-77. [PMID: 16484091 DOI: 10.1080/13803390500360315] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Previous research has indicated that patients with a family history of schizophrenia show a greater degree of cognitive and neuropsychological impairment than patients without a family history. We examined the neurocognitive performance, using the WAIS-R, of 51 patients with a family history (familial) and 103 patients without a family history (sporadic) to determine if differences exist that may help to explain the heterogeneous neuropsychological profile of the illness. The family history groups did not differ with respect to gender, diagnosis, ethnicity, age, age of onset, education or duration of illness. Multivariate analyses, covarying for age of onset and education, showed the sporadic group performed significantly better than the familial group on the digit symbol and object assembly subtests, with a trend level difference in overall performance IQ score. Additionally, we identified significant gender differences in favor of males for full scale and verbal IQ, the information, digit span, block design, and arithmetic subtests, and at a trend level, the picture assembly subtest. The family history group differences reflect relative dysfunction in visual attention and scanning, visuomotor control, and spatial processing and reasoning. Overall, the results suggest that sporadic patients have better perceptual-organizational skills and faster speed of processing.
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Affiliation(s)
- Rachel Wolitzky
- Department of Medical Genetics, New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA.
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Klemm S, Schmidt B, Knappe S, Blanz B. Impaired working speed and executive functions as frontal lobe dysfunctions in young first-degree relatives of schizophrenic patients. Eur Child Adolesc Psychiatry 2006; 15:400-8. [PMID: 16721500 PMCID: PMC1705537 DOI: 10.1007/s00787-006-0547-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/09/2006] [Indexed: 11/28/2022]
Abstract
The aim of the investigation was to detect neuropsychological markers, such as sustained and selective attention and executive functions, which contribute to the vulnerability to schizophrenia especially in young persons. Performance was assessed in 32 siblings and children of schizophrenic patients and 32 matched controls using Wisconsin Card Sorting Test, Colour-Word-Interference-Test, Trail Making Test, and d2-Concentration-Test. The first-degree relatives showed certain impairments on all four tests, in particular, slower times on all time-limited tests. These results suggest the need for more time when completing neuropsychological tasks involving selected and focused attention, as well as cognitive flexibility, as a possible indicator of genetic vulnerability to schizophrenia.
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Affiliation(s)
- Silke Klemm
- Dept. of Child and Adolescent Psychiatry, University of Jena, Philosophenweg 3-5, 07740 Jena, Germany.
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16
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Delawalla Z, Barch DM, Fisher Eastep JL, Thomason ES, Hanewinkel MJ, Thompson PA, Csernansky JG. Factors mediating cognitive deficits and psychopathology among siblings of individuals with schizophrenia. Schizophr Bull 2006; 32:525-37. [PMID: 16714471 PMCID: PMC2632255 DOI: 10.1093/schbul/sbj082] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Schizotypal traits and cognitive disturbances are known to be present in first-degree relatives of people with schizophrenia. However, there is little understanding of how these endophenotypes are related to each other. We explored the nature of this relationship in individuals with schizophrenia, their full siblings, community controls, and their siblings. All participants were assessed in the domains of working memory, attention, episodic memory, and executive function, as well as in their level of positive, negative, and disorganization symptoms. Schizophrenia probands were significantly impaired on all cognitive domains, as compared with the other 3 groups, and displayed the highest levels of positive, negative, and disorganization symptoms. Proband siblings performed significantly worse than controls on tasks of working memory, episodic memory, and executive function, and they displayed significantly more positive and negative symptoms as compared with controls. Poorer task performance across all 4 cognitive domains was most strongly correlated with increased negative symptoms. Mediation analyses revealed that working memory, episodic memory, and executive function deficits partially mediated increases in negative symptoms among proband siblings. Negative symptoms fully mediated deficits in working memory and episodic memory but only partially mediated deficits in executive function. Results suggest that there is a complex relationship between cognitive and clinical factors in this high-risk population.
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Affiliation(s)
| | | | | | | | | | - Paul A. Thompson
- Department of Radiology, Washington University
- Department of Biostatistics, Washington University
| | - John G. Csernansky
- Department of Psychiatry, Washington University
- Department of Anatomy and Neurobiology, Washington University
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Diwadkar VA, Prasad KM, Keshavan MS. Approaches for adolescents with an affected family member with schizophrenia. Curr Psychiatry Rep 2004; 6:296-302. [PMID: 15260946 PMCID: PMC3408040 DOI: 10.1007/s11920-004-0080-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Prospective studies of adolescents at risk for schizophrenia (high-risk studies) can shed light on the possible premorbid precursors of schizophrenia. Recent studies have provided evidence of neurobehavioral, brain structural, physiologic, and neurochemical deficits in adolescent nonpsychotic high-risk relatives that may date back to childhood or earlier. These results are collectively providing a critical window into the inter-relationships between genetic predisposition, neurodevelopment, and premorbid indicators of risk in schizophrenia. Convergent approaches are inherently powerful in mutually informing each other in enriching the knowledge of the risk factors that predict the eventual onset of schizophrenia. Defining such reliable predictors of the onset of schizophrenia may provide us with the tools to better understand the etiology and pathophysiology of the illness, and may pave the way for innovative methods of treatment and possibly prevention. The authors review the relevant literature in this promising field of inquiry and summarize recent findings from high-risk studies.
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Kent AR, Fox AM, Michie PT, Jablensky AV. Differential impairment of working memory performance in first-degree relatives of individuals with schizophrenia. Acta Neuropsychiatr 2004; 16:149-53. [PMID: 26984167 DOI: 10.1111/j.0924-2708.2004.00070.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Numerous studies have reported neuropsychological impairment in schizophrenia and increasing evidence suggests that individuals with schizophrenia or schizophrenia spectrum disorders and their unaffected first-degree family members exhibit similar deficits in some neuropsychological domains. Substantial modifications to the Wechsler Memory Scale (WMS) have resulted in more sensitive and reliable indicators of various aspects of memory functioning in the WMS-III, which enables generation of auditory, visual and working memory indices. OBJECTIVE The aim of the present study was to examine the memory profile of individuals with schizophrenia or schizophrenia spectrum disorder (n = 19), their unaffected first-degree family members (n = 11), and healthy controls (n = 9). METHODS The study involved neuropsychological testing, including the immediate and working memory subtests of the WMS-III, utilizing both auditory and visual domains. Symptom assessment was performed using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN), version 2.0. Two multivariate analyses of covariance (mancova) were conducted: (i) comparing patients, relatives and controls; and (ii) comparing relatives and controls only. RESULTS The first analysis indicated that the patient group obtained significantly lower index scores than both relatives and controls on all three indices. The second analysis indicated that the performance of relatives was significantly lower than controls on the working memory index, although there were no significant differences on the auditory and visual immediate index scores. CONCLUSIONS The differential impairment in working memory performance in clinically asymptomatic family members suggests that the WMS-III working memory index score may be a potential phenotypic marker of schizophrenia.
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Affiliation(s)
- Aaron R Kent
- 1Centre for Clinical Research in Neuropsychiatry/School of Psychiatry and Clinical Neurosciences, The University of Western Australia, Mt Claremont, Western Australia
| | - Allison M Fox
- 2School of Psychology, The University of Western Australia, Crawley, Western Australia
| | - Patricia T Michie
- 1Centre for Clinical Research in Neuropsychiatry/School of Psychiatry and Clinical Neurosciences, The University of Western Australia, Mt Claremont, Western Australia
| | - Assen V Jablensky
- 1Centre for Clinical Research in Neuropsychiatry/School of Psychiatry and Clinical Neurosciences, The University of Western Australia, Mt Claremont, Western Australia
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Abstract
Australian research in psychiatric genetics covers molecular genetic studies of depression, anxiety, alcohol dependence, Alzheimer's disease, bipolar disorder, schizophrenia, autism, and attention deficit hyperactivity disorder. For each disorder, a variety of clinical cohorts have been recruited including affected sib pair families, trios, case/controls, and twins from a large population-based twin registry. These studies are taking place both independently and in collaboration with international groups. Microarray studies now complement DNA investigations, while animal models are in development. An Australian government genome facility provides a high throughput genotyping and mutation detection service to the Australian scientific community, enhancing the contribution of Australian psychiatric genetics groups to gene discovery.
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Affiliation(s)
- Bryan J Mowry
- Department of Psychiatry, Queensland Centre for Schizophrenia Research, University of Queensland, The Park, Centre for Mental Health, Wacol, Queensland 4076, Australia. ,edu.au
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Abstract
OBJECTIVE This paper reports on a study designed to (i) assess levels of executive functions among patients suffering from schizophrenia; (ii) investigate associations between measures of executive functions and psychosocial adjustment; and (iii) examine the influence of psychopathology on the relationship between executive functions and psychosocial adjustment. Clear knowledge of executive functions and of their impact on social adjustment in patients with schizophrenia may play a decisive role in preparing and structuring appropriate outpatient care. METHOD An extensive battery constituted of several tests developed for the assessment of executive functions was used in 38 inpatients with a DSM-IV diagnosis of schizophrenia. Psychosocial adjustment was assessed with a set of commonly used scales. RESULTS Performance on measures of executive functions was heterogeneous among the patient population, with a subgroup performing within normal scores. A similar pattern was found on measures of psychosocial adjustment. Most of the executive measures were not dependent on demographic or clinical variables. A factorial analysis on measures of psychosocial adjustment yielded a one-factor model which showed inconsistent, and at most, weak to moderate correlations with executive functions. Regression analysis revealed that symptom levels accounted for two-thirds of the variance of psychosocial adjustment, and together with measures of executive functions for 91% of the variance. General and negative symptoms showed strong correlations with psychosocial adjustment. CONCLUSIONS Our study supports the view that executive function is a heterogeneous construct with several subdimensions. Additionally, it suggests that symptom level has an important role as "rate limiting factor" on psychosocial adjustment and is partially mediated by executive dysfunction. Our results call for careful and detailed assessment in this patient population in order to establish appropriate treatment programmes such as cognitive remediation.
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Affiliation(s)
- Andor E Simon
- University Hospital of Geneva, Department of Psychiatry, Adult Psychiatric Clinic, 2 chemin du Petit-Bel-Air, 1225 Chêne-Bourg (Geneva), Switzerland.
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Niemi LT, Suvisaari JM, Tuulio-Henriksson A, Lönnqvist JK. Childhood developmental abnormalities in schizophrenia: evidence from high-risk studies. Schizophr Res 2003; 60:239-58. [PMID: 12591587 DOI: 10.1016/s0920-9964(02)00234-7] [Citation(s) in RCA: 209] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
According to cohort studies, individuals who develop schizophrenia in adulthood show developmental abnormalities in childhood. These include delays in attainment of speech and motor milestones, problems in social adjustment, and poorer academic and cognitive performance. Another method of investigating developmental abnormalities associated with schizophrenia is the high-risk (HR) method, which follows up longitudinally the development of children at high risk for schizophrenia. Most HR studies have investigated children who have a parent with schizophrenia. This review summarizes findings concerning childhood and adolescent development from 16 HR studies and compares them with findings from cohort, conscript, and family studies. We specifically addressed two questions: (1) Does the development of HR children differ from that of control children? (2) Which developmental factors, if any, predict the development of schizophrenia-spectrum disorders in adulthood? While the answer to the first question is affirmative, there may be other mechanisms involved in addition to having a parent with schizophrenia. Factors which appear to predict schizophrenia include problems in motor and neurological development, deficits in attention and verbal short-term memory, poor social competence, positive formal thought disorder-like symptoms, higher scores on psychosis-related scales in the MMPI, and severe instability of early rearing environment.
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Affiliation(s)
- Laura T Niemi
- Department of Mental Health and Alcohol Research, KTL, National Public Health Institute, Mannerheimintie 166, FIN-00300, Helsinki, Finland.
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